General Surgery Flashcards
What is the dosage of octreotide ?
25-100mcg initial bolus, and 25-50 mcg/h for 2-5 days thereafter
What is the difference between indirect and direct bilirubin?
indirect- unconjugated
direct- conjugated
What are the causes of postoperative fever?
Wind- POD #1-2- pulminary atelectasis, pneumonia Water POD #3-7 (urine, UTI) Wound POD #3-7 Walk POD #8 (thrombosis- DVT/PE) Wonder drugs #1- drug fever
What are the typical instructions for wound care?
-Shower POD #2-3 after epithelialization of wound
-Dressings remove POD #2 and left uncovered if dry
-Skin sutures and staples can be removed POD #7-10
unless–> at which time they were removed at POD #14
a)crosses a crease
b)closed under tension
c)in extremeties
d)patient factors (elderly, corticosteroid use, immunosuppressed)
What are the types of drains?
Penrose drain- open- higher risk of infection
Jackson-Pratt-closed- connection to suction
When to remove drains?
drains should be removed once drainage is minimal (less than 30-50cc/24 hours)
What are the typical pathogens that cause surgical site infections?
Staphylococcus Aureus
Escheria. Coli- gram negative rods
Enterococcus
Streptococcus species- Group A, B, C–> can present at 24 hours
Clostridium spp- clostridium- can present at 24 hours
What are wells criteria?
Active cancer +1
Bedridden recently >/= 3days or major surgery within 12 weeks+1
Calf swelling >3cm compared to other leg +1
collateral superficial veins present (nonvericose) +1
Entire leg swollen +1
Localized tenderness along the deep venous system +1
Pitting edema, confined to symptomatic leg +1
Paralysis, paresis, or recent plaster immobilization of the lower extremity +1
Previously documented DVT +1
Alternative diagnosis to DVT at least as likely +2
Wells score 0 or lower risk of DVT
What is the negative predictive value of a d-dimer?
94%
What is the differential diagnosis of a small bowel primary mass?
GI primary tumors are rare to begin with, so these things are all rare
A-adenocarcinoma
C-Carcinoid
L-lymphoma
S-stromal tumor (GIST)
Gastrointestestinal stromal tumor (GIST)
- most common type of stromal tumors of the GI tract
- only 1% of primary GI tumors
- all GIST’s >1cm have malignant potential
- tx is resection and/or treatment with Gleevec (imatinib) a tyrosine kinase inhibitor 400mg to 800mg OD x 3years
- imatinib works best in Kit9 + mutation GISTS but does not improve mortality
What are the main differences between a hodgkins and non-hodgkins lymphoma
Hodgkins
-has reed sternberg cells
-more likely to present with B symptoms
-more commonly associated with epstein barr virus
-CHOP is most common form of chemotherapy
(cyclophosphamide, hydroxydoxorubicin (Adriamycin), vincristine (Oncovin), prednisone)
Non-hodgkins
-more commonly associated with immunodefficiency, autoimmune disease and infections
-most common subtypes are follicular (indolent) and DLBCL (aggressive)
-some forms are very responsive to chemotherapy
CHOP is most common form of chemotherapy
(cyclophosphamide, hydroxydoxorubicin (Adriamycin), vincristine (Oncovin), prednisone)
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What is Dapsone, and what is it used for?
Dapsone is an antibiotic that is useful in treating leprosy, dermatitis herpetiformis and some other complicated skin infections.
It was used for a patient who had poor wound healing in conjunction with doxycycline.
Dapsone is a competitive antagonist of para-aminobenzoic acid and prevents bacterial utilization of PABA in the synthesis of folic acid
The dosing is heavily dependant on the type of infection being treated, so just look it up
What are the reversal agents for anticoagulation and what are their dosages?
Warfarin-
Octaplex or other prothrombin complex concentrates- (increases the levels of vitamin-K dependant coagulation factors-II, VII, IX, X [1972]
-dosing is INR and weight dependant
-the INR declines rapidly within 10 minutes
Vitamin K- promotes liver synthesis of clotting factors (II, VII, IX and X through an unknown mechanism)
- it takes 12-14 hours for IV INR to return to normal
- dosing is INR dependant
Heparin
1mg of protamine sulfate neutralizes 100 units of heparin
What are the reversal guidelines from the 2011 ACP for warfarin?
INR10 (no evidence of bleeding)- administer vitamin K
If minor bleeding at any INR elevation vitamin K 2.5-5mg orally and monitor INR more frequently
If major bleeding at any INR- four factor prothrombin complex concentrate and IV vitamin K 5-10mg
Preprocedural/surgical INR normalization in patient receiving warfarin- oral 1-2.5mg once administered on the day before surgery
What is the CHADS2 score?
Congestive Heart Failure Hypertension history Age>/= 75 Diabetes mellitus history Stroke or previous TIA symptoms previously
score >2 start on warfarin
What are the he features of DCIS that would suggest doing a sentinel node biopsy?
1)the women is going to be having a complete mastectomy as you can’t go back in and do the sentinel node biopsy after a mastectomy
2) high grade on pathology
3) necrotic features on pathology
What are the benefits of radiation therapy in DCIS?
Rt significantly reduces the odds of in breast recurrence but does not change the odds of distant recurrence or mortality
What are the most important things to know about prostate cancer?
Eating a diet high in fat increases your risk by 2x
Having a first and second degree relative with prostate cancer increases your risk by 9x whereas just having a first degree relative increases it by 2x
African men are at higher risk than Caucasian men
90 % are adenocarcinoma, the rest are made up of urothelial carcinoma and other rate types
There is a 50 % risk at age 50 of getting prostate cancer, but only a 3% lifetime risk of mortality
Having a psa equal to or less than 10 and Gleason score equal to or less than 7