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DU PA Surg 2 Stu Gui

Duke PA Surgery II Study Guide

list the three most common post-MI complications VSD, Acute mitral insufficiency, LV aneurysm
list the criteria for CABG left main disease >50%, three vessel coronary disease, failed medical management, failed angioplasty, decreased LV function, complicated disease, diabetes mellitus
what is the patency of the radial artery when used as a conduit for CABG 84% five years
which conduit is most commonly used in CABG greater saphenous
list the classic triad of symptoms associated with aortic stenosis angina, syncope, CHF
indications for aortic valve replacement dyspnea on exertion, decreased LV function, pressure gradient >50 mmHg by cath
shat are two important late symptomatic findings in aortic insufficiency water hammer pulse (bounding), widened pulse pressure
mitral stenosis opening snap, apical crescendo diastolic rumble
best for diagnosing aortic dissection TEE
percentage of benign cardiac tumors 75%
diagnosis of cardiac tumor echo
diagnosis of pericarditis echo
percentage of babies born with heart defect 1%
most common congenital heart malformation bicuspid aortic valve
second most common congenital heart malformation atrial septal defect
interpretation of blood flow in a doppler ultrasound BART-blue away, red toward
name the two anatomic r to l intracardiac/great vessel shunts in utero foramen ovale, ductus arteriosus
location of the ductus arteriosus small projection connecting the pulmonary artery to the aorta, bypassing the pumonary circulation
location of the ductus venosus shunt from the umbilical vein to the inferior vena cava, bypassing the liver
major signs and symptoms of congenital heart disease cyanosis, dyspnea/tachypnea, syncope, failure to thrive, edema/ascites
lab finding consistent with cyanosis low oxygen sat, elevated hem
initial imaging modality of choice in suspected congenital heart disease echo
eisenmenger's syndrome phenomenon occuring with long standing L to R shunts in which increasing pulmonary arterial pressures and flow rate result in shunt reversal to R to L
location of ASD hole between the right and left atria
three types of ASD sinus venosus, ostium secundum, ostium primum
most commonly diagnosed congenital cardiac defect VSD
location of VSD hole between the right and left ventricles
finding in a patent ductus arteriosus continuous precordial murmur (machinery)
most common of the mixed shunts transposition of the great arteries
anatomical outcome in transposition of the great arteries two separate closed systems
the two anatomical abnormalities that must be present in order for a patient to survive transposition of the great arteries ASD, PDA
components of truncus arteriosus single trunk from the heart, VSD
tetrology of fallot pulmonary stenosis, VSD, overriding aorta)shigt to right ventrical), RV hypertrophy
anatomical abnormality that must be present for survival in tetrology of fallot patent ductus arteriosus
anatomical abnormality in tricuspid atresia hypoplasia of the R ventricle
what is fiven to patients in order to maintain a PDA prostaglandins
most common congenital obstructing lesion pulmonary stenosis
prominent physical findings in coarctation of the aorta differential bp and pulses, greater in upper extremities than lower
anatomical cause of coarctation of the aorta complication due to closure of the ductus arteriosus
most rare congenital heart disease mitral valve disease
ABI in normal patients <1
ABI in patients with intermittent claudication 0.5-0.7
ABI in patients with rest pain <0.3
treatment for lower extremity rest pain arteriography, bypass surgery
indications for surgical intervention in PVD tissue loss, rest pain, lifestyle limiting claudication
leading cause of postoperative mortality MI
risk of stroke in patients with carotid stenosis depends on degree of stenosis, and presence of symptoms
what seemingly related symptoms are not associated with carotid disease diplopia, syncope, paresthesias
which vessels are associated with the symptoms of diplopia, syncope, and paresthesias vertebrobasilar arteries
physical exam finding is consistent with carotid vascular disease carotid bruit
gold standard for defining anatomy of carotid artery disease doppler US
gold standard for defining anatomy of carotid lesions arteriography
cause of amaurosis fugax embolization of the retinal artery, resulting in a transient monocular blindness
treatment for a 75% symptomatic carotid stenosis carotid endarterectomy
at what size is AAA repair indicated >5cm in diameter
ABCDE's of the primary survey for trauma airway, breathing, circulation, disability, exposure
key components of airway assessment assess airway and pt's ability to protect airway, use chin lift or jaw thrust, keep low threshold for intubation
key components of breathing assessment evaluate breath sounds/percussion, administer supplemental oxygen, treat pneumothorax/hemothorax, flail ches
key components of circulation assessment control hemorrhage, obtain large bore IV access, administer fluids as needed
key components of disability assessment evaluate level of consciousness/pupils/ability to move extremities, determine coma score
key components of exposure assessment remove all clothing, treat/prevent hypothermia
a GCS of >13 correlates with what mild brain injury
a GCS of 9-12 correlates with what moderate brain injury
a GCS of <8 correlates with what severe brain injury
which GCS indicates the need for intubation <8
general rule for the secondary survey a finger or tube in every orifice
what does ample stand for Allergies, Meds, PMH, Last meal, events related to injury
what two tubes should be placed in every trauma patient foley, NG tube
radiographic components of the trauma triple C-spine, portable chest xray, pelvic xray
seat belt sign fracture of the L2 vertebrae, resulting in injury to the duodenum
most important lab test that should be ordered in a trauma patient type and screen
during physical exam of a trauma patient, what must be maintained midline immobilization
definition of concussion temporary deficit without CT findings
definition of contusion focal brain bruise
which intracranial injury is associated with lucid interval epidural hemorrhage
signs of tension pneumo trachial deviation, increased JVD, decreased breath sounds, tympany to percussion, hypotension
what is the treatment for tension pneumo immediate needle decompression, chest tube placement
what is the treatment for an open pneumo sterile, one way flutter valve dressing
in patients with hemothorax what is the indication for thoracotomy in the OR >1500 ml blood upon chest tube placement or continuous output of >200 ml/hr
what is Beck's triad muffled heart sounds, JVD, hypotension
treatment for cardiac tamponade immediate pericardiocentesis or sternotomy in OR
definition of flail chest two or more fractures in three consecutive ribs with paradoxical inspiration
what is diagnostic peritoneal lavage aspiration of fluid from the peritoneal cavity to assess for intra abdominal hemorrhage
results of a positive DPL aspiration of gross blood, >100,000 rbc/ml on laboratory exam of lavage fluid
advantage that abdominal CT has over DPL ability to evaluate retroperitoneum
diagnostic technique indicated for penetrating trauma or for the unstable patient with obvious evidence of abdominal injury exploratory laparotomy
upon arrival how should unstable patients with pelvic fractures be treated emergent external fixation, pelvic angiography with embolization if bleeding continues
device commonly used to stabilize pelvic fractures military anti shoch trousers MAST
treatment for femoral head fracture early traction and ORIF
three reasons to intubate a trauma patient impaired level of consciousness, mechanically compromised airway, inadequate ventilation (flail chest)
two of the earliest signs of hypovolemic shock decreased pulse pressure, orthostatic hypotension
phases of wound healing hemostasis, inflamation and recruitment, fibroblast proliferation and granulation, wound remodeling and contraction
inflammatory cells that migrate to the site of a wound neutrophils and macrophages
how soon does migration of inflammatory cells occur after an injury minutes to 24 hours
how soon does reepithelialization occur after an injury 24-48 hours
how soon does collagen deposition occur after an injury 7-14 days
how soon does increased tensile strenght occur after an injury 6 months
what is a clean wound incision through prepped skin without violation of GI, GU or repiratory tracts
what is a clean contaminated wound incision through prepped skin and into GI GU or respiratory tracts that have also been prepped
what is a contaminated wound GI, GU or respiratory tract surgery with active infection somewhere else in the body
what is an infected wound existing infection at the site of operation
treatment for abscess incision and drainage
wound closure by primary intention immediate approximation of skin edges
wound closure by delayed primary (tertiary) intention leaving a contaminated wound open for 2-5 days to allow for reduced bacterial counts, then close primarily
wound closure by secondary intention leaving a wound oopen to allow for healing by reepithelialization and contraction
how should wounds at high risk for infection be closed by secondary intention
