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EORs > Gen Surgery > Flashcards

Gen Surgery Flashcards

1
Q

Normal blood pH

A

7.35 to 7.45

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2
Q

Normal pCO2

A

35-45 is normal
↑ CO2 and ↓pH = respiratory acidosis
↓ CO2 and ↑ pH = respiratory alkalosis

If you don’t see a change in the CO2 in relation to the pH then take a look at the HCO3

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3
Q

Normal HCO3

A

20-26
↓ HCO3 and ↓pH = metabolic acidosis
↑ HCO3 and ↑ pH =metabolic alkalosis

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4
Q

Respiratory Acidosis

A
  • pH <7.30
  • high pCO2 60
  • Normal Bicarb 22

Lungs fail to excrete CO2: Breathing too slow, pulmonary disease, neuromuscular disease, drug-induced hypoventilation due to opiates or barbiturates

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5
Q

Respiratory alkalosis

A
  • pH >7.52
  • low PCO2 25
  • Normal Bicarb 22

Excessive elimination of CO2: Breathing too fast, pulmonary embolism, fever, hyperthyroid, anxiety, salicylate intoxication, septicemia

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6
Q

Metabolic Acidosis

A
  • pH <7.30
  • Normal pCO2 40
  • Low Bicarb 16
  • Calculate anion gap to tighten ddx: Anion Gap = Na – (Cl + HCO3-)
  • Normal anion gap is 10-16
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7
Q

Metabolic Acidosis

- Increased anion gap

A

> 16
- Addition of hydrogen ions: Lactic acidosis (think metformin), diabetic ketoacidosis, aspirin overdose

MUDPILES:

  • Methanol
  • Uremia
  • Diabetic Ketoacidosis
  • Paraldehyde
  • Infection
  • Lactic Acidosis
  • Ethylene Glycol
  • Salicylates
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8
Q

Metabolic Acidosis

- Decreased anion gap

A

<16

Loss of bicarbonate: think diarrhea, pancreatic or biliary drainage, renal tubular acidosis

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9
Q

Metabolic alkalosis

A
  • pH >7.52
  • Normal PCO2 40
  • High Bicarb
  • Loss of hydrogen: vomiting, bulimia, overdose of antacids, addition of bicarbonate (hyperalimentation therapy)
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10
Q

6 predictors of surgical cardiac complications

A
  • Ischemic heart disease
  • Congestive heart failure,
  • Cerebrovascular disease
  • A high-risk operation
  • Preoperative treatment with insulin
  • Preoperative serum creatinine greater than 2.0 mg/dL
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11
Q

Pre-op hx of MI

  • risk
  • testing
A
  • 5% to 10% risk of postoperative MI
  • Preoperative EKG on patients 40+ yo
  • Current unstable angina: avoid elective surgeries
  • Stage two HTN: control prior to surgery
  • Patient should take antihypertensive medication on the day of the procedure
  • History of rheumatic heart disease: prophylactic antibiotic therapy
  • Send the patient to a cardiologist for clearance to have a stress test or Echo if any concerns
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12
Q

when is noninvasive stress testing indicated (non-cardio procedures)

A
  • Active cardiac conditions (eg, unstable angina, recent MI, significant arrhythmias, or severe valvular disease)
  • Patients who require vascular operations and have clinical risk factors and poor functional capacity
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13
Q

what is the most common type of perioperative complication

A

pulmonary

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14
Q

What are the two main determinations of post-op risk?

A
  • operative site

- Presence of lung disease

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15
Q

Optimal time to stop smoking pre-op

A

8 weeks

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16
Q

Asthma and perioperative risk

  • well controlled
  • not well controlled
A
  • no additional risk

- risk factor if not well controlled

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17
Q

Asthma control

  • any surgery
  • elective surgery
A
  • step up therapy including systemic steroids if needed based on FEV1 and PVC
  • PEV >80% and wheeze free
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18
Q

Asthma control and endotracheal intubation

A
  • rapid inhaled beta agonist 2-4 puffs or nebulizer 30 min prior intubation
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19
Q

what pulm situations are absolute contraindications to elective surgery? what to do in emergency situations

