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141 Cards in this Set
- Front
- Back
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What is the postop FEV1 that you must have to perform a pneumonectomy?
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FEV1 > 800 cc. Thus, a pre-op FEV1 > 2 L is needed for a pneumonectomy.
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What is the ddx for a pulmonary coin lesion?
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Granulomatous disease, benign neoplasm, malignancy.
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What are potential complications of draining a pleural effusion too quickly?
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Reexpansion pulmonary edema, hypotension, circulatory collapse from rapid reexpansion of the collapsed lung.
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What is the arterial supply to the esophagus?
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Proximal 1/3: inferior thyroid, anterior intercostals.
Middle 1/3: esophageal arteries, bronchial arteries. Distal 1/3: left gastric artery, left inferior phrenic artery. |
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How many segments are in the right lung, and how many are in the left lung?
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10 in the right, 8 in the left.
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What are the most common tumors in the anterior mediastinum?
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Thyroid
Teratoma Thymoma Lymphoma |
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What frequency range can the adult human ear detect?
What is the range of human speech? |
200-10,000 Hz
Speech: 400-5,000 Hz |
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What is Morrison's pouch?
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Hepatorenal recess - this is where peritoneal fluid accumulates in supine position.
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What is the name of the circular folds of mucosa of the small bowel?
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Plicae circulares
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Name the layers of the abdominal wall.
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1. Skin, then fat
2. Scarpa's fascia, then more fat 3. External oblique 4. Internal oblique 5. Transversus abdominus 6. Transversalis fascia 7. Preperitoneal fat 8. Peritoneum |
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Signs and symptoms of hypocalcemia.
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Chvostek and Trousseau signs
Perioral paraesthesia Increased DTRs Confusion Abdo cramps Laryngospasm Stridor Seizure Tetany Psychiatric abnormalities |
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Signs and symptoms of hypermagnesemia.
Treatment. |
Respiratory failure, CNS depression, decreased DTRs.
Calcium gluconate IV Insulin plus glucose Furosemide Dialysis |
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Signs and symptoms of hypomagnesemia.
Treatment. |
Increased DTRs, tetany, asterixis, tremor, Chvostek sign, ventricular ectopy, vertigo, tachycardia, dysrhythmia.
IV MgSO4 |
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Complication of severe hypophosphatemia.
Treatment. |
Respiratory failure.
NaPO4 or KPO4, depending on K levels. |
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Signs and symptoms of hyperphosphatemia.
Treatment. |
Calcification (ectopic), heart block.
Aluminum hydroxide (binds phosphate). |
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How long before surgery does Heparin need to be stopped? How about warfarin?
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Heparin: 4-6 hours.
Warfarin: 3-5 days. |
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Which medication is classically associated with mesenteric ischemia?
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Digitalis.
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What pre-op antibiotic would you give for appendectomy or colon surgery?
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Second generation cephalosporin (Cefuroxime)
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What reverses the effects of benzodiazepines?
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Flumazenil.
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What is the most common cause of post-op fever during POD 1 and 2?
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Atelectasis
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When should spontaneous pneumothorax be treated with surgery?
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Complete pneumothorax
Refractory despite chest tube and suction Persistent air leak > 72 hours Bilateral simultaneous Tension pneumothorax Recurrence Complications (empyema, hemothorax, or chronic pneumothorax) Pilots and scubadivers |
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What should you suspect in women with frequent spontaneous pneumothoraces?
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Catamenial pneumothoraces. Look for pores in the diaphragm due to endometriosis.
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Treatment for septic shock
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1. IVF
2. Antiobiotics (empiric) 3. Drain infection source 4. Pressors PRN 5. Zygris PRN - activated Protein C, shown to decrease mortality in septic shock and multiple organ failure |
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What is the antibiotic of choice for Actinomyces?
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Pen G
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What is the appropriate prophylactic step in tetanus prone injury in the following patients:
3 previous immunizations 2 previous immunizations 1 previous immunization No previous immunizations |
3 previous immunizations: nothing, unless last immunization > 5 years in which case you would give tetanus toxoid.
