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Oral board studying Prep book > Robotic surgery, PPX antibiotics, Ileus > Flashcards

Robotic surgery, PPX antibiotics, Ileus Flashcards

1
Q

What are the disadvantages of robotic surgery?

A
  1. Longer operating time
  2. More surgical incisions
  3. Extensive learning curve
  4. Increased medical costs of surgical procedures
  5. Possible increased risk of vaginal cuff dehiscence
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2
Q

What are the advantages of robotic surgery?

A
  1. 3D vision
  2. More accuracy in tissue manipulation
  3. Safer application of thermal energy devices
  4. Improved fine motor control in dissection/suturing
  5. Potential decrease in operative blood loss
  6. Allows a potential minimally invasive approach in more complex cases when an experienced surgical assistant is not available
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3
Q

What are risk factors for surgical site infections?

A
  1. Smoking
  2. Obesity
  3. Diabetes
  4. Depth of subQ >3cm
  5. Immunosuppression
  6. Coexistent infection at remote body site
  7. Vaginal colonization with organisms
  8. MRSA status
  9. Nutritional status
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4
Q

What preoperative measures should be taken to prevent surgical site infections?

A
  1. Treat all infections remote from surgical site prior to procedure
  2. Do not shave incision site before procedure. it should be shaved immediately before procedure with electric clippers
  3. Control serum glucose levels and avoid perioperative hyperglycemia (<200)
  4. Advise patient to shower/bathe full body with soap or antiseptic night before skin incision
  5. perform preoperative surgical site skin preparation with alcohol based agent
  6. Use appropriate antimicrobial ppx within 1 hr before procedure start
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5
Q

What ppx antibiotic is used for hysterectomies?

A

2g of ancef

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6
Q

What ppx antibiotic is used for anterior and posterior repair?

A

2g of ancef

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7
Q

What ppx antibiotics is used for vaginal slings procedures?

A

2g of ancef

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8
Q

What ppx antibiotics is used for laparotomy without entry into vagina or bowel?

A

May consider 2g of ancef

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9
Q

What ppx antibiotics is used for laparoscopy with no entry into bowel or vagina?

A

None

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10
Q

What ppx antibiotics is used for LEEP/cone?

A

None

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11
Q

What ppx antibiotic is used for HSG or chromotubation?

A

None unless abnormal tubes or history of PID.
Doxycycline 100mg BID for 5 days

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12
Q

What ppx antibiotic is used for hysteroscopy?

A

None

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13
Q

What ppx antibiotic is used for cystoscopy?

A

None if UA negative

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14
Q

What ppx antibiotic is used for a D&C in non pregnant state?

A

None

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15
Q

What ppx antibiotic is used for induced abortion or pregnancy related D&C?

A

Doxycline 200mg x 1 pre procedure

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16
Q

When do you go to 3g of ancef for surgical ppx?

A

Weight >120kg

17
Q

When do you redose antibiotics in clean contaminated surgical procedure?

A

EBL>1500cc
Surgical time >4hrs from 1st dose of antibiotics

18
Q

What is the antibiotic of choice if there is a severe PCN allergy?

A
  1. Clindamycin 900mg q6hr
  2. Gentamicin and flagyl
  3. Aztreonam 2g q4hr
19
Q

What are the symptoms of an ileus?

A

Abdominal distention, no bowel sounds

20
Q

What are the symptoms of a small bowel obstruction?

A

Cramping pain with high pitched bowel sounds

21
Q

What is the timing for ileus to show up?

A

2-3 days post surgery

22
Q

What is the timing for small bowel to show up?

A

5-7 days post surgery

23
Q

What would you see on x-ray for ileus?

A

Air in rectum
Peripheral gas in colon

24
Q

What would you see on X-ray for small bowel obstruction?

A

Central gas in small bowel with air fluid levels
No air in rectum

25
Q

What is an ileus?

A

When there is a lack of the normal muscle contractions that leads to a build up or blockage

26
Q

What is a small bowel obstruction?

A

A partial or complete blockage of the small bowel

27
Q

Where would you make the incisions for an imperforate hymen?

A

2,6,10 o’clock

28
Q

What is an imperforate hymen?

A

Thin membrane extending across the hymen blocking the opening of the vagina

29
Q

What is the point of maximal tenderness in patients with appendicitis?

A

McBurneys point

30
Q

Where is McBurney’s point?

A

Line drawn from navel to anterior superior iliac spine and 2/3 down that line

31
Q

What are the benefits of appendectomy?

A
  1. Potential to prevent a future emergency appendectomy
  2. Exclude potential diagnosis of appendicitis
  3. With chemotherapy or radiation
32
Q

When is appendectomy not recommended?

A

> 50 years old

33
Q

How do you perform an appendectomy?

A
  1. Dissect mesa-appendix and ligate appendix vessels
  2. Clamp and cut base of appendix
  3. Place purse string suture around base
  4. Invert stump prior to closing purse string suture

Oral board studying Prep book (50 decks)

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