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Surgery shelf crash > Book1 > Flashcards

Book1 Flashcards

1
Q

Time to SAH surgery

A

48h

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2
Q

Immediate treatment for undescended testicle

A

Chorionic gonadotropin for one month

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3
Q

Kidney stone tx

A

5mm - shock. >2cm - surgery

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4
Q

Pattern of electrolytes in kidney failure

A

Ca up, LFTs up, RBC up

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5
Q

Renal carcinoma tx

A

If look like heterogenic solid and enhancing on CT - 4cm - radical nephrectomy

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6
Q

Bladder cancer tx

A

Intravesical BCG + intravesicular chemo

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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

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8
Q

Surgery for testicular torsion if

A

<6h

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9
Q

Prosthetic joint infection likely organism

A

3mo S epidermidis

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10
Q

Ideal body weight calculation

A

Women: 100 + 5x inch over 5’. Men: 106 + 6x inch over 5’

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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

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12
Q

RQ equation and use

A

CO2 produced / O2 consumed; >1 - too much, <0.82 - increase calories

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13
Q

Refeeding syndrome electrolytes

A

Low PO4, low Mg, low K –> high Glu, high Cl, acidosis, vol overload –> CHF

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14
Q

Protein requirements calculation

A

0.8 x kg every day, up to 2.5 if burns

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15
Q

When to close a dirty wound

A

If <6h old

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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

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17
Q

Silver nitrate complication

A

Hyponatremia

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18
Q

Silver sulfadiazine complication

A

Neutropenia

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19
Q

Mafenide acetate complication

A

Metabolic acidosis

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20
Q

Brown recluse antidote

A

Dabsone

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21
Q

Cleft lip palate tx

A

Lip - 3mo, Palate - 1-1.5y

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22
Q

Intraop abx #1 choice

A

Cefazolin

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23
Q

Acute angle closure glaucoma, can’t do surgery right now, tx

A

Pilocarbine, diamox, mannitol

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24
Q

RTA 1

A

Can’t excrete H+, can’t make ammonia. Autoimmune disorders.

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25
Q

RTA 2

A

Can’t reabsorb HCO3. Multiple myeloma or drugs.

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26
Q

RTA 4

A

Hyperkalemia. Aldosterone deficiency (diabetic nephropathy).

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27
Q

FeNa calculation

A

Urine Na x Serum Cr / Urine Cr x Serum Na

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28
Q

Post-op urinary retention drugs

A

Prazosin, phenoxybenzamine

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29
Q

MUDPILES

A

Methanol, Uremia, DKA, Paraldehyde, Isoniazid, Lactic acidosis, Ethanol, Salicylites

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30
Q

HARD UP

A

Normal gap: HyperPTH, Adrenal insufficiency, RTA, Diarrhea, Ureteroenteric fistula, pancreatic fistula

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31
Q

3 causes of metabolic acidosis

A

Increased acid, Decreased bicarb, Renal failure

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32
Q

Osmolar gap calculate

A

Observed Osm - [2Na + Glu/18 + BUN/2.8], should be <10

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33
Q

2 causes of metabolic alkalosis:

A

Lose H+ (GI, increased aldo, diuretics, RTA) ; 2) gain HCO3

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34
Q

MIS[HAP]3S

A

Respiratory alkalosis: Mechanical overventilation, ICP, sepsis, hypoxemia/hyperpyrexia/HF, Anxiety/asthma/ascites, Pregnancy/pain/PNA, salicylates

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35
Q

Normal PCO2

A

35-45

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36
Q

Normal HCO3

A

24-30

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37
Q

Respiratory compensation for metabolic acidosis formula

A

1.5 x HCO3 + 8 +- 2 and if not compensating, respiratory acidosis also.

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38
Q

How to tell acute respiratory acidosis vs. chronic

A

Change in pH / Change in pCO2 –> if < 0.3, chronic. If < 0.8, acute

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39
Q

Normal serum Osm

A

~290

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40
Q

Follicular cancer tx

A

4cm - total thyroidectomy, no LN

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41
Q

Similarities between adrenal insufficiency and sepsis

A

Hypotension, fever, AMS

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42
Q

Differences between adrenal insufficiency and sepsis

A

Adrenal: high K, sepsis no change K, adrenal hypoglycemic, sepsis hyperglycemic.

