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1

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

Thrombomodulin

2

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

Hemophilia B

3

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

VonWillebrand Disease

4

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

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

5

What is the integral role of platelets after vascular injury?

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

6

What are the mechanisms of maintaining adequate preload?

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

7

What is the most common organism isolated in Septic Shock?

62% Gram Negative: PSEUDOMONAS & E. COLI

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

8

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

Agitation
Cool & clammy extremities
Tachycardia
Weak/absent peripheral pulse
25-30% + physiologic compensation

9

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

15% ~700-750mL

10

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

What class of Hypovolemic Shock is this?

Class I

11

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

Class III

12

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?

Class II

13

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

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

14

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

Hypovolemic Shock

15

Type of shock: dec resistance w/in capacitance vessels

Vasodilatory/septic shock

16

Type of shock: failure of the heart as a pump

Cardiogenic shock

17

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

Neurogenic Shock

18

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.

Traumatic Shock

19

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

Obstructive Shock

20

HR

Class I

21

RR 30-40; 1500cc blood loss

Class III

22

Anxious with orthostatic hypotension

Class II

23

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

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

24

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

>120bpm

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