Surgery Flashcards
(128 cards)
1
Q
How long after an MI should a patient wait to have surgery?
A
6 mos
2
Q
What are the 6 factors of the RCRI?
A
- Ischemic heart dz
- CHF
- Stroke or TIA
- Diabetic on insulin
- CKD (creatinine >2)
- Vascular, intraperitoneal, or intrathoracic surgery
3
Q
RCRI > __ indicate increased risk for cardiac death and require perioperative beta blocker?
A
2
4
Q
If the patient is under age 35 with no history of cardiac disease, what’s the only preop test needed?
A
EKG
5
Q
What intubation is used for patients with facial trauma?
A
Cricothyroidotomy
6
Q
What intubation is used for patients with cervical spine injury?
A
Flexible bronchoscopy
7
Q
What are the SIRS criteria?
A
- Body temp <36 or >38
- HR >90
- Tachypnea >20 or PCO2 <32
- WBC <4000 or >12,000
8
Q
What does it mean when a patient has 2 SIRS criteria?
A
SIRS
9
Q
What does it mean when a patient has 2 SIRS criteria + source of infection?
A
Sepsis
10
Q
What does it mean when a patient has 2 SIRS criteria + source of infection + organ dysfunction?
A
Severe sepsis
11
Q
What does it mean when a patient has 2 SIRS criteria + a source of infection + organ dysfunction + hypotension?
A
Septic shock
12
Q
What’s the best way to differentiate brain abscess from meningitis?
A
Stiff neck
13
Q
What’s the best initial tx for an epidural abscess?
A
Steroids
14
Q
What traumatic dx presents with raccoon eyes and CSF dripping from ear?
A
Basilar skull fracture
15
Q
What’s the best diagnostic test for basilar skull fracture?
A
CT
16
Q
If it seems like a PE but there’s tracheal deviation, what is it?
A
Tension pneumothorax
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”
18
Q
Can hemorrhagic pancreatitis occur as a result of trauma?
A
Yes
19
Q
What is the FAST scan?
A
Focused Assessment with Sonography for Trauma
20
Q
What’s the first thing to do in abdominal trauma?
A
FAST scan
21
Q
What dx presents with acute LUQ pain that radiates to L shoulder and tenderness with splenomegaly?
A
Splenic infarction
22
Q
Should patients have abx and splenectomy for splenic abscess?
A
Yes
23
Q
What sign is bruising around the umbilicus?
A
Cullen sign
24
Q
What’s the differential for the Cullen sign?
A
Hemorrhagic pancreatitis vs ruptured abdominal aortic aneurysm
25
What sign is bruising in the flank?
Grey Turner sign
26
What does Grey Turner sign mean?
Retroperitoneal hemorrhage
27
What sign is pain in the L shoulder?
Kehr sign
28
What does the Kehr sign mean?
Splenic rupture
29
What sign is dull percussion on the L and shifting dullness on the R?
Balance sign
30
What does the Balance sign mean?
Splenic rupture
31
What's the best next step in a patient with acute mesenteric ischemia?
Angiography
32
Does ischemic colitis cause bloody diarrhea?
Yes
33
What's the biggest risk factor for acute mesenteric ischemia?
Afib
34
What's the tx for median arcuate ligament syndrome?
Surgical decompression of the celiac artery
35
What's the best method to diagnose median arcuate ligament syndrome?
Duplex ultrasonography
36
What dx can cause a clavicular snap crackle pop?
Boorhave (full thickness esophageal tear from wretching)
| "Wretch like a thick boar"
37
What's the most common cause of esophageal perforation?
Iatrogenic
38
What's the best diagnostic test for esophageal perforation?
Esophogram using gastrografin
39
What's a complication of esophagus repair?
Mediastinitis
40
Gastric perforation is most commonly due to ______ ______ disease?
Peptic ulcer
41
What might free air under the diaphragm indicate?
Gastric perforation
42
T/F: barium enema and colonoscopy are contraindicated in diverticulitis due to an increased incidence of perforation?
