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First Aid Step 2 🐰 > Surgery > Flashcards

Surgery Flashcards

1
Q

High Risk for surgery (5)

A
  1. age >70
  2. Pulm: FEV1< 70, PCO2>45, pulm edema
  3. Cards: MI last 30 d, poor control nonsinus arrhythmia, pathologic Q waves, severe valve D+, decompensated CHF, poor EF
  4. Renal: Cr <2 or 50% dec from baseline
  5. type of surgery: vascular or anticipated large blood loss
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2
Q

When to get preop CXR

A

> 50 yrs
Pulmonary disease (smoker, COPD, MG)
Surgery >3 hrs

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3
Q

Agent to protect kidneys from radiocontrast

A

Acetylcysteine

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4
Q

Staph is in chain or cluster

A

cluster

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5
Q

Strep is in chain or cluster

A

Chain

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6
Q

How long to wait after epidural catheter removal before restarting warfarin?

A

2 hours - need to avoid formation of epidural hematoma

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7
Q

Cause of fever: Postop day # pneumo
Major S/S
Tx

A

after 3rd day
PRODUCTIVE COUGH
Abx, bronchoscopy

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8
Q

Cause of fever: Postop day #UTI
Major S/S
Tx

A

3-5 d
FOLEY CATH
Abx, remove foley

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9
Q

Cause of fever: Postop day # wound/cath infection
Major S/S
Tx

A

5-8 d
Warm, drainage
Abx, irrigation, drainage, debridement

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10
Q

Cause of fever: Postop day # DVT

Tx

A

any time

Anticoag or IVC filter

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11
Q

Cause of fever: Postop day # PE
Major S/S
Tx

A

Any time
INCREASED A-a GRADIENT
V/Q mismatch
Anticoag/IVC filter

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12
Q

Cause of fever: Postop day # Meds
Major S/S
Tx

A

Any time
New meds, think abx
Stop Rx

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13
Q

Cause of fever: Postop day # Transfusion reaction

Tx

A

any time, check with compatibility workup

Acetaminophen, diphenhydramine, stop transfusion

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14
Q

Postop fever 5 W

A 
Wind- Pneumo
Water- UTI
Wound
Wonder drug
Walking- DVT, PE
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15
Q

Acute abdomen - previous surgery with high pitched bowel signs, crampy pain, N/V

A

Obstruction/strangulation 2/2 adhesions tumors hernias

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16
Q

Acute abdomen- LLQ pain, blood in stool

A

Diverticulitis

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17
Q

Acute Abd- hematemesis, hematochezia, sudden pain

A

Massive GI hemorrhage/perf

Need angiography w/ embolization

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18
Q

Acute abd- RLQ pain, periumbilical pain, rectal exam = tender

A

Appendicitis

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19
Q

Acute abd- severe pain out of proportion to examination

A

Mesenteric ischemia

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20
Q

Acute abd- Upper abdominal and back pain, N/V

A

Pancreatitis

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21
Q

Acute abd- amenorrhea, low abd pain

A

Ruptured ectopic

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22
Q

Acute abd- cervical motion tenderness

A

PID

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23
Q

Major causes PID

A

Chlamydia

N. gonorrhoeae

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24
Q

Cause malignant hyperthermia

A

Halothane

Succinylcholine

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25
Q

3 factors looked at when donating organs

A

HLA
ABO
Crossmatch compatibility - antidonor Ab on recipient T cells

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26
Q

Hyperacute rejection
When
Cause
Tx

A

Initial 24 hr - kidney turns bluish black after release vascular clamps during surgery
Antidonor Ab in recipient = preformed (type II hypersensitivity)
No Tx

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27
Q

Acute rejection
When
Cause
Tx

A

6 d-1 yr
Antidonor T cells in recipient
Reversible with immunosuppressive Rx= pulse corticosteroids, anti T cell ab (Polyclonal AB/OKT3), Ab (basilizimab, daclizumab), immunosuppressants (tracrolimus, mycophenolate, cyclosporine)

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28
Q

Chronic rejection
When
Cause
Tx

A

> 1 yr
Development of multiple cellular and humoral immune reactions to donor tissue
Not treatable, may be able to immunosuppress

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29
Q

Reason to transplant BM

A

Aplastic anemia

Induction chemo

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30
Q

CI heart transplant

Survival

A

Pulm HTN
Smoking last 6 months

5 Yrs

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31
Q

Reason to transplant lung
Reason to not
Survival

A

COPD, CF
Smoking
56% 3 yr, chronic rejection common

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32
Q

Reason to transplant kidney
Reason to not
Where is it placed

A

end stage renal disease

Not: DM and lupus- CI

In the iliac fossa

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33
Q

Reason to transplant pancreas

Reason to not

A

DM I

DM II

34
Q

Mechanism cyclosporine

Adverse effects

A

Helper T cell inhibition via inhibition IL-2 production

Nephrotoxic, androgenic, HTN

35
Q

Mechanism azothioprine

Adverse effects

A

Inhibit T cell proliferation via inhibition of DNA and RNA synthesis
Leukopenia

36
Q

Mechanism tacrolimus

Adverse effect

A

Inhibitor of T cell fcn via inhibition of signaling through T cell function
Nephrotoxic, neurotoxic

37
Q

Mechanism Corticosteroids

Adverse effect

A

Inhibits all leukocytes via inhibition of IL1 production

Cushing, weight gain, AVN of bone

38
Q

Mechanism Muromonab D2 (OKT3)

