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PANCE review > surgery > Flashcards

surgery Flashcards

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1
Q

what lab measuring renal function should be done for preop patients over 40?

A

creatinine

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2
Q

who should have their blood glucose tested preop?

A

family hx, personal hx of DM and patient undergoing grafting for peripheral vascular disease

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3
Q

do routine prep labs show a reduction in mortality and morbidy?

A

no, do not do for otherwise healthy individuals

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4
Q

warfarin and dig are known for causing what electrolyte abnormality?

A

K

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5
Q

ECHO are recommended in all patients older than?

A

40

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6
Q

silent MI is most common in what population?

A

elderly and DM

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7
Q

spirometry is recommend to who?

A

thoracic and upper abdominal surgery, smokers and dyspnea

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8
Q

pregnancy test?

A

for all women of child bearing years

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9
Q

H&P identify previous?

A

MI, heart failure, chronic pulmonary dz, dm, peripheral vascular disorders, hepatic or renal impairment

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10
Q

index used to measure cardiac risk?

A

detsky’s modified cardiac risk index or Lee’s

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11
Q

what does Lee’s index look at

A

high risk surgery, coronary artery dz, congestive heart failure, cerebrovascular dz, insulin dependent DM, and elevated serum creatinine >2

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12
Q

what is the best prophylactic blood thinner to use?

A

unfractionated heparin 5,000 units subcutaneouly every 8-12 hours, stop once pt is ambulatory

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13
Q

Enoxaparin is also used what is it?

A

low molecular weight heparin

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14
Q

can warfarin be used

A

yes, once the initial use of heparin has been completed, but dosing is measured via INR (therapeutic dose ranging between 2-3)

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15
Q

what is fondaparinux

A

anticoagulant, good for hip surgery

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16
Q

Greenfield filter prevents clots formed in the lower extremities to migrate, patient who are candidates include?

A

allergic to anticoagulants, trauma (risk of further bleeding), central nervous system procedures

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17
Q

malnourished criteria is

A

lost more than 10% of lean body mass, or has not has adequate intake in 7 days

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18
Q

malnourishment effects many systems including

A

GI atrophy, slow cardiac output, decreased vital capacity, immune system and skin healing

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19
Q

what labs may be abnormal of malnourishment

A

increased creatinine, high lymphocyte count, albumin, transferrin

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20
Q

what is refeeding syndrome?

A

abnormal glucose, lipid metabolism, thiamine deficiency, hypophosphatemia, hypomag, hypo k

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21
Q

how do you avoid refeeding syndrome?

A

limit initial feedings to no more than 20kcal/kg during the first week of feedings

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22
Q

basal energy expenditure

A

harris benedict equation

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23
Q

what is the preferred route of nurtrient replacement

A

enteral route (tube feeding)

