Review Week Questions Flashcards
(368 cards)
1
Q
amide local anaesthetics
A
lidocaine
bupivacaine
ropivicaine
mepivicaine
2
Q
ester local anaesthetics
A
benzocaine
tetracaine
procaine
cocaine
3
Q
mechanism of action of local anaesthetics
A
Na+ channel blockers to shut down action potential propagation
4
Q
which local anaesthetics have the fastest onset?
A
those with a pKa closest to physiological pH (7.4)
5
Q
which local anaesthetics have the longest duration of action?
A
those with highest protein binding
6
Q
which local anaesthetics are most potent?
A
those with highest lipid solubility
7
Q
which locals have more allergy?
A
esters
8
Q
which locals are more toxic?
A
amides
9
Q
fastest onset locals?
A
esters
10
Q
longest duration
A
amides
11
Q
longest acting locals
A
ester - tetracaine
amide bupivicaine
12
Q
what does 1% concentration mean regarding locals?
A
well, 1g in 100mL is 1%
13
Q
max dose bupivacaine and ropivacaine
A
3 mg/kg
14
Q
max dose lidocaine
A
4.5 mg/kg (7 mg/kg epi)
15
Q
early signs of local anaesthetic toxicity
A
perioral numbness
light-headedness
visual and auditory hallucinations
muscle twitching
16
Q
late signs of local anaesthetic toxicity
A
unconsciousness convulsions coma respiratory arrest cardiovascular collapse
17
Q
specific toxicity of cocaine
A
sympathomimetic
18
Q
specific toxicity of benzocaine
A
methemoglobinemia
19
Q
specific toxicity of bupivacaine
A
cardiac
20
Q
specific toxicity of prilocaine
A
methemoglobinemia
21
Q
specific toxicity of ropivacaine
A
less cardiac toxicity than bupivacaine
22
Q
specific toxicity of lidocaine
A
myocardial depression and vasodilatation
23
Q
down side of regional anaesthetic
A
local toxicity
neuropraxia
24
Q
when do you prefer spinal?
A
uro
perinela
low abdominal
extremity
25
complicatons of spinal
hypotension, bradycardia, epidural hematoma, urinary retention, backache, infection, respiratory distress, post-dural puncture headache, cardiac arrest
26
absolute contraindications of spinal
```
sepsis
bacteremia
cellulitis
hypovolemia
coagulopathy
theraeutic AC
increased ICP
```
27
when would you use epidural?
thoracic
abdominal
extremity
28
how long must you wait before restarting DOAC after pulling epidural?
6 hours (wait 3 days prior to starting one)
29
how long must you wait before restarting warfarin after pulling epidural?
depends on INR (7 days pre)
30
how long must you wait before restarting LMWH after pulling epidural?
12 hours (12 hours pre)
31
how long must you wait before restarting UFN after pulling epidural?
1 hour (4-6 hour pre)
32
how long must you wait before restarting antiplatelet after pulling epidural?
immediately (5-7 days)
33
favoured induction agent for children
inhalation agents
34
agent in anaesthesia that crosses over with egg or soy allergy
propofol
35
effect of propofol on cerebral perfusion pressure
decreases it
36
when should etomidate be avoided?
adrenal insufficiency
37
induction dose of propofol
1 to 2.5 mg/kg
38
induction dose of etomidate
0.15 to 0.3 mg/kg
39
induction dose of ketamine
1 to 2 mg/kg
40
increasing MAC of common anaesthetic agents
```
halothane 0.8
isoflurane
enflurane
sevoflurane
desflurane
NO
```
41
key difference between depolarizing and non-depolarizing anaesthetics
blocking versus release of acetylcholine
42
metabolism of curoniums
hepatorenal, plasma (atracuruium)
43
how can you reverse a curonium?
suggamadex truely
| neostigmine slowly
44
metabolism of succinylcholine
plasma cholinesterase
45
contraindication to succinylcholine
```
K > 5.5
open globe injury
closed head injury
3rd degree burns
paraplegia
pseudocholinesterase deficiency
```
46
when would you do pre-op urine test?
urological procedure
symptomatic
prosthetic implant
47
when would you do pre-op fasting glucose?
endocrine, renal or hepatic disorder
48
pre-op ECG?
known cardiac risk factors or cardio/resp disease
49
pre-op CXR?
smoker
COPD
recent URTI
cardiac disease
50
what are the 6 points in RCRI for pre-op cardiac risk?
