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Burns
Anesthesia
Pancreas
Hepatobiliary
Trauma
100
What is the most common infection in a burn patient?
Pneumonia S.aureas, GN most common 40% with inhalation injuries 50% of mortalities
100
Which agent used for induction of anesthesia can cause suppression of adrenal hormone synthesis?
Etomidate Can supress for 5-6 hours, even after single dose, increased mortality with prolonged use.
100
What is the most common type of in infected pancreatic necrosis or infected pseudocysts?
Polymicrobial From adjacent bowel flora or hematogenous spread.
100
What is the origin of the replaced right and left hepatic arteries?
Replaced left hepatic from left gastric in hepatogastric ligament. Replaced right hepatic from SMA lies to the right of the CBD in the lateral aspect of the hepatoduodenal ligament.
100
Which component of the GCS exam is the most important predictor of severity and recovery in TBI?
Motor
200
What is the parkland formula?
4ml LR x wt in kg x % TBSA burned Half given in first 8 hours, rest over next 16 hours Guide only. Goal normal hemodynamics and end organ perfusion. Goal urine output 0.5-1ml/kg/hr in adults and 1-1.5 in kids
200
Which muscle relaxant is contraindicated in kids?
Succinylcholine B/c of undiagnosed myopathies Also relative contraindicated in increased intracranial pressure, open orbit injuries, hyperkalemia.
200
What is the most common radiologic finding in chronic pancreatitis?
Uniform ductal dilation
200
What is the treatment of bleeding gastric varices in the setting of splenic vein thrombosis?
Splenectomy
200
What is the preferred pressor to use in neurogenic shock?
Dopamine
300
What is the mechanism and treatment of cyanide poisoning?
Inhibits oxidative phosphorylation Metabolic acidosis 100% oxygen IV sodium thiosulfate 125-250 mg/kg Hydroxocobalamin 4g
300
What is the first sign of malignant hyperthermia?
Elevated end tidal CO2. SR can't reaccumulate calcium, leading to sustained musle contractions. Tachycardia, arrhythemias. Muscle rigidity Eventual increased body temperature Metabolic acidosis, reps acidosis, increased K and CK Clinical diagnosis
300
What is MEN1 syndrome?
Pancreatic endocrine tumors parathyroid hyperplasia Pituitary adenoma
300
What is the most common malignant liver tumor and it's surgical treatment?
Metastatic disease If colorectal met- wedge resection with 1 cm margin ideally (but really as little as 1mm ok), also done with metastatic sarcoma.
300
What are the four criteria to diagnose ARDS?
Acute onset Hypoxia with PaO2 to FIO2 ratio of <200 non-cardiogenic pulmonary edema (wedge <18) bilateral infiltrates on CXR (can lag 24hrs)
400
What is the defining feature of an invasive wound infection?
Quantitative count of >10^5 organisms/g tissue Signs- partial converts to full thickness wound, early eschar separation, dark brown or black discoloration.
400
What is the first sign of local anesthetic toxicity?
CNS before CV. 1st Metallic taste Then circumoral tingling or tinnitus, seizures. Lidocaine- bradycardia, vasodilation Bupivicaine- more cardiotoxic, arrhythemias, CV collapse
400
Which tumor is associated with necrolytic migrating erythema?
Glucagonoma Also mild DM, anemia, weight loss Debulk for survival benefit and symptoms Octreotide helps, chemo
400
What are the milian criteria?
For transplant with HCC. 1 tumor less than or equal to 5 cm Or 3 or fewer tumors each 3cm or less.
400
What is the treatment of a uterine GSW in a 27 week pregnant female?
Emergency c-section during laparotomy
500
What is the treatment of hydrofluoric acid burns?
Topical or injection calcium gluconate Precipitates calcium and magnesium in tissues, causing pain and further damage.
500
What is the treatment of a post dural puncture headache refractory to bedrest, fluids and caffeine?
Epidural blood patch 10-20ml blood into epidural space Relief in 1-24 hours for 85-90% of patients Caused by brain sagging in vault after CSF leak puts traction on dural pain fibers. Usually occipital or frontal headache, worse erect, improved supine.
500
What is the Puestow procedure? What is is used for?
Side to side pancreaticojejunostomy. Chronic pancreatitis in setting of dilated pancreatic ducts.
500
What is the sugiura procedure?
For refractory bleeding esophageal varicose. Esophageal devascularization, transection at distal 5-8 cm and reanastomosis to disrupt venous collaterals. 30-59% rebelled, high morbidity and mortality.
500
What is the formula for free water deficit?
=0.6 x wt(1-140/serum Na) Correct for elevated glucose by adding 1.6 mmol Na/L for each 100 glucose over 100.