Transplant, Trauma

Front 1

hyperacute rejection: why?

Back 1

preformed antibodies (do NOT transplant when crossmatch is positive)

Front 2

acute rejection: why?

Back 2

foreign MHC antigens of graft cells

Front 3

acute rejection: tx

Back 3

Muromonab-CD3 (trade name Orthoclone OKT3)

monoclonal antibody targeted at the CD3 receptor, a membrane protein on the surface of T cells.

Front 4

Muromonab/OKT3: MOA

Back 4

monoclonal antibody targeted at the CD3 receptor, a membrane protein on the surface of T cells.

Front 5

chronic rejection: why?

Back 5

gradual loss of blood supply

Front 6

immunosuppression affects (cellular, humoral) system more, therefore more at risk for ____ infection

Back 6

cellular; viral

Front 7

#1 virus post-transplant

Back 7

CMV

Front 8

azathioprine: MOA

Back 8

6-MP derivative

Purine analog that acts as antimetabolite to decrease DNA synthesis (fewer T cells)

Front 9

mycophenolate (cellcept) : MOA

Back 9

blocks purine synth to decr T and B cell proliferation

Front 10

cyclosporine: MOA

Back 10

inhibits mRNA encoding IL-2 (interferes with growth of T Cells)

Rotamase inhibitor

Front 11

cyclosporine: toxicity to what organ system?

Back 11

kidneys

Front 12

FK506/Tacrolimus: MOA

Back 12

blocks IL-2 expression/production from T cells

Front 13

prednisone: MOA in preventing organ rejection

Back 13

blocks IL-1 from macrophages

Front 14

What to do if theres biliary stricture post liver transplant?

Back 14

check hepatic a flow, bc it might be due to ischemia

Front 15

#1 cause of oliguria post renal transplant

Back 15

ATN

Front 16

Catecholamine response to injury maximal when?

Back 16

24-48 hours

Front 17

#1 cause of preventable blunt trauma death

Back 17

missed abdominal injury

Front 18

neck zones (I-III) and implications

Back 18

I: below cricoid

II: cricoid to angle of jaw (most amenable to OR exploration)

III: jaw to skull


LOW TO HIGH

Front 19

Diagnostic peritoneal lavage: defn

Back 19

a vertical skin incision is made one third of the distance from the umbilicus to the pubic symphysis. The linea alba is divided and the peritoneum entered after it has been picked up to prevent bowel perforation. A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.

Front 20

Diagnostic peritoneal lavage: What are positive findings?

Back 20

Presence of :
-1.1cc frank blood
-food
-bile
-bacteria
->100k RBC/mm
->500 WBC/mm

Front 21

Diagnostic peritoneal lavage: next step if positive

Back 21

x lap

Front 22

cardiac tamponade: what causes hypotension?

Back 22

decrease filling during diastole (heart can't expand against fluid in pericardial sac)

Front 23

Fat emboli: symptoms

Back 23

petechiae

hypoxia

confusion/agitation

sudan urine stain for fat

Front 24

Fat emboli: dx

Back 24

sudan urine stain for fat

Front 25

Thoracotomy for hemothorax: indications

Back 25

instability

>1500ml out initially

>200 mL/hr for 4 hours

incompletely drained hemothorax despite 2 good tubes

Front 26

diaphragm rupture will be on (right, left)

Back 26

Left

Front 27

diaphragm rupture: dx

Back 27

NG tube in chest on CXR

Front 28

diaphragm rupture: treatment

Back 28

laparotomy

Front 29

surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity

Back 29

laparotomy

Front 30

Splenectomy is treatment in what diseases?

Back 30

Hereditary spherocytosis

ITP (80%)

NOT TTP

Front 31

TTP: tx

Back 31

plasmapheresis

Front 32

TTP: what is it and cause

Back 32

rare disorder of the blood-coagulation system, causing extensive microscopic clots to form in the small blood vessels throughout the body

cause: inhibition of ADAMTS13, protease that cleaves large vWF molecules. Causes formation of clots that damage RBCs when they go thru the clots --> hemolytic anemia and schistocytes

Front 33

Idiopathic thrombocytopenic purpura: what is it and cause

Back 33

usually due to formation of antibodies against platelets.

Front 34

Idiopathic thrombocytopenic purpura: tx

Back 34

splenectomy

Front 35

Pulmonary compliance: defn

Back 35

C = V/P

Change in volume for a given change in pressure. You want high pulmonary compliance.

Front 36

Pulmonary compliance: when does it decrease?

