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Allergy, immunology, infection > Surgery > Flashcards

Flashcards in Surgery Deck (69):
1

Anesthesiologist

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

2

Anesthesia assistant

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

3

Surgeon

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

4

1st Assist

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

5

Scrub tech

Can be RN or LPN
Maintains integrity and safety of the sterile field throughout the procedure

6

XR/fluoroscopy tech

Fluoroscopy = continuous XR image on monitor

7

Intern/resident/student

There to learn how to cut
Residents can do surgeries by themselves

8

Circulating nurse

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

9

Perfusionist

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

10

American society of anesthesiology
Risk assessment

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

11

Upper airway exam

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

12

Mallampati score

Grade1: easy intubation
2: see tonsilar pillars and part of uvula
3: only hard and soft palate visable
4: hard palate only visable

13

G tube

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

14

J tube

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

15

PEG tube

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

16

Pre surgery diabetes glucose level

300 = reevaluate surgery

17

Phases of wound healing 1

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

18

Phase 2 of wound healing

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

19

Phase 3 of wound healing

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

20

Phase 4 of wound healing

Remodeling
Scar formation
Myofibroblasts
Phenotypic switch to myofibroblasts from fibroblasts

21

Suture size on face

5-0 and 6-0

22

Most common surgical site infection

Staph aureus
Staph epidermidis: worry for immunocomp

23

Pathogens in sites involving intestines

E.coli
K. pneumo
Enerobacter
Bacteroides species

24

Dirty wound number of bugs

10^5

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.