UT San Antonio Flashcards Preview

Surgery > UT San Antonio > Flashcards

Flashcards in UT San Antonio Deck (124):
1

Absolute contraindications to surgery

Diabetic coma
DKA

2

3 indications where nutrition is too poor to go to surgery

Albumin 20%

3

Indications of liver failure being too severe for surgery

Bili > 2
PT > 16
Ammonia > 150
Encephalopathy

4

How long should you quit smoking prior to surgery

8 weeks prior

5

6 things in Goldman's index for evaluating surgical risk

1. CHF
2. MI w/in 6 months
3. Arrythmia
4. Old (Age > 70)
5. Emergent surgery
6. Poor medical condition

6

Meds to stop before surgery

Aspiring, NSAIDS, vit E (2 weeks)
Warfarin w/in 5 days (INR needs to be

7

When should a CKD pt dialyze before surgery

24 hours pre-op

8

Insulin dose before surgery

Take 1/2 morning dose of insulin before

9

Worry of BUN > 100

Uremic platelet dysfunction leading to post-op bleeding
*normal platelet but prolonged bleeding time*

10

What is assist control vent

Sets Tidal Volume and rate, but if the patient takes a breath, the vent gives the full volume

11

Important vent setting for weaning pt off

Pressure support
*Pt rules rate but a boost of pressure is given*

12

Most efficient setting to change on a vent? Why?

Tidal volume - more efficient that FiO2

13

Hypernatremia fluid

D5W or hypotonic fluid

14

QT interval for hyper vs hypocalcemia

Shortened in hyper
Prolonged in hypo

15

signs of hypokalemia

Paralysis, ileus, ST depression, U waves

16

Maintenance IVFs

D5 1/2 NS + 20 KCl (if peeing)

17

Maintenance IVF formula

Up to 10 kgs --> 100ml/kg/day
Next 10 kg --> 50 ml/kg/day
All above 20 --> 20 ml/Kg/day

18

TPN risks

*Acalculous cholecystitis*
Hyperglycemia
Liver dysfunction
*Zinc def*

19

Consider what in circumferential burns

Escharotomy

20

Tx for CO2 poisoning

100% O2
Hyperbaric if CO0Hb is very high

21

Unexplained clotting in older people

Think cancer

22

What disease will heparin not work in

Antithrombin III def

23

HIT tx

Leparudin or agatroban

24

Silver sulfadiazine features

Doesn't penetrate eschar
Can cause **leukopenia

25

Mafenide features

Burn ointment that penetrates eschar burt hurts like hell

26

Silver nitrate features

Burn ointment that doesn't penetrate eschar and causes HYPO K

27

1st step in electrical burn workup? Look for?

EKG
Look for myoglobinuria (Check K+ from cell lysis)

28

Zone 3 of the neck? Workup with penetrating trauma?

Above angle of mandible
Do aortography and triple endoscopy

29

Zone 2 of neck? Workup with penetrating trauma

Angle of mandible to cricoid
Do 2D dopller +/- exploratory surgery

30

Zone 1 of neck? Workup with penetrating trauma

Below cricoid
Do Aortography

31

Consider what in retroperitoneal fluid after BAT

Duodenal rupture

32

Extraperitoneal vs Intraperitoneal extrasvasation for bladder rupture

Extra: bed rest + foley
Intra: Ex-lap and surgical repair

33

4 fractures that go to OR

1. Depressed skull fracture
2. Severely depressed or angulated fracture
3. Any open Fx
4. Femoral neck or intertrochanteric fracture

34

Where is the clavicle most commonly broken

B/w middle and distal 3rd
*May need figure of 8 device*

35

Atelectasis CXR

Bilateral lower lobe fluffy infiltrates

36

Nec Fasc pattern of spread

In SubQ along Scarpa's fascia

37

Malignant hyperthermia genetic defect

Ryanodine receptor gene defect

38

Unexplained fever post op day 7 think? Dx and Tx?

Abdominal abscess
Dx by CT with triple contrast
Tx by percutaneous drainage

39

4 stages of pressure ulcers

1: skin intact but red, blanchable
2: blister or break in dermis
3: SubQ destruction into muscle
4: involvement of joint or bone

40

Low pleural glucose in transudate peracentesis

RA

41

Lights criteria

Exudate if:
LDH > 200
LHD eff/serum > 0.6
Protein eff/serum > 0.5

42

When do you operate for lung abscesses

If abs fail
Abscess > 6cm
Empyema present

43

Popcorn calcification is what in CXR?
Concentric calcification is what?

Popcorn: Hamartoma
Concentric: old granuloma

44

What do you do if a new benign nodule is found on CXR

CXR or CT scans q2mo to look for growth

45

Where does adenocarcinoma met to

Liver, bone, brain, adrenals

46

Effusion of Adenocarcinoma of the lung

Exudate with high hyaluronidase

47

Lung cancer that makes PTH-rP

Squamous cell Ca

48

Pt with ptosis that gets better after 1 min of upward gaze?

Lambert Eaton from small cell
*Ab to pre-syn Ca channels*

49

CXR showing peripheral cavitation and CT showing distant mets

Large cell carcinoma

50

3 diagnostic criteria for ARDS

1. PaO2/FiO2

51

Dysphagia worse w/ hot and cold liquids + MI like chest pain likely? Tx?

Diffuse esophogeal spasm
Tx with CCB or nitrates

52

Tx of choice for Gastric varices

BB is asymptomatic
Band if stable and symptomatic

53

Type 1 vs 2 hiatal hernia

1: sliding - GE jxn herniates into thorax, worse for GERD
2: Paraesophageal - abd pain leading to obstruction and strangulation - surgery

54

Work up for suspected gastric ulcer

Double contrast barium swallow
EGD will show punched out lesions with red margins
*Operate if lesion persists after 12 weeks of treatment

55

Gastric varices in non alcoholic could be

Splenic vein thrombosis

56

Best test for ZE syndrome

Secretin stimulation test

57

Bilious vomiting and post-prandial pain after losing lots of weight

SMA syndrome - 3rd part of the duodenum compressed by AA and SMA

58

4 steps for in pancreatitis tx

NG suction
NPO
IV rehydration
Observation

59

Bad pancreatitis prognostic factors

Old
WBC > 16k
Glc >200
LDH > 350
AST > 250
Drop in HCt, dec Ca, acidosis, hypoxia

60

Things that prevent Whipple in Pancreatic Ca

Mets (abdomen, liver, peritoneum), extension into SMA or portal vein

61

Whipple's triad for insulinoma

1.Hypoglycemic symptoms
2. Blood glucose

62

Glucagonoma Symptoms

Hyperglycemia, diarrhea, weight loss

63

VIPoma symptoms

Watery diarrhea, hypokalemia, dehydration, flushing
(looks like carcinoid)

64

Type 1 and Type 5 choledochal cysts

1. Fusiform dilation of CBD -> tx w/ excision
5. Caroli's Dz -> cysts in intrahepatic ducts (needs liver tx)

65

Dz associated with cholangiocarcinoma

PSC (ass w/ UC)

66

TIPS AE

Relieves portal HTN but worsens hepatic encephalopathy

67

HCC tumor marker

AFP

68

2nd most common benign liver tumor

Focal nodular hyperplasia

69

RUQ pain + profuse sweating and rigors + Palpable liver likely? Tx?

Entamoeba histolytica
Tx: Metronidazole (DONT DRAIN IT)

70

Pt from mexico presents with RUQ pain and large liver cysts likely? Tx?

Enchinoccus
Tx: Albendazole and sx to remove ENTIRE cyts
(rupture can lead to anaphylaxis)

71

Isolated thrombocytopenia? Tx?

ITP
Tx w/ steroids, splenectomy if relapse

72

Osmotic fragility test for

Hereditary spheroctyosis
Splenectomy can tx

73

Tx for perforated appendix abscess

Drain, Abx, and appendectomy

74

Most common site for carcinoid tumor

Appendix

75

Odd thing to look for in carcinoid

Pellagra due to niacin def
(Diarrhea, dementia, dermatitis)

76

When do you do a hemicolectomy for carcinoid of the appendix

If > 2cm, at base of the appendix, or w/ + nodes

77

When to operate on SBO

Peritoneal signs, inc WBC, or no improvement w/in 48 hrs

78

Post op ileus X-ray? od thing to cause?

