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STEP 2 > Surgery > Flashcards

Surgery Flashcards

0
Q

LGIB >40 most common cause

A

Diverticulosis

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1
Q

Upper go bleeding surgical indications

A

6 or more units of blood in first 24hrs Re bleed with maximal therapy Esophageal varicies despite measures-> TIPS Perforation Gastric outlet obstruction

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3
Q

Sbo cause

A

Adults adhesions Kids hernia

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4
Q

Progressive dysphagia dx step

A

carcinoma: barium swallow, endocsopy is diagnostic but you have to do barium first to prevent perf

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5
Q

Complication of ileum resection

A

hyperoxaluria=>nephrolithiasis

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6
Q

Hypomagnesium cause and manifestation

A

malnourshed or large GI loses Similar to hypocalcium: parasthesia, hyperreflexia, tetany ECG differentiates between hypomag vs hypocalc long QT Pr, st depression, inverted p, torsades

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7
Q

PVD preop testing

A

pharm stress test, stress test adequate for CAD but he cant exercise b/c PVD

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8
Q

HIT manifestation and tx

A

POD 5 platelets down 50% or <100,000 Stop heparin, start direct thrombin inhibitor(lepirudin, argatroban) convert to warfarin if needed

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9
Q

Low cardiac output state=>sudden epigastric pain

A

Acute mesenteric Ischemia peritoneal signs=> lap w/o peritoneal signs=> angiography

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10
Q

factors preventing Fistula closure

A

FRIENDS foreign body Radiation Inflammation Epithelialization of the tract Neoplasm Distal obstruction Steroids

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11
Q

Severe Hemophilia A surgery control

A

DDAVP + AMICAR(e-aminocarproic acid) inhibitor of fibrinolysis can also use cryoprecipitate or VIII concentrate

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12
Q

stress fraction for calculating cal needs

A

starvation .9 post op 1.1 organ failure 1.5 >50% body burns 2.0x

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13
Q

Goldman’s risk assessment

A

S3 gallop or JVD 11

MI within 6 months 10

>5PVC’s/min 7

Non sinus rhythm or SR with APC’s on ECG 7

Age > 70 5

>25 class IV 22% risk

13-25 class III 11% risk

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14
Q

Cardiac pre-op assessment

A

<35 no cardiac hx = ECG cardiac hx or old = ECG + stress or ECHO

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15
Q

Antibiotic proph

A

Cefazolin

Colorectal/Appendectomy: Cefoxitin or Cefotetan

Urologic: Cipro

ENT: Cefazolin or clinda and gent

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16
Q

Most common cause of fever within 24 hours

A

Atelectasis macrophage mediated, reduced by early ambulation, spiro tx

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17
Q

Wells’ PE Criteria

A

signs and symptoms 3 alternative dx less likely 3 tachy>100 1.5 Immobilization or surgery in the previous four weeks 1.5 Previous DVT or PE 1.5 Hemoptysis 1.0 Malignancy 1.0 >6 66.7% 2-6 20.5%

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18
Q

SSI bacteria

A

abdomen: G- or anaerobes ENT: Strept All others: Staph

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19
Q

Post op fever

A

Wind (Atelectasis) Water (UTI) Wound Walking (PE) Wonder Drugs

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20
Q

Shift curve to right(O2 unloading)

A

Acidosis(hypovent->PCO2 up), hypertherm, DPG(chronic hypoxia)

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21
Q

shift curve to left(decrease unloading)

A

Alk, hypotherm, low DPG(banked blood)

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22
Q

Hypo Shock Stages

A

I - <15% 750

II - 15-30% 750-1500 - tachy(1st(, tachypnea, tilt, oliguria,

III - 30-40% (1500-2000) - hypotension

IV - 40% bad

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23
Q

Neurogenic Shock tx

A

loss of sympathetic tone and loss of reflexive tachy

Fluid resusitation followed by dobutamine or phenylephrine

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24
Q

Fam hx of prolonged prolonged anesth paralysis

A

pseudocholinesterase deficiency

avodi succinylcholine and mivacurium

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25
Q

Post op resp acid, hypoxemia, hypercarbia

A

hypercarb is diagnostic of alveolar hypoventilation

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26
Q

diaphramatic rupture dx

A

air fluid level in left lower chest with NG tube in it

27
Q

Hormone elevated after trauma

A

Insulin but net effect is hyperglycemia due to increased insulin resistance peripherally

