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Surgery Flashcards

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0
Q

Icp tx (3)

A

Elevate head
Hyperventilate to pco2 35
Meds

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1
Q

Blown pupil with contralateral hemiparesis

A

Epidural hematoma on side of pupil.

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2
Q

Dx for gsw to upper neck

A

Arteriographic studies

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3
Q

2 sx of brown-sequard

A

Paralysis on same side distal

Loss of pain on distal contralateral side

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4
Q

Lost (2) and preserved (1) of anterior cord syndrome

A

Loss motor and pain

Preserved proprioception

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5
Q

Syndrome with hyper extension of neck in elderly and sx

A

Central cord syndrome

Paralysis and burnning of UE only

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6
Q

Rib fracture tx in elderly (2)

A

Local nerve block and epidural

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7
Q

Indication for surgery after chest tube in hemothorax

A

1500 mL from chest tube

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8
Q

Tx flail chest

A

Restrict fluids and diurese

Monitor ABGs

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9
Q

Most common site of metastasis crc

A

Liver

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10
Q

Sequence of 3 cr polyps. Increasing to more dangerous

A

Tubular, tubulovillous, villous

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12
Q

Type of pain relief for biliary dz

A

Demerol (meperidine)

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13
Q

asymtomatic dz to suspect in severe deceleration injury w/ chest bones difficult to break (sternum, scapula, or first rib)

A

ruptured aorta

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14
Q

3 locations where 1500 mL of blood can “hide”

A

pelvis, thighs, abdomen

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15
Q

3 tx for possible renal failure in sever electrical burns

A

fluids
mannitol
alkalinize urine

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16
Q

legs in rule of 9’s

A

each leg is 2 9’s

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17
Q

trunk of person in rule of 9’s

A

4 units

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18
Q

target with rehydration after burn (2, 1 target, 1 to monitor)

A

hourly urinary output of 1-2 mL/kg

avoiding CVP over 15 mmHg

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19
Q

SA (surface area) threshold for treating burns with ringer lactate

A

> 20% of body surface

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20
Q

bolus in babies

A

20 mL/kg

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21
Q

2 changes in rule of 9 in babies

A

head = 2 9’s

2 legs = 3 9’s (instead of 4)

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22
Q

prophylaxis to burn patients

A

tetanus

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23
Q

3 oitments for burns (shallow, deep, near eyes)

