Section I Overview&Background Surgical Infor; Chapter I Introduction, Flashcards Preview

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Flashcards in Section I Overview&Background Surgical Infor; Chapter I Introduction, Deck (363):
1

Your study objectives in surgery should include the following four points:
P1

1. O.R. question-and-answer periods
2. Ward questioning
3. Oral exam
4. Written exam
The optimal plan of action would include daily reading in a text, anatomy review prior to each O.R. case, and Surgical Recall. But remember, this guide helps you recall basic facts about surgical topics. Reading should be done daily! The advanced student should read Advanced Surgical Recall.

2

To facilitate learning a surgical topic, first break down each topic into the following categories and, in turn, master each category:
P1-2

1. What is it?
2. Incidence
3. Risk factors
4. Signs and symptoms
5. Laboratory and radiologic tests
6. Diagnostic criteria
7. Differential diagnoses
8. Medical and surgical treatment
9. Postoperative care
10. Complications
11. Stages and prognosis
- Granted, it is hard to read after a full day in the O.R. For a change, go to sleep right away and wake up a few hours early the next day and read before going to the hospital. It sounds crazy, but it does work.
- Remember—REPETITION is the key to learning for most adults.

3

WHAT THE PERFECT SURGICAL STUDENT CARRIES IN HER LAB COAT
P2

- Stethoscope
- Penlight
- Scissors
- Minibook on medications (e.g., trade names, doses)
- Tape/4 x 4s
- Sutures to practice tying
- Pen/notepad/small notebook to write down pearls
- Notebook or clipboard with patient’s data (always write down chores with a box next to them so you can check off the box when the chore is completed)
- Small calculator
- List of commonly used telephone numbers (e.g., radiology)
- (Oh, and of course, Surgical Recall!)

4

THE PERFECT PREPARATION FOR ROUNDS
P2-3

- Interview your patient (e.g., problems, pain, wishes)
- Talk with your patient’s nurse (e.g., “Were there any events during the last shift?”)
- Examine patient (e.g., cor/pulm/abd/wound)
- Record vital signs (e.g., Tmax)
- Record input (e.g., IVF, PO)
- Record output (e.g., urine, drains)
- Check labs
- Check microbiology (e.g., culture reports, Gram stains)
- Check x-rays
- Check pathology reports.
- Know the patient’s allergies
- Check allied health updates (e.g., PT, OT)
- Read chart
- Check medication (don’t forget H2 blocker in hyperalimentation)
- Check nutrition
- Always check with the intern for chores, updates, or insider information before rounds

5

PRESENTING ON ROUNDS
Your presentation on rounds should be like an iceberg. State important points about your patient (the tip of the iceberg visible above the ocean), but know everything else about your patient that your chief might ask about (that part
of the iceberg under the ocean). Always include:
P3

- Name
- Postoperative day s/p-procedure
- Concise overall assessment of how the patient is doing
- Vital signs/temp status/antibiotics day
- Input/output-urine, drains, PO intake, IVF
- Change in physical examination
- Any complaints (not yours—the patient’s)
- Plan
Your presentation should be concise, with good eye contact (you should not simply read from a clipboard). The intangible element of confidence cannot be overemphasized; if you do not know the answer to a question about a patient, however, the correct response should be “I do not know, but I will find out.” Never lie or hedge on an answer because it will only serve to make the
remainder of your surgical rotation less than desirable. Furthermore, do your best to be enthusiastic and motivated. Never, ever whine. And remember to be a team player. Never make your fellow students look bad! Residents pick
up on this immediately and will slam you.

6

THE PERFECT SURGERY STUDENT
P3-5

- Never whines
- Never pimps his residents or fellow students(or attendings)
- Never complains
- Is never hungry, thirsty, or tired
- Is always enthusiastic
- Loves to do scut work and can never get enough
- Never makes a fellow student look bad
- Is always clean (a patient sees only you and the wound dressing)
- Is never late
- Smiles a lot and has a good sense of humor
- Makes things happen
- Is not a “know-it-all”
- Never corrects anyone during rounds unless it will affect patient care
- Makes the intern/resident/chief look good at all times, if at all possible
- Knows more about her patients than anyone else
- Loves the O.R.
- Never wants to leave the hospital
- Takes correction, direction, and instruction very well
- Says “Sir” and “Ma’am” to the scrub nurses (and to the attending, unless corrected)
- Never asks questions he can look up for himself
- Knows the patient’s disease, surgery, indication for surgery, and the anatomy before going to the O.R.
- Is the first one to arrive at clinic and the last one to leave
- Always places x-rays up in the O.R.
- Reads from a surgery text every day
- Is a team player
- Asks for feedback
- Never has a chip on her shoulder
- Loves to suture
- Is honest and always admits fault and errors
- Knows when his patient is going to the O.R. (e.g., by calling)
- Is confident but not cocky
- Has a “Can-Do” attitude and can figure out things on her own
- Is not afraid to get help when needed
- Never says “No” or “Maybe” to involvement in patient care
- Treats everyone (e.g., nurses, fellow students) with respect
- Always respects patients’ modesty (e.g., covers groin with a sheet as soon as possible in the trauma bay)
- Follows the chain of command
- Praises others when appropriate
- Checks with the intern beforehand for information for rounds (test results/ surprises)
- RUNS for materials, lab values, test results, etc., during rounds before any house officer
- Gives credit where credit is due
- Dresses and undresses wounds on rounds
- Has a steel bladder, a cast-iron stomach, and a heart of gold
- Always writes the OP note without question
- Always checks with the intern after rounds for chores
- Always makes sure there is a medical student in every case
- Always follows the patient to the recovery room
- In the O.R., always asks permission to ask a question
- Always reviews anatomy prior to going to the O.R.
- Does what the intern asks (i.e., the chief will get feedback from the intern)
- Is a high-speed, low-drag, hardcore HAMMERHEAD
- Define HAMMERHEAD. A hammerhead is an individual who places his head to the ground and hammers
through any and all obstacles to get a job done and then asks for more work. One who gives 110% and never complains. One who desires work.

