Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OMS III > Surgery > Flashcards

Surgery Flashcards

1
Q

The number one limiting factor prior to surgery is:

A

a hx of cardiovascular disease

Ejection fraction below 35%: increased risk for noncardiovascular surgery

Recent MI: must defer the surgery 6 months and stress the pt at that interval

Congestive heart failure (JVD, le edema): medically optimize the pt with ACE Inhibitors, bblockers, and spironolactone to decrease mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Surgery risk factors

A

Male over 45

CAD

Diabetes (same as CAD)

htn

high cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If the pt is under the age of 35 and has no hx of cardiac disease

A

EKG is only thing needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pt with a hx of cardiac disease, regardless of age must have

A

EKG

stress testing to evaluate for ischemic coronary lesions

Echocardiogram for structural disease and to assess ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pulmonary Disease Risk Assessment

A

pts with known lung disease or those who have a smoking hx pft is necessary to evaluate for vital capacities.

have pt quit smoking for 6-8 weeks? prior to surgery and use a nicotine patch in the meantime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal disease risk assessment

A

pts with known renal disease must be kept adequately hydrated: otherwise, hypoperfusion of the kidneys can lead to increased mortality.

if a preexisting renal disease is present, volume loss during surgery will adversely and acutely affect renal function.
subsequent raas activation will lead to further constriction of renal vasculature and make the creatinine clearance even lower.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

To ensure adequate kidney perfusion

A

give fluids before and during surgery

if the pt is on dialysis, dialyze the pt 24 hours prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

age > 70

A

significant risk factor for a cardiac event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when do you do a thallium stress test?

A

when the pt cannot do an exercise one

pad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ABC

A

A

Airway, primary step to assess and secure the airway

orotracheal tubes are the best way to maintain an airway in pts with no facial trauma

patients with facial trauma require a cricothyroidotomy

patients with cervical spine injury still need an orotracheal tube intubation. this should be performed with flexible bronchoscopy to reduce risk of further cervical spine injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ABC

B

A

breathing: proper ventilation is necessary to maintain oxygen saturation. the routin goal in management is to keep oxygen saturation above 90%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ABC

C

A

Circulation: insert 2 large bore IVs into the patient and begin aggressive fluid reusucitation to prevent hypovolemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Interpretation of SIRS Criteria

SIRS

A

2 criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Interpretation of SIRS Criteria

Sepsis

A

2 criteria and source of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Interpretation of SIRS Criteria

severe sepsis

A

2 criteria and source of infection and organ dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Interpretation of SIRS Criteria

septic shock

A

2 criteria and source of infection and organ dysfunction and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SIRS

A

a global inflammatory state that yeileds a particular set of symptoms and objective finding before sepsis and shock set in. there are 4 SIRS criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

SIRS Criteria

A

need 2 or more to indicate SIRS:

body temperatrure <36 or >38

heart rate >90BPM

tachypnea >20 BPM or PCO2<32mmhg

WBC <4000 cells/mm or >12000 cells/mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hypovolemic schock

Signs and symptoms -

CVP -

SVR -

HR -

CO -

LVEDP or PCWP -

Treatment -

Most common cause -

A

Signs and symptoms - pale and cool

CVP - dec

SVR - inc

HR - inc

CO - dec

LVEDP or PCWP - dec

Treatment - fluids and pressors

Most common cause - massive hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiogenic shock

Signs and symptoms -

CVP -

SVR -

HR -

CO -

LVEDP or PCWP -

Treatment -

Most common cause -

A

Signs and symptoms - pale and cool

CVP - inc

SVR - inc

HR - inc

CO - dec

LVEDP or PCWP - inc

Treatment - treat cardiac problem

Most common cause - myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Neurogenic Shock

Signs and symptoms -

CVP -

SVR -

HR -

CO -

LVEDP or PCWP -

Treatment -

Most common cause -

A

Signs and symptoms - warm

CVP - dec

SVR - dec

HR - pos

CO - ded

LVEDP or PCWP - dec

Treatment - fluids and pressors

Most common cause - spinal cord injury (cervical or thoracic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Septic shock

