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PANCE review > surgery > Flashcards

surgery Flashcards

1
Q

what lab measuring renal function should be done for preop patients over 40?

A

creatinine

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2
Q

who should have their blood glucose tested preop?

A

family hx, personal hx of DM and patient undergoing grafting for peripheral vascular disease

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3
Q

do routine prep labs show a reduction in mortality and morbidy?

A

no, do not do for otherwise healthy individuals

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4
Q

warfarin and dig are known for causing what electrolyte abnormality?

A

K

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5
Q

ECHO are recommended in all patients older than?

A

40

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6
Q

silent MI is most common in what population?

A

elderly and DM

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7
Q

spirometry is recommend to who?

A

thoracic and upper abdominal surgery, smokers and dyspnea

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8
Q

pregnancy test?

A

for all women of child bearing years

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9
Q

H&P identify previous?

A

MI, heart failure, chronic pulmonary dz, dm, peripheral vascular disorders, hepatic or renal impairment

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10
Q

index used to measure cardiac risk?

A

detsky’s modified cardiac risk index or Lee’s

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11
Q

what does Lee’s index look at

A

high risk surgery, coronary artery dz, congestive heart failure, cerebrovascular dz, insulin dependent DM, and elevated serum creatinine >2

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12
Q

what is the best prophylactic blood thinner to use?

A

unfractionated heparin 5,000 units subcutaneouly every 8-12 hours, stop once pt is ambulatory

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13
Q

Enoxaparin is also used what is it?

A

low molecular weight heparin

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14
Q

can warfarin be used

A

yes, once the initial use of heparin has been completed, but dosing is measured via INR (therapeutic dose ranging between 2-3)

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15
Q

what is fondaparinux

A

anticoagulant, good for hip surgery

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16
Q

Greenfield filter prevents clots formed in the lower extremities to migrate, patient who are candidates include?

A

allergic to anticoagulants, trauma (risk of further bleeding), central nervous system procedures

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17
Q

malnourished criteria is

A

lost more than 10% of lean body mass, or has not has adequate intake in 7 days

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18
Q

malnourishment effects many systems including

A

GI atrophy, slow cardiac output, decreased vital capacity, immune system and skin healing

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19
Q

what labs may be abnormal of malnourishment

A

increased creatinine, high lymphocyte count, albumin, transferrin

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20
Q

what is refeeding syndrome?

A

abnormal glucose, lipid metabolism, thiamine deficiency, hypophosphatemia, hypomag, hypo k

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21
Q

how do you avoid refeeding syndrome?

A

limit initial feedings to no more than 20kcal/kg during the first week of feedings

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22
Q

basal energy expenditure

A

harris benedict equation

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23
Q

what is the preferred route of nurtrient replacement

A

enteral route (tube feeding)

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24
Q

are naso or gastro tube better at preventing aspiration

A

gastro

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25
Q

best tube to avoid aspiration and great for pancreatits

A

jejunostomy

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26
Q

what is hyperalimentation

A

Intravenous nutrition

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27
Q

what are the complications of hyperalimentation

A

catheter related problems, hyperglycemia, electrolyte abnormalities

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28
Q

leading cause of death between the age of 1-44

A

unintentional and violence related injuries

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29
Q

leading cause of accidental death

A

MVA (Etoh is involved in over 1/2)

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30
Q

what does the FAST exam look at

A

abdominal cavity for fluid or air, perihepatic, perisplenic, pelvic and pericardial regions

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31
Q

most common reason to intubate in trauma

A

altered mental status

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32
Q

why should open chest wounds never be occluded?

A

can develop a tension pneumo

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33
Q

what does beck’s triad evaluate for

A

cardiac tampondade

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34
Q

what is beck’s triad

A

JVD, hypotension, muffled heart sounds

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35
Q

penetrating trauma and unstable (shock, peritoneal irruption, evisceration, __________is used for dx and tx

A

laparotomy

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36
Q

workup of penetrating flank trauma

A

CT with oral and IV contrast

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37
Q

basilar fracture is associated with what PE findings

A

battle sign, raccoon eyes, rhinorrhea, otorrhea

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38
Q

lucid period with head trauma

A

epidural hematomas

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39
Q

epidural hematomas are usually result from injuring what artery

A

middle meningeal artery

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40
Q

coma, fixed or dilated pupil, and decerebrate posturing +

A

brain herniation

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41
Q

subdural hematomas are injuries to

A

the bridging veins

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42
Q

subdural hematomas are common in

A

eldery, alcoholics and axonal injuries

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43
Q

most common cause of burns

A

scald burns

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44
Q

fluid recommended for burn victims

A

LR

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45
Q

sulfadiazine

A

is the most common used topical burn ointment

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46
Q

white phosphous burn are tx with

A

copper sulfate

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47
Q

hydrofluoric acid burns are tx with

A

30 minutes of lavage, apply calcium gluconate

48
Q

most post op fever is a result of

A

cytokines and will resolve on own

49
Q

five w’s of a post op fever

A

wind, water, wound, walking and wonder drug/whopper

50
Q

the most common W of a post op fever, timeframe and tx

A

wind: complete of parial collapse of lung (atelectasis) usually occurs in the first 24-48 hours. TX: Incentive spirometry, mucolytics, expectorants

51
Q

water (what does it stand for and timeframe) and tx

A

UTI 48-72 hours, most common nosocomial infix, culture and sensitivity and tx with targeted antibiotics

52
Q

wound infection what does it stand for and timeframe) and tx

A

72 hours, most common bug is staph aureus, culture and antibiotics

53
Q

walking ;what does it stand for and timeframe)

A

after 72 hours thrombophlebitis (superficial and deep) DVT
tx: superficial stop IV line use warm compresses. Systemic start staph A and strep antibiotics. Septic thrombophlebitis requires vein stripping (b/c if will behave like an abscess and a make antibiotic penetration difficult

54
Q

wonder drug; what does it stand for and timeframe)

A

drug fever

55
Q

whopper; what does it stand for and timeframe)

A

fever after 1 week. Abscess. Tx is percutaneous drainage or surgical debridement

56
Q

what is still the gold standard for DVT dx

A

venography

57
Q

most effective approach to pressure ulcers

A

prevention

58
Q

necrotizing fasciitis is caused by

A

group A strep, clostridia or salt water is vibrio sp.

59
Q

triad for necrotizing fasciitis

A

elevated WBC, elevated BUN >15 and hyponatremia renal impairment is an hallmark of the dz)

60
Q

most common complication in cholecystecomy?

A

misidentification of hepatic duct system and injury to common bile duct due to heat

61
Q

Lap surgery complications fall into two categories: access complications and pneumoperitoneum including

A

bowel perf with introduction of trochar and cardiac output decrease due to increased systemic circulation

62
Q

most common complication for antireflux surgeries

A

perf of stomach or esophagus

63
Q

complication for inguinal hernia

A

injury to bladder, epigastic vessels and spermatic cord

64
Q

most important post op complication for hernia ingunial

A

recurrence and urinary retention

65
Q

stages of wound healing

A

coagulation and inflammation (platelet activation and migration of WBC) neovasularization and finally proliferation which is the production of collagen

66
Q

define a clean contaminated case?

A

operation of the Respiratory, GI or GU tracts

67
Q

is an inguinal heria case clean, clean contaminated or contaminated

A

clean

68
Q

antibiotic used as a prophases for the majority of clean surgical cases?

A

Cefazolin

69
Q

what does a FEV1 values less than 1 are indicative of?

A

post of pulmonary complications and ventilator dependence

70
Q

75% of gallstones are of what variety is the US

A

mixed stones (cholesterol and calcium) most common in the US

71
Q

difference between cholecystitis and choledocholithiasis

A

choledocholithiasis-is blockage of the common bile duct, thus jaundice will be a symptom.

72
Q

cholangitis is described as

A

common bile duct obstruction, with fever, jaundice, RUQ pain, and leukocytosis

73
Q

describe acute cholecystitis

A

RUQ pain (murphy’s sign), fever, and leukocytosis

74
Q

weight loss, jaundice, midepigastric pain and courvoisier sign, you are thinking?

A

pancreatic carcinoma

75
Q

weight loss, mid-epigastric pain, no jaundice

A

gastric carcinoma

76
Q

US shows thickened gallbladder wall and pericholecystic fluid, these findings point to?

A

acute cholecystitis

77
Q

US shows dilated intrahepatic and extra hepatic ducts

A

dilated ducts = obstruction = choledocholithiasis

78
Q

US shows air in the lumen of the gallbladder

A

acute emphysematous cholecystitis

79
Q

what imaging helps with the location of a gallstone obstruction and the type of pathology?

A

CT

80
Q

what is charcots triad

A

fever, chills, right upper quad pain, and jaundice

81
Q

what is charcots’s triad used for

A

ascending cholangitis

82
Q

if you add hypotension and mental status change you get__________which helps to diagnosis ______

A

Reynolds pentad and ascending cholangitis

83
Q

recurrent biliary colic and confirmed gallstones and tx with ________

A

elective lap surgery

84
Q

what is ranson’s criteria used for?

A

grade the severity of pancreatitis

85
Q

pt has recently recovered from pancreatitis, but continues to have abdominal pain, a mass is found mid epigastric region and his labs continue to show elevated amylase and lipase

A

pancreatic pseudocyst

86
Q

grey turnersand cullen’s sign are associated with

A

acute pancreatitis hemorrhage

87
Q

what is murphy’s sign

A

pain the RUQ associated with inspiratory arrest

88
Q

what is courvoisier sign?

A

palpable contender gallbladder in patient’s with jaundice, (pancreatitis carcinoma)

89
Q

out of the 5 P’s what is the first to present with an acute artery occlusion

A

PAIN, then pins and needles, then pallor

90
Q

3cm firm breast nodule, ovoid in shape and freely moveable —- most likely

A

fibroadenoma (most common benign breast mass)

91
Q

rating of ankle/brachial pulses 1.0 to .3

A

1.0 is normal, 0.7 is consistent with claudication, and 0.3 is associated with pain at rest.

92
Q

what is the most common symptom associated with abdominal pain secondary to chronic intestinal ischemia?

A

fear of eating

93
Q

when staging breast cancer tumors what does T1, T2, T3 mean?

A

T1 5cm

94
Q

what is the most common EMBOLIC source of acute arterial occlusion in the lower extremities

A

atrial fib

95
Q

what are the most common symptoms of Crohn’s disease

A

abdominal pain, weight loss, and diarrhea

96
Q

is bleeding more commonly associated with UC or Crohn’s

A

UC

97
Q

obstipation and failure to pass gas occur with both small bowel obstruction and paralytic ileus how do the bowel sounds differ?

A

ileus-hypo and SBO is high-pitched

98
Q

what is the surgical treatment for achalasia

A

myotomy and pneumatic dilatations

99
Q

what is the medical tx for achalasia

A

CCB and botulinum injection

100
Q

is a lobectomy used more frequently in early or late stage lung cancer?

A

early

101
Q

most common lung cancer

A

adenocarcinoma

102
Q

name 2 absolute contraindications of surgical resection of lung cancer

A

malignant pleural effusion and MI within 3 months

103
Q

relative contraindication of surgical resection

A

FEV1

104
Q

hemorrhoid staging

A
  1. prolapse only with straining
  2. prolapse through anus but reduce spontaneously
  3. must be manually reduced
  4. cannot be reduced
105
Q

cecal distention to 12cm, bowel obstruction: what it the treatment

A

surgical exploration

106
Q

most common cause of small bowel obstruction

A

adhesions

107
Q

most common cause of larger bowel obstruction

A

adenocarcinoma

108
Q

how do you tx acute execration of Crohn’s disease

A

steroids

109
Q

patient has UC and low grade dysplasia

A

do a proctocolectomy with oleo-anal pull through

110
Q

pathologic findings associated with ulcerative colitis

A

95% has rectal involvement

111
Q

skipped lesions and transmural

A

Crohns

112
Q

how are small bowel obstructions managed

A

correct fluid and electrolyte abnormalities, then surgery

113
Q

most common cause of massive lower GI bleeding

A

diverticular dz

114
Q

dukes aster coller is staging system for what type of CA

A

colon

115
Q

staging to colon cancer

A 
A. only mucosal penetration 
B1. penetrate into muscular
B2. penetrate through muscular 
C. into the muscular with nodes
C2 through the muscular with nodes 
D. metastasis

PANCE review (19 decks)

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