Surgery Flashcards
(105 cards)
1
Q
The thyroid gland weighs?
A
20 grams
2
Q
Water constitutes _____ of total body weight.
ECF main cation?
ICF MAIN CAtion?
A
50-60%
sodium
Potassium
3
Q
Formula for total fluid requirement
A
maintenance fluid + ongoing losses + state of hydration
4
Q
Guidance for a referral to a BURN CENTER
A
Ptb > 10% TBSA
Burns involving face hands feet genitalia perineum, major joints
3rd degree burns
Electrical / chemical burns
Inhalation injury
Burn + co morbidities
Burns + trauma
No qualified personnel to handle burns (children)
Need for special social emotional rehabilitation
5
Q
CO poisoning treatment
A
100% oxygenation is gold standard
6
Q
Largest salivary gland?
A
Parotid gland
7
Q
Normal ANION GAP
A
<12mmol/L
8
Q
Na and Cl content of PNSS?
A
154 + 154
9
Q
Electrolyte content of lactated ringer?
A
NA 130 Cl 109 K 4 Ca 28 Lactate 28mEq
10
Q
How do you compute for maintenance fluid requirements?
A
A+B+C
11
Q
Approximately how much body water is lost in severe dhn?
A
11-15%
Mild-2-5%
Mod- 6-10%
12
Q
Compute for anion gap
A
Anion gap = Na - (Cl+HCO3)
Cation - anions
13
Q
Causes of NAGMA
A
H yperalimentation A cetazolimide R enal tubular acidosis D iarrhea U reteroenteric fistula P ancreaticoduodenal fistula
14
Q
Causes of HAGMA
A
M ethanol U remia D iabetic ketoacidosis P araldehyde I infection, iron and isoniazid L actic acidosis E thylene glycol S alicylates
15
Q
What is the target of decrease in sodium concentration in hypernatremic patients? In excess of this value, patients may lead to?
A
1 mEq/l/h
Overcorrection may lead to cerebral edema and HERNIATION
16
Q
What level of Hypernatremia will a patient be symptomatic?
A
At >160mEq/l
17
Q
Symptomatic hypernatremic is given what kind of saline solution? Target of increase is?
A
3% nomal saline to increase sodium at 1mEq/l/h until 130 mEq or symptoms had improve
In asymptomatic patients : 0.5 mEq/l/h
18
Q
What measures are applied for patients with high peaked T WAVES and a K level of > 5mEq/l?
A
HyPerkalemia - In ⬆️K say BING!!!
Kayexalate
B icarbonate infusion
I nsulin infusion
N ebulize with Salbutamol
G lucose
Calcium gluconate for with ecg changes
19
Q
Critical level for serum calcium
A
15mEq/l
NV : 8.5-10-5
20
Q
Hypocalcemia refractory to treatment?
A
Treat hypomagnesemia first!
21
Q
Patient asked if her weight loss is significant. How will you answer this?
A
1wk - 2% of BW
1m- 5% of BW
3m- 7.5%of BW
6m- 10% of BW
More than these values are considered severe weight loss
22
Q
Normal BMI
A
18.5 - 24.9
23
Q
This refers to the minimum caloric requirements at rest
A
BASAL ENERGY EXPENDITURE (BEE)
24
Q
Burn patients need how many grams of of protein per kg/day? Calories?
A
- 5 protein
2. 0 calories
25
What is the source of energy in short term fasting?
Lipids
26
What is the source of energy in prolonged fasting?
Ketone bodies as principal source by 24 days but becomes important fuel source for the brain by day 2
27
TPN can provide how much nutrition requirements?
1500-2800 mOsm/L
28
How much bowels can one resect before it leads to short bowel syndrome?
More than 50%
29
Most important contraindication in TPN?
Functional GI tract
30
Patient in prolonged TPN, presenting with scaly hyperpigmented lesions. Dx? Etiology?
Enterohepatic acrodermatitis secondary to ZINC deficiency
31
Patient in TPN presents with dry, sclay dermatitis and alopecia. What is deficient in this patient?
Fatty acids
32
What is a common vitamin deficiency in refeeding syndrome?
