Surgery Flashcards by Taylor Batson

If O2 sats are below 90, do

ABG

How well did you know this?

Not at all

Perfectly

Normal bicarb =

How well did you know this?

Not at all

Perfectly

Cardiac output =

Stroke volume x Heart rate

How well did you know this?

Not at all

Perfectly

Stroke volume =

End Diastolic Volume - End Systolic Volume

How well did you know this?

Not at all

Perfectly

Total peripheral resistance =

Mean arterial pressure - Mean venous pressure

How well did you know this?

Not at all

Perfectly

Blood pressure =

Cardiac Output x Total Peripheral Resistance

How well did you know this?

Not at all

Perfectly

Immediately perform __ in pericardial tamponade

pericardiocentesis

How well did you know this?

Not at all

Perfectly

In preparation for immediate exploratory laparotomy, do a bunch of things simultaneously:

2 large bore IV lines
Type and cross
Give fluids and blood
Insert foley
Administer IV antibiotics

How well did you know this?

Not at all

Perfectly

Surgery is always done for ___ head injuries, even if the patient is asymptomatic!

comminuted or depressed skull fracture

How well did you know this?

Not at all

Perfectly

All patients with open skull fractures should receive

tetanus toxoid and prophylactic antibiotics

How well did you know this?

Not at all

Perfectly

Management of basal skull fracture =

CT scan of head/nec
CSF leak sill stop by itself
Facial palsy may occur 2-3 days later

How well did you know this?

Not at all

Perfectly

All epidermal hematomas require

emergency craniotomy

How well did you know this?

Not at all

Perfectly

Epidural hematoma = injury to

middle meningeal artery

How well did you know this?

Not at all

Perfectly

Subdural hematoma = injury to

bridging veins

How well did you know this?

Not at all

Perfectly

Only do an emergency craniotomy in case of subdural hematoma if

there are lateralizing signs and midline displacement

How well did you know this?

Not at all

Perfectly

Surgery cannot help in this head injury that is caused by acceleration-deceleration injuries to the head

diffuse axonal injury

How well did you know this?

Not at all

Perfectly

Gradual dilatation of one pupil and a decreasing responsiveness to light is an important sign of

elevating intracranial pressure

How well did you know this?

Not at all

Perfectly

DO NOT EVER DO THIS

perform an LP before getting a head CT. If you perform a lumbar puncture on a person with increased intracranial pressure, you will HERNIATE THE BRAIN, KILL THE PATIENT, GET CHLAMYDIA AND DIE.

How well did you know this?

Not at all

Perfectly

Hyperventilation causes vaso___ and decreased blood volume in the brain, causing ICP to ___

constriction; lower ICP

How well did you know this?

Not at all

Perfectly

First line measures for high ICP are

elevated head of bed
hyperventilation
avoid fluid overload

second line: mannitol, sedation/hypothermia

How well did you know this?

Not at all

Perfectly

Anisocoria =

unequal size of pupils

How well did you know this?

Not at all

Perfectly

When is surgery the answer for acute abdomen?

Peritonitis
Abdominal pain/tenderness plus sepsis signs
Pneumoperitoneum
Acute intestinal ischemia

rule out pancreatitis first

How well did you know this?

Not at all

Perfectly

Treatment for spontaneous bacterial peritonitis is

immediate paracentesis; diagnosis is made when fluid contains neutrophils greater than 250 cells per cubed mm

How well did you know this?

Not at all

Perfectly

Treat SBP with

ceftriaxone and albumin at 1.5g/kg on day 1 and day 3 of hospitalization

How well did you know this?

Not at all

Perfectly

First study of choice for esophageal perforation is

gastrografin contrast esophagram

Most accurate test for adult with GI obstruction is

CT scan of abdomen and pelvis with contrast

When diagnosing acute diverticulitis, don't forget to order

a pregnancy test in women of reproductive age!

___ is absolutely contraindicated in acute diverticulitis

Colonoscopy

When palpation of the LLQ causes pain n the RLQ, think

acute appendicitis (Rovsing's sign)

It's important to administer ___ before appendectomy

IV antibiotics: - cipro and metronidazole - ampicillin/sulbactam - levofloxacin and clinda - cefoxitin or cefotetan

If chronic UC has been present for more than 20 years, ___ is indicated

elective surgery | also if high dose chronic steroids are needed or toxic megacolon is present

What three major GI arteries arising from the abd aorta supply the gut?

celiac axis, the SMA, and the IMA SMA is most commonly affected by ischemia

The best initial and most accurate test for ischemic colitis is

CT abdomen showing thickening of the bowel in a segmental pattern

Therapy for ischemia colitis

IV fluid hydration and bowel rest

In chronic mesenteric ischemia, ___ is both therapeutic and diagnostic

computed tomography angiography

Development of symptoms (postprandial abd pain, unrelenting nausea, anorexia, weight loss) after a recent dramatic weight loss

Median Arcuate Ligament Syndrome treat by surgical decompression of the celiac artery

Always do what to an intra-abdominal abscess?

Drain it!

Which two ducts merge to form the common bile duct?

