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Z MD 2 > Surgery and peri/post operative care > Flashcards

Surgery and peri/post operative care Flashcards

1
Q

what are the big 5 reasons for fever in a post-op patient

A

surgical site

IV sites

UTI

pneumonia

DVT

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2
Q

what are the guidelines regarding insulin use (in a T1DM) prior to surgery

A

take half the dose of long acting insulin on the morning of the surgery only

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3
Q

which tendons of the hand flex the DIP and PIP

A

DIP flexion = FDP

PIP flexion = FDS

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4
Q

what is the most likely diagnosis of a breast lump in a young woman

A

fibroadenoma

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5
Q

benefits of split skin graft vs full thickenss skin graft

A

large area possible

easier take

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6
Q

suture duration for face, trunk, legs, back

A

face - 5d

trunk- 7d

legs/back - 10d

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7
Q

what is the most effective way of reducing the bacterial load of a wound

A

debridement

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8
Q

commonest diagnosis of sudden onset breast lump

A

fibrocystic change

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9
Q

3 major general causes of hypotension post surgery

A

hypovolaemia

MI/CCF

epidural - peripheral vasodilation

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10
Q

epitheliazation of wounds occurs within

A

24-48 hours (why we don’t take the dressing off to take a look within the first 2 days- leave to heal)

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11
Q

benefit of negative pressure wound therapy

A

promotes angiogenesis

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12
Q

which proximal arteries predominantly make the deep and superficial arteries of the hand

A

deep - radial

superficial - ulnar

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13
Q

4 main past medical history areas you want to ask about when doing pre-op workup for anaesthesia

A

cardiovascular

respiratory

diabetes

GORD

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14
Q

difference between graft and flap

A
  • graft = transferred tissue dependent on RECIPIENT SITE
  • flap = transferred tissue INDEPENDENT of recipient site
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15
Q

which thyroid cancer shows “Annie Eyes” histologically

A

papillary thyroid carcinoma

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16
Q

explain the ASA classification

A

1 - healthy patient

2 - mild systemic disease

3 - significant or severe systemic disease

4 - severe systemic disease that is a constant threat to life

5 - moribund patient not expected to survive 24 hours with or without surgery

6 - brain dead organ donor

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17
Q

sign of deep dehiscence

A

leakage of pink serosanginous fluid

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18
Q

which IV access devices are used for chemotherapy

A

infusaport/portocath

Hickman catheter

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19
Q

what are the main investigations for breast lumps

A

mammography (>35)

US (less than 35)

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20
Q

when do we do a sentinal node biopsy vs an axillary clearance

A

axillary clearance only done now if the patient who is positive for nodes in the axilla (by sentinal node biopsy)

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21
Q

what are the % oxygen that can be delivered through the different prongs/masks etc

A

nasal prongs - 25%

hudson mask - 50%

Hudson mask + tusks = 60%

rebreathing bag - 70%

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22
Q

a sentinal node is

A

any node that is blue, hot or palpable

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23
Q

3 major outcomes of FOOSH

A

scaphoid #

Colles # - radius + ulnar #

Radial head #

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24
Q

what causes pressure sores

A

weight of patient impairing the blood supply to an area of tissue due to occlusion of vessels

