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PRS RC 2020 > Randomx mix > Flashcards

Randomx mix Flashcards

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1
Q

What is SIRS criteria?

A

2 or more of: o Fever > 38C or < 36C o Heart rate > 90 beats / minute o Respiratory rate > 20 or PaCO2 < 32 mmHg o White blood cell count >12,000/mm3, <4,000/mm3, or >10% immature bands

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2
Q

What is sepsis?

A

SIRS + evidence of infection

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3
Q

What is severe sepsis?

A

Sepsis with evidence of end organ function

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4
Q

What is septic shock?

A

Severe sepsis + hypotension

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5
Q

What is the classification for nec fasc?

A

Type I - mixed (aerobic + anaerobic) –> RF: DM, PVD, immunosuppression, recent surgery

Type II - monomicrobial (GAS, Strep pyo, staph aureus, vibrio, aeromonas)

Type III - clostridium perfringens (gas gangrene)

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6
Q

What is empiric therapy for nec fasc?

A

Pip-tazo/carbapenem + clinda + vanco (MRSA)

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7
Q

What is therapy for nec fasc is pen allergic?

A

Fluoroquinolone + flagyl

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8
Q

What is nec fasc with sea water exposure?

A

Add doxy 100mg IV BID or ceftazidime 2g IV q18H for vibrio

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9
Q

What are the phases of lyme disease?

A
  1. Flu like illness, malaise, erythema migran 2. Weeks - neurologic: meningitis, FACIAL PALSY 3. Months-years - recurrent meningitis, neuro deficits, chronic arthritis
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10
Q

What is the treatment for lyme disease?

A

Ceftriaxone 2g IV daily x 12 days

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11
Q

How to clinically differentiate btw preseptal and orbital cellulitis?

A

Orbital: proptosis, pain with eye movements, ophthalmoplegia, diplopia

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12
Q

what is the recommended HIV post-exposure prophylaxis?

A

Zidovudine (AZT) + lamivudine (3TC) +/- third agent Nelfinavir

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13
Q

what is Melkersson-Rosenthal syndrome?

A
  1. Recurrent unilateral facial paralysis 2. Non-inflammatory facial edema 3. Ligua plicata 4. AD!!!
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14
Q

What is Ramsay Hunt syndrome?

A
  1. Varicella Zoster infection of geniculate ganglion 2. Unilateral facial paralysis 3. Ear pain, tinnitis 4. Painful rash
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15
Q

DDX for bilateral FN palsy?

A
  1. Congenital - Mobius 2. Acquired - Infectious: HIV, syphilis, - Inflammatory: Wegener’s, sarcoidosis - Neuro: Guillain-Barre, pseudobulbar palsy - Cancer: leukemia
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16
Q

DDX for congenital FN palsy?

A

Mobius CULLP Velocardiofacial Chiari malformation Hemifacial microsomia Syringobulbia

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17
Q

What is ionizing radiation?

A

Particles or EM waves with enough energy to liberate electrons from atoms/molecules

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18
Q

What are the different types of ionizing radiation?

A

1) Electromagnetic waves: Xray, gamma rays 2) Particles: electrons, neutrons, protons

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19
Q

What are factors influencing cellular response to radiation?

A

Five Rs REPAIR: cell populations can recover after non-lethal damage (ie fractionation allows for recovery) REPOPULATION: between treatments cells undergo mitosis to repopulate tumor REASSORTMENT: most radiosensitive during mitosis (ie: fractionation allows cells to enter mitosis during recovery) REOXYGENATION: cells more sensitive with high O2 RADIOSENSITIVITY: baseline at which other 4Rs are effective (depends on frequency of cell division, length of time between divisions, lifespan, ie precursor cells - high mitotic rate - very radiosensitive; mature cells - low mitotic rate - radioresistant)

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20
Q

What are the phases of acute radioexposure syndrome?

A
  1. Prodromal: GI sx - nauesa, vomiting, diarrhea 2. Latent: few or no symptoms 3. Main phase: different presentation depend on tissues irradiated…
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21
Q

What are the principles and goals of HN recon?

A

Multidisciplinary Prioritize cure Restore function Immediate recon if possible Protect vital structures Restore form Minimize donor site

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22
Q

Recipient vessels for H and N recon?