```
Hx ischemic
Hx CHF
Hx CVA
use of insulin
Cr > 177
high-risk surgery
```
51
what is a high-risk surgery according to RCRI?
anything with a vessel
52
when should you do post op serial troponins?
in anyone >64 or those with significant disease
53
how do you manage ACE/ARB perioperatively?
hold 24 hours prior, start on POD 2
54
how should you manage ASA perioperatively
hold 3 days prior and wait until risk of bleeding from surgery is gone
55
how should you handle a patient on steroids perioperatively?
minor = 25 mg hydro
moderate = 50 hydro
severe = 100 hydro
critical illness = 100 hydro q6
56
how should you manage hypothyroid during surgery?
if elective = postpone
| if urgent = give levo and operate
57
how is ventilation adjusted intraop for COPD?
need a prolonged expiratory phase
58
triggers for MH
succinylchline and all volatiles
59
Tx MH
O2
cooling
dantrolene
60
Tx lidocaine toxicity
midazolam
| lipid emulsion
61
genetics of MH
AD
ryanodine receptor
1:12,000 kids
1:40,000 adults
62
what does dantrolene do?
binds ryanodine receptor thereby decreasing free intracellular calcium
63
fentanyl odd side effect
serotonergic
64
when would you use odds ratio instead of relative risk?
if prevalence is low
65
what do you need to calculate NNT?
absolute risk reduction
66
what is variance?
the average value of the squared difference between the measurement and the mean
67
how do you avoid type 1 error?
low p value
68
how do you avoid type 2 error?
increase power (sample size)
69
3 components of power
sample size
significance level
effect size
70
how do you compare means
ANOVA
71
what does bonferroni do?
accounts for multiple comparisons
72
what does chi squared do?
tests whether tow categorical variables forming a contingency table are assoicated
73
what does fischer test do?
small sample sizes in categorical variables
74
how do you compare survival curves?
log rank test
75
what is equipoise?
that uncertainty exists over the optimal course of action
76
which studies should use relative risk?
cohort
77
which studies should use odds ratio
case control
78
layers of the skin
```
corneum
lucidum
granulosum
spinosum
basale
```
79
life cycle of a keratinocyte
28 days
80
mediator of burn swelling
histamine
81
4 stages of burn care
eval and resus
wound excision and biological closure
definitive wound cover with reconstruction of hands and face
rehabilitation
82
arterial carboxyhemogobin > 15%
airway burn
83
inhibition of cytochrome oxidase
CN poisoning
84
persistent lactic acidosis with ST elevation after burns
CN poisoning
85
Tx CN poisoning
NaThSO4, hydroxycobalamin and 100% O2
86
3 stages of pulmonary injury after burn
acute pulmonary injury
pulmonary edema (2 days)
bronchopneumonia (25 days)
87
what is the parkland formula?
4 * kg * %TBSA = mL
88
urine output goal in burns
30mL/hr in adults
| 1-1.5mL/hr in children
89
what is the parkland adjustment for inhalation burns?
add 2 * kg * %TBSA
90
what is a 3rd degree burn?
epi and dermis
91
when should you refer to a burn centre?
hands, face, feet, genitals, joints
third degree
>10% BSA (2nd degree)
92
what else do you give initially for burns?
tetanus
| NO Abx!
