Surgery 3

Front 1

Prophy Abx of choice

Back 1

Amox (or amp if IV)
Pen-allergic: clinda or cephalexin (or cefazolin if IV)

Front 2

Rx for amebic liver abscess

Back 2

Metronidazole

Front 3

Rx for pyogenic liver abscess

Back 3

Perc drainage + Abx against G- and anaerobes

Front 4

Best diagnostic test to determine treatment for sliding hiatal hernia?

Back 4

Flexible endoscopy to look for esophagitis

Front 5

1st test when extrahepatic biliary obstruction is suspected?

Back 5

EUS

Front 6

Increased SGOT and SGPT indicate

Back 6

Hepatocellular disease

Front 7

Increased alk phos indicates

Back 7

Biliary obstruction

Front 8

Obese/hirsute man with painful fluctuant mass btwn gluteal clefts

Back 8

Infected pilonidal cyst

Front 9

Hematochezia, fever, abd pain

Back 9

Ischemic colitis

Front 10

Management of ischemic colitis vs. acute mesenteric ischemia

Back 10

Expectant (IVF, bowel rest, supportive) vs. surgery

Front 11

Pts who undergo major colon resections undergo what change in their bowel habits?

Back 11

None, usually; lots of reserve capacity for water absorption

Front 12

Pts who undergo major colon resections undergo what change in their bowel habits?

Back 12

None, usually; lots of reserve capacity for water absorption

Front 13

Work-up of rectal cancer

Back 13

Rigid proctoscopy (to assess distance of lesion from anal verge); barium enema or colonoscopy to r/o other lesions; CT abd/pelvis for mets; MRI for extent of local invasion; endorectal US for depth of invasion

Front 14

Where are most dietary carbs absorbed?

Back 14

Duodenum (even in short gut syndrome is in residual jejunum)

All of milk except fat absorbed in duodenum

Front 15

Rx for hepatic adenomas <4cm vs. >4cm

Back 15

OCP cessation vs. surgical resection b/c of risk of rupture/hemorrhage

Front 16

Management of acute hemorrhage from L-sided portal HTN (gastric varices + splenic or portal vein thrombosis w/o cirrhosis)

Back 16

Splenectomy

Front 17

Management of hepatic focal nodular hyperplasia

Back 17

Nothing

Front 18

Acute appendicitis presentation but w/ terminal ileum edema/fibrinopurulent exudate in OR

Back 18

Regional enteritis; in kids, just do appy

Front 19

Management of iatrogenic injury of CBD --> biliary stricture

Back 19

End-to-side choledochojejunostomy (Roux-en-Y) performed over a stent

Front 20

Acute intestinal radiation injury is manifested by

Back 20

Diarrhea or GI bleeding

Front 21

Chronic intestinal radiation injury causes ___ and can lead to these clinical problems

Back 21

Progressive vasculitis and fibrosis

Malabsorption, ulceration, fistulization, or perforation

Front 22

4 things that inhibit intestinal motility

Back 22

Sympathetics: drugs, hormones, emotions (fear)
Gastrin

Front 23

Factor that stimulates intestinal motility

Back 23

Parasyms: acetylcholine

Front 24

Best test for diagnosis of gastrinoma

Back 24

Secretin stimulation test

Front 25

Another name for gastrinoma

Back 25

Zollinger-Ellison syndrome

Front 26

Most common location of a gastrinoma

Back 26

"Gastrinoma triangle" : duodenum, junction of neck/body and pancreas, and junction of cystic and common bile duct

Front 27

Expected fluid/electrolyte status in SBO

Back 27

Dehydration from vomiting and poor oral intake

Contraction alkalosis with hypokalemia (due to loss of H+, Na+, and Cl-)

Front 28

Concern with SBO and heme-positive stool in rectum

Back 28

Obstructing tumor or ischemic bowel

Front 29

Management of SBO due to inguinal hernia

Back 29

Urgent repair and relief of bowel obstruction due to risk of strangulation

Front 30

Most common tumor that metastasizes to the intestine

Back 30

Melanoma

Front 31

Indications for surgical exploration with SBO

Back 31

Localized abdominal tenderness, fever, tachy, leukocytosis, metabolic acidosis (high risk for strangulation)

