Prin Surgical Phys

Front 1

hypokalemia: symptoms

Back 1

ileus, weakness

Front 2

hyperkalemia: tx

Back 2

IV calcium - stabilizes myocyte membranes

glucose + insulin: gets K into cell

Bicarbonate: shifts K+ intracellularly

(Kayexelate is ion-exchange resin)

Lasix can be used if have good kidneys.

Dialysis

Can give beta agonists (albuterol)

Front 3

hyperchloremia: cause

Back 3

Excess chloride in IV solutions

Front 4

Chloride content of
A) normal saline
B) plasma

Back 4

A) 154 mEq/L
B) 90-110 mEq/L

Front 5

Composition of normal saline

Back 5

A) 154 mEq/L Na+
B) 154 mEq/L Cl-

308 mOsm/L

(it's actually hypertonic)

Front 6

Composition of Lactated Ringer's

Back 6

A) 130 mEq/L Na+
B) 109 mEq/L Cl-
C) 2.7 mEq/L Ca2+
D) 28 mEq/L lactate
E) 4 mEq/L K+

525 mOsm/L

(hypertonic!)

Front 7

typical range for maintenance fluids

Back 7

100-125 mL/hour

Front 8

Hypocalcemia: symptoms

Back 8

Neuromuscular irritability: perioral and extremity numbness

May progress to carpopedal spasm and tetany

Front 9

Why is lactated ringers given in metabolic acidosis?

Back 9

The lactate is metabolized into bicarbonate by the liver, which can help correct metabolic acidosis. (it's the reason it can't be used as maintenance fluids - because patient would become alkalotic)

Front 10

Why is sugar (dextrose) added to maintenance fluid?

Back 10

prevent muscle braekdown

Front 11

Best way to assess fluid status

Back 11

Urine output

Front 12

Minimal urine output for adult on maintenance IV

Back 12

30 mL/hour (0.5mL/kg/hr)

Front 13

Most common trauma resuscitation fluid

Back 13

Lactated Ringers (or normal saline)

Front 14

____ IV fluid is used to replaced duodenal or pancreatic loss (why)?

Back 14

Lactated ringers

Because of bicarb loss. LR is converted to bicarb in liver

Front 15

hypokalemia: ECG findings

Back 15

Flat T waves

U waves (waveform immediately after the T wave)

Front 16

Hypercalcemia: symptoms (acute)

Back 16

Fatigue, confusion, N/V, diarrhea, dehydration, anorexia

Front 17

Hypercalcemia: symptoms (chronic)

Back 17

renal stones

Ulcer disease

(mostly related to hyperPTH)

Front 18

HH equation

Back 18

pH = pK + log ([HCO3-]/(0.03 * PCO2))

Front 19

Most common cause of resp acidosis

Back 19

Decreased alveolar ventilation

Front 20

lactic acidosis: cause

Back 20

Inadequate tissue perfusion causing increased anaerobic metabolism

Front 21

most common cause of met alkalosis

Back 21

loss of gastric contents

Front 22

paradoxical aciduria: defn

Back 22

Process in which there is volume and H+ loss (ie, vomiting) where the kidney excretes extra H+ to conserve Na+

Front 23

winter's formula

Back 23

expected PCO2 = 1.8([Bicarb]) + 8 (+/- 2)

Front 24

winter's formula

Back 24

expected PCO2 = 1.8([Bicarb]) + 8 (+/- 2)

Front 25

_____ inhibits Thrombin - Xa complexes

Back 25

Antithrombin III

Front 26

______ degrades factors V and VIII

Back 26

Protein C and S

Front 27

Cleaves fibrin

Back 27

Plasmin (has to be activated via t-PA or uPA from Plasminogen)

Front 28

Clopidogrel - MOA

Back 28

blocks ADP-mediated platelet aggregation

Front 29

Vit K-dependent factors

Back 29

II, VII, IX, X, Proteins C and S

Front 30

lovenox/Enoxaparin - MOA

Back 30

low molecular weight heparin (antithrombin III activator)

Front 31

Congenital Risk Factors for DVT

Back 31

1) Protein S Def
2) Protein C Def
3) Antithrombin III mutation
4) Factor V leiden mutation

Front 32

What happens to packed RBCs when 2,3 DPG levels fall?

