Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General Surgery > Basics > Flashcards

Basics Flashcards

1
Q

…..exrection rate inc following trauma including surgery

A

Potassium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The commonest cause of water intoxication is…..

A

Overinfusion of 5% glucose postoperative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hyperactive deep tendon reflexes which then turn hypoactive are associated with…..

A

Hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

……can lead to subarachnoid hge

A

Hypernatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

…..inc in s.Na indicates 1L pure water loss

A

3mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MC cause of hyperphosphatemia is…..

A

Impaired renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mention causes of IC shift of phosphase
Symptoms of hypophophatemia are due to…..

A

Respiratory alkalosis, hungry bone $, insulin therapy
Adverse effects on O2 availabiliyu for tissue and dec high energy phophates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypomagnesemia is associated with persistent……

A

Hypocalcemia and hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to calculate IV slow K replacement for 1st 24 hrs?

A

Half deficit + expected losses + daily need

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MC cause of hyperkalemia is…..

A

Excess IV K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe ttt of hyperkalemia

A
  1. IV Ca gluconate cardioprotectibe
  2. IV NaHCO3 to induce alkalosis and intracellular shift
  3. 100 mL 50% dextrose + 20 IU regular insulin IV infusion over 30 min
  4. Ion exchange resins
  5. Estavlish good urine output or administer diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MC cause of hypocalcemia is…. while that of hypercalcemia is….

A

Injury of parathyroid
Bone secondaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List manifestations of latent and manifest tetany

A

L: chovestech sign and trouseau sign
M: hyperactive deep tendon reflexes, carpopedal spasm, circum-oral numbness, convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe medical ttt of hypercalcemia

A
  1. IV FLUIDS
  2. Bisphosphonates
  3. Calcitonin
  4. Predinsolone
  5. Lasix
  6. Hemodialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mention the type of breathing in:
1. Metabolic acidosis
2. Metabolic alkalosis

A
  1. Kussmaul respiration (inc rate and depth)
  2. Cheyne-strokes’ respiration (with periods of apnea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Memtion indiacations of bicarconate administration and its estimation

A
  1. Acidosis ass w/ myocardial depression
  2. pH<7.2, HCO3<15 mEq/L
    Estimated as: body weight × 0.3 × base deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mention an approach to preoperative maintenance fluids

A

100 mL for 1st 10 kgs weight, 50 ml for 2nd 10 kg weight, 20 ml/kg afterwards
5% dextrose in 0.45% saline 100ml/h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mention emperical fluid requirements for postoperative adult with moderate tissue dissection

A
  1. Glucose 5%, 1000ml
  2. Normal saline 0.9%, 1000ml
  3. Ringer lactate, 500ml
    Less concentrated solutions as half tonic saline are useful in GI losses as well as for maintenance fluid therapy in postoperative period.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe fluid therapy for correction of the following:
1. IO
2. Pyloric stenosis

A
  1. 3 portions isotonic salt solution + 1 portion 5% dextrose sol. + K
  2. 1:1 salt:dextrose sol but more KCl for K and Cl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List indications for nutritional support

A
  1. Oral intake less than half caloric requirements
  2. Weight loss more than 10%
  3. Anticipated time of starvation more than 5-7 days
  4. Catabolic disease
  5. Non-functioning GIT
  6. Serum albumin <3 g/dl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List specific conditions that suggest initiation of nutritional support

A
  1. Proximal intestinal fistula
  2. IBD
  3. Massive intestinal resection (<100cm small bowel)
  4. Paralytic ileus/obstruction
  5. Severe pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GR: Fine-bore NG tube is preferred in tube-feeding

A

Because it is less likely to cause gastric or esophageal erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Gastrostomy is used when enteral nutrition will last…..

A

4-6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mention tube-related complications of enteral nutrition

A
  1. Malposition
  2. Displacement
  3. Blockage
  4. Breaking & leakage
  5. Local complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

List most frequent clinical indications of PN

A
  1. Massive intestinal resection
  2. Intestinal fistula
  3. Intestinal failure for other reasons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Peripheral TPN can be used for upto…

A

2 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Central TPN preferred site for insertion is….with disadv…..
……may be used instead to improve this dis.

A

Internal/ex jugular veins
Exit site is situated on side of neck with repeated movement resulting in disruption of dressing
Infraclavicular subclavian approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Any central venous cannulation may be associated with…….

A

Pneumothorax, central venous or cardiac thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

For longer term PN…..is preferred

A

Hickman lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

List CI of PN

A
  1. Functioning GIT
  2. Poor prognosis
  3. Period of undernutrition less than 5 days with absence of severe malnourishment
  4. Inability to obtain venous access
  5. Risks outweigh benefits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Compare time & cause of reactionary & 2ry hge

A

R: within 24 hrs after trauma/op, it is caused by slipping of improperly tied ligature or dislodgement of clot from bv. PDF: normalization of BP post-op, inc venous pressure due to cough, vomiy
2ry: 7-14 days. Sloughing of vessel wall precipitated by infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute hge leads to….while chronic leads to….