A

Acute lower resp tract infections:

  • tracheitis
  • bronchitis
  • pneumonia

Emergency: humidification of inhaled gas, remove lung secretions, bronchodilators and abx

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20
Q

What type of surgery have highest risk of post-op pulmonary risk

A
  • upper abdominal
  • open aortic aneurysm
  • open thoracotomy
  • head/neck operations
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21
Q

Postop strategy to reduce risk of pulm complications

A
  • lung expansion: PT, breathing exercises, incentive spirometry, etc.
  • Early mobilization (facilitates deep breathing)
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22
Q

What does elevated glucose level increase risk for?

A

surgical site infection (SSI)

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23
Q

how to control glucose perioperative period

A

IV insulin

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24
Q

Glycemic control

A

Normal: 90-100
Moderate: 120-200

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25
Q

Renal disease

A
  • CKD c dialysis: sig increase in post-op complications (hyperkalemia, pneumonia, fluid overload, bleeding)
  • Dialysis 24 hours before surgery
  • monitor electrolytes immediately before and after surgery
  • monitor weight, I&Os, and renal function
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26
Q

Hepatic disease

complications

A

hemorrhage, infection, renal failure, encephalopathy, substantial mortality rate

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27
Q

Hepatic disease

- elective surgery

A
  • reduce ascites: leads to wound dehiscence and hernias
  • reduce encephalopathy: worsened by sedatives and analgesics
  • reduce coagulopathy: vitamin K +/- plasma transfusion
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28
Q

Hepatic disease

- postop

A
  • platelet number and function
  • electrolyte disturbances, esp hypernatremia
  • Risk for upper GI hemorrhage (esophageal or gastric varies)
  • etoh: malnutrition and vitamin deficiencies
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29
Q

tobacco use risks

A
  • decreases functional capacity
  • increases risk of bleeding, infection, wound dehiscence
  • increased risk of hernia recurrence
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30
Q

Chronic steroid use

- perioperative risks

A
  • Postop infection, dehiscence, mortality, poor wound healing, staple line leaks
  • Addisoninan crisis if inadequate pre-op dose
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31
Q

When should perioperative stress hormone be given ?

A

primary or secondary adrenal insufficiency

  • current regimen of more than 20 mg prednisone
  • monitor glucose levels!
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32
Q

Dx of DVT

  • first line if low prob
  • preferred
A
  • D-dimer: >500 positive

- compression US with doppler: preferred

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33
Q

DVT

- management

A
  1. Anticoagulation
  2. IVC filter if risk of bleed > risk VTE
  3. LMWH if cancer
  4. Pregnancy: SQ LMWH or temp IVC filter
  5. Thrombectomy: massive iliofemoral or fail other management
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34
Q

DVT prevention

A
  1. early ambulation

2. compression stockings 2 years

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35
Q

PE

- screening tests (3)

A
  1. CXR: normal, +/- atelectasis or pleural effusion. **Hampton’s Hump and Westermark’s sign
  2. D-dimer
  3. EKG: S1Q3T3
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36
Q

PE

- diagnostic tests

A
  1. Helical CT
  2. doppler US (only helpful if positive…)
  3. VQ scan
  4. Increased A-a (alveolar-arterial) gradient
  5. CT pulmonary angiography (gold standard!!)
  6. ABG- resp alkalosis
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37
Q

what test is used first to establish dx of jaundice

A

Fractionated bilirubin

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38
Q

Jaundice

- pre-hepatic causes

A

red cell breakdown

  • hemolysis
  • erythropoiesis
  • hematoma reabsorption
  • myoglobin breakdown
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39
Q

Jaundice

- pre-hepatic often leads to what kind of bilirubin

A

unconjugated/indirect

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40
Q

Jaundice

- intrahepatic causes

A
  • autoimmune
  • infectious (hepatitis)
  • genetic defects (Gilbert, Crigler-Najjar)
  • Pharm
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41
Q

Jaundice

- posthepatic

A
  • usu biliary obstruction
  • infectious (cholecystitis, cholangitis)
  • secondary to neoplasm around the biliary tract
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42
Q

