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Surgery Clerkship > Sugery Clerkship 3 > Flashcards

Sugery Clerkship 3 Flashcards

1
Q

Signs of shock

A
  • Pale, diaphoretic, cool skin
  • Tachycardia, Tachypnea
  • Hypotension
  • Decreased pulse pressure
  • Mental status changes
  • Poor capillary refill
  • Poor urine output
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2
Q

Lab values that can help assess tissue perfusion

A
  • Lactic acid (increased with inadequate tissue perfusion)

- pH from ABG (acidotic)

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3
Q

MC etiology of septic shock

A

Gram (-) septicemia

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4
Q

Tx for septic shock

A
  • IVF
  • Abx (empiric, then by culures)
  • Drainage ofinfection
  • Pressors PRN
  • Xigris (activated protein C)
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5
Q

Signs/Symptoms of cardiogenic shock

A
  • Dyspnea
  • Rales
  • Pulsus alterans
  • Loud pulmonic component of S2
  • Gallop rhythm
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6
Q

Tx for cardiogenic shock

A
  • Diuretics if CHF
  • Afterload reduction
  • Pressors
  • Intra-aortic balloon pump
  • Ventricular assist device
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7
Q

Definition of neurogenic shock

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

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8
Q

Signs of neurogenic shock

A
  • Hypotension
  • BRADYcardia
  • Neurologic deficit
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9
Q

Tx for neurogenic shock

A
  • IV fluids

- (Vasopressors are reserved for hypotension that’s refractory to fluid resuscitation)

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10
Q

acronym for tx of anaphylactic shock

A

BASE

  • Benadryl
  • Aminophylline (bronchodilator)
  • Steroids
  • Epinephrine
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11
Q

Classic signs/symptoms of inflammation/infection

A
  • Tumor (swelling/edema)
  • Calor (heat)
  • Dalor (pain)
  • Rubor (redness/erythema)
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12
Q

SIRS

A

Systemic Inflammatory Response Syndrome

  • Fever
  • Tachycardia
  • Tachypnea
  • Leukocytosis
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13
Q

Cellulitis (definition)

A

Blanching erythema from superficial dermal/epidermal infection

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14
Q

Tx for UTI

A

Antibiotics with gram (-) spectrum

  • Bactrim
  • Gentamicin
  • Ciprofloxacin
  • Aztreonam
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15
Q

Patient with a central line has unexplained hyperglycemia, fever, decreased mental status, hypotension, and tachycardia. What do you suspect?

A

Central line infection

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16
Q

Major finding associated with central line infection

A

Unexplained hypoglycemia

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17
Q

When do wound infections typically arise (what POD)?

A

PODs #5 - 7

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18
Q

MC bacteria found in postoperative wound infections

A
  • Staph aureus (20%)
  • E. coli (10%)
  • Enterococcus (10%)
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19
Q

Which bacteria cause fever and wound infection in the first 24 hours after surgery?

A
  • Streptococcus

- Clostridium

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20
Q

Clean wound (definition)

A

Elective, nontraumatic wound without acute inflammation

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21
Q

Clean-contaminated wound (definition)

A

Operation on GI or respiratory tract without unusual contamination; without entry into biliary or urinary tract

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22
Q

Contaminated wound (definition)

A
  • Acute inflammation,
  • Traumatic wound,
  • GI tract spillage, or
  • Major break in sterile technique
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23
Q

Dirty wound (definition)

A
  • Pus present,
  • Perforated viscus, or
  • Dirty traumatic wound
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24
Q

When should an abdominal CT scan be obtained looking for a postoperative abscess? Why?

A
  • After POD #7

- Because otherwise, the abscess will not be “organized” and will look like a normal postoperative fluid collection

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25
Q

Major CT finding indicating an abscess (as opposed to normal postoperative fluid collection)

A
  • Gas in the fluid collection

- Fluid collection with a fibrous rind

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26
Q

All abscesses must be drained except which type?

A

Amebiasis

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27
Q

Classic necrotizing fasciitis causative agent

A

Streptococcus pyogenes

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28
Q

MC clostridial myositis causative agent

A

Clostridium perfrigens

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29
Q

Post-op patient develops fever, shock, and a foul-smelling brown fluid leaking from her incision site. You note crepitus and find subcutaneous air on x-ray. What’s going on?

A

Clostridial myositis

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30
Q

Infection/abscess formation in apocrine sweat glands

A

Suppurative hidradenitis

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31
Q

Suppurative hidradenitis MC causative organism

A

Staph aureus

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32
Q

Infection of the parotid gland

A

Parotitis

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33
Q

What is the most common time of occurrence of parotitis?