A
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23
Q

What is the treatment for rabies exposure? (include doses)

A

Not vaccinated:

Rabies IG x 1 does 20IU/kg (as much as possible SC around wound, remainder IM)

Rabies vaccines 1cc IM (deltoid) on day 0,3,7,14,+28 if immunocompromised

Vaccinated:

No IG

Rabies vaccine 1cc IM days 0,3

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24
Q

What is the origin and insertion of lateral pterygoid?

A

Origin

Superior head: infratemporal fossa.

Inferior head: lateral pterygoid plate

Insertion

Superior head: anterior side of the condyle.

Inferior head: pterygoid fovea

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25
What is the origin and insertion of the medial pterygoid muscle?
Origin: Deep head: medial side of lateral pterygoid plate Superficial head: pyramidal process of palatine bone + maxillary tuberosity Insertion: Angle of mandible
26
What is the treatment for malignant hyperthermia?
Stop offending agent ACLS protocol 100% O2 Ventilatory support Dandrolene 2.5 mg/kg IV bolus, then 1 mg/kg q25min Cooling, IV fluids Prevent AKI
27
What is the mode of action of accutane?
Decrease the size and activity of sebaceous glands Reduction in propionibacterium acnes
28
What is the antidote to botox?
Pyridostigmine
29
What is the interpretation of ABI results?
* \> 1 = normal * 0.7-1 = mild --\> antiplatelet * 0.5-0.7 = consult vascular surgery +/- imaging * 03-0.5 = urgent consult to vascular sx * \<0.3 = critical limb ischemia, vascular sx on call
30
What is the non-operative treatment of venous ulcers?
Compression Elevation DVT treatment Dressing: absorbant, autolytic, antibacterial Drugs: pentoxyfilline, diuretics
31
What are the preventative surgical treatment for rheumatoid hand?
* Tenosynovectomy * Joint synovectomy * Tendon rebalancing
32
What are the advantages and disadvantages of primary gingivoperiosteoplasty?
Advantages * Decrease need for ABG (60%) * improved positioning of max segment Disadvantages * poor alignment * poor quality bone * damage to tooth bunds * constricted arch
33
What is the classifcation of operative wounds and the infection risk?
· Clean (\<2% SSI risk): Non-traumatic wound with no inflammation; no breach of Resp, GI, or GU tract · Clean-contaminated (4-10%): Non-traumatic wound with minor break in technique; Resp/GI/GU tract entered with minimal contamination · Contaminated (15-20%): Fresh traumatic wounds; Major break in sterile technique; Non-purulent inflammation encountered; Gross spillage from GI/GU tract · Dirty (30-40%): Traumatic wound from dirty source; Gross contamination; Purulent infection
34
What are the X-ray findings in camptodactyly?
* flattening of dorsal head PP * exaggerated recess at neck of PP * volar beaking of MP * joint space narrowing
35
What is the ddx for camptodactyly?
* trigger finger * pterygium syndrome * beal's syndrome * marfan's * arthrogryposis * boutonniere
36
Syndrome associated with macroglossia?
NF Beckwith-Wiedermann Down's Congenital hypothyroidism mucopolysaccharidosis
37
What are 3 functional goals of alveolar bone graft?
Bony suport for eventual erupting teeth Closure of alveolar oro-nasal fistula Creates stable maxillary dental arch Facilitate eventual odontontic mouvement Provide nasal base support Improved oral hygiene
38
What are 5 differences between pediatric and adult facial fractures?
* Faster bony healing * Disruption of growth centers * Unerupted tooth buds decrease strength and compliance of facial skeleton * Bone has greater cancellous to cortical ratio and more elastic and resistant to fracture * Absent or underdeveloped sinuses may predispose to cranial base fractures
38
What are hte advantages of primary alveolar bone grafting?
* Early closure of alveolar nasal-oral fistula * Decreased orthodontic and orthognathic treatment due to better bone growth and bone stock
39
Rank transplant tissues from MOST to LEAST antigenic?
1. Skin, mucosa 2. Muscle 3. SubQ tissues 4. Bone (bone marrow) 5. Cartilage, tendon, vessel
40