A

Hypovolemic shock
Anema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Correction of non-surgical hge is….

A

Requires correction of coagulation abnormalities NOT intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When to stop blood transfusion?

A

Hct 30%, UOP 50 ml/hr, CVP rising to upper half of normal range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Mention cases of inc CVP with NO improvement of condition

A

Tension pneumothorax, cardiac tamponade (obstructive)
HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

1st priority in shocked pt is….

A

Arrest bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

In shocked pt, blood sample is tested for….

A

Blood group, cross-matching & prepare blood, coagulation profile, CBC, HCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

GR: Delayed reduction of Hct level in shocked pt

A

Movement of part of interstitial fluid into the circulation & replacement of lost bloof by crystalloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

No improvement following resuscitative measures indicates…..

A

Inadequate replacement, continued hge, associated pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Best monitor for tissue perfusion in shocked pt is….

A

UOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Define MOF

A

2 or more failing systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

List dauses of cardigenic shock

A

MI, dysrhthmias, myocarditis, valve diseases, injury, myocardial depression from septic shock or drug abuse

43
Q

List distributive shock types

A

Anaphylactic, spinal (neurogenic), vasovagal attack, septic shock

44
Q

Massive pulomary embolus causes…shock

A

Obstructive

45
Q

GR: Adrenal insufficiency leads to shock

A

Hypovolemia, poor response to circulating CAs, peripheral circulatory failure, hyponatremia & hyperkalemia

46
Q

In moderate shock UOP reaches….

A

Below 0.5 ml/kg/h

47
Q

Mention special CCCs of:
1. Septic shock
2. Analhylaxis
3. Neurogenic

A
  1. Early, warm peripheries p, brisk capillary fill (VD), late: classic pic of shock
  2. Bronchospasm, laryngeal edema, respiratory distress
  3. Bradycardia
48
Q

GR: Tachycardia may be absent although pt is shocked

A

Pts on BBs, implanted pacemakers, pulse rate of 80 in a fit young adult who normally has a pulse rate of 50 is very abnormal

49
Q

GR: hypotension is a poor indicator for extent of shock

A

It is one of the LAST signs of shock:
Children & young adukts maintain BP till last stages of shock by inc stroke volume & peripheral VD
Elderly pts who are normally hypertensive may present w/ normal BP for general population

50
Q

GR: Analgesia should be given IV in shocked pts

A

Poor absorption of drugs after IM injections

51
Q

Mention indications for vasopressor & inotropic support in shock

A
  1. Distributive shock (vasopressors)
  2. In cardiogenic shock
  3. When myocardial depression complicates a shock state dobutamine may be requires
52
Q

Describe management of anaphylactic shock

A

IV hydrocortisone & antihistamine + endotracheal intubation may be needed if laryngeal edema & stridor develop

53
Q

Blood is collected on……at temp….., ……is added to red cells

A

Citrate phosphate dextrose + adenine
4-6degC
Glycerol

54
Q

Mention indications for PRBCs

A

Severe anemia, hemolytic conditions, elderly, cardiac pts

55
Q

List components of cryoprecipitate & its indications

A

Factor 8, fibrinogen, vWF, Factor 3, fibronectin
Hemophilia, DIC, VWD

56
Q

List components of prothromin complex & its indications

A

Factor 2,9,10
Emergency reversal of anti-coagulant (warfarin) therapy

57
Q

Mention MC immunological complication of blood transfusion

A

Febrile reaction

58
Q

Mention CP of hemolytic reaction

A

In consious pt: fever, rigors, chest constricting pain, headache, dypnea, pain in flanks , at site of transfusion p, smoky urine upto ARF
tachycardia, hypotension & tinge of jaundice
In comatose pt: bleeding tendency, tachcardia, hypotension, pyrexia, jaundice

59
Q

Describe treatment of hemolytic transfusion reaction

A
  1. Stop transfusion immediately & contact blood bank, take blood sample confirm group
  2. Keep vein open by giving IV saline or dextrose 5%
  3. Give NaHCO3 IV to alkalinize urine
  4. Give 200 ml of 10% mannitol for forced alkaline diuresis
60
Q

List non-immune comp of blood transfusion

A
  1. Air embolism
  2. Thrombophelbitis at transfusion site
  3. Comp of transfusion of stored blood (hyperkalemia, acidosis, bleeding tendency)
  4. Citrate intoxication(hypocalcemia)
  5. CHF
  6. Lung injury
  7. Infection
  8. Massive transfusion comp
61
Q