2 previous immunizations: tetanus toxoid. 1 previous immunization: tetanus toxoid, tetanus immunoglobulin IM No previous immunizations: tetanus toxoid, tetanus immunoglobulin IM |
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What is Fitz-Hugh-Curtis syndrome?
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RUQ pain from gonococcal perihepatitis in women
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which organs are associated with the foregut?
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liver, most of pancreas, spleen
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What are sentinel loops?
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Distention or air-fluid levels near site of abdominal inflammation (e.g. seen in RLQ in appendicitis)
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What is "thumbprinting" on AXR?
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Nonspecific colonic mucosal edema resembling thumb indentations on AXR
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What does it mean if there is pneumatosis intestinalis on AXR?
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Gas in intestinal wall. Usually means dead gut.
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What does it mean if there is air on both sides of the bowel wall on AXR?
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Rigler's sign - free air in the peritoneal cavity.
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Normal diameter of common bile duct with gallbladder present?
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< 4 mm until age 40, then add 1 mm per decade
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What should be done for a patient with a known radio contrast allergy?
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Give dexamethasone before, and use non-ionic contrast.
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Contraindications to succinylcholine.
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1. Burn patients
2. Neuromuscular disease, paraplegia 3. Eye trauma 4. Increased ICP Succinylcholine can cause hyperkalemia and also increase intraocular pressure. |
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Why doesn't lidocaine work in an abscess?
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Because it does not work in an acidic environment.
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Why is morphine less often used in patients with pancreatitis and biliary surgery?
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It can cause spasm of the sphincter of Oddi.
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What are nodules of lymphoid tissue in the small intestine (mostly in terminal ileum) called?
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Peyer patches.
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What arteries contribute to the area mostly to bleed during epistaxis?
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4 arteries form the Kiesselbach's plexus in Little's area:
•L - superior Labial artery •E - anterior Ethmoidal artery •G - Greater palatine artery •S - Sphenopalatine artery |
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What is the drug of choice for mucormycosis?
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Amphotericin B
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What is the bleeding from back of nose in an adolescent male considered to be until proven otherwise?
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Juvenile nasopharyngeal angiofibroma
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Which drugs are used to treat epistaxis?
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Oxymetazoline and phenylephrine.
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What agent is used for chemical cauterization?
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Silver nitrate.
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Treatment for otitis externa.
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Aural toilet
Topical debridement Antibiotic eardrops (Ciprofloxacin) Ear wick |
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Organisms that cause otitis externa.
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Staphylococcus aureus
Pseudomonas |
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Treatment of acute otitis media. What are indications for myringotomy and tube insertion?
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Amoxicillin 80 mg/kg/day po div tid x 5 days.
Symptomatic relief with analgesics. Children over 2 years of age, and less than 2 days of symptoms - watchful waiting is reasonable. Myringotomy and tube insertion indicated if: 1. AOM with poor response to antibiotics 2. Complicated AOM 3. Recurrence 4. Chronic TM retraction 5. Barotrauma |
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Causes of conductive hearing loss.
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EAC:
1. Wax 2. Foreign body 3. Edema from OE Tympanic mebrane 1. Perforation Middle ear 1. OM 2. Ossicular deformity 3. Otosclerosis 4. Cholesteatoma 5. Tumors |
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Causes of sensorineural hearing loss.
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Congenital
1. Genetic 2. Infection during pregnancy (CMV, Rubella, Toxo, Syphilis, Herpes) Acquired 1. Jaundice (severe) 2. Meningitis (bacterial) 3. Ototoxic drugs 4. Loud noises 5. Presbycusis 6. Hypoxia |
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What are some ototoxic drugs that can cause sensorineural hearing loss?
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Aminoglycosides
Cisplatin Vancomycin Quinine Loop diuretics Salicylates |
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ENT history taking items for ear problems.
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1. Hearing loss
2. Tinnitus 3. Otalgia 4. Otorrhea 5. Vertigo 6. Pruritus 7. Aural fullness/pressure |
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ENT history taking items for nose problems.
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1. Nasal obstruction
2. Epistaxis 3. Facial or sinus pain 4. Anterior nasal discharge 5. Post-nasal drip 6. Hyposmia/anosmia 7. Sneezing 8. Itchiness 9. Throat clearing |
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ENT history taking items for oral cavity and oropharynx.
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1. Dysphagia
2. Odynophagia 3. Halitosis 4. Bleeding 5. Taste 6. Hemoptysis 7. Hoarseness 8. Globus sensation 9. Throat clearing 10. Cough |
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Ranson's criteria
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On admission: (GALAW)
Glucose > 11.1 Age > 55 LDH AST > 250 WBC > 16 At 48 hours: (CHOBBS) Calcium < 2 mmol/L Hematocrit falls > 10% PaO₂ < 60 BUN (urea increase by > 1.8) Base deficit > 4 Sequestration of > 6 L fluid |
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What is Erb's point?
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A landmark 2.5 cm above the clavicle, on the posterior border of the sternocleidomastoid muscle. It is a landmark for cutaneous branches of the cervical plexus, which emerge from behind the posterior border of the SCM muscle
1. Lesser occipital nerve 2. Greater auricular 3. Transverse cervical 4. Supraclavicular |
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Layers of the neck, including all the cervical fascial layers.
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Skin
Note that there are 4 layers of cervical fascia (1 superficial, 3 deep) 1. Superficial layer of fascia • Platysma lies under 2. Investing layer of the deep cervical fascia • Splits to envelope SCM, strap and trapezius muscles 3. Pretracheal layer of the deep cervical fascia • Envelops the thyroid, pharynx, larynx, trachea, and laterally forms the carotid sheath 4. Prevertebral layer of the deep cervical fascia • Envelops the paraspinous muscles |
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Treatment of flail chest.
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Intubate with positive pressure ventilation, and PEEP prn.
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What signs indicate urethral injury in a trauma patient?
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High riding prostate
Blood at the meatus Perineal/scrotal bruising Foley catheter insertion is contraindicated in the case of urethral injury. |
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What is a FAST exam?
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Focused Assessment with Sonography for Trauma.
Basically an abdominal ultrasound. |
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What are the three trauma zones of the neck?
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Zone III: angle of mandible and up
Zone II: angle of mandible to the cricoid cartilage Zone I: below the cricoid cartilage |
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If you have only one vial of blood from a trauma victim to send to the lab, what test should be ordered?
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Type and cross
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What level does 1st, 2nd and 3rd degree burns affect?
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1st - epidermis, painful.
2nd - episdermis and varying levels of dermis, still painful. 3rd degree - full thickness of dermis, painless. |
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How do you calculate the amount of crystalloid needed for a burn patient?
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Parkland formula:
V = Total Body Surface Area Burn (%) X Weight (kg) X 4 Half of this is given in first 8 hours, the rest over the next 16 hours. |
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What is the name of the gastric/duodenal ulcer assocaited with burn injury?
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Curling's ulcer.
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When is surgery indicated for a duodenal ulcer?
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IHOP:
Intractibility Hemorrhage (massive) Obstruction Perforation |
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What other procedure must be performed along with a truncal vagotomy?
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Drainage procedure (pyloroplasty, antrectomy, or gastrojejunostomy) because pylorus will not open after vagotomy.
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What cancers metastasize to the esophagus?
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Breast cancer
Melanoma Small cell cancer of the lung Hodgkin lymphoma |
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What is the treatment of localized esophageal cancer?
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Surgery is the treatment of choice for lower 1/3 of esophagus. Neoadjuvant chemo and radiation if locally advanced.
Radiation is used for upper 2/3. |
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What are the 6 P's of acute arterial occlusion?
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Pulselessness
Pain Pallor Phrigidity Paresthesia Paralysis |
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What is serous otitis media?
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AKA otitis media with effusion. It is a middle ear effusion without signs of infection. Usually follows an episode of AOM.
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What factors help differentiate between arterial embolism and thrombosis in acute arterial disease?
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SCODAAA
Source recognizable (yes in embolism) Claudication in past (rare in embolism) Onset (sudden in embolism) Demarcation (sharp in embolism) Age (any age in embolism) Arrhythmia (common in embolism) Angiography (sharp cutoff in embolism) |
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What is the ddx of acute arterial occlusion?
