Surgery Flashcards
What tests are needed for a healthy pt
EKG only
EKG + stress test + echo
What tests do you do for pulmonary function?
PFTs if known smoking hx or lung disease
SIRS criteria
Temp 38
HR >90
>20 breaths/min or pco2 12k
Interpret SIRS criteria
2 criteria: SIRS
2 criteria + source: sepsis
2 criteria + source + organ failure: severe sepsis
2 criteria + source + organ failure + hypoTN: septic shock
What are the 5 abdominal trauma signs and their cause:
Cullen: umbilical bruising –> hemorrhagic pancreatitis, AAA
Grey Turner: flank bruising –> retroperitoneal hemorrhage
Kehr: left shoulder pain –> splenic rupture
Balance: dull percussion on left/shifting dullness on right –> splenic rupture
Seatbelt: bruising where seatbelt was –> deceleration injury
What is a test to evaluate ileus
Abdominal X-ray
What do you do with blood at the meatus?
1) KUB X-ray
2) RUG
3) foley placement
Most common limiting factor of surgery
Cardiovascular disease
EF
Severe abdominal pain that is out of proportion to physical findings is ____ and you should order ____
Mesanteric Ischemia –> Angiography
2 most common symptoms of ischemic bowel disease
Abdominal pain after eating (muscular contraction of bowel increases oxygen requirements)
Bloody diarrhea
Initial and most accurate tests for ischemic bowel disease
Treatment?
Initial: CT
Accurate: Angiography
Tx: IV NS followed by surgery to remove the necrotic bowel
Number one risk factor for mesenteric ischemia
A fib
Mesenteric ischemia labs
Initial test
Accurate test
Elevated lactic acid and WBC count
Abdominal X-ray
Angiography
Most common locations for intestinal infarct
Watershed areas (splenic and hepatic flexures)
Where is the most common site of an esophageal perforation and what is the most accurate test?
Left posterolateral aspect of the distal esophagus Grastrografin test (esophageal using diatrizoate meglumin and sodium solution)
What is the most common cause of esophageal perforation?
Iatrogenic (UGD)
What are the 4 steps of treatment for a gastric perforation?
1) make pt NPO
2) place NG tube
3) medical management (Abx + IV fluids)
4) emergent laparotomy
What test is contraindicated in acute diverticulitis? What is the most common complication of acute diverticulitis?
Barium enema
Abscess
What is the most accurate test for cholecystitis? What does it show?
HIDA scan –> delayed emptying of the gallbladder by failure to visualize the gallbladder from isotope accumulation
What are the 2 most common causes of SBO
Adhesions from previous surgeries
Hernias
What drug can be used to alleviate obstruction from stool impact ion in patients on chronic opioids
Methylnaltrexone (Relistor)
What is the hallmark lab test for SBO? What are the initial and accurate tests?
Elevated lactate with marked acidosis
Abdominal X-ray
Abdominal CT
What is the definition of fecal incontinance? What are the initial/accurate tests? What are 3 types of treatment?
Continuous uncontrolled >10ml feces for >1month, pt >age 3
Initial: hx + flex sig or anoscopy
Accurate: anorectal manometers (endorectal if anatomic injury)
Tx: fiber –> biofeedback –> Dextranomer/Hyaluronic acid injection –> colorectal surgery
What is a comminuted fracture and the most common cause?
Bone broken in multiple pieces –> crush injury
What is a stress fracture and the most common location?
Complete fracture from competitive insults –> metatarsals
What imaging is necessary for a stress fracture?
CT or MRI
Where are the 3 sites of compression fractures?
1/3 lumbar, 1/3 thoracolumbar, 1/3 thoracic
What is the most common shoulder dislocation?
Sx?
Tests?
Tx?
Anterior (strained GH ligaments)
External rotated forearm
X-ray initial, MRI accurate (rule out axillary A/N injury)
Relocate and immobilize
What is a rarer shoulder dislocation?
Sx?
Dx?
Tx?
Posterior (seizure or electrical burn)
Medially rotated and held at side arm
X-ray initial, MRI accurate
Traction and surgery treatment if sensation/pulses diminished
Clavicle are fracture require you to rule out what?
Treatment?
Subclavian A or brachial plexus injury
simple arm sling
How long does it take for a scaphoid fracture to show up on X-ray?
Tx?
3 weeks
Thumb spica
What is trigger finger and how is it treated?
Stenosis of the tendon sheath leading to acute flexion and pain
Steroid injection –> surgery
What is Dupuytren contracture?
Who is effected?
Tx?
Palmar fascia constriction which prevents the hand from extending open
Men over 40
Surgery
What is the triad for fat embolus
AMS
Petechial rash
Dyspnea
Where does spinal stenosis occur?
What alleviates the Sx?
How is it diagnosed?
C2 and L1
Leaning forward
MRI
How are all ligamentous knee injuries diagnosed?
MRI
What is the unhappy triad?
ACL
MCL
Lateral or medial meniscus
What is the dx for a AAA?
Management?
When is surge required?
More than 1.5x normal size 3-4cm: U/S every 2-3 years 4-5.4cm: U/S or CT every 6-12 months >5.5cm + no Sx: repair Surgery for all >5cm
What are the tests for an aortic dissection in a stable or unstable patient?
Stable: MRA
Unstable: TEE
What is the best initial HTN therapy for aortic dissection?
What do you never use alone and why?
Beta blockers
Vasodilator –> reflex tach can increase shearing forces
Post Op fever POD 1-2
Wind: atelectasis/pneumonia
Dx: CXR + sputum cultures
Tx: prevent with IS, treat with Vancy + Zosyn for HCAP
POD 3-5
Water: UTI
Dx: positive nitrates and leuk esterase on UA + Culture
Tx: Abx
POD 5-7
Walking: DVT/thrombophlebitis of IV line or PE
Dx: Doppler + change IV lines and culture IV tips
Tx: Heparin for 5 days –> bridge to Warfarin for 3-6 months
POD 7
Wound: infection or cellulitis
Tx: I&D + Abx
POD 8-15
Weird: drug fever or abscess
Dx: CT
Tx: CT guided drainage or surgery
What do you order if a postop patient is confused?
ABG CXR Blood cultures Urine cultures CBC
What is the most common finding on EKG for PE?
Nonspecific ST changes»_space;»»> S1Q3T3
When should an IVC filter be placed in a PE patient?
If a patient has a 2nd PE while on Warfarin
