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Surgery 1 > Surgery LE 1 - Boxes > Flashcards

Surgery LE 1 - Boxes Flashcards

1
Q

Locations and Causes of Referred Pain

Right Shoulder

A

Liver
Gallbladder
Right hemidiaphragm

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2
Q

Locations and Causes of Referred Pain

Left Shoulder

A

Heart
Tail of pancreas Spleen
Left hemidiaphragm

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3
Q

Locations and Causes of Referred Pain

Scrotum and Testicles

A

Ureter

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4
Q

Nonsurgical Causes of the Acute Abdomen - 3

A

Endocrine and Metabolic Causes

Hematologic Causes

Toxins and Drugs

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5
Q

Surgical Acute Abdominal Conditions - 5

A

Hemorrhage

Infection

Perforation

Blockage

Ischemia

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6
Q

Associated symptoms can be important diagnostic clues.

What are they?

A

Nausea, vomiting, constipation, diarrhea, pruritis, melena, hematochezia, and/or hematuria can all be helpful symptoms if present and recognized.

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7
Q

Murphy’s sign

A

Pain caused by inspiration while applying pressure to right upper abdomen

Acute cholecystitis

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8
Q

Rovsing’s Sign

A

Pain at McBurney’s point when compressing the left lower abdomen

Acute appendicitis

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9
Q

Aaron’s Sign

A

Pain or pressure in epigastrium or anterior chest with persistent rm pressure applied to McBurney’s point

Acute appendicitis

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10
Q

Technique to test Peritonitis

A

– ask pt to take a deep breath → sudden sharp

pain (+ sign) do not shake the bed

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11
Q

Obturator sign

A

Flexion and external rotation of right thigh while supine creates hypogastric pain

Pelvic abscess or in ammatory mass in pelvis

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12
Q

Order-specific steps in physical examination:

A
  1. General Appearance
  2. Vital signs
  3. Inspection
  4. Auscultation
  5. Percussion
  6. Palpation

G VIA PerpP

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13
Q

Iliopsoas

A

Elevation and extension of leg against resistance creates pain

Apppendicitis with retrocecal abscess

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14
Q

Clean Wound

A

(5%)

o No infection is present
o Surgery of breast, thyroidectomy and simple hernia
o Cut under sterile conditions
o No prophylaxis

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15
Q

Clean Contaminated –

A

(10%)

o Respiratory, alimentary or genitourinary under
controlled circumstances without spillage of contents

o Give prophylactic antibiotics immediately prior to
surgery –
Immediately prior to surgery (30min/1hr)
1 dose only unless the procedure is longer than the half life

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16
Q

Contaminated

A

(15%)

o Contamination of sterile area of the body due to
spillage of contents (e.g. stab wounds)

o With antibiotic prophylaxis

o e.g. acute appendicitis

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17
Q

Dirty

A

– 3.1-12.8%

Necrotic tissue and purulent material is present (e.g. fecal material)

e.g. diabetic foot gangrene

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18
Q

UNDER AGE 50 consulting for

in order!!

A

Non-specific abdominal pain

Appendicitis

Cholecystitis

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19
Q

OVER AGE 50 consulting for

in order!!

A

Cholecystitis

Non-specific abdominal pain

Appendicitis

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20
Q

pain in EPIGASTRIC REGION:

A

stomach, duodenum, biliary tract

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21
Q

pain in PERIUMBILICAL:

A

small bowel, appendix, cecum

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22
Q

Referred Pain

Ureteral obstruction –

A

testicular pain.

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23
Q

Referred Pain

2) Subdiaphragmatic infection –

A

ipsilateral shoulder or supraclavicular pain.

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24
Q

Referred Pain

3) Biliary disease –

A

right infrascapular pain.

25
Q

Referred Pain

4) MI –

A

epigastric, neck, jaw or UE pain.

26
Q

Referred Pain

5) Gynecologic pathology –

A

back or proximal lower

extremity

27
Q

5 Categories of Acute Abdomen

A

(BIOPI)

  • Bleeding or rupture of vessel, or tumor
  • Ischemia or Infarction
  • Obstruction
  • Perforation
  • Inflammation
28
Q
  1. Most common cause of ssi
A

A. Enteric microorganism

29
Q
  1. not a host defense of skin:

A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage

A

D. macrophage

30
Q
  1. organ in which presence of microorganism is important for host defense:

A. urogenital tract

b. Biliary tract
c. lungs
d. colon

A

d. colon

31
Q

Infection rate of elective cholecystectomy

A

10%

32
Q

CHARACTERISTICS OF PAIN

A

Precipitating or Alleviating Factors
• Quality – Bright, sharp, dull, achy
• Radiation – Scapula, inguinal, supraclavicular
• Severity – 1-10 scale (intensity is based on the frame
of reference of the patient. Be careful in suggesting a
scale)
• Timing – Sudden, insidious, crampy or continuous

33
Q

The type of wound with multiple deep abrasions and lacerations secondary to vehicular accident

A

contaminated

34
Q
  1. Multiple cutaneous abscesses that spread
    through dermis into the subcutaneous region and are commonly seen in diabetic patients.

A. feruncle
B. carbuncle
C.hydradentis suppurativa
D. cellulitis

A

B. carbuncle

35
Q

Handwashing using chlorine water

A

Ignaz Semmelweis

36
Q

Stated that the patient dies due to inflammatory response to infection

A

William Osler

37
Q
  1. Most common cause of ssi

A. Enteric microorganism
B. Anaerobic gram (+)
C. aerobic skin commensal
D. Aerobic gram (-)

A

A. Enteric microorganism

38
Q
  1. not a host defense of skin:

A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage

A

D. macrophage

39
Q
  1. organ in which presence of microorganism is important for host defense:

A. urogenital tract

b. Biliary tract
c. lungs
d. colon

A

d. colon

40
Q

Infection rate of elective cholecystectomy

5%
10%
15%

A

10%

explanation:
5% = clean
10% = clean contaminated
15% = contaminated

41
Q

Wound classification of penetrating abdominal trauma

A

Contaminated

42
Q

peritonitis seen in patients with ascites and patients undergoing peritoneal dialysis

A

primary

43
Q
  1. type of peritonitis which requires minimal surgical intervantion
A

Primary

44
Q

Type of peritonitis seen in perforated acute appendicitis

A

Secondary

45
Q
  1. Type of peritonitis seen after colon resection and anastomosis of perforated diverculitis
A

Secondary

46
Q
  1. Type of peritonitis managed by surgery

a. primary
b. secondary
c. tertiary
d. peritonitis like syndrome

A

b.secondary (ans)

47
Q

What is the most common cause of pyogenic liver abcess

A

cholecystitis

any infection in gut

48
Q

This is frequently seen in acne and usually begins in hair follicles

A

Furuncle

49
Q

Surgical removal of perforated sigmoid

dirty wound

A

contaminated

50
Q

Thyroid gland surgery is a

A
  • Clean wound
51
Q

Most common cause of abdominal pain under 50 -

A

Non specific abdominal pain

52
Q

Protein-energy malnutrition and dietary deficiencies = Marasmus

a. lack of protein and calories
b. lack of protein only

A

lack of protein and calories

53
Q

Protein-energy malnutrition and dietary deficiencies = Kwashiorkor

a. lack of protein and calories
b. lack of protein only

A

b. lack of protein only

54
Q

LOW RESIDUE ISOTONIC FORMULA

A

1st line formula for stable patient with intact GI tract

55
Q

ISOTONIC FORMULAS WITH FIBER

A

Fiber stimulates pancreatic lipase activity and are
degraded by gut bacteria into short-chain fatty acids, an
important fuel for colonocytes

56
Q

IMMUNE ENHANCING FORMULAS

A

Additives includes glutamine, arginine, branch-chain amino acids, omega-3 FA, nucleotides and beta-carotine

57
Q

CALORIE-DENSE FORMULA

A

Greater caloric value for the same volume to 2 Kcal/mL

58
Q

HIGH-PROTEIN FORMULAS

A

 Isotonic and nonisotonic mixtures and are proposed for critically ill or trauma patients with high protein requirements

59
Q

ELEMENTAL FORMULA

A

 Predigested nutrients

Surgery 1 (7 decks)

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