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EM/Surg > General Surgery (Exam #4) > Flashcards

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
Q

What population is most commonly affected by Mesenteric Ischemia?

A

Older patients with disease causing embolic formation

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26
Q

What condition involves pain out of proportion, severe/acute midabdominal pain, post-prandial?

A

Mesenteric Ischemia

27
Q

Under what two conditions is Bariatric Surgery considered?

A
  • BMI 40+

- BMI 35+ with comorbidity

28
Q

What is the most common type of bariatric surgery in U.S.?

A

Roux-En-Y Bypass

29
Q

What condition presents with RLQ abd. pain, anorexia, N/V, dysuria?

A

Appendicitis

30
Q

What condition involves normal/hypoactive BS, guarding and rebound, +McBurney’s point?

A

Appendicitis

31
Q

What condition involves +Rovsing’s sign, +Psoas sign, +Obturator sign?

A

Appendicitis

32
Q

What four signs are positive on PE with Appendicitis?

A
  • McBurney’s point
  • Rovsing
  • Psoas
  • Obturator
33
Q

What dx test is used for ? What will likely be seen on CBC?

A

CT WITH contrast

- Leukocytosis

34
Q

What are three possible complications of Appendicitis?

A
  • Perforation
  • Peritonitis
  • Abscess
35
Q

In what two age groups is Perforation as a complication of Appendicitis more likely?

How will this present?

A

More diffuse abdominal pain

  • <10 years
  • 50+ years
36
Q

When would Peritonitis occur as a complication of Appendicitis?

How will this present (2)?

A

Occurs AFTER perforation

- High fever +/- sepsis

37
Q

What condition involves RLQ mass on PE and CT with percutaneous drainage? What is the recommended tx?

A

Abscess as comp. of Appendicitis

- Continue abx for 3-5 more days

38
Q

What portion of the intestine is most commonly affected with Diverticulitis?

A

Sigmoid colon

39
Q

When is surgical tx considered for Diverticulitis (3)?

A
  • 2+ attacks
  • Complications
  • Failure to improve with conservative tx after 3-4 days
40
Q

What surgical procedure involves sigmoid colon removed?

41
Q

What surgical procedure involves loop of colon moved to upper abdominal wall?

A

Loop Colostomy

42
Q

What surgical procedure involves end vs. loop of ileum to upper abdominal wall?

43
Q

What surgical procedure involves the diversion of stool (temporary vs. permanent)?

44
Q

What surgical procedure involves removal of entire colon + rectum?

A

Proctocolectomy

45
Q

What surgery is used for very low rectal CA, and what is removed (3)?

A

Abdominoperineal Resection (APR)

  • Lower sigmoid colon
  • Rectum
  • Anus
46
Q

What surgery is used for upper rectal CA, and what is removed (2)?

A

Low Anterior Resection (LAR)

  • Distal sigmoid colon
  • ½ of rectum
47
Q

What is the most common cause of rectal bleeding?

A

Internal Hemorrhoid

48
Q

Differentiate Internal Hemorrhoid from External Hemorrhoid based on sxs (2)?

A
  • Internal = bleeding, NO pain

- External = painful, NO bleeding

49
Q

What condition involves anal bleeding and prolapse; NO pain?

A

Internal Hemorrhoid

50
Q

What condition involves NO anal bleeding, but may thrombose; pain, itching, scarring/tag?

A

External Hemorrhoid

51
Q

What are the four Grades of Hemorrhoids?

A
  • I: NO prolapse
  • II: prolapse WITH straining/defecation
  • III: spontaneous prolapse OR WITH straining/defecation
  • IV: chronic prolapse
52
Q

Which Hemorrhoid Grade only involves supportive tx?

A

Grade I = NO prolapse

53
Q

Which Hemorrhoid Grade involves spontaneous reduction?

A

Grade II = prolapse WITH straining/defecation

54
Q

Which Hemorrhoid Grade requires manual reduction?

A

Grade III = spontaneous prolapse OR WITH straining/defecation

55
Q

Which Hemorrhoid Grade often involves need for intervention/surgery? What are the two procedures?

A

Grade IV = chronic prolapse

  • Rubber band ligation
  • Surgery (hemorrhoidectomy)
56
Q

What condition involves anal gland infection? What is this called if chronic?

A

Anorectal Abscess

- Chronic = fistula

57
Q

What condition involves severe/sharp anal pain; palpable, tender, fluctuant mass?

A

Anorectal Abscess

58
Q

What condition involves abnormal communication between anal canal and perianal skin?

When does this condition commonly present?

A

Fistula In Ano

- Common after Anorectal Abscess

59
Q

What condition involves soft/palpable mass; mass larger with straining +/- pain?

60
Q

What can increase the size of a Hernia on PE?

A

Valsalva maneuver (@Frank)

61
Q

What condition is a complication of Hernia that is due to blunt dissection, poor hemostasis, gravity?

A

Scrotal Hematoma

62
Q

What condition is a complication of Hernia that involves deep bleeding enters retroperitoneal space?

A

Hemorrhage

63
Q

What condition is a complication of Hernia that is more common in elderly males

A

Difficulty Voiding

EM/Surg (16 decks)

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