High Yield PPT: Emma Holliday Ramahi Flashcards
(189 cards)
1
Q
Absolute contraindication to surgery?
A
Diabetic Coma, DKA
2
Q
What to do to try to maximize someones nutrition?
A
Enteral feedings
3
Q
Other reasons surgeons will delay surgery?
A
Liver failure
Poor nutrition
4
Q
When should a smoker stop smoking prior to surgery?
A
8 weeks!
5
Q
Smoker patient: what to think of as coming out of anesthesia?
A
Don’t keep O2 sat at 100 % because likely chronic CO2 retainer. Hypoxia is their strongest drive for respiration.
6
Q
What is Goldman’s Index?
A
Tells you who is at greatest risk for surgery
7
Q
Most important factor in Goldman’s index (biggest predictor of peri-operative mortality)?
A
CHF
8
Q
What should you check in patient with CHF?
A
Ejection fraction
(if less than 35 %, no surgery).
9
Q
2nd most important indicator when predicting mortality from surgery?
A
MI within 6 months
10
Q
Patient who comes in for pre-op evaluation and has a late systolic ejection murmur, crescendo-decrescendo?
A
Aortic stenosis
11
Q
Meds to stop before surgery?
A
Aspirin NSAIDs Metformin Vit. E Warfarin
12
Q
Why stop metformin?
A
Risk of lactic acidosis
13
Q
Want INR less than?
A
1.5
14
Q
Take what dose of insulin?
A
1/2 morning dose
15
Q
When do you dialyze before surgery?
A
24 hours pre-op
16
Q
Why worry if BUN > 100?
A
Increased risk of post-op bleeding. Uremia –> uremic toxins interact with platelets!!
17
Q
Coag pannel of patient with uremic platelet dysfunction?
A
normal platelet count
Increased bleeding time
18
Q
Good for weaning patient off of ventilator?
A
Pressure support
19
Q
Assist-control vent setting
A
Set Tidal Volume and Rate…if patient takes a breath, predetermined volume still delivered
20
Q
Pressure suppor vent
A
Patient rules rate! Boost of pressure is given if they are not able to take in entire TV on their own!
21
Q
CPAP
A
Patient breathes on own! But + pressure given all the time in order to make sure alveoli stay open
22
Q
PEEP
A
Keeps alveoli open in patients with ARDS or CHF…alveoli are collapsing and that’s what is causing the difficulty in facilitating gas exchange. Positive pressure only given at the END of cycle
23
Q
Patient on vent…how do we want to evaluate management?
A
ABG
24
Q
low pO2 in patient on vent
A
not getting enough oxygen…increase FiO2!
25
What does too much oxygen do?
Free radical damage...too high concentrations can worsen ARDS etc.
26
Patient has low PaCO2 and high pH...how can you fix it?
Decrease TV (better option because decreasing more of the air in the functional space)
or decrease rate--blow out less CO2
27
Anion gap equation
Na+ - (Cl- + HCO3-)
28
Normal anion gap
8-12
29
Causes of non-gap acidosis
Diarrhea**main one
Diuretic
RTAs
30
Why is diarrhea most common cause of non-gap acidosis?
GI tract has a lot of bicarb...if pooping a lot...getting rid of a lot of bicarb--metabolic acidosis
31
How to differentiate cause of metabolic alkalosis?
Check Urine Chloride
Vomiting--urine chloride will be low
High--could be genetic problem
32
Causes of hypervolemic hypernatremia?
CHF
Nephrotic
Cirrhotic
33
Next test after finding a patient with Normal volume but decreased sodium...SIADH
CXR. Paraneoplastic syndrome associated with lung cancer
34
Treatment of hyponatremia if patient is hypovolemic?
Normal saline
35
When do we use hypertonic 3 % saline?
Severly symptomatic hyponatremia (seizures, Altered mental status, or if sodium is super lowwww like less than 110)
Why don't we use this hypertonic saline more often?
Central pontine myelinolysis
36
Appropriate rate of sodium correction
Between 12-24 meq/day
| or 0.5-1 mEq/hour
37
Treatment of Hypernatremia
Replace with D5W or hypotonic fluid
38
Low calcium can do what to EKG
Prolonged QT interval
39
Symptoms of Hypokalemia
Paralysis
Ileus
ST depression
U waves
40
Tx of hypokalemia
Give potassium! Monitor renal function.
41
EKG changes of hyperkalemia?
Peaked T waves
Prolonged PR and QRS
Sine waves
42
Treatment of hyperkalemia
| *IMPORTANT
Give:
1. Calcium-gluconate-stabilize cardiac membranes
2. Insulin + glucose--shift K+ into cells
43
What can be used besides Insulin to get K+ into cells?
B-agonist like Albuterol
44
Makes you poop out potassium
kayexalate
45
maintenance iVF of choice
D51/2NS
46
erythematous, not peeling
1st deg. burn
| epidermis
47
super painful, loss of integrity of epidermis
2nd degree burn
48
Dark or pale, no sensation because damage goes all the way through dermis and starts to affect nerves
3rd degree burn
49
Patient comes in confused, headache, cherry red skin
carbon monoxide poisoning
Check carboxyhemoglobin!
50
Cause of clotting in old people
Cancer
51
New clots, edematous, high BP, foamy pee
Nephrotic syndrome
(because losing protein in urine...some of first to go-antithrombin III)--hypercoaguabule state!
52
Most common inherited hypercoaguablitity?
Factor V leiden
53
What can't you give someone with ATIII def?
Heparin
54
Young woman with multiple Spontaneous abortions?
lupus anticoagulant
55
Post op patient with thrombocytopenia but increased clotting?
Maybe they received heparain! HIT
56
Treat HIT with?
Leparudin or Agatroban
57
isolated decrease in platelets?
ITP
58
Normal platelets, increased bleeding time and PTT?
vWF disease
59
Low platelets
coags high
schistocytes
etc...
DIC
| due to gram-sepsis (LPS), carcinomatosis, OB stuff
60
Parkland formula
for burn patient fluid resuscitation
Adults:
Kg x %BSA x 3-4
Kids:
Kg x %BSA x 2-4
Give half in first 8 hours, the rest over the next 16 hours
61
Route of giving antibiotics to burn patients
TOPICAL
62
Can cause leukopenia
| Does not penetrate eschar
Silver sulfadiazene
63
Penetrates eschar
| hurts like hell
Mafenide
64
Can cause hypokalemia and hyponatremia
| doesn't penetrate eschar
Silver nitrate
65
Electrical burn...get what test?
EKG
66
Pee red but no RBC in it...
Rhabdomyolysis causing myoglobinuria
67
Find myoglobinuria, check?
K+ level! Can cause fatal arrhythmias
68
Airway if patient is unconscious?
INTUBATE
69
Feel subcutaneous emphysema in neck after patient stabbed
Fiberoptic bronchoscope
70
What do you do after you intubate patient?
listen for breath sounds
71
indications to take someone with hemothorax to OR
High output greater than 1.5 L during initial chest tube insertion or greater than 200 cc/hour for first 4 hours
72
"White out lung"
Pulmonary contusion
Tx. Control pain, wait
73
Flail chest
>3 consecutive rib fractures
| Moves in upon inspiration
74
Tx for flail chest
Nerve block (for pain control)
*Don't give opiates--decrease resp. drive
75
Petechial rash in chest
Fat embolism
76
hypotensive, tachycardic
shock
77
Pulsus parodoxus
| Electrical alternans
Pericardial tamponade
78
Confirmatory test for pericardial tamponade
FAST exam
*Then do the needle decompression
79
GCS subcategory breakdown of maximum points
Eyes 4
Verbal 5
Motor 6
80
Surgical intervention for increased ICP
ventriculostomy
81
Zone 3 of neck
above angle of mandible
82
Zone 2 of neck
angle of mandible to cricoid
83
Zone 1
below cricoid
84
W/u for zone 1
aortography and triple endoscopy
85
w/u zone 2
2D doppler
| +/- exploratory surgery
86
Zone 1 w/u
Aortography
87
Free air under diaphragm
EX LAP
88
Stable patient with blunt abdominal trauma
CT
89
Lower rib fracture + bleeding into abdomen
Spleen or liver lac
90
Positive Kehr sign + viscera in thorax
diaphram rupture
(pain in left shoulder, referred pain due to phrenic nerve)--Kehr sign
91
Handlebar sign
Pain and bruising over pancreas
92
blood at urethra, high riding prostate
pelvic fracture with urethral or bladder injury
93
test for urethral injury
Retrograde urethrogram
94
Head fracture that goes to OR
Depressed skull fracture
95
Shoulder pain after seizure
posterior shoulder dislocation
96
Arm outwardly rotated, numb over deltoid (axillary nerve injury)
Ant. dislocation
97
Old lady FOOSH, distal radius displaced
Colle's fracture
98
Hand hurts after punching wall
metacarpal neck fracture
99
clavicle break location
between middle and distal thirds
100
Fever POD1
Atelactasis
101
Dx of atelectasis?
Listen
CXR
Bilateral fluff in lower lobes
102
POD1 super high fever to 104
Nec fasc
| *spread along scarpas fascia...usually due to strep and clostridium
103
Tx of nec fasc
OR..debridement!
| With IV penicillin!!
104
Cause of malignant hyperthermia
Succ or halothane
Prob with ryanodine receptor gene defect
105
Fever POD3-5
Pneumonia
106
Tx of pneumonia
cover with fluoroquinolone Like Mocifloxacin in mean time in case it is strep pneumo...await culture
107
POD7, edema at incision site, induration, No drainage
Cellulitis
Tx. antibiotics
108
POD7, edema, induration, plus drainage
open wound
Re-pack it
No abx necessary
109
Salmon colored fluid from incision
dehiscence
110
treatment of dehiscence
go bak to OR
Problem is violation of the fascia.
Primary closure of fascia
IV abx
111
Post c-section or hysterectomy unexplained fever
Pelvic thrombophlebitis
Tx. Antibiotics, heparin
112
Cause of pressure ulcer
ischemia
113
Marjolin's ulcer
squamous cell carcinoma in chronic ulcer
114
Transudative pleural effision
| Low pleural glucose
Rheumatoid arthritis
115
Transudative effusion
| High lymphoytes
tuberculosis
116
Bloody transudative pleural effusion
malignant or pulmonary embolus
117
Lights criteria
Transudative pleural effusion if
LDH < 200
LDH effusion compared to serum <0.6
Protein eff/serum <0.5
118
VATS
video assisted thoracic surgery
119
Type of abscess you don't want to drain
Lung abscess
Tx*Antibiotics
Penicillin or Clindamycin
120
Lung shows a spot with air/fluid level
abscess
121
most common benign lung nodule...popcorn calcification
hamartoma
122
concentric calcifications on x-ray
old granuloma
123
most common type of lung cancer in non-smokers
adenocarcinoma
124
weird spot that adenocarcinomas like to go
Adrenal glands
125
Patient with kidney stones, constipation, malaise, low PTH, + central lung mass
Squamous cell carcinoma
126
Why low PTH in squamous cell carcinoma
Paraneoplastic syndrome
| Secretion of PTH-rP
127
Paraneoplastic syndromes associated with small cell carcinoma
Pancoast tumor
Lambert eaton syndrome
SIADH
128
Peripheral lung mass, cavitating, distant mets
Large Cell carcinoma
129
Which lung cancers get surgery?
Non-small cell!!
Small cell is very chemo, radio sensitive.
