Surgery Flashcards
(214 cards)
1
Q
Number one factor prior to surgery
A
History of cardiovascular disease
2
Q
Important CV risk factors for surgery
A
EF
3
Q
Other CV risk factors
A
Age >45
DM
HTN
Hyperlipidemia
4
Q
Surgical clearance in pt under 35 w/ no hx cardiac disease
A
EKG
5
Q
Surgical clearance in pt w/ hx cardiac disease
A
EKG
Stress test
Echo
6
Q
When to do PFTs before surgery
A
Known lung disease
Smoking Hx
7
Q
Current smoker needs surgery
A
Stop -68 wks before, use nicotine patch
8
Q
Pt w/ renal disease needs surgery
A
Keep adequately hydrated
9
Q
How to ensure adequate kidney perfusion before surgery
A
Fluids before and during surgery
Dialyze 24hrs prior to surgery
10
Q
Maintaining the AIRWAY
A
No facial trauma - Orotracheal tube
Facial trauma - Cricothyroidotomy
Cervical spine injury - Orotracheal tube w/ flexible bronchoscopy
11
Q
Maintain BREATHING
A
O2 sat above 90%
12
Q
Maintain CIRCULATION
A
2 large bore IVs
13
Q
SIRS criteria
A
Temp 38
HR > 90
RR >20 or PCO212
14
Q
Define sepsis
A
2/4 SIRS + source
15
Q
Define severe sepsis
A
Sepsis + organ dysfunction
16
Q
Define septic shock
A
Severe sepsis + hypotension
17
Q
Which kind of shock present as pale and cool
A
Hypovolemia
Cardiogenic
18
Q
Which kind of shock present as warm
A
Neurogenic
Septic
19
Q
Which kind of shock has elevated central venous pressure
A
Cardiogenic
20
Q
Which kind of shock has elevated CVP and SVR
A
Hypovolemic
Cardiogenic
21
Q
Which kink of shock has elevated CO
A
Septic
22
Q
Which kind of shock has elevated LVEDP or PCWP
A
Cardiogenic
23
Q
Which kind of shock is treated with fluid and pressors
A
Hypovolemic
Neurogenic
Septic (+ABX)
24
Q
How is cardiogenic shock treated
A
Treat the cardiac problem
25
MCC hypovolemic shock
Massive hemorrhage
26
MCC cardiogenic shock
MI
27
MCC neurogenic shock
Spinal cord injury
28
MCC septic shock
E. coli and S. aureus
29
Blunt abd trauma and has abd pain radiating to back
Hemorrhagic pancreatitis
30
How long after pancreatitis do pseudocysts develop
6-8 weeks
31
ABD pain and Bruising around umbilicus
Cullen
| Hemorrhagic pancreatitis, ruptured AAA
32
ABD pain and Bruising in the flank
Grey Turner
| Retroperitoneal hemorrhage
33
ABD pain and Pain in left shoulder
Kehr
| Splenic rupture
34
ABD pain and Dull percussion on L and shifting dullness on R
Balance
| Splenic rupture
35
ABD pain and Bruising where seatbelt is
Seatbelt
| Deceleration injury
36
Best initial test for free air under diaphragm
Upright CXR
37
Presentation of tension PTX
Decreased breath sounds on one side and tracheal deviation
38
Signs, Sx of pericardial tamponade
JVD
Hypotension
Muffled heart sounds
Electrical alternans
39
Signs, Sx of PTX
CP
Hyperresonance
Decreased breath sounds
40
Signs, Sx of tension PTX
CP
Hyperresonance
Decreased breath sounds
Tracheal deviation
41
Signs, Sx of Hemothorax
Absent breath sounds
| Dullness to percussion
42
Dx test in pericardial tamponade
Echo
43
Dx test in PTX of any kind
CXR
44
Dx test in hemothorax
Blunting of costophrenic angle on CXR
| CT
45
Rx cardiac tamponade
Pericardiocentesis
46
Rx PTX
Chest tube
47
Rx Tension PTX
Needle decompression then chest tube
48
Rx hemothorax
Chest tube drainage
| Possible thoracotomy
49
Evaluation of urethral disruption
XR kidneys, ureter, bladder then Retrograde urethrogram
50
Most appropriate next step in suspected mesenteric ischemia
Angiography
51
MC sx in bowel ischemia