93
what is the difference between partial and full thickness skin grafting?
partial means part of the dermis
94
Tx 1st degree burns
topical agents (like silver sulfadiazone BID)
95
contraindications to topical silver sulfadiazine
pregnancy
breast feeding
ocular proximity
signs of re-epithelialization
96
what is mafenide?
used in burns - carbonic anhydrase inhibitor
excellent penetration of eschars
can cause metabolic acidosis
97
which amino acid supplement decreases infectious complications from burns
glutamine
98
how do you supplement burns >40%
H-B equation
| age, gender, weight, height
99
how do you supplement burns <40%
curreri formula 25kcal/kg/d + 40 kcal/%TBSA/d
100
complication of using NaCl in burn resus
hyperchloremic acidosis
101
how is most CO2 transported in the blood?
as bicarb
102
level of carboxyhemoglobin in a smoker
10-15%
103
when should you use hyperbaric O2 for CO poisoning?
```
>25%
>20% and pregnant
LOC
metabolic acidosis <7.1
end organ ischemia
```
104
epinephrine
B1, B2
105
norepinephrine
B1, A1
106
dopamine
B1, B2
107
dobutamine
B1 > B2 > A1
108
isoproterenol
B1, B2
109
normal CVP
0-6
110
normal PCWP
6-12
111
normal SVR
800-1400 dynes
112
so how do you measure CVP?
at the end of expiration by transducer at the level of the RA
113
where do you measure PCWP?
3rd zone of lung
114
reverse trendelenberg does what to CO?
decreases it
115
which post op patients need ICU monitoring?
```
need for suprarenal aortic clamping
MI < 3 months ago
Poorly compensated CHF
CABG < 6 weeks ago
symptomatic mitral or aortic disease
Unstable angina
```
116
contraindication to placement of swan-ganz
LBBB
117
which 2 catheters don't require full barrier precautions
urinary
| arterial
118
why is the subclavian vein avoided?
hard to compress
119
lowest risk of infection
subclavian
120
highest risk of infection
femoral
121
highest risk of thrombosis
femoral
122
highest risk of pneumothorax
subclavian
123
highest risk of arterial puncture
IJ, femoral
124
3 reasons for mechanical ventilation
obtunded
inadequate oxygenation
inadequate ventilation
125
criteria for weaning ventilation
```
cause resolving
adequate oxygenation (PaO2 >60 FiO2 < .4 PEEP < 5
hemodynamically stable
afebrile
awake and alert
Hb 80-100
```
126
predictors of successful weaning of ventilation
```
RR < 20
VC > 10mL/kg
TV 5-7 mL/kg
minute vent >6-8 L/min
negative inspired pressure > 20-25 cm H2O
PEEP < 5cm H2O
PaO2 > 60
SpO2 > 90 on 40%
normal abg
normal hemodynamics
```
127
what type of shunt is ARDs?
R --> L
128
Berlin definition for ARDS
acute onset
associated conditions
bilateral infiltrate on PA CXR or CT
PaO2/FiO2 < 200-300 with minimum 5cm PEEP or CPAP
must not be explained by cardiac failure or fluid overload
129
3 stages of ARDs
exudate
fibroproliferative
resolution and recovery
130
Tx ARDs
treat cause
lung protecting pressure and ventilation
non-excessive PEEP
conservative fluid management
131
4 elements of consent as per healthcare consent act 1996
related to treatment
informed
voluntary
not by misrepresentation or fraud
132
what is 'informed' consent?
```
nature of the treatment
benefits
risks
side effects
alternatives
consequence of no treatment
```
133
what is 'capacity'?
understand relevant information
| appreciate the consequences of the decision
134
what is a mature minor?
any child able to fully appreciate the nature and consequences of the treatment
135
qualifications of a SDM
```
capable
16 or older (or the parent)
no separation agreement in place
is available
is willing
```
136
hierarchy of SDM
```
guardian
poa
representative appointed\spouse
child/parent
parent with right of access
sibling
any other relative
```
137
when does an advanced directive expire?
it doesn't
138
so when can you trump an SDM?
when you feel they aren't acting in the best interests of the patient "providing the necessities of life"
139
eligibility for MAID
```
eligible for health coverage
18
mentally competent
grievous and irremediable condition
not influenced
informed consent
```
140
non-exploitive age of consent
16
141
exploitive age of consent
18
142
age gap allowable for 14/15
+5 years
143
age gap allowable for 12/13
+2 years
144
which should be disclosed?