Adverse effect

A

Inhibitor T cell fcn and depletes T cell population = good for early rejection maintenance
ONE TIME CYTOKINE RELEASE = fever and bronchospasm, leukopenia; only use short term

39
Q

Rapamycin Mechanism

ADverse effect

A

Helper T cell inhibition

Thrombocytopenia, hyperlipidemia

40
Q

Mycophenolic acid mechanism

Adverse effect

A

Inhibits T cell proliferation

Leukopenia, GI toxicity

41
Q

Antithymocyte globulin mechanism

Adverse effect

A

Depletes T cell population - good for early rejection maintenance
Serum sickness, short term only

42
Q

Hydroxychloroquine mechanism

Adverse effect

A

Inhibit antigen processing= GVH

Visual disturbances

43
Q

Thalidomide mechanism

Adverse effect

A

Inhibits T cell fcn and migration - GVH

Sedation, constipation, teratogenic

44
Q

RUQ pain

A

Gallbladder
Liver disease (abscess)
Fitz Hugh Curtis
Hepatic adenoma- young woman + OCP

45
Q

LUQ

A

Spleen

PUD

46
Q

RLQ

A

Appendix
Ileocecal - Crohn
Adnexal

47
Q

Epigastric

A

Stomach- penetrating ulcer, gastric carcinoma

Pancreas

48
Q

Diffuse

A

Bowel obstruction
Peritonitis
Mesenteric ischemia

49
Q

Elderly pt with hypercalcemia, constipation, abdominal pain

A

Multiple myeloma

50
Q

Adrenal masses: 3 conditions

A

Pheo
Cushing syndrome
Conn syndrome

51
Q

Flushing, HTN, sweating

A

Pheochromocytoma

52
Q

Moon facies, elevated serum Na, HTN, truncal obesity, ABD striae

A

Cushing syndrome

53
Q

HTN, elevated serum Na, decreased serum K, metabolic alkalosis

A

Conn syndrome - secrete aldosterone

54
Q

Murphy sign

A

Cessation of inspiration during palpation of RUQ

Cholecystitis

55
Q

Labs cholelithiasis vs cholecystitis vs choledocholithiasis vs cholangitis

A

Cholelithiasis: no change
Cholecystitis: Inc WBC
Choledocholithiasis: Inc bili, ALP, ?AST/ALT
Cholangitis: Inc AST, ALT, bili, ALP, GGT, WBC

56
Q

Hernia through inner and outer inguinal ring; is lateral to epigastric vessels and into scrotum or labial region because of patent processus vaginalis (congenital defect)

A

Indirect

57
Q

Hernia protrudes medial to inferior epigastric vessels because of weakness in abd mm of Hesselbach triangle

A

Direct

58
Q

Hernia through gemoral ring onto anterior thigh below inguinal ring

A

Femoral

59
Q

Mos common in both sexes

A

Indirect

60
Q

More common in women

A

Femoral

61
Q

Most susceptible to incarceration and strangulation

A

Femoral

62
Q

Incarceration vs strangulation

A

Incarceration: swollen and edematous, most common cause SBO if never had abd surgery and 2nd most common if have had surgery
Strangulation: blood supply cut off, necrosis can occur

63
Q

Meckel can put at risk for

A

Volvulus

Intussusception

64
Q

Dx Meckel

A

Technetium-99 scan

65
Q

Pancreatic pseudocyst vs abscess

A

Pseudocyst: circumscribed peripancreatic fluid collection of pancreatic enzymes, blood, necrotic tissue (complication of pancreatitis, if severe must be drained)
Abscess: collection of pus resulting from tissue necrosis and infection that presents with abd pain, fever, leukocytosis 1-2 wks after pancreatitis; Tx drainage percutaneousl or surgically

66
Q

After splenectomy, what vaccines?

A

H flu
Pneumococcal
Meningococcal

67
Q

Open pneumothorax

A

Open defect in chest wall that causes poor ventilation and oxygenation
Tx: intubate, Positive P ventilation, close wound on 3 sides only - allow extra P to escape

68
Q

No breathe sounds on affected side, hypertympanic on affected side, hypotension, distended neck veins

A

Tension pneumo

69
Q

Tx tension pneumo

A

Needle thoracentesis 2nd intercostal space at midclavicular line w/ chest tube

70
Q

Hypotension, distended neck veins, mufled heart sounds, pulsus paradoxes, normal breat sounds

A

Cardiac tamponade

71
Q

Decreased breath sounds on affected side, dull percussion, hypotension or collapsed neck veins, tachycardia

A

Massive hemothorax

72
Q

Risk factors Fournier’s gangrene

A 
DM
Alcohol use
Immunocompromised state
Recent hx indwelling catheter
Perirectal infection
73
Q

Tx superficial thrombophlebitis

A

NSAID

74
Q

Localized extremity pain and redness, cordlike area of induration, erythema, tenderness

A

Superficial thrombophlebitis

75
Q

Test for C diff colitis
Fastest
Best

A

Fastest: Proctoscopy
Best: C diff ELISA

76
Q

Tx C diff colitis

A

Metronidazole first line

Vancomycin oral 2nd- expensive

77
Q

Blood loss amt and % for class I, II, III, IV

A

1: 2000/ >40%

Transfuse stage 3&4

78
Q

Basiliximab and Dacluzimab: monoclonal ab to what receptor

A

IL2

79
Q

Methotrexate

A

Folic acid antagonist

80
Q

OKTS Ab to what recptor

A

CD3 on T cells

First Aid Step 2 🐰 (22 decks)

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