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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
A patient presents with violent wretching and history of alcohol use- what is the work up?
Gastrographin swallow is 1st. Less irritating than barium | Surgical emergency
26
A patient has a hemorrhoid that does not hurt but bleeds- diagnosis and treatment?
Internal hemorrhoid- usually dark blood on toilet paper Diagnose via visual inspection or anoscopy Treatment- band
27
A patient has a hemorrhoid that hurts but does not bleed- diagnosis and treatment?
External hemorrhoids Diagnose via visual inspection Treat medically first, then remove
28
Patient presents with pain on defecation that lasts for hours- diagnosis, pathogenesis, treatment?
Anal fissure caused by a tight sphincter Diagnose by visual inspection Treat with lateral internal sphincterotomy after medical treatment fails
29
What can predispose to anal cancer? How is it worked up? Treatment
MSM, HIV, HPV Work up by pap smear of anus, biopsy Treat with chemoradiation- Nigro protocol
30
Describe obstructive visceral pain? Examples
Colicky pain Patient will be trying to find position of comfort NO fever, leukocytosis Gallstones, kidney stones, and early SBO
31
Describe inflammatory visceral pain? Examples
``` Constant pain- patient writhes around trying to find comfortable position Fever and leukocytosis present Cholecystitis Cholangitis Diverticulitis Appendicitis ```
32
Describe perforation visceral pain?
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
33
Describe ischemic visceral pain? Examples
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
34
Describe distended visceral pain? Examples
Referred diffuse vague pain Constipation Bloating
35
Type of ulcer due to patient being bed ridden?
Compression ulcer Sign of abuse Treat with movement and rolling
36
Type of ulcer associated with hairless leg, decreased pulses, and scaly skin. Work up? Treatment?
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
37
Ulcer above the middle maleolus with edema, hyperpigmentation? Treatment?
Venous insufficiency | Treat with compression stalkings and treat underlying cause of edema
38
What are some signs that point to urethral transection? What should be done if suspected?
Signs: blood at the meatus, high-riding prostate, scrotal hematoma Do retrograde urethrogram before Foley
39
What should be done if cribiform plate fracture is suspected?
Place OG tube rather than NG tube
40
Define the classes of hemorrhagic shock?
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
What is a way to calculate cerebral perfusion pressure?
MAP-ICP | In a hypertensive patient, lowering the BP too fast will lower CPP and create a new problem
42
What is the most common complication of dialysis patients?
Hyperkalemia
43
How much should a unit of platelets increase platelet count?
5-10K
44
What cells mediate wound contraction?
Myofibroblasts
45
What are the most common bacteria to cause early (first 24 hours post op) wound infection?
Strep and Clostridium
46
What can large amounts of normal saline cause?
Hyperchloremic metabolic acidosis
47
What can large amounts of lactate ringers cause?
Can worsens alkalosis when lactate is metabolized
48
What is the criteria for SIRS?
Temperature> 38 Pulse> 90 RR>20 PaCO2 12000
49
What is pulmonary capillary wedge pressure?
Preload- end diastolic pressure of LV
50
What is anisocoria?
Unequal pupil size- sign of uncal herniation
51
What are some measures to lower ICP?
``` Hyperventilation Diuretics Intubation Ventriculostomy Elevate the head ```
52
Which zone of the neck when injured requires OR exploration?
Zone II
53
What spinal tracts are damaged in anterior cord syndrome?
Spinothalamic- loss of pain and temperature sensation bilaterally Corticospinal tract- paraplegia below the lesion
54
What is a Jefferson fracture?
C1 burst fracture | X-ray shows increase in predental space
55
What is a Hangman's fracture?
Bilateral C2 pedicles fracture usually due to hyperextension injury
56
What is the pringle maneuver and when would it not work?
Manual clamping of portal triad to stop hemorrhage | Will not work with damage to IVC
57
When is a rigid protoscopy mandatory?
Patient with knife or gunshot wound across pelvis
58
What is the difference in retrograde cystogram and treatment of intraperitoneal and extraperitoneal bladder rupture?
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
A patient with extremity injury has elevated myoglobin--> what helps prevent renal injury?
High UOP with alkalinization of urine
60
What is ET tube based on in children?
size of cricoid ring
61
What is the parkland formula?
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
What are some sequelae for frostbite patients?
Hyperhidrosis, paresthesia, cool extremities, cold sensitivity and edema
63
All of the small bowel is supplied via branches of SMA except for?
Proximal duodenum- celiac trunk
64
Is surgery curative in Crohn's disease?
No- but is curative in ulcerative colitis
65
What is enteroclysis?
Double contrast study used to detect tumors missed by small bowel series
66
Where are adenomas most often found in the small bowel?
Ileum
67
What is a difference in metastasis between carcinoid tumors in appendix and small bowel?
Small bowel primaries are way more likely to metastasize
68
How long should fistulas be given to close spontaneously before surgery?
6 weeks Can use somatostatin to lessen output Antibiotics if necessary
69
What is the work up and treatment for intussusception
Barium enema is diagnostic and therapeutic
70
What is the blood supply of the large bowel?
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
What layer is Auerbach's plexus in? Meissner's?
Meissner's- submucosal layer | Auerbach's (inhibits colonic activity)-between muscular layers
72
What is the pathogenesis of postvagotomy diarhea? Treatment?
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
A patient s/p appendectomy develops fistula, weight loss, and night sweats- diagnosis?
Actinomycosis infection | Treat with penicillin or tetracycline
74
What are indications for surgery in ulcerative colitis?
Perforation, bleeding, refractory to medical treatment, INCREASED risk of cancer
75
What is the danger of giving barium enema or colonoscopy in acute diverticulitis?
Risk of perforation
76
What is the best method for diagnosing angiodysplasia?
Selective mesenteric angiography
77
What is a pharmacologic treatment for Ogilve's syndrome?
Neostigmine to decompress bowel
78
A patient has colon cancer- what tests should be ordered?
To rule out metastasis- CXR, Abd CT, LFTs | To follow treatment- CEA
79
What is an indication for excision of internal hemorrhoids?
Reduction of prolapse is not spontaneous
80
What is the nigro protocol?
Chemoradiation used for squamous cancer of anus
81
What is the blood supply of the appendix?
Branch of SMA-->ileocolic-->appendiceal
82
What infective agent can mimic appendicitis?
Yersinia
83
What does pelvic pain upon extension of the right thigh signify?
Retrocecal appendicitis | Iliopsoas sign
84
What is pelvic pain upon internal rotation of the right thigh called and what does it signify?
Obturator sign--> pelvic appendicitis
85
What nerve can be damaged by a direct inguinal hernia?
Ilioinguinal | However most common complication is bowel obstruction
86
Why are the neck zones important in trauma?
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
What is the treatment for pelvic fracture?
Hemodynamically stabilize but do NOT operate
88
What is VACTERL and how is ti evaluated?
``` 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
How to differentiate between omphalocele and extrophy of the bladder?
Extrophy of the bladder will be "red and shiny", "no bowel seen", or "wet with urine" Surgical emergency as opposed to omphalocele
90
What is the work up of bilious emesis in a newborn?
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
What is pneumatosis intestinalis?
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
What is the diagnostic test for meconium ileus? Treatment?
Gastrografin enema for both!
93
What is the diagnosis for biliary atresia?
look for baby with prolonged jaundice | Diagnose via HIDA scan following phenobarbital injection ( 1 week after)
94
What are the 8 Ps of rapid sequence intubation?
``` Prepare equipment Pretreat Position the patient Preoxygenate Pressure Paralyze Place tube confirm Position of tube w/ two methods ```
95
What is the treatment for cryptoorchidism?
Wait 1 year If it has not descended--> force it to descend After puberty--> take it out due to increased risk of cancer
96
What is the treatment for cryptoorchidism?
Wait 1 year If it has not descended--> force it to descend After puberty--> take it out due to increased risk of cancer
97
How quickly and what kind of surgery should occur for testicular torsion?
Within 4 hours | Bilateral orchipexy

Surgery Shelf (2 decks)

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