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Flashcards in surgery Deck (115):
1

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

creatinine

2

who should have their blood glucose tested preop?

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

3

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

no, do not do for otherwise healthy individuals

4

warfarin and dig are known for causing what electrolyte abnormality?

K

5

ECHO are recommended in all patients older than?

40

6

silent MI is most common in what population?

elderly and DM

7

spirometry is recommend to who?

thoracic and upper abdominal surgery, smokers and dyspnea

8

pregnancy test?

for all women of child bearing years

9

H&P identify previous?

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

10

index used to measure cardiac risk?

detsky's modified cardiac risk index or Lee's

11

what does Lee's index look at

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

12

what is the best prophylactic blood thinner to use?

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

13

Enoxaparin is also used what is it?

low molecular weight heparin

14

can warfarin be used

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

15

what is fondaparinux

anticoagulant, good for hip surgery

16

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

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

17

malnourished criteria is

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

18

malnourishment effects many systems including

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

19

what labs may be abnormal of malnourishment

increased creatinine, high lymphocyte count, albumin, transferrin

20

what is refeeding syndrome?

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

21

how do you avoid refeeding syndrome?

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

22

basal energy expenditure

harris benedict equation

23

what is the preferred route of nurtrient replacement

enteral route (tube feeding)

24

are naso or gastro tube better at preventing aspiration

gastro

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