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