A

silver sulfadiazine
mafenide acetate
triple abx ointment

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24
Q

tx(2) for all bites

A

tetanus

wound care

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25
black widow antidote
IV calcium gluconate
26
helpful drug for brown recluse
dapsone
27
chubby 13 yo w/ groin or knee pain | legs dangling, affected side points in
slipped capital femoral epiphysis
28
little kid w/ fever severe localized pain in bone -XR condition, test, and tx
acute hematogenous osteomyelitis MRI abx
29
dz = consistent varus beyond age 3
blount dz
30
inward turned feet w/ plantar flexion, inversion | seen at birth
``` talipes equinovarus (club foot) ```
31
monteggia fracture vs galeazzi fracture
mont: fracture of proximal 1/3 ulna gale: distal radius Mount Ulna and Gale-adius
32
tx of scaphoid fracture
thumb spica cast (remember XR show fx 3 weeks later!
33
apearance of hip fracture (2)
shortened and externally rotated leg
34
tx for postop of intertrochanteric fx of hip
anticoagulation
35
describing fractures (5)
LD PAU ``` Location Displaced Pattern (transverse vs oblique vs comminuted) Angulation/Rotation Unusual Circumstance ```
36
most reliable sign of compartment syndrome
excruciating pain w/passive extension
37
tx and dx of De Quervain tenosynovitis
thumb in fist, and ulnar deviation = pain steroid injection
38
tx of felon
surgical drainage
39
PEx finding w/ disc dz
straight leg testing gives excruciating pain
40
amaurosis fugax
transient visual loss one eye
41
carbuncle
collection boils (furuncles)
42
furuncle
boil (small subcu staph infection of follicle)
43
inspissated
hard
44
lieno-
denoting spleen
45
obstipation
failure to pass flatus or stool
46
-pexy vs. -raphe
pexy = fixation (pexation) | raphe=repair
47
phlegmon
soft tissue inflammation (commonly pancreatic)
48
succus
fluid
49
ballance's sign
dullness to percussion L flank, resonance on R. | splenic rupture
50
carcinoid triad
FDR | flushing, diarrhea, R. sided heart failure
51
blue coloration of periumbilical area
cullen's sign = retroperitoneal hemorrhage cought be hemmhoragic pancreatitis
52
obturator sign
passive internal rotation of leg
53
pheochromocytoma (3)
PhD | palps, HA, episodic diaphoresis
54
psoas sign
keep knee extended, and passively extend hip (on side)
55
Fitz-Hugh-Curtis syndrome
perihepatic gonorrhea
56
3 things (besides GI polyps in Gardner's syndrome)
Gardeners plant SOD sebaceous cysts osteoma desmoid tumors
57
most common indication for surgery w/ Crohn's
SBO : small bowel obstruction
58
most common bacteria in stool
Bacteroides fragilis
59
Upright AXR finding w/SBO
air-fluid levels
60
position of anal fissure
posterior
61
most common benign tumor of liver
hemangioma
62
monocryl
absorbable monofilament
63
postop ordering
VAN DISL ``` Vital signs and monitoring Activity Nutrition Drugs IV Special orders Labs, XR ```
64
normal time period for wound tensile strength
6 weeks
65
increased complications after what time period with ileus
3-5 days
66
IV maintenance
4-2-1 rule 4 cc/kg for the first 10 kgs of a patient's weight 2 cc/kg for the next 10 kgs of a patient's weight 1 cc/kg for the rest of the patient's weight 60 kg person = 100 mL/hr
67
when do you look at bandage?
after 48 hours (daily)
68
2 labs if concerned about shock/resuscitation
ABG and lactate
69
contents seroma
lymph | serum
70
2 most common causes acute pancreatitis
Gallstones and etoh
71
Boundaries of axilla for ln dissection (4)
Axillary vein, superior Long thoracic nerve, posterior Latissimus Dorsi, lateral Pectoral minor
72
4 nerves at risk Axillary ln dissection
Long thoracic Thoracodorsal Medial and lateral pectorals
73
Ltn innervates
Serratus anterior
74
Thoracodorsal innervates
Latissimus dorsi
75
Course of medial and lateral pectoral nerves
Opposite of one another!
76
Cutaneous nerve that crosses axilla
Intercostobrachial nerve
77
Levels 1,2,3 of Axillary lymph nodes
Lateral, deep, and medial to pectoral minor
78
Rotter's nodes
Between pec major and minor
79
Tail of spence
Tail of breast tissue into axilla
80
Breast cancer risk (5)
NAACP Nulliparity Age menarche 55 Ca breast, self or family Pregnancy 1st, >30
81
3 major blood sources to breast
Lateral and internal thoracic arteries | Intercostal
82
Dermatome of knee
L3 is the knee
83
FENa =
yoU Need Pee UNa * Plasma creatinine For numerator Denominator is reversed
84
Prerenal FENa
<1.0
