Term
|
Definition
| removal, excision, resection |
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Term
|
Definition
| surgical repair, surgical correction |
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Term
|
Definition
| process of visual examination |
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Term
|
Definition
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Term
|
Definition
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Term
| an agent, such as heat, radiation, or a chemical, that disinfects by destroying, neutralizing, or inhibiting the growth of disease-carrying microorganisms |
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Definition
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|
Term
| destruction of pathogenic organisms to prevent infection. Processes, procedures, or chemical treatments that kill or inhibit microorganisms to prevent infection. |
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Definition
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Term
| without contamination with bacteria or other microorganisms. Not producing micoorganisms or free from micoorganisms. |
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Definition
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Term
| preventing bacteria from growing or multiplying but possibly not killing them. |
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Definition
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|
Term
| an agent that destroys bacteria |
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Definition
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Term
| type of anestehsia used in outpt clinics |
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Definition
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|
Term
| agent used to reduce the MAC of inhalation agents |
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Definition
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|
Term
| benefits of opiods as anesthesia |
|
Definition
profound analgesia with minimal cardiac depression.
blunt HTN and tachycardic response to ET inbutation.
extend analgesia and facilitate a smoother awakening from anesthesia. |
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Term
|
Definition
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|
Term
| only depolarizing agent in use today |
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Definition
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Term
|
Definition
| hyperkalemia and malignant hyperthermia |
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|
Term
| first local anesthetic used |
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Definition
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|
Term
| most widely used local anesthetics (2) |
|
Definition
| lidocaine, mepivacaine, novocaine |
|
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Term
|
Definition
| oral numbness, lightheadednes, altered tase, tinnitus |
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|
Term
| what can be added to a local anesthetic to accelerate penetration? |
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Definition
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|
Term
| why epinephrine added to local anesthetics? when can it not be added? |
|
Definition
to keep the anesthetic localized, decreased systemic absorption, increase the duration of action.
Not added when working on the nose, penis, fingers, or toes. |
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|
Term
| reversal agent for benzos |
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Definition
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|
Term
| reversal agent for narcotics (opiods) |
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Definition
|
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Term
|
Definition
| it reverses ALL narcotic effects --> HTN, stroke, tachycardia, arrhythmias, CHF, cardiac arrest. |
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|
Term
| elective surgery cannot proceed with out this |
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Definition
|
|
Term
| persons (usually family) who make decisions when a pt cannot speak for themselves |
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Definition
| surrogate decision makers |
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|
Term
| legal documents that inform health care providers about the pts wishes regarding the level of care to be delivered when the pt is unable to do so |
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Definition
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|
Term
| what type of history should be taken for a surgical case? |
|
Definition
Allergies
Meds
PMHx
Last oral intake
Events preceeding the emergency |
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|
Term
| 3 major risks for a DM pt undergoing surgery |
|
Definition
derrangements in blood sugar (want to maintain between 150-200)
CV complications
increased risk of infection |
|
|
Term
| complications of hyperthyroidism with surgery |
|
Definition
increased risk of thyroid storm and arrhythmia (a-fib)
muscle weakness
decreased healing |
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|
Term
| what is used to measure the operative risk of a hepatic dysfunction pt? |
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Definition
|
|
Term
| when do alcohol withdrawals occur? peak? |
|
Definition
occur within 1-5 days
peak at 3 days |
|
|
Term
|
Definition
| vitamins, thiamin, folate |
|
|
Term
| how do you tx alcoholic DT's? |
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Definition
|
|
Term
| acute adrenal insufficiency is seen in pts on steroids for how long? tx? |
|
Definition
> 5 days
use supplemental steroids so pt can stand the stress of surgery |
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|
Term
| best indication of nutritional status |
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Definition
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|
Term
| complications of malnutrition for a surgery pt (3) |
|
Definition
decreased healing
infection
increased pulmonary complications |
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|
Term
| can you access dialysis catheters if you need an IV and can't get it? |
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Definition
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|
Term
| what should you be conscious of with a renal pt in surgery? |
|
Definition
don't used K+ IV fluids
use the "renal" dose of abx |
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|
Term
| when should prophylactic antibiotic therapy be started? |
|
Definition
| pre-op in time to reach adequate tissue levels before contamination, adequate levels must be maintained throughout surgery |
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|
Term
| prophylactic abx if anaerobic flora is NOT suspected |
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Definition
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|
Term
| prophylactic antibiotic with suspected colonic anaerobes? |
|
Definition
|
|
Term
| prophylactic abx with suspected bacteroides |
|
Definition
|
|
Term
| prophylactic abx used for colonic surgery |
|
Definition
| nicols prep: neomycin/erythromycin |
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|
Term
| when are prophylactic abx not effective? |
|
Definition
tracheostomy
indwelling catheters
burns |
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|
Term
| T/F the larger the suture prefix the larger the suture? |
|
Definition
False!