Pheochromocytoma

- first test for high risk pt

A

plasma fractionated metanephrines

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43
Q

Pheochromocytoma

- first test for low risk pt

A

24 hour urine fractionated metanephrines

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44
Q

Pheochromocytoma

- associated disorders

A

Familial tumor disorders:

  • MEN2
  • von Hippel-Lindau
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45
Q

Pheochromocytoma

- triad

A
  • palpitations/tachycardia
  • episodic HA
  • diaphoresis

*usu have hx of HTN

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46
Q

Pheochromocytoma

- testing after biochemical testing

A
  • CT or MRI to locate tumor

- poss genetic testing

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47
Q

Pheochromocytoma

- What medication given pre-op

A

a-adrenergic blockade to prevent unopposed alpha agonism once give beta blocker
- phenoxybenzamine or phentolamine

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48
Q

Pheochromocytoma

- med given during sx

A

beta blocker: maintain CV and hemodynamic stability

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49
Q

MCC appendicitis

A

fecalith

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50
Q

Surgical site infection

- def by timing

A
  • 30 days of procedure

- 90 days if prosthetic material is used

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51
Q

Surgical site infection

- RF

A
  • smoking
  • older
  • obesity
  • malnutrition
  • DM
  • immunosuppressed
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52
Q

Surgical site infection

- highest risk is sx of what location

A

abdominal

Then CABG, C-section, vascular, joint prosthesis

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53
Q

Cellulitis surgical site infection

- PE

A
  • red, warm, purulent drainage

- no wound dehiscence or fluctuance

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54
Q

Surgical site infection Tx

  • cellulitis
  • abscess
A
  • abx, no open drainage needed

- I and D

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55
Q

Burns

- Parkland formula

A

Ringers lactate = 4 ml X total BSA of burn % X body weight (kg)

  • first half over first 8 hours
  • second half of next 16 hours
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56
Q

Burn

- steps to tx

A
  • ABCDE

- fluid resuscitation with Ringer’s lactate via Parkland formula

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57
Q

Medication to treat hemophilia A

A

DDAVP / desmopressin

analogue of vasopressin which promotes factor VII and VWF release from storage pools

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58
Q

how to give iron to a patient post bariatric surgery with risk of inadequate absorption

A

IV

for example post Roux-en-Y

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59
Q

What should be done pre-op for pts with COPD who have increased respiratory sx, reduced exercise tolerance, new lung auscultation findings?

A

CXR to r/o active infection and heart failure

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60
Q

Functional Capacity

- indicator of what

A

Postop cardiac complication risk

  • assess at initial prep evaluation
  • expressed in METs
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61
Q

Functional Capacity

- 4 levels of METs

A

1: can care for self: eat, dress, use toilet
3-4: walk up steps or hill, walk on level ground
4-10: heavy work around the house, climb two flights of stairs
>10: can do strenuous sports

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62
Q

Painless mass on testicle: diagnostic steps

A
  1. PE: painless mass
  2. trans-scrotal US
  3. CT scan
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63
Q

How much of a margin should excision of melanoma contain

A

2 cm margin

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64
Q

Esophageal stricture

- MCC

A

long standing gastric reflux: form at GE junction as part of healing process of ulcerative esophagitis and lead to narrowing of the lumen

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65
Q

Esophageal stricture

- clinical

A

dysphagia: slow progressive to solids
- regurgitation
- episodic food impaction

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66
Q

Esophageal stricture

- dx

A
  • upper endoscopy: direct visualization of gastric mucosa

- biopsy during endoscopy to r/o malignancy

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67
Q

Esophageal stricture

- Tx

A
  • dilation during endoscopy

- acid-suppressive therapy with PPI to prevent recurrence

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68
Q

Empiric therapy for cellulitis

A

should cover MRSA

  • clindamycin
  • Bactrim
  • Tetracycline (doxy or mino)
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69
Q

clinical signs of perforation of acute cholecystits

A

hypoactive bowel sounds

- also high fever, toxic signs (tachycardia, tachypnea), rebound tenderness abd pain

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70
Q

DVT

- diagnostic test of choice

A

doppler US (will show non compressibility of imaged vein = thrombus)

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71
Q

DVT

- timing of presentation post surgery

A

more than one week postop

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72
Q

Nephrotic syndrome leads to edema of what area of the body

  • non-ambulatory
  • ambulatory
A
  • sacrum

- peripheral (usu LE) and periorbital

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73
Q

Solitary thyroid nodule

- TSH

A
  • first test

- if normal or high = thyroid US

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74
Q

Solitary thyroid nodule

- on US is benign

A
  • serial f/u
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75
Q

Solitary thyroid nodule

- on US is malignant

A
  • FNA
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76
Q

Solitary thyroid nodule FNA is

  • benign
  • indeterminate
  • malignant
A
  • serial f/u
  • repeat FNA
  • sx removal
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77
Q

Where do the majority of diverticula form?

A

sigmoid colon - highest pressure bc it has the smallest diameter of the colon

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78
Q

describe diverticula

A

sacs that form in weak areas of the colon all where the vasa recta penetrate the muscle layer

79
Q

What helps cause diverticula

A
  • pressure
  • colonic wall tension
  • bowel wall radius
80
Q

Diverticulosis

- clinical

A
  • usually asx
  • maybe bloating, crampy abd pain
  • painless rectal bleeding
81
Q

Diverticulosis

- dx

A
  • CT
  • colonoscopy
  • nuclear scan/angiogram
82
Q

Diverticulosis

- management

A
  • supportive, most stop bleeding spontaneously

- sx for persistent bleeding

83
Q

Tx for ascending aortic dissection

A

emergent open surgical repair

84
Q

Aortic dissection

- s/sx

A
  • acute onset severe, sharp, knife like pain in middle of chest, radiating to back
  • new decrescendo diastolic murmur RSB
  • wide pulse pressure
  • hypotension
85
Q

Aortic dissection

- dx

A
  • XR: widened mediastinum

- CT angiography to confirm and differentiate between ascending and descending

86
Q

Aortic dissection management

  • ascending
  • descending
A
  • surgical emergency

- medically with bp control and imaging surveillance

87
Q

Courvoisier sign

A
  • pancreatic cancer and gallbladder malignancy
  • painless, palpable gallbladder
  • dt obstruction of biliary tree
88
Q

Pancreatic cancer

- dx

A
  • CT
  • Serum CA 19-9
  • Endoscopic US
  • ERCP
89
Q

Pancreatic cancer

- s/sx

A
  • vague, diffuse pain in epigastrium, LUQ
  • diarrhea, weight loss
  • depression
  • painless jaundice
  • Courvoisier sign
90
Q

Pancreatic cancer

- management

A
  • surgery (body and tail tumors rarely eligible)
  • chemo
  • palliation
91
Q

SBO

- MC metabolic disturbance postop

A
  • metabolic alkalosis
  • volume contraction + gastric fluid loss
  • sx = aggressive third spacing into peritoneal cavity
  • Postop NG decompression = acid and K loss
  • Bicarb released into serum in reaction to increased HCl production by stomach

** hypochloremic, hypokalemic metabolic alkalosis

92
Q

MC post-surgical complication after sx tx for PUD?

A

Weight loss

  • limit food intake due to early satiety
  • maldigestion or dumping syndrome
  • counsel to eat smaller, more frequent meals
93
Q

Diverticulitis

- first line dx

A

Abd CT with contrast

94
Q

MCC esophageal squamous cell carcinoma

A

smoking and alcohol

95
Q

MCC esophageal adenocarcinoma

A

Barrett’s metaplasia dt GERD

96
Q

primary biliary cholangitis

A
  • pruritus, jaundice, RUQ pain, fatigue
  • AMA
  • elevated alk phos, AST, ALT
97
Q

spontaneous bacterial peritonitis

  • MC bacteria
  • Best abx
A
  • Escherichia coli, Klebsiella pneumoniae, and Streptococcus spp.
  • 3rd gen ceph like cefotaxime
98
Q

Toxic megacolon

- diagnostic criteria

A

radiographic evidence of dilated colon plus 3+:

  • Fever >38
  • WBC >10.5
  • HR >120

AND 1+

  • dehydration
  • electrolyte disturbance
  • hypotension
99
Q

Disease processes that precipitate toxic megacolon

A
  • IBD (most common)
  • pseudomembranous colitis
  • CMV colitis
  • Bacterial colitis
100
Q

Medication to treat claudication

A

ASA

Ticlopidine

101
Q

Adrenal carcinoma

  • dx
  • tx
A

CT with contrast

adrenalectomy

102
Q

lab findings in hyperparathyroidism

A
  • High PTH
  • High calcium
  • Low phosphorus
  • osteopenia and elevated vitamin Dfalphaf
103
Q

Colon polyps

- f/u based on findigns

A
  • single polyp - 10 years (same as no polyp)
  • multiple hyperplastic polyps, hyperplastic polyps at site other than distal, tubular polyps: 5 year f/u
  • villous polyp: 3 year f/u
104
Q

What blood glucose level is the “sole predictor” of SSI

A

> 140 mg/dL

105
Q

What type of surgery is at a higher risk of perioperative thromboembolism

A

colorectal (vs. general surgery)

106
Q

what two meds are used to reduce both deep venous thrombosis and pulmonary embolism

A

SQ warfarin and LMWH

Low-molecular-weight heparin has a simplified dosing regimen and a decreased incidence of heparin-induced thrombocytopenia, however, it is more expensive and there seems to be a dose-related increased risk of bleeding complications

Also Fondaparinux, a newer Xa inhibitor

107
Q

DVT prophylaxis recommendations

A
  • Very low risk: early ambulation alone
  • Low risk: mechanical prophylaxis with intermittent pneumatic compression (IPC) devices
  • Moderate risk: options of low-molecular-weight heparin (LMWH) or low-dose unfractionated heparin or IPC
  • High risk: IPC in addition to either LMWH or low-dose heparin
  • Furthermore, an extended course (4 weeks) of LMWH may be indicated among patients undergoing resections of abdominal or pelvic malignancies
108
Q

How to bridge patients who currently take Warfarin prior to surgery

A
  • last warfarin in day -6
  • start LMWH day -3, last dose AM of day -1
  • resume bridging back to Warfarin one hemostasis has occurred, 24 hours in low bleeding sx, 48-72 hours high risk bleeding
109
Q

When to stop/start ASA around sx

A

Stop 7 days before, restart 7 days after

110
Q

What does a SSI with clostridium present like?

A

bronze-brown weeping tender wound

111
Q

what is a common adverse effect after cardiac surgeries?

A

Acute kidney injury (10-30%)

112
Q

How to reduce risk of kidney injury preoperatively?

A
  • pushing fluids

- avoiding NSAIDs and exposure to IV contrast should be minimized or avoided

113
Q

perioperative maintenance fluids

  • loss
  • calculation for replacement
  • other considerations
A
  • Daily maintenance for sensible and insensible loss in adult = 1500 to 2500 mL depending on age, gender, weight, BSA
  • Multiply patient weight (kg) × 30 = fluid over 24 hours
  • Increased requirements for fever, hyperventilation, and increased catabolism

**General rule: 2000 to 2500 mL of 5% dextrose in normal saline or lactated Ringer’s solution delivered daily

114
Q

Should K be added to fluids perioperativeLY?

A

Do not add potassium during the first 24 hours because K+ is already increased during surgery (stress) with increased aldosterone activity

115
Q

when to place urinary catheter

A

(1) anticipating long procedure
(2) performing urologic or low pelvic surgery
(3) need to monitor fluid balance

116
Q

Hyponatremia

- presentation

A

Muscle cramps and seizures

117
Q

Hyponatremia

- tx

A
  • asymptomatic: free water restriction
  • moderate: IV normal saline, loop diuretics may be added
  • severe hyponatremia: hypertonic (3%) saline

*Serum Na should be corrected slowly—by ≤ 10 mEq/L over 24 h to avoid osmotic demyelination syndrome

118
Q

Hypernatremia

- s/sx

A

Poor skin turgor, dry mucous membranes, flat neck veins, hypotension, increased BUN/CR ratio > 20:1

119
Q

Hypernatremia

- tx

A

intravenous (IV) 5% dextrose in water (D5W). Rapid overcorrection causes cerebral edema and pontine herniation

120
Q

Hyperkalemia

- Presentation

A
  • Peaked T waves
  • Prolonged QRS
  • Muscle fatigue
121
Q

Hyperkalemia

- tx

A
  • calcium

- Insulin, sodium bicarbonate and glucose.

