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218 Cards in this Set
- Front
- Back
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Banana Bag
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Thiamine 100 mg
Folic acid 1 mg MVI 1 amp (Multivitamin for infusion, 1 ampule) 3 grams of magnesium sulfate |
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Wernicke's encephalopathy
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1. Ocular disturbances (nystagmus)
2. Changes in mental state (ataxia) 3. Unsteady stance and gait |
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Korsakoff's syndrome
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1. Anterograde amnesia
2. Variable presentation of retrograde amnesia |
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Wernicke–Korsakoff Syndrome
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Severe thiamine deficiency
Atropthy/Infarction of mamillay bodies DO NOT give glucose without giving thiamine as glucose will exhaust any current thiamine in system and exacerbate WKS |
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Aphasia
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Disturbance of the comprehension and formulation of language
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Apraxia
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Disturbance of the comprehension and formulation of language
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Risk of preoxygenation
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Gives you THREE minutes where your O2 sats will not drop. You don't want to wait to intervene.....LOOK AT END TIDAL CO2 INSTEAD
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What to do for obstruction in the office
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1. Suction
2. Jaw thrust/chin lift 3. Tongue Pull 4. Oral/Nasal Airway 5. Positive Pressure Ventilation 6. 100% Oxygen |
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Diff Dx of Obstruction
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1.Laryngospasm - sux 0.2mg/kg (20mg)
2.Aspiration 3.Asthma- Epi 0.2mg (2cc 1:10,000) 4. Allergic rxn- Benadryl 50mg, epi 0.2mg, decadron 8mg 5. Bronchospasm- Prop 50mg, Ketamine 50mg, Epi 0.2mg |
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5 Differences between Pediatric and Adult Airway
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1. Larger tongue
2. Higher (C 1-2 vs C 4-5) and more anterior airway 3. Floppy Trachea 4. Narrowest part is cricoid vs vocal cords in adults |
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Stage 1 Anesthesia
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"induction", the period between initial administration of induction agents and loss of consciousness. During this stage, the patient progresses from analgesia without amnesia to analgesia with amnesia. Patients can carry on a conversation at this time.
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5 Differences between Pediatric and Adult Airway
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"excitement stage", is the period following loss of consciousness and marked by excited and delirious activity. During this stage, respirations and heart rate may become irregular. In addition, there may be uncontrolled movements, vomiting, breath holding, and pupillary dilation. Since the combination of spastic movements, vomiting, and irregular respirations may lead to airway compromise, rapidly acting drugs are used to minimize time in this stage and reach stage 3 as fast as possible
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Stage 3 Anesthesia
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"surgical anaesthesia". During this stage, the skeletal muscles relax, vomiting stops , and respiratory depression occurs . Eye movements slow, then stop, the patient is unconscious and ready for surgery. It has been divided into 4 planes:
1. eyes initially rolling, then becoming fixed 2. loss of corneal and laryngeal reflexes 3. pupils dilate and loss of light reflex 4. intercostal paralysis, shallow abdominal respiration |
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Stage 4 Anesthesia
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"overdose", is the stage where too much medication has been given relative to the amount of surgical stimulation and the patient has severe brain stem or medullary depression. This results in a cessation of respiration and potential cardiovascular collapse. This stage is lethal without cardiovascular and respiratory support.
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Rational for ACLS protocol
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1.SHOCK- give a new start
2. EPI- Large sympathetic and vasoconstrictive push to help the shock 3. Amiodarone- Treat a possible arrhythmia if 1 and 2 are not working |
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H's of ACLS
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Hypovolemia
Hypoxia Hydrogen ion – acidosis Hyperkalemia / Hypokalemia Hypothermia Hypoglycemia and other metabolic disorders |
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T's of ACLS
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Tablets (drug OD, accidents)
Tamponade (cardiac) Tension pneumothorax Thrombosis, coronary (ACS) Thrombosis, pulmonary (embolism) Trauma |
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CIWA Components
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Nausea / vomiting
Anxiety Paroxysmal sweats Tactile disturbances (itching, bugs crawling on skin) Visual disturbances Tremors Agitation Orientation Auditory disturbances Headache |
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Psychiatric symptoms of ETOH withdrawal
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disorientation, confusion,
agitation, anxiety, restlessness, visual/audio hallucinations, paranoia, amnesia, anger, insomnia, coma. |
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Sympathetic symptoms of ETOH withdrawal
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tachycardia, hypertension,
sweating |
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Physical Symptoms of ETOH withdrawal
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tremors, fever, sweating
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Delerium Tremens
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Delirium
severe autonomic hypersensitivity Formication global confusion constant tremor fumbling movements of the hands insomnia |
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Submental Triangle Boundries
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disorientation, confusion,
agitation, anxiety, restlessness, visual/audio hallucinations, paranoia, amnesia, anger, insomnia, coma. |
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Submandibular Triangle Boundries
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Ant and post bellies of digastric and inferior border of mandible
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Buccinator Nodes
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Part of perifacial nodes. Can be positive when primary site of disease is lip, buccal mucosa, anterior nasal cavity, and soft tissue of the cheeck
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Level II of the neck
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contains upper jugular and jugulodigastric nodes and also the SPINAL ACCESSORY
IIa is anterior to SA IIb is posterior to SA skull base to carotid bifurcation (hyoid) |
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Level III of the neck
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contains middle jugular lymph node group including juguloomohyoid nodes.
from hydoid/carotid bifurcation to cricothyroid/junction of omohyoid with jugular |
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Level IV of the neck
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contains the lower jugular lymph node group.
from cricothyroid/omohydoid jug junction to clavicle |
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Submandibular Triangle Boundries
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parathryoidal, paratracheal, precricoid (delphian)
positive in thryoid, piriform sinus, subglotic, cericval esoph and cervical tracheal disease. |
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Modified radical neck
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Preservation of any of the three stuctures
I. Spinal Accessory II. + Jugular III. ++ SCM |
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Selective neck
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Sparing of one or more LYMPH NODE GROUPS that would usually be taken in RND
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Types of Selective Neck Dissections
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SOH
Lateral Posterolateral Anterior Compartment |
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FOM and Tongue cancer spreads to which nodes?
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Submental, submandibular, upper and middle jugular nodes
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Contra lateral theraputic neck dissection should be done when....
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N2C disease (contralateral node 3-6cm in size)
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Selective neck dissection- lateral type
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En bloc resection of II, III, and IV
indicated in ca of oro, hypo and larynx |
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Selective neck dissection- Posterolateral Type
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En bloc resection of II to V and suboccipital and postauricular nodes
used for posterior scalp, nuchal ridge, occiput or posterior upper neck malignancies nodes include post auricular nodes, occipital, posterior triangle and jugular groups |
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Selective neck dissection- Anterior Type
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En bloc removal level VI nodes
thyroid, hypo, cervical trachea, cervical esoph, larynx removal of perithyroidal, pretracheal, paratracheal, delphian |
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CT criteria for cervical metastasis
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1. any node larger than 1.5cm
2 .central lucency of node 3. irregular borders 4. loss of plane between mass and adjacent structure |
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Stage I Ca
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T1, N0, M0
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Stage II Ca
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T2, N0, M0
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Stage III Ca
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T3, N0, M0
T1,2,3 with N1 ,M0 |
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Stage IV Ca
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T4 ,N0 or N1, M0
Any T, if with N2 or 3 Any T, if with M1 |
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Triple Scope
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Laryngoscopy
Bronchonsopy Esophogoscopy |
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Inications for RND
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1. One or more clinically positive nodes are present
2. Nodal involvement other than first echelon 3. High risk of occult positive nodes 4. Regional mets after primary has been treated 5. positive node after previous radiation 6. fixed neck mass that becomes mobile after radiation |
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CONTRAINDICATIONS to RND
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1. uncontrollable cancer
2. distant mets 3. nodes unchanged by radiotherapy 4. short life expectancy (less than 3 months) |
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CT criteria for cervical metastasis
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1. Electively when there is >20% chance of occult disease and surgery if being done for primary
2. ipsilateral when it is to be followed by radiotherapy |
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Basic Radiation Therapy
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2 y per day for 5 to 7 weeks for a total of 55-65 grays
external beam radiation |
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Reasons for radiation alone
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Small cancers
Poor surgical access functional disability that will be less with rad- swallowing, speech |
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Side effects of radiation
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Mucositis
Xerostomia ORN |
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Reasons for postop radiation tx
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1. advance primary disease- t3 or 4
2. close positive margins 3. multiple positive neck nodes 4. extracapsular extension |
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Why post op rather that pre op radiation??
