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Sam: Surgery EOR > General Surgery : Study Guide 1 > Flashcards

General Surgery : Study Guide 1 Flashcards

1
Q

What IV fluid do we give to burn victims?

A

Lactated Ringers

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2
Q

What is the Parkland formula?

A

% burn x BSA x 4

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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.

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4
Q

Normally water makes up what percentage of body weight?

A

50-70%

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5
Q

What percentage of water is inside cells compared to outside cells?

A

66% ICF, 33% ECF

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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

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7
Q

Are our kidneys better at holding on to potassium or sodium?

A

Sodium

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8
Q

When giving D5W, how much stays in the cells compared to outside the cells?

A

2/3 intracellularly, 1/3 extracellularly

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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

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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

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11
Q

What must we give to avoid the protein sparing effect?

A

Glucose – given in IVs as Dextrose

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12
Q

What patients can we not give glucose to?

A

Burn victims, DKA

too much glucose can destroy veins

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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

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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

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15
Q

What are some sxs of volume excess?

A

weight gain, edema, neck veins, pulmonary congestion, pleural effusions, gallops, ascites

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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

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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

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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

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19
Q

A temp greater than ____ is worthy of investigation

A

38.0

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20
Q

5 W’s for post-op fever… what is the W that actually occurs during surgery?

A

“Wonder Drugs” – Malignant Hyperthermia

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21
Q

What is the treatment for malignant hyperthermia?

A

Oxygen, dantrolene, cool IVF

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22
Q

What “W” coincides with POD 1 fever?

A

“Wind” – atelectasis

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23
Q

What should be ordered to diagnose atelectasis?

A

Chest x-ray

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24
Q

What is the best way to prevent atelectasis?

A

Inhaled spirometry and getting patient up out of bed

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25
Q

POD 2/3, fever, what “W”?

A

Wind —> pneumonia. Often thought secondary to atelectasis

Diagnose with a CxR

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26
Q

Fever POD3-5, should be thinking of what “W”?

A

Water. UTI

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27
Q

What is the best way to prevent people from getting UTIs post surgery?

A

Take foley catheter out as soon as possible

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28
Q

POD 5 – what “W”?

A

Walking. DVT/PE

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29
Q

Best way to prevent DVT/PE?

A

Ambulating! LMWH, pneumatic compression, antiembolism stockings

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30
Q

POD 7 – what “W”?

A

Wound – possibly cellulitis

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31
Q

POD 10-14: what “W”?

A

Wound – abscess.

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32
Q

What are the 5 W’s in order from earliest in the post-op course to latest?

A

Wind. Water. Walking. Wound.

Wonder drugs during surgery – but can really happen at any time.

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33
Q

What bacteria are likely associated with ventilator associated pneumonitis?

A

Gram negative pseudomonas.

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34
Q

Arrhythmias are most common after what type of surgery?

A

Most common after cardiac and thoracic surgery

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35
Q

Hypoxia, Hypovolemia, Hyperthermia, electrolyte imbalance, hypoglycemia, HTN, infection, and medications are all causes of?

A

Post-op arrhythmias

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36
Q

If someone is in A fib, anticoagulate after _______ hours.

A

24

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37
Q

If someone is on a beta blocker prior to surgery should you stop it?

A

No. Can result in reflex tachycardia.

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38
Q

What is the most common cause of morbidity and mortality after non-cardiac surgery?

A

MI

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39
Q

An MI most often occurs _____ hours after surgery

A

48

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40
Q

Patient with dyspnea, hypoxemia with normal CO2 tension, and CxR with increased vascular markings should make you think of?

A

Heart Failure/Pulmonary Edema

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41
Q

What kinds or surgeries are associated with the highest risk of perioperative stroke?

A
  1. Double or triple valve repair.
  2. Aortic repair
  3. CABG + valve
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42
Q

Acute mechanical failure of a wound closure is called?

A

Dehiscence

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43
Q

What are some signs of a wound infection?

A

Redness, swelling, increased pain at incision site (key word is worsening pain, especially after post-op day 3).

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44
Q

Soft, nontender, moveable mass composed of adipose tissue

A

Lipoma

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45
Q

How do you treat a lipoma

A

Excision if bothersome

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46
Q

Benign subcutaneous cyst filled with epidermal cells and waxy material called sebum

A

Sebaceous cyst

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47
Q

What is a primary wound closure?

A

Close wound immediately with suture/staples, adhesives, etc.

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48
Q

What is secondary would closure?

A

Wound is left open and heals overtime WITHOUT sutures (can have a dressing inside to collect the fluids)

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49
Q

What is tertiary wound closure?

A

Suture the wound closed in 3 to 5 days AFTER incision.

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50
Q

How long does it take a wound to epithelize?

A

24-48 hours

51
Q

What can you give to a patient who is taking steroids that prevents wound healing?

A

Vitamin A

52
Q

What is negative pressure wound therapy?

A

“wound vac”

negative pressure system used to accelerate wound healing in chronic and acute

53
Q

What is a “clean” operative wound?

A

Elective, nontraumatic wound without acute inflammation.

Usually cleaned without the use of drains

54
Q

What is a “clean contaminated” wound?

A

Operation of the GI tract without unusual contamination or entry into the biliary or urinary tract

Example: cholecystectomy and hernia

55
Q

What is a “contaminated” wound?

A

“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
Q

what is a “dirty” wound?

A

Intestinal infarction (causes spillage of intestinal contents into the gut)

Intra-abdominal abscess drainage

57
Q

If a young woman presents with a breast mass, what diagnostic tool should you start with?

A

Ultrasound

58
Q

Painful/tender breast mass, size fluctuates with menstrual cycle, multiple sites, straw colored fluid with FNA

A

Fibrocystic disease

59
Q

Benign tumor of the breast consisting of stromal overgrowth collagen arranged in swirls

A

Fibroadenoma

60
Q

What is the most common breast tumor in women less than 30?

A

Fibroadenoma

61
Q

Solid, firm, mobile, well-circumscribed, nontender breast mass

A

Fibroadenoma

62
Q

How do you diagnose a fibroadenoma?

A

Core bx/FNA or U/S

63
Q

Single, nontender, firm, immobile mass

A

Malignancy

64
Q

What type of breast cancer is most common?

A

Infiltrating Ductal Carcinoma

Accounts for 80% of breast cancer

65
Q

This type of breast cancer presents with edema peau d’orange and erythema. Poor prognosis.

A

Inflammatory carcinoma

66
Q

What is Pagets disease?

A

Nipple disease. Exudative, dry, scaly appearance of the nipple.

67
Q

What are indications for a biopsy?

A

Persistent mass after aspiration, solid mass, bloody nipple discharge, ulcer or dermatitis of the nipple

68
Q

What are indications for a needle aspiration bx?

A

if the mass appears to be a cyst

69
Q

What is the most common cause of death in men and women in US?

A

Bronchogenic carcinoma

70
Q

This type of lung cancer is aggressive, spreads early, and cannot be treated with surgery.

A

Small cell lung cancer

71
Q

There are three types of non-small cell lung cancer. What are they?

A

Squamous, adenocarcinoma, and large cell

72
Q

What is the cause of appendicitis?

A

Obstruction of the appendiceal lumen – fecolith

73
Q

How does appendicitis present?

A

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
Q

Someone with severe acute abdominal pain and intraperitoneal free air on abdominal x-ray should make you think of?

A

Perforated hollow viscus

75
Q

Diverticulitis most commonly presents in what site of the colon?

A

sigmoid

76
Q

Symptoms of diverticulitis include?

A

Recurrent abdominal pain in LLQ, functional changes in bowel, bleeding, constipation, diarrhea, or alternation between the two

77
Q

How do you diagnose diverticulitis?

A

CT

78
Q

What is the difference between a incarcerated and strangulated hernia?

A

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
Q

Direct hernia occur medially or laterally to the inferior epigastric artery?

A

Medially

80
Q

Most small bowel obstructions are due to?

A

hernias and adhesions

81
Q

Most large bowel obstructions are due to?

A

Intussception, volvulus, and neoplasm

82
Q

How do small bowel obstructions most commonly present?

A

abdominal pain, distension, vomiting, and high pitched bowel sounds that then become silent

83
Q

How do large bowel obstructions most commonly present?

A

Distension, pain, may be tachy or febrile

84
Q

What is twisting of the intestine in on itself?

A

Volvulus

85
Q

What will see you on x-ray if a volvulus is suspected?

A

“Kidney bean appearance” colonic distension

86
Q

What is the most common type of colonic polyp?

A

Tubular

87
Q

Are tubular polyps or villous polyps more likely to become malignant?

A

Villous

88
Q

What are some sxs of colon cancer?

A

iron deficient anemia, rectal bleeding, alternating diarrhea/constipation, feeling of incomplete passage of stool

89
Q

Acute inflammation and infection of the gallbladder

A

Acute cholecystitis

90
Q

What diagnostic tool is used to evaluate a patient for cholecystitis?

A

U/S

91
Q

What are the 5 F’s in relation to the gallbladder

A

Fat, Female, Forty, Fertile, Fair

92
Q

Most gallstones are made up of?

A

Cholesterol

93
Q

Presents with pain that lasts longer than 3-4 hours, N/V, fever, and a positive Murphy’s sign

A

acute cholecystitis

94
Q

Presents with RUQ pain that radiates to the back. Pain typically lasts 1-4 hours. Caused by obstruction not infection/inflammation

A

Cholelithiasis

95
Q

How do you diagnose cholelithiasis?

A

TOC – U/S

Can also do MRCP. More useful if stones cannot be seen on US. MRCP done before ERCP

96
Q

What is a HIDA scan?

A

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
Q

When is an ERCP done?

A

Done if evidence of extrahepatic obstruction or obstructive jaundice.

It provides detailed radiography of and injection of dye into the biliary tree

98
Q

How do you treat cholelithiasis?

A

Cholecystectomy

99
Q

Bacteria present within the normal sterile peritoneal cavity

A

Peritonitis

100
Q

What two things cause nearly 85% of cases of acute pancreatitis?

A

Alcohol and gallstones — but mostly alcohol

101
Q

About how many years of heavy alcohol consumption does it typically take to result in pancreatitis?

A

6 to 8 years

102
Q

Non-crampy epigastric pain that radiates to the back, pain alleviated with sitting or standing, fever, tachycardia, and guarding are all symptoms of?

A

Pancreatitis

103
Q

What is Grey-Turners sign and what is Cullens sign?

A

Grey-Turners: bruising of the flanks

Cullens: bruising of periumbilical area

104
Q

what two criteria are used to assess a patient for complications or death from pancreatits

A

Ranson’s Criteria and APACHEII

105
Q

What is the treatment for pancreatitis?

A

NPO, maintain tissue perfusion and intravascular volume, and if its due to a gallstone – remove the gallbladder

106
Q

Engorgements of the venous plexus of the rectum, anus, or both with protrusion of the mucosa

A

Hemorrhoids

107
Q

What are some causes of hemorrhoids?

A

Constipation, straining, pregnancy, portal HTN

108
Q

Internal or external hemorrhoids are painless?

A

Internal

109
Q

Where is the most common place for a gastric ulcer to occur?

A

Lesser curvature

110
Q

What are some risk factors for a gastric ulcer?

A

Smoking, NSAIDs, alcohol, male

111
Q

What is the most common GU cancer?

A

Prostate

112
Q

How do you diagnose prostate cancer?

A

Transrectal US/Transrectal Bx

113
Q

How do we stage prostate cancer?

A

Using the Gleason score

114
Q

This often presents with a firm, painless lump in the testicle

A

Testicular cancer

115
Q

What is the most common cause of acute arterial occlusion?

A

A fib – embolism from heart

116
Q

What are the 6 P’s? (for acute arterial occlusion)

A

Pain, pallor, pulselessness, polar, paresthesia, paralysis

117
Q

How do you treat an acute arterial occlusion?

A

Surgical embolectomy with cutdowm and fogarty balloon

118
Q

What is a common complication associated with acute arterial occlusion?

A

Compartment syndrome

119
Q

Occlusive atherosclerotic disease in the lower extremities

A

Peripheral arterial insufficiency

120
Q

Intermittent claudication, rest pain, erectile dysfunction, sensorimotor dysfunction, tissue loss, absent pulses, and muscular atrophy are all symptoms of?

A

peripheral arterial disease

121
Q

An ABI less than ____ is diagnostic for peripheral arterial disease?

A

0.6

122
Q

What is the gold standard for diagnosing peripheral arterial disease?

A

Arteriogram

123
Q

What is the difference between dry and wet gangrene?

A

dry: dry necrosis of tissue without signs of infection
wet: moist necrotic tissue with signs of infection

Sam: Surgery EOR (3 decks)

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