Term
What diagnostic tests can you get to diagnose lumbar prolapsed nucleus pulposus? |
|
Definition
MRI or myelography; plain x ray may shownarrowing of the intervertebral space |
|
|
Term
At what level is herniated puplposes most common? |
|
Definition
L4-5 level or L5-S1 level |
|
|
Term
What is the difference between mechanical backache and back sprains? |
|
Definition
backcageare usually chronic and may result in a long-term debilitating illness without any definite or demonstrable cause; back sprains are usually associated with minor trauma producing ligamentous or muscular injury |
|
|
Term
What is cauda equina syndrome? |
|
Definition
compression of the sacral nerve bundle which forms the end of the spinal cord, with symptoms of bladder or bowel dysfunciton and/or pain or weakness in the legs. This disorder should be diagnosed at an early stage to avoid permanent injury |
|
|
Term
What complications associated with osteo and rheumatoid arthritis are associated with chronic back pain> |
|
Definition
ankylosing spondylitis, spinal stenosis, spondylolisthesis |
|
|
Term
What degenerative changes can cause compression of nerves emanating from the spinal cord? |
|
Definition
herniation of nucleus pulposis, protrusion of osteophytes |
|
|
Term
What are the characteristic symptoms of nerve compression in the back? |
|
Definition
pain radiating to buttock, posterior thigh or calf; coughing, sneezing, or straining increases pain; other exacerbating factors are bending, sitting, and getting in and out of a vehicle whereas lying flat characteristically relieves pain; |
|
|
Term
What are the PE findings for patients with spinal compression? |
|
Definition
paravertebral muscles are often in spasm, loss of normal lumbar lordosis, straight leg raising is limited on teh side of the lesion, dorosiflexion of foot exacerbates, may be tenderness to palpation of the central canal or buttock; sensory and muscular weakness may be present along appropriate dermatomes, |
|
|
Term
If you suspect herniated disk what else should be in your differential? |
|
Definition
fracture, joint subluxation, tumors of the bone, joint, or meninges; abscess; arachnoiditis; ankylosing spondylitis |
|
|
Term
What is first line conservative treatment for back pain? |
|
Definition
bed rest, application of heat pads or ice packs, NSAIDs, and muscle relaxants and/or physical therapy; back brace or corset may help |
|
|
Term
What are the indications for surgical decompression of herniated disk? |
|
Definition
development of an acute disabling neurologic deficit (bladder dysfunction) or intractable severe pain; a large trial failed to show superior efficacy of surgery versus conservative therapy |
|
|
Term
What does surgery for a herniated disk entail? |
|
Definition
laminectomy and removal of the protruding disk; if several disk spaces are involved, posterior spinal usion in addition to removal of the disks may be indicated |
|
|
Term
What are some techniques under review for herniated disk? |
|
Definition
dissolution of the disk by the injection of chemicals, steroid injections for short term relief |
|
|
Term
What does HIDA scan stand for? |
|
Definition
hepatoiminodiacetic acid scan |
|
|
Term
What is the differential diagnosis for neonatal jaundice? |
|
Definition
neonatal hepatitis; toxoplasmosis, other agents, ,rubella, CMV, HSV (TORCH), metabolic diseases (alpha 1 antitrypsin deficiency, cystic fibrosis, etc.), biliary atresia and choledochal cyst |
|
|
Term
When does physiologic jaundice typically occur? |
|
Definition
typically is evident by day 2 to 3 and resolves by day 5 to 7 of life; does not persist for more than two weeks |
|
|
Term
At what time is surgical correction for biliary atresia typically performed? |
|
Definition
before 8 weeks of age (12 weeks maximum) |
|
|
Term
How common is neonatal jaundice? |
|
Definition
60% of term infants and 80% of preterm infants |
|
|
Term
How should you evaluate neonatal jaundice that seems inconsistent with physiologic jaundice? |
|
Definition
abdominal ultrasound, HIDA scan, percutaneous liver biopsy; if the imaging studies do not rule out biliary atresia, then operative exploration with intraoperative cholangiogram is indicated |
|
|
Term
How do you treat a choledochal cyst? |
|
Definition
cyst excision and hepaticojejunostomy, where a limb of the jejunum is attached to the bifurcating hepatic ducts at their confluence |
|
|
Term
What is the term for biliary hypoplasia? |
|
Definition
|
|
Term
How do you treat alagille syndrome? |
|
Definition
|
|
Term
What are the clinical findings associated with biliary hypoplasia? |
|
Definition
cardiovascular, spinal, eye abnormalities, and jaundice common |
|
|
Term
What medical treatment can cause conjugated hyperbilirubinemia in the new born? |
|
Definition
|
|
Term
What causes inspissated bile syndrome? |
|
Definition
hemolytic diseases or cystic fibrosis |
|
|
Term
How do you treat inspissated bile syndrome? |
|
Definition
intraoperative cholangiogram may be both diagnostic and therapeutic |
|
|
Term
What are some causes of unconjugated hyperbilirubinemia? |
|
Definition
hemolytic diseases, metabolic diseases, physiologic jaundice |
|
|
Term
What are some causes of conjugated hyperbilirubinemia? |
|
Definition
biliary atresia, choledochal cyst, biliary hypoplasia (alagille syndrome), total parenteral nutrition, inspissated bile syndrome, sepsis/infection |
|
|
Term
Whatis a choledochal cyst? |
|
Definition
congenital anatomic malformation of a bile duct, including cystic dilatation of the extrahepatic bile duct or the large intrahepatic bile duct |
|
|
Term
What causes biliary atresia? |
|
Definition
exact cause is unknown; various theories include viral infection or autoimmune process |
|
|
Term
What does biliary atresia look like histologically? |
|
Definition
inflammatory cells surrounding obliterated ductules |
|
|
Term
What does biliary atresia look like grossly? |
|
Definition
fibrosis of the entire extrahepatic biliary tree, followed by proximal duct fibrosis with distal duct patency |
|
|
Term
What causes choledochal cysts? |
|
Definition
unkown; widely held theory is that common bile duct and pancreatic duct share a common channel leading to retrograde reflux of pancreatic juice into the choledochus with subsequent cystic dilation |
|
|
Term
How many types of choledochal cysts are there? |
|
Definition
|
|
Term
How many types of choledochal cysts are there? |
|
Definition
|
|
Term
What is the most common tyep of choledochal cyst? |
|
Definition
fusiform or type I is 90% |
|
|
Term
Prior to surgical treatment of biliary atresia, patients should be evaluated for what complications? |
|
Definition
coagulation abnormalities, anemia, and hypoproteinemia |
|
|
Term
How is biliary atresia corrected surgically? |
|
Definition
kasai portoenterostomy= extrahepatic biliary tree is dissected up to the level of the portal plate; a roux-en-y limb of jejunum is attached to the porta in a retrocolic manner |
|
|
Term
What are hte three main complications of the surgical management of biliary atresia? |
|
Definition
cholangitis, cessation of bile flow, and portal hypertension |
|
|
Term
What is the most common complication occuring after portoenterostomy for bile duct atresia? |
|
Definition
|
|
Term
What are the symptoms of cholangitis? |
|
Definition
charcot's triad= RUQ pain, fever, jaundice; reynold's pentad= AMS, shock |
|
|
Term
What is the treatment for cholangitis? |
|
Definition
intravenous antibiotics against gram negative organisms and steroids |
|
|
Term
What is the survival rate for biliary atresia? |
|
Definition
before the kasai procedure it was less than 5% at 12 months; with surgery 30-50% have good long term results; however ultimately only 20% who get surgery survive into adulthood without liver transplantation |
|
|
Term
What factors affect outcome in patients with biliary atresia? |
|
Definition
age, immediate bile flow (technically sound operation) and degree of parenchymal disease at diagnosis; the presence and size of ductules in the hilum are of controversial prognostic significance |
|
|
Term
What percent of cases of biliary atresia have visible normally distended gallbladders? |
|
Definition
|
|
Term
After ___ days of life, portoenterostomy is rarely indicated. |
|
Definition
|
|
Term
How do you treat patients with biliary atresia after they are 120 days old? |
|
Definition
|
|
Term
What are known risk factors for squamous cell carcinoma? |
|
Definition
caustic burns, alcohol consumption, tobacco smoking, and nitrate-and nitrate containing food |
|
|
Term
What are the risk factors for esophageal adenocarcinoma? |
|
Definition
GERD, western diet, and acid suppression medications |
|
|
Term
How do you determine whether dysphagia due to a mass is due to a benign or malignant process? |
|
Definition
rapid onset is suggestive of neoplasm |
|
|
Term
How do you stage esophageal cancer? |
|
Definition
endoscopic ultrasound and evluation for possible metastatic disease with CT of the chest and abdomen; in some institutions, PET CT has replaced standard CT as teh staging modality of choice |
