Complete Surgery Review

Overview

• Purpose: Prepare for Shelf and Step 2 exams with 120 surgery review questions
• Approach: Use memorable phrases and scenarios to aid retention

Medication Management Before Surgery

• NSAIDs and Cox-2 Inhibitors: Stop 7 days before surgery (e.g., Naproxen)
• Herbal Supplements: Stop 7 days before
• Beta Blockers & Calcium Channel Blockers: Continue without interruption
• Diuretics: Stop on the day of surgery
• Insulin: Continue long-acting; stop short-acting on the day of surgery
• Steroids: Continue, often with higher doses for stress dosing

Intraoperative Cardiac Risks

• EF < 35%: 75% mortality rate
• Transmural MI (6 months ago): 6% mortality rate

Pre-Op Smoking Cessation

• Reason: Compromised ventilation and high pCO2 levels
• Methods: Nicotine replacement, bupropion, varenicline

Pre-Op Cardiac Risk Factors

• JVD (Heart Failure): Highest risk of mortality
• Treatment: ACE inhibitors, beta-blockers

Surgical Timeouts

• Checklist: Patient identity, site, and laterality verified by two providers
• Permanent Markers: Mark operative site only

Post-Operative Fever

• Mnemonics: Atelectasis (Day 1), Pneumonia (Day 3), UTI (Day 3), DVT (Day 5), Wound Infection (Day 7), Abscess (Day 10-15)

Wound Care

• Freshly debrided wounds: Wet-to-dry dressings
• Healthy granulation tissue: Moisture-retaining dressings

Linear Skull Fractures

• Treatment: Observation

Pulmonary Embolism (PE) Post-Surgery

• Symptoms: Pleuritic chest pain, hypoxemia, hypocapnia
• Next Step: Heparin administration

Nissen Fundoplication & Vagus Nerve Damage

• Results: Gastroparesis, dietary modifications, metoclopramide

Paralytic Ileus Management

• Symptoms: Absent bowel sounds, mild distension
• Treatment: Conservative with serial exams

Mechanical Bowel Obstruction

• Symptoms: Persistent distension, dilated loops on X-ray
• Next Step: Abdominal CT and surgery

Intubation and Pneumonia Prevention

• Methods: Minimize transport, suction, semi-recumbent position

Bariatric Surgery Effects

• Duodenal Switch: Resolves type 2 diabetes in >95%

Shock Etiology

• Anaphylaxis: Dilation of blood vessels causing shock

Hirschsprung's Disease

• Next Step: Full-thickness biopsy of rectal mucosa

Peripheral Artery Disease

• Test: ABI (Ankle-Brachial Index)
• Follow-up: CT or MRI angiogram

Subdural Hematoma Management

• Contradiction: Warm fluid infusion
• Preferred: Cold water infusion, hypothermia, hypertonic solutions

Tension Pneumothorax

• Symptoms: Tachycardia, hypotension, absent breath sounds
• Management: Needle decompression, formal chest tubes

Pulmonary Contusion

• Timing: Up to 48 hours post-injury
• Symptoms: Hypoxemia, hypercapnia

Femoral Vein Catheterization

• Setting: Trauma with unsuccessful peripheral IV

DIC During Surgery

• Management: FFP and platelets, continue surgery unless hypothermia or acidosis develops

Gunshot Wounds

• Next Step: Tetanus prophylaxis

Pleural Effusion Analysis

• Exudative Effusion: LDH pleural/serum ratio > 0.6
• Likely Conditions: Chylothorax, empyema, malignancy

Hip Fractures

• Treatment: Open reduction, post-op anticoagulation

Metabolic Alkalosis

• Fluid Therapy: Normal saline with KCl

Surgery Contraindications

• Absolute: Diabetic coma

Malignant Hyperthermia

• Causes: Halothane and succinylcholine
• Treatment: Dantrolene

Radiation Proctitis

• Symptoms: Rectal bleeding, telangiectasias

Bladder Rupture

• Symptoms: Abdominal fluid wave, inability to void
• Diagnosis: Retrograde cystography

Hemolytic Transfusion Reactions

• Symptoms: Fever, flank pain, dark urine
• First Step: Coombs test

Diabetic Foot Ulcers

• Management: Imaging to rule out osteomyelitis