Signs and symptoms -

CVP -

SVR -

HR -

CO -

LVEDP or PCWP -

Treatment -

Most common cause -

A

Signs and symptoms - warm and faint

CVP - dec

SVR - dec

HR - inc

CO - inc

LVEDP or PCWP - no change

Treatment - fluids, antibiotics, and pressors

Most common cause - e. coli and s. aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

two pictures

A

study them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cullen sign

A

bruising around the umbilicus

hemorrhagtic pancraetitis, ruptured abdominal aortic anuerysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

grey turner sign

A

bruising in the flank

retroperitoneal hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

kehr sign

A

pain in the left shoulder

splenic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

balance sign

A

dull percussion on the left and shifting dullness on the right

splenic rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

seatbelt sign

A

bruising where a seatbelt was

deceleration injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

between 10-50% of pts with acute pancreatitis will have ?

A

bruising in the flanks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Abdominal trauma

A

diagnose with FAST scan to evaluate for intraabdominal bleeding. add Ct scan to evaluate retroperitoneal bleed or if you suspect splenic rupture in spite of negative FAST. manage hemodynamically stable pts with close monitoring, serial abdominal exams, and IV fluids. hemodynamically unstable pts need exploratory laparotomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

upright cxr is the best initial test to

A

evaluate free air under the diaphragm. free air under the diaphragm indicates a perforation of the bowel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

the abdominal x ray is also useful for evaluation of

A

ileus, which is a nonmechanical etiology for lack of peristalsis in the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pericardial Tamponade

etiology

A

trauma with penetration to the pericardium, secondary to broken ribs knives or bullet wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pericardial Tamponade

signs and symptoms

A

jvd, hypotenstion, muffles heart sounds, electrical alternans on EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pericardial Tamponade

diagnostic tests

A

cardiac echogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pericardial Tamponade

treatment

A

pericardiocentesis, is most effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pneumothorax

etiology

A

air in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Pneumothorax

signs and symptoms

A

chest pain

hyperresonance

decreased breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pneumothorax

diagnostic tests

A

cxr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pneumothorax

treatment

A

chest tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Tension Pneumothorax

etiology

A

air in the pleural space thorugh a one way leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Tension Pneumothorax

signs and symptoms

A

chest pain

hyperresonance

decreased breath sounds

tracheal deviation away for the involved lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Tension Pneumothorax

diagnostic tests

A

cxr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Tension Pneumothorax

treatment

A

immediate needle decompression followed by chest tube placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Hemothorax

etiology

A

blood in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Hemothorax

signs and symptoms

A

absent breath sounds and dull percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Hemothorax

diagnostic tests

A

blunting of costophrenic angle on chest xray and ct scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Hemothorax

treatment

A

chest tube drainage and possible thoracotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

atelectasis pulls the trachea

A

toward the involved lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

urethral disruption evaluation

A

kidney ureters and bladder x ray (KUB)

then a retrograde urethrogram before any other tests

don’t place a foley before these steps, but you can after if it is possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

acute mesenteric ischemia

A

severe abdominal pain that is out of proportion to physical findings

worse with eating

no peritoneal signs

increased neutros and decreased bicarb

angiography so you don’t perforate, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

severe abdominal pain that is out of proportion to physical exam findings

A

10/10 pain

no guarding

soft abdomen

no rebound tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

ischemic bowel disease

A

due to a lcak of blood flow to the mesentery of the bowel

progressive disease that begins with mild ischemia and progresses to full occlusion of blood flow

analogous to angina, occurs shortly after eating as the muscular contraction of the bowel increases its oxygen requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

ischemic bowel disease

most common symptoms

A

abdominal pain after eating

bloody diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

ischemic bowel disease

diagnostic tests

A

best initial test a ct scan of the abdomen

most accurate test is angiography

colonoscopy with biopsy can also show ischemic mucosa but it takes time to get pathology back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ischemic bowel disease

treatment

A

IV normal saline followed by surgical intervention to remove necrotic bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Mesenteric ischemia

overviews

A

the acute occlusion of mesenteric arteries, most commonly the sma.