7

OPERATING ROOM
P5-6

Your job in the O.R. will be to retract (water-skiing) and answer questions posed by the attending physicians and residents. Retracting is basically idiot-proof.
Many students emphasize anticipating the surgeon’s next move, but stick to following the surgeon’s request. More than 75% of the questions asked in the O.R. deal with anatomy; therefore, read about the anatomy and pathophysiology of the case, which will reduce the “I don’t knows.”
- Never argue with the scrub nurses—they are always right. They are the selfless warriors of the operating suite’s sterile field, and arguing with one will only make matters worse.
- Never touch or take instruments from the Mayo tray (tray with instruments on it over the patient’s feet) unless given explicit permission to do so. Each day as you approach the O.R. suite door, STOP and ask yourself if you have on scrubs, shoe covers, a cap, and a mask to avoid the embarrassing situation of being yelled at by the O.R. staff (a.k.a. the 3 strikes test: strike 1  no mask, strike 2  no headcover, strike 3  no shoe covers . . . any strikes and you are outta here—place a mental stop sign outside of the O.R. with the 3 strikes rule on it)! Always wear eye protection. When entering the O.R., first introduce yourself to the scrub nurse and ask if you can get your gloves or gown. If you
have questions in the O.R., first ask if you can ask a question because it may be a bad time and this way it will not appear as though you are pimping the resident/attending.
- Other thoughts on the O.R.: If you feel faint, ask if you can sit down (try to eat prior to going to the O.R.). If your feet swell in the O.R., try wearing support hose socks. If your
back hurts, try taking some ibuprofen (with a meal) prior to the case. Also, situps or abdominal crunches help to relieve back pain by strengthening the abdominal muscles. At the end of the case, ask the scrub nurse for some leftover ties (clean ones) to practice tying knots with and, if there is time, start
writing your OP note.

8

OPERATING ROOM FAQS (ORF) P6
1. What if I have to sneeze?

Back up STRAIGHT back; do not turn your head, as the sneeze exits through the sides of your mask!

9

2. What if I feel faint?
ORF P6

Do not be a hero—say, “I feel faint. May I sit down?” This is no big deal and is very common (Note: It helps to always
eat before going to the O.R.)

10

3. What should I say when I first enter the O.R.?
ORF P6

Introduce yourself as a student; state that you have been invited to scrub and ask if you need to get out your gloves and/or gown

11

4. Should I wear my ID tag into the O.R.?
ORF P6

Yes

12

5. Can I wear nail polish?
ORF P6

Yes, as long as it is not chipped

13

6. Can I wear my rings and my watch when scrubbed in the
O.R.?
ORF P6

No

14

7. Can I wear earrings?
ORF P6

No

15

8. When scrubbed, is my back sterile?
ORF P6

No

16

9. When in the surgical gown, are my underarms sterile?
ORF P6

No; do not put your hands under your arms

17

10. How far down my gown is considered part of the
sterile field?
ORF P6

Just to your waist

18

11. How far up my gown is considered sterile?

Up to the nipples

19

12. How do I stand if I am waiting for the case to start?
ORF P7

Hands together in front above your waist
( there is a picture)

20

13. Can I button up a surgical gown (when I am not
scrubbed!) with bare hands?
ORF P7

Yes (Remember: the back of the gown is NOT sterile)

21

14. How many pairs of gloves should I wear when scrubbed?
ORF P7

2 (2 layers)

22

15. What is the normal order of sizes of gloves: small pair,
then larger pair?
ORF P7

No; usually the order is a larger size followed by a smaller size (e.g., men commonly wear a size #8 covered by a
size #7.5; women commonly wear a size #7 covered by a size #6.5)

23

16. What is a “scrub nurse” versus a “circulating nurse”?
ORF P7

- The scrub nurse is “scrubbed” and hands the surgeon sutures, instruments, and so forth; this person is often an
Operating Room Technician (a.k.a. “Scrub Tech”)
- The circulating nurse “circulates” and gets everything needed before and during the procedure

24

17. What items comprise the sterile field in the operating
room?
ORF P7

The instrument table, the Mayo tray, and the anterior drapes on the patient

25

18. What is the tray with the instruments called?
ORF P8

Mayo tray
(there is a picture)

26

19. Can I grab things off the Mayo tray?
ORF P8

No; ask the scrub nurse/tech for permission

27

20. How do you remove blood with a laparotomy pad
(“lap pad”)?
ORF P8

Dab; do not wipe, because wiping removes platelet plugs

28

21. Can you grab the skin with DeBakey pickups?
ORF P8

NO; pickups for the skin must have teeth (e.g., Adson, rat-tooth) because it is “better to cut the skin than crush it”

29

22. How should you cut the sutures after tying a knot?
ORF P8

1. Rest the cutting hand on the noncutting hand
2. Slip the scissors down to the knot and then cant the scissors at a 45-degree angle so you do not cut the knot itself
(there is a picture)

30

23. What should you do when you are scrubbed and
someone is tying a suture?
ORF P9

Ask the scrub nurse for a pair of suture scissors, so you are ready if you are asked to cut the sutures

31

24. Why always wipe the Betadine® (povidone-iodine)
off your patient at the end of the procedure?
ORF P9

Betadine® can become very irritating and itchy

32

SURGICAL NOTES (SN) P9

The history and physical examination report, better known as the H & P

33

What are the two words most commonly misspelled
in a surgical history note?
SN P9

1. Guaiac
2. Abscess

34

Favorite Trick Questions in SN (FTQ in SN) P9
1. What is the most common intra-operative bladder
“tumor”?

Foley catheter

35

2. Describe a stool with melena
(FTQ in SN) P9

Melenic—not melanotic

36

3, Is amylase part of Ranson’s criteria?
(FTQ in SN) P9

Amylase is NOT part of Ranson’s criteria!

