Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Most common cause of aortic aneurysm is: ______.

A

Atherosclerosis
*caused by smoking!

Other causes: HLD, HTN, connective tissue d/o, male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

S&S of aortic aneurysm include:

A
  • Older male, >60y
  • Severe abdominal or back pain with syncope or HTN
  • Tender, pulsatile abdominal mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the workup for a suspected aortic aneurysm?

A

US!!–> initial test of choice to determine presence, size, and extent (also used to monitor for progression in size).

  • CT scan: test of choice for thoracic aneurysms (good for planning surgery for AAA)
  • Angiography is gold standard! (often used before surgery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An AAA that is > ___cm has an increased risk of rupture

A

5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the management of AAA?

A
  • Surgical repair if >5.5cm in diameter or if >0.5cm expansion in 6 months
  • Beta blockers can reduce shearing forces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

____ is the most important predisposing factor for aortic dissection.

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aortic dissections are most common in ____ (age range), _____ (males/females).

A

-50-60y males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Aortic dissection is a tear in the ____ (layer of aorta).

A

Tunica intima (inner most followed by media and adventitia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the S&S of an aortic dissection?

A

Abrupt onset, unrelenting, tearing “knife like,” ripping, chest/upper back pain, +/- syncope, diaphoresis, weakness, nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do you find on PE for a patient with aortic dissection?

A
  • Decreased peripheral pulses
  • Variation in pulse >20mmHg between rt and left arm
  • Ascending dissection will have acute, new onset aortic regurg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is an aortic dissection diagnosed?

A

CT w/ contrast!!!

  • Angiography is gold standard
  • CXR widened mediastinum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is an aortic dissection managed?

A
  1. Surgical management- done in ACUTE PROXIMAL (DeBakey I and II) or ACUTE DISTAL with complications (Type III).
  2. Medical management- in DESCENDING if no complications exist (DeBakey III).
    * 1st line= Esmolol and Labetalol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the primary RFs/causes of DVT?

A

Age, obesity, long distance travel, multiparity, IBD, Lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the S&S of DVT?

A

Unilateral swelling/edema of affected extremity; >3cm most specific symptom.

-Homan’s sign: pain in calf with dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is a DVT worked up?

A

Venous Duplex US

-D-dimer: a negative test can r/o DVT in low risk pts, cannot confirm dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is DVT treated/managed?

A

*Perioperative DVT prevention: early, frequent ambulation, leg exercise, compression hose

**Treatment: Anticoagulation- Enoxaparin/Lovenox (Low molecular weight heparin) or Unfractionated heparin followed by warfarin

***Major cause of pulmonary embolism :(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are S&S of Peripheral Arterial Disease?

A

Intermittent claudication!–> pain in LE brought on by exercise and relieved w/ rest.

-Advanced dz with ABI < 0.40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 6 P’s of acute arterial embolism?

A

Paresthesias, pain, pallor, paralysis, pulselessness, poikilothermia (inability to regulate core body temperature)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are signs of PAD?

A

-Decreased/absent pulses, +/- bruits, decreased cap refill, atrophic skin changes, shiny skin, hair loss, pale on elevation, dependent rubor, LATERAL malleolar ulcers!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnosing PAD…

A

ABI–> simple, quick, noninvasive. POSITIVE PAD if ABI <0.90 (0.50= severe), nml ABI= 1.0-1.2

-Arteriography is gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is PAD managed?

A
  1. Platelet inhibitors- Cilostazol mainstay, ASA, Clopidogrel
  2. Revascularization- PTA, bypass grafts fem-pop bypass, endarterectomy
  3. Supportive- foot care, exercise
  4. Acute Arterial Occlusion- heparin for acute embolism
  5. Amputation- if severe or gangrene occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

_____ veins are often culprits of varicose veins.

A

Superficial saphenous veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Increased estrogen: OCPs, pregnancy, increased stress on legs, prolonged standing, and obesity are all RFs for _____.

A

Varicose veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the clinical manifestations of varicose veins?

A
  • Dilated, tortuous veins
  • Dull ache, pressure sensation worsened with prolonged standing and relieved with elevation
  • Venous stasis ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How are varicose veins managed?