Thiamine deficiency
33
Malnourished patient presented with cardiac arrhythmias after initiation of feeding and lethargy
Refeeding syndrome -
Give first 50% of requirement on the first week to prevent this
34
How many hours after injury is a wound considered tetanus prone?
More than 6 hours
35
Components of a pancoast syndrome
Lung mass impinging on the stellate sympathetic ganglion presenting with horner's triad
P -tosis
A -nhidrosis
M -iosis
36
Maneuver done to clamp the portal triad used for hemostasis in hepatic surgery?
Pringle maneuver
37
Treatment for burn causing METABOLIC ACIDOSIS
Mefenide Acetate
38
Treatment for burn causing neutropenia
Silver sulfadiazine
39
Treatment for burns causing hyponatremia, methemoglobinema and black staining?
Silver nitrate
40
Fistula with external opening is anterior to the anal margin will have?
A short radial tract to the anterior midline
41
A fistula with an external opening more than 3 cm anterior to the anal margin will have?
A tract to the posterior margin
42
A fistula that has an external opening posterior to the anal margin will have?
A curvilinear tract to the posterior margin
43
Type of hiatal hernia with both cardia and fundus herniate?
Type III
Type IV - intestines herniate!!!
44
Type of hiatal hernia with the cardia of the stomach herniates?
Type I or sliding hernia
45
Type of hiatal hernia where the fundus of the stomach herniate?
Rolling hernia or type II
46
How many hours prior to transplant can the liver be preserved? The kidneys?
Liver -16 hours
| Kidneys - 36-40 hours
47
Poupart's ligament derived from?
External oblique
48
Osteonecrosis of the proximal femoral epiphysis of the pediatric hip and is thought to be due to vascular compromise
Legg-Calve-Perthes disease or COX PLANA
49
Orthopedic conditions related to neuropathic arthropathy that affect diabetics and alcoholics?
Charcot joints
50
Indications for repair of aortic aneurysms
1. Symptomatic
2. Asymptomatic
- >5.5 cm ascending
- >6.5 cm descending
- >5.5 cm abdominal aortic aneurysm
- rate of >1cm for thoracic and >0.5cm for abdominal aortic per year
- >5 cm in the setting of a connective tissue disorder
51
Strongest layer of the bowel wall
Submucosa
52
Strongest layer of aorta
Tunica media
53
Segment of the colon that is most prone to rupture and least prone to obstruction?
Cecum
54
Part if the colon that is most mobile and thus is most prone to volvulus?
Sigmoid colon
55
Narrowest part of the colon and is most prone to obstruction
Sigmoid
56
Thyroglossal duct cysts are most commonly located ?
In the midline at the level of the hyoid
57
Viral infection related to the development of nasopharyngeal CA
Epstein Barr virus
58
Major component of extracellular matrix in skin
Type I collagen
59
Major cell responsible for wound contraction
Myofibroblasts
60
SIRS CRITERIA
2 or more of the ff
Temp - >\=38 or 90
RR >20 OR ON MECH VENT
WBC =\> 12000 or <4000
61
Most common location for congenital diaphragmatic hernia
Left posterolateral
62
Symptoms of CHIARI I MALFORMATIONS
Usually asymptomatic but if with symptoms it includes headache, neck pain, and numbness and weakness of the extremities
63
Patient presented with caudal displacement of the lower brain stem
Chiari II malformation
64
Patient presented with cerebellar tonsil displacement
Chiari II
65
Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What would you likely find in ur PE?
PE will likely reveal an abdominal distention and high pitched bowel sounds and rushes and tinkles and tympani on percussion.
66
Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What would you likely find in an abdominal xray?
Multiple air fluid levels with dilated loops of small bowel, paucity of air in the colon and no air in the rectum
67
Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What is your impression?
Mechanical intestinal obstruction
68
Patient presented with recurrent peptic ulcer with fasting gastrin level of 1000. What is ur dx?
Zollinger -Ellison syndrome
- caused by non islet tumor that produces gastrin
- malignant tumors
69
Most common site of gastrinomas
Pancreas at the gastrinoma triangle
70
Boundaries of the gastrinoma triangle or Passaro's triangle
Junction of :
cystic and common bile ducts
Body and tail of PANCREAS
2nd and third parts of duodenum
71
What is paraphimosis?
