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
2
Q
viral etiiology of jaundice lab findings
A
AST and ALT in the 1000s
3
Q
what is local control in breast cancer
A
surgery and radiation
4
Q
what do you get UA for in malignant hyperthermia
A
possible myogloburia
5
Q
what kind of pain is when you have buring pins and needles
A
neuropathic pain from damaged nerve like in DM
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
7
Q
what will ducts look like on US with choledocholithiasis
A
mild dilation bc no time for biliary tree to adapt
8
Q
tender gallbladder
A
obstructive
9
Q
findings with choledocho
A
increased temp
increased wbc
pain
murphy sign positive
10
Q
ER and PR positive breast cancer
postmenopausal women use what
A
aromatase inhibitors like anastrozole
11
Q
what is systemic therapy in breast cancer
A
chemo and targeted therapy
12
Q
how long before sx should smoking cessation take place
A
8 weeks
13
Q
zero output post op means what
A
mechanical obstruction, unkink cath
14
Q
diagnosing cholangiocarcinoma
tx
A
CT scan wit billy mass then do ERCP with Bx
resect
15
Q
intrahepatic causes of jaundice
A
alchol hep
viral hep
cirrhosis/hepatitis
childhood genetic disesae
16
Q
ulcers on the tips of the toes
A
arterial ulcers
17
Q
treatment for invasive carcinoma
A
Mastectomy + ALND + chemo + targeted
Lump + RT + ALND + Chemo + targeted
18
Q
tx arterial ulcers
A
stent small lesions above the knee
bypass large length lesions and any above popliteal artery
19
Q
ppx for atelectasis
A
inhaled spirometry and get pt OOB
20
Q
tamoxifen effects
A
blocks ER on breast
stimulates ER on uterus
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
22
Q
diagnosing ampulla of vagter cancer
A
CT scan no mass
but FOBT + and - colonscopy
1) MRCP 2) ERCP or EUS
tx: resect
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
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
25
tx for PNA post op fever
ppx
treat for hospital acquired PNA with vanco and pip/tazo while waiting on blood cultures
spirometry and OOB is ppx
26
electrolytes to watch post op in AMS
sodium and calcium
27
anytime diagnosing breast stuff and
over 30 or
US shows mass or
aspirate is bloody or
cyst recurs then what
diagnostic mammogram and biopsy
28
post op AMS causes and tx
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
29
palpable nontender gallbladder is what
malignant
30
what is the most important part of the pulmonary part of a preop pt before surgery
ventilation is more important than O2 bc need to be able to blow off CO2
31
manage and tx PE post op
CT spiral scan heparin-->coumadin and
| IVC filter only if contraindication to anticoags
32
if get fever post op day 2 what should you do
CXR and look for consolidation with PNA
33
what things keep a fistula open
FRIEND
```
Foreign body
Radiation
Infection, Irridiation, IBD
Epithelization
Neoplasm (tumor)
Distal Obstruction
```
34
what kind of screening tool should be used in extremely high risk breast cancer pts
MRI
35
causes of perforation that leads to abdominal pain
PUD
cancer
penetrating trauma
36
marjolin's ulcer is what
margins?
dx
tx
site it occurs?
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
37
if patient has had an MI within the last 3 months what is the risk of death during surgery
what about 6
40%
6%
38
if have pulmonary complications post surgery what do you do
intubate only after sedation and don't do surgery until 8 hours of NPO to avoid aspiration pneumonia
39
when should screeing for breast cancer start and what mech
at 50 years old every 2 years
can be 40Q1 for old way if choosing btwn both pick 50q2
40
soft signs for PE
ABG with hypoxic hypocapnia
S1Q3T3
Clear CXR
41
workup with a pt who has cardiac risk for surgery
if don't do that then what should you do
EKG, ECho, Angiogram or possibly CABG before surgery
if not optimize pt medically: BB, Ace, and get them euvolemic
42
post op AMS
pt that has complicated post op suspected for what
get what image and see what
treatement
ARDS
white out on CXR
tx: PEEP
43
abdominal pain
colicky, no fever or leukocytosis, and caused by what
obstructive
stones
44
fever day 10-14 post op do what
CT or US should show abscess
I and D and Abx
45
wounds: skin is intact but the fascia has failed
what color would the dressing be?
tx?
