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Flashcards in sugery- de virgilio Deck (39)
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1
Q

elective surgery after MI?

A

postpone for 4 weeks

-perform stress test at that time

2
Q

major predictors of adverse cardiac event after elective surgery (4)

A

within one month:

  • MI
  • unstable angina
  • decomp CHF
  • sig arrythmia –> work it up!
3
Q

order of cardiovascular risk (most to least)

A

CAD, CHF, TIA/stroke, DM, creatine >2

4
Q

dresslers syndrome

A

acute pericarditis following MI

global ST elevation and PR depression

5
Q

timing of post MI complications

A

48 hr- arrythmia
5 days - vent septal rupture
weeks- months - dresslers

6
Q

whatsmore accurate, MUGA or echo?

A

MUGA! nuc stress test, but more cost prohib

7
Q

Stanford A

A

ascending aorta –> involves inominate! can lead to tamp, MI, AI, stroke

urgent OR

8
Q

Stanford B

A

invovles descneding aorta

  • can involve celiac, renal, common iliacs
  • can usually be managed medically unless signs of malperfusion (inc Cr, abd tenderness, dec pulses)
9
Q

post op R side MI management?

A

Fluids! help with preload.

avoid nitrates!!

10
Q

hammon’s crunch post CABG? with inc WBC

A

acute mediastinitis

11
Q

equalization of central pressures is associated with what cardiac phenom?

A

tamponade (blood compresses heart and decreases diastolic filling volume)

12
Q

t/f: Type A aortic dissection can present as acute MI

A

true.

thrombolysis is a big nono. Check for wide mediastinum on CXR

13
Q

beta blockade or alpha blockade before pheo surgery?

A

ALPHA for10-14 days

beta can cause unopposed alpha blockade and precip HTN crisis

14
Q

percutaneous bx for adrenal mass?

A

NO. no histo markers specific and risk seeding

15
Q

what is the indication/ rec for adrenal tumor resection?

A

> 6cm

OPEN to get margins if malig is expected

16
Q

moth eaten appearance on xray

A

osteitis fibrosa cystica

PTH overload, inc bone pain, inc fractures

17
Q

management of adrenal incidentaloma <6cm?

A

blood tests for hormonal activity

-24 hour urine for cats, cortisol, sodium

18
Q

name some causes of hypercalcemia

A

malignancy
paget’s
immobility
thiazides

19
Q

MEN2a

A

pheo –> plasma metanephrines, chromogranin A
hyperPTH
medullary thyroid–> Calcitonin

20
Q

raise in BP and temp following induction of surgery. Ddx? Differentiate

A

pheo–> pressure INC with beta blocker (unopposed alpha)

malig hyperthermia –> inc temp, inc pressure, inc etCO2 –>dantrolene

thyrotoxicosis –> inc pressure that responds to beta blockade

21
Q

thryoglossal duct cyst vs branchial. Which elevates?

A

thyroglossal

remove bc can cause recurrent infx

22
Q

how do you assess for metastatic pheo

A

metastasis in areas normally devoid of chromograffin tissue

23
Q

neck mass FNA?

A

> 1cm

24
Q

feared complication of thyroidectomy within 24 hours?

A

hematoma –> compresses airway

open and evacuate hematoma at bedside, securing airway via ETT may be difficult

25
Q

superior laryngeal nerve can be damaged when mobilizing thyroid which could effect…..

A

singing

**cutting one rec laryngeal would cause hoarseness, cutting both could cause need for trach

26
Q

indications for parathyroidectomy

A
  1. CA >1 overnormal
  2. CrCl<60
  3. T score
27
Q

chole liks sx in trauma patient? tx?

A

acalculous cholecystitis

abx, percutaenous cholecystostomy if can’t tolerate lap chole

28
Q

lab values seen in gallstone pac?

A

elevated ALT, amylase

29
Q

nutrition for someone with complicated pancreatitis past 5-7 days?

A

enteral feeding via NJ past LOT

30
Q

what should you test in white drainage after whipple?

A

amylase.

if pos, make pt NPO

31
Q

porcelian galbladder mgmt?

A

get it out

32
Q

management of bloody diarrhea and LLQ pain after descending aortic aneurysm repair?

A

ischemic colitis –> risk bc IMA is occluded during surgery

dx: flex sig–> friable mucosa
tx: IV abx, IVF

33
Q

FAP colon cancer risk/ screening

A

100% cancer by age 50

flex sig start at age 10 –> colectomy as soon as polyp arises.

34
Q

colon cancer screening in UC

A

begin colonoscopy 8 years after dx with RANDOM BIOPSIES

35
Q

biggest complication of sphincterotomy?

A

fecal incontinence

36
Q

ogilve’s syndrom

A

colonic psuedo obstruction

who: old, demented, bedridden patients with recent surgery and opiates
dx: xray will NOT show signs of obs
tx: remove drugs, replacelytes, decompress with COLONOSCOPY AND NEOSTIGMINE

cecum is most likely to rupture

37
Q

cecal vs sigmoid volvulus. which requires urgent colectomy?

A

cecal –> failure to adhere to R colon

cannot be decompressed with scope

38
Q

t/f: smoking falsely elevates CEA?

A

yes, 4 hours before testing

CEA used for colon cancer tx progress

39
Q

most common cause of appendicitis in adults vs kids

A

adults= fecalith

kids= lymphoid hyperplasia (think recent viral illness)