pestana: pre-op, post-op

Question 1

worst single finding predicting high cardiac risk

Answer 1

JVD

Question 2

most common cause of increased pulmonary risk in surgery

Answer 2

smoking

Question 3

how does smoking increase risk physiologically

Answer 3

high PCO2 (not low O2)

low FEV1

Question 4

two clinical findings and 3 lab values that predict operative mortality in patients with liver disease

Answer 4

encephalopathy
ascites

INR
bilirubin
serum albumin

Question 5

severe nutritional depletion is defined as

Answer 5

loss of 20% of body weight over a couple months

serum albumin <3

anergy to skin antigens

serum transferrin<200 mg/dL

Question 6

how many days should you wait for preoperative nutritional support to undernourished patient?

Answer 6

7-10 ideal

4-5 significant

Question 7

can you do surgery if someone is in a diabetic coma?

Answer 7

no- contraindication!

Question 8

symptoms of malignant hyperthermia

Answer 8

fever over 104
metabolic acidosis
hypercalcemia

Question 9

treat malignant hyperthermia

Answer 9

IV dantrolene
100% oxygen
correct acidosis
cooling blankets

Question 10

bacteremia is seen within how many minutes of invasive prodcedures

Answer 10

30-45 minutes

Question 11

gas gangrene is seen in how long after invasive prodedure

Answer 11

within hours

Question 12

postop causes of fever in usual range 101-103

Answer 12

atelectasis
pneumonia
UTI
deep venous thrombophlebitis
wound infection
deep abscess

Question 13

most common source of post op fever on first post op day

Answer 13

atelectasis

Question 14

pneumonia happens in how many days if atelectasis not resolved

Answer 14

3

Question 15

when do UTIs start post op?

Answer 15

day 3

Question 16

when does deep thrombophlebiis start post op

Answer 16

day 5

Question 17

when does wound infection start post op?

Answer 17

day 7

Question 18

when does deep abscess start post op

Answer 18

day 10-15

Question 19

diagnostic and treatment of deep thrombophlebitis

Answer 19

diagnostic: doppler studies of deep leg and pelvic veins
treat: heparin–>warfarin

Question 20

diagnostic of wound inf.

Answer 20

sonogram

Question 21

diagnostic of deep abscess

Answer 21

CT

Question 22

how is MI triggered most likely during surgery?

Answer 22

hypotension

Question 23

when would MI happen post op?

Answer 23

day 2-3

Question 24

most reliable diagnostic test for MI

Answer 24

troponin

Question 25

PE happens when post op?

Answer 25

day 7

Question 26

presentation of PE

Answer 26

pleuritic pain, sudden onset SOB anxious, diaphoretic, tachycardic

Question 27

diagnostic test for PE

Answer 27

spiral CT with intravenous dye (CT angio)

Question 28

treat PE

Answer 28

heparin

Question 29

therapy of aspiration if symptomatic

Answer 29

lavage and removal of acid and matter (bronchoscopy) bronchodilators, resp support

Question 30

what is the first thing to consider when post op patient becomes confused/disoriented?

Answer 30

hypoxia check blood gas, give resp support

Question 31

therapy for ARDS

Answer 31

PEEP (dont do too much!)

Question 32

common source of coma in cirrhotic patient with bleeding esophageal varices who undergoes a portocaval shunt

Answer 32

ammonia intoxication

Question 33

low urinary output defined as

Answer 33

<0.5 mL/kg/L

Question 34

most common causes of low urinary output post op and diagnostic test

Answer 34

fluid deficit or acute renal failure give bolus of 500 ml IV in 10-20 minutes - if dehydrated-->respond - renal failure-->no response or measure urinary sodium - dehydration: <10-20 mEq/L - renal failure: >40 mEq/L or FENa>1

Question 35

is paralytic ileus expected the first few days after abdominal surgery

Answer 35

yes

Question 36

what if ileus not resolved after day 5-7, think...and how should be diagnosed and treated

Answer 36

early mechanical bowel obstruction (adhesions) diagnose: CT treat: surgery

Question 37

ogilvie syndrome seen in which population

Answer 37

elderly sedentary patients who have become durther immobilized from surgery

Question 38

manage ogilvie syndrome

Answer 38

fluids, electrolyte correction c-scope: suck out air

Question 39

air fluid levels in GI tract indicate

Answer 39

normally water and air mixed from normal peristlasis but if small bowel obstructed, tract gets tired, --> liquid goes to bottom and air goes to top

Question 40

wound dehiscence seen which day post op? and how does it look

Answer 40

day 5 wound intact but pink fluid soaks dressing

Question 41

evsiceration

Answer 41

complication of dehiscence skin opens up and abdominal contents rush out emergency closing!

Question 42

type of fluid to fix hypernatremia

Answer 42

D5 1/2 saline (if developed slowly) D5 1/3 saline (if developed fast)

Question 43

every ___ mEq/L that the serum sodium concentration is above 140 represents 1 L of water lost

Answer 43

3

Question 44

causes of hypernatremia

Answer 44

slow: lost water fast: osmotic diuresis, diabetes insipidus

Question 45

hyponatremia causes

Answer 45

SIADH (slow) losing large amounts of isotonic fluid (fast)

Question 46

fixing hyponatremia if fast developing or slow

Answer 46

fast: slow 3% or % saline slow: water restriction

Question 47

causes of hypokalemia: slow vs fast

Answer 47

``` slow: GI fluid loss, urine loss (diuretics, aldosterone) ``` fast: correction of DKA

Question 48

speed limit of IV K+ adminstration

Answer 48

10 mEq/h

Question 49

hyperkalemia causes: slow vs fast

Answer 49

slow: renal failure, aldosterone antagonists fast: K+ dumped into cells from crushing injuries, dead tissue, acidosis

Question 50

treatment of hyperkalemia:

Answer 50

hemodialysis, NG suction 50% dextrose and insulin IV calcium- quickest, cardioprotective

Question 51

what forms of bicarbonate can help treat metabolic acidosis (besides treating cause of metabolic acidosis)?

Answer 51

lactate, acetate

Question 52

what is inevitable with longstanding acidosis of whichever etiology?

Answer 52

renal loss of K+

Question 53

how to treat metabolic alkalosis

Answer 53

5-10 mEq/h KCl