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Step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

What tests are needed for a healthy pt

A

EKG only

EKG + stress test + echo

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2
Q

What tests do you do for pulmonary function?

A

PFTs if known smoking hx or lung disease

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3
Q

SIRS criteria

A

Temp 38
HR >90
>20 breaths/min or pco2 12k

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4
Q

Interpret SIRS criteria

A

2 criteria: SIRS
2 criteria + source: sepsis
2 criteria + source + organ failure: severe sepsis
2 criteria + source + organ failure + hypoTN: septic shock

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5
Q

What are the 5 abdominal trauma signs and their cause:

A

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

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6
Q

What is a test to evaluate ileus

A

Abdominal X-ray

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7
Q

What do you do with blood at the meatus?

A

1) KUB X-ray
2) RUG
3) foley placement

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8
Q

Most common limiting factor of surgery

A

Cardiovascular disease

EF

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9
Q

Severe abdominal pain that is out of proportion to physical findings is ____ and you should order ____

A

Mesanteric Ischemia –> Angiography

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10
Q

2 most common symptoms of ischemic bowel disease

A

Abdominal pain after eating (muscular contraction of bowel increases oxygen requirements)
Bloody diarrhea

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11
Q

Initial and most accurate tests for ischemic bowel disease

Treatment?

A

Initial: CT
Accurate: Angiography
Tx: IV NS followed by surgery to remove the necrotic bowel

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12
Q

Number one risk factor for mesenteric ischemia

A

A fib

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13
Q

Mesenteric ischemia labs
Initial test
Accurate test

A

Elevated lactic acid and WBC count
Abdominal X-ray
Angiography

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14
Q

Most common locations for intestinal infarct

A

Watershed areas (splenic and hepatic flexures)

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15
Q

Where is the most common site of an esophageal perforation and what is the most accurate test?

A 
Left posterolateral aspect of the distal esophagus
Grastrografin test (esophageal using diatrizoate meglumin and sodium solution)
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16
Q

What is the most common cause of esophageal perforation?

A

Iatrogenic (UGD)

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17
Q

What are the 4 steps of treatment for a gastric perforation?

A

1) make pt NPO
2) place NG tube
3) medical management (Abx + IV fluids)
4) emergent laparotomy

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18
Q

What test is contraindicated in acute diverticulitis? What is the most common complication of acute diverticulitis?

A

Barium enema

Abscess

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19
Q

What is the most accurate test for cholecystitis? What does it show?

A

HIDA scan –> delayed emptying of the gallbladder by failure to visualize the gallbladder from isotope accumulation

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20
Q

What are the 2 most common causes of SBO

A

Adhesions from previous surgeries

Hernias

21
Q

What drug can be used to alleviate obstruction from stool impact ion in patients on chronic opioids

A

Methylnaltrexone (Relistor)

22
Q

What is the hallmark lab test for SBO? What are the initial and accurate tests?

A

Elevated lactate with marked acidosis
Abdominal X-ray
Abdominal CT

23
Q

What is the definition of fecal incontinance? What are the initial/accurate tests? What are 3 types of treatment?

A

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

24
Q

What is a comminuted fracture and the most common cause?

A

Bone broken in multiple pieces –> crush injury

25
Q

What is a stress fracture and the most common location?

A

Complete fracture from competitive insults –> metatarsals

26
Q

What imaging is necessary for a stress fracture?

A

CT or MRI

27
Q

Where are the 3 sites of compression fractures?

A

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

28
Q

What is the most common shoulder dislocation?
Sx?
Tests?
Tx?

A

Anterior (strained GH ligaments)
External rotated forearm
X-ray initial, MRI accurate (rule out axillary A/N injury)
Relocate and immobilize

29
Q

What is a rarer shoulder dislocation?
Sx?
Dx?
Tx?

A

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

30
Q

Clavicle are fracture require you to rule out what?

Treatment?

A

Subclavian A or brachial plexus injury

simple arm sling

31
Q

How long does it take for a scaphoid fracture to show up on X-ray?
Tx?

A

3 weeks

Thumb spica

32
Q

What is trigger finger and how is it treated?

A

Stenosis of the tendon sheath leading to acute flexion and pain
Steroid injection –> surgery

33
Q

What is Dupuytren contracture?
Who is effected?
Tx?

A

Palmar fascia constriction which prevents the hand from extending open
Men over 40
Surgery

34
Q

What is the triad for fat embolus

A

AMS
Petechial rash
Dyspnea

35
Q

Where does spinal stenosis occur?
What alleviates the Sx?
How is it diagnosed?

A

C2 and L1
Leaning forward
MRI

36
Q

How are all ligamentous knee injuries diagnosed?

A

MRI

37
Q

What is the unhappy triad?

A

ACL
MCL
Lateral or medial meniscus

38
Q

What is the dx for a AAA?
Management?
When is surge required?

A 
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
39
Q

What are the tests for an aortic dissection in a stable or unstable patient?

A

Stable: MRA
Unstable: TEE

40
Q

What is the best initial HTN therapy for aortic dissection?

What do you never use alone and why?

A

Beta blockers

Vasodilator –> reflex tach can increase shearing forces

41
Q

Post Op fever POD 1-2

A

Wind: atelectasis/pneumonia
Dx: CXR + sputum cultures
Tx: prevent with IS, treat with Vancy + Zosyn for HCAP

42
Q

POD 3-5

A

Water: UTI
Dx: positive nitrates and leuk esterase on UA + Culture
Tx: Abx

43
Q

POD 5-7

A

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

44
Q

POD 7

A

Wound: infection or cellulitis
Tx: I&D + Abx

45
Q

POD 8-15

A

Weird: drug fever or abscess
Dx: CT
Tx: CT guided drainage or surgery

46
Q

What do you order if a postop patient is confused?

A 
ABG
CXR
Blood cultures
Urine cultures
CBC
47
Q

What is the most common finding on EKG for PE?

A

Nonspecific ST changes&raquo_space;»»> S1Q3T3

48
Q

When should an IVC filter be placed in a PE patient?

A

If a patient has a 2nd PE while on Warfarin

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