Surgery shelf exam Flashcards

Bowel obstruction
Terms Definitions
ARDS mortality
40%
refeeding syndrome
hypokalemia, hypomagnesemia, hypophosphatemia (after refeeding a starving person)
Trousseau's syndrome
DVT a/w CA
how is ARDS monitored
ABG
Ogilvie's syndrome
massive nonobstructive colon distension
HITT syndrome
heparin induced thrombocytopenic thrombosis: heparin induces platelet antibodies- can be fatal or cause loss of limb
what electrolyte deficiency causes ileus
hypokalemia
complications of diverticulitis
perforation
abscess
bowel obstruction
fistula (#1 cause of fistulas in adults)
when can patient shower
after wound epithelializes
most common benign tumor of liver
hemangioma
most common bacteria in stool
b frag
most common cause of esophageal perforation
iatrogenic
How do you calculate Cerebral Perfusion Pressure?
MAP-ICP
complications of SBO
strangulation
bowel necrosis
sepsis
vomiting --> aspiration pneumonitis
intravasc fluid loss --> prerenal azotemia and acute renal insuff
What substrate is depleted earliest
in the postoperative period?
Glycogen
Fox's sign
bruising of inguinal ligament seen with retroperitoneal bleeding
most common cause of SBO in kids?
hernias
blind loop syndrome
bacterial overgrowth caused by intestinal stasis
Extension Teardrop fracture
anteroinferior portion of the vertebral bodyoccurs as an extension injury w/ avulsio nof the fragment, rather than a compression mechpost ligaments are left intact, stable fracture-
which type of hematoma (subdural or epidural) is more common
subdural
what is an ileus
distention from non-obstructive causes
how much is mortality increased in hypoxia?
2x
Which secretions are high in bicarb?
Pancreatic secretions
Hesselbach's triangle
bordered by 1. inguinal ligament 2. epigastric vessels 3. lateral border of rectus sheath
adding 1L of O2 by nasal cannula increases FiO2 by how much?
3%
Homan's sign
calf pain with foot dorsiflexion in patients with DVT
Rovsing's sign
palpation of LLQ leads to RLQ pain
Mirizzi's syndrome
obstruction of the common hepatic bile duct by a cystic duct gallstone
RED reaction syndrome
red skin after fast vancomycin admin
Dance' sign
Empty RLQ in kids with ileocecal intussusception
What is neurogenic shock?
vasomotor instability from impairment of the descending symps in the spinal cord- loss of symp tone. flaccid paralysis, hypotension, bradycard, cutaneous vasodilation, normal to wide pulse pressure
are H2 blockers or PPIs more effective in tx ulcers
PPIs
Which drug has the major SE of mucositis, dermatitis, and cerebellar dysfunction?
5-FU
Which bone tumor is associated with bone lysis and periosteal reaction often associated with a large soft tissue mass and is a round cell tumor?
Ewing's sarcoma
What is superior vena cava syndrome associated with?
bronchogenic carcinoma
what does Chvostek's sign indicate?
hypocalcemia
(facial nerve tap leads to facial twitching)
lymph nodes between pec minor and major
Rotter's lymph nodes
Clay shoveler's fracture
flexion injury resultin gin a n avulstion of the tip of the spinous processmay result from a direct blow.
incision through previous scar- good or bad?
good. promotes wound healing
cause of overt LGI bleed in >60 yo
divertic
angiodysplasia
neoplasm
dx of diverticulitis
CT scan will show colonic wall thickening, mesenteric fat stranding
can see diverticulae
tx for ascending cholangitis
ABx and supportive care
ERCP decompression of CBD
How do you find gastrinomas?
Somatostatin receptor scintography and endoscopic ultrasound
What is the best indicator of nutritional adequacy?
Serum albumin level
What does the thrombin time measure?
qualitative abnormalities in fibrinogen and the presence of inhibitors to fibrin polymerization.
how long does it take for wounds to gain 90% strength
six weeks
what are the types of anal fistulas?
intersphincteric- stays w/in intersphincteric planeTranssphincteric- Fistula connects the intersphincteric plane with the ischiorectal fossa by perforating the external sphincter.Suprashincteric- similar to transsphincteric, fistula loops above the external sphincter to penetrate teh levator ani muscleExtrasphincteric: fistual passes from rectum to perineal skin w/o penetrating sphincteric complex.
what is spinal shock?
state of flaccidity and loss of reflexed immediately after injury.Loss of visceral and peripheral autonomic control w/ uninhibited parasymp impulses.May last from seconds to wks, does not signify permanent spinal cord damage.- long-term prognosis cannot be postulated until spinal shock has resolved.
complication of typhoid fever
Peyer's patches bleed /perf in 2-3rd week following sx
featuress of large bowel ischemia
minimal pain
see thumbprinting on barium enema
BVs are usually patent
what is RBC scan
used to dx bleeding if >.1 ml/min
won't always localize bleeding accurately
do 1st then follow with mesenteric angiography
How is a cross match performed?
Donor lymphocytes incubated with recipient serum and complement
What tests predict perioperative ischemic cardiac events among patients undergoing peripheral vascular reconstruction?
gated blood pool ejection fractions of
35% or less and with reversible perfusion defects (thallium redistribution) on dipyridamole-thallium imaging.
Which patients with rib fractures should be hospitalized?
elderly, multiple rib fractures, ventilatory compromise, or underlying respiratory compromise
When are isotonic saline solutions useful?
hyponatremic or hypochloremic states and whenever a tendency to metabolic alkalosis is present, as occurs with significant nasogastric suction losses or vomiting. (b/c they cause a dilutional acidosis)
What is the management of hypermagnesemia?
Calcium chloride for cardioprotection, correct extracellular volume deficit and acidosis while holding magnesium
What is the electrolyte composition of small bowel secretions?
Na-110 K-5 Cl-105 HCO3-30
What is the optimal ratio of carbs/nitrogen for TPN?
100 kcal/ g nitrogen
what is the secondary survey in neck injury trauma pts?
stabilization-> examine wound.soft tissue films of neck and CXR.Surgical exploration for: expanding hematoma, subcutaneous emphysema, tracheal deviation, change in voice quality, air bubbling through the wound.Pules palpated for thrills, deficits, auscultate for bruits.Neuro exam.
What is trauma series for rads?
C-spine, chest, pelvis.DPL and FAST for intraabdominal bleeding.
Describe the following skull fractures:LinearStellateDepressedBasilarOpen
Linear- important if over the middle meningeal artery- or major venous dural sinusesStellate- suggestive of a more severe mechanism of injury than linear skull fracturesDepressed- risk of underlying brain injury and complication - meningitis and Post-traumatic seizuresRx- involves surgical elevation for depressions deeper than the thickness of the adjacent skullBasilar- clinical Dx and sign of a significant mech of injury- Sx- Raccoon's, retroauricular (battle's, otorrhea, rhinorrhea, hemotympanum, and CN palsiesOpen- needs careful debridement and irrigation. Avoid blind digital probing of the wound.
what is ascending cholangitis
infx of bile duct --> sepsis and multiorgan failure
value of Ranson's criteria
more criteria have more severe dz and increased risk of comlication and death
when is succussion splash seen in the abdomen
any sort of obstruction
What is a hamartoma?
denotes a tumor that arises from the disorganized arrangement of tissues normally found in an organ.
What is the treatment for hemolytic transfusion reaction?
discontinuation of the transfusion, followed by aggressive fluid resuscitation to support the hypotensive episode and increase urine output. Inducing a diuresis through aggressive fluid resuscitation and osmotic diuretics is important to clear the hemolyzed red cell membranes, which can otherwise collect in glomeruli and cause renal damage. Alkalinization of the urine (pH > 7) helps prevent hemoglobin clumping and renal damage.
What is the treatment for LCIS?
close surveillance for cancer by twice
yearly examinations and yearly mammography. a histologic marker that identifies patients
who are at increased risk for the development of breast cancer, not precancerous
When is a Peustow (longitudinal pancreaticojejunostomy) performed?
When the pancreatic duct is dilated
What is the treatment for ZES?
tumor resection and highly selective vagotomy (b/c normally metastatic by the time discovered)
what percent of gallstones can be seen on AXR? kidney stones?
gallstones: 10%; kidney stones: 90%
What are the risk factors for pulmonary complications during surgery?
