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First Aid Step 2 🐰 > Surgery > Flashcards

Surgery Flashcards

(80 cards)

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1
Q

High Risk for surgery (5)

A
  1. age >70
  2. Pulm: FEV1< 70, PCO2>45, pulm edema
  3. Cards: MI last 30 d, poor control nonsinus arrhythmia, pathologic Q waves, severe valve D+, decompensated CHF, poor EF
  4. Renal: Cr <2 or 50% dec from baseline
  5. type of surgery: vascular or anticipated large blood loss
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2
Q

When to get preop CXR

A

> 50 yrs
Pulmonary disease (smoker, COPD, MG)
Surgery >3 hrs

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3
Q

Agent to protect kidneys from radiocontrast

A

Acetylcysteine

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4
Q

Staph is in chain or cluster

A

cluster

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5
Q

Strep is in chain or cluster

A

Chain

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6
Q

How long to wait after epidural catheter removal before restarting warfarin?

A

2 hours - need to avoid formation of epidural hematoma

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7
Q

Cause of fever: Postop day # pneumo
Major S/S
Tx

A

after 3rd day
PRODUCTIVE COUGH
Abx, bronchoscopy

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8
Q

Cause of fever: Postop day #UTI
Major S/S
Tx

A

3-5 d
FOLEY CATH
Abx, remove foley

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9
Q

Cause of fever: Postop day # wound/cath infection
Major S/S
Tx

A

5-8 d
Warm, drainage
Abx, irrigation, drainage, debridement

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10
Q

Cause of fever: Postop day # DVT

Tx

A

any time

Anticoag or IVC filter

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11
Q

Cause of fever: Postop day # PE
Major S/S
Tx

A

Any time
INCREASED A-a GRADIENT
V/Q mismatch
Anticoag/IVC filter

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12
Q

Cause of fever: Postop day # Meds
Major S/S
Tx

A

Any time
New meds, think abx
Stop Rx

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13
Q

Cause of fever: Postop day # Transfusion reaction

Tx

A

any time, check with compatibility workup

Acetaminophen, diphenhydramine, stop transfusion

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14
Q

Postop fever 5 W

A 
Wind- Pneumo
Water- UTI
Wound
Wonder drug
Walking- DVT, PE
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15
Q

Acute abdomen - previous surgery with high pitched bowel signs, crampy pain, N/V

A

Obstruction/strangulation 2/2 adhesions tumors hernias

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16
Q

Acute abdomen- LLQ pain, blood in stool

A

Diverticulitis

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17
Q

Acute Abd- hematemesis, hematochezia, sudden pain

A

Massive GI hemorrhage/perf

Need angiography w/ embolization

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18
Q

Acute abd- RLQ pain, periumbilical pain, rectal exam = tender

A

Appendicitis

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19
Q

Acute abd- severe pain out of proportion to examination

A

Mesenteric ischemia

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20
Q

Acute abd- Upper abdominal and back pain, N/V

A

Pancreatitis

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21
Q

Acute abd- amenorrhea, low abd pain

A

Ruptured ectopic

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22
Q

Acute abd- cervical motion tenderness

A

PID

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23
Q

Major causes PID

A

Chlamydia

N. gonorrhoeae

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24
Q

Cause malignant hyperthermia

A

Halothane

Succinylcholine

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25
3 factors looked at when donating organs
HLA ABO Crossmatch compatibility - antidonor Ab on recipient T cells
26
Hyperacute rejection When Cause Tx
Initial 24 hr - kidney turns bluish black after release vascular clamps during surgery Antidonor Ab in recipient = preformed (type II hypersensitivity) No Tx
27
Acute rejection When Cause Tx
6 d-1 yr Antidonor T cells in recipient Reversible with immunosuppressive Rx= pulse corticosteroids, anti T cell ab (Polyclonal AB/OKT3), Ab (basilizimab, daclizumab), immunosuppressants (tracrolimus, mycophenolate, cyclosporine)
28
Chronic rejection When Cause Tx
>1 yr Development of multiple cellular and humoral immune reactions to donor tissue Not treatable, may be able to immunosuppress
29
Reason to transplant BM
Aplastic anemia | Induction chemo
30
CI heart transplant | Survival
Pulm HTN Smoking last 6 months 5 Yrs
31
Reason to transplant lung Reason to not Survival
COPD, CF Smoking 56% 3 yr, chronic rejection common
32
Reason to transplant kidney Reason to not Where is it placed
end stage renal disease Not: DM and lupus- CI In the iliac fossa
33
Reason to transplant pancreas | Reason to not
DM I | DM II
34
Mechanism cyclosporine | Adverse effects
Helper T cell inhibition via inhibition IL-2 production | Nephrotoxic, androgenic, HTN
35
Mechanism azothioprine | Adverse effects
Inhibit T cell proliferation via inhibition of DNA and RNA synthesis Leukopenia
36
Mechanism tacrolimus | Adverse effect
Inhibitor of T cell fcn via inhibition of signaling through T cell function Nephrotoxic, neurotoxic
37
Mechanism Corticosteroids | Adverse effect
Inhibits all leukocytes via inhibition of IL1 production | Cushing, weight gain, AVN of bone
38
Mechanism Muromonab D2 (OKT3) | Adverse effect
Inhibitor T cell fcn and depletes T cell population = good for early rejection maintenance ONE TIME CYTOKINE RELEASE = fever and bronchospasm, leukopenia; only use short term
39
Rapamycin Mechanism | ADverse effect
Helper T cell inhibition | Thrombocytopenia, hyperlipidemia
40
Mycophenolic acid mechanism | Adverse effect
Inhibits T cell proliferation | Leukopenia, GI toxicity
41
Antithymocyte globulin mechanism | Adverse effect
Depletes T cell population - good for early rejection maintenance Serum sickness, short term only
42
Hydroxychloroquine mechanism | Adverse effect
Inhibit antigen processing= GVH | Visual disturbances
43
Thalidomide mechanism | Adverse effect
Inhibits T cell fcn and migration - GVH | Sedation, constipation, teratogenic
44
RUQ pain
Gallbladder Liver disease (abscess) Fitz Hugh Curtis Hepatic adenoma- young woman + OCP
45
LUQ
Spleen | PUD
46
RLQ
Appendix Ileocecal - Crohn Adnexal
47
Epigastric
Stomach- penetrating ulcer, gastric carcinoma | Pancreas
48
Diffuse
Bowel obstruction Peritonitis Mesenteric ischemia
49
Elderly pt with hypercalcemia, constipation, abdominal pain
Multiple myeloma
50
Adrenal masses: 3 conditions
Pheo Cushing syndrome Conn syndrome
51
Flushing, HTN, sweating
Pheochromocytoma
52
Moon facies, elevated serum Na, HTN, truncal obesity, ABD striae
Cushing syndrome
53
HTN, elevated serum Na, decreased serum K, metabolic alkalosis
Conn syndrome - secrete aldosterone
54
Murphy sign
Cessation of inspiration during palpation of RUQ | Cholecystitis
55
Labs cholelithiasis vs cholecystitis vs choledocholithiasis vs cholangitis
Cholelithiasis: no change Cholecystitis: Inc WBC Choledocholithiasis: Inc bili, ALP, ?AST/ALT Cholangitis: Inc AST, ALT, bili, ALP, GGT, WBC
56
Hernia through inner and outer inguinal ring; is lateral to epigastric vessels and into scrotum or labial region because of patent processus vaginalis (congenital defect)
Indirect
57
Hernia protrudes medial to inferior epigastric vessels because of weakness in abd mm of Hesselbach triangle
Direct
58
Hernia through gemoral ring onto anterior thigh below inguinal ring
Femoral
59
Mos common in both sexes
Indirect
60
More common in women
Femoral
61
Most susceptible to incarceration and strangulation
Femoral
62
Incarceration vs strangulation
Incarceration: swollen and edematous, most common cause SBO if never had abd surgery and 2nd most common if have had surgery Strangulation: blood supply cut off, necrosis can occur
63
Meckel can put at risk for
Volvulus | Intussusception
64
Dx Meckel
Technetium-99 scan
65
Pancreatic pseudocyst vs abscess
Pseudocyst: circumscribed peripancreatic fluid collection of pancreatic enzymes, blood, necrotic tissue (complication of pancreatitis, if severe must be drained) Abscess: collection of pus resulting from tissue necrosis and infection that presents with abd pain, fever, leukocytosis 1-2 wks after pancreatitis; Tx drainage percutaneousl or surgically
66
After splenectomy, what vaccines?
H flu Pneumococcal Meningococcal
67
Open pneumothorax
Open defect in chest wall that causes poor ventilation and oxygenation Tx: intubate, Positive P ventilation, close wound on 3 sides only - allow extra P to escape
68
No breathe sounds on affected side, hypertympanic on affected side, hypotension, distended neck veins
Tension pneumo
69
Tx tension pneumo
Needle thoracentesis 2nd intercostal space at midclavicular line w/ chest tube
70
Hypotension, distended neck veins, mufled heart sounds, pulsus paradoxes, normal breat sounds
Cardiac tamponade
71
Decreased breath sounds on affected side, dull percussion, hypotension or collapsed neck veins, tachycardia
Massive hemothorax
72
Risk factors Fournier's gangrene
``` DM Alcohol use Immunocompromised state Recent hx indwelling catheter Perirectal infection ```
73
Tx superficial thrombophlebitis
NSAID
74
Localized extremity pain and redness, cordlike area of induration, erythema, tenderness
Superficial thrombophlebitis
75
Test for C diff colitis Fastest Best
Fastest: Proctoscopy Best: C diff ELISA
76
Tx C diff colitis
Metronidazole first line | Vancomycin oral 2nd- expensive
77
Blood loss amt and % for class I, II, III, IV
1: 2000/ >40% | Transfuse stage 3&4
78
Basiliximab and Dacluzimab: monoclonal ab to what receptor
IL2
79
Methotrexate
Folic acid antagonist
80
OKTS Ab to what recptor
CD3 on T cells

First Aid Step 2 🐰 (22 decks)

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