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SURGERY > Gen Surg > Flashcards

Gen Surg Flashcards

1
Q

Anion Gap Formula

Normal value

A

Na -(Cl+HCO3)

<12

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2
Q

HAGMA

A

MUDPILES

METHANOL
UREMIA (RENAL FAILURE)
DM KETOACIDOSIS
PARALDEHYDE
INFECTION, ISONIAZID, IRON
LACTIC ACIDOSIS
ETHANOL
SALICYLATES
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3
Q

NAGMA

A

HARD UP

HYPERALIMENTATION
ACETAZOLAMIDE (CARBONIC ANYHYDRASE INHIBITOR)
RENAL TUBULAR ACIDOSIS
DIARRHEA
URETEROENTERIC FISTULA
PANCREATICODUODENAL FISTULA
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4
Q

IDEAL BODY WEIGT FORMULA (MODIFIED BROCA)

A

Men
50kg for first 5 ft
Add 2.3 kg for each additional in

Women
45kg for first 5 ft
Add 2.3 kg for each additional in

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5
Q

Estimated caloric and protein maintenance requirement (non-stressed patients)

A

25-30kcal/kg/day

0.8-1g/kg/day

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6
Q

Clinical features of tetanus prone wounds

A

Age of wound: >6hrs
Confuguration: stellate, avulsed, abrasion
Depth: >1cm
Mech of injury: missile, crush, burn, frostbite
(+) sign of infection
(+) devitalized tissue
(+) contamination

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7
Q

Wound healing:

What constitutes early matrix scaffolding?

A

Fibronectin

Collagen type III

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8
Q

Major cell responsible for wound contraction

A

Myofibroblast

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9
Q

5 phases of wound healing

A 
Hemostasis and inflammation
Proliferation
Maturation and remodeling
Epithelialization
Wound contraction
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10
Q

Wound healing:

Strongest chemotactic factor for fibroblasts

A

PDGF

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11
Q

Parameters of SOFA

A 
Respiration
Coagulation (plt ct)
Liver (bilirubin)
Cardiovascular (MAP/vasopresors)
CNS (GCS)
Renal (crea in urine output)
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12
Q

Pre-operative dose timing for surgical prophylaxis

When to re-dose?

A

Within 60mins before incision
Within 120mins for vancomycin

If the duration of sx exceeds 2-half lives of thw drug
Excessive blood loss

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13
Q

Strongest chemotactic factor for fibroblasts

A

PDGF

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14
Q

The proliferation phase of wound healing is characterized by the proliferation of which cells primarily?

A

Fibroblasts

Endothelial Cells

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15
Q

Initial management for tension pneumothorax

A

Needle thoracostomy

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16
Q

Placement of needle in needle thoracostomy

A

2nd ICS MCL

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17
Q

Definitive mgt for tension pneumothorax

A

CTT

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18
Q

Placement of needle in CTT

A

4th-5th ICS MAL

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19
Q

Pre-operative dose timing for surgical prophylaxis

When to re-dose?

A

Within 60mins before incision
Within 120mins for vancomycin

If the duration of sx exceeds 2-half lives of thw drug
Excessive blood loss

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20
Q

Preferred test in the dx of cardiac tamponade

A

Echocardiography

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21
Q

Most common Vitamin deficiency in parenteral nutrition?

A

Vitamin K

22
Q

Parameters/Goals in Sepsis Management

A 
MAP >= 65 mmHg
UO > 0.5 mkD
Hgb > 10 g/dL
CVP: 8-12 mmHg
TV 6 ml/kg
Glucose 140-180 mg/dL
23
Q

EDH volume requiring craniotomy and evacuation

A

> 30 mL

24
Q

SDH indications for craniotomy and evacuation

A

> 10 mm thick, or

>5 mm midline shift

25
Q

Definitive mgt for cardiac tamponade

A

Sternotomy

26
Q

Initial mgt for air embolism

A

Place patient in Trendelenburg’s position. Followed by emergency thoracotomy

Rationale: to trap air in the apex of LV

27
Q

Formula:

MAP

A

MAP= SBP + (DBP x 2)/3

28
Q

Diagnostic modality of choice for incomplete spinal cord syndrome

A

Spine MRI

29
Q

Most commonly ruptured vessels in epidural hematoma vs subdural hematoma

A

Middle meningeal a. and bridging veins, respectively

30
Q

Most commonly ruptured artery resulting to massive subarachnoid hemorrhage

A

Vertebral a.

31
Q

Medical management of Acute Spinal Cord Injury

A

IV Methylprednisolone administered within 8 hrs of injury

32
Q

Results to bilateral paresis: upper > lower

A

Central cord syndrome

33
Q

Criteria for positive DPL

A 
Rbc >100,000/ml (AASW); >10,000/ml (TASW)
Wbc >500/ml
Amylase >20 IU/l
ALP >2 IU/l
Bilirubin >0.01mg/dl
34
Q

Blunt abdominal injury

Indications for abdominal CT

A 
Altered mental status
Confounding injury
Gross hematuria
Pelvic fx
Abdominal tenderness
Unexplained hct <35%
35
Q

Post-splenectomy vaccine prophylaxis

A

Pneumococcal
Meningococcal
Hib

2 weeks pre/post sx

36
Q

Hard signs

A 
Pulsatile bleeding 
Expanding hematoma
Palpable thrill
Audible bruit
Acute limb ischemia
37
Q

Indications for ED Thoracotomy

A

Salvageable Postinjury Cardiac Arrest:
Witnessed penetrating trauma with <15 mins of prehospital CPR;
Witnessed blunt trauma with <10 mins of prehospital CPR;
Witnessed penetrating nontorso trauma with <5 mins of prehospital CPR

Persistent Severe Postinjury Hypotension (<=60 mmHg) due to:
Cardiac tamponade
Hemorrhage
Air embolism

38
Q

Antibiotic recommendation for Grade III Open Fractures

A

1st gen Cephalosporin plus Aminoglycoside plus Penicillin

39
Q

Fracture of the distal radius with the fragment displaced dorsally

A

Colle’s Fracture

40
Q

Fracture of the distal radius with the fragment displaced volarly

A

Smith Fracture

41
Q

Fracture of the radial styloid

A

Hutchinson/Chauffeur

42
Q

Fracture of Ulna with dislocation of the radial head

A

Monteggia

43
Q

Fracture of the distal radius with dislocation of the DRUJ

A

Galleazi

44
Q

Fracture of the radial shaft at the junction of the middle and distal thirds without an associated fracture of the ulna

A

Piedmont

45
Q

Hard signs for penetrating neck injury

A

Massive hemoptysis

Rapidly expanding hematoma

46
Q

Parkland’s (Baxter) Formula

A

4ml PLR/kg/%TBSA

1st 1/2- 1st 8hrs
Next 1/2- next 16hrs

47
Q

Adverse reaction of mafenide

A

Metabolic acidosis

48
Q

Adverse effects of silver nitrate

A

Hyponatremia

Induces methemoglobinemia

49
Q

Adverse effect of silver sulfadiazine

A

Leukopenia

50
Q

Topical antimicrobial agents used for burns that penetrates eschar well

A

Mafenide

51
Q

Topical antimicrobial agents used for burns that has anti pseudomonal actions

A

Silver sulfadiazine

SURGERY (8 decks)

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