Nutrition
These are the diagnostic criteria for Metabolic Syndrome. (Need 4/5 for credit)
What is Obesity, Insulin resistance (fasting glucose >100), High TAGs (>100), Low HDL (<50), Hypertension (>130/85)
This is the GCS assessment of a man who opens his eyes when spoken to, pulls his arm away when palpated and knows his name but not what day it is.
What is GCS 11?
This drug is used to treat malignant hyperthermia.
What is dantrolene?
To treat Malignant Hyperthermia, Dantrolene is given initially at 2.5 mg/kg and repeated until the episode is controlled or this cumulative max dose is reached.
What electrolyte should be inspected if difficulty correcting low calcium?
What is Magnesium?
Predominant type of collagen in scar tissue
What is type I
An ICU patient on TPN has rising PaCO₂, difficulty weaning from the vent and an RQ of 1.1.
What is carbohydrate overfeeding, and the treatment is to decrease carbohydrate (and total caloric) intake?
RQ= CO2/O2
RQ>1= lipogenesis, overfeeding -decrease carbs/cals
RQ<0.7 = starvation/ketosis -increase carbs/cals
RQ=0.8 is balanced and pure protein utilization
This is the appropriate operative approach to a 50% circumferential laceration carina extending into the left proximal mainstem bronchus.
Right posterolateral thoracotomy
gets you to the carina
Devitalized tissue should be debrided and the bronchus repaired with interrupted absorbable suture.
Lidocaine and Bupivacaine belong to this chemical class of local anesthetics, which is distinct from esters.
What are Amides?
Main energy source of enterocytes?
What is glutamine?
At this point in time during healing, a wound has reached its maximum collagen accumulation.
What is 3 weeks?
(After 3 weeks, cross-linking improves wound strength. Maximum strength is reached at 8 weeks, which is 80% of pre-wound strength)
This vitamin deficiency is characterized by hyperglycemia, neuropathy.
What is chromium?
This is the appropriate next step for the following patient scenerio:
A 74-year-old man tripped on a broken sidewalk and fell. He is awake, alert, and able to provide a clear history. He hit his head and did not lose consciousness. He has an abrasion over his left eye and on his left palm, with no other obvious injury. Notably, he has no neck pain, tenderness to palpation of his cervical spine at the midline, or neurologic deficit.
Obtain CT of the cervical spine.
he most commonly used tools are the NEXUS criteria and the Canadian Cervical Spine Rule. However, both studies from which these rules were derived excluded patients over the age of 65 and should be interpreted with caution in this patient population. Older adults are more likely to have a cervical spine injury with low-energy mechanisms such as falls from standing, and they are more likely to have clinically significant injuries not apparent on physical examination.
This is the maximum dose for Lidocaine in an average adult.
What is 4.5 mg/kg?
Lidocaine max = 4.5 mg/kg (300 mg max)
Lidocaine + epi = 7 mg/kg (500 mg max)
Bupivicaine= 2 mg/kg
Bupivicaine + epi= 3 mg/kg
Include how to calculate maximum dosage based on weight
These are the electrolyte deficiencies seen in refeeding syndrome. (3)
What are K, Mg, PO4?
(leading to cardiac dysfunction, profound weakness, and encephalopathy).
This is the first cell type to arrive at a wound to promote healing.
What are neutrophils?
Day 0-2- plts and PMNs
Day 3-4- macrophages
Day 5 and on- fibroblasts
Type III- predominant collagen type during proliferation
Type I- predominant collagen type synthesized during remodeling
Type 3 replaced by Type 1 by 3 weeks
This deficiency leads to diarrhea, dermatitis, and dementia.
What is Niacin?
This is the AAST grade of the following renal injury in this patietn scenerio:
A 16-year-old unrestrained passenger is involved in a high-speed motor vehicle accident. He is taken to the operating room for exploration. He is found to have a left renal laceration that involves the deep renal cortex, the medulla and collecting system with a small contained hematoma at the renal hilum.
IV
Grade I involves contusions with an intact renal capsule.
Grade II involves minor lacerations to the renal parenchyma extending to the superficial renal cortex, but does not involve the medulla or collecting system.
Grade III involves major parenchymal lacerations that involve the renal cortex and medulla, but does not involve the collecting system.
Grade IV involves major parenchymal laceration extending through the cortex and medulla as well as the collecting system, and involves the renal vasculature with locally contained hemorrhage.
Depolarizing muscle relaxants work by occupying these specific binding sites at the neuromuscular junction.
What are Acetylcholine binding sites?
This is fluid resuscitation in first 24hr to a burn patient.
What is the Parkland formula?
4mL/kg x %TBSA burn
Half over first 8 hrs then the remaining over the next 16hr
The cytokine that is the most potent stimulant of angiogenesis
What is basic fibroblast growth factor?
Basic FGF, also known as fibroblast growth factor 1 (FGF-1), is the most potent angiogenic stimulant identified (78); heparin is an important cofactor for this gro
Deficiency in this leads to dermatitis, hair loss, and thrombocytopenia.
What are essential fatty acids?
A ureteral injury 6 cm above the bladder should be repaired with this type of repair.
What is a distal ureteral injury, managed with ureteroneocystostomy ± psoas hitch?
3-6 cm to bladder (distal)= reimplant to bladder
6-10 cm to bladder (mid)= UU or TUU
>10 cm to bladder (prox)= UU
This classic EKG finding will be present in the following patient scenario:
A 78-year-old man is brought to the emergency department via ambulance after his wife found him obtunded. He has stage 4 chronic kidney disease and has been complaining of constipation lately. He has been using over-the-counter magnesium hydroxide (Milk of Magnesia), yet has had no relief. Vital signs are blood pressure 90/50 mm Hg, temperature 98.9ºF, heart rate 93 beats/min, and respiratory rate 8 breaths/min. The man appears flushed and has decreased reflexes.
What is 1st degree AV block|
This is the free water deficit in a 83 kg male with serum Na153 mEq/dL.
4.6
free water deficit = % total body water (fraction) × weight (kg) × (current Na/ideal Na – 1).
This is the cellular location of proline hydroxylation
What is rough endoplasmic reticulum?