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Surgery > MTB > Flashcards

MTB Flashcards

1
Q

Which Cardivascular criteria are important to assess in preop eval for surgery?

A

EF <35%
Recent MI: must defer 6 months
CHF: Medically optimize pt with ACE, BB, Spironolactone

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2
Q

What pre-op tests are necessary for pt < 35 yoa and no risk factors?

A

EKG only

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3
Q

What is workup for pt with cardiac dz hx?

A

EKG
Stress test
Echo

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4
Q

What is pre-op Risk assessment for pts with lung dz or smokers?

A

PFTs - assess VC

Pt must quit smoking 6-8 wks prior to surgery

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5
Q

What is pre-op Risk assessment for pts with renal dz?

A

Hydrate - IVF pre and during surgery

Dialysis pts - dialyze pt 24 hrs prior to surgery

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6
Q

What is first line in securing airway in pt w no facial trauma?

A

Orotracheal intubation

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7
Q

What is first line in securing airway in pt w facial trauma?

A

Cricothyroidotomy

Percutaneous tracheostomy

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8
Q

What is first line in securing airway in pt w cervical spine injury?

A

Orotracheal tube via flexible bronchoscopy

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9
Q

What is the goal oxygen saturation?

A

Above 90%

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10
Q

What are the criteria for Hypovolemic shock?

A

Pale and cool
Increase: SVR, HR
Decrease: CVP, CO, LVEDP/PCWP
Tx: Fluids and pressors

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11
Q

What are the criteria for Cardiogenic shock?

A

Pale and cool
Increase: CVP, SVR, HR, LVEDP/PCWP
Decrease: CO
Tx: tx cardiac problem

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12
Q

What are the criteria for Neurogenic shock?

A

Warm
Increase: HR
Decrease: CVP, SVR, CO, LVEDP/PCWP
Tx: Fluids and pressors

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13
Q

What are the criteria for septic shock?

A 
Warm and faint
Increase: HR, CO
Decrease: CVP, SVR
NO change: LVEDP, PCWP
Tx: Fluids, Abx, pressors
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14
Q

What is the MCC of cardiogenic shock?

A

Myocardial Infarction

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15
Q

What is the MCC of septic shock?

A

E.coli

Staph aureus

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16
Q

What is the MCC of neurogenic shock?

A

spinal cord injury

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17
Q

What is the most common cause of hypovolemic shock?

A

Massive hemorrhage

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18
Q

Bruising in the flank with abdominal trauma?

A

Grey Turner Sign

Retroperitoneal Hemorrohage = blood collections for pancreatitis

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19
Q

Bruising around umbilicus with abdominal trauma?

A

Cullen Sign
Hemorrhagic pancreatitis
Ruptured AAA

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20
Q

Pain in left shoulder with abdominal trauma?

A

Kehr sign

Splenic rupture

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21
Q

Dull percussion on the left and shifting dullness on the right with abdominal trauma?

A

Balance sign

Splenic rupture

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22
Q

Bruising where seatbelt was with abdominal trauma

Seen in what injury?

A

Seatbelt sign

Deceleration injury

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23
Q

Best initial test for evaluation free air under diaphragm

A

Upright CXR

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24
Q

What does free air under diaphragm indicate?

A

Perforation of the bowel

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25
Q

When is AXR useful ?

A

Bowel Perforation

Intestinal Obstruction - i.e. ileus

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26
Q

What is the MC indication for intubation in trauma pt?

A

AMS

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27
Q

Workup for trauma pt with oxygen saturation less than 90?

A
  1. Increase oxygen flow rate
  2. Obtain ABG
  3. Determine cause of hypoxia using hx
28
Q

Pale, cold, shivering pt w/diaphoresis, hypoTN, tachycardia?

A

Hypovolemic shock

29
Q

Causes of bleeding in hypovolemic pt?

A

Large volume blood in abdomen

Thigh post diaphyseal fx of femur

30
Q

What injuries seen with thoracic trauma?

A

Pericardial tamponade

Tension Pneumothorax

31
Q

Distended neck veins or high CVP seen in?

A

Pericardial tamponade

Tension Pneumothorax

32
Q

What to do if pericardial tamponade?

A
  1. CXR for enlarged heart
  2. Immediate pericardiocentesis tap or window
  3. EKG for electrical alternans
  4. VS for pulsus paradoxus
33
Q

What is electrical alternans?