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1. to avoid a difficult dissection
2. to avoid loss of well defined margins 3. would healing complications 4. can deliver a higher dose post than preop but one big problem is that would complications delay post op rad which should ideally be given within 6 weeks |
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Upper lip and commisure ca spread to?
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preauricular, periparotid, submandibular nodes
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Lower lip ca spreads to?
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Submental and submandibular nodes
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Initial reaction to vessel injury
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1. Vasoconstriction
2. Release of 1. vWf 2. Collagen 3. Tissue Factor (III) |
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Most powerful platelet activators
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Collagen
Thrombin |
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Platelet granules
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Dense Granules- secrete serotonin, ADP, ATP, Calcium
Alpha Granunes- secrete vWF, fibringogen (I), V and XI, protein S |
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PLatelet pathology
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2 y per day for 5 to 7 weeks for a total of 55-65 grays
external beam radiation |
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Extrinsin Pathway
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III activates VII then activiates extrinsic pathway (X to II to I)
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Intrinsic (Propogator) Pathway
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XII, XI, IX, (VIII), X to Xa
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Common Pathway
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Xa turns II into IIa (thrombin) which turns I (fibrinogen) into Ia (fibrin)
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Antiplatelet vs Anticoagulant
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Anticoagulant blocks FIBRIN formation
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CHADS2
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C - CHF 1
H - HTN 1 A - AGE >75 1 D - DIABETES 1 S - STROKE 2 Used to stratify stroke risk 0 is 1.9% stroke risk 6 is 18.2% stroke risk |
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Upper lip and commisure ca spread to?
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Bare metal
Drug Eluting In first year drug eluting stents have higher risk of thrombosis as oppoed to BMS which is 1 month |
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IIb/IIIa inhibitors
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Abciximab
Eptifibitide Tirofiban ONLY IV- Used in AMI and PCI |
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ADP Inhibitors
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plavix, prasugrel, tigacrelor, ticlodipine
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NSAID MOA
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blocks cox from converting arachodonate to PG A2 which then forms TA2 which causes vasoconstriction and PLATELET AGGREGATION
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COX 1
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Increases
Mucosal integrity Platelet aggregation Vasoconstriction Vascular porliferation |
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COX 2
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Platelet aggregation
Vasoconstriction Vascular porliferation |
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Plavix vs prasugrel
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Both are prodrugs that need to activated. Plavix activated by CYP450 2C19 (liver). Prasugrel does not need this to be activated
Approximately 30% of population is missing this enzyme BUT prasugrel does have higher risk of serious bleed Both are IRREVERSIBLE |
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Ticagrelor
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does not require liver biotransformation like plavix and prasugrel
REVERSIBLE |
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Stents and surgery
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DES- Wait 6 months
BMS- Wait 6 weeks DO NOT TAKE OFF DUAL ANTIPLATELET THERAPY |
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Natural Anticoagulants
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AT III
Tissue Factor Pathway Inhibitor (TFPI) Protein C/S |
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Vitamin K dependent co-factors
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2,7,9,10 and protein c/s
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INR and odds ration of stroke
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Anticoagulant blocks FIBRIN formation
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LMWH
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inactivates Xa
thrombin (IIa) is partially inactivated can be reversed with protamine Less frequent dosing No need for APTT Less risk of HIT |
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Factor Xa inhibitors
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Fondapurinox (Arixtra) - subq
Rivoroxaban (Xarelto)- Oral |
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Antofibrinolytics
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Amicar- Aminocaproic acid