Front 32

2 operative management choices for pt with SBO with uncertain bowel viability

Back 32

Resect and anastamose
OR
Second look operation 24hrs later

Front 33

Greatest risk associated w/ enterotomy

Back 33

Postop leak and development of small bowel fistula

Front 34

3 causes of abdominal distention other than SBO

Back 34

Ileus, air swallowing, constipation

Front 35

Diagnostic tests for suspected ischemic bowel

Back 35

Sigmoidoscopy
Mesenteric angiogram (to determine whether candidate for surgical revascularization)

Front 36

Long-term medical Rx after surgical revascularization

Back 36

ASA

Front 37

Management if full-thickness necrosis found on sigmoidoscopy

Back 37

Exploration and resection (vs. mucosal ischemia only, can observe closely)

Front 38

Long-term management of pt with necrosis from ligament of Treitz to transverse colon

Back 38

Can resect, esp in younger pt, but will have short bowel syndrome and need chronic TPN/ small bowel transplant

Front 39

Most common location for Crohn's

Back 39

Ileocolic

Front 40

Thickened bowel wall with fibrous strictures and deep fissures

Back 40

Crohn's

Front 41

Epithelial ulceration and crypt abscesses

Back 41

UC

Front 42

Noncaseating granulomas or mesenteric lmphadenopathy can both indicate this type of IBD

Back 42

Crohn's

Front 43

Focal aphthous ulcers can indicate this type of IBD

Back 43

Crohn's (whereas general ulceration is usually UC)

Front 44

What is the "string sign" and what does it indicate?

Back 44

Narrowing of terminal ileum from edema: Crohn's

Front 45

Rx for acute disease vs. prevention in UC

Back 45

Steroids for acute
5-aminosalicylic acid for prevention of relapse

Front 46

Drug for perianal Crohn's

Back 46

Metronidazole

Front 47

Problems associated w/ resection of the terminal ileum

Back 47

Poor reabsorption of bile acids and vita B12 --> diarrhea, malabsorption, oxalate stones, B12 deficiency

Front 48

Rx for Crohn's disease of the rectum

Back 48

Can use 5-acetylsalicylic acid

Front 49

Screening recommendations for UC of pancolitis vs. L-colon only

Back 49

Colonoscopy every 1-2yrs beginning after 8yrs of disease vs. after 10yrs of disease

Front 50

Why are random biopsies during colonoscopy necessary in UC?

Back 50

Colon cancer of UC doesn't always follow sequence of polyp --> cancer

Front 51

Fever, blood-tinged diarrhea, and pain on defecation after a total proctocolectomy w/ ileal pouch- anal anastamosis

Back 51

Pouchitis

Front 52

Rx for pouchitis

Back 52

Metronidazole

Front 53

Pt with UC, abdominal pain, distention, fever, and bloody diarrhea

Back 53

Worry about toxic megacolon

Front 54

Diagnostic test for toxic megacolon

Back 54

Abdominal series (v. dilated colon w/ mucosal edema and w/o signs of abscess or perforation); often also a CT to r/o abscess or perf

Front 55

Rx for toxic megacolon

Back 55

If stable: NGT, NPO, TPN, IVF, broad spectrum Abx, high-dose IV steroids

Front 56

Suspected toxic megacolon + free air on upright CXR

Back 56

Perforation! Immediate OR

Front 57

Air in wall of colon on XR

Back 57

Impending perforation, likely OR!

Front 58

PEX manuever that must always be done when appendicitis is suspected?

Back 58

Rectal exam to detect pain in the right pelvis from retrocecal appendicitis

Front 59

Appendicitis like presentation + dysuria/urinary WBCs

Back 59

Possibly uncomplicated UTI, but also possibly appendiceal abscess in continuity w/ bladder

Front 60

Abd pain + urinary RBCs too numerous to count

Back 60

Severe UTI or kidney stone

Front 61

Pregnant woman with RUQ pain

Back 61

Worry about appendicits (appendix has been shifted)

Front 62

Surgical management of perforated appendicitis w/ localized abscess

Back 62

Appy + incise, drain, and irrigaet abscess; leave closed drain in abscess draining to outside; close muscle but leave skin open

Front 63

Suspected appendicitis with small yellow firm mass at TIP of appendix

Back 63

Carcinoid tumor (if not spread, just needs routine appy)

Front 64

Suspected appendicitis with larger yellow firm mass at BASE of appendix

Back 64

Needs excision; if >2cm or at base, suggestive of malignancy and indication for R colectomy

Front 65

Diagnostic tests needed after carcinoid tumor diagnosed on path

Back 65

Baseline urinary 5-hydroxyindoleacetic acid (5-HIAA) and serum serotonin level (carcinoid determinants of malignancy involve mostly biological behavior of tumor)

Front 66

Management of postop pelvic abscess

Back 66

Drain w/ perc catheter if possible, other open surgical drainage (or transrectal/ transvaginal drainage)

Front 67

Colonoscopy screening for pts with first degree relative w/ CRC or adenomatous polyp?

Back 67

Starts at 40yo (or 10yrs prior to relative's diagnosis?)

Front 68

Colonoscopy screening for pts with FH of FAP?

Back 68

Genetic counseling, yearly flex sig

Colectomy once polyps discovered

Front 69

Colonoscopy screening for pts with FH of HNPCC?

Back 69

Genetic testing and colonoscopy every 1-2yrs beginning at age 20yo, yearly beginning at 40yo

Front 70

Colonoscopy screening for pts w/ Hx of large or multiple adenomatous polyps that were remoevd?

Back 70

Colonoscopy 3yrs after removal

Front 71

Colonoscopy screening for pts with Hx of CRC

Back 71

Colonoscopy 1yr after initial op, screening at 3yrs and then 5yr intervals

Front 72

CEA measurement indications after CRC

Back 72

Every 2-3mo for 2yrs (detects 80% of recurernces)

Front 73

Surgical management for external vs. internal hemorrhoids

Back 73

External: excision
Internal: excision or banding

Front 74

Any hemorrhoids w/ bleeding need what?

Back 74

Colonoscopy to r/o colon cancer

Front 75

2 types of polyps

Back 75

Pedunculated (on a stalk)
Sessile (flush w/ mucosa)

Front 76

F/u after polypectomy

Back 76

Repeat colonoscopy after 3-6mo to ensure sucessful removal and then surveillance colonoscopy every 3yrs

Front 77

Management of carcinoma in head sv. stalk of pedunculated polyp

Back 77

Head: polypectomy only
Stalk (esp if margin <2cm, poorly differentiated, or vascular/lymphatic invasion): may require bowel resection in addition to polypectomy

Front 78

Staging studies for colon cancer

Back 78

CXR
CEA
LFTs

Front 79

Most common presenting symptoms of R or L-sided colon cancer

Back 79

Pain/mass

Front 80

Most common presenting symptoms of sigmoid colon cancer

Back 80

Pain or bowel complaints

Front 81

Most common presenting symptoms of rectal cancer

Back 81

Bowel complaints or bleeding

Front 82

Prep before bowel surgery (3 parts)

Back 82

- Bowel prep (polyethylene glycol or mag citrate)
- Oral nonabsorbed Abx (to decrease colonic bacteria)
- Single preop dose of 2nd generation cephalosporin (to decrease wound infections)

Front 83

Specific places to explore for colon cancer mets

Back 83

Small bowel mesentery, peritoneal surface, diaphragm, liver

Front 84

Postop management after colon cancer surgery

Back 84

NPO w/ IVF until bowel function returns; d/c when tolerating food

Front 85

Colon cancer prognosis worse for these types of tumors (4)

Back 85

Mucus-producing
Signet ring cell tumors
Tumors p/w bowel perf
Tumors w/ venous or perineural invasion

Front 86

What types of adjuvant chemo are used in colon cancer pts and for what stage?