number one risk factor is afib which can cause emboli to occlude the vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Mesenteric ischemia

presentation

A

excruciating pain that is out of proportion of the physical exam

labs may show increased lactic acid and leukocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Mesenteric ischemia

diagnosis

A

best initial test is abdominal xray showing air in the bowel wall.

the most accurate test is angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Mesenteric ischemia

treatment

A

emergent laparotomy with resection of necrotic bowel is the most appropriate therapy

endovascular therapy is indicated only if there is a clear reason to avoid surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

causes of abdominal pain that do not require surgery

A

mi
gerd
lower lobe pneumonias
acute porphyria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

most common locations for infarction are the 2 watershed areas

A

splenic and hepatic flexures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

RUQ pain

A

cholecytitis
biliary colic
cholangitis
perforated duodenal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

LUQ pain

A

splenic rupture

IBS-splenic flexure syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

RLQ pain

A

appendicitis
ovarian torsion
ectopic pregnancy
cecal diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

LLQ pain

A

sigmoid volvulus
sigmoid diverticulitis
ovarian torsion
ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

MI

Site of referred pain

A

left chest, jaw, and left arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Cold foods such as ice cream

Site of referred pain

A

brain freeze secondary to rapid tem change of the sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Gallbladder

Site of referred pain

A

R shoulder/scapula

70
Q

pancreas

Site of referred pain

A

back pain

71
Q

pharynx

Site of referred pain

A

ears

72
Q

prostate

Site of referred pain

A

tip of penis/perineum

73
Q

appendix

Site of referred pain

A

RLQ

74
Q

esophagus

Site of referred pain

A

substernal chest pain

75
Q

pyelonephritis, nephrolithiasis

Site of referred pain

A

CVA

76
Q

Boorhaave syndrome

A

full thickness tear of the esophagus secondary to retching

severe incessant vomiting usually from alcoholism

air in subq space, snap crackle pop

most commonly in the posterolateral aspect of the distal esophagus

25% mortality even with surgery

77
Q

esophageal perforation

etiology

A

due to the rapid increase in intraesophageal pressure combined with negative intrathoracic pressure caused by vomiting

78
Q

esophageal perforation

presents with

A

severe and acute onset of excrutiating retrosternal chest pain

odynophagia

positive hamman sign, a crunching heard upon palpation of the thorax due to subcutaneous emphysema

pain that can radiate to the left shoulder

79
Q

esophageal perforation

diagnostic test

A

most accurate test is an esophogram using diatrizoate meglumine and diatrizoate sodium solution (gastrografin; braxxo diagnostics, Princeton, new jersey); it will show leakage of contrast outside of the esophagus

do not use barium bc it is caustic to the tissues

80
Q

esophageal perforation

treatment

A

surgical exploration with debridement of the mediastinum and closure of the perforation is an absolute emergency

mediastinitis is a compicatoin that caries a very high mortality rate.

81
Q

most common cuse of esophageal perforation is

A

iatrogenic, most common procedure that causes this is upper endoscopy

82
Q

the most comon procedure that causes an esophageal perforation is

A

upper endoscopy

83
Q

Mucosal Tear:

Mallory Weiss Syndrome

Cause -

Symptoms-

Location -

Diagnosis -

Treatment -

Complications -

A

Cause - vomiting/retching in alcoholics

Symptoms- hematemesis, odynophagia

Location - gastroesophageal junction

Diagnosis - gastrografin esophagogram, no leakage

Treatment - supportive, cauterization if necessary

Complications - rare

84
Q

Esophageal Perforation:

Boerhaave Syndrome

Cause -

Symptoms-

Location -

Diagnosis -

Treatment -

Complications -

A

Cause - iatrogenic is #1 (endoscopy)

