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DU PA Surg Hint-Hint
Duke PA Surgery from the study guide for Test #1
| Question | Answer |
|---|---|
| __%, of hospitalized patients suffer from some degree of malnutrition | 15-50 |
| __ is a common finding with deficiencies in niacin, thiamine, Vitamin B6,Vitamin B12 | peripheral neuropathy |
| Represents the critical cellular mass necessary for cellular structure/function | lean body mass |
| Represents 40% of total body weight | lean body mass |
| Depletion is severe insult and defines patient morbidity and mortality | leand body mass |
| 60% skeletal muscle, 20% RBC’s and connective tissue, 20% cell mass | lean body cell mass |
| __% of the total body protein is contained in skeletal muscle, and this is major site of protein catabolism during starvation and/or illness | 60 |
| most widely used biochemical marker of muscle mass | 24 hour urine creatinine |
| energy storage compound in skeletal muscle | creatine |
| N intake - N loss | nitrogen balance |
| if nitrogen balance is +2 to +4 net state is __ | anabolism |
| if the nitrogen balance is negative net state is __ | catabolism |
| normal nitrogen loss is __ g/day | 5-8 |
| 1g N/__g protein | 6.25 |
| nitrogen intake is measured by | grams protein/24 hours |
| used to determine if protein intake is sufficient to maintain lean body mass | protein balance |
| Estimates severity of lean body mass catabolism and quantifies severity of metabolic stress. | catabolic index (CI) |
| catabolic index of <0 indicates | no significant stress |
| catabolic index of 0-5 indicates | moderate stress |
| catabolic index >5 indicates | severe distress |
| __ is the protrusion of extraperitoneal fat, peritoneum, omentum, bowel, or other viscera through a defect in the transversalis fascia | abdominal hernia |
| __ may convert an area of weakness into a hernia | intra-abdominal pressure |
| __ is especially useful for obese patients when the differential diagnosis includes simple weakness of the abdominal wall in addition to an incisional or epigastric hernia | Computed tomography (CT) scan |
| __ has not been shown more cost-effective or less morbid than open repair | laparascopic hernia repair |
| Cooper's pectineal ligament repair used for __ | femoral hernias |
| recurrence rate for repair of primary hernias is <__% | 5 |
| from superior mesenteric ganglion | Sympathetic Nerve Supply to Colon |
| increases sphincter tone | Sympathetic Nerve Supply to Colon |
| inhibits motility and secretions | Sympathetic Nerve Supply to Colon |
| arises from the vagus | Parasympathetic Nerve Supply to Colon |
| increases intestinal motility | Parasympathetic Nerve Supply to Colon |
| relaxes sphincter tone | Parasympathetic Nerve Supply to Colon |
| most common bacterial flora | bacteroides fragilis |
| 99% of colonic flora are __ | anerobic bacteria |
| symptoms of acute diverticulitis | LLQ pain + fever |
| initial management of massive lower GI bleed | ABC/vitals, 2 large bore IV lines |
| sign of Crohn's disease | transmural (full thickness) inflammation |
| superficial inflammatory process involving mucosa of colon | ulcerative colitis |
| Screening recommendations for colorectal cancer: Annual digital rectal exam and fecal occult blood test starting at AGE __ | 50 |
| Screening recommendations for colorectal cancer, flexible sigmoidoscopy every __years starting at AGE 50. | 3-5 |
| If family hx or inherited Colon Cancer Syndrome, annual screening with colonoscopy beginning at __ years of age younger than the earliest detected familial cancer. | 10 |
| adenomatous colon polyp | premalignant lesion |
| dysfunction of this muscle is associated with fecal incontinence | puborectalis |
| Regarding Hemorrhoids, Patients > 40 yrs of age should be evaluated by colonscopy to rule out __ | proximal disease |
| most common reason for fever on first day of post-op | atelectasis |
| a collapse of lung tissue affecting part or all of one lung | atelectasis |
| first sign of hypovolemia in post-op | tachycardia |
| most effective method to prevent DVT | early ambulation of patient |
| never use epinephrine on | tissue with poor collateral circulation |
| never use epinephrine on | the tips of things such as fingers, ears, nose, toes |
| __ is used with Lidocaine will cause vessels to constrict and allow less lidocaine to spread to surrounding tissues | epinephrine |
| you need to be __ whenever you are closing wounds | sterile |
| sutures in the face should be removed after __ days | 3-5 |
| sutures in the body should be removed after __ days | 7-10 |
| sutures in the upper extremities should be removed after __ days | 10-12 |
| suturse in the lower extremities should be removed after __ days | 12-16 |
| keep sutures in longer with | steroids, immunosuppression, poor nutrition |
| why do we use square nots with sutures | it retains 80-90% of its tensile strength |
| why do we use silk sutures | it is easy to manipulate |
| most widely used non-absorbable suture | silk |
| tensile strenght is lost over time | silk sutures |
| when do you use a cutting needle | on skin |
| when do you use a taper point needle | subcutaneous suture |
| when do you use a taper point needle | fascia |
| when do you use a taper point needle | GI tract mucosa and serosa |
| when do you use a taper point needle | uterus and uterine tube |
| when do you use a taper point needle | vascular surgery |
| when can you use either a taper point needle or a cutting needle | ortho tendon suture |
| __ act as the first line of cellular defense | macrophages |
| dog bites | streptococcus viridans |
| cat bites | pasteurella |
| preoperative anibiotics are given __ before skin incision | 1 hour |
| most common post-operative infection | UTI |
| 4 W's of post-operative fever | Wind, water, wound, wonder drugs |
| diarrhea post op consider | Clostridium difficile |
| causes pseudomembranous colitis | Clostridium difficile |
| Treatment for Clostridium difficile | PO flagyl |
| advantage to dry dressing | air circulation to wound |
| most commonly used dry dressing | gauze |
| daily dressing replacements | may increase the risk of infection |
| post-op dressings placed under sterile conditions should stay on for __ days depending on the size of the wound | 2-5 |
| __ are used when repeated dressing changes are required | Montgomery Straps |
| steri-strips are applied __ to wound edges | perpendicular |
| to remove steri-strips pull __ the wound | toward |
| __ is good for small lacerations (scalp) | collodion spray |
| reversed spiral bandaging is used for | tubular structures changing in diameter (calf, forearm) |
| wet compresses should not be used >__hours | 24 |
| what may occur if wet compresses are used too long | maceration |
| most versitile splint material | plaster of paris |
| __ for sprains is quick and effective for initial immobilization of acute injuries | posterior splinting |
| __ are used to decrease fluids from large abscesses, they are attached to suction | sump drains |
| blood products should not be administered with any catheter smaller than a __ga | 20 |
| at Duke it is recommended that blood products be given through an IV no smaller than __ga | 18 |
| Duke Hospital routinely gives non blood product fluids through __ ga IV needles | 20 |
| patients need to practice as many __ as possible while at the hospital | ADL's |
| the __ vein should be used only in emergency situations since it decreased mobility, requires and armboard and has a greater risk for thrombosis | anticubital |
| the __ aspect of the wrist is not an acceptable site for starting an IV | volar |
| __ should be used for immobilization if an IV is near a joint | armboards |
| tourniquets should not be left on longer than __ minutes when starting an IV | 3 |
| most common complication associated with IV therapy is __ | infiltration |
| swelling, leaking at site, coolness of tissue at site, and blanching are all signs of __ when administering fluids IV | infiltration |
| : Either 2 blades held apart by ratchet or by frames to which various blades may be attached, where one side acts as an anchor and pressure is exerted on the other side. | self-retaining retractors |
| ratchet style self retaining retractor, for superficial use | Weitlaner (thyroid) |
| abdominal retractor to which a bladder blade may be added | Balfour |
| most commonly used suction | Yankauer (chest, tonsil) |
| severed ends of bleeding vessels with minimal tissue damage | hemostats |
| short, fine curved clamp for superficial vessels | Crile (Mosquito) |
| short, straight tipped clamp slightly longer and heavier than a Crile also used for superficial vessels and may also be used to “tag” suture (hold suture in place prior to tying it and cutting it). | Halstead |
| Heavier curved clamp which varies in length and used as a general all-purpose clamp | Kelly |
| fine curved tip clamp medium in length, most commonly used clamp for hemostasis | Tonsil |
| clamp with a right angled tip and medium in length generally used to pass suture around an uncut vessel | Mixter |
| holds tissue for retraction. Vary in length and thickness and are available with and without teeth | Grasping clamps |
| multiple short teeth that do not damage tissue in its grasp. For use on delicate tissue | Allis |
| curved; fenestrated blades without teeth used to grip or enclose delicate structure such as intestines, ureters, and fallopian tubes. | Babcock |
| has a single heavy toothed tip for grasping tough tissue (i.e. fascia, bone, muscle | Kocher |
| ring shaped jaws used to hold sponges (generally prep sponges or stick sponges) and delicate tissue (i.e. lung). | sponge Stick |
| sharp, needle-like curved tips used to secure drapes or to hold tissue (i.e. bone). | towel clips |
| Non-toothed Forceps | Bayonet |
| A major concern with Hexachlorophene is __ | Neurotoxicity |
| prolonged skin contact with __ increases risk of toxicity | chloroxylenol |
| __ casts are more rediolucent | fiberglass |
| casting saw doesn't cut skin when used properly b/c it __ | rocks/vibrates rather than spin |
| when sending a biopsy specimen place lable on | bottle not lid |
| never send a biopsy specimen with a __ | counted sponge |
| gowns are considered sterile in from from __ to table level | shoulder (2" below the neck) |
| sleeves are sterile from __ inches above the elbow to the cuff | 2 |
| sterile fields are sterile to within __ of the edge only | 1 inch |
| Pt lies on back. The footboard is padded and raised. The entire table is tilted so head is higher than feet. The strap is below the knees | Reverse Trendelenburg |
| patient is lies on back, head is lower than feet, the knees are over the lower break in the table. The knee strap is above the knees, and shoulder braces are in place | Trendelenburg |
| When is it OK not to use sterile techniquewhen performing suture placement? | never |
| What size suture should you use for a Saphenous vein – femoral artery anastomosis? | 6-0 |
| Should a taper needle be used on the skin? | No-use a cutting needle |
| UUN + 4g = | nitrogen loss (from urine, GI, skin) |
| UUN - 0.5 + 3g = | Catabolic Index (CI) |
| example of a clean wound | appendectomy, breast biopsy |
| infection rate in a clean wound <__% | 5 |
| no violoation of GI, GU or respiratory tracts | clean wound |
| lowest incidence of infection | clean wound |
| elective colon resection | clean-contaminated wound |
| stab wound with colonic perforation | contaminated wound |
| perforated diverticulitis with abscess | dirty wound |
| Choice of perioperative antibiotics | depends on type of operation |
| defect in the transversalis fascia | hernia |
| atelectasis can cause fever within __ hours post-op | 48 |
| four types of colon polyps | submucosal, hyperplastic, hamartomatous, adenomatous (pre-malignant) |
| puborectalis is located on __ | the pubic floor |
| high hematocrit can be from | polycythemia, smoking, anything that increases erythrocyte production |
| low hematocrit can be from | bleeding of any kind |
| low heatocrit <__ | 30 |
| low platelets <__ | 150 |
| most cardiac reinfarctions occur in the first __ days post-op | 3 |
| with patients on steroids __ may cause hypotension and tachycardia which is unresponsive to pressors | adrenal insufficiency |
| __ hernias go through Hesselbach's triangle | direct |
| rectus abdominis muscle (medially), inguinal ligament (inferiorly), inferior epigastric vessels (superior and laterally), | Hesselbach's triangle |
| __ hernias go through the internal ring within a patent processus vaginalis | indirect |
| inability to recduce hernia contents | incarceration |
| compromise of intestinal vascular supply secondary to incarceration | strangulation |
| "tension free" repair | Lictenstein (mesh) repair |
| standard of care with hernias | put mesh in that is not under tension |
| __% of lean body cell mass is skeletal muscle | 60 |
| __% of lean body cell mass is RBC's and connective tissue | 20 |
| most reactive suture | surgical gut (chromic) |
| high tensile strength, low tissue reactivity | nylon suture |
| favored for construction of interrupted percutaneous closure | nylon suture |
| least reactive suture | stainless steel |
| surgical needles are used to pass suture material through desired tissue with __ | minimal trauma |
| peripheral IV's should be | changed routinely |
| Peripheral IV size used for trauma __ga | 16-18 |
| can you reuse a disposable needle | no, what do you think? |
| a hemorrhoid | what is Tyler Hansbrough? |
| if contamination with anaerobes is possible give __ perioperatively | second generation cephalosporins |
| if contamination with aerobes but not anaerobes is possible give __ perioperatively | first generation cephalosporins |
| have a high index of suspicion for __ when discoloration, necrosis, crepitus, drainage of thin, watery, grayish, foul-smelling fluid present | necrotizing fasciitis |
| if infection is seen in <48 hours worry about __ due to clostridium perfringens, or Strep. B | necrotizing fasciitis |
| Scissors | straight mayo, curved mayo, Metzenbaum, chest, wire |
| Hemostats | crile (mosquito), Halstead, Kelly, Tonsil, Mixter (right angle) |
| Grasping clamps | Allis, Babcock, Kocher, Sponge, Towel |
| Forceps (pickups) | Adson, 3/4's, Debakey, Ring, Bayonet |
| Hand-held retractors | vein, skin rake, Army Navy, Appendiceal, Richardson, Deaver, Malleable (Ribbon) |
| Self-Retaining retractors | Weitlaner, Balfour |
| Suction tips | Yankauer, Baby Chest, Frazier, Poole |
| Yankauer | suction |
| baby chest | suction |
| Frazier (abdominal) | suction |
| Poole (neuro) | suction |
| Weitlaner | self retaining retractor |
| Balfour | self retaining retractor |
| malleable (ribbon) | hand held retractor |
| Deaver | hand held retractor |
| Richardson | hand held retractor |
| appendiceal | hand held retractor |
| army navy | hand held retractor |
| skin rake | hand held retractor |
| vein | hand held retractor |
| bayonet | forceps |
| ring | forceps |
| Debakey | forceps |
| 3/4's | forceps |
| Adson | forceps |
| towel clips | grasping clamp |
| sponge stick | grasping clamp |
| Kocher | grasping clamp |
| Babcock | grasping clamp |
| Allis | grasping clamp |
| Mixter | hemostat |
| Tonsil | hemostat |
| Kelly | hemostat |
| Halstead | hemostat |
| Crile | hemostat |
Created by:
bwyche
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