Back 86

Stage III
5-FU and leucovorin or levamisole

Front 87

Screening f/u after colon cancer

Back 87

Repeat colonoscopy at 6mo then 12mo intervals + frequent monitoring of CXR, CEA, and LFTs

Front 88

Management of colon cancer + large liver lesion

Back 88

Large liver lesions shouldn't be resected at tmie of surgery

Front 89

Feculent vomiting postop from colectomy ddx (2)

Back 89

Leakaeg from anastomosis --> persistent ileus

Mechanical obstruction

Front 90

Cause of feculent material draining from inferior wound

Back 90

Anastomotic leak that is spontaneously draining to skin; should close with NPO and IVF; need CT scan to determine if there is undrained collection

Front 91

Diagnosis and management of distended colon

Back 91

Likely sigmoid or cecal volvulus

Proctosigmoidoscopy first to eval for/hopefully treat sigmoid volvulus; if negative, emergent celiotomy for presumed cecal volvulus (risk of rupture in 1-2hrs)

Front 92

Common additional site of liver cysts

Back 92

Lung

Front 93

2 equivalent management options for echinococcal liver infections

Back 93

Surgical drainage

Albendazole/mebendazole + perc drainage

Front 94

2 causes of feculent vomiting after colectomy

Back 94

- Leakage from anastomosis --> persistent ileus
- Mechanical obstruction due to adhesions, hernia, or obstructed anastamosis

Front 95

Management of feculent material draining from inferior aspect of colostomy wound

Back 95

Likely due to anastomotic leak

NPO, IVF, usually will self-close

Front 96

Pt 6mo s/p colostomy for colon cancer returning w abd pain, constipation, small stools

Back 96

Concern for anastomotic recurrence of cancer or stricture at anastomosis

Front 97

Rectal carcinomas spread to which lymphatic nodes?

Back 97

Internal iliac
Sacral
Inferior mesenteric
Inguinal (if <5cm from anal verge)

Front 98

Type of resection necessary for rectal cancer >5cm above anal verge vs. <5cm

Back 98

>5cm, can do anterior resection

<5cm, need abdominoperineal resection due to margins including sphincter

Front 99

Which rectal cancers require postop chemo?

Back 99

Stage III (regional LNs) or high-risk stage II

Front 100

Which rectal cancer pts receive preop radiation?

Back 100

Those with large/bulky tumors

Front 101

2 alternatives to colostomy for rectal carcinoma

Back 101

Sphincter-preserving proctectomy or local resection

Front 102

Pelvic pain after rectal cancer

Back 102

Early postop: operative nerve injury or infection

Later: need to r/o local recurrence w/ CT pelvis

Front 103

Which hepatic mets are unresectable?

Back 103

Multiple lesiosn in both lobes, lesions intimate w/ vascular structures or invading local structures, or lesions in cirrhotic livers

Front 104

Most common cause of anal cancer and presenting symptoms

Back 104

SCC
Bleeding, drainage, pain, pruritis

Front 105

Where does anal cancer metastasize to?

Back 105

Inguinal LNs (also superior rectal LNs)

Front 106

Staging w/u for anal cancer

Back 106

CT and transrectal US

Front 107

3 treatment regimens for anal cancer depending on location of lesion:
- Superficial, small, mobile
- Large w/o extension or LNs
- + LNs

Back 107

- Local excision alone
- Nigro protocol: chemo (5-FU, mitomycin C) and radiation, then resection only if there's biopsy-proven residual cancer
- Chemoradiation, then radical resection

Front 108

Pain med to be avoided in diverticulitis

Back 108

Morphine (b/c increases intracolonic pressure)

Front 109

Management of 2nd episode of diverticulitis

Back 109

Elective resection 4-6wks after inflammation has resolved (b/c risk of significant complication (perf, abscess) increases w/ each recurrence)

Front 110

What is required before surgery for diverticulitis?