A

Conservative: leg elevation, compression stockings, avoid prolonged standing

-Sclerotherapy, radiofrequency/laser ablation & ambulatory phlebectomy commonly used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

With peripheral arterial disease (PAD) leg pain is better when legs are _____ (elevated/dependent) and pain improves with ______ (movement/rest).

A

Dependent; rest

*Pain is WORSE with walking, elevation of leg, cold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Redness of the leg with dependency is known as ______ and is associated with _____.

A

Dependent rubor; PAD

*Cyanotic leg with elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Leg ulcers on the _______ are common with PAD.

A

Lateral malleolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some skin findings associated with PAD?

A

Atrophic skin changes, thin shiny skin, loss of hair, muscle atrophy, pallor, thick nails. Livedo reticularis (mottled apperance).

  • Decreased pulses and temperature usually cool
  • *Minimal to no edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

With peripheral venous disease leg pain is worse with ______ (elevation/dependency).

A

Dependency, standing, and prolonged sitting make it worse :(

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Peripheral venous disease improves with what activities?

A

Walking and elevating the leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Cyanotic leg with dependence is associated with _____ (PAD/PVD).

A

PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Leg ulcers located on the ______ are common with PVD.

A

Medial malleolus, uneven ulcer margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are some skin findings associated with PVD?

A

Stasis dermatitis, eczematous rash, thickening of skin, brownish pigmentation

  • Pulses and temperature usually normal
  • *Prominent edema is common!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Claudication is associated with ______. Symptoms include:

A

PAD

  • pain with exercising
  • intermittent pain
  • pain at rest (as condition worsens)
  • discolored skin or ulcerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is claudication/PAD diagnosed?

A

Pulses, ABI, Doppler US (to monitor blood flow to the area), MRI/CT (to see if vessels are narrowed with plaque).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are some causes of difficulty breathing after surgery?

A

Airway blockage, atelectasis and lung infection, blood clots, heart failure, blood loss, PTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Dyspnea is chronic when it occurs over a 4-8 week period and acute when it develops over hours-days.

A

FYI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most causes of cardiac-related dyspnea include:

A
  1. Cardiac diseases- acute ischemia, systolic dysfunction, valvular disorders, pericardial disease
  2. Anemia
  3. Deconditioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Dyspnea symptoms and the diseases with which they correlate:

  1. Substernal chest pain–> cardiac ischemia
  2. Fever, cough, sputum–> respiratory infections
  3. Wheezing–> acute bronchospasm
A

FYI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Exertional dyspnea and PND are both associated with heart failure and _____ is more specific.

A

PND

*Asthma also associated with exertional dyspnea and PND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

The 5 most common causes of chronic dyspnea are:

A
  1. Asthma
  2. COPD
  3. Interstitial lung disease
  4. Myocardial dysfunction
  5. Obesity/deconditioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Specific tests ordered with dyspnea complaint:

A
  • Complete blood count (to exclude anemia): The degree of dyspnea associated with anemia may depend on the rapidity of blood loss and the degree of exertion that the patient undertakes.
  • Glucose, blood urea nitrogen, creatinine, electrolytes.
  • Thyroid stimulating hormone (TSH).
  • Spirometry pre and post inhaled bronchodilator OR full pulmonary function tests (PFTs) if the clinical evaluation does not suggest asthma or COPD.
  • Pulse oximetry during ambulation at a normal pace over approximately 200 meters and/or up two to three flights of stairs.
  • Chest radiograph.
  • Electrocardiogram.
  • Plasma BNP or NT-pro BNP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the 4 major categories for syncopy?

A
  1. Reflex syncope
  2. Orthostatic syncope
  3. Cardiac arrhythmias
  4. Structural cardiopulmonary disease

*Must RULE OUT: seizures, sleep disturbances, accidental falls, some psychiatric conditions (conversion d/o)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Prodromal symptoms of syncope include:

A

●Lightheadedness

●A feeling of being warm or cold

●Sweating

●Palpitations

●Nausea or non-specific abdominal discomfort

●Visual “blurring” occasionally proceeding to temporary darkening or “white-out” of vision

●Diminution of hearing and/or occurrence of unusual sounds (particularly a “whooshing” noise)

●Pallor reported by onlookers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Evaluation of syncope if structural heart disease status is uncertain should include a ______.

A

Transthoracic echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Acute arterial occlusion is often due to:

A
  • Acute thrombosis of an atheroslerotic artery
  • Dissection of artery
  • Direct trauma to artery
  • Embolus from proximal source lodging into more distal vessel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

The majority of arterial emboli that travel to the extremities originate in the _____.

A

Heart (LE affected more than UE).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Common places for thromboemboli to lodge include:

A

The common femoral, common iliac, and popliteal artery bifurcations are frequent locations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Sources of emboli from the heart include:

A
  • Atrial thrombus formation due to atrial fibrillation
  • Left ventricular thrombus formation following myocardial infarction
  • Left ventricular dysfunction, and debris from prosthetic valves and infected cardiac valves (septic emboli).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Diagnosis of arterial embolism/thrombosis:

A
  1. Noninvasive options- Duplex US, CT angiography, MRA

2. Catheter-based arteriography (dx and treatment!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

The classic physical signs of acute limb ischemia in a patient without underlying occlusive vascular disease are the six Ps…

A 
Pain
Pallor 
Pulselessness
Poikilothermia
Paresthesia
Paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

A third heart sound (S3) in young individuals/athletes is normal. In older patients it indicates _____.

A

CHF

*KENTUCKY SOUND

54
Q

The third heart sound is caused by a sudden deceleration of blood flow into the ______ from the _____. In the anatomy tab you will see a thin-walled, dilated left ventricle with generalized decreased vigor of contraction.

A

LV from the LA

55
Q

The fourth heart sound is produced by an increase in stiffness of the left ventricle due to scar tissue formation. This may be a manifestation of ______.

A

Coronary heart disease

56
Q

A fourth heart sound can also be caused by a greatly thickened left ventricular wall such as with essential hypertension or aortic stenosis. This is shown in the anatomy tab.

A

TENNESSEE SOUND

57
Q

The most useful importance of S3 is in detecting left-sided heart failure, especially in the early stages when other signs may be normal.

A

Usually after 40y

58
Q

When S4 is loud it is usually a sign of a failing ____.

A

Left ventricle

59
Q

Loss of _____ can be the earliest sign of compartment syndrome.

A

2 point discrimination

60
Q

Which beta-adrenergic blocking agent has cardioselectivity for primarily blocking beta-1 receptors?

A

Metoprolol

61
Q

A 55-year-old male presents complaining of episodic substernal chest pain that occurs especially during strenuous exercise. Suspecting coronary artery disease (CAD), an exercise stress test is ordered. The test is considered to be abnormal if which of the following occurs?

A

A 2 mm ST-segment depression is suggestive of cardiac ischemia and is considered to be an abnormal finding

62
Q

The treatment of choice for a patient with WPW (Wolff-Parkinson-White Syndrome) who has recurrent episodes of supraventricular tachycardia is what?

A

Catheter ablation of bypass tracts

63
Q

What are the indications for a CABG?

A

Class I indications for CABG from the American College of Cardiology (ACC) and the American Heart Association (AHA) are as follows
-Over 50% left main coronary artery stenosis

-Over 70% stenosis of the proximal left anterior descending (LAD) and proximal circumflex arteries

  • Three-vessel disease in asymptomatic patients or those with mild or stable angina
  • Three-vessel disease with proximal LAD stenosis in patients with poor left ventricular (LV) function
  • One- or two-Vessel disease and a large area of viable myocardium in high-risk area in patients with stable angina

-Over 70% proximal LAD stenosis with either an ejection fraction (EF) below 50% or demonstrable ischemia on noninvasive testing

64
Q

Some studies have found that in patients undergoing noncardiac surgery, perioperative aspirin increases bleeding risk but does not improve cardiovascular or mortality outcomes.

A

Really depends on patient, doctor, and surgery though

65
Q

Most selective COX-2 inhibitors (celecoxib) and nonselective NSAIDs appear to have negative cardiovascular effects.

A

Should often be discontinued before surgery

66
Q

Generally, NSAIDs should be stopped ___ day(s) before surgery. Ibuprofen should be stopped ___ day (s) before.

A

3; 1

67
Q

Pre-surgical cardiac testing guidelines (loose)

A
  1. Patients undergoing high-risk surgical procedures or those at intermediate risk should be considered for non-invasive testing for further risk stratification
  2. Patients at high risk should be considered for angiography
  3. Patients at low risk should receive no further testing
68
Q

______ (medication class) before surgery can decrease rate of MI, especially given to those at intermediate and high-risk.