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25
what should you ask in a pre-operative assessment in regards to diabetes
- Type of diabetes - DMCC - current management of DM - Check adequacy of control - diagnose complications - evaluate other risk factors for CVD (HTN, FHx, high cholesterol)
26
difference between follicular adenoma and follicular carcinoma
adenoma - intact, well formed capsule surrounding the tumour carcinoma - capsular invasion
27
specific complications of radial head fracture
myositis ossificans recurrent instability
28
indications for drains
prevent accumulation of fluid prevent accumulation of air characterize fluid
29
4 initial steps to do when faced with a patient with low urine output
- check for IDC blockage - assess patient for hypovolaemia - ensure patient not bleeding - give fluid challenge - 500ml-1L stat
30
what causes hypertrophic and keloid scars
exagerrated normal remodelling response to a skin wound
31
what is a split skin graft
harvest epidermis and part of the dermis like a shave of skin
32
what is the most common thyroid cancer
papillary thyroid cancer
33
what are the causes of an acute fever (first week) post surgery
hospital acquired pneumonia/aspiration pneumonia IV site infection with bacteraemia UTI surgical site infection
34
why should you strive to achieve glycaemic control in diabetic patients pre-operatively
- hyperglycaemia increases wound infection - hyperglycaemia impairs wound healing and worsens outcome post neruological damage/MI - hyperglycaemia induces an osmotic diuresis --\> dehyrdation and electrolyte damage - T1DM may develop DKA - hypoglycamia may induce coma, arrhythmias and cognitive deficit
35
AB of choice for prophylaxis for a surgery that will have a contaminated or clean/contaminated wound
single shot IV first generation cephalosporin (to get rid of skin flora)
36
explain the body's metabolic stress response to surgery/acute medical illness
- elevation in catecholamines, growth hormone, glucagon, cortisol and ACTH - depression of insulin levels and insulin resistnace --\> leads to catabolic state (raised glucose levels, protein catabolism, lipolysis, FFA production and ketone body production)
37
explain the withholding of DM medications for surgery
- all oral hypoglycaemics (except metformin and long acting sulphonylureas) - withhold for the morning of surgery - metformin - with-hold 48 hours prior to surgery - long acting sulphonylurea - withhold \>12 hours prior to surgery - basal bolus insulin - give basal insulin (normal or 2/3) and then give bolus with breakfast if afternoon surgery. Also give IV 5% dextrose
38
what is the relevance of a cold or hot thyroid nodule
cold - more likely to be cancer
39
difference between a hypertrophic and a keloid scar
hypertrophic - stays within margins of original wound, can improve over time, and can respond to steroid injection keloid - extends beyond wound, progresses over time, less responsive to steroids and silicone
40
What are the causes of an immedate fever post surgery
transfusion reaction medication reaction infection prior to surgery trauma malignant hyperthermia
41
intraductal papilloma most likely presents as
bloody nipple discharge
42
where are PICC lines/CVC/Vascath/Permcath/Portocath catheters placed
PICC - basilic vein CVC - IJV or subclavian vein with tip in SVC Vascath - IJV or femoral vein (NOT subclavian) Permcath - IJV or EJV Portocath - into SVC
43
what are the clinical signs of ventilation
chest movement breath sounds expired air mask fogging capnography pulse oximetry
44
why would you do a flap instead of a graft
- bed doesn't have a sufficient vascular supply to support a graft - need to cover prosthetic material - better appearance - can contain muscle, bone, nerve etc
45
what are the suspicious features on ultrasound for malignancy of a thyroid nodule
hypoechoic microcalcification increased vascularity infiltrative margins absent halo taller than wide
46
what does a fibroadenoma look like on US
well demarcated edges lobulated uniformly hypoechoic
47
what are the contraindications for using a nasopharyngeal airway
base of skull fractures and transphenoidal surgery
48
lifetime risk of breast cancer in women
1 in 9
49
benefits of full-thickenss skin graft vs split skin graft
less contraction of skin better cosmetic outcome
50
what does the persistent fever vs the spiking fever mean
persistent - suggest drug reaction or neurosurgical spiking - suggests abscess
51
explain the maintenance fluid rule
4,2,1 rule - Give 4ml/hour/kg for the first 10kg of body weight - Give 2ml/hour/kg for the second 10kg of body weight - Remaining weight give 1ml/hour/kg
52
Which IV access devices are used for haemodialysis
vascath permacath
53
clinical features of a fibroadenoma
smooth, rubbery, discrete, well-circumscribed, non-tender, mobile HORMONE DEPENDENT
54
what are the stages of ventilation (from least invasive to most invasive)
bag and mask bag, mask and guedel LMA and bag ETT and ventilator
55
3 major complications of thyroid surgery
nerve injury (RLN and ESLN) hypoparathyrodisim bleeding
56
what are the predictors of difficult ventilation of a patient
previous difficult ventilation obesity short, thick neck OSA beard edentulous jaw pathology
57
what does the "sniffing the morning air position" do to the joints of the neck
cervical spine flexion atlanto-occipital joint extension
58
what are the guidelines regarding metformin use prior to surgery
stop 48 hours prior to surgery
59
fasting guidelines for adults and infants
adults: 6 hours for solids 2 hours for clear fluids infants: 3 hours for breast milk 4 hours for formula
60
management of DCIS
surgery - can progress to breast cancer
61
what is the fasting blood glucose target for dibetics for surgery
5-10mmol/L
62
reversible causes of pulseless electrical activity
5 Hs and 5 Ts Hypoxia, Hydrogen ions (acidosis), hypovolaemia, hypothermia, hypo/hyperkalaemia Tamponade (cardiac), thrombosis (cardiac), thrombosis (pulmonary), toxins, tension pneumothorax
63
what are the predictors of difficult intubation
history of difficult intubation acquired conditions: RA, ankylosing sponylitis, TMJ problems, airway/neck pathology, radiation examination findings: High Mallampati score, small inter-incisor gap, small thyromental distance, limited neck flexion, teeth, jaw protrusion or receeding jaw
64
what do you do to examine the airway in regards to pre-op workup for anaesthesia
Mallampati score thyromental distance tongue size neck circumference range of motion of head and neck ability to protrude mandible forwards
65
classification of surgical wounds
clean clean/contaminated contaminated dirty - pus, preop infection
66
medullary carcinoma is associated with which condition
MEN 2A or 2B
67
what are the US findings of fibrocystic changes
thin outer membrane hypoechoic
68
how do you reverse warfarin
prothrombinex +/- Vit K and FFP
69
what is the major different between an LMA and an ETT
LMA - no protection against aspiration!
70
what are the difference between a continuous, passive expiration and forced expiration air leak in a drain
continuous - leak present during both insp and exp passive exp - leak only present in exp forced exp - leak only present during forced exp
71
treatment options for a toxic thyroid nodule
medication - carbimazole, PTU surgery radioactive iodine treatment
72
what is the normal punching injury of the hand
Boxers # - fracture of the distal 5th metacarpal

Z MD 2 (15 decks)

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