Surgery Clerkship 2 Flashcards
(160 cards)
1
Q
How long does Vicryl retain its strength?
A
- 60% at 2 weeks
- 8% at 4 weeks
2
Q
What is a taper-point needle used for?
A
Suturing soft tissues other than skin (GI tract, muscle, peritoneum, fascia)
3
Q
What are conventional cutting needles used for?
A
Suturing SKIN
4
Q
Shape of a conventional cutting needle
A
Triangular body with sharp edge
5
Q
Shape of a taper-point needle
A
Round body
6
Q
Minimum number of throws for silk
A
3
7
Q
Minimum number of throws for catgut
A
4
8
Q
Minimum number of throws for Vicryl, Dexon, and other braided synthetics
A
4
9
Q
Minimum number of throws for Nylon, polyester, polypropylene, PDS, and Maxon
A
6
10
Q
How long should suture be left in the face?
A
3-5 days
11
Q
How long should suture be left in the extremities?
A
10 days
12
Q
How long should suture be left in the joints?
A
10-14 days
13
Q
How long should suture be left in the back?
A
14 days
14
Q
How long should suture be left in the abdomen?
A
7 days
15
Q
In which group of patients should sutures be left in longer than normal?
A
Those on steroids
16
Q
When drawing blood from the femoral vein, do you place the needle medial or lateral to the femoral pulse? How can you remember?
A
- MEDIAL
- Remember “NAVEL” from lateral to medial
- Nerve, Artery, Vein, Empty space Lymphatics
17
Q
How can you clinically confirm NGT placement in the stomach?
A
- Inject air into the NGT and auscultate over the stomach
- You will hear a “swish” if the NGT is in place
18
Q
What must you obtain and examine before using an NGT for feeding?
A
A chest/upper abdominal x-ray
19
Q
What is the best position for a pregnant patient?
A
Left side down to take the gravid uterus off of the IVC
20
Q
“-orrhaphy” (meaning)
A
Surgical REPAIR
21
Q
“-plasty” (meaning)
A
Surgical “shaping” or formation
22
Q
Surgical “shaping” or formation (suffix)
A
“-plasty”
23
Q
Surgical repair (suffix)
A
“-orrhaphy”
24
Q
Surgical incision into an organ (suffix)
A
-otomy
25
"-otomy" (meaning)
Surgical incision into an organ
26
Surgical creation of an opening between two organs, or an organ and the skin (suffix)
-ostomy
27
"-ostomy" (meaning)
Surgical creation of an opening between two organs, or an organ and the skin
28
If a patient is on antihypertensives, should they take the drugs on the day of surgery?
Yes
29
If the patient is on an oral hypoglycemic agent, should they take the drug on the day of surgery?
Not if the patient is to be NPO on the day of surgery
30
If the patient is taking insulin, should they take it the day of surgery?
No. Only half of a long-acting insulin and start D5 NS IV
| -Check glucose levels preoperatively, operatively, and postoperatively
31
Should a patient who smokes stop before an operation?
Yes, improvement is seen 2-4 weeks after smoking cessation
32
What labs must all women of childbearing age have before entering the OR?
Beta-HCG and CBC (possible anemia from menses)
33
What preoperative medication can decrease postoperative cardiac events and death?
Beta blockers
34
What must you always order for surgical patients?
- NPO/IVF
- Preoperative antibiotics
- Type and cross blood
35
What electrolyte must be checked preoperatively if patient is on dialysis?
Potassium
36
Who gets a preoperative EKG?
Those >40 yo
37
Primary wound closure
Wound is sutured and closes immediately
38
Secondary wound closure
Wound is left open and heals over time without sutures
39
How long until a sutured wound epithelializes?
24-48 hours
40
After primary closure, when should the dressing be removed?
Anytime after POD #2
41
What inhibits wound healing?
- Infection
- Ischemia
- Diabetes mellitus
- Malnutrition
- Anemia
- Steroids
- Cancer
- Radiation
- Smoking
42
What reverses the deleterious effects of steroids on wound healing?
Vitamin A
43
- Open drain system composed of a thin rubber hose
| - Associated with increased infection rate in clean wounds
Penrose drain
44
G-tube (define)
- Gastrostomy tube
| - Used for drainage or feeding
45
J-tube (define)
- Jejunostomy tube
| - Used for feeding
46
What is a chest tube called?
Thoracostomy tube
47
Is a chest tube placed over or under the rib?
Over
48
What are the three chambers of the Pleuravac?
- Collection chamber
- Water seal
- Suction control
49
What test should be performed before feeding via any tube?
-High abdominal x-ray to confirm placement (to ensure it's not in the lung!)
50
Common cause of excessive NGT drainage
Tip of NGT is placed in duodenum and is draining pancreatic fluid and bile
51
Foley catheter with a small, curved tip to help maneuver around a large prostate
Coude catheter
52
What can be used if a patient has a urethral injury and a Foley cannot be placed?
A suprapubic catheter
53
What parts of the GI tract are retroperitoneal?
