sugery- de virgilio Flashcards
elective surgery after MI?
postpone for 4 weeks
-perform stress test at that time
major predictors of adverse cardiac event after elective surgery (4)
within one month:
- MI
- unstable angina
- decomp CHF
- sig arrythmia –> work it up!
order of cardiovascular risk (most to least)
CAD, CHF, TIA/stroke, DM, creatine >2
dresslers syndrome
acute pericarditis following MI
global ST elevation and PR depression
timing of post MI complications
48 hr- arrythmia
5 days - vent septal rupture
weeks- months - dresslers
whatsmore accurate, MUGA or echo?
MUGA! nuc stress test, but more cost prohib
Stanford A
ascending aorta –> involves inominate! can lead to tamp, MI, AI, stroke
urgent OR
Stanford B
invovles descneding aorta
- can involve celiac, renal, common iliacs
- can usually be managed medically unless signs of malperfusion (inc Cr, abd tenderness, dec pulses)
post op R side MI management?
Fluids! help with preload.
avoid nitrates!!
hammon’s crunch post CABG? with inc WBC
acute mediastinitis
equalization of central pressures is associated with what cardiac phenom?
tamponade (blood compresses heart and decreases diastolic filling volume)
t/f: Type A aortic dissection can present as acute MI
true.
thrombolysis is a big nono. Check for wide mediastinum on CXR
beta blockade or alpha blockade before pheo surgery?
ALPHA for10-14 days
beta can cause unopposed alpha blockade and precip HTN crisis
percutaneous bx for adrenal mass?
NO. no histo markers specific and risk seeding
what is the indication/ rec for adrenal tumor resection?
> 6cm
OPEN to get margins if malig is expected
moth eaten appearance on xray
osteitis fibrosa cystica
PTH overload, inc bone pain, inc fractures
management of adrenal incidentaloma <6cm?
blood tests for hormonal activity
-24 hour urine for cats, cortisol, sodium
name some causes of hypercalcemia
malignancy
paget’s
immobility
thiazides
MEN2a
pheo –> plasma metanephrines, chromogranin A
hyperPTH
medullary thyroid–> Calcitonin
raise in BP and temp following induction of surgery. Ddx? Differentiate
pheo–> pressure INC with beta blocker (unopposed alpha)
malig hyperthermia –> inc temp, inc pressure, inc etCO2 –>dantrolene
thyrotoxicosis –> inc pressure that responds to beta blockade
thryoglossal duct cyst vs branchial. Which elevates?
thyroglossal
remove bc can cause recurrent infx
how do you assess for metastatic pheo
metastasis in areas normally devoid of chromograffin tissue
neck mass FNA?
> 1cm
feared complication of thyroidectomy within 24 hours?
hematoma –> compresses airway
open and evacuate hematoma at bedside, securing airway via ETT may be difficult
superior laryngeal nerve can be damaged when mobilizing thyroid which could effect…..
singing
**cutting one rec laryngeal would cause hoarseness, cutting both could cause need for trach
indications for parathyroidectomy
- CA >1 overnormal
- CrCl<60
- T score
chole liks sx in trauma patient? tx?
acalculous cholecystitis
abx, percutaenous cholecystostomy if can’t tolerate lap chole
lab values seen in gallstone pac?
elevated ALT, amylase
nutrition for someone with complicated pancreatitis past 5-7 days?
enteral feeding via NJ past LOT
what should you test in white drainage after whipple?
amylase.
if pos, make pt NPO
porcelian galbladder mgmt?
get it out
management of bloody diarrhea and LLQ pain after descending aortic aneurysm repair?
ischemic colitis –> risk bc IMA is occluded during surgery
dx: flex sig–> friable mucosa
tx: IV abx, IVF
FAP colon cancer risk/ screening
100% cancer by age 50
flex sig start at age 10 –> colectomy as soon as polyp arises.
colon cancer screening in UC
begin colonoscopy 8 years after dx with RANDOM BIOPSIES
biggest complication of sphincterotomy?
fecal incontinence
ogilve’s syndrom
colonic psuedo obstruction
who: old, demented, bedridden patients with recent surgery and opiates
dx: xray will NOT show signs of obs
tx: remove drugs, replacelytes, decompress with COLONOSCOPY AND NEOSTIGMINE
cecum is most likely to rupture
cecal vs sigmoid volvulus. which requires urgent colectomy?
cecal –> failure to adhere to R colon
cannot be decompressed with scope
t/f: smoking falsely elevates CEA?
yes, 4 hours before testing
CEA used for colon cancer tx progress
most common cause of appendicitis in adults vs kids
adults= fecalith
kids= lymphoid hyperplasia (think recent viral illness)
