Term
| short term support for a failing heart? |
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Definition
- intra-aortic balloon pump
- left ventricular assist device |
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Term
| best plan for LONG term treatment for a patient with refractory left ventricular failure? |
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Definition
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Term
| most likely cause of a fever in first 24h hours post-op? |
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Definition
| Atelectasis- usually sudden onset fever and tachycardia, may hear posterior rales, diminished breath sounds, and bronchial breathing |
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Term
| woman wets herself uncontrollably, but does not have the sensation of voiding or a full bladder. What does this suggest? |
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Definition
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Term
| Test of choice for vesicovaginal fistula? |
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Definition
Methylene Blue instillation into the bladder
- dye is instilled into the bladder via a folley catheter and a tampon is placed in the vagina. Leakage of urine through the vagina can be confirmed y finding blue dye on the tampon. |
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Term
| A postoperative ileus can be caused by __, __ __, and/or __ __. |
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Definition
- anesthesia
- electrolyte imbalances
- wound infections |
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Term
| How do you treat most early postop fever? |
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Definition
| nothing, early post op fevers usually resolve without treatment |
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Term
| typical exam findings of an ileus? |
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Definition
| - silent distended abdomen that is tympanic to percussion |
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Term
| In lower Mallampati Classifications, ++ of the oropharynx is visible. In higher classifications, __ structures of the oropharynx are visible. |
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Definition
- lower, more visible
- higher, fewer visible |
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Term
Class 1: Full visibility of tonsils, uvula and soft palate
Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula
Class 3: Soft and hard palate and base of the uvula are visible
Class 4: Only Hard Palate visible
Class 5: Only the tongue can be seen - as in the rare case of James Webster |
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Definition
Mallampati Classifications pics
http://en.wikipedia.org/wiki/Mallampati_score |
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Term
| __ __ bacteria are the most common causes of septic shock. This can be a problem in surgery or injuries involving the bowel. |
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Definition
Gram negative bacteria
The proteobacteria are a major group of Gram-negative bacteria, including Escherichia coli (E. coli), Salmonella, Shigella, and other Enterobacteriaceae, Pseudomonas, Moraxella, Helicobacter, Stenotrophomonas, Bdellovibrio, acetic acid bacteria, Legionella and numerous others. Other notable groups of Gram-negative bacteria include the cyanobacteria, spirochaetes, green sulfur and green non-sulfur bacteria.
Medically relevant Gram-negative cocci include three organisms, which cause a sexually transmitted disease (Neisseria gonorrhoeae), a meningitis (Neisseria meningitidis), and respiratory symptoms (Moraxella catarrhalis).
Medically relevant Gram-negative bacilli include a multitude of species. Some of them primarily cause respiratory problems (Hemophilus influenzae, Klebsiella pneumoniae, Legionella pneumophila, Pseudomonas aeruginosa), primarily urinary problems (Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens), and primarily gastrointestinal problems (Helicobacter pylori, Salmonella enteritidis, Salmonella typhi).
Gram-negative bacteria associated with nosocomial infections include Acinetobacter baumannii, which cause bacteremia, secondary meningitis, and ventilator-associated pneumonia in intensive-care units of hospital establishments. |
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Term
| If the superior laryngeal nerve, which enervates the upper larynx, is injured, how does it affect the patient? |
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Definition
- prevents the patient from speaking in a high pitched voice
- may be injured during carotid endarterectomy and other neck surgeries |
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Term
| Most volvuluses occur in the __ __ (60% occur here). |
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Definition
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Term
| what electrolyte abnormality may cause post-op ileus? |
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Definition
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Term
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Definition
- Hypokalemia
- Sepsis
- Anticholinergic medications
- Opiates
- Increased sympathetic activity
- Peritonitis
- Pancreatitis
- Uremia
- Anastomotic leaks |
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Term
| __ __ occurs within minutes to several hours after organ transplant. It has become less common as cross-matching has improved. |
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Definition
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Term
| One week after receiving a lung transplant, the pt begins to experience coughing and wheezing. After ruling out infection, what is your treatment of choice? |
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Definition
- This is an acute rejection reaction
- Most can be overcome with increasing immunosuppressive agents like CORTICOSTEROIDS AND AZATHIPRINE.
