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Surgery > Surgery > Flashcards

Surgery Flashcards

1
Q

when can u get Sx after recent MI

A

6 months

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2
Q

renal disease patient - surgery prep

A

Give fluids before and during Sx

if the patient was on dialysis - dialyze that patient 24 hours prior to Sx

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3
Q

71 year old man w/ SEVERe claudication and DM2 what testing is recommended?

A

BMP (basic metabolic panel) + EKG + stress test (Thallium stress test - since the patient can’t exercise)

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4
Q

best way to maintain upper airways in patient with no facial trauma

A

orotracheal tubes

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5
Q

best way to maintain upper airways in patient with facial trauma

A

cricothyroidotomy

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6
Q

best way to maintain upper airways in patient with cervical spine injury

A

orotracheal tube w/ flexible bronchoscopy to reduce further cervical spent injury

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7
Q

Systemic inflammatory response syndrome SIRS

A

Body temp 38 degrees
Heart rate >90BPM
Tachypnea ?20 , Pco2 12000 cells/mm3

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8
Q

2 SIRS criteria + source of infection + organ dysfunction + hypotension =

A

SEPTIC SHOCK

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9
Q

2 SIRS criteria + source of infection + organ dysfunction

A

SEVERE SEPSIS

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10
Q

2 SIRS criteria

A

Sepsis

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11
Q

shock occurs in tissue - brain , kidney, liver , heart and lungs

A 
- brain - confusion 
 kidney - increase BUN:Cr 
 liver: elevated AST AND ALT 
 heart: chest pain and SOB  
blood: increase lactic acid
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12
Q

warm and flushed skin

A 
CO change 
Decreased  - think eugenic shock 
Elevated - check PWCP
no change - septic shock 
Decreased - anaphylactic shock -  epinephrine
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13
Q

cullens sign

A

Brushing around the umbilicus
Cause
- due to heamorragic pancreatitis
- rupture of aortic aneurysm

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14
Q

Grey turner sign

A

brushing of the flank
Cause
- retroperitoneal heamorrage

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15
Q

Kehr sign

A

pain in left shoulder
cause
- splenic rupture

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16
Q

balance sign

A

dull percussion on the left and shifting dullness on the right
cause
- splenic rupture

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17
Q

Seatbelt sign

A

brushing whre a seatbelt was
Causes
- deceleration injruy

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18
Q

best test to Dx free air under the diaphragm

A

upright chest x-ray

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19
Q

management of hemodynamically stable patients with ado pain w/

A
  • close monitoring
  • serial abdominal exams
  • IV fluids
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20
Q

if heamodynamically unstable w/ abdo pain

A

EXPLORE w/ laparotomy

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21
Q

what investigations do u do if there is urethral disruption

A

KUB X-ray followed by urethrogram

Then - foley catheter

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22
Q

acute mesenteric ischema clinical and management

A

ABDO PAIN out of proportion of clinical findings

angiography then surgery

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23
Q

ischemic Bowl disease

A
  • bloody diarrhea
  • abdo pain after eating

CT , angiogrpahy (most accurate) then surgery

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24
Q

Mesenteric idchemia labs

A

lactic acidosis and leukocystosis

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25
Q

referred pain after MI

A

jaw left chest and left arm

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26
Q

Cold foods such as ice cream referred pain to

A

BRAIN freeze = temp chang in sinus

27
Q

Gall bladder referred pain

A

right shoulder / scapula

28
Q

Pancreas referred pain

A

Back pain

29
Q

Pharynx referred pain

A

Ears

30
Q

Appendix referred pain

A

right lower quadrant

31
Q

esopagus regerred pian

A

Substernal chest pain

32
Q

pyelonephritis and nephrolithiasis referred pain

A

costovertebral angle

33
Q

most common cause of esophageal perforation

A

iatrogenic - ENDOSCOPY

Boerhavve syndrome (only 25% of cause)

34
Q

dx of MW tear and BS

A

Gastrograffin esophagogram using diatrizoate meglumine and diatrizoate sodium solution
MW - no leakage
BS - leakage

35
Q

complication of Boerhaave Syndrome

A

Acute mediastinitis - VERY high mortality

36
Q

most common cause secondary to ulcer disease

A

Gastric perforation

37
Q

treatment of gastric perforation

A
  1. NILL PO
  2. Place NG tube - suction of gastric content
  3. Medical managemnt - BSantibiotics , IV fluid in prep for Surgery
  4. emergent surgery - laparotomy and repair of the perforation
38
Q

Clinical of gastric perforation

A

ACUTE progressive worsening pain

Guarding
rebound tenderness
Abnominal rigidity

39
Q

what is contraindicated in diverticulitits

A

Barium enema and colonoscopy - due to increase incidence of perforation

40
Q

most accurate test for Cholecystitis

A

HIDA scan - most accurate

41
Q

high pitch tinkling sounds

A

indicate small bowl obstruction and intestinal fluid and air under high pressure in the bowl

42
Q

methylnaltrexone (Relistor

A

shown to alleviate obstruction from stool impaction in patient on chronic opiods

43
Q

best test for fecal incontinance

A

anorectal manometry

Fecal incontinance = inability to pass fecal material >10ml for a least 1 month in an individual >3

44
Q

treatment of fecal incontinence

A
  1. Medical - fiber
  2. biofeeedback - control exercise and muscle strenthening
    ingection - dextranomer/ hyaluronic acid (decrease by 50%)
  3. Surgery
45
Q

fracture of the metatarsals

A

Stress fracture

46
Q

fracture from crush injury

A

Comminuted fracture

47
Q

athlete with persistent pain is at increase risk of what fracture

A

Stress fracture

48
Q

Dx of stress fracture

A

CT

x-ray will not show it

49
Q

osteoporotic vertebral injury

A

compression fracture

50
Q

fracture of a rib when coughing

A

pathological fracture

51
Q

arm is held to side, externally rotated and in severe pain - injury to what

A

Aterior shoulder dislocation

52
Q

arm medially rotated and held to side - injury

A

posterior shoulder dislocation

53
Q

tx for trigger finger

A

steroid injection

54
Q

age of ppl with dupuytren contracture

A

men >40 (involves the tendon)

do not confuse with trigger finger (any age - not involving tendon only finger

55
Q

fracture of long bone plus confusion and rash SOB and dyspnea

A

fat embolism

56
Q

findings of ABG with a fat embolism

A

PO2

57
Q

spinal stenosis

A

sounds like claudication BUT its bilateral legs therefore spine aetiology than vascular. pain is ALLEVIATED by leaning FORWARD (spine flexion opens spinal canal and relieves the compression. Leading forward will NOT help vascular claudication )

58
Q

6 signs of compartment syndrome

A 
Early: 
pain 
pallor
paresthesia 
Late:
pulselessness
parylsis 
poikothermia - cold to touch
59
Q

1 risk factor for aortic dissection

A

HTN

60
Q

Screening for AAA

A

former or current smokers > 65

61
Q

clinically ustable aortic dissection investigation

A

TEE - fastest method

62
Q

why should vasodilators never be used alone

A

reflex tachycardia

63
Q

postop fever assesment

A 
WIND POD1-2
Water 3-5
Walking 5-7
Wound 7
Weird 8-15
64
Q

UTI urinlaysis shows

A

nitrates, leucocytes esterase

Surgery (1 decks)

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