A

Beta blockers

69
Q

Amoxicillin is a common antibiotic to prevent _____ in patients with a history of rheumatic heart disease.

A

Endocarditis

70
Q

Functional residual capacity (FRC) decreases by:
_____% in lower abdominal operations
_____% in upper abdominal operations
_____% in thoracotomy/lung resection

A
  • 10-15%
  • 30%
  • 35%
71
Q

Closing volume affects postoperative pulmonary complications. This is the volume at which the flow from the dependent portion of the lungs stops during expiration because of airway closure.

A

Factors that promote increased CV:

  • advanced age
  • tobacco use
  • fluid overload
  • bronchospasm
  • presence of airway secretions
72
Q

Lung expansion maneuvers are the mainstay of postoperative prevention of complications and include deep breathing exercises and…

A

INCENTIVE SPIROMETRY

73
Q

Which hormones increase in the operative period?

A

Catecholamines, growth hormone, glucagon, ACTH, and cortisol

*This causes HYPERGLYCEMIA in the postoperative patient

74
Q

Usually give ____ (fraction) of the normal dose of injectable insulin the morning of surgery.

A

1/2

75
Q

In diabetic patient you should give continuous infusion of _____ (IV fluid).

A

5% dextrose to provide 10 grams of glucose per hour

76
Q

About Adrenal Insufficiency (Addisons)…

A

Prolonged use of steroids for inflammatory d/o (asthma, RA, IBD) can cause suppression of the hypothalamic release of corticotropin-releasing hormone and the pituitary release of ACTH. This leads to a decrease in the adrenal production of cortisol.

77
Q

______ (medication) can reduce, but not eliminate, the risk of adrenal suppression.

A

Hydrocortisone (10mg/hr)

78
Q

Fever < ____ is common after surgery.

A

38.5C (101.3F)

79
Q

Fever associated cytokines are:

A

IL-1, IL-6, TNF-alpha, IFN-gamma

80
Q

Cytokines in bloodstream act on hypothalamic endothelium–> stimulates production of ____ & ____. This raises the hypothalamic set-point which results in heat conservation & increased heat production.

A

PGE2 & cAMP

*Get rigors

81
Q

In general, early post-op fever is NOT infectious w/ 1 critical exception:

A 
Necrotizing fasciitis (soft tissue infection) 
*Also consider malignant hyperthermia and anastomotic leak!!
82
Q

What are the 5 W’s of postoperative fever?

A
  1. Wind- POD#1-3
  2. Water- POD#3
  3. Wound- POD#5
  4. Walking- POD#7
  5. Wonder-drug/What did we do?- Any time
83
Q

Atelectasis occurs in the most dependent parts of the lung in 90% of patients who are anesthetized.

RFs include:

A

Painful abdominal or thoracic incision, smoking, pulmonary dz (asthma, CF), obesity, respiratory muscle weakness

*Increases risk of PNA and causes fever!

84
Q

To differentiate PNA from atelectasis look for…

A

Sputum production, elevated WBC, and temp curve that progresses upward

*Atelectasis will usually be bilateral! PNA often presents with a unilateral infiltrate

85
Q

Most common treatment for a wound infection (POD#5) is:

A

Open it up, release pus, allow tissue to heal from the inside out and “fill in”

86
Q

What is Virchow’s triad for DVT/PE (POD#7)?

A

Stasis, vessel damage, hypercoaguability

87
Q

Necrotizing infection often presents within first 48hrs and kills rapidly. Common agents are:

A

Clostridium perfringens, Group A B-hemolytic streptococcus

88
Q

Treatment of necrotizing infection includes:

A

Resuscitation, Pen G, surgical debridement

89
Q

For a subacute/delayed fever (after 5 days post-op)–> infectious etiology is more likely

A

Remember Wound infection= 40%, UTI = 29%, PNA= 12%

  • Also think- C. diff, line sepsis, bacteremia, intra-abdominal abscess
  • *Weeks out- endocarditis, infected prostheses
90
Q

Factors that increase the risk of wound infection:

A

malnutrition, advanced age, immunosuppressive drugs, prolonged hospitalization, recent abx, obesity, catheters, poor tissue perfusion, steroids, radiation

91
Q

Prophylactic abx are given about ____ (length of time) before the operation and discontinued after ____ (length of time).

