UT San Antonio Flashcards
(124 cards)
1
Q
Absolute contraindications to surgery
A
Diabetic coma
DKA
2
Q
3 indications where nutrition is too poor to go to surgery
A
Albumin 20%
3
Q
Indications of liver failure being too severe for surgery
A
Bili > 2
PT > 16
Ammonia > 150
Encephalopathy
4
Q
How long should you quit smoking prior to surgery
A
8 weeks prior
5
Q
6 things in Goldman’s index for evaluating surgical risk
A
- CHF
- MI w/in 6 months
- Arrythmia
- Old (Age > 70)
- Emergent surgery
- Poor medical condition
6
Q
Meds to stop before surgery
A
Aspiring, NSAIDS, vit E (2 weeks)
Warfarin w/in 5 days (INR needs to be
7
Q
When should a CKD pt dialyze before surgery
A
24 hours pre-op
8
Q
Insulin dose before surgery
A
Take 1/2 morning dose of insulin before
9
Q
Worry of BUN > 100
A
Uremic platelet dysfunction leading to post-op bleeding
normal platelet but prolonged bleeding time
10
Q
What is assist control vent
A
Sets Tidal Volume and rate, but if the patient takes a breath, the vent gives the full volume
11
Q
Important vent setting for weaning pt off
A
Pressure support
Pt rules rate but a boost of pressure is given
12
Q
Most efficient setting to change on a vent? Why?
A
Tidal volume - more efficient that FiO2
13
Q
Hypernatremia fluid
A
D5W or hypotonic fluid
14
Q
QT interval for hyper vs hypocalcemia
A
Shortened in hyper
Prolonged in hypo
15
Q
signs of hypokalemia
A
Paralysis, ileus, ST depression, U waves
16
Q
Maintenance IVFs
A
D5 1/2 NS + 20 KCl (if peeing)
17
Q
Maintenance IVF formula
A
Up to 10 kgs –> 100ml/kg/day
Next 10 kg –> 50 ml/kg/day
All above 20 –> 20 ml/Kg/day
18
Q
TPN risks
A
Acalculous cholecystitis
Hyperglycemia
Liver dysfunction
Zinc def
19
Q
Consider what in circumferential burns
A
Escharotomy
20
Q
Tx for CO2 poisoning
A
100% O2
Hyperbaric if CO0Hb is very high
21
Q
Unexplained clotting in older people
A
Think cancer
22
Q
What disease will heparin not work in
A
Antithrombin III def
23
Q
HIT tx
A
Leparudin or agatroban
24
Q
Silver sulfadiazine features
A
Doesn’t penetrate eschar
Can cause **leukopenia
25
Mafenide features
Burn ointment that penetrates eschar burt hurts like hell
26
Silver nitrate features
Burn ointment that doesn't penetrate eschar and causes HYPO K
27
1st step in electrical burn workup? Look for?
EKG
| Look for myoglobinuria (Check K+ from cell lysis)
28
Zone 3 of the neck? Workup with penetrating trauma?
Above angle of mandible
| Do aortography and triple endoscopy
29
Zone 2 of neck? Workup with penetrating trauma
Angle of mandible to cricoid
| Do 2D dopller +/- exploratory surgery
30
Zone 1 of neck? Workup with penetrating trauma
Below cricoid
| Do Aortography
31
Consider what in retroperitoneal fluid after BAT
Duodenal rupture
32
Extraperitoneal vs Intraperitoneal extrasvasation for bladder rupture
Extra: bed rest + foley
Intra: Ex-lap and surgical repair
33
4 fractures that go to OR
1. Depressed skull fracture
2. Severely depressed or angulated fracture
3. Any open Fx
4. Femoral neck or intertrochanteric fracture
34
Where is the clavicle most commonly broken
B/w middle and distal 3rd
| *May need figure of 8 device*
35
Atelectasis CXR
Bilateral lower lobe fluffy infiltrates
36
Nec Fasc pattern of spread
In SubQ along Scarpa's fascia
37
Malignant hyperthermia genetic defect
Ryanodine receptor gene defect
38
Unexplained fever post op day 7 think? Dx and Tx?
