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General Surgery (Exam #4) Flashcards

1
Q

When should tobacco use be D/C prior to surgery?

A

D/C 8 weeks prior to surgery

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2
Q

When should anticoagulant use be D/C prior to surgery?

A

D/C 7-10 days prior to surgery

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3
Q

What is the best predictor for developing DVT/PE during surgery/post-operatively?

A

Prior hx of DVT/PE

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4
Q

What is the best predictor for bleeding risk during surgery/post-operatively?

A

Prior hx of bleeding

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5
Q

What is the general metabolic progression seen with surgery (hint: within hours vs. days vs. weeks)?

A
  • Within hours = shock
  • Within days = catabolism/breakdown
  • Within weeks (recovery) = anabolism/rebuild
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6
Q

What is the normal caloric need vs. a stressed patient’s caloric needs? What about protein needs?

A

Normal Caloric Needs = 25-30 kcal/kg/day
- 0.8-1g protein/kg/day

Stressed Patient Needs = 50 kcal/kg/day
- 2.5 g protein/kg/day

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7
Q

WHEN should prophylactic abx be given (think time)? When should they be D/C?

A
  • 1 hour before incision time

- D/C 24 hours post-op

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8
Q

Should hair be removed pre-op? What is the preferred skin antiseptic used pre-op?

A

YES = immediately before

- Chlorhexidine solutions preferred

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9
Q

What are the three types of replacement fluids used post-op?

A
  • Crystalloids
  • Colloids
  • Blood/Blood Products
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10
Q

What is the primary osmotically active particle in Crystalloids? What about with Colloids? What about with Blood/Blood Products?

A
  • Crystalloids = Na
  • Colloids = high-molecular weight substances (do NOT migrate easily across capillary walls)
  • Blood/Blood Products = RBCs
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11
Q

What are the four types of Crystalloids, and which is best for maintenance/perioperative?

A
  • Isotonic = best for maintenance/perioperative
  • Hypertonic
  • Hypotonic
  • D5W
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12
Q

How do Hypertonic Crystalloids differ from Hypotonic Crystalloids?

A
  • Hypertonic = higher salt concentration than normal cells in body
  • Hypotonic = lower salt concentration than normal cells in body
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13
Q

When would Colloids be considered for use? What are two examples of when Colloids would be used?

A

Used when Crystalloids fail to sustain plasma volume
- Colloids are more likely to expand vascular compartment

Use Colloids if burn patient or peritonitis

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14
Q

What are the three types of Blood/Blood Products?

A
  • Packed Red Blood Cells (PRBCs)
  • Platelets
  • Fresh Frozen Plasma (FFP)
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15
Q

What does 1 unit of Packed Red Blood Cells (PRBCs) result in?

A

1 unit = 1 g/dL increase in Hb

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16
Q

When would Platelets be given?

A

Active bleeding in thrombocytopenic patients

- Platelet count <50,000 uL

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17
Q

What three additional substances are found in Fresh Frozen Plasma (FFP)?

A
  • Clotting factors
  • Albumin
  • Fibrinogen
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18
Q

What class of meds is the mainstay for pain relief post-op?

A

Opioids (PO vs. IV/PCA)

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19
Q

What is the primary sign seen with Necrotizing Fasciitis?

A

Wound crepitus

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20
Q

What condition involves wound crepitus, fever, gray/dusky skin discoloration?

A

Necrotizing Fasciitis

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21
Q

During what time period is Wound Dehiscence most common?

A

Between 5th and 8th post-op day

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22
Q

What is Evisceration, and what is the recommended tx?

A

Wound Dehiscence with protrusion of abdominal organs through incision
- EMERGENT = get to OR

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23
Q

What condition involves the “Rule of 2’s”, and what are the six aspects of this rule?

A

Meckel’s Diverticulum

  • 2% of general population
  • 2:1 M:F
  • Often occurs by 2 years old
  • 2 feet from ileocecal valve
  • About 2 in. long
  • 2 types of mucosa
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24
Q

What is the dx test used for Meckel’s Diverticulum?

A

Meckel’s Scan

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25
What population is most commonly affected by Mesenteric Ischemia?
Older patients with disease causing embolic formation
26
What condition involves pain out of proportion, severe/acute midabdominal pain, post-prandial?
Mesenteric Ischemia
27
Under what two conditions is Bariatric Surgery considered?
- BMI 40+ | - BMI 35+ with comorbidity
28
What is the most common type of bariatric surgery in U.S.?
Roux-En-Y Bypass
29
What condition presents with RLQ abd. pain, anorexia, N/V, dysuria?
Appendicitis
30
What condition involves normal/hypoactive BS, guarding and rebound, +McBurney’s point?
Appendicitis
31
What condition involves +Rovsing’s sign, +Psoas sign, +Obturator sign?
Appendicitis
32
What four signs are positive on PE with Appendicitis?
- McBurney's point - Rovsing - Psoas - Obturator
33
What dx test is used for ? What will likely be seen on CBC?
CT WITH contrast | - Leukocytosis
34
What are three possible complications of Appendicitis?
- Perforation - Peritonitis - Abscess
35
In what two age groups is Perforation as a complication of Appendicitis more likely? How will this present?
More diffuse abdominal pain - <10 years - 50+ years
36
When would Peritonitis occur as a complication of Appendicitis? How will this present (2)?
Occurs AFTER perforation | - High fever +/- sepsis
37
What condition involves RLQ mass on PE and CT with percutaneous drainage? What is the recommended tx?
Abscess as comp. of Appendicitis | - Continue abx for 3-5 more days
38
What portion of the intestine is most commonly affected with Diverticulitis?
Sigmoid colon
39
When is surgical tx considered for Diverticulitis (3)?
- 2+ attacks - Complications - Failure to improve with conservative tx after 3-4 days
40
What surgical procedure involves sigmoid colon removed?
Colostomy
41
What surgical procedure involves loop of colon moved to upper abdominal wall?
Loop Colostomy
42
What surgical procedure involves end vs. loop of ileum to upper abdominal wall?
Ileostome
43
What surgical procedure involves the diversion of stool (temporary vs. permanent)?
Stoma
44
What surgical procedure involves removal of entire colon + rectum?
Proctocolectomy
45
What surgery is used for very low rectal CA, and what is removed (3)?
Abdominoperineal Resection (APR) - Lower sigmoid colon - Rectum - Anus
46
What surgery is used for upper rectal CA, and what is removed (2)?
Low Anterior Resection (LAR) - Distal sigmoid colon - ½ of rectum
47
What is the most common cause of rectal bleeding?
Internal Hemorrhoid
48
Differentiate Internal Hemorrhoid from External Hemorrhoid based on sxs (2)?
- Internal = bleeding, NO pain | - External = painful, NO bleeding
49
What condition involves anal bleeding and prolapse; NO pain?
Internal Hemorrhoid
50
What condition involves NO anal bleeding, but may thrombose; pain, itching, scarring/tag?
External Hemorrhoid
51
What are the four Grades of Hemorrhoids?
- I: NO prolapse - II: prolapse WITH straining/defecation - III: spontaneous prolapse OR WITH straining/defecation - IV: chronic prolapse
52
Which Hemorrhoid Grade only involves supportive tx?
Grade I = NO prolapse
53
Which Hemorrhoid Grade involves spontaneous reduction?
Grade II = prolapse WITH straining/defecation
54
Which Hemorrhoid Grade requires manual reduction?
Grade III = spontaneous prolapse OR WITH straining/defecation
55
Which Hemorrhoid Grade often involves need for intervention/surgery? What are the two procedures?
Grade IV = chronic prolapse - Rubber band ligation - Surgery (hemorrhoidectomy)
56
What condition involves anal gland infection? What is this called if chronic?
Anorectal Abscess | - Chronic = fistula
57
What condition involves severe/sharp anal pain; palpable, tender, fluctuant mass?
Anorectal Abscess
58
What condition involves abnormal communication between anal canal and perianal skin? When does this condition commonly present?
Fistula In Ano | - Common after Anorectal Abscess
59
What condition involves soft/palpable mass; mass larger with straining +/- pain?
Hernia
60
What can increase the size of a Hernia on PE?
Valsalva maneuver (@Frank)
61
What condition is a complication of Hernia that is due to blunt dissection, poor hemostasis, gravity?
Scrotal Hematoma
62
What condition is a complication of Hernia that involves deep bleeding enters retroperitoneal space?
Hemorrhage
63
What condition is a complication of Hernia that is more common in elderly males
Difficulty Voiding

EM/Surg (16 decks)

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