General Surgery Flashcards
“Number of deaths occurred due to a specific condition” is the definition of
Mortality
“State of having a specific disease or condition” is the definition of
Morbidity
What is the ASA classification?
Grades severity of morbidity
If a patient doesn’t want to hear the risks of a procedure and says they consent anyway, can you let them go through with the procedure?
No
What is the name of the surgical risk scoring system used to compare morbidity/mortality?
P-POSSUM
Operating at wrong site, using wrong implants/prosthesis or leaving foreign object retained post procedure are all examples of what?
Surgical never events
What is a central venous catheter also known as?
Central line
A central line is placed in US guidance - T or F
True
‘Used for infusion of chemotherapy, nutrition, long term ABx’ describes what?
PICC line
Are veins or arteries compressible on US?
Veins compressible
What are the 3 moments for the WHO surgical safety checklist?
Before induction of anaesthesia
Before first skin incision
Before patient leaves room
Diathermy is contraindicated in patients with what PMH?
Pacemaker
Put the stages of wound healing in the correct order
- Proliferative phase
- Remodeling
- Inflammation
- Haemostasis
Haemostasis > inflammation > proliferative phase > remodeling
The BRAN system is used for explaining surgery do a patient, what does it involves?
Benefits
Risks
Alternatives
What if we do nothing
NSAIDs inhibit ______ which decreases ______
Cyclooxygenase
Prostaglandins
What is telemetry?
Constant cardiac monitoring ECG
What is a pan scan?
CT head - mid femur (done in trauma)
What drug class is ondansetron in?
5HT3 antagonist
What drug class is hyoscine in?
Anticholinergic AKA antimuscarinic
What drug class is cyclizine in?
H1 antihistamine
What drug class is metoclopramide in?
D2 antagonist prokinetic
What drug class is haloperidol in?
D2 antagonist
Which D2 antagonists are prokinetic?
Metoclopramide and domperidone
What type of laxative is lactulose?
Osmotic laxative
What type of laxative is senna?
Stimulant laxative
What is the mechanism of a stimulant laxative?
Increases intestinal motility
What type of laxative is fibrogel and bran powder?
Bulk laxative
What is a contraindication to stimulant laxatives?
Obstruction
What is the management of a capsulated splenic haematoma?
Embolization
done by interventional radiology
When our immediate, early and late surgical complications?
Immediate <24hr
Early <30d
Late >30d
Pyrexia less than 24 hours after surgery is a red flag - true or false
False - less than 24hr after is not too worrying
Anastomotic leak, chest infections and intra-abdo collections all generally occurs after how many days post surgery?
4 days
Incontinence is a complication of perianal abscesses if there is damage to what structure?
Anal sphincter
What is an anastomotic leak?
From bowel anastomosis - if there is a leak bowel contents can get into the abdomen
What is a stoma?
An opening to divert stool/urine out the body
Name 3 examples of stomas
Urostomy, ileostomy, colostony
A stoma may be loop or end - what does this mean?
Loop = temporary planning on reversing (2 holes) Permanent = end
Colostomy / ileostomy
- which is on left / right hand side
- which sticks out and which is flush with the skin?
- which is higher output?
- ileostomy LHS
- colostomy RHS
- ileostomy sticks out
- colostomy flush
- ileostomy higher output (need to empty more often)
What is the Hb threshold for transfusion? What if in CVD?
<70 transfuse
<80 if CVD
What % of the body fluid is intravascular and extravascular?
2/3 intravascular
1/3 extravascular
What are the 2 main types of non-blood IV fluids?
Crystalloids
Colloids
What is the fluid of choice for ABCDE fluid resuscitation? What volume? How fast? After what volume should you seek expert help?
500ml bolus crystalloid 0.9% NaCl saline over 15min
Reassess + repeat
After 2L seek expert help
Name 2 examples of colloid fluids
Albumin
Gelofusin
What risk should you be aware of with colloid fluids?
Anaphylaxis
Name 3 examples of crystalloid fluids
NaCl saline
Hartmann’s solution
Dextrose
What is the concentration of Na, Ca, K, Cl and lactate in saline?
Na 154 Ca 0 K 0 Cl 154 Lactate
What is the concentration of Na, Ca, K, Cl and lactate in Hartmann’s solution?
Na 131 Ca 2 K 5 Cl 111 Lactate 29
What is the concentration of Na, Ca, K, Cl and lactate in dextrose fluid?
No ions or electrolytes
all 0
Is saline 0.9% NaCl hypo or hypertonic?
Isotonic
Is dextrose hypo or hypertonic? What does this mean?
Hypotonic - most leaks into interstitial space, doesn’t stay in vessels
True or false - seek expert help for calculating fluid requirements for obese patients BMI >40
True
Elderly patients, CKD and HF patients all have _____ fluid requirement
Reduced
Fluid requirement = _____ + _____
Routine maintenance + abnormal losses
What is normal urine output?
0.5ml/kg/hr
Give 5 examples of abnormal fluid losses
Reduced oral intake Sweating D+V Polyuria Stoma loss Haematemesis Leaking wound Melena NGT
How do you calculate routine maintenance fluids? What volume is that for a 70kg human?
How much Na + K + Cl + glucose?
25-30ml/kg/day water
1mmol/kg/day K + Na + Cl
50-100g/day glucose
Is 0.18% NaCl / 4% glucose hypo or hypertonic? What is it used for
Hypotonic
For maintenance
What is the definition of massive transfusion?
Replacement of total blood volume in <24hr
or
Half of total blood volume in <3hr
What is the ratio of platelets to FFP transfused in massive haemorrhage?
1 : 1
In transfusion, blood products need to be warmed using a blood warmer. True or false
True
Tranexamic acid is used with transfusion in the management of trauma patients. True or false
True
Rapid massive transfusion complications:
- low or high calcium
- low or high potassium
- low or high temperature
- acidosis or alkalosis
Hypocalcaemia
Hyperkalaemia
Hypothermia
Acidosis