Abdominal abscess
Dx by CT with triple contrast
Tx by percutaneous drainage
39
4 stages of pressure ulcers
1: skin intact but red, blanchable
2: blister or break in dermis
3: SubQ destruction into muscle
4: involvement of joint or bone
40
Low pleural glucose in transudate peracentesis
RA
41
Lights criteria
Exudate if:
LDH > 200
LHD eff/serum > 0.6
Protein eff/serum > 0.5
42
When do you operate for lung abscesses
If abs fail
Abscess > 6cm
Empyema present
43
Popcorn calcification is what in CXR?
| Concentric calcification is what?
Popcorn: Hamartoma
Concentric: old granuloma
44
What do you do if a new benign nodule is found on CXR
CXR or CT scans q2mo to look for growth
45
Where does adenocarcinoma met to
Liver, bone, brain, adrenals
46
Effusion of Adenocarcinoma of the lung
Exudate with high hyaluronidase
47
Lung cancer that makes PTH-rP
Squamous cell Ca
48
Pt with ptosis that gets better after 1 min of upward gaze?
Lambert Eaton from small cell
| *Ab to pre-syn Ca channels*
49
CXR showing peripheral cavitation and CT showing distant mets
Large cell carcinoma
50
3 diagnostic criteria for ARDS
1. PaO2/FiO2
51
Dysphagia worse w/ hot and cold liquids + MI like chest pain likely? Tx?
Diffuse esophogeal spasm
| Tx with CCB or nitrates
52
Tx of choice for Gastric varices
BB is asymptomatic
| Band if stable and symptomatic
53
Type 1 vs 2 hiatal hernia
1: sliding - GE jxn herniates into thorax, worse for GERD
2: Paraesophageal - abd pain leading to obstruction and strangulation - surgery
54
Work up for suspected gastric ulcer
Double contrast barium swallow
EGD will show punched out lesions with red margins
*Operate if lesion persists after 12 weeks of treatment
55
Gastric varices in non alcoholic could be
Splenic vein thrombosis
56
Best test for ZE syndrome
Secretin stimulation test
57
Bilious vomiting and post-prandial pain after losing lots of weight
SMA syndrome - 3rd part of the duodenum compressed by AA and SMA
58
4 steps for in pancreatitis tx
NG suction
NPO
IV rehydration
Observation
59
Bad pancreatitis prognostic factors
```
Old
WBC > 16k
Glc >200
LDH > 350
AST > 250
Drop in HCt, dec Ca, acidosis, hypoxia
```
60
Things that prevent Whipple in Pancreatic Ca
Mets (abdomen, liver, peritoneum), extension into SMA or portal vein
61
Whipple's triad for insulinoma
1. Hypoglycemic symptoms
| 2. Blood glucose
62
Glucagonoma Symptoms
Hyperglycemia, diarrhea, weight loss
63
VIPoma symptoms
Watery diarrhea, hypokalemia, dehydration, flushing
| looks like carcinoid
64
Type 1 and Type 5 choledochal cysts
1. Fusiform dilation of CBD -> tx w/ excision
| 5. Caroli's Dz -> cysts in intrahepatic ducts (needs liver tx)
65
Dz associated with cholangiocarcinoma
PSC (ass w/ UC)
66
TIPS AE
Relieves portal HTN but worsens hepatic encephalopathy
67
HCC tumor marker
AFP
68
2nd most common benign liver tumor
Focal nodular hyperplasia
69
RUQ pain + profuse sweating and rigors + Palpable liver likely? Tx?
Entamoeba histolytica
| Tx: Metronidazole (DONT DRAIN IT)
70
Pt from mexico presents with RUQ pain and large liver cysts likely? Tx?
Enchinoccus
Tx: Albendazole and sx to remove ENTIRE cyts
(rupture can lead to anaphylaxis)
71
Isolated thrombocytopenia? Tx?
ITP
| Tx w/ steroids, splenectomy if relapse
72
Osmotic fragility test for
Hereditary spheroctyosis
| Splenectomy can tx
73
Tx for perforated appendix abscess
Drain, Abx, and appendectomy
74
Most common site for carcinoid tumor
Appendix
75
Odd thing to look for in carcinoid
Pellagra due to niacin def
| Diarrhea, dementia, dermatitis
76
When do you do a hemicolectomy for carcinoid of the appendix
If > 2cm, at base of the appendix, or w/ + nodes
77
When to operate on SBO
Peritoneal signs, inc WBC, or no improvement w/in 48 hrs
78
Post op ileus X-ray? od thing to cause?