List comp of massive blood transfusion

A

Hyperkalemia, hypocalcemia, metabolic acidosis, circulatory overload, hypothermia, coagulapathy & DIC, Iron overload & hemosiderosis

62
Q

Mention indications for endotracheal intubation

A

Apnea, risk of aspiration, airway compromise, closed head injuries (dec ICP)

63
Q

Mention indications of FAST

A

Assess for blood in pericardial sac, hepatorenal pouch, pelvis, & spleno-renal pouch but not in RPS

64
Q

Most common types of shock in surgical practice are……

A

Septic & hypovolemic

65
Q

Mention uses of non-absorbable sutures

A

Used in hernia repair, abdominal wound closure, vascular anastomosis

66
Q

Delayed 1ry repair is done in….
For 2ry repair,….

A

Suspicsious wounds & late presentation at 5-7 days
Infected wound is left open to granulate & only when it gets cleaned sutures can be applied

67
Q

TTT of wound contraction is….

A

Minimise deformity by proper positioning of the joint by prophylactic splint during the healing process

68
Q

Mention steps for 1ry wound care

A

Wound cleansing, debridement, excision, bleeding pointcontrolled by electrocautery or ligation

69
Q

Mention Abx given in each type of operation

A

Clean: none unless prosthetic is present give prophylactic
Clean-contaminated: single dose of Ab given one hr before start of op
Contaminated or dirty: as before + postop Ab for 1-3 days

70
Q

Classify operations according to risk of venous thromboembolism

A

Low risk: minor operation (+no risk factors at any age), major op (+no risk factors below 40), minor trauma or medical illness
Moderate risk: major surgery (+age more than 40, or other risk), major medical illness, trauma or surgery, minor surgery in pt w/ personal or family hx of VT
High risk: major surgery of pelvis, hip, LL. Major surgery, trauma, illness in pt w/ +ve family Hx, LL paralysis or amputation

71
Q

Mention recommendations for pulmonary risk reduction

A

Preop: stop smoking 8wks before, treat airflow obst & COPD, administer Abx & delay surgery if respiratory infection is present, pt education regarding postop lung expansion maneuvers
Intraop: limit surgery less than 3hrs, spinal or epidural analgesia, avoid pancuronium, use laparoscopic procedures when possible
Postop: deep-breathing exercises or incentive spirometry, epidural analgesia, intercostals nerve blocks

72
Q

In case of major CV event elective surgery is postponed….

A

3-6 months

73
Q

MC cause of periop pulmonary CCC is….

A

Smoking

74
Q

Preop blood transfusion is done if…

A

Hb less than 8g/dl

75
Q

Mention risks of obesity in surgery

A

Difficult intubation, regurgitation, aspiration, MI, DVT, pulmonary embolism, CVA, respiratory compromise

76
Q

When to postpone elective surgery?

A
  1. MI in prev 6 mon
  2. PTA 4-6 wks prev
  3. SBP >1160, DBP>95
  4. Chronic smoking until stopped for at least 8 wks
  5. HF until controlled
  6. Tight AS/MS until surgically corrected
77
Q

List local wound ccc

A

Seroma, hematoma, SSI, dehiscence & evisceration, incisional hernia

78
Q

Describe TTT of wound hematoma

A

Depends on size & duration
Small hematoma, resolve spontaneously while large ones need evacuation
If occurs soon after surgery wound is explored & evacuated looking for spurter, if late within 2 wks reabsorb spontaneously

79
Q

Mention non-infectious causes of postop fever

A

DVT, atelactasis, wound hematoma, pyrogenic reaction to drugs or infusions, transfusion reactions

80
Q

Menion causes of postop fever that require emergency management

A

Surgical inf causing myonecrosis, pulmonary embolism, acute adrenal insufficiency, malignant hyperthermia

81
Q

Causes of acute postop shortness of breath

A

MI & HF
PE
Chest infection
Exacerbation of asthma or COPD

82
Q

List causes of postop collapse

A

CVS: MI, PE, Arrhythmia, stroke
RESP: Failure to reverse anesthesia, pneumonia, hypoxia dt resp depressant drugs
Inf: SSI, neglected infection of central lines
Met: hypo or hyperglycemia in diabetics, electrolyte disturbance, adrenal insufficiency
Drug reactions, anaphylaxis

83
Q

Mention signs of pus formation

A

Throbbing pain, hectic fever, pitting edema of covering skin, shooting leukocytosis w shift to left, fluctuation (DO NOT WAIT for parotid, breast, perineum, pulp, prostate

84
Q

Mention local CCC of acute abscess

A

Pointing & rupture at site of least resistance
Antibioma
Chronicity
Cellulitis, lymphangitus, lymphadenitis
Sinus & fistula

85
Q

MC site of carbuncle is…..