Back 32

Oxygen binds too avidly

Front 33

Stages/Classes of shock (4)

Back 33

1) <750cc blood loss
2) 750-1500cc loss - tachycardia, decreased pulse pressure
3) 1500-2000cc blood loss - tachycardia, DECREASED SYSTOLIC BP
4) >2000cc blood lost - all the above plus confusion, lethargy, oliguria

Front 34

Clean wound - defn

Back 34

nontraumatic procedure

Does not enter bowel, tracheobronchial tree, GU system, or oropharynx, and isn't infected

Ex. hernia repair.

Lowest risk of infection

Front 35

Clean-contaminated wound - defn

Back 35

nontraumatic procedure, except that bowel, tracheobronchial tree, GU system, or oropharynx were entered.

Ex. cholecystectomy, bladder sx.

Front 36

Contaminated wound - defn

Back 36

Fresh traumatic wound

and/or

Contamination during procedure (eg., bowel was cut).

Wounds are LEFT OPEN

Front 37

Contaminated wound - how treated?

Back 37

Left open

Front 38

Dirty and infected wound - defn and how treated?

Back 38

Infection is established before wound is made surgically.

Eg., appendiceal abscess

Treatment by leaving open.

Front 39

Normal wound healing phases and timeframe

Back 39

1) Coagulation phase - immediately

2) Inflammatory phase - Cellular --> Vascular --> Mediators etc (will expound)

3) Proliferative - fibroblasts migrate and produce collagen (continues 3 weeks)

4) Remodeling - initial collagen is broken down and remade

Front 40

Inflammatory phase of wound healing: What occurs and in what timeframe?

Back 40

Immediately there is increased vascular permeability --> PMNs come in.

24 - 48 hours : macrophages replace and start remodeling ECM

48- 72 hours : Epithelial bridging and adherence across surgically closed wound edges has occurred

Front 41

What happens 48- 72 hours after surgery re wound healing?

Back 41

Epithelial briding and adherence via epithelial cell migration

Front 42

Tissue growth factors (PDGF and TGF-&beta;) promote influx of ________

Back 42

fibroblasts

Front 43

_________ enzymes promote breakdown of injured tissue and wound remodeling.

Back 43

Matrix metalloproteinases.

Front 44

What kind of dressing needs to promote epithelial migration and what does it consist of?

Back 44

Large, open dermal wounds (eg. skin graft donor sites)

Petroleum-base impregnated gauze allow formation of scab, which facilitates epithelial migration.

Front 45

What kind of dressing is wet-to-wet for?

Back 45

Clean open wound or dirty wound that has been cleaned by wet-to-dry

Front 46

wet-to-wet dressing : defn

Back 46

Gauze isn't allowed to dry. Keeps tissues moist, removes exudates, and doesn't debride healthy tissue

Front 47

Wet-to-dry dressing:
A) Defn
B) indication

Back 47

A) Thin piece of gauze is moistened, packed in wound, and covered with dry dressing. When dry gauze is removed, it takes necrotic debris (but also some healthy tissue) with it.

B) Good for open wound with necrotic debris

Front 48

It takes about ____ hours for epithelium to migrate across sutured wound and seal it.

Back 48

48

Front 49

Best dressing for
A) clean open wound
B) wound with necrotic debris
C) Large, open dermal wounds

Back 49

A) Wet-to-wet (no healthy tissue removal)
B) wet-to-dry (removes necrosis and some healthy tissue unfortunately)
C) Petroleum-based impregnated gauze

Front 50

How does Vitamin A affect wound healing?

Back 50

Promotes inflammation and production of collagen

Front 51

How does hyperbaric Oxygen affect wound healing?

Back 51

Seems to speed and improve healing in Patients with nonhealing wounds, such as radiation, osteomyelitis.

Front 52

How does severe illness affect metabolism?

Back 52

1) BMR increases
2) Body becomes more dependent on glucose and less able to utilize protein and fat
3) Catabolic rate increases (ameliorate with dextrose administration)

Front 53

How to assess adequacy of protein nutrition?

Back 53

Measure visceral proteins (albumin, transferrin, pre-albumin)

Pre-albumin is best for reflecting protein nutrition as it has a shorter half-life than albumin.

