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Online Med Ed notes DF > Surgery: General > Flashcards

Surgery: General Flashcards

1
Q

fever post op day 5 is what

dx and tx and ppx

A

B/L US LE

LMWH (hep to warfarin bridge)

early mobilization and heparins

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2
Q

viral etiiology of jaundice lab findings

A

AST and ALT in the 1000s

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3
Q

what is local control in breast cancer

A

surgery and radiation

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4
Q

what do you get UA for in malignant hyperthermia

A

possible myogloburia

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5
Q

what kind of pain is when you have buring pins and needles

A

neuropathic pain from damaged nerve like in DM

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6
Q

4 types of abdominal pain and which is only one that is not sudden onset pain

which 2 have generalized pain

A

obstructive
inflammatory
ischemic
perforating

inflammatory is not sudden

perforating and ischemic are generalized

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7
Q

what will ducts look like on US with choledocholithiasis

A

mild dilation bc no time for biliary tree to adapt

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8
Q

tender gallbladder

A

obstructive

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9
Q

findings with choledocho

A

increased temp
increased wbc
pain
murphy sign positive

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10
Q

ER and PR positive breast cancer

postmenopausal women use what

A

aromatase inhibitors like anastrozole

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11
Q

what is systemic therapy in breast cancer

A

chemo and targeted therapy

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12
Q

how long before sx should smoking cessation take place

A

8 weeks

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13
Q

zero output post op means what

A

mechanical obstruction, unkink cath

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14
Q

diagnosing cholangiocarcinoma

tx

A

CT scan wit billy mass then do ERCP with Bx

resect

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15
Q

intrahepatic causes of jaundice

A

alchol hep
viral hep
cirrhosis/hepatitis
childhood genetic disesae

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16
Q

ulcers on the tips of the toes

A

arterial ulcers

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17
Q

treatment for invasive carcinoma

A

Mastectomy + ALND + chemo + targeted

Lump + RT + ALND + Chemo + targeted

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18
Q

tx arterial ulcers

A

stent small lesions above the knee

bypass large length lesions and any above popliteal artery

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19
Q

ppx for atelectasis

A

inhaled spirometry and get pt OOB

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20
Q

tamoxifen effects

A

blocks ER on breast

stimulates ER on uterus

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21
Q

lump: pt is under 30 and it is a cyst on US then what

A

FNA

bloody = cancer
pus = abscess
fluid = benign cyst
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22
Q

diagnosing ampulla of vagter cancer

A

CT scan no mass

but FOBT + and - colonscopy

1) MRCP 2) ERCP or EUS
tx: resect

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23
Q

if pt is positve for BRCA1/2 what is ppx

A

mastectomy and BSO or annual MRI and mamm if doesn’t want that

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24
Q

if what appears to be a paralytic ileus hasn’t resolved by how many days think what and what are next steps

A

5-7 days, think bowel obstruction

upright KUB = dilated bowel and air fluid levels before obstruction and decompressed bowel beyond the obstruction

contrast swallow CT to see if tracer passes obstruction and back to OR

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25
Q

tx for PNA post op fever

ppx

A

treat for hospital acquired PNA with vanco and pip/tazo while waiting on blood cultures

spirometry and OOB is ppx

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26
Q

electrolytes to watch post op in AMS

A

sodium and calcium

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27
Q

anytime diagnosing breast stuff and

over 30 or
US shows mass or
aspirate is bloody or
cyst recurs then what

A

diagnostic mammogram and biopsy

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28
Q

post op AMS causes and tx

A

electrolytes: BMP: replace
sundowning: elderly: atypical antipsychotics

DT: 48-72 hrs after admission in alcoholic: benzo

ARDS: complicated post op: PEEP

psychos (AMS) want a dudes SEAD

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29
Q

palpable nontender gallbladder is what

A

malignant

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30
Q

what is the most important part of the pulmonary part of a preop pt before surgery

A

ventilation is more important than O2 bc need to be able to blow off CO2

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31
Q

manage and tx PE post op

A

CT spiral scan heparin–>coumadin and

IVC filter only if contraindication to anticoags

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32
Q

if get fever post op day 2 what should you do

A

CXR and look for consolidation with PNA

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33
Q

what things keep a fistula open

A

FRIEND

Foreign body
Radiation
Infection, Irridiation, IBD
Epithelization
Neoplasm (tumor)
Distal Obstruction
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34
Q

what kind of screening tool should be used in extremely high risk breast cancer pts

A

MRI

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35
Q

causes of perforation that leads to abdominal pain

A

PUD
cancer
penetrating trauma

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36
Q

marjolin’s ulcer is what

margins?

dx

tx

site it occurs?

A

chronic inlfammation—> SCC

heaped up margins

dx: bx
tx: wide resection
occurs: at sites of chronic sinus draining tract or wound that heals and breaks down over and over

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37
Q

if patient has had an MI within the last 3 months what is the risk of death during surgery

what about 6

A

40%

6%

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38
Q

if have pulmonary complications post surgery what do you do

A

intubate only after sedation and don’t do surgery until 8 hours of NPO to avoid aspiration pneumonia

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39
Q

when should screeing for breast cancer start and what mech

A

at 50 years old every 2 years

can be 40Q1 for old way if choosing btwn both pick 50q2

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40
Q

soft signs for PE

A

ABG with hypoxic hypocapnia
S1Q3T3
Clear CXR

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41
Q

workup with a pt who has cardiac risk for surgery

if don’t do that then what should you do

A

EKG, ECho, Angiogram or possibly CABG before surgery

if not optimize pt medically: BB, Ace, and get them euvolemic

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42
Q

post op AMS

pt that has complicated post op suspected for what

get what image and see what

treatement

A

ARDS
white out on CXR

tx: PEEP

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43
Q

abdominal pain

colicky, no fever or leukocytosis, and caused by what

A

obstructive

stones

44
Q

fever day 10-14 post op do what

A

CT or US should show abscess

I and D and Abx

45
Q

wounds: skin is intact but the fascia has failed

what color would the dressing be?

tx?

A

dehiscence

salmon colored dressing

tx: bind abdomen and limit movement, ELECTIVE surgical repair too

46
Q

treating venous insufficiency ulcer

A

control edema by controlling underlying disease like CHF with diuretics and elevate feet and compresion stalkings

47
Q

if pre albumin, CRP, and albumin are all low then what is the problem

what if only albumin is low

A

not enough protein in diet

albumin only = problem with liver making albumin

48
Q

what is malnutrtion ID by

A

loss of body weight of over 20% in a few months, an albumin under 3 or anergy to skin antigens

49
Q

dx pancreatic cancer

A

CT see pancreatic mass then EUS with biopsy

50
Q

if a patient has an EF under 35% then what is risk of death

A

75%

51
Q

lump pt is under 30 then what

A

wait 1,2 cycles and see what happens

52
Q

what kind of pt should you look for in ischemic abdominal pain

A

old guy whose status is post MI (shock) or w/ Afib (emboli)

POOP with PE

53
Q

what should be given at time of sx to help pulmonary risk if ther is one

A

inhalers and o2

54
Q

prehepatic causis of jaundice

A

hemolysis and hematomas

55
Q

wounds: both the skin and fascia fail after pt does something to increase intra abdominal pressure is what

tx

what should you never do

A

evisceration

bowel pops out so cover with warm saline dressings and go to OR NOW

never push back in and never use dry dressing

56
Q

fever on day post op day 3 what should you do

tx

ppx

A

UA and Urine Cx bc likely UTI

abx: ceftriaxone if catheter related
ppx: take foley cath out

57
Q

Goldman index highest risk things in it

A

1) JVD
2) MI within 6 months
3) arrhytmia
4) over 70

58
Q

neoadjuvant chemo in what breast cancers

A

inflmmatory

locally advanced stage IIIa

59
Q

is ileus normal after surgery and what is dx and tx

A

yes

dx: upright KUB: dilated small and large bowel
tx: fluid, K+, OOB

60
Q

jaundice billy production from conversion

A

liver disease, acute or chronic

increased unconjugated billy, and LFTs elevated

61
Q

treating breast adenocarcinoma

A

surgery, radiation, and/or chemo

62
Q

goal of therapy for malnutrition is what

A

replace food

PO > IV
10 days > 5 days

63
Q

what electrolyte abnormality can lead to ileus

A

hypokalemia

64
Q

low output post op means what

test how

A

RF

500cc bolus challenge

  • if dehydrated then urine output will increase slightly
  • if doesn’t theres some sort of intrinsic RF that needs more workup
65
Q

if have acute abdomen with positive peritoneal findings what should you do

A

ex lap

KUB to show air under diaphragm and CT to give correct diagnosis

before cutting: R/O mimickers of acute abdomen

  • CXR (lower lobe pneumonia)
  • EKG (MI)
  • amylase/lipase (pancreatitis)
66
Q

fever right after surgery from what, dx, tx, ppx

A

bacteremia, poked stool

blood cx

broad spectrum abx: vanco and pip/tazo

maintain sterile field

67
Q

chemo after breast cancer in what stages

A

I and II

68
Q

what should always be done prior to axillary LN dissection in breast cancer

A

sentinel LN dissection

if negative then only 5% chance other nodes involved

69
Q

diagnosing obstructive GB

A

ERCP and ERCP to treat

70
Q

first step in evaluating pulmonary risk in sx pt

A

FEV/FVC which is best prognostic indicator

then blood gases (low O2 and high CO2 is bad)

71
Q

if pt will be under anesthesia for at least ___ hrs a foley cath is placed automatically

A

3

72
Q

diagnosing pain type

perforation
obstruction
inflammation
ischemia

A

perforation: upright KUB
obstruction: CT or US
inflammation: US or CT
ischemia: Arteriogram or colonscopy

73
Q

what kind of ulcer:

hairless legs

shiny skin
absent pulse

A

arterial

macrovascular

74
Q

Her2Neu is a what and what prognosis and what drug with what AE of drug

A

TK, worse prognosis, trastuzumab, independent REVERSIBLE CHF, so get echo Q3 months

75
Q

Post Op chest pain what do you do with ST changes and positive troponins

A

PCI/Heparin

no clot busters

76
Q

if nontoxic choledoco

if toxic choledoco

management for each

A

nontoxic: RUQ US–>MRCP–>ERCP–>cholecystectomy

toxic (cholangitis): Abx and ERCP

77
Q

crescendo pain in abdomen that becomes localized and constant

A

inflammatory pain

78
Q

If a pt feels the need to void post op but cannot, what should you do after how long of not voiding

A

in and out cath after SIX hours

leave foley in place if two in and out caths required

79
Q

if a patient is at risk for spontaneous bacterial peritonitis (larger amount of asictes) what should be done

A

paracentesis with abx

80
Q

post-hepatic causes of jaundice

A 
gallstones
pancreatic cancer
PBC
PSC
Stricture
81
Q

diagnosing malignant GB and treatment

A

MRCP, then ERCP or EUS = Bx
CT scan for stage
surgery

82
Q

treatment for local control breast cancer

A

lumpectomy and axillary LN disection (ALND) + radiotherapy

mastectomy + ALND

83
Q

chemo for breast cancer

A

DPC (donkey punch central them titties)

doxorubicin, paclitaxel, cyclophosphamide

84
Q

diagnosing arterial ulcers

A

ABI

U/S doppler for macrovascular dx, if + then CT angiogram to confirm

85
Q

doxorubincin AE

A

dose dependent non reversible CHF

86
Q

ER and PR positive breast cancer

premenopausal women treatment

A

SERMS like tamoxifen or raloxifene

87
Q

what determines hepatic risk in sx

A

Encephalopathy, Ascites,
Bilirubin, Albumin, INR (PT)

EA
BAI

A (5-6), B (7-9), C (10-15)

88
Q

if any one of the child pugh score risks are abnormal then what is mortality and what if all 5

A

40%

100%

need liver transplant at that point

89
Q

urine color and stool color in obstructive jaundice

A

dark urine and clay colored stools

90
Q

jaundice bilirbubin production problem from what and lab findings

A

hemolysis, increased unconjugated bili only

91
Q

treatment for pancreastic cancer

A

whipple procedure

pancredo-duodeno-jejunostomy

92
Q

if under 30 and lump persists and US shows cyst and aspirate and it goes away then what

A

stop, you are done

93
Q

if pt has DKA should you do surgery? then what

A

no

IV fluids and insulin

94
Q

pruritius or icterus wil be a sign of what kind of jaundice

A

obstructive

95
Q

what kind of ulcer

edema, hyperpigmentation (stasis dermatitis), indurated?

location?

A

venous insufficiency

location: above the medial malleolus

96
Q

post op fever: day 1. do what

A

CXR and listen to the lungs

if positive give spirometry to improve ventilation

if no improvement, complete fever workup may be needed

97
Q

which has increased risk of DVT tamoxifen or raloxifene and which works better

A

tamox but it works better

98
Q

what is ogilvie syndrome

what pts

dx

tx

A

paralytic ileus of the colon only

elderly sedentary pts after surgery

colon only very dilated on KUB, do colonscopy to rule out cancer and to decompress abdomen,

leave rectal tube in place

99
Q

3 tumors can present with painless jaundice, palpable GB and weight loss

what is imaging you will get

A

pancreatic cancer

cholangiocarcinoma

ampulla of vater cancer

CT scan and see mass in billy system or pancreas or no mass = ampulla of vater

100
Q

lump: pt is under 30 and persists

A

US see mass vs cyst

101
Q

treatment of open fistula

A

remove it or divert the bowel so fistula can close on own

102
Q

jaundice billy production from obstruction and lab findings

A

increased conjugated billy, and LFTs,and alk phos, and pancreatic enzymes

103
Q

what is a really bad prognosis in the golman index

A

JVD which means EF is probably below 35

MI as well

104
Q

treating CIS for breast cancer

A

local resection is curative

lumpectomy + RT+ ALND or
Mastectomy + ALND

105
Q

staging breast cancer off size

A

I: <2cm no nodes
II: <2 cm and 1-3 nodes, or 2-5 cm and 0-3 nodes
III: >5cm
IV: distant metastassis

106
Q

pain out of proportion, bloody BM, sepsis

what kind of abdominal pain

A

ischemic

Online Med Ed notes DF (4 decks)

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