Saturday: 9/10/16 Surgery Exam 4 Flashcards
What are some causes for immediate (0-2 hrs) postoperative fever?
- Prior trauma/infection
- Blood products
- Malignant hyperthermia
What are some causes of acute (within 1 week) Postoperative fever?
- Nosocomial infections (pneumonia, UTI)
- MI, PE, DVT
- Surgical site infection due to Group A strep or Clostridum perfringens
What are some causes of subacute (more than 1 week) postoperative fever?
- Surgical site infection due to organisms other than GAS or C. perfringens
- Clostridium difficle
- Drug fever
- PE/DVT
What are some causes of delayed postoperative fever?
- Viral infection from blood products
2. Infective endocarditis
What is febrile nonhemoltyic transfusion reaction?
- Fever and chills
- within 1 -6 hours of transfusion
- Caused by cytokine accumulation during blood storage
* Most common reaction
How does malignant hyperthermia present?
- high fever over 104
- muscle rigidity
- rhabdomyolysis
- metabolic acidosis
- hemodynamic instability
- caused by inhaled anesthetics
How would left ventricular dysfunction caused by myocardial contusion present?
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.
What would the PCWP be before and after saline infusion in a patient who is hypovolemic?
PCWP would be decreased at baseline that improves toward normal with saline infusion.
How do scaphoid fractures occur?
Result from falls onto an outstretched hand that cause axial compression or wrist hyperextension
How are scaphoid fractures characterized?
- tenderness in the anatomic snuff box
- 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.
What is the arterial supply that enters the schaphoid through foramina in the bone’s distal pole before proceeding to the proximal pole?
Radial artery
What are you at risk for with a scaphoid fracture?
- avascular necrosis
2. nonunion
What types of scaphoid fractures may not be seen on X-ray for 7-10 days?
compressed or non displaced fractures
What type of test is used for diagnosis of scaphoid fracture?
CT or MRI of the wrist can confirm fracture if immediate diagnosis is needed
When would you immobilize the wrist in a cast for 4-6 weeks?
Nondisplaced distal fractures. the fracture should be confirmed first as prolonged casting is contraindicated in uncomplicated soft-tissue injury
What is one of the known complications of AAA repair?
Bowel ischemia
Why does bowel ischemia happen in a AAA repair?
From inadequate colonic collateral arterial perfusion to the left and sigmoid colon after loss of the IMA during aortic graft placement
How do patients present with bowel ischemia after AAA repair?
Abdominal pain
Bloody diarrhea
How do you prevent bowel ischemia from happening after AAA repair?
Checking sigmoid colon perfusion following placement of the aortic graft
What types of patients are likely to get acute bacterial parotitis?
Dehydrated post op patients and the elderly
How does acute bacterial parotitis present?
- painful swelling involving the parotid gland that is aggravated by chewing.
- Tender, swollen and erythematous gland
- purulent saliva expressed from the parotid duct
What is the most common infectious agent in an acute bacterial parotitis?
Staph aureus
How can you prevent acute bacterial parotitis?
Adequate fluid hydration
Oral hygiene
Describe a recurrent parotid neoplasm.
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
What nerve courses through the two lobes of the parotid gland?
The facial nerve
What do the extra cranial facial nerves carry?
Motor innervation to the muscles of facial expression
What would happen if you destroyed the extra cranial facial nerve?
Unilateral facial droop
What is tic douloureux?
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.
What type of surgery can cause injury to the hypoglossal nerve.
Surgery below the mandible, such as for a tumor of the submandibular salivary gland
What would cause jaw asymmetry?
can result from unilateral paralysis of the muscles of mastication, which are innervated by the mandibular division of the trigeminal nerve V3.
Where does V3 exit out of the cranium?
foramen ovale
Explain pilonidal disease?
Acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues.
prevalent in young males, with large amounts of body hair.
What is treatment for pilonidal disease?
Drainage of abscesses and excision of sinus tracts
What is a perianal abcess?
Anal pain and a tender, erythematous bulge at the anal verge.
What is a perianal fistula due to?
Chronic anal crypt infection or crohn’ss disease. Located within 3 cm of the anal margin
Where is the coccyx located in adults?
At least 5 cm above the anus
What is suppurative hidradenitis?
Multiple painful nodules and pustules of the axillae and groin
Bowen’s disease is what?
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
What is the main goal of rib fracture management?
Adequate ventilation
What are rib fractures associated with?
- Significant pain which causes hypoventilation and may lead to atelectasisi and pneumonia
PAIN CONTROL IS ESSENTIAL
What is the preferred method of management in extensive rib fractures?
Epidural infusion
When is positive pressure indicated?
Case of flail chest, it corrects the paradoxical respiratory motion of the isolated segment of chest wall and improves oxygenation of fluid filled alveoli
