Surgery Study Guide

CLINICAL YEAR 2005-2006
STUDY GUIDES

Jefferson College of Health Sciences
Roanoke, VA

General Surgery Rotation

For the following medical conditions or disease processes, understand the

physiology and epidemiology

clinical presentation, acute and chronic

laboratory and diagnostic findings

treatment

management, pharmacological and non-pharmacological

prevention

Resources: first-year lectures, required reading, preceptor’s materials, PANCE review books, the Blueprint series, and Uptodate.com

Surgical Competencies Expected of PA Students

**Abdominal Pain**
o Workup for abdominal pain. o Presenting signs & symptoms, timing of symptoms, PE findings, bowel sounds pattern, particular signs for each (McBurney’s point, Murphy’s sign, etc.), lab work, radiological studies, treatment, antibiotics, indications for surgery for:
Appendicitis Pancreatitis Cholecystitis Diverticulitis Small bowel obstruction Hernia: inguinal and ventral Peptic Ulcer Disease	GI Bleeding: upper and lower Bleeding ulcer, Mallory Weiss tear Diverticulitis, hemorrhoids Testicular torsion Crohn’s disease vs. ulcerative colitis Pseudomembranous colitis

Questions To Ask Yourself

Pain: location, quality, severity, timing, exacerbating or remitting symptoms, associated manifestations.

Is there tenderness to palpation on physical exam?

Is there guaiac positive stool?

Is it associated with nausea and/or vomiting?

Were there any abnormalities in the lab work?

What studies are appropriate to evaluate for the presumed diagnosis?

What would study show if positive?

What would be the next step in treatment plan?

Have I checked pregnancy status? Even though patient swears, “there is no way” she is pregnant?

Trauma

Blunt Trauma

The most common scenario and indications for further workup are falls, motor vehicle accidents, contact sports, and assaults.

Penetrating Trauma

Indications for surgery. Location of entrance wound important. Exit wound apparent? In what cases is surgery not indicated? (For example, is a gunshot wound to the leg a surgical case? What if it hits an artery? A bone?)

Know the empiric antibiotic used for penetrating trauma

Indications for a chest tube: what % pneumothorax, hemothorax, other indications

**Neurosurgery**
Pathophysiology, presenting signs and symptoms, physical exam, diagnostics and indications for surgery for:
Traumatic: contusion, epidural, subdural Subarachnoid hemorrhage, aneurysm Intervertebral disc disease

**Cardiovascular**
Pathophysiology, presenting signs and symptoms, physical findings, radiological studies and surgical indications for:
Aortic aneurysm Aortic dissection Mesenteric ischemia Carotid disease	Pericardial tamponade Claudication Bypass grafts—lower extremity occlusive disease (4 P’s)

**Cancer**
Signs, symptoms, treatment protocol, preventive screening for, and most common types of:
Prostate cancer Breast cancer Thyroid cancer	Colon cancer Lung cancer Intra-abdominal cancer

**Radiologic Studies**
Know the indications, contraindications, and limitations of the following:
Ultrasound Barium enema V.Q. Scan Upper GI series CT scan	Mammography Doppler studies Bone scan MRI Colonoscopy	Abdominal Extremity films HIDA ERCP IVP
Distinguish the abnormal findings on a PA and lateral chest x-ray, flat and upright abdominal x-ray.

**Laboratory Interpretation**
Indications for and interpretation of the following lab studies. (Know why you ordered them and what you are looking for.)
CBC with differential Acute vs. chronic blood loss Electrolytes Arterial blood gases	Urinalysis and microscopic PT and PTT (normal and anticoagulated) Liver function tests Amylase and lipase

**Wound Care**
Primary Closure Healing: Primary Secondary, Tertiary Delayed closure Factors affecting wound healing: smoking, diabetes, noncompliance.	Wound debridement: common indications Sterile technique Various suture materials

**Postoperative Complications**
Know which procedures are at highest risk for complications Wound infection: most common organism and treatment DVT: precautions and signs and symptoms Know what to do about post-op fever Atelectasis: precautions to take and treatment

**Anesthesia**
Various methods of anesthesia: local, regional and general Pre-anesthesia history and physical examination Management of anesthesia complications and side effects

**Skills You Need To Have**
**Documentation**
Take a surgical history and do physical exam Write admission orders Write pre- and postoperative orders Perform necessary observations to record progress notes Write discharge summaries

**-Technical Skills**
Indications, contraindications, and complications of the following technical skills:
Arterial, venous blood collection Starting IV’s Foley catheter insertion Chest tube insertion, removal Central lines Paracentesis	Blood culture collection Performing EKG N/G tube insertion Suture techniques Thoracentesis Lumbar puncture

**Aseptic Techniques**
Gowning and gloving Prepping an operative field OR assisting Surgical wound dressing

o Workup for abdominal pain.

o Presenting signs & symptoms, timing of symptoms, PE findings, bowel sounds pattern, particular signs for each (McBurney’s point, Murphy’s sign, etc.), lab work, radiological studies, treatment, antibiotics, indications for surgery for:

Indications, contraindications, and complications of the following technical skills: