Didactic Summative pt 2

sensitive indicator of protein status

prealbumin

most powerful predictor of post-op complications

albumin

stents

drug eluting → 6 mo - 1 yr

bare metal → 30 days

balloon angioplasty → 14 days

bridge therapy for surgery

5 days → d/c warfarin

3 days → start LMWH

2 days → check INR

24 hrs → d/c LMWH

12-24 hrs post-op → restart warfarin

NPO guidelines

solid food 8 hrs

nonhuman milk 6 hrs

breast milk 4 hrs

clear liquids 2 hrs

when to give prophylactic abx in surgery

30 mins w/in incision (no > 60 mins)

ASA guidelines

1 - normal, healthy

2 - mild dz → smoker, preg, controlled DM

3 - severe dz → uncontrolled DM, pacemaker, alcoholic

4 - constant threat to life → MI, TIA, CAD

5 - not expected to live → ruptured AAA

6 - brain dead

surgical incisions

wound classifications

1: Clean → closed wounds

2: Clean-contaminated → involves resp, GI/GU

3: Contaminated → non sterile or GI leak

4: Dirty

wound healing phases

inflammatory → ↑ vasc permeability

proliferative → granulation tissue, neovascularization, epithelialization

maturation → scar forms

RAPID ↑ in temo

skeletal muscle rigidity

tachy

HoTN

malignant hyperthermia → dx by caffeine halothane contracture

MC post-op complication

MCC of fever < 48 hrs after surgery

↓ breath sounds, tachycardia/pnea

atelectasis → do incentive spirometer

sudden tachycardia, hypoxia, rales, rhonchi

↓ breath sounds

CXR: patchy infiltrates

aspiration

longest duration local anesthetic

Bupivacaine

most & least reactive sutures

absorbable: fast gut → PDS II

non absorbable: silk → prolene

when to remove sutures

face/eyelids/neck = 5 days

trunk/UE = 7 days

scalp = 7-10 days

LE = 8-14 days

digits = 10-14 days

joints = 14 days

fluid that stays in intravascular space

isotonic

what nerve to watch out for with breast surgery

long thoracic nerve

blood at urethral meatus

painful urination

inability to void

palpable bladder

urethral trauma → do retrograde urethrogram

hesselbach triangle borders

medial = rectus abdominus

inferior = inguinal ligament

lateral = inferior epigastric vessels

hernia on lateral edge of rectus muscle, below umbilicus

spigelian

MC hernia repair

lichtenstein

separation of rectus muscle

wide linea alba

diastasis recti

hiatal hernia tx

Nissen fundoplication

sliding (type 1) is MC type if hiatal hernia

diverticulum in hypopharynx

halitosis

dysphagia, choking

zener'd diverticulum

bean sign

volvulus

surgical indications for AAA

> 5.5 cm

growing > 0.5 cm in 6 mos or > 1 cm in 12 mos

symptomatic

widened mediastinum

aortic dissection

seen in men

impotence

↓/absent femoral pulses

transient numbness of extremities

Leriche syndrome

normal ABI level

1.4 - 0.9

Parkland formula

glascow coma scale

CSF rhinorrhea

basilar fx

difference btw heat stroke vs exhaustion

heat stroke has NO sweat

linear, pruritic, whiplike lesions

Portuguese man-o-war

LeFort Fractures

MC site of epistaxis

antieror = Kiesselbach's plexus

posterior = sphenopalatine

MC organ injured in blunt & penetrating trauma

liver

yellow vision

Digoxin toxicity

beck's triad: JVD, HoTN, muffled heart sounds

pulses paradoxus

Kussmaul's sign

cardiac tamponade

PCI within ___ mins

90

thrombolytics within ____ mins

30

sepsis protocol

blood cx b4 abx

lactate < 90 mins

IV abx < 60 mins

30 mL/kg IVF < 180 mins

MC initiating even of cardiogenic shock

MI

MC reason for postpartum infection

genital tract infection

best test for pancreatitis

lipase

