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Surgery Flashcards

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1
Q

What tests are needed for a healthy pt

A

EKG only

EKG + stress test + echo

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2
Q

What tests do you do for pulmonary function?

A

PFTs if known smoking hx or lung disease

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3
Q

SIRS criteria

A

Temp 38
HR >90
>20 breaths/min or pco2 12k

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4
Q

Interpret SIRS criteria

A

2 criteria: SIRS
2 criteria + source: sepsis
2 criteria + source + organ failure: severe sepsis
2 criteria + source + organ failure + hypoTN: septic shock

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5
Q

What are the 5 abdominal trauma signs and their cause:

A

Cullen: umbilical bruising –> hemorrhagic pancreatitis, AAA
Grey Turner: flank bruising –> retroperitoneal hemorrhage
Kehr: left shoulder pain –> splenic rupture
Balance: dull percussion on left/shifting dullness on right –> splenic rupture
Seatbelt: bruising where seatbelt was –> deceleration injury

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6
Q

What is a test to evaluate ileus

A

Abdominal X-ray

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7
Q

What do you do with blood at the meatus?

A

1) KUB X-ray
2) RUG
3) foley placement

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8
Q

Most common limiting factor of surgery

A

Cardiovascular disease

EF

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9
Q

Severe abdominal pain that is out of proportion to physical findings is ____ and you should order ____

A

Mesanteric Ischemia –> Angiography

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10
Q

2 most common symptoms of ischemic bowel disease

A

Abdominal pain after eating (muscular contraction of bowel increases oxygen requirements)
Bloody diarrhea

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11
Q

Initial and most accurate tests for ischemic bowel disease

Treatment?

A

Initial: CT
Accurate: Angiography
Tx: IV NS followed by surgery to remove the necrotic bowel

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12
Q

Number one risk factor for mesenteric ischemia

A

A fib

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13
Q

Mesenteric ischemia labs
Initial test
Accurate test

A

Elevated lactic acid and WBC count
Abdominal X-ray
Angiography

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14
Q

Most common locations for intestinal infarct

A

Watershed areas (splenic and hepatic flexures)

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15
Q

Where is the most common site of an esophageal perforation and what is the most accurate test?

A 
Left posterolateral aspect of the distal esophagus
Grastrografin test (esophageal using diatrizoate meglumin and sodium solution)
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16
Q

What is the most common cause of esophageal perforation?

A

Iatrogenic (UGD)

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17
Q

What are the 4 steps of treatment for a gastric perforation?

A

1) make pt NPO
2) place NG tube
3) medical management (Abx + IV fluids)
4) emergent laparotomy

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18
Q

What test is contraindicated in acute diverticulitis? What is the most common complication of acute diverticulitis?

A

Barium enema

Abscess

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19
Q

What is the most accurate test for cholecystitis? What does it show?

A

HIDA scan –> delayed emptying of the gallbladder by failure to visualize the gallbladder from isotope accumulation

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20
Q

What are the 2 most common causes of SBO

Study These Flashcards
A

Adhesions from previous surgeries

Hernias

21
Q

What drug can be used to alleviate obstruction from stool impact ion in patients on chronic opioids

Study These Flashcards
A

Methylnaltrexone (Relistor)

22
Q

What is the hallmark lab test for SBO? What are the initial and accurate tests?

Study These Flashcards
A

Elevated lactate with marked acidosis
Abdominal X-ray
Abdominal CT

23
Q

What is the definition of fecal incontinance? What are the initial/accurate tests? What are 3 types of treatment?

Study These Flashcards
A

Continuous uncontrolled >10ml feces for >1month, pt >age 3
Initial: hx + flex sig or anoscopy
Accurate: anorectal manometers (endorectal if anatomic injury)
Tx: fiber –> biofeedback –> Dextranomer/Hyaluronic acid injection –> colorectal surgery

24
Q

What is a comminuted fracture and the most common cause?

Study These Flashcards
A

Bone broken in multiple pieces –> crush injury

25
What is a stress fracture and the most common location?
Complete fracture from competitive insults --> metatarsals
26
What imaging is necessary for a stress fracture?
CT or MRI
27
Where are the 3 sites of compression fractures?
1/3 lumbar, 1/3 thoracolumbar, 1/3 thoracic
28
What is the most common shoulder dislocation? Sx? Tests? Tx?
Anterior (strained GH ligaments) External rotated forearm X-ray initial, MRI accurate (rule out axillary A/N injury) Relocate and immobilize
29
What is a rarer shoulder dislocation? Sx? Dx? Tx?
Posterior (seizure or electrical burn) Medially rotated and held at side arm X-ray initial, MRI accurate Traction and surgery treatment if sensation/pulses diminished
30
Clavicle are fracture require you to rule out what? | Treatment?
Subclavian A or brachial plexus injury | simple arm sling
31
How long does it take for a scaphoid fracture to show up on X-ray? Tx?
3 weeks | Thumb spica
32
What is trigger finger and how is it treated?
Stenosis of the tendon sheath leading to acute flexion and pain Steroid injection --> surgery
33
What is Dupuytren contracture? Who is effected? Tx?
Palmar fascia constriction which prevents the hand from extending open Men over 40 Surgery
34
What is the triad for fat embolus
AMS Petechial rash Dyspnea
35
Where does spinal stenosis occur? What alleviates the Sx? How is it diagnosed?
C2 and L1 Leaning forward MRI
36
How are all ligamentous knee injuries diagnosed?
MRI
37
What is the unhappy triad?
ACL MCL Lateral or medial meniscus
38
What is the dx for a AAA? Management? When is surge required?
``` More than 1.5x normal size 3-4cm: U/S every 2-3 years 4-5.4cm: U/S or CT every 6-12 months >5.5cm + no Sx: repair Surgery for all >5cm ```
39
What are the tests for an aortic dissection in a stable or unstable patient?
Stable: MRA Unstable: TEE
40
What is the best initial HTN therapy for aortic dissection? | What do you never use alone and why?
Beta blockers | Vasodilator --> reflex tach can increase shearing forces
41
Post Op fever POD 1-2
Wind: atelectasis/pneumonia Dx: CXR + sputum cultures Tx: prevent with IS, treat with Vancy + Zosyn for HCAP
42
POD 3-5
Water: UTI Dx: positive nitrates and leuk esterase on UA + Culture Tx: Abx
43
POD 5-7
Walking: DVT/thrombophlebitis of IV line or PE Dx: Doppler + change IV lines and culture IV tips Tx: Heparin for 5 days --> bridge to Warfarin for 3-6 months
44
POD 7
Wound: infection or cellulitis Tx: I&D + Abx
45
POD 8-15
Weird: drug fever or abscess Dx: CT Tx: CT guided drainage or surgery
46
What do you order if a postop patient is confused?
``` ABG CXR Blood cultures Urine cultures CBC ```
47
What is the most common finding on EKG for PE?
Nonspecific ST changes >>>>>>> S1Q3T3
48
When should an IVC filter be placed in a PE patient?
If a patient has a 2nd PE while on Warfarin

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