|
|
Term
Why is it improtant to differentiate between esophageal and stomach cancer? |
|
Definition
they require different treatments so its important to get EGD, endoscopic ultrasound and CTs to pinpoint teh exact tumor location |
|
|
Term
When evaluating a patient with esophageal cancer, its important to assess their... |
|
Definition
nutritional status with quantification of weight loss, measurement of serum albumin level |
|
|
Term
T/F Pts who can not swallow secondary to esophageal malignancy should get TPN. |
|
Definition
false; they should get a g tube or j tube |
|
|
Term
How are GE junction adenocarcinomas classified? |
|
Definition
|
|
Term
Siewert classification type I= |
|
Definition
located more than 1 cm above the GE junction |
|
|
Term
Seiwert classification type II= |
|
Definition
located within 1 cm proximal and 2 cm distal to the GE junction (surgical treatment would consist of esophagectomy with partial resection of the Ge junction) |
|
|
Term
What is transthoracic esophagectomy? |
|
Definition
resection traditionally done through an incision in the abdomen (or laparoscopic approach) and a separate incision through the right chest at approximately the level of the azygous vein and distal transection is usually at the level of the proximal stomach; the stomach is then brought into the mediastinum and anastomosed to the proximal esphagus |
|
|
Term
What are the disadvantages ot a transthoracic esophagectomy? |
|
Definition
anastomosis is in the mediastinum; high rate of pulmonary complications due to pain from incisions in both the chest and upper abdomen |
|
|
Term
What is a transhiatal esophagectomy? |
|
Definition
resection done through an abdominal incision and a cervical incision; through the abdomen= stomach is mobilized and the distal esophagus is dissected after enlargement of the hiatal opening; through the cervical= cervical esophagus is mobilized and the proximal throacic esophagus is dissected and the entire throacic esophagus and the proximal stomach are resected and the gastricconduit is brouht up through the posterior mediastinum and anastomosed to the cervical esophagus in the neck |
|
|
Term
What are hte advantages of transhiatal esophagectomy? |
|
Definition
reduction in pulmonary complications and reduced mortality and morbidity associated cervical anastomoticleaks |
|
|
Term
What is the most common type of esophageal cancer? |
|
Definition
squamous cell world wide; adenocarcinoma in north america |
|
|
Term
Esophageal cancer is the __th leading cancer type. |
|
Definition
|
|
Term
T/F Esophageal cancer rates are rising. |
|
Definition
true; incidence has increased sixfold over the past 25 years |
|
|
Term
What is the overal prognosis for cancers of the esophagus and GE junction for all affectedpatients? |
|
Definition
|
|
Term
What percent of patients presenting with esophageal cancers are eligible for surgical resection? |
|
Definition
|
|
Term
What kind of therapy is recommended for patients with resectable esophageal cancer? |
|
Definition
surgery + chemo + radiation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
tumor invades lamina propria, muscularis mucosa, submucosa, but does not penetrate through the submucosa |
|
|
Term
|
Definition
tumor invades into but not beyond the muscularis propria |
|
|
Term
|
Definition
tumor invades periesophageal tissue but not adjacent structures |
|
|
Term
What is T4 esophageal cancer? |
|
Definition
tumor invasion of adjacent structures |
|
|
Term
|
Definition
regional lymph nodes cannot be assessed |
|
|
Term
|
Definition
no regional lymph node metastasis |
|
|
Term
|
Definition
regional lymph node metastasis |
|
|
Term
|
Definition
distant metastasis cannot be assessed |
|
|
Term
|
Definition
|
|
Term
What is M1a esophageal cancer? |
|
Definition
upper esophageal tumor with cervical LN mets; midthoracic tumor with mediastinal LN mets; lower thoracic lesion with celiac node metastasis |
|
|
Term
What is M1b esophageal cancer? |
|
Definition
upper lesion with mets to mediastinum or celiac lymphnodes; midthroacic lesion with mets to cervical or celiac nodes; lower thoracic lesion with mets to cervical or mediastinal lymphnodes |
|
|
Term
What is stage 0 esophageal cancer? |
|
Definition
|
|
Term
What is stage 1 esophageal cancer? |
|
Definition
|
|
Term
What is stage IIA esophageal cancer? |
|
Definition
|
|
Term
What is stage IIB esophageal cancer? |
|
Definition
|
|
Term
What is stage III esophageal cancer? |
|
Definition
T3, N1, M0; T4, N0 or N1, M0 |
|
|
Term
What is stage IVA esophageal cancer? |
|
Definition
|
|
Term
What is stage IVB esophageal cancer? |
|
Definition
|
|
Term
5 yr survival of stage 0 esophageal cancer? |
|
Definition
|
|
Term
5y survival of stage 1 esophageal cancer= |
|
Definition
|
|
Term
5 yr survival of stage IIA esophageal cancer? |
|
Definition
|
|
Term
5 yr survival of stage IIB esophageal cancer |
|
Definition
|
|
Term
5 yr survival of stage III esophageal cancer? |
|
Definition
|
|
Term
5 yr survival of stage IVA esophageal cancer? |
|
Definition
|
|
Term
5 yr survival of stage IVB esophageal cancer? |
|
Definition
|
|
Term
Do you use chemo for esophageal cancer? |
|
Definition
good evidence for use of pre and post op chemo in tx of patients with adeno carcinoma of the esophagus and stomach but not for squamous cell |
|
|
Term
Wht is palliative therapy for esophageal cancer? |
|
Definition
relieving dysphagia and prevent bleeding, perforation and tracheoesopahgeal fistula formation |
|
|
Term
What are the different types of palliative treatmentsfor dysphagia of esophageal cancer? |
|
Definition
endoscopic therapy (laser, stent placemnt, photocoagulation), radiation therapy (external beam or intraluminal), chemotherapy, and feeding tube placement |
|
|
Term
What are the advantages to endosocpic stent placement for palliation of esopaheal cancer? |
|
Definition
rapid relief, treatment of choice for tracheoesophageal fistula, easy outpt procedure |
|
|
Term
What are hte disadvantages of endoscopic stent placement? |
|
Definition
recurrence due to stent migration, tumor overgrowth; GERD; increased risk of late hemorrhage |
|
|
Term
What are hte advantages of using photodynamic therapy and Nd:YAG laser for esophageal cancer palliation? |
|
Definition
works well with exophytic lesions; generally low complication rates |
|
|
Term
What are the disadvantages to photodynamic therapy and Nd:YAG laser? |
|
Definition
often available in specialized centers; repeat tx every 4 to 8 weeks |
|
|
Term
What are hte advantages to single dose brachiotherapy? |
|
Definition
long dterm dysphagia improvement is better than stent placement; longterm quality of life was better when compared with stent; lowerrate of hemorrhage than stent |
|
|
Term
What are the disadvantages of palliative chemo for obstruction secondayr to esophageal carcinoma? |
|
Definition
response to obstruction is variable therefore, additional treatment is for obstruction may be needed; relief from obstruction may be delayed |
|
|
Term
What can renal U/S tell you? |
|
Definition
renal sie and number, urinary obstruction, renal vascular obstruction, and tumor infiltration |
|
|
Term
How do you stage renal disease? |
|
Definition
assessment fo cr clearance allows for estimation of GFR to stage renal disease |
|
|
Term
Half of the mortality of renal pts is due to complications of... |
|
Definition
|
|
Term
Why should renal pts get echos? |
|
Definition
because LVH is common in renal patients and echo can diagnose uremic pericarditis and pericardial effusion |
|
|
Term
At what GFR should you hemodialyse? |
|
Definition
|
|
Term
What is the definition of CRF? |
|
Definition
kidney damage of greater than 3 months duration and/or GRF less than 60 mL/min /1.73m2 |
|
|
Term
|
Definition
kidney damage with normal or increased GFR(>90) |
|
|
Term
|
Definition
kidney damage with mild decrease in GFR (60-89) |
|
|
Term
|
Definition
moderate decrease in GFR (30-59) |
|
|
Term
|
Definition
severe decrease in GFR (15-29); predialysis day |
|
|
Term
|
Definition
kidney fialure (GFR less than 15), indication for chronic dialysis usually |
|
|
Term
How do you alter diets of patients with CRF? |
|
Definition
K restriction if GFR is approaching 20 to avoid hyperkalemia; prevent hyperparathyroidism by dietary phosphate restriction, phosphate binder adinistration at meal time, syntehtic 1,25 dihydroxy vitamin D, and subtotal parathyroidectomy if needed |
|
|
Term
What are the leading causes of LVH in pts with renal failure? |
|
Definition
|
|
Term
What are the effects of uremia on the body? |
|
Definition
immunodeficiency state that is not reversible with hemodialysis, uremic encephalopathy, uremic peripheral neuropathy, uremic autonomic neuropathy producing postural hypotension and hypotension during dialysis, uremic platelet dysfunction |
|
|
Term
THe immunodeficiency state produced by uremia puts pts at greater risk for what kinds of infections? |
|
Definition
bacterial, viral, and mycobacterial infections and anergic states |
|
|
Term
Hemodialysis involves two spaces divided by a semipermeable membrane where blood passes through one side of the membrane and _____ passes on the other side. |