A

Fluid in pericardium causes ventricular axis changes

Alteration of QRS amplitude or axis b/t beats and possible wandering baseline

34
Q

What is pulsus paradoxus?

A

Drop in SBP >10mmHg during Inspiration

35
Q

DDX for pulsus paradoxus?

A

Pericardial tamponade
Constrictive Pericarditis
COPD/Asthma exacerbation

36
Q

Respiratory distress, Tracheal deviation, absent breath sounds, hyperresonance to percussion?

A

Tension Pneumothorax

37
Q

Tx for Tension pneumothorax?

A

Large-bore needle or IV catheter into pleural space

Then place chest tube

38
Q

Do we wait for CXR for dx in tension pneumothorax?

39
Q

Management of circulation in Abdominal trauma?

A
  1. Control site of bleeding - apply direct local pressure if known
  2. Fluid resuscitation
    - 2 Large IV lines
    - Give fluids and blood
    - type and screen
  3. Insert Foley
  4. Abx
40
Q

What to suspect in pt who is warm and flushed, hypotensive, tachycardic, hx of medical use, spinal anesthesia or exposure to allergen?
TX?

A

Vasomotor shock

Tx: Vasocostrict and fluids

41
Q

What is diagnostic test for Pericardial tamponade?

42
Q

Trauma w/penetration to pericardium, secondary to broken ribs,knives, bullet wounds?

A

Pericardial Tamponade

43
Q

Diff b/t Pneunothorax and tension pneumothorax?

A

Tension Pneumothorax - one-way leak causes tracheal deviation away from affected lung
Tx:
P - Chest tube placement
TP - Needle decompression

44
Q

Trauma pt with absent breath sounds and dullness to percussion?

A

Blood in pleural space = Hemothorax

45
Q

CXR and CT finding on Hemothorax?

A

Blunting of costophrenic angle

46
Q

Tx for hemothorax?

A

Chest tube drainage

possible thoracotomy

47
Q

Trachea shifts toward involved lung?

A

Atelectasis

48
Q

When do we see spontaneous pneumothorax?

A

Secondary to COPD
Acute onset chest pain and SOB
Affected side - breath sounds reduced, chest hyper-resonant to percussion

49
Q

Pathophysiology of spontaneous pneumothorax?

A

Cigarette smoke causes chronic airway inflammation and respiratory bronchiolitis -> chronic destruction of alveolar sacs -> form large alveolar blebs -> rupture and leak into pleural space

50
Q

Blood at the urethral meatus and high riding prostate - next step in management?

A

Retrograde urethrogram

51
Q

High riding prostate indicative for what?

A

Prostate and prostatic urethra torn; membranous urethral injury

52
Q

What is a RUG?

A

Retrograde injection of radiopaque contrast into urethra

visualize rupture of urethra or urethral stricture

53
Q

What is radiopaque?

A

stops or reduces passage of xrays

Appear white on xray - i.e. bones

54
Q

Next best step in pt with acute mesenteric ischemia?

A

Angiography

55
Q

Post traumatic child presents with epigastric pain and vomiting?

A

BAT - duodenal hematoma - blood b/t submucosal and muscular layer -> obstruction
Resolves spontaneously w/in 1-2 wks
Tx: NG tube suction w/TPN

56
Q

Abdominal pain after eating and bloody diarrhea?

A

Mesenteric ischemia

57
Q

Best initial test in mesenteric ischemia?

A

CT Abdomen

58
Q

Most accurate test in mesenteric ischemia?

A

Angiography

59
Q

Tx for mesenteric ischemia?

A

IV Normal Saline

Surgery to remove necrotic bowel

60
Q

Most common abdominal locations for infarction?

A

Watershed areas:
Splenic flexure - LUQ
Hepatic flexure

61
Q

What are some causes of Mesenteric ischemia?

A

A fib

SMA - MC vessel

62
Q

Pt with hx of severe incessant vomiting (alcoholism) and substernal chest pain shortly after?

A

Boerhaave syndrome

63
Q

Snap, crackle, pop heard on palpation of clavicle?

A

Clavicular FX

64
Q

Rapid increase in intraesophageal pressure w/negative intrathoracic pressure caused by vomiting?

A

Esophageal perforation

65
Q

CXR finding of cardiac tamponade

A

Enlarged heart

Surgery (2 decks)

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