random Flashcards

1
Q

Courvoisier’s law

A
Enlarged nontender gallbladder seen with
obstruction of the common bile duct,
most commonly with pancreatic cancer
Note: not seen with gallstone obstruction
because the gallbladder is scarred
secondary to chronic cholelithiasis
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2
Q

Charcot’s triad

A

Seen with cholangitis:

  1. Fever (chills)
  2. Jaundice
  3. Right upper quadrant pain
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3
Q

Laplace’s law

A

Wall tension = pressure x radius (thus,
the colon perforates preferentially at the
cecum because of the increased radius
and resultant increased wall tension)

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4
Q

Murphy’s sign

A
Cessation of inspiration while palpating
under the right costal margin; the
patient cannot continue to inspire
deeply because it brings an inflamed
gallbladder under pressure (seen in
acute cholecystitis)
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5
Q

Raccoon eyes

A

Bilateral black eyes as a result of basilar

skull fracture

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6
Q

Reynold’s pentad

A
  1. Fever
  2. Jaundice
  3. Right upper quadrant pain
  4. Mental status changes
  5. Shock/sepsis
    Thus, Charcot’s triad plus #4 and #5; seen
    in patients with suppurative cholangitis
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7
Q

What is dumping syndrome?

A

Delivery of a large amount of
hyperosmolar chyme into the small
bowel, usually after vagotomy and a
gastric drainage procedure (pyloroplasty/
gastrojejunostomy); results in autonomic
instability, abdominal pain, and diarrhea

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8
Q

What is Ogilvie’s syndrome?

A

Massive nonobstructive colonic

dilatation

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9
Q

What is short-gut syndrome?

A

Malnutrition resulting from <200 cm of

viable small bowel

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10
Q

Abdominal x-ray (AXR)

finding with SBO?

A

Air-fluid levels

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11
Q

Electrolyte deficiency

causing ileus?

A

Hypokalemia

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12
Q

Abdominal organ injured
in blunt abdominal
trauma?

A

Liver (not the spleen, as noted in recent

studies!)

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13
Q

Abdominal organ injured
in penetrating abdominal
trauma?

A

small bowel

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14
Q

femoral vessels

A

lat to med NAVEL

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15
Q

thoracatomy vs thorocostomy

A
cotomy = open chest
costomy = chest tube
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16
Q

where put chest tube

A

4 or 5th ICS over rib NOT under

17
Q

What preoperative
medication can decrease
postoperative cardiac events
and death?

A

beta blockers

18
Q

PEG tube purpose

A

Feeding in person unable to take in food by mouth for a prolonged period of time

19
Q

purpose of water seal

A

prevents tension pneumo by creating one way valve; think of a straw in cup, can blow air into straw but suck on it and water comes up

20
Q

NG tube continous or intermittent suction

A

continuous

21
Q

3 locations of central lines

A

subclavian, IJ, femoral vein

22
Q

what does gauge mean on a needle

A

14 mean 1/14 of an inch, 18 means 1/18 of an inch

23
Q

is 14 or 18 gauge bigger

A

14

24
Q

What are the indications for

intubation and ventilation?

A
Cannot protect airway (unconscious),
excessive work of breathing, progressive
hypoxemia (PaO2 <55 despite
supplemental O2), progressive acidosis
(pH <7.3 and PCO2 >50), RR >35
25
Q

hypo or hypervent with PE

A

hypervent so low paO2 and PaCO2

26
Q

What is the treatment of PE if the

patient is stable?

A

Anticoagulation (heparin followed by
long-term [3–6 months] Coumadin®) or
Greenfield filter

27
Q

What is the differential
diagnosis of postoperative
atrial fibrillation?

A
Fluid overload, PE, MI, pain (excess
catecholamines), atelectasis, pneumonia,
digoxin toxicity, hypoxemia, thyrotoxicosis,
hypercapnia, idiopathic, acidosis,
electrolyte abnormalities
28
Q

What are the indications for

dialysis?

A

Fluid overload, refractory hyperkalemia,
BUN 130, acidosis, uremic complication
(encephalopathy, pericardial effusion)

29
Q

What can cause

hypotension?

A

Hypovolemia (iatrogenic, hemorrhage),
sepsis, MI, cardiac dysrhythmia, hypoxia, pneumothorax, PE,
cardiac tamponade, medications (e.g.,
morphine)

30
Q

What are the common
causes of postoperative
hypertension?

A

Pain (from catecholamine release), anxiety,
hypercapnia, hypoxia (which may also
cause hypotension), preexisting condition,
bladder distention

31
Q

What are the causes of

tachycardia?

A

Hypovolemia/third-spacing, pain,
alcohol withdrawal, anxiety/agitation,
urinary retention, cardiac dysrhythmia
(e.g., sinoventricular tachycardia, atrial
fibrillation with rapid rate), MI, PE, B-blocker withdrawal, anastomotic
leak, anemia

32
Q

What are the causes of

decreased urine output?

A
Hypovolemia, urinary retention, Foley
catheter malfunction, cardiac failure,
MI, acute tubular necrosis (ATN),
ureteral/urethral injury, abdominal
compartment syndrome, sepsis
33
Q

When should PO feedings be

started after a laparotomy?

A

Classically after flatus or stool PR

usually postoperative days 3–5

34
Q

when do you get SSI

A

POD 5-7

35
Q

What is the most common
cause of fever on
postoperative days 1 to 2?

A

atelectasis

36
Q

What is a PCA pump?

A

Patient-Controlled Analgesia

37
Q

Eye GCS

A
Eye opening (E)
4—Opens spontaneously
3—Opens to voice (command)
2—Opens to painful stimulus
1—Does not open eyes
(Think: Eyes = “four eyes”)
38
Q

Motor GCS

A
Motor response (M)
6—Obeys commands
5—Localizes painful stimulus
4—Withdraws from pain
3—Decorticate posture (flexion)
2—Decerebrate posture (extension)
1—No movement
(Think: Motor = “6-cylinder motor”)
39
Q

Verbal GCS

A
Verbal response (V)
5—Appropriate and oriented
4—Confused
3—Inappropriate words
2—Incomprehensible sounds
1—No sounds
(Think: Verbal = “Jackson 5”)