37

4. Can a patient in shock have “STABLE” vital signs?
(FTQ in SN) P9

Yes—stable vital signs are any vital signs that are not changing! Always say “normal” vital signs, not “stable!”

38

5. What is the most commonly pimped, yet the rarest,
cause of pancreatitis?
(FTQ in SN) P9

Pancreatitis from a scorpion bite
(scorpion found on island of Trinidad)

39

6. Where can you go to obtain an abdominal CT scan on a
600-pound, morbidly obese patient?
(FTQ in SN) P9

The ZOO (used in the past, but now rare due to liability)

40

Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):

7. Mr. Smith is a 22-year-old African American man who was in his normal state of excellent health until he noted the onset of periumbilical pain 1 day prior to admission. This pain was followed 4 hours later by pain in his right lower quadrant that any movement exacerbated. vomiting, anorexia. fever, urinary tract symptoms, change in bowel habits, constipation, BRBPR, hematemesis, or diarrhea.
(FTQ in SN) P10

- Medications: ibuprofen prn headaches
- Allergies: NKDA
- PMH: none
- PSH: none
- SH: EtOH, tobacco
- FH: --CA
- ROS: --resp disease, --cardiac disease, --renal disease
- Physical Exam:
a) V/S 120/80 85 12 T 37 C
b) HEENT ncat, tms clear
c) cor nsr, m, r, g
d) pulm clear b/l
e) abd nondistended, +bs, +tender RLQ, +rebound RLQ
f) rectal guaiac --nl tone, --mass
g) ext nt, --c, c, e
h) neuro wnl
- LABS: urinalysis (ua) normal, chem 7, PT/PTT, CBC pending
- X-RAYS: none
- ASSESSMENT: 22 y.o. m with Hx and physical findings of
right lower quadrant peritoneal signs consistent with (c/w) appendicitis
- Plan:
a) NPO
b) Consent
c) IVF with Lactated Ringer’s
d) IV cefoxitin
e) To O.R. for appendectomy

41

Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):

8. Wilson Tyler cc III/

NKDA = no known drug allergies;
PMH = past medical history;
PSH = past surgical history;
SH = social history;
FH = family history;
ROS = review of systems;
V/S = vital signs;
ncat = normocephalic atraumatic;
tms = tympanic membranes;
cor = heart;
m, r, g = murmur, rub, gallop;
NSR = normal sinus rhythm;
b/l = bilateral;
bs = bowel sounds;
ext = extremity;
nt = nontender;
c, c, e = cyanosis, clubbing, or erythema;
wnl = within normal limits;
cc III = clinical clerk, third year
(FTQ in SN) P10-11

PREOP NOTE:
The preop note is written in the progress notes the day before the operation
Example:
- Preop Dx: colon CA
- Labs: CBC, chem 7, PT/PTT
- CXR: --infiltrate
- Blood: T & C 2 units
- EKG: NSR, wnl
- Anesthesia: preop completed
- Consent: signed and on front of chart
- Orders:
1. Void OCTOR
2. 1 gm cefoxitin OCTOR
3. Hibiclens scrub this p.m.
4. Bowel prep today
5. NPO p- MN

NPO = nothing by mouth;
OCTOR = on call to O.R.;
p- = after;
MN = midnight

OP NOTE:
The OP note is written in the progress note section of the chart in the O.R. before the patient is in the PACU (or recovery room).
Example:
- Preop Dx: acute appendicitis
- Postop Dx: same
- Procedure: appendectomy
- Surgeon: Halsted
- Assistants: Cushing, Tribble
- OP findings: no perforation
- Anesthesia: GET
- *I/O: 1000 mL LR/uo 600 mL
- *EBL: 50 mL
- Specimen: appendix to pathology
- Drains: none
- Complications: none (Note: If there are complications, ask what you should write.)

To PACU in stable condition
GET = general endotracheal;
I/O = ins and outs; uo urine output;
EBL = estimated blood loss;
PACU = postanesthesia care unit

*Ask the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for this information.

42

9. How do I remember what is in the OP note when I am in
the O.R.?
(FTQ in SN) P12

Remember the acronym “PPP SAFE DISC”:
- Preop Dx
- Postop Dx
- Procedure
- Surgeon (and assistants)
- Anesthesia
- Fluids
- Estimated blood loss (EBL)
- Drains
- IV Fluids
- Specimen
- Complications

43

10. POSTOP NOTE
The postop note is written on the day of the operation in the progress notes
Example:
(FTQ in SN) P12

- Procedure: appendectomy
- Neuro: A&O  3
- V/S: wnl/afebrile
- I/O: 1 L LR/uo 600 mL
- Labs: postop Hct: 36
- PE:
a) cor RRR
b) pulm CTA
c) abd drsg dry and intact
- Drains: JP 30 mL serosanguinous fluid
- Assess: stable postop
- Plan:
1. IV hydration
2. 1 g cefoxitin q 8 hr

A&O x 3 = alert and oriented times 3;
V/S = vital signs;
uo = urine output;
Hct = hematocrit;
RRR = regular rhythm and rate; JP  Jackson-Pratt; wnl 
within normal limits

44

11. ADMISSION ORDERS

The admission orders are written in the physician orders section of the patient’s chart on admission, transfer, or postop
Example:
P12-13

Admit to 5E Dr. DeBakey
- Dx: AAA
- Condition: stable
- V/S: q 4 hr or q shift; if postop, q 15 min  2 hr, then q 1 hr  4, then q 4 hr
- Allergies: NKDA
- Activity: bedrest or OOB to chair
- Nursing: daily wgt; I/O; change drsg q shift
- Call HO for:
a) temp >38.5
b) UO 180 100
e) HR 110
- Diet: NPO
- IVF: D5 1/2 NSc - 20 KCL
- Drugs: ANCEF
- Labs: CBC

OOB = out of bed;
I/O = ins and outs;
HO = House Officer;
SBP = systolic blood pressure;
DBP = diastolic blood pressure;
HR = heart rate;
KCL = potassium chloride

45

ADMISSION ORDERS/POSTOP ORDERS

“AC/DC AVA PAIN DUD”:
P13

Admit to 5E
Care Provider
Diagnosis
Condition

Allergies
Vitals
Activity

Pain meds
Antibiotics
IVF/Incentive Spirometry
Nursing (Drains, etc.)