- If the reaction is reversed, he should be able to keep the lung. |
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Term
| What blood components are present in cryoprecipitate? |
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Definition
| coagulation factors (fibrinogen, factors VII, VIIIR, XIII, and fibronectin) |
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Term
| What patients need fresh frozen plasma transfusions? |
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Definition
| - pts with clotting factor deficiencies and abnormal bleeding times |
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Term
| Parenteral nutrition indications: |
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Definition
- large acute burns
- short bowel syndrome
- gastrointestinal cutaneous fistulas
- acute radiation enteritis
- prolonged ileus
- acute chemotherapy toxicity |
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Term
| A contaminated wound to the thigh is debrided for several days while the patient is placed on systemic antibiotics. After 5 days, a skin graft is placed and the wound is closed. What type of closure is this called? |
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Definition
| Tertiary Closure aka Delayed Primary Closure |
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Term
| A contaminated wound is debrided for several days while the patient is on abx. The wound is left open to heal on its own. What type of closure is this? |
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Definition
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Term
| Is appendicitis associated with low or high grade fever? |
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Definition
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Term
| test of choice for appendicitis? |
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Definition
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Term
| Diagnostic evaluation of appendicitis: |
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Definition
- CT is test of choice
- Leukocytosis
- Microscopic hematuria and pyuria may be seen
- Radiographic finding of free air suggests perforation |
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Term
| Appendectomy: laparoscopic—longer surgery time than open surgery, shorter recovery time, and less infectious complication |
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Definition
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Term
| Most significant risk factor for development of aortic aneurysm: |
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Definition
atherosclerosis- causes inflammatory mediators to degrade the media of the artery weakening it
other causes: trauma, infectious arteritis, great vessel arteritis |
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Term
| __ __ __, a condition commonly seen with Marfan Syndrome, is also a significant cause of aortic aneurysms. |
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Definition
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Term
| Aortic Dissections are divided into those that involve the ascending aorta, __ __ __, and those that involve the descending aorta, __ __ __. |
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Definition
- ascending aorta dissection- Stanford Type A
- descending aorta dissection- Stanford Type B |
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Term
| Dissections involving the ascending aorta threaten blood supply to the __ and __ and warrant early surgical intervention. |
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Definition
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Term
| Dissections of the descending aorta may often be managed medically, unless they compromise blood flow to an organ by occluding vessels such as the renal or mesenteric arteries. |
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Definition
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Term
| Aortic dissesction most commonly occurs in the ___ __. |
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Definition
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Term
| Possible PE findings with aortic dissection: |
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Definition
- difference b/w pulse amplitude among extremities
- difference b/w blood pressure among extremities
- new aortic regurgitation murmur may develop if region of the aortic valve is involved |
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Term
|
Definition
ultrasound
dx with u/s, track size once dx has been made with CT |
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Term
| Aortic dissection dx test: |
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Definition
| - Transesophageal Echocardiography (TEE)- test of choice if available |
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Term
| Aortic aneurysm pts should probably be on __ __ to control their blood pressure. |
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Definition
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Term
| When the dx of aortic dissection is suspected, IV ___ and __ __ are used to aggressively lower blood pressure to the lowest level that adequately supports cerebral, cardiac, and renal perfusion. |
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Definition
- Labetalol
- Sodium Nitroprusside |
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Term
| Generally, repair is indicated in patients with symptomatic AAA and in large asymptomatic AAA (e.g., with a diameter exceeding 5.5 cm in men or 5.0 cm in women in the US), |
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Definition
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Term
| Alternative tmt option for pts with AAA who are not surgical candidates? |
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Definition
| percutaneous placement of endovascular stent |
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Term
| USPTF recommendations for AAA screening: |
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Definition
- Any male b/w 65 and 75 who has ever smoked should be screened once with ultrasound
- No recommendations for or against screening in non-smokers
- Does NOT recommend screening women |
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Term
| Most common form of skin cancer in US: |
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Definition
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Term
| Is BCC more common in men or women? |
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Definition
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Term
| Basal cell carcinoma is __ growing and __ metastasizes. |
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Definition
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Term
Lesion:
- waxy, nodular, rolled edge
- telangiectic, translucent
- white/pink in color
- often shows central depression or erosion
- painless
- placing traction around edge helps show a pearly border |
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Definition
| Basal Cell Carcinoma (most common types are classical or nodular) |
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Term
| When should you have follow up evaluations of a pt treated for BCC? |
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Definition
| 4 months and 12 months after treatment for 5 years |
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Term
| Preferred topical treatment for superficial BCC: |
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Definition
| Imiquimod with or without occlusion |
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Term
| Surgical managment of BCC: |
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Definition
- surgical excision/currettage
- Moh's surgery gives highest cure rate
- cryosurgery |
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Term
| MCC of small bowel obstruction: |
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Definition
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Term
| MCC of large bowel obstruction: |
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Definition
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Term
| difference b/w SBO and LBO: |
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Definition
- LBO has less acute onset
- LBO has more cramping, pain, and distention, but less emesis |
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Term
| With bowel obstructions hyperactive bowel sounds occur early on and hypoactive bowel sounds occur later on. |
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Definition
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Term
| first tests to order if suspect bowel obstruction? |
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Definition
- Abdominal x-ray: air fluid levels (at least 6), dilated intestinal loops
- CMP (hyponatremia, hypokalemia, metabolic alkalosis)
- CBC
- LDH |
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Term
| medical managment of intestinal obstruction: |
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Definition
- Hospitalize
- NPO
- NG tube
- Surgical consult |
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