Misc. surgical knowledge

Question 1

CRP RR

Answer 1

<10

Question 2

WCC RR

Answer 2

<11

Question 3

Phlegmon

Answer 3

a localised inflammatory mass of soft tissue, usually secondary to a bacterial infection. May develop into an abscess.

Question 4

Fat stranding

Answer 4

The change in attenuation of fat around an inflamed structure. Relatively high sensitivity for intra-abdominal pathology.

Question 5

Radiologic features of fat stranding

Answer 5

Ill-defined margins, slightly increased density, fat still seen amid increased connective tissue lines.

Question 6

If a patient is recognised to be on DAPT pre-operatively what is the recommended course of action?

Answer 6

Hold 1 week prior

Question 7

If a patient is identified to be on warfarin pre-operatively what is the preferred course of action?

Answer 7

Check INR and potentially reverse with vitamin K

Question 8

If a patient is identified to be taking metformin pre-operatively what is the preferred course of action?

Answer 8

Hold 48hrs prior to surgery due to risk of lactic acidosis

Question 9

If a patient is identified to be taking sulphonylureas pre-operatively what is the preferred course of action?

Answer 9

Short acting = hold morning of surgery
Long acting = hold 48hrs prior

Question 10

If a patient is found to be taking antihypertensives pre-operatively what is the preferred course of action?

Answer 10

ACEi and ARBs should be held for 24hrs prior

Question 11

If a patient is found to be taking fish oil pre-operatively then the preferred course of action is?

Answer 11

Hold 1 week prior to procedures with bleeding risk

Question 12

If a patient is found to be taking steroids pre-operatively then what is the preferred course of action?

Answer 12

Increase the dose perioperatively if dose>5mg

Question 13

If a patient is found to be taking St John’s Wort pre-operatively what is the preferred course of action?

Answer 13

Hold 2 weeks prior

Question 14

If a patient is found to be a marijuana user pre-operatively what two things must be considered?

Answer 14

Higher anaesthetic requirements and increased airway irritability

Question 15

If a patient is found to be a cocaine user pre-operatively what two pathologies are they at risk of developing?

Answer 15

Rhabdomyolysis and stroke

Question 16

If a patient is found to be an amphetamine user preoperatively what 3 pathologies are they at increased risk for?

Answer 16

Rhabdomyolysis, coagulopathy and renal failure

Question 17

Situational risk factors for clotting include:

Answer 17

Age >70, reduced mobility, obesity and pregnancy/post-partum

Question 18

Medical risk factors for clotting include:

Answer 18

Prior VTE, recent trauma, thrombophilia, cardiorespiratory failure, recent MI, ischaemic stroke, rheumatological disorders, orthopaedic surgery and varicose veins

Question 19

Risk factors for clotting:

Answer 19

Hormonal therapy, active cancer, acute infection and surgery

Question 20

Situational risk factors for bleeding

Answer 20

Active bleeding, coagulopathy and surgical procedures with high risk of bleeding

Question 21

past medical history risk factors for bleeding

Answer 21

Thrombocytopaenia, severe hepatic disease, haemorrhagic stroke and bleeding disorders

Question 22

The _____ risk prediction score can be used to predict risk of VTE in hospitalised patients

Answer 22

Padua

Question 23

A Padua score of >__ is indicative of high risk of VTE

Answer 23

4

Question 24

TEDS stockings are contraindicated in:

Answer 24

DVT, intermittent claudication, severe limb oedema, recent skin graft, leg deformity, diabetic neuropathy and dermatitis

Question 25

Non-pharmacological VTE prophylaxis includes:

Answer 25

TEDs stockings, intermittent compression devices and early mobilisation

Question 26

Pharmacological VTE prophylaxis should be administered ___-___hrs before/after surgery

Answer 26

6-12hrs before surgery

Question 27

Pharmacological VTE prophylaxis should be continued for __ postoperatively

Answer 27

1 week or until fully mobile

Question 28

The first-line pharmacological agent for VTE prophylaxis is:

Answer 28

Low molecular weight heparins e.g. enoxaparin

Question 29

Unfractionated heparin is indicated for VTE prophylaxis in the following conditions:

Answer 29

Severe renal impairment or requirement for rapid reversal

Question 30

Factor Xa inhibitors/thrombin inhibitors are indicated for VTE prophylaxis in the following conditions:

Answer 30

Hip/knee replacement surgery, hip fracture surgery, current DVT/PE

Question 31

Warfarin is indicated for VTE prophylaxis in the following situation:

Answer 31

Current DVT/PE with renal impairment

Question 32

Tetanus toxoid should be administered when the last immunisation was:

Answer 32

Greater than 5 years ago

Question 33

Risk factors for tetanus infection include:

Answer 33

Gross wound contamination, delayed presentation (>6hrs), >1cm deep, avulsion/puncture/crush injury, body fluid exposure, instances where an ischaemic element is present, compound fractures, extensive tissue burns

Question 34

Local anaesthesia mechanism of action

Answer 34

Inactivates sodium channels which inhibits depolarisation of the neuron and therefore prevents the transmission of the pain signal

Question 35

Short-acting local anaesthetics include:

Answer 35

Lignocaine and lignocaine with adrenaline

Question 36

The maximum dose of lignocaine is:

Answer 36

3mg/kg

Question 37

The maximum dose of lignocaine with adrenaline is:

Answer 37

6mg/kg

Question 38

Advantages of lignocaine include:

Answer 38

Fast onset and less cardiotoxic

Question 39

Long acting local anaesthetics include:

Answer 39

Bupivacaine and ropivacaine

Question 40

The maximum dose of bupivacaine is:

Answer 40

2mg/kg

Question 41

The maximum dose of ropivacaine is:

Answer 41

3mg/kg

Question 42

Sepsis definition

Answer 42

An acute life-threatening condition characterised by organ dysfunction due to a dysregulated immune response to infection

Question 43

Sepsis can be classified by severity into:

Answer 43

SIRS, sepsis, severe sepsis and septic shock

Question 44

The most common cause of sepsis is:

Answer 44

Community-acquired pneumonia

Question 45

Causative pathogens in sepsis are usually:

Answer 45

Gram positive bacteria

Question 46

Risk factors for development of sepsis include:

Answer 46

Age less than 1 or greater than 65, diabetes mellitus, immunosuppression, intensive care, invasive medical devices

Question 47

Symptoms of sepsis include:

Answer 47

Chills, diaphoresis, oliguria and symptoms of primary infection