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MS3 > Surgery Rotation 9 > Flashcards

Surgery Rotation 9 Flashcards

1
Q

Management for fx of metatarsal

A

Middle metatarsals (2, 3, 4) - can usually heal with rest and analgesics

5th metatarsal has increased risk for nonunion - managed with casting or internal fixation

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2
Q

Causes of post-op fever

A 
Malignant hyperthermia (immediate)
Bacteremia
Atelectasis
Pneumonia 
UTI (3 days later)
DVT (5 days later)
Wound infection 
Remember: 4 Ws for timing
Wind - atelectasis 
Water - UTI
Walking - DVT 
Wound - infection 
Wonder where - abscess
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3
Q

Contents of the spermatic cord

A 
Ductus deferens
Testicular artery
Pampiniform plexus
Genital branch of genitofemoral nerve
Cremasteric muscle
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4
Q

What is the referred subscapular pain from gallstones called?

A

Boas sign

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5
Q

What is Charcot’s triad

A

For cholangitis

Jaundice, fever, RUQ pain

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6
Q

What is the pentad of sx associated with cholangitis

A

Reynold’s pentad

jaundice, fever, RUQ pain, hypotension, AMS

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7
Q

Boundaries of femoral canal

A
  1. Cooper’s ligament posteriorly
  2. Inguinal ligament anteriorly
  3. Femoral vein laterally
  4. Lacunar ligament medially
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8
Q

Most important factors for predicting mortality for surgery

A
  1. CHF - check EF
  2. MI within 6 months - check EKG
  3. Arrhythmias
  4. Old age
  5. Emergent surgery
  6. Aortic stenosis - listen for murmur (late systolic, crescendo-decrescendo)
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9
Q

Meds to stop before surgery

A

Aspirin, NSAIDs, Warfarin, metformin (lactic acidosis)

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10
Q

Formula for anion gap + normal value

A

Na - (Cl + HCO3)

Normal = 8-12

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11
Q

What is the concern when correcting hypernatremia

A

Cerebral edema

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12
Q

Treatment for hyperkalemia

A

Calcium gluconate (to stabilize cardiac membranes), insulin and glucose, albuterol (also shifts K+ into cells), last resort = dialysis

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13
Q

Formula for fluid resuscitation in adult burn victim

A

(Kg) x (% burn surface area) x (3-4)

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14
Q

Formula for fluid resuscitation in child burn victim

A

(Kg) x (% burn surface area) x (2-4)

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15
Q

What do you see on X-ray of paralytic ileus

A

Dilated gas-filled loops of bowel with no transition point

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16
Q

What will you see on CT in colonic ischemia

A

Edema and air (pneumatosis) in the bowel wall

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17
Q

What will you see on colonoscopy of colonic ischemia?

A

Segments of cyanotic mucosa and hemorrhagic ulceration with sharp transition from affected to unaffected mucosa

18
Q

Management of colonic ischemia

A
  • IV fluids and bowel rest
  • Antibiotics with enteric coverage
  • Colonic resection only if necrosis develops
19
Q

Management of penile fracture

A

Urological emergency = urgent operative care

If there is evidence of urethral injury (blood at meatus, hematuria, dysuria, urinary retention) - indication for retrograde urethrogram

20
Q

Management of blunt abd trauma in hemodynamically unstable patients

A

FAST (US) exam

  • If positive (intraperitoneal fluid) = urgent laparotomy
  • If negative = stabilize if signs of extra-abd hemorrhage, or stabilize then CT if no signs of extra-abd hemorrhage
21
Q

Management of blunt abd trauma in hemodynamically stable patients

A

Positive FAST exam = CT abd

22
Q

Management of hemodynamically stable patient with penetrating abd trauma and signs of peritonitis (rebound/guarding)

A

Urgent exploratory laparotomy

23
Q

Causes of hypervolemic hyponatremia

A

CHF, nephrotic syndrome, cirrhosis

24
Q

Causes of hypovolemic hyponatremia

A

vomiting, diuretics

25
Q

Causes of euvolemic hyponatremia

A

SAIDH, Addisons, hypothyroidism

26
Q

Cause of post op pt with thromocytopenia and increased clots

A

HIT - Heparin-induced thrombocytopenia

27
Q

Cause of bleeding with normal platelets but increased bleeding time and PTT

A

vWD

vWF needed to activate platelets = increased BT
vWF stabilizes factor VIII = increased PTT

28
Q

Damage and presentation of humeral mid-shaft fracture

A

Damage to radial nerve - sensation to posterior arm, forearm, and dorsolateral hand; extensor muscles

29
Q

Presentation of uncal herniation

A

Ipsilateral hemiparesis and CN III (oculomotor) palsy

30
Q

Presentation of pulmonary contusion

A

Presents <24 hours after blunt thoracic trauma

Tachypnea, tachycardia, hypoxia

CT scan or CXR with patchy, alveolar infilatrate

31
Q

Management of abd fistula

A
  • fluid replacement
  • electrolyte replacement
  • elemental nutrient replacement (something that won’t stir up enzymes)
  • protection of abd wall from bowel contents (suction device)
32
Q

Things that prevent a fistula from healing

A

FETID

  • Foreign body
  • Epithelialization (epithelium from skin and from bowel can grow towards each other to line the lumen)
  • Tumor
  • Infection, irradiated tissue, IBD
  • Distal obstruction
33
Q

Management of flail chest

A

Pain control, supplemental O2

Positive pressure ventilation (+/-) chest tube if respiratory failure

34
Q

Will you have increased or decreased bowel sounds in small bowel obstruction and in ileus

A 
SBO = increased bowel sounds
Ileus = decreased/absent bowel sounds
35
Q

Muscles of rotator cuff

A

SItS:

  • Supraspinatus (initial abduction of arm, before deltoid)
  • Infraspinatus (lateral rotation)
  • Teres minor (lateral rotation and adduction)
  • Subscapularis (medial rotation and adduction)
36
Q

What structures are at risk for damage in a supracondylar fracture of the humerus (right above the elbow)

A

Entrapment of brachial artery (which branches into radial and ulnar artery) or median nerve

37
Q

Components of Whipple procedure

A
  • Cholecystectomy
  • Truncal vagotomy
  • Antrectomy
  • Pancreaticoduodenectomy—removal of head of pancreas and duodenum
  • Choledochojejunostomy—anastomosis of common bile duct to jejunum
  • Pancreaticojejunostomy—anastomosis of distal pancreas remnant to jejunum
  • Gastrojejunostomy—anastomosis of stomach to jejunum
38
Q

Fluid given for hypovolemic hypernatrermia (both symptomatic and asymptomatic)•

A

Non-symptomatic
o 5% dextrose
Symptomatic
o 0.9% saline (isotonic solution) until Euvolemic, then 5% dextrose (hypotonic solution)

39
Q

What causes metabolic alkalosis

A 
♣	Causes:
•	Losing H+  excessive vomiting, diuretics, hyperaldosteronism 
♣	Differential of metabolic alkalofis (pH > 7.45; HCO3- > 24)
•	Low urine chloride
♣	Will respond to saline
o	Vomiting/nasogastric aspiration
o	Prior diuretic use
•	High urine chloride
o	Hypovolemia/euvolemia
♣	Current diuretic use
•	Will responds to saline
♣	Bartter &amp; Gitelman syndrome
•	Saline unresponsive
o	Hypervolemia
♣	Excessive mineralocorticoid activity
o	Saline unresponsive
•	Primary hyperaldosteronism
•	Cushing disease
•	Ectopic ACTH production
40
Q

What causes metabolic acidosis

A 
•	Anion gap  Adding acid to the blood
o	MUDPILES:
♣	M – Methanol
♣	U – Uremia (renal failure) 
♣	D – Diabetic ketoacidosis
♣	P –  Propylene glycol/Paraldehyde
♣	I – Isoniazid/Iron
♣	L – Lactic acidosis
♣	E – Ethylene glycol (antifreeze)
♣	S – Salicylates (aspirin)
•	Non-anion gap  Losing excessive HCO3-
o	Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide
41
Q

IV fluids given to treat DKA

A

♣ 0.9% normal saline initially

♣ Add dextrose 5% when serum glucose <200 mg/dL

MS3 (88 decks)

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