Dilated loops of small bowel w/ air-fluid level
*Consider hypoK or opiates*

79

What is Ogilvie's syndrome

Massive colonic distension in eldery
If

80

First 2 steps in SBO

IVF, NG tube, bowel rest

81

Direct inguinal hernias go through

Fascia through Hasselbeck's triangle

82

Most common side for indirect inguinal hernias

Right

83

IBD that commonly involves terminal ileum

Chron's (can mimic appendicitis)

84

IBD associated with p-ANCA

UC (also higher risk of Ca)

85

Give what for any fistula in chrons

Metronidazole

86

Are diverticulosis true diverticula?

No, only outpocketings of mucosa

87

When do you do a colonoscopy after acute diverticulitis

4-6 weeks later

88

Workup for colon Ca

DRE, transrectal US (Depth of invasion), Colonoscopy
CEA for recurrence
CT for staging

89

Screening for AAA

Ab US on men 65-75 who have ever smoked

90

Post op-complications of AAA

-MI (#1 cause of death)
-Ischemic colits (bloody poo)
-ASA syndrome (preserved vib sense)
-Aortoenteric fistula (brisk GI bleeding 1-2 years later)

91

Pain out of proportion to abdominal exam

Think chronic mesenteric ischemia
Dx w/ duplex or angiography

92

Anticoagulation regimen for DVT

Heparin, then overlap with warfarin for 5 days, then warfarin for 3-6 months

93

First step in suspected PE?

Heparin!

94

Papillary thyroid Ca features

MC type, spreads via lymphatics
*Psammoma bodies*

95

Follicular thyroid Ca featuers

Spreads via blood
Take out whole thyroid

96

Hashimoto's predisposes to what thyroid cancer

Thyroid lymphoma

97

What would an adrenocortical carcinoma cause? Test to run

Virilization or feminization
Test Urine 17-ketosteroids

98

Labs in hypoparathyroidism

Dec. Ca and PTH
Inc. PO4

99

MEN 2a

PTH adenoma
Medullary thyroid cancer
Pheo

100

MEN 2b

Medullary thyroid cancer
Pheo
Marfanoid

101

Best imaging for young breast

MRI

102

Fluid asipirate in fibrocystic changes? Tx

Green or straw colored
Restrict caffeine, take Vit E, wear supportive bra

103

DCIS surgical tx

Excision with clear margins or simple mastectomy if multiple lesions

104

Breast Ca more likely to be bilateral

LCIS

105

Think of what with eczema of nipple

Pagets Dz
Do mammogram to find the mass

106

Where do you biopsy SCC

Edge of lesion

107

Worst prognosis melaonoma

Superficial spreading

108

Where do soft tissue sarcomas spread?

Hemotaogenously to LUNGS
Can do wedge resection

109

1st step in neck mass workup

MC is reactive node, so examine mouth for inflammatory lesion

110

Good prognostic factor in Hodgkin's lymphoma

Lymphocyte predom

111

Neck mass anterior to SCM likely? If lateral?

Anterior: Branchial cleft cysts
Lateral: Cystic hygroma (Turner's, Down's, Klinefelters)

112

MC salivary gland tumor

Pleomorphic adenoma
*Usually on parotid, benign but recurs*

113

MC malignant ENT cancer

Mucoepidermoid carcinoma

114

Biggest concern for congenital diaphragmatic hernia

Pulmonary hypoplasia
If dx prenatally, deliver at place with ECMO, then let lungs mature and wait 3-4 days for surgery

115

Baby born with respiratory distress and excess drooling

TE- Fistula
To dx place feeding tube, take X-ray, and see feeding tube coiled in thorax

116

High maternal what in gastroschisis

AFP

117

Intestinal atresia ass w/?

Polyhydramnios in pregnancy
Down syndrome

118

1 wk old baby w/ bilious vomiting, draws his legs up, and has and distention

Malrotation and volvulus

119

Dx and tx for meconium ileus

Gastrograffin enema

120

Current jelly stool in baby

Inussusception

121

Prostate Ca meds

Leuprolide or flutamide

122

Part of bone osteosarcoma in? Ewings sarcoma?

Metaphysics of long bones
Diaphysis in Ewings (onion skinning)

123

What is Epi for in local anesthesia

To prevent systemic absorption
Don't use in fingers, nose, penis, toes

124

What is Merperidine

Norperidine metabolite that can lower seizure threshold, esp in Renal Failure