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QUESTION NOTES > MISC (pre/post-op, endo, admin) > Flashcards

MISC (pre/post-op, endo, admin) Flashcards

1
Q

Papaverine

A

vasodilator; also relaxes muscles of digestive system - good for diffuse mesenteric vasoconstriction

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2
Q

Pre-op: who gets EKG?

A

typically >50yo but not shown to predict cardiac risk peri-op

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3
Q

Pre-op: who gets CXR?

A

pts w/ cardiac or pulm sxs; need one within 6mo

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4
Q

Pre-op: who gets Hct/Hgb checked?

A

elderly w/ major organ dysfxn (liver) or known anemia, or pts undergoing surgery w/ possible signif blood loss

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5
Q

Pre-op: ACE inhibitors

A

HOLD - to avoid hypotension with an anesthesia

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6
Q

Risk factors for medication toxicity (even if within therapeutic range)

A
  • low serum albumin (higher free drug concentrations)
  • dehydration
  • obesity (longer storage)
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7
Q

Highest risk delayed cx (bleeding, perf) in endoscopy pts

A

coag mode

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8
Q

What monopolar mode should be used (cut/coag) nearby cardiac devices?

A

cut mode - lowest voltage monopolar mode; transfers least amount energy

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9
Q

Absolute C/I to most robotic operations

A
  • inability to tolerate pneumoperitoneum
  • ascites
  • gross contamination
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10
Q

Mgmt CO2 embolism

A

trendelenberg, left-side down, aspiration of gas thru central line

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11
Q

Mech CO2 embolism during laparoscopy

A

trocar insertion into vessel or direct absorption

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12
Q

Effect if give ACEI in pts with HTN 2/2 renal artery stenosis

A

decrease GFR -> acute oliguric or anuric renal failure (hence C/I)

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13
Q

Plain gut suture vs. chromic gut (tensile strength and absorption time)

A

tensile strength: plain 7-10d; chromic 10-14d

absorption: plain 70d; chromic >90d
* both absorbed by proteolytic enzymatic digestive process

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14
Q

Polyglactin 910 (coated vicryl)

A

copolymer slows water penetration
tensile strength: maintains >65% after 14d
absorption: min at 40d, complete at 56-70d

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15
Q

Polyglecaprone 25 (monocryl)

A

tensile strength: 50-60% at 7d, 20-30% at 14d, lost at 21d

absorption: complete at 91-119d

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16
Q

Polydioxanone (PDS)

A

tensile strength: 70% at 14d, 50% at 28d, 25% at 42d

absorption: minimal until 90d, complete within 6m

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17
Q

Silk

A

tensile strength: lost when exposed to moisture

absorption: nonabsorbable ~2yr

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18
Q

Fothergill sign

A

abdominal wall mass that does NOT cross midline + does NOT move with contraction of abdominal wall muscles -> if pos, then rectus sheath hematoma

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19
Q

Imaging presentation of Echinococcus

A

calcified cystic wall in the lungs and liver

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20
Q

Mgmt Echinococcal cysts

A

Staged procedure: all w/ lap pads soaked in hypertonic saline, which is toxic to parasite

  1. lobectomy
  2. nonanatomic rsection of liver lobe + entire cyst (avoid spilling)
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21
Q

When should pre-op SSI prophylactic Abx be given?

A

within 60 min of incision (except vanc)

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22
Q

When should do intra-op repeat of SSI prophylactic Abx?

A

if time of surgery > 2x half-life of drug or there is excessive blood loss during procedure
amp/sulb: 0.8-1.3 hrs
cefoxitin: 0.7-1.1 hrs
cefotetan: 2.8-4.6 hrs

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23
Q

Pregnant women have what alteration of PaCO2?

A

decreased @ 30mmHg (bc increase in minute ventilation)

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24
Q

Alpha-receptor cascade

A

GPCR -> phospholipase C -> inositol trisphosphate + diacylglycerol -> intracellular Ca -> vasoconstriction of vascular smooth muscle cells

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25
Q

Beta-receptor cascade

A

GPCR -> adenylate cyclase -> ATP to cAMP -> protein kinase A -> ion channels phosphorylated -> increase Ca2+ influx

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26
Q

Empiric Abx choice for GAS necrotizing SSI

A

penicillin (vanc, linezolid) + clindamycin (or zosyn, carbapenum, or ceftriaxone+metro)

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27
Q

New-onset a.fib after non-CT surgery is associated with increased risk of…?

A

stroke

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28
Q

Absolute C/I to ERAS (enhanced recovery after surgery)

A
  • undergoing urgent operation
  • ASA of 4+
  • limited or no mobility
  • severely malnourished
  • noncompliant or reluctant to participate in protocol
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29
Q

In setting of hollow viscus injury, length of post-op Abx to decrease incidence of SSI?

A

24-hrs

30
Q

When use vancomycin for pre-op prophylactic Abx?

A

for high-risk pts for MRSA, or have penicillin allergy (must be given over longer time than 60min bc required slow administration)

31
Q

What does the APACHE score evaluate?

A

(acute physiology and chronic health eval) severity of disease classification system to estimate mortality in ICU

32
Q

What is a quick test to quantify fraility?

A

Timed Up and Go - mobility instructions; prolonged if takes >12 seconds

33
Q

What does the SOFA score evaluate?

