Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gen surg > Pre-op assessment > Flashcards

Pre-op assessment Flashcards

1
Q

Oral fluids/fasting requirements for surgery

A

May drink clear fluids until 2 hours before their operation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Purpose of drinking clear fluids before the operation

A

Can help reduce headaches, nausea and vomiting afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How long must patients fast for prior to surgery

A

Generally advised to fast from non-clear liquids/food for at least 6 hours before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Potential complications of poorly managed diabetes during surgery

A

Undetected hypoglycaemia whilst a patient is under GA

increased risk of wound and resp infections

Increased risk of post-op acute kidney injury

Increased length of hospital stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which grading system can be used to classify patients to indicate risk of absolute mortality

A

American Society of Anesthesiologists Grade (ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Group and Save

A

Determines the patient’s blood group (ABO and RhD) and screens the blood for any atypical antibodies(takes around 40 mins)

Recommended if blood loss is not anticipated, but blood may be required if greater blood loss occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is cross-match

A

Involves physically mixing the patient’s blood with donor’s blood, in order to see if any immune reaction takes place –> transfusion if not

Should be done pre-emptively if blood loss is anticipated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens if an MRSA sample is isolated from a patient prior to surgery

A

Decontamination hair and body wash, along with topical ointment applied to the nostrils, will be given

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What might high-risk patients undergoing major surgery be referred for

A

Cardiopulmonary exercise testing(CPET)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is CPET

A

Involves a graded intensity period on a stationary bicycle whilst wearing a mask, as well as ECG monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Purpose of CPET

A

Provides VO2max and anaerobic threshold, which can be used to risk-stratify patients for post-op complications and need for higher level care environments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How long before surgery should a patient ideally have a pre-op assessment

A

2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What classification is used to assess the potential difficulty of a patient’s airway for intubation

A

Mallampati score stratifies the difficulty of endotracheal intubation based on anatomic features

Also Wilson’s score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rules regarding use of antihypertensives and antiarrhythmics in patients undergoing surgery

A

ACE inhibitors should be withheld on the morning of major surgery

Beta-blockers should be continued as per prescription

Digoxin will need an ECG and blood tests to exclude hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rules regarding use of antiplatelets in patients undergoing major surgery

A

Aspirin and NSAIDs can be continued

Clopidogrel causes irreversible platelet inhibition and therefore should be stopped 7 days before surgery and/or neuraxial intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long before surgery should warfarin be stopped

A

Last dose of warfarin should be given 6 days before procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How long before surgery should heparin be stopped

A

Unfractionated heparin is short-acting and administered IV so must be stopped 4 hours before neuraxial block with evidence of a normal APTT

LMWH is longer acting and administered subcut so a neuraxial block cannot be performed for 12 hours following a prophylactic dose and 24 hours following a treatment dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Oral hypoglycaemic agents in patients undergoing major surgery

A

Agents such as metformin should be omitted on the day of surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Use of hormonal therapies in patients undergoing surgery

A

OCP can increase risk of DVT so should be stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why are antacids given prior to surgery

A

Ranitidine or omeprazole given to minimise stomach acid and reduce risk of aspiration during induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Purpose of giving glycopyrrolate prior to surgery

A

Anti-sialogogue which reduces oral secretions prior to airway instrumentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the three phases of an operation identified by the WHO checklist

A

1) Before the induction of anaesthesia (sign in)
2) Before the incision of the skin (time out)
3) Before the patient leaves the operating room (sign out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Appropriate ix in IHD prior to surgery

A

Bloods
Urine
ECG
Treadmill/myocardial perfusion scan/angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Important blood parameter to check prior to thyroid surgery

A

Calcium

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Anticoagulant to cover warfarin during surgery
Prophylactic tinzaparin | IV unfractionated heparin if mechanical heart valve
26
IX for respiratory disease patients prior to surgery
Peak Flow/FEV1 FVC/6 min walk Peri-op - saline nebulisers, bronchodilators, chest physiotherapy, ABG
27
Important imaging ix prior to surgery for rheumatoid arthritis patients
Cervical x-ray - risk of Atlanta-axial subluxation
28
What is primary bleeding
bleeding that occurs within the intra-operative period This should be resolved during the operation, with any major haemorrhages recorded in the operative notes and the patient monitored closely post-operatively
29
What is reactive bleeding
Occurs within 24 hrs of op
30
What are most reactive bleeding case slinked to
A ligature that slips or a missed vessel. These vessels are often missed intraoperatively due to intraoperative hypotension and vasoconstriction, meaning only once the blood pressure normalises post-operatively will this bleeding occur
31
What is secondary bleeding
occurs 7-10 days post-operatively Secondary haemorrhage is often due to erosion of a vessel from a spreading infection. Secondary haemorrhage is most often seen when a heavily contaminated wound is closed primarily
32
Which artery is vulnerable to laparoscopic ports
Inferior epigastric artery
33
Which artery is vulnerable during angiography
The puncture site is often the external iliac artery, above the inguinal ligament. Therefore, any bleeding from this artery will go into the retroperitoneum.
34
General mx of post op haemorrhage
``` Review operation notes Rapid fluid resus(18G minimum for IV) Direct pressure Urgent senior surgical review Urgent blood transfusion ``` Prep for theatre after senior review
35
Risk factors for post-op nausea and vomitng(PONV)
Female Hx of pONV Opioids Non-smoker
36
Prophylactic measures for post-op nausea and vomiting
Anaesthetic measures – reduce opiates, reduce volatile gases, avoiding spinal anaesthetics Prophylactic antiemetic therapy Dexamethasone* at induction of anaesthesia
37
Conservative measures for post-op nausea and vomiting
Adequate fluid hydration Adequate analgesia Consider nasogastric tube insertion to aid gastric decompression
38
Pharmaceutical measures for post-op nausea and vomiting
Impaired gastric emptying or gastric stasis should be trialled on prokinetic agent(metoclopramide) unless bowel obstruction Hyoscine to reduce secretions Ondanstron or cyclising for opioid induced nausea and vomiting
39
What can nausea and vomiting after operation indicate
May be a sign of post-op complication such as ileum
40
Likely aetiology of pyrexia - day1-2 post op
consider a respiratory source (or body’s routine response to surgery)
41
Likely aetiology of pyrexia - day3-5 post op
consider a respiratory or urinary tract source
42
Likely aetiology of pyrexia - day5-7
Surgical site infection or abscess/collection formation
43
Other causes of pyrexia post op
Iatrogenic(drugs/transfusions) VTE(low grade fever) Prosthetic implantation
44
Causes of pyrexia of unknown origin
infection of unknown source (30%), malignancy (classically B-symptoms from lymphoma, 30%), connective tissue diseases or vasculitis (30%), or drug reactions
45
Mx of LRTI post op
Co-Amoxiclav 1.2g IV +/- Amikacin
46
Mx of UTI catheter associated
Co-Amoxiclav 1.2g IV +/- Amikacin | Nitrofurantoin 50mg PO + Change of Catheter
47
Mx of surgical site infection
Flucloxacillin 1g IV
48
Mx of central line infection
Replace line (trial antibiotic line lock with vancomycin if not able to replace line)
49
Interpretation of SOFA score
greater than or equal to two indicates sepsis; the SOFA score can also be used to monitor and quantify a patient’s clinical course and response to treatment for sepsis.
50
qSOFA criteria
Respiratory Rate ≥ 22/min (1 point) Altered Mental State (1 point) Systolic Blood Pressure ≤100mmHg (1 point)
51
Risk factors for anastomotic leak
Medication (such as corticosteroids and immunosuppressants) Smoking or alcohol excess Diabetes Mellitus Obesity or malnutrition
52
Clinical features of anastomotic leak
Abdo pain and fever 5-7 days post op Delirium Prolonged ileus Tachycardia Signs of peritonism
53
IX for anastomotic leak
CT contrast of abdomen and pelvis FBC/CRP/U&Es/LFTs and clotting screen VBG Repeat group and save
54
Initial mx of anastomotic leak
A-E NBM Broad spectrum ABX IV fluids and urinary catheter
55
Definitive mx of anastomotic leak
Collections <5cm managed conservatively Larger ones drained percutaneously Exploratory laparotomy if septic or multiple collections
56
Risk factors for post-op ileus
Increased age Electrolyte derangement (e.g. Na+, K+ and Ca2+ derangement) Neurological disorders (e.g. Dementia or Parkinson’s Disease) Use of anti-cholinergic medication
57
Surgical factors which increase risk of post-op ileum
Use of opioid medication Pelvic surgery Extensive intra-operative intestinal handling Peritoneal contamination (by free pus or faeces) Intestinal resection
58
Clinical features of post-op ileus
Failure to pass flatus or faeces Sensation of bloating and distention Nausea and vomiting (or high NG output) Abdominal distension and absent bowel sounds
59
Ix for post-op ileus
FBC and CRP U&Es Electrolytes CT abdo and pelvis
60
Mx of post-op ileus
NBM Daily bloods to monitor AKI Encourage mobilisation Reduce opiate analgesia
61
Prophylactic measures for post-op ileus
Minimise intra-operative intestinal handling Avoid fluid overload (causing intestinal oedema) Minimise opiate use Encourage early mobilisation
62
What are adhesions
fibrous bands of scar tissue. Many occur secondary to previous surgery or intra-abdominal inflammation (particularly pelvic)*, however they can also be congenital. Common cause of SBO
63
Clinical features of bowel adhesions
Asymptomatic Obstruction Infertility Chronic pelvic pain
64
Mx of bowel adhesions
Conservative mx with tube decompression NBM IV fluids Adequate analgesia
65
Surgical mx of bowel adhesions
``` Adhesiolysis Laparoscopic mx(mainstay) ```
66
Risk factors for incisional hernia
``` Emergency surgery BMI > 25 Midline incision Post-op wound infection DM Steroids Age Smoking ```
67
Clinical features of incisional hernia
reducible, soft and non-tender swelling at or near the site of a previous surgical wound. If the hernia is incarcerated, it can become painful, tender, and erythematous.
68
Mx of incisional hernia
Suture repair for small hernias Laparoscopic mesh repair/open mesh repair Abdominal wall reconstruction
69
Iatrogenic causes of post-op constipation
medications such as opioid analgesia, anticonvulsants, iron supplements, or antihistamines

Gen surg (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions