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Question

Local anesthetics MoA? | 2 types and characteristics?

Answer 1

Blockage of sodium channels preventing depolarization. ``` Amino esters (one 'i') - procaine, chloroprocaine, and tetracaine Metabolized in plasma by cholinesterases Breaksdown into PABA which can cause allergic reactions ``` ``` Amino amides (two 'i's) - lidocaine, mepivacaine, prilocaine, bupivacaine, and ropivacaine Marcaine is actually bupivacaine Metabolized in the liver Lidocaine halflife is 30-90 minutes Bupivacaine halflife is 4-6 hours ```

Answer 2

- originates at the cisterna chyli at T10-L3 - courses superior through the aortic hiatus to the right of the aorta - crosses to the left at T4-T5 POSTERIOR to the aortic arch - then empties in to the left jugulo-subclavian vein junction.

Answer 3

Total Thyroidectomy WITH a central neck dissection. If evidence of mets to lateral lymph nodes then add a lateral neck dissection as well.

Answer 4

Normal UES resting pressure is 50-70mmHg Normal LES resting pressure is 10-20mmHg Pressures when swallowing approach 0mmHg

Answer 5

- hypertensive LES - achalasia - scleroderma (treat the scleroderma first) - ineffective esophagus motility - nut-cracker esophagus

Answer 6

Migrating myoelectrlic complex Phase I – quiescence; Phase II – Increased frequency of action potentials and smooth muscle contractility; Phase III – A few minutes of peak electrical and mechanical activity; MMC is at its peak plasma level. Phase IV – Declining activity which merges with the next Phase I.

Answer 7

Escherichia coli, Klebsiella pneumonia, and pneumococci. Usually one organism, if many then consider other diagnosis. 3rd gen cephalosporin - ie cefotaxime

Answer 8

1 - where the graft meets the vessel - needs immediate repair, usually with balloon dilation 2 - from another vessel communicating with the aneurysm, ie lumbar artery - observe or angioembolization 3 - where the graft meets another graft - needs immediate repair, usually needs another stent to cover the defect 4 - graft porosity or suture holes - observe or place non-porous stent 5 - endotension, expansion without sign of leak - repeat EVAR or open repair

Answer 9

Presence of chylomicrons on lipoprotein analysis and a triglyceride level of more than 110 mg/dL.

Answer 10

PT < 15 or INR < 1.2 - FFP, vitamin K, calcium and limited use of crystalloids Fibrinogen > 100 - cryoprecipitate or fibrinogen concentrate Platelets > 100,000 - packed platelets Heating to temperature of 37 C (98.6 F)

Answer 11

``` Shortest = Factor 7 - 5 hours Longest = Factor 8 - 200 hours ```

Answer 12

internal iliac nodes

Answer 13

``` On admission: Glucose > 200 AST > 250 U/L LDH > 350 U/L Age > 55 years WBC > 16 x 109 cells/L ``` ``` After 48 hours: Calcium < 8.0 Hematocrit fall > 10pts O2 <60 mmHg BUN increase from admission > 5 Base deficit > 4 mEq/L Sequestrated fluids > 6L ``` 1 or 2 - 1% mortality 3 to 4 – 15% mortality 5 to 6 – 40% > 6 – 90% - 100%

Answer 14

periampillary tumors. So need EGD q1-2 years with side-viewing scope. Desmoid tumors. Cytologically bland fibrous neoplasm with local infiltration. Treated with tamoxifen, NSAIDS, or Sulindac

Answer 15

``` D1 = Resection of the lymph nodes at the greater and lesser curvature. D2 = D1 + around CHA, celia axis, left gastric and splenic arteries D3 = D2 + LN's in the hepatoduodenal ligament and the root of the mesentery ```

Answer 16

Insulinoma Gastrinoma Insulinoma

Answer 17

anchoring the conjoint tendon to Coopers ligament thereby obliterating the femoral space.

Answer 18

Reversibly inhibits sodium, potassium-ATPase enzymes. Leads to increase intracellular sodium which is then exchanged for calcium, increasing intracellular calcium and resulting in positive inotropy. Side-affect is increased extracellular potassium.

Answer 19

cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure, and is often fatal

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