A

Nape of neck or back of trunk

86
Q

List recommendations for surgical Abx prophyalxis

A
  1. Clean wounds no need for Abx
  2. Clean contaminated single dose IV abx prophylaxis 1 hr before surgery to time of induction of anesthesia & scalpel use
  3. Contaminated as 2 but continue 1-3 days postop
  4. Dirty as 2 but continue 3-5 days postop
87
Q

Mention ind for Abx prophylaxis in clean op

A
  1. With implant (mesh/graft)
  2. Pt w/ valvular heart disease (IEC)
  3. Emergency surgery in pt w/ pre-existing inf
  4. Inf would be very severe or life-threatening, aotic surgery, transplant. 1 dose 1st gen ceph or ampicillin + sulbactam before surgery
88
Q

Mention causes of intestinal barrier break

A
  1. Splanchnic ischemia
  2. Poor luminal nutrition of enterocytes
  3. Altered intestinal flora
89
Q

Describe TTT of Ludwig angina

A

Tracheostomy if needed
Early massive doses of Abx (amox, metro), rest in semi-sitting position
Submental curved incision of skin & deep fascia

90
Q

Define suppurative hydradenitis & it DD

A

Mixed staph & strept inf of apocrine glands of axilla or perineum producing multiple abscesses & pus discharging sinuses, can progress to chronic esp in perineum
DD multiple anale fistulae (diff by presence of internal openings)

91
Q

Mention 1st sign of skin death in necrotizing fascitis

A

Hemorrhagic bullae

92
Q

Describe TTT of gas gangere

A

URGENT
1. Isolation
2. High doses of IV penicillin
2. Emergency excsion of all necrotic tissue until healthy bleeding tissue is reached followed by packing of wound NOT suturing + hydrogen peroxide
3. Hyperbaric O2 therapy 3 atm pure O2 several hrs per day
4. Anti-shock measures & anti-gas gangrene toxin serum infusion

93
Q

Describe TTT of tetanus

A

Isolation in quient setting in ICU
Artificial ventilation, anticonvulsant, muscle ralxant
Benzyl penicillin
Passive immunization w/ tetanus antitoxin
Local wound care

94
Q

Describe TTT of infection in the following spaces:
1. Apical subungal
2. Subcuticular
3. Thenar space
4. Parona space

A
  1. Removal of small V from center of free edge of nail
  2. Raised epidermis is removed then gentle probing is done for a track extending to a deeper abscess, which if present should be drained (collat stud abscess)
  3. Classically dosal incision done along lower border of 1st interosseous muscle, alternative incision for radial bursitis
  4. Longitudinal incison starting 2 cm above styloid process of ulna, immediately in front of its subcutaneous border
95
Q

Compound palmar ganglion involves….

A

Ulnar burna

96
Q

MC hand infection is….., while 2nd is…..

A

Paronychia
Pulp space infection

97
Q

Describe drainage of acute paronychia

A
  1. If limited to one side: a small incision is made into nail fold & raise a triangular flap over drain, tri piece of skin may be removed for drainage
  2. If tracking all around: a long incision is made at the nail fold to evacuate pus & raise a rectangular flap over a drain
  3. If pus is subungal: proximal part overlying abscess is excised
98
Q

Why is mid-lateral incision done in pulp space infection?

A
  1. Skin is less subjected to trauma thus better healing & preserve touch receptors
  2. Incision avoids injury of digital vessels & nerves
  3. A painful tender midline wound might preclude proper finger function late after healing
99
Q

Mention CCC of web space infection

A

Spread to midpalmar space, ajacent volat spaces, adjacent web spaces

100
Q

What are Kanavel’s four cardinal signs?
What is Kanavel’s sign?

A

4 C signs
1. Symmentrically swollen finger
2. Semiflexion of all joints of affected finger
3. Both active & passive movements are painful
4. Tenderness along whole sheath esp proximal cul-de-sac
Kanavel’s sign: max tenderness over area between the transverse palmar creases in ulnar bursitis

101
Q

Mention CCC of suppurative tenosynovitis

A
  1. Necrosis of the tendon (suspect if persistent discharge from wound after drainage)
  2. Spread of inf to parona space & joints
  3. Stiffness of fingers
102
Q

Mention actions of tetanus neurotoxin

A
  1. Anti-choline esterase action: interferes w/ destruction of Ach at motor end plates —> tonic rigidity of muscles
  2. Extreme excitability of AHCs: convulsion attacks on exposure to minor stimuli
103
Q

MI cause of postop wound inf is….
MC cause of endotoxic shock is….
MC pulp space infection…..
Most lethal toxin of C.perfringes is…..

A

Presence of dead space
E. Coli
Thumb & index
Lecithinase (a-toxin)

General Surgery (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions