Term
| EKG recommended for who preoperatively? |
|
Definition
|
|
Term
| who needs to have creatine checked before surgery? |
|
Definition
if intraoperative hypoTN is possibility
if nephrotoxic meds/dyes are part of workup
cross clamping aorta will be performed |
|
|
Term
| all females get what before surgery? |
|
Definition
|
|
Term
| how long should heparin/lovenox be continued after the operation? |
|
Definition
| until full ambulation or 14d post op |
|
|
Term
| warfarin is good for what type of surgeries? |
|
Definition
|
|
Term
| tx of choice if pt can't tolerate anticoag? |
|
Definition
| sequential compression devices |
|
|
Term
| define a malnourished pt? |
|
Definition
lost 10% of body mass
no adequate nutrition x7d |
|
|
Term
| why do surgical patients have increased nutritional requirements? |
|
Definition
| hypermetabolic, hypercatabolic response to systemic inflammatory response syndrome |
|
|
Term
| what triad characterizes cardiac tamponade? |
|
Definition
| Beck's triad - JVD, hypotension, muffled heart sounds |
|
|
Term
| basilar skull fx associated with what? |
|
Definition
| rhinorrhea, otorrhea, ecchymosis of lids, battle's sign |
|
|
Term
| epidural hematoma caused by injury to what? |
|
Definition
|
|
Term
| brain herniation with epidural hematoma can cause what signs? |
|
Definition
coma
fixed, dilated pupils
decerebrate posturing |
|
|
Term
| who is most likely to have a chronic subdural hematoma? |
|
Definition
|
|
Term
| burn involving minor damage to epidermis? |
|
Definition
|
|
Term
| burn that extends into papillary dermis |
|
Definition
| superficial partial thickness burn (2nd deg) |
|
|
Term
| burn that extends into reticular dermis |
|
Definition
| deep superficial burn (2nd deg) |
|
|
Term
| burns that destroy the epidermis AND the dermis |
|
Definition
|
|
Term
| burns that destroy skin, subQ, fascia, bone, etc |
|
Definition
|
|
Term
| burn with white skin, leathery charred appearence? |
|
Definition
|
|
Term
| fever in 1st 24h after surgery? |
|
Definition
| WIND - bronchial breathing, shift of trachea toward affected side |
|
|
Term
| fever <72h postoperatively?> |
|
Definition
| think WATER - check catheter for UTI, culture urine |
|
|
Term
|
Definition
| WOUND - check wound for infection |
|
|
Term
| deep thrombophlebitis is associated with? |
|
Definition
| indweling central lines, DVT |
|
|
Term
| fever >1 week postoperatively? |
|
Definition
WONDER DRUGS - anesthetics, sulfa abx
dx of exclusion after you've ruled out sepsis |
|
|
Term
| tx for complicated UTI in hospital? |
|
Definition
aminoglycoside + cephalosporin
suspect candida if on lots of abx |
|
|
Term
| what stage ulcer is - skin that is intact but erythematous, blanches? |
|
Definition
|
|
Term
| ulcer stage - partial skin loss, may look like abrasion, blister, shallow crater |
|
Definition
|
|
Term
| full thickness skin loss going to subQ but not beyond fascia |
|
Definition
|
|
Term
| full thickness skin/subQ loss, extends to muscle, tendon, bone |
|
Definition
|
|
Term
| triad seen wtih necrotizing fasciitis? |
|
Definition
WBC >14k
elevated BUN >15
hyponatremia <135
multiple sx - erythema, tenderness, tachy, hypoTN, AMS, tissue crepitus |
|
|
Term
| disadvantages of opioids? |
|
Definition
ventilatory depression
hypnosis
amnesia |
|
|
Term
| anesthetic used for emergent endotracheal intubation |
|
Definition
| succinylcholine - but can cause hyperK, brady, malig hyperthermia (tx is dantrolene) |
|
|
Term
| wounds immediately sealed with skin suturing/flap closure |
|
Definition
|
|
Term
| contaminated wound is debrided, abx applied, then later on surgical intervention is used to close the wound |
|
Definition
| tertiary (delayed primary) closure |
|
|
Term
| factors that impede wound healing? |
|
Definition
diabetes
infections
drugs - steroids
nutritional problems
tissue necrosis
hypoxia
excessive tension on wound edges
another concurrent wound (competition for resources)
low temp |
|
|
Term
| vitamins most important for wound healing? |
|
Definition
|
|
Term
| wounds that are chronically inflamed can lead to what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how long should pt wait after MI to have surgery? |
|
Definition
|
|
Term
| liver failure pts should get what pre-op? |
|
Definition
CBC, electrolytes, AST/ALT, lactate dehydrogenase, coag profile
all should have type + cross |
|
|
Term
| what considerations are needed for diabetic patients preoperatively? |
|
Definition
stop metformin (lactic acidosis)
d/c long acting sulfonyureas (hypoglycemia)
use shorter acting/sliding scale insulin
hold insulin preps on the day of surgery if IDDM - schedule early in morning |
|
|
Term
uninfected operative wound
no inflammation
no entry into GI/respiratory/urinary tract |
|
Definition
|
|
Term
| staples are useful for what? |
|
Definition
GI repair, closure
external skin
scalp repair |
|
|
Term
| most common pathogen of surgical site infection? |
|
Definition
staph aureus
then enterococcus, e coli |
|
|
Term
| what are the classes of strains? |
|
Definition
grade I - stretching of ligament, no instability
grade II - partial rupture; minor instability
grade III - complete rupture, lots of instability |
|
|
Term
| IV fluid of choice for burn pts? |
|
Definition
lactated ringer's w/o dextrose
if <2y - LR wtih 5% dextrose |
|
|
Term
| if pt is asymptomatic 6h after snakebite with normal labs, what is happening? |
|
Definition
| unlikely venom poisoning occured |
|
|
Term
| should you suture animal/human bites on feet/hands? |
|
Definition
| no bc they have a higher risk of infection |
|
|
Term
| anibiotic for cat and dog bites? |
|
Definition
dog bite - nothing unless the hand/foot got bit
cat bite - augmentin, 2nd gen cephalosporin, bactrim
*if >24h since bite occured, no abx are needed |
|
|
Term
| type of spider bit ehtat causes dermonecrosis, hemolysis, coagulation, platelet aggregation |
|
Definition
| brown recluse - needs I&D |
|
|
Term
| spider bite that causes severe pain, spasms of large muscle groups, abd cramps, rigidity HTN, tachycardia |
|
Definition
|
|
Term
|
Definition
Ca gluconate
narcotics
benzodiazepine |
|
|
Term
| MUC-1 associted with what cancer? |
|
Definition
|
|
Term
| most common site of mets. for nondutaneous melanoma is? |
|
Definition
|
|
Term
| nodal metasteses appear where? |
|
Definition
| basins draining from the primary site - if these are resected (elective node dissection) = increased survival |
|
|
Term
| palpable lymph node with cancer concern - what is next step? |
|
Definition
|
|
Term
| a +FNA means you need to do what |
|
Definition
| complete resection of nodal basin |
|
|
Term
|
Definition
| excisional biopsy of that node |
|
|
Term
|
Definition
|
|
Term
| radical neck dissectino removes what? |
|
Definition
nodal levels 1-5
sternocleidomasteoid muscle
internal jugular vein
cranial nerve 11
cervical plexus
submandibular gland |
|
|
Term
| combo of dysphagia, hypopharangyeal webs/esophageal webs, wt loss, fe def anemia? |
|
Definition
|
|
Term
| workup for hypopharynx CA? |
|
Definition
| endoscopy, barium swallow, CT |
|
|
Term
| pt presents with hoarseness, sore throat, ear pain, dysphagia, airway comprimise |
|
Definition
|
|
Term
| most common benign tumor of nasopharynx, often hits young males? |
|
Definition
|
|
Term
| diagnostic test of choice for salivary neoplasms? |
|
Definition
|
|
Term
| what is difference between tracheotomy and tracheoStomy? |
|
Definition
otomy = in place for 5-7d, will close spontaneously
-ostomy = permanent opening |
|
|
Term
| what is a common use for tracheotomy? |
|
Definition
| pt who requires prolonged mechanical ventilation - ie after 3d intubation |
|
|
Term
| injury to what nerve causes vocal cord paresis/paralysis? |
|
Definition
| recurrent laryngeal nerve |
|
|
Term
cyclic breast pain, tenderness, nodularity
bilaterally symmetrical diffuse pain |
|
Definition
|
|
Term
| what is cyclical mastalgia? |
|
Definition
| bilateral upper outer quadrant breast pain - dull, diffuse |
|
|
Term
|
Definition
skin edema, erythema (peau de orange)
nipple retraction
warmth of breast
needs chemo, mastectomy, radiation |
|
|
Term
| abnormal mammo, what is next step? |
|
Definition
|
|
Term
| follow up for abnormal mammo and US: |
|
Definition
wire localiation with surg excisional bx OR
image guided stereotactic/US guided large core needle bx |
|
|
Term
| what is used to prevent contralateral breast cancer with a history of breast CA? |
|
Definition
|
|
Term
| what types of breast CA are non invasive? |
|
Definition
lobar carcinoma in situ
ductal carcinoma in situ |
|
|
Term
| what are the invasive types of breast ca? |
|
Definition
lobular cancer
ductal *most common*
medullary |
|
|
Term
| vascular tumor following radical mastectomy |
|
Definition
|
|
Term
| what is a radical mastectomy? |
|
Definition
offers a CURE for breast CA
underlying pectoralis, axillary lymph nodes also cut out |
|
|
Term
eczematous scaling and flaking around breast
97% have underlying carcinoma |
|
Definition
paget's dx
tx is simple mastectomy |
|
|
Term
| tx for thoracic outlet syndrome? test? |
|
Definition
removal of 1st rib
scalene test |
|
|
Term
| most common tumor in the mediastinum? |
|
Definition
| neurogenic tumors, may cause chest and back pain |
|
|
Term
| what tumors would cause mediastinal mass? |
|
Definition
| thymoma, germ cell tumor, lymphoma, thyroid/PTH masses |
|
|
Term
| tx for small pneumothorax (<20%)? |
|
Definition
|
|
Term
|
Definition
hoarseness
chest pain
horner's syndrome
dysphagia
pleural effusion
hemoptysis |
|
|
Term
| choices for CABG harvest? |
|
Definition
GSV, SSV
internal mammary
radial/ulnar artery
PTV, ATV artery
peroneal artery
cephalic vein |
|
|
Term
| sx of large aortic aneurysms? |
|
Definition
hoarseness
dyspnea
pulm HTN
dysphagia |
|
|
Term
| which aneurysms should be treated? |
|
Definition
| if >5cm or if rapidly enlarging |
|
|
Term
| diagnosis test for aortic aneurysm? |
|
Definition
|
|
Term
| most common cause of ischemic stroke in the US? |
|
Definition
| plaque at the bifurcation of the common carotid artery, then extending in to carotids (always get carotid US) |
|
|
Term
| when should carotid endarectomy be done? |
|
Definition
>50% occlusion if symptomatic
>80% if nonsymptomatic |
|
|
Term
| acute lower extremity ischemia from thromboembolic dx can cause what? |
|
Definition
| reperfusion syndrome - edema, compartemnt syndrome, neuropathy |
|
|
Term
| signs of primary venous insufficiency? |
|
Definition
telangiectasias
reticular veins
varicose veins |
|
|
Term
| how does occlusive vascular dx present? |
|
Definition
arterial claudication
if advanced, may have pain at rest
tx- walking regimen |
|
|
Term
| describe skin changes w lymphadema? |
|
Definition
swells, then has hardened consistency and takes on "tree trunk" shape, lichenification
CT, MRI, lymphoscintigraphy helps confiem drainage is delayed |
|
|
Term
| complications of port placement? |
|
Definition
pneumo/hemothorax
arterial injury
bleeding
nerve injury
thrombosis
infection |
|
|
Term
| what is difference btwn indirect and direct hernias? |
|
Definition
indirect passes thru the indirect ring
direct passes medial to inguinal ring |
|
|
Term
| more hernias occur on which side? |
|
Definition
|
|
Term
| what may cause umbilical hernias in adults? |
|
Definition
obesity, pregnancy
ascites
abdominal distention |
|
|
Term
| which type of hernia are females most likely to have? |
|
Definition
|
|
Term
| what is a sliding hernia? |
|
Definition
| when an internal organ comprimises a portion of the wall of the hernia sac |
|
|
Term
| what is the difference btwn strangulated and incarcerated hernias? |
|
Definition
incarcerated - can't be reduced
strangulated - blood supply is comprimised (potentially fatal) |
|
|
Term
| what are some things that can cause peritonitis? |
|
Definition
infection
inflammation (pancreatitis)
in kids = pneumococcus, hemolytic strep
ESRD
ascites, cirrhosis - e coli, klebsiella |
|
|
Term
| what lab is helpful for making dx of ischemic bowel? |
|
Definition
|
|
Term
| describe upper GI hemorrhage? |
|
Definition
bleeding is PROXIMAL to ligament of treitz
usually peptic ulcer dz or variceal hemorrhage |
|
|
Term
|
Definition
vascular malformation in gut
common cause of GI bleed, anemia
similar to telengictasia, just found in bowels |
|
|
Term
| most common causes of lower GI bleed? |
|
Definition
diverticula
angiodysplasia |
|
|
Term
| initial diagnostic test of choice for slow/intermittent GI bleeding? |
|
Definition
|
|
Term
|
Definition
h pylori
NSAIDs are 2nd most common |
|
|
Term
| what is early dumping syndrome? |
|
Definition
| 20-30m after a meal - N/V/D, tachycardia, palpitations, diaphoresis |
|
|
Term
| what is late dumping syndrome? |
|
Definition
2-3h after meal
rapid gastric emptying
hyperglycemia = lots of insulin released = then severe hypoglycemia |
|
|
Term
|
Definition
tachycardia
hypoTn
Fever
distended abdomen |
|
|
Term
| what will xray show in pt who has SBO? |
|
Definition
dilated loops of small intestine
air fluid levels
possible FB if caused by stone |
|
|
Term
|
Definition
nasogastric suction
fluids, antibiotics
usually operative intervention |
|
|
Term
| pt presentation with appendicitis? |
|
Definition
lying still in bed
diminished bowel sounds
tenderness @ mcburney's point
rosving's sign |
|
|
Term
| colonic volvulus most commonly occurs where? |
|
Definition
|
|
Term
| pt presentation wtih colonic volvulus? |
|
Definition
abd pain
vomiting
abd distention
XRay is diagnostic |
|
|
Term
| diagnostic test needed for rectal prolapse? |
|
Definition
| colonoscopy, defecography |
|
|
Term
| sx of internal hemorrhoids? |
|
Definition
painless, red bleeding
may prolapse with defecation |
|
|
Term
| cholangitis secondary to biliary stones and strictures? |
|
Definition
| recurrent pyogenic cholangitis |
|
|
Term
| what makes a HIDA scan different than US for determining gallbaldder dx? |
|
Definition
| technetium-99 injected into a vein, circulates thru liver and then into GB. if GB not visualized in 4h then you know there is cholecystitis OR a ductal obstruction. generally done AFTER an US is ordered |
|
|
Term
| tx for choledocholithiasis? |
|
Definition
|
|
Term
| most common type of pancreatic tumor? where is it mostly found? |
|
Definition
ductal adenocarcinoma
found in pancreatic head |
|
|
Term
| pt presentation of pancreatic cancer? |
|
Definition
pancreatitis
jaundice
n/v/d, steatorrhea
wt loss |
|
|
Term
| occurs at squamocolumnar epithelial junction usually due to hiatial hernia |
|
Definition
|
|
Term
pt presents with cervical dysphagia
chronic Fe def anemia
abnormal pharyngeal/esophageal motility |
|
Definition
|
|
Term
| what are the locations of schatzi's rings and plummer vinson syndrome? |
|
Definition
schatzi's = lower in the esophagus
plummer vinson = upper esophageal webs |
|
|
Term
psychogenic cause of dysphagia
pt has lump in throat, pain can go to jaw and ears |
|
Definition
|
|
Term
| most common type of esophageal cancer? |
|
Definition
|
|
Term
| Most common type of thyroid CA? |
|
Definition
|
|
Term
| how is thyroid cancer confirmed? |
|
Definition
| fine needle aspiration is diagnostic |
|
|
Term
|
Definition
hypoglycemia
mental confusion |
|
|
Term
|
Definition
hypoglycemia
low blood glucose
relief of Sx after IV glucose |
|
|
Term
| sx include profound watery diarrhea, high levels VIP, pancreatic tumor |
|
Definition
|
|
Term
| what is the whipple procedure for? |
|
Definition
| treats tumors on head of pancreas, tumors in common bile duct, or tumors of duodenum near pancreas |
|
|
Term
| describe the whipple's procedure? |
|
Definition
en bloc removal of:
distal segment of stomach
duodenum
head of pancreas
common bile duct
gallbladder
**head of pancreas & duodenum share same blood supply (gastroduodenal artery), so both organs must be removed if the blood supply is cut (otherwise there would be tissue necrosis in duodenum) |
|
|
Term
| leading cause of death for children 1-15y? |
|
Definition
|
|
Term
| fastest route for IV access in kids <6? |
|
Definition
|
|
Term
| most common symptoms of cerebral arteriovenous malformation? |
|
Definition
headache
epilepsy
vertigo
dysarthria, aphasia, apraxia
confusion, dementia, hallucinations |
|
|
Term
| most brain tumors metastisize from where? |
|
Definition
|
|
Term
| sutures on the face are removed in how many days? |
|
Definition
|
|
Term
| pt presents with microscopic hematuria, flank pain, negative leukocytes? |
|
Definition
|
|
Term
|
Definition
pain meds - Toradol, hydration
if <3mm - send home
if >6mm shock lithotropsy |
|
|
Term
| patient who has been NPO for 2w bc of chron's dz in the hospital has RUQ pain, what kind of cholecystitis is this? |
|
Definition
| acalculous - the NPO state causes bile stasis |
