Surgery Halo-halo 5 (TPN, H/N)’ Flashcards
(28 cards)
beyond ______, TOTAL parenteral nutrition should be instituted
2 weeks
remarks on PPN
not appropriate for repleting patients with SEVERE malnutrition
_______ is not part of any commercially prepared vitamin solution
vitamin K, so it should be supplemented on a weekly basis
parenteral nutrition:
fatty acid deficiency may manifest as
dry, scaly dermatitis
loss of hair
prevented by periodic infusion of a fat emulsion at a rate equivalent to 10-15% of total calories
parenteral nutrition: most frequent presentation of trace mineral deficiencies
eczematoid rash devloping both diffusely and at intertriginous areas in ZINC-deficient patients
other trace mineral deficiencies
microcytic anemia with COPPER def
glucose intolerance with CHROMIUM def
parenteral nutrition: target glucose range
140 or 150 to 180 mg/dL for the general ICU population
complicatinos of parenteral nutrition
TECHNICAL
Sepsis
Pneumothorax, etc
METABOLIC Hyperglycemia CO2 retiention and respi insuf Hepatic steatosis Cholestasis, gallstones
INTESTINAL ATROPHY
-due to lack of intestinal stimulation
rate of catheter infection is highest for those placed in
FEMORAL VEIN
lower for those in JUGULAR VEIN
lowest for those in SUBCLAVIAN VEIN
FJS
if indwelling time is 3-7 days, infection risk is
3-5%
<3 days: negligible
3-7 days: 3-5%
>7 days: 5-10%
thyroid nodule: features suspicious for malignancy
“1MVITH”
>1 cm Microcalcifications Vascularity, intranodal Irregular margins Taller than wide Hypoechogenic
neck ultrasound: features of lymph node suspicious for malignancy
Loss of fatty hylum Periphereal vascularity Round shape Cystic change Calcification Hypoechogenic
invasive fibrous thyroiditis
Reidel’s thyroiditis
STN, FNAB: AUS/FLUS
what to do
Atypia of Unknown Significance
FLUS: Follicular Lesion of Unknown significance
repeat FNAB
(5-15% risk of malignancy)
STN: FNAB: Suspicious for FN. what to do
lobectomy
15-35% risk of malignancy
possible FNAB results and risk for malignancy
- Nondiagnostic (1-4%)
- Benign
3 AUS/FLUS (5-15%) - FN or suspicious for FN (15-35%)
- Suspicious for malignancy (60-75%)
- Malignant (97-99%)
*optimum cytology specimen: at least 6 follicles each containing at least 10-15 cells from at least 2 aspirates
thyroid gland palpation
CRICOID CARTILAGE: isthumus is situated just below it
cold vs hot lesions
risk for malignancy
cold: 20%
hot: <5%
remarks on toxic thyroid adenoma
most hyperfunctioning or autonomous thyroid nodules have attained a size of at least 3 cm before thyroidism occurs
RAI: “hot” nodule with suppression of the rest of the thyroid gland
management of toxic thyroid adenoma
SMALL NODULES
-antithyroid medicatiotns and RAI
LARGER NODULES
-LOBECTOMY and ISTHMUSECTOMY is preffered to treat young patients and those with larger nodules
thyroglossal duct cyst
___% occurs at _______
80% occurs at or just below the hyoid bone
5% contain functional thyroid tissue
tx: sistrunk procedure
HNSCC: N staging
2 ipsilateral nodes 4cm, 5cm
N2b
N0: no regional LN mets
N1: mets in single ipsilateral node ≤3 cm
N2a: Mets in SINGLE ipsilateral LN bet 3-6 cm
N2b: mets in MULTIPLE ipsilateral LN, ≤6 cm
N2c: mets in BILATERAL or CONTRALATERAL, ≤<6cm
N3: mets in ln >6cm
HNSCC: N staging
1 ipsilateral node 2.5 cm
N1
N0: no regional LN mets
N1: mets in single ipsilateral node ≤3 cm
N2a: Mets in SINGLE ipsilateral LN bet 3-6 cm
N2b: mets in MULTIPLE ipsilateral LN, ≤6 cm
N2c: mets in BILATERAL or CONTRALATERAL, ≤<6cm
N3: mets in ln >6cm
MNRD types
type 1: SAN lang matitira
type 2: SAN, IJV
type 3: all 3 preserved (SAN, IJV, SCM)
Delphian nodes
pretracheal nodes
-hyroid and advanced glottic tumors with subglottic extension
