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2013-10-16 16:46:45
Surgery PA

Surgery PA
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  1. adenocarcinoma is the most common lung cancer seen in nonsmokers, particularly....

    It generally originates in the ____ of the lung.

    large cell carcinoma, originate _____
    women and younger patients (like other lung cancer types, is more likely to appear in smokers)


  2. Most common Salter-Harris fracture is
    II, those that involve both the growth plate and a chip fracture of the metaphysis
  3. most appropriate therapy for an acute bowel perforation is a  _____ procedure
    Hartmann, which includes resection of the affected portion of the bowel, a temporary diverting colostomy, and oversewing of the distal rectal stump; the second stage of the procedure will involve taking down the colostomy with anastomosis to the rectal stump.
  4. Pancreatic pseudocysts are the most common complication associated with acute ______. should be suspected for a patient who has continued abdominal pain, the development of an abdominal mass, and continued elevations of amylase or lipase levels following an episode of acute pancreatitis.
  5. A _____ involves injury to the muscles and tendons that are responsible for active movement of various body parts. Fascia is a part of the muscle-tendon unit, so injury to fascia would be considered a _____ as well. Injury to ligaments and joint capsules would be considered a ____ and damage to bone would be classified as a fracture.


  6. When a hip fracture occurs in the ______ that includes displacement, the leg appears shortened, abducted and externally rotated. The tension that exists from muscles attached above and below the fracture site results in shortening of leg length after the fracture as the muscles contract. If there is no displacement of the bone, no leg length changes should occur.
    femoral neck
  7. When the leg appears shortened, flexed, adducted, and internally rotated, a ___ hip dislocation should be suspected
  8. A leg that is flexed, abducted and externally rotated suggests an _____ hip dislocation
    anterior, accounting for more than 90% of all hip dislocations
  9. The sensory nerve emanating from the C7 level is responsible for sensation of the ____.

    The ____ is supplied by C6

    The ___ arm is supplied by C5.

    The _____ arm is supplied T1 and the ____ is supplied by C8.
    the third finger

    lateral forearm

    lateral upper

    medial upper

    medial forearm
  10. The clinical symptoms associated with chronic intestinal ischemia include....
    severe epigastric pain following meals, which results in weight loss and fear of eating. Nausea, bloody diarrhea, and vomiting as well as guarding and rigidity are consistent with acute intestinal ischemia.
  11. Obturator and psoas signs are indicative of
    Obturator and psoas signs are indicative of
  12. Many trauma surgery services use an absolute tissue pressure of approximately _____ as the threshold for diagnosing compartment syndrome.
    30 mm Hg
  13. Congenital cerebral aneurysms or Berry aneurysms account for 75% to 80% of _____
    nontraumatic subarachnoid hemorrhages (SAHs).
  14. controlled hypertension and anticoagulant use are more commonly associated with
    intracerebral hemorrhages (ICH).
  15. .... can cause either SAH or ICH
  16. _____ carcinoma presents with weight loss, jaundice, and midepigastric pain.
  17. A palpable, nontender gallbladder (____ sign) is more often associated with a pancreatic malignancy than cholelithiasis, especially if the tumor is in the head of the pancreas.
  18. obstruction of the common bile duct in choledocholithiasis will result in ____ but not weight loss
  19. Routine follow-up after surgical resection of a colon cancer includes annual _____ not sigmoidoscopy, which only assesses the distal colon.
  20. The tumor marker for colon cancer is .....
    carcinoembryonic antigen (CEA)
  21. carbohydrate antigen 19-9 (CA 19-9) is used for ....
    pancreatic cancer
  22. Barium enema finding of carcinoma of the sigmoid colon causing high-grade obstruction shows the classic ....
    "apple core" lesion
  23. Barium enema finding of ______ is typically associated with the string sign, which is an area of stricture or stenosis that shows up as a narrow line of contrast, giving the appearance of a string associated with the stricture.
     Crohn's disease
  24. Barium enema finding of ____ is associated with outpouchings from the colon that will be filled with barium
    Diverticular disease
  25. _____ is a common electrolyte disturbance in surgical patients. It can be caused by enhanced losses, hyperaldosteronism, inappropriate replacement, and intracellular shifts caused by alkalosis.
  26. Symptoms of hypokalemia may include ....
    constipation, neuromuscular weakness, diminished tendon reflexes, paralysis, and distinctive electrocardiographic changes
  27. Concomitant deficiencies in _____ can contribute significantly to the development of hypokalemia as well as hypocalcemia.
  28. ____ is the first-line study in the evaluation of patients presenting with signs and symptoms of biliary disease.
  29. ______ is a type of primary bone cancer.

    bimodal occurrence rate with the highest prevalence between ages ___ and over the age of __ .
    Osteosarcoma and more common in the pediatric population