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43
Q

Screen for medullary thyroid cancer

A

Calcitonin, pentagastrin, provocative ca. infusion

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44
Q

Sarcoma likely if

A

> 5cm, surgery only

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45
Q

How to mediate XRT damage

A

Sulfhydryl - free radical scavenger

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46
Q

If give methotrexate

A

Also give folinic acid

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47
Q

Give IL-2 for

A

Renal cancer and melanoma

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48
Q

Floxuridine side effect

A

Bile duct inflammation

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49
Q

L-asparaginase side effect

A

pancreatitis

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50
Q

Normal SVR

A

800-1200

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51
Q

Normal PCWP

A

12

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52
Q

Normal CO

A

5

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53
Q

Normal CI

A

2.6 - 4.2

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54
Q

EKG stress test positive if

A

STD > 0.2

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55
Q

Liver failure ammonia

A

> 150

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56
Q

Poor nutrition indicators - 4

A

> 20% body weight over months, albumin < 3, transferrin <200, anergy to skin-test antigens

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57
Q

Pulsus paradoxus amount of BP difference

A

10

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58
Q

Percent stenosis in important vessel that should cause CABG

A

70%

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59
Q

Aortic stenosis cutoff for surgery

A

Stenosis > 50%

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60
Q

Pleural effusion tx

A

If >1cm on XR, thoracentesis

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61
Q

Light’s criteria are for:

A

Pleural effusion is a transudate if: LDH effusion / serum = 0.6; or protein effusion / serum = 0.5

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62
Q

Transudate + low glucose

A

RA

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63
Q

Transudate + high L0

A

TB

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64
Q

Transudate + blood

A

Cancer or PE

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65
Q

Exudate

A

Cancer or PNA

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66
Q

Pleural effusion with organisms, pH, decreased glucose - tx

A

Insert chest tube

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67
Q

Normal tidal volume

A

8 mL x kg –> titrate to 6 mL x kg

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68
Q

Peak inspiratory pressure is high if

A

> 30; means compliance pressure. If low, means resistance problem.

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69
Q

Intubation criteria

A

RR > 35; PO2 < 60, PCO2 > 55, severe acidosis

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70
Q

ARDS tx

A

PEEP, pressure-limited ventilation, permissive hypercapnea, prone

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71
Q

Criteria for ARDS

A

PO2 / FiO2 < 200, PCWP < 18, b/l infiltrates

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72
Q

Lung abscess tx

A

Abx; surg if >6cm, empyema, doesn’t resolve

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73
Q

When a coin lesion is not cancer

A

< 40, round

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74
Q

Lung clearance for surgery

A

FEV >800, V/Q adequate after surgery

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75
Q

Acute STEMI criteria

A

STE > 1mm OR new LBBB

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76
Q

Non-STEMI needs what when

A

Cath in 12-48h if: elevated trops, new STD 0.5mm, recurrent, unstable, prior CABG

77
Q

Non-STEMI EKG

A

New STD 0.5mm (high risk) or T wave inversion > 2mm

78
Q

Diffuse STE on EKG can be

A

Cardiac tamponade

79
Q

Vit K

A

2, 5, 7, 10, C/s

80
Q

Heparin counteracts

A

Factor 10

81
Q

Transfusion rxn looks like on labs

A

pos coombs. Oliguria. Haptoglobin < 50. Urine free hgb > 5

82
Q

Electrolyte abnormalities after blood stranfusion

A

Low Ca, metabolic alkalosis

83
Q

Coagulation abnormalities after blood transfusion

A

Low factor 5, 8, platelets, acidosis (interferes), hypothermia

84
Q

Rate of PT drop when warfarin stopped

A

2 per day

85
Q

Carcinoid tumor tx

A

resect - if <2cm, distal, no further resection; sx treat HT antag (cyproheptadine), octreotide