|
Definition
|
|
Term
What kind of access is needed for dialysis? |
|
Definition
large bore venous catheters through which blood can be drawn off at a high rate (350-400 mL/min) through one lumen and returned through a separate lumen |
|
|
Term
What are the different classifications of HD catheters? |
|
Definition
temporary access (days), intermediate term access (weeks to months), or permanent access |
|
|
Term
What are intermediate-term catheters for HD access like? |
|
Definition
they contain a cuff barrier and subcutaneous tunneled portion which are barriers against containation by skin flora and are associated with lower cather related infections and complications than the temporary dialysis catheters |
|
|
Term
What are the pros and cons of using the femoral vein for temporary dialysis access? |
|
Definition
rapid and safe but associated with increased infections when left in for more then a few days |
|
|
Term
What is the ideal site for either temporary or intermediate catheter insertion for HD for most patients? |
|
Definition
|
|
Term
What are the pros and cons of using thesubclavian vein for temporary vascular access in dialysis patients? |
|
Definition
shouldbe avoided because of the potential for thrombosis and stenosis which would affect venous return and copromise the success of future upper extremity arterial-venous fistulas on that side |
|
|
Term
Name soe commonly constructed AVFs? |
|
Definition
brescia-crimino fistula (radial artery to cephalic vein), brachial artery-cephalic vein fisula in the upper arm, brachial-basilic fistula in the upper arm |
|
|
Term
What are the major limitations to AVF creation? |
|
Definition
inadequate size and quality of the veins; because injuries to the vein can occur with blood draws and IV insertions, it isextreely important to preserve the upper extremity veins in any pt in whom long term dialysis is to be anticipated |
|
|
Term
How long do AVFs needed before tehy are mature enough for dialysis? |
|
Definition
|
|
Term
What is the most commonly used material for AV grafts? |
|
Definition
|
|
Term
Which is better, an AVF or an AVG? |
|
Definition
grafts are less desirable because of increased complications including infection and pseudointimal hyperplasia on the venous end of the graft-vein connection leading to graft thrombosis |
|
|
Term
What are the pros and cons of peritoneal dialysis? |
|
Definition
allows pts to ambulate and carry on some of the activities of daily living during dialysis but is done at home so ptsneed to be functional and capable of troubleshooting problems; also there is a risk of peritoneal infection and peritoneal dialysis catheter-related complications |
|
|
Term
Which is better for survival rates, hemodialysis or kidney transplant? |
|
Definition
kidneytransplant has an overal improved survival of 10 yrs |
|
|
Term
What are the three most common causes of CRF treated by renal transplantation? |
|
Definition
diabetes mellitus (27%), hypertension (20%), glomerular disease (21%) |
|
|
Term
What is the ratio of people on waitlist for kidney transplant and number of kidneys transplanted? |
|
Definition
|
|
Term
What is the median time on weight list for kidney transplant before recieving kidney? |
|
Definition
|
|
Term
When are patients considered for renal transplantation? |
|
Definition
when their GFR falls below 20 mL/min |
|
|
Term
What preop testing should pts undergo before getting a kidney? |
|
Definition
psychiatric eval to determine whether they are likely to comply with imunosuppressivetherapy; valuation to rule out urinary obstructive process and reflux as a cause of CFR and ABO/HLA typing. All patients are also evaluated for possible infections such as HIV, Hep B, hep C, CMV and syphilis |
|
|
Term
Can patients with cancer be considered for renal transplant? |
|
Definition
they need to be at least 2 years without evidence of disease prior to being considered for transplantation |
|
|
Term
T/F Age is a contraindication to organ transplantation. |
|
Definition
false; up to 20% of the pts on the kidney waitlist are over 65 |
|
|
Term
What are the two types of kidney transplants you can get and which is more common? |
|
Definition
living donor transplantation (40%) and cadaveric transplantation (60%) |
|
|
Term
Why does living donor transplantation have less complications than cadaveric transplantation? |
|
Definition
overall better medical condition of the donors and short cold ischemia time |
|
|
Term