122
Q

Hypokalemia

- presentation

A
  • Muscle cramps
  • Constipation
  • Flattened/inverted T waves
  • U waves
123
Q

Hypokalemia

- tx

A
  • Potassium repletion
  • Remember to NOT use dextrose-containing fluids as this will stimulate insulin release and shift potassium within the cell which worsens the hypokalemia
124
Q

Hypocalcemia

- presentation

A
  • QT prolongation
  • Trousseau’s sign, Chvostek’s sign
  • Labs: ↓ Ca+ ↓ PTH ↑ phosphate
125
Q

Hypocalcemia

- tx

A

IV calcium gluconate or calcium chloride

126
Q

Hypercalcemia

- presentation

A

“Stones, bones, abdominal groans, psychiatric moans”, EKG: shortened QT interval.

Blood: ↑ PTH, ↑ Calcium, ↓ phosphorus
Associated with malignancy and hyperparathyroidism

127
Q

Hypercalcemia

- tx

A

Normal IV saline and furosemide

128
Q

Hypomagnesemia

- presentation

A
  • Muscle weakness
  • hyperreflexia
  • prolonged QT, PR and wide QRS
  • ventricular tachycardia
  • torsades de pointes
129
Q

Hypomagnesemia

- tx

A

IV magnesium sulfate (acute) or oral magnesium oxide (chronic)

130
Q

Hypermagnesemia

- presentation

A

Muscle weakness

  • prolonged QT, PR and wide QRS
  • *same as hypomagnesmemia
131
Q

Hypermagnesemia

- tx

A
  • IV isotonic saline

- loop diuretics can be considered

132
Q

Hyperphosphatemia

  • etiology
  • presentation
  • treatment
A
  • Etiology: Chronic kidney disease
  • Presentation: typically asymptomatic
  • Treatment: calcium carbonate, restrict potassium
133
Q

Hypophosphatemia

  • presentation
  • treatment
A
  • Presentation: weakness, muscle and bone pain, osteomalacia, rickets
  • Treatment: IV phosphate replacement
134
Q

Hyperthyroidism

- Tx

A
  1. beta blockers for heart rate symtpoms
  2. PTU and *methimazole (PTU during pregnancy and breastfeeding)
  3. IV methylprednisolone for ophthalmopathy
135
Q

Cold vs. hot nodule after RAI scan

A
  • Cold: no uptake = hypo functioning, require sx

- Hot: increased uptake = functional, lower risk of malignancy

136
Q

What medication is CI in isolated PAD?

A

BB - will worse claudication

137
Q

Management of AAA by size

A
  • < 3.0 cm no testing
  • 3 - 4.4 cm annual US
  • 4.5 - 5.0 cm US every 6 months
  • 5.0 - 5.4 cm US every 3 months
  • > 5.5 or more than 0.5 cm expansion in 6 months : immediate sx repair, even if asx
138
Q

Medication to treat TIA

A

Aspirin + dipyridamole or clopidogrel monotherapy

139
Q

Tremor associated with hyperthyroid

A

high frequency, low amplitude tremor that is present with action

140
Q

What two electrolytes can cause palpitations if out of nl range

A

hypokalemia, hypomagnesemia

141
Q

MCC secondary hyperparathyroidism

A

chronic kidney disease (physiologic response to hypocalcemia or vitamin D deficiency)

142
Q

MCC primary hyperparathyroidism

A

PTH secreting parathyroid ADENOMA

143
Q

Antibodies in Graves disease

A

Anti-thyrotropin antibodies

144
Q

MCC cellulitis

A

S. aureus (GABHS)

145
Q

Cellulitis

- tx

A
  • Outpatient nonpurulent: dicloxacillin, cefazolin, clindamycin
  • Outpatient purulent: Clinda, bactrim, tetracycline (MRSA)
  • Inpatient: IV abx
146
Q

Treatment for postop urticaria

A
  • stop offending agent
  • anthistamines
  • steroids
147
Q

MC type melanoma

A

superficial spreading - on sun exposed parts of body

148
Q

2nd MC type melanoma

A

nodular

  • older patients
  • often ulcerate and hemorrhage
149
Q

What size of lesion is suspicious for melanoma

A

> 6 mm

150
Q

Do stage I pressure ulcers blanch?

A

NO

151
Q

Stages of pressure ulcer

A
  • Stage I: erythema of localized area, usually non-blanching over a bony surface. If the area blanches, it is not a stage 1 pressure ulcer. If it stays red, it is a stage 1 pressure ulcer.
  • Stage II: partial loss of dermal layer, resulting in pink ulceration
  • Stage III: full dermal loss often exposing subcutaneous tissue and fat
  • Stage IV: full thickness ulceration exposing bone, tendon, or muscle. Osteomyelitis may be present
152
Q

Early signs of local anesthetic toxicity

A 
Tinnitus,
perioral/tongue numbness
metallic taste
blurred vision
muscle twitches
drowsiness
153
Q

MCC postop vision loss

A

corneal abrasion

154
Q

Other reasons for postop vision loss

A
  • central retinal artery occlusion
  • ischemic optic neuropathy
  • cerebral vision loss
155
Q

aphasia

A
  • inability to comprehend or formulate language because of damage to specific brain regions
  • typically caused by a postoperative cerebral vascular accident (stroke), or head trauma
156
Q

dysarthria

A
  • motor speech disorder resulting from neurological injury of the motor component of the motor-speech system
  • Causes include toxic, metabolic, degenerative diseases, traumatic brain injury, or thrombotic or embolic stroke
157
Q

Anterior cord injury

A

Loss of pain and temperature below the level with preserved joint position/vibration sense

158
Q

Central cord syndrome

A

Loss of pain and temperature sensation at the level of the lesion, where the spinothalamic fibers cross the cord, with other modalities preserved (dissociated sensory loss)

159
Q

Complete cord transection

A

Rostral zone of spared sensory levels (reduced sensation caudally, no sensation in levels below injury); urinary retention and bladder distention

160
Q

Brown-Sequard syndrome

A

(hemisection of the cord)

  • Loss of joint position sense and vibration sense on the same side as lesion and pain and temperature on the opposite side a few levels below the lesion
  • Lesion of half-ipsilateral cervical cord lesion
  • Contralateral sensory findings: pain and temperature loss
161
Q

Carotid artery disease

- treatment

A
  • Smoking cessation
  • Antiplatelet therapy for symptomatic patients: Clopidogrel, Aspirin plus dipyridamole
  • Statins for all patients
  • Operative - carotid artery revascularization if Stenosis > 70%, Post-transient ischemic attack or stroke
  • Surgeries: Carotid endarterectomy (CEA): first-line for patients who can tolerate surgery. Carotid artery stenting: for patients unable to tolerate CEA
162
Q

bladder carcinoma

- gold standard for dx

A

Cystoscopy with biopsy

163
Q

bladder carcinoma

- tx

A
  • Endoscopic resection with cystoscopy every 3 months

- Recurrent or multiple lesions can be treated with intravesical chemotherapy.

164
Q

classic sign of urinary retention in elderly

A

confusion

165
Q

Postoperative Urinary Retention (POUR)

A

common complication of both spinal and epidural anesthesia is a prolonged blockade of parasympathetic fibers that innervate the bladder with resultant urinary retention and the need for a urinary bladder catheter

166
Q

indications for extracorporeal shock wave lithotripsy

A

stones greater than 6 mm in size or intractable pain.

