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3rd Year > Surgery > Flashcards

Surgery Flashcards

1
Q

Epidural, what moving through?

A

supraspinous ligament -> interspinous ligament -> ligamentum flavaum (inside)

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2
Q

Epidural, what layer provides the most drug resistance?

A

Arachnoid mater provides about 90% of resistance to drug migration into CNS

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3
Q

folds of small intestine =?

A

valvulae conniventes (also called plicae circulares) are thin, circular, folds of mucosa, some of which are circumferential

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4
Q

decubitus

A

the posture of lying down

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5
Q

lipodermatosclerosis

A

tapering of legs due to underlying inflammation and contraction of subcutaneous fat

found in venous stasis (cvi = chronic venous insufficiency)

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6
Q

SIRS criteria
sepsis
septic shock

A 
SIRS
2 or more
Temp   >38.5 (101.3) or  90
RR > 20   
WBC  >12,000, 10%band's

Sepsis = SIRS criteria with evidence of infection

Severe Sepsis = SIRS with hypotension

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7
Q

what bacterial growth is cutoff for skin graft?

A

10^5th organism per gram of tissue

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8
Q

postop ileus

when PO

A

up and moving = gum

  • > clear liquid
  • > liquid diet
  • > gas/stool = normal diet.
  • move steadily along every day unless fails with N/V.
  • physiologic ileus: stomach =24hr, small intestine = 24-48, Colon =48-72hrs. Colectomy/hemicolectomy avg is more like 5 days.
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9
Q

pneumatosis

A

gas within the wall of small or large intestine

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10
Q

pseudomyxoma peritonei (PP)

A

The term pseudomyxoma peritonei refers to the accumulation of mucin within the peritoneal cavity.
mucinous adenocarcinomas that have seeded peritoneum

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11
Q

Preoperative withholding of foods time frames

A

> =2hrs clear liquids
=6hrs solid food, up to 8 if greasy/large meals
=4hrs for breast milk
=6hrs formula feeding

*A clear liquid includes water, coffee, or tea without dairy; clear fruit juice without pulp; and clear carbonated beverages.

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12
Q

Blood volume/kg

A

77, round to 70?

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13
Q

serious blood pressure changes when?

A

30-40% EBL, 1.5-2L

can lose about 1L without noticing much change

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14
Q

prerenal acute renal failure (azotemia

BUN:Cr

A

Decreased flow to kidney

oliguria, decreased GFR, azotemia -renin release -> aldosterone -> na and BUN reabsorbed

BUN:Cr > 15-20
FeNA 500

NORMAL BUN: Cr 15, or 10-15ish

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15
Q

postrenal acute renal failure

BUN:Cr

A

blockage of kidney outflow

decrease GFR, azotemia, oliguria

early; increased tubular pressure -> BUN back into blood
BUN:Cr >15, FeNa 500

as dmg continues
BUN resorb decreases- BUN:Cr 1%
Urine Osm

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16
Q

intrarenal azotemia

A

**most common cause of acute renal failure

Acute tubular necrosis (ischemic or toxic). injury to tubules
granular casts, poor resorption
BUN:Cr 2%
Urine Osm >500

=> hyperkalemia and metabolic acidosis

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17
Q

Left shift =

A

Neutropenia with bands >700/microL

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18
Q

shock

A

any state that causes perfusion inadequate to meet the oxygen and nutrient demand of supplied tissues

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19
Q

when does post-operative atelectasis peak?

how long does it last?

A

peak POD 2, lasts up to 5 days

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20
Q

winters formula

A

pCO2 = 1.5xBicarb+8 +-2

*in the winter you change your breathing (it’s cold) because of the shit around you

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21
Q

what is the MINIMUM recommended duration of quitting cigarettes prior to surgery

A

8 weeks: helps reduce complications, including pulm complications like atelectasis

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22
Q

compartment syndrome

s/s and at what pressure?

A 
pain out of proportion
pain with passive flexion
paresthesia
pulselessness
pallor
compartment pressure >30mmHg or delta pressure (diastolic - compartment pressure
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23
Q

What mg prednisone is not associated with HPA axis suppression?

A
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24
Q

the W’s

A

Atelectasis arises POD 1-5. often with fever.

25
Q

When is BiCarb recommended for lactic acidosis?

A

Not until pH

26
Q 
post-op fever
first hours
first week
first month
>month
A

Fever above 38ºC (100.4ºF) is common in the first few days after major surgery [1,2]. Most early postoperative fever is caused by the inflammatory stimulus of surgery and resolves spontaneously

IMMEDIATE
first hours is usually non-infectious
-Fever due to the trauma of surgery usually resolves within two to three days.
-(rare) malignant hyperthermia (usually within 30min of anesthetic agent)
-rxn to trauma and meds or preexisting infection

ACUTE
first week may be surgically acquired but more often UTI's (if caths in place) or pneumonia
-C. Diff
-atelectasis
-DVT

SUBACUTE
2-4weeks, usually SSI (surgical site infection)

DELAYED
>1month more indolent organism SSI

27
Q

5W’s post-op fever

A

Wind: atelectasis and or pneumonia POD1-2
WATER: UTI POD 3-5
WEINS (Veins): DVT’s or PE. POD 5-7
WOUND: POD7+ SSI

What did we do? = everything else
1,3,5,7

28
Q

Respiratory Quotient definition

And # for

Carbohydrate
Protein
Lipids

Normal body

A

RQ is the CO2/O2 release/uptake

Pure
Carbs= 1.0
Protein= 0.8
Fatty Acids = 0.7

Body normal is around 0.8
This is useful with ventilated pts as too much CO2 can make it difficult to wean

29
Q

What is PAO2 sea lvl?

Normal A-a gradient?

A

Sea lvl 76

Normal A-a is less than 15
>30 is always abnormal

30
Q

Anterior vs posterior male urethral damage

A

Anterior= painful perineum and normal prostate, often can void urine

Posterior = suprapubic pain, high prostate, scrotal hematoma, Inability to void, often assoc with pelvic fx

31
Q

tenesmus

A

need or feeling the need to constantly evacuate bowels

32
Q

intrabdominal abscesses

what size tx with antibiotcs vs percutaneous drainage?

A

3cm is drainage

33
Q

torus palatinus?

A

benign bony growth midline of hard palate, may grow slowly over years. May ulcerate with trauma and heal slowly. Weird looking

34
Q

laparotomy vs laparoscopy

A

laparotomy is an incision in abdomen for open procedures

laparoscopy is with a scope

laparo word root is greek for “flank” meaning “abdomen” in medicine

35
Q

prolonged QT from electrolytes

A

hypok, hypomag, hypocalcemia

hypok and hypo mag cause prolongation more often the hypocalcemia

36
Q

c. diff
s/s
time frame

A

voluminous diarrhea, abdominal pain, fever, typically NOT bloody

takes 4-5 days of Antibiotic use prior to appearance

37
Q

male nipples are considered to be at what intercostal space?

A

4th

any penetrating trauma below involves abdomen until proven otherwise

38
Q

MAC of
Sevoflurane
Desflurane
Isoflurane

A

Sevo: 1.8, medium quick on quick off, pleasant odor, potent bronchodilator

Des: 6.6, THE QUICKEST on quickest off, expensive, poor odor, cause of bronchospasm

Iso 1.2, cheaper, longer acting. Highly soluble and potent

  • *all decrease MAP and SVR.
  • Des > Iso increase HR, sevo doesn’t much
  • ** Start with sevo -> iso or Des
  • **All are assoc. with post-op N/V
39
Q

IV induction choice:

Propofol vs Etomidate vs Ketamine

A

Propofol: fast onset and recovery (minutes), use especially with ambulatory surgery, decreases SVR, antiemetic properties

Etomidate: minimal cardiovascular effects, use for patients with cardiopulmonary compromise

Ketamine: bronchodilator properties, good use for acute bronchospasm

MOA: Propofol and Etomidate act through GABA
MOA: Ketamine though NMDA

40
Q 
Anti-emetics MOI and area
Dexamethasone (unknown but when use?)
Droperidol/Haldol/metoclopramide
Ondansetron
Scopolamine
Diphenhydramine
A

