Surgery EOR Exam 1 Questions with 100%
Verified Correct Answers
the test of choice for detection of DVT
Venous duplex U/S
- All pts w/ DVT w/ or w/o a PE need a _____ months of anticoagulation to reduce the
risk of recurrent rhombosis
min. of 3
- Target INR is btwn 2.0 & 3.0
pulsatile epigastric mass
AAA
Abdominal ultrasonography is the diagnostic study of choice for AAA
Elective repair of AAAs that are _____ in greatest diameter is appropriate if the pt is
likely to tolerate the procedure & has life expectance > 2 yrs
5 cm or larger
elective reapir is indicated for
AAAs 5.5 cm or greater OR for those that have expanded 5 mm or more in 6 mo;
pts w/ pain or tenderness (may indicate impending rupture) should
have repair regardless of diameter
Major perioperative risks for ruptured AAA
higher risk of exsanguination, leading to death (perioperative mortality is as high as 80%)
Syncope, HYPOtension, & a pulsatile abdominal mass are considered
,evidence of ruptured AAA until proven otherwise - important to suspect rupture AAA, b/c a
delay in dx is often fatal
- > 50% of pts w/ this condition die before arriving to the ED
Excruciating ripping/tearing abdominal pain that radiates to back
ruptured AAA
- Sudden, tearing chest pain w/ radiation to the back, abdomen, or neck in
HYPERtensive pt
Aortic Dissection
what do you see on CXR in Aortic Dissection
- Widened mediastinum on CXR
ruptured AAA has ___tension
Aortic dissection has ___tension
ruptured AAA = HYPOtension
Aortic dissection has HYPERtension
standard therapy for aortic dissection is
control HTN
• Beta-blockers are 1st-line therapy
when is urgent surgery needed in type A and B dissections
- for ALL type A dissections (dissection of ascending aorta)
- for type B dissections if there is aortic branch compromise causing malperfusion of the
renal, visceral, or extremity vessels
,mcc of arterial embolism
a fib/ the heart
get
- Echo
- Arteriogram
5Ps of embolism
pain, pallor, pulselessness, paresthesias, paralysis
needs:
- Heparin
- Embolectomy
Lower leg pain w/ exercise, which is relieved by rest (intermittent claudication), usually
is the 1st sx of peripheral dz. Later, pain at rest occurs
PVD
cornerstone of dx of peripheral vascular disease
Ankle-brachial index (ABI)
• Normal ABI is 1.0 or greater
• ABI is unreliable in pts w/
calcified vessels (i.e. diabetics). Why? Calcified vessels are not easily compressed, so you
cannot get good pressures
main drug used to treat PVD initially
Cilostazol
biggest RF for PVD
, smoking
Arterial ulcer disease has ___ pain and ___ necrotic tissue while venous ulcer disease
tends to have ____ pain and ____ necrotic tissue
AUD= severe- relieved by lowering the leg and CONTAINS necrotic tissue
VUD= no pain and no necrotic tissue
Leg has minimal/no hair; thin, dry & shiny skin
Arterial ulcer disease
describe the ulcers seen in AUD
- looks like a deep pale base w/ well-defined edges;
- contain black or necrotic tissue
- Locations of ulcers: *at tips of toes or btwn toes** over phalangeal heads, above lateral
malleolus, over the metatarsal heads, on the side or sole of feet
describe the typical onset of VUD
Red, pruritic patches of stasis dermatitis often precede ulceration
Classically, chronic edema is followed by a dermatitis, which is often pruritic
describe the location of the ulcers seen in VUD
lower 1/3 of leg, pretibial area, anterior to medial malleolus
Dull, aching heaviness &/or feeling of fatigue in the legs after prolonged standing
Varicose Veins
Dilated, tortuous, superficial veins in the lower extremities
most commonly involved in varicose veins
Verified Correct Answers
the test of choice for detection of DVT
Venous duplex U/S
- All pts w/ DVT w/ or w/o a PE need a _____ months of anticoagulation to reduce the
risk of recurrent rhombosis
min. of 3
- Target INR is btwn 2.0 & 3.0
pulsatile epigastric mass
AAA
Abdominal ultrasonography is the diagnostic study of choice for AAA
Elective repair of AAAs that are _____ in greatest diameter is appropriate if the pt is
likely to tolerate the procedure & has life expectance > 2 yrs
5 cm or larger
elective reapir is indicated for
AAAs 5.5 cm or greater OR for those that have expanded 5 mm or more in 6 mo;
pts w/ pain or tenderness (may indicate impending rupture) should
have repair regardless of diameter
Major perioperative risks for ruptured AAA
higher risk of exsanguination, leading to death (perioperative mortality is as high as 80%)
Syncope, HYPOtension, & a pulsatile abdominal mass are considered
,evidence of ruptured AAA until proven otherwise - important to suspect rupture AAA, b/c a
delay in dx is often fatal
- > 50% of pts w/ this condition die before arriving to the ED
Excruciating ripping/tearing abdominal pain that radiates to back
ruptured AAA
- Sudden, tearing chest pain w/ radiation to the back, abdomen, or neck in
HYPERtensive pt
Aortic Dissection
what do you see on CXR in Aortic Dissection
- Widened mediastinum on CXR
ruptured AAA has ___tension
Aortic dissection has ___tension
ruptured AAA = HYPOtension
Aortic dissection has HYPERtension
standard therapy for aortic dissection is
control HTN
• Beta-blockers are 1st-line therapy
when is urgent surgery needed in type A and B dissections
- for ALL type A dissections (dissection of ascending aorta)
- for type B dissections if there is aortic branch compromise causing malperfusion of the
renal, visceral, or extremity vessels
,mcc of arterial embolism
a fib/ the heart
get
- Echo
- Arteriogram
5Ps of embolism
pain, pallor, pulselessness, paresthesias, paralysis
needs:
- Heparin
- Embolectomy
Lower leg pain w/ exercise, which is relieved by rest (intermittent claudication), usually
is the 1st sx of peripheral dz. Later, pain at rest occurs
PVD
cornerstone of dx of peripheral vascular disease
Ankle-brachial index (ABI)
• Normal ABI is 1.0 or greater
• ABI is unreliable in pts w/
calcified vessels (i.e. diabetics). Why? Calcified vessels are not easily compressed, so you
cannot get good pressures
main drug used to treat PVD initially
Cilostazol
biggest RF for PVD
, smoking
Arterial ulcer disease has ___ pain and ___ necrotic tissue while venous ulcer disease
tends to have ____ pain and ____ necrotic tissue
AUD= severe- relieved by lowering the leg and CONTAINS necrotic tissue
VUD= no pain and no necrotic tissue
Leg has minimal/no hair; thin, dry & shiny skin
Arterial ulcer disease
describe the ulcers seen in AUD
- looks like a deep pale base w/ well-defined edges;
- contain black or necrotic tissue
- Locations of ulcers: *at tips of toes or btwn toes** over phalangeal heads, above lateral
malleolus, over the metatarsal heads, on the side or sole of feet
describe the typical onset of VUD
Red, pruritic patches of stasis dermatitis often precede ulceration
Classically, chronic edema is followed by a dermatitis, which is often pruritic
describe the location of the ulcers seen in VUD
lower 1/3 of leg, pretibial area, anterior to medial malleolus
Dull, aching heaviness &/or feeling of fatigue in the legs after prolonged standing
Varicose Veins
Dilated, tortuous, superficial veins in the lower extremities
most commonly involved in varicose veins