no-harm and harm incidents (not near misses)
145
4 criteria for negligence
duty of care was owed
breech in the standard of care
causation
consequent harm
146
what do seropositive doctors need to do?
get their viral load under 2000 before they operate
147
plasma % of total body weight
5
148
interstitial fluid % of total body weight
15
149
intracellular volume % of total body weight
40
150
volume of plasma in male
3.5 L
151
volume of extracellular fluid in male
14 L
152
volume of interstitial fluid in male
10.5 L
153
volume of intracellular fluid
28 L
154
what is inside cells
K
| Mg
155
what is outside cells
Na
| Ca
156
what is the difference between oncotic and osmotic pressure?
proteins versus Na
157
calculate plasma osmolality
2*Na + glucose + BUN
| normal 290-310
158
normal fluid intake daily
2 L (75% from liquid)
159
how much insensible losses occur daily
600 mL (75% from skin, 25% from lungs)
160
losses from an open abdomen
0.5 - 1 L /hr
161
urine daily
800-1200 mL
162
secretion from:
stomach
biliary
pancreas
1-2 L
.5 - 1 L
.5 - 1 L
163
K and Na requirement daily
.5-1 and 1-2 respectively
164
what controls volume?
1. osmoreceptors in the hypothalamus
| 2. baroreceptors in the carotid and aortic arch
165
2 most common causes of hyponatremia in a surgical paitent
fluid overload
| SIADH
166
what is pseudohyponatremia
increase in glucose of 10 decreases Na by 3
167
causes of hypernatremia
dehydration
| DI
168
max correction of Na in
hyper
hypo
8/day
| 0.5-1/day
169
how do you tell the difference between central and nephrogenic DI
central improves with DDAVP
170
2 causes of intracellular shift of K
meds - insulin, dig, B12, ventolin
| hyperthyroidism
171
common cause of hyperkalemia
renal failure
172
Tx hyperkalemia
```
CaGluc
bicarb
insulin
dextrose
kayexalate
dialysis
```
173
how does acidosis affect Ca
decreases the amount bound to protein
174
how does calcitonin affect Ca
decreases ionized Ca
175
causes of hypoCa
```
hypoPTHism
congenital
hypo Mg
tumor lysis
Vit D intake
pancreatitis
EDTA, citrate, etc
cisplatin, 5FU
```
176
Tx hypoCa
IV CaGluc with Mg
177
signs of hyperCa
stones etc
178
causes of hyperCa
```
primary hyperparathyroidism
malignancy
theophylline
li
thiazide
vit A
milk alkali syndrome
AKI
metabolic alkalosis
```
179
Tx hyperCa
```
fluids
diuretic
bisphosphonates
calcitonin
dialysis
```
180
causes of hyper Mg
renal failure
theophylline
antacids
epsom salts
181
Tx hyper Mg
CaGluc
NS
diuretics
dialysis
182
diaphragm weakness
hypophosphatemia
183
causes of hypophos
resp alkalosis
insulin
refeeding
hungry bone syndrome
184
paradoxical aciduria
metabolic alkalosis from contraction
185
normal anion gap
10-15
186
4 causes of renal failure
ATN
AIN
glomerular nephritis
intrinsic renal issue
187
how does FeNa help?
it tells you if the kidneys are working <1% means proper resorption is occurring
188
what are the 3 exceptions to FeNa as a valuable test?
ATN superimporsed on cirrhosis
after radiocontrast
diuretic use
189
what does acetazolamide do?
carbonic anhydrase inhibitor in the PCT - makes you acidotic
190
what does spironolactone do?
inhibits aldosterone receptor in CT
191
% of a crystaloid that will remain intravascular
~30%
192
why do we avoid ringers in diabetics?
lactate can be used for gluconeogenesis
193
2 types of albumin
5% or 25% (1 g brings in 18 mL water)
194
so when would you use the 2 different albumins?
use 5% for volume expansion
use 25% for oncotic deficit
*do not use in hemorrhagic shock
195
why do we give fluids overnight pre-op?
volume expansion because of vasodilatation during surgery
196
normal maintenance fluids
4-2-1
197
how do you replace deficit?
half in first hour, quarter in the next two hours each
198
quantify third spacing
0-2 mL/kg/hr for min surgeyr
2-4 for moderate
4-6 for severe
199
why are salt and water retained after surgery?