86
Q

Polycythemia vera before surgery

A

Busulfan / chlorambucil = alkylating agents

87
Q

AAA numbers

A

< 4cm - observe. >6cm - repair if good surg candidate

88
Q

Carotid occlusion

A

CEA >60%; <60% just ASA

89
Q

Arterial embolus to periphery do what when

A

embolectomy <6h; prep both sides

90
Q

Graft occlusion drug

A

Urokinase

91
Q

% body that’s water

A

50-70%

92
Q

Water distribution in body

A

60% ICF + 30% ECF + 10% plasma

93
Q

When to give FFP

A

INR > 1.6

94
Q

When to give platelets

A

<10,000

95
Q

When to give cryoprecipitate

A

Low 8, fibrinogen, VWF

96
Q

Formula for maintenance fluid

A

10 (100), 10 (50), rest (20)

97
Q

Free water deficit

A

0.6 x kg x (1 - 140/serum Na)

98
Q

Mperidine side effect

A

Lower sz threshold, esp if renal failure

99
Q

Enflurane

A

Lower sz threshold

100
Q

Methoxyflurane

A

Nephrotoxic

101
Q

Fevers on post op day 1

A

Malignant hyperthermia, atelectesis, necrotizing fasciitis (104)

102
Q

Fevers on post op day 3

A

PNA/UTI; empiric = fluoroquinolone/moxi

103
Q

Fever POD 5

A

DVT, thrombophlebitis

104
Q

Fever POD 7

A

Wound (drains; open, pack); cellulitis (no drainage); line infection

105
Q

Fever POD 10-15

A

Abscess

106
Q

Unexplained fever PO

A

Thyroid storm, adrenal inusfficiency, lymphangitis, sepsis

107
Q

Postpericardotomy syndrome tx

A

NSAIDs

108
Q

Liver failure looks like

A

Low K, alkalosis, high CO, low SVR

109
Q

Low urine output is renal origin if

A

Urine Na >40

110
Q

Extubation criteria

A

RR / TV = 60-105; NIF > 20; PEEP < 5; Spontaneous RR <20

111
Q

Azothiaprine tox

A

Bone marrow

112
Q

SIRS criteria

A

T 38; WBC 15,000; HR > 100, RR > 20 or pCO2 < 32

113
Q

HR > 100 is what % dehydration

A

15-30

114
Q

AMS is what % dehydration

A

30-40%

115
Q

Alpha 1 does what other than vasoconstrict

A

increase insulin

116
Q

Phenylephrine

A

A1

117
Q

How to dx acromegaly

A

Somatomedin C

118
Q

Boerhave tx

A

Repair within 6 hours

119
Q

Meckel’s tx

A

Resect if 2cm, ectopic tissue, fibrous band, male

120
Q

Drugs for HP

A

clarithromycin + amox/amp + metronidazole + pantroprazole

121
Q

Test for DU

A

CLOtest

122
Q

Gastric cancer margins

A

5 cm

123
Q

Menetrier’s

A

protein in urine foamy pee, giant gastric folds

124
Q

Liver failure presents as

A

ascites, jaundice, bleeding, gynecomastia

125
Q

Portal HTN presents as

A

HSM, caput medusae, ascites

126
Q

BRBPR

A

> 2mL/min –> angiogram; <0.5 – wait then colonoscopy

127
Q

ZES fasting gastrin

A

> 1000

128
Q

Blood type associated with GU

A

O

129
Q

chronic mesenteric ischemia requires tx

A

stenosis 2.5 vessels

130
Q

Glucagonoma metastatic tx

A

Chemo: streptozycin, palliation: SS

131
Q

Toxic megacolon if

A

> 6cm distension + fever + HR >120 + PMN WBC > 10,500

132
Q

Ogilvie syndrome tx

A

< 10 cm - bowel rest, NG, neostigmine; >10cm - surg

133
Q

UC

A

Crypt abscesses, superficial ulcers, ankylosing spondylitis, arthritis

134
Q

Chrohns

A

Transmural, perianal fistulas, granulomas

135
Q

c diff cutoff for drugs

A

15,000 - vanco –> ileus –> +metro

136
Q

biliary dyskinesia

A

gall EF < 35%

137
Q

cholecystitis dx

A

wall > 8cm

138
Q

acute ascending cholangitis sx

A

fever + WBC + abd pain –> + jaundice + AMS + BP

139
Q

Gallbladder polyp bad if

A

1, >1cm, >50y, symptomatic

140
Q

Drugs that can cause acute pancreatitis

A

VPA, diuretics, IBD drugs, HIV

141
Q

Pancreatic failure (like hemorrahgic acute pancreatitis)