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1. Vasospasm
2. Arterial thrombosis 3. Low flow 4. Trauma 5. Aortic dissection 6. Phlegmasia cerulea dolens |
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What is the window of time to restore perfusion to a limb with compromised arterial flow before risk of ischemic irreversible damage?
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6 hours.
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Complications of treating acute arterial occlusion.
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Reperfusion syndrome → acute cardiac decompensation.
Compartment syndrome. Rhabdomyolysis → renal toxicity. |
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What is pseudoclaudication, and how do you differentiate it with claudication?
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Pseudoclaudication: caused by spinal cord stenosis. Patients usually have a trick they do to alleviate pain (e.g. leaning forward, straightening spine).
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What are the two types of diverticulae?
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Pulsion - high intraluminal pressures causes outpouching.
Traction - pulling forces from the outside due to adjacent inflammatory process. |
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On upper GI endoscopy, what are the normal distance of certain structures?
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Landmark distance from the incisors:
15 cm - cricopharyngeus 25 cm - carina of trachea 40 cm - GE junction |
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What are some etiologies of GERD?
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Decreased LES tone
Hiatus hernia Zollinger-Ellison syndrome Scleroderma |
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Typing of hiatus hernia
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Type 1: sliding
Type 2: paraesophageal Type 3: combined sliding and paraesophageal Type 4: small bowel or colon |
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What is the function of the nasal turbinates?
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They increase surface area in order to warm, humidify, and filter air.
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Complications of acute bacterial sinusitis.
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Orbital abscess
□ Periorbital erythema □ Edema Cavernous sinus thrombosis □ Visual loss □ Pain Intracranial abscess □ Epidural or subdural abscess □ Brain abscess Meningitis |
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Best imaging test for Meckel's diverticulum.
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Technetium pertechnetate scan
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Four manifestations of congenital bowel obstruction.
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1. Polyhydramnios
2. Bilious vomit 3. Distended abdomen 4. Failure to pass meconium |
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Causes of duodenal obstruction.
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1. Atresia
2. Malrotation of midgut 3. Annular pancreas |
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Causes of jejunoileal obstruction in pediatric population.
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1. Atresia
2. Meconium ileus 3. Duplication of intestine |
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Causes of colonic obstruction in pediatric population.
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1. Hirschsprung disease
2. Neonatal small left sided colon syndrome 3. Meconium plug 4. Atresia |
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What is recurrent pyogenic cholangitis?
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• Associated with strictures within biliary tree secondary to inflammation caused by parasite: Clonorchis sinensis
• Strictures lead to bile stasis, low grade infection and formation of intrahepatic stones |
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Complications of choledocholithiasis.
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Gallstone pancreatitis
Cholangitis |
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What is Mirizzi's syndrome?
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Impacted stone in the cystic duct causes extrinsic compression of common hepatic duct
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What is involved in the non-operative approach to managing spontaneous pneumothorax?
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1. Observe
2. Oxygen 3. Aspiration 4. Percutaneous drain and Heimlich valve 5. Tube thoracostomy and underwater seal drainage |
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Causes of secondary spontaneous pneumothorax.
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Airway disease
Infection ILD Neoplasm |
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In facial trauma, how long can delay of soft tissue closure be? how long can delay of facial fracture repair be?
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Soft tissue closure: 24 hours.
Fractures: 1 week. |
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What is the symptomatic treatment of SVC obstruction?
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Diuretics
Low salt diet Head elevation Oxygen |
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Which malignancies can cause SVC obstruction?
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Lung cancer
Lymphoma Germ cell tumors |
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Which cancers most frequently cause spinal cord compression?
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Prostate
Breast Lung |
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What is the medical management of raised ICP?
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Mannitol (1 g/kg)
Hyperventilation (aim for PCO₂ of 30) |
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Management of SAH
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Analgesia
Sedate SBP no more than 130-140 mmHg Stool softener (prevent Valsalva) Nimodipine 60 mg po q4h x 21 days (prevents vasospasm) Catheterize (art line, central line, Foley) Coil or clip the aneurysm |
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Who should be screened for aortic aneurysms?
