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Flashcards in 13 Gen Surg Deck (25):
1

how many hours after removal of foley after surgery do you worry if no urine output

6 hours before doing any intervention
then can try in/out cath, and assess for post-residual void. if high post residual, leave in catheter. Low, give fluids.

2

Marjolin's ulcer
-vignette
-what is it, presentation
-tx

Mexican immigrant with ulcer. (pt usu immigrant b/c would be fixed in USA)

-SCC from chronic inflamm. site of chronic draining sinus tract or chronic wound
-ugly, deep, heaped up margins

-bx to confirm, do wide excision

3

Breast CA general rule:
-screening test
-confirm test

mammogram
core bx

4

Breast CA surgery options.
-what is equivalent?
-CIS vs invasive, difference?

Lumpectomy+Rad = Mastectomy

Also do ALND, if sentinel LN bx was positive.

If invasive carcinoma on bx, also add chemo/targeted systemic tx

5

Post op AMS
-what to think (2 common causes, 2 to think of for test)

1. hypoxia
2. e-lytes, glucose

1. ARDS
2. DTs

6

BRCA 1/2
-what do they get

ppx mastectomy and b/l salping-oopherectomy

If not, do MRI and mmamography q1y

7

Pt needs elective surgery but had MI 1 month ago. Do what

do heart cath, delay 6 months.

8

Post op ileus:
-At what post-op day to be worried when not resolving

If day 5-7 still ileus, concern for obstruction. Get KUB

Also make sure K+ repleted. hypoK can cause ileus

9

Breast lump workup in young woman:

Mammogram not sens in young females

1. If <30, wait 2-3 cycles.
2. persists, get U/S (mass vs cyst)
3. If cystic, FNA (fluid is cyst, bloody can be CA)

If female >30, or U/S shows mass, or aspirate is bloody, or cyst recurs:
Get mammogram

10

29y F presenting with asx breast lump. do what

Reassurance b/c <30y. Wait, often goes away in 1-2 menstrual cycles (fibrocystic change). So, RTC 6wks

11

Pt with Breast CA on systemic tx, has CHF
think what?

Doxorubicin/Daunorubicin has dose-dependent irreversible CHF. LATE

Trastuzumab has non dose dependent, reversible CHF. EARLY. Get echos q3mo

12

Surgery contraindications:
-Pulm risk, how to eval

-when to do smoking cessation

-evaluate high risk (smoker, COPE, asthma, ILD). Ventilation more important than oxygenation b/c surgery creates acidosis
-FEV1/FVC and ABG

Also, smoking cessation must be started 8 weeks+ (any earlier is more secretions)

13

Venous insufficiency:
why is skin darker

blood sitting so long, deposits hemosiderin

14

Surgery contraindications:
hepatic risk

use Child-Pugh/MELD score
-bili, alb, PT, encephaloopathy, ascites. If any 1 is abnormal, 40% mortality.

15

Post op chest pain
-think what

2 things:
PE, MI

16

Breast CA neo and adjuvant tx:
-what meds, when to use which

Find out Her2Neu, ER, PR receptors:

1. ER/PR+ and:
premenopausal: tamoxifen or raloxifene
postmenopausal: anastozole/letrozole (aromatase i)

2. Her2Neu+ can use: Trastuzumab
Her2Neu- uses Bevacizumab

3. Chemo

17

Fistulas
-Causes

FRIEND:

foreign bodies
radiation
infxn
epithelialization
neoplasm
distal obstruction

18

Ogilvie's syndrome
-how looks on KUB
-tx

Unlike postop ileus, Ogilvie's has only colon dilated. Postop ileus has small bowel and colon dilated.

-rectal tube to decompress
-colonoscopy to r/o CA and help decompress

19

Post op fever
-what causes

5 W's
Wind, Water, Walking, Wound, Wonder Drugs
1/2,3,5,7/10
Atelectasis (1), PNA (2), UTI, DVT, wound (7), abscess (>10)
drugs either end of spectrum

wonder drugs means: halothane/succ malignant hyperthermia (give dantrolene)

Also, fever immediately after surgery can mean infection

20

Surgery contraindications:
Cardiac risk (2)

-what tests to get

2 main things:
1. EF<35%
2. MI within 6 mo
Also, Goldman index. includes JVD, arrythmia, age>70, etc

Get: Echo, EKG, arteriogram, possibly CABG

21

Post op wounds:
dehiscence vs evisceration
-what to do

Dehisence: skin intact, but fasica failed. Serosanguinous salmon colored drainage. Bind and limit straining. Potential hernia, so nonemergent surgery to fix

Eviseration. skin and fascia fail. Cover bowel with warm saline dressings, don't put back in.

22

Post op low urine output
-how to workup?

1. Does pt feel like urinating? If so, may be retention. Do straight cath

2. Zero output? Maybe kinked foley

3. There is some output. Do 500ml fluid challenge. If urine comes out, then simply dehydrated. If not, then maybe intrarenal dz.

23

29F with hx of Hodgkin's lymphoma 10y ago treated with radiation.

-how to screen breast CA

-b/c rad hx, do annual MRI

24

Breast CA ppx meds?

Tamoxifen vs Raloxifene

Tamoxifen: stronger, but more DVT and endo CA

Ralox: weaker, but no DVT or endo CA

25

Surgery contraindications:
malnutrition
-how to eval, what 3 main things?
-what other important tests?
-how to treat

1. weight loss >20% in 3mo
2. albumin <3
3. anergy to skin antigens

Also, prealbumin tells you nutritional production. If alb low but prealb normal, then there is a liver disfxn, not malnutrition.

Vigorous nutritional support. PO>IV, 10 days>5days