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Allergy, immunology, infection > Surgery > Flashcards

Surgery Flashcards

1
Q

Anesthesiologist

A

MD or DO
Chooses and applies correct meds
Monitors physicologic function during surgery
In charge of fluids

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2
Q

Anesthesia assistant

A

AKA an anesthetist such as CRNA
works up the anesthesiologist
Edu: RN + BSN+ 2 years extra school + 1 year on the job experience

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3
Q

Surgeon

A

MD, DO
Board certifed in their surgical field
In charge of surgical procedure

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4
Q

1st Assist

A

Can be PA or MD
Person standing directly across from surgeon
Maintains visibility of surgical site with suction
Holds retractors, control bleeding
Apply dressing etc

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5
Q

Scrub tech

A

Can be RN or LPN

Maintains integrity and safety of the sterile field throughout the procedure

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6
Q

XR/fluoroscopy tech

A

Fluoroscopy = continuous XR image on monitor

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7
Q

Intern/resident/student

A

There to learn how to cut

Residents can do surgeries by themselves

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8
Q

Circulating nurse

A

RN
Monitor and coordinate all actvities within the room
Manage care required for the patient

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9
Q

Perfusionist

A

Makes sure the heart-lung machine is efficienctly managing the lungs and heart
Delivers the drug that stops a patients heart in cardiac surgery

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10
Q

American society of anesthesiology

Risk assessment

A

ASA 1 Normal healthy
ASA 2 mild systemic disease
ASA 3 Severe systemic disease
ASA 4 Severe systemic with constant threat to live
ASA 5 Moribund, not expect to survive without operation
ASA 6 declared brain dead

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11
Q

Upper airway exam

A 
ROM of cervical spine
Thyroid cartilage to mentum dis: >6cm
Mouth opening greater than 3 cm
Look at dentition, dentures loos teeth
Jaw protrusion
Presence of beard
Mallampati score
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12
Q

Mallampati score

A

Grade1: easy intubation

2: see tonsilar pillars and part of uvula
3: only hard and soft palate visable
4: hard palate only visable

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13
Q

G tube

A

gastrostomy tube, surgical access
tube inserted thru abdomen directly into stomach
Indicated when patient needs long term access
Also used for decompression
Can bolus feed

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14
Q

J tube

A

jejunostomy tube
same as g tube but placed more distally
Reduced risk of aspiration
Continuous drip w pump required

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15
Q

PEG tube

A

percutaneous endoscopic gastrostomy
specific technique
Done with endoscope
Most common use if for head and neck cancer

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16
Q

Pre surgery diabetes glucose level

A

300 = reevaluate surgery

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17
Q

Phases of wound healing 1

A

Coagulation:
Fibrin plug form
Main cell type: platelets
Platelets aggregate, release fibrinogen fragments

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18
Q

Phase 2 of wound healing

A

Inflammatory
Cell recruitment and chemotaxis
Cell types: neutrophils, monocytes/macrophages

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19
Q

Phase 3 of wound healing

A

Migratory/proliferative
Epidermal resurfacing, angiogenesis
Keratinocytes, fibroblasts, endothelial cells

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20
Q

Phase 4 of wound healing

A

Remodeling
Scar formation
Myofibroblasts
Phenotypic switch to myofibroblasts from fibroblasts

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21
Q

Suture size on face

A

5-0 and 6-0

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22
Q

Most common surgical site infection

A

Staph aureus

Staph epidermidis: worry for immunocomp

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23
Q

Pathogens in sites involving intestines

A

E.coli
K. pneumo
Enerobacter
Bacteroides species

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24
Q

Dirty wound number of bugs

A

10^5

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25
Q

Furuncle

A

Boil
Caused by S aureus, can also be strep
Tx: most often resolve, can I&D

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26
Q

Carbuncle

A

Collection of furuncles
Extend to subQ
RF: DM, immunoComp, chronic steroid use
Manage: I&D, often excision

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27
Q

Cellulitis

A

Eti: strep, staph, MRSA in hospital
Mangement: Abx: keflex, amox, dicloxacilin
(TMP-SMX if MRSA)
Severe: IV PCN G, naficillin (+vanco if MRSA)
drain abcess

