?
Rule of 9s : List the %BSA assigned for each area ?
Rule of 9’s ; each arm (9), each leg (18), torso (36%) , groin (1), head (9)
- pediatrics : head (18), each arm (9) , each leg (14), torso (36)
Most common location of an ectopic parathyroid gland?
Thymus
MC missed gland location = normal anatomic position
CCK secreted from what cells?
*Bonus 100 : what action does it have and what stimulates secretion?
I cells (duodenum/ jejunum)
A: inc gall contraction, dec gastric emptying, inc panc fluid secretion / sphincter of oddi relaxation
- Stim: fats (also aa) in duodenum
List Arterial Blood Supply to the Esophagus by level?
cervical (inf thyroid), thoracic (aorta), abdominal (left gastric and inferior phrenic)
Femoral hernia defect is where in relation to the inguinal ligament ?
*Bonus 100 : Briefly describe the Surgical repair
defect is below the inguinal lig, medial to the femoral vein , above superior pubic ramus w/ cooper’s ligament , Lateral to pubic tubercle
McVay : close femoral space by suturing conjoint tendon to coopers ligament
What is the Parkland formula ?
weight in Kg x % TBSA x 4ml
- use for burns over 20% TBSA, % TBSA caps at 50 for the equation, use LR in first 24
Margin goals for Melanoma ?
*Extra 100 : when do you do a SLNB ?
1 cm for < 1 mm
1-2cm for 1-2 mm
2 cm for > 2 mm
(preserve facial n branches unless clinically involved - ie dont resect for neg margins)
- SLNB : done for clinically node neg patients w/ primary tumor > 0.8 mm, or any ulceration
- LDN for clinically pos nodes
Mechanism of ADH effect on serum osmolality ?
(V2 receptors) and BP (V1 receptors)
inc aquaporin channel insertion in principal cells of renal collecting duct
When should patients be given stress dose steroids?
daily > 20 mg for > 3 wks
List the 5 types of Gastric Ulcers by location
1 lesser curve,
2 duodenal and lesser curve
3 pre-pyloric
4 proximal lesser curve (cardia)
5 anywhere /diffuse (NSAIDs)
*2 & 3 due to inc acid production
Most common type of TE fistula ?
C (mc , blid ending esophageal atresia and distal TE fisutla) > Type A (just esophageal atresia no fistula)
Treatment for a gastric MALToma ?
- trt w/ abx (triple therapy)
**when found in the sm intestine - typ presents w/ obstruction and found on final path . isolated disease after resection needs no further trt
Describe the Renin -Aldosterone System ?
- dec intravscaular fluid and hyponatremia stimulate renin release from JGA
> renin stim conversion of circulating angiotensinogen (Sec in liver) to angiotensin 1
> angiotensin 1 converted to angiotensin 2 by ACE in lung
What IV anesthetic inhibits the synthesis of cortisol ?
Etomidate ! - inhibits adrenal 11 B hydroxylase : = dec in synth of cortisol , found even in single dose admin
Side effect of bacitracin?
*Bonus 100: Side effect of Silver nitrate ?
Rarely can cause anaphylaxis
Hyponatermia, methemoglobinemia
Surgical Treatment for a Zenker's diverticulum based on size ?
*Bonus 100: Where does a Zenker Diverticulum typically occur?
> 3cm endoscopic division of upper esophageal sphincter = common lumen between diverticulum and esophagus , and pexy
- < 3cm : open myotomy (l neck incision) w/ or w/out diverticulectomy + cricopharyngeal myotomy
Killian : above cricopharyngeous (UES), and below inferior constrictors
What vitamin can be given to help wound healing for patients on steroids?
Vitamin A
Surgical treatment for Achalasia ?
*Bonus 100 : Describe it .
trt w/ Heller myotomy w/ partial fundoplication
- Heller : 6 cm on esophagus, 2 cm on stomach
List the Bethesda Criteria
-1 :non diagnostic - repeat FNA
- 2 benign - reapeat exam in 6-12 mon
- 3 atypia or follicular lesion of unknown sig - repeat FNA
- 4 : follicular neoplasm / sus follic neoplasm - need lobectomy for dx
- 5 : sus for malignacy - lobectoby vs total thyroid
- 6 : malignant
Describe the surgical correction for intestinal malrotation?
Ladds' procedure : resect ladd’s bands (typically in RUQ connecting cecum to the liver), straighten the duodenum, inspect/broaden the mesentery , counterclockwise detorsion , sm intestine placed in R abdomen, Large intestine placed in left abdomen +. appendetomy
List the effects of IL 1, 2,3,4,5,6, 8
IL-1 ; fever , lymphocyte activation
IL-2 ; T cell growth factor
IL-3 : Bone marrow growth
IL-4 : B cell growth factor
IL-5 : B cell diff , IgA production
IL-6 : acute phase reactants, + B ecell diff / synth
IL-8 ; neutrophil chemotaxis
Nutritional deficiencies seen in patients with refeeding syndrome ? (3)
hypophos, hypokal, hypomag
List the (3) Branched chain amino acids ?
leucine, isoleucine, valine
TEG :
Describe R time , K time and Max Amp and what are the implications of each being deranged.
- reaction Time : (R) (how long to start to clot ) : give FFP
- clot formation time (K) ; time until clot reaches fixed strength (20 mm, 1-3 min normal) : issue with fibrinogen : give cryo
- Angle : speed of fibrin accumulation : give cryo (concentrated clotting factors, vWF, factor 8, fibrinogen)
- Amp (Max amp , MA) : size of clot ; give platelets / DDAVP
- LY30 (% of amp loss 30 min after MA) ; measures lysis : if high give TXA / aminocapnotic acid
ARDS : how do you classify the severity and what are the classifications ?
severity determined by pO2 /FiO2 (decimal) = Berlin criteria
- mild P:F ratio = 200-300
- moderate = 100-200
- severe < 100
manage with low TV 4-6cc/kg protocol,