DVT prophylaxis
Ulcer prophylaxis
Diet

46

DAILY NOTE—PROGRESS NOTE

Basically a SOAP note, but it is not necessary to write out SOAP; for many reasons, make your notes very OBJECTIVE and, as a student, do not mention discharge because this leads to confusion
Example:
P13-14

10/1/90 Blue Surgery
POD #4 s/p appendectomy
Day #5 cefoxitin
Pt without c/o

V/S: 120/80 76 12 afebrile (Tmax 38)
I/O: 1000/600
Drains: JP #1 60 last shift
PE: cor RRR—no m, g, r
pulm CTA
abd + BS, +flatus, --rigidity
ext nt, --cyanosis, --erythema
ASSESS: Stable POD #4 on IV antibiotics
PLAN:
1. Increase PO intake
2. Increase ambulation
3. Follow cultures
Grayson Stuart, cc III/
Important: Always date, time, and sign your notes and leave space for them to be cosigned!

POD = Postop day (Note: The day after operation is POD #1. The day of operation is the operative day. But: Antibiotic day #1 is the day the antibiotics were started.);
c/o = complains of; nt nontender; cc III clinical clerk, third year

The following is an acronym for what should be checked on your patient daily before rounding with the surgical team: “AVOID WTE”:
Appearance—any subjective complaints
Vital signs
Output—urine/drains
Intake—IV/PO
Drains—# of/output/character

Wound/dressing/weight
Temperature
Exam—cor, pulm, abd, etc.

47

INTENSIVE CARE NOTE

This note is by systems:
P14

Neurologic (GCS, MAE)
Pulmonary (vent settings, etc.)
CVS (pressors, swann numbers, etc.)
Heme (CBC)
FEN (Chem 10, nutrition, etc.)
Renal (urine output, BUN, Cr, etc.)
I & D (T, WBC, antibiotics, etc.)
Assessment
Plan

CVS = current vital signs;
FEN = fluids, electrolytes, nutrition;
BUN = blood urea nitrogen;
Cr = creatinine;
I & D = incision and drainage (Note: PE, labs, radiology studies, etc. are included in each section. This is also an excellent way to write progress notes for the very complicated floor patient.)

48

CLINIC NOTE
Often the clinic note is a letter to the referring doctor. It should always include:
P15

1. Patient name, history #, date
2. Brief Hx, current complaints/symptoms
3. PE, labs, x-rays
4. Assessment
5. Plan

49

How is a medication prescription written?

CLINIC NOTE
P15

Tylenol® 500 mg tablet
Disp (dispense): 100 tablets
sig: 1–2 PO q 4 hrs PRN pain

50

COMMON ABBREVIATIONS YOU SHOULD KNOW
(CASK) P15
(Check with your hospital for approved abbreviations!)

a(over a line)

Before

51

AAA
(CASK) P15

Abdominal aortic aneurysm; “triple A”

52

ABD
(CASK) P15

Army battle dressing

53

ABG
(CASK) P15

Arterial blood gas

54

ABI
(CASK) P15

Ankle to brachial index

55

AKA
(CASK) P15

Above the knee amputation

56

a.k.a.
(CASK) P15

Also known as

57

Ao
(CASK) P15

Aorta

58

APR
(CASK) P15

Abdominoperineal resection

59

ARDS
(CASK) P15

Acute respiratory distress syndrome

60

ASA
(CASK) P15

Aspirin

61

AXR
(CASK) P15

Abdominal x-ray

62

B1
(CASK) P15

Billroth 1 gastroduodenostomy

63

B2
(CASK) P15

Billroth 2 gastrojejunostomy

64

BCP
(CASK) P15

Birth control pill

65

BE
(CASK) P15

Barium enema

66

BIH
(CASK) P15

Bilateral inguinal hernia

67

BKA
(CASK) P15

Below the knee amputation

68

BRBPR
(CASK) P15

Bright red blood per rectum

69

BS
(CASK) P15

Bowel sounds; Breath sounds; Blood sugar

70

BSE
(CASK) P15

Breast self-examination

71

c (a line over)
(CASK) P15

With

72

CA
(CASK) P15

Cancer

73

CABG
(CASK) P15

Coronary artery bypass graft (“CABBAGE”)

74

CBC
(CASK) P15

Complete blood cell count

75

CBD
(CASK) P16

Common bile duct

76

c/o
(CASK) P16

Complains of

77

COPD
(CASK) P16

Chronic obstructive pulmonary disease

78

CP
(CASK) P16

Chest pain

79

CTA
(CASK) P16

Clear to auscultation; CT angiogram

80

CVA
(CASK) P16

Cerebral vascular accident

81

CVAT
(CASK) P16

Costovertebral angle tenderness

82

CVP
(CASK) P16

Central venous pressure

83

CXR
(CASK) P16

Chest x-ray

84

Dx
(CASK) P16

Diagnosis

85

DDx
(CASK) P16

Differential diagnosis

86

DI
(CASK) P16

Diabetes insipidus

87

DP
(CASK) P16

Dorsalis pedalis

88

DPL
(CASK) P16

Diagnostic peritoneal lavage

89

DPC
(CASK) P16

Delayed primary closure

90

DT
(CASK) P16

Delirium tremens

91

DVT
(CASK) P16

Deep venous thrombosis

92

EBL
(CASK) P16

Estimated blood loss

93

ECMO
(CASK) P16

Extracorporeal membrane oxygenation

94

EGD
(CASK) P16

Esophagogastroduodenoscopy (UGI scope)

95

EKG
(CASK) P16

Electrocardiogram (also ECG)