85
Melanoma on Palm or sole of African american
Acral lentiginous
86
Two findings with chronic anal fissure
Sentinel pile | Hypertrophied Anal papilla
87
Surgical tx anal fissure
LIS lateral internal sphincterotomy
88
indirect vs direct hernia location
indirect = lateral to inferior epigastrics
89
position inguinal hernias usually resolve
recumbency
90
indirect v direct etiology
``` indirect = patent processus vaginalis direct = weakness of transversolis fascia ```
91
vague aching low back pain sudden onset severe neurogenic pain excruciating pain on straight leg test
disc dz
92
ulcer w/o pressure gradient on doppler
microvascular dz (no amenable to surgery)
93
SCC from chronic leg ulcer
Marjolin ulcer
94
inflammation at digital nerve at between 3rd, 4th toe
morton neuroma
95
EF cutoff for +surgery risk
35%
96
fever over 104, 30-45 minutes after surgery
bacteremia if wound pain, consider gas gangrene
97
therapy for atelectasis if no imrpovement w/deep breathing, cough and postural draining
bronchoscopy
98
most common fever POD>3
UTI
99
fever on POD 5
thrombophlebitis
100
fever days 7 vs 9
7 = wound infection | 9=abscess
101
ABG w/PE (2)
hypoxemia | hypocapnia
102
FENa significance, 1, >4
``` 1 = intrinsic AKI >4 = postrenal ```
103
FENa =
(PCr * UNa ) / (PNa x UCr) %
104
ileus not resolving after 7 days
mechanical ileus (adhesions)
105
paralytic ileus in immobilization +abd distension, dilated colon mechanical obstruction ruled out
Ogilvie syndrome
106
tx Ogilvie syndrome (2, 1 is a consideration)
``` Decompress w/ sigmoidoscopy or colonoscopy and rectal tube IV neostigmine (consider) ```
107
typical day for wound dehiscence
day 5
108
hypernatremia, how much dehydration for every 3 meg above 140?
1 liter
109
safe speed limit of potassium admin
10 meq/hr
110
colicky abd pain w/ high pitched bowel sounds | then silence and loops of bowels w/air-fluid levels
mechanical obstruction
111
main tx of SCC of anus
chemoradiation
112
rate of active Gi bleed caught on angiogram
2 mL/minute (1 unit blood q4 hrs)
113
blood er rectum child
meckel diverticulum
114
dx meckel
technetium scan
115
parrot's beak on axr
volvulus of sigmoid
116
large thin-walled distended gallbladder
Courvoisier-Terrier sign (malignant obstructive jaundice)
117
acute pancreatitis w/+ Ht or -Ht
``` +Ht = edematous pancreatitis -Ht = hemhorrhagic pancreatitis ```
118
size of pancreatic pseudocyst likely to rupture or have prob
6 cm
119
bloody nipple discharge
intraductal papilloma
120
breast cancer patient w/ backache or persistent headache
metastasis to brain or vertebral pedicles
121
hypersecretion of insulin in newborn
nesidioblastosis (devastating = 95% pancreatic resection)
122
patient w/DM migratory necrotic dermatitis mild anemia, glossitis, stomatitis
glucagonoma
123
newborn first fed; | feeding intolerance, abd. distension, rapidly developing thrombocytopenia
necrotizing enterocolitis
124
person w/mono gets L. shoulder pain
Kehr sign | ruptured spleen
125
physical findings (2) in hemorrhagic pancreatitis
cullen sign; bruising around umbilicus | bruising on flanks
126
electric alternans on EKG
pericardial tamponade
127
abdominal pain 10/10 but no physical findings
acute mesenteric ischemia
128
acute abd pain out of proportion. best first test? most accurate test?
CT scan of abdomen | angiography
129
subcutaneous emphysema upon palpation of thorax or clavicles
esophogeal perf
130
histology of boerhaave vs mallory-weiss
``` boerhaave = full thickness tear mallory-weiss = mucosa only ```
131
3rd vs 4th degree burn
``` 3rd = subcu 4th = muscle ```
132
front of torso = what percent?
18
133
% more calories w/major burns
40%
134
IV access for all burns over
20% (NG tube too)
135
2 tests to order with 20 yo F w/ RLQ pain
B-HCG | pelvic sonogram
136
most accurate test for cholecystitis
``` HIDA scan (delayed emptying of gallbladder) ```
137
high pitched tinkling bowel sounds +lactate and acidosis dx?
bowel obstruction
138
open reduction and internal fixation fractures
displacement or misalignment of bones
139
close fracture vs open fracture
``` closed = mild w/o displacement open = skin punctured ```
140
fracture w/several pieces
comminuted fracture
141
most common stress fracture
metatarsals
142
tx scaphoid fracture
thumb spica cast
143
unhappy triad knee (3)
ACL MCL Lateral meniscus
144
surgery indicated on AAA when......
5 cm
145
5 causes, in order of post-operative fever
