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
- O.R. question-and-answer periods
- Ward questioning
- Oral exam
- 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.
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
- What is it?
- Incidence
- Risk factors
- Signs and symptoms
- Laboratory and radiologic tests
- Diagnostic criteria
- Differential diagnoses
- Medical and surgical treatment
- Postoperative care
- Complications
- 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.
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!)
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
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.
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.
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.
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!
9
Q
- 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.)
10
Q
- 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
11
Q
- Should I wear my ID tag into the O.R.?
ORF P6
A
Yes
12
Q
- Can I wear nail polish?
ORF P6
A
Yes, as long as it is not chipped
13
Q
- Can I wear my rings and my watch when scrubbed in the
O.R.?
ORF P6
A
No
14
Q
- Can I wear earrings?
ORF P6
A
No
15
Q
- When scrubbed, is my back sterile?
ORF P6
A
No
16
Q
- When in the surgical gown, are my underarms sterile?
ORF P6
A
No; do not put your hands under your arms
17
Q
- How far down my gown is considered part of the
sterile field?
ORF P6
A
Just to your waist
18
Q
- How far up my gown is considered sterile?
A
Up to the nipples
19
Q
- 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
20
Q
- 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)
21
Q
- How many pairs of gloves should I wear when scrubbed?
ORF P7
A
2 (2 layers)
22
Q
- 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)
23
Q
- 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
24
Q
- 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
25
18. What is the tray with the instruments called?
| ORF P8
Mayo tray
| there is a picture
26
19. Can I grab things off the Mayo tray?
| ORF P8
No; ask the scrub nurse/tech for permission
27
20. How do you remove blood with a laparotomy pad
(“lap pad”)?
ORF P8
Dab; do not wipe, because wiping removes platelet plugs
28
21. Can you grab the skin with DeBakey pickups?
| ORF P8
NO; pickups for the skin must have teeth (e.g., Adson, rat-tooth) because it is “better to cut the skin than crush it”
29
22. How should you cut the sutures after tying a knot?
| ORF P8
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)
30
23. What should you do when you are scrubbed and
someone is tying a suture?
ORF P9
Ask the scrub nurse for a pair of suture scissors, so you are ready if you are asked to cut the sutures
31
24. Why always wipe the Betadine® (povidone-iodine)
off your patient at the end of the procedure?
ORF P9
Betadine® can become very irritating and itchy
32
SURGICAL NOTES (SN) P9
The history and physical examination report, better known as the H & P
33
What are the two words most commonly misspelled
in a surgical history note?
SN P9
1. Guaiac
| 2. Abscess
34
Favorite Trick Questions in SN (FTQ in SN) P9
1. What is the most common intra-operative bladder
“tumor”?
Foley catheter
35
2. Describe a stool with melena
| (FTQ in SN) P9
Melenic—not melanotic
36
3, Is amylase part of Ranson’s criteria?
| (FTQ in SN) P9
Amylase is NOT part of Ranson’s criteria!
37
4. Can a patient in shock have “STABLE” vital signs?
| (FTQ in SN) P9
Yes—stable vital signs are any vital signs that are not changing! Always say “normal” vital signs, not “stable!”
38
5. What is the most commonly pimped, yet the rarest,
cause of pancreatitis?
(FTQ in SN) P9
Pancreatitis from a scorpion bite
| scorpion found on island of Trinidad
39
6. Where can you go to obtain an abdominal CT scan on a
600-pound, morbidly obese patient?
(FTQ in SN) P9
The ZOO (used in the past, but now rare due to liability)
40
Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):
7. 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
- 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
41
Example H & P (very brief—for illustrative purposes only—see below or next section for abbreviation key):
8. 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
```
```
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.
42
9. How do I remember what is in the OP note when I am in
the O.R.?
(FTQ in SN) P12
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
43
10. POSTOP NOTE
The postop note is written on the day of the operation in the progress notes
Example:
(FTQ in SN) P12
- 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
44
11. 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
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
```
45
ADMISSION ORDERS/POSTOP ORDERS
“AC/DC AVA PAIN DUD”:
P13
Admit to 5E
Care Provider
Diagnosis
Condition
Allergies
Vitals
Activity
Pain meds
Antibiotics
IVF/Incentive Spirometry
Nursing (Drains, etc.)
DVT prophylaxis
Ulcer prophylaxis
Diet
46
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
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.
47
INTENSIVE CARE NOTE
This note is by systems:
P14
```
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.)
```
48
CLINIC NOTE
Often the clinic note is a letter to the referring doctor. It should always include:
P15
1. Patient name, history #, date
2. Brief Hx, current complaints/symptoms
3. PE, labs, x-rays
4. Assessment
5. Plan
49
How is a medication prescription written?
CLINIC NOTE
P15
Tylenol® 500 mg tablet
Disp (dispense): 100 tablets
sig: 1–2 PO q 4 hrs PRN pain
50
COMMON ABBREVIATIONS YOU SHOULD KNOW
(CASK) P15
(Check with your hospital for approved abbreviations!)
a(over a line)
Before
51
AAA
| (CASK) P15
Abdominal aortic aneurysm; “triple A”
52
ABD
| (CASK) P15
Army battle dressing
53
ABG
| (CASK) P15
Arterial blood gas
54
ABI
| (CASK) P15
Ankle to brachial index
55
AKA
| (CASK) P15
Above the knee amputation
56
a.k.a.
| (CASK) P15
Also known as
57
Ao
| (CASK) P15
Aorta
58
APR
| (CASK) P15
Abdominoperineal resection
59
ARDS
| (CASK) P15
Acute respiratory distress syndrome
60
ASA
| (CASK) P15
Aspirin
61
AXR
| (CASK) P15
Abdominal x-ray
62
B1
| (CASK) P15
Billroth 1 gastroduodenostomy
63
B2
| (CASK) P15
Billroth 2 gastrojejunostomy
64
BCP
| (CASK) P15
Birth control pill
65
BE
| (CASK) P15
Barium enema
66
BIH
| (CASK) P15
Bilateral inguinal hernia
67
BKA
| (CASK) P15
Below the knee amputation
68
BRBPR
| (CASK) P15
Bright red blood per rectum
69
BS
| (CASK) P15
Bowel sounds; Breath sounds; Blood sugar
70
BSE
| (CASK) P15
Breast self-examination
71
c (a line over)
| (CASK) P15
With
72
CA
| (CASK) P15
Cancer
73
CABG
| (CASK) P15
Coronary artery bypass graft (“CABBAGE”)
74
CBC
| (CASK) P15
Complete blood cell count
75
CBD
| (CASK) P16
Common bile duct
76
c/o
| (CASK) P16
Complains of
77
COPD
| (CASK) P16
Chronic obstructive pulmonary disease
78
CP
| (CASK) P16
Chest pain
79
CTA
| (CASK) P16
Clear to auscultation; CT angiogram
80
CVA
| (CASK) P16
Cerebral vascular accident
81
CVAT
| (CASK) P16
Costovertebral angle tenderness
82
CVP
| (CASK) P16
Central venous pressure
83
CXR
| (CASK) P16
Chest x-ray
84
Dx
| (CASK) P16
Diagnosis
85
DDx
| (CASK) P16
Differential diagnosis
86
DI
| (CASK) P16
Diabetes insipidus
87
DP
| (CASK) P16
Dorsalis pedalis
88
DPL
| (CASK) P16
Diagnostic peritoneal lavage
89
DPC
