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Surgery literally enochs + stuff that I can't remember > Lecture 1: Intro to Surgery > Flashcards

Lecture 1: Intro to Surgery Flashcards

1
Q

What are the MC complaints in surgical candidates?

A
  1. Pain
  2. Emesis
  3. Change in bowel habits
  4. Hematemesis/hematochezia
  5. Trauma
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2
Q

What are the goals of Pre-op testing?

A
  1. Screening for asymptomatic disease that may affect surgical result
  2. Appraising current diseases that may affect course of surgery
  3. Dx of disorders that may require sx
  4. Evaluate any metabolic or septic complications
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3
Q

What INR level is needed to do an elective procedure?

A

Lower than 1.5

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4
Q

How long ago can previous labs be for pre-op diagnostic work-up?

A

Within past 4 months

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5
Q

When is CXR recommended for pre-op diagnostic work-up?

A
  • Cardiopulmonary disease
  • > =50 undergoing AAA or upper abd/thoracic sx
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6
Q

Who gets a Beta-hCG lab in pre-op diagnostic work-up?

A

Any pre-menopausal women

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7
Q

What kind of pre-op pts would require a nutritional assessment?

A

Cancer or intestinal disorders

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8
Q

Describe the Obturator sign and and what it can be indicative of?

A

The patients thigh is flexed to a right angle and gently rotated, first internally and then externally.

Appendicitis, Diverticulitis, PID

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9
Q

MC site for breast malignancy

A

Upper outer quadrant, slightly more on left boob.

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10
Q

What are the three positions someone should be in for a breast exam?

A

upright with arm above head
sitting upright with arms at her side
lying down with arm above head

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11
Q

What ABI is indicative of Arterial disease?

A

0.9

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12
Q

What is the recommendation regarding labs for pre-op diagnostic work-up in surgical pts?

A

Do not routinely screen if healthy or recent within 4 months.

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13
Q

Who gets an EKG for pre-op workup?

A
  1. Known CAD/arrhythmia/PVD/CVD/Structural heart disease
  2. Intermediate or high risk sx
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14
Q

What METs level is considered good for surgery prognosis?

A

At least 4 without symptoms.

Higher is better

Physiologic age > chronologic age
Ex: walking up a small incline, single flight of stairs, 3-4mph on flat ground

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15
Q

What physical activity is considered 4 METs?

A
  • Walking up a small incline
  • Single flight of stairs
  • 3-4 mph walking speed on ground
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16
Q

What weight loss is considered very high risk in surgical candidates?

A

> 10% wt loss from their baseline

common in cancer patients and those w/ intestinal disorders

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17
Q

When would a screening workup include PT/INR, PTT, and CBC?

A

any h/o bleeding tendencies (Epitaxis, gingival bleeding, easy bruising, menorrhagia, excessive bleeding with other surgeries)
Fam h/o bleeding disorders (Hemophilia, VWD)
Drug history (ASA, NSAIDS, Clopidogrel, Warfarin, Pradaxa, Xarelto)

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18
Q

What is the screening tool for obstructive sleep apnea?

A
  1. Snoring
  2. Tiredness
  3. Observed apnea
  4. Pressure (BP)
  5. BMI > 35
  6. Age > 50
  7. Neck > 40cm circumference
  8. Gender (Male)

STOP-BANG

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19
Q

What workup would you do for someone high risk for post operative pulmonary complications?

Heavy smoking, SOB/DOE, Chronic cough, Pulm disease, COPD, Asthma, OSA

A

CXR, ECG
ABG-poorly controlled COPD
PFTs-undiagnosed DOE, COPD/Asthma not at baseline

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20
Q

What screening tool determines risk of postop pulmonary complication?

A

ARISCAT Calculator

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21
Q

How do we pre-op prep someone with compromised pulmonary function?

A
  1. No smoking 8 weeks prior
  2. Bronchodilators/Chest physiotherapy
  3. Pre-op/post-op supplemental O2

Pre-op high flow helps with reducing site infections!

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22
Q

What are the major predictors of cardiovascular risk?

A
  • Recent MI (6months)
  • Unstable angina
  • Recent PCI
  • Active CHF
  • VTach or AV Blocks
23
Q

What are the minor predictors for cardiovascular risk?

A
  • AFib
  • Age > 70
  • LVH or LBBB
  • Poorly controlled HTN
24
Q

What are the intermediate predictors for cardiovascular risk?

A
  • CAD
  • Stable angina
  • Remote MI
  • Compensated CHF
  • Renal insufficiency
  • DM
  • CVD
  • Obesity
25
Q

What is NSQIP for?

A

National Surgical Quality Improvement Program to measure risk stratification

ACS-NSQIP-SRC (surgical risk calculator)

26
Q

How are no risk, low risk, and intermediate cardiovascular risk patients managed/worked up per AHA/ACC guidelines?

A
  • No risk = no workup
  • Low risk = EKG
  • Intermediate = EKG + pertinent labs
27
Q

How are high risk and very high cardiovascular risk patients worked up prior to surgery?

A
  • High = 3+ intermediate factors or high risk surgery = EKG + labs + echo + cardiac consult
  • Very high = 1+ major = Cardiac consult + postpone until stabilized.
28
Q

What preoperative treatment can significantly decrease incidence of surgical site infections?

A

high flow oxygen

29
Q

What is associated with a very low sugrical cardiac risk?

A
  • absense of symptoms (chest pain, palpitations, DOE, syncope)
  • good functional assesment (METs)
30
Q

What do all anesthesias cause?

A
  • CNS depression
  • Respiratory depression
  • Cardiac depression
31
Q

ASA Classifications (1-6)

A

ASA is classified based on presence of systemic disease and its threat to life.

Pre-anesthesia classification

32
Q

What is mallampati classification?

A

Classification of oropharynx to predict ease of intubation

33
Q

What are the two parts of informed consent for surgery?

A
  • Operative consent (patient and surgeon sign)
  • Anesthesia consent (patient and anesthesia sign)
34
Q

What medications must be stopped 5-7 days prior to surgery?

A
  • Oral AC (pradaxa only 2 days prior)
  • NSAIDs
  • OTC vitamins with vitamin E
  • Herbals
35
Q

What is the reversal agent for each of these:
Warfarin
Plavix
Xarelto/Eliquis
Pradaxa

A

Warfarin: Vit K, Kcentra
Plavix: NO, give them platelets
Xarelto/Eliquis: prothrombin complex concentrate or Andexxa
Pradaxa: Praxbind

36
Q

How do we manage glycemic control perioperatively for DM pts?

A

Sliding scale insulin

Goal: tight glycemic control before surgery

37
Q

If a preop workup is needed for a DM pt, what would it include?
What should be checked morning of surgery?

A

workup: ECG, CXR, UA, CMP, CBC, BG

Blood glucose checked morning of!

38
Q

What is the goal of surgery for thyroid complications?

A

Achieving euthyroid state PRIOR to surgery

39
Q

For hyperthyroidism, what are the main drugs for emergency surgery?

A
  • BBs like propranolol
  • Potassium iodide

PTU for non-emergent

40
Q

What can occur in addisonian crisis that is a danger in surgery?

A
  • Hypovolemia
  • Hypotension
  • Shock
  • Death

Risk is present during the entire surgery

41
Q

How do we pre-op manage adrenal insufficiency?

A
  • IV/IM cortisol injections
  • admit 1-2 days prior to sx, IVF and sodium replacement
  • Correction of any electrolyte abnormalities PRIOR to surgery
42
Q

What is the mainstay of treating addisonian crisis?

A

High dose corticosteroids

43
Q

What is the preop workup for a patient with pulmonary disease?

A

CXR, ABG, PFTs, CT (if abnormal CXR)

44
Q

What is the best predictor of airway function test with PFTs?

A

FEV1

FEV1<50% is associated with high rate of pulmonary complication

45
Q

What PFT value correlates with high risk of pulmonary complications?

A

FEV1 < 50%

Any acute pulmonary disease should be treated prior to surgery.

46
Q

What is the MCC of perioperative death?

A

MI

47
Q

If a patient had a PCI, how long should they wait before undergoing an elective surgery?

A
  • Angioplasty: 2-4 weeks
  • Angioplasty + metal stents: 4-6 weeks
  • Angioplasty + Drug-eluting stent: 1 year

Stenting = wait longer

48
Q

For surgical pts with prosthetic heart valves, what is the ABX for endocarditis prophylaxis?

A

Amoxicillin 2gm single dose 30-60 preop

Prevention of strep viridans

49
Q

Who is highest risk for infective endocarditis due to surgery?

A
  • Prosthetic heart valves
  • Prior endocarditis
  • Cyanotic congenital heart disease (The T diseases)
  • Cardiac transplantation with recent development of valvulopathy
50
Q

What prophylaxis do patients with a prosthetic heart valve require prior to surgery?

A

Endocarditis prophylaxis with Amoxicillin 2gm single dose 30-60 min pre op

should also be given to patients with prior endocarditis, cyanotic congenital heart disease, cardiac transplantation recipients who developed cardiac valvulopathy

51
Q

What is the MCC of spontaneous bacteremias?

A

Gingivitis

Can cause severe cardiovascular complications.

52
Q

What surgical procedures does oral hygiene affect the most?

A

Cardiovascular surgery

53
Q

What is no abdominal exam complete without?

A

a rectal exam!

Surgery literally enochs + stuff that I can't remember (7 decks)

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