Tranexamic acid Inhibit conversion of plasminogen to plasmin..therefore increase clot stabilization |
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Direct Thrombin Inhibitors
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Hirudin
Argatroban Dabigatran (Pradaxa)- Oral NO REVERSAL AGENTS |
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Brain Volume with growth
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Triples in first year
Quadruples by second year |
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NSAID MOA
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14% with one fused suture
42% with more than one fused suture |
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Trigonocephaly
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Meitopic suture synostoses
Midline forhead ridge Triangular shape Hypotelorism Bitemporal narrowing |
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Scaphocephaly
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Saggital suture synostosis
Biparietal and bitemporal narrowing occipital protuberence varrying degree of frontal bossing |
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Anterior Plagiocephaly
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Unilateral coronal suture synostosis
oblique/flat shape unilateral palpebral fissure widening unilateral supraorbital rim displacement sup and post Elevation of ear, sphenoid wing (harlequin) Flattning of root of nose on affected side |
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Brachycephaly
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Bilateral coronal suture synostosis
"short head" apert, crouzon, pfeiffer bilateral palpebral fissure widening bilateral supraorbital rim displacement sup and post bilateral harlequin |
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Posterior Plagiocephaly
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Lambdoid suture synostosis
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Components of epidermis
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Keratinocytes - structural integrity
Langerhan- Immune response Melanocytes- Pigmentation Merkel Cells- tactile receptors |
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3 phases of wound healing
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Inflammatory
Proliferative Remodeling |
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Accutane
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Isoretinoin- kills sebaceous glands so acne can't form
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Types of peels
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Keratolytic - aha (glycolic acid), salicylic acid
Disprupt keratinocyte adhesion and promose collagen production Protein denaturants- TCA, Obagi blue, phenosis Cause protein coagulation and denaturation Retin A- compacts stratum corneum, increases cell turnover and increases collagen production |
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Problem with deep peels
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Phenols and bakers or littons solutions
ARRHYTHMOGENIC |
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Papillary
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inactivates Xa
thrombin (IIa) is partially inactivated can be reversed with protamine Less frequent dosing No need for APTT Less risk of HIT |
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Acanthotic
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Thick
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Layers of epithelium
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Basal
Spinous Granular Keratin |
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Desmoplastic/fibrotic/sclerotic/hyalinized
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pink, dense, few nuclei
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ectatic
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dilated (vessels or ducts)
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Plasmacytoid
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nucleus is pushed off to one end
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Craniosynostoses and increased ICP
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wide variety
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cherry red nuleolus
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Melanoma
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parakeratin
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nuclei are present
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orthokeratin
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no nuclei
bigger granular cell layer |
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2 types of salivary gland cells
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acinar
serous |
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spindle shaped nucleus
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elongated- think nerve tissue
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saw tooth rete ridges
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think lichenoid
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peripheral palisading
reverse polarity |
ameloblastoma
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hpv driven scca occurs where
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oropharynx vs oral cavity
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with central giant cell granuloma, you need to rule out what?