ADH is released in response to stress
200
when is a good time to use colloids?
when the losses are to third-spacing (cirrhosis, etc)
201
5 steps of platelet activation
```
shape change / vesiculation
degranulation
membrane phospholipid metabolism
membrane flipping
activation of fibrinogen receptors
```
202
time for NSAIDs to stop affecting platelets after stopping
3 days
203
P2Y inhibitors
clopidogrel, prasugrel, ticagrelor
204
GP2b3a inhibitors
abciximab
| tiorfiban
205
phosphodiesterase inhibitors
dipyridamole
206
intrinsic pathway
12 11 9 10 aptt
207
extrinsic pathway
7 10 pt
208
what does thrombin time tell you?
fibrinogen deficiency or presence of an inhibitor
209
which factor doesn't the live produce?
VIII (endothelial cells)
210
what is the problem in F5L?
protein C cant turn of factor 5 = more clotting
211
what whould you think if a patient failed to respond to heparin?
AT3 deficiency
212
clotting and on heparin
antiphospholipid syndrome
213
Tx HITTS
stop heparin and start a direct thrombin inhibitor (argatroban)
214
when is tranexamic acid contraindicated?
DIC
215
when do you transfuse platelets in DIC?
<10-20 or 50 with severe bleed
216
antidotes for xabans
andexanet alfa
217
antidotes for babigatran
idarucizumab
218
what is the tissue factor pathway?
TF inhibits VIIa
219
what is the protein C/S pathway
thrombin binds thrombomodulin which makes thrombin unavailable, this activates protein C which binds protein S which inhibits Va and VIIIa
220
what is the antithrombin pathway?
ATIII inhibits thrombin and Xa
221
would you transfuse an asymptomatic patient with platelets 10?
no
222
when do you give platelets to an ITP patient?
you don't
223
Tx TTP
FFP
224
what is in cryoprecipitate
```
fibronectin
fibrinogen
13
8
von willibrand
```
225
when do you give cryoprecipitae
fibrinogen < 1 g/L (adult dose is 10 units or 4 g)
226
are pRBCs acidic or basic
actually have a basic result due to bicarb production (even though it is 7.10)
227
what besides blood is in the massive transfusion protocol
```
replace 1:1:1
TXA q8
fibrinogen above 2
INR < 8
platelets >50 (or 100 with head injury)
```
228
what is prothrombin complex?
2, 7, 9, 10
229
high risk sickle cell surgery
exchange transfusion for HbS < 30%
230
moderate risk sickle cell surgery
transfuse up to 100
231
how does txa work
inhibits plasminogen
232
what is the cell cycle
```
G1
S
G2
M
G0
```
233
where does retinoblastoma protein act?
negative regulator at restriction point G1-S
234
sequence of events in apoptosis
cytochrome C release
caspase activation
DNA frag
apoptosis
235
supraclavicular nodes
```
breast
neck
lung
stomach
pancreas
```
236
suspicious axillary node
lymphoma
breast
melanoma
237
periumbilical node
pancreas
238
where did an ovarian met come from?
stomach
| colon
239
where did a bone met come from?
