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Step 2 CK > Surgery > Flashcards

Surgery Flashcards

1
Q

Number one factor prior to surgery

A

History of cardiovascular disease

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2
Q

Important CV risk factors for surgery

A

EF

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3
Q

Other CV risk factors

A

Age >45
DM
HTN
Hyperlipidemia

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4
Q

Surgical clearance in pt under 35 w/ no hx cardiac disease

A

EKG

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5
Q

Surgical clearance in pt w/ hx cardiac disease

A

EKG
Stress test
Echo

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6
Q

When to do PFTs before surgery

A

Known lung disease

Smoking Hx

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7
Q

Current smoker needs surgery

A

Stop -68 wks before, use nicotine patch

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8
Q

Pt w/ renal disease needs surgery

A

Keep adequately hydrated

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9
Q

How to ensure adequate kidney perfusion before surgery

A

Fluids before and during surgery

Dialyze 24hrs prior to surgery

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10
Q

Maintaining the AIRWAY

A

No facial trauma - Orotracheal tube
Facial trauma - Cricothyroidotomy
Cervical spine injury - Orotracheal tube w/ flexible bronchoscopy

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11
Q

Maintain BREATHING

A

O2 sat above 90%

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12
Q

Maintain CIRCULATION

A

2 large bore IVs

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13
Q

SIRS criteria

A

Temp 38
HR > 90
RR >20 or PCO212

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14
Q

Define sepsis

A

2/4 SIRS + source

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15
Q

Define severe sepsis

A

Sepsis + organ dysfunction

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16
Q

Define septic shock

A

Severe sepsis + hypotension

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17
Q

Which kind of shock present as pale and cool

A

Hypovolemia

Cardiogenic

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18
Q

Which kind of shock present as warm

A

Neurogenic

Septic

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19
Q

Which kind of shock has elevated central venous pressure

A

Cardiogenic

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20
Q

Which kind of shock has elevated CVP and SVR

A

Hypovolemic

Cardiogenic

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21
Q

Which kink of shock has elevated CO

A

Septic

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22
Q

Which kind of shock has elevated LVEDP or PCWP

A

Cardiogenic

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23
Q

Which kind of shock is treated with fluid and pressors

A

Hypovolemic
Neurogenic
Septic (+ABX)

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24
Q

How is cardiogenic shock treated

A

Treat the cardiac problem

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25
Q

MCC hypovolemic shock

A

Massive hemorrhage

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26
Q

MCC cardiogenic shock

A

MI

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27
Q

MCC neurogenic shock

A

Spinal cord injury

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28
Q

MCC septic shock

A

E. coli and S. aureus

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29
Q

Blunt abd trauma and has abd pain radiating to back

A

Hemorrhagic pancreatitis

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30
Q

How long after pancreatitis do pseudocysts develop

A

6-8 weeks

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31
Q

ABD pain and Bruising around umbilicus

A

Cullen

Hemorrhagic pancreatitis, ruptured AAA

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32
Q

ABD pain and Bruising in the flank

A

Grey Turner

Retroperitoneal hemorrhage

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33
Q

ABD pain and Pain in left shoulder

A

Kehr

Splenic rupture

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34
Q

ABD pain and Dull percussion on L and shifting dullness on R

A

Balance

Splenic rupture

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35
Q

ABD pain and Bruising where seatbelt is

A

Seatbelt

Deceleration injury

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36
Q

Best initial test for free air under diaphragm

A

Upright CXR

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37
Q

Presentation of tension PTX

A

Decreased breath sounds on one side and tracheal deviation

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38
Q

Signs, Sx of pericardial tamponade

A

JVD
Hypotension
Muffled heart sounds
Electrical alternans

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39
Q

Signs, Sx of PTX

A

CP
Hyperresonance
Decreased breath sounds

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40
Q

Signs, Sx of tension PTX

A

CP
Hyperresonance
Decreased breath sounds
Tracheal deviation

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41
Q

Signs, Sx of Hemothorax

A

Absent breath sounds

Dullness to percussion

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42
Q

Dx test in pericardial tamponade

A

Echo

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43
Q

Dx test in PTX of any kind

A

CXR

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44
Q

Dx test in hemothorax

A

Blunting of costophrenic angle on CXR

CT

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45
Q

Rx cardiac tamponade

A

Pericardiocentesis

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46
Q

Rx PTX

A

Chest tube

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47
Q

Rx Tension PTX

A

Needle decompression then chest tube

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48
Q

Rx hemothorax

A

Chest tube drainage

Possible thoracotomy

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49
Q

Evaluation of urethral disruption

A

XR kidneys, ureter, bladder then Retrograde urethrogram

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50
Q

Most appropriate next step in suspected mesenteric ischemia

A

Angiography

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51
Q

MC sx in bowel ischemia

A

Abd pain after eating

bloody diarrhea

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52
Q

Best initial test for bowel ischemia

A

CT

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53
Q

Most accurate test for bowel ischemia

A

Angiography

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54
Q

Rx bowel ischemia

A

IV NS then surgery

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55
Q

2 MC locations for bowel infarction

A

Splenic and hepatic flexures

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56
Q

Causes of RUQ pain

A

Cholecystitis
Biliary colic
Cholangitis
Perforated duodenal ulcer

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57
Q

Causes of LUQ pain

A

Splenic rupture

IBS

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58
Q

Causes of RLQ pain

A

Appendicitis
Ovarian torsion
Ectopic pregnancy
Cecal diverticulitis

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59
Q

Causes of LLQ pain

A

Sigmoid volvulus or diverticulitis
Ovarian torsion
Ectopic pregnancy

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60
Q

Causes of midepigastric pain

A

Pancreatitis
Aortic dissection
PUD

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61
Q

MI pain refers to

A

Left chest, arm, jaw

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62
Q

Gallbladder pain refers to

A

Right shoulder, scapula

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63
Q

Pancreas pain refers to

A

Back pain

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64
Q

Pharynx pain refers to

A

Ears

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65
Q

Prostate pain refers to

A

Tip of penis, perineum

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66
Q

Appendix pain refers to

A

LLQ

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67
Q

Esophagus pain refers to

A

Substernal CP

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68
Q

Pyelonephritis, nephrolithiasis pain refers to

A

CVA

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69
Q

Presentation of esophageal rupture

A

Retrosternal CP
Odynophagia
Hamman sign “snap crackle pop”
Left shoulder pain

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70
Q

What is Boerhaave

A

Full thickness tear 2/2 severe retching and vomitting

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71
Q

Boerhaave is commonly seen in

A

Alcoholics

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72
Q

Location of Boerhaave

A

Left posterolateral aspect of distal esophagus

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73
Q

MCC esophageal tear

A

Iatrogenic

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74
Q

MC procedure causing esophageal tear

A

Upper endoscopy

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75
Q

Mortality in Boerhaave

A

25%

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76
Q

What is Mallory-Weiss

A

Mucosal tear 2/2 vomitting

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77
Q

Location of Mallory-Weiss

A

GE junction

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78
Q

Most accurate test for esophageal tear

A

Esophogram using gastrografin showing leakage outside esophagus

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79
Q

Rx esophageal tear

A

Surgical exploration and debridement of mediastinum

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80
Q

Complication of esophageal tear

A

Mediastinitus

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81
Q

MCC gastric perforation

A

Ulcer disease

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82
Q

RFs for gastric perforation

A 
H. pylori
NSAIDs
Burns
Head trauma
CA
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83
Q

Role of alcohol and smoking in ulcer disease

A

Delays healing

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84
Q

Presentation of gastric rupture

A

Acute, progressively worse abd pain radiating to R shoulder 2/2 acid irritation of phrenic nerve
Signs of peritonitis

