Surg Flashcards
pre-op eval: what are 2 cardiac contraindications for surg?
- EF <35%
- MI in past 6mo
pre-op eval: what classification can be used to determine cardiac risk?
Goldman Index
pre-op eval: what 5 systems are reviewed?
- cardiac
- pulm
- hepatic
- nutrition
- metabolic
pre-op eval –> pulm risk: when should pt undergoing surg stop smoking?
8wk
pre-op eval: how determine hepatic risk?
Child-Pugh score:
- bili
- albumin
- PT/INR
- encephalopathy
- ascites
definition of malnutrition
- weight loss >20% in past few mo
- albumin <3
- anergy to skin antigens
pre-op eval –> malnutrition: when start vigorous nutritional support?
10 days
pregnant patient –> trauma –> what position?
left lat decubitus
2nd-3rd trimester pregnant patient –> trauma –> what position?
left lat decubitus
2nd-3rd trimester pregnant patient –> trauma –> should be placed in left lat decubitus –> why?
to prevent positional hypotension from aortocaval compression from enlarged uterus
epidural hematoma –> MC mechanism of injury?
trauma to side of head
epidural hematoma –> presentation
LOC –> lucid interval –> general decreasing mental function –> coma
epidural hematoma –> possible complication
uncal herniation
epidural hematoma –> uncal herniation –> presentation
- ipsilat fixed dilated pupil
- contralat hemiparesis
what kind of intracranial bleed is more commonly found in elderly?
subdural hematoma
epidural hematoma –> shape on CT?
football
subdural hematoma –> acute –> no midline shift –> tx?
decrease ICP
epidural hematoma –> tx?
craniotomy
subdural hematoma –> tx: decrease ICP –> how?
- elevation
- hyperventilation
- mannitol
subdural hematoma –> shape on CT?
crescent
MVA –> car struck at angle –> car spin –> patient in coma –> what condition?
diffuse axonal injury
diffuse axonal injury –> pathophys?
angular trauma –> shear axon fibers
diffuse axonal injury –> what is seen on MRI?
blurring of grey-white matter
playing sports –> head trauma –> LOC & retrograde amnesia –> what condition?
concussion
subdural hematoma –> chronic –> tx?
craniotomy
ant vs posterior shoulder dislocation –> which is more common?
ant
ant shoulder dislocation –> presentation
- shoulder pain
- arm: slight abduct, ext rot
ant shoulder dislocation –> can injure what nerve
axillary N
ant shoulder dislocation –> axillary N injury –> presentation
loss of sensation in shoulder badge distribution
posterior shoulder dislocation –> can injure what vessels?
axillary & subclavian arteries
mid-shaft fx of humerus –> can injure what nerve?
radial N
low serum ceruloplasmin –> found in what condition
Wilson’s disease
Wilson’s disease –> TX? MOA?
penicillamine –> complex w copper –> excrete in urine –> stop progression of disease
43F –> total abd hysterectomy –> several hours later –> R eye –> photophobia, conjunctival injection, small watery discharge –> vision intact
what condition
corneal abrasion
corneal abrasion after surgery –> pathophys
- intraoperative: something brush the open eye
- postoperative: patient rub eye when awaken from anesthesia
corneal abrasion after surgery –> tx
prophylaxis w broad-spectrum abx drop
corneal abrasion after surgery –> dx
slit lamp
AAA –> 3.8cm –> next step
monitor yearly with US
AAA –> recommend surgery at what diameter?
> 5.5cm
AAA –> what diameter can be monitored yearly with US?
3-4cm
AAA –> 4 to 5.5cm –> next step
monitor q6month with US
patient undergoing TAH+BSO –> during operation, how can assess for damage to ureters?
IV indigo carmine injection
4vessel CABG –> 2wk f/u visit –> c/o LLE swelling –> no fever, SOB, ambulating well
what condition?
harvest greater saphenous vein for CABG –> decreased venous return –> unilat leg swell
burn to head
total surface body area?
9%
burn to arm
total surface body area?
9%
burn to chest
total surface body area?
18%
burn to back
total surface body area?
18%
burn to leg
total surface body area?
18%
burn to head (infant)
total surface body area?
18%
burn to arm (infant)
total surface body area?
9%
burn to chest (infant)
total surface body area?
18%
burn to back (infant)
total surface body area?
18%
burn to leg (infant)
total surface body area?
13.5%
burn patient –> how calculate maintenance fluids?
Parkland formula:
total fluids for 24hr = 4ml x kg x TBSA%
first 8 hr: administer half total
next 16hr: administer rest
closed angle glaucoma –> dilated pupil –> reactive or nonreactive?
nonreactive
closed angle glaucoma –> tx
- relieve pressure: laser –> hole in eye
- constrict pupil: a-agonist + BB
closed angle glaucoma –> what medication is contraindicated?
atropine
periorbital cellulitis vs orbital cellulitis –> differentiate in presentation
periorbital –> can mv eye
orbital –> cannot move eye
eye inflamed and swollen –> cannot move eye –> next step
CT
“curtain” over vision –> dx?
- retinal detachment
- retinal artery occlusion (amaurosis fugax)
what typically causes retinal detachment?
- trauma (MVA)
- HTN crisis
retinal detachment –> tx
spot-weld laser
retinal artery occlusion –> pathognomonic finding on fundoscopy?
cherry red spots on fovea
retinal artery occlusion –> tx
intra-arterial TPA
retinal artery occlusion –> alternate tx
if can’t TPA –> vasodilation:
- global pressure
- hyperventilation
chronic progress loss of central vision –> peripheral vision intact
dx?
macular degeneration
posterior epistaxis –> what blood vessel?
maxillary A –> sphenopalatine A
POD#1-2 –> fever
dx?
PNA
POD#3-5 –> fever
dx?
UTI
POD#5-7 –> fever
dx?
surgical site infect
POD#4-6 –> fever
dx?
DVT/PE
POD#7+ –> fever
dx?
medication
burn patient –> what IVF?
LR