``` WIND: 1-2 water: 3-5 walking: 5-7 WOund: 7 WOnder/abscess: 8-15 ```
146
infant first few months failure to thrive pansystolic murmur at USB
VSD
147
gradient where surgery indicated for aortic stenosis
50 mmHg | or CHF, angina or syncope
148
square root sign on EKG
pericarditis
149
FEV1 required for surgery in lung cancer
minimum 800 mL
150
management tender AAA
surgery
151
medical term lazy eye
amblyopia
152
medical term crossed eyes
strabismus
153
abscess of floor of mouth, often due to bad tooth infection
ludwig angina
154
diplopia with person with sinutisitis
cavernous sinus thrombosis | a medical emergency
155
therapy for prolactinoma
bromocriptine
156
several months after crush injury | pain
reflex sympathetic dystrophy (causalgia)
157
reflex sympathetic dystrophy | dx and tx
``` dx = successful sympathetic block tx = sympathectomy ```
158
absolute contraindication to surgery
DKA
159
Assist-control on vent
patient takes a breath, vent gives volume
160
vent setting for weaning
pressure support | patient rules rate
161
with high paCO2, adjustment on vent
tidal volume | rate also acceptable
162
acidosis vs alkalosis | check what 2 values after pH?
HCO3, pCO2
163
anion gap equation | include normal
Na - (Cl + HCO3) | 8-12
164
Na correction rate
12-24 meq/24 hours
165
maintenance daily 1-10 kg? 10-20? 20+?
4-2-1 rule ``` 1-10 = 4 mL/kg/hr 10-20 = +2 mg/kg/ hr 20+= +1 mL/kg/hr ```
166
clotting edema, htn foamy pee
nephrotic syndrome
167
bleeding with isolated thrombocytopenia
ITP
168
parkland formula for burn resuscitation
kgX BSA X 4 ml Over 24 hrs. 1/2 over 1st 8
169
side effect silver sulfadiazene
leukopenia
170
burn topical that penetrates
mafenide
171
burn topical that causes hypoK and hypoNa
silver nitrate
172
electrolyte to check if rhabdo
potassium
173
pressure of compartment syndrome
>30 mmHg
174
normal CVP w/flat neck veins'what type of shock?
hypovolemic
175
GCS scoring
eyes 4 motor 6 verbal 5
176
GSW or stab to zone 3 workup (2)
aortography and triple endoscopy
177
zone 3 of neck
above mandible
178
zone 2 of neck
angle of mandible to cric
179
GSW or stab wound to zone 2 of neck workup
2D doppler +/- surgery
180
zone 1 of neck
below cricoid
181
zone 1 of neck penetrating workup
aortography
182
handlebar sign
pancreatic rupture
183
4 phases wound healing
In every fresh cut Inflammation Epitheliazation Fibroplasia Contraction
184
effusion characteristic of lung adenocarcinom
exudative w/ high hyalurondase
185
PCWP cutoffs for ards vs cardiogenic
Less than 12 is ards | More than 15 is cardiogenic
186
valsalva or squatting with systolic murmurs(2)
``` softer = aortic stenosis louder = HOCM ```
187
mentrier's
protein losing gastropathy
188
if duodenal ulcers persist, consider
ZE syndrome
189
best test for ZE syndrome
secretin stimulation test (high gastrin)
190
chronic pancreatitis causes thrombosis of
splenic veins (gives gastric varices)
191
hyperglycemia diarrhea weight loss dark rash
glucagonoma
192
tumor that looks like carcinoid
VIPoma
193
choledochal cysts | type 1 v 4
1 = fusiform dilation Biliary duct = excision | 4=caroli's dz = intrahepatic ducts =liver transplantation
194
``` RUQ pain fever jaundice -BP AMS ```
ascending cholangitis
195
RUQ pain +bili +alk phos
choledocholithiasis
196
+AST, ALT | s/p hemorrhage, surg, or sepsis
shock liver (from hypotension)
197
TIPS relieves portal HTN, but
worsens hepatic encephalopathy
198
3 most common bugs for liver abscess
EBE E.coli Bacteroides enterococcus
199
RUQ pain in traveler | sweating, rigors, palpable liver
ENTAMOEBA HISTOLYTICA
200
TX entamoeba histolytica
metronidazole do not drain it
201
from mexico RUQ pain large liver cysts on US
echinococcus
202
thrombocytosis post splenectomy | tx?
asa
203
ITP tx | 1st, 2nd
``` 1st= steroids 2nd = splenectomy ```
204
carcinoid tumor #1 site
appendix
205
when sx of carcinoid
mets to liver
206
vitamin deficiency with carcinoid
niacin (Diarrhea, dementia, dermatitis)
207
postop ileus vs ogilvie's syndrome on XR
postop ileus = dilated loops of small bowel w/air-fluid livels ogilvie = colonic distension
208
tx of ogilvie syndrome (2)
>10 cm decompression w/NG tube | neostigmine
209
sigmoid vs cecal volvulus on AXR
``` sigmoid = coffee bean sign cecal = bird beak ```
210
direct vs indirect inguinal hernias anatomy
