Term
|
Definition
Dana's Mac Cheese More Filling.
- Diazepam (Valium)
- Midazolam (Versed)
- Cimetidine (Tagament) or Ranitidine (Zantac) (H2 blockers)
- Morphine sulfate
- Fentanyl |
|
|
Term
| pre-op dose, purpose, and adverse reactions of Diazepam: |
|
Definition
- 0.12mg/kg given 1-2 hours pre-op
- relieves anxiety, causes sedation
- adverse reactions: cardiovascular collapse, respiratory failure |
|
|
Term
| pre-op dose, purpuse, and adverse effects of Midazolam: |
|
Definition
- 1mg/70kg given 10-30 minutes before going into the OR
- causes amnesia
- adverse effects: respiratory depression/arrest |
|
|
Term
|
Definition
|
|
Term
|
Definition
- aka Diprivan
- most commonly used IV general anesthetic
- for induction and maintenance
- no analgesic properties so use with fentanyl
- rapid onset, pt can be roused quickly after ceasing administration
- adverse effects: pain at injection site, rarely dystonia
INDUCTION 2MG/KG IV
MAINTENANCE 100-200 MCG/KG or 6-12mg/kg/hour |
|
|
Term
| Succinylcholine information: |
|
Definition
- depolarizing muscle relaxant used for intubation during anesthesia
- blocks acetylcholine receptors causing paralysis
- Dose: 0.6mg/kg
- Adverse effects: malignant hyperthermia, respiratory arrest |
|
|
Term
| drug that blocks acetylcholine receptors thus causing paralyis. this drug is used for intubation during anesthesia: |
|
Definition
|
|
Term
| General anesthetic drugs: |
|
Definition
- Propofol (Diprivan)
- Succinylcholine |
|
|
Term
|
Definition
Ester class: Novocaine
Amide class: Lidocaine (Xylocaine) and Bupivicaine (Marcaine) |
|
|
Term
|
Definition
- local anesthetic of ester class
- max dose 10 mg/kg or 1000mg/dose
- 1,2, or 10% strength
- Adverse effects: CNS toxicity, myocardial depression, seizures |
|
|
Term
|
Definition
- Local anesthetic of amide class
- dosing varies from 0.5-2.0%
- max dose alone 4-5mg/kg
- max dose mixed with epi 7mg/kg
- SE: malignant hyperthermia |
|
|
Term
|
Definition
- a lot like lidocaine but has longer duration so can use less, can also mix with epi
- SE: malignant hyperthermia |
|
|
Term
| 2 anesthetic drugs that do NOT cause malignant hyperthermia: |
|
Definition
- Propofol: pain at injection site and dystonia
- Novocaine: myocardial depression, CNS toxicity, seizures |
|
|
Term
| Anesthetic drugs that can cause malignant hyperthermia: |
|
Definition
- Succinylcholine: respiratory arrest and malignant hyperthermia
- Lidocaine (Xylocaine): malignant hyperthermia
- Bupivacaine(Marcaine): malignant hyperthermia |
|
|
Term
| Diffuse non-toxic goiter due to iodine deficiency diagnostics: |
|
Definition
- T4 and TSH usually normal
- Thyroid RAI usually elevated unless iodine intake has improved, then it may be normal
- Serum antithyroid antibodies usually low to absent
- Elevated serum thyroglobulin |
|
|
Term
| How is iodine sufficiency assessed? |
|
Definition
- urinary iodide excretion
- target being more than 10mcg/dL |
|
|
Term
| prevention of endemic goiteres and cretninism: |
|
Definition
| - adding potassium iodine to commercial salts |
|
|
Term
| simple measure to reduce goiter size: |
|
Definition
- vitamine A and iodine
can also give Levothyroxine |
|
|
Term
| Primary brain tumors are divided into what 2 categories: |
|
Definition
1. Glial tumors- arising from brain parenchyma, MC: Glioblastoma Multiforme
2. Non-glial tumors: arise from meninges, skull base, pituitary gland, and pineal areas, MC: Meningioma (26% of all brain tumors) |
|
|
Term
| 90% of brain mets come from the __, __, and __. |