Common hepatic duct and Cystic duct

CT scan of obstructive jaundice caused by a tumor will show

double duct sign (aka simultaneous dilatation of both the common bile duct and the pancreatic duct)

Treat acute cholecystitis is

``` NG suction NPO IV fluids antibiotics then cholecystectomy after 6-12 weeks ```

Reynold's pentad:

``` jaundice RUQ pain fever AMS shock ```

Treat acute ascending cholangitis with

IV antibiotics Emergency decompression of the common duct ERCP or percutaneous transhepatic cholangiogram Surgery isn't often necessary

The most accurate test for fecal incontinence is

anorectal manometry

Do not perform surgery in patients with multiple

derangements in hepatic risk factors

The most lethal cause of post-op disorientation if not recognized and treated early is

hypoxia, so order an ABG

The leakage of fecal, gastric, or duodenal contents to the outside opstoperatively is ___

not an indication for emergency surgery! observe stable patients

Manage malignant hyperthermia by

IV dantrolene, 100% O2, acidosis correction, cooling blankets watching for development of myoglobinuria

Manage bacteremia and fever >104 with

blood cultures x3 and empiric abx

The most important step before surgery at birth is

check for congenital anomalies and look for VACTERL constellation

If excessive salivation or chocking spells are noted shortly after birth, it could be

esophageal atresia

What causes esophageal atresia?

Ventrally displaced location of the notochord in an embryo

Confirm diagnosis of esophageal atresia with

NG tube, which becomes coiled in the upper chest on x-ray

If anal atresia is suspected, look for

a fistula nearby; if no fistula present, perform a colostomy

The primary abnormality of congenital diaphragmatic hernia is

hypoplastic lung with fetal type circulation

Treat CDH with

endotracheal intubation low pressure ventilation sedation NG suction

Where is the defect in gastroschisis?

To the right of the umbilical cord due to failure of neural crest cells to migrate

Incomplete fusion during the fourth week of development results in

omphalocele

Which trisomies are a/w omphalocele?

Edwards syndrome and Patau syndrome

Exstrophy of the urinary bladder requires

Surgical repair in the first 1-2 days of life! Transfer to a specialized center

What can present with double bubble sign?

Annular pancreas malrotation duodenal atresia

Intestinal atresia is not associated with

other congenital abnormalities

A sign of sepsis in newborns is

rapidly dropping platelet count

The most common pathogens in necrotizing enterocolitis are

E. coli and Klebsiella pneumonia

Feeding intolerance + bilious vomiting + CF =

meconium ileus

In meconium ileus, ___ is both diagnostic and therapeutic

gastrografin enema

Diagnose hypertrophic pyloric stenosis with

sonogram showing target sign

Treat pyloric stenosis by

first correcting metabolic abnormalities and dehydration, then performing a pyloromyotomy

Persistent progressively increasing jaundice in 6-8 week old babies =

biliary atresia

Treat biliary atresia with

HIDA scan after 1 week of phenobarbital, then surgery if that doesn't work

diagnose Hirschsprung Disease with

full-thickness biopsy of rectal mucosa

When does intussusception show up?

6-12 months of age, chubby healthy looking kids with brief episodes of colicky abdominal pain

Lower GI bleeding in a child of pediatric age =

Meckel diverticulum

When a fracture is suspected, order

2 views at 90 degrees to one another and always include the joints above and below the broken bone

When a fracture is displaced severely or angulated or cannot be aligned, what should you do?

Open reduction and internal fixation

When does an open fracture need to be reduced?

within 6 hours from time of injury

Neuro dysfunction, petechial rash, respiratory distress, fracture =

fat embolism

Fixing a long-bone fracture within ___ reduces the incidence of respiratory distress from embolic phenomena

24 hours

Which type of shoulder dislocation is possible in a patient with a recent seizure?

Posterior shoulder dislocations. Otherwise, anterior shoulder dislocations are the most common

What type of xray should you order in a patient with a recent seizure and shoulder pain?

axillary or scapular views of the affected shoulder

Painful wrist + dinner fork deformity =

Colle's fracture

Direct blow to the ulna or radius results in a combo __ and __ fracture

diaphyseal and displaced dislocation. Treat w/ ORIF

Suspected scaphoid fracture, treat w/

thumb spica cast

Treat femoral neck fractures with

femoral head replacement

Intertrochanteric fractures are treated with

open reduction and pinning

Femoral shaft fractures are treated with

intramedullary rod fixation

Posterior dislocation of the hip (knees hit dashboard in MVA) =

orthopedic emergency! Leg is internally rotated and shortened

Symptoms caused by tapping the nerve over the flexor retinaculum and awaiting parasthesias =

Tinel's sign for CTS

Flexing the wrist gently and holding the position =

Phalen's test for CTS

Signs of a __ injury include inability to dorsiflex (extend) the wrist

oblique distal humerus, complicated by radial nerve paralysis

The most important intervention for a urologic obstruction is

a ureteral stent or percutaneous nephrostomy

A child who has hematuria from a trivial trauma has ___ until proven otherwise

undiagnosed congenital urologic anomaly

A teenager drinks large volumes of beer and develops colicky flank pain

Ureteropelvic Junction Obstruction | -only symptomatic with diuretics

Treat subclavian steal syndrome with

bypass surgery

Classic symptoms of subclavian steal syndrome are

visual symptoms, equilibrium problems, and claudication in the arm during arm exercises