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SURG LE3 > OSCE > Flashcards

OSCE Flashcards

1
Q

What are mnemonics for difficult direct laryngoscopy?

A

LEMONS
Look externally (gestalt)
Evalute 3-3-2
Mallampati = PUSH
Obstruction/Obesity
Neck mobility
Space (access to patient)/Skill

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2
Q

What is the mnemonic for difficult bag mask ventilation?

A

ROMAN

Radiation/Restriction (eg stiff lungs, COPD, cancer px)
Obstruction/Obesity/OSA
Mask seal/Male/Mallampati = male
Aged
No teeth = put an OS or gauze in part with the leak

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3
Q

What is the mnemonic for difficult extraglottic device?

A

RODS (for difficult airway alternatives)

Restriction (ie mouth opening, stiff lungs)
Obstruction/Obesity
Distorted Anatomy
Short thyromental distance

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4
Q

What is the mnemonic for difficult cricothyroidoctomy?

A

SMART
Surgery
Mass
Access/Anatomy
Radiation
Tumor

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5
Q

What should be evaluated in a px for inadequate ventilation due to poor inspiratory effect?

A

Chest walll movement
Respiratory rate
Pattern and depth of breathing
Use of accessory muscles
Abnormal sounds
Signs of injury

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6
Q

What is the diff betw partial airway and complete airway obstruction?

A

Partial obstruction = snoring, gurgling sounds

Complete osbutrction = accessory muscles, cyanosis, respiratory arrest

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7
Q

What are facial features to note in evaluationg anatomic airwya?

A

Small mouth
Facial hair/beard
High-arched palate = down syndrome
Short/long neck
Receeding chin
Protruding/buck teeth

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8
Q

What are the diff airway maneuvers?

A

Head tilt chin lift = if cervical spine injury is not a concern
Jaw thrust = if cervical spine injury is of concern

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9
Q

What are the diff basic airway adjuncts?

A

Oropharyngeal airway (OPA)
Nasophatyngeal airway

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10
Q

What do airway adjuncts do not do?

A

Pass the larynx
Protect the trachea from aspiration of secretions
Substitute for definitive airway

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11
Q

What are oropharyngeal airway adjuncts?

A

Curved, firm, hollow tube with a rectangular apertue
Used to maintain a conduit betw mouth and glottis to prevent obstriction by the px’s tongue and other soft tissue

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12
Q

What are indications of OPA?

A

Complete/partial obstruction of upper airway

Bite block in unconscious or intubated px

Adjunct for Oropharyngeal suctioning

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13
Q

What are C/Is for OPA?

A

Use with caution on awake, responsive px

Do not use on px with intact gag reflex

Should not be used in px with oral trauma

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14
Q

What are complications of OPA?

A

Soft tissue trauma
Vomiting
Exacerbation of airway obstruction

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15
Q

What are indications of nasopaharyngeal airway (NPA)?

A

Awake/semi-comatose px
Clenched teeth
Unable to lcoate OPA
Inadequate airway patency

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16
Q

What are C/Is for NPA?

A

Responsive px
Suspected fracture to the base of the skull or midface

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17
Q

What are the indications of bag mask ventilation?

A

Absent or inadequate spontaneou ventilation
Preliminary pre-oxygenation when intubation is planned
Short-term oxygenation when ventilation is temporarily compromised

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18
Q

What are the 3 critical errors in ventilation?

A

Excessive tidal volumes
Forcing air too quickly
Ventilating too rapidly

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19
Q

What are the adult ventilation rates?

A

Respiratory rate = 10-20/min

BLS/ACLS CPR Ratio compression: ventilation = 30:2 (2 breaths after every 30 chest compressions)

ACLS/CPR with advanced airway = 8-10/min (1 respiration every 6-8 secs, asynch with chest compression)

Respiratory Arrest = 10-12/min (1 respiration every 5-6 secs)

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20
Q

What rapid sequence induction and intubation is done with application of backward or downward pressure on the cricoid cartilage to occlude the esophagus?

A

Sellick’s maneuver/Cricoid pressure
= used to prevent aspiration of gastric events

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21
Q

What is the measurement of the bandage in the arms and legs?

A

3in = small limbs of children
4in = arms, forearm
6in = legs, thighs

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22
Q

What are indications of circular cast?

