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FUNDAMENTALS OF SURGERY Flashcards

1
Q

Never events (5)

A
  1. Retained surgical items
  2. Wrong site surgery
  3. Death on the day of surgery of a normal healthy patient
  4. Wrong patient
  5. Wrong procedure
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2
Q

Overall effect of cortisol in trauma and inflammation?

A

Anti-inflammatory

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3
Q

Vitamin K dependent clotting factor?

A

Factors IX , X, VII, II , Protein C and S

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4
Q

Coagulation factors tested by aPTT (8)

A

Factors VIII, IX, X, XI, XII (8, 9, 10, 11, 12) Intrinsic Pathway
Factors I, II, V (1, 2, 5) Common Pathway

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5
Q

Which coagulation factor does not require vitamin K in its production ?

A

Factor V

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6
Q

Treatment for hemophilia A and B

A

A: Factor VIII concentrate ( Aeight)
B: Factor IX concentrate

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7
Q

A 10yo/M with hemophilia A is scheduled for emergency appendectomy. Which should you administer prior to surgery?

A

Factor VIII

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8
Q

Inciting etiology with associated thrombocytopenia, prolongation of the thrombin time, a low fibrinogen level, and elevated fibrin markers (FDPs, D-dimer, Soluble fibrin monomers)

A

Disseminated Intravascular Coagulation

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9
Q

Which has an inhibitory effect on the coagulation process?

A

Drotrecogin alfa

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10
Q

Recombinant form of human activated protein C that has anti-thrombotic , anti-inflammatory and profibrinolytic properties

A

Drotrecogin

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11
Q

Principles of antimicrobial prophylaxis?

A
  1. Select an agent with activity against organisms commonly found at the site of surgery.
  2. Administer the initial dose of the antibiotic within 30mins prior to inicison.
  3. Redose the antibiotic during long operations based upon the half-life of the agent to ensure adequate tissue levels.
  4. Limit the antibiotic regimen no more than 24hrs after surgery for routine prophylaxis
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12
Q

Sustained defervescene of fever after 3 days on Naproxen

A

Positive Naproxen Test= Neoplastic fever

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13
Q

Amino acid from which nitric acid is derived?

A

Arginine

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14
Q

Monofilament suture advantages vs multifilament?

A
  1. Encounters less resistance when passing through tissues
  2. Less infection causing organisms
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15
Q

Ideal suture characteristics?

A
  1. Pliability for ease of handling and knot security.
  2. Uniform tensile strength
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16
Q

Types of surgical wound healing?

A
  1. Primary Intention
    - clean tissue approximated by sutures without tension
  2. Secondary Intention
    - wound left open to heal by granulation tissue formation and contraction.
  3. Tertiary Intention
    - would initially managed as secondary intention then closed when wound is clean and granulation tissue is abundant.
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17
Q

Type of surgical wound healing for heavily contaminated wounds?

A

Secondary intention

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18
Q

Wound closure characterized by initial debridement and observation for around 5 days before closure is called?

A

Tertiary intention

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19
Q

Clean wounds? (2)

A

Hernia repair
Breast Biopsy

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20
Q

Operative wound class of appendectomy of acute appendicitis?

A

Class III: Contaminated

Appendectomy is class II if there is no evident infection

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21
Q

Operative wound class of incisional wounds that follow blunt trauma?

A

Class I - Clean

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22
Q

Which of the following statement regarding wound healing is true ?

A

Myoepithelial cell derived growth factors cause fibroblast differentiation

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23
Q

The main action of flucocorticoids in response to injury and stress is?

A

Inhibits the inflammatory response

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24
Q

The primary purpose using pneumatic anti-shock garments (PASH) is to?

A

Increase venous return to the right atrium

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25
Q

Manifestations of respiratory failure in post-op patient?

A

RR >30/ min
PaCO2 >45mmHg
PaO2 < 60mmHg

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26
Q

Tests for pulmonary risk pre-operative assessment

A

CXR, CBC, PFTs

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27
Q

Candidates for bleeding risk pre-operative assessment?

A
  1. Patients on anticoagulant
  2. Liver & Kidney dysfunction
  3. Anemia
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28
Q

What type of shock is characterized by increase cardiac output, tachycardia, warm dry skin and increased central venous pressure?

A

Septic shock

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29
Q

True statement regarding prophylactic antibiotic is?

A

Give one hour prior to surgery

30
Q

The recommended first line vasoactive drug used in the measurement of hypotension in severe sepsis is?

A

Norepinephrine

31
Q

In septic shock, secondary to peritonitis , which of these vasopressors is the initial drug of choice to stabilize the patient?

A

Norepinephrine

32
Q

Post-operative maintenance therapy after total adrenalectomy?

A

Hydrocortisone

33
Q

Virilization caused by congenital adrenal hyperplasia is treated with?

A

Glucocorticoid

34
Q

Preoperative dose timing of parenteral antibiotics for surgical prophylaxis

A

60min

120min for vancomycin

35
Q

Timing of redosing of parenteral antibiotics for surgical prophylaxis

A

Duration of surgery >2 half-lives of the antibiotic

36
Q

Timing and depth of superficial incisional surgical site of infection?

A

Within 30 days after surgery.
Only skin and subcutaneous tissue of the incision

37
Q

5Ws of postoperative fever

A

Wind : <48hrs
Water: 3-5days
Walk: 4-6days
Wound: 5-7 days
Wonder if drug: >7days

38
Q

Five days after appendectomy, the patient developed fever and severe incisional pain. This is more probably due to?

A

Surgical site infection

39
Q

Antibiotic prophylaxis for low-risk laparoscopic biliary tract surgery?

40
Q

SIRS Criteria?

A
  1. Temp >38c or <36 c
  2. HR >90 bpm
  3. RR >20 cpm or PaCo2 <32 mmHg or mechanical ventilation
  4. WBC >12,000 uL or <4,000 ul or >10% bands
41
Q

Presence of multiplying organisms on the surface of the wound

A

Colonization

42
Q

A patient undergoing debridement of abscess on the left big toe under local anesthesia infiltration may still feel pain because of?

A

Decreased pH of the affected tissue

43
Q

Which of the following is provided by general anesthesia?

A

Reversible state of various levels of unconsciousness

44
Q

Most common fluid disorder in surgical patients

A

Extracellular volume deficit

45
Q

Most common cause of volume deficit in surgical patients?

A

Loss of GI fluids

Loss from nasogastric suction, vomiting, diarrhea, or enterocutaneous fistula

46
Q

Basal caloric requirement of a normal healthy adult?

A

25-30 kcal/kg/day

47
Q

Phases of surgical metabolism?

A
  1. Ebb phase
  2. Flow phase
    2a. Catabolic Phase
    2b. Anabolic Phase
48
Q

Indication for parenteral nutrition

A

Inability to absorb adequate nutrients via GI tract

49
Q

Most common trace mineral deficiency manifesting as diffuse eczematoid rash at interiginous areas

A

Zinc deficiency

50
Q

Most common common complication of total parenteral nutrition use?

51
Q

Electrolytes involved in refeeding syndrome?

A

Phosphate
Magnesium
Potassium
Calcium

52
Q

Coagulopathy precipitated by tissue injury and or hemorrhagic shock with a distinct process from DIC.

A

Trauma Induced Coagulopathy (TIC)

frequency of TIC is reduced by using Damage Control Resuscitation

53
Q

Hemoglobin level threshold for starting transfusion in patients undergoing cardiac surgery.

A

8g/dL

7g/dL : threshold for hemodynamically stable patients

54
Q

Ratio of RBC , platelets, and plasma in Massive Tranfusion Ratio

55
Q

Most common indication for blood transfusion in surgical patients?

A

Replacement of blood volume

56
Q

Blood type transfused when blood is needed immediately and blood type is unknown?

A

O-

As soon as possible, switch to O- for females , O+ for males.

Type-specific, uncross-matched blood should be available in 5-10mins

Completely cross-matched blood should be available in 40mins

57
Q

Prevention of febrile non hemolytic transfusion reaction?

A

Use leukocyte- reduced blood

58
Q

Transfusion reaction manifesting as pulmonary edema due to large volumes of blood transfused?

A

Transfusion associated circulatory overload (TACO)

Transfusion-related Acute Lung Injury (TRALI) which is non cardiogenic pulmonary edema

59
Q

Presentation of Acute hemolytic transfusion reaction vs delayed hemolytic transfusion reaction?

A

ACUTE
-Fever, hypotension, DIC, hemoglobinuria, Renal insufficiency

DELAYED
-Anemia, Indirect hyperbilirubinemia, (+) Direct Coombs

60
Q

Timing of post-operative oral nutrition and mobilization in ERAS

A

Early Enteral Nutrition & Ambulation

61
Q

Analgesic used in ERAS

A

Non-opioid oral analgesia / NSAIDs

62
Q

Timing of acute wounds vs chronic wounds?

A

ACUTE : healed <4weeks
CHRONIC : >4weeks

63
Q

Characteristics of tetanus prone wounds?

A
  1. Age > 6 hours
  2. Configuration: Stellate, Avulsion, Abrasion
  3. Depth: >1cm
  4. Mechanism: Missile, Crush, Burn, Frostbite
  5. Positive signs of infection
  6. Positive devitalized tissue
  7. With Contaminants
64
Q

Predominant leukocytes during the inflammation phase of wound healing and their timings

A
  1. PMNs peak 25-48hrs post injury
  2. Macrophage peak 48-96hrs post injury
  3. T cells peak 1week post injury
65
Q

Collagen type in Early wound healing vs Mature wounds

A

Early : Type 3

Mature: Type 1

66
Q

Local factors that impair wound healing?

A
  1. Infection
  2. Foreign bodies
  3. Ischemia/ Hypoxia
  4. Venous insufficiency
  5. Toxins
  6. Previous Trauma
  7. Radiation
  8. Cigarette Smoking
67
Q

Threshold of platelet transfusion in sepsis/ septic shock for patients with active bleeding?

A

50,000/m3

20,000 / mm3 - High risk for bleeding
10,000 / mm3 - Even without bleeding

68
Q

Routine treatment for congenital adrenal hyperplasia associated virilization?

A

Glucocorticoid treatment

69
Q

Most common indication for splenectomy overall?

70
Q

Most common complication after splenectomy?

A

Infection

Most feared and extreme complication is Overwhelming Postsplenectomy Infection (OPSI)

71
Q

Vaccination timing in emergent splenectomy?

A

2 weeks after

Elective splenectomy: 2 weeks before

72
Q

Which of the following is a type of IV anesthetic?

Surgery (14 decks)

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