General Surgery : Study Guide 1 Flashcards
1
Q
What IV fluid do we give to burn victims?
A
Lactated Ringers
2
Q
What is the Parkland formula?
A
% burn x BSA x 4
3
Q
At what rate do you give fluids to burn victims?
A
Half the total from the Parkland formula in the first 8 hours. Second half over 16 hours.
4
Q
Normally water makes up what percentage of body weight?
A
50-70%
5
Q
What percentage of water is inside cells compared to outside cells?
A
66% ICF, 33% ECF
6
Q
What is “obligatory renal water loss”?
A
Absolute minimum amount of water that must be excreted along with the solute load excreted daily
7
Q
Are our kidneys better at holding on to potassium or sodium?
A
Sodium
8
Q
When giving D5W, how much stays in the cells compared to outside the cells?
A
2/3 intracellularly, 1/3 extracellularly
9
Q
When giving NS, how much stays intracellularly compared to extracellularly?
A
NONE goes into the intracellular space. All remains extracellular. 3/4 interstitial, 1/4 intravascular
Better option for a hypotensive patient
10
Q
What two electrolytes must you worry about replacing if patient is NPO long term.
A
Calcium and magnesium
Only give if they have been getting IV fluids for 6-7 days
11
Q
What must we give to avoid the protein sparing effect?
A
Glucose – given in IVs as Dextrose
12
Q
What patients can we not give glucose to?
A
Burn victims, DKA
too much glucose can destroy veins
13
Q
What are some sxs of volume depletion?
A
weight down, increased pulse, decreased BP, postural changes, dry mucous membranes, increased skin turgor, flat neck veins, decreased urine output
14
Q
What labs are a good indicator of someone who is volume depleted?
A
Increased Hct, increased BUN/Cr ratio (prerenal azotemia), decreased urine Na
15
Q
What are some sxs of volume excess?
A
weight gain, edema, neck veins, pulmonary congestion, pleural effusions, gallops, ascites
16
Q
What are colloids and when are they used?
A
greater than 8000 daltons mw – high oncotic pressure; remain intravasuclar
used for rapid volume expansion during shock or hemorrhage
17
Q
What are crystalloids and when are they used?
A
less than 8000 daltons mw – low onctoic pressure
most widely used option for fluid replacement
18
Q
What fluids should you give if a patient doesn’t need volume expansion but needs maintenance fluids?
A
Usually give more hypotonic solutions – 1/2 NS with glucose
19
Q
A temp greater than ____ is worthy of investigation
A
38.0
20
Q
5 W’s for post-op fever… what is the W that actually occurs during surgery?
A
“Wonder Drugs” – Malignant Hyperthermia
21
Q
What is the treatment for malignant hyperthermia?
A
Oxygen, dantrolene, cool IVF
22
Q
What “W” coincides with POD 1 fever?
A
“Wind” – atelectasis
23
Q
What should be ordered to diagnose atelectasis?
A
Chest x-ray
24
Q
What is the best way to prevent atelectasis?
A
Inhaled spirometry and getting patient up out of bed
25
POD 2/3, fever, what "W"?
Wind ---> pneumonia. Often thought secondary to atelectasis
Diagnose with a CxR
26
Fever POD3-5, should be thinking of what "W"?
Water. UTI
27
What is the best way to prevent people from getting UTIs post surgery?
Take foley catheter out as soon as possible
28
POD 5 -- what "W"?
Walking. DVT/PE
29
Best way to prevent DVT/PE?
Ambulating! LMWH, pneumatic compression, antiembolism stockings
30
POD 7 -- what "W"?
Wound -- possibly cellulitis
31
POD 10-14: what "W"?
Wound -- abscess.
32
What are the 5 W's in order from earliest in the post-op course to latest?
Wind. Water. Walking. Wound.
Wonder drugs during surgery -- but can really happen at any time.
33
What bacteria are likely associated with ventilator associated pneumonitis?
Gram negative pseudomonas.
34
Arrhythmias are most common after what type of surgery?
Most common after cardiac and thoracic surgery
35
Hypoxia, Hypovolemia, Hyperthermia, electrolyte imbalance, hypoglycemia, HTN, infection, and medications are all causes of?
Post-op arrhythmias
36
If someone is in A fib, anticoagulate after _______ hours.
24
37
If someone is on a beta blocker prior to surgery should you stop it?
No. Can result in reflex tachycardia.
38
What is the most common cause of morbidity and mortality after non-cardiac surgery?
MI
39
An MI most often occurs _____ hours after surgery
48
40
Patient with dyspnea, hypoxemia with normal CO2 tension, and CxR with increased vascular markings should make you think of?
Heart Failure/Pulmonary Edema
41
What kinds or surgeries are associated with the highest risk of perioperative stroke?
1. Double or triple valve repair.
2. Aortic repair
3. CABG + valve
42
Acute mechanical failure of a wound closure is called?
Dehiscence
43
What are some signs of a wound infection?
Redness, swelling, increased pain at incision site (key word is worsening pain, especially after post-op day 3).
44
Soft, nontender, moveable mass composed of adipose tissue
Lipoma
45
How do you treat a lipoma
Excision if bothersome
46
Benign subcutaneous cyst filled with epidermal cells and waxy material called sebum
Sebaceous cyst
47
What is a primary wound closure?
Close wound immediately with suture/staples, adhesives, etc.
48
What is secondary would closure?
Wound is left open and heals overtime WITHOUT sutures (can have a dressing inside to collect the fluids)
49
What is tertiary wound closure?
Suture the wound closed in 3 to 5 days AFTER incision.
50
How long does it take a wound to epithelize?
24-48 hours
51
What can you give to a patient who is taking steroids that prevents wound healing?
Vitamin A
52
What is negative pressure wound therapy?
"wound vac"
negative pressure system used to accelerate wound healing in chronic and acute
53
What is a "clean" operative wound?
Elective, nontraumatic wound without acute inflammation.
Usually cleaned without the use of drains
54
What is a "clean contaminated" wound?
Operation of the GI tract without unusual contamination or entry into the biliary or urinary tract
Example: cholecystectomy and hernia
55
What is a "contaminated" wound?
"spill" during elective surgery. acute inflammation, traumatic wound, GI tract spillage, major break in sterile technique
Example: person goes in for gallbladder and its so friable you poke a hole in it.
56
what is a "dirty" wound?
Intestinal infarction (causes spillage of intestinal contents into the gut)
Intra-abdominal abscess drainage
57
If a young woman presents with a breast mass, what diagnostic tool should you start with?
Ultrasound
58
Painful/tender breast mass, size fluctuates with menstrual cycle, multiple sites, straw colored fluid with FNA
Fibrocystic disease
59
Benign tumor of the breast consisting of stromal overgrowth collagen arranged in swirls
Fibroadenoma
60
What is the most common breast tumor in women less than 30?
Fibroadenoma
61
Solid, firm, mobile, well-circumscribed, nontender breast mass
Fibroadenoma
62
How do you diagnose a fibroadenoma?
Core bx/FNA or U/S
63
Single, nontender, firm, immobile mass
Malignancy
64
What type of breast cancer is most common?
Infiltrating Ductal Carcinoma
Accounts for 80% of breast cancer
65
This type of breast cancer presents with edema peau d'orange and erythema. Poor prognosis.
Inflammatory carcinoma
66
What is Pagets disease?
Nipple disease. Exudative, dry, scaly appearance of the nipple.
67
What are indications for a biopsy?
Persistent mass after aspiration, solid mass, bloody nipple discharge, ulcer or dermatitis of the nipple
68
What are indications for a needle aspiration bx?
if the mass appears to be a cyst
69
What is the most common cause of death in men and women in US?
Bronchogenic carcinoma
70
This type of lung cancer is aggressive, spreads early, and cannot be treated with surgery.
Small cell lung cancer
71
There are three types of non-small cell lung cancer. What are they?
Squamous, adenocarcinoma, and large cell
72
What is the cause of appendicitis?
Obstruction of the appendiceal lumen -- fecolith
73
How does appendicitis present?
Periumbilical pain that becomes RLQ pain <24 hours. N/V. Rebound tenderness and involuntary guarding.
and all those special tests -- McBurneys point, rovsings, psoas, obturator
74
Someone with severe acute abdominal pain and intraperitoneal free air on abdominal x-ray should make you think of?
Perforated hollow viscus
75
Diverticulitis most commonly presents in what site of the colon?
sigmoid
76
Symptoms of diverticulitis include?
Recurrent abdominal pain in LLQ, functional changes in bowel, bleeding, constipation, diarrhea, or alternation between the two
77
How do you diagnose diverticulitis?
CT
78
What is the difference between a incarcerated and strangulated hernia?
Incarcerated -- contents of the hernia become trapped and can't reduce back into the abdominal wall
Strangulation -- when entrapment becomes so severe that the blood supply is cut off
79
Direct hernia occur medially or laterally to the inferior epigastric artery?
Medially
80
Most small bowel obstructions are due to?
hernias and adhesions
81
Most large bowel obstructions are due to?
Intussception, volvulus, and neoplasm
82
How do small bowel obstructions most commonly present?
abdominal pain, distension, vomiting, and high pitched bowel sounds that then become silent
83
How do large bowel obstructions most commonly present?
Distension, pain, may be tachy or febrile
84
What is twisting of the intestine in on itself?
Volvulus
85
What will see you on x-ray if a volvulus is suspected?
"Kidney bean appearance" colonic distension
86
What is the most common type of colonic polyp?
Tubular
87
Are tubular polyps or villous polyps more likely to become malignant?
Villous
88
What are some sxs of colon cancer?
iron deficient anemia, rectal bleeding, alternating diarrhea/constipation, feeling of incomplete passage of stool
89
Acute inflammation and infection of the gallbladder
Acute cholecystitis
90
What diagnostic tool is used to evaluate a patient for cholecystitis?
U/S
91
What are the 5 F's in relation to the gallbladder
Fat, Female, Forty, Fertile, Fair
92
Most gallstones are made up of?
Cholesterol
93
Presents with pain that lasts longer than 3-4 hours, N/V, fever, and a positive Murphy's sign
acute cholecystitis
94
Presents with RUQ pain that radiates to the back. Pain typically lasts 1-4 hours. Caused by obstruction not infection/inflammation
Cholelithiasis
95
How do you diagnose cholelithiasis?
TOC -- U/S
Can also do MRCP. More useful if stones cannot be seen on US. MRCP done before ERCP
96
What is a HIDA scan?
The injection of technetium 99 radioactive that is excreted by the liver into bile in high concentrations. This enters the gallbladder within 30 minutes. If after 4 hours there is visualization of the common bile duct and duodenum without filling of the GB, this means there is obstruction of the cystic duct. Only shows stones in the cystic duct.
97
When is an ERCP done?
Done if evidence of extrahepatic obstruction or obstructive jaundice.
It provides detailed radiography of and injection of dye into the biliary tree
98
How do you treat cholelithiasis?
Cholecystectomy
99
Bacteria present within the normal sterile peritoneal cavity
Peritonitis
100
What two things cause nearly 85% of cases of acute pancreatitis?
Alcohol and gallstones --- but mostly alcohol
101
About how many years of heavy alcohol consumption does it typically take to result in pancreatitis?
6 to 8 years
102
Non-crampy epigastric pain that radiates to the back, pain alleviated with sitting or standing, fever, tachycardia, and guarding are all symptoms of?
Pancreatitis
103
What is Grey-Turners sign and what is Cullens sign?
Grey-Turners: bruising of the flanks
| Cullens: bruising of periumbilical area
104
what two criteria are used to assess a patient for complications or death from pancreatits
Ranson's Criteria and APACHEII
105
What is the treatment for pancreatitis?
NPO, maintain tissue perfusion and intravascular volume, and if its due to a gallstone -- remove the gallbladder
106
Engorgements of the venous plexus of the rectum, anus, or both with protrusion of the mucosa
Hemorrhoids
107
What are some causes of hemorrhoids?
Constipation, straining, pregnancy, portal HTN
108
Internal or external hemorrhoids are painless?
Internal
109
Where is the most common place for a gastric ulcer to occur?
Lesser curvature
110
What are some risk factors for a gastric ulcer?
Smoking, NSAIDs, alcohol, male
111
What is the most common GU cancer?
Prostate
112
How do you diagnose prostate cancer?
Transrectal US/Transrectal Bx
113
How do we stage prostate cancer?
Using the Gleason score
114
This often presents with a firm, painless lump in the testicle
Testicular cancer
115
What is the most common cause of acute arterial occlusion?
A fib -- embolism from heart
116
What are the 6 P's? (for acute arterial occlusion)
Pain, pallor, pulselessness, polar, paresthesia, paralysis
117
How do you treat an acute arterial occlusion?
Surgical embolectomy with cutdowm and fogarty balloon
118
What is a common complication associated with acute arterial occlusion?
Compartment syndrome
119
Occlusive atherosclerotic disease in the lower extremities
Peripheral arterial insufficiency
120
Intermittent claudication, rest pain, erectile dysfunction, sensorimotor dysfunction, tissue loss, absent pulses, and muscular atrophy are all symptoms of?
peripheral arterial disease
121
An ABI less than ____ is diagnostic for peripheral arterial disease?
0.6
122
What is the gold standard for diagnosing peripheral arterial disease?
Arteriogram
123
What is the difference between dry and wet gangrene?
dry: dry necrosis of tissue without signs of infection
wet: moist necrotic tissue with signs of infection
