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Section I, Surgical Recall Sixth Edition > Section I Overview&Background Surgical Infor; Chapter I Introduction, > Flashcards

Section I Overview&Background Surgical Infor; Chapter I Introduction, Flashcards

1
Q

Your study objectives in surgery should include the following four points:
P1

A
  1. O.R. question-and-answer periods
  2. Ward questioning
  3. Oral exam
  4. Written exam
    The optimal plan of action would include daily reading in a text, anatomy review prior to each O.R. case, and Surgical Recall. But remember, this guide helps you recall basic facts about surgical topics. Reading should be done daily! The advanced student should read Advanced Surgical Recall.
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2
Q

To facilitate learning a surgical topic, first break down each topic into the following categories and, in turn, master each category:
P1-2

A
  1. What is it?
  2. Incidence
  3. Risk factors
  4. Signs and symptoms
  5. Laboratory and radiologic tests
  6. Diagnostic criteria
  7. Differential diagnoses
  8. Medical and surgical treatment
  9. Postoperative care
  10. Complications
  11. Stages and prognosis
    - Granted, it is hard to read after a full day in the O.R. For a change, go to sleep right away and wake up a few hours early the next day and read before going to the hospital. It sounds crazy, but it does work.
    - Remember—REPETITION is the key to learning for most adults.
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3
Q

WHAT THE PERFECT SURGICAL STUDENT CARRIES IN HER LAB COAT

P2

A
  • Stethoscope
  • Penlight
  • Scissors
  • Minibook on medications (e.g., trade names, doses)
  • Tape/4 x 4s
  • Sutures to practice tying
  • Pen/notepad/small notebook to write down pearls
  • Notebook or clipboard with patient’s data (always write down chores with a box next to them so you can check off the box when the chore is completed)
  • Small calculator
  • List of commonly used telephone numbers (e.g., radiology)
  • (Oh, and of course, Surgical Recall!)
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4
Q

THE PERFECT PREPARATION FOR ROUNDS

P2-3

A
  • Interview your patient (e.g., problems, pain, wishes)
  • Talk with your patient’s nurse (e.g., “Were there any events during the last shift?”)
  • Examine patient (e.g., cor/pulm/abd/wound)
  • Record vital signs (e.g., Tmax)
  • Record input (e.g., IVF, PO)
  • Record output (e.g., urine, drains)
  • Check labs
  • Check microbiology (e.g., culture reports, Gram stains)
  • Check x-rays
  • Check pathology reports.
  • Know the patient’s allergies
  • Check allied health updates (e.g., PT, OT)
  • Read chart
  • Check medication (don’t forget H2 blocker in hyperalimentation)
  • Check nutrition
  • Always check with the intern for chores, updates, or insider information before rounds
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5
Q

PRESENTING ON ROUNDS
Your presentation on rounds should be like an iceberg. State important points about your patient (the tip of the iceberg visible above the ocean), but know everything else about your patient that your chief might ask about (that part
of the iceberg under the ocean). Always include:
P3

A
  • Name
  • Postoperative day s/p-procedure
  • Concise overall assessment of how the patient is doing
  • Vital signs/temp status/antibiotics day
  • Input/output-urine, drains, PO intake, IVF
  • Change in physical examination
  • Any complaints (not yours—the patient’s)
  • Plan
    Your presentation should be concise, with good eye contact (you should not simply read from a clipboard). The intangible element of confidence cannot be overemphasized; if you do not know the answer to a question about a patient, however, the correct response should be “I do not know, but I will find out.” Never lie or hedge on an answer because it will only serve to make the
    remainder of your surgical rotation less than desirable. Furthermore, do your best to be enthusiastic and motivated. Never, ever whine. And remember to be a team player. Never make your fellow students look bad! Residents pick
    up on this immediately and will slam you.
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6
Q

THE PERFECT SURGERY STUDENT

P3-5

A
  • Never whines
  • Never pimps his residents or fellow students(or attendings)
  • Never complains
  • Is never hungry, thirsty, or tired
  • Is always enthusiastic
  • Loves to do scut work and can never get enough
  • Never makes a fellow student look bad
  • Is always clean (a patient sees only you and the wound dressing)
  • Is never late
  • Smiles a lot and has a good sense of humor
  • Makes things happen
  • Is not a “know-it-all”
  • Never corrects anyone during rounds unless it will affect patient care
  • Makes the intern/resident/chief look good at all times, if at all possible
  • Knows more about her patients than anyone else
  • Loves the O.R.
  • Never wants to leave the hospital
  • Takes correction, direction, and instruction very well
  • Says “Sir” and “Ma’am” to the scrub nurses (and to the attending, unless corrected)
  • Never asks questions he can look up for himself
  • Knows the patient’s disease, surgery, indication for surgery, and the anatomy before going to the O.R.
  • Is the first one to arrive at clinic and the last one to leave
  • Always places x-rays up in the O.R.
  • Reads from a surgery text every day
  • Is a team player
  • Asks for feedback
  • Never has a chip on her shoulder
  • Loves to suture
  • Is honest and always admits fault and errors
  • Knows when his patient is going to the O.R. (e.g., by calling)
  • Is confident but not cocky
  • Has a “Can-Do” attitude and can figure out things on her own
  • Is not afraid to get help when needed
  • Never says “No” or “Maybe” to involvement in patient care
  • Treats everyone (e.g., nurses, fellow students) with respect
  • Always respects patients’ modesty (e.g., covers groin with a sheet as soon as possible in the trauma bay)
  • Follows the chain of command
  • Praises others when appropriate
  • Checks with the intern beforehand for information for rounds (test results/ surprises)
  • RUNS for materials, lab values, test results, etc., during rounds before any house officer
  • Gives credit where credit is due
  • Dresses and undresses wounds on rounds
  • Has a steel bladder, a cast-iron stomach, and a heart of gold
  • Always writes the OP note without question
  • Always checks with the intern after rounds for chores
  • Always makes sure there is a medical student in every case
  • Always follows the patient to the recovery room
  • In the O.R., always asks permission to ask a question
  • Always reviews anatomy prior to going to the O.R.
  • Does what the intern asks (i.e., the chief will get feedback from the intern)
  • Is a high-speed, low-drag, hardcore HAMMERHEAD
  • Define HAMMERHEAD. A hammerhead is an individual who places his head to the ground and hammers
    through any and all obstacles to get a job done and then asks for more work. One who gives 110% and never complains. One who desires work.
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7
Q

