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Basic Science Flashcards

1
Q

What is the first sign of gram-negative sepsis?

A

Hyperglycemia

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2
Q

What is the ideal glucose range in a septic patient?

A

100-120 mg/dL

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3
Q

What patients need antibiotics for an abscess?

A

DM, cellulitis, sepsis, fever, elevated WBC, bioprosthetic hardware

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4
Q

What are the common causes of SSI within 48 hours of surgery?

A 
Injury to Bowel with Leak
Invasive infection (C. Perfringens, beta hemolytic strep)
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5
Q

What is the most common organism in ICU pneumonia?

A

S. Aureus #1 bug

GNR #1 class

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6
Q

What is the most common causes of line infections?

A

1) S. Epidermidis
2) S. Aureus
3) Yeast

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7
Q

What is the definition of a line infection?

A

> 15 cfu from a central line culture

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8
Q

What are the sx of NSTI?

A

Pain out of proportion, WBC > 20, thin gray drainage, skin blisters/necrosis, crepitus or gas on x-ray

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9
Q

What is characteristic of C. perfringens gram stain?

A

GPRs without WBCs

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10
Q

What is the diagnosis of SBP based on?

A

PMNs > 500 cells/cc

Tx: Ceftriaxone

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11
Q

What must be ruled out if paracentesis is polymicrobial?

A

Intra-abdominal source (e.g. bowel perf)

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12
Q

What is the most common site of lymphoma in HIV patients?

A

Stomach, then rectum

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13
Q

What organisms are common in LGIB in HIV?

A

CMV, bacterial, HSV

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14
Q

What is the abx choice for diabetic foot infections?

A

Unasyn

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15
Q

What is the treatment for bite wounds?

A

Augmentin

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16
Q

What is the treatment for a PD cath infection?

A

IP vancomycin and gentamicin

removal of catheter if > 4-5 days

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17
Q

What is the ideal trough level for vancomycin?

A

5-10 ug/mL (too high decrease frequency)

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18
Q

What do ampicillin/amoxicillin add to coverage?

A

Enterococci + Penicillin

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19
Q

What does Unasyn/Augmentin add?

A

Pick up GPCs, GNRs, Anaerobes

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20
Q

What is the side effect of Ticarcillin and piperacillin?

A

Inhibit platelets

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21
Q

What is a side effect of Ceftriaxone?

A

Cholecstatic jaundice, GB sludge

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22
Q

What organisms do Carbapenems not cover?

A

MEP (MRSA, Eterococcus, Proteus)

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23
Q

What drug is synergistic with aminoglycosides?

A

Beta-lactams (ampicillin for Enterococcus)

24
Q

What drugs are good for enterococcus?

A

Vancomycin
Timentin/Zosyn
Gentamicin + Ampicillin
Unasyn

25
What antifungals should be used for fungal sepsis?
Candida -> Anidulafungin Aspergillus -> Voriconazole All others -> liposomal Ampho B
26
What drugs are good for serratia, acinetobacter, pseudomonas?
``` Timentin/Zosyn 3rd Gen Cephalosporins Aminoglycosides Meropenem/Imipenem Fluoroquinolones ```
27
What are metyrapone and aminoglutethimide?
Inhibitors of adrenal steroid synthesis (used in patients with adrenocortical CA)
28
What are some complications with halothane?
highest degree of cardiac depression and arrhythmias. Halothane hepatitis (fever, eosinophilia, jaundice)
29
What is the first sign of malignant hyperthermia?
Increased ETCO2
30
What patients should not get succynlcholine?
Burns, neurologic injury, neuromuscular disorder, SCI, trauma, ARF (hyperkalemia risk), open angle glaucoma
31
What should be given with neostigmine or edrophonium?
Atropine or glycopyrolate
32
What is the toxic dose of 1% lidocaine?
0.5 cc/kg
33
What opioids should be avoided in renal failure?
Demerol
34
What are the side effects of lidocaine in an epidural?
Bradycardia, Hypotension
35
What patients are epidurals contraindicated in?
Hypertrophic Cardiomyopathy Cyanotic Heart Disease (decreases afterload)
36
What is a spinal blockade?
Injection into subarachnoid space. Spread determined by position. Neurologic blockade above motor blockade
37
What is different about MIs post-op?
Can have no pain or EKG changes
38
Where should the tip of an ET tube terminate?
2 cm above carina
39
What quantity of H2O is lost as insensible losses daily?
10cc/kg
40
What replacement fluid should be used for GI surgery?
1-24 hrs: LR | After 24 hrs: D51/2NS + 20K
41
What replacement fluid should be used for losses from the GI tract?
Gastric - D51/2NS + 20K Panc/Bili/SI: LR + HCO3 Colon: LR + K
42
What is the treatment for hyperkalemia?
10 U insulin + 1 amp of D50
43
What is the protein adjustment for calcium?
For each 1 g decrease in protein add 0.8 to Ca
44
How do you calculate calorie requirements in Surgery and Burns?
Surgery: increased 20-40% Burns: 25kcal/kg/day + 30kcal/day x %Burn Protein: 1-1.5 g/kg/day + 3gx%Burn
45
How do you calculate IBW?
``` Men = 106 lb + 6 lb/inch>5 feet Women = 100 lb + 5lb/inch>5 feet ```
46
Why don't protein-conserving mechanisms occur after trauma?
Catecholamine and cortisol release
47
What are the electrolyte abnormalities in re-feeding syndrome?
Decreased K, Mg, PO4
48
How do you calculate nitrogen balance?
protein/6.25 - 24hour urine N + 4g
49
What is the most common met to the small bowel?
Melanoma
50
How long does it take for wound to reach max tensile strength?
8 weeks
51
How does hyperglycemia inhibit wound healing?
Impedes leukocyte chemotaxis
52
What can counteract the effect of steroids on wound healing?
Vitamin A
53
What are risk factors for poor wound healing?
``` Bacteria Devitalized Tissue Foreign Bodies Cytotoxic Drugs Diabetes Albumin < 3.0 Steroids Ischemia ```
54
What is Charcot's joint?
2nd MTP Joint (common for diabetic ulcers)
55
How many days till chemo has no effect on wound healing?
14 Days
56
What are the contents of Alpha granules?
PF4, beta-thrombomodulin, PDGF, TGF-beta
57
What are in dense granules?
Adenosine, Serotonin, Calcium

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