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EH Reviews > EH - Surgery > Flashcards

EH - Surgery Flashcards

1
Q

Absolute contraindication to surgery?

A

DKA, Poor nutritional status, Liver failure

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2
Q

3 pre-operative measurements of nutritional status?

A

Albumin, Body Weight, Transferrin

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3
Q

Albumin level that contraindicates surgery?

A

< 3

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4
Q

Body weight loss that contraindicates surgery?

A

Loss of 20% BW

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5
Q

Transferrin level that contraindicates surgery?

A

< 200

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6
Q

Best strategy for maximizing patient nutrition?

A

Enteral feedings

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7
Q

3 measurements of liver function?

A

Bilirubin, PT, NH3

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8
Q

Best pre-operative advice for smokers?

A

Cessation 2 months before surgery

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9
Q

Important consideration for smokers during anesthesia resuscitation?

A

Worry about chronic CO2 retention … strongest respiratory drive is hypoxia … need to keep O2 slightly hypoxic

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10
Q

Value of Goldman’s Index?

A

Determines peri-operative mortality risk

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11
Q

Most important factor in Goldman’s Index?

A

CHF … (EF %) … need ECHO

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12
Q

2nd most important factor in Goldman’s Index?

A

Recent MI … need EKG

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13
Q

Which type of murmur represents risk for peri-operative mortality?

A

Aortic stenosis

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14
Q

Medications that should be stopped before surgery?

A

ASA, Metformin, NSAIDs, Warfarin

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15
Q

How long before surgery should ASA be stopped?

A

7-10 days

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16
Q

Why does metformin need to be stopped before surgery?

A

Risk of developing lactic acidosis

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17
Q

Goal INR before surgery?

A

< 1.5

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18
Q

Insulin considerations for patients about to undergo surgery?

A

Instruct patient to take ½ AM insulin dose … (NPO after midnight)

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19
Q

Patient with CKD is preparing for surgery – when should last dialysis appointment be completed before surgery?

A

24 hour prior

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20
Q

How do BUN and creatinine affect surgery?

A

Patients with CKD may have uremia … Uremia inhibits platelet clotting ability

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21
Q

Effect of platelet count on coagulation panel?

A

NML

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22
Q

Effect of bleeding time on coagulation panel?

A

Prolonged

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23
Q

Role of Assist-control Ventilator setting?

A

Ventilator sets Tidal Volume and RR

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24
Q

Important Ventilator setting for patient weaning off ventilator use?

A

Pressure support setting

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25
Q

Role of PEEP?

A

Patients with ARDS … allows alveoli to remain open

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26
Q

Patient on ventilator – which tests should be ordered regularly to assess ventilator function?

A

ABG

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27
Q

Patient on ventilator – PaO2 is low … what is the remedy?

A

Increase FiO2

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28
Q

Patient on ventilator – PaO2 is high … what is the remedy?

A

Decrease FiO2

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29
Q

Patient on ventilator – PaCO2 is low … what is the remedy?

A

Decrease RR, Decrease Tidal Volume

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30
Q

Patient on ventilator – PaCO2 is high … what is the remedy?

A

Increase RR, Increase Tidal Volume

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31
Q

Why is adjusting Tidal Volume more effective in adjusting PaCO2?

A

Multiplicative effect … Increasing RR will waste O2 on dead space

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32
Q

2 parameters for ventilation?

A

RR, Tidal Volume

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33
Q

2 types of non-AG metabolic acidosis?

A

RTA, Diarrhea, Diuretic abuse

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34
Q

Best treatment for hyponatremia + hypotensive?

A

NS

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35
Q

When should hypertonic saline used?

A

Severely symptomatic hyponatremia, Na < 110

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36
Q

Appropriate rate of Na+ correction in hyponatremia?

A

12-24 mEq per day

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37
Q

Best treatment for Hypernatremia?

A

Replace fluid with hypotonic solution

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38
Q

Complication of correcting hypernatremia too quickly?

A

Cerebral edema

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39
Q

EKG change associated with hypocalcemia?

A

Prolonged QT interval

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40
Q

EKG change associated with hypercalcemia?

A

Shortened QT interval

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41
Q

Appropriate next step in evaluation of hypo/hypercalcemia?

A

EKG

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42
Q

Best treatment for hypokalemia?

A

K+ … with renal monitoring

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43
Q

Best treatment for hyperkalemia?

A

Calcium gluconate … IV fluids … Diuretics … Insulin/Glucose … Albuterol … Dialysis

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44
Q

Role of giving Calcium gluconate in patients with hyperkalemia?

A

Cardio-protective

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45
Q

Maintenance IV fluids – best for nutrition?

A

D5 ½ NS + 20 mEq KCl

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46
Q

Patient presents with burn – erythematous, painful but not peeling – diagnosis?

A

1st degree burn

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47
Q

Skin layer involved in 1st degree burn?

A

Epidermis

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48
Q

Patient presents with burn – painful, peeling – diagnosis?

A

2nd degree burn

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49
Q

Patient presents with burn – painless, peeling – diagnosis?

A

3rd degree burn

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50
Q

Skin layer involved in 3rd degree burn?

A

Dermis

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51
Q

Major concern in patients with circumferential burns?

A

Compartment Syndrome

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52
Q

Concern for elderly patients with sudden increased in clots?

A

Hypercoagulability of malignancy

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53
Q

Patient presents with new blood clots (hypercoagulability); PE shows patient is edematous, foamy urine – diagnosis?

A

Nephrotic Syndrome

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54
Q

What accounts for hypercoagulability in Nephrotic Syndrome?

A

Anti-thrombin 3 (anticoagulant) is one of the first proteins lost in urine

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55
Q

Most common inherited disease of abnormal clotting?

A

Factor V Leiden

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56
Q

Significance of anti-thrombin 3 deficiency in surgery?

A

Heparin won’t work

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57
Q

Young female presents with multiple spontaneous abortions?

A

Anti-Phospholipid Syndrome

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58
Q

Post-op patient presents with thrombocytopenia, but increased arterial + venous clotting – diagnosis?

A

HIT … paradoxical thrombosis in setting of thrombocytopenia

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59
Q

2 hallmark components of HIT?

A

Low platelets + Clotting

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60
Q

Best treatment for HIT?

A

Stop heparin, Start Argatroban

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61
Q

MOA of Argatroban?

A

Direct thrombin inhibitor

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62
Q

Patient presents with bleeding; Labs show isolated thrombocytopenia – diagnosis?

A

ITP

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63
Q

Patient presents with bleeding; Labs show NML platelets, increased bleeding time, increased PTT– diagnosis?

A

Von Willebrand Disease

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64
Q

Why not give burn patients IV/oral ABX, when they are more susceptible to infection?

A

Breeds resistance … give topical ABX

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65
Q

Which topical ABX for burn patients does not penetrate eschar, but causes leukopenia?

A

Silver sulfadiazine

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66
Q

Which topical ABX for burn patients will penetrate eschar, but causes pain?

A

Mafenide

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67
Q

penetrate eschar, but causes does not penetrate eschar, but causes hypokalemia, hyponatremia?

A

Silver nitrate

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68
Q

Next best step for patient with suspected electrical burns?

A

EKG … arrhythmia risk

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69
Q

Next best step of workup for burn patient with rhabdomyolysis?

A

CMP … check for K+ … arrhythmia risk

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70
Q

Best treatment for patient with facial + neck trauma; Unable to visualize airway during intubation?

A

Cricothyrotomy

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71
Q

Indications for taking patient with hemothorax to OR?

A

Lost 1.5L of blood; Lose 200mL per hour for first 4 hours

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72
Q

Treatment for pulmonary contusion?

A

Supportive

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73
Q

Best treatment for flail chest?

A

Nerve block (control pain)

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74
Q

Why are opioids contraindicated in flail chest?

A

Decrease respiratory drive

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75
Q

Patient presents with AMS, petechial rash, acute SOB; Reports recent MVC – diagnosis?

A

Fat embolism

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76
Q

Patient passes away suddenly after removal of central line – diagnosis?

A

Venous air embolism

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77
Q

Patient is hypotensive and tachycardiac; PE shows flat neck veins, NML central venous pressure – diagnosis?

A

Hypovolemic shock

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78
Q

Next best step for suspected hypovolemic shock?

A

2 large bore IV placement, 2L NML saline

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79
Q

Patient is hypotensive and tachycardiac; PE shows JVD, muffled heart sounds; EKG shows electrical alternans – diagnosis?

A

Cardiac tamponade

80
Q

Diagnostic test for pericardial tamponade?

A

Symptomatic improvement with pericardiocentesis

81
Q

Max verbal GCS score?

A

5

82
Q

Max motor GCS score?

A

6

83
Q

Max ocular GCS score?

A

4

84
Q

How can you distinguish between acute and chronic subdural hemorrhage on head CT?

A

Acute = hyperdense (bright) fluid crescent; Chronic = hypodense (dark) fluid crescent

85
Q

Initial management of increased ICP?

A

Elevate head of bed, Mannitol, Hyperventilate

86
Q

Boundaries of Zone 3 in neck trauma?

A

Above angle of mandible

87
Q

Best treatment for neck trauma that involves Zone 3?

A

Check aorta (aortogram), Endoscopy

88
Q

Boundaries of Zone 2 in neck trauma?

A

Cricoid Cartilage&raquo_space; Angle of Mandible

89
Q

Best treatment for neck trauma that involves Zone 2?

A

2D Doppler

90
Q

Boundaries of Zone 1 in neck trauma?

A

Clavicle&raquo_space; Cricoid Cartilage

91
Q

Best treatment for neck trauma that involves Zone 1?

A

Check aorta (aortogram), Endoscopy

92
Q

Patient presents with stab wound; PE shows patient is stable – next step in management?

A

FAST exam

93
Q

Next step in management of unstable patient after abdominal trauma?

A

Surgical intervention

94
Q

Handle bar sign on PE after blunt abdominal trauma – diagnosis?

A

Pancreatic trauma

95
Q

Patient presents after blunt abdominal trauma; PE shows stable vital signs; Patient complains of epigastric pain – next step?

A

Abdominal CT

96
Q

Patient presents after blunt abdominal trauma; Abdominal CT shows retroperitoneal fluid – what was injured?

A

Duodenum

97
Q

Patient presents after pelvic trauma; PE shows blood at urethral meatus; Retrograde urethrogram is NML – what should you check next?

A

Evaluate bladder for bleeding; Retrograde cystogram

98
Q

Result of retrograde cystogram that suggests bladder injury?

A

Dye extravasating from bladder

99
Q

Elderly female experiences FOOSH – which fracture is most likely fracture?

A

Colles fracture … distal radius fracture

100
Q

Which structures are injured in Boxer’s fracture (guy punched wall)?

A

4th/5th metacarpal neck

101
Q

Most common location of clavicle fracture?

A

Between middle third + distal third

102
Q

Most common cause of fever on postop Day #1?

A

Atelectasis

103
Q

Best treatment of atelectasis on postop Day #1?

A

Incentive spirometry

104
Q

Most common cause of very high fever on postop Day #1?

A

Necrotizing fasciitis

105
Q

Route of spread for Necrotizing fasciitis?

A

Along Scarpa’s subcutaneous fascia

106
Q

Most common pathogens responsible for Necrotizing fasciitis?

A

Strep, Clostridium

107
Q

Best treatment for Necrotizing fasciitis?

A

Surgical debridement + IV penicillin

108
Q

Most common cause of very high + muscle rigidity immediately after surgery?

A

Malignant hyperthermia … halothane/succinylcholine

109
Q

Genetic defect that predisposes patients to Malignant hyperthermia?

A

Defects in ryanodine receptor

110
Q

Best treatment for Malignant hyperthermia?

A

Dantrolene

111
Q

MOA of Dantrolene in treatment of Malignant hyperthermia?

A

Inhibition of ryanodine receptor … decreases intracellular Ca2+ levels

112
Q

Most common causes of fever on postop Day #3-5?

A

PNA, UTI

113
Q

Most common cause of fever on postop Day #5-7?

A

DVT, Cellulitis

114
Q

Clinical presentation of post-op cellulitis?

A

Pain at incision site without drainage

115
Q

Best treatment for post-op cellulitis?

A

Blood cultures, ABX

116
Q

Clinical presentation of post-op wound infection?

A

Pain at incision site with drainage

117
Q

Best treatment for post-op wound infection?

A

Change wound packing; No ABX

118
Q

Post-op patient develops pain at incision site; PE shows serosanguinous drainage – diagnosis?

A

Wound dehiscence

119
Q

Location of problem in Wound dehiscence?

A

Violation of fascia

120
Q

Best treatment for Wound dehiscence?

A

Surgical intervention

121
Q

Patient undergoes gynecologic surgery; Develops unexplained fever late in post-op course – diagnosis?

A

Thrombophlebitis

122
Q

Best treatment for Thrombophlebitis after gynecologic surgery?

A

ABX + Heparin

123
Q

Etiology of pressure ulcers? (1 word)

A

Ischemia

124
Q

Stage 1 of pressure ulcer development?

A

Blanchable

125
Q

Treatment for Stage 1 of pressure ulcer?

A

Mattress … relieve pressure

126
Q

Stage 2 of pressure ulcer development?

A

Blister, Break in dermis, Crusting

127
Q

Treatment for Stage 2 of pressure ulcer?

A

Mattress … relieve pressure

128
Q

Stage 3 of pressure ulcer development?

A

Erosion into muscle

129
Q

Treatment for Stage 3 of pressure ulcer?

A

Surgical intervention

130
Q

Stage 4 of pressure ulcer development?

A

Erosion to bone

131
Q

Treatment for Stage 4 of pressure ulcer?

A

Surgical intervention

132
Q

Complication of Marjolin’s ulcer?

A

Chronic ulcer that predisposes to Squamous Cell Carcinoma

133
Q

Threshold for need of thoracentesis for pleural effusion?

A

Fluid collection in phrenic angle > 1cm

134
Q

3 most common causes of transudative pleural effusion?

A

CHF, cirrhosis, nephrotic syndrome

135
Q

Transudative pleural effusion with low pleural glucose – diagnosis?

A

Rheumatoid arthritis

136
Q

Transudative pleural effusion with high lymphocyte count – diagnosis?

A

TB

137
Q

Initial treatment of lung abscess seen on CXR?

A

ABX

138
Q

Appearance of lung abscess on CXR?

A

Air-fluid levels

139
Q

Characteristic of lung nodule that is a hamartoma?

A

Popcorn calcifications

140
Q

Characteristic of lung nodule that is TB?

A

Concentric calcifications

141
Q

Unique location of metastasis for lung adenocarcinoma?

A

Adrenal glands

142
Q

Characteristic of exudative effusion seen in setting of lung adenocarcinoma?

A

High hyaluronic acid

143
Q

Which type of lung CA are Pancoast tumors?

A

Squamous cell carcinoma

144
Q

Lung CA that presents as ptosis that improves after looking up for 1 minute?

A

Small cell CA … Lambert Eaton

145
Q

Lung CA that presents as advanced masses with multiple early metastasis?

A

Large cell lung CA

146
Q

Location of Large cell lung CA?

A

Peripheral

147
Q

Significance of Small cell vs. Non-Small cell lung CA?

A

Small cell = can’t resect; Non-small cell = surgical resection

148
Q

3 diagnostic criteria for ARDS?

A

CXR shows bilateral infiltrates; PaO2/FiO2 > 200; NML pulmonary capillary wedge pressure (< 18)

149
Q

Ventilator setting used in treatment of ARDS?

A

PEEP

150
Q

Holosystolic murmur that radiates to axilla?

A

MR

151
Q

Holosystolic murmur with late rumble?

A

VSD

152
Q

Rumbling diastolic murmur with opening snap?

A

Mitral stenosis

153
Q

Blowing diastolic murmur with widened pulse pressure?

A

AR

154
Q

Characteristic of all R-sided murmurs?

A

Increase with inspiration

155
Q

Best treatment of achalasia?

A

CCBs + Myotomy

156
Q

2 DOC for esophageal spasm?

A

CCBs, Nitrates

157
Q

3 atypical symptoms of GERD?

A

Wheezing, dry cough, hoarseness

158
Q

Best first step of workup for Boerhave’s Syndrome?

A

CXR … avoid barium

159
Q

Type 1 hiatal hernia?

A

Sliding

160
Q

Type 2 hiatal hernia?

A

Paraesophageal

161
Q

Most common type of gastric CA?

A

Adenocarcinoma

162
Q

Epidemiology of gastric lymphoma?

A

AIDS patients

163
Q

Etiology of gastric varices?

A

Splenic vein thrombosis

164
Q

Are gastric or duodenal ulcers more likely to be associated with H. pylori?

A

Duodenal

165
Q

Concern if H. pylori treatment does not relieve peptic ulcers?

A

Zollinger-Ellison Syndrome

166
Q

Patient recently lost a lot of weight; Presents with bilious vomiting, post-prandial abdominal pain – diagnosis?

A

SMA Syndrome

167
Q

Diagnostic test for pancreatitis?

A

Abdominal CT

168
Q

Complications of pancreatitis?

A

Pseudocyst, Hemorrhage, Abscess, ARDS

169
Q

Chronic pancreatitis may lead to ____ thrombosis

A

Splenic vein

170
Q

When is surgery not contraindicated in pancreatic cancer?

A

Localized to pancreas

171
Q

Whipple’s Triad seen in insulinoma?

A

Low BG, Symptoms of BG, Symptomatic improvement with glucose administration

172
Q

2 symptoms that distinguish cholelithiasis from cholecystitis?

A

Cholecystitis = fever, RUQ pain

173
Q

Best initial test for suspected cholecystitis?

A

RUQ US

174
Q

2 labs associated with choledocholithiasis?

A

Elevated Alkaline Phosphatase, Elevated bilirubin

175
Q

Best treatment for ascending cholangitis?

A

ERCP (to remove the CBD stone) + ABX

176
Q

Location of Type 1 biliary cysts?

A

Extrahepatic

177
Q

Location of Type 4 biliary cysts?

A

Intrahepatic

178
Q

Patient’s labs show ALT and AST in 1000s; ALT > AST – diagnosis?

A

Viral hepatitis

179
Q

Elevated AST and ALT after cardiovascular surgery – diagnosis?

A

Hypotension (shock)

180
Q

AE of TIPS procedure?

A

Encephalopathy

181
Q

Etiology of Encephalopathy after TIPS procedure?

A

Retained NH3

182
Q

Most common benign lesion in lever?

A

Hepatic angioma

183
Q

Female on OCPs with palpable liver mass – diagnosis?

A

Hepatic adenoma

184
Q

Best management of Hepatic adenoma?

A

OCP cessation

185
Q

2nd most common benign lesion in lever?

A

Focal Nodular Hyperplasia

186
Q

Bacterial liver abscess is most commonly caused by …

A

E. coli, Bacteroides, Enterococcus

187
Q

Lab test seen in Echinococcus infection?

A

Eosinophilia

188
Q

Best test for carcinoid tumor that is > 2cm in base of appendix, or with (+) LN involvement – best surgery?

A

Hemicolectomy

189
Q

Best test for carcinoid tumor that is < 2cm in tip of appendix, or with (-) LN involvement – best surgery?

A

Appendectomy

190
Q

2 indications for surgery in patient with SBO?

A

Conservative management fails after 48 hours; (+) peritoneal sign

191
Q

Appearance of post-op ileus on XR?

A

Dilation throughout entire intestine

192
Q

Etiology of 2 Ogelby’s syndrome?

A

Isolated colonic ileus … especially cecum

193
Q

2 treatments for Ogelby’s syndrome?

A

Neostigmine, Colonic decompression

194
Q

AE of Neostigmine?

A

Bradycardia

195
Q

Which electrolyte deficiency can contribute to post-op ileus?

A

Hypokalemia

196
Q

Appearance of cecal volvulus on XR?

A

Birds beak

197
Q

Appearance of sigmoid volvulus on XR?

A

Coffee bean … crease = mesenteric vessel

EH Reviews (4 decks)

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