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Emergency Medicine > General Surgery > Flashcards

General Surgery Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Continue or hold meds?

significant withdrawal sxs

dont affect anesthesia

A

continue

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2
Q

continue or hold meds?

CV meds

A

continue

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3
Q

Continue or hold meds?

statins

A

continue

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4
Q

continue or hold meds?

antiplatelets

A

hold 7-10 days prior

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5
Q

Which organ systems are included in operative risk assessment? (6)

A 
CV
Pulm
Renal
Hepatic
Endocrine
Heme
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6
Q

What are you looking for in pre-op heme risk assessment?

A

DVT/PE hx/mobility

hx of bleed

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7
Q

weight loss > ____ over last 3-4 mo indicates greater risk during surgery

A

15%

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8
Q

albumin < ____g/dl = increased risk

A

< 3g/dl

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9
Q

nutrition requirement for stressed patients…

A

50kcal/kg/day

2.5 g protein/kg/day

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10
Q

to prevent complications, core temp should be…

A

36-38C

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11
Q

to prevent complications, prophylactic abx should be given 1 hour before incision time, and d/c ____

A

24 hours post op

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12
Q

preferred skin antiseptic…

A

chlorhexidine

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13
Q

FiO2 is maintained at ____ intraoperatively to prevent complications

A

80%

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14
Q

mechanical and systemic method to prevent intraoperative VTE…

A

pneumatic compression + anticoag

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15
Q

Fluids and lytes should be evaluated ______ POD 1 and ______ POD 2+

A

q 4-6 hours POD1

qD POD2+

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16
Q

GI peristalsis:

Small intestine returns in ____hrs

right colon returns in ____ hours

left colon returns in _____ hours

A

small = 24 hours

right = 48 hours

left = 72 hours

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17
Q

_____ are the mainstay of post-op pain mgmt

A

opioids

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18
Q

what complication? Pt. p/w:

fever
wound crepitence
gray/dusty skin color
rapidly progressing…

A

necrotizing fasciitis

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19
Q

dehiscence is MC between…

A

POD 5 and POD 8

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20
Q

the below are RFs for…

> 60 yo
DM
Uremia
Immunosuppression
Jaundice
Sepsis
Hypoalbuminemia
CA
Obesity 
CS use
A

wound dehiscence

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21
Q

Rule of 2’s for meckel’s diverticulum…

A 
2%
2:1 male:female
2 years
2 ft from ileocecal valve
2 inches long
2 types of mucosa
22
Q

pt. p/w:

asxs
abd pain
bleeding
obstruction
diverticulitis
A

meckel’s diverticulum

23
Q

3 dx tools for meckel’s diverticulum

A

meckel’s scan
mesenteric arteriography
abd. exploration

24
Q

This d/o is MC in older patients with disease causing embolism

A

mesenteric ischemia

25
Q

Pt. p/w:

severe midabdominal pain out of proportion to exam

radiates to UQs

post-prandial

+/-hematochezia/diarrhea

A

mesenteric ischemia

26
Q

The below are RFs for…

cardiac arrhythmia
advanced age
low CO
valve dz
MI
malignancy
A

mesenteric ischemia

27
Q

Tx for mesenteric ischemia…

A

fluid resuscitation + NG Tube and foley

Abx + anticoags

embolectomy, colon resection

28
Q

MC cause of enterocutaneous fistulae…

A

post-op

29
Q

which type of bariatric procedure?

vertical band
lap band
sleeve gastrectomy

A

restrictive

30
Q

Which type of bariatric procedure?

jejunoileal bypass
biliopancreatic diversion

biliopancreatic diversion with duodenal switch

A

malabsorptive

31
Q

Roux-en-Y gastric bypass is which type of bariatric procedure?

A

combination restrictive and malabsorptive

32
Q

Which bariatric procedure?

30 m: pouch of lesser curvature created via staples

not commonly performed

A

vertical band

33
Q

perioperative abx recommended within days ___ to ___ in patients with perf

A

3-5

34
Q

3 complications of appendicitis…

A

perforation
peritonitis
abscess

35
Q

pt. p/w appendicitis + :

RLQ mass
CT showing percutaneous drainage

A

abscess

36
Q

bimodal distribution of appendix perforation…

A

> 50 and < 10

37
Q

diverticulitis is most present in the ____ colon

A

sigmoid

38
Q

4 indications for surgical mgmt of diverticulitis

A

repeated attacks

complication

failure to improve after 3-4 days

right sided

39
Q

What procedure for diverticulitis?

colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

A

hartmann’s procedure

40
Q

What procedure for diverticulitis?

colon is divided

proximal end of colon brought through abd. wall

A

colostomy

41
Q

This is the removal of the entire colon and rectum

A

proctocolorectomy

42
Q

this is performed for very low rectal cancers

remove lower sigmoid colon, entire rectum and anus

A

abdominoperineal resection

43
Q

this is performed for:

CA of middle/upper rectum

removal of distal sigmoid and half of rectum

proximal sigmoid-distal rectum anastamosis formed

A

low anterior resection

44
Q

office hemorrhoid tx

A

rubber band ligation (grade II/III internal)

45
Q

what hemorrhoid tx is indicated?

mixed internal and external

extensive thrombosis and pain

persistent bleeding

A

surgical hemorrhoidectomy

46
Q

The below hernias can be treated with what approach…

bilateral inguinal
recurring
ventral/epigastric

A

laparoscopic

47
Q

5 post-operative complications of hernia repair

A 
scrotal hematoma
hemorrhage
voiding difficulty
pain
neuroma
48
Q

Which hernia surg complication?

occurs due to Blunt dissection

Inadequate hemostasis

Gravity
A

scrotal hematoma

49
Q

Which hernia surg complication?


May not be apparent initially

Deep bleeding enters the retroperitoneal space

S/S: hypotension, orthostasis , tachycardia

A

hemorrhage

50
Q

difficulty voiding post hernia repair is most common in what population?

A

older males

Emergency Medicine (12 decks)

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