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109 Cards in this Set
- Front
- Back
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Primary fuel for small bowel and colon enterocytes? |
Small bowel- glutamine during times of stress Colon- short chain fatty acids |
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What percent excess body weight should be lost by 2 years post sleeve gastrectomy? |
60% of excess body weight, so if pre surgery weight is 150 kg and ideal body weight is 75 kg, excess weight is 75 kg and 60% of that is 45 kg, or the expected weight loss post sleeve. |
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What percent of population has pancreas divisum? |
10-20%. Of patients with pancreas divisum, only 5-10% experience pancreatitis. |
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Most important predicted post op PFT value for lung resection? |
FEV1 should be greater than 0.8. If less than this, get V/Q scan to assess relative contributions of lung |
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Ulcer associated with sliding hiatal hernias |
Cameron's ulcer- on lesser curvature, occurs in 5% of hiatal hernias |
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Treatment hydatid cyst? |
Surgical resection or PAIR (puncture, aspiration, injection, respiration) with albendazole or mebendazole |
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Treatment of pseudo aneurysm? |
Hold pressure 10-20 min, if doesn't work do US guided thrombin injection into aneurysm sac, if doesn't work then surgical repair |
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Contraindication to DPL? |
Pregnancy. DPL better than CT at detecting hollow viscous injuries. |
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When should trunk and extremity sarcomas get adj radiation? |
If large (>5 cm) or high grade or close resection margins. Neoadj chemo only for >5 cm high grade pleiomorphic liposarcoma and synovial sarcoma. |
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Symptoms of nausea, bilious vomiting and epigastric pain not relieved by antacids after gastric surgery? |
Likely due to alkaline reflux gastritis, often after gastrectomy as in a Bilroth II. Diagnose with HIDA scan which shows bike refluxing into stomach or esophagus. Treat by converting Billroth II into a roux-en-y with long (40 cm) afferent limb. |
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Maximum brain swelling after traumatic injury? |
48-72 hours. Intermittent bradycardia is sign of severely elevated ICP and pending herniation. |
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Delayed immune hemolytic reaction? |
3-10 days post pRBCs with declining Hgb, due to preformed antibodies against minor antigens from prior blood transfusions, prevent by retuning and screening when patient getting multiple transfusions during a hospital stay |
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Best marker of acute nutritional status? |
Pre albumin- half life is 24-48 hours and best nutritional marker for ICU patients who may be having an inflammatory response. Albumin is more like 21 days and better to assess nutritional status for elective operations. Transferrin is 8 days |
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Most common small bowel tumor? |
Carcinoid. Most tumors are in duodenum, except crohns patients in terminal ileum. Most diagnosed late. HNPCC, FAP and celiac all risk factors. |
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Work up thyroid nodule? |
Check T3/T4. If elevated give thyroxine and look for regression of nodule. If not elevated do FNA. |
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Ideal hep bolus for acute limb ischemia? |
80 U per kg |
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In fractionated heparin versus LMWH? |
LMWH cannot be followed by PTT. Less risk of bleeding complications and HIT. Excreted by kidney so contraindicated with renal disease. |
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Treatment for coagulopathic uremia? |
DDAVP |
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30 day mortality for EVAR versus open AAA repair? |
EVAR 1-2% Open 5% |
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Consequences of massive transfusion? |
HyperK HypoCa Alkalosis Narrowed pulse pressure Thrombocytopenia |
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Timeline for preop abx? |
Full dose within 1 hour of incision |
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Physical exam indication for immediate revasc of an ischemic limb? |
Muscle weakness most important exam finding |
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Physical exam indication for immediate revasc of an ischemic limb? |
Muscle weakness most important exam finding |
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CMV versus HSV treatment? |
CMV- gancyclovir HSV- acyclovir |
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Types of RTA and treatment? |
Type I- distal, needs HCO3 replacement (50-100 mEq/day), hypoK thus also need K Type II- proximal, does not respond to bicarb, treat with thiazides Type IV- aldosterone def or resistance, high K and low urine pH, treat by discontinuing offending drug (NSAIDS, heparin, K sparing diuretic) |
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Risk of SSI by wound type? |
Clean- 1-5% Clean-contaminated- 3-11% Contaminated- 10-17% Dirty- >27% |
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Immunoglobulin in breast milk? |
IgA |
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Types of RTA and treatment? |
Type I- distal, needs HCO3 replacement (50-100 mEq/day), hypoK thus also need K Type II- proximal, does not respond to bicarb, treat with thiazides Type IV- aldosterone def or resistance, high K and low urine pH, treat by discontinuing offending drug (NSAIDS, heparin, K sparing diuretic) |
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Risk of SSI by wound type? |
Clean- 1-5% Clean-contaminated- 3-11% Contaminated- 10-17% Dirty- >27% |
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Immunoglobulin in breast milk? |
IgA |
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Types of RTA and treatment? |
Type I- distal, needs HCO3 replacement (50-100 mEq/day), hypoK thus also need K Type II- proximal, does not respond to bicarb, treat with thiazides Type IV- aldosterone def or resistance, high K and low urine pH, treat by discontinuing offending drug (NSAIDS, heparin, K sparing diuretic) |
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Risk of SSI by wound type? |
Clean- 1-5% Clean-contaminated- 3-11% Contaminated- 10-17% Dirty- >27% |
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Immunoglobulin in breast milk? |
IgA |
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Abx for human bite? If need IV? If pcn allergic? |
Augmentin. Cefoxitin/cefotetan/zosyn. Doxy. |
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Major energy source during stress and starvation? |
Fat is major energy source. Starvation has decreased metabolic rate, stress has increased metabolic rate. Stress has more protein breakdown in addition to fat. |
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Appropriate ppx abx for colon surgery? |
Cefoxitin alone Cefotetan alone Ancef/flagyl |
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Antibiotic with best pancreatic penetration? |
Imipenem (for necrotizing pancreatitis) |
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Ideal body weight calculation |
Male- 50+2.3*each inch over 5ft Female- 45+2.3*each inch over 5ft |
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Daily calorie requirements? |
Surgical pt- 25 kcal/kg/day Trauma- 25-30 kcal/kg/day Trauma with sepsis- 30-35 kcal/kg/day Burn- 35-40 kcal/kg/day |
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Ideal body weight calculation |
Male- 50+2.3*each inch over 5ft Female- 45+2.3*each inch over 5ft |
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Adrenal incidentalomas... |
Excise if >4 cm. if nonfunctioning hormonally and <4 cm, follow up with CT at 6, 12 and 24 months and annual hormonal testing for 4 years. |
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Staging follicular thyroid cancer... |
If 45, stage 1 4 cm or with LN, stage 4 with mets |
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Daily calorie requirements? |
Surgical pt- 25 kcal/kg/day Trauma- 25-30 kcal/kg/day Trauma with sepsis- 30-35 kcal/kg/day Burn- 35-40 kcal/kg/day |
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Daily protein requirements? |
Surgical pt- 1 g/kg/day Trauma- 1.5 g/kg/day Trauma with sepsis- 1.5-2 g/kg/day Burn- 2-2.5 g/kg/day |
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Most common pathogen with infected prosthetic graft? |
S. Epidermis |
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Treatment hypermagnesium? |
Calcium. Then hydrate. |
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Diagnosis of ZES? |
Gastrin >100 AND basal acid >15. Secretin stim not necessary but diagnostic if increase in gastronomic >200 |
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MIBG scan? |
Used to localize pheo |
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Diagnosis acute and chronic adrenal insufficiency? |
Rapid ACTH stim test- give 250 ug ACTH, measure plasma cortisol 30 and 60 min later, normal peak should exceed 20 ug/dL |
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Neuroblastoma prognosis? |
Worse with age >1, neuron specific enolase, amplification N-myc and elevated LDH. Hyperdiploid tumors are actually more susceptible to chemo and have a better prognosis. |
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Staging follicular thyroid cancer... |
If less than 45 only stage 1 (no mets) and stage 2 (mets). If older than 45, stage 1 is less than 2 cm, stage 2 is 2-4 cm, stage 3 is bigger than 4 cm or with LN, stage 4 with mets |
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DCIS with <1 mm margin on lumpectomy? |
Re excise. If at the boundary of the skin then higher dose radiation is indicated. |
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Treatment external hemorrhoid? |
If presenting within 24 hours, decompress with incision under local. If after 24 hours the clot will already start to be resorting so treat with stool softener and topical anesthetic. |
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Treatment internal hemorrhoid? |
Stage 1 and 2- sclerotherapy Stage 2 and 3- rubber band ligation Stage 3 and 4- dissect, ligate and reap proximate mucosa |
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Internal hemorrhoid staging? |
1- prolapse into anal canal 2- prolapse beyond anal canal but reduce spontaneously 3- manually reduce 4- irreducible |
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What is folfox? |
5-FU, leucovorin and oxaliplatin, adjuvant therapy benefits Stage III colon cancer |
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Resting pressure of esophageal sphincters? |
Upper is 50-70 Lower is 10-20 |
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Risk factors for gastric cancer? |
Tubular and villous polyps, history of gastric bypass, nitrates, diets high in salted meats and fish, type A blood, tobacco, prior H pylori infection |
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Presentation and treatment of cecal volvulus? |
Middle aged females, distended large bowel pointing to the RLQ, endoscopic detorsion rarely successful so go straight to ileocecectomy, primary anastomosis if no gangrene or perforation, otherwise end ileostomy |
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Treatment bile reflux after Billroth II? |
Lifestyle modifications, cholestyramine and metoclopramide. If this doesn't work, convert to roux en y with afferent limb at least 40 cm |
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Treatment bile reflux after Billroth II? |
Lifestyle modifications, cholestyramine and metoclopramide. If this doesn't work, convert to roux en y with afferent limb at least 40 cm |
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Crohn's disease flare treatment? |
For partial SBO, start with medical management. If not successful, do multiple stricturoplasties, if long stricture then resection and primary anastamosis. For complete obstruction go straight to surgery. |
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Retrocolic vs antecolic gastrojejunal anastamosis? |
Antecolic anastamosis has higher risk of afferent loop syndrome from partial obstruction of the proximal loop. |
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What landmark is most important to identify in a nissen fundoplication? |
Gastrohepatic ligament |
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Most common aberrant anatomy to be aware of when dividing the gastrohepatic ligament in a Nissen? |
Accessory left hepatic artery coming off the left gastric artery. |
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Nigro protocol? |
For SCC of anal canal, must be <5 cm, 5-FU and mitomycin with radiation followed by surgical excision |
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Nigro protocol? |
For SCC of anal canal, must be <5 cm, 5-FU and mitomycin with radiation followed by surgical excision |
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Difference between LAR and APR? |
LAR for tumors further from the anal canal, APR for tumors closer to anal canal. APR requires permanent colostomy. LAR leaves anus intact to reverse colostomy at a later date. |
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Requirements for trans-anal excision of rectal cancer? |
Smaller than 4 cm, less than 40% of circumference of lumen, proximal extent palpable on DRE (less than 8 cm from anal verge) |
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Reversal of uremic coagulopathy? |
DDAVP to temporize, hemodialysis |
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Indications for operation of chronic aortic dissection? |
Type A aneurysm >5.5 cm Type B aneurysm >6.5 cm |
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Best diagnostic test for aortic dissection? |
Helical CT scan |
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Best diagnostic test for aortic dissection? |
Helical CT scan |
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Initial management of aortic dissection? |
Beta blockers to get SBP 100-120, HR <60 may also decrease risk of adverse events |
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When to use an intra aortic balloon pump? |
1. Cardiogenic shock following MI 2. MR with hemodynamic instability 3. VSD following MI |
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Meaning of respiratory quotient? |
1.0- pure carbohydrate metabolism >1.0- over feeding, may lead to inability to wean ventilation <0.7- starvation |
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Meaning of respiratory quotient? |
>1.0- over feeding, may lead to inability to wean ventilation 1.0- pure carbohydrate metabolism 0.825- balanced feeding 0.8- pure protein metabolism <0.7- starvation |
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Severe GI bleed post whipple? |
Usually after POD10, due to arterial enteric fistula. If have GDA stump blowout (most common cause bleeding) treat with embolization |
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Definitive treatment for PSC? |
Liver transplant |
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Most common location of accessory spleen? |
Splenic hilum |
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Diastase recti |
No need for surgical intervention, usually post partum women, bulge only appears with sit ups, treat with abdominal wall strengthening exercises |
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Treatment for hereditary spherocytosis? |
AD transmission, splenectomy after age 5, US of RUQ prior so that a cholecystectomy can be done at same time if needed for gallstones |
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Treating UGI bleed due to varices |
Intubate, rescucitate, transfuse to hematocrit 25-30%, vasopressin and nitroglycerin infusion, octreotide, control with EGD and sclerotherapy or banding, balloon tamponide if needed, if rebleeding consider TIPS |
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Best repair for femoral hernia requiring bowel resection? |
McVay/coopers- no mesh, best for incarcerated femoral hernias. Bassini- also no mesh but doesn't work for femoral hernias, higher recurrence. Shouldice- similar to Bassini but better distributes forces, lower recurrence, cannot use for femoral. Lichtenstein- uses mesh, lowest recurrence. |
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Presentation of autoimmune pancreatitis? |
Can present with mass in head of pancreas and lymphadenopathy, other symptoms like lung/IBD/dry eyes/renal insufficiency, elevated IgG4 very specific, pancreatic duct strictures |
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Indications for ppx chole? |
Pediatric pts with gallstones, bariatric surgery, prior to transplants or planned immunosuppression, long common channel between pancreatic and biliary ducts (higher risk GB cancer), porcelain gallbladder |
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Mirizzi syndrome? |
Large cystic duct stone compressing CBD, leading to elevated LFTs |
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Posterior vs anterior hip dislocations |
Posterior- internally rotated, adducted Anterior- externally rotated, abducted |
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Pediatric circulatory numbers.. |
Hypotension is <70 +2*age Total blood volume is 80 cc/kg body weight |
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Splenic injury grading? |
1- hematoma <10%, lac <1 cm 2- hematoma 10-50%, 1-3 cm lac 3- hematoma >50%, lac >3 cm 4- injury to hilar vessels Avoid sports for grade + 2 weeks |
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Fracture management? |
Closed reduction with sling if minimally displaced. Closed reduction with pinning if largely displaced. Open reduction if neurovascular injury, open fx, or if unable to obtain adequate closed reduction. |
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Injuries with shoulder dislocations? |
Anterior- axillary nerve Posterior- axillary artery |
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Incisions for forearm compartment syndrome? |
2 incisions- a curved one volar (releases superficial and deep compartments) and 1 straight line dorsal (releases extensor compartment) |
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Normal SVR |
900-1200 dyn*sec/cm Or 18 wood units |
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Diagnostic test for flank stab wohnds |
CT with triple contrast (PO, IV, rectal) |
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Liver lac treatment |
Most grade 1-3 can be managed non operatively. To OR if serial transfusion requirements. If extravasation is seen, needs angioembolization. Once in OR, liver should be packed and fully mobilized. Do not directly pack into lacs. Hepatic artery ligation a/w abcess and should be avoided. |
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Classes of hemorrhagic shock |
1- 2- 15-30% (750-1500 cc), tachy, drop in pulse pressor, peripheral vasoconstriction 3- 30-40% (1500-2000 cc), hypotension, tachy ones, AMS 4- >40% (2000 cc) obtunded, loss of pulse/pressure |
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Classes of hemorrhagic shock |
1- 2- 15-30% (750-1500 cc), tachy, drop in pulse pressor, peripheral vasoconstriction 3- 30-40% (1500-2000 cc), hypotension, tachy ones, AMS 4- >40% (2000 cc) obtunded, loss of pulse/pressure |
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Side effect silver nitrate? |
Hyponatremia, methemeglobinemia |
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Side effect bacitracin? |
Rare anaphylaxis |
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Side effect silvadene? |
Leukopenia, self limiting, no need to discontinue drug, irritation in those with sulfa allergy |
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Side effect silvadene? |
Leukopenia, self limiting, no need to discontinue drug, irritation in those with sulfa allergy |
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Side effect sulfamylon? |
Pain on application, metabolic acidosis |
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Parkland formhla |
% BSA * kg * 4 Give half over 8 hours, other half over remaining 16 hours |
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Parkland formhla |
% BSA * kg * 4 Give half over 8 hours, other half over remaining 16 hours |
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Common electrolyte abnormality in burn patients? |
Hypernatremia |
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Treatment and staging merkel cell? |
Stage 1- <2 cm Stage 2- > 2 cm Stage 3- lymph nodes Stage 4- mets Adj rads for >2 cm or LNs, wide local excision all |
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Prevent rhabdo acute renal failure? |
UOP > 300 cc / hour Alkalinize urine pH >6.5 |
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Cyanide toxicity? |
Can develop from nitroprusside, weakness, confusion, pulmonary edema, treat with amyl nitrite, sodium nitrite or sodium thiosulfate |