Back 110

Preop or intraop colonoscopy to identify region w/ diverticula

Front 111

Diverticulitis w/ patient deteriorating

Back 111

Free perforation or intra-abdominal abscess

Front 112

Eval for suspected perf/abscess from diverticulitis

Back 112

CT

Front 113

Management of diverticulitis abscess

Back 113

CT-guided needle insertion of catheter in collection

Front 114

What is Ogilvie syndrome?

Back 114

Pseudo-obstruction: massive cecal and colonic dilation in absence of mechanical obstruction

Front 115

Management of Ogilvie syndrome?

Back 115

D/c narcotics/ anticholinergics; endoscopic colonic decompression if dilation >10cm; surgery if perforation or ischemia suspected

Front 116

Cause of Zenker's diverticulum

Back 116

Premature contraction of cricopharyngeal muscle on swallowing --> partial obstruction

Front 117

Symptoms of Zenker's

Back 117

Dysphagia, regurgitation, recurrent aspiration PNA

Front 118

Diagnosis and treatment of Zenker's

Back 118

Barium swallow
Diverticulectomy w/ cricopharyngeal myotomy

Front 119

RUQ pain, jaundice, GI bleeding

Back 119

Quincke triad for hemobilia

Front 120

Causes of hemobilia

Back 120

Iatrogenic (from percutaneous liver procedures), anticoagulation, gallstones, parasitic infection, neoplasm

Front 121

Diagnosis and treatment of hemobilia

Back 121

Angiography/ endoscopy
Angiographic embolization if intrahepatic
Surgery if bleeding from extrahepatic bile ducts or gallbladder

Front 122

Noncaseating granulomas are associated with this type of IBD

Back 122

Crohn's

Front 123

IBD w/ crypt abscess

Back 123

UC

Front 124

Sensation of voided air with urination

Back 124

Pneumaturia, e.g. from colovesical fistula

Front 125

Most common type of fistula due to diverticulitis

Back 125

Colovesical fistula

Front 126

Most common cause of rapid lower GI bleeding

Back 126

Bleeding diverticula and vascular ectasias

Front 127

Rx for vascular ectasia

Back 127

Coagulation w/ monopolar current

Front 128

Why are diverticula associated w/ bleeding?

Back 128

Underlying vasa recta artery penetrating thru bowel wall

Front 129

How to diagnose an ongoing GI bleed w/ negative upper and lower scopes

Back 129

Technetium-labeled RBC scan or mesenteric angiography

Front 130

When to use angiography vs.RCN scanning

Back 130

Angiography in less stable pts
RBC scanning in more stable pts, can detect slower bleeds

Front 131

2 treatment options for bleeding discovered during angiography

Back 131

Vasopressin into the vessel
Embolization

Front 132

Typical pt/ causes of sigmoid volvulus

Back 132

Debilitated pts from nursing homes due to chronic laxative use, chronic illness, or dementia

Front 133

Type of obstruction in sigmoid volvulus

Back 133

Closed loop obstruction

Front 134

Rx for sigmoid volvulus

Back 134

Rigid proctosigmoidoscopy and placement of rectal tube

Front 135

Definitive Rx for sigmoid volvulus

Back 135

Sigmoid colectomy w/ colostomy or anastomosis

Front 136

Rx for cecal volvulus

Back 136

Urgent surgical treatment w/ detorsion alone, cecopexy, or right colectomy

Front 137

3 treatment options for Ogilvie's syndrome w/ colon diameter >11-12cm (otherwise conservative Rx)

Back 137

1) Endoscopic decompression
2) Neostigmine (increases colonic tone and counteracts dilation)
3) Surgical decompression

Front 138

Rx for rectal prolapse

Back 138

Internal: high fiber diet
External w/ bleeding: surgery

Front 139

3 surgical options for prolapse

Back 139

1) Rectopexy (no removal)
2) Transabdominal rectosigmoid resection
3) Perineal approach w/ removal and anastamosis

Front 140

Rx for anal fissures (conservative vs. more invasive)

Back 140

Bulk agents/ softeners, sitz baths

If deep and chronic, lateral sphincterotomy +/- biopsy if suspicious for cancer

Front 141

What are anal fissures and what causes them?

Back 141

Tears in the anoderm (--> painful BM, tenderness on palpation, blood on TP) due to repeated trauma from hard stools or IBD

Front 142

Pain and drainage in sacrococcygeal area

Back 142

Pilonidal abscess (infection in hair-containing sinus in sacrococcyx)

Front 143

Rx for pilonidal abscesses

Back 143

Unroof, remove all hair, leave open to heal by secondary intention

Front 144

Most common complications of stomas

Back 144

#1: leakage around the bag
Also parastomal herniation, bowel obstruction abscess, fistula formation

Front 145

What is a Hartmann pouch?

Back 145

If distal bowel is closed and not brought to abdominal wall but rather dropped back into pelvis

Front 146

Common indication for Hartmann pouch

Back 146

Diverticulitis when bowel can't be safeul reconnected

Front 147

Small intestine bleeding in a pt under 30

Back 147

Meckel's diverticulum

Front 148

Work-up for suspected Meckel's?

Back 148

99m-Tc pertechnate scan

Front 149

What type of tumor is a carcinoid tumor?

Back 149

Apudoma

Front 150

Congenital cystic dilation of the extrahepatic biliary duct?

Back 150

Choledochal cyst

Front 151

Management of choledochal cyst?

Back 151

Complete resection of cyst (due to risk of malignant changes) and roux-en-y choledochojejunostomy

Front 152

What is stress ulceration?

Back 152

Acute gastric or duodenal erosive lesions following shock, sepsis, major surgery, trauma, or burns

Front 153

Cause of stress ulceration?

Back 153

NOT increased acid; may be ischemic damage to mucosa; often ulcers are in multiple places

Front 154

Treatment of pancreatic pseudocyst?

Back 154

Wait 6wks to allow for spontaneous resolution; then excise, externally drain, or internally drain into GI tract

Front 155

Do pancreatic pseudocysts have malignant potential?

Back 155

No, b/c have no epithelial lining

Front 156

Complications of pseudocysts

Back 156

Gastric outlet and extrahepatic biliary obstruction

Spontaneous rupture and hemorrhage

Front 157

What is a Diuelafoy's lesion?

Back 157

Abnormally large submucosal artery that protrudes thru small, solitary mucosal defect 6cm distal to GEJ --> spontaneous bleeding

Front 158

Rx for Diuelafoy's lesion?

Back 158

Endoscopic

Front 159

When is hemicolectomy needed for appendiceal carcinoid tumors?

Back 159

If >2cm

Front 160

Asthma, right heart valvular disease, flushing, hepatomegaly, diarrhea

Back 160

Carcinoid syndrome

Front 161

Indication for resection of a gallbladder polypoid lesion?

Back 161

Clinical symptoms

Front 162

Electrolyte abnormalities after pancreatectomy

Back 162

Hypocalcemia
Hypophosphatemia
Iron deficiency
Pernicious anemia

Front 163

Characteristics of cecal diverticula?

Back 163

Congenital
Solitary
True diverticula (involve all layers of bowel wall)

Front 164

Management of liver hemangiomas?

Back 164

Can usually observe; affected by hormones, but usually only hemorrhage iatrogenically (from attempted biopsy)

Front 165

CEA is elevated in these pts w/o cancer

Back 165

Smokers

Front 166

High CEA indicates?

Back 166

High likelihood liver involvement/ peritoneal spread

Front 167

Management of Mallory Weiss tear?

Back 167

If bleeding stopped: expectant
To control bleeding: balloon tamponade, endoscopic control, gastrostomy/oversewing, or vasopressin (but not in CAD pts)

Front 168

Types of gastric ulcers and which are acid-associated?

Back 168

I (lesser curvature)
II (gastric and duodenal)
III (pyloric)
IV (juxtracardial)
II and III are acid associated

Front 169

Rx for Type I ulcer

Back 169

Antrectomy (+/- vagotomy)

Front 170

Surgical Rx for type III ulcer?

Back 170

Vagotomy and antrectomy

Front 171

Surgical Rx for toxic megacolon?