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85
Q

Best initial test for gastric perforation

A

Upright CXR

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86
Q

Most accurate test for gastric perforation

A

CT

87
Q

Rx gastric perforation

A

NPO
NG tube
IV NS, broad spectrum ABX
Surgically repair

88
Q

Consider in RLQ pain in female of childbearing age

A

Ectopic pregnancy
Cysts
Torsion

89
Q

Always get in a female pt w/ abd pain

A

Beta-HCG

Pelvic sonogram

90
Q

Rx first time diverticulitis

A

Medically

91
Q

Rx recurrent diverticulitis

A

Surgical resection

92
Q

MC complication of diverticulitis

A

Abscess

93
Q

Contraindicated in diverticulitis

A

Barium enema

Colonoscopy

94
Q

MC site of diverticulitis

A

Sigmoid

95
Q

Dx abd abscess

A

CT

96
Q

Rx abd abscess

A

I & D

ABX

97
Q

Abd pain that radiates to back

A

Pancreatitis

Aortic dissection

98
Q

PE Signs of appendicitis

A

Rovsing
Psoas
Obturator

99
Q

Signs of appendicitis

A

Anorexia
Fever
Periumbilical pain with RLQ tenderness
Elevated WBC w/ left shift

100
Q

Signs of acute pancreatitis

A

Fever
Severe midabdominal pain radiating to back
N/V

101
Q

Signs of diverticulitis

A

Fever
Nausea
LLQ pain
Peritonitis

102
Q

Signs of cholecystitis

A

Fever
RUQ pain
Murphy sign

103
Q

Most accurate test appendicitis

A

CT

104
Q

Best initial test for pancreatitis

A

CT

Amylase is sensitive, Lipase is specific

105
Q

Best initial test for diverticulitis

A

CT

106
Q

Most accurate test for diverticulitis

A

CT

107
Q

Best initial test for cholecystitis

A

U/S

108
Q

What is seen on ultrasound in cholecystitis

A

Pericholecystic fluid
GB wall thickening
Stones
Sonographic murphy’s

109
Q

Rx Appendicitis

A

Laparoscopic removal

110
Q

Rx acute pancreatitis

A

Aggressive IV fluids

NPO

111
Q

Rx diverticulitis

A

ABX for first attack

Resection if recurrent or perforates

112
Q

Rx cholecystitis

A

14 days ABX

Laparoscopic/open cholecystectomy if no better

113
Q

Complications of appendicitis

A

Abscess

Gangrenous perforation

114
Q

Complications of acute pancreatitis

A

Hemorrhagic pancreatitis

Pseudocyst formation

115
Q

Complications of diverticulitis

A

Abscess

116
Q

Complications of cholecystitis

A

Perforation

117
Q

Most accurate test for cholecystitis

A

HIDA

- Delayed emptying

118
Q

Characteristics of bowel obstruction

A 
Failure to pass stool or flatus
Waves of intermittent crampy abd pain
Hyperactive bowel sounds "tinkling"
N/V
Fever
Hypovolemia due to 3rd spacing
119
Q

Types of bowel obstruction

A

Partial

Complete

120
Q

MCC bowel obstruction

A

Adhesions

121
Q

Other causes of bowel obstruction

A 
IBD
Hernias
Intussusception
Volvulus
Neoplasms
Foreign bodies
Intestinal atresia
Carcinoid
122
Q

Hallmark sign of bowel obsctruction

A

Elevated lactate with marked acidosis

123
Q

Best initial test for bowel obstruction

A

Abd XR - air fluid levels

124
Q

Most accurate test for bowel obstruction

A

CT - transition zone

125
Q

Rx bowel obstruction

A

NPO
NG tube
IV fluid
Emergent surgical resection

126
Q

What is fecal incontinence

A

Continuous/recurrent uncontrolled passage of fecal material for at least 1 month in an individual over 3

127
Q

Best initial test for fecal incontinence

A

Clinical hx combined w/ flex sig or anoscopy

128
Q

Most accurate test for fecal incontinence

A

Anorectal manometry

129
Q

Best initial test for fecal incontinence if there is hx of anatomic injury

A

Endorectal manometry

130
Q

Medical rx for fecal incontinence

A

Bulking agents - fiber

131
Q

Biofeedback rx for fecal incontinence

A

Control exercises

Muscle strengthening exercises

132
Q

Last resort rx for fecal incontinence

A

Surgery

133
Q

Decreases incontinence episodes by 50%

A

Dextranomer/hyaluronic acid (Solesta)

134
Q

Fractures are always diagnosed with

A

XR

135
Q

Types of fracture correction

A

Closed reduction
Open reduction and internal fixation
Open fractures - close skin, bone set in OR w/ debridement

136
Q

Types of fractures

A 
Comminuted
Stress
Compression
Pathologic
Open
137
Q

What is a comminuted Fx

A

Bone broken in multiple pieces

138
Q

MCC comminuted Fx

A

Crush

139
Q

What is a stress fracture

A

Complete fracture from repetitive insults to bone

140
Q

Which bone is MC fractured in stress fx

A

Metatarsals

141
Q

How to dx stress Fx

A

CT or MRI

142
Q

Rx stress Fx

A

Rehabillitation, reduced physical activity, casting

143
Q

Locations of compression fractures

A

1/3 lumbar
1/3 thoracolumbar
1/3 thoracic

144
Q

Who gets compression fractures

A

Osteoporosis

145
Q

Common vignette for pathologic Fx

A

Older person fractures rib from coughing

146
Q

Pathological conditions that can cause fractures

A

Paget’s
Multiple Myeloma
Bone mets

147
Q

Rx pathologic Fx

A

Surgical realignment

Rx underlying disease

148
Q

What is an open Fx

A

Bone pierces skin

149
Q

Rx open fx

A

Surgery

150
Q

Common vignette for stress Fx

A

Athlete w/ persistent pain

151
Q

Most common type of shoulder dislocation

A

Anterior

152
Q

Causes of posterior shoulder dislocation

A

Seizure

Electrical burn

153
Q

Cause of clavicular Fx

A

Trauma

154
Q

Cause of scaphoid Fx

A

FOOSH

155
Q

Signs of anterior shoulder dislocation

A

Arm held to side, externally rotated, severe pain

156
Q

Signs of posterior shoulder dislocation

A

Arm medially rotated held to side

157
Q

Signs of clavicular Fx

A

Pain over location

158
Q

Signs of scaphoid Fx

A

Persistent pain in “snuffbox”

159
Q

Best initial test for shoulder injuries

A

XR

160
Q

Most accurate test for shoulder dislocations

A

MRI

161
Q

Rx anterior shoulder dislocations

A

Shoulder relocation and immobilization

162
Q

Rx posterior shoulder dislocations

A

Traction and surgery if pulses or sensation diminished

163
Q

Rx clavicular fx

A

Simple arm sling

164
Q

Rx scaphoid Fx

A

Thumb spica cast

165
Q

Finger flexed and painful. Loud popping sound and no more pain when pulled

A

Trigger finger

166
Q

Cause of trigger finger

A

Stenosis of tendon sheath

167
Q

Rx trigger finger

A

Steroids

Surgery if fails

168
Q

Who gets dupuytren’s

A

Men > 40

169
Q

Rx dupuytren’s

A

Surgery

170
Q

MC bone implicated in fat embolism

A

Femur

171
Q

Onset of fat embolism sx

A

Within 5 days of Fx

172
Q

Presentation of fat embolism

A

Confusion
Petechial rash
SOB

173
Q

Dx tests for fat embolism

A

PO2

174
Q

Rx fat embolism

A

Keep PO2 > 95

175
Q

6 signs of compartment syndrome

A 
Pain
Pale
Paresthesia
Paralysis
Pulselessness
Poikilothermia
176
Q

Rx compartment syndrome

A

Fasciotomy

177
Q

Dx torn ACL

A

MRI

178
Q

Most definitive rx of ACL tear

A

Arthroscopic repair followed by rehabilitation

179
Q

Anterior drawer sign is for

A

ACL

180
Q

Posterior drawer sign is for

A

PCL

181
Q

Rx knee injuries

A

MRI

182
Q

Rx MCL/LCL

A

Surgical repair

183
Q

Which knee injuries are repaired arthroscopically

A

ACL
PCL
Meniscus

184
Q

Knee injury w/ popping sound on flexion and extension

A

Meniscus

185
Q

Unhappy Triad

A

ACL
MCL
Medial meniscus

186
Q

Done for all pts under 50 presenting for acute onset back pain

A

MRI to r/o slipped disk or lumbar disk herniation

187
Q

Most appropriate next step after MRI in acute back pain

A

Antiinflammtory agents

188
Q

MC sites of lumbar herniation

A

L4-5

L5-S1

189
Q

Hallmark signs of AAA

A

Bruit

Pulsatile abdominal mass

190
Q

Syncope in setting of AAA

A

Rupture until proven otherwise

191
Q

Diagnostic tests in AAA

A

CT/MRI - relation of AAA to surrounding structures
U/S for size and monitoring
Surgery when AAA reaches 5cm

192
Q

Who gets screened for AAA

A

Former or current smokers over 65

193
Q

POD 1-2 fever cause

A

Atelectasis

Post-op PN

194
Q

POD 3-5 fever cause

A

UTI

195
Q

POD 5-7 fever cause

A

DVT, thrombophlebitis of IV

PE

196
Q

POD 7 fever cause

A

Wound infections and cellulitis

197
Q

POD 8-15 fever cause

A

Drug fever

Deep abscess

198
Q

Dx test for POD 1-2 fever

A

CXR and sputum Cx

199
Q

Prevent POD 1-2 fever

A

Incentive spirometry

200
Q

Rx POD 1-2 fever

A

Vanco, tazobactam-pipercillin for HCAP

201
Q

Dx POD 3-5 fever

A

UA showing +nitrates and leukocyte esterase

UCx for species and sensitivity

202
Q

Dx POD 5-7 fever

A

Doppler U/S
Change IV access
Cx IV tips

203
Q

Rx POD 5-7 fever

A

Heparin for 5 days as bridge to coumadin

204
Q

Dx POD 8-15 fever

A

CT

205
Q

Rx POD 8-15 fever

A

CT guided percutaneous drainage or surgery

206
Q

Post-op confusion

A

Likely hypoxis or sepsis

  • ABG
  • CXR
  • Blood Cx
  • UCx
  • CBC
207
Q

Causes of post-op hypoxia

A

PE
Atelectasis
PN

208
Q

Signs of post-op ARDS

A

Severe hypoxia
Tachypnea
Accessory muscle use
Hypercapnia

209
Q

Dx post-op ARDS

A

CXR - B/L infiltrates w/o JVD

210
Q

Rx post-op ARDS

A

Positive end expiratory pressure

211
Q

Signs of post-op PE

A

Acute onset PE w/ clear lungs

212
Q

Best initial dx test for post-op PE

A

EKG (No ST changes)
Confirm with troponins and cardiac enzymes
Then do CT angio

213
Q

Rx post-op PE

A

Heparin as bridge for coumadin

214
Q

Second PE while on coumadin for post-op PE

A

Place IVC filter

Step 2 CK (21 decks)

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