    11-13  65
  30.  A leiomyoma is another name for a .....
     benign uterine fibroid
  31. ______ is a benign, soft, freely movable, generally nontender mass in the soft tissue sometimes referred to as a fatty tumor. These are generally inconsequential, but may be a marker for spina bifida if found in the lumbar region.
  32. Isometric hand grip exercises will increase the intensity of the murmur of .....
    aortic regurgitation, which is usually described as a high-frequency decrescendo early diastolic murmur that is heard best at the left upper sternal border or at the right upper sternal border. Radiation, if it occurs, is frequently to the lower left sternal border and the apex. Isometric hand exercises increase arterial and left ventricular pressure, which increases the flow across the aortic valve, thereby increasing the murmur's intensity.
  33.  Patients with factor XI deficiency have a prolonged ____ , normal ____, and normal platelets count.
    • aPTT
    • PT
  34. ____ extremity DVTs are rare, even after trauma, and warrant a hypercoaguability work-up to rule out inherited disease.
  35.  The ____ is commonly compressed as it passes through the carpal tunnel in the wrist.
    median nerve-This syndrome is most often diagnosed in middle aged or pregnant female patients.
  36. The ___ nerve passes through the axilla and is often compressed when patients use crutches improperly and bear weight on the axillary area.
  37. The ____ is second only to the median nerve and can be compressed as it passes through the cubital tunnel at the elbow or as it passes through the humeral and ulnar heads of the flexor carpi radialis muscle.
    ulnar nerve
  38. Compression of the ____ (and its branches) as it passes through the radial tunnel on the lateral side of the elbow is often confused with lateral epicondylitis.
  39. The ______ is associated with the lower extremities and pain is often elicited as a result of a lumbar disk herniation causing nerve root impingement.
    sciatic nerve
  40. Myotomy or pneumatic dilatations are treatments of choice in otherwise healthy individuals with _____.
  41. _____ is used for gastroesophageal reflux and is relatively contraindicated in achalasia
    Nissen fundoplication
  42. Esophagectomy is reserved for treatment of refractory or ______ achalasia
  43. Medical treatment for achalasia, consisting of __________ can also be used but has not been found to provide the long-term relief of symptoms achieved with myotomy
    calcium channel blockers and botulinum injections
  44. Papillary carcinoma is the ______ type of thyroid malignancy. Treatment includes a ____. Radioiodine ablation is recommended postoperatively
    most common

    thyroid lobectomy and isthmusectomy or total thyroidectomy
  45. _____ is used as prophylaxis for the majority of clean surgical procedures.  For cases in which there is an increased likelihood of encountering gram-negative organisms or anaerobic bacteria, a second-generation cephalosporin is recommended to provide broader coverage. Vancomycin is an alternative if the patient has an allergy to cephalosporin antibiotics
  46. The initial study to diagnose a subarachnoid hemorrhage is a ___ of the head. the clinical suspicion is high, then proceed with a lumbar puncture for the presence of red blood cells in the cerebrospinal fluid; xanthochromia can be seen with an old SAH.
    noncontrast CT scan
  47.  : Massive distention of the cecum, as detected on plain radiograph, is typically seen in "closed loop" obstructions where the ileocecal valve is competent. When distention approaches 12 cm, there is an increased risk of perforation and/or gangrene. Expedient ______ is indicated. Although observation with intravenous fluids and nasogastric decompression are important adjuncts to management, surgical exploration is the only way to rapidly address this emergent situation.
    surgical intervention
  48. _____ typically presents with severe, steady midepigastric abdominal pain that radiates through to the back; pain is associated with fever, nausea, and vomiting.
    Acute pancreatitis
  49. The most common causes of acute pancreatitis are ___and ____. Laboratory studies will show elevated WBC and serum amylase levels. Amylase elevations are nonspecific and can be elevated with perforated ulcers and mesenteric ischemia.
    •  gallstones
    • alcohol
  50. A perforated ulcer will show evidence of____ on plain film; mesenteric ischemia will not present with fever or an elevated WBC unless there is the presence of infarcted bowel at which point the patient would appear septic.
     free air
  51.  When there is greater than __ degrees of angulation or an extensor lag (the patient cannot fully extend the affected finger) then a referral is required. Lesser degrees of angulation without an extensor lag can generally be handled conservatively with an ulnar gutter.
  52. What is the recurrence rate of an individual with a pneumothorax?
    The recurrence rate of 30% is usually either seen right after chest tube removal by observation or by obtaining serial chest radiographs. These recurrences can be observed immediately or by delay, sometimes several weeks to months after the initial event. Once corrected by surgery the recurrence is dramatically reduced.
  53. What is the most common joint dislocation in children?
    In children the elbow is the most commonly dislocated joint and it is the second most common joint dislocation for adults. The shoulder and finger are dislocated more frequently than the elbow in adults. Knee dislocations at the femur-tibia joint are rare (patellofemoral dislocations are more common) and ankle dislocations are also relatively rare
  54. What are the three conditions that must exist for compartment syndrome to occur?
    By definition, compartment syndrome occurs within a closed space or a compartment. When tissue injury occurs, due to either acute or chronic insult, swelling in that tight space causes an increase in pressure. When the pressure rises, that decreases tissue perfusion. Perfusion may also be affected by blood vessel damage during acute trauma.
  55. Patients who present with hematemesis and shock requiring multiple transfusions in 24 hours are at high risk for mortality from gastrointestinal bleeding. The hematemesis in this patient warrants further investigation with__________ to both determine the site of bleeding and provide potential therapy by endoscopic electrocautery or injection.
     upper gastrointestinal endoscopy
  56. _______ scans and chest radiographs should be obtained as part of the preoperative staging of colon carcinoma for the evaluation of distant metastasis.
    Abdominal/pelvic CT
  57. The ____ is the most common bone fracture that leads to acute compartment syndrome. It can also occur after other long bone fractures of the arms and legs. While it does occur in the hands and feet, it is unlikely that the fracture of a small carpal bone (scaphoid) or tarsal bone (talus) would result in compartment syndrome.
  58. When a bone is fractured, there are the 3 stages of healing. What is the proper order in which the healing occurs?
    Inflammatory changes happen after fractures and this is followed by a reparative phase and ultimately, a remodeling phase. The healing from acute injuries generally starts with inflammation,. Once the integrity of the bone has been restored on the macro level, bone remodeling continues until full healing has
  59. Entrapment of which nerve can lead to muscle wasting of the hypothenar eminence over time?
    ulnar nerve innervates this area, so a more proximal ulnar nerve entrapment can result in atrophy in the hypothenar area over time. Damage to the long thoracic nerve affects the function of the serratus anterior muscles and can produce winging of the scapula. Prolonged median nerve entrapment can lead to muscle wasting in the thenar eminence on the anterior lateral aspect of the hand. Entrapment of the radial nerve, specifically a deep branch of the radial nerve called the posterior interosseous nerve can cause lateral elbow pain. The radial nerve is responsible for supplying neurological input for the wrist and finger extensors, so entrapment can produce weakness and atrophy of those muscles. The sciatic nerve is located in the lower extremities and has no impact on the hands.
  60. A patient is recovering from having a total thyroidectomy two days ago for medullary thyroid cancer. An extensive neck dissection was required during the surgery. Post-operative lab testing reveals a low serum calcium level. Which of the following clinical presentations will most likely occur in this patient?
    paresthesias. Circumoral paresthesias are signs of hypocalcemia. Hypocalcemia can occur after any type of neck surgery that may have resulted in destruction of the parathyroid glands.
  61. A 64-year-old man has been experiencing intermittent left lower abdominal pain associated with alternating diarrhea and constipation. The pain has been increasing over the past 24 hours and is now associated with a fever. The abdomen is tender with evidence of peritoneal signs. Which of the following diagnostic studies is most appropriate to evaluate this patient?
    For a patient with diverticular disease, the preferred study to evaluate complications, such as a perforation or abscesses, is a CT scan. A barium enema or endoscopic procedure is contraindicated due to increased risk of perforation during an acute exacerbation
  62. Osteomyelitis is an infection in a bone and can occur in patients of all ages. List bugs and what age group they target
    The most common organism implicated in osteomyelitis across all age groups is Staphylococcus aureus.