130
ARDS causes
Gram - sepsis
Pancreatitis
Gastric aspiration
131
Criteria for ARDS criteria
Bilateral fluffy infiltrates
PaO2/FiO2 ratio <200
PCWP is < 18 (means not cardiac)
132
Treatment of ARDS
Vent setting on PEEP
133
diastolic murmur
| widened pulse pressure
aortic regurgitation
134
Late systolic murmur with click
mitral valve prolapse
135
holosystolic murmur with late diastolic rumble
VSD
136
Tx of Zenker's
Surgery
137
Bird beak on barium swallow
Achalasia
138
Surgery done on achalasia if medical management fails
Heller myotomy
139
Dysphagia worse with hot/cold liquids
Diffuse esophogeal spasm
140
Medical treatment of esophageal spasm and achalasia
Calcium channel blocker
| Nitrates
141
Gastric lymphoma associated with what disease
HIV
142
MALT lymphoma tx
Eradicate H. Pylori
143
Mentriers disease
protein losing enteropathy
| enlarged rugae
144
Mid epigastric pain better with eating
Duodenal ulcer
145
Triple therapy
PPI
Clarithromycin
Amoxicillin
146
Refractory ulcers after Triple therapy?
ZE syndrome
147
SMA syndrome
Happens after rapid weight loss...duodenal compressed between abdominal aorta and SMA
148
How does one get gastric varices from pancreatitis?
Pancreatitis can cause splenic vein thrombosis...which leads to gastric varices.
149
Courvoisier's sign
large nontender GB
Itching and jaundice
*Adenocarcinoma of pancreas
150
Trousseau's sign
Migratory thrombophlebitis
151
Pancreatic cancer dx
Endoscopic US and FNA biopsy
152
When is pancreatic tumor deemed resectable
No mets outside abdomen
| no extension into SMA, portal vein, liver, etc.
153
Whipple's triad (insulinoma)
Sxs (sweat, tremors, hunger, seizures)
Blood glucose <45
Sx resolve when glucose administered
154
Glucagonoma sx
hyperglycemia
diarrhea
weight loss
155
characteristic rash of glucagonoma
necrolytic migratory erythema
156
VIPoma sx
```
watery diarrhea
flushing
hypokalemia
dehydration
flushing
```
157
```
Pentad: RUQ pain
Fever
Jaundice
Decrease BP
Altered mental status
```
Ascending cholangitis
158
liver bacterial abscess bugs
E. Coli
Bacteroides
Enterococcus
159
Treatment for entamoeba histolytica
Metronidazole
160
RUQ pain with large liver cysts
enchinococcus (from dog feces)
161
Skin test for enchinococcus
+Casoni test
162
Tx for echinococcus
SURGERY + Albendazole
| Remove entire cyst, rupture = anaphylaxis
163
what happens to carcinoid tumor to get syndrome?
Mets!
| If was just in GI tract, serotonin would be denatured before it got out
164
#1 spot for carcinoid tumor
appendix
165
vitamin ppl with carcinoid syndrome def. in?
Niacin!
| Serotonin and niacin both made from tryptophan! All is being used to make serotonin
diarrhea, dementia, dermatitis
166
Transmural inflammation
Crohns
167
Granulomas
Crohns
168
Smokers have low risk
UC
169
Smokers have high risk
Crohns
170
Higher risk for colon cancer: Crohns or UC?
UC
171
Associated with p-ANCA
UC! and PSC!
172
#1 cause of death post AAA repair
MI
173
Post AAA repair 1-2 years later have GI bleeding
Aortoenteric fistula
174
W/u for mesenteric ischemia
angiography
175
Best test for PAD
ABI
176
Blood thinner regimen for DVT
Treat with heparin
Overlap heparin for 5 days with Warfarin
Continue warfarin 3-6 months
177
Hashimoto's predisposes to....
Thyroid lymphoma
178
Breast cancer that is more often bilateral
LCIS
179
Orange peel skin on breast
Inflammatory BC
180
Eczema of nipple
Paget's Disease of breast
181
Precursor to squamous cell carcinoma of skin
actinic keratosis
182
number one prognostic indicator of melanoma
Depth
183
Dx of sarcoma
BIOPSY
| not FNA
184
Where does sarcoma like to spread to first? How?
LUNGS
| Hematogenously
185
Osteosarcoma
Proximal femur, distal tibia
| Codman's triangle and sunray appearance on x-ray
186
Cause of hyperacute rejection
preformed antibodies
187
cause of acute rejection
T cell reaction
188
Treatment of acute rejection
Steroid bolus
| + Antilymphocyte agent (OKT3)
189
What do you do for chronic rejection
re-transplantation
