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STEP 2 > Surgery > Flashcards

Surgery Flashcards

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0
Q

LGIB >40 most common cause

A

Diverticulosis

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1
Q

Upper go bleeding surgical indications

A

6 or more units of blood in first 24hrs Re bleed with maximal therapy Esophageal varicies despite measures-> TIPS Perforation Gastric outlet obstruction

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3
Q

Sbo cause

A

Adults adhesions Kids hernia

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4
Q

Progressive dysphagia dx step

A

carcinoma: barium swallow, endocsopy is diagnostic but you have to do barium first to prevent perf

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5
Q

Complication of ileum resection

A

hyperoxaluria=>nephrolithiasis

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6
Q

Hypomagnesium cause and manifestation

A

malnourshed or large GI loses Similar to hypocalcium: parasthesia, hyperreflexia, tetany ECG differentiates between hypomag vs hypocalc long QT Pr, st depression, inverted p, torsades

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7
Q

PVD preop testing

A

pharm stress test, stress test adequate for CAD but he cant exercise b/c PVD

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8
Q

HIT manifestation and tx

A

POD 5 platelets down 50% or <100,000 Stop heparin, start direct thrombin inhibitor(lepirudin, argatroban) convert to warfarin if needed

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9
Q

Low cardiac output state=>sudden epigastric pain

A

Acute mesenteric Ischemia peritoneal signs=> lap w/o peritoneal signs=> angiography

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10
Q

factors preventing Fistula closure

A

FRIENDS foreign body Radiation Inflammation Epithelialization of the tract Neoplasm Distal obstruction Steroids

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11
Q

Severe Hemophilia A surgery control

A

DDAVP + AMICAR(e-aminocarproic acid) inhibitor of fibrinolysis can also use cryoprecipitate or VIII concentrate

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12
Q

stress fraction for calculating cal needs

A

starvation .9 post op 1.1 organ failure 1.5 >50% body burns 2.0x

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13
Q

Goldman’s risk assessment

A

S3 gallop or JVD 11

MI within 6 months 10

>5PVC’s/min 7

Non sinus rhythm or SR with APC’s on ECG 7

Age > 70 5

>25 class IV 22% risk

13-25 class III 11% risk

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14
Q

Cardiac pre-op assessment

A

<35 no cardiac hx = ECG cardiac hx or old = ECG + stress or ECHO

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15
Q

Antibiotic proph

A

Cefazolin

Colorectal/Appendectomy: Cefoxitin or Cefotetan

Urologic: Cipro

ENT: Cefazolin or clinda and gent

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16
Q

Most common cause of fever within 24 hours

A

Atelectasis macrophage mediated, reduced by early ambulation, spiro tx

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17
Q

Wells’ PE Criteria

A

signs and symptoms 3 alternative dx less likely 3 tachy>100 1.5 Immobilization or surgery in the previous four weeks 1.5 Previous DVT or PE 1.5 Hemoptysis 1.0 Malignancy 1.0 >6 66.7% 2-6 20.5%

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18
Q

SSI bacteria

A

abdomen: G- or anaerobes ENT: Strept All others: Staph

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19
Q

Post op fever

A

Wind (Atelectasis) Water (UTI) Wound Walking (PE) Wonder Drugs

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20
Q

Shift curve to right(O2 unloading)

A

Acidosis(hypovent->PCO2 up), hypertherm, DPG(chronic hypoxia)

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21
Q

shift curve to left(decrease unloading)

A

Alk, hypotherm, low DPG(banked blood)