A

Fracture of distal femur
Fracture of proximia tibia
Fracture of tibial shaft

Goals: stabilize distal upper leg & lower leg

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23
Q

WHAT ARE THE diff methods of bandaging?

A

Circular bandage
Spiral bandage
Reverse spiral bandage
Figure of eight
RECURRENT bandage = stump or head injury, fingers & hand also

Ankle bandage

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24
Q

Where do u do figures of eight?

A

Joints
- knees, ankle, elbow and wrists

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25
Q

What should be observed in the px during orthoepdia exam?

A

GALS
Gait
Arms
Legs
Stance

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26
Q

What is the order of sequence of orthopedia exam?

A

Insoection
Palpation
Passive movement
Active movement

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27
Q

What device is used to measure angles?

A

Goniometer

Stationary arm = align with proximal line of reference point

Moving arm = place along moving arm in line with long bone

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28
Q

What are the important dermatomes of the upper ex?

A

C4 = deltoid/shoulder
C5 = biceps/flexion of elbow
C6 = wrist extensors
C7 = triceps/elbow extension
C8 = wrist flexors
T1 = finger abducction

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29
Q

What are the important dermatomes of the lower ex?

A

L2 = hip flexion
L3 = knee extension
L4 = ankle dorsiflexion
L5 = great toe extension
S1 = ankle plantarflexion

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30
Q

What are the diff neurological and vascular assessment?

A

Pulse and capillaryrefill time
Power
Reflexes
Sensations
Muscle tone

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31
Q

What are diff special tests/techniques?

A

Measuring hte length of the legs
Describing limited motion of a joint

32
Q

What is the joint of the shoulders?

A

Glenohumeral joint

33
Q

What are the diff special maneuvers of the shoulder?

A

Likelihood ratio
= probability of obtaining a giver test result in a diseased px divided by probability of obtaining a gievn test result in a non-diseased px

Pain provocation test
= painful arc test = has a positive LR of 3.7
= Neer test = Positive LR <2 (less diagnostic)
= Hawkins test = Positive LR is <2 (less diagnostic)

Strength tests
-> internal rotation lag test
-> external rotation lag test
-> drop arm test
-> positive LRs of 7.2, 5.6, and 3.3

34
Q

What are other tests for the shoulders?

A

Laxity
Sulcus test = assess the glenohumeral joint for inferior stability

Apprehension

35
Q

What are special maneuvers of the elbow?

A

Cozen test = lateral epicondylitis or “tennis elbow”
Mill test = passive stretching of wrist extensors
Maudsley test = resisted extension of middle finger with wrist extended

36
Q

What are the maneuvers of the fingers and hands?

A

Test sensation for

Median nerve = pulp of index finger
Ulnar n = pulp of fifth finger
Radial n = dorsal web space of thumb & index finger

37
Q

How long does a local anesthesia last? What should u prescribe for this?

A

2 hrs

After anesthesia:
- analgesic
- antibiotics

38
Q

What is the sequence of donning & removing PPE?

A

Donning = Gown > Mask > Goggle/face shield > Gloves

Doffing = Gloves > Goggle/face shield > Gown > Mask

39
Q

What are the agents used in routine hand wash, antiseptic hand wash, antiseptic hand rub, surgical antisepsis?

A

Routine hand wash = water & non-antimicrobial soap

Antiseptic hand wash = water & antimicrobial soap

Antiseptic hand rub = alcohol based hand rub

Surgical antisepsis = water & antimicrobial soap + alcohol based surgical hand scrub

40
Q

What are the diff sterilization techniques?

A

1. Ethylene oxide sterilization: heat-sensitive instruments (plastic, suture material, lenses, and finely-shaped instruments)
2. Chemical sterilization (cold): bactericidal, fungicidal, virucidal, sporicidal
3. Radiation sterilization: prepacked surgical equipment
4. Filter sterilization: removal of microorganisms in fluids & gasses
5. Gas Plasma: heat & moisture-sensitive devices and surgical instruments

41
Q

What are the result of rinne and webber test for conductive and sensorineural heairng loss?

A

Conductive hearing loss (bone)
Rinne: BC>AC
Weber: lateralizes on the affected ear (heard better here)

Sensorineural hearing loss (nerve)
Rinne: AC>BC
Weber: lateralizes on the normal ear (better hearing there)

42
Q

What are the 2 tests for visual cuity?

