Book1 Flashcards
(188 cards)
1
Q
Time to SAH surgery
A
48h
2
Q
Immediate treatment for undescended testicle
A
Chorionic gonadotropin for one month
3
Q
Kidney stone tx
A
5mm - shock. >2cm - surgery
4
Q
Pattern of electrolytes in kidney failure
A
Ca up, LFTs up, RBC up
5
Q
Renal carcinoma tx
A
If look like heterogenic solid and enhancing on CT - 4cm - radical nephrectomy
6
Q
Bladder cancer tx
A
Intravesical BCG + intravesicular chemo
7
Q
Testicular cancer tx
A
NO BX - Take b-HCG + alpha-fetoprotein - then radical orchiectomy unless seminoma (radiosensitive), monitor recurrence with BHCG + AFP + LDH. LN resection only if teratoma that hasn?t spread above diaphragm or embryonal
8
Q
Surgery for testicular torsion if
A
<6h
9
Q
Prosthetic joint infection likely organism
A
3mo S epidermidis
10
Q
Ideal body weight calculation
A
Women: 100 + 5x inch over 5’. Men: 106 + 6x inch over 5’
11
Q
Calorie requirement calculation
A
25 x kg every day, multipy by 1.2 for nonstressed hospitalized, 1.5 postsurg, 1.8 for trauma/burns
12
Q
RQ equation and use
A
CO2 produced / O2 consumed; >1 - too much, <0.82 - increase calories
13
Q
Refeeding syndrome electrolytes
A
Low PO4, low Mg, low K –> high Glu, high Cl, acidosis, vol overload –> CHF
14
Q
Protein requirements calculation
A
0.8 x kg every day, up to 2.5 if burns
15
Q
When to close a dirty wound
A
If <6h old
16
Q
Burn fluids
A
To maintance fluids, add LR: 4 mL x kg x BSA affected – 1/2 over 8, 1/2 over 16
17
Q
Silver nitrate complication
A
Hyponatremia
18
Q
Silver sulfadiazine complication
A
Neutropenia
19
Q
Mafenide acetate complication
A
Metabolic acidosis
20
Q
Brown recluse antidote
A
Dabsone
21
Q
Cleft lip palate tx
A
Lip - 3mo, Palate - 1-1.5y
22
Q
Intraop abx #1 choice
A
Cefazolin
23
Q
Acute angle closure glaucoma, can’t do surgery right now, tx
A
Pilocarbine, diamox, mannitol
24
Q
RTA 1
A
Can’t excrete H+, can’t make ammonia. Autoimmune disorders.
25
RTA 2
Can't reabsorb HCO3. Multiple myeloma or drugs.
26
RTA 4
Hyperkalemia. Aldosterone deficiency (diabetic nephropathy).
27
FeNa calculation
Urine Na x Serum Cr / Urine Cr x Serum Na
28
Post-op urinary retention drugs
Prazosin, phenoxybenzamine
29
MUDPILES
Methanol, Uremia, DKA, Paraldehyde, Isoniazid, Lactic acidosis, Ethanol, Salicylites
30
HARD UP
Normal gap: HyperPTH, Adrenal insufficiency, RTA, Diarrhea, Ureteroenteric fistula, pancreatic fistula
31
3 causes of metabolic acidosis
Increased acid, Decreased bicarb, Renal failure
32
Osmolar gap calculate
Observed Osm - [2Na + Glu/18 + BUN/2.8], should be <10
33
2 causes of metabolic alkalosis:
Lose H+ (GI, increased aldo, diuretics, RTA) ; 2) gain HCO3
34
MIS[HAP]3S
Respiratory alkalosis: Mechanical overventilation, ICP, sepsis, hypoxemia/hyperpyrexia/HF, Anxiety/asthma/ascites, Pregnancy/pain/PNA, salicylates
35
Normal PCO2
35-45
36
Normal HCO3
24-30
37
Respiratory compensation for metabolic acidosis formula
1.5 x HCO3 + 8 +- 2 and if not compensating, respiratory acidosis also.
38
How to tell acute respiratory acidosis vs. chronic
Change in pH / Change in pCO2 --> if < 0.3, chronic. If < 0.8, acute
39
Normal serum Osm
~290
40
Follicular cancer tx
4cm - total thyroidectomy, no LN
41
Similarities between adrenal insufficiency and sepsis
Hypotension, fever, AMS
42
Differences between adrenal insufficiency and sepsis
Adrenal: high K, sepsis no change K, adrenal hypoglycemic, sepsis hyperglycemic.
43
Screen for medullary thyroid cancer
Calcitonin, pentagastrin, provocative ca. infusion
44
Sarcoma likely if
>5cm, surgery only
45
How to mediate XRT damage
Sulfhydryl - free radical scavenger
46
If give methotrexate
Also give folinic acid
47
Give IL-2 for
Renal cancer and melanoma
48
Floxuridine side effect
Bile duct inflammation
49
L-asparaginase side effect
pancreatitis
50
Normal SVR
800-1200
51
Normal PCWP
12
52
Normal CO
5
53
Normal CI
2.6 - 4.2
54
EKG stress test positive if
STD > 0.2
55
Liver failure ammonia
>150
56
Poor nutrition indicators - 4
>20% body weight over months, albumin < 3, transferrin <200, anergy to skin-test antigens
57
Pulsus paradoxus amount of BP difference
10
58
Percent stenosis in important vessel that should cause CABG
70%
59
Aortic stenosis cutoff for surgery
Stenosis > 50%
60
Pleural effusion tx
If >1cm on XR, thoracentesis
61
Light's criteria are for:
Pleural effusion is a transudate if: LDH effusion / serum = 0.6; or protein effusion / serum = 0.5
62
Transudate + low glucose
RA
63
Transudate + high L0
TB
64
Transudate + blood
Cancer or PE
65
Exudate
Cancer or PNA
66
Pleural effusion with organisms, pH, decreased glucose - tx
Insert chest tube
67
Normal tidal volume
8 mL x kg --> titrate to 6 mL x kg
68
Peak inspiratory pressure is high if
>30; means compliance pressure. If low, means resistance problem.
69
Intubation criteria
RR > 35; PO2 < 60, PCO2 > 55, severe acidosis
70
ARDS tx
PEEP, pressure-limited ventilation, permissive hypercapnea, prone
71
Criteria for ARDS
PO2 / FiO2 < 200, PCWP < 18, b/l infiltrates
72
Lung abscess tx
Abx; surg if >6cm, empyema, doesn't resolve
73
When a coin lesion is not cancer
< 40, round
74
Lung clearance for surgery
FEV >800, V/Q adequate after surgery
75
Acute STEMI criteria
STE > 1mm OR new LBBB
76
Non-STEMI needs what when
Cath in 12-48h if: elevated trops, new STD 0.5mm, recurrent, unstable, prior CABG
77
Non-STEMI EKG
New STD 0.5mm (high risk) or T wave inversion > 2mm
78
Diffuse STE on EKG can be
Cardiac tamponade
79
Vit K
2, 5, 7, 10, C/s
80
Heparin counteracts
Factor 10
81
Transfusion rxn looks like on labs
pos coombs. Oliguria. Haptoglobin < 50. Urine free hgb > 5
82
Electrolyte abnormalities after blood stranfusion
Low Ca, metabolic alkalosis
83
Coagulation abnormalities after blood transfusion
Low factor 5, 8, platelets, acidosis (interferes), hypothermia
84
Rate of PT drop when warfarin stopped
2 per day
85
Carcinoid tumor tx
resect - if <2cm, distal, no further resection; sx treat HT antag (cyproheptadine), octreotide
86
Polycythemia vera before surgery
Busulfan / chlorambucil = alkylating agents
87
AAA numbers
< 4cm - observe. >6cm - repair if good surg candidate
88
Carotid occlusion
CEA >60%; <60% just ASA
89
Arterial embolus to periphery do what when
embolectomy <6h; prep both sides
90
Graft occlusion drug
Urokinase
91
% body that's water
50-70%
92
Water distribution in body
60% ICF + 30% ECF + 10% plasma
93
When to give FFP
INR > 1.6
94
When to give platelets
<10,000
95
When to give cryoprecipitate
Low 8, fibrinogen, VWF
96
Formula for maintenance fluid
10 (100), 10 (50), rest (20)
97
Free water deficit
0.6 x kg x (1 - 140/serum Na)
98
Mperidine side effect
Lower sz threshold, esp if renal failure
99
Enflurane
Lower sz threshold
100
Methoxyflurane
Nephrotoxic
101
Fevers on post op day 1
Malignant hyperthermia, atelectesis, necrotizing fasciitis (104)
102
Fevers on post op day 3
PNA/UTI; empiric = fluoroquinolone/moxi
103
Fever POD 5
DVT, thrombophlebitis
104
Fever POD 7
Wound (drains; open, pack); cellulitis (no drainage); line infection
105
Fever POD 10-15
Abscess
106
Unexplained fever PO
Thyroid storm, adrenal inusfficiency, lymphangitis, sepsis
107
Postpericardotomy syndrome tx
NSAIDs
108
Liver failure looks like
Low K, alkalosis, high CO, low SVR
109
Low urine output is renal origin if
Urine Na >40
110
Extubation criteria
RR / TV = 60-105; NIF > 20; PEEP < 5; Spontaneous RR <20
111
Azothiaprine tox
Bone marrow
112
SIRS criteria
T 38; WBC 15,000; HR > 100, RR > 20 or pCO2 < 32
113
HR > 100 is what % dehydration
15-30
114
AMS is what % dehydration
30-40%
115
Alpha 1 does what other than vasoconstrict
increase insulin
116
Phenylephrine
A1
117
How to dx acromegaly
Somatomedin C
118
Boerhave tx
Repair within 6 hours
119
Meckel's tx
Resect if 2cm, ectopic tissue, fibrous band, male
120
Drugs for HP
clarithromycin + amox/amp + metronidazole + pantroprazole
121
Test for DU
CLOtest
122
Gastric cancer margins
5 cm
123
Menetrier's
protein in urine foamy pee, giant gastric folds
124
Liver failure presents as
ascites, jaundice, bleeding, gynecomastia
125
Portal HTN presents as
HSM, caput medusae, ascites
126
BRBPR
>2mL/min --> angiogram; <0.5 -- wait then colonoscopy
127
ZES fasting gastrin
>1000
128
Blood type associated with GU
O
129
chronic mesenteric ischemia requires tx
stenosis 2.5 vessels
130
Glucagonoma metastatic tx
Chemo: streptozycin, palliation: SS
131
Toxic megacolon if
>6cm distension + fever + HR >120 + PMN WBC > 10,500
132
Ogilvie syndrome tx
< 10 cm - bowel rest, NG, neostigmine; >10cm - surg
133
UC
Crypt abscesses, superficial ulcers, ankylosing spondylitis, arthritis
134
Chrohns
Transmural, perianal fistulas, granulomas
135
c diff cutoff for drugs
15,000 - vanco --> ileus --> +metro
136
biliary dyskinesia
gall EF < 35%
137
cholecystitis dx
wall > 8cm
138
acute ascending cholangitis sx
fever + WBC + abd pain --> + jaundice + AMS + BP
139
Gallbladder polyp bad if
#1, >1cm, >50y, symptomatic
140
Drugs that can cause acute pancreatitis
VPA, diuretics, IBD drugs, HIV
141
Pancreatic failure (like hemorrahgic acute pancreatitis)
Ca up despite given Ca, BUN up, met acidosis, low PO2
142
Normal bili
<2.5; think 1 for each
143
Pseudocyst treat if
>6cm or >6 weeks
144
Tx hepatic encephalopathy
lactulose
145
3 most common organisms causing primary peritonitis
E coli, enterococcus, bacterioides
146
Giant liver cysts
Echinocococcus - tx = surgery + albendozole
147
Liver adenoma tx
>4cm - surg; <4cm - none
148
Eye surg > trauma if
>2mm eno, 50% orbital fracture, muscle trapped, diplopia on primary gaze
149
Biliary leak guidelines
>300 - CBD (relap); <300 - ERCP
150
Acute drop end-tidal CO2
PE
151
Ureteral injury
Anterior - repair now; posterior - wait 4-6 weeks
152
Chest tube need thoracotomy if
>1500; >600/6h
153
DPL guidelines
>100,000 RBC, >10mL blood, >500 WBC, inc amylase, bili, alk phos
154
ABI
>1.3 calcified need arteriogram; <.5 = ulcers
155
Open fracture tx
OR within 6 h
156
Don't ever biopsy
Kidney mass (unless transplant), neck (ex thyroid), bones, scrotum, parotid
157
ICP nl
<20
158
CCP =
MAP - ICP
159
For every Na over 140,
every 3 = 1L water lost
160
Limit on infusing K
10 mEq/h
161
Hyperkalemia can be caused by meds
B blockers, HTN meds, K-sparing diuretics, digitalis, heparin, NSAIDs, succ
162
Hypothermia on EKG
J waves
163
Hypo-Ca is
<8
164
Low albumin - correction of calcium
0.8 (4 - albumin) + total Ca = actual Ca2+
165
Both low Ca and Mg cause on EKG
long QT
166
But low Mg on EKG causes
STD, long PR, torsades, flat P
167
Low Ca on EKG causes
T wave inversion, heart block
168
Low Ca on exam
Hyperactive DTRs
169
Refractory low K
Hypo-Mg (due to alcoholism)
170
High Ca
>15
171
Tx for hyper-Ca
NaCl, diuretics that aren't thiazides which cause it, mithramicin
172
Correct Na for hyperglycemia
Add 1.6 for every 100 glucose above 200
173
Thrombolysis BP cutoff
<180/110
174
Anticholinergic overdose - tx
Physiostigmine, unless it's a TCA overdose
175
Cholinergic overdose - tx
Atropine
176
Seizures, make sure it's not
Salicylate, theophyline, lithium b/c reversible
177
Portal vein thrombosis is 2/2
OCP or cirrhosis
178
PSC vs PBC
Intra and extrahepatic ducts vs. just intrahepatic
179
Take out adrenal mass if
>4cm - surg; <4cm - none
180
Diuretics for CHF can cause what problem
Low CO and kidney failure
181
Warfarin can cause
skin necrosis
182
TAA operate if
> 7cm
183
simoma bodies
papillary thyroid cancer
184
Top melanoma type
Superficial spreading
185
Inguinal hernia complications
Urinary retention, irritation of nerves
186
Lidocaine vs Procainamide
Amide (2 I's), PABA
187
Deep peroneal injury
Foot drop
188
MI 5 days ago and now decompensates, can be
Papillary muscle / MR? VSD? LV rupture
