Surgery p415-425

Question 1

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

Answer 1

35%

Question 2

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

Answer 2

ACE inhibitors, beta blockers, and spirinolactone

Question 3

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

Answer 3

under the age of 35 and no hx of cardiac dz

Question 4

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

Answer 4

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

Question 5

best way to maintain an airway with no facial trauma?

Answer 5

orotracheal tubes

Question 6

best way to maintain an airway with facial trauma?

Answer 6

cricothyroidotomy

Question 7

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

Answer 7

cervical spine injury

Question 8

for breathing you should keep the O2 sat above

Answer 8

90%

Question 9

Name 4 SIRS criteria

Answer 9

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

Question 10

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

Answer 10

2

Question 11

define sepsis

Answer 11

2 SIRS criteria + source of infection

Question 12

define severe sepsis

Answer 12

2 SIRS criteria + source of infection + organ dysfunction

Question 13

define septic shock

Answer 13

severe sepsis + hypotension

Question 14

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

Answer 14

high CVP, high PCWP

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

pt comes with pale/cool skin the next step?

Answer 17

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

Question 18

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

Answer 18

cullen sign, hemorrhagic pancreatitis, ruptured abdominal aortic aneurysm

Question 19

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

Answer 19

grey turner sign, retroperitoneal hemorrhage

Question 20

what are the two signs and symptoms from splenic rupture?

Answer 20

1. kehr sign: pain in the Lt. shoulder

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

Question 21

the best test to evaluate free air under the diaphragm?

Answer 21

upright chest x-ray

Question 22

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

Answer 22

perforation of the bowel

Question 23

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

Answer 23

FAST scan

Question 24

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?

Answer 24

CT scan

Question 25

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

Answer 25

serial abdominal exams, IV fluids

Question 26

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

Answer 26

exploratory laparotomy

Question 27

how is the treatment diff btw tension vs plain pneumothorax

Answer 27

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

Question 28

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?

Answer 28

(hemothorax) chest tube drainage and possible thoracotomy

Question 29

what is the etiology of hemothorax?

Answer 29

blood in the pleural space

Question 30

what is the etiology of pneumothorax?

Answer 30

air in the plueral space

Question 31

3 signs of pericardial tamponade?

Answer 31

1. JVD 2. hypotension 3. muffled heart sounds

Question 32

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

Answer 32

pericardial tamponade

Question 33

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

Answer 33

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

Question 34

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

Answer 34

retrograde urethrogram

Question 35

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?

Answer 35

angiography

Question 36

what are the 2 most common watershed areas for infarction?

Answer 36

splenic, hepatic flexures

Question 37

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

Answer 37

abdominal pain after eating, bloody diarrhea

Question 38

best initial test for ischemic bowel dz?

Answer 38

CT abdomen

Question 39

most accurate test for ischemic bowel dz?

Answer 39

angiography

Question 40

tx for ischemic bowel dz?

Answer 40

IV normal saline followed by surgical intervention to remove necrotic bowel

Question 41

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

Answer 41

superior mesenteric artery

Question 42

number one risk factor for acute mesenteric ischemia?

Answer 42

a fib

Question 43

best initial test for mesenteric ischemia?

Answer 43

abdominal x-ray

Question 44

the most accurate test for mesenteric ischemia?

Answer 44

angiography

Question 45

the most appropriate therapy for mesenteric ischemia?

Answer 45

emergent laparotomy with resection of necrotic bowel

Question 46

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

Answer 46

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

Question 47

2 diff dx for Lt. upper quadrant?

Answer 47

1. splenic rupture | 2. IBS - splenic flexure syndrome

Question 48

3 diff dx for midepigastrium?

Answer 48

1. pancreatitis 2. aortic dissection 3. peptic ulcer dz

Question 49

Rt. lower q abdominal pain, 4 diff dx?

Answer 49

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

Question 50

Lt. lower q abdominal pain, 4 diff dx?

Answer 50

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

Question 51

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

Answer 51

MI

Question 52

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?

Answer 52

pancreas

Question 53

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

Answer 53

gall bladder