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3rd Year > Surgery > Flashcards

Surgery Flashcards

(59 cards)

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1
Q

Epidural, what moving through?

A

supraspinous ligament -> interspinous ligament -> ligamentum flavaum (inside)

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2
Q

Epidural, what layer provides the most drug resistance?

A

Arachnoid mater provides about 90% of resistance to drug migration into CNS

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3
Q

folds of small intestine =?

A

valvulae conniventes (also called plicae circulares) are thin, circular, folds of mucosa, some of which are circumferential

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4
Q

decubitus

A

the posture of lying down

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5
Q

lipodermatosclerosis

A

tapering of legs due to underlying inflammation and contraction of subcutaneous fat

found in venous stasis (cvi = chronic venous insufficiency)

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6
Q

SIRS criteria
sepsis
septic shock

A 
SIRS
2 or more
Temp   >38.5 (101.3) or  90
RR > 20   
WBC  >12,000, 10%band's

Sepsis = SIRS criteria with evidence of infection

Severe Sepsis = SIRS with hypotension

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7
Q

what bacterial growth is cutoff for skin graft?

A

10^5th organism per gram of tissue

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8
Q

postop ileus

when PO

A

up and moving = gum

  • > clear liquid
  • > liquid diet
  • > gas/stool = normal diet.
  • move steadily along every day unless fails with N/V.
  • physiologic ileus: stomach =24hr, small intestine = 24-48, Colon =48-72hrs. Colectomy/hemicolectomy avg is more like 5 days.
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9
Q

pneumatosis

A

gas within the wall of small or large intestine

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10
Q

pseudomyxoma peritonei (PP)

A

The term pseudomyxoma peritonei refers to the accumulation of mucin within the peritoneal cavity.
mucinous adenocarcinomas that have seeded peritoneum

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11
Q

Preoperative withholding of foods time frames

A

> =2hrs clear liquids
=6hrs solid food, up to 8 if greasy/large meals
=4hrs for breast milk
=6hrs formula feeding

*A clear liquid includes water, coffee, or tea without dairy; clear fruit juice without pulp; and clear carbonated beverages.

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12
Q

Blood volume/kg

A

77, round to 70?

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13
Q

serious blood pressure changes when?

A

30-40% EBL, 1.5-2L

can lose about 1L without noticing much change

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14
Q

prerenal acute renal failure (azotemia

BUN:Cr

A

Decreased flow to kidney

oliguria, decreased GFR, azotemia -renin release -> aldosterone -> na and BUN reabsorbed

BUN:Cr > 15-20
FeNA 500

NORMAL BUN: Cr 15, or 10-15ish

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15
Q

postrenal acute renal failure

BUN:Cr

A

blockage of kidney outflow

decrease GFR, azotemia, oliguria

early; increased tubular pressure -> BUN back into blood
BUN:Cr >15, FeNa 500

as dmg continues
BUN resorb decreases- BUN:Cr 1%
Urine Osm

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16
Q

intrarenal azotemia

A

**most common cause of acute renal failure

Acute tubular necrosis (ischemic or toxic). injury to tubules
granular casts, poor resorption
BUN:Cr 2%
Urine Osm >500

=> hyperkalemia and metabolic acidosis

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17
Q

Left shift =

A

Neutropenia with bands >700/microL

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18
Q

shock

A

any state that causes perfusion inadequate to meet the oxygen and nutrient demand of supplied tissues

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19
Q

when does post-operative atelectasis peak?

how long does it last?

A

peak POD 2, lasts up to 5 days

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20
Q

winters formula

A

pCO2 = 1.5xBicarb+8 +-2

*in the winter you change your breathing (it’s cold) because of the shit around you

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21
Q

what is the MINIMUM recommended duration of quitting cigarettes prior to surgery

A

8 weeks: helps reduce complications, including pulm complications like atelectasis

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22
Q

compartment syndrome

s/s and at what pressure?