NPO → IVF → pain mgmt

best lab value to classify anemias

MCV

granulocytes

neutrophils, eosinophils, basophils

agranulocytes

lymphocytes and monocytes

EPO is produced in

kidneys

best test to assess total iron body stores

ferritin

↓ ferritin ↑ TIBC ↓ serum iron

↑ RDW ↓ retic

IDA

classic finding: microcytosis out of proportion to degree of anemia

thalassemia → do hemoglobin electrophoresis

↑ HgF & A2 levels

beta thalassemia

basophilic stippling

lead poisoning anemia

MC RBC enzyme defect

Heinz bodies, bite cells

G6PD deficiency

Coombs test

autoimmune hemolytic anemia

MCC of normochromic anemia

anemia of chronic disease (CKD)

pancytopenia

aplastic anemia

MCC of megaloblastic anemia

folate deficiency

macrocytosis + hypersegmented neutrophils

megaloblastic anemia

neuropsych probs

glossitis, stomatitis

↑ MMA

B12 deficiency

can progress to AML

pancytopenia w macrocytic anemia

myelodysplastic syndrome

AVN of hip, pain crisis, ACS

HgS

sickle cells

ring sideroblasts in bone marrow bx

MCC is acquired clonal disorder

abnormal heme synthesis

sideroblastic anemia

MC type of porphyria (defect in enzyme for heme synthesis)

red wine urine

adult → porphyria cutanea tarda (vampire dz)

kids → erythropoietic porphyria (EEP)

allogenic transplants only

GVHD

petechial bruising

bleeding from mucous membranes

ONLY plts are low

ITP → IGIV + steroids

ADAMTS13 deficiency

pentad: MAHA (schistocytes), thrombocytopenia, fever, renal insufficiency, neuro sxs

TTP

MC inherited liver disease

HFE1 gene

↑ skin pigmentation

hemochomatosis

circulating blasts

leukemia

MC leukemia in ADULTS

auer rods

> 20% myeloblasts in bone marrow bx

AML

philadelphia chromosome

CML

MC childhood leukemia

> 20% lymphoblasts

neuro deficits

ALL → pts need CNS prophylaxis

MC leukemia OVERALL

smudge cells

mature lymphocytes in bone marrow bx

CLL

assoc w EBV

reed-sternberg ("owls eye")

staging via Ann Arbor

Hodgkin lymphoma

95% B cell in origin

assoc w Burkitt's

painless LAD

staged via Lugano classification

Non-Hodgkin lymphoma

tumor of immature B cells

assoc w EBV

starry sky

Burkett's lymphoma

bence-jones proteins

"moth eaten" lytic lesions

rouleaux formation

bone pain

multiple myeloma

peau d'orange

tumor marker: CA 15-3, CA 27-29, CEA

breast cancer

tumor marker for ovarian CA

CA125

MC type of kidney CA

triad: flank pain, hematuria, palpable abd renal mass

renal cell carcinoma

tumor marker for lung CA

CEA

colorectal CA screening guidelines

start 45 y/o

flex sig Q5

colonscopy Q10

barium enema Q5

multiple polyp in proximal colon

HNPCC (Lynch syndrome)

MC type of stomach CA

adenocarcinoma

tumor marker for stomach CA

CA 19-9

painless jaundice + dull LUQ/epigastric discomfort radiating to the back

Courvoisier's sign

tumor marker: CA19-9

pancreatic CA → ERCP

tumor markers for GB cancer

CEA

CA 19-9

MC paraneoplastic endocrine syndrome

hypercalcemia

when does birth weight double and triple

double by 4-5 mos

triples by 1 yr

APGAR

MCC of hyaline membrane disease in term infants

transient tachypnea

waiter tip sign

MCC is shoulder dystocia during difficult birth

erb duchenne

claw hand deformity

Klumpke's palsy

heart defect in down syndrome

ASD

Trisomy 13 (Patau)

holoprosencephaly

polydactyly

cleft lip/palate

trisomy 18 (Edwards)

rocker bottom feet

clenched hands and overlapping fingers

prominent occiput

MC sex abnormality in females

turner syndrome

acyanotic heart defects

VSD

ASD

PS

PDA

AS

CoA