|
Definition
|
|
Term
| study of choice for brain tumor: |
|
Definition
|
|
Term
| is chemotherapy effective for brain tumors? |
|
Definition
|
|
Term
| medical managment of brain tumors: |
|
Definition
- water restriction to prevent further increase in intracranial pressure
- edema: dexamethasone 4mg orally 4 times a day |
|
|
Term
| ___ is done with malignant primary brain tumors even after the lesion has been removed. |
|
Definition
|
|
Term
| Indirect inguinal hernias are found at or superior to the __ __ and are in the __ __ of the inguinal canal.These are usually ___. |
|
Definition
- inguinal ligament
- internal ring
- congenital |
|
|
Term
| With indirect inguinal hernias, the inferior epigastric vessels are __, with direct inguinal hernias, the inferior epigastric vessels are ___. |
|
Definition
- medial
- lateral (think D, L and HD) |
|
|
Term
| Inguinal hernias arise __ the inguinal ligament, while femoral hernias arise __ the inguinal ligament. |
|
Definition
|
|
Term
| Subaerolar abscesses occur in ___ women in the __ ___. |
|
Definition
- non-lactating
- lactiferous ducts |
|
|
Term
| What do you tell a lactating woman with a breast abscess with regard to breast feeding? |
|
Definition
| - pump and discard milk until infection is resolved |
|
|
Term
|
Definition
|
|
Term
| risk factors for breast cancer: |
|
Definition
| Risk factors: age, personal history of breast cancer, BRCA1 and BRCA2 mutations, two or more first-degree relatives, nulliparous, first full-term pregnancy over 30 years of age, early menarche (age less than 12), late natural menopause (age over 50), whites more than nonwhites, endometrial cancer, obesity; fibrocystic change with proliferative changes, papillomatosis, or atypical epithelial hyperplasia. |
|
|
Term
| Is breast cancer more common in whites or non-whites? |
|
Definition
|
|
Term
| Most common benign neoplasm of breast that derives from intralobular stroma? |
|
Definition
|
|
Term
| What race are breast fibroadenomas more common in? |
|
Definition
|
|
Term
| Do fibrocystic breast changes increase one's risk for breast cancer? |
|
Definition
|
|
Term
| 3 most common causes of otitis media: |
|
Definition
- Strep pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis |
|
|
Term
| Treatment for acute otitis media: |
|
Definition
Amoxicillin 80-100mg/kg/day in divided doses every 12 hours for 10 days
- alternatives are Macrolides: Azithromycin, Clarithromycin, Erythromycin
- Pain relief: tylenol/ibuprofen, topical analgesia with antipyrine/benzocaine otic 4-5 drops every 2 hours as needed |
|
|
Term
| when should tympanostomy tubes be considered? |
|
Definition
- 6-12 months bilatereal continuous otitis media with effusions
- 9-18 months unilateral continuous otitis media with effusions |
|
|
Term
| define acute, subacute, and chronic otitis media: |
|
Definition
- Acute: 0-3 weeks ( less than 1 month)
- Subacute: 3-12 weeks (between and 1 and 3 months)
- Chronic: > 12 weeks (or > 3 months) |
|
|
Term
| sinusitis most commonly affects the __ sinuses. |
|
Definition
|
|
Term
| most common bacterial causes of sinusitis: |
|
Definition
- Strep pneumonia
- Haemophilus influenzae
- Moraxella catarrhalis |
|
|
Term
| how to distinguish b/w URI and sinusitis? |
|
Definition
| - sinusitis usually gets worse after 5 days or lasts longer than 10 days |
|
|
Term
| test of choice for sinusitis: |
|
Definition
|
|
Term
| Abx treatment for sinusitis: |
|
Definition
- First line: amoxicillin for 2 weeks