breast
prostate
MM
240
where did skin mets come from
breast
| melanoma
241
where did small bowel mets come from
melanoma
242
CEA
colon
243
AFL
liver
244
CA 19-9
pancreas
245
CA 125
ovarian
246
beta HCG
testicular
| choriocarcinoma
247
PSA
prostate
248
Chromogranin A
carcinoid tumor
249
arsenic
skin cancer
250
benzene
leukemia
251
ethylene oxide
lymphoma
252
tamoxifen
endometrial
253
epstein barr
burkitt's lymphoma
| hodgkins
254
hep B/C
HCC
255
HIV and HHV8
kaposi's
256
2 hereditary cancers non AD
ataxia-telangectasia
| xeroderma pigmentosa
257
RB1 mutation
well this is a tumour suppressor so you get
sarcomas
melanomas
CNS tumors
258
Li-fraumeni
```
bone
soft tissue sarcomas
brain
leukemias
*must get a sarcoma before 45 + first-degree relative with any cancer before 45
```
259
mutation in 5q21
APC
260
other associations with FAP
desmoid tumors
papillary thyroid cancer
duodenal adenocarcinoma
261
Lynch syndrome
mutation in dna mismatch repair with microsatellite instability
faster progression
262
other associateions with lynch syndrome
ovarian
| endometrail
263
BRCA mutations
5-10% of all breast cancer
264
where is MEN1 located
11q13
265
mutation in MEN2
RET oncogene
266
10q11 mutation
VHL:
hemangioblastomas
RCC
pheos
267
principles of surgical biopsy
```
will it change anything
obtain enough for pathology
avoid contaminating new planes
avoid hematoma
place needle tracks for later excision
```
268
border for a 5 mm thich melanoma
2 cm
269
alkylating agents
crosslink dna
mytomycin
nitrogens
270
taxanes
inihibits mitosisvia microtubule dysfunction
271
topoisomerase II inhibitors
interfere with dna structure
| etoposide
272
platinums
crosslink dna
273
anthracyclines
inhibit dna and rna syntesis via interecalation of base pairs
inhibit topo
generate free radicals
doxirubicin
274
methotrexate
inhibits dihydrofolate reductase
275
tubulin inferers
vinchristine
276
what is the typical radiation dose schedule
2 Gy/d for 5 days a week for 3-7 weeks
277
tx neurogenic shock
phenylephrine (after you've Dx with failure of response to fluid)
278
SIRS criteria (need 2)
```
temp >38 or < 36
>90HR
paco <32
RR >20
WCC >12 or <4
```
279
cytokine that is antiinflammatory
```
IL10
IL4
IL13
TGFb
PGE2
```
280
+ acute phase proteins
```
ceruloplasmin
fibrinogen
complement F3
CRP
haptoglobin
```
281
what happens to transferring in inflammation?
decreases
282
systemic vascular resistance in sepsis
< 800
283
mortality from sepsis
20-50%
284
top 2 G+ organisms in sepsis
aureus
enterococcus
cag neg staph
285
top 3 G- in sepsis
e coli
klebsiella
pseudomonas
286
fluid in sepsis
30mL/kg if hypotensive or lactate>4
287
besides abx and fluid, what else decreases mortality in sepsis
maintaining glucose between 80-110
| maybe low dose steroids (controversial)
288
most likely bug in transfusion-associated sepsis
pseudomonas
289
4 early goals of sepsis management
MAP > 65
urine output > 0.5
CVP 8-12
mixed venous O2 sat >70%
290
fat/day required
1g/kg
291
protein/day required
0.8g/kg
292
what is the target kcal/day
35 kcal/kg/day
293
calories from fat in starvation
40%
294
essential AAs
VILL TT PM
295
how much protein for 1 gram of nitrogen
6g
296
how much urinary nitrogen is lost daily?
1.5% (30% = death)
297
how do we know if we're eating enough protein?
caloric:nitrogen ratio
298
when is the only time you'd want to increase the caloric:N ratio?
renal failure
299
carb requirement
2-6g/kg/day
300
carb energy conversion
1g = 4kcal
301
microcytic anemia
copper
302
delayed wound healing
vit c
303
impaired glucose metabolism and peripheral neuropathy
cr
304
hair loss, dermatitis, decreased taste
Zn
305
cardiomyopathy wakness anergy
selenium
306
dry flaky skin
alopecia
thrombocytopenia
fatty acid
307
vit A
poor wound healing
308
megaloblasctic anemia
B12 and folate
309
ecg changes
biotin
310
coagulopathy
vit k
311
slowed collagen crosslinking
B6
312
when should you start nutritional support?
```
anorexic
500mL blood loss
hx severe malnutrition
failure to thrive
catabolic disease
unable to meet their own demands at 7 days
```
313
time frame for peripheral PN
2 weeks
314
how much dextrose is required to spare protein catabolism in PN?
100g
315
what should you do with protein for HD pts?
increase it to 1.4
316
additional nutritional requirements in burns
50%
317
threshold for starting abx in asymptomatic uti
100,000
318
3 criteria for qSOFA
BP < 100
RR > 22
confusion
319
MAP target in sepsis
65
320
dose limit for pregnants
4 mSv/pregnancy
321
for nuclear energy worker
50 mSv/year
322
public
1 mSv/year
323
background radiation
2mSv/year
324
what is the worrying dose of radiation in pregnancy
0.05 Gy
325
2 cemicals of concern in electrocautery
HCN
| acrylonitrile
326
nosocomial infection incidence
UTI > SSI > resp > central line
327
nosocomial infection incidence in ICU pts
VAP > central line > UTI > SSI
328
most infectious BBP
HBV
329
PEP regimen
NRTI and integrase inhibitor
330
follow up after exposure to HIV
6 weeks and 4 months
331
when to start PEP
1-2 hours after exposure
332
basiliximab
IL2 receptor blocker
333
cyclosporine
calceneurin inhibitor
334
tacrolimus
calceneurin inhibitor
335
siroloimus
mTOR inhibitor
336
mycophenylate
inhibitor of IMPDH (purine synthesis
337
azathioprine
6MP inhibitor
338
nivolumab
blocker of programmed death ligand 1
339
what is PRA
panel reactive antibody
340
what are the expanded criteria donor
age > 59
age 50-59 with any 2 of: hx hypertension, death from cva, terminal creatinine 133
associated with 70% increased risk of rejection
341
how long should you wait after cancer treatment before you get a new kidney?
usually 2 years, 0 if localized and bladder or kidney, 2-5 if melanoma, breast, colon
342
parts of the MELD score
creatinine
INR
bilirubin
343
how much liver do you need to leave behind?
30%
344
how long do you have to wait before removing organs after cardiac death
5 mins
345
at what age is live liver donation contraindicated
>55
346
major cause of mortality after liver transplant
infection
347
rejection drug with reduced risk of new cancer
sirolimus
348
rejection drug that causes diarrhea
mycophenilate
349
indications for traumatic thoracotomy after chest tube insertion
>1.5L immediately or
| 200mL/hr for 2-4 hours
350
bladder pressure for anuria
20mmHg
351
target CPP in brain injury
60-80
352
pathological ICP
20 or up
353
when do you get autonomic dysreflexia
T6 or above
354
tx rhabdo
fluids
mannitol
bicarb
355
obtunded definition of compartment sydndrome
d < 30
| absolute >30
356
what do platelets release in wound healing
PDGF
| TGF-a
357
what type of collagen is laid down in early wound healing
3
358
type 4 collagen
basement membrane
359
type 5 collagen
cornea
360
abnormal type III, deletion of part of type I, abnormal copper utilization, or deficiency of lysyl hydroxylase
ehlers-danlos
361
absence of type VII that is the main component of fibrils that anchor epidermis to dermis
epidermolysis bullosa
362
osteogenesis imperfecta
deletion on procollagen E1 allele
363
when do you consider antibiotics in wound care?
| why?
when > 10^5 bacteria per gram of tissue.
| because more than this and the wound won't heal
364
definition of chronic wound
3 months
365
3 reasons a wound becomes chronic
WBCs release MMPs faster than matrix laid down
protein leak from capillaries binds growth factors
fibroblasts stop responding to normal wound signals
366
when does a pressure ulcer develop?
when pressure is > 32 mmHg (capillaries)
367
4 stages of pressure ulcer
hyperemia >30 mins
through epidermis
through dermis
into muscle or bone
368
tx venous ulcer
hydrocolloid dressing, compression.elevation