- Most of the duodenum
- Ascending colon
- Descending colon
- Pancreas
54
Border's of Calot's triangle
- Common hepatic duct
- Cystic duct
- Cystic artery
55
On average, what percentage of body weight does blood account for in adults?
7%
56
Classic signs of third spacing
- Tachycardia
| - Decreased urine output
57
When does 3rd spacing occur postoperatively?
3rd-space fluid tends to mobilize back into the intravascular space around POD #3; at this point, switch to hypotonic fluid and decrease IV rate
58
Surgical causes of metabolic acidosis due to a loss of bicarb
- Diarrhea
- Ileus
- Fistula
- High-output ileostomy
- Carbonic anhydrase inhibitors
59
Surgical causes of metabolic acidosis due to an increase in acids
- Lactic acidosis (ischemia)
- Ketoacidosis
- Renal failure
- Necrotic tissue
60
Cause of hypochloremic alkalosis
- NGT suction
| - Vomiting
61
Causes of metabolic alkalosis
- Vomiting/NGT suction
- Diuretics
- Alkali ingestion
- Mineralocorticoid excess
62
Classic acid-base finding with significant vomiting or NGT suctioning
Hypokalemic, hypochloremic alkalosis
63
Why do we have hypokalemia with loss of gastric fluid
Loss of HCl causes alkalosis, driving K+ into cells
64
Changes in vital signs associated with hypovolemia
- Tachycardia
- Tachypnea
- Initial rise in BP due to peripheral vasoconstriction, but subsequent decrease in BP
65
Insensible fluid losses
Sources of fluid loss that are not measured
- Feces
- Breathing
- Skin
66
Loss of fluid from bile, gastric losses, and small intestine losses
Remember BGS, 123:
- Bile --> 1 liter
- Gastric --> 2 liters
- Small intestine --> 3 liters
67
What comprises normal saline?
154 mEq of Cl-
| 154 mEq of Na+
68
What comprises 1/2 NS?
77 mEq of Cl-
| 77 mEq of Na+
69
What comprises 1/4 NS?
39 mEq of Cl-
| 39 mEq of Na+
70
What comprises D5W?
5% dextrose in H20
71
What electrolytes are found in lactated ringers?
```
Na
Cl
K
Ca
And lactate
```
72
100/50/20 rule for IV fluids for a 24-hour period of time
- 100 mL/kg for the first 10 kg
- 50 mL/kg for the next 10 kg
- 20 mL/kg for every kg over 20
73
4/2/1 rule for IV fluids for hourly rate
- 4 mL/kg for the first 10 kg
- 2 mL/kg for the next 10 kg
- 1 mL/kg for every kg over 20
74
Most common adult maintenance fluid
D5 1/2 NS with 20 mEq KCl/L
75
Minimal urine output for adult on maintenance IVF
0.5 cc/kg/hr
76
How many mL are in 1 tsp?
5 mL
77
What type of fluids should be given for resuscitation of intravascular volume?
Isotonic fluids
78
MC trauma resuscitation fluid
LR
79
Normal range for K+
3.5 - 5.0 mEq/L
80
Normal range for Na+
135 - 145 mEq/L
81
Normal range for Cl-
100-108
82
Normal range for bicarb
22-29
83
Normal range for glucose
70-100
84
What can happen if hyperkalemia is left untreated?
Vtach/Vfib
85
Which electrolyte abnormality can cause peaked T waves?
Hyperkalemia
86
What is the most common cause of electrolyte-mediated ileus?
Hypokalemia
87
An elderly patient goes into CHF of POD #3 after a laparotomy. What is going on?
Mobilization of the "third-space" fluid into the intravascular space, resulting in fluid overload and CHF
88
What fluid is used to replace NGT aspirate?
D5 1/2 NS with 20 KCl
89
Which pathway does PT test?
Extrinsic pathway
90
Which pathway does PTT test?
Intrinsic pathway
91
What does fresh frozen plasma replace?
Clotting factors
92
What does cryoprecipitate replace?
- Fibrinogen
- von Willebrand factor
- Some clotting factors
93
Mathematical relationship between Hgb and Hct
Hgb x 3 = Hct
94
What are general guidelines for blood transfusions?
- Acute blood loss
- Hgb < 10 with hx of CAD/COPD
- Hgb < 7 if otherwise healthy
95
Which blood type is the universal donor for PRBCs?
O negative
96
Which blood type is the universal donor for FFP?
AB
97
Define thrombocytopenia
Plt count < 100,000
98
What platelet count is associated with spontaneous bleeding?
< 20,000
99
What should plt count be before surgery?
> 50,000
100
When should "prophylactic" platelet transfusions be given?
With platelets < 10,000
101
What are the symptoms of a transfusion reaction?
- FEVER
| - Chills, nausea, hypotension, lumbar pain, chest pain, abnormal bleeding
102
Tx for transfusion hemolysis
- Stop the transfusion
- Provide fluids
- Give lasix to protect the kidneys
- Alkalinize urine
- Give pressors as needed
103
Normal life of platelets
7-10 days
104
Clotting factor that's deficient in hemophilia A
VIII
105
Clotting factor that's deficient in hemophilia B
IX
106
What can be used to correct von Willebrand's disease?
- Cryoprecipitate
| - DDAVP (Desmopressin - stimulates vWF formation)
107
Which coagulation "test" is abnormal with hemophilias A and B?
PTT
108
Pathophysiology behind Factor V Leiden disorder
The Leiden variant of Factor V cannot be inactivated by protein C
109
Signs of atelectasis
- Fever
- Decreased breath sounds with rales
- Tachypnea
- Tachycardia
110
Most common cause of fever on POD 1 and 2
Atelectasis
111
ABG findings associated with a PE
Decreased PO2 and PCO2 from hyperventilation
112
Gold standard for diagnosing a PE
Pulmonary angiogram
113
Classic EKG findings associated with a PE
- S1Q3T3
- RBBB
- Right axis deviation
- Flipped T waves or ST depression
114
Tx of PE if patient is stable
Anticoagulation
115
TX of PE if patient is unstable
- Consider thrombolytic therapy
- Consult thoracic surgeon for possible Trendelenburg operation
- Consider catheter suction embolectomy
116
Which lobe is most often involved in aspiration pneumonia of a patient in supine position?
RUL
117
Which lobe is most often involved in aspiration pneumonia of a patient in a sitting or semirecumbent position?
RLL
118
What is blind loop syndrome?
Bacterial overgrowth of the small intestine
119
Signs of DKA
- Polyuria
- Tachypnea
- Dehydration
- Confusion
- Abdominal pain
120
Which electrolyte must be closely monitored during DKA tx?
Potassium - Administration of glucose/insulin drives K+ into cells
121
Postoperative inadequate cortisol release (acute adrenal insufficiency) in the face of a stressor
Addisonian crisis
122
What typically causes Addisonian crisis
Steroid use
123
Classic lab values found in Addisonian crisis. Why?
- Decreased Na+ and Increased K+
| - From the decreased aldosterone
124
Tx of Addisonian crisis
- IVF (D5 NS)
- Hydrocortisone
- Fludrocortisone (mineralcorticoid (aldosterone) replacement)
125
Drug used for central diabetes insipidus
Vasopressin
126
Drugs used for nephrogenic diabetes insipidus
Thiazide diuretics
127
Common causes of dyspnea after central line placement
- Pneumothorax
- Pericardial tamponade
- Carotid puncture
128
What's something weird about how a postoperative MI may present?
They often present without chest pain
129
First imaging study for postoperative CVA
Heat CT to rule out hemorrhage if anticoagulation is going to be used
130
If suspicious of abdominal compartment syndrome, how can you measure the intra-abdominal pressure?
- Read intrabladder pressure
| - Use a foley catheter hooked up to manometry after istillation of 50-100 cc of water
131
What is normal intra-abdominal pressure?
< 15 mmgHg
132
What intra-abdominal pressure indicates the need for treatment?
>= 25 mmHg
133
Rubor (definition)
Redness/Erythema
134
Calor (definition)
Heat
135
Tumor (definition)
Swelling
136
Dolor (definition)
Pain
137
What can help resorption of a subacute wound hematoma?
Heat
138
How often will bloody diarrhea be present with pseudomembranous colitis?
10%
139
Classic antibiotic that causes C. difficile?
Clindamycin
140
Tx for pseudomembranous colitis
1. Flagyl (PO or IV)
| 2. PO Vancomycin if refractory to Flagyl
141
Normal daily dietary requirements for protein in adults
1 g/kg/day
142
Normal daily dietary requirements for calories in adults
30 kcal/kg/day
143
How much is basal energy expenditure increased with a severe head injury?
1.7x
144
How much is basal energy expenditure increased with severe burns?
2-3x
145
Calorie contents of fat
9 kcal/g
146
Calorie content of protein
4 kcal/g
147
Calorie content of carbohydrates
4 kcal/g
148
What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern?
Decrease carbohydrate calories and increase calories from fat
149
Major lab test used to monitor nutritional status
Prealbumin
150
Where is iron absorbed?
Duodenum
151
Where is Vit B12 absorbed?
Terminal ileum
152
Which vitamins are fat-soluble?
K
A
D
E
153
Sign of Vitamin A deficiency
Poor wound healing
154
Sign of vitamin B12/folate deficiency
Megaloblastic anemia
155
Sign of vitamin C deficiency
Poor wound healing, Bleeding gums
156
Sign of Vitamin K deficiency
- Decrease in the vit K-dependent clotting factors (II, VII, IX, and X)
- Bleeding
- Elevated PT
157
What vitamin increases the PO absorption of iron?
PO Vitamin C
158
What is the major nutrient of the small bowel?
Glutamine
159
What is the major nutrient of the colon?
Butyrate
160
What must bind B12 for absorption?
Intrinsic factor from the gastric parietal cells
