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USLME Step 2 > MTB Surgery > Flashcards

Flashcards in MTB Surgery Deck (23):
1

If the patient is under the age of 35 and has no history of cardiac disease, EKG is the only test needed. A patient who has a history of cardiac disease, regardless of age, must have a(n):

• EKG
• Stress testing to evaluate for ischemic coronary lesions
• Echocardiogram for structural disease and to assess ejection fraction

2

Have the patient quit smoking for xxx prior to surgery and use a nicotine patch in the meantime.

6 to 8 weeks

3

Systemic Inflammatory Response Syndrome
There are 4 SIRS criteria; the presence of at 2 or more indicates SIRS.

1. Body temperature 38°C
2. Heart rate >90 BPM
3. Tachypnea >20 breaths per minute, or PC02 12,000 cells/mm3

4

2 criteria of SIRS + source of infection=

sepsis

5

2 criteria of SIRS + source
of infection + organ dysfunction =

severe sepsis

6

2 criteria SIRS + source
of infection+ organ dysfunction + hypotension =

septic shock

7

Four kinds of shocks

cardio
hypo
neuro
septic

8

Kehr sign

Pain in the left shoulder
Splenic rupture

9

KUB x-ray

A kidney, ureters, and bladder

10

Ischemic bowel disease The most common symptoms are:

• Abdominal pain after eating • Bloodydiarrhea

11

a full-thickness tear of the esophagus secondary to retching.

Boerhaave syndrome

12

Rovsing sign

palpation of the left lower quadrant causes pain in the right lower quadrant

13

Psoas sign

pain with extension of the hip

14

Obturator sign

pain with internal rotation of the right thigh

15

SMO causes

• Adhesions from previous
• Intussusception
• abdominal surgery
• Hernias
• Crohn disease
• Neoplasms
• Volvulus
• Foreign bodies
• Intestinalatresia • Carcinoid

16

POD 1- 2

Atelectasis or postoperative
pneumonia

17

POD 3- 5

Urinary tract infection

18

POD 5-7

Deep vein thrombosis or thrombophlebitis of
the IV access lines.
Must also consider pulmonary embolism for new-onset tachycardia and chest pain.

19

POD 7

Wound infections and cellulitis

20

POD 8-15

Drug fever or deep abscess

21

SBO diagnosis

• An elevated white count is sensitive but not specific.
• An elevated lactate with marked acidosis is a hallmark sign.
Xray and CT

22

SBO Treatment


1. Make the patient NPO.
2. Place an NG tube to help decompress the bowel.
3. IVfluidhydrationasvolumeislosttothirdspacing.
4. Transport to the operation room for emergent surgical resection.

23

Compartment Syndrome
The 6 signs of compartment syndrome are:

1. Pain: most commonly the first symptom
2. Pallor:lackofbloodflowcausespaleskin
3. Paresthesia: "pins and needles" sensation
4. Paralysis: inability to move the limb
5. Pulselessness: lack of distal pulses
6. Poikilothermia: cold to the touch

immediate fasciotomy