28
Q

Knee dislocation concern and workup

A

popliteal artery injury due to extreme force required

Ankle Brachial index

If <.9 do an angiogram

29
Q

Bladder injury management

A

Extraperitoneal: Catheter Drainage with repeat imaging

fix if doing surgery for something else

Intraperitoneal: surgery

30
Q

Splenic trauma reasons for surgery

A

Peritoneal signs

Hemo unstable

Degree of spenic damage doesnt matter

31
Q

Positive DPL

A

>10cc blood

>100,000 RBC/ul

>500 WBC/ul

elevated amylase

bilirubin

alk phos

32
Q

kid resusitation

A

20cc/kg bolus

repeat if no response

transfuse

33
Q

hemothorax thoracotomy indication

A

1500 cc initial

200cc/hr for 4 hrs

Thoracic vessel injury

Esophogeal injury

Decompensation after initial stabilization

34
Q

Acute hyperparathyroidism managment

A

vigorous IV hyrdration

then lasix

then resection of adenomas

35
Q

Pheo preop managment

A

a-block phenoxybenzamine 1-3 weeks before surgery

36
Q

breast cancer pregnant

A

surgery without sentinal lymph node due to radiation

37
Q

thryoid storm prevention and tx

A

preop lugol iodine solution 10 days before or PTU or Methamizole

fluid, antithyroid drugs, bb’s, iodine solution and steroids

38
Q

hyperparathyroid xray finding

A

osteitis fibrosa cystica

39
Q

ITP tx

A

steroids <30000

splenectomy if ineffective

40
Q

surgical tx of upper gi bleed

A

6 units of blood in 24 hrs

esophageal bleeding despite medical man: do TIPS

Perforation

Gastic outlet obstruction

41
Q

CRC staging

A

Stage 0 Tis N0 M0 mucosa; cancer-in-situ
Stage I T1-2 N0 M0 T1:invades submucosa or invades muscularis propria
Stage II-A T3 N0 M0 T3: Tumor invades subserosa or beyond (without other organs involved)
Stage II-B T4 N0 M0 T4: Tumor invades adjacent organs or perforates the visceral peritoneum
Stage III-A T1-2 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T1 or T2.
Stage III-B T3-4 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4.
Stage III-C any T, N2 M0 N2: Metastasis to 4 or more regional lymph nodes. Any T.
Stage IV any T, any N, M1 M1: Distant metastases present. Any T, any N.

42
Q

Cholangitis man

A

IV antibiotics and fluids, fail? => ERCP, fail? => T tube

43
Q

Chronic Pancreatitis dx

A

ERCP is most accurate

44
Q

insulinoma tx

A

resection

45
Q

epidermoid cancer of anus tx

A

chemoradiation

46
Q

volvulus tx

A

Sigmoid: reduced with enema or scope then eventually surgery

Cecal: Surgery

47
Q

acute pancreatitis after tx complication and tx

A

pseudocyst

If stays for >6 weeks Drain if >6cm

48
Q

carcinoid found on appendectomy tx

A

Right Hemicolectomy if >1-2cm or involve the base

49
Q

liver

hemangioma

adenoma tx

A

hemangioma: resect if symptomatic
adenoma: stop OCP’s if it doesnt go away take it out

50
Q

normal common bile duct size

A

3mm

1.0cm is big

51
Q

succinylcholine sfx

A
52
Q

kidney stones needing a procedure

A

>5mm

53
Q

glascow coma scale

A

4 eyes, jackson 5, 6 cylinder motor, 7 intubate

Eye Opening (E)

4 = spontaneous
3 = to voice
2 = to pain
1 = none

Verbal Response (V)

5 = normal conversation
4 = disoriented conversation
3 = inappropriate words
2 = no words, only sounds
1 = none

Motor Response (M)

6 = normal
5 = localized to pain
4 = withdraws to pain
3 = decorticate posture 
2 = decerebrate
1 = none
54
Q

mailig hypertherm tx

A

stop anesthesia, 100% o2 hypervent, dantroline, alkanalyse urine

55
Q

eosinophilia following angiography

A

cholesterol embolysm

56
Q

VTE tx

A

heparin->coumadin

filter for recurrence with tx

thrombolytic if unstable(massive PE)

57
Q

resusitation goals

A

intubate if hypoxic

fluid resus to CVP 8-12

vasopressors to 65 MAP norepi, dopamine

58
Q

NO sfx

A

distended loops of bowel

59
Q

Pancuronium sfx

A

neuromuscular blocker: tachycardia

60
Q

Melanoma tx

A

<1mm thick 1cm margin

1-4mm thick 2cm margin + sentinal node biopsy

61
Q

burn formula

A

4ml LR/kg in 24 hrs

1/2 first 8 hours

1/2 next 16 hours

62
Q

ischemic colitis man

A

expectant unless full thckness nec, perf, bleeding

63
Q

hepatic adenoma vs focal nodular hyperplasia

A

remove hepatic adenomas >4cm due to risk of rupture and malig transformation

FNH no treatment neccessary

Adenoma “cold” on Nuc Med, FNH “hot”

STEP 2 (2 decks)

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