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28
Q

Pyomyositis

A

Bact infx of skeletal muscles due to hematogenous spread, leads to abcess formation and sepsis
Most common in the tropics

29
Q

Gas gangrene

A

Eti: Trauma, IVDU. One of clostridia
Crepitus, gas in tissue on palpation and CT/XR
Manage: surg debridement, IV abx

30
Q

Necrotizing fascitis

A 
Strep, Kleb, Clostrid, E.coli, Staph
Infection of fascia
Type 1: polymicrob
Type 2: group a strep
Type 3: gas gangrene
Marked systemic toxicity and pain out of proportion to local findings
31
Q

Post surgical pneumonia

A

Most common pulmonary comp for pt. who die after surgery
Usually 2/2 aspiration of gram - bact.
Sx/s: fever, tachyP, increased secretions, consolidation on PE

32
Q

Dehiscence

A

Surgical complication when wound ruptures along a surgical incision
Often result from using too few sutures

33
Q

Evisceration

A

Rupture of all layers of the abdominal wall and extrustion of abdominal viscera
Most common on 5-8th day PostOpp

34
Q

Atelectasis

A

Complete or partial collapse of a lung or a lobe
Most common surgical pulmonary complication 25%
Most freq: old, OW, smokers,
Sx/s: vent/profusion mismatch, low O2

35
Q

Ileus

A

disruption of normal propulsive ability of the GI tract

Caused by failure of peristalsis rather than mechanical obstruction

36
Q

Fecal impaction

A

Most common in elderly and with opioid use

37
Q

Post op anemia

A

Result of gastric operation
Iron absorption in proximal tract
Intrinsic factor needed for B12 absorption

38
Q

IV phlebitis

A

Inflammation of IV site entry
One of the most common causes of post op fever
Day 3ish
Tx: removal of IV at first sign of it

39
Q

Post op fever

A

Occurs in about 40% of pt. post major surgery
48 hours: IV phleb, Pneumonia, UTI
>5 days: wound infection

40
Q

Post op DVT

A

Surgery increases risk 21 times

DVT most common source of PE

41
Q

Upper abdominal pain

A 
Fore gut:
esophagus
liver
gallbladder
pancreas
stomach
duodenum
42
Q

Midline periumblicial pain

A 
Midgut pain:
small intestine
cecum
appendix
ascending colon
43
Q

Lower abdominal pain

A

Hindgut:
descending colon
sigmoid colon
rectum

44
Q

Ruptured spleen

A

Eti: commonly blunt trauma
S/s: Kehr’s sign: (blood leaking->abd pain radiates to left shoulder/neck
Tenderness with palp of LUQ 9-10th rib
Splenomegaly

45
Q

Perforated bowel

A

Eti: commonly: diverticulitis & colonoscopies
S/s: Sudden onset of severe agonizing mid/low abd pain
Abdomen is rigid and tender

46
Q

Choelithiasis/Cholecystitis

A 
4F's: Fat, female, forty, fertile
s/s: biliary colic, RUQ pain. episodes of pain
Pain may refer to scapula
Murphy's sign.
Ultra sound
47
Q

Peritonitis

A

Eti: Preexisting large-volume ascites
- 2nd: appendicitis, perf bowel/ulcer divertic, trauma
Positive peritoneal sign
Dx: CBC, blood cult, abd paraC for gram stain

48
Q

Bowel obstruction etiology

A

Small bowel 3 most common:
Adhesion (65-75%), hernias, neoplasm
Large bowel: 15%

49
Q

Bowel obstruction s/s

A

High pitched bowel sounds or absence of them
Crampy pain, occurs in cycles
Classic: vomiting, distention, obstipation (severe constipation)

50
Q

Colon cancer

A

3rd most common men and women
Majority asymptomatic
Subclinical bleeding-> asymptomatic iron deficiency anemia
Dx: colonoscopy

51
Q

Diverticulitis

A

More common in colon
Remains asymptomatic in 80%, incidentally found
Mild tenderness in LLQ

52
Q

Volvulus

A 
Rotation of a segment of intestine
Surgical emergency
S/s: Severe intermittent colicky pain that begins in the right abdomen and becomes continous
Dx: Coffee bean sign in cecum
Barium enema - > Bird beak sign
53
Q

Appendicitis

A

Gangrene and perforation can occur in about 24 hours
Progression of symptoms is key
Begin: vague midabdominal/ periumbilical discomfort
N/V/indigestion
Pain continuous but not severe with mild cramping
Pain shifts to RLQ, causing discomfort on moving, walking etc.
Localized tenderness (McBurney), guarding, rebound tenderness

54
Q

Pilonidal disease

A 
Chronic gland infection of the gluteal cleft
3 types
- Acute, chronic, recurrent
S/s: pain and swelling
Tx: I&D
55
Q

Hemorrhoids, internal

A

Bleeding, pressure-like pain, prolapse
Can have sig blood loss and show symptoms of anemia
Dx: DRE to rule out mass lesions or malignancy
Tx: grade 1: fiber, fluid, possible laxitive
grade 2-3: rubber band ligation
grade 4: excisional hemorrhoidectomy

56
Q

Hemorrhoid internal grades

A

Grade 1: no prolapse
Grade 2: prolapse that spontaneously reduces
Grade 3: prolapse that requires manual reduction
Grade 4: prolapse that is not reducible

57
Q

Anorectal fistulas

A

Chronic drainage of mucus and blood, typically a history of anorectal abcess. Occur in 50% of anal abcesses
Image: MRI choice
Tx: fistulotomy, lays flat the tract

58
Q

Perirectal abcess

A

Acute pain, swelling, possible fever
Occasional leakage of pus and mucus
Dx: may have elevated WBC, history and physical usually all that is needed. MRI if necessary
Tx: I&D

59
Q

Carcinoma of the breast

A

s/s: single, nontender, firm to hard mass with ill-defined margins
Later s/s: skin or nipple retraction, axillary lymphA, breast enlargement, erythema, edema, pain, fixation of the mass

60
Q

Simple mastectomy

A

removal of entire breast, leaving pectoralis muscle not all the lymphnodes

61
Q

Modified radical mstectomy

A

Removal of breast, leaving pectoral muscle, taking axillary lymphnodes

62
Q

Fibroadenoma

A

Most frequent in young women within 20 years of puberty

Typically: round or ovoid, rubber, discrete, relatively mobile, non-tender 1-5 cm

63
Q

Mitral regurgitation

A

Associated with pulmonary congestion and low cardiac output
S/s: dyspnea, poor exercise tolerance, fatigue
PE: displaced PMI, S3 gallop over apex
XR: shows cardiomegally
Echo is the mainstay of diagnosis

64
Q

Mitral valve stenosis

A

Eti: most common cause: rheumatic fever
s/s: mid diastolic rumble best heard over apex
opening snap can be heard in beginning of disease

65
Q

Aortic stenosis

A

Eti: most common senile calcific aortic stenosis
s/s: gradual decrease in exercise tolerance, syncopy, angina, dyspnea on exertion
Ausc: harsh ejection murmur (heard best base of heart)

66
Q

Aortic insufficiency

A

S/s: most pt. don’t develop symp until LV dialation
PE: water hammer pulse (head bob with heart beat)
Ausc: High-pitched blowing diastolic murmur immediately after S2

67
Q

Thoracic aortic aneurysm

A

Abrupt tearing sensation in chest radiating to the back

UE pulse deficit and possible regurg murmur

68
Q

AAA

A

AA: greater than 3 cm, surgical if greater than 5 cm
Think old smokers
s/s: sudden abdominal or flank pain with pulsatile mass and hypertension
Dx: FAST or Ct if patient is stable
Tx: reduce HTN with BB and nitroprusside, vascular surgery

69
Q

Mesenteric ischemia

A

patients > 60 (afib, CHF, recent MI)
Abdominal pain out of proportion with clinical presentation
Intestinal pain after eating, relieved by vomiting
Progression: N?V, bloody diarrhea, peritonitis.

Allergy, immunology, infection (12 decks)

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