Surgery EOR Exam

Question 1

What are the 5 W’s for post op fever?

Answer 1

Wind, water, walking, wound, wonder drugs

Question 2

Atelectasis/Pneumonia is which of the five W’s, and occurs on what day?

Answer 2

WIND; POD 1-2

Question 3

Pneumonia usually occurs after how many hours post op?

Answer 3

48

Question 4

UTI is which of the 5 W’s and occurs on what days?

Answer 4

WATER; POD 3-5

Question 5

DVT is which of the 5 W’s and occurs on what days?

Answer 5

WALKING; POD 4-6

Question 6

Infection is which of the 5 W’s and occurs on what days?

Answer 6

WOUND; POD 5-7

Question 7

Drugs is the cause of which of the 5 W’s and occurs on what days?

Answer 7

WONDER DRUGS; POD 7+

Question 8

Stone formation in the gallbladder

Answer 8

Cholelithiasis

Question 9

Infrequent episodes of steady, severe pain in the epigastrium or RUQ with radiation to the right scapula that can sometimes be brought on my eating a large or fatty meal is a sx of?

Answer 9

Cholelithiasis

Question 10

How do you diagnose cholelithiasis?

Answer 10

RUQ US

Question 11

Surgical tx of choice for cholelithiasis?

Answer 11

Laparoscopic cholecystectomy

Question 12

Cholecystitis is typically caused by a stone lodged where?

Answer 12

Cystic duct

Question 13

If there isn’t a stone causing cholecystitis, what could the cause be?

Answer 13

Klebsiella or e coli

Question 14

N/V, fever, murphys sign (positive), guarding, rebound tenderness, jaundice are signs and sxs of?

Answer 14

Cholecystitis or choledocholithiasis

Question 15

Initial test of choice for cholecystitis?

Answer 15

US, but can use a HIDA scan if you think it is acalculous

Question 16

Test of choice for choledocholithiasis?

Answer 16

Endoscopic US or MRCP; ERCP in high risk patients

Question 17

Treatment of of cholecystitis or choledocholithiasis?

Answer 17

Removal of the stone endoscopically or surgically; ERCP

Question 18

Choledocholithiasis is a stone in the ??

Answer 18

Common bile duct

Question 19

Charcot’s triad

Answer 19

Fever, RUQ pain, jaundice

Question 20

Reynold’s pentad

Answer 20

Charcot’s triad + confusion and hypotension

Question 21

Reynold’s pentad and chariot’s triad are characteristic symptoms of ??

Answer 21

Ascending cholangitis

Question 22

What is ascending cholangitis?

Answer 22

When choledocholithiasis proceeds to infection

Question 23

How do you diagnose ascending cholangitis?

Answer 23

ERCP or abdominal US will show common bile duct dilation

Question 24

Treatment for ascending cholangitis?

Answer 24

ERCP to help w biliary drainage; Zosyn or ceftriaxone + metronidazole

Question 25

Acute cholecystitis that progresses to suppurative infection in which the gallbladder fills with purulent material

Answer 25

Gallbladder empyema

Question 26

Most common pathogens that cause gallbladder empyema?

Answer 26

Klebsiella, e coli, strep faecalis

Question 27

How do you treat gallbladder empyema?

Answer 27

Antibiotics & immediate drainage or resection of gallbladder to prevent perforation

Question 28

Uninfected with no inflammation surgical classification - Resp, GI, GU tracts NOT entered - Closed primarily

Answer 28

Clean

Question 29

Exploratory laparotomy, mastectomy, neck dissection, thyroid, vascular, hernia, splenectomy are what type of surgical procedures?

Answer 29

Clean

Question 30

Resp, GI, GU tracts entered in a controlled environment | - No unusual contamination

Answer 30

Clean contaminated

Question 31

Chole, SBR, Whipple, liver txp, gastric surgery, bronch, colon surgery are examples of what type of surgical procedures

Answer 31

Clean contaminated

Question 32

Open, fresh, accidental wounds, major break in sterile technique, gross Spillage from GI tract, acute nonpurulent inflammation

Answer 32

Contaminated

Question 33

Inflamed appendectomy, bile spillage in chole, diverticulitis, Rectal surgery, penetrating wounds are what type of surgical classification?

Answer 33

Contaminated

Question 34

- Old traumatic wounds, devitalized tissue - Existing infection or perforation - Organisms present BEFORE procedure

Answer 34

Dirty

Question 35

Abscess I&D, perforated bowel, peritonitis, wound debridement, positive cultures pre-op are examples of what type of surgical classification?

Answer 35

Dirty

Question 36

This occurs where the tissue surfaces have been approximated (closed). This can be with stitches, or staples, or skin glue (like Derma bond), or even with tapes (like steri-strips). This kind of closure is used when there has been very little tissue loss.

Answer 36

First intention healing

Question 37

Example of first intention healing

Answer 37

Surgical incision

Question 38

A wound that is extensive and involves considerable tissue loss, and in which the edges cannot be brought together heals in this manner. This is how pressure ulcers heal.

Answer 38

Secondary intention healing

Question 39

Three differences between primary and secondary intention healing

Answer 39

- Wound takes longer to heal - More scarring - Higher chance of infection

Question 40

This type of wound healing is indicated where there is a reason to delay suturing or closing a wound some other way, for example when there is poor circulation to the injured area. These wounds are closed later. Require more connective tissue (scar tissue) than wounds that heal by secondary intention.

Answer 40

Tertiary intention healing or secondary closure

Question 41

Abdominal wound that is initially left open to allow for drainage but then closed

Answer 41

Tertiary healing or secondary closure

Question 42

The partial or total rupture of a wound

Answer 42

Dehiscence

Question 43

Protrusion of internal viscera through an incision

Answer 43

Evisceration

Question 44

Obesity, poor nutrition, multiple trauma, failure of sutures, excessive coughing, vomiting, and dehydration all increase risk for ???

Answer 44

Dehiscence

Question 45

A noticeable increase in serosanguineous drainage on POD 6 should cause concern for what?

Answer 45

Dehiscence or wound infection

Question 46

4 Phases of healing

Answer 46

Hemostasis, inflammation, granulation, remodeling

Question 47

Appendicitis is usually caused by?

Answer 47

Fecolith

Question 48

- Dull periumbilical pain that progresses to focal sharp pain with RLQ radiation - Anorexia, n/v -Low grade fever

Answer 48

Appendicitis

Question 49

Positive: - McBurney’s point tenderness -Obturator sign - Psoas sign - Rovsing’s sign

Answer 49

Appendicitis

Question 50

Abdominal CT is preferred in which populations to diagnose appendicitis?

Answer 50

Adults and nonpregnant women

Question 51

Abdominal US is preferred in which populations to diagnose appendicitis?

Answer 51

Children and pregnant women

Question 52

Treatment for appendicitis

Answer 52

Appendectomy; If abscess or rupture may need cipro or zosyn treatment first

Question 53

What comes first with appendicitis, N/V or abdominal pain?

Answer 53

Abdominal pain

Question 54

Most common type of hernia

Answer 54

Indirect

Question 55

When hernia goes through hole in inguinal canal; Patent processus vaginalis

Answer 55

Indirect

Question 56

Bulge in scrotum due to herniation through inguinal canal

Answer 56

Indirect hernia

Question 57

Surgery is usually indicated for an indirect hernia, why?

Answer 57

Risk of strangulation is higher

Question 58

When intestinal tissue breaks through hole in weak abdominal muscle in hasselbach's triangle; DOES NOT GO THROUGH INGUINAL CANAL

Answer 58

Direct hernia

Question 59

Treatment for direct hernia

Answer 59

Watch and wait if mild/not strangulated | Surgery if symptomatic

Question 60

Surgical risk factors

Answer 60

``` History of CAD History of heart failure History of cerebrovascular disease Diabetes requiring treatment with insulin Serum creatinine (2.0 mg/dL) ```

Question 61

When does a patient need prophylactic antibiotic before a dental procedure?

Answer 61

- With an artificial heart valve - Previous infective endocarditis - A previous heart transplant when there are problems with a heart valve - Certain heart defects, such as unrepaired cyanotic congenital heart disease - Joint replacement hip or knee

Question 62

When is the only time you need to prophylactically treat with antibiotics prior to a dental procedure (or after if not given prophylaxis before)

Answer 62

- During dental procedures that involve manipulation of gingival tissue (around bone and teeth) or the periapical region of teeth (tip of the tooth root) - When the inside lining of the mouth is perforated

Question 63

Which bacteria is found in the mouth that can cause infective endocarditis?

Answer 63

Strep viridans