- Second line: amoxicillin/clavulanic acid for 2 weeks
- Nasal steroids
- Increase fluids
- Allergic to PCN: Clarithromycin |
|
|
Term
| length of time to be classified as chronic sinusitis? |
|
Definition
|
|
Term
| MC bacterial causes of chronic otitis media: |
|
Definition
- Pseudomonas aeruginosa
- Proteus speciea
- Staphylococcus aureus
- Mixed anaerobic infections |
|
|
Term
| with chronic otitis media, pain is actually uncommon unless it is during an acute exacerbation |
|
Definition
|
|
Term
| Chronic Otitis Media treatment: |
|
Definition
| - Fluorquinolone or Aminoglycoside drops (remember to be careful with aminoglycoside drops b/c ototoxic, so if cannot visualize intact TM, do not give aminoglycoside drops) |
|
|
Term
|
Definition
- Salicylates
- Furosemide
- Aminoglycosides |
|
|
Term
| Pre-op antibiotics for appendicitis: |
|
Definition
Cefoxitin or
Ampicillin/Sulbactam |
|
|
Term
| blood supply to the appendix? |
|
Definition
| appendiceal artery, which branches off of the ileocolic artery |
|
|
Term
| The ___ aka the __ of the appendix contains the appendiceal artery. |
|
Definition
| - Mesoappendix aka mesentery of the appendix contains the appendiceal artery |
|
|
Term
| How do you finger sweep to find the appendix? |
|
Definition
| - Follow the taenia coli off of the cecum down to the appendix with a finger sweep from lateral to medial along the peritoneum (this way you won't tear the mesoappendix which lies medially) |
|
|
Term
| Layers at McBurney's Point: |
|
Definition
1. Skin
2. Subcutaneous Fat
3. Scarpa's Fascia
4. External Oblique
5. Internal Oblique
6. Transversus muscles
7. Transversus Fascia
8. Preperitoneal Fat
9. Peritoneum |
|
|
Term
| Non-perforated abx for appendicitis: |
|
Definition
- Cefoxitin
- Cefotetan
- Unaxyn
(these are given for 24 hours)
- Cipro
- Flagyl |
|
|
Term
| Perforated appendicitis abx treatment: |
|
Definition
| - Triple antibiotic coverage with Ampicillin, Cipro, Clinda or broad specturm with Zosyn - usually given 3-7 days until WBC is normal, afrebrile, ambulaint, and eating a regular diet |
|
|
Term
| ___ ___, the bacteria associated with __ ___, closely mimics appendicitis. |
|
Definition
- Yersinia entoerolytica
- Mesenteric Adenitis |
|
|
Term
| partial knee replacement: |
|
Definition
| - unicompartmental involving just the end of ONE bone, either tibia or femur |
|
|
Term
|
Definition
| the ends of both bones, and often patella are renewed |
|
|
Term
| With knee replacements, __ or ____ are used to replace the ends of the long bones of the knee. A high density __ liner made of __ wits on the tibia to separate it from the femur. It is all held in place by bone cemnt made of __, cemented are quicker healers than screws/bolts. |
|
Definition
- titanium or chromium/cobalt
- plastic liner made of polyethylene
- polymethylmethacrylate |
|
|
Term
| how long do knee replacements last? |
|
Definition
|
|
Term
| when should a fasciotomy be performed? |
|
Definition
| - pressure > 40mmHg withing 4 hours |
|
|
Term
| The dentate line is the junction of the __ with its ___ __ and the __ with its __ __. |
|
Definition
- rectum with its columnar epithelium
- anus with its squamous epithelium |
|
|
Term
| 3 possible locations for hemorrhoids: |
|
Definition
- Left Lateral
- Right Anterior
- Right Posterior |
|
|
Term
| Describe the degrees of hemorrhoids: |
|
Definition
- First Degree: does NOT prolapse
- Second Degree; prolapses with defecation but returns on its own
- Third Degree: prolapses with any type of valsalva and requires active manual reduction
- Fourth Degree: prolapses and cannot be reduced |
|
|
Term
| Contraindication for Hemorrhoidectomy: |
|
Definition
|
|
Term
| PPH (Procedure for Prolapse and Hemorrhoids) is indicated for what types of patients? |
|
Definition
- Second degree hemorrhoids after failure of multiple rubber band ligations
2. Third and Fourth Degree Hemorrhoids
3. Rectal Mucosa Prolapse |
|
|
Term
|
Definition
- Too much muscle drawn up> damage to rectal wall resulting in inflammation/infection
- Damage to internal muscles of sphincter> short/long term dysfunction like pain or incontinence |
|
|
Term
| Ventral hernias occur in the midline along the __ __, usually between the __ and __. |
|
Definition
- linea alba
- xyphoid and umbilicus |
|
|
Term
| MC type of ventral hernia? |
|
Definition
| Incisional hernia (5% of abdominal surgeries end in ventral hernia) |
|
|
Term
| Risk Factors for incisional hernias: |
|
Definition
- Inadequate fascial closure
- Wound infection
- Midline incision
- Obesity
- Diabetes
- Lung disease
- Smoking
- Marfan's Syndrome
- Ehlers-Danlos Syndrome
- Pregnant
- Ascites
- Malnutrition
- Elderly
- Peritoneal dialysis
- Steroids
- Chemotherapy |
|
|
Term
| An Epigastric Hernia is herniation through a __ in the __ __ above the ___. This is MC in __ and there may be multiple. |
|
Definition
- defect in the linea alba
- umbilicus
- men |
|
|
Term
| Describe the ventral hernia repair approach: |
|
Definition
- Old scar is incised and removed
- Prosthetic mesh is used to repair defects and minimize tension
- This method has decreased number of recurrences but has increased number of post-op infection leading to obstruction and fistula formation |
|
|
Term
| Describe the laparascopic repair of a ventral hernia: |
|
Definition
- Large piece of prosthetic mesh is placed UNDER the hernia defect with a wide margin of mesh outside the defect.
- Mesh is then anchored in place with 8 fulll thickness sutures and secured to the anterior abdominal wall with tacs |
|
|
Term
| Cholodocholithiasis means there are gallstones in the __ __ __. |
|
Definition
|
|
Term
| 3 characteristics of acute cholecystitis: |
|
Definition
- RUQ pain
- Fever
- Leukocytosis |
|
|
Term
| possible lab findings with cholecystitis: |
|
Definition
- Leukocytosis with left shift
- Increased ALP
- Increased Bilirubin |
|
|
Term
| first test of choice for cholecystitis: |
|
Definition
| Ultrasound (will show gall bladder wall thickening > 5mm) |
|
|
Term
| Nuclear medicine scan that can be used for diagnosis of cholecystitis when ultransound is non-diagnostic: |
|
Definition
| - Cholescintigraphy aka HIDA scan: nuclear medicine study that uses contrast to outline the gallbladder and the entire biliary tree |
|
|
Term
| Fitz-High-Curtis Syndrome is a __ caused by a __ __, this can have RUQ pain and even a positive __ sign. But the __ __ will be negative. Think of this in patients with high risk of __. |
|
Definition
- perihepatitis
- gonococcal infection
- Murphy's sign
- HIDA scan will be negative
- STDs |
|
|
Term
| WBCs greater than ___ support dx of cholecystitis. |
|
Definition
|
|
Term
| What lab studies suggest a common bile duct obstruction: |
|
Definition
| - disproportionate increase of alk phos and bilirubin compared to transaminases |
|
|
Term
| Acalculous cholecystitis occurs in critically ill patients (burn, sepsis, trauma, or postop). These pts generally lack localized pain and tenderness and present with symptoms of __ __ of an uknown source. |
|
Definition
generalized sepsis
acalculous cholecysitis: crtical illness leads to biliary stasis and mucosal ischemia |
|
|
Term
| Pre-op abx for cholecystitis: |
|
Definition
ACLMZ
- Ampicillin/Sulbactam
- Clindamycin
- Levaquin
- Metronidazole
- Zosyn |
|
|
Term
|
Definition
| - admitted for parenteral antiobiotics, analgesia, fluid replacement, and cholecystecomty in 24-72 hours |
|
|
Term
| WBCs and LFTs usually increased with cholecysitis but normal with cholelithiasis. |
|
Definition
|
|
Term
| Predisposing factors for cholecystitis: |
|
Definition
- Chronic Hemolytic Diseases (sickle cell and thalassemia)
- Ilium disease or resection
- Obesity
- Multiparity
- Drugs: OCP, Diuretics, Clofibrate |
|
|
Term
| Drugs that incease risk for cholecystitis: |
|
Definition
- OCP
- Diuretics
- Clofibrate |
|
|
Term
| what type of gallstones do patients with hemolytic diseases get? |
|
Definition
| Bilirubin and pigment stones |
|
|
Term
|
Definition
| RUQ pain radiating to the scapula with cholecystitis |
|
|
Term
| Gram __ organisms usually cause cholecystitis, the most common being ___. |
|
Definition
|
|
Term
| A ___ forms with cholecystitis if the gall bladder remains obstructed and the contents are sterile. |
|
Definition
|
|
Term
| An ___ forms with cholecystitis if the gallbladder stays obstsructed and infection persists. |
|
Definition
|
|
Term
| Complications of cholecystitis: |
|
Definition
- Pancreatitis: if stone obstructs pancreatic duct
- Obstructuve jaundice: stone lodges in common bile duct preventing drainage of bile
- Ascending cholangitis: infection develops in an obstructed biliary system> Charcot's triad (RUQ pain, fevor/rigors, jaundice), at risk for septicemia |
|
|
Term
| For asymptomatic cholecystitis, you ONLY treat it in the following situations: |
|
Definition
- Children
- Sickle Cell Anemia
- Porecelain/Calcified GB |
|
|
Term
| chronic cholecystitis treatment: |
|
Definition
| - low fat diet and cholecystectomy if more than 1 attak has occured |
|
|
Term
| Acute cholecystitis treatment: |
|
Definition
- analgesia, fliuids, abx
- does not resolve> lap chole in 48 hours if adhesions are present or 4-6 weeks after acute attack |
|
|
Term
| Common bile duct stone management: |
|
Definition
- US will who dilated bile dugct
- urgent ERCP (endoscopic retrograde chlangiopancreotography) |
|
|
Term
| The left and right hepatic ducts form the __ __ __. The __ __ __ and the __ __ form the __ __ __. |
|
Definition
- common hepatic duct
- common hepatic duct
- cystic duct
- common bile duct |
|
|
Term
| The __ __ artery is at risk during a cholecystecomty due to proximity to the __ __ and __ __. |
|
Definition
- right hepatic artery
- cystic artery
- Calot's triad (cystic duct, cystic artery, common hepatic duct) |
|
|
Term
|
Definition
- cholesterol
- lecithin (phospholipids)
- bile acids
- bilirubin |
|
|
Term
| bile acids are mainly absorbed in the __ _-. |
|
Definition
|
|
Term
| Jaundice begins with serum __ is greater than __. It will first be noticed where? |
|
Definition
|
|
Term
| Signs and symptoms of obstructive jaundice: |
|
Definition
- Dark urine
- Jaundice
- Clay colored stools
- Pruritis (bile salt in dermis)
- Decreased appetite
- Nausea |
|
|
Term
|
Definition
| - right subcostal incision made for lap chole |
|
|
Term
| inraoperative cholanciogram: |
|
Definition
- put dye in bile duct via cystic duct and x-ray to see anatomy