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rule out hyperparathyroidism (brown tumor)- get PTH level
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central giant cell granuloma non surgical treatment
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intralesional steroids
intranasal calcitonin |
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secondary hyperparathyroidism caused by
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Keratolytic - aha (glycolic acid), salicylic acid
Disprupt keratinocyte adhesion and promose collagen production Protein denaturants- TCA, Obagi blue, phenosis Cause protein coagulation and denaturation Retin A- compacts stratum corneum, increases cell turnover and increases collagen production |
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Absorbable sutures
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Gut
Vicryl Monocryl PDS |
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Absolute Indications for opening a condyle
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1. Displacement of condyle into middle cranial fossa
2. Inability to obtain adequate occlusion with MMF 3. lateral extracapsular displacement with esthetic deformity 4. foreign body in joint space |
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Relative Indications for opening a condyle
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1. bilateral
2. uni or bi where MMF would not be tolerated 3. bilateral condylar fx with unstable midface fx's where vertical butresses cannot be reconstructed 4. bilateral fxs with gnathological problems such as apertognathia, prognathism, retrognathism or dental abnormalities (perio dx, loss of teeth) |
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5 Differences between peds and adult airway
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1. More rostral larynx
2. Relatively larger tongue 3. Angled vocal cords 4. Differently shaped epiglottis 5. Peds narrowest part is cricoid, adult is cords |
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Treatment for bronchospasm
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Epi 0.1-0.5mg IV is definitive if you know pt is indeed in bronchospasm
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Bones of Orbit
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PFLEZMS
Palatine Frontal Lacrimal Ethmoid Zygomatic Maxillary Sphenoid |
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New name for bacteriodes
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Prevotella
Melanogenica and intermedia |
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Danger Space
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Between alar fascia and prevertebral fascia
superior- skull base Inferior posterior mediastinum |
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Bone Scan
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indium 111
technetium 99 |
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TUGSE
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Traumatic ulcerative granuloma with stromal eosinophilia
Lymphocytes, neutrophils, plasma cells, eosinophils, histiocytes |
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Bone within a soft tissue mass
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Perifpheral ossifying f ibroma
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strawberry gingivitis
large vessel vasculitis nasal drainage lethargy |
Wegeners Granulomatosis
Oral manifestations rare also involves kidneys, lungs C-ANCA |
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TB treatment
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RIPE for 6 weeks
then drop to Rifampin and isonizid for 6 months presentation: tongue lesion with neck mass Diffrential to remember: cat scrath..presents with neck mass but NO oral lesions in young kid |
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Granulomatous diseases
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Sarcoid
TB Fungal infections Chrohns Oro facial granulomatosous- dx of exclusion |
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cicatricial pemphigoid
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oral and ocular (scarring) lesions
subepithelial clefting- separation of basement membrane |
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Markowitz Classification of NOE Fractures
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I: Attached to large piece of bone
II: Comminuted but still attached to large piece of bone III: Communuted and avulsed |
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Acetazolamide
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Carbonic anhydrase inhibitor
decreases prodiction of HCO3 decreases intracranial hypertension used for glaucoma used for medical treatment of retrobulbar hematoma |
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Bone
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Osteocytes- hypocellular - white spaces empty
Osteoblasts plump and lined up on surface of bone Osteclasts Trabeculae - spongy looking matrix Eosinophilic Looks like a sponge |
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Cartilage
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Chondrocytes instead of osteocytes, larger
more myxoid/amphophilic (bluish) more hypercellular BLUE BACKGROUND Pleomorphma Adenoma has a cartilagenous background |
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Nerve
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Schwann cels- supporting cells
Axons- surrounded by myelin sheath axons bundeled into nerve fibres surrounded by CT called endoneurium those fibers are surrounded by perineurium and then THOSE fibers are bundled into fascicles Grouping of fascicles form the nerve Silver stain is used for nerves - S100 stain (brown) on H and E, cells look spindle shapes |
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Fat
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Meshwork of empty
Small inconspicuous adipocytes Fibrous connective tissue septa separate lobules |
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Smooth Muscle
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No cross striations
Surrounds blood vessels, GI tract, GU tract, Respiratory tract Leiomyoma Angionleiomyoma |
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Fibrous connective tissue
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Collagen of varying densities
Ground substance- small proteins, water. looks more pale blue collagen can be sclerotic, hyalinized |
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Peripheral giant cell granuloma
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Only on alveolar ridge
cuz it originates from dental tissue - PDL |
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Peripheral ossifying fibroma originates from?