Back 36

In ARDS, pulmonary edema (takes greater pressure to get same volume)

Front 37

O2 delivery equation:

Back 37

Cardiac Output * O2 content of blood = CO * (Hb*1.3*O2sat)

Front 38

O2 content of blood equation

Back 38

Hb * 1.3 * O2 Sat

Front 39

O2 use equation

Back 39

Cardiac output * (CaO2 - CvO2)

Front 40

Air embolus: treatment

Back 40

1) Trendelenberg with L side down
2) Air aspiration via central line in RA

Front 41

Positive End Expiratory Pressure (PEEP) : defn

Back 41

pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration

Front 42

Positive End Expiratory Pressure : what does it do?

Back 42

Mitigates end-expiratory alveolar collapse

Increases FRC, increases compliance

Front 43

Positive End Expiratory Pressure : what can it cause that's bad?

Back 43

pneumothorax if set too high

Front 44

the amount of air in lungs after normal exhalation is known as ____

Back 44

FRC (functional residual capacity)

Front 45

Greatest volume that can be exhaled

Back 45

Vital capacity

Front 46

What causes increased O2 dissociation from Hb? (right shift)

Back 46

Increase temp

Increased CO2

H+

2,3 DPG (high altitude, babies)

Front 47

What is EDRF and what does it do?

Back 47

NO. Made from Arg in endothelial cells.

Causes vasodilation via cGMP, increased in sepsis

Front 48

HF burns: treatment

Back 48

Calcium (topical)

Interferes with body's calcium metabolism

Front 49

____ falsely elevates O2 Sat reading.

Back 49

CO

Front 50

Tx for CO poisoning

Back 50

100% o2

Front 51

#1 infection in burn patients

Back 51

pneumonia

Front 52

Silver sulfadiazine (aka silvadene): what's it used for?

Back 52

topical burn cream on burns, including chemical burns. It prevents the growth of a wide array of bacteria, as well as yeast, on the damaged skin.

Front 53

Silver sulfadiazine (aka silvadene): adverse effects

Back 53

Risk of neutropenia. Poor eschar penetration

Front 54

Silver nitrate: adverse effects

Back 54

hyponatremia and hypochloremia due to leeching of NaCl

Front 55

What changes in burn patient's cardiac physiology?

Back 55

initially have drop in cardiac output, then become hyperdynamic

Front 56

Marjolin's ulcer: defn

Back 56

Squamous cell cancer arising in previously traumatized, chronically inflamed, or scarred skin.

They are commonly present in the context of chronic wounds including burn injuries, venous ulcers, ulcers from osteomyelitis, and post radiotherapy scars.

Front 57

Suspected basilar skull fx (raccoon eyes, CSF nosebleed, ecchymosis behind ear): what's next?

Back 57

neurosurgery consult, ANTIBIOTICS

Front 58

hypovolemic shock: immediate tratment

Back 58

Fluid resuscitation thru large-bore IV

foley cath

iv abx

Front 59

symptoms common to tamponade and tension pneumo

Back 59

distended neck veins

high CVP

Front 60

CVP: what is it and what dose it measure?

Back 60

describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system.

Essentially measuring preload

Front 61

tension pneumo sx:

Back 61

trachea deviation to OTHER side

absent breath sounds ipsilaterally

resonant hemithorax

distended neck veins

Front 62

pericardial tamponade: tx

Back 62

Pericardial window

then thoracotomy

then ex lap

Front 63

Pericardial window: defn

Back 63

cardiac surgical procedure to create a fistula - or "window" - from the pericardial space to the pleural cavity.[1] The purpose of the window is to allow a pericardial effusion (usually malignant) to drain from the space surrounding the heart into the chest cavity - where the fluid is not as dangerous; an untreated pericardial effusion can lead to cardiac tamponade and death.

Front 64

tension pneumo: tx

Back 64

needle place into ipsilateral 2nd ICS

Front 65

tx for vasomotor (anaphylactic) shock

Back 65

Vasoconstrictors and fluid resuscitation

Front 66

Flail chest: physical findings

Back 66

Inhaling causes chest to cave in (paradoxical breathing)

Multiple rib fx

Front 67

Colloid vs Crystalloid fluids

Back 67

Colloids preferentially increase intravascular volume

Crystalloids increase intravascular, intracellular, and interstitial

Front 68

plain pneumothorax: tx

Back 68

Chest tube to underwater seal and suction high in pleural cavity

Front 69

hemothorax: dx

Back 69

CXR

will be dull to percussion (contrast with PTX)