True
43
Abdominal pain that radiates to the back stems from what 2 emergent conditions?
1. Pancreatitis
| 2. Aortic dissection
44
What presents with severe waves of intermittent crampy abdominal pain, nausea and vomiting, fever, high pitched tinkling sounds?
Bowel obstruction
45
What's the best initial imaging test for acute ascending cholangitis?
US
46
What's the best way to treat acute ascending cholangitis?
IV abx and ERCP
47
What dx presents after cholecystectomy with fever, abdominal pain, and bilious ascites?
Bile leak
48
What's the best imaging study for bile leak?
HIDA scan
49
What can be a cause of biliary pain without any obvious cause?
Sphincter of Oddi dysfunction
50
What's the indication of a Whipple procedure?
Pancreatic cancer
51
What's the best test to diagnose pyogenic liver abscess?
US
52
What's the most common organism in pyogenic liver abscesses?
E coli
53
What's the risk factor for Klebsiella pneumoniae pyogenic liver cyst?
Colorectal cancer
54
What's the risk factor for S aureus pyogenic liver cyst?
Transarterial embolization for HCC
55
What's the risk factor for Candida pyogenic liver cyst?
Neutropenic episode
56
What's the risk factor for Burkholderia pseudomallei pyogenic liver cyst associated with?
SE Asia
57
What's the risk factor for E histolytica pyogenic liver cyst associated with?
Recent travel to Central and S America
58
What are 2 common risk factors for acalculus cholecystitis?
1. Sepsis
| 2. TPN
59
What is a pilodinal cyst?
Acute or chronic sacrococcygeal abscess arising from a skin infex
60
What's the tx for pilodinal cyst?
Incision and drainage
61
Where do most anal fissures occur?
Posterior midline
62
What is another word for rectal prolapse?
Procidentia
63
What's the dx of a patient with pain, bleeding, and a palpable rectal mass?
Rectal prolapse
64
What's the dx of a patient with Crohn's disease who presents with a red fluctuant anal mass?
Anal abscess
65
What's the surgical option if dietary measures fail at healing hemorrhoids?
Rubber band ligation
66
Acutely thrombosed external hemorrhoids can be treated by excision if the patient presents within the first __ days of symptoms?
3
67
External hemorrhoids are ____ to the dentate line?
Distal
68
What's the best initial test for suspected hydronephrosis?
US
69
What are the 4 types of male incontinence?
1. Stress
2. Urge
3. Mixed
4. Postvoid dribbling
70
What drugs are used for BPH?
Alpha blockers
71
What 3 types of drugs may worsen sx of BPH?
1. Pseudoephedrine
2. Anticholinergics
3. Calcium channel blockers
72
What type of drugs are terazosin, doxazosin, and tamsulosin?
Alpha-1-antagonists
73
What type of drugs are finasteride and dutasteride?
5-alpha-reductase inhibitors
74
What's a contraindication to circumcision?
Hypospadias
75
Does epispadias require surgery?
Yes
76
What are the 2 types of priapism?
1. Ischemic
| 2. Non-ischemic
77
What is ischemic priapism caused by?
Decreased venous flow
78
What is non-ischemic priapism caused by?
Fistula between cavernosal artery and corporal tissue; associated with trauma to the perineum
79
How do you treat ischemic priapism?
Phenylephrine injection
80
How do you treat non-ischemic priapism?
Monitor conservatively
81
What's the best treatment for hydrocele?
Watchful waiting for 12 mos, then surgery if still present
82
What is the pathophysiology of a hydrocele?
Remnant of tunica vaginalis
83
What is a varicocele?
Varicose vein in the scrotal veins causing swelling and pressure of the pampiniform plexus
84
What dx causes a dull ache and heaviness in the scrotum and looks like a bag of worms?
Varicocele
85
What dx presents with severe pain in the lower abdomen, testicles, and groin?