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22
Q

Hypo Shock Stages

A

I - <15% 750

II - 15-30% 750-1500 - tachy(1st(, tachypnea, tilt, oliguria,

III - 30-40% (1500-2000) - hypotension

IV - 40% bad

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23
Q

Neurogenic Shock tx

A

loss of sympathetic tone and loss of reflexive tachy

Fluid resusitation followed by dobutamine or phenylephrine

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24
Q

Fam hx of prolonged prolonged anesth paralysis

A

pseudocholinesterase deficiency

avodi succinylcholine and mivacurium

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25
Post op resp acid, hypoxemia, hypercarbia
hypercarb is diagnostic of alveolar hypoventilation
26
diaphramatic rupture dx
air fluid level in left lower chest with NG tube in it
27
Hormone elevated after trauma
Insulin but net effect is hyperglycemia due to increased insulin resistance peripherally
28
Knee dislocation concern and workup
popliteal artery injury due to extreme force required Ankle Brachial index If \<.9 do an angiogram
29
Bladder injury management
Extraperitoneal: Catheter Drainage with repeat imaging fix if doing surgery for something else Intraperitoneal: surgery
30
Splenic trauma reasons for surgery
Peritoneal signs Hemo unstable Degree of spenic damage doesnt matter
31
Positive DPL
\>10cc blood \>100,000 RBC/ul \>500 WBC/ul elevated amylase bilirubin alk phos
32
kid resusitation
20cc/kg bolus repeat if no response transfuse
33
hemothorax thoracotomy indication
1500 cc initial 200cc/hr for 4 hrs Thoracic vessel injury Esophogeal injury Decompensation after initial stabilization
34
Acute hyperparathyroidism managment
vigorous IV hyrdration then lasix then resection of adenomas
35
Pheo preop managment
a-block phenoxybenzamine 1-3 weeks before surgery
36
breast cancer pregnant
surgery without sentinal lymph node due to radiation
37
thryoid storm prevention and tx
preop lugol iodine solution 10 days before or PTU or Methamizole fluid, antithyroid drugs, bb's, iodine solution and steroids
38
hyperparathyroid xray finding
osteitis fibrosa cystica
39
ITP tx
steroids \<30000 splenectomy if ineffective
40
surgical tx of upper gi bleed
6 units of blood in 24 hrs esophageal bleeding despite medical man: do TIPS Perforation Gastic outlet obstruction
41
CRC staging
Stage 0 Tis N0 M0 mucosa; cancer-in-situ Stage I T1-2 N0 M0 T1:invades submucosa or invades muscularis propria Stage II-A T3 N0 M0 T3: Tumor invades subserosa or beyond (without other organs involved) Stage II-B T4 N0 M0 T4: Tumor invades adjacent organs or perforates the visceral peritoneum Stage III-A T1-2 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T1 or T2. Stage III-B T3-4 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4. Stage III-C any T, N2 M0 N2: Metastasis to 4 or more regional lymph nodes. Any T. Stage IV any T, any N, M1 M1: Distant metastases present. Any T, any N.
42
Cholangitis man
IV antibiotics and fluids, fail? =\> ERCP, fail? =\> T tube
43
Chronic Pancreatitis dx
ERCP is most accurate
44
insulinoma tx
resection
45
epidermoid cancer of anus tx
chemoradiation
46
volvulus tx
Sigmoid: reduced with enema or scope then eventually surgery Cecal: Surgery
47
acute pancreatitis after tx complication and tx
pseudocyst If stays for \>6 weeks Drain if \>6cm
48
carcinoid found on appendectomy tx
Right Hemicolectomy if \>1-2cm or involve the base
49
liver hemangioma adenoma tx
hemangioma: resect if symptomatic adenoma: stop OCP's if it doesnt go away take it out
50
normal common bile duct size
3mm 1.0cm is big
51
succinylcholine sfx
52
kidney stones needing a procedure
\>5mm
53
glascow coma scale
4 eyes, jackson 5, 6 cylinder motor, 7 intubate ## Footnote Eye Opening (E) ``` 4 = spontaneous 3 = to voice 2 = to pain 1 = none ``` Verbal Response (V) ``` 5 = normal conversation 4 = disoriented conversation 3 = inappropriate words 2 = no words, only sounds 1 = none ``` Motor Response (M) ``` 6 = normal 5 = localized to pain 4 = withdraws to pain 3 = decorticate posture 2 = decerebrate 1 = none ```
54
mailig hypertherm tx
stop anesthesia, 100% o2 hypervent, dantroline, alkanalyse urine
55
eosinophilia following angiography
cholesterol embolysm
56
VTE tx
heparin-\>coumadin filter for recurrence with tx thrombolytic if unstable(massive PE)
57
resusitation goals
intubate if hypoxic fluid resus to CVP 8-12 vasopressors to 65 MAP norepi, dopamine
58
NO sfx
distended loops of bowel
59
Pancuronium sfx
neuromuscular blocker: tachycardia
60
Melanoma tx
\<1mm thick 1cm margin 1-4mm thick 2cm margin + sentinal node biopsy
61
burn formula
4ml LR/kg in 24 hrs 1/2 first 8 hours 1/2 next 16 hours
62
ischemic colitis man
expectant unless full thckness nec, perf, bleeding
63
hepatic adenoma vs focal nodular hyperplasia
remove hepatic adenomas \>4cm due to risk of rupture and malig transformation FNH no treatment neccessary Adenoma "cold" on Nuc Med, FNH "hot"

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