A

30-60mins

48-72hrs

92
Q

KOH, silver, or Giemsa stains done to identify _____.

A

Fungal hyphae or spores

93
Q

Mycobacteria can be identified using the _______ (test).

A

Ziehl-Neelson

94
Q

If wound infection persists > 48 hours after abx administration then suspect abscess formation and treat by:

A

Opening and draining the wound

95
Q

What are the 4 classes of wounds?

A
  1. Clean- breast bx, inguinal hernia repair. Usually STAPH. Treat with 1st generation Ceph, may not need prophylaxis.
  2. Clean, Contaminated- GI, GU, gyn organs entered, no gross contamination. Cephalosporins used- 1st generation for elective procedures. 2nd or 3rd generation for chole w/ acute cholecystitis and gastric & proximal small bowel surgery.
  3. Contaminated- Perforated appendectomy, colectomy for diverticulitis, perforated ulcer or bowel, penetrating GI trauma. Give 2nd gen Ceph or Ampicillin/Gentamycin/Flagyl
  4. Dirty- traumatic wounds, burns older than 72 hours, free colon perforation
    * Keep skin OPEN in classes 3 and 4.
96
Q

Fornier’s gangrene is a type of _______ that originates in the urethral glands and spreads to the perineal tissue.

A

Necrotizing fasciitis

97
Q

Treatment of necrotizing fasciitis includes:

A
  1. Debride tissues
  2. Abx and hemodynamic support with IV infusion
    - Ampicillin/sulbactam (Unasyn) + Clindamycin + Cipro
    - Add Vanc if there’s a concern for MRSA
98
Q

_____ most often occurs in the LE and pelvis: 80% in deep veins of calf, 20% femoral or iliac vein

A

DVT

99
Q

Precipitators of DVT include:

A

Prolonged bed rest or immobility, long air travel, malignancy, nephrotic syndrome, use of OCPs and hormone replacement therapy, and hypercoaguable syndromes (protein C/S, Factor V Leiden, Antithrombin III, PNG, homocystinuria)

Also- advanced age, type A blood, obesity, multiparity, IBD, lupus,

100
Q

S&S of DVT include:

A

Dull aching pain in leg that is worse with walking, edema, palpable cord, low grade temperature, tachycardia

*Homan’s sign about 50% of the time (pain with dorsiflexion)

101
Q

How is DVT diagnosed?

A
  1. Duplex US is preferred study!! (Doppler analysis similar and also used)
  2. Venography is most accurate method but has increased risk
  3. D-dimer–> a fibrin degradation product that is elevated in the presence of thrombus
    * An elevated D-dimer does NOT diagnose, BUT a negative D-dimer test can r/o and omit need for US

**If pulmonary emboli suspected- VQ scan versus spiral CT

102
Q

Preferred treatment for DVT is ______ (med)

A

LMWH (preferred over continuous IV infusion of unfractionated heparin)

  • Heparin followed by warfarin may be used
  • *Need heparin until INR is therapeutic for 48 hrs
103
Q

How long will a patient need to remain on warfarin after DVT?

A

*1st event and idiopathic: 6 months

**Non-idiopathic or recurrent event: consider indefinite therapy

104
Q

Thrombolytic therapy indicated in:

A

Younger patients with large (ileofemoral) thrombi that are detected within 2 weeks of onset

105
Q

Embolectomy (now can be done percutaneously) gaining popularity. One advantage over lytic therapy is:

A

There is a decreased bleeding risk

106
Q

______ used in cases of contraindication to anticoagulation, failure of anticoagulation, or prophylactic use against high-risk of PE.

A

IVC filter

107
Q

What is Wells Criteria?

A
  1. Clinical evidence for DVT= 3pts
  2. PE is number one diagnosis= 3pts
  3. HR > 100 bpm= 1.5pts
  4. Immobilization/Surgery in past 4 weeks= 1.5pts
  5. Previous DVT/PE= 1.5pts
  6. Cancer= 1pt
  7. Hemoptysis= 1pt

*Score of < 2 makes diagnosis highly unlikely. SCORE > 6= LIKELY DVT/PE

108
Q

Clinical RFs for perioperative DVT:

A
  • Older
  • Prolonged immobility/paralysis
  • Prior DVT
  • Cancer
  • Major surgery (abdomen/pelvic)
  • Obesity
  • Varicose veins
  • CHF
  • MI
  • Stroke
  • Fractures of pelvis, leg, hip
  • Indwelling femoral vein catheters
  • IBD
  • Nephrotic syndrome
  • Estrogen use
  • Hypercoaguable state
109
Q

DVT prophylaxis includes:

A

Heparin- 5000 units subcutaneously started 2 hours before the operation and continued every 8-12hrs after surgery until fully ambulatory or discharged

*Or Enoxaparin- 40mg qd. Also SCDs and/or compression stockings

110
Q

During laparotomy, estimated evaporative fluid loss is ____mL/kg/hr.

A

10

111
Q

______ is the most frequent d/o in the preoperative patient.

A

Dehydration w/ accompanying salt loss

112
Q

If patient is febrile, maintenance fluid must be increased by 10% for each degree above ____.

A

37.2C

113
Q

IV requirements for HYPERnatremia:

May see with TPN

A

Water in 5% dextrose

114
Q

IV requirements for HYPOnatremia:

A

Water restriction; may need hypertonic saline (watch out for fluid overload!)

115
Q

Pure water excess usually due to _____ and seen in patients with CNS lesions and burns.

A

SIADH

*Mannitol is treatment of choice

116
Q

Metabolic acidosis is defined by a pH < ___ and plasma bicarb < ____.

A

7.35; 22mEq/L

117
Q

Causes of Anion Gap Metabolic Acidosis:

A

DR. MAPLES

Diabetic ketoacidosis, Renal failure, Methanol, Alcohol, Paraldehyde, Lactic acidosis, ethylene glycol, salicylates

118
Q

Causes of Non-anion Gap Metabolic Acidosis:

A

Characterized by lack of buffer base-
GI tract losses, renal tubular acidosis, Addison’s, TPN, and use of carbonic anhydrase inhibitors (anti-convulsant, glaucoma, diuretic).

119
Q

Metabolic acidosis can lead to:

A

Myocardial depression, HYPOtension, arrhythmias, HYPERkalemia, insulin resistance, obtundation, coma

120
Q

Treatment of metabolic acidosis depends on etiology:

A
  1. Trauma- restore blood and fluid
  2. DKA- manage insulin and restore volume
  3. If acidosis is severe treat with sodium bicarbonate
121
Q

Metabolic Alkalosis is usually accompanied by respiratory compensation, or an increase in _____.

A

pCO2

122
Q

Some causes of metabolic alkalosis are:

A
  1. Chloride responsive- nasogastric losses, vomiting, past use of diuretics, volume contraction, posthypercapnic
  2. Chloride resistant- aldosteronism, renal artery stenosis, renin-secreting tumor, Cushings.
    * Severe metabolic alkalosis is associated with cerebral hypoperfusion and HYPOkalemia
123
Q

Treatment of metabolic alkalosis includes:

A

Saline, carbonic-anhydrase inhibitor (acetazolamide)

124
Q

Respiratory acidosis is defined by a ____ (high/low) pH and a (high/low) pCO2.

A

low; high

125
Q

Causes of respiratory acidosis include:

A

Decompensation of preexisting respiratory disease, asthma, neuromuscular disorders, CNS depression, airway obstruction.

126
Q

Plasma bicarb concentrations do not increase much in ____ (acute/chronic) cases of respiratory acidosis. In _____ (acute/chronic), renal adaptation is substantial.

A

acute; chronic

127
Q

In Respiratory Alkalosis pH is (low/high) and pCO2 is (low/high).

A

high; low

128
Q

Respiratory alkalosis is caused by alveolar _____ (hypo/hyperventilation).

A

HYPERventilation

129
Q

In surgical patients, respiratory alkalosis may be due to:

A

Hypoxia, CNS lesions, pain, hepatic encephalopathy, mechanical ventilation

130
Q

Most patients with respiratory alkalosis are ______ (symptomatic/asymptomatic).

A

Asymptomatic

131
Q

The most accurate method for diagnosing thrombophlebitis in the lower leg is _____

A

Venography

132
Q

A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial tamponade is strongly supported by the presence of:

A

Distended neck veins- Cardiac compression will manifest with distended neck veins and cold clammy skin.

Surgery (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions