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Surgery EOR (billie) > 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

Pts thigh is flexed to a right angle and gently rotated internally then externally.

what is this sign
what can it indicate

A
  1. obturator sign
  2. can indicate appendicitis, diverticulitis and PID
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3
Q

pain on passive extension of the right thigh while pt is lying on the left side.

what is this sign
what can it indicate

A
  1. psoas sign
  2. indicates appendicitis
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4
Q
A
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5
Q

No abdominal exam is complete without___________

A

a rectal exam

rectal masses, hemoccult test

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6
Q

how do you calculate an ABI and what is normal, acceptable, mild, moderate and severe

A

systolic of ankle ÷ systolic of arm

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7
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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8
Q

What INR level is needed to do an elective procedure?

A

Lower than 1.5

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9
Q

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

A

Within past 4 months

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10
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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11
Q

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

A

Any pre-menopausal women

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12
Q

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

A

Cancer or intestinal disorders

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13
Q

MC site for breast malignancy

A

Upper outer quadrant, slightly more on left.

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14
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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15
Q

Who gets an EKG for pre-op workup?

A
  1. Known CAD/arrhythmia/PVD/CVD/Structural
  2. Intermediate or high risk sx
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16
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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17
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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18
Q

in what 4 ways does malnutrition affect surgery

A
  1. increases operative death rates
  2. increases infection rates
  3. prolongs rcovery
  4. may require pre/post op hyperalimentation (feedng tubes, protein shakes, ect.)
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19
Q

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

A

> 10% wt loss from their baseline

20
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

21
Q

What screening tool determines risk of postop pulmonary complication?

A

ARISCAT Calculator

22
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!

23
Q

What are the major predictors of cardiovascular risk?

A
  • Recent MI (6months)
  • Unstable angina
  • Recent PCI
  • Active CHF
  • VTach or AV Blocks
24
Q

What are the minor predictors for cardiovascular risk?

A
  • AFib
  • Age > 70
  • LVH or LBBB
  • Poorly controlled HTN
25
Q

What are the intermediate predictors for cardiovascular risk?

A
  • CAD
  • Stable angina
  • Remote MI
  • Compensated CHF
  • Renal insufficiency
  • DM
  • CVD
  • Obesity
26
Q

What is NSQIP for?

A

National Surgical Quality Improvement Program to measure risk stratification

ACS-NSQIP-SRC (surgical risk calculator)

27
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
28
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.
29
Q

What do all anesthesias cause?

A
  • CNS depression
  • Respiratory depression
  • Cardiac depression
30
Q

ASA Classifications (1-6)

A

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

Pre-anesthesia classification

31
Q

What is mallampati classification?

A

Classification of oropharynx to predict ease of intubation

32
Q

What are the two parts of informed consent for surgery?

A
  • Operative consent (patient and surgeon sign)
  • Anesthesia consent (patient and anesthesia sign)
33
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
34
Q

How do we manage glycemic control perioperatively for DM pts?

A

Sliding scale insulin

35
Q

What is the goal of surgery for thyroid complications?

A

Achieving euthyroid state PRIOR to surgery

36
Q

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

A
  • BBs like propranolol
  • Potassium iodide

PTU for non-emergent

37
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

38
Q

How do we pre-op manage adrenal insufficiency?

A
  • IV/IM cortisol injections
  • 1-2 days prior to sx, IVF and sodium replacement
  • Correction of any lyte abnormalities PRIOR to surgery
39
Q

What is the mainstay of treating addisonian crisis?

A

High dose corticosteroids

40
Q

What PFT value correlates with high risk of pulmonary complications?

A

FEV1 < 50%

Any acute pulmonary disease should be treated prior to surgery.

41
Q

What is the MCC of perioperative death?

A

MI

42
Q

How long do you wait to do surgery post angioplasty?

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

Stenting = wait longer

43
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

44
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
45
Q

What is the MCC of spontaneous bacteremias?

A

Gingivitis

Can cause severe cardiovascular complications.

46
Q

What surgical procedures does oral hygiene affect the most?

A

Cardiovascular surgery

Surgery EOR (billie) (17 decks)

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