Back 171

Subtotal colectomy with end ileostomy

Front 172

Rx for SCC of the anus refractory to Nigro protocol (chemo and XRT)?

Back 172

Abdominal-perineal resection w/ permanent end colostomy

Front 173

Rx for proximal and midrectal cancers?

Back 173

Low anterior resection

Front 174

Radiolucency under right hemidiaphragm indicates?

Back 174

Pneumoperitoneum

Front 175

Causes of pneumoperitoneum

Back 175

Perforated diverticulum, perforated gastric ulcer, perforated transverse colon carcinoma, or strangulated hernia w/ necrotic bowel

Front 176

Intestines in upside down U

Back 176

Sigmoid volvulus

Front 177

How does PEEP improve oxygenation?

Back 177

Increasing FRC b ykeeping alveoli open at end of expiration

Front 178

Potential negative effects of increased PEEP (3)

Back 178

- Alveolar overdistention --> pneumothoraces
- Decreased venous return/CO
- Increased minute ventilation requirements due to increased dead space ventilation

Front 179

Systemic hypotension, JVD, distant heart sounds

Back 179

Beck's triad for cardiac tamponade

Front 180

What is pulsus paradoxus?

Back 180

Decrease in SBP by >10 at end of inspiration

Front 181

Risk factors for eriop MI

Back 181

Previous infarction, esp w/in 6mo
DOE
Age >70
MR
> 5 PVCs/min
Tortuous or calcified aorta

Front 182

When should you not use epi w/ lidocaine?

Back 182

Tissues supplied by end arteries (fingers/ toes, ears, nose, penis)

Front 183

What can interfere with measurement of wedge pressure w/ Swan Ganz catheter?

Back 183

PEEP or CPAP

Front 184

Increased risk of periop stroke with?

Back 184

History of stroke

Front 185

What is the mortality from periop stroke?

Back 185

High

Front 186

PaCO2 levels are a reliable indicator of?

Back 186

Adequacy of alveolar ventilation

Front 187

Respiratory acidosis from hypercarbia

Back 187

Alveolar hypoventilation

Front 188

Hypoxemia with increased PCO2 is NOT

Back 188

PE, pulmonary edema, PNA, or atelectasis (b/c those pts should be hyperventilating (decreased CO2) to improve oxygenation

Front 189

Benefits of albumin vs. transferrin/acute phase reactants to eval nutritional status

Back 189

Long life life (3 wks) vs. short (hrs), but not affected by intravascular volume

Front 190

The physiologic goal of shivering is to ___, which causes ___

Back 190

Generate heat to maintain core temp

Increases metabolism by 3-5x, which increases O2 consumption/ CO2 production, which is usually counterproductive in critically ill pts

Front 191

What should be administered preop in a pt with vWD?

Back 191

Cryoprecipitate (provides both FVIII and vWF)

Front 192

Best choice for stress ulcer prophylaxis

Back 192

Sucralfate (better than antacids, which cause loss of acidic protection and G- overgrowth)

Front 193

Procedure for tracheostomy

Back 193

Skin incision below cricoid cartilage, strap muscles spared and retracted, thyroid isthmus divided if necessary, trachea entered at second tracheal ring

Front 194

Rx for malignant hyperthermia
(3)

Back 194

Cessation of anesthesia, hyperventilation w/ 100% O2, IV dantrolene

Front 195

Effect of PE on CVP

Back 195

Increases by causing RV overload and increasing RAP

Front 196

Renal failure with eosinophilia

Back 196

Cholesterol atheroembolism

Front 197

Hyperkalemia, hyponatremia, hypoglycemia, fever, weight loss, dehydration

Back 197

Adrenocortical insufficiency (e.g. Addison's disease)

Front 198

Why are antacids given before emergency intubation?

Back 198

Risk of intubation, esp if don't know gastric contents

Front 199

Rx for necrotizing fasciitis

Back 199

Wide debridement

Front 200

Passive rewarming is appropriate for which pts?

Back 200

Mild hypothermia (between 34 and 36C)