How is tolerance achieved?
1. Immunosuppression 2. T-cell anergy 3. Cytokine pattern alterations 4. Immunoregulatory cells
41
When should patients stop smoking?
4 weeks prior (SR 2012)
42
What are 4 features of carpenter syndrome? Which gene and chromosome?
Features: synostosis, flat nasal bridge, low-set ears, symbrachydactyly, preaxial polydactyly Genetics: AR, RAB23 on chromosome 6
43
What is the mechanism of Rivaroxaban (Xarelto)? What is the reversal agent?
Direct factor Xa inhibitor Direct factor Va inhibitor Reversal agent: Andexxa, FFP
44
What is the preoperative workup for malignant hyperthermia?
Caffeine-halothane contracture test Piece of skeletal muscle is excised, ryanodine receptor exposed to halothane and/or caffeine Abnormal contractile activity = susceptible
45
How to avoid cardiac arrhythmias in phenol peels?
* Continuous cardiac monitoring * 30 minutes after procedure * Space out application of phenol to each unit * IV fluids * Diuresis (lasix 20mg) 10 min before application of phenol (?)
46
What is the sequence of eruption of permanent teeth?
First molars 7 years Median incisors 8 Lateral incisor 9 First premolar 10 Second premolar 11 Canines 11 to 12 Second molars 13 to 14 Third molars 17 to 40
47
Which gense are associated with the following syndromes? * Saethre-Chotzen * Apert * Crouzon * Pfeiffer * Muenke * craniofrontonasal syndrome
* Saethre-Chotzen: TWIST1 * Apert: FGFR2 * Crouzon: FGFR2, FGFR1 * Pfeiffer: FGFR 2 * Muenke: FGFR 3 * Craniofrontonasal syndrome: EFNB1
48
What are the contents of the optic foramen?
Optic nerve Ophthalmic artery
49
What is the pathophysiology of oculocardiac syndrome?
Compression of nasociliary nerve which gives signal thorugh the reticular formation to the vagus nerve
50
What are the contents of the SOF?
* CN3,4,6 * V1: NFL (nasociliary, frontal, lacrimal) * Lazy (lacrimal) French (frontal) Tarts (Trochlear) Sit (superior oculomotor) Naked (nasociliary) In (inferior oculomotor) anticipation (abducens) * Parasympasynmethic to pupil * Recurrent meningeal artery * Superior ophthalmic vein
51
What are the contents of the IOF?
* inferior ophthalmic vein * V2 infraorbital zygomaticotemporal zygomaticofacial sphenopalatine * Infraorbital orbital artery
52
What is the clinical triad of oculocardiac reflex? What is the treatment?
Triad: bradycardia, nausea, syncope Treatment: antiemetic, atropine 0.5mg IV, urgent release of ST structures
53
What are indications for urgent management of orbital fractures?
* White eye blow out * Entrapment * Retrobulbar hematoma * Blow in fracture * Oculocardiac reflex
54
What are the clinical findings in enophthalmos?
* Superior sulcus defomrit * Supratarsal hollowing * Hypoglobus * Diplopia
55
What is a white eye blowout fracture?
1. Discrete evidence of fracture on imaging studies 2. restriction in ocular motility 3. minimal to no soft tissue trauma, hence the term “white-eye”
56
What are the principles of orbital floor management?
* Reduce entrapped structures * Replace orbital contents * Restore orbital volume * Get ophtho consult
57
When is coercion OK?
Therapeutic privilege - when MD can withhold information if believes that patient may be unable to cope with explanations (i.e.: delirious patient after cholecystectomy wants to revmoe her IVs and go home)
58
What is the percentatge of occult breast cancer discovered incidentally at time of breast reduction?
5% - symmetry after mastectomy 0.4% - macromastia
59
Difference between mechanical and biologic creep?
Mechanical: elongation of skin with a constant load over time beyond intrinsic extensibility Biologic: generation of new tissue due to a chronic stretching force
60
When can you breach confidentiality
Serious danger of bodily harm or death Danger is imminent Risk to specific persons or groups Commucable disease
61
What are risk factors for dry eyes?
Proptosis/exophthalmos Poor bell's reflex Contact lenses intolerance Lower lid hypotonia Negative vector
62
Bones of the nasal septum?

PRS RC 2020 (6 decks)

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