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Surgery Clerkship > Surgery Clerkship 2 > Flashcards

Surgery Clerkship 2 Flashcards

1
Q

How long does Vicryl retain its strength?

A
  • 60% at 2 weeks

- 8% at 4 weeks

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2
Q

What is a taper-point needle used for?

A

Suturing soft tissues other than skin (GI tract, muscle, peritoneum, fascia)

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3
Q

What are conventional cutting needles used for?

A

Suturing SKIN

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4
Q

Shape of a conventional cutting needle

A

Triangular body with sharp edge

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5
Q

Shape of a taper-point needle

A

Round body

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6
Q

Minimum number of throws for silk

A

3

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7
Q

Minimum number of throws for catgut

A

4

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8
Q

Minimum number of throws for Vicryl, Dexon, and other braided synthetics

A

4

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9
Q

Minimum number of throws for Nylon, polyester, polypropylene, PDS, and Maxon

A

6

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10
Q

How long should suture be left in the face?

A

3-5 days

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11
Q

How long should suture be left in the extremities?

A

10 days

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12
Q

How long should suture be left in the joints?

A

10-14 days

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13
Q

How long should suture be left in the back?

A

14 days

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14
Q

How long should suture be left in the abdomen?

A

7 days

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15
Q

In which group of patients should sutures be left in longer than normal?

A

Those on steroids

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16
Q

When drawing blood from the femoral vein, do you place the needle medial or lateral to the femoral pulse? How can you remember?

A
  • MEDIAL
  • Remember “NAVEL” from lateral to medial
  • Nerve, Artery, Vein, Empty space Lymphatics
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17
Q

How can you clinically confirm NGT placement in the stomach?

A
  • Inject air into the NGT and auscultate over the stomach

- You will hear a “swish” if the NGT is in place

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18
Q

What must you obtain and examine before using an NGT for feeding?

A

A chest/upper abdominal x-ray

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19
Q

What is the best position for a pregnant patient?

A

Left side down to take the gravid uterus off of the IVC

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20
Q

“-orrhaphy” (meaning)

A

Surgical REPAIR

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21
Q

“-plasty” (meaning)

A

Surgical “shaping” or formation

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22
Q

Surgical “shaping” or formation (suffix)

A

“-plasty”

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23
Q

Surgical repair (suffix)

A

“-orrhaphy”

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24
Q

Surgical incision into an organ (suffix)

A

-otomy

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25
Q

“-otomy” (meaning)

A

Surgical incision into an organ

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26
Q

Surgical creation of an opening between two organs, or an organ and the skin (suffix)

A

-ostomy

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27
Q

“-ostomy” (meaning)

A

Surgical creation of an opening between two organs, or an organ and the skin

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28
Q

If a patient is on antihypertensives, should they take the drugs on the day of surgery?

A

Yes

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29
Q

If the patient is on an oral hypoglycemic agent, should they take the drug on the day of surgery?

A

Not if the patient is to be NPO on the day of surgery

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30
Q

If the patient is taking insulin, should they take it the day of surgery?

A

No. Only half of a long-acting insulin and start D5 NS IV

-Check glucose levels preoperatively, operatively, and postoperatively

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31
Q

Should a patient who smokes stop before an operation?

A

Yes, improvement is seen 2-4 weeks after smoking cessation

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32
Q

What labs must all women of childbearing age have before entering the OR?

A

Beta-HCG and CBC (possible anemia from menses)

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33
Q

What preoperative medication can decrease postoperative cardiac events and death?

A

Beta blockers

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34
Q

What must you always order for surgical patients?

A
  • NPO/IVF
  • Preoperative antibiotics
  • Type and cross blood
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35
Q

What electrolyte must be checked preoperatively if patient is on dialysis?

A

Potassium

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36
Q

Who gets a preoperative EKG?

A

Those >40 yo

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37
Q

Primary wound closure

A

Wound is sutured and closes immediately

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38
Q

Secondary wound closure

A

Wound is left open and heals over time without sutures

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39
Q

How long until a sutured wound epithelializes?

A

24-48 hours

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40
Q

After primary closure, when should the dressing be removed?

A

Anytime after POD #2

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41
Q

What inhibits wound healing?

A
  • Infection
  • Ischemia
  • Diabetes mellitus
  • Malnutrition
  • Anemia
  • Steroids
  • Cancer
  • Radiation
  • Smoking
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42
Q

What reverses the deleterious effects of steroids on wound healing?

A

Vitamin A

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43
Q
  • Open drain system composed of a thin rubber hose

- Associated with increased infection rate in clean wounds

A

Penrose drain

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44
Q

G-tube (define)

A
  • Gastrostomy tube

- Used for drainage or feeding

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45
Q

J-tube (define)

A
  • Jejunostomy tube

- Used for feeding

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46
Q

What is a chest tube called?

A

Thoracostomy tube

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47
Q

Is a chest tube placed over or under the rib?

A

Over

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48
Q

What are the three chambers of the Pleuravac?

A
  • Collection chamber
  • Water seal
  • Suction control
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49
Q

What test should be performed before feeding via any tube?

A

-High abdominal x-ray to confirm placement (to ensure it’s not in the lung!)

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50
Q

Common cause of excessive NGT drainage

A

Tip of NGT is placed in duodenum and is draining pancreatic fluid and bile

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51
Q

Foley catheter with a small, curved tip to help maneuver around a large prostate

A

Coude catheter

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52
Q

What can be used if a patient has a urethral injury and a Foley cannot be placed?

A

A suprapubic catheter

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53
Q

What parts of the GI tract are retroperitoneal?

A
  • Most of the duodenum
  • Ascending colon
  • Descending colon
  • Pancreas
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54
Q

Border’s of Calot’s triangle

A
  • Common hepatic duct
  • Cystic duct
  • Cystic artery
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55
Q

On average, what percentage of body weight does blood account for in adults?

A

7%

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56
Q

Classic signs of third spacing

A
  • Tachycardia

- Decreased urine output

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57
Q

When does 3rd spacing occur postoperatively?

A

3rd-space fluid tends to mobilize back into the intravascular space around POD #3; at this point, switch to hypotonic fluid and decrease IV rate

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58
Q

Surgical causes of metabolic acidosis due to a loss of bicarb

A
  • Diarrhea
  • Ileus
  • Fistula
  • High-output ileostomy
  • Carbonic anhydrase inhibitors
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59
Q

Surgical causes of metabolic acidosis due to an increase in acids

A
  • Lactic acidosis (ischemia)
  • Ketoacidosis
  • Renal failure
  • Necrotic tissue
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60
Q

Cause of hypochloremic alkalosis

A
  • NGT suction

- Vomiting

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61
Q

Causes of metabolic alkalosis

A
  • Vomiting/NGT suction
  • Diuretics
  • Alkali ingestion
  • Mineralocorticoid excess
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62
Q

Classic acid-base finding with significant vomiting or NGT suctioning

A

Hypokalemic, hypochloremic alkalosis

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63
Q

Why do we have hypokalemia with loss of gastric fluid

A

Loss of HCl causes alkalosis, driving K+ into cells

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64
Q

Changes in vital signs associated with hypovolemia

A
  • Tachycardia
  • Tachypnea
  • Initial rise in BP due to peripheral vasoconstriction, but subsequent decrease in BP
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65
Q

Insensible fluid losses

A

Sources of fluid loss that are not measured

  • Feces
  • Breathing
  • Skin
66
Q

Loss of fluid from bile, gastric losses, and small intestine losses

A

Remember BGS, 123:

  • Bile –> 1 liter
  • Gastric –> 2 liters
  • Small intestine –> 3 liters
67
Q

What comprises normal saline?

A

154 mEq of Cl-

154 mEq of Na+

68
Q

What comprises 1/2 NS?

A

77 mEq of Cl-

77 mEq of Na+

69
Q

What comprises 1/4 NS?

A

39 mEq of Cl-

39 mEq of Na+

70
Q

What comprises D5W?

A

5% dextrose in H20

71
Q

What electrolytes are found in lactated ringers?

A 
Na
Cl
K
Ca
And lactate
72
Q

100/50/20 rule for IV fluids for a 24-hour period of time

A
  • 100 mL/kg for the first 10 kg
  • 50 mL/kg for the next 10 kg
  • 20 mL/kg for every kg over 20
73
Q

4/2/1 rule for IV fluids for hourly rate

A
  • 4 mL/kg for the first 10 kg
  • 2 mL/kg for the next 10 kg
  • 1 mL/kg for every kg over 20
74
Q

Most common adult maintenance fluid

A

D5 1/2 NS with 20 mEq KCl/L

75
Q

Minimal urine output for adult on maintenance IVF

A

0.5 cc/kg/hr

76
Q

How many mL are in 1 tsp?

