Flashcards in Module 2 Deck (105)
Loading flashcards...
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
