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Surgery Flashcards

1
Q

How long after an MI should a patient wait to have surgery?

A

6 mos

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2
Q

What are the 6 factors of the RCRI?

A
  1. Ischemic heart dz
  2. CHF
  3. Stroke or TIA
  4. Diabetic on insulin
  5. CKD (creatinine >2)
  6. Vascular, intraperitoneal, or intrathoracic surgery
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3
Q

RCRI > __ indicate increased risk for cardiac death and require perioperative beta blocker?

A

2

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4
Q

If the patient is under age 35 with no history of cardiac disease, what’s the only preop test needed?

A

EKG

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5
Q

What intubation is used for patients with facial trauma?

A

Cricothyroidotomy

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6
Q

What intubation is used for patients with cervical spine injury?

A

Flexible bronchoscopy

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7
Q

What are the SIRS criteria?

A
  1. Body temp <36 or >38
  2. HR >90
  3. Tachypnea >20 or PCO2 <32
  4. WBC <4000 or >12,000
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8
Q

What does it mean when a patient has 2 SIRS criteria?

A

SIRS

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9
Q

What does it mean when a patient has 2 SIRS criteria + source of infection?

A

Sepsis

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10
Q

What does it mean when a patient has 2 SIRS criteria + source of infection + organ dysfunction?

A

Severe sepsis

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11
Q

What does it mean when a patient has 2 SIRS criteria + a source of infection + organ dysfunction + hypotension?

A

Septic shock

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12
Q

What’s the best way to differentiate brain abscess from meningitis?

A

Stiff neck

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13
Q

What’s the best initial tx for an epidural abscess?

A

Steroids

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14
Q

What traumatic dx presents with raccoon eyes and CSF dripping from ear?

A

Basilar skull fracture

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15
Q

What’s the best diagnostic test for basilar skull fracture?

A

CT

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16
Q

If it seems like a PE but there’s tracheal deviation, what is it?

A

Tension pneumothorax

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17
Q

Tension pneumothorax ____ the trachea _____ the involved lung?

A

Pushes the trachea away from the involved lung

“There’s so much tension, I need to run away”

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18
Q

Can hemorrhagic pancreatitis occur as a result of trauma?

A

Yes

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19
Q

What is the FAST scan?

A

Focused Assessment with Sonography for Trauma

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20
Q

What’s the first thing to do in abdominal trauma?

A

FAST scan

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21
Q

What dx presents with acute LUQ pain that radiates to L shoulder and tenderness with splenomegaly?

A

Splenic infarction

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22
Q

Should patients have abx and splenectomy for splenic abscess?

A

Yes

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23
Q

What sign is bruising around the umbilicus?

A

Cullen sign

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24
Q

What’s the differential for the Cullen sign?

A

Hemorrhagic pancreatitis vs ruptured abdominal aortic aneurysm

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25
Q

What sign is bruising in the flank?

A

Grey Turner sign

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26
Q

What does Grey Turner sign mean?

A

Retroperitoneal hemorrhage

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27
Q

What sign is pain in the L shoulder?

A

Kehr sign

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28
Q

What does the Kehr sign mean?

A

Splenic rupture

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29
Q

What sign is dull percussion on the L and shifting dullness on the R?

A

Balance sign

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30
Q

What does the Balance sign mean?

A

Splenic rupture

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31
Q

What’s the best next step in a patient with acute mesenteric ischemia?

A

Angiography

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32
Q

Does ischemic colitis cause bloody diarrhea?

A

Yes

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33
Q

What’s the biggest risk factor for acute mesenteric ischemia?

A

Afib

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34
Q

What’s the tx for median arcuate ligament syndrome?

A

Surgical decompression of the celiac artery

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35
Q

What’s the best method to diagnose median arcuate ligament syndrome?

A

Duplex ultrasonography

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36
Q

What dx can cause a clavicular snap crackle pop?

A

Boorhave (full thickness esophageal tear from wretching)

“Wretch like a thick boar”

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37
Q

What’s the most common cause of esophageal perforation?

A

Iatrogenic

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38
Q

What’s the best diagnostic test for esophageal perforation?

A

Esophogram using gastrografin

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39
Q

What’s a complication of esophagus repair?

A

Mediastinitis

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40
Q

Gastric perforation is most commonly due to ______ ______ disease?

A

Peptic ulcer

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41
Q

What might free air under the diaphragm indicate?

A

Gastric perforation

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42
Q

T/F: barium enema and colonoscopy are contraindicated in diverticulitis due to an increased incidence of perforation?

A

True

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43
Q

Abdominal pain that radiates to the back stems from what 2 emergent conditions?

A
  1. Pancreatitis

2. Aortic dissection

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44
Q

What presents with severe waves of intermittent crampy abdominal pain, nausea and vomiting, fever, high pitched tinkling sounds?

A

Bowel obstruction

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45
Q

What’s the best initial imaging test for acute ascending cholangitis?

A

US

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46
Q

What’s the best way to treat acute ascending cholangitis?

A

IV abx and ERCP

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47
Q

What dx presents after cholecystectomy with fever, abdominal pain, and bilious ascites?

A

Bile leak

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48
Q

What’s the best imaging study for bile leak?

A

HIDA scan

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49
Q

What can be a cause of biliary pain without any obvious cause?

A

Sphincter of Oddi dysfunction

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50
Q

What’s the indication of a Whipple procedure?

A

Pancreatic cancer

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51
Q

What’s the best test to diagnose pyogenic liver abscess?

A

US

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52
Q

What’s the most common organism in pyogenic liver abscesses?

53
Q

What’s the risk factor for Klebsiella pneumoniae pyogenic liver cyst?

A

Colorectal cancer

54
Q

What’s the risk factor for S aureus pyogenic liver cyst?

A

Transarterial embolization for HCC

55
Q

What’s the risk factor for Candida pyogenic liver cyst?

A

Neutropenic episode

56
Q

What’s the risk factor for Burkholderia pseudomallei pyogenic liver cyst associated with?

57
Q

What’s the risk factor for E histolytica pyogenic liver cyst associated with?

A

Recent travel to Central and S America

58
Q

What are 2 common risk factors for acalculus cholecystitis?

A
  1. Sepsis

2. TPN

59
Q

What is a pilodinal cyst?

A

Acute or chronic sacrococcygeal abscess arising from a skin infex

60
Q

What’s the tx for pilodinal cyst?

A

Incision and drainage

61
Q

Where do most anal fissures occur?

A

Posterior midline

62
Q

What is another word for rectal prolapse?

A

Procidentia

63
Q

What’s the dx of a patient with pain, bleeding, and a palpable rectal mass?

A

Rectal prolapse

64
Q

What’s the dx of a patient with Crohn’s disease who presents with a red fluctuant anal mass?

A

Anal abscess

65
Q

What’s the surgical option if dietary measures fail at healing hemorrhoids?

A

Rubber band ligation

66
Q

Acutely thrombosed external hemorrhoids can be treated by excision if the patient presents within the first __ days of symptoms?

67
Q

External hemorrhoids are ____ to the dentate line?

68
Q

What’s the best initial test for suspected hydronephrosis?

69
Q

What are the 4 types of male incontinence?

A
  1. Stress
  2. Urge
  3. Mixed
  4. Postvoid dribbling
70
Q

What drugs are used for BPH?

A

Alpha blockers

71
Q

What 3 types of drugs may worsen sx of BPH?

A
  1. Pseudoephedrine
  2. Anticholinergics
  3. Calcium channel blockers
72
Q

What type of drugs are terazosin, doxazosin, and tamsulosin?

A

Alpha-1-antagonists

73
Q

What type of drugs are finasteride and dutasteride?

A

5-alpha-reductase inhibitors

74
Q

What’s a contraindication to circumcision?

A

Hypospadias

75
Q

Does epispadias require surgery?

76
Q

What are the 2 types of priapism?

A
  1. Ischemic

2. Non-ischemic

77
Q

What is ischemic priapism caused by?

A

Decreased venous flow

78
Q

What is non-ischemic priapism caused by?

A

Fistula between cavernosal artery and corporal tissue; associated with trauma to the perineum

79
Q

How do you treat ischemic priapism?

A

Phenylephrine injection

80
Q

How do you treat non-ischemic priapism?

A

Monitor conservatively

81
Q

What’s the best treatment for hydrocele?

A

Watchful waiting for 12 mos, then surgery if still present

82
Q

What is the pathophysiology of a hydrocele?

A

Remnant of tunica vaginalis

83
Q

What is a varicocele?

A

Varicose vein in the scrotal veins causing swelling and pressure of the pampiniform plexus

84
Q

What dx causes a dull ache and heaviness in the scrotum and looks like a bag of worms?

A

Varicocele

85
Q

What dx presents with severe pain in the lower abdomen, testicles, and groin?

A

Testicular torsion

86
Q

What’s the best confirmatory test for testicular torsion?

87
Q

When does the testicle suffer irreversible damage if it is twisted?

88
Q

What’s the surgery for testicular torsion?

A

Surgery; but try manual if surgery isn’t available

89
Q

What dx is extreme groin pain that later blisters?

A

Fournier gangrene

90
Q

What’s the most common contraindication to bariatric surgery?

A

Untreated mental illness

91
Q

What’s the criteria for bariatric surgery (2)?

A
  1. BMI 40+

2. BMI 35+ with >1 comorbidity

92
Q

What’s the follow-up schedule for AAA 3-4cm?

A

US every 2-3 years

93
Q

What’s the follow-up schedule for AAA 4-5.4cm?

A

US or CT every 6-12 mos

94
Q

What’s the follow-up schedule for AAA 5.5+cm?

A

Asymptomatic surgical repair

95
Q

What is an aortic dissection?

A

When a tear in the intima creates a false lumen

96
Q

What’s the best test for aortic dissection if the patient is unstable?

97
Q

What’s the best test for aortic dissection if the patient is stable?

98
Q

What’s the best initial test for thoracic outlet syndrome?

A

Doppler US of subclavian vessels

99
Q

When should surgical decompression be done with thoracic outlet syndrome?

A

Vascular sx, disabling pain, or neurologic weakness

100
Q

Inguinal hernia protrudes lateral to the _______ ______ ______?

A

Inferior epigastric vessels

101
Q

Which type of hernia protrudes through the femoral ring?

A

Femoral hernia

102
Q

A direct hernia protrudes medial to the inferior epigastric vessels within which triangle?

A

Hasselbalch

103
Q

What does the Hasselbalch triangle consist of?

A
  1. Inferior inguinal ligament
  2. Lateral inferior epigastric artery
  3. Medial conjoint tendon
104
Q

What’s the 5W mnemonic for postoperative fever?

A 
Wind
Water
Walking
Wound
Weird
105
Q

What’s the time frame in days for each of the 5W’s of postoperative fever?

A 
Wind: 1-2
Water: 3-5
Walking: 5-7
Wound: 7
Weird: 8-15
106
Q

What does wind stand for?

A

Atelectasis or pneumonia

107
Q

What does water stand for?

108
Q

What does walking stand for?

A

DVT or thrombophlebitis of the IV access lines

109
Q

What does wound stand for?

A

Infection, cellulitis

110
Q

What does weird stand for?

A

Drug fever or abscess

111
Q

When should you stop the following drug prior to surgery?:

Diuretics

A

Withhold day of surgery

112
Q

When should you stop the following drug prior to surgery?:

B-blockers & CCB

A

Continue through

113
Q

When should you stop the following drug prior to surgery?:

Lipid lowering agents

A

Withhold day of surgery

114
Q

When should you stop the following drug prior to surgery?:

Inhalers

A

Continue through

115
Q

When should you stop the following drug prior to surgery?:
PPI
H2 blockers

A

Continue through

116
Q

When should you stop the following drug prior to surgery?:

Oral hypoglycemics

A

3 days prior to surgery

117
Q

When should you stop the following drug prior to surgery?:

Short acting insulin

A

Morning of surgery

118
Q

When should you stop the following drug prior to surgery?:

Long acting insulin

A

Continue at half-dose

119
Q

When should you stop the following drug prior to surgery?:

Thyroid medications

A

Continue through

120
Q

When should you stop the following drug prior to surgery?:

Glucocorticoids

A

Stress dose for chronic use but continue through in general

121
Q

When should you stop the following drug prior to surgery?:

Estrogen

A

D/C several weeks prior

122
Q

When should you stop the following drug prior to surgery?:

Anti-epileptic

A

Continue through

123
Q

When should you stop the following drug prior to surgery?:

Herbal medications

A

Stop 1 week prior

124
Q

When should you stop the following drug prior to surgery?:

Nontransplant immunomodulators

A

DC 2 weeks prior

125
Q

When should you stop the following drug prior to surgery?:

Transplant immunomodulators except sirolimus

A

Continue all, DC sirolimus

126
Q

What’s a good initial test for PE?

A

Spiral CT and EKG

127
Q

What does CT scan show in postoperative ileus?

A

Air fluid levels without a transition zone (as seen in SBO)

128
Q

How can postcardiac surgery syndrome be prevented?

A

Colchicine after surgery

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