how long should an operative dressing be left in place 48 hours
traditional dressing for open contaminated wound wet to dry
best dressing for open contaminated wound wound VAC
factors that reduce wound healing infection, malnutrition, increased age, ischemia, smoking, diabetes, steroids, radiation and chemo
highest rates of esophageal cancers are found in northern China and Japan
most common type of proximal esophageal tumor squamous cell carcinoma
most common type of distal esophageal tumor adenocarcinoma
which form of esophageal cancer is on the rise adenocarcinoma
risk factors for esophageal cancer barret's, reflux, iron def anemia, poor nutrition, family history, heavy smoking, heavy alcohol
most common presenting signs in esophageal cancer dysphagia, wt loss, pain
etiology of esophageal cancer dysplasia of the squamous epithelium
imaging modality that is the gold standard for evaluation of esophageal tumor stage esophageal ultrasound
treatment that offers the best chance for survival in absence of metastases with esophageal cancer surgical resection of involved esophagus, proximal stomach and regional lymph nodes and anastomosis
best methods of palliation in the absence of metastases with esophageal cancer stent, photodynamic therapy, gastrostomy feeding tube
most common post operative complication following esophageal resection pneumonia
lung cancer is the most common cause of death by malignancy in which population men
in which population is there an increasing incidence in lung cancer young, white, non-smoking females
what is the most common cause of death in lung cancer distant metastases
what lung tumor is the most common non-small cell
of the non-small cell lung cancers which are the most common centrally squamous cell carcinoma
of the non-small cell lung cancers which are the most common peripherally adenocarcinoma
what constitutes stage IV lung cancer and degree of metastasis
which stages of lung cancer are resectable stages I-IIIa
initial imaging modality for suspicion of lung cancer chest x-ray
a __ lesion on chest x-ray is considered malignant until proven otherwise non-calcified
imaging used to evaluate for mets pet, brain ct, mr
imaging modality considered the standard of care in proper staging of lung tumors bronchoscopy
gold standard for lymph node evaluation with lung cancer cervical mediastinoscopy
general management for traumatic wounds irrigation, bleeding control, close vs don't close
treatment for clean wounds less than 6-8 hours old primary closure, dry dressing 2-3 days, suture removal in 3-10 days
treatment for dirty wounds or wounds older than 8 hours healing by secondary intention, dressing change after 1-3 days, antibiotics in presence of cellulitis or lymphadenopathy, delayed primary closure with steri-strips in 3-5 days after granulation tissue has formed
treatment of puncture wounds pack with clean gauze to allow for bottom to top healing
purpose of wet to dry dressing facilitates mechanical debridement of the wound (does not prevent bacterial colonization)
three indications for primary closure wound <6-8 hours old, edges come together without tension, clean wound
common local anesthesia used in office or clinic topical or subcutaneous infiltration at wound site
common method for field block anesthesia infiltration circumferentially around the wound
common method for peripheral nerve block injection of local anesthetics adjacent to the appropriate peripheral nerve
effects of epinephrine when used as an anesthetic additive causes vasoconstriction, decreases rate of systemic vascular absorption
effects of sodium bicarbonate when used as an anesthetic additive neutralizes the pH of anesthetic, decreasing pain secondary to injection
most commonly used lidocaine dosages 1% solution, 0.5 cc/kg of body weight, common dose, 35ml of 1% in 70kg pt
areas where epi should never be used in conjunction with lidocaine distal appendages: ears, fingers, nose, toes, hose
type of anesthesia most useful for procedures on digits peripheral nerve block, injected on both sides of the metacarpo-phalangeal joint
first sign of lidocaine tox tinnitus
ultimate sign of lidocaine tox seizure
characteristics of a tetanus prone wound >6 hours old, stellate or avulsion, depth >1cm, missile/crush/burn/frostbite, devitalized tissue, contaminated with dirt or saliva
tetanus prophalaxis for a tetanus prone wound, last booster >5 years ago tetanus toxoid alone
tetanus prophalaxis fora tetanus prone wound, never immunized previously or unknown tetanus toxoid plus tetanus immune globulin at separate site
tetanus prophalaxis for a non-tetanus prone wound, last booster >10 years ago tetanus toxoid alone
infection of hair follicle cuased by obstruction furuncle
infection of the terminal phalanx or pulp of the finger felon
infection involving the subepithelial folds of tissue around the nailbed paronychia
technique for fusiform excision length to width ratio of 3:1 with corner angles at approximately 30 degrees
most common benign epithelial skin tumor seborrheic keratosis
most common type of skin cancer basal cell carcinoma
characteristic appearance of a basal cell carcinoma pearly lesion
treatment for all pigmented lesion punch biopsy or excision biopsy
5 conctraindications for laparoscopic surgery ongoing intra-abdominal sepsis, bowel obstruction, morbid obesity, pregnancy, cardiopulmonary compromise
7 operations that can be performes using laparoscopic technique evaluate ab trauma, stage intra-ab cancers, biopsy, gastric bypass, appendectomy, cholecystectomy, splenectomy
mos common complication of laparoscopic surgery bleeding, infection, bowel obstruction
advantages of minimally invasive surgery reduced post-op pain, reduced hospital stay, quicker return to normal, improved cosmesis, reduced wound complications associated with large scar
disadvantages of minimally invasive surgery expensive equipment, need for additional training, loss of tactile sensation, loss of 3D vision, general anesthesia necessary
4 procedures that can be performed thoracopically lung biopsy, wedge resection, pericardial window, pleurodesis in pneumothorax
pre-operative testing necessary in a patient <50 y/o prior to orthopedic surgery none
pre-operative testing necessary in a patient 50-75 y/o prior to orthopedic surgery EKG
pre-operative testing necessary in a patient >75 y/o prior to orthopedic surgery EKG and H/H
guidlines for pre-operative antibiotics cefazolin 1gm IV on call to OR given 1 hour prior to OR
two methods utilized in prophylaxis of postoperative DVT TED hose, LMWH/coumadin
metabolic abnormality associated with post-operative infection perioperative hyperglycemia
what intervention helps to reduce the risk of perioperative hyperglycemia intraoperative insulin
diagnosis given to patients who present with a traumatic knee effusion, until proven otherwise ACL tear
possible graft choices in an ACL repair bone-patellar tendon-bone, hamstring autograft, cadaver allograft
best non-surgical treatment for osteoarthritis wt loss
most common cause of shoulder pain impingement
initial treatment for rotator cuff tendonitis physical therapy and NSAIDS
comorbid illness that predisposes to adhesive capsulitis diabetes
single most sensitive and specific physical exam finding in rotator cuff tears weakness with resisted external rotation and or abduction
indications for rotator cuff repair <60 yo, or 60-70 yo with favorable medical history and comorbities
shoulder dislocation that is the most common anterior
two fractures associated with the shoulder Bankart, Hillsach
test that should be ordered to rule out DVT in the case of shoulder pain doppler ultrasound
initial test to be ordered to evaluate post-operative pain x-ray to evaluate for hardware failure
indications for intubation inability to oxygenate patient (SpO2,90%), inability to ventilate patient (resp acidosis), patient unable to protect airway
most common cause of airway obstruction in an unconscious patient tongue
three maneuvers to temporarily relieve airway obstruction chin lift/jaw thrust, oral airway in an unconscious patient, nasopharyngeal airway
five signs of airway compromise agitation, tachypnea, increased resp effort, stridor, hoarseness
proper oxygenation of a patient prior to intubation 100% oxygen via mask for 5 min
which endotacheal tube should be used in patients <8 years old uncuffed to avoid tearing of airway due to overinflation
size of ET tube used for most women 7-8 mm
size of ET tube used for most men 7.5-9 mm
size of ET tube used for most pediatrics diameter of patients little finger
how should the laryngoscope blade be inserted on the right side of the mouth and used to sweep the tongue to the left
three benefits of applying cricoid pressure prevents aspiration of gastric contents, prevents intubation into the esophagus, aids in visualization of the cords
five methods used to confirm tube placement condensation in the ET tube, auscultate both lung bases, observe chest movement and symmetry, attach end-tidal CO2 analyzer to ET tube, check stat chest x-ray (tube should be 4-5 cm above the carina)
which method of ET tube confirmation is most accurate end-tidal CO2 detection
after intubation, if breath sounds are heard on teh right but not on the left, what should be done pull back on the ET tube and auscultate again
the early complications of intubation aspirations, trauma, equipment failure, inability to intubate
the late complications of intubation ventilator associated pneumonia, accidental extubation, vocal cord dysfunction or paralysis
the max amount of time that ventilations should be interrupted to perform intubation 30 sec
most important anatomical divider used in classification of intracranial tumors tentorium
a tumor in the supratentorial region may result in which pathologic disorder epilepsy
which cancers met to the brain the fastest lung and renal
in which area of the brain do most met tumors arise cerebrum 80%
five step algorithm for diagnosis and treatment of a patient with suspected brain tumor MRI is study of choice for confirmation of brain tumor. Pan CT of chest/abd/pelvis to detect other tumors. Biopsy of distant tumor or resection of brain tumor to confirm pathology. Radiation/chemo for malignancy. Follow-up surveillance MRI, PET
medically intractable epilepsy failure of two or more medications to prevent further seizures
indicate the success rate of temporal lobectomy for the treatment of epilepsy 85-90% remain seizure free for life
status epilepticus ongoing seizure for 30 min or multiple seizure in succession without sensorium returning to normal between them
what is the fisher grade used for classify appearance of sub arachnoid hemorrhage on scan
what is the Hunt Hess scale used for classify severity of symptoms in sub arachnoid hemorrhage
components on Triple H therapy for subarachnoid hemorrhage hypervolemia, heme dilution, hypertension
when can a burr-hole be done to treat subdural hemorrhage 2 weeks after injury
treatment for myelomeningocele planned c section, emergen closure of defect withing 24 hours
tethered cord abnormally low conus medullaris
major cause of increased demand for organs hepatitis C
antigen presenting cell APC a cell that displays foreign antigen complesed with MHC on its surface, which is then recognized by t-cell receptors on T cells
major histocompatibility complex MHC genes expressed on the surface of cells in all jawed vertebrates and display fragments of foreign molecules to T cells
define cross match a test for determining tissue compatibility between a transplant donor and the recipient before transplantation, in which the recipient's serum is tested for antibodies that may react with the lymphocytes or other cells of the donor
which cytokine is responsible for the majority of immune cell activation interleukin 2 IL-2
immediate killing of a transplanted organ occuring in patients with preformed antibodies to the donor in the bloodstream hyperacute rejection
rejection of the transplanted organ occuring between 5-90 days due to the infiltration of the recipient's immune system into the donor organ acute rejection
chronic allograft vasculopathy due to development of atherosclerosis chronic rejection
antilymphocyte antibodies used to prevent rejection during first few days after transplant induction immunosuppression
maintenance immunosuppression long term therapy with two or three drugs
treatment of acute rejection steroids and antilymphocyte preparations given over period of several days
most important side effect of cyclosporine nephrotoxicity
most important complication of immunosuppression opportunistic infection
how are donor organs transported hypothermic storage with UW solution
why is the left kidney preferred in renal transplant the renal vein is longer on the left side
what lab value is used to evaluate success of liver transplant PT/INR
what lab value is used to evaluat the success of pancreatic transplant glucose
1-year survival rate following liver transplant 85%
1-year survival rate following heart transplant 80%
1-year survival rate following lung transplant 70%
what imaging modality is used to evaluate liver and kidney anastomoses post-operatively ultrasound
what consideration must be made regarding pancreas transplant risk of diabetic complications vs complications of lifelong immunosuppression therapy
what clinical sign is associated with acute heart transplant rejection tachycardia
approach to the patient 3 hours post renal transplant who stops making urine flush foley cath, assess fluid status(give 500cc crystalloid LR or NS), ultrasound to assess renal artery/vein patency, return to OR
why must you be overly concerned for infectious processes in patients s/p organ transplant immunosuppression therapy results in a blunted inflammatory response and thus, the patient will no present with typical symptoms
fever threshold in immunocompetent 38.5 C
fever threshold in immunocompromised 38.0 C
what are patients s/p lung transplant at greatest risk for infection secondary to aspiration
Created by: bwyche