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If > 50 years old, and have first degree relative with AAA
Men > 65 □ Especially with risk factors ? Women > 65 |
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What is the classic triad of signs of AAA?
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1. Collapse
2. Pulsatile abdominal mass 3. Hypotension |
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What is spontaneous axillosubclavian vein thrombosis called?
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Paget Schroetter syndrome
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Which tumours are not radiosensitive?
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Renal cancer
Osteogenic sarcoma |
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Contraindications to radiation therapy.
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Connective tissue disease - SLE, scleroderma
IBD: Crohns, UC Pregnant Genetic DNA repair syndromes ◊ Ataxia-telangiectasia ◊ Xeroderma pigmentosum Pacemaker or defibrillator in treatment field |
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What is an external sign of anal fissure?
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Sentinel pile - hypertrophic skin tags at the distal edge of the fissure.
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Boundaries of femoral hernia.
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Superiorly by iliopubic tract
Inferiorly by Cooper's ligament Laterally by femoral vein Medially by lacunar ligament (insertion of iliopublic tract into Cooper's ligament) |
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What are the 4 hallmarks of cancer?
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• Inappropriate cell proliferation
• Angiogenesis • Invasion and metastasis • Genomic instability |
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Contraindications to radiation therapy
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Connective tissue disease - SLE, scleroderma
IBD: Crohns, UC Pregnant Genetic DNA repair syndromes - ataxia-telangiectasia, xeroderma pigmentosum Pacemaker or defibrillator in treatment field |
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What are some early and late side effects of radiation therapy?
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Early:
- Usually affects rapidly dividing cells > slowly dividing cells - GI - Skin - Hair - Fatigue - Nausea Late side effects - Osteoporosis - Telangiectasia - 2ndary cancers |
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Side effects of tamoxifen
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Hot flushes
DVT, VTE Fluid retention Endometrial cancer Uterine bleeding |
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What is the pre-op antibiotics to give for bowel surgery?
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Ciprofloxacin 400 mg IV q12h
Flagyl 500 mg IV q12h |
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Risk factors for developing varicose veins
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□ Genetics
□ Pregnancy □ Standing occupation □ Obesity □ Age □ Female, Caucasians □ Previous DVT |
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Side effects of Heparin.
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- bleeding
- HITT - osteoporosis |
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Side effects of warfarin.
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- bleeding
- teratogenesis - skin necrosis - drug interactions |
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Breast cancer: lobular CIS and ductal CIS - which one has higher potential to become invasive?
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Ductal CIS.
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Risk factors for breast cancer.
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- Family history
- BRCA1 or BRCA2 - Breast hyperplasia with atypia - Personal history of lobular CIS - Mammographic density > 75% of breast volume - Age - North american - Nulliparity - High social status - Early age of menarche, later age at menopause |
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Four I's in ADDAVID
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Investigations
IV fluids Imaging INs and OUTs |
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7 P's in admission/post-op orders.
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Pain
PE prophylaxis Pillow Poop Pus Puke Past meds |
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Rule of nines for adult burn victims.
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Upper limbs 9%
Head 9% Anterior and posterior trunk each 18% Lower limbs 18% Genitalia and perineum 1% |
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Indications for thyroid surgery.
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Cancer suspicion
Pressure symptoms Hyperthyroidism Cosmetic reasons |
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What skin changes happen with carcinoid tumours?
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Pellagra-like symptoms, due to decreased niacin production:
-dermatitis -diarrhea -dementia |
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Why does carcinoid tumour cause SBO?
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Severe mesenteric fibrosis.
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Gardner's syndrome.
Peutz-Jeghers' syndrome. Turcot's syndrome. |
Gardner's: colorectal adenomatous polyps, sebaceous cysts, osteomas, desmoid tumours.
Peutz-Jeghers' syndrome: hamartomas throughout GI tract, ovarian cancer, buccal melanotic pigmentation. Turcot's syndrome: colon polyps, CNS tumours (GBM). |
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What test is done to localize lower GI bleed if there is too much active bleeding to see with a colonoscopy?
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Mesenteric angiography.
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What is the name of the liver capsule
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Glisson's capsule.
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What is the max amount of liver that can be resected while retaining adequate liver function?