A

Far visoin = 20ft with snellen chart

Near vision = 14 in with pocket chart

43
Q

What CNs are responsible for gag reflex?

A

CN IX & X

44
Q

What aer the 2 lymph nodes checked during breast exam?

A

Axillary nodes
Supraclavicular nodes

45
Q

What is the Grey turner sign and Cullen sign?

A

Grey turner sign = ecchymosis of the flank & groin seen in hemorrhagic pancreatitis

Cullen sign= periumbilical ecchymosis from retroperitoneal hemorrhage or intra-abdominal hemorrhage

46
Q

What are the normal bowel sounds, rate?

A

Normal rate = 2-5clicks/min
Normal bowel sounds = low pitched and gurgling

47
Q

What is the normal liver span?

A

6-12cm in the R midclavicular line
4-8cm in midsternal line

48
Q

What is the Castell’s point?

A

Most inferior interspace on the L anterior axillary line (spleen area)

49
Q

What are the indications of catheterization?

A

*Chronic urinary retention
*Cystography = way to check if thre is perforation of bladder or UB injury

50
Q

What are C/Is of cathetization?

A

Acute prostatitis
Urethral injury in trauma px with blood noted per meatus

51
Q

What are the measurements of French catheters?

A

1 Fr = 0.33m
24 Fr = 8mm

52
Q

What aer the diff types of catheter and for what condition do u use it?

A

*Indwelling catheter = long period of time & accurate output monitoring
- temporaory or permanent drainage for urinary/bladder outlet patho

*intermittent catheter = removed once the bladder is completely emptied

53
Q

What aer the diff parts of the catheter and its use?

A

Drainage eye**: where urine flows in
**Balloon anchor: enables catheter to be indwelling and avoid slipping our of the px’s bladder
Catheter shaft**: longest part of the catheter
**Inflation funnel: insertion of sterile water to inflate the balloon anchor
*Irrigation funnel: not seen in 2 way catheter

54
Q

What are the 3 types of catheter and its use?

A

single lumen catheter**: 1 lumen for drainage (intermettent catheterization)
**2-way catheter: most common (1 drainage, 1 balloon inflation
*3-way catheter: continously irrigate the urinary bladder with sterile saline (1 drainage, 1 balloon, 1 irrigation fluid)

55
Q

What is the most preferred material for catheter?

A

Silicone = avoids microbial growth

56
Q

What are the measurements of FOley catheter/other catheter used in practice?

A

*French 16 2-way catheter = readily available
*French 24 3-way catheter
*Robinson’s catheter = 1 lumen for intermittent catheter

57
Q

What are the positions of the patient in catheterization?

A

Males: supine
Females: Lithotomy or frog leg

58
Q

How long can u use a latex catheter and silicone catheter?

A

*Latex catheter = 14 days
*Silicone catheter = 4-6wks

59
Q

What are C/Is of DRE?

A

*thronbosed hemorrhoids
*Imperforate anus
*abdomino-perineal reaction surgery
*acute prostatitis
*recent cardiac event (MI)

60
Q

What is the proper position of the px during DRE?

A

Lateral decubitus position or standin gposition

61
Q

What are the outer diameters of 18, 24, & 30Fr urethral catheter?

A

18Fr = 6mm
24 Fr = 8mm
30 Fr = 10mm

62
Q

What are indications of NGT?

A

*enteral feeding
*decompression of stomach and its contents in case of bowel obstruction
*obtain specimen of gastric contents
*drainage and lavage in drug overdose or poisoning

63
Q

What aer C/Is of NGT insertion?

A

Severe facial trauma (cribriform plate disruption

64
Q

What is used to remove fluid from the surgical site?

A

Bulb drains

65
Q

What aer the natural and synthetic absorbable sutures?

A

Natural
*Plain gut
*chromic gut

Synthetic
*Vicryl rapide
*Vicryl plus
PSD II
*Monocryl

66
Q

How long is wound support and mass absorption in plain gut and chromic gut?