The larger the prefix, the smaller the suture |
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|
Term
| what size suture: face, scalp, trunk/extremities, deep tissues |
|
Definition
face: 5-0, 6-0
scalp: 3-0
trunk/extremities: 4-0, 5-0
deep tissues: 3-0, 4-0 |
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|
Term
| when should sutures be removed: face/neck, scalp/body, extremities |
|
Definition
face/neck = 3-5d
scalp/body = 5-7d
extremities = 7-10d |
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|
Term
| how is total body water and blood volume distrubted in the body? |
|
Definition
2/3 of TBW is intracellular
1/3 of TBW is extracellular
85% of total blood volume is venous
15% of total blood volume is arterial |
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|
Term
| what is of the utmost importance with post-op infection |
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Definition
|
|
Term
| signs of post-op infection (5) |
|
Definition
| pain, fever, hemodynamic changes, wound discharge, erythema |
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|
Term
| tx for Gram + post op infections |
|
Definition
| cefotaxime, ceftizoxime, ceftriaxone, ceftazadime, aztreonam |
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|
Term
| tx for gram - post op infections |
|
Definition
| gentamycin, trobramycin, amikacin, fluoroquinalones |
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|
Term
| tx of anaerobic post op infections |
|
Definition
| clindamycin, metronidazole, chloramphenicol |
|
|
Term
| superficial wounds usually appear how long post op? |
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Definition
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|
Term
| organisms common of superficial post op wounds above the waist |
|
Definition
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|
Term
| organisms common of superficial post op wounds in the axillae |
|
Definition
| prominent gram - bacteria |
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|
Term
| organisms common of superficial post op wounds below the waist |
|
Definition
| mixed aerobic/anaerobic gram - flora |
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|
Term
| tx of intra-abdominal infections |
|
Definition
ampicillin/gentamycin/clindamycin
unasyn, piperacillin |
|
|
Term
| when should you d/c post op antibiotics? |
|
Definition
| if pt is afebrle x 48 hrs, consider d/c or change to PO rx for 7-10 days |
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|
Term
| risks inherent to surgery (4) |
|
Definition
| bleeding, infection, pulmonary complications, DVT's |
|
|
Term
| co-morbid illnesses that increase the risk of infection |
|
Definition
|
|
Term
| most fevers within the first 24 hrs are related to |
|
Definition
| normal physiologic responses from surgery |
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|
Term
| 5 W's of post op wound infection |
|
Definition
wound
wind
water
walk
weird drugs/what did we do? |
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|
Term
| superficial wound infections: early, late |
|
Definition
early: think necrotizing soft tissue
late (5-10d): superficial abscess |
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|
Term
| intra-abdominal abscesses usually occur when? |
|
Definition
|
|
Term
|
Definition
atelectasis (collapse of small airways, within the first 24 hrs)
aspiration - pneumonitis, pneumonia |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| stasis, hypercoagulability, endothelial damage |
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|
Term
| calf edema, tenderness, + Homan's |
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Definition
|
|
Term
|
Definition
| age, obesity, OC's, malignancy, leg trauma, ortho surgery, immobility |
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|
Term
| what is the normal return of GI motility post op |
|
Definition
small bowel returns first
stomach activity within 24-48 hrs
colon activity is last > 48 hrs |
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|
Term
| Pt is NPO until when after surgery? |
|
Definition
| bowel sounds are auscultated and pt passes flatus |
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|
Term
|
Definition
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|
Term
| partial or total disruption of any/all layers of a post-op wound: early, late |
|
Definition
early: wound dihiscence
late: incisional hernia |
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|
Term
| collection of liquefied fat, serum, and lymphatic fluid, often opened or aspirated |
|
Definition
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|
Term
| collection of blood, usually in the subcutaneous layer of a recent incision |
|
Definition
|
|
Term
|
Definition
compression of the airway = evacuated immediately
small = often resorb |
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|
Term
|
Definition
primary - immediate closure
secondary - no closure
tertiary - delayed primary |
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|
Term
| risk factors for delayed post op wound healing |
|
Definition
| advanced age, malnutrition, diabetes, morbid obesity, immunosuppression, coexisting remote infection, colonization with bacteria, prior radiation therapy, smoking |
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|
Term
| causes of abnormal wound healing |
|
Definition
DIDNT HEAL
DM
Infection
Drugs
Nutritional Problems
Tissue necrosis
Hypoxia
Excessive tension
Another concurrent wound
Low Temperature |
|
|
Term
|
Definition
staphylococcus aureus followed by:
staphylococcus coagulase negative
enterococcus
escherichia coli |
|
|
Term
| how does protein effect wound healing? |
|
Definition
| protein catabolism results in delayed wound healing |
|
|
Term
| how does vitamin C affect wound healing? |
|
Definition
deficiency can affect wound healing.
tx = 100-1000 g/day |
|
|
Term
| how does vitamin A affect wound healing? |
|
Definition
| deficiency impedes monocyte activation and vitamin A contributes to lysosomal activity and directly counteracts the effect of glucocorticoids |
|
|
Term
| how does vitamin K affect wound healing? |
|
Definition
| vitamin K metabolism is impeded by antibiotics |
|
|
Term
| how does zinc affect wound healing? |
|
Definition
| zinc deficiency results in early wound healing delays |
|
|
Term
| summary of post op fever: day 1-2, day 3-5, day 5-7, day 7+ |
|
Definition
1-2 = wind (atelectasis)
3-5 = water (UTI)
5-7 = wound (infection)
7+ = wonder drugs |
|
|
Term
| dyspnea, SOB, hemoptysis, tachycardia |
|
Definition
|
|
Term
| what should you monitor while the pt is on heparin? warfarin? |
|
Definition
heparin = PTT
warfarin = PT |
|
|
Term
| rapid rise in body temp, muscle rigidity/stiffness, dark brown urine, muscle ache |
|
Definition
|
|
Term
| triggers of malignant hyperthermia |
|
Definition
inhaled halothane anesthetics
succinylcholine |
|
|
Term
| gold standard for dx of malignant hyperthermia |
|
Definition
IVCT (in vitro contracture test)
+ occurs with contracture of muscle fibers to halothane or caffeine |
|
|
Term
| treatment of malignant hyperthermia |
|
Definition
| dantrolene via rapid IVP, d/c the triggering anesthetic |
|
|
Term
| complications of malignant hyperthermia |
|
Definition
| rhabdo, renal failure, myopathy, death |
|
|
Term
| post op fever weeks later |
|
Definition
| endocarditis, infected prostheses |
|
|
Term
| divisions of the pharynx (3) |
|
Definition
nasopharynx
oropharynx
hypopharynx |
|
|
Term
|
Definition
supraglottis (epiglottis)
glottis
subglottis |
|
|
Term
| where does most lip cancer occur? |
|
Definition
| lower lip (often in the 50-80 yo group) |
|
|
Term
|
Definition
|
|
Term
| MC cancer of the upper lip |
|
Definition
|
|
Term
| formation of an opening that will close spontaneously (5-7days) |
|
Definition
|
|
Term
| formation of a permanent opening(remains open after removal of the tube) |
|
Definition
|
|
Term
| MC use for a tracheostomy today |
|
Definition
| mechanical ventilation (after 3 days of intubation - 2-3 weeks) |
|
|
Term
| most common breast tumor in young women |
|
Definition
|
|
Term
| most common cause of bloody nipple discharge |
|
Definition
|
|
Term
| firm nodular breast lesions, cysts, epithelial hyperplasia |
|
Definition
|
|
Term
| risk factors for malignant disease of the breast |
|
Definition
increasing age
+FHx breast or ovarian cancer
HRT
Alcohol consumption
early menarche
late menopause
nulliparity
radiation exposure |
|
|
Term
|
Definition
Airway
Breathing
Circulation
Disability (neurologic)
Exposure of the pt, Environment |
|
|
Term
| MC complication from breast cancer tx |
|
Definition
|
|
Term
| dual carcinogenic role of ionizing radiation |
|
Definition
disrupts cellular DNA
induces chronic TSH stimulation by damaging the production of thyroid hormone |
|
|
Term
| in regards to thyroid cancer, what does hot/cold mean on a radionuclide thyroid scan? |
|
Definition
hot = not (benign)
cold = low levels of uptake, minimal function, 5% = malignant |
|
|
Term
| 4 types of thyroid cancer |
|
Definition
anaplastic - most malignant/aggressive
medullary - asstd with MEN 2A or 2B
follicular - iodine deficiency
papillary - MC in the US, grows slowly, mets via lymph, asstd with exposure to ionizing radiation |
|
|
Term
| with regards to a toxic adenoma, what does hot mean on thyroid scan? |
|
Definition
| hot = functional, not malignant |
|
|
Term
| raising the arms above the head --> venous compresson of the thoracic inlet --> engorgement of the head and neck and a feeling of strangulation |
|
Definition
|
|
Term
| How is TSH affected in thyrotoxicosis? Hashimoto's? |
|
Definition
thyrotoxicosis = decreased TSH
Hashimotot's = increased TSH |
|
|
Term
| what is the defintive dx for thyroid nodule? |
|
Definition
|
|
Term
| when is a solitary cystic nodule considered resolved? |
|
Definition
| if the fluid has negative cytology, and the mass disappears |
|
|
Term
| when should you follow up a pt who has a solid, benign nodule? |
|
Definition
| 3-6m, give thyroid hormone PO to suppress tumor growth |
|
|
Term
|
Definition
HTN
+ FHx
hypercholesterolemia
smoking
obesity
diabetes
physical inactivity |
|
|
Term
| how does DM affect the risk for CAD? |
|
Definition
| increased risk for CAD and increased mortality rate after CABG |
|
|
Term
| how does being a woman afffect risk for CAD? |
|
Definition
lower incidence of CAD than men
CAD = leading cause of death in US women
mortality rate after CABG is higher than men |
|
|
Term
| what is an independent risk factor for survival after CABG? |
|
Definition
|
|
Term
|
Definition
| cardiac catheterization (diagnostic and therapeutic) |
|
|
Term
| medical management of CAD |
|
Definition
CCB, ACEI
Lipid lowering agents
lifestyle changes |
|
|
Term
|
Definition
GSV, LSV
internal mammary
radial artery, ulnar artery
PTV/A
ATV/A
peroneal vein/artery
cephalic vein |
|
|
Term
|
Definition
sliding - only significant when gastric acid is refluxed into the lower esophagus
Paraesophageal hernia - fundus can become incarcerated |
|
|
Term
| hiatal hernias are usually found in who? |
|
Definition
women who have been pregnant
overweight men and women |
|
|
Term
| hiatal hernias predispose a person to? |
|
Definition
|
|
Term
|
Definition
most pts respond to medical therapy
H2RA, PPI, antacides
if no response - reconstruction of the valve mechanism (Nissen fundoplication, Hill, Belsey) |
|
|
Term
| fibrotic ring at the LES from chronic reflux |
|
Definition
|
|
Term
| epithelium change from squamous to columnar at the LES |
|
Definition
|
|
Term
| Barrett's esophagus is the precursor to |
|
Definition
| adenocarcinoma of the esophagus |
|
|
Term
| failure of the LES to relax, occurs at the distal esophageal circular muscular segment, results in progressive dilation of the esophagus |
|
Definition
|
|
Term
| what disease is associated with achalasia? |
|
Definition
|
|
Term
| bird beak deformity on xray |
|
Definition
|
|
Term
|
Definition
CCB
surgery (most reliable)
esophageal myotomy (Heller), modified fundoplication can be done at the same time |
|
|
Term
| caused by a dysfucntion of the cricopharyngeal muscle |
|
Definition
|
|
Term
| pt regurgitates recently swallowed food or pills, and has a foul odor to their breath, dx? |
|
Definition
|
|
Term
|
Definition
| myotomy of the cricopharyngeal muscle and excision or elevation of teh diverticula |
|
|
Term
| All of lecture 12 (abdomen) is fair game |
|
Definition
|
|
Term
| all of lecture 13 (vascular) except accesses and ports) |
|
Definition
|
|
Term
| the highlights of lecture 14 (surgical specialties) |
|
Definition
|
|