- done during lap chole if pt is jaundice, hyperbilirubinemia, gallstone pancreatitis, elevated alk phos, or if US shows choledocolithiasis |
|
|
Term
| With choledocolithiasis a ___ needs to be done. |
|
Definition
|
|
Term
| acute cholecystitis on ultrasound: |
|
Definition
- thickened gallbladder wall (>3mm)
- pericholecystic fluid
- distended gallbladder
- stones |
|
|
Term
| Acalculous cholecystitis occurs secondary to the absense of __ stimulation. Risk factors for this include: |
|
Definition
- Cholecystokinin
- Prolonged fasting
- TPN
- Trauma
- Multiple Transfusions
- Dehydration
- Post-op |
|
|
Term
| Ascending cholangitis is an infection of the biliary tract, most commonly caused by ____. You may see Charcot's triad (RUQ pain, jaundice, fever/rigors) or Reynold's pentad which includes_____________. Labs will show increased WBC, increased bilirubin and alk phosph, and __ __ __. Gram __ bacteria are MCC, but __ is the most common gram __ cause. |
|
Definition
- choledocolithiasis
- Reynold's pentad: RUQ pain, fever/rigors, jaundice, altered mental status, shock
- positive blood cultures
- Gram negative bacteria are MCC
- eneterocci is MC gram positive cause |
|
|
Term
| Barrets esophagus leads to ___, while smoking and alochol lead to __ __ __ of the esophagus. |
|
Definition
- BARRETS> ADENOCARCINOMA
- SMOKING, ALCOHOL> SQUAMOUS CELL CARCINOMA |
|
|
Term
| Is streptococci gram positive or negative? |
|
Definition
| POSTIVE DANG IT, STREP IS GRAM POSITIVE |
|
|
Term
| Is staphylococci gram positive or negative? |
|
Definition
| POSITIVE, DANG IT, STAPH IS GRAM POSITIVE |
|
|
Term
| MCC of pyogenic liver abscesses: |
|
Definition
|
|
Term
| A lead pipe colon is the appearance of a forshortened colon on barium enema that has lost its redundancy and haustral markings. This sign is specific for __ __, which is associated with the ___ antibody. |
|
Definition
- ulcerative colitis
- P-ANCA antibody |
|
|
Term
| extra-intestinal manifestations of ulcerative colitis: |
|
Definition
| erythemanodosum- erythematous plaques and nodules on pretibial areas |
|
|
Term
| meds for treatment of Ulcerative colitis: |
|
Definition
- Sulfapyridine
- Mesalamine
- Corticosteroids
- 6-Mercaptopurine
- Azathioprine |
|
|
Term
| Cobblestone appearance and string sign on barium enema are signs of ___ __. |
|
Definition
|
|
Term
| Thumbprinting is a radiographical finding associated with __ __, a disease usually of older people with __ __ __ pain and __ __ __. |
|
Definition
- ischemic colitis
- left lower quadrant pain
- gross rectal bleeding |
|
|
Term
Lead pipe colon= Ulcerative Colitis (may also have erythemanodosum on shins)
String Sign, Cobblestoning- Crohn's Disease
Thumbprinting Sign: Ischemic Colitis
Apple Core Appearance: Colon Cancer |
|
Definition
|
|
Term
| Apple core appearance on barium enema suggests: |
|
Definition
|
|
Term
| P-ANCA antibodies are associated with: |
|
Definition
|
|
Term
| Virtually all NSAID users develop some degree of ___. |
|
Definition
|
|
Term
| What tumor marker is found with pancreatic cancer? |
|
Definition
| CA 19-9 (carbohydrate antigen 19-9) |
|
|
Term
| Treatment for IBS besides fiber and exercise? |
|
Definition
- SSRIs or
- TCA (Amitriptyline at bedtime)
If pt has failed two SSRIs try TCA |
|
|
Term
|
Definition
male 13.5-17.5
female 12-16 |
|
|
Term
|
Definition
- male 39-49
- female 35-45 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| neurologic manifestations occur with what type of anemia? |
|
Definition
|
|
Term
| normal urine specific gravity: |
|
Definition
|
|
