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Usmle Step 2 > surgery: OME videos > Flashcards

surgery: OME videos Flashcards

- gallstone diseases

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USMLE® Step 1 flashcards
1
Q

what are the ultrasound findings for choledocholithiasis?

A

gallstones in GB/CBD; CBD distention >0.8cm (8mm)

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2
Q

primary intervention for gallstones in cbd

A

ERCP (then cholesystectomy)

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3
Q

what test should be performed prior to ERCP?

A

MRCP (except for ascending cholangitis)

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4
Q

US findings for acute cholecystitis

A

pericholecystic fluid, GB wall inflammation/thickening, gallstones in cystic duct

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5
Q

what patients are at the greatest risk for acute acalculous cholecystitis?

A

critically ill for a while, usually no enteric feeding (parenteral nutrition)

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6
Q

major potential complication of ERCP that is quite common?

A

pancreatitis

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7
Q

who gets black pigmented stones?

A

pts with hemolytic anemias (children or adults)

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8
Q

risk factors for cholesterol gallstones

A

fat (hyperlipidemia, hypercholesterolemia)
fertile (multiparous - inc exposure to estrogen during pregnancy)
female (estrogen - fat and cholesterol metabolism)
40 yo+
foreign (hispanic, native american,black)

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9
Q

what does biliary dyskinesia look like on US and HIDA scan?

A

US = normal
HIDA= fails to fully empty gall bladder

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10
Q

what organisms should be covered in acute cholecystitis and ascending cholangitis?

A

gram negatives and anaerobes
(metronidazole? zosyn?)

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11
Q

what does charcot’s triad (RUQ pain, fever, jaundice) suggest?

A

ascending cholangitis- obstruction of the CBD (jaundice + RUQ pain) with infection (fever)

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12
Q

describe the abdominal pain associated with biliary colic

A

RUQ pain worse with fatty foods (intermittent)

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13
Q

what is the difference between biliary colic and the pain of acute calculous cholecystitis

A

colic = intermittent, spontaneous resolution
cholecystitis = constant, does not resolve

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14
Q

what is the primary intervention for cholelithiasis?

A

elective cholecystectomy

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15
Q

how do you treat an abdominal wound evisceration?

A

saline gauze dressings –> surgical emergency

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16
Q

how do you protect against intraoperative aspiration?

A

NPO 6-8 hours pre op +/- 4 hours no clear liquid
NGT w/ suction
avoid preoxygenation with ventilation

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17
Q

who gets acute colonic pseudo-obstruction (oglivie)?

A

elderly esp after abdominal surgery

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18
Q

how do you treat acute colonic pseudobstruction?

A

conservative measures for ileus, neostigmine, colonoscopy without insufflation and leave a rectal tube, hemicolectomy

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19
Q

what does post-op ileus look like on imaging?

A

dilated loops of large AND small bowel

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20
Q

cessation of smoking pre-op for wound healing

A

30 days before surgery

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21
Q

post- op pt has reduced urine output overnight and a foley in place. what’s the likely cause?

A

volume depletion (foley kink ruled out, urinary retention can’t be the answer)

  • high specific gravity
  • pre-renal azotemia
  • hx of diarrhea, vomiting, NPO, etc.
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22
Q

what should you do if the pt has no urinary output for 6 hours and a distended suprapubic mass?

A

bladder scan –> in and out cath

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23
Q

how to prevent and tx a post-op ileus

A

out of bed, ambulation, fluids, potassium correction (hypokalemia)

24
Q

who is at greatest risk for post-op urinary retention?

A

older men with BPH

25
Q

What is the difference between wound dehiscence and evisceration?

A

both are wound closure failure, evisceration is bowel protruding through the defect

wound dehiscence typically occurs 5-8 hours post-op

26
Q

post-op pt has zero output overnight but has a foley in place; what is the next step?

A

flush and reposition the kinked catheter

27
Q

How long must DAPT be continued for a bare metal stent and for a drug- eluting stent?

A

1 month for bare metal stent
1 year for Drug-eluting stent, though can consider urgent surgery after 6 months.

28
Q

when do you perform stress testing in a preop work-up?

A

the patient has known CAD or risk factors and they cannot perform 4 METs of activity

29
Q

which patients with cirrhosis can undergo elective surgery?

A

childs-pugh A+ B or C–>B

30
Q

when is pulmonary function testing appropriate for preoperative clearance?

A

A previously undiagnosed obstructive lung disease that is apparent through history and physical (not routinely done).

31
Q

When should a patient stop smoking to optimize post-op wound healing?

A

30 days before surgery

32
Q

How long should smoking cessation occur prior to surgery pulmonary complications?

A

Any amount of time (not the erroneous 8 wk guideline, now revoked)

33
Q

describe the general rules for determining the risk of a procedure.

A

The deeper you go (skin/GI tract vs. into body cavity), the more you remove (resection worse than no resection), and the more you add (transplants highest risk), the higher the risk

34
Q

How do you perform stress testing in a pre-op work-up?

A

because they can’t do 4 METs to qualify for stress testing, there must be pharmacologically induced stressing

35
Q

What is the cutoff for platelets to preclude elective general surgery (not neurosurgery)?

A

below 50,000 platelets

36
Q

what is the cutoff for INR that precludes elective surgery?

A

above 1.5

37
Q

What lab values should be used (and which should not be used) to assess the nutritional status of a patient?

A

albumin (not “prealbumin” aka transthyretin or CRP)

38
Q

what are the options for treating a peritoneal abscess following abdominal surgery

A

drain and antibiotics or open for washout and abx

39
Q

what are the options for treating an anastomotic leak following abdominal surgery

A

open to washout, then either fix anastomosis or create diverting ostomy

40
Q

what does rising end-tidal CO2 following administration of halothan or succinylcholine mean?

A

malignant hyperthemia

41
Q

what does UTI infection look like in a foley bag?

A

blood tinged, milky white, pus floaters

42
Q

fever after surgery but on post operative day zero is suspicious for what infections?

A

bacteremia or necrotizing fasciitis of the surgical incision site

43
Q

what is meant by early vs late post- op fever?

A

early <48 hrs; do not investigate
late >48 hours - do fever work up (CBC, CMP, UA, CXR, inspection of surgical site, urine blood culture, etc.)

44
Q

what is the work-up for post op fever?

A

UA, urine blood culture, CXR, look at surgical site, (CBC w/ diff; CMP)

45
Q

In order from best to worst, what are the ways to prevent DVTs in post-op pts?

A

ambulation>LMWH> pneumatic compression (SCDs)

46
Q

how do you prevent post-op pneumonia?

A

out of bed (early ambulation) and probably incentive spirometry

47
Q

How do you prevent UTI in post-op pts?

A

get cath out as soon as no longer indicated

48
Q

how do you prevent surgical site infections by skin flora?

A

prophylactic antibiotics (1st/2nd gen cephalosporins, clindamycin?)

Second-generation cephalosporins have coverage against Haemophilus influenzae (H. influenzae), Moraxella catarrhalis, and Bacteroides spp.

The three antibiotics used in adult surgical prophylaxis, where weight-based dosing is recommended, are cefazolin, vancomycin, and gentamicin

49
Q

how do you treat a new, postop DVT?

A

SubQ LMWH then bridge to warfarin or NOAC

50
Q

what are NOACs and DOACs?

A

Direct oral anticoagulants (DOACs) are oral medications that specifically inhibit factors IIa or Xa. They are also known as new oral anticoagulants (NOACs) or target-specific oral anticoagulants (TSOACs).

There are currently 4 NOACs available for healthcare providers to prescribe for patients with atrial fibrillation (see Table 1): dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban (Eliquis®), and edoxaban (Lixiana [Europe/Asia], Savaysa [Nth Am]).

51
Q

what is a heparin bridge

A

“Bridging” is a term that refers to the use of short-acting anticoagulants (heparin or LMWH) for a period of time during interruption of warfarin therapy when the INR is not within a therapeutic range.

There is no established single bridging regimen.

Usually low-molecular-weight heparin given by subcutaneous injection for 5- 10 to 12 days around the time of the surgery/procedure

52
Q

what medication treats malignant hyperthermia?

A

Dantrolene

53
Q

Name the symptoms of cellulitis

A
  • systemic fever
    -warmth and erythema
  • not well circumscribed
  • most likely staph. aureus
54
Q

symptoms of an infected surgical wound

A
  • same as cellulitis
  • staph aureus
55
Q

symptoms of a deep abscess associated with surgery?

A

pain, ileus that does not resolve

56
Q

symptoms of subphrenic abscess

A
  • post splenectomy/gastrectomy
    -referred left shoulder pain
57
Q

how do you dx deep abscess or anastomotic leak?

A

abd CT

Usmle Step 2 (7 decks)

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