Surgery Flashcards
1
Q
ABCDES
Airway
Breathing
Circulation
D ______
Environment
A
Disability (Brain)
2
Q
Best type of intubation:
A
Oral endotracheal intubation
3
Q
Nasotracheal intubation (temporary or permanent)
A
Temporary
4
Q
Patient with altered mental status, is this indication for intubation?
A
Yes
5
Q
Cervical spine injury, still intubate?
A
Yes
6
Q
Initial surgical airway is _______.
A
Cricothyroidotomy
7
Q
Cricothyroidotomy is permanent/temporary?
A
Temporary
Convert to tracheostomy within a day.
8
Q
Most common type of shock in trauma:
A
Hypovolemic shock
9
Q
Which comes first tachycardia or hypotension?
A
Tachy
10
Q
The best access to address shock: (what type of veins)
A
Short and Fat
- Antecubitals - best
- Saphenous
- Femoral (dirty)
- Central line
11
Q
What is the risk when putting central line in kids?
A
Pneumothorax
12
Q
Interosseous line start with what bone?
A
Tibia… then femur
13
Q
Intraosseous line permanent or temp?
A
Temporary
14
Q
Risk for prolonged intraosseous line placement.
A
Osteomyelitis
15
Q
5 areas where you can lose blood in the body:
A
C - Chest
A - Abdomen
R - Retroperitoneum
P - Pelvis
T - Thigh
16
Q
What happens to mediastinum in the tension pneumothorax?
A
Mediastinum shifts and kinks blood vessels
17
Q
Why is patient hypotensive and tachycardic in tension pneumo?
A
Heart cannot fill
18
Q
Where do you insert needle to relieve tension pneumo?
A
2nd ICS
19
Q
How to manage recurrent cardiac tamponade?
A
Pericardial window.
20
Q
How to differentiate between cardiac tamp or pneumothorax?
A
Breath sounds (no breath sounds means tension pneumo)
21
Q
Patient comes with MI and hypotensive and tachy, what shock?
A
Cardiogenic shock
22
Q
What type of shock is anaphylaxis?
A
Vasomotor shock
23
Q
Treatment of vasomotor shock?
A
Fluids and pressors
24
Q
Difference in vasomotor and cardiogenic shock.
A
Patient is pale in hypovolemic. Patient is red is vasomotor.
25
Systems you always evaluate in neck trauma:
V\_\_\_\_\_\_ system. Use _________ to evaluate.
V ________ . Use CT Angio.
26
Systems you always evaluate in neck trauma:
R\_\_\_\_\_\_ system. Use _________ to evaluate.
Respiratory system. Use **bronchoscopy** to evaluate.
27
Systems you always evaluate in neck trauma:
G\_\_\_\_\_\_ system. Use _________ to evaluate.
GastroIntenstinal system. Use gastrografin swallow (water soluble) to evaluate.
28
What to do in gunshot wound to the angle of the jaw?
Call interventional radio and have them do an angiographic embolization.
29
Most common complication to a flail chest:
ARDS
30
Why is there ARDS in flail chest?
Vasoactive amines secreted during trauma cause surfactant to decrease resulting in ARDS
31
How to address ARDS in flail chest?
PEEP
32
What do you think about when you see a sternum fracture?
Cardiac contusion
33
What to do in sternum fracture?
Check heart:
1. EKG
2. Troponins
3. Echo
34
What labs are to be done in a sternum fracture?
1. E\_\_\_
2. T\_\_\_
3. Echo
EKG
Troponin
35
Most common site of aortic rupture?
Just distal to the left subclavian artery
36
2nd most common site of aortic rupture?
Aortic root
37
Patient experienced head-on collision. X-ray taken showed this. Patient asymptomatic. Dx?
Aortic rupture
| (Widened mediastinum)
38
How to diagnose aortic rupture?
CT angiography
39
What does a non-expanding lung after chest tube insertion mean?
Bronchial injury
40
Patient with multiple fractures,
hypoxic, thrombocytopenic, petechiae.
Dx?
Fat embolism
41
What parts are done in FAST scan?
RUQ
LUQ
Pericardium
Pelvis
42
Most common solid organ injured is the \_\_\_\_\_\_?
Spleen
43
Most common organ injured in the infant?
Liver
44
Most common cause of oozing in the OR while transfusion is
dilutional thrombocytopenia
45
Which is more important? Platelets or Factors?
Platelets
46
What do you do in pelvic bleeder?
stabilize the pelvis
47
Do you operate on pelvic bleeding?
no
48
2nd line management of pelvic bleeding?
| (if pelvic stabilization does not work)
Angiographic embolization of the hypogastric (internal iliac) artery
49
Which do you embolize in pelvic bleeding?
Internal iliac artery
50
Other name for hypogastric artery?
Internal iliac artery
51
Gunshot wound with gross hematuria, wound in the right flank, which do you inspect? Bladder or Kidney?
Both
52
What does high riding prostatet mean?
Urethral injury
53
If adult has microscopic hematuria after sports, do you follow up?
no
54
If child has microscopic hematuria after fall, do you follow up?
Yes (after 1 week)
Check for congenital abnormality
55
What is main tx for chemical burns?
Irrigation
56
What chemicals are released in a crush injury?
Acid, potassium, and myoglobin
57
Tx for crush injuries?
Hydrate, diurese, alkalinize the urine
58
Intubate right away in inhalational burns?
yes
59
What layer affected in 1st degree burn?
Epidermis
60
%regeneration in 1st deg burn?
100%
61
2nd degree burn looks like
blister
62
What layer affected in 2nd degree burn?
dermis
63
%regeneration in 2nd deg burn?
100%
64
3rd deg burns look like
white/char
65
What layer affected in 3rd deg burn?
full thickness
66
Pain in 3rd deg burn?
none
67
%regeneration in 3rd deg burn?
0%
68
pain in 2nd degree burn?
yes but less than 1st deg
69
Most common systemic complication of skin burns is
hypovolemic shock
70
1st line treatment of burns:
hydrate
71
What is the parkland formula for burns
4cc/kg/%burn
72
Fill blanks
73
How do you determine the adequacy of fluid resuscitation?
urine output
74
How to infuse fluids?
1st half in 8 hours, 2nd half in 16 hours
75
What is the late complication in burns?
Gram neg infection
76
What degree of burn?
full thickness
77
What to do when you see an eschar?
Take it out - escharotomy
78
Amount of antivenom depends on...
amount of venom injected
79
Falling with outstretched arm in kids results in what fracture?
Supracondylar fracture
80
What is a common complication of supracondylar fracture?
compartment syndrome
81
Falling with outstretched arm in **adults** results in what fracture?
Colle's fracture
82
What bones are involved in a Colle's fracture?
distal radius and styloid process
83
Fall with associated pain in the snuffbox:
carpal navicular fracture (scaphoid fracture)
84
Repeat x-ray if fracture unclear after 2 weeks. Why?
Osteoclasts make the fracture visible
85
Venous stasis ulcer caused by what?
Incompetent valves
86
Best test for osteomyelitis?
MRI
87
Most common site of diabetic ulcer?
first metatarsal-phalengeal joint
88
How long does treatment for osteomyelitis last?
6 weeks
89
Most common complication for diabetic foot ulcer
osteomyelitis
90
2nd most common site of diabetic foot ulcer?
calcaneus
91
Ulcer from squamous cell carcinoma?
Marjolin's Ulcer
92
What is this? Dx?
43 y/o woman wearing heels with pain in this area.
Morton's Neuroma
93
Child's x-ray showed this? Most likely..
Osteogenic sarcoma
94
Child 6 y/o with bone pain on x-ray. Dx?
Ewing sarcoma
| (5-15 y/o)
95
Most common cause of pathologic fracture in women?
Breast CA
96
Most common cause of pathologic fracture in men?
Lung CA
97
Most common cause of any bone metastasis in men?
Prostate CA
98
Lung CA in men with lets to where?
Long bones
99
3 contraindications to elective general anesthesia:
## Footnote
1. ________ Heart failure
2. A\_\_\_\_\_\_\_\_\_\_\_\_
3. MI within \_\_\_\_\_\_\_\_\_\_\_.
1. Congestive heart failure
2. Arrhythmia
3. MI within 6 months
100
5 medical conditions that defer general anesthesia surgery that have to do with the liver.
1. encephalopathy
2. ascites
3. inc bilirubin
4. dec albumin
5. coagulopathy
101
Best test for malnutrition:
Skin test anergy
102
What fo general anesthetics do to the heart?
Decrease inotropy
Increase ectopy
103
Malnourishment decreased what kind of immunity?
Cell-mediated immunity
104
Patient acquires fever after day 1-2 of post-op... most likely due to...
Pneumonia caused by atelectasis
105
Patient has fever after day 3-5 post-op.. cause?
UTI
(usually caused by catheter)
(but also due to increased urine stasis)
106
Most common cause of post op fever on day 6-7?
Wound infection
107
Dx test for pulmonary embolism?
Spiral CTA
108