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24
Q

are naso or gastro tube better at preventing aspiration

A

gastro

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25
best tube to avoid aspiration and great for pancreatits
jejunostomy
26
what is hyperalimentation
Intravenous nutrition
27
what are the complications of hyperalimentation
catheter related problems, hyperglycemia, electrolyte abnormalities
28
leading cause of death between the age of 1-44
unintentional and violence related injuries
29
leading cause of accidental death
MVA (Etoh is involved in over 1/2)
30
what does the FAST exam look at
abdominal cavity for fluid or air, perihepatic, perisplenic, pelvic and pericardial regions
31
most common reason to intubate in trauma
altered mental status
32
why should open chest wounds never be occluded?
can develop a tension pneumo
33
what does beck's triad evaluate for
cardiac tampondade
34
what is beck's triad
JVD, hypotension, muffled heart sounds
35
penetrating trauma and unstable (shock, peritoneal irruption, evisceration, __________is used for dx and tx
laparotomy
36
workup of penetrating flank trauma
CT with oral and IV contrast
37
basilar fracture is associated with what PE findings
battle sign, raccoon eyes, rhinorrhea, otorrhea
38
lucid period with head trauma
epidural hematomas
39
epidural hematomas are usually result from injuring what artery
middle meningeal artery
40
coma, fixed or dilated pupil, and decerebrate posturing +
brain herniation
41
subdural hematomas are injuries to
the bridging veins
42
subdural hematomas are common in
eldery, alcoholics and axonal injuries
43
most common cause of burns
scald burns
44
fluid recommended for burn victims
LR
45
sulfadiazine
is the most common used topical burn ointment
46
white phosphous burn are tx with
copper sulfate
47
hydrofluoric acid burns are tx with
30 minutes of lavage, apply calcium gluconate
48
most post op fever is a result of
cytokines and will resolve on own
49
five w's of a post op fever
wind, water, wound, walking and wonder drug/whopper
50
the most common W of a post op fever, timeframe and tx
wind: complete of parial collapse of lung (atelectasis) usually occurs in the first 24-48 hours. TX: Incentive spirometry, mucolytics, expectorants
51
water (what does it stand for and timeframe) and tx
UTI 48-72 hours, most common nosocomial infix, culture and sensitivity and tx with targeted antibiotics
52
wound infection what does it stand for and timeframe) and tx
72 hours, most common bug is staph aureus, culture and antibiotics
53
walking ;what does it stand for and timeframe)
after 72 hours thrombophlebitis (superficial and deep) DVT tx: superficial stop IV line use warm compresses. Systemic start staph A and strep antibiotics. Septic thrombophlebitis requires vein stripping (b/c if will behave like an abscess and a make antibiotic penetration difficult
54
wonder drug; what does it stand for and timeframe)
drug fever
55
whopper; what does it stand for and timeframe)
fever after 1 week. Abscess. Tx is percutaneous drainage or surgical debridement
56
what is still the gold standard for DVT dx
venography
57
most effective approach to pressure ulcers
prevention
58
necrotizing fasciitis is caused by
group A strep, clostridia or salt water is vibrio sp.
59
triad for necrotizing fasciitis
elevated WBC, elevated BUN >15 and hyponatremia renal impairment is an hallmark of the dz)
60
most common complication in cholecystecomy?
misidentification of hepatic duct system and injury to common bile duct due to heat
61
Lap surgery complications fall into two categories: access complications and pneumoperitoneum including
bowel perf with introduction of trochar and cardiac output decrease due to increased systemic circulation
62
most common complication for antireflux surgeries
perf of stomach or esophagus
63
complication for inguinal hernia
injury to bladder, epigastic vessels and spermatic cord
64
most important post op complication for hernia ingunial
recurrence and urinary retention
65
stages of wound healing
coagulation and inflammation (platelet activation and migration of WBC) neovasularization and finally proliferation which is the production of collagen
66
define a clean contaminated case?
operation of the Respiratory, GI or GU tracts
67
is an inguinal heria case clean, clean contaminated or contaminated
clean
68
antibiotic used as a prophases for the majority of clean surgical cases?
Cefazolin
69
what does a FEV1 values less than 1 are indicative of?
post of pulmonary complications and ventilator dependence
70
75% of gallstones are of what variety is the US
mixed stones (cholesterol and calcium) most common in the US
71
difference between cholecystitis and choledocholithiasis
choledocholithiasis-is blockage of the common bile duct, thus jaundice will be a symptom.
72
cholangitis is described as
common bile duct obstruction, with fever, jaundice, RUQ pain, and leukocytosis
73
describe acute cholecystitis
RUQ pain (murphy's sign), fever, and leukocytosis
74
weight loss, jaundice, midepigastric pain and courvoisier sign, you are thinking?
pancreatic carcinoma
75
weight loss, mid-epigastric pain, no jaundice
gastric carcinoma
76
US shows thickened gallbladder wall and pericholecystic fluid, these findings point to?
acute cholecystitis
77
US shows dilated intrahepatic and extra hepatic ducts
dilated ducts = obstruction = choledocholithiasis
78
US shows air in the lumen of the gallbladder
acute emphysematous cholecystitis
79
what imaging helps with the location of a gallstone obstruction and the type of pathology?
CT
80
what is charcots triad
fever, chills, right upper quad pain, and jaundice
81
what is charcots's triad used for
ascending cholangitis
82
if you add hypotension and mental status change you get__________which helps to diagnosis ______
Reynolds pentad and ascending cholangitis
83
recurrent biliary colic and confirmed gallstones and tx with ________
elective lap surgery
84
what is ranson's criteria used for?
grade the severity of pancreatitis
85
pt has recently recovered from pancreatitis, but continues to have abdominal pain, a mass is found mid epigastric region and his labs continue to show elevated amylase and lipase
pancreatic pseudocyst
86
grey turnersand cullen's sign are associated with
acute pancreatitis hemorrhage
87
what is murphy's sign
pain the RUQ associated with inspiratory arrest
88
what is courvoisier sign?
palpable contender gallbladder in patient's with jaundice, (pancreatitis carcinoma)
89
out of the 5 P's what is the first to present with an acute artery occlusion
PAIN, then pins and needles, then pallor
90
3cm firm breast nodule, ovoid in shape and freely moveable ---- most likely
fibroadenoma (most common benign breast mass)
91
rating of ankle/brachial pulses 1.0 to .3
1.0 is normal, 0.7 is consistent with claudication, and 0.3 is associated with pain at rest.
92
what is the most common symptom associated with abdominal pain secondary to chronic intestinal ischemia?
fear of eating
93
when staging breast cancer tumors what does T1, T2, T3 mean?
T1 5cm
94
what is the most common EMBOLIC source of acute arterial occlusion in the lower extremities
atrial fib
95
what are the most common symptoms of Crohn's disease
abdominal pain, weight loss, and diarrhea
96
is bleeding more commonly associated with UC or Crohn's
UC
97
obstipation and failure to pass gas occur with both small bowel obstruction and paralytic ileus how do the bowel sounds differ?
ileus-hypo and SBO is high-pitched
98
what is the surgical treatment for achalasia
myotomy and pneumatic dilatations
99
what is the medical tx for achalasia
CCB and botulinum injection
100
is a lobectomy used more frequently in early or late stage lung cancer?
early
101
most common lung cancer
adenocarcinoma
102
name 2 absolute contraindications of surgical resection of lung cancer
malignant pleural effusion and MI within 3 months
103
relative contraindication of surgical resection
FEV1
104
hemorrhoid staging
1. prolapse only with straining 2. prolapse through anus but reduce spontaneously 3. must be manually reduced 4. cannot be reduced
105
cecal distention to 12cm, bowel obstruction: what it the treatment
surgical exploration
106
most common cause of small bowel obstruction
adhesions
107
most common cause of larger bowel obstruction
adenocarcinoma
108
how do you tx acute execration of Crohn's disease
steroids
109
patient has UC and low grade dysplasia
do a proctocolectomy with oleo-anal pull through
110
pathologic findings associated with ulcerative colitis
95% has rectal involvement
111
skipped lesions and transmural
Crohns
112
how are small bowel obstructions managed
correct fluid and electrolyte abnormalities, then surgery
113
most common cause of massive lower GI bleeding
diverticular dz
114
dukes aster coller is staging system for what type of CA
colon
115
staging to colon cancer
``` A. only mucosal penetration B1. penetrate into muscular B2. penetrate through muscular C. into the muscular with nodes C2 through the muscular with nodes D. metastasis ```

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