Airway & ARDS
Immune
Vascular Access
Abdomen (Liver)
Preop / Periop
100
A 45yo male who weighs 80kg presents to trauma bay with GCS 7 and combative with concern for closed head injury. This should be his initial tidal volume setting.
5-7 ml/kg = 400-560ml
100
These are the 2 cellular components of the adaptive immune system.
B cells -> Antibodies
T cells -> Direct cell death, cytokines
100
These are the Rule of 6s for fistula creation
At 6 weeks post-op:
Flow volume >600ml/min
>6mm in diameter
<6mm deep from surface
6cm in length available
100
These are the components of the MELD score.
What is Sodium, Creatinine, Bilirubin, INR?
100
In the setting of emergent procedures, this cardiac medication should be continued
What are Beta Blockers?
200
These are the Berlin Criteria for diagnosing ARDS
Within one week of symptoms/clinical insult
CXR with bilateral opacities, not explained by cardiogenic shock or fluid overload
P:F ratio < 100 = Severe
P:F ratio 100-200 = Moderate
P:F ratio 200-300 = Mild
200
These are the 4 types of hypersensitivity reactions.
Type I = Anaphylactic, IgE mediated via histamine
Type II = Cytotoxic, antibody mediated (i.e. Rh incompatibility)
Type III = Serum Sickness, i.e. Lupus, RA
Type IV = Delayed, antigens stimulate T cells and cause a reaction (i.e. rejection, contact dermatitis, PPD test)
200
This is the definition of an air embolism during central venous access, and this is how you treat it.
As little as 20ml of air; 200ml can be fatal. Treated in left lateral decubitus position and trendelenburg
200
How a post-operative bile leak after hepatectomy is typically managed.
What is Percutaneous drainage?
200
This evaluation/test is the best predictor of perioperative cardiac events, according to 2014 AHA Guidelines
What is Maximally tolerated metabolic equivalents (METs)?
300
By increasing PEEP on the ventilator, this effect is created on: 1) cardiac output, 2) Functional Residual Capacity, 3) Preload, 4) paCO2 on ABG
1) Decreases cardiac preload
2) Increases functional residual capacity
3) Decreases preload
4) None - it increases paO2
300
This is the mechanism of action of sirolimus.
mTOR inhibitor, binds FKBP and prevents progression of cell cycle within T cells
300
This is how a central line placed in the carotid artery is handled.
Open repair with removal of the catheter.
300
A 35 year old man is an IV drug user who presents with fever, chills, and right upper quadrant pain, then diagnosed with a hepatic abscess. After treatment is complete, this follow-up procedure is required.
What is an Echocardiogram?
300
This preexisting condition and/or lifestyle choice poses the greatest risk of periop pulmonary complications, according to ASA
- half points for 2nd highest risk
What is Age > 60?
What is Smoking history >20 pack years?
400
These are the treatment goals for ARDS.
Low tidal volume 4-6 ml/kg
Plateau pressure <30cm (and/or driving pressure <15cm H2O)
Proning
Inhaled NO, Prostacyclins, Neuromuscular blockade
VV-ECMO
400
This type of transplant rejection is the major cause of late graft failure, and this is when it occurs.
Chronic Rejection = Type IV hypersensitivity, Months to years due to alloantibodies created during prior acute rejection episodes
400
These are the symptoms and management of Steal Syndrome.
Pain and poor perfusion (signals, cap refill, cool) distal to fistula that resolves with compression of the fistula. No inflow/outflow obstruction on angio/duplex.
DRIL procedure
400
This liver lesion typically enhances on arterial phase and washes out on portal venous phase.
What is HCC?
400
A 76 yr old man with COPD presents for elective Nissen. He has hypertension and is able to climb two flights of stairs without difficulty. This is the next test he needs for preoperative cardiac evaluation.
What is an EKG?
500
These are common reasons a patient is unable to undergo successful bag-valve mask after sudden dislodging of tracheostomy.
Subglottic stenosis
Air leak through tracheostomy site
Bronchopulmonary plug
obstruction within the oral cavity
500
Name the cancer/cancer syndrome associated with these genes:
BRCA; APC; MLH/MSH; CDH1; TP53; Ckit/CD117; BRAF; Ret; c-myc
Breast cancer, ovarian, melanoma (BRCA); Colon cancer/duodenal/FAP/Gardner's Syndrome (APC); Lynch Syndrome/Ovarian/Endometrial/colon (MSH, MLH); Hereditary Diffuse Gastric Cancer (CDH1); Li-Fraumeni, Melanoma, colon, Rhabdomyosarcoma (p53); GISTs (Ckit/CD117); Melanoma (BRAF); Medullary thyroid cancer, MEN2a/2b (Ret); Burkitt's lymphoma (C-myc)
500
This artery can be inadvertently transected in the gastrohepatic ligament when trying to obtain supraceliac control of the aorta
What is the Replaced Left hepatic artery? (comes off left gastric)
500
What is Focal Nodular Hyperplasia?
500
A 75 yr old patient is undergoing an elective colectomy for cancer. He has controlled htn and COPD, and has smoked 2 packs daily for 40 years. This intervention at this time interval will reduce his risk of pulmonary complications.
Post-op incentive spirometry