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TrueLearn > Surgical Management > Flashcards

Surgical Management Flashcards

1
Q

What are physiologic states that can cause an increase in insensible losses?

A
  1. fever
  2. open abdomen / chest (ex: exlap)
  3. burn injury
  4. hyperventilating
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2
Q

Which patients do not need additional steroids for stress dosing prior to surgery?

A

Patients taking <5 mg/day of prednisone for any duration or < 3 weeks of any doses.
Take their home dose of steroids on day of surgery only.

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3
Q

Which patients need additional stress dose steroids in addition to their home dose prior to moderate-major surgery?

A

Patients taking > 20mg/day of prednisone for 3 or more weeks
Patients with a Cushingoid appearance.

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4
Q

Patients who have intermediate risk (5-20mg/day for 3 or more weeks) for HPAA suppression should undergo evaluation of HPAA suppression preoperatively with

A

Cortisol levels and corticotropin (ACTH) stimulation testing.

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5
Q

What kind of closure does an FTSG donor site need to mitigate donor site morbidity?

A

Primary closure.

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6
Q

Management for a patient with a stab wound without anterior fascia violation

A

Discharge home

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7
Q

Histamine releasing medications should be avoided in patients with history of vancomycin infusion reaction such as

A

Opioids, muscle relaxants, abx (ciprofloxacin and rifampin).
Use fetanyl and/or tramadol for pain.

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8
Q

Management for hyperkalemia

A

IV calcium gluconate
- Calcium chloride in cases of circulatory arrest or cardiac arrest (increase cardiac output and preserves vascular tone).

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9
Q

When is calcium contraindicated in cases of hyperkalemia?

A

Digitalis toxicity

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10
Q

What is a biomarker useful in early diagnosis of sepsis in patients with burn injuries?

A

Procalcitonin.

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11
Q

Steps for sleeve gastrectomy:

A
  1. Devascularization of the greater curvature of the stomach.
  2. Using a bougie or endoscope to size the gastric sleeve.
  3. Transection of the stomach starting at a location 2-6 cm proximal to the pylorus.
  4. Specimen extraction.
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12
Q

When should patients on anticoagulation stop their medication prior to surgery? (Apixaban, Rivaroxaban, Dabigatran with normal renal function)

A

24 hours before low-risk surgeries, 48 hours before high risk surgeries.
Patients taking Dabigatran with decreased renal function should stop dabigatran 48 hours before low-risk procedures and 96 hours before high risk procedures.

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13
Q

Management of a patient who develops salmon color leakage from midline abdominal wound 2-3 weeks after surgery without herniation of bowel

A

Delayed repair of hernia 3-6 months later

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14
Q

Modified Blair incision is the most common incision used when performing a

A

Parotidectomy.

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15
Q

What maneuver exposes the entire abdominal aorta from the diaphragmatic hiatus to the celiac axis, SMA, IMA, and proximal L renal artery?

A

Mattox maneuver (medial visceral rotation)
- Divide left crus of diaphragm to access the distal thoracic aorta.

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16
Q

What maneuver exposes the retrohepatic IVC?

A

Cattell-Brassch (right medial visceral rotation)

17
Q

What maneuver is used to mobilize the duodenum for better access to the pancreas and retroperitoneal structures over the great vessels?

A

Kocher maneuver

18
Q

Management for postpolypectomy electrocoagulation syndrome

A

Bowel rest, IV hydration, broad-spectrum abx

19
Q

What are the 2 common techniques for fasciotomy?

A
  1. One lateral incision from the head of the fibula to the ankle.
  2. Two vertical incisions. Lateral incision decompress the anterior and lateral compartment. Medial incision decompress the 2 posterior compartments.
20
Q

Which bariatric surgery offers the most excess weight loss?

A

Duodenal switch with biliopancreatic diversion (BPD)
- Combines elements of a sleeve gastrectomy and bypass with a common channel.

21
Q

Absolute contraindications to STNB in breast surgery

A
  1. Inflammatory breast cancer
  2. Palpable LN (clinically positive)
  3. Prior axillary surgery
  4. Chemo / radiation therapy in the past
  5. Multifocal breast cancers
22
Q

Management of incidentally found Meckel diverticulum in adults vs. children intraoperatively

A

Adults: No resection > 50 yo unless oncologic concerns
Children: Resect

23
Q

When follicular cells of undetermined significant are found on FNA, what is the next step in management?

A

Surgical resection
- lobectomy first for pathology
- completion thyroidectomy if cancer is found

24
Q

Most common complication of PEG tube placement

A

Superficial infection at insertion site

25
Q

Management of symptomatic infected pancreatic necrosis that does not respond to percutaneous catheter drainage

A
  1. Endoscopic transluminal necrosectomy
  2. Percutaneous transperitoneal minimally invasive necrosectomy (anterior collection)
  3. Video-assisted retroperitoneal debridement (posterior collections)
26
Q

What is clamped in a Pringle?

A

Hepatoduodenal ligament: CBD, portal vein, proper hepatic artery

27
Q

Management of difficult foley in a patient with BPH

A

Use coude cath that is larger in size

28
Q

Management of a difficult foley in pts with obstruction d/t strictures

A

Use smaller size catheter

29
Q

What albumin level is recommended by the SCIP for surgery?

A

3.5 mg/dL

30
Q

Management for duodenal obstructions

A

Gastrojejunostomy

31
Q

What is the FEV1 required for patients considered for pneumonectomy?

A

> 80% of predicted or > 2 L without dyspnea or other lung disease

32
Q

What is the difference between closed (Ferguson) hemorrhoidectomy versus open (Milligan-Morgan) hemorrhoidectomy?

A

Closed hemorrhoidectomies have faster wound healing rates than open.

33
Q

Percentage of decrease in PTH after excision of localized parathyroid gland to confirm the pathologic gland has been removed

A

50%

34
Q

What are the minimum FEV1 values to allow for resection?

A

Pneumopnectomy - > 2.0 L
Lobectomy - > 1.5 L
Wedge resection > 0.8 L

35
Q

What is the recommended reversal agent for a patient on Warfarin who needs rapid reversal for emergent surgery?

A

Prothrombin complex concentrate (PCC)

36
Q

Therapies for low cardiac output syndrome after CABG
- SBP < 90
- Cardiac index < 2.2 L/min/m2

A

High dose inotropic
Intra-aortic balloon pump

37
Q

Nasal septal bulge that is bluish in color after facial injury

A

Septal hematoma
- incision and drainage at base of septum
- plastic splint and anterior nasal packing
- antibiotic prophylaxis

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