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Surgery Shelf > General Information > Flashcards

General Information Flashcards

1
Q

What are the 5 things to consider in order to clear a patient for surgery?

A

1 is cardiac health- get EKG, echo, possibly cath

Pulmonary- if smoker, get them to stop 8 weeks ahead
Liver- low albumin, low PT or PTT, ascites, or encephalopathy increase mortality by 40%
Nutrition
Acidosis- normally DKA (check glucose pre-op, ALWAYS), but should never go to surgery when acidotic unless surgery is going to fix it

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2
Q

What can cause a fever during an operation? Treatment?

A

Malignant hyperthermia
Tx: Dantrolene, O2, cool IVF
Maybe ask about family history

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3
Q

What can cause a fever immediately after surgery? Treatment?

A

Iatrogenic bacteremia- keep sterile field clean!1

Get cultures and tx with broad spectrum antibiotics

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4
Q

What can cause a fever FIRST day post op? treatment?

A

Atelectasis- get CXR

Give ICS and get patient out of bed

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5
Q

What can cause a fever POD2? Treatment?

A

Pneumonia- get CXR
Tx- antibiotics
Prophylaxis would have been incentive spirometry and get out of bed

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6
Q

What can cause a fever POD3? Treatment?

A

UTI- get urine cultures (if you see casts, probably pre-op surgery)

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7
Q

What can cause a fever POD5? treatment?

A

DVT or PE- get CXR
Treat with Heparin then coumadin
Could have used heparin prophylactically

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8
Q

What are the 5 Ws of post op fever?

A

Wind, Water, Walking, Wound, Wonder drugs

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9
Q

What can cause a fever POD7? Treatment?

A

Wound infection- U/S will be negative

Tx- antibiotics to cover cellulitis

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10
Q

What can cause fever POD10?

A

Wound infection via abscess- U/S will be positive

Tx with incision and drainage with culture

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11
Q

What to do with post-op chest pain?

A

Rule out MI or PE: ECG, CXR, troponins

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12
Q

What to do with post-op altered mental status?

A 
If ARDS (will see white out on CXR)- treat with PEEP
If delirium tremens (POD2 HTN with seizures)- treat with BZDs
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13
Q

What causes decreased urine output when a patient has the urge to void post op?

A

Urinary obstruction

Treat with in/out catheter

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14
Q

What causes a decreased urine output when a patient does NOT have urge to void?

A

Renal failure- must be ruled out with 500 cc bolus–> should increase UOP
If this does not increase UOP- acute renal failure

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15
Q

What should you think if a patient with normal renal function pre op has ZERO UOP post op?

A

Foley could be kinked

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16
Q

What causes POD1 ileus? What is seen on KUB? What is the treatment?

A

Paralytic ileus- this is normal on POD1
KUB shows distended small and large bowel
Treat with moving the patient and getting the walking

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17
Q

What causes POD5 ileus? What is seen on KUB? Treatment?

A

Obstruction due to adhesions or hernia
KUB shows distension followed by thin decompressed bowel
Tx is surgery

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18
Q

What causes ileus of colon in elderly patients post-op? What is seen on KUB? Treatment?

A

Ogilves’ syndrome
KUB shows large bowel distension with no area of obstruction
Tx is bowel decompression and colonoscopy to rule out cancer

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19
Q

What is the treatment for wound eviceration?

A

Warm saline dressing, bed rest, and OR ASAP

DO NOT push bowel back in

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20
Q

What are causes of fistula?

A 
Foreign Body
Epithelialization
Tumor
Inflammation
Radiation
Distal Obstruction
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21
Q

A patient has obstructive jaundice but a negative CT scan–> next step?

A

ERCP- looking for ampullary cancer

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22
Q

What are some indications for CT scan of pancreatitis?

A

Fever and leukocytosis that are unresolved for days- possibly abscess
Decreased Hgb or poor Ranson’s criteria- possibly necrotizing pancreatitis
Early satiety or ascites weeks later- possibly psuedocyst

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23
Q

What is ranson’s criteria at admission?

A 
Age> 55
WBC> 16
blood glucose> 200
AST> 250
LDH> 350
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24
Q

What is ranson’s criteria within 48 hours?

A 
calcium < 2.0
10% fall in Hct
PO2< 60
BUN increases by 1.8
Base deficit
Sequestration of fluid
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25
Q

A patient presents with violent wretching and history of alcohol use- what is the work up?

A

Gastrographin swallow is 1st. Less irritating than barium

Surgical emergency

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26
Q

A patient has a hemorrhoid that does not hurt but bleeds- diagnosis and treatment?

A

Internal hemorrhoid- usually dark blood on toilet paper
Diagnose via visual inspection or anoscopy
Treatment- band

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27
Q

A patient has a hemorrhoid that hurts but does not bleed- diagnosis and treatment?

A

External hemorrhoids
Diagnose via visual inspection
Treat medically first, then remove

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28
Q

Patient presents with pain on defecation that lasts for hours- diagnosis, pathogenesis, treatment?

A

Anal fissure caused by a tight sphincter
Diagnose by visual inspection
Treat with lateral internal sphincterotomy after medical treatment fails

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29
Q

What can predispose to anal cancer? How is it worked up? Treatment

A

MSM, HIV, HPV
Work up by pap smear of anus, biopsy
Treat with chemoradiation- Nigro protocol

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30
Q

Describe obstructive visceral pain? Examples

A

Colicky pain
Patient will be trying to find position of comfort
NO fever, leukocytosis
Gallstones, kidney stones, and early SBO

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31
Q

Describe inflammatory visceral pain? Examples

A 
Constant pain- patient writhes around trying to find comfortable position
Fever and leukocytosis present
Cholecystitis
Cholangitis
Diverticulitis
Appendicitis
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32
Q

Describe perforation visceral pain?

A

Sudden onset of constant severe pain
Patient will not move because of pain
Peritoneal- fever, luekocytosis, guarding and rebound tenderness
Free air under diaphragm
Caused by cancer, trauma, PUD, diverticulitis

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33
Q

Describe ischemic visceral pain? Examples

A

Constant excruciating pain disproportional to physical exam
Bowel or visceral organ are actively having necrosis
Look for PVD, CAD, A fib
Ischemic colitis or Mesenteric ischemia
Can present with bloody bowel movement

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34
Q

Describe distended visceral pain? Examples

A

Referred diffuse vague pain
Constipation
Bloating

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35
Q

Type of ulcer due to patient being bed ridden?

A

Compression ulcer
Sign of abuse
Treat with movement and rolling

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36
Q

Type of ulcer associated with hairless leg, decreased pulses, and scaly skin. Work up? Treatment?

A

Arterial insufficiency due to peripheral vascular disease
Will be furtherest away from blood supply–> tip of the toes
Work up: Ankle-Brachial index–> Doppler–> arteriogram
Tx- revascularize

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37
Q

Ulcer above the middle maleolus with edema, hyperpigmentation? Treatment?

A

Venous insufficiency

Treat with compression stalkings and treat underlying cause of edema

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38
Q

What are some signs that point to urethral transection? What should be done if suspected?

A

Signs: blood at the meatus, high-riding prostate, scrotal hematoma
Do retrograde urethrogram before Foley

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39
Q

What should be done if cribiform plate fracture is suspected?

A

Place OG tube rather than NG tube

40
Q

Define the classes of hemorrhagic shock?

A

Class 1- 15% blood loss, no symptoms
Class 2- 15-30% blood loss, increased HR, decreased SBP
Class 3- 30-40% blood loss, HR> 120, decreased pulse and decreased SBP, altered mental status
Class 4-40% blood loss, very severe vital signs, death is imminent

41
Q

What is a way to calculate cerebral perfusion pressure?

A

MAP-ICP

In a hypertensive patient, lowering the BP too fast will lower CPP and create a new problem

42
Q

What is the most common complication of dialysis patients?

A

Hyperkalemia

43
Q

How much should a unit of platelets increase platelet count?

A

5-10K

44
Q

What cells mediate wound contraction?

A

Myofibroblasts

45
Q

What are the most common bacteria to cause early (first 24 hours post op) wound infection?

A

Strep and Clostridium

46
Q

What can large amounts of normal saline cause?

A

Hyperchloremic metabolic acidosis

47
Q

What can large amounts of lactate ringers cause?

A

Can worsens alkalosis when lactate is metabolized

48
Q

What is the criteria for SIRS?

A

Temperature> 38
Pulse> 90
RR>20
PaCO2 12000

49
Q

What is pulmonary capillary wedge pressure?

A

Preload- end diastolic pressure of LV

50
Q

What is anisocoria?

A

Unequal pupil size- sign of uncal herniation

51
Q

What are some measures to lower ICP?

A 
Hyperventilation
Diuretics
Intubation
Ventriculostomy
Elevate the head
52
Q

Which zone of the neck when injured requires OR exploration?

A

Zone II

53
Q

What spinal tracts are damaged in anterior cord syndrome?

A

Spinothalamic- loss of pain and temperature sensation bilaterally
Corticospinal tract- paraplegia below the lesion

54
Q

What is a Jefferson fracture?

A

C1 burst fracture

X-ray shows increase in predental space

55
Q

What is a Hangman’s fracture?

A

Bilateral C2 pedicles fracture usually due to hyperextension injury

56
Q

What is the pringle maneuver and when would it not work?

A

Manual clamping of portal triad to stop hemorrhage

Will not work with damage to IVC

57
Q

When is a rigid protoscopy mandatory?

A

Patient with knife or gunshot wound across pelvis

58
Q

What is the difference in retrograde cystogram and treatment of intraperitoneal and extraperitoneal bladder rupture?

A

Intraperitoneal- extravasation of contrast into pouch of douglas or between loops of intestine–> treat with surgery
Extraperitoneal- extravasation of contrast behind the bladder–> treat with foley

59
Q

A patient with extremity injury has elevated myoglobin–> what helps prevent renal injury?

A

High UOP with alkalinization of urine

60
Q

What is ET tube based on in children?

A

size of cricoid ring

61
Q

What is the parkland formula?

A

Used for first 24 hour fluid resuscitation in burn patients:
4mL/kg/% BSA burn
Give 1/2 of fluid in first 8 hours, the other in 16 hours
In kids 3mL/kg/%

62
Q

What are some sequelae for frostbite patients?

A

Hyperhidrosis, paresthesia, cool extremities, cold sensitivity and edema

63
Q

All of the small bowel is supplied via branches of SMA except for?

A

Proximal duodenum- celiac trunk

64
Q

Is surgery curative in Crohn’s disease?

A

No- but is curative in ulcerative colitis

65
Q

What is enteroclysis?

A

Double contrast study used to detect tumors missed by small bowel series

66
Q

Where are adenomas most often found in the small bowel?

A

Ileum

67
Q

What is a difference in metastasis between carcinoid tumors in appendix and small bowel?

A

Small bowel primaries are way more likely to metastasize

68
Q

How long should fistulas be given to close spontaneously before surgery?

A

6 weeks
Can use somatostatin to lessen output
Antibiotics if necessary

69
Q

What is the work up and treatment for intussusception

A

Barium enema is diagnostic and therapeutic

70
Q

What is the blood supply of the large bowel?

A

SMA (right and middle colic)- cecum, ascending colon, proximal 1/3 of transverse colon
IMA–> distal 2/3 of transverse colon, descending, sigmoid, proximal rectum
Internal iliac–>middle and distal rectum
Internal pudendal- branch of internal iliac–> anus

71
Q

What layer is Auerbach’s plexus in? Meissner’s?

A

Meissner’s- submucosal layer

Auerbach’s (inhibits colonic activity)-between muscular layers

72
Q

What is the pathogenesis of postvagotomy diarhea? Treatment?

A

Denervation of biliary tree and small intestine results in rapid transit of unconjugated bile salts into the colon and decreasing water absorption causing diarrhea
Treat with cholestyramine

73
Q

A patient s/p appendectomy develops fistula, weight loss, and night sweats- diagnosis?

A

Actinomycosis infection

Treat with penicillin or tetracycline

74
Q

What are indications for surgery in ulcerative colitis?

A

Perforation, bleeding, refractory to medical treatment, INCREASED risk of cancer

75
Q

What is the danger of giving barium enema or colonoscopy in acute diverticulitis?

A

Risk of perforation

76
Q

What is the best method for diagnosing angiodysplasia?

A

Selective mesenteric angiography

77
Q

What is a pharmacologic treatment for Ogilve’s syndrome?

A

Neostigmine to decompress bowel

78
Q

A patient has colon cancer- what tests should be ordered?

A

To rule out metastasis- CXR, Abd CT, LFTs

To follow treatment- CEA

79
Q

What is an indication for excision of internal hemorrhoids?

A

Reduction of prolapse is not spontaneous

80
Q

What is the nigro protocol?

A

Chemoradiation used for squamous cancer of anus

81
Q

What is the blood supply of the appendix?

A

Branch of SMA–>ileocolic–>appendiceal

82
Q

What infective agent can mimic appendicitis?

A

Yersinia

83
Q

What does pelvic pain upon extension of the right thigh signify?

A

Retrocecal appendicitis

Iliopsoas sign

84
Q

What is pelvic pain upon internal rotation of the right thigh called and what does it signify?

A

Obturator sign–> pelvic appendicitis

85
Q

What nerve can be damaged by a direct inguinal hernia?

A

Ilioinguinal

However most common complication is bowel obstruction

86
Q

Why are the neck zones important in trauma?

A

WORK UP!
With knife injury- all zones get arteriogram
With gun injury- zone II goes to surgery, zone I gets an arteriogram first, and zone III gets a bronchoscopy, esophagoscopy, and arteriogram first

87
Q

What is the treatment for pelvic fracture?

A

Hemodynamically stabilize but do NOT operate

88
Q

What is VACTERL and how is ti evaluated?

A 
If a newborn is diagnosed with an abnormality that fits this criteria- before going to surgery check for other abnormalities
Vertebral- CXR
Anal- imperforate anus
Cardiac- Echo
Tracheal
Esophageal
Renal- US
Limb- thumb
89
Q

How to differentiate between omphalocele and extrophy of the bladder?

A

Extrophy of the bladder will be “red and shiny”, “no bowel seen”, or “wet with urine”
Surgical emergency as opposed to omphalocele

90
Q

What is the work up of bilious emesis in a newborn?

A

Babygram!
If double bubble sign–> duodenal atresia or annular pancreas–> both fix with surgery
Air fluid level–> intestinal atresia due to maternal cocaine use–>baby needs surgery
Double bubble with normal gas pattern beyond–> malrotation–> do enema then UGI series–>surgical emergency if either test is positive

91
Q

What is pneumatosis intestinalis?

A

Gas in the bowel wall seen in infants with necrotizing enterocolitis–> treat with TPN and bowel rest
Get U/S of brain to rule out interventricular hemorrhage!

92
Q

What is the diagnostic test for meconium ileus? Treatment?

A

Gastrografin enema for both!

93
Q

What is the diagnosis for biliary atresia?

A

look for baby with prolonged jaundice

Diagnose via HIDA scan following phenobarbital injection ( 1 week after)

94
Q

What are the 8 Ps of rapid sequence intubation?

A 
Prepare equipment
Pretreat
Position the patient
Preoxygenate
Pressure
Paralyze
Place tube
confirm Position of tube w/ two methods
95
Q

What is the treatment for cryptoorchidism?

A

Wait 1 year
If it has not descended–> force it to descend
After puberty–> take it out due to increased risk of cancer

96
Q

What is the treatment for cryptoorchidism?

A

Wait 1 year
If it has not descended–> force it to descend
After puberty–> take it out due to increased risk of cancer

97
Q

How quickly and what kind of surgery should occur for testicular torsion?

A

Within 4 hours

Bilateral orchipexy

Surgery Shelf (2 decks)

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