Indirect Inguinal-MC through inguinal ring (lat to epigastric vessles) in spermatic cord. R>L, more often congenital (patent proc vaginals) •Direct Inguinal-through Hasselbeck’s triangle (med to epigastric vessles), more often acquired weakness.
211
MEN syndromes | names and shapes (3)
diamond square triangle
212
MEN syndromes | mnemonics
PPP MPP MMP
213
MEN 1 syndrome (3)
pituitary parathyroid pancreas
214
MEN2a syndrome (3)
medullary thyroid Ca parathyroid pheo
215
MEN2b syndrome
medullary thyroid Ca marfan oral pheo
216
tx for fibrocystic change of breast (3)
restrict caffeine vitamin E supportive bra
217
ped umbilical hernia association | and big tongue
hypothyroidism
218
ddx (2) of 3 day old newborn has still not passed meconium
``` meconium ileus (CF) Hirschprung's ```
219
4-5 yo w/painless limp and avascular necrosis
leg-calve-perthes's dz
220
caution rocuronium
allergic rxn if asthmatic
221
caution meperidine
lower seizure threshold, esp if renal failure
222
problem with succinylcholine if burn/crush victim
hyperK
223
Varus memory tool
Varus = airus. Air between knees
224
normal urinary output
.5 cc/kg
225
paralytic ileus on AXR
everything is dilated
226
paralytic ileus of entire large colon in elderly
Ogilvie's
227
tx Ogilvie's (2)
rectal tube | colonoscopy
228
etiology of dehiscence vs evisceration
failure of fascia | failure of fascia and skin
229
tx wound evisceration prior to surgery (2)
saline towel strict bed rest never push back in!
230
borborygmi
high pitched sounds of bowel obstruction
231
on test, if person has appendicitis sx, next step
OR!! (CT not necessary)
232
String of pearls sign
SBO
233
initial tx of sigmoid volvulus
sigmoid scope for decompression
234
crohn's dz most commonly effects
terminal ileum
235
bezoar
chunk of food; commonly a gastrolith
236
``` pancreatic tumor Copious Watery Diarrhea, Hypokalemia, and Achlorhydria (WDHA syndrome). ```
VIPoma
237
amt and fluid to give 75 kg person with burns in 24 hrs.
15 L of LR
238
most common lung cancer
adenocarcinoma
239
if necrotizing pancreatiti, ICU, daily CTs, and what abx?
carbepenem
240
weeks after pancreatitis | early satiety, +/- ascities, dyspnea
pseudocyst
241
pseudocyst >6 weeks or >6 cm
complicated pseudocyst | drainage necessary
242
soot on their nostrils/mouth
respiratory burn; evaluated w/bronchoscopy
243
electrical burn, what labs
CK-MB
244
tx rhabdo
IVF and mannitol
245
parkland formula for burns
%BSA * kg * 4cc +2000 D5W 50% in 8 hours 50% in 16 hours
246
PCWP in CHF vs ARDS
normal (10) in ARDS | + (25) in CHF
247
O2 rate of face/venti mask vs NRB
face/venti = 6-10 | NRB is 10-15
248
FiO2 of NC vs face/venti mask
to 40% | 40-80%
249
after NRB, | NIPPV - 3 types
high flow NC CPAP BiPAP
250
NIPPV if AMS or vomiting
high flow NC
251
bipap 10/5 means
``` 10 = pressure support 5 = PEEP ```
252
bipap used in ventilation support for unloading CO2 for COPD NOT
asthma
253
ventilation changes
CO2
254
2 components of ventilation
Tidal volume | Respiratory rate
255
+PS/PEEP increases
ventilation
256
monitoring vents CO2 method O2 method
CO2 method = ABG | O2 method = O2sat
257
2 components of oxygenation
FiO2 | PEEP
258
normal pCO2
40
259
normal pO2 range
75-105
260
lab to check if suspecting inhalation burn
carboxyhemoglobin
261
autograft vs allograft
``` autograft = patient's own skin allograft = cadaveric skin ```
262
SCC ulceration in burn rissue
marjolin's ulcer
263
before chemo/surgery with lung Ca (3) but after bx
stage PET CT PFT
264
stable pulmonary nodule size to watch only
<2 cm
265
tx of small cell Ca
chemo only! | never operate
266
lung mass flushing, diarrhea dx, and side of heart affected
carcinoid LEFT! (unlike GI which is right)
267
dx of +PTHism
sestamibi scan
268
migratory necrolytic dermatitis | mild DM
glucagonoma
269
calcium and phos levels in 1 vs 2nd degree hyper PTH
exact opposites! Ca+, Ph- in 1 Ca-, Ph+ in 2
270
chalazion
like a stye, but painless, and inside the lid (rather than on edge
271
Hyphema
blood in anterior chamber of eye
272
iridocyclitis
uveitis
273
Ratio of NS or LR to replace blood lost
3:1
274
PaO2/ FiO2 indicative of ARDS
Less than 200
275
Dx of ventilator associated pneumonia
Greater than 10K cfu/ml
276
Tx of urine if myoglobinuria
Alkalize the urine
277
Mafenide side effect
Metabolic acidosis
278
Flap
Vascularized tissue for skin graft
279
2 types coag - staph
Epidermidis and saprophyticus
280
+ diagnostic peritoneal lavage
100 k/uL

Step 2 CK (12 decks)

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