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Deck Kat > Surgery > Flashcards

Surgery Flashcards

1
Q

The thyroid gland weighs?

A

20 grams

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2
Q

Water constitutes _____ of total body weight.

ECF main cation?
ICF MAIN CAtion?

A

50-60%

sodium
Potassium

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3
Q

Formula for total fluid requirement

A

maintenance fluid + ongoing losses + state of hydration

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4
Q

Guidance for a referral to a BURN CENTER

A

Ptb > 10% TBSA
Burns involving face hands feet genitalia perineum, major joints
3rd degree burns
Electrical / chemical burns
Inhalation injury
Burn + co morbidities
Burns + trauma
No qualified personnel to handle burns (children)
Need for special social emotional rehabilitation

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5
Q

CO poisoning treatment

A

100% oxygenation is gold standard

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6
Q

Largest salivary gland?

A

Parotid gland

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7
Q

Normal ANION GAP

A

<12mmol/L

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8
Q

Na and Cl content of PNSS?

A

154 + 154

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9
Q

Electrolyte content of lactated ringer?

A 
NA 130
Cl 109
K 4
Ca 28
Lactate 28mEq
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10
Q

How do you compute for maintenance fluid requirements?

A

A+B+C

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11
Q

Approximately how much body water is lost in severe dhn?

A

11-15%

Mild-2-5%
Mod- 6-10%

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12
Q

Compute for anion gap

A

Anion gap = Na - (Cl+HCO3)

Cation - anions

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13
Q

Causes of NAGMA

A 
H yperalimentation
A cetazolimide
R enal tubular acidosis
D iarrhea
U reteroenteric fistula
P ancreaticoduodenal fistula
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14
Q

Causes of HAGMA

A 
M ethanol
U remia
D iabetic ketoacidosis
P araldehyde
I infection, iron and isoniazid
L actic acidosis
E thylene glycol
S alicylates
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15
Q

What is the target of decrease in sodium concentration in hypernatremic patients? In excess of this value, patients may lead to?

A

1 mEq/l/h

Overcorrection may lead to cerebral edema and HERNIATION

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16
Q

What level of Hypernatremia will a patient be symptomatic?

A

At >160mEq/l

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17
Q

Symptomatic hypernatremic is given what kind of saline solution? Target of increase is?

A

3% nomal saline to increase sodium at 1mEq/l/h until 130 mEq or symptoms had improve

In asymptomatic patients : 0.5 mEq/l/h

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18
Q

What measures are applied for patients with high peaked T WAVES and a K level of > 5mEq/l?

A

HyPerkalemia - In ⬆️K say BING!!!

Kayexalate

B icarbonate infusion
I nsulin infusion
N ebulize with Salbutamol
G lucose

Calcium gluconate for with ecg changes

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19
Q

Critical level for serum calcium

A

15mEq/l

NV : 8.5-10-5

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20
Q

Hypocalcemia refractory to treatment?

A

Treat hypomagnesemia first!

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21
Q

Patient asked if her weight loss is significant. How will you answer this?

A

1wk - 2% of BW
1m- 5% of BW
3m- 7.5%of BW
6m- 10% of BW

More than these values are considered severe weight loss

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22
Q

Normal BMI

A

18.5 - 24.9

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23
Q

This refers to the minimum caloric requirements at rest

A

BASAL ENERGY EXPENDITURE (BEE)

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24
Q

Burn patients need how many grams of of protein per kg/day? Calories?

A
  1. 5 protein

2. 0 calories

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25
Q

What is the source of energy in short term fasting?

A

Lipids

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26
Q

What is the source of energy in prolonged fasting?

A

Ketone bodies as principal source by 24 days but becomes important fuel source for the brain by day 2

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27
Q

TPN can provide how much nutrition requirements?

A

1500-2800 mOsm/L

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28
Q

How much bowels can one resect before it leads to short bowel syndrome?

A

More than 50%

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29
Q

Most important contraindication in TPN?

A

Functional GI tract

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30
Q

Patient in prolonged TPN, presenting with scaly hyperpigmented lesions. Dx? Etiology?

A

Enterohepatic acrodermatitis secondary to ZINC deficiency

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31
Q

Patient in TPN presents with dry, sclay dermatitis and alopecia. What is deficient in this patient?

A

Fatty acids

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32
Q

What is a common vitamin deficiency in refeeding syndrome?

A

Thiamine deficiency

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33
Q

Malnourished patient presented with cardiac arrhythmias after initiation of feeding and lethargy

A

Refeeding syndrome -

Give first 50% of requirement on the first week to prevent this

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34
Q

How many hours after injury is a wound considered tetanus prone?

A

More than 6 hours

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35
Q

Components of a pancoast syndrome

A

Lung mass impinging on the stellate sympathetic ganglion presenting with horner’s triad

P -tosis
A -nhidrosis
M -iosis

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36
Q

Maneuver done to clamp the portal triad used for hemostasis in hepatic surgery?

A

Pringle maneuver

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37
Q

Treatment for burn causing METABOLIC ACIDOSIS

A

Mefenide Acetate

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38
Q

Treatment for burn causing neutropenia

A

Silver sulfadiazine

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39
Q

Treatment for burns causing hyponatremia, methemoglobinema and black staining?

A

Silver nitrate

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40
Q

Fistula with external opening is anterior to the anal margin will have?

A

A short radial tract to the anterior midline

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41
Q

A fistula with an external opening more than 3 cm anterior to the anal margin will have?

A

A tract to the posterior margin

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42
Q

A fistula that has an external opening posterior to the anal margin will have?

A

A curvilinear tract to the posterior margin

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43
Q

Type of hiatal hernia with both cardia and fundus herniate?

A

Type III

Type IV - intestines herniate!!!

44
Q

Type of hiatal hernia with the cardia of the stomach herniates?

A

Type I or sliding hernia

45
Q

Type of hiatal hernia where the fundus of the stomach herniate?

A

Rolling hernia or type II

46
Q

How many hours prior to transplant can the liver be preserved? The kidneys?

A

Liver -16 hours

Kidneys - 36-40 hours

47
Q

Poupart’s ligament derived from?

A

External oblique

48
Q

Osteonecrosis of the proximal femoral epiphysis of the pediatric hip and is thought to be due to vascular compromise

A

Legg-Calve-Perthes disease or COX PLANA

49
Q

Orthopedic conditions related to neuropathic arthropathy that affect diabetics and alcoholics?

A

Charcot joints

50
Q

Indications for repair of aortic aneurysms

A
  1. Symptomatic
  2. Asymptomatic
    - >5.5 cm ascending
    - >6.5 cm descending
    - >5.5 cm abdominal aortic aneurysm
    - rate of >1cm for thoracic and >0.5cm for abdominal aortic per year
    - >5 cm in the setting of a connective tissue disorder
51
Q

Strongest layer of the bowel wall

A

Submucosa

52
Q

Strongest layer of aorta

A

Tunica media

53
Q

Segment of the colon that is most prone to rupture and least prone to obstruction?

A

Cecum

54
Q

Part if the colon that is most mobile and thus is most prone to volvulus?

A

Sigmoid colon

55
Q

Narrowest part of the colon and is most prone to obstruction

A

Sigmoid

56
Q

Thyroglossal duct cysts are most commonly located ?

A

In the midline at the level of the hyoid

57
Q

Viral infection related to the development of nasopharyngeal CA

A

Epstein Barr virus

58
Q

Major component of extracellular matrix in skin

A

Type I collagen

59
Q

Major cell responsible for wound contraction

A

Myofibroblasts

60
Q

SIRS CRITERIA

A

2 or more of the ff

Temp - >=38 or 90
RR >20 OR ON MECH VENT
WBC => 12000 or <4000

61
Q

Most common location for congenital diaphragmatic hernia

A

Left posterolateral

62
Q

Symptoms of CHIARI I MALFORMATIONS

A

Usually asymptomatic but if with symptoms it includes headache, neck pain, and numbness and weakness of the extremities

63
Q

Patient presented with caudal displacement of the lower brain stem

A

Chiari II malformation

64
Q

Patient presented with cerebellar tonsil displacement

A

Chiari II

65
Q

Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What would you likely find in ur PE?

A

PE will likely reveal an abdominal distention and high pitched bowel sounds and rushes and tinkles and tympani on percussion.

66
Q

Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What would you likely find in an abdominal xray?

A

Multiple air fluid levels with dilated loops of small bowel, paucity of air in the colon and no air in the rectum

67
Q

Patient presented with crampy abdominal pain that waxes and wanes, constipation and nausea and vomiting. What is your impression?

A

Mechanical intestinal obstruction

68
Q

Patient presented with recurrent peptic ulcer with fasting gastrin level of 1000. What is ur dx?

A

Zollinger -Ellison syndrome

  • caused by non islet tumor that produces gastrin
  • malignant tumors
69
Q

Most common site of gastrinomas

A

Pancreas at the gastrinoma triangle

70
Q

Boundaries of the gastrinoma triangle or Passaro’s triangle

A

Junction of :
cystic and common bile ducts
Body and tail of PANCREAS
2nd and third parts of duodenum

71
Q

What is paraphimosis?

