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Quarter 4 finals > E-Med > Flashcards

E-Med Flashcards

1
Q

ORIF

A

Open Reduction

Internal fixation

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2
Q

CRPPF

A

Closed Reduction

Percutaneous pin fixation

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3
Q

DRUJ

A

Distal Radio-ulnar joint

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4
Q

TFCC

A

Triangular fibro-cartilage complex

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5
Q

AVN

A

Avascular necrosis

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6
Q

Incomplete FXs

A

Bowing
Greenstick
Torus

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7
Q

Physeal FX (children)

A

Salter Harris classif

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8
Q

Type 1 “S”

A

Separation

right along the physeal line

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9
Q

Type 2 “A”

A

above the line, into the shaft

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10
Q

Type 3 “L’

A

Lower, below the line into the epiphysis

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11
Q

Type 4 “T”

A

Through

through the line

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12
Q

Type 5 “R”

A

Ruined, rammed

crushed together
high impact, MVA

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13
Q

Comminuated FX

A

bunch of pieces

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14
Q

Two factors that we can control as providers to prevent Osteomyelitis

A

Surgical debridement

Proph Abx

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15
Q

Most common open fracture

A

Tibia (so close to skin)

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16
Q

Most common ABX used for open fractures

A

IV Cephazolin

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17
Q

What can you add to Cephazolin to treat open fracturess?

A

+ Aminoglycoside (like Gentamicin)

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18
Q

What do you still have to worry about with open fractures that you may think was not now a problem?

A

Compartment syndrome

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19
Q

Keep in mind with Scapula fx

A

Often another injury involved (make sure to evaluate Spine)

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20
Q

Proximal humeral fracture

A

Neer classification

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21
Q

Humerus Shaft fracture

A

Radial nerve; “wrist drop”

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22
Q

Humerus AND Forearm fracture result in

A

“Floating elbow”

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23
Q

X Rays for Humeral Shaft fracture

A

AP and

AP w external rotation

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24
Q

Most common shoulder dislocation

A

Anterior

Mechanism: sports, blow to shoulder while abducted

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25
Q

Posterior shoulder dislocation mechanism of injury

A

Seizures

Electrocution

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26
Q

Sulcus sign

Apprehension and Relocation test

A

Shoulder dislocation

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27
Q

What do you need to order to rule out Posterior shoulder dislocation?

A

Axillary view

best to see posterior dislocation

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28
Q

3 injuries associated with Anterior Shoulder dislocation

A

Bankart lesion
Hills Sachs lesion
Axillary nerve

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29
Q

Bankart lesion

A

lower part of Labrum becomes detached

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30
Q

Hills Sachs lesion

A

Fracture, depression of the humeral head

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31
Q

Axillary nerve damage

A

secondary to Anterior dislocation

Decreased Sensation to lateral aspect of shoulder and Decreased deltoid fx

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32
Q

Elbow fat pad sign

A

Be cautious of a fracture!!! signifies blood coming out of the bone

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33
Q

Nursemaid’s elbow is an example of

A

Elbow Sublux

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34
Q

Sublux vs Dislocaiton

A

Sublux: harder to detect, may spontaneously reduce

Dislocate: clinically deformed, very painful, needs immediate reduction

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35
Q

Main scan for Dislocations

A

X Ray

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36
Q

If you suspect an Avulsion injury associated with Dislocation, THEN

A

order CT

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37
Q

If you have concern for Ligament integrity

A

order MRI

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38
Q

Forearm fracture consideration

A

Suspect TWO injuries:

two FX
FX + dislocation

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39
Q

What two X Ray views to oder with Forearm fracture?

A

AP

Lateral

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40
Q

Monteggia fracture

A

Ulnar shaft + Radial head dislocarion

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41
Q

Colles fracture

A

“dinner fork”

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42
Q

Dinner fork

Colles fracture

A

DORSAL displacement

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43
Q

Smiths fracture is

A

Volar displacement

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44
Q

Dinner fork

Colles fracture mecanism

A

FOOSh

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45
Q

Snuff box pain, order _____ X Ray

A

Scaphoid view

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46
Q

Galeazzi fracture

A

DRUJ

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47
Q

Scaphoid fracture

A

Snuffbox pain

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48
Q

Complication of Scaphoid fracture

A

Avascular Necrosis

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49
Q

What part of Scaphoid is at highest risk for Avascular Necrosis?

A

Proximal aspect

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50
Q

Tx of IP Dislocation

A

Buddy tape x 2 weeks

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51
Q

Jersey finger

A

Flexor tendon rupture

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52
Q

Jersey finger

A

Flexor tendon

Usually also see Avulsion fracture

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53
Q

Jersey finger

A

ring finger most common

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54
Q

Mallet finger

A

Rupture of Extensor tendon (DIP)

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55
Q

Tx for Mallet finger (extensor tendon)

A

STAX extension splint

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56
Q

Boxer’s fracture

A

Neck of 5th MC

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57
Q

Tx for Boxer’s fracture

A

Ulnar gutter splint

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58
Q

Bennett’s fracture

A

base of 1st MC

into joint

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59
Q

Game Keepers thumb fracture

A

injury to MCP joint, —> ulnar collateral ligament tear

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60
Q

Tx for Game keepers thumb “skiers thumb”

A

Thumb spica splint

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61
Q

Stop ASA, NSAIDs, Plavix, Warfarin ___ days before surgery

A

3-5 days before

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62
Q

SCIP

A

Surgical Care Improvement Project

prevent INFECTION

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63
Q

SCIP was in response to

A

77% deaths related to infection

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64
Q

SCIP protocol

A

Proph abx 1 hr before surgery
Stop abx 24 hr after surgery, or end time 48 for Cardiac

Cardiac pts controlled 6am post op glucose measure

Approp hair removal

Colorectal pts appropriate normothermia

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65
Q

ASA classification

Predict operative risk

A

6 classes:

1: healthy
2: mild systemic dz
3: severe systemic dz
4: dz constant threat to life
5: will not survive w/o surgery
6: organs for donation

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66
Q

Mallampati Score

A

Class 1-4
Ease of intubation- how well will someone do with protecting airway?

4: toughest time

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67
Q

Pre op EKG needed for

men younger age

A

Men >45
Women >55

Known hx of Cardiac dz
Diabetes
HTN
Major surgery

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68
Q

Pulm risk assmt

A

High risk:

  • Smoking (stop 2 months before surgery)
  • COPD, Asthma
  • Thoracic/abd procedure
  • Obesity
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69
Q

Pre op assessment for those at high risk - PULMONARY

A

CXR
Pulmonary Function Tests
ABGs
Pulm consult

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70
Q

Risk of peri-op MI

A 
Prior hx:
HTN
MI
CHF
Dysrhythmia
Valvular heart dz
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71
Q

Post MI, no surgery until

A

6 months after MI

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72
Q

Highest risk peri-op MI

dont want a score higher than 10

A 
>age 70
previous MI
S3 gallop or JVD
Aortic stenosis
EKG : PVC
Abnormal labs
Emergency surgery

Total possible: 53 points

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73
Q

Pre-op Diabetes assessment

A

Elevations in glucose and A1C increases risk of post op INFECTIONS

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74
Q

Post op care for Diabetics

A

Follow Blood Sugar every 6 hours

maintain b/w 150-200

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75
Q

Adrenal insufficiency, need to cover pre-op with

A

Give Hydrocortisone

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76
Q

-otomy

A

incision into

“thoracotom”

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77
Q

-ectomy

A

removal of

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78
Q

-ostomy

A

creation of new opening

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79
Q

-plasty

A

plastic surgery

repair of something

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80
Q

-pexy

A

fixation

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81
Q

-rraphy

A

suturing or oversewing something to make it safe/more durable

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82
Q

Most common used surgical position

A

supine

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83
Q

Pelvic organs

Central lines

A

Trendelenburg

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84
Q

Upper abd viscera

A

reveres Trendelenburg

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85
Q

Sitting position

A

Cranial surgeries

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86
Q

Lithotomy

A

Urology
Gynecology
Rectal

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87
Q

Prone

A

spinal surgery only

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88
Q

Lateral position

A

Retro-peritoneal approaches

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89
Q

LaparoTOMY

A

open, large incision

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90
Q

Arthroscopy

used in Ortho

A

small incision, camera in JOINT SPACE

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91
Q

LaparoSCOPY

minimally invasive

A

VERY COMMON

use gas (CO2) to inflate peritoneum, use instruments through small incisions, video camera

Referred R shoulder pain
diaphragm stretch

92
Q

Common procedures done via LaparaSCOPY

A

Gall bladder removal
Appendectomy
Hernia repair (Inguinal, Ventral)
Nissen fundoplication

93
Q

What days are we most worried about fever/infection post-op

A

3-5

94
Q

Immediate post-op fever

within hours

A

Meds
Blood products
Malignant hyperthermia

95
Q

Acute post-op fever

first week

A

Nosocomial infection
UTI
Aspiration PNA

96
Q

Subacute post-op fever

1-4 weeks

A

Central venous catheter

97
Q

Delayed post op fever

>1 month

A

Abscess

98
Q

post op fever >102 F, quick to draw

A

CBC
UA
Cultures
CXR

on BOTH arms

99
Q

Post op fever within 48 hours

A

Atelectasis

100
Q

Wound infection

A

Group A strep

101
Q

Leakage of bowel anastomosis

A

back to OR

102
Q

Aspiration PNA

A

Pulmonary toilet

Get respiratory involved

103
Q

Clean surgical wounds

A

Leave in place 48 hours to allow for epithelialization

104
Q

Contaminated wounds

A

Packed open

Wet to moist change every 8-12 hours

105
Q

Infections post op

24-48 hours

A

Clostridium

Group A Strep

106
Q

Wound dehiscence

A

5-8 days post op
salmon colored fluid
GET BACK TO OR

potential risk for Evisceration

107
Q

Most commonly used Proph abx

A

1st and 2nd gen Cephalosporin

108
Q

Most common cause of fever within 48 hours of surgery

A

Atelectasis

109
Q

Why is atelectasis so common after surgery?

A

Surgical manipulation –> Diaphragm dysfx and Diminished surfactant activity

110
Q

Peritonitis

A

Look septic
shaking bed test

CXT
CT
US all helpful

111
Q

Intrabdominal infections

A

E.coli
Enterobacter

Laparotomy
I and D
Drainage

Broad spectrum Abx

112
Q

Bacteremia

A

fever, chills, tachy

check IV lines every 3 days to PREVENT bacteremia

113
Q

Debridement options

A

Sharp- remove w blade, often in OR, large amt tissue, infected wounds, fast, painful

Mechanical- wet to dry dressing

Autolytic- use body’s own enzymes

Enzymatic- chemicals, turn necrotic tissue into slough

Biologic- maggot

114
Q

CONTRA to using VAC drain

A 
Necrotic tissue
Untx Osteomyelitis
Fistula
CA in wound
Exposed artery/vein

otherwise, great choice

115
Q

Mayo Scissors

A

Multi-purpose “workhorse”

Straight- “suture scissors”, superficial tissue, fascia
VS
Curved- cut tendons, ligaments, muscle, heavy tissue

116
Q

Metzenbaum Scissors

aka “Metz”

A

Blunt dissection, or cut delicate tissue

NOT for suture

117
Q

Mayo Scissors

A

SUTURE scissors

118
Q

DeBakey forceps

A

Grasp fine tissue and blood vessels

Soft tissue dissection

119
Q

Adson forceps

A

with teeth
without teeth
grasp delicate tissue

120
Q

Tissue forceps w/teeth

A

“Rat tooth Forceps”

grasp HEAVIER tissue for manipulation and retraction

121
Q

Russian forceps

A

grasp DENSE tissue

hold during wound debride and closure

122
Q

MANY types of Locking forceps

A 
Mosquito
Hemostat
Kelly
Tonsil
Right angle
Ring
Babcock
Kocher
Rochester Peon
Allis
Towel clips
123
Q

Mosquito forceps

A

Fine tip

Use: clamp vessels, grasp bleeding tissue, suture-ligate vessel

124
Q

Hemostat (crile) forceps

A

Same as mosquito, just different in size

Clamp vessels, Grasp bleeding tissue, Suture-ligate vessel

125
Q

Kelly forceps

A

LARGER hemostat

Clamp large vessels, manipulate heavy tissue, soft tissue dissection

126
Q

Tonsil forceps

A

tunneling for Drain placement

127
Q

Right angle

A

Hard to reach vessels

“Tie on a passer”

128
Q

Ring forceps

A

Sponge forceps, sponge stick

Use: FOLDED SPONGE IN JAWS to retract tissue and ABSORB fluids in surgical field, or tissue removal

129
Q

Babcock forceps

A

Tubular organs

130
Q

Kocher forceps

A

TRAUMATIC
poky, will do damage to whatever it holds so it will be something you plan to retract anyway

i.e. hemostasis, hold tough cartilage, hold ribs during rib resection

131
Q

Rochester Peon clamp

A

Large KELLY
Traumatic

Use: Mesenteric (stomach organ) hemostasis, Chest tube insertion

132
Q

Allis forceps

A

Traumatic
Hold tough structures
Grasp tissue that’s going to be removed (i.e. breast tissue, thyroid)

133
Q

Towel clips

“penetrating type”

A

Traumatic
Clamp towels together
Clamp tissue for manipulation and removal
Caution- will pierce drapes, gloves, and fingers!!

134
Q

Towel clips

“Non-penetrating type”

A

Clamp drapes, towels together

135
Q

“Self retaining” Retractors

you don’t have to hold them

A

Weitlaner

Gelpi

136
Q

Weitlaner (self-retaining) Retractos

A

sharp or dull ties

137
Q

Gelpi (self- retaining) Retractors

A

sharp tips

138
Q

Retractor holders (manual) may be instructed to

A

“toe-in” bring the tips closer together, little at a time

139
Q

Types of manual retractors (MANY)

A 
Army navy
Goulet
Richardson
Malleable/ribbon
Dever
Rakes
140
Q

Types of Self-retaining Retractors

only two

A

Weitlaner

Gelpi

141
Q

Army Navy and Goulet retractor

A

Shallow, superficial retraction

142
Q

Richardson retractor

A

“Big rich” (large) and “baby rich” (small)

Common in most specialties

retracts various tissues

143
Q

Malleable/Ribbon retractors

A

Many widths
Bend to shape

Used often in ABDOMEN and CHEST

144
Q

Dever retractors

A

used in DEEP incisions

145
Q

Consider with Dever retractors

A

can use blue towel to wrap around edges if you are holding for long time bc sides may be sharp

146
Q

Rake retractors

A

Elevating subQ tissue, broad surfaces and edges

147
Q

Additional equipment

A 
Bovie 
Irrigation
Suction
Sponges
Needles
148
Q

“Bovie”

A 
used in Electrosurgery
Can do many things:
-cut
-coagulate
-desiccate
-destroy tissue
149
Q

Irrigation

A

usually saline (diff temps)

150
Q

Bulb syringe irrigation

A

irrigate wounds, wet hands for suture tyine

151
Q

Pitcher pour irrigation

A

“washout”

152
Q

Suction types

A

Yankauer
Poole
Frazier

153
Q

Yankauer suction

A

general MULTI PURPOSE suction tip

154
Q

Poole suction

A

good for LARGE VOLUME

155
Q

Frazier suction

A

very tine suction tip

156
Q

Suction-Irrigator

A

just like what it sounds like

can do both things at once

157
Q

When to stop smoking before surgery

A

8 weeks is optimal

158
Q

Post op stress response

A

“Fight or Flight”

increased SNS
Metabolism, gut motility, absorption affected

159
Q

Meds to continue throughout surgery

A

If sig withdrawal sx
Cardiovascular meds
Statins
Tight glycemic control

160
Q

Med to stop

A

Anticoags

7-10 days b4 surgery

161
Q

Assessment of Surgical risk

A

Age
Urgency of operation
Anesthetic mortality
Risk assessment

162
Q

If the surgery is emergent, how does that affect the risk for operative mortality?

A

Doubles it

163
Q

Coag disorder risk factor

A

Previous clot

Mobility

164
Q

Bleeding risk

A

Prior hx of bleeding is best predictor

165
Q

Risk for malnutrition

A

> 15% weight loss over prior 3-4 months

Albumin <3

166
Q

“Ebb and flow” of post surgery

A

hours;shock

days; catabolism (break down)

weeks; anabolism (build stuff back up)

167
Q

“Ebb”

A

Immediate
Tissue hypoperfusion (LESS blood flow)
Decrease metabolism (slow down)
Ne release

168
Q

“Flow”

Peaks at 3-5 days

A

Catabolic and anabolic

Increased CO
Increased metabolism
Hyperglycemia

169
Q

Anabolic (last part) of the “Flow”

A

Corticoid withdrawal

Repletion

170
Q

Most sensitive test of illness and perioperative morbidity

A

Prealbumin

half life 2-3 days

171
Q

Serum Transferrin can test for

A

Protein deficiency

<200

172
Q

“SQIP” or “SCIP” stands for

A

Surgical Quality Improvement Project

decreasing surgical infections with standard protocols

173
Q

Prevent complications in all of these ways:

A 
Normothermia
Proph Abx
Glucose control
Hair removal
Skin antiseptic
Oxygen
Clot prevention
174
Q

Goal temperature

A

98.6-100.4

175
Q

Glucose control

A

average 150

176
Q

Skin antiseptic

A

Chlorhexidine

or maybe Iodine

177
Q

Oxygenation preferred to remain at

A

80%

178
Q

How often to measure I&O after surgery

A

on day 1: every 4-6 hrs

after that: every 24 hrs

179
Q

Crystalloids

A

Most commonly used

Sodium is main osmotically active particle

180
Q

Colloids

A

High molecular weight

more likely to stay in vascular compartment

181
Q

Isotonic Crystalloids

  • Normal saline
  • Lactated Ringer
A

Have same salt concentration as normal cells of the body

can bolus

use when someone hasn’t been eating/drinking

182
Q

When to use Colloids?

high molecular weight, stay in vascular compartment

A

Burns
Peritonitis

when you NEED to increase volume

183
Q

Trigger number when we need to TRANSFUSE BLOOD

A

if Hg <7 : stable pts

may be lower in those with cardiac, pulm, CVA, or transplant

184
Q

When to transfuse platelets

A

Active bleeding in Thrombocytopenic (low platelet) pts

185
Q

when to use FFP

A

pts with Deficiencies in clotting factors
OR
on Anti-coags

186
Q

How many hours for epitheliazation

A

48

187
Q

How long does it take for gut to become active again

A

Small int: 24 hrs
R. colon: 48 hrs
L. colon: 72 hrs

188
Q

POD 1 fever

A

PNA, atelectasis

189
Q

POD 3-5 fever

A

UTI

190
Q

POD 4-6 fever

A

Blood clot

191
Q

POD 5-7 fever

A

Surgical site infection

OBGYN

192
Q

POD 7+

A

drug fever
IV lines or
Rxn to blood products

193
Q

Gray, dusky discoloration
Crepitence

Need aggressive surgical excision

A

Necrotizing Fasciitis

194
Q

Rupture of ALL layers and extrusion of abdominal viscera

A

Evisceration

5-8 days post op

195
Q

Meckel’s diverticulum

rule of 2s

A

Antimesenteric border of ileum (meaning opposite side of ileum)

196
Q

Mesenteric Ischemia

DEC blood flow

A

Occlusive (clot) or non-occlusive process (hypotension…etc)

197
Q

Mesenteric ischemia is most common in

A

Older pts with dz causing clot formation

198
Q

Intestinal angina

relating to Mesenteric Ischemia

A

Stomach pain worse AFTER MEALS

also: pain out of proportion, hematochezia

199
Q

Tx for Mesenteric Ischemia

A 
Aggressive IVF
NG tube
Foley catheter
Abx
Anti-coags
Surgery
200
Q

Enteric fistula

usually happens:

A

Post-op!!

a connection b/w two epitheliazed surfaces that is not supposed to be there

201
Q

Problem with Enteric Fistula is:

A

Loss of GI contents
Malnutrition

losing a much too high amount of GI contents

202
Q

Tx for Enteric Fistula

A 
Close it
Fluids
Bowel rest
Control drainage/ skin protection
Surgery
203
Q

Bariatric surgery candidates

A

BMI >40 YO
BMI >35 + comorbidities
Nothing else working
Compliant pt

204
Q

Roux-En-Y gastric bypass

A

Most common!!
Restrictive AND Malabsorptive

Make stomach smaller AND bypass duodenum

205
Q

Gastric banding

A

Silicone band lines with inflatable balloon
RESTRICTIVE

risk: band can move/slide

206
Q

Vertical Band Gastroplasty; RARELY done

A

RESTRICTIVE

staple and band

207
Q

Sleeve Gastrectomy

A

Slice off the outside portion of stomach

Staple close

Make stomach smaller; RESTRICTIVE

208
Q

Perforation is more common if your age is

A

younger than 10

older than 50

209
Q

PeritonITIS

A

follow Perforation
High fever –> SEPSIS risk

can be localized (contained by surrounding viscera or omentum) OR generalized (gross spillage into peritoneal cavity)

210
Q

Where is Diverticulitis most common?

A

Sigmoid colon

LLQ

211
Q

When to consider surgery for Diverticulitis?

A

Repeated attacks (2 or more)
Complication
Nothing else working

212
Q

Harmann’s procedure

A

commonly done for Diverticulitis

213
Q

Loop colostomy

A

Helps to:

  • decompress Distal end
  • allow Proximal end to drain
214
Q

Ileostomy: loop of ileum (last part of sm. int) brought up to abdominal wall

A

HIGH OUTPUT

bc you don’t have absorption going on

215
Q

Proctocolectomy

A

removal of ENTIRE colon and rectum

216
Q

Abdominoperineal resection

A

low rectal CA

Removal of: lower sigmoid, entire rectum and anus

217
Q

Low Anterior Resection

A

CA of middle and upper section of rectum

Remove: distal sigmoid, 1/2 of rectum. then perform Proximal sigmoid-distal rectum anastamosis

218
Q

Common tx for Hemmorhoids

A

Rubber band ligation

219
Q

Surgical Hemorrhoidectomy

A

Mixed internal and external hemorrhoids

Very uncomfortable procedure

220
Q

Common organisms of Anorectal ABSCESS

A

E.Coli

Proteus

221
Q

Common problem after Anorectal Abscess

A

Fistula

50% chance

222
Q

What is Seton placement used for?

A

Tx of Anal Fistula

It’s a loop drainage tube to encourage body to heal from inside out

223
Q

Borders of Heisselbach’s triangle

A

Epigastric artery/vein
Rectus abd muscles
Inguinal ligament

224
Q

INDIRECT hernias go into

A

inguinal canal

225
Q

Rate of recurrence with hernias is higher in what type?

A

DIRECT hernias

Quarter 4 finals (11 decks)

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