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Y3 Workbooks and Mock Exam Qs > Surgery Workbook > Flashcards

Surgery Workbook Flashcards

1
Q

How is the water in 5% dextrose v normal saline distributed throughout the body?

A

dextrose - into total body water
normal saline - into extracellular water

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2
Q

What factors can increase fluid losses?

A

high urine output
D+V
stoma output
sweating
burns
haemorrhage

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3
Q

What should you do before prescribing IV fluids to any patient?

A
  1. check notes to understand clinical setting
  2. look at recent bloods
  3. inspect patients fluid charts and BP charts
  4. decide if pt is high risk (renal compromise/HF)
  5. are they in balance or deficit or surplus?
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4
Q

Why does urea increase relative to creatinine during dehydration?

A

decreased perfusion of kidneys = decreased excretion of urea

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5
Q

Consequences of starvation prior to surgery?

A

decreased wound healing
inc infection and skin breakdown

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6
Q

Why does surgery place additional demands on nutritional status of the body?

A

creates a catabolic state

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7
Q

Average daily calorie requirements for adult patients?

A

M = 2900
F = 2200

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8
Q

Complications of parenteral feeding?

A

thrombosis
infection
liver failure
micronutrient deficiencies

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9
Q

Commonest cause of preventable death in surgical patients?

A

P.E

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10
Q

Where do surgical patients often develop DVTs?

A

soleal and gastrocnemius venous sinuses

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11
Q

What pre-op, intra-op and post-op factors increase risk of DVT ?

A

Pre:
poor hydration, obesity, malignancy, prothrombotic drugs e.g. COCP

Intra-op:
longer procedure, under GA

Post:
prolonged immobility

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12
Q

How long must have elapsed since insertion of epidural before administering LMWH? Why?

A

4 hours
risk of epidural haematoma which can cause spinal cord compression

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13
Q

Which surgical pts should receive Dalteparin for up to 35 days post surgery?

A

Hip fracture and THR
Malignancy

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14
Q

target range of intra-op blood glucose?
below what value = ‘rescue tx’?

A

6-12
<4

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15
Q

Why is there risk of aspiration at induction of anaesthesia? Why is it so dangerous?

A

loss of LOS tone and protective laryngeal reflexes due to paralysis

can causes asphyxiation and aspiration pneumonia

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16
Q

Half life of IV insulin?

A

5 mins

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17
Q

How many calories does a litre of 5% dextrose contain?

A

700

18
Q

What normally happens to serum ACTH after a major trauma such as surgery? Benefit?

A

It increases

prevent adrenal crisis because surgery increases demand on cortisol as your body is under physiological stress

19
Q

Why is Addisonian crisis often difficult to detect operatively and operatively?

A

mimics other surgical complications

20
Q

How long before surgery should EPO be given to increase Hb?

A

6 weeks

21
Q

What 3 requirements must be met for consent to be legally valid?

A

given voluntarily
patient has capacity to consent
patient understands nature of tx

22
Q

How should you present a CXR?

A
  1. Give the type of radiograph and projection
  2. Give the patients name
  3. Give the date the X-ray was taken
  4. Briefly assess the film quality to ensure it is adequate
  5. Run through the ABC of chest radiology
  6. Give a short Summary at the end.
23
Q

What are you looking for in a CXR?

A

Airway - trachea, bronchi
Breathing - lung expansion, lung outlines, lung fields
Circulation - cardiac size, great vessels, mediastinum
Dem bones - ribs and shoulder girdle
Everything else - air under diaphragm, surgical emphysema, foreign bodies

24
Q

What are you looking for in an abdo XR?

A

Air in the wrong place - pneumoperitoneum, air in biliary tree, Rigler’s sign
Bowel - dilated bowel, volvulus, hernias, thickened walls
Calcification - calcified gallstones, pancreatic calcification, AAA, foetus
Disability - fractures and solid organ enlargement
Everything else - evidence of surgery, lung bases, foreign bodies

25
Q

Indications for AXR?

A

Suspected bowel obstruction - To look for dilated loops of small or large bowel or a dilated stomach

Suspected perforation - To look for evidence of pneumoperitoneum. An erect CXR should always be requested at the same time to look for free gas under the diaphragm

Moderate-to-severe undifferentiated abdominal pain - May be useful if the provisional diagnosis includes any of the following: toxic megacolon, bowel obstruction and perforation

Suspected foreign body

Renal tract calculi follow-up - To look for the presence or movement of known renal tract calculi.

26
Q

Differentials for acute epigastric pain?

A

acute pancreatitis
perforated gastric / duodenal ulcer
GORD
gastritis
ruptured AAA
Boerhaave’s
MI
trauma

27
Q

By what mechanisms can gallstones cause acute pancreatitis?

A

duct obstruction (pancreatic duct or bile duct) by migrated gallstones

increasing duct pressure and subsequent unregulated activation of pancreatic digestive enzymes

28
Q

Which organs most commonly perforate?

A

appendix
duodenum
sigmoid colon

29
Q

define peritonitis

A

inflammation of the peritoneum

30
Q

What is the natural hx of untreated hernias?

A

incarcerated > strangulated > obstructed / infarcted

31
Q

most common complications of appendicectomy?

A

peritonitis, peritoneal abscess

32
Q

How long should patients refrain from driving after an uncomplicated appendicectomy?

A

1-3 weeks

33
Q

indications for surgery in gallstones?

A

symptomatic
acute cholecystitis
gallbladder trauma / cancer

34
Q

How would a patient with generalised peritonitis present?

A

lying very still, taking shallow breaths, pale

35
Q

What factors increase risk of developing IBD?

A

fam hx
abx use
diet
smoking

36
Q

Indications for surgery in IBD?

A

toxic megacolon
bowel perf
severe strictures/fistulae

37
Q

Are diverticula in diverticular disease ‘true’?

A

yes - contain contents of mucosa and submucosa

38
Q

Complications / indications for surgery in diverticular disease?

A

perf with faecal peritonitis
overwhelming sepsis
bowel obstruction
persistent vomiting
PR bleeding

39
Q

What causes of SBO and LBO can be managed operatively? (if no signs of peritonitis)

A

SBO - intussusception
LBO - foreign body

40
Q

Give 3 reasons for forming a stoma

A

perforation
ischaemia
cancer

41
Q

Complications of stoma formation?

A

bleeding
local skin irritation
loss of bowel length = dehydration and malnutrition
obstruction
prolapse / retraction
psycho-social

Y3 Workbooks and Mock Exam Qs (6 decks)

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