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MGH interview

QuestionAnswer
whats does SIRS stand for? Signs? systemic inflammatory response syndrome; fever, tachycardia, tachypnea, incrsd WBC
how is sepsis defined documented infxn and SIRS
define septic shock sepsis and hypotension refractory to fluid resuscitation
define class I hemorrhage; signs/symptoms 750cc of 15%, nml vitals
define class II hemorrhage; signs/symptoms 30-40% blood loss, nml SBP, decrsd pulse P, tachycardia, tachypnea
define class III hemorrhage; signs/symptoms decrsd SBP, tachycardia, tachypnea, decrsd pulse P
define class IV hemorrhage; signs/symptoms >40%, no UOP, decrsd SBP, tachycardia, tachypnea, decrsd pulse P, confused/lethargic
calculating hourly fluids 4/2/1 rule, 4ml/kg for first 10kg, 2ml/kg for next 10, 1ml/kg beyond that
MIVF for 110kg man 110ml/hr
why is 1/4NS used in young children inability to concentrate urine
what composes Hesselbachs triangle inguinal lig, epigastric vessels, rectus sheath
what nerve is on top of the spermatic cord ilioinguinal nerve
what does the L testicular vein drain into L renal vein
what does the R testicular vein drain into IVC
what is gubernaculum adheres the testes to scrotal sac
what are white lines of Toldt peritoneal reflections of asc and desc colon
what is vein on top of pylorus vein of Mayo
what is pouch of douglas pouch bw rectum and bladder or uterus
what does the thoracic duct empty into L subclavian at jxn L IJ
what is internal iliac artery called hypogastric
what are layers of abd wall scarpas, ext oblique, int oblique, transversus abdominis, transversalis fascia
how colon and small bowel difft colon has taenia coli, haustra, and appendices epiploicae
what dermatome umbilicus T10
what % body wgt is intracellular fluid, extracellular fluid? fluid is 60% total body wgt, 40% is intracellular, 20% is extracellular
how much blood in 70kg man 7% of 70kg=5L
EKG changes of hyperkalemia peaked T, depressed ST, prolonged PR, wide QRS
tx high K C BIG K=calcium, bicarb, insulin and glucose, kayexelate, Lasix (dialysis if emergency)
when do post op pts mobilize their fluid POD3
tx C Dif diarrhea oral vanc (poorly absorbed in gut)
who is at risk for protamine rxn DMI on NPH
key components FFP all clotting factors
key components cryo fibrinogen, VWF
which pain med can cause sphincter of Odi constriction Demerol
tx narcotic OD naloxone (narcan)
reverse benzos flumazenil
DVT MC in L or R iliac vein L bc aortic bifurcation crosses and could compress
sign of DVT Homan (pain on flexing ankle)
Virchows triad of hypercoag blood stasis, endothelial injury, hypercoag
EKG of cor pulmonale (ie PE) S1Q3T3
what kind of filter do you put in the IVC to prevent PE Greenfield
before putting in an arterial line in the radial artery you must document what? Allen test, whether adequate collateral from the ulnar artery
formular FENa U Na/Cr x Pl Cr/Na
key characteristics pre renal renal failure (4) BUN:Cr >20, FENa <1%, U Osm >500, U Na <20
indications for dialysis fluid overload, refractory hyperK, uremic encephalopathy incl uremic pericarditis, BUN>130
what P for abdominal compartment syndrome 25mmHg (nml <15), can test bladder pressure
why is their decrsd pulse P w shock vasoconstriction incrreases DBP
what is a clean contaminated wound/operation GI or respiratory, without contamination or entry into biliary
what is a contaminated wound/operation acute inflammation, truamatic wound, GI tract spillage, or major break in sterile technique
rates of infxn clean contaminated? Contaminated? <3%, 5%
what causes nec fascitis Streptococcus
what causes gas gangrene Clostridium perfringens
what is the pneumonic for post op fever Wind, water, wound, walking (DVT), wonder drugs
characteristics indirect inguinal hernia MC, congenital defect in processus vaginalis, LIE lateral to inferior epigastric and goes through internal ring
characteristics direct inguinal hernia go through Hesselbach's triangle, from wear and tear
what are boundaries of Hesselbach inferior epigastric, inguinal (Poupart) ligament, rectus sheath
what's a mcvay hernia repair suture cooper's ligament to transversus abdominus aponeurosis (tension free repair
what's a tension free hernia repair suture cooper's ligament to transversus abdominus aponeurosis (mcvay repair)
what happens if cut ilioinguinal nerve numbness inner thigh or lateral scrotum
what does cremaster mscl come from internal oblique
what derives from external oblique inguinal lig
what's in spermatic cord (5) cremasteric mscl, vas deferens, testicular artery, pampiniform venous plexus, genital branch of genitofemoral nerve
what's a cord lipoma preperitoneal fat on cord (not real lipoma)
where's femoral hernia medial to femoral vessels, travels beneath inguinal ligament down the femoral canal
how diagnose tension PTX clinically: dyspnea, JVD, tachypnea, decrsd breath sounds +/- displaced trachea
tx tension PTX needle decompressions 2nd intercostal at midclavicular line
s/s cardiac tamponade tachycardia, hypotension, JVD, pulsus paradoxus, Kussmauls
what's kussmaul's sign JVD w inspiration
how difft cardiac tamponade and constrictive pericarditis constrictive pericarditis doesn't have pulsus paradoxus, had rapid x and y descent (tamponade has no y descent in RA pressure)
how difft restrictive cardiomyopathy and tamponade or constrictive pericarditis no equalization of chamber P, doees have Kussmauls but no pulsus paradoxus
how much blood can an upright CXR hide 500
if femoral pulse is palpable SBP is at least? If radial? 60, 80
if think urethral injury, what do before placing Foley retrograde urethrogram
Glascow coma scale categories and ranges eye (1-4), motor (1-6), verbal (1-5). Think 4 eyes, 6 cylinder motor, Jackson 5
categories eyes GCS 4 opens spont, 3 opens to command, 2 opens to pain, 1 doesn't open
categories motor GCS 6 moves spont, 5 localizes painful, 4 wdrwls pain, 3 decorticate, 2 decerebrate, 1 none
categories verbal GCS 5 nml, 4 confused, 3 inappropriate, 2 incomprehensible
GCS for a coma 8 or below
how score GCS if intubated can't evaluate verbal so put 10T
signs of basilar skull fracture hemotympanum, otorrhea
will Hct be low after massive hemorrhage no, no time to equilibrate
s/s possible urethral injury high riding prostate, blood at meatus
zones for neck injury III above angle of mandible, I below cricoid
tx of penetrating neck trauma II automatically gets surgical exploration, the other 2 get arteriogram, bronchoscopy, esophagoscopy and then decide
how much crystalloid for given amt blood loss 3 for 1
pelvic bleeding in pelvic fx is arterial or venous venous
how high does diaphragm go nipple (intercostal space 4)
how calculate areas for burns 9% for ea upper limb and head and ea side of trunk, 18% for ea lower limb
1st degree burn includes what? 2nd? Third? 1st=epidermis only, 2nd=some dermis, 3rd=entire dermis
3rd degree appears? Feels? painless, no sensation, white
parkland formula for burns % surface area x kg x 4; give 1/2 in 8hrs and the rest over 18hrs
if smoke burn injury be sure to check carboxyHb
3 Abx used in combo to clear H Pylori Ampicillin, Flagyl, Clarithro (+ PPI like omeprazole)
duodenal ulcer hurts more or less with food less
bilroth II consists of vagotomy, antrectomy, and gastro-jejunostomy (end-to-side, so 2 limbs off of stomach)
bilroth II v bilroth I vagotomy, antrectomy, and gastro-duoostomy (end-to-end, so 1 limbs off of stomach)
what's mallory-weiss tears after retching submucosa and mucosa tears of stomach near GE Junction
what' boehaaves esophageal rupture (all layers) above GE jxn
what's triple Abx coverage amp, gent, clinda (covers everything)
s/s carcinoid diarrhea, flushing, bronchospasm
what hormones cause carcinoid syndrome serotonin release
tx of carcinoid syndrome octreotide
what's falciform ligament contains lig teres (obliterated umbilical vein) and goes from anterior abd wall to liver
what's Glisson's capsule capsule around liver
what provides O2 to liver 50% portal vein, 50% hepatic artery (portal system give 75% blood)
what's venous drainage liver portal vein (from splenic vein and SMV)
what's budd chiari syndrome thrombosis of hepatic veins
how measure portal pressure wedge pressure of hepatic vein
tx esophageal varices (2 types) vasopressin + NG or Blakemore tube if that didn't work
what's TIPs stand for, what does it involve transjugular intrahepatic portosystemic shunt (bw hepatic vein and branch of portal vein)
what's a total shunt for liver portal vein-IVC (end to side)
what lab level seen in liver failure ammonia level
tx of liver failue lactulose
what's hartmann's pouch Gb infundibulum
boundaries of triangle of calot cystic duct, c hepatic duct, cystic artery
where does referred biliary colic pain go R subscapular boas sign
what's murphy's sign inspiratory arrest from GB rubbing against ur hand
what's IOC intraop cholangiogram if unsure stone in CBD
what Rx can be used gallstones uresodeoxycholic acid
signs of acute cholecystitis on US thickened GB wall >3mm, pericholecystic fluid, distended GB, gallstones
what's charcot triad F/C, RUQ pain, jaundice (for cholangitis)
what's gallstone ileus SBO from stone that gone into duo or small bowel (ie eroded through wall)
what's Rouex-en-Y anastomose bile duct to jejunum
2 pancreatic ducts Wirsung and Santorini
Ranson criteria for admission for pancreatitis GA LAW: glu>220, age>55, LDH>350, AST>250, WBC>16K
Ranson criteria for 48 hrs CHOBBS: Ca<8, Hct drop 10%, O2<60, Base deficit >4, BUN incrs 5, sequester 6L
splenic vein thrombosis causes gastric varices
components of Whipple remove GB, remove head pancreas and duo, remove antrum of stomach, vagotomy, then connect CBD, stomach, distal pancreas to jejunum
why must remove duo and head of pancreas they come off the same blood supply
Created by: ehstephns on 2011-11-27



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