Surgical Medicine Exam 1 ALL SOLUTION 2025 LATEST GUARANTEED GRADE A+

Surgical Medicine Exam 1 ALL SOLUTION 2025 LATEST GUARANTEED GRADE A+ What were the 3 early obstacles of surgery? -pain -bleeding -infection What is the oldest surgery evidence? Trepanation Who is the father of surgical medicine? Hippocrates Extirpation complete excision of a body part -otomy cutting into something -ostomy (stoma) create an opening Resection take something out of body Amputation Removing part of the body 6 types of surgery: -diagnostic -exploratory -reconstructive -curative -palliative -transplant Classification of surgery: -Elective -Urgent -Emergent Surgical magnitude -minor -medium -major 4 aspects of patient communication -respect -listen -empathy -clarity Routine communication vs. urgent communication Routine - asynchronous, mailed or put in EMR Urgent - synchronous, direct verbal or phone conversation Nontechnical skills for surgeons (NOTSS) -situation awareness -decision making -communication and teamwork -leadership 4 Principles of medical ethics -autonomy -beneficence -nonmalifecence -justice Purpose of anesthesia: -sedate the person for procedures and reduce sensation of pain 5 main types of anesthesisa: -general -regional -local -monitored anesthesia care (MAC) -topical anesthesia ASA Physical Status Classification 1. Healthy person. 2. Mild systemic disease. 3. Severe systemic disease. 4. Severe systemic disease that is a constant threat to life. 5. A moribund person who is not expected to survive without the operation. 6. A declared brain-dead person whose organs are being removed for donor purposes. Mallampati Airway Classification What is a surgical time out? A period where the surgical team double checks all the details of the patient and surgery prior to the incision. Can be done more than once if more than one procedure is done on the same patient. Most common anesthesia post-op problems: -hypothermia -N/V -uncontrolled pain -hypo/HTN -hypoxemia -hypercapnia -agitation Common health situations that require surgery (POEM) -perforations/ punctures -obstructions -erosions/extravasation -masses Elective surgery examples: -knee replacement -fatty tumor removal -bariatric surgery for weight loss -tonsillectomy Urgent surgery examples: -early appendicitis -closed hip fracture -choledocolithiasis Emergent surgery examples: -incarcerated hernia -open fractures -ruptured spleen -testicular torsion -ectopic pregnancy Vitamin C (ascorbic acid) deficiency -scurvy -bleeding gums -dry skin -bruising B1 (Thiamine) deficiency Beriberi, Wernicke- Korsakoff. Mostly seen in alcoholics and bariatric surgery patients. B2 (riboflavin) deficiency -Cheilosis (cracks/fissures at angles of mouth) -Glossitis (inflam/atrophy of tongue) -Facial dermatitis B3 (niacin) deficiency Pellegra (4 D's include dementia, diarrhea, dermatitis, death) B5 (Pantothenic Acid) deficiency irritability, fatigue, cramps, vomiting Vitamin B12 (cobalamin) deficiency "Hunters glossitis" - beefy red patches on tongue -MACROCYTIC anemia -loss of balance -weakness B6 (pyridoxine) deficiency Cheilosis, stomatitis, glossitis, irritability, confusion, depression B7 (Biotin) deficiency scaly skin, dermatitis, dry eyes, insomnia, hair loss B9 (Folate) deficiency Neuro tube defects!! Vitamin A (Retinoids) deficiency night blindness, blindness Vitamin D (Calciferol) deficiency -Rickets: Bone softening and malformation -bone pain -weakness Vitamin E (Trocopherol) deficiency -vision problems -muscular weakness Vitamin K deficiency -bruising -hemorrhage Indications for EN/ PN: -NPO >7 days -enterocutaneous fistula -short bowel syndrome -prolonged ileus -patient cannot tolerate oral intake -intubated/ sedated Difference between EN and PN: EN: The gut WORKS - USE IT PN: Gut does not work -feeding through a peripheral IV line or central IV line -more expensive and more complicated Complications of PN: Air Embolism Hyperglycemia Hypervolemia Hypoglycemia Infection Pneumothorax Complications of EN: -tube related: bad placement, leakage, blockage -GI: diarrhea, bloating, cramping -metabolic: electrolyte disorders, vitamin deficiency Short Bowel Syndrome (SBS) Syndrome of: -malabsorption -diarrhea -steatorrhea -fluid imbalance -electrolyte imbalance -malnutrition Causes of SBS in adults Crohn's disease Mesenteric infarction Radiation enteritis Tumors Trauma Causes of SBS in children Necrotizing enterocolitis Intestinal atresias Malrotation with volvulus Extensive aganglionosis Gastroschisis Cloacal exstrophy Treatment of SBS: -surgery -diet modification -oral rehydration solution -soluble fiber -vitamin supplements -antidiarrheals -PPIs -Antibiotics (if C.diff) -PERT Surgical situations that require drain placement: -Eliminate dead space -Evacuate existing accumulation of fluid or gas -Remove blood, pus, or serous exudates -prevent potential accumulation of fluid or gas 3 main types of drains: 1. packs and wicks 2. Sheet drains 3. tube drains Shirley drain Drain with a flushing mechanism Classification of surgical drains: 1. open or closed 2. Active or passive Open passive drains Closed passive drains -Robinson tube drain -chest tube -ventriculo peritoneal shunt Closed active drain -redivac -hemovac -jackson pratt Complications of surgical drains -poor drain selection -Infection -pain/discomfort -Inefficient drainage -Incision dehiscence -Premature removal T/F: diabetics should not take their insulin the morning of surgery TRUE Supplemental corticosteroids for surgical patients minor surgery: usual dose moderate surgery: usual dose + 50mg hydrocortisone Major surgery: usual dose to 100mg hydrocortisone How often should you stop anticoagulants prior to surgery? 2-5 days prior How often should you stop antiplatelets (aspirin) prior to surgery? 7 days prior Makary score Pre-surgical risk assessment for the elderly -gender -BMI height Out of 5 points 4 or 5 = frail CIWA protocol decision making based on alcohol withdrawal symptoms if <8 score monitor 72 hours Risks of pulmonary complications post surgery -Major surgery -Prolonged duration of surgery (over 2 hrs) -Emergent surgery -Use of general anesthesia -smoking -OSA -Recent pulmonary infection -Preoperative anemia Risks for surgical site infections (SSI) -diabetes -hypoalbuminemia -cancer -immunosuppression 3 major roles of documentation: -record of care -billing -legal documentation CONTINUED.....