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Surgery > UT San Antonio > Flashcards

UT San Antonio Flashcards

1
Q

Absolute contraindications to surgery

A

Diabetic coma

DKA

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2
Q

3 indications where nutrition is too poor to go to surgery

A

Albumin 20%

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3
Q

Indications of liver failure being too severe for surgery

A

Bili > 2
PT > 16
Ammonia > 150
Encephalopathy

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4
Q

How long should you quit smoking prior to surgery

A

8 weeks prior

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5
Q

6 things in Goldman’s index for evaluating surgical risk

A
  1. CHF
  2. MI w/in 6 months
  3. Arrythmia
  4. Old (Age > 70)
  5. Emergent surgery
  6. Poor medical condition
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6
Q

Meds to stop before surgery

A

Aspiring, NSAIDS, vit E (2 weeks)

Warfarin w/in 5 days (INR needs to be

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7
Q

When should a CKD pt dialyze before surgery

A

24 hours pre-op

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8
Q

Insulin dose before surgery

A

Take 1/2 morning dose of insulin before

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9
Q

Worry of BUN > 100

A

Uremic platelet dysfunction leading to post-op bleeding

normal platelet but prolonged bleeding time

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10
Q

What is assist control vent

A

Sets Tidal Volume and rate, but if the patient takes a breath, the vent gives the full volume

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11
Q

Important vent setting for weaning pt off

A

Pressure support

Pt rules rate but a boost of pressure is given

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12
Q

Most efficient setting to change on a vent? Why?

A

Tidal volume - more efficient that FiO2

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13
Q

Hypernatremia fluid

A

D5W or hypotonic fluid

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14
Q

QT interval for hyper vs hypocalcemia

A

Shortened in hyper

Prolonged in hypo

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15
Q

signs of hypokalemia

A

Paralysis, ileus, ST depression, U waves

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16
Q

Maintenance IVFs

A

D5 1/2 NS + 20 KCl (if peeing)

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17
Q

Maintenance IVF formula

A

Up to 10 kgs –> 100ml/kg/day
Next 10 kg –> 50 ml/kg/day
All above 20 –> 20 ml/Kg/day

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18
Q

TPN risks

A

Acalculous cholecystitis
Hyperglycemia
Liver dysfunction
Zinc def

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19
Q

Consider what in circumferential burns

A

Escharotomy

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20
Q

Tx for CO2 poisoning

A

100% O2

Hyperbaric if CO0Hb is very high

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21
Q

Unexplained clotting in older people

A

Think cancer

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22
Q

What disease will heparin not work in

A

Antithrombin III def

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23
Q

HIT tx

A

Leparudin or agatroban

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24
Q

Silver sulfadiazine features

A

Doesn’t penetrate eschar

Can cause **leukopenia

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25
Q

Mafenide features

A

Burn ointment that penetrates eschar burt hurts like hell

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26
Q

Silver nitrate features

A

Burn ointment that doesn’t penetrate eschar and causes HYPO K

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27
Q

1st step in electrical burn workup? Look for?

A

EKG

Look for myoglobinuria (Check K+ from cell lysis)

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28
Q

Zone 3 of the neck? Workup with penetrating trauma?

A

Above angle of mandible

Do aortography and triple endoscopy

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29
Q

Zone 2 of neck? Workup with penetrating trauma

A

Angle of mandible to cricoid

Do 2D dopller +/- exploratory surgery

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30
Q

Zone 1 of neck? Workup with penetrating trauma

A

Below cricoid

Do Aortography

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31
Q

Consider what in retroperitoneal fluid after BAT

A

Duodenal rupture

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32
Q

Extraperitoneal vs Intraperitoneal extrasvasation for bladder rupture

A

Extra: bed rest + foley
Intra: Ex-lap and surgical repair

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33
Q

4 fractures that go to OR

A
  1. Depressed skull fracture
  2. Severely depressed or angulated fracture
  3. Any open Fx
  4. Femoral neck or intertrochanteric fracture
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34
Q

Where is the clavicle most commonly broken

A

B/w middle and distal 3rd

May need figure of 8 device

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35
Q

Atelectasis CXR

A

Bilateral lower lobe fluffy infiltrates

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36
Q

Nec Fasc pattern of spread

A

In SubQ along Scarpa’s fascia

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37
Q

Malignant hyperthermia genetic defect

A

Ryanodine receptor gene defect

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38
Q

Unexplained fever post op day 7 think? Dx and Tx?

A

Abdominal abscess
Dx by CT with triple contrast
Tx by percutaneous drainage

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39
Q

4 stages of pressure ulcers

A

1: skin intact but red, blanchable
2: blister or break in dermis
3: SubQ destruction into muscle
4: involvement of joint or bone

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40
Q

Low pleural glucose in transudate peracentesis

A

RA

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41
Q

Lights criteria

A

Exudate if:
LDH > 200
LHD eff/serum > 0.6
Protein eff/serum > 0.5

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42
Q

When do you operate for lung abscesses

A

If abs fail
Abscess > 6cm
Empyema present

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43
Q

Popcorn calcification is what in CXR?

Concentric calcification is what?

A

Popcorn: Hamartoma
Concentric: old granuloma

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44
Q

What do you do if a new benign nodule is found on CXR

A

CXR or CT scans q2mo to look for growth

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45
Q

Where does adenocarcinoma met to

A

Liver, bone, brain, adrenals

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46
Q

Effusion of Adenocarcinoma of the lung

A

Exudate with high hyaluronidase

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47
Q

Lung cancer that makes PTH-rP

A

Squamous cell Ca

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48
Q

Pt with ptosis that gets better after 1 min of upward gaze?

A

Lambert Eaton from small cell

Ab to pre-syn Ca channels

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49
Q

CXR showing peripheral cavitation and CT showing distant mets

A

Large cell carcinoma

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50
Q

3 diagnostic criteria for ARDS

A
  1. PaO2/FiO2
51
Q

Dysphagia worse w/ hot and cold liquids + MI like chest pain likely? Tx?

A

Diffuse esophogeal spasm

Tx with CCB or nitrates

52
Q

Tx of choice for Gastric varices

A

BB is asymptomatic

Band if stable and symptomatic

53
Q

Type 1 vs 2 hiatal hernia

A

1: sliding - GE jxn herniates into thorax, worse for GERD
2: Paraesophageal - abd pain leading to obstruction and strangulation - surgery

54
Q

Work up for suspected gastric ulcer

A

Double contrast barium swallow
EGD will show punched out lesions with red margins
*Operate if lesion persists after 12 weeks of treatment

55
Q

Gastric varices in non alcoholic could be

A

Splenic vein thrombosis

56
Q

Best test for ZE syndrome

A

Secretin stimulation test

57
Q

Bilious vomiting and post-prandial pain after losing lots of weight

A

SMA syndrome - 3rd part of the duodenum compressed by AA and SMA

58
Q

4 steps for in pancreatitis tx

A

NG suction
NPO
IV rehydration
Observation

59
Q

Bad pancreatitis prognostic factors

A 
Old
WBC > 16k
Glc >200
LDH > 350
AST > 250
Drop in HCt, dec Ca, acidosis, hypoxia
60
Q

Things that prevent Whipple in Pancreatic Ca

A

Mets (abdomen, liver, peritoneum), extension into SMA or portal vein

61
Q

Whipple’s triad for insulinoma

A
  1. Hypoglycemic symptoms

2. Blood glucose

62
Q

Glucagonoma Symptoms

A

Hyperglycemia, diarrhea, weight loss

63
Q

VIPoma symptoms

A

Watery diarrhea, hypokalemia, dehydration, flushing

looks like carcinoid

64
Q

Type 1 and Type 5 choledochal cysts

A
  1. Fusiform dilation of CBD -> tx w/ excision

5. Caroli’s Dz -> cysts in intrahepatic ducts (needs liver tx)

65
Q

Dz associated with cholangiocarcinoma

A

PSC (ass w/ UC)

66
Q

TIPS AE

A

Relieves portal HTN but worsens hepatic encephalopathy

67
Q

HCC tumor marker

A

AFP

68
Q

2nd most common benign liver tumor

A

Focal nodular hyperplasia

69
Q

RUQ pain + profuse sweating and rigors + Palpable liver likely? Tx?

A

Entamoeba histolytica

Tx: Metronidazole (DONT DRAIN IT)

70
Q

Pt from mexico presents with RUQ pain and large liver cysts likely? Tx?

A

Enchinoccus
Tx: Albendazole and sx to remove ENTIRE cyts
(rupture can lead to anaphylaxis)

71
Q

Isolated thrombocytopenia? Tx?

A

ITP

Tx w/ steroids, splenectomy if relapse

72
Q

Osmotic fragility test for

A

Hereditary spheroctyosis

Splenectomy can tx

73
Q

Tx for perforated appendix abscess

A

Drain, Abx, and appendectomy

74
Q

Most common site for carcinoid tumor

A

Appendix

75
Q

Odd thing to look for in carcinoid

A

Pellagra due to niacin def

Diarrhea, dementia, dermatitis

76
Q

When do you do a hemicolectomy for carcinoid of the appendix

A

If > 2cm, at base of the appendix, or w/ + nodes

77
Q

When to operate on SBO

A

Peritoneal signs, inc WBC, or no improvement w/in 48 hrs

78
Q

Post op ileus X-ray? od thing to cause?

A

Dilated loops of small bowel w/ air-fluid level

Consider hypoK or opiates

79
Q

What is Ogilvie’s syndrome

A

Massive colonic distension in eldery

If

80
Q

First 2 steps in SBO

A

IVF, NG tube, bowel rest

81
Q

Direct inguinal hernias go through

A

Fascia through Hasselbeck’s triangle

82
Q

Most common side for indirect inguinal hernias

A

Right

83
Q

IBD that commonly involves terminal ileum

A

Chron’s (can mimic appendicitis)

84
Q

IBD associated with p-ANCA

A

UC (also higher risk of Ca)

85
Q

Give what for any fistula in chrons

A

Metronidazole

86
Q

Are diverticulosis true diverticula?

A

No, only outpocketings of mucosa

87
Q

When do you do a colonoscopy after acute diverticulitis

A

4-6 weeks later

88
Q

Workup for colon Ca

A

DRE, transrectal US (Depth of invasion), Colonoscopy
CEA for recurrence
CT for staging

89
Q

Screening for AAA

A

Ab US on men 65-75 who have ever smoked

90
Q

Post op-complications of AAA

A
  • MI (#1 cause of death)
  • Ischemic colits (bloody poo)
  • ASA syndrome (preserved vib sense)
  • Aortoenteric fistula (brisk GI bleeding 1-2 years later)
91
Q

Pain out of proportion to abdominal exam

A

Think chronic mesenteric ischemia

Dx w/ duplex or angiography

92
Q

Anticoagulation regimen for DVT

A

Heparin, then overlap with warfarin for 5 days, then warfarin for 3-6 months

93
Q

First step in suspected PE?

A

Heparin!

94
Q

Papillary thyroid Ca features

A

MC type, spreads via lymphatics

Psammoma bodies

95
Q

Follicular thyroid Ca featuers

A

Spreads via blood

Take out whole thyroid

96
Q

Hashimoto’s predisposes to what thyroid cancer

A

Thyroid lymphoma

97
Q

What would an adrenocortical carcinoma cause? Test to run

A

Virilization or feminization

Test Urine 17-ketosteroids

98
Q

Labs in hypoparathyroidism

A

Dec. Ca and PTH

Inc. PO4

99
Q

MEN 2a

A

PTH adenoma
Medullary thyroid cancer
Pheo

100
Q

MEN 2b

A

Medullary thyroid cancer
Pheo
Marfanoid

101
Q

Best imaging for young breast

A

MRI

102
Q

Fluid asipirate in fibrocystic changes? Tx

A

Green or straw colored

Restrict caffeine, take Vit E, wear supportive bra

103
Q

DCIS surgical tx

A

Excision with clear margins or simple mastectomy if multiple lesions

104
Q

Breast Ca more likely to be bilateral

A

LCIS

105
Q

Think of what with eczema of nipple

A

Pagets Dz

Do mammogram to find the mass

106
Q

Where do you biopsy SCC

A

Edge of lesion

107
Q

Worst prognosis melaonoma

A

Superficial spreading

108
Q

Where do soft tissue sarcomas spread?

A

Hemotaogenously to LUNGS

Can do wedge resection

109
Q

1st step in neck mass workup

A

MC is reactive node, so examine mouth for inflammatory lesion

110
Q

Good prognostic factor in Hodgkin’s lymphoma

A

Lymphocyte predom

111
Q

Neck mass anterior to SCM likely? If lateral?

A

Anterior: Branchial cleft cysts
Lateral: Cystic hygroma (Turner’s, Down’s, Klinefelters)

112
Q

MC salivary gland tumor

A

Pleomorphic adenoma

Usually on parotid, benign but recurs

113
Q

MC malignant ENT cancer

A

Mucoepidermoid carcinoma

114
Q

Biggest concern for congenital diaphragmatic hernia

A

Pulmonary hypoplasia

If dx prenatally, deliver at place with ECMO, then let lungs mature and wait 3-4 days for surgery

115
Q

Baby born with respiratory distress and excess drooling

A

TE- Fistula

To dx place feeding tube, take X-ray, and see feeding tube coiled in thorax

116
Q

High maternal what in gastroschisis

A

AFP

117
Q

Intestinal atresia ass w/?

A

Polyhydramnios in pregnancy

Down syndrome

118
Q

1 wk old baby w/ bilious vomiting, draws his legs up, and has and distention

A

Malrotation and volvulus

119
Q

Dx and tx for meconium ileus

A

Gastrograffin enema

120
Q

Current jelly stool in baby

A

Inussusception

121
Q

Prostate Ca meds

A

Leuprolide or flutamide

122
Q

Part of bone osteosarcoma in? Ewings sarcoma?

A

Metaphysics of long bones

Diaphysis in Ewings (onion skinning)

123
Q

What is Epi for in local anesthesia

A

To prevent systemic absorption

Don’t use in fingers, nose, penis, toes

124
Q

What is Merperidine

A

Norperidine metabolite that can lower seizure threshold, esp in Renal Failure

Surgery (8 decks)

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