96

ELAP
(CASK) P16

Exploratory laparotomy

97

EOMI
(CASK) P16

Extraocular muscles intact

98

ERCP
(CASK) P16

Endoscopic retrograde cholangiopancreatography

99

EtOH
(CASK) P16

Alcohol

100

EUA
(CASK) P16

Exam under anesthesia

101

EX LAP
(CASK) P16

Exploratory laparotomy

102

FAP
(CASK) P16

Familial adenomatous polyposis

103

FAST
(CASK) P16

Focused abdominal sonogram for trauma

104

FEN
(CASK) P16

Fluids, electrolytes, nutrition

105

FNA
(CASK) P16

Fine needle aspiration

106

FOBT
(CASK) P16

Fecal occult blood test

107

GCS
(CASK) P16

Glasgow Coma Scale

108

GERD
(CASK) P16

Gastroesophageal reflux disease

109

GET(A)
(CASK) P16

General endotracheal (anesthesia)

110

GU
(CASK) P16

Genitourinary

111

HCT
(CASK) P16

Hematocrit

112

HEENT
(CASK) P16

Head, eyes, ears, nose, and throat

113

HO
(CASK) P16

House officer

114

Hx
(CASK) P16

History

115

IABP
(CASK) P16

Intra-aortic balloon pump

116

IBD
(CASK) P16

Inflammatory bowel disease

117

ICU
(CASK) P16

Intensive care unit

118

I & D
(CASK) P16

Incision and drainage

119

I & O
(CASK) P16

Ins and outs, in and out

120

IMV
(CASK) P16

Intermittent mandatory ventilation

121

IVC
(CASK) P17

Inferior vena cava

122

IVF
(CASK) P17

Intravenous fluids

123

IVP
(CASK) P17

Intravenous pyelography

124

IVPB
(CASK) P17

Intravenous piggyback

125

JVD
(CASK) P17

Jugular venous distention

126

L (a circle around L)
(CASK) P17

Left

127

LE
(CASK) P17

Lower extremity

128

LES
(CASK) P17

Lower esophageal sphincter

129

LIH
(CASK) P17

Left inguinal hernia

130

LLQ
(CASK) P17

Left lower quadrant

131

LR
(CASK) P17

Lactated Ringer’s

132

LUQ
(CASK) P17

Left upper quadrant

133

MAE
(CASK) P17

Moving all extremities

134

MAST
(CASK) P17

Military antishock trousers

135

MEN
(CASK) P17

Multiple endocrine neoplasia

136

MI
(CASK) P17

Myocardial infarction

137

MSO4
(CASK) P17

Morphine sulfate

138

NGT
(CASK) P17

Nasogastric tube

139

NPO
(CASK) P17

Nothing per os

140

NS
(CASK) P17

Normal saline

141

OBR
(CASK) P17

Ortho bowel routine

142

OCTOR
(CASK) P17

On call to O.R.

143

OOB
(CASK) P17

Out of bed

144

ORIF
(CASK) P17

Open reduction internal fixation

145

p (a line over P)
(CASK) P17

After

146

PCWP
(CASK) P17

Pulmonary capillary wedge pressure

147

PE
(CASK) P17

Pulmonary embolism; Physical examination

148

PEEP
(CASK) P17

Positive end-expiratory pressure

149

PEG
(CASK) P17

Percutaneous endoscopic gastrostomy (via EGD and skin
incision)

150

PERRL
(CASK) P17

Pupils equal and react to light

151

PFT
(CASK) P17

Pulmonary function tests

152

PICC
(CASK) P17

Peripherally inserted central catheter

153

PGV
(CASK) P17

Proximal gastric vagotomy (i.e., leaves fibers to pylorus intact to preserve emptying)

154

PID
(CASK) P17

Pelvic inflammatory disease

155

PO
(CASK) P17

Per os (by mouth)

156

POD
(CASK) P17

Postoperative day

157

PR
(CASK) P17

Per rectum

158

PRN
(CASK) P17

As needed, literally, pro re nata

159

PT
(CASK) P17

Physical therapy; Patient; Posterior tibial; Prothrombin time

160

PTC
(CASK) P17

Percutaneous transhepatic cholangiogram (dye injected via a catheter through skin and into dilated intrahepatic bile duct)

161

PTCA
(CASK) P17

Percutaneous transluminal coronary angioplasty

162

PTX
(CASK) P17

pneumothorax

163

q(a line over q) or q
(CASK) P18

Every

164

R(a line over R)
(CASK) P18

Right

165

RIH
(CASK) P18

Right inguinal hernia

166

RLQ
(CASK) P18

Right lower quadrant

167

Rx
(CASK) P18

Treatment

168

RTC
(CASK) P18

Return to clinic

169

s (a line over s)
(CASK) P18

Without

170

SBO
(CASK) P18

Small bowel obstruction

171

SCD
(CASK) P18

Sequential compression device

172

SIADH
(CASK) P18

Syndrome of inappropriate antidiuretic hormone

173

SICU
(CASK) P18

Surgical intensive care unit

174

SOAP
(CASK) P18

Subjective, objective, assessment, and plan

175

S/P
(CASK) P18

Status post

176

STSG
(CASK) P18

Split thickness skin graft

177

SVC
(CASK) P18

Superior vena cava

178

Sx
(CASK) P18

Symptoms

179

TEE
(CASK) P18

Transesophageal echocardiography

180

T & C
(CASK) P18

Type and cross

181

T & S
(CASK) P18

Type and screen

182

T
(CASK) P18

Maximal temperature

183

TPN
(CASK) P18

Total parenteral nutrition

184

TURP
(CASK) P18

Transurethral resection of the prostate

185

UE
(CASK) P18

Upper extremity

186

UGI
(CASK) P18

Upper gastrointestinal

187

UO
(CASK) P18

Urine output

188

U/S
(CASK) P18

Ultrasound

189

UTI
(CASK) P18

Urinary tract infection

190

VAD
(CASK) P18

Ventricular assist device

191

VOCTOR
(CASK) P18

Void on call to O.R.

