Module 2 Flashcards

(105 cards)

1
Q

Aka Thrombin Sink. This forms a complex with Fibrin -> no cleavage of fibrinogen. This also activates Protein C which inhibits Factors V and VIII.

A

Thrombomodulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aka Christmas Disease or Factor IX Deficiency. The severity depends on levels of Factor VIII and IX

A

Hemophilia B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aka Factor VIII Deficiency. This is the most common CONGENITAL bleeding d/o. Symptoms include: easy bruising, mucosal bleeding, menorrhagia (in women)

A

VonWillebrand Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Secondary hemostasis starts with the exposure of what factor? What is its end result?

A

Factor III/ Tissue Factor

Secondary hemostasis ends with consolidation of the platelet plug by Factor XIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the integral role of platelets after vascular injury?

A

Formation of hemostatic plug. It also contributes to Thrombin formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the mechanisms of maintaining adequate preload?

A

Venoconstriction
Inc sympathetic tone = dec splanchic bf
RAAS
Coordinated Atrial Activity & Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common organism isolated in Septic Shock?

A

62% Gram Negative: PSEUDOMONAS & E. COLI

47% Gram Positive: Staphylococcus aureus
19% Fungi: Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs and symptoms of patients with Acute Blood Loss?

A
Agitation
Cool & clammy extremities 
Tachycardia
Weak/absent peripheral pulse
25-30% + physiologic compensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How much blood loss would be allowed to maintain normal bp & hr?

A

15% ~700-750mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient has the following ssx:
600mL blood loss
85 bpm
120/80 bp

What class of Hypovolemic Shock is this?

A

Class I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patient presented with 1800mL blood loss, 140bpm, 90/60 bp and is confused. What class of hypovolemic shock is this patient experiencing?

A

Class III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patient presents with 800mL blood loss, 110bpm, and bp was 120/80 while supine and 90/65 when standing. This patient is experiencing what class of hypovolemic shock?

A

Class II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the role of Goal-oriented therapy for Septic Shock?

A
This is done during the first 6 hrsin the hospital. This aims to:
Inc venous o2 saturation
Dec lactate lvls
Dec base deficit
Inc pH
Dec 28-day mortality rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

This is the most common type of shock; loss of circulating blood volume

A

Hypovolemic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type of shock: dec resistance w/in capacitance vessels

A

Vasodilatory/septic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Type of shock: failure of the heart as a pump

A

Cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Form of vasogenic shock; spinal cord injury/anesthesia= vasodilation due to acute loss of sympathetic tone

A

Neurogenic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Type of Shock: involves soft tissue + bone injury -> activation of inflammatory cells & release of circulating factors -> modulation of immune response.
The effects of tissue injury are combined with effects of hemorrhage.

A

Traumatic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Type of Shock: form of cardiogenic shock; from mechanical impediment to circulation leading to decreased cardiac output

A

Obstructive Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HR

A

Class I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

RR 30-40; 1500cc blood loss

A

Class III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anxious with orthostatic hypotension

A

Class II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If juan is 60kg sustaining a stab wound with class III shock, how much is the blood loss?

A
30-40% or 1500-2000mL yan ang textbook definition ng class III hypovolemic shock.
But based on man's wait which is 60kg...
60kg x 0.6 =36 kg
36x 1/3= 12kg
12 kg x 1/3 =4L blood vol

4L x 0.3 =1.2L
4L x 0.4 = 1.6 L

So range is 1.2-1.6L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pedro is in shock with blood loss of 1500mL, what is the expected HR?

A

> 120bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the best method for preop skin preparation?
Mild mechanical exfoliation of the arm & forearm using antibacterial preps. Clipping of hair rather than shaving
26
What are the criteria for prophylactic antibiotics?
Activity against microbes Dosage Half life
27
How many mins prior to surgery is prophylactic antibiotic given?
30 mins
28
For Non-Biliary/Pancreatic/GIT surgery, what prophylactic antibiotic should you give?
Cephalosporin
29
For Biliary/Pancreatic/GIT surgery, what antibiotic should you give?
Broad spectrum antibiotics
30
Type of Wound: no infection; only skin microflora can potentially contaminate; no hollow viscera
Class I: CLEAN
31
Type of Wound: Respi, GIT & GUT opened under controlled circumstances without significant spillage of contents
Class II: CLEAN/CONTAMINATED
32
Type of Wound: intro of bacteria into a normally sterile area or body cavity. Due to accidental wounds or majore breaks in sterile techniques. There is gross spillage of viscous contents or incision thru inflamed but non-purulent tissue
Class II: CONTAMINATED
33
Type of Wound: traumatic wounds in which delay in tx occured. There is necrotic tissue, purulent material, and existing infection/perforation
Class IV: DIRTY
34
Type of Wound: when prosthetic device is inserted
Class ID
35
Type of Wound: hernia repair
Class I: Clean
36
Type of Wound: abscess
Class IV: Dirty
37
Type of Wound: rectal surgery
Class III: contaminated
38
Type of Wound: cholecystectomy
Class II: clean/contaminated
39
Type of Wound: laparoscopic surgery
Class I: Clean
40
Type of Wound: perforated bowel
Class IV: dirty
41
Type of Wound: bile spillage
Class III: contaminated
42
Type of Wound: penetrating wounds
Class III: contaminated
43
Type of Wound: necrotizing soft tissue infection
Class IV: Dirty
44
Type of Wound: biopsy
Class I: clean
45
Type of Wound: removal of pins, chest & gynecologic procedures
Class II: clean/contaminated
46
What are the recommended antibiotics for Head & Neck surgery?
Clindamycin + Gentamicin
47
What are the recommended antibiotics for Gastroduodenal surgery?
Cefuroxime
48
What are the recommended antibiotics for Biliary Surgery?
Cefazoline
49
What are the recommended antibiotics for Colorectal Surgery?
Ciprofloxacine + any: Ampicillin-Sulbactam Amoxicillin-Clavulanic Cefoxitin Cefazolin + Metronidazole
50
What are the recommended antibiotics for Spinal Surgery?
Cefazoline, Oxacillin
51
What are the recommended antibiotics for CSF Shunt and Craniotomy?
Cloxacillin, Oxacillin, Gentamicin
52
What is the most common bacteria found in the oral cavity?
Gram positive bacteria
53
What bacteria predominates in tooth cavities?
Gram Negative
54
What bacteria predominates in Oral Abscesses?
Anaerobes
55
What bacteria predominates in Tumors?
All. Gram positive, gram neg, and anaerobes
56
This is giving of antibiotics before surgery to reduce the number of microbes that enter the tissue or body cavity
Prophylaxis
57
This refers to the use of antibiotics when risk of infection is high or when significant contamination during the surgery has occured. This is usually given for 3-5 days
Empiric Therapy
58
This therapy is based on the results of culture and on the course of the disease
Therapeutic Therapy
59
What is the expected infection rate of Clean wounds?
1-5.4%
60
What is the expected infection rate of clean/contaminated wounds?
2.1-9.5%
61
What is the expected infection rate of contaminated wounds?
3.1-12.8%
62
What is the expected infection rate of dirty wounds?
3.4-13.2%
63
What are the most common AEROBIC gram positive pathogens in surgical infections?
``` S. aureus S. epidermidis S. pyogenes S. pneumoniae/pneumococci E. faecalis ```
64
What are the most common AEROBIC gram NEGATIVE pathogens in surgical infections?
``` E. coli H. influenzae K. pneumoniae P. mirabilis S. marcescens ```
65
What are the most common anaerobic gram positive pathogens in surgical infections?
Clostridium spp | Peptostreptococcus
66
What are the most common anaerobic gram negative pathogens in surgical infections?
Bacteroides | Fusobacterium
67
What are the most common aside from gram pos and gram neg pathogens in surgical infections?
Mycobacteria Nocardia Legionella Listeria
68
What are the most common fungal pathogens in surgical infections?
Candida | Mucor
69
What are the most common viral pathogens in surgical infections?
``` CMV EBV HEPAVIRUS HSV VZV HIV ```
70
Common in hospital practice (pathogen)
Staphylococcus aureus | Usually MRSA
71
Type of Peritonitis: microbes invade normal sterile confines of the peritoneal cavity via hematogenous dissemination. What is the tx?
Primary Microbial Peritonitis Tx: remove in dwelling peritoneal dialysis catheter or peritoneovenous shunt
72
Type of peritonitis: due to perforation or severe inflammation of an intraabdominal organ Tx?
Secondary microbial peritonitis Tx: debridement & resection
73
Type of peritonitis: usually seen in the immunosuppressed Tx?
Tertiary/Persistent peritonitis Tx: reexploration and drainage or percutaneous drainage
74
What is the expected infection rate of Clean wounds?
1-5.4%
75
What is the expected infection rate of clean/contaminated wounds?
2.1-9.5%
76
What is the expected infection rate of contaminated wounds?
3.1-12.8%
77
What is the expected infection rate of dirty wounds?
3.4-13.2%
78
What are the top 3 cancers in men
Lung Prostate Colorectal
79
What are the top 3 cancers in women?
Breast Colorectum Lung
80
What are the two principal molecular pathways of apoptosis?
Mitochondrial pathway | Death receptor pathway
81
This type of invasion involves malignant tumor cells above the basement membrane
In-situ cancer
82
This type of cancer involves breach of the basement membrane and penetration of surrounding stroma
Invasice cancer
83
What are the criteria for p53 & Li Fraumeni Syndrome?
Bone or soft tissue sarcoma
84
What is the HNPCC Revised Amsterdam Criteria?
3 or more rel with HNPCC-related CA At least 2 successive generations affected At least 1diagnosed
85
Tamoxifen causes what cancer?
Endometrial Cancer
86
H. pylori can cause what cancer
Gastric cancer
87
Asbestos can cause what cancer?
Mesothelioma
88
What are the endogenous microflora of the integument?
``` Primarily Gram-Positive: Staphylococcus Streptococcus Corynebacteria Propionibacterium ```
89
What traps larger particles in The upper respi tract?
Mucus traps
90
What traps smaller particles in the lower respi tract?
Pulmonary Alveolar Macrophage
91
Which parts of the body do not have resident microflora in healthy individuals?
Urogenital Biliary Pancreatic Ductal Distal Respiratory Tracts
92
What is the gatekeeper of the abdomen?
The omentum
93
What are the ways to do source control?
Drainage of purulent material Debridement of all infected, devitalized tissu, and debris Removal of foreign bodies at the site of infection Remediation of underlying cause of infection
94
What 3 factors affect the development of Surgical Site Infections?
Degree of microbial contamination of thr wound during surgery Duration of the procedure Host factors (diabetes, malnutrition, obesity, immune suppression, etc)
95
By definition, an Incisional Surgical Site Infection occurred if...
Wound drains purulent material or if the surgeon judges it to be infected and opens it
96
This type of peritonitis is more common among patients who retain large amounts if peritoneal fluid due to ascites and among those individuals who are being treated for renal failure
Primary Microbial Peritonitis
97
These are example of what type of peritonitis? | Appendicitis, perforation of GIT, diverticulitis
Secondary Microbial Peritonitis
98
Patients in whome standard therapy failes typically develop one or more of the ff: Intra-abdominal abscess Leakage of GIT anastomosis Or __________ (type of peritonitis)
Tertiary / Persistent Peritonitis
99
What should be suspected if skin infection persists after tx with adequate drainage and administration of first line antibiotics?
methicillin-resistant Staphylococcus aureus
100
What are the risk factors for Surgical Site Infections?
``` Older age Immunosuppression Obesity Diabetes mellitus Chronic inflammatory process Malnutrition Peripheral vascular disease Anemia Radiation Chronic skin disease Carrier state Recent operation ```
101
Postoperative UTI should be based on?
Urinalysis demonstarting WBC or bacteria Positive for leukocyte esterase Or combination
102
When is the diagnosis of postoperative UTI established?
After >100,000 CFU/mL of microbes are identified in Symptomatic patients Or >1,000,000 CFU/mL in Asymptomatic patients
103
What is the tx for postoperative UTI?
Single antibiotic directed against the most common organism, E. Coli or Klebsiella pneumoniae
104
What nosocomial infection is associated with prolong mechanical ventilation?
Nosocomial Pneumonia
105
What establishes the diagnosis of Nosocomial Pneumonia?
Presence of purulent sputum Elevated leukocyte count Fever New CXR with abnormalities such as consolidation *2 findings + cxr= inc likelihood of pneumonia