Known pulmonary diseaseabnl PFTs- FEV < 11, max breathing capacity < 50% predicted, smoking, age > 60, Obesity, Upper abdominal or thoracic surgery, long OR time
Ranson's criteria following 48 hrs
HCt fall by 10%
Ca &lt;8
BUN increase of 5
fluid requirement &gt;6 L
base excess of &gt;4
P02 &lt;60
what are risk factors for CEA
prior radiation to the neck
coronary artery stent
recrrent coronary artery stenosis
What is a Dieulafoy’s ulcer?
located within 6 cm distal to the gastroesophageal junction. Dieulafoy’s lesion typically consists of an abnormally large submucosal artery that protrudes through a small, solitary mucosal defect.
What is an indication for radical mastectomy?
Very few. Locally advanced breast cancer with wide invasion of the pectoralis major in a patient who is physiologically able to tolerate general anesthesia.
What is the treatment for malignant hyperthermia?
prompt conclusion of the operative procedure and cessation of anesthesia, hyperventilation with 100% oxygen, and administration
of intravenous dantrolene. The urine should be alkalinized to protect the
kidneys from myoglobin precipitation.
What are the criteria for ventilatory support?
apnea, RR&lt;30, Pao2&gt;60 on RA, Paco2&lt;65
What is indicated for pts with acute arterial insufficiency with neuro symptoms?
immediate exploration and repair (first symptoms are paresthesias and paralysis)
When is a Whipple procedure indicated?
When pancreatic disease is confined to the head of the pancreas
What is the ASA guide to surgical patients?
P1- normal healthyP2- mild systemic diseaseP3- severe systemic diseaseP4- severe systemic disease that is a constant threat to lifeP5- moribund pt who won't survive w/o operationP6- brain-dead- donorE- emergency
tx perf of duo ulcers
if no h/o prior ulcers or + HP, omental patch closure and HP tx
if + h/o prior ulcers and - HP, highly selective vagotomy
how is mild Na deficiency tx?
severe Na defic?
fluid restriction
if CNS sx present, give hypertonic saline
What happens with a R shift of the oxygen/hgb curve?
decreased hemoglobin for oxygen, meaning more is released in the periphery.
What is Thompson's sign and what does it mean?
failure of plantar flexion when squeezing the gastroc. Achilles tendon rupture
What is the normal treatment for a primary gastric ulcer that is refractory to medical treatment?
Billroth I (partial distal gastrectomy with gastroduodenal anastomosis)
dx if there is stool on DRE of pt with SBO
ileus, NOT mechanical obstruction
what are the 2 types of AAA repairs
benefits of each
EVAR (endovascular aneurysm repair) - pts with copd, obesity, malig, etc get more protection from rupture with EVAR

open repair - stood the test of time, est as a tx
What can cause difficulty weaning a patient from a ventilator?
too much glucose load in TPN, from increased production of CO2
What things result in a non gap metabolic acidosis?
Loss of bicarb (small bowel fistula, pancreatic fistula, diarrhea) and gain of chloride (administered or decreased excretion from distal renal tubular acidosis)
What should be done for patients with PCV before elective surgery?
chlorambucil to lower RBC and platelet count
What is the cutoff for observation of an incidental adrenal lesion?
observation and a search for evidence of endocrine dysfunction for lesions less than 5 cm in diameter.
What is the anatomy of the spine:how many of each bone (cervical, thoracic...)What is the most vulnerable?What's special about the thoracic spine?What is the speciala bout the thoracolumbar region?What is tpecail about the l
7 cervical, 12 thoracic, 5 lumbar, 5 sacra, 4 coccygeal.cervical spine is most vulnerable.Thoracic is protected by the ribs. Spinal canal is narrow here, so injuries can be devastating.Thoracolumbar junction is vulnerable due to the inflexible thoracic and flexible lumbar.lumbosacral- proper spinal cord ends.
How do you calculate hourly rates for fluid replacement?
4,2,1 rule. 4ml/kg for the first 10 kg, 2 mls/kg for the second 10, 1 ml/kg for each additional kg.
When should barium enema be used in dx diverticulitis
never- there is sig risk involved with intraeritoneal leakage of barium
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