Abd pain after eating
| bloody diarrhea
52
Best initial test for bowel ischemia
CT
53
Most accurate test for bowel ischemia
Angiography
54
Rx bowel ischemia
IV NS then surgery
55
2 MC locations for bowel infarction
Splenic and hepatic flexures
56
Causes of RUQ pain
Cholecystitis
Biliary colic
Cholangitis
Perforated duodenal ulcer
57
Causes of LUQ pain
Splenic rupture
| IBS
58
Causes of RLQ pain
Appendicitis
Ovarian torsion
Ectopic pregnancy
Cecal diverticulitis
59
Causes of LLQ pain
Sigmoid volvulus or diverticulitis
Ovarian torsion
Ectopic pregnancy
60
Causes of midepigastric pain
Pancreatitis
Aortic dissection
PUD
61
MI pain refers to
Left chest, arm, jaw
62
Gallbladder pain refers to
Right shoulder, scapula
63
Pancreas pain refers to
Back pain
64
Pharynx pain refers to
Ears
65
Prostate pain refers to
Tip of penis, perineum
66
Appendix pain refers to
LLQ
67
Esophagus pain refers to
Substernal CP
68
Pyelonephritis, nephrolithiasis pain refers to
CVA
69
Presentation of esophageal rupture
Retrosternal CP
Odynophagia
Hamman sign "snap crackle pop"
Left shoulder pain
70
What is Boerhaave
Full thickness tear 2/2 severe retching and vomitting
71
Boerhaave is commonly seen in
Alcoholics
72
Location of Boerhaave
Left posterolateral aspect of distal esophagus
73
MCC esophageal tear
Iatrogenic
74
MC procedure causing esophageal tear
Upper endoscopy
75
Mortality in Boerhaave
25%
76
What is Mallory-Weiss
Mucosal tear 2/2 vomitting
77
Location of Mallory-Weiss
GE junction
78
Most accurate test for esophageal tear
Esophogram using gastrografin showing leakage outside esophagus
79
Rx esophageal tear
Surgical exploration and debridement of mediastinum
80
Complication of esophageal tear
Mediastinitus
81
MCC gastric perforation
Ulcer disease
82
RFs for gastric perforation
```
H. pylori
NSAIDs
Burns
Head trauma
CA
```
83
Role of alcohol and smoking in ulcer disease
Delays healing
84
Presentation of gastric rupture
Acute, progressively worse abd pain radiating to R shoulder 2/2 acid irritation of phrenic nerve
Signs of peritonitis
85
Best initial test for gastric perforation
Upright CXR
86
Most accurate test for gastric perforation
CT
87
Rx gastric perforation
NPO
NG tube
IV NS, broad spectrum ABX
Surgically repair
88
Consider in RLQ pain in female of childbearing age
Ectopic pregnancy
Cysts
Torsion
89
Always get in a female pt w/ abd pain
Beta-HCG
| Pelvic sonogram
90
Rx first time diverticulitis
Medically
91
Rx recurrent diverticulitis
Surgical resection
92
MC complication of diverticulitis
Abscess
93
Contraindicated in diverticulitis
Barium enema
| Colonoscopy
94
MC site of diverticulitis
Sigmoid
95
Dx abd abscess
CT
96
Rx abd abscess
I & D
| ABX
97
Abd pain that radiates to back
Pancreatitis
| Aortic dissection
98
PE Signs of appendicitis
Rovsing
Psoas
Obturator
99
Signs of appendicitis
Anorexia
Fever
Periumbilical pain with RLQ tenderness
Elevated WBC w/ left shift
100
Signs of acute pancreatitis
Fever
Severe midabdominal pain radiating to back
N/V
101
Signs of diverticulitis
Fever
Nausea
LLQ pain
Peritonitis
102
Signs of cholecystitis
Fever
RUQ pain
Murphy sign
103
Most accurate test appendicitis
CT
104
Best initial test for pancreatitis
CT
| Amylase is sensitive, Lipase is specific
105
Best initial test for diverticulitis
CT
106
Most accurate test for diverticulitis
CT
107
Best initial test for cholecystitis
U/S
108
What is seen on ultrasound in cholecystitis
Pericholecystic fluid
GB wall thickening
Stones
Sonographic murphy's
109
Rx Appendicitis
Laparoscopic removal
110
Rx acute pancreatitis
Aggressive IV fluids
| NPO
111
Rx diverticulitis
ABX for first attack
| Resection if recurrent or perforates
112
Rx cholecystitis
14 days ABX
| Laparoscopic/open cholecystectomy if no better
113
Complications of appendicitis
Abscess
| Gangrenous perforation
114
Complications of acute pancreatitis
Hemorrhagic pancreatitis
| Pseudocyst formation
115
Complications of diverticulitis
Abscess
116
Complications of cholecystitis
Perforation
117
Most accurate test for cholecystitis
HIDA
| - Delayed emptying
118
Characteristics of bowel obstruction
```
Failure to pass stool or flatus
Waves of intermittent crampy abd pain
Hyperactive bowel sounds "tinkling"
N/V
Fever
Hypovolemia due to 3rd spacing
```
119
Types of bowel obstruction
Partial
| Complete
120
MCC bowel obstruction
Adhesions
121
Other causes of bowel obstruction
```
IBD
Hernias
Intussusception
Volvulus
Neoplasms
Foreign bodies
Intestinal atresia
Carcinoid
```
122
Hallmark sign of bowel obsctruction
Elevated lactate with marked acidosis
123
Best initial test for bowel obstruction
Abd XR - air fluid levels
124
Most accurate test for bowel obstruction
CT - transition zone
125
Rx bowel obstruction
NPO
NG tube
IV fluid
Emergent surgical resection
126
What is fecal incontinence
Continuous/recurrent uncontrolled passage of fecal material for at least 1 month in an individual over 3
127
Best initial test for fecal incontinence
Clinical hx combined w/ flex sig or anoscopy
128
Most accurate test for fecal incontinence
Anorectal manometry
129
Best initial test for fecal incontinence if there is hx of anatomic injury
Endorectal manometry
130
Medical rx for fecal incontinence
Bulking agents - fiber
131
Biofeedback rx for fecal incontinence
Control exercises
| Muscle strengthening exercises
132
Last resort rx for fecal incontinence
Surgery
133
Decreases incontinence episodes by 50%
Dextranomer/hyaluronic acid (Solesta)
134
Fractures are always diagnosed with
XR
135
Types of fracture correction
Closed reduction
Open reduction and internal fixation
Open fractures - close skin, bone set in OR w/ debridement
136
Types of fractures
```
Comminuted
Stress
Compression
Pathologic
Open
```
137
What is a comminuted Fx
Bone broken in multiple pieces
138
MCC comminuted Fx
Crush
139
What is a stress fracture
Complete fracture from repetitive insults to bone
140
Which bone is MC fractured in stress fx
Metatarsals
141
How to dx stress Fx
CT or MRI
142
Rx stress Fx
Rehabillitation, reduced physical activity, casting
143
Locations of compression fractures
1/3 lumbar
1/3 thoracolumbar
1/3 thoracic
144
Who gets compression fractures
Osteoporosis
145
Common vignette for pathologic Fx
Older person fractures rib from coughing
146
Pathological conditions that can cause fractures
Paget's
Multiple Myeloma
Bone mets
147
Rx pathologic Fx
Surgical realignment
| Rx underlying disease
148
What is an open Fx
Bone pierces skin
149
Rx open fx
Surgery
150
Common vignette for stress Fx
Athlete w/ persistent pain
151
Most common type of shoulder dislocation
Anterior
152
Causes of posterior shoulder dislocation
Seizure
| Electrical burn
153
Cause of clavicular Fx
Trauma
154
Cause of scaphoid Fx
FOOSH
155
Signs of anterior shoulder dislocation
Arm held to side, externally rotated, severe pain
156
Signs of posterior shoulder dislocation
Arm medially rotated held to side
157
Signs of clavicular Fx
Pain over location
158
Signs of scaphoid Fx
Persistent pain in "snuffbox"
159
Best initial test for shoulder injuries
XR
160
Most accurate test for shoulder dislocations
MRI
161
Rx anterior shoulder dislocations
Shoulder relocation and immobilization
162
Rx posterior shoulder dislocations
Traction and surgery if pulses or sensation diminished
163
Rx clavicular fx
Simple arm sling
164
Rx scaphoid Fx
Thumb spica cast
165
Finger flexed and painful. Loud popping sound and no more pain when pulled
Trigger finger
166
Cause of trigger finger
Stenosis of tendon sheath
167
Rx trigger finger
Steroids
| Surgery if fails
168
Who gets dupuytren's
Men > 40
169
Rx dupuytren's
Surgery
170
MC bone implicated in fat embolism
Femur
171
Onset of fat embolism sx
Within 5 days of Fx
172
Presentation of fat embolism
Confusion
Petechial rash
SOB
173
Dx tests for fat embolism
PO2
174
Rx fat embolism
Keep PO2 > 95
175
6 signs of compartment syndrome
```
Pain
Pale
Paresthesia
Paralysis
Pulselessness
Poikilothermia
```
176
Rx compartment syndrome
Fasciotomy
177
Dx torn ACL
MRI
178
Most definitive rx of ACL tear
Arthroscopic repair followed by rehabilitation
179
Anterior drawer sign is for
ACL
180
Posterior drawer sign is for
PCL
181
Rx knee injuries
MRI
182
Rx MCL/LCL
Surgical repair
183
Which knee injuries are repaired arthroscopically
ACL
PCL
Meniscus
184
Knee injury w/ popping sound on flexion and extension
Meniscus
185
Unhappy Triad
ACL
MCL
Medial meniscus
186
Done for all pts under 50 presenting for acute onset back pain
MRI to r/o slipped disk or lumbar disk herniation
187
Most appropriate next step after MRI in acute back pain
Antiinflammtory agents
188
MC sites of lumbar herniation
L4-5
| L5-S1
189
Hallmark signs of AAA
Bruit
| Pulsatile abdominal mass
190
Syncope in setting of AAA
Rupture until proven otherwise
191
Diagnostic tests in AAA
CT/MRI - relation of AAA to surrounding structures
U/S for size and monitoring
Surgery when AAA reaches 5cm
192
Who gets screened for AAA
Former or current smokers over 65
193
POD 1-2 fever cause
Atelectasis
| Post-op PN
194
POD 3-5 fever cause
UTI
195
POD 5-7 fever cause
DVT, thrombophlebitis of IV
| PE
196
POD 7 fever cause
Wound infections and cellulitis
197
POD 8-15 fever cause
Drug fever
| Deep abscess
198
Dx test for POD 1-2 fever
CXR and sputum Cx
199
Prevent POD 1-2 fever
Incentive spirometry
200
Rx POD 1-2 fever
Vanco, tazobactam-pipercillin for HCAP
201
Dx POD 3-5 fever
UA showing +nitrates and leukocyte esterase
| UCx for species and sensitivity
202
Dx POD 5-7 fever
Doppler U/S
Change IV access
Cx IV tips
203
Rx POD 5-7 fever
Heparin for 5 days as bridge to coumadin
204
Dx POD 8-15 fever
CT
205
Rx POD 8-15 fever
CT guided percutaneous drainage or surgery
206
Post-op confusion
Likely hypoxis or sepsis
- ABG
- CXR
- Blood Cx
- UCx
- CBC
207
Causes of post-op hypoxia
PE
Atelectasis
PN
208
Signs of post-op ARDS
Severe hypoxia
Tachypnea
Accessory muscle use
Hypercapnia
209
Dx post-op ARDS
CXR - B/L infiltrates w/o JVD
210
Rx post-op ARDS
Positive end expiratory pressure
211
Signs of post-op PE
Acute onset PE w/ clear lungs
212
Best initial dx test for post-op PE
EKG (No ST changes)
Confirm with troponins and cardiac enzymes
Then do CT angio
213
Rx post-op PE
Heparin as bridge for coumadin
214
Second PE while on coumadin for post-op PE
Place IVC filter
