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Flashcards in Surgery PEARLS Deck (63):
1

Stress induced hyperglycemia is primarily due to

Peripheral resistance to insulin

2

Basal caloric requirement in mild stress

25-30 kcal/kg/day

3

Basal caloric requirement in moderate stress

30 kcal/kg/day

4

Basal caloric requirement in severe stress

30-35 kcal/kg/day

5

Cancer + severe malnutrition

30 kcal/kg/day

6

Phase of surgical metabolism/injury with reduced REE

EBB phase

7

Primary source of energy during stress

Fat

8

Systemic proteolysis following injury is mediated primarily by

Glucocorticoids

9

% protein catabolised per day

1.5%

10

Dry, scaly dermatitis following prolonged parenteral treatment

Essential fatty acid (EFA) deficiency

11

MC fluid disorder in surgical patients

Extracellular, mainly GI

12

Source of HCO3 in plain LR

Lactate

13

Dextrose in D5-containing IVFs

50 g/L

14

What to request in patients with persistent hypocalcemia/hypokalemia

Serum magnesium

15

Most important treatment of metabolic acidosis

Volume resuscitation, NOT bicarbonate

16

Early acid-base picture of sepsis

Respiratory alkalosis

17

Criteria for SIRS

1) Temp 36C or less OR 38 or more 2) HR 90 or more 3) RR 20 or more 4) WBC 4000 or less OR 12000 or more or 10% or more bands

18

MC organism isolated in G- septicemia

E.coli

19

Adverse changes in G- septicemia is due to

Lipid A release

20

Earliest stage of hemostasis

Vascular constriction (> platelet plug > fibrin > fibrinolysis)

21

Average life span of platelets

7-10 days

22

Inherited disorder of platelet disorder due to lack of gpIIb/IIIa

Glanzmann thrombasthenia

23

Inherited disorder of platelet disorder due to lack of gpIb/IX/V

Bernard-Soulier syndrome

24

MC abnormality of homeostasis in surgical patients

Thrombocytopenia

25

Platelet level when there is spontaneous hemorrhage

26

Treatment of choice in patients with von Willebrand disease

Intermediate purity factor 8/DDAVP

27

Best method of identifying a potential bleeder

Complete history and PE

28

MC indication for blood transfusion in surgical patients

Volume replacement

29

Treatment for bleeding due to fibrinolysis

Aminocaproic acid aka tranexamic acid

30

Most important management for DIC

Treat underlying cause

31

Mechanism of DIC

Excessive plasminogen activator

32

Differentiates DIC from primary fibrinolysis

Protamine test (+) in DIC

33

Diffuse oozing of blood from SSI is most likely due to

Platelet deficiency

34

Most important management of immediate transfusion reaction

Stop the transfusion

35

Delayed transfusion reaction usually occurs within how many days post-transfusion

2-10 days

36

Differentiate delayed from immediate transfusion reaction

Delayed is d/t EXTRAVASCULAR hemolysis and no specific intervention is needed

37

Shock in a setting of adequate intravascular volume

Cardiogenic shock

38

Preferred test in the diagnosis of cardiac tamponade

Echocardiography

39

Immediate step after 2D echo-confirmed cardiac tamponade

Pericardiocentesis

40

Sign seen in echocardiography of patient with cardiac tamponade

Halo sign

41

Persistently elevated base deficit in a trauma patient is usually due to

Ongoing bleeding

42

Caloric content of 1L D5LR

180

43

MCC of death of all individuals aged 1-44

Trauma

44

Widened mediastinum

Aortic dissection

45

Gold standard for determining blunt descending torn aortic injury

CT scan

46

MC indication for intubation

Altered mental status

47

Preferred technique used in establishing a definitive airway

Orotracheal intubation

48

Main difference between tension pneumothorax and simple pneumothorax

Hypotension

49

Multiple sta wounds on right chest, awake, normotensive, tachypneic, tachycardic, absent breath sounds on right. Next best step.

CXR

50

3 contiguous ribs fractured on both right and left hemithorax

Flail chest

51

Lethargic, arousable, palpable femoral pulse. SBP is at least

70 mmHg

52

Cutoff blood volume in a massive hemothorax

1500mL

53

Blood volume that may cause cardiac tamponade

Less than 100 mL

54

Most reliable indicator of organ perfusion

UO

55

Adequate UO in adult

0.5cc/kg/hr

56

Adequate UO in child

1cc/kg/hr

57

Adequate UO in infant

2cc/kg/hr

58

Hypotensive, tachycardic, tachhypneic, anxious, confused. Class of shock

3

59

Estimated blood loss in a class 3 shock

At least 30%

60

Fracture of 3 ribs can result to approximately how much blood loss

300-600

61

Most important radiograph to obtain in the setting of a blunt trauma or motor vehicular accident

1) Cervical 2) Chest 3) Pelvic (SFA NOT included)

62

MC organ injured in blunt trauma

Spleen

63

Next best step in management of symptomatic neck injuries

CT angio of neck and chest