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Allergy, immunology, infection > Surgery > Flashcards

Surgery Flashcards

(69 cards)

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1
Q

Anesthesiologist

A

MD or DO
Chooses and applies correct meds
Monitors physicologic function during surgery
In charge of fluids

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2
Q

Anesthesia assistant

A

AKA an anesthetist such as CRNA
works up the anesthesiologist
Edu: RN + BSN+ 2 years extra school + 1 year on the job experience

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3
Q

Surgeon

A

MD, DO
Board certifed in their surgical field
In charge of surgical procedure

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4
Q

1st Assist

A

Can be PA or MD
Person standing directly across from surgeon
Maintains visibility of surgical site with suction
Holds retractors, control bleeding
Apply dressing etc

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5
Q

Scrub tech

A

Can be RN or LPN

Maintains integrity and safety of the sterile field throughout the procedure

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6
Q

XR/fluoroscopy tech

A

Fluoroscopy = continuous XR image on monitor

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7
Q

Intern/resident/student

A

There to learn how to cut

Residents can do surgeries by themselves

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8
Q

Circulating nurse

A

RN
Monitor and coordinate all actvities within the room
Manage care required for the patient

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9
Q

Perfusionist

A

Makes sure the heart-lung machine is efficienctly managing the lungs and heart
Delivers the drug that stops a patients heart in cardiac surgery

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10
Q

American society of anesthesiology

Risk assessment

A

ASA 1 Normal healthy
ASA 2 mild systemic disease
ASA 3 Severe systemic disease
ASA 4 Severe systemic with constant threat to live
ASA 5 Moribund, not expect to survive without operation
ASA 6 declared brain dead

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11
Q

Upper airway exam

A 
ROM of cervical spine
Thyroid cartilage to mentum dis: >6cm
Mouth opening greater than 3 cm
Look at dentition, dentures loos teeth
Jaw protrusion
Presence of beard
Mallampati score
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12
Q

Mallampati score

A

Grade1: easy intubation

2: see tonsilar pillars and part of uvula
3: only hard and soft palate visable
4: hard palate only visable

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13
Q

G tube

A

gastrostomy tube, surgical access
tube inserted thru abdomen directly into stomach
Indicated when patient needs long term access
Also used for decompression
Can bolus feed

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14
Q

J tube

A

jejunostomy tube
same as g tube but placed more distally
Reduced risk of aspiration
Continuous drip w pump required

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15
Q

PEG tube

A

percutaneous endoscopic gastrostomy
specific technique
Done with endoscope
Most common use if for head and neck cancer

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16
Q

Pre surgery diabetes glucose level

A

300 = reevaluate surgery

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17
Q

Phases of wound healing 1

A

Coagulation:
Fibrin plug form
Main cell type: platelets
Platelets aggregate, release fibrinogen fragments

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18
Q

Phase 2 of wound healing

A

Inflammatory
Cell recruitment and chemotaxis
Cell types: neutrophils, monocytes/macrophages

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19
Q

Phase 3 of wound healing

A

Migratory/proliferative
Epidermal resurfacing, angiogenesis
Keratinocytes, fibroblasts, endothelial cells

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20
Q

Phase 4 of wound healing

A

Remodeling
Scar formation
Myofibroblasts
Phenotypic switch to myofibroblasts from fibroblasts