Symptoms-tetrosternal chest pain, severe acute onset, radiates to l shoulder, subcutaneous emphysema

Location - distal esophagus, left posterolateral aspect

Diagnosis - gastrografin esophagogram, leakage

Treatment - emergent surgery (25% mortality)

Complications - acute mediastinitis, very high mortality

85
Q

hemorrhagic ulcers

A

coffee ground hematemesis

86
Q

Gastric perforation

etiology

A

most commonly seen secondary to ulcer disease

risk factors include: h pylori, nsaid abuse, burns, head injury, trauma, and cancer. these either diminish the stomachs barrier against acid, or create increased levels of gastric acid

alcohol and smloking prevent ulcer healing.

once the ulcer erodes deep enough into the stomach, allows for leakage og gasric acid into the abdominal cavity and causes peritonitis

can cause pancreatitis if the ulcer is in the posterio part of the sotmach

87
Q

Gastric perforation

presentation

A

acute, progressive worsening abdominal pain that radiates to the right shoulder due to acid irritation of the phrenic nerve

likely signs of peritonitis by the time the pt comes to the ED including
guarding
rebound tenderness
abdominal rigidity

88
Q

Gastric perforation

diagnostic tests

A

best initial test is an upright cxr which shows free air under the diaphragm

most accurate test is a CT scan

89
Q

Gastric perforation

Treatment

A

make pt npo- prevents further extrusion of gastric contents into preitoneal cavity

place ng tube - suctions gastric contents, mitigates risk from newly formed acid

medical management - broad spectrum abs to combat infection, iv fluids in preparation for surgery

emergent surgery - exploratory laparatomy and repair of the perforation

90
Q

RLQ pain in a female of childbearing age

A

ectopic pregnancy, cysts, and torions must be considered

get a beta hcg and pelvic sonogram

avoid radiation in a pt who may be pregnant

emergent surgery if ectopic

91
Q

acute diverticulitis

A

acute onset of severe abdominal pain most likely in the LLQ,

treat medically if not complications

recurrent will need resection of the affected loop of bowel

most common complication is abscess formation

highly associated with constipation

92
Q

barium enema and colonoscopy are contraindicated in

A

diverticulitis due to an increased incidence of perforation

93
Q

RLQ pain algorithm

A

picture

94
Q

Abdominal abscess

A

occur after invasive procedure, inflammatory conditions and traumatic events

diagnosed by Ct

incision and drainage is only therapy

percutaneous drainage can be done by Ct or ultrasound guidance

abs to prevent bacteremia

95
Q

abdominal pain that radiates to the back has 2 emergent origin

A

pancreatitis and aortic dissection

96
Q

acute cholecystitis

A

inflammatory condition that occurs often in obese women in their 40’s

gallstone occludes the lumen of the cystic duct

peritoneal signs and positive murphy sign

on us it will have perisholecystic fluid and a thickened gallbladder wall

97
Q

sonoraphic murphys sign

A

is when the us probe causes a cessation of breathing when it presses against the abdominal wall

98
Q

Appendicitis

Etiology -

Signs and sx -

diagnostic tests -

treatment -

complications -

A

Etiology - fecolith obsturctint he appendiceal orifice, causing inflammation

Signs and sx - anorexia, fever, periumbilical pain with RLQ tenderness. elevated white count with left shift

diagnostic tests - ct scan is the most accurate test

treatment - laparoscopic surgery

complications - abscess formation and gangrenous perforation

99
Q

Acute Pancreatitis

Etiology -

Signs and sx -

diagnostic tests -

treatment -

complications -

A

Etiology - alcohol or gallstone obstruction of the duct, causing inflammation

Signs and sx - fever, severe midabdominal pain radiating to the back, nausea and vomiting

diagnostic tests - Ct scan is the best test. amylase is sensitive and lipase is specific

treatment - aggressive IV fluids and npo until sx resolve

complications - hemorrhagic pancreatitis and pseudocyst formation

100
Q

Diverticulitis

Etiology -

Signs and sx -

diagnostic tests -

treatment -

complications -

A

Etiology - fecal impaction into pseudodiverticula, causing inflammation

Signs and sx - fever, nausea, most commonly LLQ pain, and peritonitis

diagnostic tests - ct scan is the best and most accurate test

treatment - antibiotics for the first attack, surgical resection if it recurs or perforates

complications - abscess formation, no endoscopy due to risk of perforation

101
Q

Cholecystitis

Etiology -

Signs and sx -

diagnostic tests -

treatment -

complications -

A

Etiology - gallstones occluding the lumen of the cystic duct, causing inflammation of the gallbaldder

Signs and sx - fever, severe RUQ tnederness, murphy sign, pain on inspiration causing a cesation of breathing, nausea, and vomiting

diagnostic tests - us will reveal pericholecystic fluid, gallbaldder wall thickening, and stones in the gallbladder. HIDA scan is the most accurate test

treatment - laparoscopic surgery, or open surgery if there is perforation of the gallbladder

complications - perforation of the gallbladder

102
Q

Acute cholecystitis HIDA Scan

A

shows delayed empyting oft he gallbladder by failure to visulaize the gallbladder from istotope accumulation

103
Q

Signs of appendicitis

A

Rovsing sign - palpation of the LLQ cause pain int he RLQ

psoas sign - pain with extension of the hip

obturator sign - pain with internal rotation of the right thigh

104
Q

hallmarks of small bowel obstruction

A

failure to pass stool

flatus

hyperactive bowel sounds

nausea

vomiting

abdominal pain

105
Q

significant risk factor for small bowel obstruction

A

prior abdominal surgery

106
Q

bowel obstruction

A

a mechanical of runctional obstructiono f the intestines due to various causes

upon occlusion gas and gluid build up and incrase the pressure within the lumen leading to decreased perfusion of the bowel and necrosis

most common cause is prior abdominal surgery

107
Q

2 types of bowel obstruction

A

partial: a small amount of GI contents can pass

Complete: no GI contents can pass

108
Q

bowel obstruction

signs and symptoms

A

severe waves of intermittent crampy abdominal pain

nausea and vomiting

fever

hyperactive bowel sounds

high pitched tinkling sounds indicate that the intestinal fluid and air are under high pressure in the bowel

hypovolemia due third spacing

109
Q

bowel obstruction

etiology

A

adhesions from pervious abdominal surgery (MCC)

hernias

crohn disease

neoplasms

intussusception

volvulus

foreign bodies

intestinal atresia

carcinoid

110
Q

what alleviates obstruction from stool impaction in pts on chronic opiods

A

methylnatrexone (relistor)

111
Q

bowel obstruction

diagnostic tests

A

an elevated white count is sensitive but not specific

an elevated lactate with marked acidosis is a hallmark sign

the best initial test is abdominal xray which will show multiple air fluid levels with dilated loops of small bowel

most accurate test is ct of the abdomen. it will show a transition zone from dilated loops of bowel with contrast to an area of bowel with no cotrast

112
Q

bowel obstruction

treatment

A

make pt npo - prevents further increase in bowel pressure

place ng tube with suction - lowers bowel pressure proximal to obstruction

medical management - iv fluids to replace volume lost via third spacing

surgical decompression indicated if - complete obstruction (emergent), lack of improvement with medical management

113
Q

Fecal incontinence

definition

A

defined as the continuous or recurrent uncontrolled passage of fecal material (>10ml) for at least 1 month in an individual >age3

114
Q

bowel obstruction

diagnostic testing

A

diagnosed by clinical hx combined with flexible sigmoidoscopy or anoscopy as the best initial test

most accurate test is anorectal manometry

if there is a hx of anatomic injury then the best itest is endorectal manometry

115
Q

bowel obstruction

treatment

A

medical therapy includes bulking agents such as fiber

biofeedback includes control exercises and muscle strengthening exercises

injection of dextranomer/hyaluronic acid (solesta) has been shown to decrease incontinence episodes by 50%

if this all fails colorectal surgery is needed

116
Q

fractures are always diagnosed with

A

xray

117
Q

general rules of fracture therapy

A

closed reduction: mild fractures without replacement

open reduction and internal fixation: severe fractures with displacement or misalignment of bone pieces

open fractures: skin must be lcosed and the bone must be set int eh operating room with debridement

118
Q

fractures present with

A

pain, swelling, and deformity

119
Q

5 types of fractures

A

comminuted fractures

stress fractures

compression fractures

pathologic fracture

open fracture

120
Q

comminuted fracture

A

a fracture in which the bone gets broken into multiple pieces

most commonly caused by crush injuries

121
Q

stress fractures

A

a complrete fracture from repetitive insults to the bone in question

most common stress fracture is in the metatarsals

think athlete with persistent pain

do not see on xray so do a ct or mri

treat with rehab, reduced physical activity, and casting, if persistent then surgery

122
Q

compression fractures

A

specific fracture of the vertebra in the setting of osteoporosis

approximately one-third of osteoporotic vertebral injuries are lumbar, 1/3 are thoracic, and 1/3 are thoracolumbar

123
Q

pathologic fracture

A

occurs from minimal trauma to bone that is weakened by disease

metastatic carcinoma (breast or colon), multiple myeloma, and paget disease

older person fractures rib from coughing

must surgically realign bone and treat underlying disease

124
Q

open fracture

A

when injury causes a broken bone to pierce the skin

associated with high rates of bacterial infection

SURGERY

125
Q

Anterior Shoulder Dislocation

Etiology -

signs and sx -

diagnosis -

treatment -

A

Etiology - any injury that cause strain on the glenohumoral ligaments, most common type more than 95%

signs and sx - arm held to the side with externally rotated forearm with severe pain

diagnosis - xray is the best initial test and mri si the most accurate test. must rule out axillary artery or nerve injury

treatment - shoulder relocation and immobilization

126
Q

Posterior shoulder dislocation

Etiology -

signs and sx -

diagnosis -

treatment -

A

Etiology - seizure or electrical burn

signs and sx - arm is medially rotated and held to the side

diagnosis - xray is the best initial test and mri is the most accurate

treatment - traction and surgery if pulses or senation are diminished during physical exam

127
Q

Clavicular fracture

Etiology -

signs and sx -

diagnosis -

treatment -

A

Etiology - trauma

signs and sx - pain over location

diagnosis - xray is the best test. must rule out subclavian artery/brachial plexus injury

treatment - simple arm sling

128
Q

Scaphoid fracture

Etiology -

signs and sx -

diagnosis -

treatment -

A

Etiology - falling on an outstretched hand

signs and sx - persistent pain in the anatomical snuffbox

diagnosis - xray wont show results for 3 weeks

treatment - thumb spica cast

129
Q

figure 8 slings for a clavicular fracture

A

no longer used bc outcomes are not better than a simple arm sling

130
Q

trigger finger

A

acutley flexed and painful finger

steroid injection first

then surery

caused by a stenosis of the tendon sheath

131
Q

dupuytrens contracture

A

more common in men over 40

the palmar fascia becomes contracted and the hand can no longer be properly extended open

surgery is only effective therapy

132
Q

fat embolism syndrome

A

confusion, petechial rash, dyspnea and tachypnea

fracture of long bones causes fat to escape as little vesicle and occlude vasculateru throughout the body

femur is most common bone

w/in 5 days of fracture

133
Q

fat embolism diagnostic tests

A

abg will show p02 under 60 mm hg

cxr will show infiltrates

ua may show fat droplets

134
Q

fat embolism treatment

A

oxygen to keep P02 over 95%

intubation and mechanical ventilation if pt becomes severely hypoxic

135
Q

Spinal stenosis

A

arthritic changes narrow the spinal canal at L1 and C2

neck and back pain, bilateral leg/buttock pain and numbness, and psuedoclaudication