What are the graft survival rates of living donor kidney transplants at 1, 5, and 10 yrs? |
|
Definition
|
|
Term
What type of patients do we get cadaveric organs from? |
|
Definition
retrieved fro brain dead donors between the ages of 3 to60 yoa and without systemic degenerative diseases such as hypertensiona dn diabetes and history of a stroke; however, because of the shortage of organs, ECDs (expanded criteria donors)= older than 60 or between 50 and 60 with a stroke, hx ofHTN, diabetes or elevated Cr |
|
|
Term
What are the survival rates of non ECD cadaveric kidney transplant at 1 and 5 yrs? |
|
Definition
|
|
Term
What are the survival rates of ECD cadaveric kidney transplants at 1 and 5 yrs? |
|
Definition
|
|
Term
T/F All patients who have renal transplants need immunosuppressive agents. |
|
Definition
false; if the kidney is from an identical twin donor you don't need immunosuppresion |
|
|
Term
What is the MOA of cyclosporin? |
|
Definition
inhibits the calcineurin pathway and the production of IL-2 |
|
|
Term
What are some major side effects associated with cyclosporin? |
|
Definition
gingival hyperplasia, hypertension, hyperkalemia, nephrotoxicity |
|
|
Term
What is the MOA of tacrolimus? |
|
Definition
calcineurin inhibitor causing inhibition of IL-2, IL-3, and IL-4 and gamma interferon production |
|
|
Term
Which is more potent, tacrolimus or cyclosporin? |
|
Definition
|
|
Term
What are the side effects of tacrolimus? |
|
Definition
nephrotoxicity, hypertension, hyperkalemia, hypomagnesemia, CNS symptoms (headaches, tremors, seizures) and insulin resistence |
|
|
Term
What is the MOA of sirolimus? |
|
Definition
a T cell inhibitor that acts through a pathway that is different from the calcineurin pathway |
|
|
Term
What is another name for sirolimus? |
|
Definition
|
|
Term
What are the side effects of sirolimus? |
|
Definition
less nephrotoxic than cyclosporine and tacrolimus but can cause thrombocytopenia, hyperlipidemia and poor wound healing |
|
|
Term
|
Definition
|
|
Term
What is the MOA of mycophenolate mofetil? |
|
Definition
inhibitor of B and T cell proliferation |
|
|
Term
What is the MOA of azathioprine? |
|
Definition
inhibits B and T cell proliferation |
|
|
Term
MMF is often combined with... |
|
Definition
|
|
Term
When is azathioprine used? |
|
Definition
substitued for MMF when intolerance develops |
|
|
Term
|
Definition
monoclonal murine antibiotdy agains the CD3 receptor complex on T cells |
|
|
Term
When acuteorgan transplant rejections are resistant to steroid induction, what is the next line of therapy? |
|
Definition
antilymphocytic antibiodies |
|
|
Term
What percent of people get a cute graft rejetion during the first few weeks to months after tranplantation? |
|
Definition
|
|
Term
What are the side effects of prolonged antilymphocytic therapy? |
|
Definition
serious viral infections, thrombocytopenia, and leukopenia |
|
|
Term
What are the symptoms of acute graft rejection? |
|
Definition
fever, malaise, hypertension, oliguria, increase in serum creatinine, and tenderness and swelling over the transplanted kidney |
|
|
Term
What percent of patients developsome form of infection during the first year after tranplant? |
|
Definition
|
|
Term
What is the most common type of infection in the first month following transplantation? |
|
Definition
|
|
Term
What are the most common types of infections seen after the first month post transplant? |
|
Definition
CMV, PCP, aspergillosis, toxoplasmosis, cryptococcosis, nodardiosis, and blastomycosis |
|
|
Term
What kind of prophylactic antimicrobial can be given to pts post transplant? |
|
Definition
TMP-SMX for the first 6 months after transplant to decrease risk of PCP |
|
|
Term
Post-transplant immune suppression increases your risk of malignancy by... |
|
Definition
|
|
Term
What kinds of neoplasms are common post transplant? |
|
Definition
viral associated neoplasms, squamous cell carcinoma (HPV), kaposi sarcoma (EBV), non-hodgkin lymphoma (EBV), and hepatocellular carcinoma (hep B and C), lymphoma or post-transplant lymphoproliferative disorders are the most common post transplant malignancies and the occurence is related to the intensity and duration of anti T cell therapy |
|
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Term
If a patient post transplant starts having lymphoproliferative disorder approaching malignancy, what should you do? |
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Definition
decrease immuno suppression meds because they may cause regression of the lymphoproliferation |