Front 54

TPN vs PPN - main differences

Back 54

TPN has high osmolarity and is toxic to peripheral veins. Must be given centrally.

PPN has less glucose and is not significantly hyperosmolar.

Front 55

Reasons for ICU admission

Back 55

1) Airway control -
2) Ventilator support
3) Invasive monitoring - A-lines, pulmonary catheters, ICP
4) Vasoactive and antiarrhythmic drugs
5) Intensive patient care

Front 56

______ determines CO2 elimination

Back 56

Ventilation

Front 57

What is dependent on alveolar minute ventilation?

Back 57

CO2 elimination (ventilation)

Front 58

What is dependent on alveolar minute ventilation?

Back 58

CO2 elimination (ventilation)

Front 59

Determines oxygenation or PO2

Back 59

Partial pressure of alveolar oxygen and intrapulmonary shunt

Front 60

What does increasing PEEP do?

Back 60

Decreases shunt and increases PO2

Front 61

How is vent weaning usually accomplished?

Back 61

By turning down the ventilator rate and making the patient assume more work of breathing until vent is not needed.

Front 62

What are factors that determine whether a patient is ready for vent weaning?

Back 62

1) RR <30

2) Spontaneous tidal volume >5mL/kg

3) Rapid shallow breathing index (RR/tidal volume in liters)

4) Vital capacity

5) Negative inspiratory force - amount of negative pressure patient is able to create against a closed glottis

6) Arterial blood gases - O2 sats should be > 90%, PCO2 should be 35-45

Front 63

Pulm Artery catheters monitor ______

Back 63

cardiac output

Front 64

Dobutamine mainly affects what receptors? What is result?

Back 64

&beta;1 and &beta;2

Primary causes increase in CO plus vasodilation

Front 65

Variable dosing effects of dopamine

Back 65

1) Lowest doses : causes increased flow in kidneys and intestine (its own dopamine receptors)

2) Medium doses: &beta; receptor agonist leading to increase in cardiac contractility with resulting increase in CO

3) Highest doses - primarily alpha agonist and vasoconstrictor

Front 66

Alpha agonist that causes pure arterial constriction (good in SEPSIS)

Back 66

phenylephrine

Front 67

Nitroprusside is primarily (venous, arterial) vasodilator. while nitroglycerin is primarily (venous, arterial) vasodilator.

Back 67

Arterial; Venous

Front 68

Neurogenic shock - cause

Back 68

Loss of sympathetic tone leading to peripheral vasodilation

Front 69

Tension pneumothorax - tx

Back 69

Placement of chest tube on affected side

Front 70

How are central venous prsesures changed in
A) cardiogenic
B) hypovolemic
shock?

Back 70

A) Increased
B) decreased

Front 71

Cardiogenic shock - how does tx differ from other types of shock?

Back 71

Give dobutamine or dopamine (with/out nitroglycerin) instead of volume resuscitation.

Front 72

In ____ intention, deep layers are closed but subcutaneous layer and skin are left open

Back 72

Secondary

Front 73

In _____ intention, deep layers are closed while subcutaneous layer and skin are left open and packed

Back 73

delayed primary

Front 74

Sump drain: defn

Back 74

Double lumen catheters.

Air or other fluid can go in one lumen while suction is applied to the other lumen.

Front 75

malignancies from mesoderm

Back 75

Sarcoma

Front 76

Highest number of cancer deaths is from ____ cancer overall.

Back 76

lung

Front 77

______ genes are genes expressed during cellular proliferation

Back 77

Proto-oncogenes

Front 78

two copies of recessive gene of _____ are inherited to result in FAP

Back 78

APC

Front 79

HNPCC - pathway to colon cancer

Back 79

Defects in DNA repair

Front 80

Steps in colon carcinogenesis

Back 80

1) APC mutations
2) DCC gene lost (Deleted in Colon Cancer)
3) k-rae mutations --> small adenomatous polyposis emerges
4) loss of second normal allele of p53

Front 81

TNM system - definition

Back 81

For cancer stages

T - describes primary tumor

N - describes involvement of lymph nodes

M - describes distant metastases

Front 82

Atelectasis occurs on days ____ postop

Back 82

1-3

Front 83

Wound infection occurs on days ____ postop

Back 83

5-8

Front 84

UTI occurs on days ____ postop

Back 84

3-5