Surgery Other Systems Flashcards
tx for cellulitis if we think its MRSA
-outpatient non MRSA
IV Vanco or linezolid–> IV ABX is IND if they meet SIRS criteria
-bactrim, clinda, doxy= outpatient
NON MRSA OP–>dicloxacillin, cephalexin** amoxicllin
poorly demarcated boarders of erythema
cellulitis
MC pathogens for cellulitis
GAS
Strep pyogenes
STaph aureus
MRSA
cat bite abx
augmentin or doxy
puncture wound– what abx?
ciprofloxacin or ceftazidime to cover pseudomonas
lab values for primary hyperthyroidism aka?
Graves Disease
Increased T3 T4
Low TSH
MCC of hyperthyroidism?
-sx?
graves
tachycardia, palpiations, afib, PVCs anxiety, tremors, insomnia, brittle hair, moist and warm skin weight loss heat intolerance exopthalmos, pretibila myxedema
stages of pressure ulcers
- nonblanching erythema, intact skin, may be painful—-only involves epidermis
- partial thickness, shallow open ulcer, red/pinnk wound bed
- full thickness skin loss, subcu fat may be visible, slough or eschar present, bone muscle tendon not expose, can include tunneing—>through the epidermis
- exposed bone, tendon or muscle,
how often to respotion patient to avoid pressure ulcers
2 hours
which stage of ulcer is adipose tissue exposed but not bone and tendon
3
what is a late sign for acute arterial oclusion
loss of motor function
cold leg, weak or loss of pulses—-
acute arterial occlusion
pain out of proportion to exam pallor pulselessness paresthesia poikilothermia paralysis
acute aterial occlusion and acute compartment syndrome
which type of AAA needs immediate surgery
type A— a for ASCENDING
tx for type B AAA
reduce BP—–IV BBs–>esmolol, labetalol, propranalol (DO NOT GIVE TO PT WITH HX OF ASTHMA)
xanthochromia on LP can indicate
early s/s of sub arachnoid hem
pharmalogical management for SAH
to reduce BP give Nimodipine—- a DHP CCB
60 mg q4h
this will decrease vasopsasms
if CT scan is negative for a bleed but suspicions are high for a SAH– next test?
LP
xanthochromia will show
increased fibrin degradation products and schistocytes on CBC consistent with?
DIC
intervention for suspected melanoma
excisinoal biopsy with skin margins of at least 2 mm
Pheochromocytoma
- dx
- tx
DX–urine metanephrines and VMA elevated, CT shows adrenal mass
TX– complete adrenalectomy and PREOP we will give NONSELECTIVE alpha blockers 7-14 days prior to surgery and BBs after surgery
HX of thyroidectomy—- pt will comes in with tinginling aorund mouth, muscle sapsms, numbness and tingling in hands/feet
-hyperactive DTR
DX?
primary hyPOparathyroidism
DECR in PTH means DECR in Calcium HIGH phosph
epidural
traffic accident, falls, trauma, assualts— MC type of brain bleeed ?
epidural
biconvex/lens-shaped bleed
epidural
what artery invovled with epidural bleed
middle meningeal artery
crescent-shaped bleed
subdural
ETOH disorder… older population MC brain bleed?
subdural
meds used to reduced ICP
Intravenous mannitol and hypertonic solution.
shave biopsy reveals multifocal nests of basophilic staining cells with peripheral palisading nuclei
basal cell carcinoma
pearly nodule, telangelic vessels with rolled edgegs
BCC
contraindication to sharp debridement of pressure ulcer
anticoagualiton therapy
cool, shiny extremitiy with decrease hair
PAD
What is the ankle brachial index for PAD
ABI <0.9= PAD with >50% stenosis
<0.4=ischemia
OVER 1.4= noncompressilble arteries due to vascular calcification
NORAML = 1-1.4
tx for PADM
-ASA, clopidogrel, Cilstazol (vasodilator) for claudication +ACEI +statin
if drugs fail–>revascularization with PTA
or bypass graft or stent or ednarterectomy
next step in intervention for a pt with an ABI of 1.5
toe brachial index is needed
MC artery affected in PAD
distal superficial femoral artery —-CALF pain
thigh and buttock pain with PAD— what artery affected
common iliac artery
ulcer is punched out, deep and irregular shape with +/- necrotic tissue minimal exudate unless infected
-type of uler?
arterial
shallow and flat margins, moderate to heavy exudate.. slough at the base with granualtino tissue
venous ulcer
what part of adrenal gland is resp for prod of catecholamines
- glucocorticoids?
- androgens?
- mineralcorticoids
adrenal medulla=catecholamines
zona fasiculata= glucos
zona glomerulosa= outermost=mineralcorticoids
-zona reticularias=innermost=androgens
what drug can cause itchiness all over body but theres little to no rash
morphine or other opioids
hypothyroidism does what to DBP
raises it
lab values for hypothyroidism
HIGH tsh and LOW T4 T3
AAA with any size + good surigcal candidate=?
urgent open or endovadular repair
Infrarenal AAA <5.5 cm and pt is asympto?
watchful waiting, montior with US
> 5.5 cm AAA
surgical repair
list some factors that would indicate suriglca repair for a AAA < 5.5 cm
female
CAD
rapid expansino
coexisting aneurysm
NGT post op with ileus– what do we want to give IV
-what do we avoid
Potassium!!!!
avoid dextrose containign fluids bc insulin release will shift K back into the cell
hemoptysis hematuria— general malaise— CXR pulmonary infiltrates
good pastures
which thyroid CA assoc with MEN 1 and 2
medullary
MC type of thyroid CA
papillary
parkland formula
4ml X bodyweight in kg x % TBSA burned
compartment pressure over ______ mmhg conssitent with compart syndrome
30
Necrotizing Fascitis intervention
surgical debridement very early— Q1-2 days until nerotic tissue is no longer present
BS abx until wound cultures come back
tearing quality abd pain or cp
aortic disection
initial test OC for aortic dissection for HD:
- unstable
- stable
UNSTABLE:
- transesophageal echocardiogram (TEE) ****
- transthoracic echo
STABLE:
- CTA
- MR angio
MC abx prescribed for mastitis or breast abscesss
Dicloxacillin or cephalexin.
how does chronic subdural hematoma show on CT
hypodense crescent-shaped……. concave
craving ice, koilonychia
low hemoglobin low crit
FE def anemia
***total iron binding capacity will be HIGH
recent head injury, incr in thirs and incr urination
Central DI
MC precancerous lesion and precursor for sqaumous cell carcinoma
Actinic keratosis
irregular, erythematous plaque with hemorrhagic crust
*non healing lesion that bleeds without trauma
SCC
two viruses assoc with SCC
EBV
HPV
PT recently took sulfonamides
-developed a rash + fever
Skin BX shws necrotic tissue
Erythema Multiforme
MCC of TIA
carotid artery stenosis
Tx for TTP
plasma exchange
at what threshold do we start giving platlete exchange
<50,000
post op fever 5-7 days after procedure is MC due to?
superficial or deep wound infection
post op fever within 48-72 hours MC due to
UTI
triad for renal cell carcinoma
flank pain
hematuria
abdominal pass nontender and palpable
**hx of smoking
glossitis
decr DTR
pernicious anemia
**hx of bariatric surgery too
triad for cardiac tamponade
- name?
- list the things
BECK TRIAD
hypotension
muffled heart sounds
JVD
**also will see electrical alternans
first line med tx for PAD with intermittent claudication
Cilostazol
threshold for platelet count to be ok for most major surgery
50K
For nonemergent and elective surgeries, first-line treatment for patients with immune thrombocytopenia is
steroids and IVIG
tx stepwise for pheochromocytooma
- control BP BEFORE DOING SURGERY—– alpha blocker (pheonybenzamine) or a ccb—alone or in combo
- lap surgical resection
***never give the BB (esp cardioselective… metorpolol) before the alpha or CCB becuse can result in paradoxical worsening HTN due to unopossoed alpha status
indication for surgical tx of primary hyperparathyroidism in an asymptomatic pt?
presence of kidney stones
hemophilia A pt get ____before surgery
desmopressin
An ___________approach is typically used for resection of any adrenal tumor when malignancy is suspected
open transabdominal
Classic prodromal symptoms for vasovagal
nausea, diaphoresis, a warm or cold sensation, and blurred vision.
ost common postsurgical complication experienced by patients undergoing surgical treatment for peptic ulcer disease?
wt loss
__________is the recommended imaging modality in the assessment of acute arterial embolism that is not immediately limb-threatening,
CTA of the pelvis with runoff
drug zTreatment of PAD
-ASA or clopidogrel (anti-plats) + RF redduction
pH: > 7.45; PaCO2: < 35 mm Hg; HCO3: normal
resp alkalosis
pH: < 7.35; PaCO2: > 45 mm Hg; HCO3: normal
resp aciodsis
-hyPOventilation
pH: < 7.35; PaCO2: normal; HCO3: < 22 mEq/L
met acidosis
pH: > 7.45; PaCO2: normal; HCO3: > 26 mEq/L
met alkalosis
Patients complaining of esophageal dysphagia should undergo
upper endoscopy
decreased hemoglobin and hematocrit with an elevated mean corpuscular volume.
b12 def or folate
Intravenous _______ is administered to prevent hypotension secondary to adrenal insufficiency in a patient undergoing unilateral or bilateral adrenalectomy.
hydrocortisone (50 to 100 mg)
A wide excision with a ____cm wide margin of normal tissue is standard for melanoma that is less than 1 mm in thickness.
1 cm
A wide excision with a ____ cm wide margin of normal tissue is standard for melanoma that is > than 1 mm in thickness.
2 cm
Life-long _________ is required for patients who undergo Roux-en-Y gastric bypass
micronutrient supplementation
Hypoactive bowel sounds are an indicator that
perforatoiin occured
What are three tumor markers that should be assessed in cases of suspected testicular cancer?
Alpha-fetoprotein (AFP), the beta subunit of human chorionic gonadotropin (beta-hCG), and lactate dehydrogenase (LDH).
