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MGH interview
| Question | Answer |
|---|---|
| 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
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