dehiscence
salmon colored dressing
tx: bind abdomen and limit movement, ELECTIVE surgical repair too
46
treating venous insufficiency ulcer
control edema by controlling underlying disease like CHF with diuretics and elevate feet and compresion stalkings
47
if pre albumin, CRP, and albumin are all low then what is the problem
what if only albumin is low
not enough protein in diet
albumin only = problem with liver making albumin
48
what is malnutrtion ID by
loss of body weight of over 20% in a few months, an albumin under 3 or anergy to skin antigens
49
dx pancreatic cancer
CT see pancreatic mass then EUS with biopsy
50
if a patient has an EF under 35% then what is risk of death
75%
51
lump pt is under 30 then what
wait 1,2 cycles and see what happens
52
what kind of pt should you look for in ischemic abdominal pain
old guy whose status is post MI (shock) or w/ Afib (emboli)
| POOP with PE
53
what should be given at time of sx to help pulmonary risk if ther is one
inhalers and o2
54
prehepatic causis of jaundice
hemolysis and hematomas
55
wounds: both the skin and fascia fail after pt does something to increase intra abdominal pressure is what
tx
what should you never do
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
fever on day post op day 3 what should you do
tx
ppx
UA and Urine Cx bc likely UTI
abx: ceftriaxone if catheter related
ppx: take foley cath out
57
Goldman index highest risk things in it
1) JVD
2) MI within 6 months
3) arrhytmia
4) over 70
58
neoadjuvant chemo in what breast cancers
inflmmatory
locally advanced stage IIIa
59
is ileus normal after surgery and what is dx and tx
yes
dx: upright KUB: dilated small and large bowel
tx: fluid, K+, OOB
60
jaundice billy production from conversion
liver disease, acute or chronic
increased unconjugated billy, and LFTs elevated
61
treating breast adenocarcinoma
surgery, radiation, and/or chemo
62
goal of therapy for malnutrition is what
replace food
PO > IV
10 days > 5 days
63
what electrolyte abnormality can lead to ileus
hypokalemia
64
low output post op means what
test how
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
if have acute abdomen with positive peritoneal findings what should you do
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
fever right after surgery from what, dx, tx, ppx
bacteremia, poked stool
blood cx
broad spectrum abx: vanco and pip/tazo
maintain sterile field
67
chemo after breast cancer in what stages
I and II
68
what should always be done prior to axillary LN dissection in breast cancer
sentinel LN dissection
if negative then only 5% chance other nodes involved
69
diagnosing obstructive GB
ERCP and ERCP to treat
70
first step in evaluating pulmonary risk in sx pt
FEV/FVC which is best prognostic indicator
then blood gases (low O2 and high CO2 is bad)
71
if pt will be under anesthesia for at least ___ hrs a foley cath is placed automatically
3
72
diagnosing pain type
perforation
obstruction
inflammation
ischemia
perforation: upright KUB
obstruction: CT or US
inflammation: US or CT
ischemia: Arteriogram or colonscopy
73
what kind of ulcer:
hairless legs
shiny skin
absent pulse
arterial
macrovascular
74
Her2Neu is a what and what prognosis and what drug with what AE of drug
TK, worse prognosis, trastuzumab, independent REVERSIBLE CHF, so get echo Q3 months
75
Post Op chest pain what do you do with ST changes and positive troponins
PCI/Heparin
no clot busters
76
if nontoxic choledoco
if toxic choledoco
management for each
nontoxic: RUQ US-->MRCP-->ERCP-->cholecystectomy
toxic (cholangitis): Abx and ERCP
77
crescendo pain in abdomen that becomes localized and constant
inflammatory pain
78
If a pt feels the need to void post op but cannot, what should you do after how long of not voiding
in and out cath after SIX hours
leave foley in place if two in and out caths required
79
if a patient is at risk for spontaneous bacterial peritonitis (larger amount of asictes) what should be done
paracentesis with abx
80
post-hepatic causes of jaundice
```
gallstones
pancreatic cancer
PBC
PSC
Stricture
```
81
diagnosing malignant GB and treatment
MRCP, then ERCP or EUS = Bx
CT scan for stage
surgery
82
treatment for local control breast cancer
lumpectomy and axillary LN disection (ALND) + radiotherapy
=
mastectomy + ALND
83
chemo for breast cancer
DPC (donkey punch central them titties)
doxorubicin, paclitaxel, cyclophosphamide
84
diagnosing arterial ulcers
ABI
U/S doppler for macrovascular dx, if + then CT angiogram to confirm
85
doxorubincin AE
dose dependent non reversible CHF
86
ER and PR positive breast cancer
premenopausal women treatment
SERMS like tamoxifen or raloxifene
87
what determines hepatic risk in sx
Encephalopathy, Ascites,
Bilirubin, Albumin, INR (PT)
EA
BAI
A (5-6), B (7-9), C (10-15)
88
if any one of the child pugh score risks are abnormal then what is mortality and what if all 5
40%
100%
need liver transplant at that point
89
urine color and stool color in obstructive jaundice
dark urine and clay colored stools
90
jaundice bilirbubin production problem from what and lab findings
hemolysis, increased unconjugated bili only
91
treatment for pancreastic cancer
whipple procedure
pancredo-duodeno-jejunostomy
92
if under 30 and lump persists and US shows cyst and aspirate and it goes away then what
stop, you are done
93
if pt has DKA should you do surgery? then what
no
IV fluids and insulin
94
pruritius or icterus wil be a sign of what kind of jaundice
obstructive
95
what kind of ulcer
edema, hyperpigmentation (stasis dermatitis), indurated?
location?
venous insufficiency
location: above the medial malleolus
96
post op fever: day 1. do what
CXR and listen to the lungs
if positive give spirometry to improve ventilation
if no improvement, complete fever workup may be needed
97
which has increased risk of DVT tamoxifen or raloxifene and which works better
tamox but it works better
98
what is ogilvie syndrome
what pts
dx
tx
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
3 tumors can present with painless jaundice, palpable GB and weight loss
what is imaging you will get
pancreatic cancer
cholangiocarcinoma
ampulla of vater cancer
CT scan and see mass in billy system or pancreas or no mass = ampulla of vater
100
lump: pt is under 30 and persists
US see mass vs cyst
101
treatment of open fistula
remove it or divert the bowel so fistula can close on own
102
jaundice billy production from obstruction and lab findings
increased conjugated billy, and LFTs,and alk phos, and pancreatic enzymes
103
what is a really bad prognosis in the golman index
JVD which means EF is probably below 35
| MI as well
104
treating CIS for breast cancer
local resection is curative
lumpectomy + RT+ ALND or
Mastectomy + ALND
105
staging breast cancer off size
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
pain out of proportion, bloody BM, sepsis
what kind of abdominal pain
ischemic
