MTB Surgery

Question 1

If the patient is under the age of 35 and has no history of cardiac disease, EKG is the only test needed. A patient who has a history of cardiac disease, regardless of age, must have a(n):

Answer 1

• EKG
• Stress testing to evaluate for ischemic coronary lesions
• Echocardiogram for structural disease and to assess ejection fraction

Question 2

Have the patient quit smoking for xxx prior to surgery and use a nicotine patch in the meantime.

Answer 2

6 to 8 weeks

Question 3

Systemic Inflammatory Response Syndrome

There are 4 SIRS criteria; the presence of at 2 or more indicates SIRS.

Answer 3

1. Body temperature 38°C
2. Heart rate >90 BPM
3. Tachypnea >20 breaths per minute, or PC02 12,000 cells/mm3

Question 4

2 criteria of SIRS + source of infection=

Answer 4

sepsis

Question 5

2 criteria of SIRS + source

of infection + organ dysfunction =

Answer 5

severe sepsis

Question 6

2 criteria SIRS + source

of infection+ organ dysfunction + hypotension =

Answer 6

septic shock

Question 7

Four kinds of shocks

Answer 7

cardio
hypo
neuro
septic

Question 8

Kehr sign

Answer 8

Pain in the left shoulder

Splenic rupture

Question 9

KUB x-ray

Answer 9

A kidney, ureters, and bladder

Question 10

Ischemic bowel disease The most common symptoms are:

Answer 10

• Abdominal pain after eating • Bloodydiarrhea

Question 11

a full-thickness tear of the esophagus secondary to retching.

Answer 11

Boerhaave syndrome

Question 12

Rovsing sign

Answer 12

palpation of the left lower quadrant causes pain in the right lower quadrant

Question 13

Psoas sign

Answer 13

pain with extension of the hip

Question 14

Obturator sign

Answer 14

pain with internal rotation of the right thigh

Question 15

SMO causes

Answer 15

• Adhesions from previous
• Intussusception
• abdominal surgery
• Hernias
• Crohn disease
• Neoplasms
• Volvulus
• Foreign bodies
• Intestinalatresia • Carcinoid

Question 16

POD 1- 2

Answer 16

Atelectasis or postoperative

pneumonia

Question 17

POD 3- 5

Answer 17

Urinary tract infection

Question 18

POD 5-7

Answer 18

Deep vein thrombosis or thrombophlebitis of
the IV access lines.
Must also consider pulmonary embolism for new-onset tachycardia and chest pain.

Question 19

POD 7

Answer 19

Wound infections and cellulitis

Question 20

POD 8-15

Answer 20

Drug fever or deep abscess

Question 21

SBO diagnosis

Answer 21

• An elevated white count is sensitive but not specific.
• An elevated lactate with marked acidosis is a hallmark sign.
Xray and CT

Question 22

SBO Treatment

Answer 22

1. Make the patient NPO.
2. Place an NG tube to help decompress the bowel.
3. IVfluidhydrationasvolumeislosttothirdspacing.
4. Transport to the operation room for emergent surgical resection.

Question 23

Compartment Syndrome

The 6 signs of compartment syndrome are:

Answer 23

1. Pain: most commonly the first symptom
2. Pallor:lackofbloodflowcausespaleskin
3. Paresthesia: “pins and needles” sensation
4. Paralysis: inability to move the limb
5. Pulselessness: lack of distal pulses
6. Poikilothermia: cold to the touch

immediate fasciotomy