A

Wound support
*Plain gut: 7-10 days
*chromic gut: 17-21 days

Mass absorption
*plain gut: 60-90 days
*chromic gut: 90-110 days

67
Q

A patient who complains of “loose” shoulder. One of the tests will not be helpful in confirming this.
a. Anterior - posterior stress test
b. Sulcus test
c. Apprehension test
d. Jobe’s test

A

Answer: D = a composite
test for the shoulder testing for supraspinatus
rotator cuff tear

A, B & C = special test
for instability of the shoulder

68
Q

A patient has weakness of wrist flexion. Where is the lesion?
a. T1
b. C7
c. C6
d. C8

A

Answer: C6
Upper Extremities
■ C4: Deltoid / Shoulder
■ C5: Biceps / Flexion of elbow
■ C6: Wrist extensors
■ C7: Triceps / Elbow extension
■ C8: Wrist flexors
■ T1: Finger abduction
○ Lower Extremities
■ L2: Hip flexion
■ L3: Knee extension
■ L4: Ankle dorsiflexion
■ L5: Great toe extension
■ S1: Ankle plantar flexion

69
Q

As a general physician you are expected after taking the Hx and PE, when confronted with diabetic foot ulcers of the following except one?
a. Amputation of a single toe as an emergency procedure
of those with sepsis
b. Reliance on a single test such as Doppler pressure
c. Hospital based referral for ulceration and tissue
necrosis
d. The assessment of the vascular status of the foot

A

Answer: B

in the management of diabetic foot
ulcers it is important not to rely on a single
finding such as the doppler pressure as this may
be misleading

70
Q

In diabetic patients, deformity of the foot results generally from which of the following?
a. Impairment of motor function
b. Clawing of toes
c. Impairment of sensory function
d. Muscle imbalance

A

Answer: C
- Deformity of the foot is not addressed early
on because of lack of sensory function

71
Q

For a patient who has sustained an overuse injury to the abductor pollicis longus and extensor pollicis brevis tendon, what finding can give you a confirmation of this:
a. Finkelstein test is present
b. pain on range of motion of wrist
c. Tenderness at the anatomical snuffbox
d. Madelung’s deformity

A

Answer: A

  • Injury to the abductor pollicis longus and
    extensor pollicis brevis tendon (tendons on the
    thumb side of the wrist) indicate de Quervain
    tenosynovitis, confirmed by a positive (+)
    Finkelstein test
72
Q

The following items can be used for emergency immobilization except:
a. Popsicle stick and scotch tape
b. Nylon rope and cloth
c. Elastic bandage and wooden board
d. Newspaper rolls and duct tape

A

Answer: B
If one will use nylon rope and cloth, material
for holding the immobilization in place (i.e. tape)
will be lacking

73
Q

Among the choices below, the first layer that is nearest the skin during a CASTING procedure is the:
a. Plaster of Paris
b. Cast padding
c. Waddling sheet
d. Fiberglass roll
e. Stockinette

A

Answer: E = - Closest to the skin to prevent skin irritation; optional

A, C - Options for casting material; outermost for
setting
B, D- Cushion bony prominences; placed after
stockinette

74
Q

The best technique for wrapping joints with a bandage is:
a. Figure of 8 roll
b. Circular roll
c. Semi-circular roll
d. Spiral roll

A

Answer:A = used over joints or
bandaging around a joint which is a junction of 2
axes (e.g. the shoulder is the junction between
the appendicular axis and the axial axis)

B = circular roll is indicated as a usual
technique in injured limbs, used over a tubular
area like the arm or leg
D - Spiral (or reverse spiral) bandage is a
technique used for application of compression
bandaging

75
Q

A patient who has an injury of the proximal interphalangeal joint on her ring finger from a basketball game will benefit with:
a. Short arm splint
b. Long arm splint
c. Ulnar gutter splint
d. Buddy Taping

A

Answer: D = immobilizing the
fingers; this type is less rigid and will permit
some motion in flexion and extension. It will need the adjacent LONGER DIGIT as its buddy

A - Short-arm splint: Spans from the knuckles and distal palmar crease distally up to 4 cms. from the cubital fossa proximally
**B **- Long-arm splint: Spans from the **knuckles and distal palmar **crease distally up to 4 cms. below the axilla proximally
**C **- Ulnar gutter splint: flexible splint that is used to
support, stabilize, and immobilize injuries,
dislocations and fractures of the hands, fingers, or
wrists (not mentioned in lecture)

SURG LE3 (4 decks)

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