Testicular torsion
86
What's the best confirmatory test for testicular torsion?
US
87
When does the testicle suffer irreversible damage if it is twisted?
12 hours
88
What's the surgery for testicular torsion?
Surgery; but try manual if surgery isn't available
89
What dx is extreme groin pain that later blisters?
Fournier gangrene
90
What's the most common contraindication to bariatric surgery?
Untreated mental illness
91
What's the criteria for bariatric surgery (2)?
1. BMI 40+
| 2. BMI 35+ with >1 comorbidity
92
What's the follow-up schedule for AAA 3-4cm?
US every 2-3 years
93
What's the follow-up schedule for AAA 4-5.4cm?
US or CT every 6-12 mos
94
What's the follow-up schedule for AAA 5.5+cm?
Asymptomatic surgical repair
95
What is an aortic dissection?
When a tear in the intima creates a false lumen
96
What's the best test for aortic dissection if the patient is unstable?
TEE
97
What's the best test for aortic dissection if the patient is stable?
MRA
98
What's the best initial test for thoracic outlet syndrome?
Doppler US of subclavian vessels
99
When should surgical decompression be done with thoracic outlet syndrome?
Vascular sx, disabling pain, or neurologic weakness
100
Inguinal hernia protrudes lateral to the _______ ______ ______?
Inferior epigastric vessels
101
Which type of hernia protrudes through the femoral ring?
Femoral hernia
102
A direct hernia protrudes medial to the inferior epigastric vessels within which triangle?
Hasselbalch
103
What does the Hasselbalch triangle consist of?
1. Inferior inguinal ligament
2. Lateral inferior epigastric artery
3. Medial conjoint tendon
104
What's the 5W mnemonic for postoperative fever?
```
Wind
Water
Walking
Wound
Weird
```
105
What's the time frame in days for each of the 5W's of postoperative fever?
```
Wind: 1-2
Water: 3-5
Walking: 5-7
Wound: 7
Weird: 8-15
```
106
What does wind stand for?
Atelectasis or pneumonia
107
What does water stand for?
UTI
108
What does walking stand for?
DVT or thrombophlebitis of the IV access lines
109
What does wound stand for?
Infection, cellulitis
110
What does weird stand for?
Drug fever or abscess
111
When should you stop the following drug prior to surgery?:
| Diuretics
Withhold day of surgery
112
When should you stop the following drug prior to surgery?:
| B-blockers & CCB
Continue through
113
When should you stop the following drug prior to surgery?:
| Lipid lowering agents
Withhold day of surgery
114
When should you stop the following drug prior to surgery?:
| Inhalers
Continue through
115
When should you stop the following drug prior to surgery?:
PPI
H2 blockers
Continue through
116
When should you stop the following drug prior to surgery?:
| Oral hypoglycemics
3 days prior to surgery
117
When should you stop the following drug prior to surgery?:
| Short acting insulin
Morning of surgery
118
When should you stop the following drug prior to surgery?:
| Long acting insulin
Continue at half-dose
119
When should you stop the following drug prior to surgery?:
| Thyroid medications
Continue through
120
When should you stop the following drug prior to surgery?:
| Glucocorticoids
Stress dose for chronic use but continue through in general
121
When should you stop the following drug prior to surgery?:
| Estrogen
D/C several weeks prior
122
When should you stop the following drug prior to surgery?:
| Anti-epileptic
Continue through
123
When should you stop the following drug prior to surgery?:
| Herbal medications
Stop 1 week prior
124
When should you stop the following drug prior to surgery?:
| Nontransplant immunomodulators
DC 2 weeks prior
125
When should you stop the following drug prior to surgery?:
| Transplant immunomodulators except sirolimus
Continue all, DC sirolimus
126
What's a good initial test for PE?
Spiral CT and EKG
127
What does CT scan show in postoperative ileus?
Air fluid levels without a transition zone (as seen in SBO)
128
How can postcardiac surgery syndrome be prevented?
Colchicine after surgery