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Also originates from PDL
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4 P's of ginigiva/alveolar ridge
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Pyogenic granuloma
Parulus Peripheral ossifying fibroma Peripheral giant cell granuloma |
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Keratoacanthoma
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Sun exposure
lower lip rough surface- warty premalignant old people grow fast looks like cancer (scca- keratocanthoma variant) left alone...would regress |
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Nevus of Ota
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Black sclera
Trigeminal distribution |
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Melanocytic Nevus
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Common at birth
caucaisians start out typocally flat and pigmented as we age they start to raise up (mole) can have normal adnexal skin structures- Hair as we age, they depigment |
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Antoni A
Antoni B |
Nerve tissue- Schwannoma
Antoni A is more organized nerve tissue with vercay bodies Antoni B is more disorganized |
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schwannoma with ancient change
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Looks ugly but just LOOKS wierd do to changes over time but you can find areas of classic schwannoma
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Nasofrontal duct drainanage
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Middle meatus
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maxillary sinus drainage
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Middle meatus
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Drugs that cross the BBB
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1) Cephalosporins:
eg. Ceftriaxone, Cefotaxime, ceftazidime, cefepime 2) Penicillins: Ampicillin 3) Antifungals: Amp B with flucytosine, Fluconazole 4) Vancomycin 5) Anti-tuberculous drugs. (eg. INH) |
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Indications for obliterations of sinus
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Posterior wall fx
NOE fx frontal sinus floor fracture |
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Most common causes of adult meningitis
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strep pneumo
h flu nisseria menningitis treat with third generation ceph like cephtriaxone |
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Neurofibromatosis
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2 or more Neurofibromas or 1 plexiform
6 or more Cafe Au laits 2 or more Lisch Nodules (pigmented iris hamartomas) optic glioma axillary freckling first degree relative with NF-1 "comet shaped nuclei" and mast cells (fried egg with fine granules) Treatment consists of biopsy |
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Cigar shaped nuclei
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Smooth muscle
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mass in FOM yellow in color looks like a stone
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Lymphoepithelial cyst
Dermoid cyst Epidermoid cyst Lipo Sialolith |
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MACHO
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Differential for posterior mandible radiolucent lesions
Myxoma Ameloblatoma CGCG Hemangionma OKC |
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Multiple Myeloma workup
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IgM markers
Bence jones proteins Kappa lambda light chain protein Bone scan technicium 99 |
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Plasmacytoma
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Remember the lesion s/p ext #19
radiolucent - use MACHO to diffrentiate malignant disease make sure to diffrentiate from multiple myeloma resect as it is malignant disease |
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Multiple myeloma treatment
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Treat with Thalidomide
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Histoplasmosis
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Ohio River Valley
Mississippi Valley |
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Characteristics of Malignancy
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Increased nuclear size (with increased nuclear/cytoplasmic ratio--N/C ratio).
Variation in nuclear or cell size (pleomorphism). Lack of differentiation (anaplasia). Increased nuclear DNA content with subsequent dark staining on H and E slides (hyperchromatism). Prominent nucleoli or irregular chomatin distribution within nuclei. Mitoses (especially irregular or bizarre mitoses). |
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Granular cell tumor
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Remember lesion on palate that looks spongy and red
look for Pseudoepitheliomatous Hyperplasia which is drops off the epitheilium Common on tongue Histologically looks very granular debulk it (cus it passes the margins) and it usually doesnt come back |
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Features of dysplasia - architecture
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Irregular eppithelial stratification
Loss of polarity of basal cells DROP shpaed, rounded or bulbous rete ridges (not test tube like as normal) increased numbers of mitotic figures absnoramlly superficial mitosis premature keratinization keratin pearls within rete ridges |
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features of dysplasia - cytology
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Abnormal variation in nuclear size
variation in shape in cell size cell shape increased n to c ration increased nucluear size atypical mitotic figures increased number and size of nucleoli |
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Verrucous carinoma - remember the lesion in the buccal vestible from denture wearing that looks like a yellow irregular plaque
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Rete ridges broad and pushing
Lesion is described as rather boring because it is a low grade not a highly dysplastic lesion so not very sensitive to radiation should resect lesion but laser ablation and liquid nitrogen can also be done |
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Focal epithelial hyperplasia (hecks disease)
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lesions on lips tongue etc
kids native american anscestry related to hpv 13 and 32 spontaneously regress looks like neuromas in the mouth or sometimes condyloma like too mom may have it too Mitosoid cells |