sx are worse with walking but improve with spinal flexion

136
Q

herniated disk disease

A

intervertebral disk herniates, compressing the spinal nerve root

seen in the elderly and is associated with a lifting injury

electrical pain following a dermatomal distribution

straight leg raise, MRI

nsaids and activity modification

137
Q

Compartment syndrome

A

compression of nerves blood vessels and muscle insided a closed space

can happen from trauma or from a cast after setting a fracture

medical emergency and immediate fasciotoy must be done before necrosis occurs

138
Q

6 signs of compartment syndrome

A
  1. pain - usually first sx
  2. pallor - lack of blood flow causes pale skin
  3. paresthesia - Pins and needles sensation
  4. paralysis - inability to move the limb
  5. pulselessness - lack of distal pulses
  6. poikilothermia - cold to the touch
139
Q

Early findings in compartment syndrome

A

pain pallor parethesias

140
Q

late findings in compartment syndrome

A

poikilothermia paralysis pulselessness

141
Q

what is the most common knee ligament injury

A

ACL

142
Q

Medial and lateral collateral ligament injury

etiology -

signs and sx -

diagnosis -

treatment -

A

etiology - trauma to the opposite side of the injury

signs and sx - pain

diagnosis - mri

treatment - surgical repair

143
Q

ACL

etiology -

signs and sx -

diagnosis -

treatment -

A

etiology - direct trauma to teh knee

signs and sx - pain and positive anterior drawer sign

diagnosis - mri

treatment - arthroscopic repair

144
Q

PCL

etiology -

signs and sx -

diagnosis -

treatment -

A

etiology - direct trauma tot he knee

signs and sx - pain and positive posterior drawer sign

diagnosis - mri

treatment - arthroscopic repair

145
Q

Meniscal injury

etiology -

signs and sx -

diagnosis -

treatment -

A

etiology - traumatic injury of the knee

signs and sx - popping sound upon flexion and extension

diagnosis - mri

treatment - arthroscopic repair

146
Q

Terrible triad

A

acl

mcl

lateral or medial meniscus

147
Q

acute onset of back pain under the age of 50

A

mri to rule out spinal cord ocmpression due to a slipped disk or herniation

antiinflammtory agetns

l4-l6 and l5-s1 are most common

148
Q

AAA

A

occurs when theprtion of the arota in abdomen grows to 1.5 times its normal size or exceeds the normal diameter by more than 50

true anuersym bc it involves all layers of the arterial wall

bruit and pulsatile mass are hallmark signs

syncope is rupture until proven otherwise

smoking and age are risk factors

149
Q

ruptured AAA

A

painful pulsatile mass in abdomen with signs of hypovolemia (hyptension and tachycardia) the ruptured aorta is pouring blood into the retroperitoneal space and it bulges with every heartbeat

150
Q

AAA

diagnostic tests

A

Ct or MRI will give infor regarding the relationschip of the AAA to surrounding vessels

us must be done bc it gives info on the size and can be sued to monitor the AAA over time

surgery is indicated when it reaches 5 cm

151
Q

Management of AAA

A

3-4cm, us q 2-3 years

4-5.4 cm, us or ct q 6-12 months

> 5.5 cm, asymptomatic, surgical repair

152
Q

Screening for AAA

A

former or current smokers over 65 should have abdominal ultrasound. this is >95% sensitive and specific

153
Q

Aortic Dissection

definition

A

occurs when a tear in the intima of the aorta creates a false lumen, this weak spot extends with each beat, extending the tear

154
Q

Aortic Dissection

risk factors

A

htn is the number one risk factor

age>40

marfans

155
Q

Aortic Dissection

presentation

A

sudden onset of tearing chest pain that radiates to the back

asymmetric bp in the R and L arms

156
Q

Aortic Dissection

diagnostic tests

A

magnetic resonance angiogram (MRA), computed tomography angiogragphy (CTA), and transesophageal echocardiogram (TEE) are all equal in sensitivity and specificity. However, TEE is the fastest of the 3 modalities and is used if the pt is clinically unstable. in a stable pt, MRA is the diagnostic test of choice