A 
pain out of proportion
pain with passive flexion
paresthesia
pulselessness
pallor
compartment pressure >30mmHg or delta pressure (diastolic - compartment pressure
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23
Q

What mg prednisone is not associated with HPA axis suppression?

A
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24
Q

the W’s

Study These Flashcards
A

Atelectasis arises POD 1-5. often with fever.

25
When is BiCarb recommended for lactic acidosis?
Not until pH
26
``` post-op fever first hours first week first month >month ```
Fever above 38ºC (100.4ºF) is common in the first few days after major surgery [1,2]. Most early postoperative fever is caused by the inflammatory stimulus of surgery and resolves spontaneously IMMEDIATE first hours is usually non-infectious -Fever due to the trauma of surgery usually resolves within two to three days. -(rare) malignant hyperthermia (usually within 30min of anesthetic agent) -rxn to trauma and meds or preexisting infection ``` ACUTE first week may be surgically acquired but more often UTI's (if caths in place) or pneumonia -C. Diff -atelectasis -DVT ``` SUBACUTE 2-4weeks, usually SSI (surgical site infection) DELAYED >1month more indolent organism SSI
27
5W's post-op fever
Wind: atelectasis and or pneumonia POD1-2 WATER: UTI POD 3-5 WEINS (Veins): DVT's or PE. POD 5-7 WOUND: POD7+ SSI What did we do? = everything else 1,3,5,7
28
Respiratory Quotient definition And # for Carbohydrate Protein Lipids Normal body
RQ is the CO2/O2 release/uptake Pure Carbs= 1.0 Protein= 0.8 Fatty Acids = 0.7 Body normal is around 0.8 This is useful with ventilated pts as too much CO2 can make it difficult to wean
29
What is PAO2 sea lvl? | Normal A-a gradient?
Sea lvl 76 Normal A-a is less than 15 >30 is always abnormal
30
Anterior vs posterior male urethral damage
Anterior= painful perineum and normal prostate, often can void urine Posterior = suprapubic pain, high prostate, scrotal hematoma, Inability to void, often assoc with pelvic fx
31
tenesmus
need or feeling the need to constantly evacuate bowels
32
intrabdominal abscesses | what size tx with antibiotcs vs percutaneous drainage?
3cm is drainage
33
torus palatinus?
benign bony growth midline of hard palate, may grow slowly over years. May ulcerate with trauma and heal slowly. Weird looking
34
laparotomy vs laparoscopy
laparotomy is an incision in abdomen for open procedures laparoscopy is with a scope laparo word root is greek for "flank" meaning "abdomen" in medicine
35
prolonged QT from electrolytes
hypok, hypomag, hypocalcemia hypok and hypo mag cause prolongation more often the hypocalcemia
36
c. diff s/s time frame
voluminous diarrhea, abdominal pain, fever, typically NOT bloody takes 4-5 days of Antibiotic use prior to appearance
37
male nipples are considered to be at what intercostal space?
4th any penetrating trauma below involves abdomen until proven otherwise
38
MAC of Sevoflurane Desflurane Isoflurane
Sevo: 1.8, medium quick on quick off, pleasant odor, potent bronchodilator Des: 6.6, THE QUICKEST on quickest off, expensive, poor odor, cause of bronchospasm Iso 1.2, cheaper, longer acting. Highly soluble and potent * *all decrease MAP and SVR. * Des > Iso increase HR, sevo doesn't much * ** Start with sevo -> iso or Des * **All are assoc. with post-op N/V
39
IV induction choice: | Propofol vs Etomidate vs Ketamine
Propofol: fast onset and recovery (minutes), use especially with ambulatory surgery, decreases SVR, antiemetic properties Etomidate: minimal cardiovascular effects, use for patients with cardiopulmonary compromise Ketamine: bronchodilator properties, good use for acute bronchospasm MOA: Propofol and Etomidate act through GABA MOA: Ketamine though NMDA
40
``` Anti-emetics MOI and area Dexamethasone (unknown but when use?) Droperidol/Haldol/metoclopramide Ondansetron Scopolamine Diphenhydramine ```
Dexamethasone: use during induction of anesthesia **All below except serotonin antagonists work in area postrema (by the 4th ventricle that relays to medulla vomiting center), serotonin is more confusing Droperidol/Haldol/metoclopramide: D2 antagonists Ondansetorn: 5HT3 serotonin antagonist Scopolamine: M1 antagonist Diphenhydramine: H1 antagonist All have antiemetic properties *
41
retropharyngeal infection spaces
esophagus -> Buccopharyngeal fascia -> alar fascia -> prevertebral fascia **if abscess is btw alar and prevertebral fascia (danger zone) goes to the mediastinum
42
Ruling in vs Ruling out with troponin assays (timeframe)
``` Can generally (80%) rule in MI within 2-3hrs Rule out at 6hrs, but wait 12hrs in suspicious cases peak at 18hrs ```
43
meniscal vs ligamentous injury swelling
meniscal injuries pop, pain, then swell around 24hrs ligamentous swell rapidly from hemarthrosis ACL... immediate instability
44
normal aortic diameter | when to repair aneurysm?
1-3cm, if >3cm infrarenal = aneurysm typically at or above lvl of umbilicus when >5.5cm: risk of rupture > risk of repair => repair indicated
45
perioperative anticoagulation use
if low risk but on anticoags: stop warfarin on day -5 if moderate to high risk, bridge heparin and stop it on day of surgery with 50% reduction of dose (or night before if on BID) **restart heparin > 24hrs after surgery. Studies show no increased risk of bleeding after 48hrs if hemostasis was secured. ***restart coumadin when able to drink
46
scaphoid fracture, when to do open
If displaced >2mm, otherwise splint for 6-10weeks
47
what cutaneous cancer is associated with wounds/inflammation
Squamous cell cancer arises in areas of inflammation/chronic irritation - burns - overlying osteomyelitis - venous ulcers
48
valgus vs varus
Varus -> Airus -> air inbetween joint ===> The distal segment is outwardly angulated Valgus ==> distal segment is inwardly angulated **BUT whatever, valgus stress of knee pulls thigh in pushes distal tibia outward ***knee abduction apparently involves thigh fixation with leg abduction.
49
miosis
miosis is smaller than mydriasis = pupil constriction
50
phosphate in calcium deficiency | in PTH deficiency
Decreased bc of PTH kidney wasting in normally functioning system phosphate increased bc kidneys are not told to waste phosphate
51
meniscal vs ligamentous injury swelling
meniscal injuries pop, pain, then swell around 24hrs ligamentous swell rapidly from hemarthrosis
52
normal aortic diameter
1-3cm, if >3cm infrarenal = aneurysm | typically at or above lvl of umbilicus
53
perioperative anticoagulation use
if low risk but on anticoags: stop warfarin on day -5 if moderate to high risk, bridge heparin and stop it on day of surgery with 50% reduction of dose (or night before if on BID) **restart heparin > 24hrs after surgery. Studies show no increased risk of bleeding after 48hrs if hemostasis was secured. ***restart coumadin when able to drink
54
scaphoid fracture, when to do open
If displaced >2mm, otherwise splint for 6-10weeks
55
what cutaneous cancer is associated with wounds/inflammation
Squamous cell cancer arises in areas of inflammation/chronic irritation - burns - overlying osteomyelitis - venous ulcers
56
valgus vs varus
Varus -> Airus -> air inbetween joint ===> The distal segment is outwardly angulated Valgus ==> distal segment is inwardly angulated
57
miosis
miosis is smaller than mydriasis = pupil constriction
58
phosphate in calcium deficiency | in PTH deficiency
Decreased bc of PTH kidney wasting in normally functioning system phosphate increased bc kidneys are not told to waste phosphate
59
hemithorax can hold.... blood
1/2 your volume. so about 3L? Massive hemothorax is 1.5L

3rd Year (4 decks)

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