General principles, miscellaneous, psych med and surg

Question 1

Indications for selective preoperative tests?

1.ECG?
2. Chest radiography?
3. Hemoglobin?
4. Coagulation and platelets?
5. Creatinine and electrolytes?

Answer 1

1. History of coronary artery disease or arrhythmia. Asymptomatic with risk of mace of at least 1%
2. History of cardiopulmonary disease, undergoing upper abdominal or thoracic surgery
3. History of anemia, significant expected blood loss, undergoing major surgery
4. History of abnormal bleeding or anticoagulant use. Liver disease, malignancy, planned spinal anaesthesia
5. History of kidney disease, cardiovascular risk calculation. Medications such as diuretic,ace inhibitor arb

Essentially in healthy patients, routine preoperafive tests not recommended

Question 2

Fall
Left sided chest pain and left sided abdominal pain
Bruising of left side of chest and abdomen
Pain with inspiration
Left upper quadrant of abdomen is tender
Left shoulder pain
Tachycardia
CXR and fast scan for trauma negative
Next step in management?

Answer 2

CT scan of abdomen! Concerning for splenic injury,most common complication of blunt abdominal trauma.

Tachycardia in keeping with hemmorrhage
Left shoulder pain irritation;of phrenic nerve

Question 3

In penetrating abdominal trauma, when would you use immediate explorative laparotomy instead of a CT abdomen?

Answer 3

Hemodynamic instability = systolic BP less than 90
Peritonitis (rigidity, rebound tenderness)
Evisceration = externally exposed organs

Any penetrating injury below the nipple can involve intr abdominal organs

Question 4

What fluid is used for resus in burns victims?

Answer 4

Lactate ringer solution

Question 5

High c spine injury, risk of diaphragmatic paralysis.
Trauma patient with respiratoyr compromise. First step in management?

Answer 5

Orotracheal intubation

Question 6

Antibiotic prophylaxis first line options for Clean procedures ( cardiovascular, neurological, orthopaedic, vascular)

Answer 6

Cefazolin first line!

Also consider vancomycin, clindamycin

Question 7

Antibiotic prophylaxis first line options for clean contaminated surgeries, GI GU, obgyn, head and neck, thoracic

Answer 7

Based on surgical site, broader coverage often indicated

Question 8

persistent pneumothorax and large air leak despite tube thoracostomy after fblunt chest trauma. Most likely diagnosis?
First step in management?

Answer 8

Tracheobronchial rupture,
Bronchoscopy

Question 9

In haemorrhaging shock with no signs of external bleeding, which trauma sites are most likely cause of bleeding

Answer 9

Chest
Abdomen
Pelvis/retroperitoneum!- eg pelvic fracture!!
Thigh