General Surgery

Question 1

Continue or hold meds?

significant withdrawal sxs

dont affect anesthesia

Answer 1

continue

Question 2

continue or hold meds?

CV meds

Answer 2

continue

Question 3

Continue or hold meds?

statins

Answer 3

continue

Question 4

continue or hold meds?

antiplatelets

Answer 4

hold 7-10 days prior

Question 5

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

Answer 5

CV
Pulm
Renal
Hepatic
Endocrine
Heme

Question 6

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

Answer 6

DVT/PE hx/mobility

hx of bleed

Question 7

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

Answer 7

15%

Question 8

albumin < ____g/dl = increased risk

Answer 8

< 3g/dl

Question 9

nutrition requirement for stressed patients…

Answer 9

50kcal/kg/day

2.5 g protein/kg/day

Question 10

to prevent complications, core temp should be…

Answer 10

36-38C

Question 11

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

Answer 11

24 hours post op

Question 12

preferred skin antiseptic…

Answer 12

chlorhexidine

Question 13

FiO2 is maintained at ____ intraoperatively to prevent complications

Answer 13

80%

Question 14

mechanical and systemic method to prevent intraoperative VTE…

Answer 14

pneumatic compression + anticoag

Question 15

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

Answer 15

q 4-6 hours POD1

qD POD2+

Question 16

GI peristalsis:

Small intestine returns in ____hrs

right colon returns in ____ hours

left colon returns in _____ hours

Answer 16

small = 24 hours

right = 48 hours

left = 72 hours

Question 17

_____ are the mainstay of post-op pain mgmt

Answer 17

opioids

Question 18

what complication? Pt. p/w:

fever
wound crepitence
gray/dusty skin color
rapidly progressing…

Answer 18

necrotizing fasciitis

Question 19

dehiscence is MC between…

Answer 19

POD 5 and POD 8

Question 20

the below are RFs for…

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

Answer 20

wound dehiscence

Question 21

Rule of 2’s for meckel’s diverticulum…

Answer 21

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

Question 22

pt. p/w:

asxs
abd pain
bleeding
obstruction
diverticulitis

Answer 22

meckel’s diverticulum

Question 23

3 dx tools for meckel’s diverticulum

Answer 23

meckel’s scan
mesenteric arteriography
abd. exploration

Question 24

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

Answer 24

mesenteric ischemia

Question 25

Pt. p/w: severe midabdominal pain out of proportion to exam radiates to UQs post-prandial +/-hematochezia/diarrhea

Answer 25

mesenteric ischemia

Question 26

The below are RFs for... ``` cardiac arrhythmia advanced age low CO valve dz MI malignancy ```

Answer 26

mesenteric ischemia

Question 27

Tx for mesenteric ischemia...

Answer 27

fluid resuscitation + NG Tube and foley Abx + anticoags embolectomy, colon resection

Question 28

MC cause of enterocutaneous fistulae...

Answer 28

post-op

Question 29

which type of bariatric procedure? vertical band lap band sleeve gastrectomy

Answer 29

restrictive

Question 30

Which type of bariatric procedure? jejunoileal bypass biliopancreatic diversion biliopancreatic diversion with duodenal switch

Answer 30

malabsorptive

Question 31

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

Answer 31

combination restrictive and malabsorptive

Question 32

Which bariatric procedure? 30 m: pouch of lesser curvature created via staples not commonly performed

Answer 32

vertical band

Question 33

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

Answer 33

3-5

Question 34

3 complications of appendicitis...

Answer 34

perforation peritonitis abscess

Question 35

pt. p/w appendicitis + : RLQ mass CT showing percutaneous drainage

Answer 35

abscess

Question 36

bimodal distribution of appendix perforation...

Answer 36

> 50 and < 10

Question 37

diverticulitis is most present in the ____ colon

Answer 37

sigmoid

Question 38

4 indications for surgical mgmt of diverticulitis

Answer 38

repeated attacks complication failure to improve after 3-4 days right sided

Question 39

What procedure for diverticulitis? colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

Answer 39

hartmann's procedure

Question 40

What procedure for diverticulitis? colon is divided proximal end of colon brought through abd. wall

Answer 40

colostomy

Question 41

This is the removal of the entire colon and rectum

Answer 41

proctocolorectomy

Question 42

this is performed for very low rectal cancers remove lower sigmoid colon, entire rectum and anus

Answer 42

abdominoperineal resection

Question 43

this is performed for: CA of middle/upper rectum removal of distal sigmoid and half of rectum proximal sigmoid-distal rectum anastamosis formed

Answer 43

low anterior resection

Question 44

office hemorrhoid tx

Answer 44

rubber band ligation (grade II/III internal)

Question 45

what hemorrhoid tx is indicated? mixed internal and external extensive thrombosis and pain persistent bleeding

Answer 45

surgical hemorrhoidectomy

Question 46

The below hernias can be treated with what approach... bilateral inguinal recurring ventral/epigastric

Answer 46

laparoscopic

Question 47

5 post-operative complications of hernia repair

Answer 47

``` scrotal hematoma hemorrhage voiding difficulty pain neuroma ```

Question 48

Which hernia surg complication? ``` occurs due to Blunt dissection  Inadequate hemostasis  Gravity ```

Answer 48

scrotal hematoma

Question 49

Which hernia surg complication?  May not be apparent initially  Deep bleeding enters the retroperitoneal space  S/S: hypotension, orthostasis , tachycardia

Answer 49

hemorrhage

Question 50

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

Answer 50

older males