167
Q

Four main types of kidney stone

A
  • Calcium oxalate (MC): 75% to 85% – stones are radiopaque
  • Uric Acid: 5% to 8% – stones are radiolucent.
    Form in individuals with persistently acidic urine.
  • Cystine: < 1% (stones are radiolucent)
  • Struvite: 10% to 15% (radiopaque)
168
Q

Gold standard diagnosis for nephrolithiasis

A

Noncontrast CT of the Abdomen and Pelvis

Urinalysis will often show microscopic hematuria

169
Q

Nephrolithiasis treatment by stone size

A
  • Stones < 5 mm will have an 80% chance of spontaneous passage
  • Stones > 5 – 10 mm have a 20 % chance of passage and may require elective lithotripsy, patients should be considered for early elective intervention.
  • Stones > 10 mm may are not likely to pass spontaneously. Ureteral stent or percutaneous nephrostomy (gold standard) should be used if renal function is jeopardized.
  • Urgent treatment with extracorporeal shock wave lithotripsy can be used for renal stones of less than 2 cm or for ureteral stones of less than 10 mm.
170
Q

renal cell carcinoma triad clinical

A

flank pain, hematuria and a palpable abdominal/renal mass

171
Q

Renal cell carcinoma MC RF

A

smoking

172
Q

Renal cell carcinoma 2 types

A
  • Renal clear cell carcinoma MC 80%

- Transitional cell is the second most common type (20%)

173
Q

Renal cell carcinoma

- dx

A
  • CT

- bx

174
Q

renal vascular disease

- dx imaging

A
  • US usually first line

- Renal arteriography is GOLD STANDARD for diagnosis

175
Q

renal vascular disease

- management

A
  • Stenting

- Percutaneous transluminal angioplasty (PTA) plus stent placement or with surgical bypass of the stenotic segment

176
Q

MCC testicular cancer

A

seminoma

177
Q

AV fistula for dialysis

A

large vein that is close to the skin, cephalic vein is a great option

178
Q

what other electrolyte disorder is hypokalemia associated with?

A

hypomagnesemia

179
Q

which electrolyte disorder is associated with malignancy

A

hypercalcemia

180
Q

definitive diagnosis of testicular cancer

A

Radical inguinal orchiectomy

181
Q

classic hemodialysis access fistula

A

radial artery to cephalic vein arteriovenous fistula

182
Q

best type of graph autogenous vs. prosthetic

A

autogenous fistula formation > prosthetic

*To maximize autogenous vein utilization, current practice includes transposing deep veins such as the basilic vein in the upper arm to the subcutaneous tissue

183
Q

Indications for hemodialysis

A
  • Uremic symptoms: pericarditis, encephalopathy, GI complications (anorexia, nausea, vomiting), azotemia
  • GFR <10 mL/min/1.73 m2
  • Fluid overload unresponsive to diuresis
  • Refractory hyperkalemia
184
Q

What do Petechiae suggest?

A

problem with platelets

185
Q

what two electrolyte disorders are associated with fatigue?

A

hypercalcemia and hyponatremia

186
Q

3 MCC hemoptysis

A
  1. bronchitis
  2. tumor mass
  3. TB

Other: bronchiectasis, pulmonary catheters, trauma, pulmonary hemorrhage

187
Q

What foods increase sx of heartburn

A

Caffeine, chocolate, ethanol, peppermint, fatty foods and nicotine

188
Q

external hemorrhoids

- initial pharm treatment

A
  • topical steroids
189
Q

Three MCC SBO

A
  • Postoperative adhesions are the most common cause of SBOs (70%)
  • Cancer (20%)
  • Incarcerated hernias (10%).
190
Q

Toxic megacolon

- first dx test

A

plain film

191
Q

Trousseau’s syndrome

A

Related to the hypercoagulability that accompanies many cancers, and is found on examination as tender migratory thrombophlebitis which can occur in crops of veins at different times.

192
Q

Primary biliary cholangitis

A
  • autoimmune
  • rare disease of the liver that causes progressive cholestasis and can result in end-stage liver disease
  • loss of these bile ducts causes the signs and symptoms of cholestasis
  • fatigue, pruritus and right upper quadrant discomfort
  • AMA
  • increased ALT, AST, Alk phos
193
Q

MC surgical emergency in preg women

A

appendicitis

EORs (9 decks)

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