|
|
Term
| giving a pt the incorrect blood type causes what type of hypersensitivity reaction? |
|
Definition
|
|
Term
| type of acute stress ulcer that can occur after a head injury or intracranial surgery |
|
Definition
|
|
Term
| most common breast malignancy? |
|
Definition
|
|
Term
| what parts of the colon does the superior mesenteric artery supply? |
|
Definition
cecum
ascending colon
mid-transverse |
|
|
Term
| where do AV malformations most commonly occur in the colon? |
|
Definition
|
|
Term
| most common type of hernias? |
|
Definition
|
|
Term
| describe a direct hernia? |
|
Definition
| the fascia transversalis is weakened and abdominal contents go DIRECTLY thru the fascia |
|
|
Term
| 90% of bladder cancers are? |
|
Definition
|
|
Term
| most common BENIGN liver tumor? |
|
Definition
|
|
Term
| what usually causes liver abscesses? |
|
Definition
bacteria from somewhere else in the gut - infection in the GB, appendix, intestine
or ameobas! |
|
|
Term
| what is gardner's syndrome |
|
Definition
neoplastic polyps of small bowel and colon
100% have cancer by age 40
desmoid tumors in abd wall/cavity
osteomas of skull
sebaceous cysts |
|
|
Term
| what is peutz jegher's syndrome? |
|
Definition
hamartomas throughout the GI tract, mostly in duodenum/ileum
freckles on lips, fingers, palms, feet |
|
|
Term
| treatment for peutz jegher's syndrome? |
|
Definition
removal of polyps if symptomatic
also watch for ovarian cancer bc they are at increased risk |
|
|
Term
| what is pathophys of diverticulosis? |
|
Definition
| weakness in bowel develops where blood vessels enter, and increased intraluminal pressure = herniation |
|
|
Term
| most common site for divertic involvment? |
|
Definition
|
|
Term
| when is it safe to get colonoscopy after divertic flare? |
|
Definition
|
|
Term
| massive GI bleed is more commonly seen w diverticulosis or diverticulitis? |
|
Definition
|
|
Term
| risk factors for volvulus? |
|
Definition
tortous elongated colon
chronic constipation
laxitive abuse
pregnancy
bedridden elderly pt
hx of prior abd surgery |
|
|
Term
| where is the dentate line? |
|
Definition
| below the anal columns and rectum |
|
|
Term
| most common carcinoma of anus? |
|
Definition
|
|
Term
| risk factors for anal cancer? |
|
Definition
HPV, HIV
condyloma
herpes
chronic inflammation
cervical/vaginal CA |
|
|
Term
| anal fistula from rectum to perianal skin |
|
Definition
|
|
Term
|
Definition
thick suture places thru fistula tract
allows slow transection of spinchter muscle
a scar is formed, holds the spinchter muscle in place |
|
|
Term
| what hormone stimulates GB contraction and release of bile into duodenum? |
|
Definition
|
|
Term
| what method does Dr. Melba Ovalle use to cut her hair? |
|
Definition
|
|
Term
| blood supply for the gallbladder? |
|
Definition
|
|
Term
| most common bugs seen with cholecystitis? |
|
Definition
e coli
klebsiella
enterococci
bacteriodes fragilis |
|
|
Term
| stones in common bile duct? |
|
Definition
|
|
Term
| why do bile stones develop? |
|
Definition
| 80% are cholesterol stones - they develop when bile is saturated in cholesterol, stones then precipitate out of the solution |
|
|
Term
| describe the pain with gallbladder dx? |
|
Definition
pain in RUQ
gets worse AFTER eating**
episodes may last for a few hours
n/v |
|
|
Term
| pt complains of clay colored stool or dark urine? |
|
Definition
| choledocholithiasis - bc bile is unable to reach the stool so it builds up in blood and is excreted in urine |
|
|
Term
|
Definition
signs of Cholangitis -
fever
RUQ pain
jaundice |
|
|
Term
|
Definition
RUQ pain
fever
jaundice
hypoTN
altered mental state
**indicates ascending cholangitis |
|
|
Term
| if you suspect stones in common bile duct, which test should be ordered? |
|
Definition
| ERCP or intraoperative cholangiogram |
|
|
Term
| if a pt is too sick to have a cholecystectomy and has cholangitis, what do you do |
|
Definition
| cholecystostomy tube - this drains the GB to decompress it |
|
|
Term
|
Definition
ETOH
biliary tract disease |
|
|
Term
upper abd pain radiating to back
n/v
low grade fever |
|
Definition
|
|
Term
| best test for determining pancreatic dx? |
|
Definition
LIPASE!!
amylase is not specific - lipase ONLY comes from pankreas |
|
|
Term
| where are Ca and Fe absorbed? |
|
Definition
|
|
Term
| hormone that controls GB contraction? |
|
Definition
|
|
Term
| what stops gallbladder emptying? |
|
Definition
somatostatin
sympathetic nervous activation |
|
|
Term
|
Definition
portal vein (75%)
hepatic artery (25%) |
|
|
Term
| signs of peritoneal irritaiton? |
|
Definition
tenderness
rebound tenderness
guarding |
|
|
Term
| if you suspect pneumothorax, best type of CXR to get is what? |
|
Definition
|
|
Term
| how can you rule out free abdominal air (from perf) if the pt cannot stand up? |
|
Definition
| Left lateral decubitus position - the airw ill collect over the liver |
|
|
Term
| what happens if ilioinguinal nerve is cut during hernia repair? |
|
Definition
| numbness of testicle/inner thigh x6mos |
|
|
Term
| what is found in spermatic cord during hernia repair? |
|
Definition
creamasteric muscle fibers
testicular artery/venous plexus
genitofemoral nerve
vas deferens
hernia sac |
|
|
Term
| what is the hernia sac made of ? |
|
Definition
peritoneum (direct)
patent processus vaginalis (indirect) |
|
|
Term
| what is in the female inguinal canal? |
|
Definition
|
|
Term
| hernia assctd with GI reflux? |
|
Definition
|
|
Term
|
Definition
| start with medical - PPI /H2, If that doesn't work do Lap Nissen fundoplication (wrapping fundus around LES, suturing it into place) |
|
|
Term
| what causes post laparoscopic shoulder pain? |
|
Definition
| CO2 pushes on diaphragm, it is referred pain from this |
|
|
Term
|
Definition
borders = common hepatic duct, cystic duct, inferior edge of liver
cystic artery passes thru here |
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|
Term
| where is most bile acid absorbed? |
|
Definition
|
|
Term
|
Definition
tachycardia
decreased urine output
edema |
|
|
Term
| why does 3rd spacing tend to occur after surgery? |
|
Definition
loss of albumin = decreased oncotic pressure
tissue trauma in surgery = fluid leaks extravascularly (hydrostatic pressure pushes fluid out) |
|
|
Term
| why do 3rd spacing pts have tachycardia and HTN? |
|
Definition
baroreceptors sense reduced circulating volume(since it has leaked out) and activate sympathetic nervous system
low perfusion of kidneys = RAAS activation = HTN |
|
|
Term
| why do pts with NG tubes get HYPOkalemic? |
|
Definition
| pt is losing HCl, so they become alkalotic = K pushed into cell, H comes out to balance out the problem |
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|
Term
| classic acid base finding w NG suction? |
|
Definition
metabolic alkalosis
hypoK
hypoCl |
|
|
Term
| what exam findings are seen with hypovolemia? |
|
Definition
tachycardia
tachypnea
initial rise in diastolic BP but then reduction in systolic and diastolic |
|
|
Term
| what happens to lactated ringers in the body? |
|
Definition
| It gets converted to bicarb - if the pt is on it too long they will get alkalotic |
|
|
Term
| best way to assess fluid status? |
|
Definition
|
|
Term
|
Definition
iatrogenic
blood transfusion
acidosis
renal failure
diuretics
tissue destruction |
|
|
Term
| EKG findings w hypOkalemia |
|
Definition
flattened T waves
U waves
ST depression
PAC/PVC/A fibb |
|
|
Term
| major complication of REDUCING Na+ levels too quickly? |
|
Definition
|
|
Term
| how long should sutures on face stay in? |
|
Definition
|
|
Term
| how long should sutures on trunk stay in place? |
|
Definition
|
|
Term
| MC bleeding vessel in duodenal artery? |
|
Definition
|
|
Term
| MCC small bowel obstruction in kiddos? |
|
Definition
hernias
(in adults = adhesions) |
|
|
Term
| how to measure for a NG tube? |
|
Definition
|
|
Term
| surgical resection of the rectosigmoid colon with closure of the rectal stump and colostomy, used for diverticulitis or cancer |
|
Definition
| Hartman's procedure (done only if reanastomosis is not possible) |
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|
Term
| where does a chest tube get inserted? |
|
Definition
| inserted into the 5th intercostal space slightly anterior to the mid axillary line |
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|
Term
| drainage of L testes? R testes? |
|
Definition
Left = left renal vein
Right = inferior vena cava |
|
|
Term
| how to tell the colon from small bowel? |
|
Definition
| colon = fat appendegaes, haustra, taenia coli |
|
|
Term
| what are some remidies for hyperkalemia? |
|
Definition
IV calcium
IV sodium bicarb (bc alkalosis pushes K intracellularly)
dialysis
insulin, glucose
albuterol
lasix
kayexelate |
|
|
Term
| ileus, tetany, weakness, paresthesias, flat T waves are signs of what electrolyte disturbance? |
|
Definition
|
|
Term
| what causes pseudohyonatremia? |
|
Definition
hyperglycemia
hyperlipids
hyperproteinemia |
|
|
Term
| what blood product replaces fibrinogen and VwF? |
|
Definition
|
|
Term
| 1 unit PRBC increases HCT by what? |
|
Definition
|
|
Term
| what will correct platelet dysfunction caused by ASA? |
|
Definition
|
|
Term
| coagulation dx caused by deficiency in factor 8, INCREASED pTT |
|
Definition
|
|
Term
| what are different dz that cause hypercoagulability? |
|
Definition
factor V Leiden (most common)
deficiency in protein C, S, and antithrombin C |
|
|
Term
how does heparin work?
how do you reverse it? |
|
Definition
activates antithrombin III
protamine sulfate - 1mg protamine : 100 units heparin |
|
|
Term
| which narcotic causes the spinchter of Oddi to spasm/contract? |
|
Definition
|
|
Term
| most common site for DVT? |
|
Definition
|
|
Term
| condition that occurs when the intestine is obstructed, slowing or stopping the progress of digested food, and thus facilitating the growth of bacteria to the point that problems in nutrient absorption occur. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is absorbed in terminal ileum? |
|
Definition
b12
bile salts
fat soluble vitamins |
|
|
Term
| what bugs cause central line infection? |
|
Definition
staph aureus
staph epidermidis |
|
|
Term
| MCC necrotizing fasciitis? |
|
Definition
|
|
Term
| duration of lidocaine alone? duration of lidocaine w epi? |
|
Definition
|
|
Term
| describe meckel's diverticulum? |
|
Definition
located 2ft from ileocecal valve
sx=hemorrhage, obstruction, inflammation
can get obstructed |
|
|
Term
| most common type of colon cancer? |
|
Definition
|
|
Term
|
Definition
| thrombosis of hepatic veins |
|
|
Term
last resort tx for pts who have duodenal ulcers, usually used if they hav failed PPI/H2/antibiotic tx
also used to tx gastric outlet obstruction |
|
Definition
|
|
Term
| pt complains of recurrent vomiting (worse after meals) stomach pain, on EGD a mass is seen blocking pylorus |
|
Definition
| Gastric outlet obstruction (note - may also be caused by peptic ulcer dz) |
|
|
Term
Claudication of buttocks/thighs
impotence
atrophy of legs |
|
Definition
| Leriche's syndrome (occlusive iliac dx) |
|
|
Term
| Chemical pneumonitis after aspiration of gastric contents |
|
Definition
|
|
Term
| massive NONOBSTRUCTIVE colonic dilation |
|
Definition
|
|
Term
| syndrome of GI tract telangiectasias and AV malformations |
|
Definition
| Rendu-Osler-Webber syndrome |
|
|
Term
| MC indication for surgery w Chron's dz? |
|
Definition
|
|
Term
| most common electrolyte deficiency that causes ileus? |
|
Definition
|
|
Term
|
Definition
| middle meningeal artery injury |
|
|
Term
| what can cause free peritoneal air? |
|
Definition
|
|
Term
| what are the retroperitoneal organs? |
|
Definition
kidneys/ureters/bladder/adrenals
aorta/inferior VC
esophagus/rectum
ascending, descending colon |
|
|
Term
| what causes metabolic ALKALOSIS? |
|
Definition
NG suction
vomiting
increased mineralocorticoids |
|
|
Term
|
Definition
tachycardia
low urine output |
|
|
Term
| can LR be used as maintenance fluid? |
|
Definition
| no - it has lactate that becomes bicarb, so the pt would get ALKALOTIC |
|
|
Term
| fluid of choice after gastric surgery? |
|
Definition
|
|
Term
| BEST way to measure fluid status? |
|
Definition
urine output!!
if pt has renal dz - central venous pressure |
|
|
Term
| most common fluids after laparotomy? |
|
Definition
| LR or D5LR for 24h then maintinence fluid |
|
|
Term
| surgical causes of hyperKalemia? |
|
Definition
iatrogenic OD
blood transfusion
renal failure
diuretics
acidosis
tissue destruction |
|
|
Term
|
Definition
decreased DTR
weakness
paresthesias
paralysis
resp failure |
|
|
Term
|
Definition
peaked T waves
prolonged PR
wide QRS
brady, v fib
ST depression |
|
|
Term
| nonacute tx for hyperkalemia? |
|
Definition
|
|
Term
| surgical causes of hypoKalemia? |
|
Definition
diuretics, antibiotics
alkalosis
diarrhea, vomiting
NG aspiration
insufficient supplementation |
|
|
Term
| signs and sx of hypokalemia |
|
Definition
weakness, tetany
n/v
ileus
paresthesias |
|
|
Term
| EKG findings with hypokalemia |
|
Definition
FLATTENED T WAVES
U saves
ST depression
PAC/PVC/a fib |
|
|
Term
| max K you can give/hour in peripheral line? |
|
Definition
|
|
Term
| what causes Hypernatremia? |
|
Definition
dehydration
DI
v/d
diaphoresis |
|
|
Term
|
Definition
seizures
confusion
stupir
pulm/peripheral edema
resp paralysis |
|
|
Term
|
Definition
seizure, coma
n/v
ileus
lethargy
confusion, weakness |
|
|
Term
| EKG change with hypercalcemia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| does heparin dissolve clots? |
|
Definition
| NO - it only slows clot progression and allows the bodys fibrinolytic system to break down the clot |
|
|
Term
| most common liver cancer? |
|
Definition
|
|
Term
| causes of Conn's syndrome? |
|
Definition
adrenal hyperplasia
adrenal adenoma |
|
|
Term
|
Definition
|
|
Term
| common causes of hyperparathyroidism? |
|
Definition
| parathyroid adenoma, hyperplasia, carcinoma |
|
|
Term
| what labs change after a spleen is removed? |
|
Definition
platelets INCREASE
WBC INCREASE
increased rate of infection |
|
|
Term
| MC physical finding of portal HTN? |
|
Definition
|
|
Term
| how is lymphoma diagnosed? |
|
Definition
| cervical/axillary node biopsy |
|
|
Term
| signs/symp of splenic rupture? |
|
Definition
hemoperitoneum
LUQ pain
L shoulder pain |
|
|
Term
|
Definition
CXR
bilat infiltrate
capillary wedge pressure <18 |
|
|
Term
|
Definition
|
|
Term
| most common bacteria that gets infected in grafts? |
|
Definition
|
|
Term
| compresion of subclavian artery/vein or brachial plexus? |
|
Definition
|
|
Term
| most common cancer in lung hilus? |
|
Definition
|
|
Term
| most common type of lung CA in nonsmokers? |
|
Definition
|
|
Term
| what autoimmune dx is thymoma associated w? |
|
Definition
|
|
Term
| tumor markers assctd w teratoma? |
|
Definition
|
|
Term
|
Definition
degeneration of auerbach's plexus
chagas dz |
|
|
Term
| MC artery involved in epidural hematoma? |
|
Definition
|
|
Term
| most cardiotoxic anesthetic? |
|
Definition
|
|
Term
| large doses of this anesthetic causes accumulation of methhemoglobin, cyanosis, chocolate colored blood |
|
Definition
|
|
Term
|
Definition
|
|
Term
| most common cause superior vena cava syndrome? |
|
Definition
|
|
Term
| HTN drug that is CI with renal artery stenosis? |
|
Definition
|
|
Term
| vein most commonly involved in varicosity? |
|
Definition
|
|
Term
| pt presents with L pleural effusion + leukocytosis? |
|
Definition
|
|
Term
| gas in spleen seen on xray |
|
Definition
|
|
Term
malignant bone tumor that develops during periods of growth esp in knee shoulder
sx = bone pain, fx, limited ROM |
|
Definition
|
|
Term
| superior vena cava syndrome occurs most commonly with what? |
|
Definition
|
|
Term
| pt has WBC >20,000 with appendicitis, what is happening? |
|
Definition
| perforation or gangrene of appy |
|
|
Term
| test of choice for appendicitis? |
|
Definition
|
|
Term
| US findings of appendicitis? |
|
Definition
appendix >7mm
thick walled
non compressible structure |
|
|
Term
| bugs most commonly associated w appy? |
|
Definition
Bacteriodes fragilis
E coli
Bacteriodes thetaiotaomicron |
|
|
Term
| most common benign colon polyp type? |
|
Definition
|
|
Term
| what causes pancreatic pseudocyst? |
|
Definition
acute pancreatitis!!
cyst is lined w granulation tissue, contains enzymes/blood/necrotic tissue |
|
|
Term
| treatment for pancreatic pseudocyst? |
|
Definition
endoscopic trans gastric drainage
image guided percutaneous drainage
cystogastrostomy |
|
|
Term
| how many days for delayed primary closure? |
|
Definition
|
|
Term
|
Definition
Right axis deviation
Flipped T waves
ST depression |
|
|
Term
| what constitutes flail chest? |
|
Definition
|
|
