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Master the Boards > Gen Surg > Flashcards

Gen Surg Flashcards

1
Q

numer one limiting factor prior to surgery is….

A

hx of cardiovascular disease

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2
Q

history of CV disease predisposing to surgery complications

A
  • EF
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3
Q

if had a recent MI and surgery

A

must defer surgery for 6 months and stress the patient at that interval

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4
Q

patient has CHF and needs surgery for something else

A

give the drugs that decrease mortality:

ACE inhibitors, beta blockers, spironolactone

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5
Q

cardiovascular risk factor if male

A

male older than 45yo

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6
Q

patient with CV risk factors– what needs to be done before surgery

A
  • bp meds adjusted
  • daily finger sticks monitored
  • insulin regimen adjusted
  • stress test with ECG
    (possibly ECHO if murmur)
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7
Q

preop assessment if under 35yo and no hx of cardiac disease

A

EKG ONLY

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8
Q

preop assessment if hx of cardiac disease and ANY AGE

A
  • EKG
  • stress testing– evaluate for ischemic coronary lesions
  • ECHO for structural disease, and for ejection fraction
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9
Q

preop assessment PFT’s necessary for…

A

known lung disease

smoking history

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10
Q

preop patient is a smoker– what suggestions

A

quit smoking for 6-8weeks before surgery and use nicotine patch in meantime

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11
Q

preop assessment patient with renal disease

A
  • give fluids before and during surgery

- if patient is on dialysis, dialyze pt 24hrs before surgery

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12
Q

ABC’s: airway

A
  • no facial trauma= orotracheal tubes
  • facial trauma= cricothyroidotomy
  • C-spine injury= orotracheal tube with flexible bronchoscopy
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13
Q

ABC’s: breathing

A

O2 sats above 90%= ideal

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14
Q

ABC’s: circulation

A

insert 2 large bore IV cannulas and being aggressive fluid resuscitation to prevent hypovolaemic shock

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15
Q

cool skin, shock

A

cardiogenic or hypovolaemic shock

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16
Q

cardiogenic vs. hypovolaemic shock

A

PCWP/LVEDP:

cardio: increased
hypo: decreased

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17
Q

warm skin, shock

A

neurogenic, anaphylactic, septic

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18
Q

CO change in neurogenic shock

A

decreased CO

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19
Q

CO change in anaphylactic and septic shock

A

increased CO

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20
Q

PCWP change anaphylactic vs. septic shock

A

anaphylactic: decreased
septic: no change

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21
Q

sepsis definition

A

2/4 and infection source

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22
Q

SIRS criteria

A

2/4

  1. bp: less than 36, greater than 38
  2. HR: greater than 90bpm
  3. resp: tachypnea>20breaths/min, or O2 sats
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23
Q

severe sepsis

A

2/4 + infection source + organ dysfunction

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24
Q

septic shock definition

A

2/4 + infection source + organ dysfunction + HYPOtn

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25
Q

example of “infection source”

A

CXR: shows infiltrates= pneumonia

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26
Q

car accident and abdomen hurts, and end up with large ecchymosis on right flank, most likely diagnosis

A

HAEMORRHAGIC PANCREATITIS

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27
Q

complication 6-8 weeks after pancreatitis

A

pancreatic pseudocyst

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28
Q

differential for cullen sign

A

haemorrhagic pancreatitis

ruptured aortic aneurysm

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29
Q

grey turner sign

A

flank bruising–> RETROperitoneal haemorrhage

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30
Q

kehr sign

A

pain in L shoulder—> splenic rupture

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31
Q

balance sign

A

dull percussion of the L and shifting dullness on the R–> splenic rupture

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32
Q

seatbelt sign

A

bruising where the seatbelt was–> deceleration injury

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33
Q

free air under the diaphragm

A

perforation of the bowel, best initial test= UPRIGHT CXR

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34
Q

imaging of choice paralytic ileus

A

abdominal xray

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35
Q

abdominal trauma– imaging to be done

A
  1. US– ASAP

2. CT– check for retroperitoneal bleed (even if the US was normal)

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36
Q

blunting of costophrenic angle on chest XR and CT

A

hemothorax

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37
Q

urethral meatus injury and high riding prostate, what next…

A
  1. KUB followed by….
  2. RETROGRADE URETHROGRAM
  3. then….. foley catheter (don’t do this immediately because it can lead to further urethral damage; just placed to aid in urination)
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38
Q

MOST ACCURATE TEST–suffering from ischaemic bowel (severe pain out of proportion to physical findings)

A

ANGIOGRAPHY or surgery

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39
Q

severe abdo pain 10/10 no guarding, soft abdomen and no rebound tenderness

A

PAIN OUT OF PROPORTION= MESENTERIC ISCHAEMIA

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40
Q

best initial test ischemic bowel

A

CT of the abdomen

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41
Q

tx mesenteric ischaemia

A

IV normal saline, followed by surgical removal necrotic bowel

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42
Q

types of abdominal pain that DO NOT require surgery

A

MI
GERD
Lower lobe pneumonia
acute porphyrias

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43
Q

2 mc sites of mesenteric ischaemia

A

splenic and hepatic flexures

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44
Q

number one risk factor for mesenteric ischemia

A

A FIB— shoots off an emboli

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45
Q

best initial test ischaemic bowel vs. mesenteric ischaemia

A

ischaemic bowel= CT abdo

mesenteric isch= abdo XR: air in bowel wall

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46
Q

pain in tip of penis or perineum

A

referred pain from prostate

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47
Q

pain in the ears

A

referred pain from pharynx

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48
Q

crunching upon palpation of the thorax due to subcutaneous emphysema

A

HAMMAN’S sign– form boerhaave/ eso perforation

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49
Q

most common cause of esophageal perforation

A

IATROGENIC– endoscopy

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50
Q

mortality with boerhaave syndrome, even with surgery

A

25%

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51
Q

most accurate test in diagnosis of eso rupture

A

ESOPHOGRAM: using diatrizoate meglumine and diatrizoate sodium solution (GASTROGRAFFIN), which shows leakage of contrast outside the esophagus

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52
Q

barium used in esophagram for eso rupture?

A

NOOOOO– because it damages the tissues

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53
Q

tx of boerhaave

A

surgery

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54
Q

complication with high mortality rate in boerhaave surgery

A

MEDIASTINITIS

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55
Q

don’t forget that gastric perforation can cause….

A

PANCREATITIS, recall ulcers erode–> release gastric acid–> activate enzymes

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56
Q

pain from gastric perforation

A

right shoulder pain

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57
Q

most accurate test for gastric perforation

A

abdo CT

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58
Q

best initial test for gastric perforation

A

erect CXR

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59
Q

tx for gastric perforation HYHYHYHYHYHHYHY

A
  1. NPO
  2. NG tube
  3. Medical mgmt
  4. Surgical mgmt
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60
Q

medical mgmt of gastric perforation

A
  1. broad spectrum antibiotics– combat infection

2. IV fluids in prep for surgery

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61
Q

surgical mgmt of gastric perforation

A

exploratory laporotomy and repair of the perforation

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62
Q

acute diverticulitis first round tx

A

medical tx– antibiotics, fluids, pain etc.

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63
Q

recurrent diverticulitis tx

A

SURGERY

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64
Q

most common complication post-diverticulitis

A

ABSCESS

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65
Q

okay to do barium enema and colonoscopy in diverticulitis?

A

NOOOOO–causes perforation

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66
Q

right lower quadrant pain in someone>60yo

A

CECAL diverticulitis

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67
Q

diagnostic test for ovarian torsion

A

doppler US

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68
Q

diagnosis of abdominal abscess

A

CT scan

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69
Q

treatment of abdominal abscess

A

CT or US guided incision and drainage, and antibiotics

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70
Q

US findings of acute cholecystitis

A

pericholecystic fluid and thickened gallbladder wall

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71
Q

only 2 differentials for abdo pain radiating to the back

A
  1. pancreatitis

2. aortic dissection

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72
Q

diagnostic test for appendicitis

A

CT scan

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73
Q

2 complications from appendicitis

A

abscess and gangrenous perforation

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74
Q

best imaging for pancreatitis

A

CT scan;
amylase= sensitive
lipase= specific

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75
Q

best imaging for diverticulitis

A

CT scan= best and most accurate

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76
Q

best initial imaging for cholecystitis

A

US

77
Q

most accurate test for cholecystitis

A

HIDA scan

78
Q

HIDA scan

A

for cholecystitis– shows delayed emptying of gallbladder ( can’t visualize gallbladder form isotope accumulation)

79
Q

3 signs of appendicitis

A

rovsing sign
posts sign
obturator sign

80
Q

rovsing sign

A

palpation of the LLQ causes pain in the RLQ

81
Q

psoas sign

A

pain the hip E

82
Q

obturator sign

A

pain with internal rotation of the right thigh

83
Q

hyperactive tinkling bowel sounds

A

small bowel obstruction, = intestinal fluid and air are under high pressure in the bowel

84
Q

patient on chronic opiod with stool impaction, tx:

A

methylnaltrexone (relistor)