| (CASK) P16
Delayed primary closure
90
DT
| (CASK) P16
Delirium tremens
91
DVT
| (CASK) P16
Deep venous thrombosis
92
EBL
| (CASK) P16
Estimated blood loss
93
ECMO
| (CASK) P16
Extracorporeal membrane oxygenation
94
EGD
| (CASK) P16
Esophagogastroduodenoscopy (UGI scope)
95
EKG
| (CASK) P16
Electrocardiogram (also ECG)
96
ELAP
| (CASK) P16
Exploratory laparotomy
97
EOMI
| (CASK) P16
Extraocular muscles intact
98
ERCP
| (CASK) P16
Endoscopic retrograde cholangiopancreatography
99
EtOH
| (CASK) P16
Alcohol
100
EUA
| (CASK) P16
Exam under anesthesia
101
EX LAP
| (CASK) P16
Exploratory laparotomy
102
FAP
| (CASK) P16
Familial adenomatous polyposis
103
FAST
| (CASK) P16
Focused abdominal sonogram for trauma
104
FEN
| (CASK) P16
Fluids, electrolytes, nutrition
105
FNA
| (CASK) P16
Fine needle aspiration
106
FOBT
| (CASK) P16
Fecal occult blood test
107
GCS
| (CASK) P16
Glasgow Coma Scale
108
GERD
| (CASK) P16
Gastroesophageal reflux disease
109
GET(A)
| (CASK) P16
General endotracheal (anesthesia)
110
GU
| (CASK) P16
Genitourinary
111
HCT
| (CASK) P16
Hematocrit
112
HEENT
| (CASK) P16
Head, eyes, ears, nose, and throat
113
HO
| (CASK) P16
House officer
114
Hx
| (CASK) P16
History
115
IABP
| (CASK) P16
Intra-aortic balloon pump
116
IBD
| (CASK) P16
Inflammatory bowel disease
117
ICU
| (CASK) P16
Intensive care unit
118
I & D
| (CASK) P16
Incision and drainage
119
I & O
| (CASK) P16
Ins and outs, in and out
120
IMV
| (CASK) P16
Intermittent mandatory ventilation
121
IVC
| (CASK) P17
Inferior vena cava
122
IVF
| (CASK) P17
Intravenous fluids
123
IVP
| (CASK) P17
Intravenous pyelography
124
IVPB
| (CASK) P17
Intravenous piggyback
125
JVD
| (CASK) P17
Jugular venous distention
126
L (a circle around L)
| (CASK) P17
Left
127
LE
| (CASK) P17
Lower extremity
128
LES
| (CASK) P17
Lower esophageal sphincter
129
LIH
| (CASK) P17
Left inguinal hernia
130
LLQ
| (CASK) P17
Left lower quadrant
131
LR
| (CASK) P17
Lactated Ringer’s
132
LUQ
| (CASK) P17
Left upper quadrant
133
MAE
| (CASK) P17
Moving all extremities
134
MAST
| (CASK) P17
Military antishock trousers
135
MEN
| (CASK) P17
Multiple endocrine neoplasia
136
MI
| (CASK) P17
Myocardial infarction
137
MSO4
| (CASK) P17
Morphine sulfate
138
NGT
| (CASK) P17
Nasogastric tube
139
NPO
| (CASK) P17
Nothing per os
140
NS
| (CASK) P17
Normal saline
141
OBR
| (CASK) P17
Ortho bowel routine
142
OCTOR
| (CASK) P17
On call to O.R.
143
OOB
| (CASK) P17
Out of bed
144
ORIF
| (CASK) P17
Open reduction internal fixation
145
p (a line over P)
| (CASK) P17
After
146
PCWP
| (CASK) P17
Pulmonary capillary wedge pressure
147
PE
| (CASK) P17
Pulmonary embolism; Physical examination
148
PEEP
| (CASK) P17
Positive end-expiratory pressure
149
PEG
| (CASK) P17
Percutaneous endoscopic gastrostomy (via EGD and skin
| incision)
150
PERRL
| (CASK) P17
Pupils equal and react to light
151
PFT
| (CASK) P17
Pulmonary function tests
152
PICC
| (CASK) P17
Peripherally inserted central catheter
153
PGV
| (CASK) P17
Proximal gastric vagotomy (i.e., leaves fibers to pylorus intact to preserve emptying)
154
PID
| (CASK) P17
Pelvic inflammatory disease
155
PO
| (CASK) P17
Per os (by mouth)
156
POD
| (CASK) P17
Postoperative day
157
PR
| (CASK) P17
Per rectum
158
PRN
| (CASK) P17
As needed, literally, pro re nata
159
PT
| (CASK) P17
Physical therapy; Patient; Posterior tibial; Prothrombin time
160
PTC
| (CASK) P17
Percutaneous transhepatic cholangiogram (dye injected via a catheter through skin and into dilated intrahepatic bile duct)
161
PTCA
| (CASK) P17
Percutaneous transluminal coronary angioplasty
162
PTX
| (CASK) P17
pneumothorax
163
q(a line over q) or q
| (CASK) P18
Every
164
R(a line over R)
| (CASK) P18
Right
165
RIH
| (CASK) P18
Right inguinal hernia
166
RLQ
| (CASK) P18
Right lower quadrant
167
Rx
| (CASK) P18
Treatment
168
RTC
| (CASK) P18
Return to clinic
169
s (a line over s)
| (CASK) P18
Without
170
SBO
| (CASK) P18
Small bowel obstruction
171
SCD
| (CASK) P18
Sequential compression device
172
SIADH
| (CASK) P18
Syndrome of inappropriate antidiuretic hormone
173
SICU
| (CASK) P18
Surgical intensive care unit
174
SOAP
| (CASK) P18
Subjective, objective, assessment, and plan
175
S/P
| (CASK) P18
Status post
176
STSG
| (CASK) P18
Split thickness skin graft
177
SVC
| (CASK) P18
Superior vena cava
178
Sx
| (CASK) P18
Symptoms
179
TEE
| (CASK) P18
Transesophageal echocardiography
180
T & C
| (CASK) P18
Type and cross
181
T & S
| (CASK) P18
Type and screen
182
T
| (CASK) P18
Maximal temperature
183
TPN
| (CASK) P18
Total parenteral nutrition
184
TURP
| (CASK) P18
Transurethral resection of the prostate
185
UE
| (CASK) P18
Upper extremity
186
UGI
| (CASK) P18
Upper gastrointestinal
187
UO
| (CASK) P18
Urine output
188
U/S
| (CASK) P18
Ultrasound
189
UTI
| (CASK) P18
Urinary tract infection
190
VAD
| (CASK) P18
Ventricular assist device
191
VOCTOR
| (CASK) P18
Void on call to O.R.
192
W→D
| (CASK) P18
Wet-to-dry dressing
193
XRT
| (CASK) P18
X-ray therapy
194
−
| (CASK) P18
No; negative
195
+
| (CASK) P18
Yes; positive
196
↑
| (CASK) P18
Increase; more
197
↓
| (CASK) P18
Decrease; less
198
Less than
199
>
| (CASK) P18
Greater than
200
≈
| (CASK) P18
Approximately
201
GLOSSARY OF SURGICAL TERMSYOU SHOULD KNOW
(GSTK) P18
Abscess
Localized collection of pus anywhere in the body, surrounded and walled off by damaged and inflamed tissues
202
Achlorhydria
| (GSTK) P19
Absence of hydrochloric acid in the stomach
203
Acholic stool
| (GSTK) P19
Light-colored stool as a result of decreased bile content
204
Adeno-
| (GSTK) P19
Prefix denoting gland or glands
205
Adhesion
| (GSTK) P19
Union of two normally separate surfaces
206
Adnexa
| (GSTK) P19
Adjoining parts; usually means ovary/fallopian tube
207
Adventitia
| (GSTK) P19
Outer coat of the wall of a vein or artery
| composed of loose connective tissue
208
Afferent
| (GSTK) P19
Toward
209
-algia
| (GSTK) P19
Suffix denoting pain
210
Amaurosis fugax
| (GSTK) P19
Transient visual loss in one eye
211
Ampulla
| (GSTK) P19
Enlarged or dilated ending of a tube or canal
212
Analgesic
| (GSTK) P19
Drug that prevents pain
213
Anastomosis
| (GSTK) P19
Connection between two tubular organs or parts
214
Angio-
| (GSTK) P19
Prefix denoting blood or lymph vessels
215
Anomaly
| (GSTK) P19
Any deviation from the normal (i.e., congenital or developmental defect)
216
Apnea
| (GSTK) P19
Cessation of breathing
217
Atelectasis
| (GSTK) P19
Collapse of alveoli
218
Bariatric
| (GSTK) P19
Weight reduction; bariatric surgery is performed on morbidly obese patients to effect weight loss
219
Bifurcation
| (GSTK) P19
Point at which division into two branches occurs
220
Bile salts
| (GSTK) P20
Alkaline salts of bile necessary for the emulsification of fats
221
Bili-
| (GSTK) P20
Prefix denoting bile
222
Boil
| (GSTK) P20
Tender inflamed area of the skin containing pus
223
Bovie
| (GSTK) P20
Electrocautery
224
Calculus
| (GSTK) P20
Stone
225
Carbuncle
| (GSTK) P20
Collection of boils (furuncles) with multiple drainage channels (CARbuncle = car = big)
226
Cauterization
| (GSTK) P20
Destruction of tissue by direct application of heat
227
Celiotomy
| (GSTK) P20
Surgical incision into the peritoneal cavity
| laparotomy = celiotomy
228
Cephal-
| (GSTK) P20
Prefix denoting the head
229
Chole-
| (GSTK) P20
Prefix denoting bile
230
Cholecyst-
| (GSTK) P20
Prefix denoting gallbladder
231
Choledocho-
| (GSTK) P20
Prefix denoting the common bile duct
232
Cleido-
| (GSTK) P20
Prefix denoting the clavicle
233
Colic
| (GSTK) P20
Intermittent abdominal pain usually indicating pathology in a tubular organ (e.g., small bowel)
234
Colloid
| (GSTK) P20
Fluid with large particles (e.g., albumin)
235
Colonoscopy
| (GSTK) P20
Endoscopic examination of the colon
236
Colostomy
| (GSTK) P20
Surgical operation in which part of the colon is brought through the abdominal wall
237
Constipation
| (GSTK) P20
Infrequent or difficult passage of stool
238
Cor pulmonale
| (GSTK) P21
Enlargement of the right ventricle caused by lung disease and resultant pulmonary hypertension
239
Curettage
| (GSTK) P21
Scraping of the internal surface of an organ or body cavity by means of a spoon-shaped instrument
240
Cyst
| (GSTK) P21
Abnormal sac or closed cavity lined with epithelium and filled with fluid or semisolid material
241
Direct bilirubin
| (GSTK) P21
Conjugated bilirubin (indirect = unconjugated)
242
-dynia
| (GSTK) P21
Suffix denoting pain
243
Dys-
| (GSTK) P21
Prefix: difficult/painful/abnormal
244
Dyspareunia
| (GSTK) P21
Painful sexual intercourse
245
Dysphagia
| (GSTK) P21
Difficulty in swallowing
246
Ecchymosis
| (GSTK) P21
Bruise
247
-ectomy
| (GSTK) P21
Suffix denoting the surgical removal of a part or all of an organ (e.g., gastrectomy)
248
Efferent
| (GSTK) P21
Away from
249
Endarterectomy
| (GSTK) P21
Surgical removal of an atheroma and the inner part of the vessel wall to relieve an obstruction
(carotid endarterectomy = CEA)
250
Enteritis
| (GSTK) P21
Inflammation of the small intestine, usually causing diarrhea
251
Enterolysis
| (GSTK) P21
Lysis of peritoneal adhesions; not to be confused with enteroclysis, which is a contrast study of the small bowel
252
Eschar
| (GSTK) P21
Scab produced by the action of heat or a corrosive substance on the skin
253
Excisional biopsy
| (GSTK) P22
Biopsy with removal of entire tumor
| Think: Excisional Entire removal
254
Fascia
| (GSTK) P22
Sheet of strong connective tissue
255
Fistula
| (GSTK) P22
Abnormal communication between two hollow, epithelialized organs or between a hollow organ and the exterior (skin)
256
Foley
| (GSTK) P22
Bladder catheter
257
Frequency
| (GSTK) P22
Abnormally increased frequency (e.g., urinary frequency)
258
Furuncle
| (GSTK) P22
Boil, small subcutaneous staphylococcal infection of follicle (Think: Furuncle = follicle car = carbuncle)
259
Gastropexy
| (GSTK) P22
Surgical attachment of the stomach to the abdominal wall
260
Hemangioma
| (GSTK) P22
Benign tumor of blood vessels
261
Hematemesis
| (GSTK) P22
Vomiting of blood
262
Hematoma
| (GSTK) P22
Accumulation of blood within the tissues, which clots to form a solid swelling
263
Hemoptysis
| (GSTK) P22
Coughing up blood
264
Hemothorax
| (GSTK) P22
Blood in the pleural cavity
265
Hepato-
| (GSTK) P22
Prefix denoting the liver
266
Herniorrhaphy
| (GSTK) P22
Surgical repair of a hernia
267
Hesitancy
| (GSTK) P22
Difficulty in initiating urination
268
Hiatus
| (GSTK) P22
Opening or aperture
269
Hidradenitis
| (GSTK) P22
Inflammation of the apocrine glands, usually caused by blockage of the glands
270
Icterus
| (GSTK) P22
Jaundice
271
Ileostomy
| (GSTK) P23
Surgical connection between the lumen of the ileum and the skin of the abdominal wall
272
Ileus
| (GSTK) P23
Abnormal intestinal motility (usually paralytic)
273
Incisional biopsy
| (GSTK) P23
Biopsy with only a “slice” of tumor removed
274
Induration
| (GSTK) P23
Abnormal hardening of a tissue or organ
275
Inspissated
| (GSTK) P23
Hard
276
Intussusception
| (GSTK) P23
Telescoping of one part of the bowel into another
277
-itis
| (GSTK) P23
Suffix denoting inflammation of an organ, tissue, etc. (e.g., gastritis)
278
Lap appy
| (GSTK) P23
Appendectomy via laparoscopy
279
Laparoscopy
| (GSTK) P23
Visualization of the peritoneal cavity via a laparoscope
280
Laparotomy
| (GSTK) P23
Surgical incision into the abdominal cavity
| laparotomy = celiotomy
281
Lap chole
| (GSTK) P23
Cholecystectomy via laparoscopy
282
Leiomyoma
| (GSTK) P23
Benign tumor of smooth muscle
283
Leiomyosarcoma
| (GSTK) P23
Malignant tumor of smooth muscle
284
Lieno-
| (GSTK) P23
Denoting the spleen
285
Melena
| (GSTK) P23
Black tarry stool (melenic, not melanotic stools)
286
Necrotic
| (GSTK) P23
Dead
287
Obstipation
| (GSTK) P23
Failure to pass flatus or stool
288
Odynophagia
| (GSTK) P23
Painful swallowing
289
-orraphy
| (GSTK) P23
Surgical repair (e.g., herniorrhaphy)
290
-ostomy
| (GSTK) P24
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
-otomy
| (GSTK) P24
Suffix denoting surgical incision into an organ
292
Percutaneous
| (GSTK) P24
Performed through the skin
293
-pexy
| (GSTK) P24
Suffix denoting fixation
294
Phleb-
| (GSTK) P24
Prefix denoting vein or relating to veins
295
Phlebolith
| (GSTK) P24
Calcification in a vein—a vein stone
296
Phlegmon
| (GSTK) P24
Diffuse inflammation of soft tissue, resulting in a swollen mass of tissue
(most commonly seen with pancreatic tissue)
297
Plica
| (GSTK) P24
Fold or ridge
298
Plicae circulares
| (GSTK) P24
Circular (complete circles) folds in the lumen of the small intestine (a.k.a. valvulae conniventes)
299
Plicae semilunares
| (GSTK) P24
Folds (semicircular) into lumen of the large intestine
300
Pneumaturia
| (GSTK) P24
Passage of urine containing air
301
Pneumothorax
| (GSTK) P24
Collapse of lung with air in pleural space
302
Pseudocyst
| (GSTK) P24
Fluid-filled cavity resembling a true cyst, but not lined with epithelium
303
Pus
| (GSTK) P24
Liquid product of inflammation, consisting of dying leukocytes and other fluids from the inflammatory response
304
Rubor
| (GSTK) P25
Redness; a classic sign of inflammation
305
Steatorrhea
| (GSTK) P25
Fatty stools as a result of decreased fat absorption
306
Stenosis
| (GSTK) P25
Abnormal narrowing of a passage or opening
307
Sterile field
| (GSTK) P25
Area covered by sterile drapes or prepped in sterile fashion using antiseptics (e.g., Betadine®)
308
Succus
| (GSTK) P25
Fluid (e.g., succus entericus is fluid from
| the bowel lumen)
309
Tenesmus
| (GSTK) P25
Urge to defecate with ineffectual straining
310
Thoracotomy
| (GSTK) P25
Surgical opening of the chest cavity
311
Transect
| (GSTK) P25
To divide transversely (to cut in half)
312
Trendelenburg
| (GSTK) P25
Patient posture with pelvis higher than the head, inclined about 45º (a.k.a. “headdownenburg”)
313
Urgency
| (GSTK) P25
Sudden strong urge to urinate; often seen with a UTI
314
Wet-to-dry dressing
| (GSTK) P25
Damp gauze dressing placed on a wound and removed after the dressing dries to the wound, providing
microdébridement
315
SURGERY SIGNS,TRIADS, ETC.YOU SHOULD KNOW
(SSTE) P25
What are the ABCDs of melanoma?
```
Signs of melanoma:
Asymmetric
Border irregularities
Color variation
Diameter > 0.6 cm and Dark color
```
316
What is the Allen’s test? (picture)
| (SSTE) P26
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
Define the following terms: Ballance’s sign
| (SSTE) P26
Constant dullness to percussion in the left flank/LUQ and resonance to percussion in the right flank seen with
splenic rupture/hematoma
318
Barrett’s esophagus
| (SSTE) P26
Columnar metaplasia of the distal esophagus (GERD related)
319
Battle’s sign (picture)
| (SSTE) P26
Ecchymosis over the mastoid process in patients with basilar skull fractures
320
Beck’s triad
| (SSTE) P27
Seen in patients with cardiac tamponade:
1. JVD
2. Decreased or muffled heart sounds
3. Decreased blood pressure
321
Bergman’s triad
| (SSTE) P27
Seen with fat emboli syndrome:
1. Mental status changes
2. Petechiae (often in the axilla/thorax)
3. Dyspnea
322
Blumer’s shelf
| (SSTE) P27
Metastatic disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a “shelf” that is palpable on
rectal examination
323
Boas’ sign
| (SSTE) P27
Right subscapular pain resulting from cholelithiasis
324
Borchardt’s triad
| (SSTE) P27
Seen with gastric volvulus:
1. Emesis followed by retching
2. Epigastric distention
3. Failure to pass an NGT
325
Carcinoid triad
| (SSTE) P27
Seen with carcinoid syndrome (Think: “FDR”):
1. Flushing
2. Diarrhea
3. Right-sided heart failure
326
Charcot’s triad
| (SSTE) P27
```
Seen with cholangitis:
1. Fever (chills)
2. Jaundice
3. Right upper quadrant pain
(Pronounced “char-cohs”)
```
327
Chvostek’s sign
| (SSTE) P27
Twitching of facial muscles upon tapping the facial nerve in patients with hypocalcemia
(Think: CHvostek’s = CHeek)
328
Courvoisier’s law
| (SSTE) P27
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
Cullen’s sign (picture)
| (SSTE) P28
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
Cushing’s triad
| (SSTE) P28
Signs of increased intracranial pressure:
1. Hypertension
2. Bradycardia
3. Irregular respirations
331
Dance’s sign
| (SSTE) P28
Empty right lower quadrant in children with ileocecal intussusception
332
Fothergill’s sign
| (SSTE) P28
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
Fox’s sign
| (SSTE) P28
Ecchymosis of inguinal ligament seen with retroperitoneal bleeding
334
Goodsall’s rule (picture)
| (SSTE) P28
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
Grey Turner’s sign
| (SSTE) P29
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
Hamman’s sign/crunch
| (SSTE) P29
Crunching sound on auscultation of the heart resulting from emphysematous mediastinum; seen with Boerhaave’s
syndrome, pneumomediastinum, etc.
337
Homans’ sign
| (SSTE) P29
Calf pain on forced dorsiflexion of the foot in patients with DVT
338
Howship-Romberg sign
| (SSTE) P29
Pain along the inner aspect of the thigh; seen with an obturator hernia as the result of nerve compression
339
Kehr’s sign
| (SSTE) P29
Severe left shoulder pain in patients with splenic rupture (as a result of referred pain from diaphragmatic irritation)
340
Kelly’s sign
| (SSTE) P29
Visible peristalsis of the ureter in response to squeezing or retraction; used to identify the ureter during surgery
341
Krukenberg tumor
| (SSTE) P29
Metastatic tumor to the ovary (classically from gastric cancer)
342
Laplace’s law
| (SSTE) P29
Wall tension = pressure x radius (thus, the colon perforates preferentially at the cecum because of the increased radius
and resultant increased wall tension)
343
McBurney’s point
| (SSTE) P30
One third the distance from the anterior iliac spine to the umbilicus on a line connecting the two
344
McBurney’s sign
| (SSTE) P30
Tenderness at McBurney’s point in patients with appendicitis
345
Meckel’s diverticulum rule of 2s
| (SSTE) P30
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
Mittelschmerz
| (SSTE) P30
Lower quadrant pain due to ovulation
347
Murphy’s sign
| (SSTE) P30
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
```
Obturator sign (picture)
(SSTE) P30
```
Pain upon internal rotation of the leg with the hip and knee flexed; seen in patients with appendicitis/pelvic abscess
349
Pheochromocytoma SYMPTOMS triad
| (SSTE) P30
Think of the first three letters in the word pheochromocytoma—“P-H-E”:
- Palpitations
- Headache
- Episodic diaphoresis
350
Pheochromocytoma rule of 10s
| (SSTE) P30
10% bilateral, 10% malignant, 10% in children, 10% extra-adrenal, 10% have multiple tumors
351
```
Psoas sign (picture)
(SSTE) P31
```
Pain elicited by extending the hip with the knee in full extension, seen with appendicitis and psoas inflammation
352
```
Raccoon eyes (picture)
(SSTE) P31
```
Bilateral black eyes as a result of basilar skull fracture
353
Reynold’s pentad
| (SSTE) P31
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
Rovsing’s sign
| (SSTE) P31
Palpation of the left lower quadrant resulting in pain in the right lower quadrant; seen in appendicitis
355
Saint’s triad
| (SSTE) P31
1. Cholelithiasis
2. Hiatal hernia
3. Diverticular disease
356
Silk glove sign
| (SSTE) P31
Indirect hernia sac in the pediatric patient; the sac feels like a finger of a silk glove when rolled under the examining finger
357
Sister Mary Joseph’s sign (a.k.a. Sister Mary Joseph’s node)
| (SSTE) P32
Metastatic tumor to umbilical lymph node(s)
358
Virchow’s node
| (SSTE) P32
Metastatic tumor to left supraclavicular node (classically due to gastric cancer)
359
Virchow’s triad
| (SSTE) P32
Risk factors for thrombosis:
1. Stasis
2. Abnormal endothelium
3. Hypercoagulability
360
Trousseau’s sign
| (SSTE) P32
Carpal spasm after occlusion of blood to the forearm with a BP cuff in patients with hypocalcemia
361
Valentino’s sign
| (SSTE) P32
Right lower quadrant pain from a perforated peptic ulcer due to succus/pus draining into the RLQ
362
Westermark’s sign
| (SSTE) P32
Decreased pulmonary vascular markings on CXR in a patient with pulmonary embolus
363
Whipple’s triad
| (SSTE) P32
```
Evidence for insulinoma:
1. Hypoglycemia (50)
2. CNS and vasomotor symptoms
(e.g., syncope, diaphoresis)
3. Relief of symptoms with
administration of glucose
```
