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MTB > Surgery p415-425 > Flashcards

Surgery p415-425 Flashcards

1
Q

what is the minimum ejection fraction for non-cardiovascular surgery?

A

35%

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2
Q

what meds can you give to CHF pts to reduce mortality before surgery?

A

ACE inhibitors, beta blockers, and spirinolactone

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3
Q

what is the indication for EKG being the only pre-op test?

A

under the age of 35 and no hx of cardiac dz

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4
Q

name the 3 pre-op tests for a pt with a hx of cardiac dz

A
  1. EKG
  2. stress test for ischemic coronary lesions
  3. echo for structural dz to assess ejection fraction
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5
Q

best way to maintain an airway with no facial trauma?

A

orotracheal tubes

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6
Q

best way to maintain an airway with facial trauma?

A

cricothyroidotomy

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7
Q

what is the indication for flexible bronchoscopy in Trauma/ABC assessment algorithm?

A

cervical spine injury

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8
Q

for breathing you should keep the O2 sat above

A

90%

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9
Q

Name 4 SIRS criteria

A
  1. temp < 36 or > 38
  2. HR more than 90
  3. RR > 20 or pCO2 < 32 mmHg
  4. WBC < 4,000 or > 12,000
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10
Q

among the 4 SIRS criteria, how many do you need to fulfill SIRS?

A

2

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11
Q

define sepsis

A

2 SIRS criteria + source of infection

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12
Q

define severe sepsis

A

2 SIRS criteria + source of infection + organ dysfunction

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13
Q

define septic shock

A

severe sepsis + hypotension

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14
Q

among 4 types of shock (hypovolemic, cardiogenic, neurogenic, septic), which two parameters are the best one to use to identify cardiogenic

A

high CVP, high PCWP

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15
Q

pt with shock comes in and you feel warm/flushed, what is your next step to identify the type of shock?

A

are there changes in cardiac output? if it’s elevated then septic shock, if not neurogenic

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16
Q

warm/flushed shock pt comes in and cardiac output is increased, what is your next step?

A

measure PCWP, if low it’s anaphylatic, if no change then septic

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17
Q

pt comes with pale/cool skin the next step?

A

measure PCWP, if high then it’s cardiogenic, if low it’s hypovolemic

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18
Q

a trauma pt comes in with bruising around the umbilicus, what are the causes and what is it called?

A

cullen sign, hemorrhagic pancreatitis, ruptured abdominal aortic aneurysm

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19
Q

a trauma pt comes with bruising in the flank. what is the name of the sign and what causes it?

A

grey turner sign, retroperitoneal hemorrhage

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20
Q

what are the two signs and symptoms from splenic rupture?

A
  1. kehr sign: pain in the Lt. shoulder

2. balance sign: dull percussion on the Lt. and shifting dullness on the Rt.

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21
Q

the best test to evaluate free air under the diaphragm?

A

upright chest x-ray

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22
Q

a trauma pt comes in and you see a free air under the diagphragm, what is the most likely dx?

A

perforation of the bowel

23
Q

the best test to diagnose intraabdominal bleeding for a trauma pt?

A

FAST scan

24
Q

a trauma pt comes in with a possible retroperitoneal bleed or splenic rupture, but the FAST scan was negative, what do you want to do?

A

CT scan

25
Q

abdominal trauma pt comes in bp is 100/80, how would you manage?

A

serial abdominal exams, IV fluids

26
Q

abdominal trauma pt comes in and bp is 80/50, what is your next step

A

exploratory laparotomy

27
Q

how is the treatment diff btw tension vs plain pneumothorax

A

for tension, you need immediate needle decompression followed by chest tube placement, plan pneumothorax, just chest tube placement

28
Q

a trauma pt comes in with absent breath sounds and dull to percussion. chest x-ray shows blunting of costophrenic angle, what is your next step?

A

(hemothorax) chest tube drainage and possible thoracotomy

29
Q

what is the etiology of hemothorax?

A

blood in the pleural space

30
Q

what is the etiology of pneumothorax?

A

air in the plueral space

31
Q

3 signs of pericardial tamponade?

A
  1. JVD
  2. hypotension
  3. muffled heart sounds
32
Q

a trauma pt comes in with chest pain and the EKG shows electrical alternans, what is the dx?

A

pericardial tamponade

33
Q

how would you diff btw tension pneumothorax vs. atelectacis on chest x-ray?

A

TP pushes the trachea away from the involved lung, whereas atelectasis pulls the trachea toward the involved lung

34
Q

a trauma pt comes in with blood at the urethral meatus, what is the best next step?

A

retrograde urethrogram

35
Q

80 y/o old male with significant hx of CAD, a fib comes in with pain in abdomen after meals, no fever, no peritoneal sign, what is the best next step?

A

angiography

36
Q

what are the 2 most common watershed areas for infarction?

A

splenic, hepatic flexures

37
Q

what are the 2 most common symptoms of ischemic bowel dz?

A

abdominal pain after eating, bloody diarrhea

38
Q

best initial test for ischemic bowel dz?

A

CT abdomen

39
Q

most accurate test for ischemic bowel dz?

A

angiography

40
Q

tx for ischemic bowel dz?

A

IV normal saline followed by surgical intervention to remove necrotic bowel

41
Q

acute mesenteric ischemia is the acute occlusion of mesenteric arteries, most commonly which artery?

A

superior mesenteric artery

42
Q

number one risk factor for acute mesenteric ischemia?

A

a fib

43
Q

best initial test for mesenteric ischemia?

A

abdominal x-ray

44
Q

the most accurate test for mesenteric ischemia?

A

angiography

45
Q

the most appropriate therapy for mesenteric ischemia?

A

emergent laparotomy with resection of necrotic bowel

46
Q

a pt comes with Rt. upper q pain, give 4 diff dx

A
  1. cholecystitis
  2. biliary colic
  3. cholangitis
  4. perforated duodenal ulcer
47
Q

2 diff dx for Lt. upper quadrant?

A
  1. splenic rupture

2. IBS - splenic flexure syndrome

48
Q

3 diff dx for midepigastrium?

A
  1. pancreatitis
  2. aortic dissection
  3. peptic ulcer dz
49
Q

Rt. lower q abdominal pain, 4 diff dx?

A
  1. appendicitis
  2. ovarian torsion
  3. ectopic preg
  4. cecal diverticulitis
50
Q

Lt. lower q abdominal pain, 4 diff dx?

A
  1. sigmoid volvulus
  2. sigmoid diverticulitis
  3. ovarian tosrion
  4. ectopic preg
51
Q

a 65 y/o male with significant hx of CAD comes in with pain in Lt. chest, haw, and Lt. arm, dx?

A

MI

52
Q

70 y/o female with significant weight loss in 3 months comes in with back pain as a referred pain, what organ is responsible for this pain?

A

pancreas

53
Q

60 y/o male with recent jaundice comes in with pain in Rt. shoulder/scapular, what organ is responsible for this pain?

A

gall bladder

MTB (22 decks)

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