Patient Safety

Question 1

Donabedian model

Answer 1

Measures quality by identifying 3 types of improvements: changes in
Structure
Process
Outcome?
*context: Are we improving the safety culture?

Question 2

The most common delayed complication following carotid endarterectomy

Answer 2

Myocardial infarction

*should be cosidered a casue of labile BP and arryhthmias in high-risk patients

Question 3

The most appropriate treatment for a seroma after a soft-tisssue biopsy

Answer 3

Multiple attempts of aspiration with applicaation of pressure dressings

Question 4

Prophylaxis using low-dose unfractionated heparin reduces the incidence of fatal pulmonary embolism by

Answer 4

50%

Question 5

Remarks on DVT/PE

Answer 5

DVT occurs after approx 25% of all major surgical procedures performed without prophylaxis, and PE occurs after 7%

Question 6

Which is the best test to predict successful extubation of a patient

Answer 6

Tobin index
(Breaths per min / tidal volume)
“Rapid shallow breathing index”
-best negative predictive instrument
<=105, then there is nearly a 70% chance the patient will pass extubation.
>105, 80% chance of failing extubation

Question 7

Risk factors for wront-site surgery

Answer 7

Communication errors (70%)
Multiple surgeons
Multiple procedures
Time pressure
Emergency surgery
Abnormal patient anatomy
Morbid obesity

Question 8

In order to reduce the overall risk of stress gastritis in ICU patients mechanically ventilated for >48 hours, their gastric pH level should be kept greater than

Answer 8

4

Question 9

Remarks on stress gastritis

Answer 9

When patients iin the ICU have a major bleed from stress gastritis, the mortality risk is as high as 50%
*take note that gastritis prophyplaxis carries a risk of causing pneumonia

Question 10

The treatment of choice for a biloma after laparoscopic cholecystectomy is

Answer 10

Biliary stent

Question 11

The most frequent nosocomial infection is

Answer 11

UTI

2nd - pneumonia

Question 12

The first step in treating a 70-kg ptaient with plt of 12,000 due to heparin-induced thrombocytopenia is

Answer 12

Transufsion of 12 units of platelets
📌 scwartz 10th pp 384-385
“The treatment is anticoagulatiotn with syntheitc agents such as argatroban.”

Question 13

Remarks on thrombocytopenia

Answer 13

Thrombocytopenia may require platelet tranfusion for a plt count < 20,000/mL when invasive procedures are performed
1 unit of platelets will increse the platelet count by 5,000 to 7,500L in adults

Question 14

VAP in ventilated ICU patients reaches a 70% probability at

Answer 14

30 days

Question 15

Remarks on VAP

Answer 15

VAP occurs in 15-40% of ventilated ICU pateints
With a probability rate of 5% per day,
Up to 70% at 30 days.
The 30-day mortality rate of nosocomil pneuminia can ba as high as 40%

Question 16

Tracheostom may decrease the incidence of VAP, overall length of ventilator time, and the number of ICU patient days when performed

Answer 16

Before the 10th day of ventilatory support

Question 17

Remarks on tracheosotmy

Answer 17

Decreases the pulmonary dead space and provides for improved pulmonary toilet

Question 18

SIRS

Answer 18

Temp >38, <36
HR > 90
RR > 20 or PaCO2 < 32mmHg
WBC <4,000 or >12,000 or >10% immature forms

Question 19

SIRS AND MORTALITY

Answer 19

2 SIRS criteria - 5%
3 - 10%
4: 15-20%

Question 20

Laryngoscopic findings after a superior laryngeal nerve injury

Answer 20

Asymmetry of the glottic opening

Question 21

Remarks on skin prep and antibiotics

Answer 21

“The contemporary formulas of chlorhexidine gluconate with isopropyl alcohol remain more advantageous”

Perhaps not flammable with electrocautery use?

Question 22

The most common cause of an empyema in the postop patient is

Answer 22

Pneumonia

*empyema = infection of the pleural space

Question 23

The primary cause of hyperbilirubinemia in the surgical patient is

Answer 23

Cholestasis