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Proliferative Verucous leukolplakia - remember the lesion on the side of the tongue, dorsal, lateral and carrying on to the ventral
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Diffuse white lesions on tongue, lips, gingiva, buccal mucosa
looks kind of like lichen planus sometimes looks like a fungal lesion - can try antifungals first before doing biopsy once diagnosed you can just watch and wait as sometimes there are so many lesions that develop |
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AE1/AE3 Stain
CAM 5.2 |
Stains epithelium brown
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SMA stain
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Stains Muscles
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Ortho vs parakeratin
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Parakeratin has nuclei with more even surface
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Diffrential for squamous papilloma
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Verruca
Condyloma Verruciform Xanthoma Focal epithelial hyperplasia (hecks disease) Associated with HPV 6 and 11 Koilocytes |
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Verruca Vulgaris
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HPV 2,4,6,40
Contageous Skin of hands common Treat with cryo or conservative excision does not become malignant Koilocytes |
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Condyloma acuminatum
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High risk subtypes are 16 and 18
STD Koilocytes |
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Koilocytes
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Virus altered epithelial clear cells with small dark (pyknotic) nuclei. seen in prickle cell layer
surgical excision or laser ablation (?? airborne spread) |
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Inverted Papilloma
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Benign localized proliferation proliferation of the respiratory mucosa
Has a potential to become malignant HPV 6,11,16 Median age 55 years males arises from lateral nasal cavity or antrum has significant growth potential histo- looks like big islands of cells |
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Molluscum Contagiosum
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Usually kids and young adults
Warms parts of skin- neck, eyelids, trunk, genitals Sexual contact, but also sharing clothing, communal bathing, etc look like little CRATERS histologically the craters in the middle are filled with bloated keratinocytes (molluscum bodies) spontaneous remission in 6-9 months cryo NO potential for transformation |
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Seborrheic Keratosis
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Benign proliferation of epidermal basal cells
Chronic sun exposure Histo- hyperkeratotic, acanthosis, numerous PSEUDOCYSTS Common form in black people - Dermatosis papulosa nigra |
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Actinic Lentigo
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Chronic sun
Looks like flatter seborrheic keratosis histo- melanin laden basilar cells |
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Oral Melanocytic Macule
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Flat brown mucosal discoloration caused by focal increase in melanin deposition and possibly and increase in melanocytes as well
Histo- increased melanin in the basal layes |
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Acquired Melanocytic Nevus
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MOLE
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Absolute health contraindications to surgery
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MI less than 1 month
De compensated CHF Acute coronary syndromes HTN urgency/emergency Severe valvular disease severe arrhythmia |
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Ketamine effects on BP
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Increases
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General Asthma Meds
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Beta Agonists
Long Acting Short Acting Inhaled Corticosteroids Leukotriene Receptor Blockers Anticholinergic meds |
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Classes of asthma of FEV
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Mild Intermittent >80%
Mild Persistent >80% Moderate Persistant 60-80% Severe <60% |
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Pain and sedation meds to avoid in asthma (3)
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Beta blockers
Toradol Morphine (histamine release) |
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Lantus vs lispro vs NPH in duration
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Lantus long
Lispro short NPH intermediate for sedations always continue long acting (usually night before) half of intermediate hold short acting and then cover post op with sliding scale Oral hypos should be held in AM for surgery |
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Diabetes diagnosis
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Random > 200
fasting >126 |
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MELD
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Model for end stage renal disease
Score of < 10 okay for elective sx >15 no surgery 5 Components Age Bilirubin Creatinine INR Dialysis |
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Normal GFR
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120 ml/min
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DDAVP dosing for HF A
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30micrograms/kg in saline solution
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Most common causes of thrombocytopenia in surgical pt
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Sepsis
DIC Heparin H2 Blockers Certain ABX Massive Transfusion |
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Indications for trach
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1. Unable to orally intubate
2. Tumor 3. Emergent Airway 4. Prolonged intubation |
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Indications for intubation
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Hypercarbia PCO2 > 55
Hypoxia PO2 < 60 Unable to hold secretions Unable to protect airway |
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Whats different about cricoid cartilage
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only ones that go completely around
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Inferior Strap Muscles
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Streno hydoid