A

5 mL

77
Q

What type of fluids should be given for resuscitation of intravascular volume?

A

Isotonic fluids

78
Q

MC trauma resuscitation fluid

A

LR

79
Q

Normal range for K+

A

3.5 - 5.0 mEq/L

80
Q

Normal range for Na+

A

135 - 145 mEq/L

81
Q

Normal range for Cl-

A

100-108

82
Q

Normal range for bicarb

A

22-29

83
Q

Normal range for glucose

A

70-100

84
Q

What can happen if hyperkalemia is left untreated?

A

Vtach/Vfib

85
Q

Which electrolyte abnormality can cause peaked T waves?

A

Hyperkalemia

86
Q

What is the most common cause of electrolyte-mediated ileus?

A

Hypokalemia

87
Q

An elderly patient goes into CHF of POD #3 after a laparotomy. What is going on?

A

Mobilization of the “third-space” fluid into the intravascular space, resulting in fluid overload and CHF

88
Q

What fluid is used to replace NGT aspirate?

A

D5 1/2 NS with 20 KCl

89
Q

Which pathway does PT test?

A

Extrinsic pathway

90
Q

Which pathway does PTT test?

A

Intrinsic pathway

91
Q

What does fresh frozen plasma replace?

A

Clotting factors

92
Q

What does cryoprecipitate replace?

A
  • Fibrinogen
  • von Willebrand factor
  • Some clotting factors
93
Q

Mathematical relationship between Hgb and Hct

A

Hgb x 3 = Hct

94
Q

What are general guidelines for blood transfusions?

A
  • Acute blood loss
  • Hgb < 10 with hx of CAD/COPD
  • Hgb < 7 if otherwise healthy
95
Q

Which blood type is the universal donor for PRBCs?

A

O negative

96
Q

Which blood type is the universal donor for FFP?

A

AB

97
Q

Define thrombocytopenia

A

Plt count < 100,000

98
Q

What platelet count is associated with spontaneous bleeding?

A

< 20,000

99
Q

What should plt count be before surgery?

A

> 50,000

100
Q

When should “prophylactic” platelet transfusions be given?

A

With platelets < 10,000

101
Q

What are the symptoms of a transfusion reaction?

A
  • FEVER

- Chills, nausea, hypotension, lumbar pain, chest pain, abnormal bleeding

102
Q

Tx for transfusion hemolysis

A
  • Stop the transfusion
  • Provide fluids
  • Give lasix to protect the kidneys
  • Alkalinize urine
  • Give pressors as needed
103
Q

Normal life of platelets

A

7-10 days

104
Q

Clotting factor that’s deficient in hemophilia A

A

VIII

105
Q

Clotting factor that’s deficient in hemophilia B

A

IX

106
Q

What can be used to correct von Willebrand’s disease?

A
  • Cryoprecipitate

- DDAVP (Desmopressin - stimulates vWF formation)

107
Q

Which coagulation “test” is abnormal with hemophilias A and B?

A

PTT

108
Q

Pathophysiology behind Factor V Leiden disorder

A

The Leiden variant of Factor V cannot be inactivated by protein C

109
Q

Signs of atelectasis

A
  • Fever
  • Decreased breath sounds with rales
  • Tachypnea
  • Tachycardia
110
Q

Most common cause of fever on POD 1 and 2

A

Atelectasis

111
Q

ABG findings associated with a PE

A

Decreased PO2 and PCO2 from hyperventilation

112
Q

Gold standard for diagnosing a PE

A

Pulmonary angiogram

113
Q

Classic EKG findings associated with a PE

A
  • S1Q3T3
  • RBBB
  • Right axis deviation
  • Flipped T waves or ST depression
114
Q

Tx of PE if patient is stable

A

Anticoagulation

115
Q

TX of PE if patient is unstable

A
  • Consider thrombolytic therapy
  • Consult thoracic surgeon for possible Trendelenburg operation
  • Consider catheter suction embolectomy
116
Q

Which lobe is most often involved in aspiration pneumonia of a patient in supine position?

A

RUL

117
Q

Which lobe is most often involved in aspiration pneumonia of a patient in a sitting or semirecumbent position?

A

RLL

118
Q

What is blind loop syndrome?

A

Bacterial overgrowth of the small intestine

119
Q

Signs of DKA

A
  • Polyuria
  • Tachypnea
  • Dehydration
  • Confusion
  • Abdominal pain
120
Q

Which electrolyte must be closely monitored during DKA tx?

A

Potassium - Administration of glucose/insulin drives K+ into cells

121
Q

Postoperative inadequate cortisol release (acute adrenal insufficiency) in the face of a stressor

A

Addisonian crisis

122
Q

What typically causes Addisonian crisis

A

Steroid use

123
Q

Classic lab values found in Addisonian crisis. Why?

A
  • Decreased Na+ and Increased K+

- From the decreased aldosterone

124
Q

Tx of Addisonian crisis

A
  • IVF (D5 NS)
  • Hydrocortisone
  • Fludrocortisone (mineralcorticoid (aldosterone) replacement)
125
Q

Drug used for central diabetes insipidus

A

Vasopressin

126
Q

Drugs used for nephrogenic diabetes insipidus

A

Thiazide diuretics

127
Q

Common causes of dyspnea after central line placement

A
  • Pneumothorax
  • Pericardial tamponade
  • Carotid puncture
128
Q

What’s something weird about how a postoperative MI may present?

A

They often present without chest pain

129
Q

First imaging study for postoperative CVA

A

Heat CT to rule out hemorrhage if anticoagulation is going to be used

130
Q

If suspicious of abdominal compartment syndrome, how can you measure the intra-abdominal pressure?

A
  • Read intrabladder pressure

- Use a foley catheter hooked up to manometry after istillation of 50-100 cc of water

131
Q

What is normal intra-abdominal pressure?

A

< 15 mmgHg

132
Q

What intra-abdominal pressure indicates the need for treatment?

A

> = 25 mmHg

133
Q

Rubor (definition)

A

Redness/Erythema

134
Q

Calor (definition)

A

Heat

135
Q

Tumor (definition)

A

Swelling

136
Q

Dolor (definition)

A

Pain

137
Q

What can help resorption of a subacute wound hematoma?

A

Heat

138
Q

How often will bloody diarrhea be present with pseudomembranous colitis?

A

10%

139
Q

Classic antibiotic that causes C. difficile?

A

Clindamycin

140
Q

Tx for pseudomembranous colitis

A
  1. Flagyl (PO or IV)

2. PO Vancomycin if refractory to Flagyl

141
Q

Normal daily dietary requirements for protein in adults

A

1 g/kg/day

142
Q

Normal daily dietary requirements for calories in adults

A

30 kcal/kg/day

143
Q

How much is basal energy expenditure increased with a severe head injury?

A

1.7x

144
Q

How much is basal energy expenditure increased with severe burns?

A

2-3x

145
Q

Calorie contents of fat

A

9 kcal/g

146
Q

Calorie content of protein

A

4 kcal/g

147
Q

Calorie content of carbohydrates

A

4 kcal/g

148
Q

What dietary change can be made to decrease CO2 production in a patient in whom CO2 retention is a concern?

A

Decrease carbohydrate calories and increase calories from fat

149
Q

Major lab test used to monitor nutritional status

A

Prealbumin

150
Q

Where is iron absorbed?

A

Duodenum

151
Q

Where is Vit B12 absorbed?

A

Terminal ileum

152
Q

Which vitamins are fat-soluble?

A

K
A
D
E

153
Q

Sign of Vitamin A deficiency

A

Poor wound healing

154
Q

Sign of vitamin B12/folate deficiency

A

Megaloblastic anemia

155
Q

Sign of vitamin C deficiency

A

Poor wound healing, Bleeding gums

156
Q

Sign of Vitamin K deficiency

A
  • Decrease in the vit K-dependent clotting factors (II, VII, IX, and X)
  • Bleeding
  • Elevated PT
157
Q

What vitamin increases the PO absorption of iron?

A

PO Vitamin C

158
Q

What is the major nutrient of the small bowel?

A

Glutamine

159
Q

What is the major nutrient of the colon?

A

Butyrate

160
Q

What must bind B12 for absorption?

A

Intrinsic factor from the gastric parietal cells

Surgery Clerkship (4 decks)

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