Dilated loops of small bowel w/ air-fluid level
| *Consider hypoK or opiates*
79
What is Ogilvie's syndrome
Massive colonic distension in eldery
| If
80
First 2 steps in SBO
IVF, NG tube, bowel rest
81
Direct inguinal hernias go through
Fascia through Hasselbeck's triangle
82
Most common side for indirect inguinal hernias
Right
83
IBD that commonly involves terminal ileum
Chron's (can mimic appendicitis)
84
IBD associated with p-ANCA
UC (also higher risk of Ca)
85
Give what for any fistula in chrons
Metronidazole
86
Are diverticulosis true diverticula?
No, only outpocketings of mucosa
87
When do you do a colonoscopy after acute diverticulitis
4-6 weeks later
88
Workup for colon Ca
DRE, transrectal US (Depth of invasion), Colonoscopy
CEA for recurrence
CT for staging
89
Screening for AAA
Ab US on men 65-75 who have ever smoked
90
Post op-complications of AAA
- MI (#1 cause of death)
- Ischemic colits (bloody poo)
- ASA syndrome (preserved vib sense)
- Aortoenteric fistula (brisk GI bleeding 1-2 years later)
91
Pain out of proportion to abdominal exam
Think chronic mesenteric ischemia
| Dx w/ duplex or angiography
92
Anticoagulation regimen for DVT
Heparin, then overlap with warfarin for 5 days, then warfarin for 3-6 months
93
First step in suspected PE?
Heparin!
94
Papillary thyroid Ca features
MC type, spreads via lymphatics
| *Psammoma bodies*
95
Follicular thyroid Ca featuers
Spreads via blood
| Take out whole thyroid
96
Hashimoto's predisposes to what thyroid cancer
Thyroid lymphoma
97
What would an adrenocortical carcinoma cause? Test to run
Virilization or feminization
| Test Urine 17-ketosteroids
98
Labs in hypoparathyroidism
Dec. Ca and PTH
| Inc. PO4
99
MEN 2a
PTH adenoma
Medullary thyroid cancer
Pheo
100
MEN 2b
Medullary thyroid cancer
Pheo
Marfanoid
101
Best imaging for young breast
MRI
102
Fluid asipirate in fibrocystic changes? Tx
Green or straw colored
| Restrict caffeine, take Vit E, wear supportive bra
103
DCIS surgical tx
Excision with clear margins or simple mastectomy if multiple lesions
104
Breast Ca more likely to be bilateral
LCIS
105
Think of what with eczema of nipple
Pagets Dz
| Do mammogram to find the mass
106
Where do you biopsy SCC
Edge of lesion
107
Worst prognosis melaonoma
Superficial spreading
108
Where do soft tissue sarcomas spread?
Hemotaogenously to LUNGS
| Can do wedge resection
109
1st step in neck mass workup
MC is reactive node, so examine mouth for inflammatory lesion
110
Good prognostic factor in Hodgkin's lymphoma
Lymphocyte predom
111
Neck mass anterior to SCM likely? If lateral?
Anterior: Branchial cleft cysts
Lateral: Cystic hygroma (Turner's, Down's, Klinefelters)
112
MC salivary gland tumor
Pleomorphic adenoma
| *Usually on parotid, benign but recurs*
113
MC malignant ENT cancer
Mucoepidermoid carcinoma
114
Biggest concern for congenital diaphragmatic hernia
Pulmonary hypoplasia
| If dx prenatally, deliver at place with ECMO, then let lungs mature and wait 3-4 days for surgery
115
Baby born with respiratory distress and excess drooling
TE- Fistula
| To dx place feeding tube, take X-ray, and see feeding tube coiled in thorax
116
High maternal what in gastroschisis
AFP
117
Intestinal atresia ass w/?
Polyhydramnios in pregnancy
| Down syndrome
118
1 wk old baby w/ bilious vomiting, draws his legs up, and has and distention
Malrotation and volvulus
119
Dx and tx for meconium ileus
Gastrograffin enema
120
Current jelly stool in baby
Inussusception
121
Prostate Ca meds
Leuprolide or flutamide
122
Part of bone osteosarcoma in? Ewings sarcoma?
Metaphysics of long bones
| Diaphysis in Ewings (onion skinning)
123
What is Epi for in local anesthesia
To prevent systemic absorption
| Don't use in fingers, nose, penis, toes
124
What is Merperidine
Norperidine metabolite that can lower seizure threshold, esp in Renal Failure
