Basics Flashcards
(103 cards)
1
Q
…..exrection rate inc following trauma including surgery
A
Potassium
2
Q
The commonest cause of water intoxication is…..
A
Overinfusion of 5% glucose postoperative
3
Q
Hyperactive deep tendon reflexes which then turn hypoactive are associated with…..
A
Hyponatremia
4
Q
……can lead to subarachnoid hge
A
Hypernatremia
5
Q
…..inc in s.Na indicates 1L pure water loss
A
3mEq/L
6
Q
MC cause of hyperphosphatemia is…..
A
Impaired renal function
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
8
Q
Hypomagnesemia is associated with persistent……
A
Hypocalcemia and hypokalemia
9
Q
How to calculate IV slow K replacement for 1st 24 hrs?
A
Half deficit + expected losses + daily need
10
Q
MC cause of hyperkalemia is…..
A
Excess IV K
11
Q
Describe ttt of hyperkalemia
A
- IV Ca gluconate cardioprotectibe
- IV NaHCO3 to induce alkalosis and intracellular shift
- 100 mL 50% dextrose + 20 IU regular insulin IV infusion over 30 min
- Ion exchange resins
- Estavlish good urine output or administer diuretics
12
Q
MC cause of hypocalcemia is…. while that of hypercalcemia is….
A
Injury of parathyroid
Bone secondaries
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
14
Q
Describe medical ttt of hypercalcemia
A
- IV FLUIDS
- Bisphosphonates
- Calcitonin
- Predinsolone
- Lasix
- Hemodialysis
15
Q
Mention the type of breathing in:
1. Metabolic acidosis
2. Metabolic alkalosis
A
- Kussmaul respiration (inc rate and depth)
- Cheyne-strokes’ respiration (with periods of apnea)
16
Q
Memtion indiacations of bicarconate administration and its estimation
A
- Acidosis ass w/ myocardial depression
- pH<7.2, HCO3<15 mEq/L
Estimated as: body weight × 0.3 × base deficit
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
18
Q
Mention emperical fluid requirements for postoperative adult with moderate tissue dissection
A
- Glucose 5%, 1000ml
- Normal saline 0.9%, 1000ml
- 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.
19
Q
Describe fluid therapy for correction of the following:
1. IO
2. Pyloric stenosis
A
- 3 portions isotonic salt solution + 1 portion 5% dextrose sol. + K
- 1:1 salt:dextrose sol but more KCl for K and Cl
20
Q
List indications for nutritional support
A
- Oral intake less than half caloric requirements
- Weight loss more than 10%
- Anticipated time of starvation more than 5-7 days
- Catabolic disease
- Non-functioning GIT
- Serum albumin <3 g/dl
21
Q
List specific conditions that suggest initiation of nutritional support
A
- Proximal intestinal fistula
- IBD
- Massive intestinal resection (<100cm small bowel)
- Paralytic ileus/obstruction
- Severe pancreatitis
22
Q
GR: Fine-bore NG tube is preferred in tube-feeding
A
Because it is less likely to cause gastric or esophageal erosions
23
Q
Gastrostomy is used when enteral nutrition will last…..
A
4-6 wks
24
Q
Mention tube-related complications of enteral nutrition
A
- Malposition
- Displacement
- Blockage
- Breaking & leakage
- Local complications
25
List most frequent clinical indications of PN
1. Massive intestinal resection
2. Intestinal fistula
3. Intestinal failure for other reasons
26
Peripheral TPN can be used for upto...
2 wks
27
Central TPN preferred site for insertion is....with disadv.....
......may be used instead to improve this dis.
Internal/ex jugular veins
Exit site is situated on side of neck with repeated movement resulting in disruption of dressing
Infraclavicular subclavian approach
28
Any central venous cannulation may be associated with.......
Pneumothorax, central venous or cardiac thrombosis
29
For longer term PN.....is preferred
Hickman lines
30
List CI of PN
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
31
Compare time & cause of reactionary & 2ry hge
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
32
Acute hge leads to….while chronic leads to….
Hypovolemic shock
Anema
33
Correction of non-surgical hge is….
Requires correction of coagulation abnormalities NOT intervention
34
When to stop blood transfusion?
Hct 30%, UOP 50 ml/hr, CVP rising to upper half of normal range
35
Mention cases of inc CVP with NO improvement of condition
Tension pneumothorax, cardiac tamponade (obstructive)
HF
36
1st priority in shocked pt is….
Arrest bleeding
37
In shocked pt, blood sample is tested for….
Blood group, cross-matching & prepare blood, coagulation profile, CBC, HCT
38
GR: Delayed reduction of Hct level in shocked pt
Movement of part of interstitial fluid into the circulation & replacement of lost bloof by crystalloids
39
No improvement following resuscitative measures indicates…..
Inadequate replacement, continued hge, associated pathology
40
Best monitor for tissue perfusion in shocked pt is….
UOP
41
Define MOF
2 or more failing systems
42
List dauses of cardigenic shock
MI, dysrhthmias, myocarditis, valve diseases, injury, myocardial depression from septic shock or drug abuse
43
List distributive shock types
Anaphylactic, spinal (neurogenic), vasovagal attack, septic shock
44
Massive pulomary embolus causes…shock
Obstructive
45
GR: Adrenal insufficiency leads to shock
Hypovolemia, poor response to circulating CAs, peripheral circulatory failure, hyponatremia & hyperkalemia
46
In moderate shock UOP reaches….
Below 0.5 ml/kg/h
47
Mention special CCCs of:
1. Septic shock
2. Analhylaxis
3. Neurogenic
1. Early, warm peripheries p, brisk capillary fill (VD), late: classic pic of shock
2. Bronchospasm, laryngeal edema, respiratory distress
3. Bradycardia
48
GR: Tachycardia may be absent although pt is shocked
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
GR: hypotension is a poor indicator for extent of shock
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
GR: Analgesia should be given IV in shocked pts
Poor absorption of drugs after IM injections
51
Mention indications for vasopressor & inotropic support in shock
1. Distributive shock (vasopressors)
2. In cardiogenic shock
3. When myocardial depression complicates a shock state dobutamine may be requires
52
Describe management of anaphylactic shock
IV hydrocortisone & antihistamine + endotracheal intubation may be needed if laryngeal edema & stridor develop
53
Blood is collected on……at temp….., ……is added to red cells
Citrate phosphate dextrose + adenine
4-6degC
Glycerol
54
Mention indications for PRBCs
Severe anemia, hemolytic conditions, elderly, cardiac pts
55
List components of cryoprecipitate & its indications
Factor 8, fibrinogen, vWF, Factor 3, fibronectin
Hemophilia, DIC, VWD
56
List components of prothromin complex & its indications
Factor 2,9,10
Emergency reversal of anti-coagulant (warfarin) therapy
57
Mention MC immunological complication of blood transfusion
Febrile reaction
58
Mention CP of hemolytic reaction
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
Describe treatment of hemolytic transfusion reaction
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
List non-immune comp of blood transfusion
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
7. Massive transfusion comp
61
List comp of massive blood transfusion
Hyperkalemia, hypocalcemia, metabolic acidosis, circulatory overload, hypothermia, coagulapathy & DIC, Iron overload & hemosiderosis
62
Mention indications for endotracheal intubation
Apnea, risk of aspiration, airway compromise, closed head injuries (dec ICP)
63
Mention indications of FAST
Assess for blood in pericardial sac, hepatorenal pouch, pelvis, & spleno-renal pouch but not in RPS
64
Most common types of shock in surgical practice are……
Septic & hypovolemic
65
Mention uses of non-absorbable sutures
Used in hernia repair, abdominal wound closure, vascular anastomosis
66
Delayed 1ry repair is done in….
For 2ry repair,….
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
TTT of wound contraction is….
Minimise deformity by proper positioning of the joint by prophylactic splint during the healing process
68
Mention steps for 1ry wound care
Wound cleansing, debridement, excision, bleeding pointcontrolled by electrocautery or ligation
69
Mention Abx given in each type of operation
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
Classify operations according to risk of venous thromboembolism
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
Mention recommendations for pulmonary risk reduction
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
In case of major CV event elective surgery is postponed….
3-6 months
73
MC cause of periop pulmonary CCC is….
Smoking
74
Preop blood transfusion is done if…
Hb less than 8g/dl
75
Mention risks of obesity in surgery
Difficult intubation, regurgitation, aspiration, MI, DVT, pulmonary embolism, CVA, respiratory compromise
76
When to postpone elective surgery?
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
List local wound ccc
Seroma, hematoma, SSI, dehiscence & evisceration, incisional hernia
78
Describe TTT of wound hematoma
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
Mention non-infectious causes of postop fever
DVT, atelactasis, wound hematoma, pyrogenic reaction to drugs or infusions, transfusion reactions
80
Menion causes of postop fever that require emergency management
Surgical inf causing myonecrosis, pulmonary embolism, acute adrenal insufficiency, malignant hyperthermia
81
Causes of acute postop shortness of breath
MI & HF
PE
Chest infection
Exacerbation of asthma or COPD
82
List causes of postop collapse
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
Mention signs of pus formation
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
Mention local CCC of acute abscess
Pointing & rupture at site of least resistance
Antibioma
Chronicity
Cellulitis, lymphangitus, lymphadenitis
Sinus & fistula
85
MC site of carbuncle is…..
Nape of neck or back of trunk
86
List recommendations for surgical Abx prophyalxis
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
Mention ind for Abx prophylaxis in clean op
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
Mention causes of intestinal barrier break
1. Splanchnic ischemia
2. Poor luminal nutrition of enterocytes
3. Altered intestinal flora
89
Describe TTT of Ludwig angina
Tracheostomy if needed
Early massive doses of Abx (amox, metro), rest in semi-sitting position
Submental curved incision of skin & deep fascia
90
Define suppurative hydradenitis & it DD
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
Mention 1st sign of skin death in necrotizing fascitis
Hemorrhagic bullae
92
Describe TTT of gas gangere
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
Describe TTT of tetanus
Isolation in quient setting in ICU
Artificial ventilation, anticonvulsant, muscle ralxant
Benzyl penicillin
Passive immunization w/ tetanus antitoxin
Local wound care
94
Describe TTT of infection in the following spaces:
1. Apical subungal
2. Subcuticular
3. Thenar space
4. Parona space
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
Compound palmar ganglion involves….
Ulnar burna
96
MC hand infection is….., while 2nd is…..
Paronychia
Pulp space infection
97
Describe drainage of acute paronychia
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
Why is mid-lateral incision done in pulp space infection?
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
Mention CCC of web space infection
Spread to midpalmar space, ajacent volat spaces, adjacent web spaces
100
What are Kanavel’s four cardinal signs?
What is Kanavel’s sign?
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
Mention CCC of suppurative tenosynovitis
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
Mention actions of tetanus neurotoxin
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
MI cause of postop wound inf is….
MC cause of endotoxic shock is….
MC pulp space infection…..
Most lethal toxin of C.perfringes is…..
Presence of dead space
E. Coli
Thumb & index
Lecithinase (a-toxin)