Sterno thyroid thyrohydoid omohyoid |
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Layers to trach
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Skin
Subq Strap thryoid fasicia throid isthmus pretracheal fascia trach |
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Trach tubes
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Shileys (brand) come in 4, 6 or 8
cuffed, non fenestrated men ususally 8 women usually 6 |
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Carnoys solution
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Carnoy's solution is a fixative composed of 60% ethanol, 30% chloroform and 10% glacial acetic acid.[1]
Carnoy's Solution is composed of: 1 g of ferric chloride (FeCl3) dissolved in 24 mL of absolute alcohol 12 mL of chloroform 4 mL of glacial acetic acid |
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Townes View
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30 degress upward pointing to glabella (hariline)
shows lateral medial condyle position |
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Wharthins Tumor
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Papillary Cystadenoma Lymphomatosus
MOstly parotid ALOT of times bilateral but metachrounous associated with SMOKING (8 fold increase) histology- look for papillary projections, yst like structures and palisading lining. pretty distinct look 6-12% recrrence rate and remember it can later present on the other side |
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Polymorhous low grade adenocarcinoma
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minor salivary glands
classic is palate swiss cheese look on low power differentiated from adenoid cystic on high power because it shows cord like architecture also shows perineural invasion like adenoid cystic recurrence rate is |
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Enamel organ forms....
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Enamel
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Dental papilla forms....
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dentin and pulp
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inner enamel epithelium forms...
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ameloblasts
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OKC's
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Hyperchromatic
palisading nuclei parakeratin 6-8 cells thick |
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Gingival cyst of adult
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soft tissue lateral perio cyst counterpart
look for "speedbumps" in the cyst lining can be "botryoid" |
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Ameloblastic Fibroma
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Look for "islands" of epithelium in a fibrous background (denta papilla background)
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Dentigerous cyst versus aot on radiograph
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cyst attaches at cej in DC while it attaches at midroot on AOT
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Langerhans histiocytisis
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Gingival appearance
Teeth floating in space Lots of eosinophils |
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Histoplasmosis
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Birds and bats
Ohio river valley Pigeons |
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4 P's
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Pyogenic granulona
Peripheral giant cell Peripheral ossifying fibroma Peripheral fibroma |
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Plasmacytoma stain
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CD 138
If localized then radiation is treatment of choice but rarely curative. Usually develops into multiple myeloma |
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What causes cleft palate?
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failure of fusion of medial nasal prominence and maxillary prominence. usually happens at 4-8 weeks
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Cleft lip repairs
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Tennison Randall - z plasty across philtrum
Millard (remember "c flap" is to lengthen columella) |
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cleft palate repairs
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Manchester
Millard - sacrifice prolabium and use tissue from lip |
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submucous cleft classic sign
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bifid uvula
important because 1/3 require surgery for speech issues |
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Binder syndrome classic sign
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absence of ANS
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Most basic dx of tmj
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Muscular pain
Joint pain Both most |
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Questions to ask for tmj
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Ttp
Pain on loading (opposite side usually hurts) Joint noises Muscles of mastication ROM - with pain, wo pain, lateral and protrusive (10mm each) Evaluate teeth- wear facets, cross bites, interferences |
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Tmj imaging
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Pano
MRI CT RADIONUCLEIDE |
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Tmj diff dx
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Myofascial pain
Internal derangement |
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Wilkes
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I Painless click
II Painful click III Intermittent lock, pain IV Closed lock, chronic pain V Crepitus, perforation, chronic pain |
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PVL
|
High grade dysplasia
Multiple diffuse lesions Leukoplakia with papillomas on side of tongue Diffuse white plaques on gingiva (bad) |
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Pyostomatitis vegetans
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Yellowish linear Pustules in a red mucosal background on the gingiva
Unusual oral expression of inflammatory bowel disease Snail track ulcerations Colbetasol |
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Amyloid like material
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think CEOT
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Ghost cells
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Calcifying odontogenic cyst
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