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Blown pupil with contralateral hemiparesis

Epidural hematoma on side of pupil.

1

Icp tx (3)

Elevate head
Hyperventilate to pco2 35
Meds

2

Dx for gsw to upper neck

Arteriographic studies

3

2 sx of brown-sequard

Paralysis on same side distal
Loss of pain on distal contralateral side

4

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

Loss motor and pain
Preserved proprioception

5

Syndrome with hyper extension of neck in elderly and sx

Central cord syndrome
Paralysis and burnning of UE only

6

Rib fracture tx in elderly (2)

Local nerve block and epidural

7

Indication for surgery after chest tube in hemothorax

1500 mL from chest tube

8

Tx flail chest

Restrict fluids and diurese

Monitor ABGs

9

Most common site of metastasis crc

Liver

10

Sequence of 3 cr polyps. Increasing to more dangerous

Tubular, tubulovillous, villous

12

Type of pain relief for biliary dz

Demerol (meperidine)

13

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

ruptured aorta

14

3 locations where 1500 mL of blood can "hide"

pelvis, thighs, abdomen

15

3 tx for possible renal failure in sever electrical burns

fluids
mannitol
alkalinize urine

16

legs in rule of 9's

each leg is 2 9's

17

trunk of person in rule of 9's

4 units

18

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

hourly urinary output of 1-2 mL/kg
avoiding CVP over 15 mmHg

19

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

>20% of body surface

20

bolus in babies

20 mL/kg

21

2 changes in rule of 9 in babies

head = 2 9's
2 legs = 3 9's (instead of 4)

22

prophylaxis to burn patients

tetanus

23

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

silver sulfadiazine
mafenide acetate
triple abx ointment

24

tx(2) for all bites

tetanus
wound care

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