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Term
What do you call the chronic fibrotic changes and accelerated loss of renal functions that occurs in transplanted kidneys? |
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Definition
chronic allograft nephropathy |
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Term
What lab results suggest chronic allograft nephropathy? |
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Definition
pogressive increase in serum Cr, proteinuria,a nd microscopic hematuria; confirm with biopsy |
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Term
What is the treatment for chronic allograft nephropathy? |
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Definition
there is no effective treatment but generally immunosuppressive treatemtn is gradually tappered to limit nephrotoxicity associatedwith calcineurin inhibitors |
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Term
T/F UTIs are common causes of infection after kidney transplantation. |
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Definition
bacterial infections are high on the list of possible infections within the first 4 weeks after transplantation |
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Term
What are the initial tests and initial clinical management of patients with a diabetic foot ulcer? |
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Definition
biopsy the wound for culture and send blood for culture; obtain xrays of the foot to look for charcot neuroarthropathy and/or osteomyelitis; the patietn should be put on bed rest, IV antibiotics, and strict glycemic control |
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Term
Inital evaluation of a foot ulcer can made with what criteria? |
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Definition
PEDIS= perfusion, extent, depth,infection, sensation |
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Term
What should you send to the lab to determine whether a wound is infected? |
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Definition
tissue biopsy of the wound, NOT a swab (because all wounds are colonized but not necessarily infected) |
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Term
What are the most common pathogens involved in diabetic foot infections? |
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Definition
staph aureus and beta hemolytic strep |
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Term
What is appropriateinitial empiric therapy of diabetic foot ulcer? |
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Definition
amoxicililn-clavulanic acid, ciprofloxacin, cephazolin, and vancomycin |
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Term
How long should you treat diabetic foot ulcers with antibiotics? |
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Definition
no good range has been determined but a reasonable range would be between 7 and 14 days |
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Term
Why is it important to control blood sugars in pts with diabetic foot ulcers? |
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Definition
hyperglycemia contributs to leukocyte dysfunction and compromised host response to infections |
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Term
When might you give 4 to 6 weeks of antibiotic therapy to a person with a diabetic foot ulcer? |
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Definition
if their xray shows degenerative changes that could be osteomyelitis vs. charcot's arthropathy |
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Term
What local wound care is needed for diabetic foot ulcers? |
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Definition
sharp debridement, larval therapy with medicinal maggots, topical agent applications, and in some cases the local infections associated with abscesses would require surgical drainage oand minor amputations; contact casting to offload pressure from the wound site |
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Term
Once healing of a foot ulcer is completed the pt should be thoroughlyexamined for contributory conditions such as... |
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Definition
limited joint mobility of the foot and ankle, calluses, bunions, hammer toes, claw toes |
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Term
What is charcot's neuroarthropathy? |
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Definition