192

W→D
(CASK) P18

Wet-to-dry dressing

193

XRT
(CASK) P18

X-ray therapy

194


(CASK) P18

No; negative

195

+
(CASK) P18

Yes; positive

196


(CASK) P18

Increase; more

197


(CASK) P18

Decrease; less

198

<
(CASK) P18

Less than

199

>
(CASK) P18

Greater than

200


(CASK) P18

Approximately

201

GLOSSARY OF SURGICAL TERMSYOU SHOULD KNOW
(GSTK) P18

Abscess

Localized collection of pus anywhere in the body, surrounded and walled off by damaged and inflamed tissues

202

Achlorhydria
(GSTK) P19

Absence of hydrochloric acid in the stomach

203

Acholic stool
(GSTK) P19

Light-colored stool as a result of decreased bile content

204

Adeno-
(GSTK) P19

Prefix denoting gland or glands

205

Adhesion
(GSTK) P19

Union of two normally separate surfaces

206

Adnexa
(GSTK) P19

Adjoining parts; usually means ovary/fallopian tube

207

Adventitia
(GSTK) P19

Outer coat of the wall of a vein or artery
(composed of loose connective tissue)

208

Afferent
(GSTK) P19

Toward

209

-algia
(GSTK) P19

Suffix denoting pain

210

Amaurosis fugax
(GSTK) P19

Transient visual loss in one eye

211

Ampulla
(GSTK) P19

Enlarged or dilated ending of a tube or canal

212

Analgesic
(GSTK) P19

Drug that prevents pain

213

Anastomosis
(GSTK) P19

Connection between two tubular organs or parts

214

Angio-
(GSTK) P19

Prefix denoting blood or lymph vessels

215

Anomaly
(GSTK) P19

Any deviation from the normal (i.e., congenital or developmental defect)

216

Apnea
(GSTK) P19

Cessation of breathing

217

Atelectasis
(GSTK) P19

Collapse of alveoli

218

Bariatric
(GSTK) P19

Weight reduction; bariatric surgery is performed on morbidly obese patients to effect weight loss

219

Bifurcation
(GSTK) P19

Point at which division into two branches occurs

220

Bile salts
(GSTK) P20

Alkaline salts of bile necessary for the emulsification of fats

221

Bili-
(GSTK) P20

Prefix denoting bile

222

Boil
(GSTK) P20

Tender inflamed area of the skin containing pus

223

Bovie
(GSTK) P20

Electrocautery

224

Calculus
(GSTK) P20

Stone

225

Carbuncle
(GSTK) P20

Collection of boils (furuncles) with multiple drainage channels (CARbuncle = car = big)

226

Cauterization
(GSTK) P20

Destruction of tissue by direct application of heat

227

Celiotomy
(GSTK) P20

Surgical incision into the peritoneal cavity
(laparotomy = celiotomy)

228

Cephal-
(GSTK) P20

Prefix denoting the head

229

Chole-
(GSTK) P20

Prefix denoting bile

230

Cholecyst-
(GSTK) P20

Prefix denoting gallbladder

231

Choledocho-
(GSTK) P20

Prefix denoting the common bile duct

232

Cleido-
(GSTK) P20

Prefix denoting the clavicle

233

Colic
(GSTK) P20

Intermittent abdominal pain usually indicating pathology in a tubular organ (e.g., small bowel)

234

Colloid
(GSTK) P20

Fluid with large particles (e.g., albumin)

235

Colonoscopy
(GSTK) P20

Endoscopic examination of the colon

236

Colostomy
(GSTK) P20

Surgical operation in which part of the colon is brought through the abdominal wall

237

Constipation
(GSTK) P20

Infrequent or difficult passage of stool

238

Cor pulmonale
(GSTK) P21

Enlargement of the right ventricle caused by lung disease and resultant pulmonary hypertension

239

Curettage
(GSTK) P21

Scraping of the internal surface of an organ or body cavity by means of a spoon-shaped instrument

240

Cyst
(GSTK) P21

Abnormal sac or closed cavity lined with epithelium and filled with fluid or semisolid material

241

Direct bilirubin
(GSTK) P21

Conjugated bilirubin (indirect = unconjugated)

242

-dynia
(GSTK) P21

Suffix denoting pain

243

Dys-
(GSTK) P21

Prefix: difficult/painful/abnormal

244

Dyspareunia
(GSTK) P21

Painful sexual intercourse

245

Dysphagia
(GSTK) P21

Difficulty in swallowing

246

Ecchymosis
(GSTK) P21

Bruise

247

-ectomy
(GSTK) P21

Suffix denoting the surgical removal of a part or all of an organ (e.g., gastrectomy)

248

Efferent
(GSTK) P21

Away from

249

Endarterectomy
(GSTK) P21

Surgical removal of an atheroma and the inner part of the vessel wall to relieve an obstruction
(carotid endarterectomy = CEA)

250

Enteritis
(GSTK) P21

Inflammation of the small intestine, usually causing diarrhea

251

Enterolysis
(GSTK) P21

Lysis of peritoneal adhesions; not to be confused with enteroclysis, which is a contrast study of the small bowel

252

Eschar
(GSTK) P21

Scab produced by the action of heat or a corrosive substance on the skin

253

Excisional biopsy
(GSTK) P22

Biopsy with removal of entire tumor
(Think: Excisional  Entire removal)

254

Fascia
(GSTK) P22

Sheet of strong connective tissue

255

Fistula
(GSTK) P22

Abnormal communication between two hollow, epithelialized organs or between a hollow organ and the exterior (skin)

256

Foley
(GSTK) P22

Bladder catheter

257

Frequency
(GSTK) P22

Abnormally increased frequency (e.g., urinary frequency)

258

Furuncle
(GSTK) P22

Boil, small subcutaneous staphylococcal infection of follicle (Think: Furuncle = follicle < car = carbuncle)