Dexamethasone: use during induction of anesthesia

**All below except serotonin antagonists work in area postrema (by the 4th ventricle that relays to medulla vomiting center), serotonin is more confusing

Droperidol/Haldol/metoclopramide: D2 antagonists
Ondansetorn: 5HT3 serotonin antagonist
Scopolamine: M1 antagonist
Diphenhydramine: H1 antagonist

All have antiemetic properties
*

41
Q

retropharyngeal infection spaces

A

esophagus -> Buccopharyngeal fascia -> alar fascia -> prevertebral fascia

**if abscess is btw alar and prevertebral fascia (danger zone) goes to the mediastinum

42
Q

Ruling in vs Ruling out with troponin assays (timeframe)

A 
Can generally (80%) rule in MI within 2-3hrs
Rule out at 6hrs, but wait 12hrs in suspicious cases
peak at 18hrs
43
Q

meniscal vs ligamentous injury swelling

A

meniscal injuries pop, pain, then swell around 24hrs

ligamentous swell rapidly from hemarthrosis
ACL… immediate instability

44
Q

normal aortic diameter

when to repair aneurysm?

A

1-3cm, if >3cm infrarenal = aneurysm
typically at or above lvl of umbilicus

when >5.5cm: risk of rupture > risk of repair => repair indicated

45
Q

perioperative anticoagulation use

A

if low risk but on anticoags: stop warfarin on day -5
if moderate to high risk, bridge heparin and stop it on day of surgery with 50% reduction of dose (or night before if on BID)

**restart heparin > 24hrs after surgery. Studies show no increased risk of bleeding after 48hrs if hemostasis was secured.

***restart coumadin when able to drink

46
Q

scaphoid fracture, when to do open

A

If displaced >2mm, otherwise splint for 6-10weeks

47
Q

what cutaneous cancer is associated with wounds/inflammation

A

Squamous cell cancer arises in areas of inflammation/chronic irritation

  • burns
  • overlying osteomyelitis
  • venous ulcers
48
Q

valgus vs varus

A

Varus -> Airus -> air inbetween joint
===> The distal segment is outwardly angulated

Valgus ==> distal segment is inwardly angulated

**BUT whatever, valgus stress of knee pulls thigh in pushes distal tibia outward

***knee abduction apparently involves thigh fixation with leg abduction.

49
Q

miosis

A

miosis is smaller than mydriasis = pupil constriction

50
Q

phosphate in calcium deficiency

in PTH deficiency

A

Decreased bc of PTH kidney wasting in normally functioning system

phosphate increased bc kidneys are not told to waste phosphate

51
Q

meniscal vs ligamentous injury swelling

A

meniscal injuries pop, pain, then swell around 24hrs

ligamentous swell rapidly from hemarthrosis

52
Q

normal aortic diameter

A

1-3cm, if >3cm infrarenal = aneurysm

typically at or above lvl of umbilicus

53
Q

perioperative anticoagulation use

A

if low risk but on anticoags: stop warfarin on day -5
if moderate to high risk, bridge heparin and stop it on day of surgery with 50% reduction of dose (or night before if on BID)

**restart heparin > 24hrs after surgery. Studies show no increased risk of bleeding after 48hrs if hemostasis was secured.

***restart coumadin when able to drink

54
Q

scaphoid fracture, when to do open

A

If displaced >2mm, otherwise splint for 6-10weeks

55
Q

what cutaneous cancer is associated with wounds/inflammation

A

Squamous cell cancer arises in areas of inflammation/chronic irritation

  • burns
  • overlying osteomyelitis
  • venous ulcers
56
Q

valgus vs varus

A

Varus -> Airus -> air inbetween joint
===> The distal segment is outwardly angulated

Valgus ==> distal segment is inwardly angulated

57
Q

miosis

A

miosis is smaller than mydriasis = pupil constriction

58
Q

phosphate in calcium deficiency

in PTH deficiency

A

Decreased bc of PTH kidney wasting in normally functioning system

phosphate increased bc kidneys are not told to waste phosphate

59
Q

hemithorax can hold…. blood

A

1/2 your volume. so about 3L? Massive hemothorax is 1.5L

3rd Year (4 decks)

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