Day 1-Medical Assessment

Question 1

What’s the number 1 rule of OS?

Answer 1

Patient survival!

Question 2

What is the acronym for assessing the Pt’s chief complaint?

Answer 2

SOCRATES

Question 3

A sequential, comprehensive method of eliciting patient symptoms on an organ system basis

Answer 3

ROS-Review of Systems

Question 4

Heart Rate: Tachycardia: >____ BPM…Bradycardia:

Answer 4

tachy > 100 BPM….brady

Question 5

What does a fixed lymph node most likely indicate?

Answer 5

that it is malignant and is incorporating into the surrounding tissues

Question 6

A patient with severe systemic disease that is not incapacitating

Answer 6

ASA III

Question 7

A normal healthy patient

Answer 7

ASA I

Question 8

A moribund patient who is not expected to survive without the operation

Answer 8

ASA V

Question 9

A patient with mild systemic

disease or significant health risk factor

Answer 9

ASA II

Question 10

A patient with severe systemic disease that is a constant threat to life

Answer 10

ASA IV

Question 11

A declared brain-dead patient whose organs are being removed for donor purposes

Answer 11

ASA VI

Question 12

Caused by ↑ myocardial O2 demand greater than available O2 delivery to the myocardium - myocardial ischemia

Answer 12

Angina Pectoris

Question 13

Angina – stable If CP occurs only after significant exertion, responds readily to NTG administration, and no recent increase in severity **ambulatory OS procedures usually ____ with proper precautions

Answer 13

SAFE

Question 14

Whats the magic limit for EPI use in CV at risk Pts?

Answer 14

0.04mg

Question 15

Angina-prohylactic Abx after first __-__ weeks post stint placement.

Answer 15

6-8weeks

Question 16

Unstable angina is a ____ risk for OS surgery!

Answer 16

MAJOR

Question 17

One way we are going to discern Angina from MI is duration of ____ minutes or more = MI

Answer 17

15 minutes

Question 18

What time range is the highest risk for reoccurrence of an MI?

Answer 18

within 6months of the first MI

Question 19

Patients with transvenous pacemakers usually (do or do not?) Abx prophylaxis

Answer 19

DO NOT

Question 20

Is Abx prophy req for pacemaker?

Answer 20

NO

Question 21

Acute Rheumatic Heart Failure occurs as a result of a group ___ β- hemolytic streptococcal pharyngotonsillitis

Answer 21

Group A

Question 22

What are the two standard Abx and their doses for prophylactic tx? How long before?

Answer 22

amoxicillin 2g and clindamycin 600mg 30min-1hr before.

Question 23

\_\_\_\_\_\_\_\_\_ is NO LONGER NEEDED for
• Rheumatic heart disease
• Hypertrophic cardiomyopathy • Ventricular septal defect
• Atrial septal defect
• Calcified aortic stenosis
• Bicuspid valve disease
• Mitral Valve Prolapse

Answer 23

Antibiotic Prophylaxis

Question 24

Patients with _______ should take all of their normal antihypertensive medications at their normal times with a sip of water prior to surgery

Answer 24

HTN

Question 25

In OMS clinic upstairs, we generally will not tx anyone with SBOP>____, DBP>____. Med consult required. Often will consult for lower #’s, to encourage pt to get tx for their HTN.

Answer 25

> 200….>100

Question 26

Avoid Rxing these antiinflammatories with asthma Pts…

Answer 26

NSAIDS and Aspirin

Question 27

Kidney Patients; Defer treatment until day post ______ (best physiologic status, heparin duration of action is 3-4 hrs)

Answer 27

dialysis

Question 28

RENAL TRANSPLANT: Which drug causes induced

gingival hyperplasia

Answer 28

cyclosporine A

Question 29

Whats a normal platelet count? What can a pt with thrombocytepenia go down to?

Answer 29

150k-300k normal…19k thrombo pt

Question 30

Hemoglobin A1c reflects an average glucose level of the previous ___-___ months.

Answer 30

3-6 months

Question 31

When is the best time to schedule DM patients?

Answer 31

EARLY AM!!

Question 32

Potency: Prednisone is _____ the strength of Cortisol.

Answer 32

4x

Question 33

WHAT ARE THE THREE MAIN CATEGORIES OF PATIENTS WE WILL PROPHYLACTICALLY TREAT WITH ANTIBIOTICS?

Answer 33

1. Prosthetic Cardiac Valve 2.Previous Bacterial Endocardidts 3.Congentital Heart Disease(cardiac transplants or valve repairs)

Question 34

Dental Procedures where AbxProphy is recommended: ANY ________

Answer 34

EXTRACTIONS

Question 35

When trying to decide whether or not to do AbXProphy for Bacterial Endocarditis, typically think: am I causing _______ or not?

Answer 35

bleeding (nice flashcard dude.)

Question 36

What can the INR tell us about patients using plavix or aspirin?

Answer 36

Nothing :) INR is only used for Warfarin (coumadin)

Question 37

What is the limit for INR to do a procedure?

Answer 37

3

Question 38

If the INR is above 3 what do you do?

Answer 38

With physician approval, stop warfarin 3 days before surgery

Question 39

What is the time window you want to have when checking Pt’s INR?

Answer 39

within 24 hours

Question 40

What are the 4 categories of Congenital Heart Disease Pts that I will prophylactically Rx Abx to?

Answer 40

1.Unrepaired cyanotic congenital heart disease 2.Completely repaired CHD with prosthetic material or device for 6 months after placement 3.Repaired CHD with residual defects 4.Cardiac transplants with valvar disease

Question 41

Would you recommend Abx Trophy for bleeding from trauma to lips or oral mucosa?

Answer 41

Nope

Question 42

Would I give prophy Abx for someone with Bacterial Endocarditis if I was taking out sutures?

Answer 42

Nope