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Z MD 2 > Surgery and peri/post operative care > Flashcards

Surgery and peri/post operative care Flashcards

1
Q

what are the big 5 reasons for fever in a post-op patient

A

surgical site

IV sites

UTI

pneumonia

DVT

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2
Q

what are the guidelines regarding insulin use (in a T1DM) prior to surgery

A

take half the dose of long acting insulin on the morning of the surgery only

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3
Q

which tendons of the hand flex the DIP and PIP

A

DIP flexion = FDP

PIP flexion = FDS

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4
Q

what is the most likely diagnosis of a breast lump in a young woman

A

fibroadenoma

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5
Q

benefits of split skin graft vs full thickenss skin graft

A

large area possible

easier take

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6
Q

suture duration for face, trunk, legs, back

A

face - 5d

trunk- 7d

legs/back - 10d

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7
Q

what is the most effective way of reducing the bacterial load of a wound

A

debridement

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8
Q

commonest diagnosis of sudden onset breast lump

A

fibrocystic change

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9
Q

3 major general causes of hypotension post surgery

A

hypovolaemia

MI/CCF

epidural - peripheral vasodilation

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10
Q

epitheliazation of wounds occurs within

A

24-48 hours (why we don’t take the dressing off to take a look within the first 2 days- leave to heal)

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11
Q

benefit of negative pressure wound therapy

A

promotes angiogenesis

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12
Q

which proximal arteries predominantly make the deep and superficial arteries of the hand

A

deep - radial

superficial - ulnar

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13
Q

4 main past medical history areas you want to ask about when doing pre-op workup for anaesthesia

A

cardiovascular

respiratory

diabetes

GORD

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14
Q

difference between graft and flap

A
  • graft = transferred tissue dependent on RECIPIENT SITE
  • flap = transferred tissue INDEPENDENT of recipient site
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15
Q

which thyroid cancer shows “Annie Eyes” histologically

A

papillary thyroid carcinoma

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16
Q

explain the ASA classification

A

1 - healthy patient

2 - mild systemic disease

3 - significant or severe systemic disease

4 - severe systemic disease that is a constant threat to life

5 - moribund patient not expected to survive 24 hours with or without surgery

6 - brain dead organ donor

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17
Q

sign of deep dehiscence

A

leakage of pink serosanginous fluid

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18
Q

which IV access devices are used for chemotherapy

A

infusaport/portocath

Hickman catheter

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19
Q

what are the main investigations for breast lumps

A

mammography (>35)

US (less than 35)

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20
Q

when do we do a sentinal node biopsy vs an axillary clearance

A

axillary clearance only done now if the patient who is positive for nodes in the axilla (by sentinal node biopsy)

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21
Q

what are the % oxygen that can be delivered through the different prongs/masks etc

A

nasal prongs - 25%

hudson mask - 50%

Hudson mask + tusks = 60%

rebreathing bag - 70%

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22
Q

a sentinal node is

A

any node that is blue, hot or palpable

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23
Q

3 major outcomes of FOOSH

A

scaphoid #

Colles # - radius + ulnar #

Radial head #

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24
Q

what causes pressure sores

A

weight of patient impairing the blood supply to an area of tissue due to occlusion of vessels

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25
Q

what should you ask in a pre-operative assessment in regards to diabetes

A
  • Type of diabetes - DMCC
  • current management of DM
  • Check adequacy of control
  • diagnose complications
  • evaluate other risk factors for CVD (HTN, FHx, high cholesterol)
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26
Q

difference between follicular adenoma and follicular carcinoma

A

adenoma - intact, well formed capsule surrounding the tumour

carcinoma - capsular invasion

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27
Q

specific complications of radial head fracture

A

myositis ossificans

recurrent instability

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28
Q

indications for drains

A

prevent accumulation of fluid

prevent accumulation of air

characterize fluid

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29
Q

4 initial steps to do when faced with a patient with low urine output

A
  • check for IDC blockage
  • assess patient for hypovolaemia
  • ensure patient not bleeding
  • give fluid challenge - 500ml-1L stat
30
Q

what causes hypertrophic and keloid scars

A

exagerrated normal remodelling response to a skin wound

31
Q

what is a split skin graft

A

harvest epidermis and part of the dermis like a shave of skin

32
Q

what is the most common thyroid cancer

A

papillary thyroid cancer

33
Q

what are the causes of an acute fever (first week) post surgery

A

hospital acquired pneumonia/aspiration pneumonia

IV site infection with bacteraemia

UTI

surgical site infection

34
Q

why should you strive to achieve glycaemic control in diabetic patients pre-operatively

A
  • hyperglycaemia increases wound infection
  • hyperglycaemia impairs wound healing and worsens outcome post neruological damage/MI
  • hyperglycaemia induces an osmotic diuresis –> dehyrdation and electrolyte damage
  • T1DM may develop DKA
  • hypoglycamia may induce coma, arrhythmias and cognitive deficit
35
Q

AB of choice for prophylaxis for a surgery that will have a contaminated or clean/contaminated wound

A

single shot IV first generation cephalosporin (to get rid of skin flora)

36
Q

explain the body’s metabolic stress response to surgery/acute medical illness

A
  • elevation in catecholamines, growth hormone, glucagon, cortisol and ACTH
  • depression of insulin levels and insulin resistnace

–> leads to catabolic state (raised glucose levels, protein catabolism, lipolysis, FFA production and ketone body production)

37
Q

explain the withholding of DM medications for surgery

A
  • all oral hypoglycaemics (except metformin and long acting sulphonylureas) - withhold for the morning of surgery
  • metformin - with-hold 48 hours prior to surgery
  • long acting sulphonylurea - withhold >12 hours prior to surgery
  • basal bolus insulin - give basal insulin (normal or 2/3) and then give bolus with breakfast if afternoon surgery. Also give IV 5% dextrose
38
Q

what is the relevance of a cold or hot thyroid nodule

A

cold - more likely to be cancer

39
Q

difference between a hypertrophic and a keloid scar

A

hypertrophic - stays within margins of original wound, can improve over time, and can respond to steroid injection

keloid - extends beyond wound, progresses over time, less responsive to steroids and silicone

40
Q

What are the causes of an immedate fever post surgery

A

transfusion reaction

medication reaction

infection prior to surgery

trauma

malignant hyperthermia

41
Q

intraductal papilloma most likely presents as

A

bloody nipple discharge

42
Q

where are PICC lines/CVC/Vascath/Permcath/Portocath catheters placed

A

PICC - basilic vein

CVC - IJV or subclavian vein with tip in SVC

Vascath - IJV or femoral vein (NOT subclavian)

Permcath - IJV or EJV

Portocath - into SVC

43
Q

what are the clinical signs of ventilation

A

chest movement

breath sounds

expired air

mask fogging

capnography

pulse oximetry

44
Q

why would you do a flap instead of a graft

A
  • bed doesn’t have a sufficient vascular supply to support a graft
  • need to cover prosthetic material
  • better appearance
  • can contain muscle, bone, nerve etc
45
Q

what are the suspicious features on ultrasound for malignancy of a thyroid nodule

A

hypoechoic

microcalcification

increased vascularity

infiltrative margins

absent halo

taller than wide

46
Q

what does a fibroadenoma look like on US

A

well demarcated edges

lobulated

uniformly hypoechoic

47
Q

what are the contraindications for using a nasopharyngeal airway

A

base of skull fractures and transphenoidal surgery

48
Q

lifetime risk of breast cancer in women

A

1 in 9

49
Q

benefits of full-thickenss skin graft vs split skin graft

A

less contraction of skin

better cosmetic outcome

50
Q

what does the persistent fever vs the spiking fever mean

A

persistent - suggest drug reaction or neurosurgical

spiking - suggests abscess

51
Q

explain the maintenance fluid rule

A

4,2,1 rule

  • Give 4ml/hour/kg for the first 10kg of body weight
  • Give 2ml/hour/kg for the second 10kg of body weight
  • Remaining weight give 1ml/hour/kg
52
Q

Which IV access devices are used for haemodialysis

A

vascath

permacath

53
Q

clinical features of a fibroadenoma

A

smooth, rubbery, discrete, well-circumscribed, non-tender, mobile HORMONE DEPENDENT

54
Q

what are the stages of ventilation (from least invasive to most invasive)

A

bag and mask

bag, mask and guedel

LMA and bag

ETT and ventilator

55
Q

3 major complications of thyroid surgery

A

nerve injury (RLN and ESLN)

hypoparathyrodisim

bleeding

56
Q

what are the predictors of difficult ventilation of a patient

A

previous difficult ventilation

obesity

short, thick neck

OSA

beard

edentulous

jaw pathology

57
Q

what does the “sniffing the morning air position” do to the joints of the neck

A

cervical spine flexion

atlanto-occipital joint extension

58
Q

what are the guidelines regarding metformin use prior to surgery

A

stop 48 hours prior to surgery

59
Q

fasting guidelines for adults and infants

A

adults: 6 hours for solids 2 hours for clear fluids
infants: 3 hours for breast milk 4 hours for formula

60
Q

management of DCIS

A

surgery - can progress to breast cancer

61
Q

what is the fasting blood glucose target for dibetics for surgery

A

5-10mmol/L

62
Q

reversible causes of pulseless electrical activity

A

5 Hs and 5 Ts

Hypoxia, Hydrogen ions (acidosis), hypovolaemia, hypothermia, hypo/hyperkalaemia

Tamponade (cardiac), thrombosis (cardiac), thrombosis (pulmonary), toxins, tension pneumothorax

63
Q

what are the predictors of difficult intubation

A

history of difficult intubation

acquired conditions: RA, ankylosing sponylitis, TMJ problems, airway/neck pathology, radiation

examination findings: High Mallampati score, small inter-incisor gap, small thyromental distance, limited neck flexion, teeth, jaw protrusion or receeding jaw

64
Q

what do you do to examine the airway in regards to pre-op workup for anaesthesia

A

Mallampati score

thyromental distance

tongue size

neck circumference

range of motion of head and neck

ability to protrude mandible forwards

65
Q

classification of surgical wounds

A

clean

clean/contaminated

contaminated dirty - pus, preop infection

66
Q

medullary carcinoma is associated with which condition

A

MEN 2A or 2B

67
Q

what are the US findings of fibrocystic changes

A

thin outer membrane hypoechoic

68
Q

how do you reverse warfarin

A

prothrombinex +/- Vit K and FFP

69
Q

what is the major different between an LMA and an ETT

A

LMA - no protection against aspiration!

70
Q

what are the difference between a continuous, passive expiration and forced expiration air leak in a drain

A

continuous - leak present during both insp and exp

passive exp - leak only present in exp

forced exp - leak only present during forced exp

71
Q

treatment options for a toxic thyroid nodule

A

medication - carbimazole, PTU

surgery

radioactive iodine treatment

72
Q

what is the normal punching injury of the hand

A

Boxers #

  • fracture of the distal 5th metacarpal

Z MD 2 (15 decks)

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