259

Gastropexy
(GSTK) P22

Surgical attachment of the stomach to the abdominal wall

260

Hemangioma
(GSTK) P22

Benign tumor of blood vessels

261

Hematemesis
(GSTK) P22

Vomiting of blood

262

Hematoma
(GSTK) P22

Accumulation of blood within the tissues, which clots to form a solid swelling

263

Hemoptysis
(GSTK) P22

Coughing up blood

264

Hemothorax
(GSTK) P22

Blood in the pleural cavity

265

Hepato-
(GSTK) P22

Prefix denoting the liver

266

Herniorrhaphy
(GSTK) P22

Surgical repair of a hernia

267

Hesitancy
(GSTK) P22

Difficulty in initiating urination

268

Hiatus
(GSTK) P22

Opening or aperture

269

Hidradenitis
(GSTK) P22

Inflammation of the apocrine glands, usually caused by blockage of the glands

270

Icterus
(GSTK) P22

Jaundice

271

Ileostomy
(GSTK) P23

Surgical connection between the lumen of the ileum and the skin of the abdominal wall

272

Ileus
(GSTK) P23

Abnormal intestinal motility (usually paralytic)

273

Incisional biopsy
(GSTK) P23

Biopsy with only a “slice” of tumor removed

274

Induration
(GSTK) P23

Abnormal hardening of a tissue or organ

275

Inspissated
(GSTK) P23

Hard

276

Intussusception
(GSTK) P23

Telescoping of one part of the bowel into another

277

-itis
(GSTK) P23

Suffix denoting inflammation of an organ, tissue, etc. (e.g., gastritis)

278

Lap appy
(GSTK) P23

Appendectomy via laparoscopy

279

Laparoscopy
(GSTK) P23

Visualization of the peritoneal cavity via a laparoscope

280

Laparotomy
(GSTK) P23

Surgical incision into the abdominal cavity
(laparotomy = celiotomy)

281

Lap chole
(GSTK) P23

Cholecystectomy via laparoscopy

282

Leiomyoma
(GSTK) P23

Benign tumor of smooth muscle

283

Leiomyosarcoma
(GSTK) P23

Malignant tumor of smooth muscle

284

Lieno-
(GSTK) P23

Denoting the spleen

285

Melena
(GSTK) P23

Black tarry stool (melenic, not melanotic stools)

286

Necrotic
(GSTK) P23

Dead

287

Obstipation
(GSTK) P23

Failure to pass flatus or stool

288

Odynophagia
(GSTK) P23

Painful swallowing

289

-orraphy
(GSTK) P23

Surgical repair (e.g., herniorrhaphy)

290

-ostomy
(GSTK) P24

General term referring to any operation in which an artificial opening is created between two hollow organs or between
one viscera and the abdominal wall for drainage purposes (e.g., colostomy) or for feeding (e.g., gastrostomy)

291

-otomy
(GSTK) P24

Suffix denoting surgical incision into an organ

292

Percutaneous
(GSTK) P24

Performed through the skin

293

-pexy
(GSTK) P24

Suffix denoting fixation

294

Phleb-
(GSTK) P24

Prefix denoting vein or relating to veins

295

Phlebolith
(GSTK) P24

Calcification in a vein—a vein stone

296

Phlegmon
(GSTK) P24

Diffuse inflammation of soft tissue, resulting in a swollen mass of tissue
(most commonly seen with pancreatic tissue)

297

Plica
(GSTK) P24

Fold or ridge

298

Plicae circulares
(GSTK) P24

Circular (complete circles) folds in the lumen of the small intestine (a.k.a. valvulae conniventes)

299

Plicae semilunares
(GSTK) P24

Folds (semicircular) into lumen of the large intestine

300

Pneumaturia
(GSTK) P24

Passage of urine containing air

301

Pneumothorax
(GSTK) P24

Collapse of lung with air in pleural space

302

Pseudocyst
(GSTK) P24

Fluid-filled cavity resembling a true cyst, but not lined with epithelium

303

Pus
(GSTK) P24

Liquid product of inflammation, consisting of dying leukocytes and other fluids from the inflammatory response

304

Rubor
(GSTK) P25

Redness; a classic sign of inflammation

305

Steatorrhea
(GSTK) P25

Fatty stools as a result of decreased fat absorption

306

Stenosis
(GSTK) P25

Abnormal narrowing of a passage or opening

307

Sterile field
(GSTK) P25

Area covered by sterile drapes or prepped in sterile fashion using antiseptics (e.g., Betadine®)

308

Succus
(GSTK) P25

Fluid (e.g., succus entericus is fluid from
the bowel lumen)

309

Tenesmus
(GSTK) P25

Urge to defecate with ineffectual straining

310

Thoracotomy
(GSTK) P25

Surgical opening of the chest cavity

311

Transect
(GSTK) P25

To divide transversely (to cut in half)

312

Trendelenburg
(GSTK) P25

Patient posture with pelvis higher than the head, inclined about 45º (a.k.a. “headdownenburg”)

313

Urgency
(GSTK) P25

Sudden strong urge to urinate; often seen with a UTI

314

Wet-to-dry dressing
(GSTK) P25

Damp gauze dressing placed on a wound and removed after the dressing dries to the wound, providing
microdébridement

315

SURGERY SIGNS,TRIADS, ETC.YOU SHOULD KNOW
(SSTE) P25

What are the ABCDs of melanoma?

Signs of melanoma:
Asymmetric
Border irregularities
Color variation
Diameter > 0.6 cm and Dark color

316

What is the Allen’s test? (picture)
(SSTE) P26

Test for patency of ulnar artery prior to
- placing a radial arterial line or performing an ABG:
- Examiner occludes both ulnar and radial arteries with fingers as patient makes fist;
- patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand

317

Define the following terms: Ballance’s sign
(SSTE) P26

Constant dullness to percussion in the left flank/LUQ and resonance to percussion in the right flank seen with
splenic rupture/hematoma

318

Barrett’s esophagus
(SSTE) P26

Columnar metaplasia of the distal esophagus (GERD related)

319

Battle’s sign (picture)
(SSTE) P26

Ecchymosis over the mastoid process in patients with basilar skull fractures

320

Beck’s triad
(SSTE) P27

Seen in patients with cardiac tamponade:
1. JVD
2. Decreased or muffled heart sounds
3. Decreased blood pressure

321

Bergman’s triad
(SSTE) P27

Seen with fat emboli syndrome:
1. Mental status changes
2. Petechiae (often in the axilla/thorax)
3. Dyspnea

322

Blumer’s shelf
(SSTE) P27

Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on
rectal examination

323

Boas’ sign
(SSTE) P27

Right subscapular pain resulting from cholelithiasis

324

Borchardt’s triad
(SSTE) P27

Seen with gastric volvulus:
1. Emesis followed by retching
2. Epigastric distention
3. Failure to pass an NGT

325

Carcinoid triad
(SSTE) P27

Seen with carcinoid syndrome (Think: “FDR”):
1. Flushing
2. Diarrhea
3. Right-sided heart failure

326

Charcot’s triad
(SSTE) P27

Seen with cholangitis:
1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain
(Pronounced “char-cohs”)

327

Chvostek’s sign
(SSTE) P27

Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia
(Think: CHvostek’s = CHeek)

328

Courvoisier’s law
(SSTE) P27

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
(Pronounced “koor-vwah-ze-ay”)

329

Cullen’s sign (picture)
(SSTE) P28

Bluish discoloration of the periumbilical area due to retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial planes
(e.g., acute hemorrhagic pancreatitis)

330

Cushing’s triad
(SSTE) P28

Signs of increased intracranial pressure:
1. Hypertension
2. Bradycardia
3. Irregular respirations

331

Dance’s sign
(SSTE) P28

Empty right lower quadrant in children with ileocecal intussusception

332

Fothergill’s sign
(SSTE) P28

Used to differentiate an intra-abdominal mass from one in the abdominal wall; if mass is felt while there is tension on the musculature, then it is in the wall
(i.e., sitting halfway upright)

333

Fox’s sign
(SSTE) P28

Ecchymosis of inguinal ligament seen with retroperitoneal bleeding

334

Goodsall’s rule (picture)
(SSTE) P28

Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline (Think of a dog with a
straight anterior nose and a curved posterior tail)

335

Grey Turner’s sign
(SSTE) P29

Ecchymosis or discoloration of the flank in patients with retroperitoneal hemorrhage as a result of dissecting
blood from the retroperitoneum
(Think: TURNer’s = TURN side-to-side = flank)

336

Hamman’s sign/crunch
(SSTE) P29

Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s
syndrome, pneumomediastinum, etc.

337

Homans’ sign
(SSTE) P29

Calf pain on forced dorsiflexion of the foot in patients with DVT

338

Howship-Romberg sign
(SSTE) P29

Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression

339

Kehr’s sign
(SSTE) P29

Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmatic irritation)

340

Kelly’s sign
(SSTE) P29

Visible peristalsis of the ureter in response to squeezing or retraction; used to identify the ureter during surgery

341

Krukenberg tumor
(SSTE) P29

Metastatic tumor to the ovary (classically from gastric cancer)

342

Laplace’s law
(SSTE) P29

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

343

McBurney’s point
(SSTE) P30

One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two

344

McBurney’s sign
(SSTE) P30

Tenderness at McBurney’s point in patients with appendicitis

345

Meckel’s diverticulum rule of 2s
(SSTE) P30

2% of the population have a Meckel’s diverticulum, 2% of those are symptomatic, and they occur within 2 feet of the
ileocecal valve

346

Mittelschmerz
(SSTE) P30

Lower quadrant pain due to ovulation

347

Murphy’s sign
(SSTE) P30

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)

348

Obturator sign (picture)
(SSTE) P30

Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendicitis/pelvic abscess

349

Pheochromocytoma SYMPTOMS triad
(SSTE) P30

Think of the first three letters in the word pheochromocytoma—“P-H-E”:
- Palpitations
- Headache
- Episodic diaphoresis

350

Pheochromocytoma rule of 10s
(SSTE) P30

10% bilateral, 10% malignant, 10% in children, 10% extra-adrenal, 10% have multiple tumors

351

Psoas sign (picture)
(SSTE) P31

Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation

352

Raccoon eyes (picture)
(SSTE) P31

Bilateral black eyes as a result of basilar skull fracture

353

Reynold’s pentad
(SSTE) P31

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

354

Rovsing’s sign
(SSTE) P31

Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appendicitis

355

Saint’s triad
(SSTE) P31

1. Cholelithiasis
2. Hiatal hernia
3. Diverticular disease

356

Silk glove sign
(SSTE) P31

Indirect hernia sac in the pediatric patient; the sac feels like a finger of a silk glove when rolled under the examining finger

357

Sister Mary Joseph’s sign (a.k.a. Sister Mary Joseph’s node)
(SSTE) P32

Metastatic tumor to umbilical lymph node(s)

358

Virchow’s node
(SSTE) P32

Metastatic tumor to left supraclavicular node (classically due to gastric cancer)

359

Virchow’s triad
(SSTE) P32

Risk factors for thrombosis:
1. Stasis
2. Abnormal endothelium
3. Hypercoagulability

360

Trousseau’s sign
(SSTE) P32

Carpal spasm after occlusion of blood to the forearm with a BP cuff in patients with hypocalcemia

361

Valentino’s sign
(SSTE) P32

Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ

362

Westermark’s sign
(SSTE) P32

Decreased pulmonary vascular markings on CXR in a patient with pulmonary embolus

363

Whipple’s triad
(SSTE) P32

Evidence for insulinoma:
1. Hypoglycemia (50)
2. CNS and vasomotor symptoms
(e.g., syncope, diaphoresis)
3. Relief of symptoms with
administration of glucose