    Hemophilus influenzae was a much more common organism in pediatric osteomyelitis in the past, but its prevalence is decreasing due to routine immunizations.

    Group A beta-hemolytic streptococci
    is the second most common organism found in osteomyelitis in children, while Pseudomonas aeruginosa is the second most common pathogen in adults.

    induced osteomyelitis is relatively rare and usually confined to immunocompromised patients

  63. The presenting symptoms associated with ascending cholangitis include ______; the symptoms are secondary to an infected obstruction of the common bile duct. With spread of the infection, the patient may also develop hypotension and mental status changes; these additional symptoms in conjunction with Charcot's triad are known as Reynolds' pentad. Additional symptoms of common bile duct obstruction include light-colored stools and dark, tea-colored urine.
    fever, chills, right upper quadrant pain, and jaundice (Charcot's triad);
  64. Minimally displaced Salter-Harris types I, II, and III fractures generally can be treated with _____.
    Types IV and V involve the cartilage of both the articular surface and the growth plate. To ensure proper alignment and a congruous joint surfaces ____
    immobilization only

    open reduction and internal fixation is usually necessary
  65. ______ is the forward movement of one vertebral body on the vertebra below. This most commonly occurs with L5 on S1 (more than 85% of cases) or L4 on L5. It is often due to a spondylosis (a bony defect) in the pars articularis as pictured above which is an acquired condition that may develop as a result of a stress fracture and it is not uncommon in children or adolescents. A small number of spondylolithesis cases are congenital.
  66. The heart accounts for 80% of all ____, with ______ making up 70% of that.

    atrial fibrillation
  67. Surgical resection of lung carcinoma is ______ in cases of superior vena cava syndrome, extrathoracic metastases, heart, pericardial or great vessel involvement, recurrent laryngeal or phrenic nerve involvement, esophageal or carina involvement, malignant effusion, or contralateral mediastinal lymph nodes. Other contraindications are patient and staging dependent.
  68.  In Graves' disease, the thyroid is diffusely enlarged in contrast to a toxic adenoma in which the thyroid is normal sized but with a palpable nodule. ____is the treatment of choice for a toxic adenoma. Surgical treatment of a toxic adenoma is a thyroid lobectomy and isthmusectomy. A subtotal or total thyroidectomy is indicated for toxic multinodular goiters or Plummer disease. Thionamides and radioiodine ablation are not effective therapies for toxic adenomas.
  69. The most common site for an acute embolic occlusion is the ____. Other common sites include the axillary, popliteal, and iliac arteries as well as the aortic bifurcation and mesenteric vessels. The majority (80%) of arterial embolic originate in the heart in patients with atrial fibrillation or from mural thrombi in the left ventricle from an akinetic or dyskinetic portion of the myocardium following a myocardial infarction.
    femoral artery
  70.  ___ percent of cancer patients will develop metastatic disease of the vertebrae at some point during the course of their illness. The highest percentages of cancers that lead to such spinal lesions are carcinomas of the breast, lung, prostate, colon, thyroid and kidney. (BLT Kosher Pickle)This likely occurs through hematogenous spread. Pain is a common presenting symptom, but it may be found while still asymptomatic if routine screenings are done with bone scans, MRI or CT in patients with a known primary tumor elsewhere in the body. The pain is usually worse with weight bearing activities and better when lying down, but pain that persists through the night and prevents sleep needs to be evaluated for possible neoplasm. Some metastatic disease of the spine may present with neurological symptoms such as sensory or motor deficits following a spinal nerve root distribution or more generalized neurological deficits due to spinal cord compression or cauda equina

    • BLT Kosher Pickle with cheese
    • breast, lung, thyroid, kidney, prostate, colon
  71. Dysphagia on a background of GERD is an alarm signal for ___, since GERD is related to increased risk for esophageal adenocarcinoma.

    Esophageal cancer is associated with a progressive course of dysphagia, first to bulky foods, then softer foods, and then liquids as the tumor invades the esophagus; significant weight loss is almost universal at the time of presentation.
  72. In emergent situations an AMPLE history should be taken...
    • Allergies
    • Medications
    • Past medical history
    • Last meal
    • Events leading up to the emergency
  73. Allergy history should include not only food and medication _____ but also any history of problems with ______.
    • reactions
    • anesthesia
  74. Medications houls be reviews for any that cause increeased bleeding tendencies: (at least six____)
    Herbal supplements that increase bleeding time are (at least six____)
    aspirin, warfarin, alcohol, NSAIDs, chemotherapeutic agens, abx

    feverfew, garlic, ginger, gingko biloba, ginseng, and vit E
  75. Determine if the event is  _____, ______, or ______. Seven cardinal signs of the symptom include (7X____)
    acute, subacute, or chronic

    location of the complatint, quality of the symptom, quantity or severity, timing, setting, alleviateing or aggreavating facotrs, and any associated complaints.
  76. DRUGS mnemonic for takeing a drug history
    • Dispensed: by a doctor or other medical provider
    • Recreational: alcohol, tobacco, street drugs, anabolic steroids
    • User: OTC, herbal supplements
    • Gynecologic: birth control, hormone replacement therapy
    • Sensitivities: focus is on drug sensitivities rather than on allergies
  77. No documentation exists linking a redcution in mortality and morbidity to routine laboratory testing in otherwise healthy patients undergoing elective surgical procedures. True or False
  78. The history and physical examination are the ___ important preoperative evaluation that can be perfomred by the surgical team.
  79. CBC should be considered if the patient has signs and symptoms compatible with ____ or if the loss of blood during the procedure is determined to be significant.
  80. Serum Electrolytes
         _____ indicated for pts without medical problems.
         Should be conidered in patient taking certain medications b/c of the association with ____ abnormalities and toxicity
        More useful as a _____ laboratory evaluation


    post opererative
  81. Serum Creatinine
       Easy and cheap marker for renal function.  Cr lvls decrease with ____ and ____ muscle mass
        Should be obtained in all pts > ___ y.o.
        Should be obtained if the pt is going to receive nephrotoxic meds. or if intraoperative hypotension is anticipated or cross clamping of the aorta will be performed
    age and decreasing muscle mass

    40 y.o.
  82. Blood glucose: obtain in pts with a personal or family history of DM or those who will undergo ___ ___ for peripheral vascular dz, abdominal ____ ___ repair, or CABG
    bypass grafting, AAA
  83. Hepatic Enzymes
         ___ indicated routinely in healthy pts
        ____ if clinical signs and symptoms indicate hepatic dysfuntion
    Not, order
  84. Coagulation studies
         The best determinant of bleeding tendencies during surgeris is an accurate history detailing coagulation response to minor trauma True or False
    PT and PTT should be done in pts taking anti coagulants True or False
    • True
    • True
  85. Urinalysis
        The incidence of asymptomatic UTI is _% to __%. Asymptomatic UTIs are a concern to the surgical team whenever a prosthetic deice is to be used.
       There is no consensus on the routine use of urinalysis in healthy patiets. true or false

  86. Electrocardiography
      This is generally recommended in all pts older than ___ y.o.
      Silent MIs are most common in __ and __ pts

    Elderly and those with DM
  87. CXR
         A lot of evidence supports routine CXR in pts without significant risk.  True or false
      CXR may be indicated in pts older than ___ y.o.  and it should be perfomred in all pts regardless of age, who have any history of significant pulmonary or cardiac dz.

  88. Spirometry
         The american college of Physicians recommends preoperative spirometry for pts being evaluated for ____ and _________ surgery and for pts who have a history of ____ or ____
    thoracic and upper abdominal

    smoking or dyspnea
  89. ABG
         Only done in the preop if there is any indication of severe underlying cardiopulmonary disease or to confirm acid base disturbance. True or False
    Pulse ox should not be used before considering an ABG True or False
    • True
    • False do a pulse ox before ABG and it is often good enough data preop
  90. Pregnancy test: Are indicated in all women of childbearing age who are undergoing surgery. True or False
  91. Detsky's Modified Cardiac Risk index
    Class I: points____ : cardiac risk ____
    Class II: points___ : cardiac risk _____
    Class III:points___ : cardiac risk _____
    0-15 low

    20-30 intermediate

    31+ high
  92. General hx for post op risk assessment
        previous ___, heart ___, COPD, ____, PVD, and ___ or ____ impairment
    MI, heart failure, DM, hepatic or renal impairment
  93.  PE for post op risk assessment
          look for JVD, heart ____, irregular ___, pulmonary ____,abnormal aortic pulsations, and peripheral edema
    heart murmurs, irregular heart beats, pulmonary crackles
  94. DVT prophylaxis
        Rudolp Virchow's Triad (3X__) describes pts at risk.
        DVT is though to start at the induction of ______ in elective surgical cases, so any attempts at prophylxis should start preoperatively.
    stasis, intimal damage, and hypercoagulability

  95. DVT prophylaxis
        high risk populations include pts > __ y.o., and those undergoing a surgery lasting >__ hours
    • 70

    2 hours
  96. DVT
       Prophylaxis using agents that alter blood coagulability should or should no be considered for procedures within the central nervous system
    should not!
  97. Moderate risk DVT
    major general, urologic, gynecologic, cardiothoracic, vascular, or neurologic surgery, age >40 y.o.

    major medical illness, heart or lung disease, malignancy

    Major trauma or thermal injury

    minor surgery, trauma in patients with thromboembolism history
  98. major risk DVT
    Fracture or orthopaedic procedure of pelvis, hip, or lower extremity

    pelvic or abdominal surgery for malignancy

    major surgery or trauma in patients with thromboembolism hisotry

    lower limb paralysis

    major lower limb amputation
  99. Some high risk pt populations (orthopaedics, obesity surgery) may require DVT propylaxis for up to __ days after discharge.
  100. DVT prophylaxis options
      unfractionated heparin ____Units subcutaneously every __ to __ hrs. should be started preoperatively and continued intil the pt is fully ____

    8 to 12 hrs

  101. Heparin therapy is cost effective and efficacious method of prophylaxis True or False
  102. DVT prophylaxis options
        Enoxaparin ___ mg subcutaneously daily should be started ___ hrs before or after the procedure and continued until the patient is fully ambulatory or up to __ days following surgery
        Adjustment is necessary in cases of ____ impairment.



  103. DVT prophylaxis options
        Warfarin has been used in orthopaedic pts populations after initial use of heparin.
        The dosing is usually begun the night before or the day following surgery and is ___ to ___ mg
         The dosing is complicated and a __ level must be checked periodically. Warfarin is associated with higher incidence of bleeding complications.
    5 to 10 mg

  104. DVT prophylaxis options
         Fondaparinux is associated witha lower incidence of DVT in ___ surgery
        adjustment is necessary in pts with ___ insufficiency

  105. DVT prophylaxis options
        Nonfitted thromboembolic stockins are recommended. True or false
    • false ARE NOT rec.
    •  the elastic band at the top can restrict blood flow and act like a tourniquet
  106. DVT prophylaxis options
        Sequential compression devices are benfical in all pt populations and the choice for pts in whom anticoagulation is contraindicated. True or false
  107. DVT prophylaxis options
        Greenfield filter insertion is a ____ procedure that protects from clots that form in the ___

    lower extremity
  108. DVT prophylaxis options
        Dextran can be used but is associated with the risk of heart failure, renal failure, and difficulties in the cross matching of blood. true or false
  109. Surgical Nutrition
         a malnourished pt is defined as someone who has lost more thatn ___% of their lean body mass and/or  has not had adequate nutritional intake fror more than ___ days.

  110. Surgical Nutrition
        in severe malnutrition _____ or ____ may develop
    marasmus or kwashiorkor

    (big belly and skinny extremities)
  111. Surgical Nutrition
       BMI, arm circumferencem and nitrogen balance are useful parameters to measure overal status true or false
  112. Diarrhea
       never assume that diarrhea is solely from enteral feedings, always consider _____as a potential etiology
    Clostridium difficile pseumembranous enterocolitis
  113. Trauma
        Traumatic inhuries are the leading cause of death between the ages of __ and __ years
        MVA are the leading cause of accidental deaths in the US.  __ is linked to at least half of all fatal motor vehicle incidents.
    1 and 44 years

  114. Trauma
       Primary Survery; ____
    • ABCs
    • Airway
    • Breathing
    • Circulation
  115. Trauma Primary survey
        First priority is a ___ and ___ ___.
        C-spine stabilization should be provided by a _____ collar.
        AMS is the most common indication for ___-
    patent and functioning airway

    Hard (philadelphia)

  116. Trauma: Primary Survey
        Orotracheal intubation is the _____ modality.
        Nasotracheal intubation requires that patient be _____.
        Cricothyroidotomy can be performed in emergent situations but only by experienced operators and not in pts under age ___ due to the risk of developing _____ stenosis



  117. Trauma: Primary Survey, Breathing
         Caregivers shouuld look for the presence of ___ ____, open ___ ___, or ____ ____.
         Tension pneumothorax is associated with ____, ___ _____ away from the side of injury, JVD, _____ breath sounds, hyperressonance on the effected side, and subcutaneous emphysema.
    tension pneumothorax, open chest wounds, or flail chest

    hypotension, tracheal deviation, decreased or absent
  118. Trauma: Primary Survey
        open chest wounds should be completely occluded with dressing, because this may convert the wound into a tension pneumothroax True or False
    FALSE should not!!!
  119. Trauma: Primary Survey
        Flail chest is characterized by ____ breathing.
        Segmental rib fractures cause free floating segments tha move opposite to the normal respiratory patterns.
        the major problem is not the fracture byt rather the underlying pulmonary _____

  120. Trauma: Primary Survey
       IV access with at least two angiocatherters of (>___ gauge) should be established.
      Infusion of balanced soln such as ___or ___ should be started.

    LR or normal Saline
  121. Trauma: Primary Survey
         Persistent hypotensions requires the exlcusion of ____ _____, _____ ____, or ____ _____
    tension pneumo, MI, cardiac tamponade (beck's triad muffled heart sounds, JVD, hypotension)
  122. Trauma: Secondary Survey
        After the primary survey and assurance of the ABCs, a ____ __ should be done.  The focus is to idnentify any ____ injuries the pt may have sustained.
    secondary survey

  123. Trauma: Secondary Survey
      Secondary survey inlcudes thoracic or abdominal injuries, neurologic deficits, lacerations, or hematomas, msk injuries must be IDed. true or false
  124. Penetrateing chest trauma
      ____% of penetrating chest trauma can be managed by a tube throacostomy alone.
  125. Indication for thoracostomy in penetrating trauma
         ______  ______ unable to drain via thoracostomy tube.
        Evacuation of 1,500 mL of blood in an injury <_____ hrs old
    caked hemothorax

    less than 3 hours old
  126. Indication for thoracostomy in penetrating trauma
        Signs of cardiac _____
        signs of ______ perforation

  127. Indication for thoracostomy in penetrating trauma
        ______ sounds in chest indicating diaphragmatic injury
        persistant leakage of ____
        development of bronchopleural _____


  128. Penetrating Flank Trauma
      Workup in the stable pt include CT with oral and IV ____.  Penetrating flank trauma is difficult to assess, because many injuries in this region may be _____.

  129. Penetrating Flank Trauma
        Analgesia with appropiate NSAIDs or opiates should be used in penetrating flank trauma. true or false

    witholding appropiate analgesia for fear of changing the findings during sequential clinical examination is unfounded and can cause sever physiologic and psychological consequences in pts
  130. Vascular Trauma
         Look for signs of ___ injury, such as a pulsatile mass or hemorrhage, expanding hematoma, significant hemorrhage, presene of a thrill or bruit, or acute ishcemia to the involved extremity
  131. Vascular Trauma
         The presence of a pulse distal to the injury does rule out significant vascular injury.  true or false

    the presence of a pulse distal to the injury does not rule out significant vascular injury.
  132. vascular trauma
         Arteriography and the ___-____ index are useful diagnostic tests for determining arterial injury
    ankle brachial
  133. Head trauma
        the ___ ____ ___ score should be calculated in all trauma pts.
       -it is useful for triage and prognosis
       - even a ___ has a score of three
    Glascow coma scale

  134. Head trauma
        The avoidance of secondary insults to the brain as caused by hypotension and ____ is paramount in determining the outcome and reducing the ____ of the injury.
    • hypoxemia
    • severity
  135. ____ skull fractures may be associated with rhinorrhea, otorrhea, or ecchymosis of lids (_____ eyes)

  136. ____ sign is ecchymosis behind the ear and is a sign of a ____ skull fracture

  137. Glasgow Coma Scale
    4 ___
    5 ___
    6 ___
    • Eye opening (4 eyes)
    • Verbal (5 vowels)
    • Motor (6 banger)
  138. Epidural Hematomas
          Epidural Hematomas are usually cause by injuries to the ____ ____ ____
          a brief period of unconsciousness is followed by a ____ interval
    middle meningeal artery

  139. epidural hematoma
        herniation may develop and is heralded by a triad of ___, ____ and dilated ____, and decerebrate posturing.
    coma, fixed and dilated pupils
  140. epidural meatomas
         Diagnosis is established by CT and requires emergent _____
  141. subdural hematoma
         subdural hematomas usually result from injuries to bridging ____
         theyare associated with severe head injuries and can result in significant ____ injury even after evacuation

  142.  subdural hematoma
         Chronic subdural hematomas are more common in ____ and ____ pts
         it can occur after apparently ___ trauma and is associated with mental status chages or focal neurologic signs.
    alcoholic and elderly

  143. subdural hematoma
          ___ is diagnostic and once the diagnosis hjas been made ____ holes over the hematoma are indicated to evacuate the clot.

  144. BURNS
        first degree burnds involve minor damage to the ____
        second degree burns are subdivided into superficial parital thickness burns that extend to the papilallary dermis and ___ ___ burns that extending into the reticular dermis

    deep superficial
  145. BURNS
        third degree burns destroy the ____ and ____ and are called full thickness burns
    epidermis and dermis
  146. BURNS
         ______ burn injuries are treated each year
         5000 deaths per year with 40,000 hospitalizations in United states due to burns
        ______ burns are the most common

  147. BURNS clinical features
       first degree burs are characterized by erythema, tenderness, and the absence of ____
  148. BURNS clinical features
        superficial second degree burns have thin walled fluid filled blisters that are ___, ____ with pressure, and are painful
        deep second degree burns have ____ walled blisters, many of which are ruptured, exhibit a mixture of erythema and pallor, and are painful with the application of pressure.


  149. BURNS clinical features
        third degree burns give the skin a ____, _____, ______
        the skin is ____ and with out _____
     white, leathery, or charred appearance


    w/o sensation
  150.  BURNS labs
         required labs include _____, electrolytes, _____ and creatinine, UA and _____

    BUN (CBC and Chem7)

  151. BURNS
        any burn that occurs on the face, on the upper torse, or in an unconscious pt should raise the suspicion of associatied ____ _____ ____
    upper airway involvement
  152. BURNS
        electrical burns do correlate with findings on the skin true or false

    they do not
  153. BURNS Tx
         maintain _____
         estimate the burn %
  154. BURNS
        Rule of 9's
        the head represents ___% and each arm is ___%
         the front of each leg is _____% and the back is _____%
         the front of the torso is ____% and the back of the torso is ____%
         the perineum is ____%



  155. BURNS  stop the burning process
        sterile ___ is usually sufficient, but first look for ____ if dealing with a chemical substacne, as pouring water on a chemical may activate it and cause further burn dmg.

  156. BURNS TX
      burs that are caused by white phosphorus may  require nertralizastion with 1% ____ _____ solution and administration of ____ gluconate to address concomitant hypo____
    1% copper sulfate soln

    calcium gluconate

  157. BURNS
  158. burns, shock
      become familiar with formulas for burns
       Parkland formula: % of burn area X body wt (kg) X 4 mL/hr equals total amount of fluid needed in the next 24 hours
       half the calculated fluid is given during the first __ hours and the rest over the remaining ___ hours
       ____ solns are recommended
       monitor ___ output as a measure of adequate circulation and hemodynamic stability



  159. burns tx
       insert a ____ tube b/c gastric distention can be problematic and in severe cases may cause non fluid respondent hypotension because of mediastinal shift from an overly disteded stomach.
  160. burns Tx
       a foley catheter should be inserted early and used for monitoring urine output.
       ____ mL/kg/hr in adult
       ____ mL/kg/hr in child

  161. burns
       escharotomy may be needed to prevent ____ syndrome, if on torse it could make ventilation difficult
  162. Burns
       Most common used topical burn ointment
    sulfadiazine (silvadene)
  163. Burns
       deep dermal and full thickness burns are typically excised on or about day ___.
  164. Post op complications
         post op fever
         Most early post op fever is caused by _____ released as part of the inflammatory response to trauma and resolves without intervention
  165. Post op complications
          Name the 5 Ws that aid in determining the cause of fever
    • Wind
    • Wound
    • Water
    • Walking
    • Wonder drugs/ Whopper
  166. Post op complications
        Wind (______)
        Wind is usually the cause of fever in the first ____ to ____ hours post op
          Examination may reveal _____ breathing and in cases of significant atelectasis, the trachea may be ____ toward the ____ side

    24 to 48


    deviated toward the affected side
  167. Post op complications
          Water (_____)
           Post op UTI most commonly develops ____ to ___ hours after surgery
          Many cases are caused by indwelling ______ _____ or GU _____
          Pts may complain of ____, ____, or _____

    48 to 72

    indwelling urinary catheters

    GU instrumentation

    dysuria, frequency, or urgency
  168. Post op complications
         Wound infx
         Wound infx are most common post op fever > ____ hrs
          ___________ is the most common pathogen
         Mild change in the vital signs is seen early and pain may or may not eb present at the site of infection
         Superficial infx involve the skin and ____ tissue; deep infx involve areas below the ____

    Staphyloccus aureus


  169. Post op complications
         Walking (____)
         superficial thrombophlebitis most commonly is associated with intravascular catheters.  ____ drainage around an indwelling catheter with induration of the vein may be detected on physical exam
          deep thrombophlebitis can be associated with indwelling ___ ____ or ____

    central lines

  170. Post op complications
         Wonder drugs
          wonder drugs, such as _____, sulfa containing ____ and others are implicated in drug fever that develope ____ week after post op
         this is a diagnosis of ____ and should be considered when faced witha a ____ sepsis workup in post op pt with fever



  171. Post op complications
         Whopper refers to the presence of a post op ______.
      in the case of intra abdominal fluids collection and ____ may develop as a sequela of an occult abscess
        blood cultures may be _____ indicating anastomotic leakage.


  172. Post op complications
        The gold standard for DVT is _____. but it is invasive and can cause inflammation because of intimal injury.
  173. Post op complications Tx
        Atelectasis is tx by _____
        pts should be told to stop smoking ____ week/s before a thoracic or upper abdominal operation
         instuction in using an ____ ____ should be given and its use encouraged as a preventive measure

    2 weeks

    incentive spirometry
  174. Post op complications Tx
         if atelectasis develops post op, incentive spirometry, ____, _____ and inhaled ____ are beneficial
    expectorants, mucolytics, and beta agonists
  175. Post op complications Tx
           UTIs are the most common _____ infx
           UTIs should be treated based off the ____ and ____ reports
           If feasible the ____ should be removed
           in critically ill pts aleardy on multiple abx a UTI with ____ may be suspected

    culture and sensitivity

    foley catheter

    Candida sp
  176. Post op complications
          Superficial thrombophlebitis requires _____ of the IV line at the site of the infx and the use of _____ ______
          if systemic signs and symptoms are present or if the pt is immunocompromised or diabetic, abx that cover both _____ and _____ should be started

    warm compresses

    staphylococcus streptococcus
  177. septic thrombophlebitis requires a ___ ____ of the affected site, b/c it will behave like an abscess and abx will not penetrate the infx
    vein stripping
  178. Post op complications
         DVT should be tx with ____ or ____
         if anticoagulation is contraindicated a ____ should be used
    heparin LMWH

    ivc filter
  179. Post op complications
         whopper  intraabdominal abscess require surigical or radiologically drained with ___ given
  180. Keloids and hypertrophic scars
       both represent abdormal healing and imbalance between ____ deposition and degradation
        keloids are more common in _____ and ____

    AA and Asians
  181. Keloids and hypertrophic scars
        _____ may work as tx
    kenalog (topical triamcinolone)
  182. Decubitus ulcers (pressure ulcers)
        decubitus ulcers are linked to ____ and ____ forces over bony prominces
         most come from immobile pts that sustain uniterrupted pressure with subsequent tissue ______
          pts with _____ injuries are the most likely to develop these injuries
    pressure and shear


    spinal cord
  183. pressure sores
        abx should be used for all pressure sores True or false
    false only if they are septic
  184. Necrotizing fasciitis
         Rare complication but is more common with pts with ____, ____, and ____ drug users
         mortality rates range from ___ to ___
         it can be polymicrobial or cause by _____ or ____. saltwater Necrotizing fasciitis is caused by _____
    DM, alcoholics, IV drug

    25 to 70

    Group A strep, clostridial infx

  185. Necrotizing fasciitis Clinical characteristics
        Pts can present with a multidude of symptoms including rapidly progresssing_____, tissue crepitus, marked tissue tenderness, high____,  tachycardia, hypotension, and _____


  186. Necrotizing fasciitis Diagnostics
         Look for triad WBC > ______, elevated _____, and _____
         triad is not in all pts


  187. Necrotizing fasciitis
         Plan films are helpful only if gas is present within the affected tissues True or false
  188. Necrotizing fasciitis Tx
          surgical ___ is mainstay of therapy
          ABX include Penicillin G, clindamycin, and gentamicin
          monitor ____ function

  189. 70 kg person 60% of body wt is water

       ___ is intracellular
       ___ is extracellular
             ____ is plasma around 3.5 L
             RBC is around ____ L
             total is around ____ L for blood volume
    2/3 intracellular

    1/3  extracellular

    1/3 plasma

    1.5 L RBC

    5 L of blood
  190. Extracellular        Intracellular
    Na         _________          __________    
    K           _________          __________  
    Ca         _________          __________  
    Magn     _________          __________  
    Cl          _________          __________  
    Carbonate _______          __________  
    phosphate ________        __________
    • Extracellular        Intracellular
    • Na       140                 10       
    • K         4.0                  150         
    • Ca       2.5                   4.0
    • Magn   1.1                   34    
    • Cl        104                  4.0    
    • Carbonate24                12                phosphate 2.0              40
  191. Correction of hypernatremia should not be corrected  at a rate exceeding ____mEq/L per hour.

    this can lead to ____3X

    seizures, cerebral edema, and death
  192. Peptic ulceration is the most common inflammatory process of ____
    GI tract
  193. hydrochloric acid is secreted via ____ and found in the ____ of the stomach
    parietal cells and found in the fundus
  194. pepsinogen is secreted via ____ cells found in the ____ part of the stomach
    chief cells

    proximal stomach
  195. gastrin cells secreting ___ cells found in the ___ part of the stomach

  196. ____ arteries feed the stomach
  197. Vagus nerve gives the stomach _____ signal and this _______

    increase gastric secretions and motility
  198. Name the things that can alter GI mucosa
    NSAIDS, EtOH, tobacco, H. Pylori
  199. Triple Tx for H. pylori is
    tetracycline, metronidazole, bismuth subsilicylate

    amoxicillin, metronidazole, rantitidine
  200. Cushing's ulcer should be thought of when
    there is intracranial pathology
  201. Zollinger Ellison gastinoma are found in the ____

    Tx with ____
    gastrinoma triangle cystic duct, common bile duct, and the duodenum

    • Tx with H2 and PPI
    • somatostatin analogs
    • curable with resection, if not resectable debulking is palliative
  202. Stomach cancer
    Physical exam shows
    Firm nontender mobile epigastric mass

    mets virchow suprclavicular setinal node

    sister joseph umbilical nodes

    blumer shelf on rectal exam
  203. Indications for surgery in Crohn's D
    • fistula
    • abscess
    • perforation
    • bleeding
  204. Medical treatment of Crohn's
    4-6 wks course of sulfazalazine or mesalazine

    metronidazole may be helpful

    bile salt induced diarrhea after resection may benefit from cholestyramine
  205. Meckel's diverticulum rule of 2s
    2% of pop

    within 2 ft of ileocecal valve

    2 in long

    most common reason 2 year old have rectal bleeding
  206. Surgical Tx for Meckel's diverticulum
    if causing symptoms resection

    if presented in asymptomatic pts and found incidentally it is best left alone

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