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COMLEX 3 > Surg > Flashcards

Surg Flashcards

1
Q

pre-op eval: what are 2 cardiac contraindications for surg?

A
  • EF <35%

- MI in past 6mo

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2
Q

pre-op eval: what classification can be used to determine cardiac risk?

A

Goldman Index

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3
Q

pre-op eval: what 5 systems are reviewed?

A
  • cardiac
  • pulm
  • hepatic
  • nutrition
  • metabolic
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4
Q

pre-op eval –> pulm risk: when should pt undergoing surg stop smoking?

A

8wk

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5
Q

pre-op eval: how determine hepatic risk?

A

Child-Pugh score:

  • bili
  • albumin
  • PT/INR
  • encephalopathy
  • ascites
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6
Q

definition of malnutrition

A
  • weight loss >20% in past few mo
  • albumin <3
  • anergy to skin antigens
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7
Q

pre-op eval –> malnutrition: when start vigorous nutritional support?

A

10 days

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8
Q

pregnant patient –> trauma –> what position?

A

left lat decubitus

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9
Q

2nd-3rd trimester pregnant patient –> trauma –> what position?

A

left lat decubitus

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10
Q

2nd-3rd trimester pregnant patient –> trauma –> should be placed in left lat decubitus –> why?

A

to prevent positional hypotension from aortocaval compression from enlarged uterus

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11
Q

epidural hematoma –> MC mechanism of injury?

A

trauma to side of head

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12
Q

epidural hematoma –> presentation

A

LOC –> lucid interval –> general decreasing mental function –> coma

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13
Q

epidural hematoma –> possible complication

A

uncal herniation

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14
Q

epidural hematoma –> uncal herniation –> presentation

A
  • ipsilat fixed dilated pupil

- contralat hemiparesis

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15
Q

what kind of intracranial bleed is more commonly found in elderly?

A

subdural hematoma

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16
Q

epidural hematoma –> shape on CT?

A

football

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17
Q

subdural hematoma –> acute –> no midline shift –> tx?

A

decrease ICP

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18
Q

epidural hematoma –> tx?

A

craniotomy

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19
Q

subdural hematoma –> tx: decrease ICP –> how?

A
  • elevation
  • hyperventilation
  • mannitol
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20
Q

subdural hematoma –> shape on CT?

A

crescent

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21
Q

MVA –> car struck at angle –> car spin –> patient in coma –> what condition?

A

diffuse axonal injury

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22
Q

diffuse axonal injury –> pathophys?

A

angular trauma –> shear axon fibers

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23
Q

diffuse axonal injury –> what is seen on MRI?

A

blurring of grey-white matter

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24
Q

playing sports –> head trauma –> LOC & retrograde amnesia –> what condition?

A

concussion

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25
Q

subdural hematoma –> chronic –> tx?

A

craniotomy

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26
Q

ant vs posterior shoulder dislocation –> which is more common?

A

ant

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27
Q

ant shoulder dislocation –> presentation

A
  • shoulder pain

- arm: slight abduct, ext rot

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28
Q

ant shoulder dislocation –> can injure what nerve

A

axillary N

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29
Q

ant shoulder dislocation –> axillary N injury –> presentation

A

loss of sensation in shoulder badge distribution

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30
Q

posterior shoulder dislocation –> can injure what vessels?

A

axillary & subclavian arteries

31
Q

mid-shaft fx of humerus –> can injure what nerve?

A

radial N

32
Q

low serum ceruloplasmin –> found in what condition

A

Wilson’s disease

33
Q

Wilson’s disease –> TX? MOA?

A

penicillamine –> complex w copper –> excrete in urine –> stop progression of disease

34
Q

43F –> total abd hysterectomy –> several hours later –> R eye –> photophobia, conjunctival injection, small watery discharge –> vision intact

what condition

A

corneal abrasion

35
Q

corneal abrasion after surgery –> pathophys

A
  • intraoperative: something brush the open eye

- postoperative: patient rub eye when awaken from anesthesia

36
Q

corneal abrasion after surgery –> tx

A

prophylaxis w broad-spectrum abx drop

37
Q

corneal abrasion after surgery –> dx

A

slit lamp

38
Q

AAA –> 3.8cm –> next step

A

monitor yearly with US

39
Q

AAA –> recommend surgery at what diameter?

A

> 5.5cm

40
Q

AAA –> what diameter can be monitored yearly with US?

A

3-4cm

41
Q

AAA –> 4 to 5.5cm –> next step

A

monitor q6month with US

42
Q

patient undergoing TAH+BSO –> during operation, how can assess for damage to ureters?

A

IV indigo carmine injection

43
Q

4vessel CABG –> 2wk f/u visit –> c/o LLE swelling –> no fever, SOB, ambulating well

what condition?

A

harvest greater saphenous vein for CABG –> decreased venous return –> unilat leg swell

44
Q

burn to head

total surface body area?

A

9%

45
Q

burn to arm

total surface body area?

A

9%

46
Q

burn to chest

total surface body area?

A

18%

47
Q

burn to back

total surface body area?

A

18%

48
Q

burn to leg

total surface body area?

A

18%

49
Q

burn to head (infant)

total surface body area?

A

18%

50
Q

burn to arm (infant)

total surface body area?

A

9%

51
Q

burn to chest (infant)

total surface body area?

A

18%

52
Q

burn to back (infant)

total surface body area?

A

18%

53
Q

burn to leg (infant)

total surface body area?

A

13.5%

54
Q

burn patient –> how calculate maintenance fluids?

A

Parkland formula:
total fluids for 24hr = 4ml x kg x TBSA%

first 8 hr: administer half total
next 16hr: administer rest

55
Q

closed angle glaucoma –> dilated pupil –> reactive or nonreactive?

A

nonreactive

56
Q

closed angle glaucoma –> tx

A
  • relieve pressure: laser –> hole in eye

- constrict pupil: a-agonist + BB

57
Q

closed angle glaucoma –> what medication is contraindicated?

A

atropine

58
Q

periorbital cellulitis vs orbital cellulitis –> differentiate in presentation

A

periorbital –> can mv eye

orbital –> cannot move eye

59
Q

eye inflamed and swollen –> cannot move eye –> next step

A

CT

60
Q

“curtain” over vision –> dx?

A
  • retinal detachment

- retinal artery occlusion (amaurosis fugax)

61
Q

what typically causes retinal detachment?

A
  • trauma (MVA)

- HTN crisis

62
Q

retinal detachment –> tx

A

spot-weld laser

63
Q

retinal artery occlusion –> pathognomonic finding on fundoscopy?

A

cherry red spots on fovea

64
Q

retinal artery occlusion –> tx

A

intra-arterial TPA

65
Q

retinal artery occlusion –> alternate tx

A

if can’t TPA –> vasodilation:

  • global pressure
  • hyperventilation
66
Q

chronic progress loss of central vision –> peripheral vision intact

dx?

A

macular degeneration

67
Q

posterior epistaxis –> what blood vessel?

A

maxillary A –> sphenopalatine A

68
Q

POD#1-2 –> fever

dx?

A

PNA

69
Q

POD#3-5 –> fever

dx?

A

UTI

70
Q

POD#5-7 –> fever

dx?

A

surgical site infect

71
Q

POD#4-6 –> fever

dx?

A

DVT/PE

72
Q

POD#7+ –> fever

dx?

A

medication

73
Q

burn patient –> what IVF?

A

LR

COMLEX 3 (17 decks)

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