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> 80%
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What is Cantle's line?
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Line drawn between gallbladder and to just left of IVC that transects the liver into right and left lobes.
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Indications for carotid endarterectomy.
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Asymptomatic carotid stenosis > 60% (ACAS study)
TIA with significant carotid artery stenosis CVA with substantial neurologic recovery and significant carotid artery stenosis Nonfocal neurologic symptoms along with: ◊ Bilateral high-grade stenosis or ◊ Unilateral occlusion and contralateral stenosis |
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Definition of an aneurysm.
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Greater than 1.5 times the normal diameter of an artery.
Bulging of all 3 layers of vessel wall = true aneurysm. |
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What is the concept of Laplace's Law?
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T = ( P * R ) / M
Wall tension in an artery is proportional to pressure * radius. It explains risk for aneurysms. |
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Risk factors for developing arterial aneurysms
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Smoking
Cholesterol Hypertension Age Men Family history of aneurysms |
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Indications for surgery in AAA.
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AAA which is asymptomatic and over 5-5.5 cm in diameter.
Saccular aneurysm of any size. Symptomatic. Rapidly enlarging. |
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Treatment of pulmonary contusion.
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Fluid restrict. Give colloid fluid if necessary to give fluid.
Diuretics. Respiratory support if necessary (intubate, PEEP). |
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What does the timing of blood in urine (initial, total, terminal) tell you?
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Initial - usually arises from the urethra (BPH, anterior urethral lesions)
Total - usually arises from above the bladder Terminal - usually arises from bladder neck, trigone or posterior urethra (tumors, TB, posterior urethritis, schistosomiasis) |
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Differential for an abnormal prostate exam (DRE)
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• BPH
• Prostate calculi • Prostate cyst • Prostate TB • Chronic granulomatous prostatitis • Previous TURP or needle biopsy |
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T stages of prostate cancer.
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T1 - no nodule, but tumor found on biopsy/TURP
T2 - tumour palpable by DRE and confined to gland T2a - one lobe T2b - both lobes T3 - tumour protrudes beyond prostate T4 - tumour has extended beyond prostate |
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What is the indication for surgery in the different types of hernias and hydroceles in pediatric population?
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Inguinal hernia - never resolve spontaneously, therefore operate.
Hydroceles - if non-communicating, will self-resolve. If communicating, watch for 1 year and repair if not resolving. Umbilical hernia - conservative in most cases. Surgery if persist beyond age 4, or > 1.5 cm fascial defect by age 2. |
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Differential of a midline neck mass.
Differential of a lateral neck mass. |
Thyroglossal duct cyst.
Dermoid cyst. Lymph node. Ectopic thyroid gland. Lymph node. Cystic hygroma. Branchial cleft cyst. |
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Treatment of intussusception in pediatric population.
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Barium enema may be able to reduce it.
If not, then surgical reduction. |
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Absolute indications for tonsillectomy.
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Recurrent tonsillitis
Recurrent PTA Severe airway obstruction Malignancy (suspected) |
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Treatment of subarachnoid hemorrhage.
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1. Analgesics, sedation
2. BP control - up-to-date recommends placing a ventriculostomy, which allows monitoring of ICP and decreasing ICP at the same time 3. Catheterize (arterial, CVP, Foley) 4. CCB (Nimodipine 60 mg po q4h x 21 days) 5. Clip the ruptured aneurysm 6. Stool softener (prevent Valsalva) |
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Classic antibiotics for "triple" antibiotics.
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Flagyl
Ampicillin Gentamicin |
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Diagnostic tests for hypercalcemia when suspecting parathyroid adenoma.
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PTH
Sestamibi scan |
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T stages of lung cancer.
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T1: size < 3, surrounded by lung
T2: - Between 3-7 cm - Involvement of visceral pleura or main bronchus but > 2 cm from carina T3: > 7 cm or involvement of chest wall mediastinal pleura, diaphragm, main bronchus < 2 cm from carina T4: - Invasion of carina, heart, esophagus, mediastinum, vertebrae |
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What are indications for thyroid surgery?
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Cosmesis
Compression symptoms Cancer Hyperthyroidism |
