Surgery Flashcards
Young IVDA with CHF Sx =
Acute Ao regurg 2/t endocarditis.
LMWH all DVT pts except… (3)
CRF (UFH)
Bleed risk- need to “turn off” quick (UFH)
Hx HIT (Argatroban)
20-40yoM heavy smoker with rest pain in LE
Thromboangitis Obliterans aka Buerger’s Disease (vasculitis caused by smoking without real tx)
First line for intermittent claudication?
Modify risk factors/inc exercise
THEN cilostazol/pentoxyfilline/ASA.
Murmur of acute AR 2/t endocarditis?
Loud diastolic murmur in Ao region
How do you tx acute AR 2/t endocarditis?
Emergent valve replacement + long-term abx
What is affected in Reynaud’s?
Arteries (exaggerated response)
Claudication + erectile dysfxn + dec fem pulses =
Leriche’s (bilat aortoiliac PAD)
Imaging for severe extremity wound in a diabetic?
MRI (XR only shows late-stage osteomyelitis)
ABI cutoffs?
<0.9 = to vasc specialist <0.8 = to surg
Three special tests in diabetic PVD exam?
Trendelenburg test
ABI
Doppler the pulses
Bypass grafting for aortoiliac disease? (4)
Ao-fem if bilat (preferred)
Ao-iliac or iliofem if unilat
Fem-fem if bad anesthesia candidate
Axillopop as a last ditch effort
Bypass grafting for infrainguinal disease?
Indications? (3)
Fempop or saphenous if it’s past popliteal a
If ulcers, ABI<0.8, or persistent infection
Indications for carotid endardectomy? (2)
Sx + >50% occlusion
ASx + > 70% occlusion
C/C is painless problems with night driving and fine print. What are three possible fundoscopic findings most likely to fit this dx?
Nuclear opacification (= myopia)
Posterior subcapsular haze (= blinding glare when in bright light)
Cortical spoking
{cataracts}
Triad for ruptured AAA? What are two additional inspection findings?
Pulsatile mass + hypotension + lower abd or back pain
Cullen sign: periumbilical ecchymosis
Grey-Turner sign: flank ecchymosis
Pre-op, what are the two big concerns with an AAA?
Peri-op? (1)
Post-op? (5)
Pre-op: rupture or embolus causing acute limb ischemia
Peri-op: injuring lumbar aa = spinal cord paralysis
Post-op: MI, CVA, embolus to fem & below, ARF, and ischemic sigmoid
Surgical indication and options for AAA?
Rupture, obviously, or AAA >5cm
EVAR or open
Initial Dx for AAA?
U/S
Might have gotten CT already if you thought it was diverticulitis
Main cause of AAA? Of pseudoaneurysm?
AAA - atherosclerosis risk factors
Pseudo - injury
Proximal Ao dissection might have two specific Sx:
AR
Pericardial tamponade
If you happen to get CXR before CTA in suspected Ao dissection, what might you see?
Wide mediastinum (>8cm supine or >6cm upright)
Classifications and brief overview of Ao dissections?
Type A Stanford = Ascending Ao; more common and more fatal (emerg)
Type B Stanford = Descending Ao; try medical tx before surg tx since it’s a risky fix
Debakey Type I = both those.
Medical intervention for Ao dissection?
IV esmolol + IV nicardipine or nitropress to BP 100/60
