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Surgery > Emma > Flashcards

Emma Flashcards

1
Q

absolute contraindications to surgery

A

DKA, diabetic coma

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2
Q

poor nutrition indicators to delay surgery

A

weight loss >20%, albumin

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3
Q

how to assess poor liver failure to delay surgery

A

bili>2, >16, ammonia>150, encephalopathy

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4
Q

smoker pre op and post op.

A

stop smoking 8 weeks before surgery. post op: they are CO2 retainers, go easy on the O2 during post op period because it can suppress respiratory drive

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5
Q

goldmans index

A

tells you who is at greatest risk for surgery. #1 factor= CHF. EFmust be >35. #2 factor: get EKG. MI w/i 6 months. arrhythmia, old age, AS.

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6
Q

what meds to stop before surgery

A

aspirin. NSAIDS. metformin (-> lactic acidosis). warfarin (7-10 days- can use vitamin K). if DM on insulin, 1/2 the morning dose.

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7
Q

why care about BUN and creatinine pre-op

A

uremic platelet disfunction-> increased risk bleeding

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8
Q

assist control vent setting

A

set TV and rate but if pt takes breath, vent gives volume.

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9
Q

pressure support vent setting

A

pt rules rate but a boost of pressure is given. important for weaning!

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10
Q

CPAP

A

continuous positive pressure. pt has all drive

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11
Q

PEEP

A

keeps alveoli open. ARDS

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12
Q

if PCO2 is low on vent, what to do

A

can adjust rate or tidal volume. tidal volume is more efficient. rate gives stuff to dead space but tidal volume doesnt.

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13
Q

things that cause anion gap acidosis. non anion gap?

A

Na-Cl- bicarb. anion gap: MUDPILES: methanol, uremia, DKA, isoniazid, lactic acidosis, ethylene glycol, salicilates. nonanion gap: diarrhea, diuretic, RTA

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14
Q

next step after alkalotic

A

check urine chloride. if 20: Conns, barriers, gittelmans

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15
Q

hyponatremia tx?

A

fluid restriction

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16
Q

hyponatremia but volume depleted. next steps?

A

fluid rescusistate!

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17
Q

hyponatremia

A

3% NS . but try to avoid bc you worry about CML.

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18
Q

how to treat hypernatremia

A

replace with D5W or hypotonic fluid but worry about cerebral edema

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19
Q

paralysis, ileus, St depressions, U waves on EKG

A

hypokalemia. give K. monitor renal function.

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20
Q

maintenance IVF of choice

A

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

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21
Q

pt with clotting problem, edema, HTN, and foamy pee

A

nephrotic syndrome causes clotting problems

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22
Q

why do surgeons care about anti-thrombin II deficiency

A

heparin wont work!

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23
Q

post op patients with low platelets and high clotting.

A

HIT! give synthetic heparin like enoxaparin.

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24
Q

normal plus but increased bleeding time, and PTT

A

vWF

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25
Q

low platelets, increased PT, PTT

A

DIC. caused by GN sepsis, carcinomatosis, OB stuff.

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26
Q

burn topical that doesnt penetrate eschar and can cause leukopenia

A

silver sulfadiazine.

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27
Q

burn topical that penetrates eschar but hurts like hell

A

mafenide

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28
Q

burn topical that doesnt penetrate eschar and causes hypoK and hypoNa

A

silver nitrate

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29
Q

electrical burn, first step

A

EKG! look for arrhythmia. if abnormal get 48 hours of telemetry

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30
Q

if you have rhabdo, what do you check next

A

K+ that is what will kill you when cells break apart.

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31
Q

if guy is stabbed in neck, GCS=15, expanding mass in lateral neck

A

intubate!

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32
Q

guy is stabbed in neck, crackly sounds with palpating anterior neck tissues

A

intubate with fiberoptic bronchoscope. laryngeal injury form subQ emphysema.

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33
Q

if huge facial trauma, blood obscures oral and nasal airway, GCS is 7

A

cricothyroidomy. if you can’t assess where you’re putting tube

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34
Q

after intubating, breath sounds are decreased on left

A

you intubated right main bronchus. pull back your ET tube.

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35
Q

pt has hemothorax. what to do? when to go to OR?

A

put in chest tube. OR when high output- >1L. or if >200cc/hr over first two hours.

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36
Q

stab wound in upper neck above angle of mandible. next steps?

A

aortography and triple endoscopy

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37
Q

stab wound in middle neck

A

2D doppler +/- exploratory surgery

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38
Q

stab wound in lower neck

A

aortography

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39
Q

blunt abdominal trauma, HD stable, handebar sign

A

pancreas injury

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40
Q

blunt abdominal trauma, stable, epigastric pain. next steps? what if you find retroperitoneal bleeding?

A

abdominal CT. if RP bleed, worry that duodenum ruptured. not really acute abdomen trauma.

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41
Q

how to treat malignant hyperthermia

A

dantrolen sodium- blocks ryanodine receptor and decreases intracellular calcium

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42
Q

pain at incision site, edema, induration, without drainage

A

cellulitis. check bcx. give antibiotics

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43
Q

pain at incision site, edema, induration, with drainage

A

simple wound infection. open wound and repack. no antibiotics necessary.

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44
Q

pain with salmon colored fluid from incision site

A

dehiscence. go back to OR to close fascia.

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45
Q

MC cancer in non smoker? location and mets? characteristics of effusion?

A

adenocarcinoma. peripheral. mets to adrenals, liver, brain bone. effusion is exudative with high hyalduronidase.

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46
Q

lung cancer with kidney stones, constipation, low PTH, central lung mass

A

squamous= paraneoplastic of PTHrP. low PO4, high Ca.

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47
Q

what lung cancer is most likely to cause pan coast?

A

small cell

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48
Q

what lung cancer causes ptosis better after 1 minute of upward gaze

A

lambert eaton from small cell.

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49
Q

OLD SMOKER WITH NA= 125, mmm, n jvd?

A

SIADH from small cell. (almost all paraneoplastic come from small cell except squamous cell)

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50
Q

small cell vs non small cell treatment

A

surgery for non small cell cancer. small cell is sensitive to chemo and radiation

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51
Q

dx of ARDS

A
  1. radiographic features: fluffy white infiltrates. 2. PaO2/FiO2>200. 3. PCWP
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52
Q

dysphagia worse with hot and cold liquids and chest pain that feels like MI with NO regard. dx? tx?

A

diffuse esophogeal spasm. tx with NO and CCB

53
Q

krukenberg

A

gastric cancer mets to ovary

54
Q

blummers shelf

A

gastric cancer mets felt on DRE

55
Q

virchows node

A

L supraclavicular fossa node from gastric cancer

56
Q

sister mary joseph node

A

umbilical fossa

57
Q

lymphoma association

A

HIV

58
Q

MALT lymphoma association

A

H pylori

59
Q

mentriere’s

A

protein losing enteropathy associated with enlarged rugae

60
Q

what are gastric varices associated with

A

splenic vein thrombosis

61
Q

mid epigastric pain better with eating

A

duodenal ulcer

62
Q

which type of ulcer is more associated with H pylori

A

duodenal ulcer! healthy people

63
Q

tx for duodenal ulcer

A

PPI, clarithromycin, amoxicillin for 2 weeks breath or stool test to test cure

64
Q

what do you worry about if duodenal ulcers don’t get better with triple therapy?

A

ZEG. do secretin stimulation test (high gastrin even when we give secretin indicates tumor). tumor in pancreas- do resection. MEN1. look for pituitary and parathyroid.

65
Q

a patient who lost 200 pounds has bilious vomiting and post prandial pain

A

SMA syndrome. the third part of the duodenum is compressed by the AA and SMA. tx= restore weight and nutrition, or roux en y.

66
Q

complications of pancreatitis

A

pseudocyst (no cells), hemorrhage, abscess. third spacing-> ARDS

67
Q

chronic mid epigastric pain, DM, malabsorption (steatorrhea)

A

chronic pancreatitis

68
Q

splenic vein and chronic pancreatitis

A

CP-> splenic vein thrombosis-> gastric varcies

69
Q

MC cancer of pancreas

A

adenocarcinoma.

70
Q

courvoisiers sign

A

palpable non tender gallbladder. associate with pancreatic cancer.

71
Q

trousseau’s sign

A

migratory thromboplebitis. associated with pancreatic cancer.

72
Q

how to dx pancreatic cancer

A

EUS and FNA bx

73
Q

pancreatic cancer treatment?

A

whipple if no mets outside of abdomen, portal vein, no liver mets, no peritoneal mets

74
Q

sxs (sweat, tremors, hunger, seizures) + BGL

A

whiles triad of insulinoma!

75
Q

labs for insulinoma

A

increased insulin, increased C peptide, increased pro insulin

76
Q

tumor that presents with malabsorption

A

somatostatinoma. commonly malignant. ect from exocrine pancreas malfunction

77
Q

watery diarrhea, flushing, hypokalemia, dehydration, flushing

A

VIPoma. looks similar to carcinoid syndrome. tx: octreotide can help symptoms.

78
Q

cholecystitis vs symptomatic gallstones

A

fever is difference!

79
Q

choledochal cysts type 1 and type 4

A

type 1: fusiform dilation of CBD-> tx with excision. type 4: Caroli’s dz- cysts in intrahepatic ducts-> need liver transplant.

80
Q

cholangiocarcinoma risk factor? tx?

A

PSC (UC) x: surgery +/- radiation

81
Q

2nd MC benign liver tumor. W>M but less likely to rupture. tx?

A

focal nodular hyperplasia. no tx needed.

82
Q

what are most common bugs for bacterial abscess in liver? tx?

A

E coli, bacteriodes, enterococcus. surgical drainage and IV antibx

83
Q

RUQ pain, profuse sweating and rigors, palpable liver. dx? tx?

A

amebic abscess. worse sxs than bacterial. tx: MDZ DONT DRAIN

84
Q

what abscess don’t you drain

A

lung abscess. amebic liver abscess.

85
Q

pt from Mexico presents with RUQ and multiple large liver cysts on US. mode of transmission? lab findings? tx?

A

echinococcus. transmission: dog poo. lab: eosinophilia bc parasite. positive casino skin test. tx: albendazole but then SURGERY but careful not to break cyst (can cause anaphylaxis)

86
Q

MC location for carcinoid? sxs?

A

appendix (after a pass through the liver)! sxs: flushing, wheezing, diarrhea

87
Q

nutritional deficincy in carcinoid

A

niacin (diarrhea, dementia, dermatitis). (serotonin and niacin are both used in tryptophan)

88
Q

if carcinoid tumor is >2 cm, at base of appendix, or with positive LN, what tx?

A

hemicolectomy. otherwise just appendectomy.

89
Q

when to do surgery for SBO

A

peritoneal signs, increased WBC, no improvement in 48 hours

90
Q

direct vs indirect hernias

A

indirect is more common. through the inguinal ring lateral to the epigastric vessels. usually congenital. direct is more often from acquired weakness

91
Q

which IBD can cause Fe deficiency

A

Crohns. involves terminal ileum.

92
Q

which IBD is more likely to have granulomas on biopsy

A

Crohns

93
Q

skin manifestation of UC

A

pyoderma gangenosum

94
Q

sxs of left sided colon cancer? sxs of right sided colon cancer? rectal?

A

right: bleeding. left: obstruction (pencil thin stools). rectal: pain/fullness, bleeding/obstruction

95
Q

post op complications for AAA. number 1 complications?

A

do surg when >5cm. MI.

96
Q

bloody diarrhea after AAA surgery

A

ischemic colitis

97
Q

AAA surgery-> weakeness, decreased pain with preserved vibration and proprioception

A

ASA syndrome

98
Q

ASA syndrome-> 1-2 years later have brisk GI bleeding

A

AV fistula

99
Q

acute abdominal pain in pt w/a fib sub therapeutic on warfarin or pt s/p high dose vasoconstrictor (shock, bypass)

A

suspect acute mesenteric ischemia. workup is angiography of SMA/IMA. tx= embolectomy. if thrombus, or aortomesenteric bypass

100
Q

severe MEG pain after eating, pain out of proportion to physical exam

A

chronic mesenteric ischemia. slow progressing stenosis of 2.5 vessels-> celiac, SMA, and IMA. dx with duplex or angiography. tx: aortomesenteric bypass or transaortic mesenteric endarterectomy

101
Q

acute arterial occlusion: 5Ps and no dopplerable pulses. next steps?

A

immediate heparin and prepare for surgery. thrombolytics may be possible if no surg in

102
Q

complications of treatment for acute arterial occlusion

A

compartment syndrome during reperfusion. do fasciotomy and watch for myoglobiuria.

103
Q

best test for claudication and tx for diff types.

A

ankle brachial index surgery.

104
Q

how to treat DVT. complications?

A

hepatin-> warfarin for 3-6 months. comp: post phlebotic syndrome= chronic valvular incompetence, cyanosis, and edema

105
Q

how do different types of thyroid cancer spread (2)

A

papillary: lymph, psammoma bodies. follicular: blood, must excise whole thyroid.

106
Q

adrenal nodule+ high BP, catechol symptoms. test? dx?

A

get urine and plasma metanephrines. pheochromocytoma.

107
Q

adrenal nodule + high BP, low K, low PRA

A

primary aldosteronism. get plasma aldo-renin ratio

108
Q

adrenal nodule + virilization/feminization

A

adrenocortical carcinoma- get urine 17 ketosteroids

109
Q

tx for adrenal nodule

A

if observe and CT scan q6mo. if >6cm or funcitonal-> surgical excision

110
Q

MEN1

A

parathyroid hyperplasia, pituitary adenoma, pancreatic islet cell tumor (ZES

111
Q

MEN2

A

pheo, parathyroid hyperplasia, medullary thyroid cancer

112
Q

MEN3

A

Marfanoid features, pheo, medullary thyroid cancer

113
Q

fibrocystic change in breast features and tx

A

cysts are painful and change with menses. fluid is typically green or straw colored. tx: restrict caffeine, take vitamin E, wear a supportive bra

114
Q

tx for DCIS

A

excision with clear margins or simple mastectomy if multiple lesions (no node sampling) + adjuvant therapy

115
Q

tx for LCIS

A

more often bilateral. consider b/l mastectomy only if FH, hormone sensitive, or prior hx of breast cancer

116
Q

infiltrating ductal/lobular carcnoma tx

A

if small and away from nipple, can do lumpectomy with ax node sampling. adjuvant RT. chemo if node + tamoxifen/raloxifen if ER. or modified radial mastectomy w/ax node sampling w/o adjutant RT

117
Q

tx for Pagets Dz

A

do mammo to find mass

118
Q

tx for melanoma

A

need full thickness bx bc depth is #1 prognosis. tx with excision. 1 cm margin if 4mm. high dose IFN or IL2 may help

119
Q

painless enlarging mass. dx? tx?

A

sarcoma. dx with bx (NOT FNA). excisional if

120
Q

spread of sarcoma

A

hematogenously. first to the lungs. can do wedge resection if only met and primary is under control

121
Q

hard round mass on extremity.

A

lymphangiosarcoma. can occur in areas of chronic lymphedema.

122
Q

why give lidocaine with epi

A

to prevent systemic absorption-> numb tongue, seizures, hypotension, arrythmias. no epic in fingers, nose, penis

123
Q

who gets spinal subarachnoid anasthesia

A

for people who can’t be intubated. but also can’t be given if increased ICP

124
Q

what happen if a high blood of epidural (local + opioid)

A

blocks heart SNS nerves and phrenic nerve

125
Q

meperidine side effect

A

can lower seizure threshold in pts with renal failure

126
Q

succinylcholine side effect

A

can cause malignant hyperthermia, hyperK (not for burn or crush victim)

127
Q

rocuronium side effect

A

sometimes causes allergic rxn in asthamtic

128
Q

halothane side

A

can cause malignant hyperthermia (dantrolene NA) liver toxicity)

Surgery (12 decks)

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