noninfective bone and joint destruction that occurs in well perfused an insensate foot; thought to be caused by repetitive trauma to an insensate portion of teh foot |
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Term
What does charcot's neuroarthropathy look likeradiographically? |
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Definition
extensive bone and joint destruction, fragmentation, and remodeling |
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Term
What is the clinical presentaiton of acute Charcot neuroparthropthy? |
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Definition
soft tissue swelling, soft tissue erythema and increased local skin temp; can be very difficult to differentiate clinically from foot infections and osteoyelitis |
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Term
How does diabetic neuropathy predispose to foot ulcers? |
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Definition
muscle atrophy, altered biomechanics, and foot deformities, sensory neuropathy that increases susceptibility to injuries, autonoic neuropathy leading to decreased sweating, skin dryness, cracks, and increases susceptibility to infections |
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Term
"diabetic foot" refers to a nuber of pathologic conditions encountered in this pt population including= |
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Definition
diabetic neuropathy, ischemic vascular disease, Charcot neuroarthropathy, skin ulceration, soft tissue infections and osteomyelitis |
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Term
What is the lifetie risk of foot ulcer in a diabetic? |
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Definition
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Term
What percent of nontraumatic foot amputations are due to diabetic foot ulcers? |
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Definition
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Term
Pts at low risk for diabetic foot ulcer= |
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Definition
normal sensation and pulses; annual foot exam |
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Term
Moderate risk for diabetic foot ulcer= |
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Definition
pts with enuropathy or absence of uplses should get exams and maintenence care every 3 to 6 months |
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Term
pts at high risk for diabetic foot ulcers= |
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Definition
neuroapthy or abscence of pulses in addition to foot defority, skin changes or prior history of ulcers; need evaluation every 1 to 3 months |
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Term
What are signs associated with a foot ulcer that indicate deeper infection? |
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Definition
pain, induration and wound drainage |
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Term
What signs with diabetic foot ulcer suggest osteomyelitis? |
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Definition
pain, deeper ulcers, elevated leukocyte count |
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Term
WHat is a helpful radiographic study used to diagnose acute osteomyelitis? |
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Definition
radionuclide scan with gallium |
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Term
Why are diabetic patients less likely to have calf claudication? |
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Definition
arterial occlusion occurs at the tibial-peroneal arteries so they get foot claudication but because of sensory neuropathy this may go unnoticed |
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Term
How can you assess blood flow to distal extremities? |
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Definition
measurement of ABI's, TBIs and duplex ultrasonography |
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Term
Why are ABIs falsely elevated in diabetics? |
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Definition
calcifications of tibial vessels |
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Term
What is teh best way to surgically revascularize diabetic pts with poor peripheral perfusion? |
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Definition
open vascular reconstruction because there is increased frequency of ultiple level occlusivedisease and tibial level occlusive disease |
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