85
Q

labs for small bowel obstruction

A

elevated WCC
elevated lactate
SIGNIFICANT ACIDOSIS

86
Q

best initial test for SBO

A

abdo XR: multiple air fluid levels with delated loops of small bowel

87
Q

most accurate test for SBO

A

CT scan of the abdomen

88
Q

HYHYHYHHYHYHYHYHY mgmt of SBO

A
  1. NPO
  2. NG tube with suction
  3. medical mgmt
  4. surgical mgmt
89
Q

medical mgmt of SBO

A

IV fluids to replace volume lost via third pacing

90
Q

surgical mgmt of SBO

A

complete obs= EMERGENCY

lack of improvement with medical mgmt

91
Q

fecal incontinence dx

A

CLINICAL

92
Q

best initial test for fecal incontinence

A

flexible sigmoidoscopy or anoscopy

93
Q

most accurate test for fecal incontinence

A

anorectal manometry

94
Q

hx of anatomic injury with fecal incontinence

A

endorectal manometry

95
Q

3 types of tx for fecal incontinence

A
  1. medical
  2. biofeedback
  3. surgical
96
Q

medical mgmt fecal incontinence

A

bulking agents–fiber

97
Q

biofeedback mgmt fecal incontinence

A

control exercises and muscle strengthening exercises

98
Q

what injection can decrease incontinence by 50%

A

dextranomer/hyaluronic acid (soloist)

99
Q

dx of all fractures

A

XR

100
Q

CLOSED REDUCTION

A

mild fractures without displacement

101
Q

ORIF:

A

severe fractures with displacement or misalignment of bone pieces

102
Q

open fractures mgmt

A

skin must be closed and the bone must be set in the operating room with debridement

103
Q

PC of all fractures

A

pain/swelling/deformity

104
Q

fracture where bone is shattered into multiple pieces

A

comminuted fractures

105
Q

MCC of comminuted fractures

A

crush injuries

106
Q

complete fracture from repetitive insults to bone

A

stress fracture

107
Q

most common site of stress fractures

A

metatarsals

108
Q

athlete with persistent pain—>

A

STRESS FRACTURE

109
Q

Dx of stress fracture

A

CT or MRI> XR (doesn’t show)

110
Q

fracture of vertebrae in osteoporosis

A

compression fracture

111
Q

location of compression fractures

A 
1/3= lumbar
1/3= thoracolumbar
1/3= thoracic
112
Q

older person fractures rib from coughing—->

A

PATHOLOGIC fracture

113
Q

tx of pathologic fracture

A

surgical realignment

tx underlying disease

114
Q

broken bone pierces skin

A

open fracture

115
Q

tx for open fracture

A

ALWAYS ALWAYS ALWAYS SURGERY

116
Q

strain on glenohumeral ligaments

A

anterior shoulder dislocation

117
Q

arm held to the side with ER forearm with severe pain

A

anterior shoulder dislocation

118
Q

anterior shoulder dislocation damages

A

axillary nerve/artery

119
Q

best initial test for anterior shoulder dislocation, posterior shoulder dislocation and clavicular fracture

A

XR

120
Q

most accurate test for anterior shoulder dislocation, posterior shoulder dislocation and clavicular fracture

A

MRI

121
Q

tx anterior shoulder dislocation

A

relocation and immobilization

122
Q

seizure or electrical burn

A

posterior shoulder dislocation

123
Q

arm held to the side and medially rotated

A

posterior shoulder dislocation

124
Q

tx of posterior shoulder dislocation

A

traction and surgery if pulses or sensation diminished during physical exam

125
Q

tx clavicular fracture

A

simple arm sling

126
Q

FOOSH

A

scaphoid fracture

127
Q

imaging for scaphoid fracture

A

3 WEEKS for the XR to show

128
Q

tx of scaphoid fracture

A

thumb spica cast

129
Q

simple arm sling or figure 8 sling for clavicular fracture

A

SIMPLE ARM SLING– since the figure 8 is not any better

130
Q

tx trigger finger

A

steroid injection

131
Q

definitive tx trigger finger

A

cut the sheet thats restricting the tendon

132
Q

DUPUTYRENS IS NOT TRIGGER FINGER

A

duputyrens: men over 40yo, palmar fascia constricted, and hand cannot extend properly

133
Q

only effective tx for duputyren

A

surgery

134
Q

fat embolism syndrome

A
  • confusion
  • petechial rash
  • SOB
135
Q

dx fat embolism

A
  1. ABG pO2
136
Q

tx fat embolism

A

oxygen over 95%;

mechanical ventilation if become severely hypoxic

137
Q

spinal stenosis leg pain

A

bilateral

alleviated by leaning forward (since opens the spinal canal)

138
Q

claudication leg pain

A

unilateral

NO relief by leaning forward

139
Q

dx spinal stenosis

A

spine MRI

140
Q

tx of spinal stenosis

A

NSAID’s or surgery

141
Q

electric shock down dermatome distribution

A

herniated disc

142
Q

patient group for herniated disc

A

elderly a/w lifting

143
Q

dx of herniated disc

A

straight leg raise

144
Q

confirmatory herniated disc

A

NSAID’s

145
Q

tx of herniated disc

A

NSAID’s and activity modification

146
Q

6P’s of compartment syndrome (first 3= early)

A

Pain– mc first; SEVERE, worse with muscle stretch
Pallor
Paresthesia

Paralysis
Pulselessness
Poikilothermia: cold to touch

147
Q

mgmt torn ACL

A

arothroscopic repair

148
Q

direct trauma to front of knee, pain and positive lachman

A

torn ACL

149
Q

direct trauma to back of knee, pain and positive posterior drawer

A

torn PCL

150
Q

traumatic injury to the knee, with POPPING SOUND with flexion and extension

A

meniscale injury

151
Q

arthroscopic repair for which knee injuries

A
  1. ACL
  2. PCL
  3. meniscal injury
152
Q

surgical repair for which knee injury

A

medial and lateral collateral ligament

153
Q

trauma to opposite side of injury

A

medial and lateral collecteral ligament

154
Q

trauma to bent knee

A

medial collateral ligament

155
Q

dx of ALL KNEE injuries

A

MRI

156
Q

most common knee ligament injury

A

ACL

157
Q

UNHAPPY TRIAD

A

medial OR lateral meniscus
medial collateral
ACL

158
Q

most common sites for disc herniation

A

L4-5, L5-S1

159
Q

AAA 3-4cm

A

US every 2-3 years

160
Q

AAA 4-5.4cm

A

US or CT every 6-12mos

161
Q

AAA greater than 5.5cm

A

surgical repair

162
Q

ado US screening

A

former or current smokers over 65yo– gives info on size, cost-effective, monitoring

163
Q

relationship of AAA to surrounding vessels

A

CT/MRI

164
Q

FASTEST diagnostic test for aortic disection

A

TEE – used if patient clinical UNSTABLE

165
Q

aortic dissection and patient is stable

A

MRA

166
Q

mgmt ascending dissection

A

Sx ASAP and bp control

167
Q

mgmt descending dissection

A

medical tx bp control

168
Q

bp mgmt in dissection

A
  1. BETA BLOCKERS= best intial,

2. followed by sodium nitroprusside (never give on own)

169
Q

tricky question— patient had emergency cholecystectomy, 3 days post-op, currently has fever

A

= UTI

170
Q

post op day 1-2

A

WIND: atelectasis or postop pneumonia

171
Q

post op day 3-5

A

WATER: uti

172
Q

post op day 5-7

A

WALKING: DVT or thrombophlebitis at IV access lines

173
Q

post op day 7

A

WOUND: wound infections or cellulitis

174
Q

post op day 8-15

A

WEIRD: drug fever or deep abscess

175
Q

how to prevent post op atelectasis or post op pneumonia

A

incentive spirometry

176
Q

hospital acquired pneumonia tx

A

piptazo

177
Q

UTI Dx

A

urinalysis: nitrates and leukocyte esterase

urine culture

178
Q

DVT dx

A

doppler uS of LL

change IV access lines and culture IV tips

179
Q

tx for DVT:

A

5 days heparin, as bridge to warfarin for 3-6months

180
Q

deep abscess post op

A

dx: CT
tx: CT guided percuranteous drainage, otherwise sx

181
Q

post op confusion

A
  • hypoxic: atelectasis/pneumonia OR PE

- septic: bacteremia or UTI

182
Q

DX ARDS

A

CXR: bilateral pul infiltrates WITHOUT JVD

183
Q

Tx ARDS

A

positive end expiratory pressure, PEEP

184
Q

best initial dx of PE

A

EKG: sinus tachycardia without evidence of ST changes

[cardiac enzymes and trooping to exclude cariidac chest pain]

185
Q

tx of PE

A

heparin as a brdige to warfarin

186
Q

patient has second PE while on warfarin

A

IVC filter via inguinal catheterization

187
Q

next best step for PE…. and have allergy to IV contrast

A

EKG + V/Q scan

188
Q

next best step for PE…. and have allergy to IV contrast

A

EKG + spiral CT scan

189
Q

okay to give heparin without knowing if there is a PE?

A

NOOOOO, must have dx of PE before give heparin

Master the Boards (20 decks)

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