Inability to reduce the foreskin after it has been retracted
72
Cantrell pentalogy components
CODES
```
CARDIAC ANOMALIES
OMPHALOCELE
Diaphragmatic hernia (Anterior)
Ectopia cordis
Sternal cleft
```
73
Approach to treatment with BARRETT's esophagus
Barrett with NO DYSPLASIA - surveillance every year
Barrett with LOW GRADE DYSPLASIA - surveillance every 6months
Barrett with HIGH GRADE DYSPLASIA- refer for ESOPHAGECTOMY
74
Absolute contraindications for breast conservative surgery
3Ps MD
```
Pregnancy
Prior RT
Positive margins
Multicentric
Diffuse micro calcification
```
75
Confirmatory test to dx ACHALASIA
Manometry
76
Basal caloric requirement of a normal healthy individual
25-30 kcal/kg/day
77
Single most important test in the evaluation of thyroid nodules
FNAB
78
Severe abdominal pain with normal PE
Abd pain out of proportion to PE findings is the HALLMARK OF MESENTERIC ISCHEMIA
79
Most common presentation of Meckel's diverticulum in adults?
Intestinal obstruction
80
Most common abnormality of hemostasis in surgical patients?
Thrombocytopenia
81
Risk of perforation of acute appendicitis?
25% in the first 24 hours from onset of sx then 50% by 36 hours and 75% by 48 hours
82
Most common appendicial tumor
Carcinoid tumor
83
Six Ps of acute limb ischemia?
```
Pallor
Pain
Pulselessness
Paresthesia
Paralysis
Poikilothermia
```
84
Most common location of an insulinoma?
Evenly distributed throughout the pancreas
85
Most common location of a glucagonoma?
Pancreatic tail
86
Most common cause of fever in the first 48 hours post operatively?
Atelectasis
87
What sedative medication has a caloric value?
Propofol delivers 1kcal/cc in the form of lipid
88
What electrolyte abnormalities are expected in refeeding syndrome?
Decreased levels of K, Mg and phosphate
89
Most common congenital bleeding disorder
von Willberand's disease
| - characterized by mucocutaneous disorder associated with Factor 8 deficiency
90
Interleukin related to eosinophil proliferation and airway inflammation
IL -5 secreted by mast cells and basophils
91
Most common indication for intubation?
Altered mental status
92
The goal MAP of surviving sepsis guidelines
>65mmHg
93
The most common form of Basal cell carcinoma?
Nodular form
94
Basal cell carcinoma presents more often as?
Bleeding, ulceration and itching
It arises from the BASAL LAYER OF NON KERATINOCYTES and accounts for 75% of all skin cancers
95
NPCA will classically spread to what level of neck lymph nodes?
Level 5 or posterior triangle LDs
96
HERNIATION involving a Meckel's diverticulum is also known as
LITTRE'S hernia
97
Epidural hematoma occurs due to a bleed in the?
Middle meningeal artery
Its an extra axial bleed that appears convex and presents with lucid interval most commonly related to trauma
98
Subdural hematoma occurs due to a bleed in?
Bridging veins in the dural venous sinuses
99
Which bones of the orbital wall will be involved in a blowout fracture?
Orbital plate of the maxilla
100
Most common cause of proptosis in children?
Orbital cellulitis
101
Adequate urine output monitoring in adults is? In children? In infants?
Adults -0.5 cc/kg/hr
Children -1cc/kg /hr
Infants - 2cc/kg/hr
102
MRND TYPE 1 PRESERVES?
Spinal accessory nerve
Removed: LN I-V, SCM, IJV and submandibular gland
103
MRND 2 PRESERVES?
Spinal accessory nerve and SCM
Removes: LN 1-5 and Internal jugular vein
104
MRND TYPE 3 PRESERVES?
SAN, SCM, and IJV
LN1-5 and submandibular gland is excised
105
Triangle of CALOT
Inferior border of the liver
Common hepatic duct
Cystic duct