OPERATING ROOM

P5-6

A

Your job in the O.R. will be to retract (water-skiing) and answer questions posed by the attending physicians and residents. Retracting is basically idiot-proof.
Many students emphasize anticipating the surgeon’s next move, but stick to following the surgeon’s request. More than 75% of the questions asked in the O.R. deal with anatomy; therefore, read about the anatomy and pathophysiology of the case, which will reduce the “I don’t knows.”
- Never argue with the scrub nurses—they are always right. They are the selfless warriors of the operating suite’s sterile field, and arguing with one will only make matters worse.
- Never touch or take instruments from the Mayo tray (tray with instruments on it over the patient’s feet) unless given explicit permission to do so. Each day as you approach the O.R. suite door, STOP and ask yourself if you have on scrubs, shoe covers, a cap, and a mask to avoid the embarrassing situation of being yelled at by the O.R. staff (a.k.a. the 3 strikes test: strike 1 no mask, strike 2 no headcover, strike 3 no shoe covers . . . any strikes and you are outta here—place a mental stop sign outside of the O.R. with the 3 strikes rule on it)! Always wear eye protection. When entering the O.R., first introduce yourself to the scrub nurse and ask if you can get your gloves or gown. If you
have questions in the O.R., first ask if you can ask a question because it may be a bad time and this way it will not appear as though you are pimping the resident/attending.
- Other thoughts on the O.R.: If you feel faint, ask if you can sit down (try to eat prior to going to the O.R.). If your feet swell in the O.R., try wearing support hose socks. If your
back hurts, try taking some ibuprofen (with a meal) prior to the case. Also, situps or abdominal crunches help to relieve back pain by strengthening the abdominal muscles. At the end of the case, ask the scrub nurse for some leftover ties (clean ones) to practice tying knots with and, if there is time, start
writing your OP note.

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8
Q

OPERATING ROOM FAQS (ORF) P6

1. What if I have to sneeze?

A

Back up STRAIGHT back; do not turn your head, as the sneeze exits through the sides of your mask!

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9
Q
  1. What if I feel faint?

ORF P6

A

Do not be a hero—say, “I feel faint. May I sit down?” This is no big deal and is very common (Note: It helps to always
eat before going to the O.R.)

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10
Q
  1. What should I say when I first enter the O.R.?

ORF P6

A

Introduce yourself as a student; state that you have been invited to scrub and ask if you need to get out your gloves and/or gown

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11
Q
  1. Should I wear my ID tag into the O.R.?

ORF P6

A

Yes

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12
Q
  1. Can I wear nail polish?

ORF P6

A

Yes, as long as it is not chipped

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13
Q
  1. Can I wear my rings and my watch when scrubbed in the
    O.R.?
    ORF P6
A

No

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14
Q
  1. Can I wear earrings?

ORF P6

A

No

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15
Q
  1. When scrubbed, is my back sterile?

ORF P6

A

No

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16
Q
  1. When in the surgical gown, are my underarms sterile?

ORF P6

A

No; do not put your hands under your arms

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17
Q
  1. How far down my gown is considered part of the
    sterile field?
    ORF P6
A

Just to your waist

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18
Q
  1. How far up my gown is considered sterile?
A

Up to the nipples

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19
Q
  1. How do I stand if I am waiting for the case to start?

ORF P7

A

Hands together in front above your waist

there is a picture

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20
Q
  1. Can I button up a surgical gown (when I am not
    scrubbed!) with bare hands?
    ORF P7
A

Yes (Remember: the back of the gown is NOT sterile)

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21
Q
  1. How many pairs of gloves should I wear when scrubbed?

ORF P7

A

2 (2 layers)

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22
Q
  1. What is the normal order of sizes of gloves: small pair,
    then larger pair?
    ORF P7
A

No; usually the order is a larger size followed by a smaller size (e.g., men commonly wear a size #8 covered by a
size #7.5; women commonly wear a size #7 covered by a size #6.5)

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23
Q
  1. What is a “scrub nurse” versus a “circulating nurse”?

ORF P7

A
  • The scrub nurse is “scrubbed” and hands the surgeon sutures, instruments, and so forth; this person is often an
    Operating Room Technician (a.k.a. “Scrub Tech”)
  • The circulating nurse “circulates” and gets everything needed before and during the procedure
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24
Q
  1. What items comprise the sterile field in the operating
    room?
    ORF P7
A

The instrument table, the Mayo tray, and the anterior drapes on the patient

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25
Q
  1. What is the tray with the instruments called?

ORF P8

A

Mayo tray

there is a picture

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26
Q
  1. Can I grab things off the Mayo tray?

ORF P8

A

No; ask the scrub nurse/tech for permission

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27
Q
  1. How do you remove blood with a laparotomy pad
    (“lap pad”)?
    ORF P8
A

Dab; do not wipe, because wiping removes platelet plugs

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28
Q
  1. Can you grab the skin with DeBakey pickups?

ORF P8

A

NO; pickups for the skin must have teeth (e.g., Adson, rat-tooth) because it is “better to cut the skin than crush it”

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29
Q
  1. How should you cut the sutures after tying a knot?

ORF P8

A
  1. Rest the cutting hand on the noncutting hand
  2. Slip the scissors down to the knot and then cant the scissors at a 45-degree angle so you do not cut the knot itself
    (there is a picture)
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30
Q
  1. What should you do when you are scrubbed and
    someone is tying a suture?
    ORF P9
A

Ask the scrub nurse for a pair of suture scissors, so you are ready if you are asked to cut the sutures

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31
Q
  1. Why always wipe the Betadine® (povidone-iodine)
    off your patient at the end of the procedure?
    ORF P9
A

Betadine® can become very irritating and itchy

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32
Q

SURGICAL NOTES (SN) P9

A

The history and physical examination report, better known as the H & P

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33
Q

What are the two words most commonly misspelled
in a surgical history note?
SN P9

A
  1. Guaiac

2. Abscess

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34
Q

Favorite Trick Questions in SN (FTQ in SN) P9
1. What is the most common intra-operative bladder
“tumor”?

A

Foley catheter

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35
Q
  1. Describe a stool with melena

(FTQ in SN) P9

A

Melenic—not melanotic

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36
Q

3, Is amylase part of Ranson’s criteria?

(FTQ in SN) P9

A

Amylase is NOT part of Ranson’s criteria!

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37
Q
  1. Can a patient in shock have “STABLE” vital signs?

(FTQ in SN) P9

A

Yes—stable vital signs are any vital signs that are not changing! Always say “normal” vital signs, not “stable!”

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38
Q
  1. What is the most commonly pimped, yet the rarest,
    cause of pancreatitis?
    (FTQ in SN) P9
A

Pancreatitis from a scorpion bite

scorpion found on island of Trinidad

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39
Q
  1. Where can you go to obtain an abdominal CT scan on a
    600-pound, morbidly obese patient?
    (FTQ in SN) P9
A

The ZOO (used in the past, but now rare due to liability)

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40
Q

Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):

  1. Mr. Smith is a 22-year-old African American man who was in his normal state of excellent health until he noted the onset of periumbilical pain 1 day prior to admission. This pain was followed 4 hours later by pain in his right lower quadrant that any movement exacerbated. vomiting, anorexia. fever, urinary tract symptoms, change in bowel habits, constipation, BRBPR, hematemesis, or diarrhea.
    (FTQ in SN) P10
A
  • Medications: ibuprofen prn headaches
  • Allergies: NKDA
  • PMH: none
  • PSH: none
  • SH: EtOH, tobacco
  • FH: –CA
  • ROS: –resp disease, –cardiac disease, –renal disease
  • Physical Exam:
    a) V/S 120/80 85 12 T 37 C
    b) HEENT ncat, tms clear
    c) cor nsr, m, r, g
    d) pulm clear b/l
    e) abd nondistended, +bs, +tender RLQ, +rebound RLQ
    f) rectal guaiac –nl tone, –mass
    g) ext nt, –c, c, e
    h) neuro wnl
  • LABS: urinalysis (ua) normal, chem 7, PT/PTT, CBC pending
  • X-RAYS: none
  • ASSESSMENT: 22 y.o. m with Hx and physical findings of
    right lower quadrant peritoneal signs consistent with (c/w) appendicitis
  • Plan:
    a) NPO
    b) Consent
    c) IVF with Lactated Ringer’s
    d) IV cefoxitin
    e) To O.R. for appendectomy
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41
Q

Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):

  1. Wilson Tyler cc III/
NKDA = no known drug allergies; 
PMH = past medical history; 
PSH = past surgical history; 
SH = social history; 
FH = family history; 
ROS = review of systems; 
V/S = vital signs; 
ncat = normocephalic atraumatic; 
tms = tympanic membranes;
cor = heart; 
m, r, g = murmur, rub, gallop; 
NSR = normal sinus rhythm; 
b/l = bilateral; 
bs = bowel sounds; 
ext = extremity; 
nt = nontender; 
c, c, e = cyanosis, clubbing, or erythema; 
wnl = within normal limits; 
cc III = clinical clerk, third year
(FTQ in SN) P10-11
A 
PREOP NOTE:
The preop note is written in the progress notes the day before the operation
Example:
- Preop Dx: colon CA
- Labs: CBC, chem 7, PT/PTT
- CXR: --infiltrate
- Blood: T & C  2 units
- EKG: NSR, wnl
- Anesthesia: preop completed
- Consent: signed and on front of chart
- Orders: 
1. Void OCTOR
2. 1 gm cefoxitin OCTOR
3. Hibiclens scrub this p.m.
4. Bowel prep today
5. NPO p- MN
NPO = nothing by mouth; 
OCTOR = on call to O.R.; 
p- = after;
MN = midnight
OP NOTE:
The OP note is written in the progress note section of the chart in the O.R. before the patient is in the PACU (or recovery room).
Example:
- Preop Dx: acute appendicitis
- Postop Dx: same
- Procedure: appendectomy
- Surgeon: Halsted
- Assistants: Cushing, Tribble
- OP findings: no perforation
- Anesthesia: GET
- *I/O: 1000 mL LR/uo 600 mL
- *EBL: 50 mL
- Specimen: appendix to pathology
- Drains: none
- Complications: none (Note: If there are complications, ask what you should write.)
To PACU in stable condition
GET = general endotracheal; 
I/O = ins and outs; uo  urine output; 
EBL = estimated blood loss; 
PACU = postanesthesia care unit

*Ask the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for this information.

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42
Q
  1. How do I remember what is in the OP note when I am in
    the O.R.?
    (FTQ in SN) P12
A

Remember the acronym “PPP SAFE DISC”:

  • Preop Dx
  • Postop Dx
  • Procedure
  • Surgeon (and assistants)
  • Anesthesia
  • Fluids
  • Estimated blood loss (EBL)
  • Drains
  • IV Fluids
  • Specimen
  • Complications
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43
Q
  1. POSTOP NOTE
    The postop note is written on the day of the operation in the progress notes
    Example:
    (FTQ in SN) P12
A
  • Procedure: appendectomy
  • Neuro: A&O 3
  • V/S: wnl/afebrile
  • I/O: 1 L LR/uo 600 mL
  • Labs: postop Hct: 36
  • PE:
    a) cor RRR
    b) pulm CTA
    c) abd drsg dry and intact
  • Drains: JP 30 mL serosanguinous fluid
  • Assess: stable postop
  • Plan:
    1. IV hydration
    2. 1 g cefoxitin q 8 hr
A&O x 3 = alert and oriented times 3; 
V/S = vital signs; 
uo = urine output;
Hct = hematocrit; 
RRR = regular rhythm and rate; JP  Jackson-Pratt; wnl 
within normal limits
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44
Q
  1. ADMISSION ORDERS

The admission orders are written in the physician orders section of the patient’s chart on admission, transfer, or postop
Example:
P12-13

A

Admit to 5E Dr. DeBakey

  • Dx: AAA
  • Condition: stable
  • V/S: q 4 hr or q shift; if postop, q 15 min 2 hr, then q 1 hr 4, then q 4 hr
  • Allergies: NKDA
  • Activity: bedrest or OOB to chair
  • Nursing: daily wgt; I/O; change drsg q shift
  • Call HO for:
    a) temp >38.5
    b) UO 180 100
    e) HR 110
  • Diet: NPO
  • IVF: D5 1/2 NSc - 20 KCL
  • Drugs: ANCEF
  • Labs: CBC
OOB = out of bed; 
I/O = ins and outs; 
HO = House Officer; 
SBP = systolic blood pressure; 
DBP = diastolic blood pressure; 
HR = heart rate; 
KCL = potassium chloride
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45
Q

ADMISSION ORDERS/POSTOP ORDERS

“AC/DC AVA PAIN DUD”:
P13

A

Admit to 5E
Care Provider
Diagnosis
Condition

Allergies
Vitals
Activity

Pain meds
Antibiotics
IVF/Incentive Spirometry
Nursing (Drains, etc.)

DVT prophylaxis
Ulcer prophylaxis
Diet

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46
Q

DAILY NOTE—PROGRESS NOTE

Basically a SOAP note, but it is not necessary to write out SOAP; for many reasons, make your notes very OBJECTIVE and, as a student, do not mention discharge because this leads to confusion
Example:
P13-14

A

10/1/90 Blue Surgery
POD #4 s/p appendectomy
Day #5 cefoxitin
Pt without c/o

V/S: 120/80 76 12 afebrile (Tmax 38)
I/O: 1000/600
Drains: JP #1 60 last shift
PE: cor RRR—no m, g, r
    pulm CTA
    abd + BS, +flatus, --rigidity
    ext nt, --cyanosis, --erythema
ASSESS: Stable POD #4 on IV antibiotics
PLAN:
   1. Increase PO intake
   2. Increase ambulation
   3. Follow cultures
Grayson Stuart, cc III/
Important: Always date, time, and sign your notes and leave space for them to be cosigned!
POD = Postop day (Note: The day after operation is POD #1. The day of operation is the operative day. But: Antibiotic day #1 is the day the antibiotics were started.); 
c/o = complains of; nt  nontender; cc III  clinical clerk, third year
The following is an acronym for what should be checked on your patient daily before rounding with the surgical team: “AVOID WTE”:
Appearance—any subjective complaints
Vital signs
Output—urine/drains
Intake—IV/PO
Drains—# of/output/character

Wound/dressing/weight
Temperature
Exam—cor, pulm, abd, etc.

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47
Q

INTENSIVE CARE NOTE

This note is by systems:
P14

A 
Neurologic (GCS, MAE)
Pulmonary (vent settings, etc.)
CVS (pressors, swann numbers, etc.)
Heme (CBC)
FEN (Chem 10, nutrition, etc.)
Renal (urine output, BUN, Cr, etc.)
I & D (T, WBC, antibiotics, etc.)
Assessment
Plan
CVS = current vital signs; 
FEN = fluids, electrolytes, nutrition; 
BUN = blood urea nitrogen; 
Cr = creatinine; 
I & D = incision and drainage (Note: PE, labs, radiology studies, etc. are included in each section. This is also an excellent way to write progress notes for the very complicated floor patient.)
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48
Q

CLINIC NOTE
Often the clinic note is a letter to the referring doctor. It should always include:
P15

A
  1. Patient name, history #, date
  2. Brief Hx, current complaints/symptoms
  3. PE, labs, x-rays
  4. Assessment
  5. Plan
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49
Q

How is a medication prescription written?

CLINIC NOTE
P15

A

Tylenol® 500 mg tablet
Disp (dispense): 100 tablets
sig: 1–2 PO q 4 hrs PRN pain

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50
Q

COMMON ABBREVIATIONS YOU SHOULD KNOW
(CASK) P15
(Check with your hospital for approved abbreviations!)

a(over a line)

A

Before

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51
Q

AAA

(CASK) P15

A

Abdominal aortic aneurysm; “triple A”

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52
Q

ABD

(CASK) P15

A

Army battle dressing

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53
Q

ABG

(CASK) P15

A

Arterial blood gas

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54
Q

ABI

(CASK) P15

A

Ankle to brachial index

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55
Q

AKA

(CASK) P15

A

Above the knee amputation

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56
Q

a.k.a.

(CASK) P15

A

Also known as

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57
Q

Ao

(CASK) P15

A

Aorta

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58
Q

APR

(CASK) P15

A

Abdominoperineal resection

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59
Q

ARDS

(CASK) P15

A

Acute respiratory distress syndrome

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60
Q

ASA

(CASK) P15

A

Aspirin

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61
Q

AXR

(CASK) P15

A

Abdominal x-ray

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62
Q

B1

(CASK) P15

A

Billroth 1 gastroduodenostomy

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63
Q

B2

(CASK) P15

A

Billroth 2 gastrojejunostomy

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64
Q

BCP

(CASK) P15

A

Birth control pill

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65
Q

BE

(CASK) P15

A

Barium enema

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66
Q

BIH

(CASK) P15

A

Bilateral inguinal hernia

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67
Q

BKA

(CASK) P15

A

Below the knee amputation

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68
Q

BRBPR

(CASK) P15

A

Bright red blood per rectum

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69
Q

BS

(CASK) P15

A

Bowel sounds; Breath sounds; Blood sugar

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70
Q

BSE

(CASK) P15

A

Breast self-examination

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71
Q

c (a line over)

(CASK) P15

A

With

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72
Q

CA

(CASK) P15

A

Cancer

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73
Q

CABG

(CASK) P15

A

Coronary artery bypass graft (“CABBAGE”)

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74
Q

CBC

(CASK) P15

A

Complete blood cell count

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75
Q

CBD

(CASK) P16

A

Common bile duct

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76
Q

c/o

(CASK) P16

A

Complains of

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77
Q

COPD

(CASK) P16

A

Chronic obstructive pulmonary disease

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78
Q

CP

(CASK) P16

A

Chest pain

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79
Q

CTA

(CASK) P16

A

Clear to auscultation; CT angiogram

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80
Q

CVA

(CASK) P16

A

Cerebral vascular accident

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81
Q

CVAT

(CASK) P16

A

Costovertebral angle tenderness

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82
Q

CVP

(CASK) P16

A

Central venous pressure

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83
Q

CXR

(CASK) P16

A

Chest x-ray

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84
Q

Dx

(CASK) P16

A

Diagnosis

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85
Q

DDx

(CASK) P16

A

Differential diagnosis

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86
Q

DI

(CASK) P16

A

Diabetes insipidus

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87
Q

DP

(CASK) P16

A

Dorsalis pedalis

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88
Q

DPL

(CASK) P16

A

Diagnostic peritoneal lavage

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89
Q

DPC

(CASK) P16

A

Delayed primary closure

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90
Q

DT

(CASK) P16

A

Delirium tremens

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91
Q

DVT

(CASK) P16

A

Deep venous thrombosis

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92
Q

EBL

(CASK) P16

A

Estimated blood loss

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93
Q

ECMO

(CASK) P16

A

Extracorporeal membrane oxygenation

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94
Q

EGD

(CASK) P16

A

Esophagogastroduodenoscopy (UGI scope)

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95
Q

EKG

(CASK) P16

A

Electrocardiogram (also ECG)

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96
Q

ELAP

(CASK) P16

A

Exploratory laparotomy

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97
Q

EOMI

(CASK) P16

A

Extraocular muscles intact

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98
Q

ERCP

(CASK) P16

A

Endoscopic retrograde cholangiopancreatography

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99
Q

EtOH

(CASK) P16

A

Alcohol

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100
Q

EUA

(CASK) P16

A

Exam under anesthesia

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101
Q

EX LAP

(CASK) P16

A

Exploratory laparotomy

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102
Q

FAP

(CASK) P16

A

Familial adenomatous polyposis

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103
Q

FAST

(CASK) P16

A

Focused abdominal sonogram for trauma

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104
Q

FEN

(CASK) P16

A

Fluids, electrolytes, nutrition

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105
Q

FNA

(CASK) P16

A

Fine needle aspiration

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106
Q

FOBT

(CASK) P16

A

Fecal occult blood test

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107
Q

GCS

(CASK) P16

A

Glasgow Coma Scale

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108
Q

GERD

(CASK) P16

A

Gastroesophageal reflux disease

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109
Q

GET(A)

(CASK) P16

A

General endotracheal (anesthesia)

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110
Q

GU

(CASK) P16

A

Genitourinary

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111
Q

HCT

(CASK) P16

A

Hematocrit

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112
Q

HEENT

(CASK) P16

A

Head, eyes, ears, nose, and throat

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113
Q

HO

(CASK) P16

A

House officer

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114
Q

Hx

(CASK) P16

A

History

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115
Q

IABP

(CASK) P16

A

Intra-aortic balloon pump

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116
Q

IBD

(CASK) P16

A

Inflammatory bowel disease

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117
Q

ICU

(CASK) P16

A

Intensive care unit

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118
Q

I & D

(CASK) P16

A

Incision and drainage

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119
Q

I & O

(CASK) P16

A

Ins and outs, in and out

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120
Q

IMV

(CASK) P16

A

Intermittent mandatory ventilation

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121
Q

IVC

(CASK) P17

A

Inferior vena cava

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122
Q

IVF

(CASK) P17

A

Intravenous fluids

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123
Q

IVP

(CASK) P17

A

Intravenous pyelography

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124
Q

IVPB

(CASK) P17

A

Intravenous piggyback

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125
Q

JVD

(CASK) P17

A

Jugular venous distention

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126
Q

L (a circle around L)

(CASK) P17

A

Left

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127
Q

LE

(CASK) P17

A

Lower extremity

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128
Q

LES

(CASK) P17

A

Lower esophageal sphincter

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129
Q

LIH

(CASK) P17

A

Left inguinal hernia

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130
Q

LLQ

(CASK) P17

A

Left lower quadrant

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131
Q

LR

(CASK) P17

A

Lactated Ringer’s

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132
Q

LUQ

(CASK) P17

A

Left upper quadrant

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133
Q

MAE

(CASK) P17

A

Moving all extremities

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134
Q

MAST

(CASK) P17

A

Military antishock trousers

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135
Q

MEN

(CASK) P17

A

Multiple endocrine neoplasia

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136
Q

MI

(CASK) P17

A

Myocardial infarction

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137
Q

MSO4

(CASK) P17

A

Morphine sulfate

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138
Q

NGT

(CASK) P17

A

Nasogastric tube

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139
Q

NPO

(CASK) P17

A

Nothing per os

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140
Q

NS

(CASK) P17

A

Normal saline

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141
Q

OBR

(CASK) P17

A

Ortho bowel routine

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142
Q

OCTOR

(CASK) P17

A

On call to O.R.

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143
Q

OOB

(CASK) P17

A

Out of bed

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144
Q

ORIF

(CASK) P17

A

Open reduction internal fixation

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145
Q

p (a line over P)

(CASK) P17

A

After

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146
Q

PCWP

(CASK) P17

A

Pulmonary capillary wedge pressure

147
Q

PE

(CASK) P17

A

Pulmonary embolism; Physical examination

148
Q

PEEP

(CASK) P17

A

Positive end-expiratory pressure

149
Q

PEG

(CASK) P17

A

Percutaneous endoscopic gastrostomy (via EGD and skin

incision)

150
Q

PERRL

(CASK) P17

A

Pupils equal and react to light

151
Q

PFT

(CASK) P17

A

Pulmonary function tests

152
Q

PICC

(CASK) P17

A

Peripherally inserted central catheter

153
Q

PGV

(CASK) P17

A

Proximal gastric vagotomy (i.e., leaves fibers to pylorus intact to preserve emptying)

154
Q

PID

(CASK) P17

A

Pelvic inflammatory disease

155
Q

PO

(CASK) P17

A

Per os (by mouth)

156
Q

POD

(CASK) P17

A

Postoperative day

157
Q

PR

(CASK) P17

A

Per rectum

158
Q

PRN

(CASK) P17

A

As needed, literally, pro re nata

159
Q

PT

(CASK) P17

A

Physical therapy; Patient; Posterior tibial; Prothrombin time

160
Q

PTC

(CASK) P17

A

Percutaneous transhepatic cholangiogram (dye injected via a catheter through skin and into dilated intrahepatic bile duct)

161
Q

PTCA

(CASK) P17

A

Percutaneous transluminal coronary angioplasty

162
Q

PTX

(CASK) P17

A

pneumothorax

163
Q

q(a line over q) or q

(CASK) P18

164
Q

R(a line over R)

(CASK) P18

165
Q

RIH

(CASK) P18

A

Right inguinal hernia

166
Q

RLQ

(CASK) P18

A

Right lower quadrant

167
Q

Rx

(CASK) P18

168
Q

RTC

(CASK) P18

A

Return to clinic

169
Q

s (a line over s)

(CASK) P18

170
Q

SBO

(CASK) P18

A

Small bowel obstruction

171
Q

SCD

(CASK) P18

A

Sequential compression device

172
Q

SIADH

(CASK) P18

A

Syndrome of inappropriate antidiuretic hormone

173
Q

SICU

(CASK) P18

A

Surgical intensive care unit

174
Q

SOAP

(CASK) P18

A

Subjective, objective, assessment, and plan

175
Q

S/P

(CASK) P18

A

Status post

176
Q

STSG

(CASK) P18

A

Split thickness skin graft

177
Q

SVC

(CASK) P18

A

Superior vena cava

178
Q

Sx

(CASK) P18

179
Q

TEE

(CASK) P18

A

Transesophageal echocardiography

180
Q

T & C

(CASK) P18

A

Type and cross

181
Q

T & S

(CASK) P18

A

Type and screen

182
Q

T

(CASK) P18

A

Maximal temperature

183
Q

TPN

(CASK) P18

A

Total parenteral nutrition

184
Q

TURP

(CASK) P18

A

Transurethral resection of the prostate

185
Q

UE

(CASK) P18

A

Upper extremity

186
Q

UGI

(CASK) P18

A

Upper gastrointestinal

187
Q

UO

(CASK) P18

A

Urine output

188
Q

U/S

(CASK) P18

A

Ultrasound

189
Q

UTI

(CASK) P18

A

Urinary tract infection

190
Q

VAD

(CASK) P18

A

Ventricular assist device

191
Q

VOCTOR

(CASK) P18

A

Void on call to O.R.

192
Q

W→D

(CASK) P18

A

Wet-to-dry dressing

193
Q

XRT

(CASK) P18

A

X-ray therapy

194
Q

−

(CASK) P18

A

No; negative

195
Q

+

(CASK) P18

A

Yes; positive

196
Q

↑

(CASK) P18

A

Increase; more

197
Q

↓

(CASK) P18

A

Decrease; less

198
Q

<

(CASK) P18

199
Q

>

(CASK) P18

A

Greater than

200
Q

≈

(CASK) P18

A

Approximately

201
Q

GLOSSARY OF SURGICAL TERMSYOU SHOULD KNOW
(GSTK) P18

Abscess

A

Localized collection of pus anywhere in the body, surrounded and walled off by damaged and inflamed tissues

202
Q

Achlorhydria

(GSTK) P19

A

Absence of hydrochloric acid in the stomach

203
Q

Acholic stool

(GSTK) P19

A

Light-colored stool as a result of decreased bile content

204
Q

Adeno-

(GSTK) P19

A

Prefix denoting gland or glands

205
Q

Adhesion

(GSTK) P19

A

Union of two normally separate surfaces

206
Q

Adnexa

(GSTK) P19

A

Adjoining parts; usually means ovary/fallopian tube

207
Q

Adventitia

(GSTK) P19

A

Outer coat of the wall of a vein or artery

composed of loose connective tissue

208
Q

Afferent

(GSTK) P19

209
Q

-algia

(GSTK) P19

A

Suffix denoting pain

210
Q

Amaurosis fugax

(GSTK) P19

A

Transient visual loss in one eye

211
Q

Ampulla

(GSTK) P19

A

Enlarged or dilated ending of a tube or canal

212
Q

Analgesic

(GSTK) P19

A

Drug that prevents pain

213
Q

Anastomosis

(GSTK) P19

A

Connection between two tubular organs or parts

214
Q

Angio-

(GSTK) P19

A

Prefix denoting blood or lymph vessels

215
Q

Anomaly

(GSTK) P19

A

Any deviation from the normal (i.e., congenital or developmental defect)

216
Q

Apnea

(GSTK) P19

A

Cessation of breathing

217
Q

Atelectasis

(GSTK) P19

A

Collapse of alveoli

218
Q

Bariatric

(GSTK) P19

A

Weight reduction; bariatric surgery is performed on morbidly obese patients to effect weight loss

219
Q

Bifurcation

(GSTK) P19

A

Point at which division into two branches occurs

220
Q

Bile salts

(GSTK) P20

A

Alkaline salts of bile necessary for the emulsification of fats

221
Q

Bili-

(GSTK) P20

A

Prefix denoting bile

222
Q

Boil

(GSTK) P20

A

Tender inflamed area of the skin containing pus

223
Q

Bovie

(GSTK) P20

A

Electrocautery

224
Q

Calculus

(GSTK) P20

225
Q

Carbuncle

(GSTK) P20

A

Collection of boils (furuncles) with multiple drainage channels (CARbuncle = car = big)

226
Q

Cauterization

(GSTK) P20

A

Destruction of tissue by direct application of heat

227
Q

Celiotomy

(GSTK) P20

A

Surgical incision into the peritoneal cavity

laparotomy = celiotomy

228
Q

Cephal-

(GSTK) P20

A

Prefix denoting the head

229
Q

Chole-

(GSTK) P20

A

Prefix denoting bile

230
Q

Cholecyst-

(GSTK) P20

A

Prefix denoting gallbladder

231
Q

Choledocho-

(GSTK) P20

A

Prefix denoting the common bile duct

232
Q

Cleido-

(GSTK) P20

A

Prefix denoting the clavicle

233
Q

Colic

(GSTK) P20

A

Intermittent abdominal pain usually indicating pathology in a tubular organ (e.g., small bowel)

234
Q

Colloid

(GSTK) P20

A

Fluid with large particles (e.g., albumin)

235
Q

Colonoscopy

(GSTK) P20

A

Endoscopic examination of the colon

236
Q

Colostomy

(GSTK) P20

A

Surgical operation in which part of the colon is brought through the abdominal wall

237
Q

Constipation

(GSTK) P20

A

Infrequent or difficult passage of stool

238
Q

Cor pulmonale

(GSTK) P21

A

Enlargement of the right ventricle caused by lung disease and resultant pulmonary hypertension

239
Q

Curettage

(GSTK) P21

A

Scraping of the internal surface of an organ or body cavity by means of a spoon-shaped instrument

240
Q

Cyst

(GSTK) P21

A

Abnormal sac or closed cavity lined with epithelium and filled with fluid or semisolid material

241
Q

Direct bilirubin

(GSTK) P21

A

Conjugated bilirubin (indirect = unconjugated)

242
Q

-dynia

(GSTK) P21

A

Suffix denoting pain

243
Q

Dys-

(GSTK) P21

A

Prefix: difficult/painful/abnormal

244
Q

Dyspareunia

(GSTK) P21

A

Painful sexual intercourse

245
Q

Dysphagia

(GSTK) P21

A

Difficulty in swallowing

246
Q

Ecchymosis

(GSTK) P21

247
Q

-ectomy

(GSTK) P21

A

Suffix denoting the surgical removal of a part or all of an organ (e.g., gastrectomy)

248
Q

Efferent

(GSTK) P21

249
Q

Endarterectomy

(GSTK) P21

A

Surgical removal of an atheroma and the inner part of the vessel wall to relieve an obstruction
(carotid endarterectomy = CEA)

250
Q

Enteritis

(GSTK) P21

A

Inflammation of the small intestine, usually causing diarrhea

251
Q

Enterolysis

(GSTK) P21

A

Lysis of peritoneal adhesions; not to be confused with enteroclysis, which is a contrast study of the small bowel

252
Q

Eschar

(GSTK) P21

A

Scab produced by the action of heat or a corrosive substance on the skin

253
Q

Excisional biopsy

(GSTK) P22

A

Biopsy with removal of entire tumor

Think: Excisional Entire removal

254
Q

Fascia

(GSTK) P22

A

Sheet of strong connective tissue

255
Q

Fistula

(GSTK) P22

A

Abnormal communication between two hollow, epithelialized organs or between a hollow organ and the exterior (skin)

256
Q

Foley

(GSTK) P22

A

Bladder catheter

257
Q

Frequency

(GSTK) P22

A

Abnormally increased frequency (e.g., urinary frequency)

258
Q

Furuncle

(GSTK) P22

A

Boil, small subcutaneous staphylococcal infection of follicle (Think: Furuncle = follicle < car = carbuncle)

259
Q

Gastropexy

(GSTK) P22

A

Surgical attachment of the stomach to the abdominal wall

260
Q

Hemangioma

(GSTK) P22

A

Benign tumor of blood vessels

261
Q

Hematemesis

(GSTK) P22

A

Vomiting of blood

262
Q

Hematoma

(GSTK) P22

A

Accumulation of blood within the tissues, which clots to form a solid swelling

263
Q

Hemoptysis

(GSTK) P22

A

Coughing up blood

264
Q

Hemothorax

(GSTK) P22

A

Blood in the pleural cavity

265
Q

Hepato-

(GSTK) P22

A

Prefix denoting the liver

266
Q

Herniorrhaphy

(GSTK) P22

A

Surgical repair of a hernia

267
Q

Hesitancy

(GSTK) P22

A

Difficulty in initiating urination

268
Q

Hiatus

(GSTK) P22

A

Opening or aperture

269
Q

Hidradenitis

(GSTK) P22

A

Inflammation of the apocrine glands, usually caused by blockage of the glands

270
Q

Icterus

(GSTK) P22

271
Q

Ileostomy

(GSTK) P23

A

Surgical connection between the lumen of the ileum and the skin of the abdominal wall

272
Q

Ileus

(GSTK) P23

A

Abnormal intestinal motility (usually paralytic)

273
Q

Incisional biopsy

(GSTK) P23

A

Biopsy with only a “slice” of tumor removed

274
Q

Induration

(GSTK) P23

A

Abnormal hardening of a tissue or organ

275
Q

Inspissated

(GSTK) P23

276
Q

Intussusception

(GSTK) P23

A

Telescoping of one part of the bowel into another

277
Q

-itis

(GSTK) P23

A

Suffix denoting inflammation of an organ, tissue, etc. (e.g., gastritis)

278
Q

Lap appy

(GSTK) P23

A

Appendectomy via laparoscopy

279
Q

Laparoscopy

(GSTK) P23

A

Visualization of the peritoneal cavity via a laparoscope

280
Q

Laparotomy

(GSTK) P23

A

Surgical incision into the abdominal cavity

laparotomy = celiotomy

281
Q

Lap chole

(GSTK) P23

A

Cholecystectomy via laparoscopy

282
Q

Leiomyoma

(GSTK) P23

A

Benign tumor of smooth muscle

283
Q

Leiomyosarcoma

(GSTK) P23

A

Malignant tumor of smooth muscle

284
Q

Lieno-

(GSTK) P23

A

Denoting the spleen

285
Q

Melena

(GSTK) P23

A

Black tarry stool (melenic, not melanotic stools)

286
Q

Necrotic

(GSTK) P23

287
Q

Obstipation

(GSTK) P23

A

Failure to pass flatus or stool

288
Q

Odynophagia

(GSTK) P23

A

Painful swallowing

289
Q

-orraphy

(GSTK) P23

A

Surgical repair (e.g., herniorrhaphy)

290
Q

-ostomy

(GSTK) P24

A

General term referring to any operation in which an artificial opening is created between two hollow organs or between
one viscera and the abdominal wall for drainage purposes (e.g., colostomy) or for feeding (e.g., gastrostomy)

291
Q

-otomy

(GSTK) P24

A

Suffix denoting surgical incision into an organ

292
Q

Percutaneous

(GSTK) P24

A

Performed through the skin

293
Q

-pexy

(GSTK) P24

A

Suffix denoting fixation

294
Q

Phleb-

(GSTK) P24

A

Prefix denoting vein or relating to veins

295
Q

Phlebolith

(GSTK) P24

A

Calcification in a vein—a vein stone

296
Q

Phlegmon

(GSTK) P24

A

Diffuse inflammation of soft tissue, resulting in a swollen mass of tissue
(most commonly seen with pancreatic tissue)

297
Q

Plica

(GSTK) P24

A

Fold or ridge

298
Q

Plicae circulares

(GSTK) P24

A

Circular (complete circles) folds in the lumen of the small intestine (a.k.a. valvulae conniventes)

299
Q

Plicae semilunares

(GSTK) P24

A

Folds (semicircular) into lumen of the large intestine

300
Q

Pneumaturia

(GSTK) P24

A

Passage of urine containing air

301
Q

Pneumothorax

(GSTK) P24

A

Collapse of lung with air in pleural space

302
Q

Pseudocyst

(GSTK) P24

A

Fluid-filled cavity resembling a true cyst, but not lined with epithelium

303
Q

Pus

(GSTK) P24

A

Liquid product of inflammation, consisting of dying leukocytes and other fluids from the inflammatory response

304
Q

Rubor

(GSTK) P25

A

Redness; a classic sign of inflammation

305
Q

Steatorrhea

(GSTK) P25

A

Fatty stools as a result of decreased fat absorption

306
Q

Stenosis

(GSTK) P25

A

Abnormal narrowing of a passage or opening

307
Q

Sterile field

(GSTK) P25

A

Area covered by sterile drapes or prepped in sterile fashion using antiseptics (e.g., Betadine®)

308
Q

Succus

(GSTK) P25

A

Fluid (e.g., succus entericus is fluid from

the bowel lumen)

309
Q

Tenesmus

(GSTK) P25

A

Urge to defecate with ineffectual straining

310
Q

Thoracotomy

(GSTK) P25

A

Surgical opening of the chest cavity

311
Q

Transect

(GSTK) P25

A

To divide transversely (to cut in half)

312
Q

Trendelenburg

(GSTK) P25

A

Patient posture with pelvis higher than the head, inclined about 45º (a.k.a. “headdownenburg”)

313
Q

Urgency

(GSTK) P25

A

Sudden strong urge to urinate; often seen with a UTI

314
Q

Wet-to-dry dressing

(GSTK) P25

A

Damp gauze dressing placed on a wound and removed after the dressing dries to the wound, providing
microdébridement

315
Q

SURGERY SIGNS,TRIADS, ETC.YOU SHOULD KNOW
(SSTE) P25

What are the ABCDs of melanoma?

A 
Signs of melanoma:
   Asymmetric
   Border irregularities
   Color variation
   Diameter > 0.6 cm and Dark color
316
Q

What is the Allen’s test? (picture)

(SSTE) P26

A

Test for patency of ulnar artery prior to

  • placing a radial arterial line or performing an ABG:
  • Examiner occludes both ulnar and radial arteries with fingers as patient makes fist;
  • patient opens fist while examiner releases ulnar artery occlusion to assess blood flow to hand
317
Q

Define the following terms: Ballance’s sign

(SSTE) P26

A

Constant dullness to percussion in the left flank/LUQ and resonance to percussion in the right flank seen with
splenic rupture/hematoma

318
Q

Barrett’s esophagus

(SSTE) P26

A

Columnar metaplasia of the distal esophagus (GERD related)

319
Q

Battle’s sign (picture)

(SSTE) P26

A

Ecchymosis over the mastoid process in patients with basilar skull fractures

320
Q

Beck’s triad

(SSTE) P27

A

Seen in patients with cardiac tamponade:

  1. JVD
  2. Decreased or muffled heart sounds
  3. Decreased blood pressure
321
Q

Bergman’s triad

(SSTE) P27

A

Seen with fat emboli syndrome:

  1. Mental status changes
  2. Petechiae (often in the axilla/thorax)
  3. Dyspnea
322
Q

Blumer’s shelf

(SSTE) P27

A

Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on
rectal examination

323
Q

Boas’ sign

(SSTE) P27

A

Right subscapular pain resulting from cholelithiasis

324
Q

Borchardt’s triad

(SSTE) P27

A

Seen with gastric volvulus:

  1. Emesis followed by retching
  2. Epigastric distention
  3. Failure to pass an NGT
325
Q

Carcinoid triad

(SSTE) P27

A

Seen with carcinoid syndrome (Think: “FDR”):

  1. Flushing
  2. Diarrhea
  3. Right-sided heart failure
326
Q

Charcot’s triad

(SSTE) P27

A 
Seen with cholangitis:
1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain
(Pronounced “char-cohs”)
327
Q

Chvostek’s sign

(SSTE) P27

A

Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia
(Think: CHvostek’s = CHeek)

328
Q

Courvoisier’s law

(SSTE) P27

A

Enlarged nontender gallbladder seen with obstruction of the common bile duct, most commonly with pancreatic cancer
Note: not seen with gallstone obstruction because the gallbladder is scarred secondary to chronic cholelithiasis
(Pronounced “koor-vwah-ze-ay”)

329
Q

Cullen’s sign (picture)

(SSTE) P28

A

Bluish discoloration of the periumbilical area due to retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial planes
(e.g., acute hemorrhagic pancreatitis)

330
Q

Cushing’s triad

(SSTE) P28

A

Signs of increased intracranial pressure:

  1. Hypertension
  2. Bradycardia
  3. Irregular respirations
331
Q

Dance’s sign

(SSTE) P28

A

Empty right lower quadrant in children with ileocecal intussusception

332
Q

Fothergill’s sign

(SSTE) P28

A

Used to differentiate an intra-abdominal mass from one in the abdominal wall; if mass is felt while there is tension on the musculature, then it is in the wall
(i.e., sitting halfway upright)

333
Q

Fox’s sign

(SSTE) P28

A

Ecchymosis of inguinal ligament seen with retroperitoneal bleeding

334
Q

Goodsall’s rule (picture)

(SSTE) P28

A

Anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline (Think of a dog with a
straight anterior nose and a curved posterior tail)

335
Q

Grey Turner’s sign

(SSTE) P29

A

Ecchymosis or discoloration of the flank in patients with retroperitoneal hemorrhage as a result of dissecting
blood from the retroperitoneum
(Think: TURNer’s = TURN side-to-side = flank)

336
Q

Hamman’s sign/crunch

(SSTE) P29

A

Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s
syndrome, pneumomediastinum, etc.

337
Q

Homans’ sign

(SSTE) P29

A

Calf pain on forced dorsiflexion of the foot in patients with DVT

338
Q

Howship-Romberg sign

(SSTE) P29

A

Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression

339
Q

Kehr’s sign

(SSTE) P29

A

Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmatic irritation)

340
Q

Kelly’s sign

(SSTE) P29

A

Visible peristalsis of the ureter in response to squeezing or retraction; used to identify the ureter during surgery

341
Q

Krukenberg tumor

(SSTE) P29

A

Metastatic tumor to the ovary (classically from gastric cancer)

342
Q

Laplace’s law

(SSTE) P29

A

Wall tension = pressure x radius (thus, the colon perforates preferentially at the cecum because of the increased radius
and resultant increased wall tension)

343
Q

McBurney’s point

(SSTE) P30

A

One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two

344
Q

McBurney’s sign

(SSTE) P30

A

Tenderness at McBurney’s point in patients with appendicitis

345
Q

Meckel’s diverticulum rule of 2s

(SSTE) P30

A

2% of the population have a Meckel’s diverticulum, 2% of those are symptomatic, and they occur within 2 feet of the
ileocecal valve

346
Q

Mittelschmerz

(SSTE) P30

A

Lower quadrant pain due to ovulation

347
Q

Murphy’s sign

(SSTE) P30

A

Cessation of inspiration while palpating under the right costal margin; the patient cannot continue to inspire
deeply because it brings an inflamed gallbladder under pressure (seen in acute cholecystitis)

348
Q 
Obturator sign (picture)
(SSTE) P30
A

Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendicitis/pelvic abscess

349
Q

Pheochromocytoma SYMPTOMS triad

(SSTE) P30

A

Think of the first three letters in the word pheochromocytoma—“P-H-E”:

  • Palpitations
  • Headache
  • Episodic diaphoresis
350
Q

Pheochromocytoma rule of 10s

(SSTE) P30

A

10% bilateral, 10% malignant, 10% in children, 10% extra-adrenal, 10% have multiple tumors

351
Q 
Psoas sign (picture)
(SSTE) P31
A

Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation

352
Q 
Raccoon eyes (picture)
(SSTE) P31
A

Bilateral black eyes as a result of basilar skull fracture

353
Q

Reynold’s pentad

(SSTE) P31

A
  1. Fever
  2. Jaundice
  3. Right upper quadrant pain
  4. Mental status changes
  5. Shock/sepsis
    Thus, Charcot’s triad plus #4 and #5; seen in patients with suppurative cholangitis
354
Q

Rovsing’s sign

(SSTE) P31

A

Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appendicitis

355
Q

Saint’s triad

(SSTE) P31

A
  1. Cholelithiasis
  2. Hiatal hernia
  3. Diverticular disease
356
Q

Silk glove sign

(SSTE) P31

A

Indirect hernia sac in the pediatric patient; the sac feels like a finger of a silk glove when rolled under the examining finger

357
Q

Sister Mary Joseph’s sign (a.k.a. Sister Mary Joseph’s node)

(SSTE) P32

A

Metastatic tumor to umbilical lymph node(s)

358
Q

Virchow’s node

(SSTE) P32

A

Metastatic tumor to left supraclavicular node (classically due to gastric cancer)

359
Q

Virchow’s triad

(SSTE) P32

A

Risk factors for thrombosis:

  1. Stasis
  2. Abnormal endothelium
  3. Hypercoagulability
360
Q

Trousseau’s sign

(SSTE) P32

A

Carpal spasm after occlusion of blood to the forearm with a BP cuff in patients with hypocalcemia

361
Q

Valentino’s sign

(SSTE) P32

A

Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ

362
Q

Westermark’s sign

(SSTE) P32

A

Decreased pulmonary vascular markings on CXR in a patient with pulmonary embolus

363
Q

Whipple’s triad

(SSTE) P32

A 
Evidence for insulinoma:
1. Hypoglycemia (50)
2. CNS and vasomotor symptoms
     (e.g., syncope, diaphoresis)
3. Relief of symptoms with
    administration of glucose

Section I, Surgical Recall Sixth Edition (33 decks)

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