A

Ca up despite given Ca, BUN up, met acidosis, low PO2

142
Q

Normal bili

A

<2.5; think 1 for each

143
Q

Pseudocyst treat if

A

> 6cm or >6 weeks

144
Q

Tx hepatic encephalopathy

A

lactulose

145
Q

3 most common organisms causing primary peritonitis

A

E coli, enterococcus, bacterioides

146
Q

Giant liver cysts

A

Echinocococcus - tx = surgery + albendozole

147
Q

Liver adenoma tx

A

> 4cm - surg; <4cm - none

148
Q

Eye surg > trauma if

A

> 2mm eno, 50% orbital fracture, muscle trapped, diplopia on primary gaze

149
Q

Biliary leak guidelines

A

> 300 - CBD (relap); <300 - ERCP

150
Q

Acute drop end-tidal CO2

A

PE

151
Q

Ureteral injury

A

Anterior - repair now; posterior - wait 4-6 weeks

152
Q

Chest tube need thoracotomy if

A

> 1500; >600/6h

153
Q

DPL guidelines

A

> 100,000 RBC, >10mL blood, >500 WBC, inc amylase, bili, alk phos

154
Q

ABI

A

> 1.3 calcified need arteriogram; <.5 = ulcers

155
Q

Open fracture tx

A

OR within 6 h

156
Q

Don’t ever biopsy

A

Kidney mass (unless transplant), neck (ex thyroid), bones, scrotum, parotid

157
Q

ICP nl

A

<20

158
Q

CCP =

A

MAP - ICP

159
Q

For every Na over 140,

A

every 3 = 1L water lost

160
Q

Limit on infusing K

A

10 mEq/h

161
Q

Hyperkalemia can be caused by meds

A

B blockers, HTN meds, K-sparing diuretics, digitalis, heparin, NSAIDs, succ

162
Q

Hypothermia on EKG

A

J waves

163
Q

Hypo-Ca is

A

<8

164
Q

Low albumin - correction of calcium

A

0.8 (4 - albumin) + total Ca = actual Ca2+

165
Q

Both low Ca and Mg cause on EKG

A

long QT

166
Q

But low Mg on EKG causes

A

STD, long PR, torsades, flat P

167
Q

Low Ca on EKG causes

A

T wave inversion, heart block

168
Q

Low Ca on exam

A

Hyperactive DTRs

169
Q

Refractory low K

A

Hypo-Mg (due to alcoholism)

170
Q

High Ca

A

> 15

171
Q

Tx for hyper-Ca

A

NaCl, diuretics that aren’t thiazides which cause it, mithramicin

172
Q

Correct Na for hyperglycemia

A

Add 1.6 for every 100 glucose above 200

173
Q

Thrombolysis BP cutoff

A

<180/110

174
Q

Anticholinergic overdose - tx

A

Physiostigmine, unless it’s a TCA overdose

175
Q

Cholinergic overdose - tx

A

Atropine

176
Q

Seizures, make sure it’s not

A

Salicylate, theophyline, lithium b/c reversible

177
Q

Portal vein thrombosis is 2/2

A

OCP or cirrhosis

178
Q

PSC vs PBC

A

Intra and extrahepatic ducts vs. just intrahepatic

179
Q

Take out adrenal mass if

A

> 4cm - surg; <4cm - none

180
Q

Diuretics for CHF can cause what problem

A

Low CO and kidney failure

181
Q

Warfarin can cause

A

skin necrosis

182
Q

TAA operate if

A

> 7cm

183
Q

simoma bodies

A

papillary thyroid cancer

184
Q

Top melanoma type

A

Superficial spreading

185
Q

Inguinal hernia complications

A

Urinary retention, irritation of nerves

186
Q

Lidocaine vs Procainamide

A

Amide (2 I’s), PABA

187
Q

Deep peroneal injury

A

Foot drop

188
Q

MI 5 days ago and now decompensates, can be

A

Papillary muscle / MR? VSD? LV rupture

Surgery shelf crash (1 decks)

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