A

(sequential organ failure assessment) predicts ICU mortality based on lab/clinical data

34
Q

MC organism causing VAP and SSI

A

S.aureus

35
Q

MC (#1, #2) organism causing central-cath-associated bloodstream infection

A 
#1: S. epidermidis
#2: S. aureus
36
Q

VitC vs. VitD: decreased resus volumes in burns

A

VitC

37
Q

VitC vs. VitD: antioxidant effect

A

VitC

38
Q

VitC vs. VitD: decreased MOF after trauma and burns

A

both

39
Q

PPI decreases absorption of what oral AC?

A

dabigatran

40
Q

What oral AC has high oral bioavailability?

A

rivaroxaban, apixaban, edoxaban

41
Q

Renal vs. hepatic elimination: rivaroxaban, dabigatran

A

rivaroxaban: both
dabigatran: renal

42
Q

What is inspiratory resistance training?

A

inhalation exercise against progressively increasing inspiratory resistance - those who improved pre-op have decreased post-op pulm operation

43
Q

Time of onset, half-life: Oral factor Xa inhib

A

Time of onset: 2-4hr

Half-life: 7-15hr

44
Q

Time of onset, half-life: Oral direct thrombin inhib

A

Time of onset: 2-3hr

Half-life: 12-14hr

45
Q

Which pts should receive extended DVT ppx beyond their inpatient stay?

A
  • total hip replacements
  • total knee replacements
  • major cancer resections
  • high-risk gyn resections
46
Q

What does the Frailty Index estimate?

A
  • risk for post-op Cx
  • length of stay
  • discharge to SNF
47
Q

Half-life fondaparinux (SubQ)

A

12-17 hrs

48
Q

RF for periop cardiac events

A
  • increasing age
  • increasing ASA status
  • decreasing functional status
49
Q

Ultrasound surgical energy instruments: highest temp, thermal spread, cooling time

A

Tmax: 200 C
Highest thermal spread
Longest cooling time (>40sec)

50
Q

Bipolar surgical energy: highest temp, thermal spread, cooling time

A

Tmax: 90 C (same as monopolar)
Least amt thermal spread
Cool quickly

51
Q

Neck circumference associated with CAP

A

> 40cm

52
Q

Post-op mgmt for COPD pt s/p thoracic surgery

A

thoracic epidural pain control + removal of urinary cath POD#1

53
Q

Abx with cross-reactivity for penicillin

A

cephalosporin, carbapenem (beta-lactam ring)

54
Q

When should warfarin be held pre-operatively for low-risk pts?

A

5 days

55
Q

After bridging AC to LMWH before surgery, when should LMWH be held pre-operatively? When can you give it post-operatively?

A

held 24-hours pre-op

held 48-72 hours post-op after high-risk bleeding procedures

56
Q

After drug-eluting coronary stent, at what point can anti-plt therapy be held so these pts can have elective surgery?

A

at least 6 months - to allow for stent endothelialization

57
Q

Pre-op bundle for pts having colorectal surgery (and possibly intra-op colonoscopy)

A

PO Abx + mechanical bowl prep (reduces rate SSI) + IV abx

58
Q

When and how give TXA for trauma pt?

A

Within 3 hours as bolus, then continue for 8-hrs as gtt - can still give even if closed head injury

59
Q

Pre-op anemia is strongly associated ? in pts undergoing noncardiac surgery

A

mortality (2x greater odds dying within 90d surgery)

60
Q

Promethazine MOA, interaction with metoclopramide?

A

MOA: H1-R antag in vomiting center of medulla, vestibular nucleus, and chemo-R trigger zone
Interaction: blocks cholinergic-R on intestinal muscle fibers -> decreased tone and peristalsis of gut SM (counteracts prokinetic drugs)

61
Q

Ondansetron MOA, best used for…?

A

MOA: serotonin antag -> effect on 5HT3-R
peripheral effects: via enterochromaffin cells of enteric nervous system
central effects: via nucleus tractus solitaries + chemo-R trigger zone
best used for: chemotherapy-induced emesis

62
Q

Anti-emetic for cerebral edema (2/2 brain mass)

A

corticosteroids

63
Q

Scopolamine MOA, best used for…?

A

MOA: anticholinergic via M1-5 R antag

best used for: movement-related nausea, bowel obstruction

64
Q

Elimination of methadone

A

two-phase: alpha (8-12hr) and beta (30-60h)
analgesic effect correlates with alpha-phase.
withdrawal sxs held abay with beta-phase.

65
Q

MCC immune deficiency worldwide

A

malnutrition

66
Q

First cell present during inflammatory phase of wound healing

A

Neutrophils

67
Q

Laparoscopic insufflator initial flow rate? To obtain pressure of…? Pneumoperitoneum is maintained by constant gas flow of…?

A

Initial flow rate = 4-6L/min
Obtain pressure = 10-20 mmHg
Constant gas flow = 200-400 L/min-1

68
Q

Dominant feature of remodeling phase of wound healing

A

Collagen remodeling (collagen III replaced with collagen I) and scar formation

69
Q

Types of collagen

A 
1 = MC; main type in healed wounds (scars)
2 = cartilage
3 = blood vessels, fetal skin, uterus
4 = basement membrane
5 = cornea
70
Q

What is Palmer’s technique?

A

method of abdominal Veress access though left subcostal margin - Palmer’s point is 3cm below left subcostal margin @ midclavicular line - C/I hepatosplenomegaly

71
Q

What is Hasson’s technique?

A

open cutdown and direct visualization before placement of primary trocar

72
Q

Bipolar can be used to seal vessels of max. what diameter?

A

7mm

QUESTION NOTES (28 decks)

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