A

Inability to reduce the foreskin after it has been retracted

72
Q

Cantrell pentalogy components

A

CODES

CARDIAC ANOMALIES
OMPHALOCELE
Diaphragmatic hernia (Anterior)
Ectopia cordis
Sternal cleft
73
Q

Approach to treatment with BARRETT’s esophagus

A

Barrett with NO DYSPLASIA - surveillance every year
Barrett with LOW GRADE DYSPLASIA - surveillance every 6months
Barrett with HIGH GRADE DYSPLASIA- refer for ESOPHAGECTOMY

74
Q

Absolute contraindications for breast conservative surgery

A

3Ps MD

Pregnancy
Prior RT
Positive margins 
Multicentric
Diffuse micro calcification
75
Q

Confirmatory test to dx ACHALASIA

A

Manometry

76
Q

Basal caloric requirement of a normal healthy individual

A

25-30 kcal/kg/day

77
Q

Single most important test in the evaluation of thyroid nodules

A

FNAB

78
Q

Severe abdominal pain with normal PE

A

Abd pain out of proportion to PE findings is the HALLMARK OF MESENTERIC ISCHEMIA

79
Q

Most common presentation of Meckel’s diverticulum in adults?

A

Intestinal obstruction

80
Q

Most common abnormality of hemostasis in surgical patients?

A

Thrombocytopenia

81
Q

Risk of perforation of acute appendicitis?

A

25% in the first 24 hours from onset of sx then 50% by 36 hours and 75% by 48 hours

82
Q

Most common appendicial tumor

A

Carcinoid tumor

83
Q

Six Ps of acute limb ischemia?

A 
Pallor
Pain
Pulselessness
Paresthesia
Paralysis
Poikilothermia
84
Q

Most common location of an insulinoma?

A

Evenly distributed throughout the pancreas

85
Q

Most common location of a glucagonoma?

A

Pancreatic tail

86
Q

Most common cause of fever in the first 48 hours post operatively?

A

Atelectasis

87
Q

What sedative medication has a caloric value?

A

Propofol delivers 1kcal/cc in the form of lipid

88
Q

What electrolyte abnormalities are expected in refeeding syndrome?

A

Decreased levels of K, Mg and phosphate

89
Q

Most common congenital bleeding disorder

A

von Willberand’s disease

- characterized by mucocutaneous disorder associated with Factor 8 deficiency

90
Q

Interleukin related to eosinophil proliferation and airway inflammation

A

IL -5 secreted by mast cells and basophils

91
Q

Most common indication for intubation?

A

Altered mental status

92
Q

The goal MAP of surviving sepsis guidelines

A

> 65mmHg

93
Q

The most common form of Basal cell carcinoma?

A

Nodular form

94
Q

Basal cell carcinoma presents more often as?

A

Bleeding, ulceration and itching

It arises from the BASAL LAYER OF NON KERATINOCYTES and accounts for 75% of all skin cancers

95
Q

NPCA will classically spread to what level of neck lymph nodes?

A

Level 5 or posterior triangle LDs

96
Q

HERNIATION involving a Meckel’s diverticulum is also known as

A

LITTRE’S hernia

97
Q

Epidural hematoma occurs due to a bleed in the?

A

Middle meningeal artery

Its an extra axial bleed that appears convex and presents with lucid interval most commonly related to trauma

98
Q

Subdural hematoma occurs due to a bleed in?

A

Bridging veins in the dural venous sinuses

99
Q

Which bones of the orbital wall will be involved in a blowout fracture?

A

Orbital plate of the maxilla

100
Q

Most common cause of proptosis in children?

A

Orbital cellulitis

101
Q

Adequate urine output monitoring in adults is? In children? In infants?

A

Adults -0.5 cc/kg/hr
Children -1cc/kg /hr
Infants - 2cc/kg/hr

102
Q

MRND TYPE 1 PRESERVES?

A

Spinal accessory nerve

Removed: LN I-V, SCM, IJV and submandibular gland

103
Q

MRND 2 PRESERVES?

A

Spinal accessory nerve and SCM

Removes: LN 1-5 and Internal jugular vein

104
Q

MRND TYPE 3 PRESERVES?

A

SAN, SCM, and IJV

LN1-5 and submandibular gland is excised

105
Q

Triangle of CALOT

A

Inferior border of the liver
Common hepatic duct
Cystic duct

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