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21
Q

Suture size on face

A

5-0 and 6-0

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22
Q

Most common surgical site infection

A

Staph aureus

Staph epidermidis: worry for immunocomp

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23
Q

Pathogens in sites involving intestines

A

E.coli
K. pneumo
Enerobacter
Bacteroides species

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24
Q

Dirty wound number of bugs

A

10^5

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25
Furuncle
Boil Caused by S aureus, can also be strep Tx: most often resolve, can I&D
26
Carbuncle
Collection of furuncles Extend to subQ RF: DM, immunoComp, chronic steroid use Manage: I&D, often excision
27
Cellulitis
Eti: strep, staph, MRSA in hospital Mangement: Abx: keflex, amox, dicloxacilin (TMP-SMX if MRSA) Severe: IV PCN G, naficillin (+vanco if MRSA) drain abcess
28
Pyomyositis
Bact infx of skeletal muscles due to hematogenous spread, leads to abcess formation and sepsis Most common in the tropics
29
Gas gangrene
Eti: Trauma, IVDU. One of clostridia Crepitus, gas in tissue on palpation and CT/XR Manage: surg debridement, IV abx
30
Necrotizing fascitis
``` Strep, Kleb, Clostrid, E.coli, Staph Infection of fascia Type 1: polymicrob Type 2: group a strep Type 3: gas gangrene Marked systemic toxicity and pain out of proportion to local findings ```
31
Post surgical pneumonia
Most common pulmonary comp for pt. who die after surgery Usually 2/2 aspiration of gram - bact. Sx/s: fever, tachyP, increased secretions, consolidation on PE
32
Dehiscence
Surgical complication when wound ruptures along a surgical incision Often result from using too few sutures
33
Evisceration
Rupture of all layers of the abdominal wall and extrustion of abdominal viscera Most common on 5-8th day PostOpp
34
Atelectasis
Complete or partial collapse of a lung or a lobe Most common surgical pulmonary complication 25% Most freq: old, OW, smokers, Sx/s: vent/profusion mismatch, low O2
35
Ileus
disruption of normal propulsive ability of the GI tract | Caused by failure of peristalsis rather than mechanical obstruction
36
Fecal impaction
Most common in elderly and with opioid use
37
Post op anemia
Result of gastric operation Iron absorption in proximal tract Intrinsic factor needed for B12 absorption
38
IV phlebitis
Inflammation of IV site entry One of the most common causes of post op fever Day 3ish Tx: removal of IV at first sign of it
39
Post op fever
Occurs in about 40% of pt. post major surgery 48 hours: IV phleb, Pneumonia, UTI >5 days: wound infection
40
Post op DVT
Surgery increases risk 21 times | DVT most common source of PE
41
Upper abdominal pain
``` Fore gut: esophagus liver gallbladder pancreas stomach duodenum ```
42
Midline periumblicial pain
``` Midgut pain: small intestine cecum appendix ascending colon ```
43
Lower abdominal pain
Hindgut: descending colon sigmoid colon rectum
44
Ruptured spleen
Eti: commonly blunt trauma S/s: Kehr's sign: (blood leaking->abd pain radiates to left shoulder/neck Tenderness with palp of LUQ 9-10th rib Splenomegaly
45
Perforated bowel
Eti: commonly: diverticulitis & colonoscopies S/s: Sudden onset of severe agonizing mid/low abd pain Abdomen is rigid and tender
46
Choelithiasis/Cholecystitis
``` 4F's: Fat, female, forty, fertile s/s: biliary colic, RUQ pain. episodes of pain Pain may refer to scapula Murphy's sign. Ultra sound ```
47
Peritonitis
Eti: Preexisting large-volume ascites - 2nd: appendicitis, perf bowel/ulcer divertic, trauma Positive peritoneal sign Dx: CBC, blood cult, abd paraC for gram stain
48
Bowel obstruction etiology
Small bowel 3 most common: Adhesion (65-75%), hernias, neoplasm Large bowel: 15%
49
Bowel obstruction s/s
High pitched bowel sounds or absence of them Crampy pain, occurs in cycles Classic: vomiting, distention, obstipation (severe constipation)
50
Colon cancer
3rd most common men and women Majority asymptomatic Subclinical bleeding-> asymptomatic iron deficiency anemia Dx: colonoscopy
51
Diverticulitis
More common in colon Remains asymptomatic in 80%, incidentally found Mild tenderness in LLQ
52
Volvulus
``` Rotation of a segment of intestine Surgical emergency S/s: Severe intermittent colicky pain that begins in the right abdomen and becomes continous Dx: Coffee bean sign in cecum Barium enema - > Bird beak sign ```
53
Appendicitis
Gangrene and perforation can occur in about 24 hours Progression of symptoms is key Begin: vague midabdominal/ periumbilical discomfort N/V/indigestion Pain continuous but not severe with mild cramping Pain shifts to RLQ, causing discomfort on moving, walking etc. Localized tenderness (McBurney), guarding, rebound tenderness
54
Pilonidal disease
``` Chronic gland infection of the gluteal cleft 3 types - Acute, chronic, recurrent S/s: pain and swelling Tx: I&D ```
55
Hemorrhoids, internal
Bleeding, pressure-like pain, prolapse Can have sig blood loss and show symptoms of anemia Dx: DRE to rule out mass lesions or malignancy Tx: grade 1: fiber, fluid, possible laxitive grade 2-3: rubber band ligation grade 4: excisional hemorrhoidectomy
56
Hemorrhoid internal grades
Grade 1: no prolapse Grade 2: prolapse that spontaneously reduces Grade 3: prolapse that requires manual reduction Grade 4: prolapse that is not reducible
57
Anorectal fistulas
Chronic drainage of mucus and blood, typically a history of anorectal abcess. Occur in 50% of anal abcesses Image: MRI choice Tx: fistulotomy, lays flat the tract
58
Perirectal abcess
Acute pain, swelling, possible fever Occasional leakage of pus and mucus Dx: may have elevated WBC, history and physical usually all that is needed. MRI if necessary Tx: I&D
59
Carcinoma of the breast
s/s: single, nontender, firm to hard mass with ill-defined margins Later s/s: skin or nipple retraction, axillary lymphA, breast enlargement, erythema, edema, pain, fixation of the mass
60
Simple mastectomy
removal of entire breast, leaving pectoralis muscle not all the lymphnodes
61
Modified radical mstectomy
Removal of breast, leaving pectoral muscle, taking axillary lymphnodes
62
Fibroadenoma
Most frequent in young women within 20 years of puberty | Typically: round or ovoid, rubber, discrete, relatively mobile, non-tender 1-5 cm
63
Mitral regurgitation
Associated with pulmonary congestion and low cardiac output S/s: dyspnea, poor exercise tolerance, fatigue PE: displaced PMI, S3 gallop over apex XR: shows cardiomegally Echo is the mainstay of diagnosis
64
Mitral valve stenosis
Eti: most common cause: rheumatic fever s/s: mid diastolic rumble best heard over apex opening snap can be heard in beginning of disease
65
Aortic stenosis
Eti: most common senile calcific aortic stenosis s/s: gradual decrease in exercise tolerance, syncopy, angina, dyspnea on exertion Ausc: harsh ejection murmur (heard best base of heart)
66
Aortic insufficiency
S/s: most pt. don't develop symp until LV dialation PE: water hammer pulse (head bob with heart beat) Ausc: High-pitched blowing diastolic murmur immediately after S2
67
Thoracic aortic aneurysm
Abrupt tearing sensation in chest radiating to the back | UE pulse deficit and possible regurg murmur
68
AAA
AA: greater than 3 cm, surgical if greater than 5 cm Think old smokers s/s: sudden abdominal or flank pain with pulsatile mass and hypertension Dx: FAST or Ct if patient is stable Tx: reduce HTN with BB and nitroprusside, vascular surgery
69
Mesenteric ischemia
patients > 60 (afib, CHF, recent MI) Abdominal pain out of proportion with clinical presentation Intestinal pain after eating, relieved by vomiting Progression: N?V, bloody diarrhea, peritonitis.

Allergy, immunology, infection (12 decks)

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