A

Usually 2 weeks postoperative

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34
Q

Parotitis MC causative organism

A

Staphylococcus

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35
Q

Classic antibiotics for “triple” antibiotics

A
  • Ampicillin
  • Gentamycin
  • Metronidazole
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36
Q

Temperature defining postoperative fever

A

> 38.5 C

> 101.5 F

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37
Q

When would a UTI cause a postoperative fever?

A

After POD #3

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38
Q

When would a wound infection cause a postoperative fever?

A

Usually after POD #5, but can be anytime

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39
Q

What causes fever before 24 postoperative hours?

A
  • Atelectasis
  • Beta hemolytic strep or clostridial wound infections
  • Anastomotic leak
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40
Q

Tx for malignant hyperthermia due to intraoperative anesthesia?

A

Dantrolene

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41
Q

What are contraindications of the depolarizing agent succinylcholine? Why?

A 
Patients with:
-Burns
-Neuromuscular diseases/Paraplegia
-Eye trauma
-Increased IOP
Because it can cause life-threatening hyperkalemia
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42
Q

Contraindications to nitrous oxide. Why?

A

NO is poorly soluble in serum, so it expands any air-filled body pockets. So avoid in:

  • Pneumothorax
  • Small bowel obstruction
  • Middle ear occlusion, etc.
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43
Q

What medication is a contraindication to Demerol?

A

MAO-I’s

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44
Q

Why should you give Demerol (meperidine) with pancreatitis or biliary surgery over Morphine?

A

Morphine causes spasm of the sphincter of Oddi

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45
Q

Tx for respiratory depression caused by narcotics?

A

Narcan (naloxone)

46
Q

Major side effect of epidural analgesia

A

Orthostatic hypotension

47
Q

Major side effect of spinal anesthesia

A

Urinary retention

48
Q

Benefit of epidural analgesia

A

You get the analgesia without the decreased cough reflex

49
Q

Major side effect of inhalation anesthesia

A

Hypotension

50
Q

Examples of nondepolarizing muscle blockers

A

Vecuronium, Pancuronium

51
Q

Depolarizing muscle blocker

A

Succinylcholine

52
Q

Labs used to evaluate acute abdomen

A
  • CBC with differential
  • Chem-10
  • Amylase
  • Type and screen
  • Urinalysis
  • LFTs
  • Beta hCG
53
Q

What does a “left shift” indicate?

A

Inflammatory response

54
Q

How can you rule out free air on x-ray if the patient cannot stand

A

Left lateral decubitus position

Make sure it’s left so the air will collect over the liver - that way, it won’t get confused with the gastric bubble

55
Q

Classic diagnosis for “abdominal pain out of proportion to exam”

A

Mesenteric ischemia

56
Q

Classic diagnosis for hypotension and a pulsatile abdominal mass

A

Ruptured AAA

57
Q

Classic diagnosis for Fever, LLQ pain, and a Change in bowel habits

A

Diverticulitis

58
Q

Imaging of choice for cholelithiasis

A

U/S

59
Q

Imaging of choice for bile duct obstruction

A

U/S

60
Q

Imaging of choice for mesenteric ischemia

A

Mesenteric angiogram

61
Q

Imaging of choice for an AAA

A

Abdominal CT or U/S

62
Q

Imaging of choice for an abdominal abscess

A

Abdominal CT

63
Q

Imaging of choice for severe diverticulitis

A

Abdominal CT

64
Q

Classically, what endocrine problems can cause abdominal pain?

A
  • Addisonian crisis

- DKA

65
Q

Boundaries of Hesselbach’s triangle

A
  • Inferior epigastric vssels
  • Inguinal ligament
  • Lateral border of the rectus sheath
66
Q

What attaches the testicle to the scrotum?

A

The gubernaculum

67
Q

Does a femoral hernia travel down the femoral can medial or lateral to the femoral vessels?

A

Medial

68
Q

During ATLS, how and when should the patient history be obtained?

A

While completing the primary survey

69
Q

In addition to the airway, what must be considered during the airway step of ATLS?

A

Spinal immobilization

70
Q

What’s the quickest way to test for an adequate airway in an alert patient?

A

If the patient can speak, the airway is intact

71
Q

Flail chest (define)

A

Two separate rib fractures in 3 or more consecutive ribs

72
Q

What’s the major cause of respiratory compromise with flail chest?

A

Underlying pulmonary contusion

73
Q

Kussmaul’s sign

A
  • Present with cardiac tamponade

- JVD with inspiration

74
Q

Imaging study used to diagnose cardiac tamponade

A

U/S (ECHO)

75
Q

Indications for emergent thoractomy for hemothorax

A

Massive hemothorax:

  • > 1500 cc of blood on initial placement of chest tube
  • Persistent >200 cc of bleeding via chest tube per hour x4 hours
76
Q

Initial test for adequate circulation

A

Palpation of pulses

  • If radial pulse, systolic BP at least 80
  • If femoral or carotid pulse, systolic BP at least 60
77
Q

What comprises a complete assessment of circulation?

A
  • HR
  • BP
  • Peripheral perfusion
  • Urinary output
  • Mental status
  • Cap refill
  • Exam of skin (make sure it’s not cold or clammy)
78
Q

Which patients may not mount a tachycardic response to hypovolemic shock?

A
  • Those with concomitant spinal injury
  • Those on beta blockers
  • Conditioned athletes
79
Q

What is the trauma resuscitation fluid of choice? Why?

A
  • Lactated ringer’s

- Isotonic and the lactate helps buffer the hypovolemia-induced metabolic acidosis

80
Q

How is gastric decompression achieved with maxillofacial fracture?

A
  • NOT with an NG tube because it may perforate cribiform plate
  • Must use an oral-gastric tube (OGT)
81
Q

Normal glasgow coma scale score

A

15

82
Q

Glasgow coma scale score for a dead person

A

3

83
Q

Glasgow coma scale score for a patient in a coma

A

=< 8

84
Q

Why look in the ears of a trauma patient?

A

Hemotypanum and otorrhea are signs of basilar skull frature

85
Q

What does subcutaneous air indicate until proven otherwise?

A

Pneumothorax

86
Q

Common trauma labs

A
  • CBC
  • Chemistry
  • Amylase
  • LFTs
  • Lactic acid
  • Coagulation studies
  • Type and crossmatch
  • UA
87
Q

How will the Hct change after an acute massive hemorrhage?

A

It won’t! No time to equilibrate

88
Q

MC radiographic finding with thoracic aortic injury

A

Widened mediastinum

89
Q

Gold standard imaging study done to rule out/rule in a thoracic aortic injury

A

Thoracic arch aortogram

90
Q

MC site of thoracic aortic traumatic tear

A

Just distal to the take-off of the left subclavian artery

91
Q

What diagnostic test is the test of choice for evaluation of the unstable patient with blunt abdominal trauma?

A

FAST (Focused Assessment with Sonography for Trauma)

92
Q

What is the indication for DPL (Diagnostic peritoneal lavage) or FAST (Focused Assessment with Sonography for Trauma)?

A

Unstable vital signs (hypotension)

93
Q

What is the indication for abdominal CT scan in blunt trauma?

A

Normal vital signs with abdominal pain/tenderness

94
Q

Where should the DPL catheter be placed in a patient with a pelvic fracture?

A

Above the umbilicus

95
Q

What must be placed before a DPL is performed?

A

NG tube and Foley to remove the stomach and bladder from the “line of fire”

96
Q

What injuries does CT scan miss?

A

Small bowel injuries and diaphragm injuries

97
Q

What injuries does DPL miss?

A

Retroperitoneal injuries

98
Q

3-for-1 rule for treating traumatic hypovolemic shock

A

3 L of crystalloid (LR) is required for every 1 L of blood loss

99
Q

What is the brief history taken during ATLS?

A

“AMPLE”

  • Allergies
  • Medications
  • PMH
  • Last meal
  • Events leads up to the injury
100
Q

Most important “test” to order for a trauma patient

A

Type and cross

101
Q

What is the “lethal triad” in a trauma patient?

A

-Acidosis
-Coagulopathy
-Hypothermia
Think “ACHe”

102
Q

What findings on abdominal/pelvic CT scan require exploratory lap in the blunt trauma patient with normal vital signs?

A
  • Free air

- No solid organ injury but lots of free fluid

103
Q

Why are alkali burns more serious?

A

The body can’t buffer the alkali, thus allowing it to burn for longer

104
Q

Tx for myoglobinuria

A
  • Hydration with IVF
  • Alkalinization of the urine with IV bicarb
  • Mannitol diuresis
105
Q

Tissue involved in a 2nd degree burn

A

Epidermis and varying levels of the dermis

106
Q

Tissue involved in a 3rd degree burn

A

Epidermis and the entire dermis

107
Q

Tissue involved in a 4th degree burn

A

Epidermis and entire dermis, with injury down into the bone or muscle

108
Q

Major clinical difference between 2nd and 3rd degree burns

A

2nd degree are painful, 3rd degree are painless

109
Q

Difference between autograft and allograft

A

Autograft - from patient’s own skin

Allograft - from a cadaver

110
Q

Diagnostic imaging used for smoke inhalation

A

Bronchoscopy

111
Q

What lab value assess smoke inhalation

A

Carboxyhemoglobin

Surgery Clerkship (4 decks)

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