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Uworld: Surgery > Monday 9/5/16: Surgery exam 2 > Flashcards

Monday 9/5/16: Surgery exam 2 Flashcards

1
Q

What is a common complication of a thyroidectomy for Grave’s disease?

A

Post-surgical hypoparathyroidism

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2
Q

What is a common complication from the removal of 3.5 parathyroid glands due to parathyroid hyperplasia?

A

Post-surgical hypoparathyroidism

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3
Q

What does post-surgical hypoparathyroidism cause in patient who has just had a thyroidectomy?

A

Hypocalcemia

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4
Q

How does hypocalcemia present?

A
  1. Fatigue
  2. Anxiety
  3. Depression
  4. Involuntary contractions involving the lips, face
  5. Seizures
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5
Q

How might an electrocardiogram look for someone with hypocalcemia?

A

May show a prolonged QT interval.

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6
Q

What is associated with hypercalcemia?

A

Vitamin D toxicity

Shortened QT interval

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7
Q

What can happen in persistent hypothyroidism?

A

Can cause hyponatremia if without thyroid supplementation.

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8
Q

How can you characterize hypoparathyroidism?

A
  1. Low calcium
  2. High phosphorus
    All in the presence of normal renal function.
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9
Q

What are some causes of hypoparathyroidism?

A
  1. Post surgical
  2. Autoimmune parathyroid destruction
  3. Defective calcium-sensing receptor
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10
Q

How does a patient with a perforation of a hollow abdominal viscus present?

A
  1. Acute abdomen
  2. Rebound tenderness
  3. Subdiaphragmatic free (intraperitoneal air) on abdominal X-ray
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11
Q

What is the treatment of a perforated hollow abdominal viscus?

A
  1. Pre-operative NG decompression
  2. IV fluids and antibiotics
  3. Emergent laparotomy
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12
Q

If a patient in need of an ex lap has an INR of 2.1 which is therapeutic for atrial fib, what needs to happen before the surgery and why?

A

Warfarin-induced anticoagulation must be reversed because it will predispose the patient to intra-operative and post-operative bleeding complications.

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13
Q

What is the most rapid means of normalizing the prothrombin time?

A

Restoration of the vitamin-k dependent clotting factors through an infusion of fresh frozen plasma

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14
Q

When do patients receive packed red blood?

A

Usually when the tissue oxygen delivery does not become deficient until the hgb is below 7g/dL

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15
Q

What platelet lab values provide adequate hemostasis for most invasive procedures?

A

Above 50,000

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16
Q

What does vitamin k administration depend on to correct the coagulation time in warfarin treated patients?

A

Synthesis of new vitamin k dependent clotting factors (2,7,9,10) by the liver which takes time so should not be used in emergent situations,

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17
Q

When is desmopressin or DDAVP given pre-operatively?

A

Patients with mild hemophilia A in order to prevent excessive bleeding.

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18
Q

What does DDAVP do?

A

Indirectly increases factor 8 levels by causing vWF release from endothelial cells.

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19
Q

What can happen in a circumferential, full-thickness (3rd degree burn)

A

Eschar formation that restricts venous and lymphatic drainage leading to acute compartment syndrome.

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20
Q

What is acute compartment syndrome?

A

Occurs when excessive fluid accumulation in a confined compartment in the body causes an increase in compartment pressure to the point that blood flow is severely impaired.

21
Q

What is the first presenting symptom of acute compartment syndrome?

A

Pain out of proportion to clinical findings

22
Q

What are some other symptoms of acute compartment syndrome?

A
  1. Worsening pain on passive stretch
  2. Tissue tension
  3. Pallor
    4 decreased sensation
23
Q

What will happen if elevated compartment pressure is allowed to persist?

A

Tissue ischemia and eventual tissue death will occur.

24
Q

How should acute compartment syndrome be managed?

A
  1. Serial compartment pressure monitoring to determine need for surgical intervention
  2. Surgical: compartment decompression by fasciotomy or in the case of circumferential burns, escharotomy.
25
Q

How is cellulitis characterized?

A

Skin warmth

26
Q

How is gas gangrene characterized?

A

Crepitus.

27
Q

How does inflammatory arthritis present?

A

Pain and swelling often involving the bacterial metacarpal phalangeal joints.

28
Q

What is the clinical presentation of a small bowel obstruction?

A
  1. Colicky abdominal pain
  2. Vomiting
  3. Inability to pass gas or stool
  4. Hyperactive bowel sounds
  5. Distended and tympanic abdomen
29
Q

How do you diagnose a small bowel obstruction?

A
  1. Dilated loops of bowel with air fluid levels
  2. Partial: air in colon
  3. Complete: transition point (abrupt cutoff) no air in colon
30
Q

What are some complications of small bowel obstruction?

A
  1. Ischemia/necrosis (strangulation)

2. Bowel perforation

31
Q

How do you manage small bowel obstructions?

A
  1. Bowel rest, NG suction, IV fluids

2. Surgical exploration for signs of complications

32
Q

What is an important risk factor for small bowel obstruction?

A

A history of prior abdominal surgery. SBO due to adhesion development

33
Q

What is indicative of a complicated small bowel obstruction?

A
  1. Changes in the character of pain
  2. Fever
  3. Hemodynamic instability (hypotension, tachycardia)
  4. Significant metabolic acidosis (ex. Low bicarbonate)
34
Q

Should antibiotics be given to patient with complicated SBO?

A

No, although it would be helpful in an uncomplicated SBO because they have increased risks of intestinal bacteria translocation with strangulation.

35
Q

What does a small bowel follow through help diagnose?

A

Partial intestinal obstruction in clinically stable patients who do not respond completely to initial conservative management.

36
Q

What is the preferred imaging choice for acute mesenteric ischemia

A

CT angiography

37
Q

How would you know you have a colonic pseudo obstruction?

A

Imaging would instead show dilated colon.

38
Q

When do you see acalculous cholecystitis?

A

In severely ill patients in the ICU with multiorgan failure, severe trauma, burns, sepsis, or prolonged parentral nutrition.

39
Q

What causes acalculous cholecystitis?

A

Due to cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms and resultant edema and necrosis of the gallbladder.

40
Q

What are the signs of acalculous cholecystitis?

A
  1. Fever, leukocytosis

2. Usually no communicative due to their general medical condition.

41
Q

What are some radiologic signs for acalculous cholecystitis?

A
  1. Gallbladder wall thickening

2. Presence of pericholecystic fluid

42
Q

What is the immediate treatment in critically ill patients with acalculous cholecystitis?

A

Antibiotics

Percutaneous cholecystostomy under radiologic guidance.

43
Q

What is the definitive therapy of acalculous cholecystitis?

A

Cholecystectomy with drainage of any associated abscesses when the patient stabilizes

44
Q

How does ileus present?

A

Small and large bowel distinction

Hypoactive bowel sounds

45
Q

How does pancreatitis present on CT?

A

Parenchymal enhancement with IV contrast( with no pancreatic necrosis)
Pseudocyst formation
Peripancreatic fluid collection

46
Q

How does mesenteric ischemia present?

A
  1. Sudden periumbilical pain out of proportion to physical findings.
47
Q

What are risk factors for mesenteric ischemia?

A
  1. Older age
  2. A. Fib.
  3. CHF
  4. Atherosclerotic vascular disease
48
Q

How does the CT look for mesenteric ischemia?

A
  1. Focal or segmental bowel wall thickening
  2. Small bowel dilation
  3. Mesenteric stranding
49
Q

How does duodenal perforation present?

A
  1. Sudden onset
  2. Diffuse abdominal pain
  3. Abdomen is rigid
  4. Signs of peritonitis
  5. Imaging shows free air under the diaphragm

Uworld: Surgery (4 decks)

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