157
Q

Aortic Dissection

treatment

A

if imaging demonstrates an ascending dissection, manage the pt with emergent surgery and bp control

for a descending dissection provide medical therapy for bp control

bblockers are best inital antihypertensive therapy. follow with vasodilators such as sodium nitropursside.

vasodilators should never be used alone bc they will cause relfex tachycardia that will increase shearing forces

158
Q

postoperative care

most likely infection

A

uti

159
Q

POD 1-2

Mnemonic -

possible cause -

diagnostic test -

therapy -

A

Mnemonic - wind

possible cause - atelectasis or postoperative pneumonia

diagnostic test - cxr followed by sputum cultures

therapy - prevention by incentive spirometry, vancomycin and tazobactam-pipercillin for hospital acquired pneumonia

160
Q

POD 3-5

Mnemonic -

possible cause -

diagnostic test -

therapy -

A

Mnemonic - water

possible cause - uri

diagnostic test - urine analysis showing pos nitrates and leukocyte esterase. urine culture for species and sensitivity

therapy - antibiotics appopriate for the organism

161
Q

POD 5-7

Mnemonic -

possible cause -

diagnostic test -

therapy -

A

Mnemonic - walking

possible cause - dvt or thrombophlebitis of the IV access lines

diagnostic test - doppler us of the extremities. changing of iv access lines and culture of the iv tips

therapy - heprain for 5 days as a bridge to coumadin for 3-6 months

162
Q

POD 7

Mnemonic -

possible cause -

diagnostic test -

therapy -

A

Mnemonic - wound

possible cause - wound infections and cellulitis

diagnostic test - pe of the wound for erythema, purulent discharge, and/or swelling

therapy - incision and drainage if abscess or fluid followed by abs

163
Q

POD 8-15

Mnemonic -

possible cause -

diagnostic test -

therapy -

A

Mnemonic - weird

possible cause - drug fever or deep abscess

diagnostic test - ct scan for examination of a deep fluid collection

therapy - ct guided peructaneous guided dranage of the abscess, otherwise surgery

164
Q

Postoperative confusion

A

likely they are hypoxic or septic

get an abg xcr blood cultures urin culture and cbc

treate appropriate organism

if hypoxic consider pe atelectasis or pneumonia as the cause

165
Q

confused pt postop

obtain abg cxr cbc

evidence of infection (abnormal CBC)

A

culture likely sources
blood (bacteremia)
urine (UTI)

treat with empiric abs

166
Q

confused pt postop

obtain abg cxr cbc

changes on cxr

yes

A

atelectasis vs pneumonia

incentive spirometry

antibiotics

167
Q

confused pt postop

obtain abg cxr cbc

changes on cxr

no

A

cosider pe

spiral ct

168
Q

Adult respiratory distress syndrome

A

ARDS

is seen postop with severe hypoxia, tachypnea, accessory muscle use for ventilation, and hypercapnia.

diagnose with cxr that will show b/l pulmonary infiltrates w/out jvd (rule out chf) and treate with peep

169
Q

PE

A

presents as an acute onset of chest pain with clear lung exam

best intial diagnostic test is an ekg - shows tachycardia w/out st segment changes. ou can confiem noncardiac ches pain with troponins and cardiac enzymes. then follow with a ct angiogram of the ches

treat with heparin as a bridge to coumadin

if pt has second pe while on coumadin the place an ivc filter via inguinal catheterization

170
Q

The most common finding on ekg for pe is

A

nonspecific st segment changes

s1q3t3 is not the most common and is seen less than 10% of pts

171
Q

PE testing

A

ekg

do a spiral ct scan if pt is not allergic to contrast dye

if allergic to dye then do vq mismatching

OMS III (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions