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DU PA Surg Hint-Hint

Duke PA Surgery from the study guide for Test #1

__%, 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