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Uworld: Surgery > Saturday: 9/10/16 Surgery Exam 4 > Flashcards

Saturday: 9/10/16 Surgery Exam 4 Flashcards

1
Q

What are some causes for immediate (0-2 hrs) postoperative fever?

A
  1. Prior trauma/infection
  2. Blood products
  3. Malignant hyperthermia
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2
Q

What are some causes of acute (within 1 week) Postoperative fever?

A
  1. Nosocomial infections (pneumonia, UTI)
  2. MI, PE, DVT
  3. Surgical site infection due to Group A strep or Clostridum perfringens
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3
Q

What are some causes of subacute (more than 1 week) postoperative fever?

A
  1. Surgical site infection due to organisms other than GAS or C. perfringens
  2. Clostridium difficle
  3. Drug fever
  4. PE/DVT
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4
Q

What are some causes of delayed postoperative fever?

A
  1. Viral infection from blood products

2. Infective endocarditis

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5
Q

What is febrile nonhemoltyic transfusion reaction?

A
  1. Fever and chills
  2. within 1 -6 hours of transfusion
  3. Caused by cytokine accumulation during blood storage
    * Most common reaction
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6
Q

How does malignant hyperthermia present?

A
  1. high fever over 104
  2. muscle rigidity
  3. rhabdomyolysis
  4. metabolic acidosis
  5. hemodynamic instability
  6. caused by inhaled anesthetics
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7
Q

How would left ventricular dysfunction caused by myocardial contusion present?

A

The PCWP is slightly elevated at baseline and increases significantly after infusion of saline without an appreciable change in systemic blood pressure.
That’s suggestive of elevated intracardiac filling pressures.

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8
Q

What would the PCWP be before and after saline infusion in a patient who is hypovolemic?

A

PCWP would be decreased at baseline that improves toward normal with saline infusion.

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9
Q

How do scaphoid fractures occur?

A

Result from falls onto an outstretched hand that cause axial compression or wrist hyperextension

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10
Q

How are scaphoid fractures characterized?

A
  1. tenderness in the anatomic snuff box
  2. shallow depression at the dorsoradial wrist bounded medially by the tendon of the extensor pollicis longs and laterally by the tendons of the abductor pollicis longs and extensor policies brevis.
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11
Q

What is the arterial supply that enters the schaphoid through foramina in the bone’s distal pole before proceeding to the proximal pole?

A

Radial artery

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12
Q

What are you at risk for with a scaphoid fracture?

A
  1. avascular necrosis

2. nonunion

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13
Q

What types of scaphoid fractures may not be seen on X-ray for 7-10 days?

A

compressed or non displaced fractures

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14
Q

What type of test is used for diagnosis of scaphoid fracture?

A

CT or MRI of the wrist can confirm fracture if immediate diagnosis is needed

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15
Q

When would you immobilize the wrist in a cast for 4-6 weeks?

A

Nondisplaced distal fractures. the fracture should be confirmed first as prolonged casting is contraindicated in uncomplicated soft-tissue injury

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16
Q

What is one of the known complications of AAA repair?

A

Bowel ischemia

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17
Q

Why does bowel ischemia happen in a AAA repair?

A

From inadequate colonic collateral arterial perfusion to the left and sigmoid colon after loss of the IMA during aortic graft placement

18
Q

How do patients present with bowel ischemia after AAA repair?

A

Abdominal pain

Bloody diarrhea

19
Q

How do you prevent bowel ischemia from happening after AAA repair?

A

Checking sigmoid colon perfusion following placement of the aortic graft

20
Q

What types of patients are likely to get acute bacterial parotitis?

A

Dehydrated post op patients and the elderly

21
Q

How does acute bacterial parotitis present?

A
  1. painful swelling involving the parotid gland that is aggravated by chewing.
  2. Tender, swollen and erythematous gland
  3. purulent saliva expressed from the parotid duct
22
Q

What is the most common infectious agent in an acute bacterial parotitis?

A

Staph aureus

23
Q

How can you prevent acute bacterial parotitis?

A

Adequate fluid hydration

Oral hygiene

24
Q

Describe a recurrent parotid neoplasm.

A

Firm, non-tender swelling of right cheek. Examination reveals fullness of the pre auricular space on the right side. Must excise the deep lobe of the parotid

25
Q

What nerve courses through the two lobes of the parotid gland?

A

The facial nerve

26
Q

What do the extra cranial facial nerves carry?

A

Motor innervation to the muscles of facial expression

27
Q

What would happen if you destroyed the extra cranial facial nerve?

A

Unilateral facial droop

28
Q

What is tic douloureux?

A

Trigeminal neuralgia, short bursts of excruciating, lancinating pain lasting from seconds to minutes in the distribution of the second and their branches of the trigraminal nerve.

29
Q

What type of surgery can cause injury to the hypoglossal nerve.

A

Surgery below the mandible, such as for a tumor of the submandibular salivary gland

30
Q

What would cause jaw asymmetry?

A

can result from unilateral paralysis of the muscles of mastication, which are innervated by the mandibular division of the trigeminal nerve V3.

31
Q

Where does V3 exit out of the cranium?

A

foramen ovale

32
Q

Explain pilonidal disease?

A

Acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues.
prevalent in young males, with large amounts of body hair.

33
Q

What is treatment for pilonidal disease?

A

Drainage of abscesses and excision of sinus tracts

34
Q

What is a perianal abcess?

A

Anal pain and a tender, erythematous bulge at the anal verge.

35
Q

What is a perianal fistula due to?

A

Chronic anal crypt infection or crohn’ss disease. Located within 3 cm of the anal margin

36
Q

Where is the coccyx located in adults?

A

At least 5 cm above the anus

37
Q

What is suppurative hidradenitis?

A

Multiple painful nodules and pustules of the axillae and groin

38
Q

Bowen’s disease is what?

A

A squamous cell carcinoma in situ of the skin. presents a thin erythematous plaque with well-defined irregular boarders and an overlying scale or crust

39
Q

What is the main goal of rib fracture management?

A

Adequate ventilation

40
Q

What are rib fractures associated with?

A
  1. Significant pain which causes hypoventilation and may lead to atelectasisi and pneumonia
    PAIN CONTROL IS ESSENTIAL
41
Q

What is the preferred method of management in extensive rib fractures?

A

Epidural infusion

42
Q

When is positive pressure indicated?

A

Case of flail chest, it corrects the paradoxical respiratory motion of the isolated segment of chest wall and improves oxygenation of fluid filled alveoli

Uworld: Surgery (4 decks)

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