General Surgery
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| Which types of medications should be stopped preoperatively? | 1) Anticoagulants
2) Antiplatelets
3) Diabetic medications
4) ACEIs and statins
🗑
|
||||
| When do we perform CBCs preoperatively? | As baseline
If the estimated blood loss is >500mL
In patients with chronic illness or anemia
🗑
|
||||
| When do we perform urine analysis preoperatively? | Urological symptoms present
Instruments in UT
Possible surgical placement of prosthesis
🗑
|
||||
| When do we check serum electrolytes preoperatively? | If the patient is >50
Chronic diarrhea
Major procedures
Renal, liver, cardiac disease
HTN, DM
Diuretic use, digoxin use, ACEI use
🗑
|
||||
| When do we perform coagulation studies preoperatively? | Anticoagulant use
Family history of bleeding disorders
History of abnormal bleeding
Liver disease, malnutrition, and alcohol use
🗑
|
||||
| When do we test Beta-hCG preoperatively? | In any patient within the childbearing age
🗑
|
||||
| When do we test LFTs preoperatively? | Major procedure
History of liver or biliary disease
Albumin is a strong predictor for preoperative morbidity
🗑
|
||||
| When do cross-match blood preoperatively? | If estimated blood loss is >500 mL
🗑
|
||||
| When do we perform a chest x-ray preoperatively? | Acute cardiac or pulmonary symptoms
Smokers
🗑
|
||||
| When do you perform ECGs preoperatively? | All patients >50
Patients with known heart disease
Diabetic patients
🗑
|
||||
| What are the cardiovascular risks which increase morbidity in surgery? | Age >70
DM
Unstable angina
Recent MI (within 6 months)
CHF
Valvular heart disease
Arrhythmias
Peripheral vascular disease
🗑
|
||||
| Which drugs reduce peri-operative risk of cardiac events and MI? | Beta blockers
🗑
|
||||
| What are the pulmonary risks which increase morbidity in surgery? | COPD
Smoking
Advanced age
Obesity
Acute RTI
🗑
|
||||
| Which tests should be performed preoperatively in patients with a history of lung disease or smoking? | ABGs
🗑
|
||||
| What test should be done in a patient >30 years of age with breathlessness? | ECG
🗑
|
||||
| What are the renal risks which increase morbidity in surgery? | DM
HTN
CAD
Hyperkalemia
IV volume overload
Infectious complications
🗑
|
||||
| What questions do you want to ask in the history of a patient with CKD? | Is it due to HT or DM?
When was your first dialysis?
How much fluid was removed?
What is your preoperative weight?
🗑
|
||||
| How do you assess volume status in physical examination? | JVP and lung crackles
🗑
|
||||
| What investigations do we perform in patients with renal risk? | CBC, electrolytes, creatinine, BUN
Urine analysis and culture
🗑
|
||||
| How do you manage patients with CKD? | Dialysis within 24 hours of surgery
Intravascular volume status monitoring
🗑
|
||||
| What is the risk of AKI in patients without preexisting CKD for cardiac surgery and patients undergoing AAA repair? | 1.5-2.5%
🗑
|
||||
| What are the indications for dialysis? | Intavascular volume overload
Hyperkalemia
Severe metabolic acidosis
Complications of uremia (encephalopathy,
pericarditis)
🗑
|
||||
| What are the risk factors for AKI? | Increased BUN/ increased Creatinine
CHD/introperative hypotension
Advanced age
Sepsis
Administration of nephrotoxic substances
🗑
|
||||
| What post-operative events increase the chance of CVA? | A-fib
Hypotensions
🗑
|
||||
| What are the types of wounds, according to the surgical procedure? | Clean
Clean, contaminated
Contaminated
Dirty
🗑
|
||||
| What is the definition of a clean wound? | Non-traumatic
No entry of GI, biliary, tracheobronchial, respiratory, or gut
🗑
|
||||
| What are some examples of clean wounds? | Wide, local excision of mass
Hernia repair
Thyroid surgeries
🗑
|
||||
| What is the definition of clean-contaminated wounds? | Respiratory, GU, GI entry with minimal contamination
🗑
|
||||
| What are some examples of clean-contaminated wounds? | Gastrectomy
Hysterectomy
Cholecystectomy
🗑
|
||||
| What is the definition of contaminated wounds? | Open, fresh traumatic wounds
Uncontrolled spillage from poorly prepared hollow viscus
Minor breaks in sterile techniques
🗑
|
||||
| What are some examples of contaminated wounds? | Ruptured Appendix
Resection of unprepared bowel
🗑
|
||||
| What is the definition of dirty wounds? | Open, traumatic, dirty wounds
Traumatic perforated viscus
Pus in the operative field
🗑
|
||||
| What are some examples of dirty wounds? | Intestinal fistula resection
Hartman’s for diverticular perforation
🗑
|
||||
| What are the risks of contamination in the different types of wounds? | Clean --> 2%
Clean-contaminated --> <10 %
Contaminated --> 20%
Dirty --> 30-70%
🗑
|
||||
| What are the methods of prophylaxis of of preventing infections? | Strict sterile techniques
Maintaining normal body temperature, blood glucose levels, and
hyperoxygenation
Pre-operative skin antisepsis by chlorhexidine-alcohol (better) or using Povidone-iodine scrub
Antibiotic prophylaxis
🗑
|
||||
| What are the likely pathogens in cardiac operations? | Staphylococci
Corynebacteria
Enteric gram negative bacilli
🗑
|
||||
| What are the recommended antibiotics in cardiac surgery? | Vancomycin, cefazolin, and aztreonam
🗑
|
||||
| What are the likely pathogens in thoracic surgery? | Staphylococci
🗑
|
||||
| What are the recommended antibiotics in thoracic surgery? | Cefazolin
Vancomycin
🗑
|
||||
| What are the likely pathogens in vascular surgery? | Staphylococci
Streptococci
Enteric grame negative bacilli
Clostridia
🗑
|
||||
| What are the recommended antibiotics in vascular surgery? | Cefazolin
Vancomycin and Aztreonam
🗑
|
||||
| What are the likely pathogens in orthopedics surgery? | Staphylococci
🗑
|
||||
| What are the recommended antibiotics in orthopedics surgery? | Cefazolin
Vancomycin
🗑
|
||||
| What are the likely pathogens in Upper GI and hepato-biliary surgery? | Enteric gram negative bacilli
Enterococci
Clostridia
🗑
|
||||
| What are the recommended antibiotics in upper GI and hepatobiliary surgery? | Cefazolin
Cefatetran
Cefoxitin
Clindamycin + Gentamycin (if allergic)
Ciprofloxacin + metronidazole
🗑
|
||||
| What are the likely pathogens in appendectomy and colorectal surgery? | Gram-negative bacilli
Enterococci
Anaerobes
🗑
|
||||
| What are the recommended antibiotics in appendectomy and colorectal surgery? | Cefoxiting
Cefotetan
Ciprofloxacin and Metronidazole
🗑
|
||||
| What are the likely pathogens in OBGYN surgery? | Gram negative bacilli
Anaerobes
Group B steptococci
Enterococci
🗑
|
||||
| What are the recommend antibiotics in OBGYN surgery? | Cefatetan
Cefoxitin
Cefazolin
Clindamycin + Gentamycin
🗑
|
||||
| When undergoing and elective surgery, blood glucose levels should be controlled between | 100-250
🗑
|
||||
| Patients on oral hypoglycemic agents should discontinue their medications | The night before the surgery
🗑
|
||||
| Patients on insulin undergoing major surgeries should receive: | ½ their insulin dose and 5% dextrose IV at 100-125 mL/hour
🗑
|
||||
| It is considered safe to perform surgery when INR is | <1.5
🗑
|
||||
| If the INR is high before an emergency procedure, you should give: | you can either give factor VIII (immediately effective) or vitamin K (effective within 8 hours)
🗑
|
||||
| Most common indications for warfarin treatment: | Atrial fibrillation
Venous thromboembolism
Mechanical heart valve
🗑
|
||||
| How do you activate the pulmonary toiler postoperatively? | Early mobilization
Incentive spirometry
Cough
Deep breathing exercises
🗑
|
||||
| What are the consequences of inadequate pulmonary toilet? | Fever, hypoxemia, pneumonia, and atelactasis
🗑
|
||||
| What medications are generally given to a patient post-op? | Antiemetics
Ulcer prophylaxis (sucralfate)
Morphine
Antibiotics
🗑
|
||||
| What lab investigations are performed in a post operative patient? | CBC and coagulation (in significant blood loss)
KFT (in insufficiency, large IV fluid volumes, TPN, tranfusion, NPO)
Daily EGH and 3 troponin 3 levels (in cardiac risk factor patients)
Chest X-ray (if thoracic cavity involved/cardiopulmonary risk)
🗑
|
||||
| What are the intraoperative causes of fever? | Malignant hyperthermia
Transfusion reaction
Pre-existing infection
🗑
|
||||
| What are the postoperative causes of fever? | Wind/Atelactasis (first 2 days)
Water/UTI (3rd day)
Wound (5th day)
Walking/DVT (7-10 days)
Wonder drug
🗑
|
||||
| Which bacteria can cause fever in the first 2 days after an operation? | Beta hemolytic strep or clostridium
🗑
|
||||
| Clostridium infections appear as | Painful bronze/brown weeping wounds
🗑
|
||||
| What is the treatment of malignant hyperthermia? | Dantrolene (antidote)
100% oxygen
Correct acidosis and cooling blankets
Water for developing myoglobinurea
🗑
|
||||
| What is the clinical presentation of post-op MI? | Often without chest pain
New onset congestive heart failure
New onset cardiac arrhythmias
Abnormal vital signs: hypotension, tachypnea, tachycardia, or
bradycardia
🗑
|
||||
| Treatment of post-op MI: | MONAH-B
Morphine
Oxygen
Nitrates
Aspirin
Heparin
Beta blockers
🗑
|
||||
| What are the risk factors for atelactasis post-op? | COPD/smoking
Abdominal/thoracic surgery
Poor pain control: patient cannot breathe in deeply secondary to pain on inspiration
Oversedation
🗑
|
||||
| What are the signs of atelactasis? | Fever, tachypnea, and tachycardia
Decreased breath sounds with crackles
Increased density on chest X-ray
🗑
|
||||
| What is the treatment for post-op atelactasis? | Postoperative incentive spirometry
Deep breathing exercises
Coughing
Early ambulation
Chest and physiotherapy along with NT suction
🗑
|
||||
| What are the risk factors for aspiration pneumonia? | Intubation/extubation
Chest pain
Increased Impaired level of consciousness (drugs/ethanol
overdose)
NG tube
Tendelburg position
Emergent intubation on full stomach
Gastric dilation
🗑
|
||||
| What are the common sites of aspiration pneumonia? | Supine: right upper lobe
Sitting/semi-recumbent: right lower lobe
🗑
|
||||
| What are the common causes of urine retention post-op? | Enlarged urinary bladder resulting from medications or spinal anesthesia
🗑
|
||||
| What is the treatment of post-op urine retention? | Urinary catheter (Foleys)
🗑
|
||||
| How do you drain a massive urinary bladder? | Don’t drain all urine immediately to avoid a vasovagal reaction. Clamp after draining 1 liter of urine, then drain the rest slowly
🗑
|
||||
| The classic symptom of urinary retention in elderly is | Confusion
🗑
|
||||
| What are the differential diagnoses in postoperative renal failure? | Prerenal: inadequate perfusion
Renal: kidney parynchemal dysfunction
Postrenal: obstruction to outflow of urine
🗑
|
||||
| How do you interpret the work up to differentiate between Pre-renal and renal failure? | BUN: Cr
>20:1 pre-renal
<20:1 renal
Specific gravity:
>1.02 Pre-renal
<1.02 renal
Urine Na:
<20 pre renal
>40 renal
Urine osmolality
>500 pre renal
<350 renal
FENa
<1% pre-renal
>1% renal
🗑
|
||||
| What are the indications for dialysis? | Fluid overload
Refractory hypotension
Severe metabolic acidosis
BUN >130
Uremic complications
🗑
|
||||
| What are the post-op neurological complications? | Delirium tremans
Postop CVA
🗑
|
||||
| How do you treat delirium tremans? | IV benzodiazepenes
🗑
|
||||
| How do you treat post-op CVA? | Aspirin and Heparin
🗑
|
||||
| What are the possible complications of NG tube insertion? | Aspiration pneumonia
Atelactasis if the tube is clogged
Sinusitis
Minor upper GI bleeding
🗑
|
||||
| What are the postop causes of paralytic ileus? | Lapotomy
Hypokalemia
Narcotics
Intraperitoneal infection
🗑
|
||||
| What is short bowel syndrome? | malabsorption and diarrhea resulting from extensive
bowel resection (<120 cm of small intestines remaining)
🗑
|
||||
| How is short bowel syndrome treated? | With TPN followed by many small meals chronically
🗑
|
||||
| What is Blind loop syndrome? | Bacterial overgrowth in the small intestines
🗑
|
||||
| What are the causes of post-op B12 deficiency? | Gastrectomy (decreased secretion of intrinsic factor)
Excision of terminal ileum (site of B12 absorption)
🗑
|
||||
| What is Dumping syndrome? | Delivery of hyperosmotic chyme to the small intestine causing massive fluid shifts into the bowel
🗑
|
||||
| What are the signs and symptoms of Dumping syndrome? | Post prandial diaphoresis
Tachycardia
Emesis
Dizziness, weakness
Increased flatus
Abdominal pain and distention
🗑
|
||||
| What are the causes of prehepatic jaundice? | Hemolysis
Resolving hematoma
Transfusion reaction
Post-cardiopulmonary bypass
🗑
|
||||
| What are the causes of hepatic jaundice? | Drugs
Hypotension/hypoxia
Sepsis
Pre-existing cirrhosis
Right sided heart failure
Gilbert/ Criglar-Najjar syndrome
🗑
|
||||
| What are the causes of posthepatic jaundice? | Choledocholithiasis
Stricture
Cholangitis
🗑
|
||||
| What are the post-op infectious complications? | Catheter related infection
Prosthetic device related
Facial muscle infection
Intra-abdominal abscess/peritonitis
Respiratory/GI/GU infection
Wound infection
Patients requiring mechanical ventilation for longer than 48 hours
🗑
|
||||
| When are potassium supplements contraindicated? | ECG changes or when potassium >6
🗑
|
||||
| What are the potassium supplement doses recommended at different potassium levels? | <3: 30-40 mg/hour
3-4: 20-30 mg/hour
>4 10-20 mg/hour
5
🗑
|
||||
| When do you give bicarbonate to a DKA patient? | If the pH is <7.1
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Ulaisl
Popular Surgery sets