Pre/post op

Question 1

The earliest clinical indication of hypermagnesemia is

Answer 1

loss of deep tendon reflexes

Question 2

States of magnesium excess are characterized by

Answer 2

generalized neuromuscular depression

neuromuscular effects resemble those of calcium deficiency

Question 3

Symptomatic hyponatremia levels

Answer 3

NA less than 120 mEq/L
–> HA, SZ, coma, and signs of ↑ICP
may require infusion of hypertonic saline

Question 4

Pts w/ loss of much of the ileum is at high risk of developing ?

Answer 4

enteric hyperoxaluria

Normally, fatty acids are absorbed by the terminal ileum, and calcium and oxalate combine to form an insoluble compound that is not absorbed.

with no ileum, unabsorbed fatty acids reach the colon, where they combine with calcium
* leaving free oxalate to be absorbed–> kidney stone

Question 5

elevated arterial pH and PCO2

Answer 5

met alk with resp comp

The PCO2 would be normal if the metabolic alkalosis was uncompensated

Question 6

decreased pH, increased PCO2, and increased bicarbonate levels

Answer 6

resp acidosis

Question 7

pH is normal, but the PCO2 and bicarbonate levels are abnormal

Answer 7

mixed process

*or if the compensatory responses appear to be
excessive or inadequate

Question 8

Volume depletion acid/ base state

Answer 8

metabolic alkalosis

volume depletion –> excessive salt / water retention–> ↑ bicarbonate reabsorption –> alkalosis

Correction of volume depletion alone is usually sufficient to correct the alkalosis

Question 9

lepirudin is?

Answer 9

an anti-coag.

Question 10

In the postoperative period, transfusion reactions usually present as

Answer 10

fever, apprehension, and headache

Question 11

von Willebrand factor (vWF) is?

Answer 11

an important stimulus for platelet aggregation at the site of tissue injury
major carrier protein for circulating factor VIII.

Question 12

Systemic inflammatory response syndrome (SIRS)

Answer 12

*2 OR MORE*
 >38°C (100°F) or <36°C (97°F)
HR >90 
RR >20 or PaCO2 <32 mm Hg
WBC count >12,000 or <4000/mm/ >10%pmns

Question 13

Sepsis

Answer 13

= SIRS + documented infection

SIRS: 
*2 OR MORE*
 >38°C (100°F) or <36°C (97°F)
HR >90 
RR >20 or PaCO2 <32 mm Hg
WBC count >12,000 or <4000/mm/ >10%pmns

Question 14

Severe sepsis

Answer 14

sepsis + organ dysfunction or hypoperfusion

(lactic acidosis, oliguria, or AMS).

Question 15

Septic shock

Answer 15

sepsis + organ dysfunction + hypotension

(systolic blood pressure <90 mm Hg or >90 mm Hg with vasopressors).

Question 16

class IV hemorrhagic shock

Answer 16

loss of more than 40% of circulating blood volume

requires massive blood transfusion

Question 17

The term massive blood transfusion is defined as

Answer 17

transfusion > 10 units of PRBCs over 24 hours

Question 18

. The _________ remains uncoordinated in its muscular activity and does not empty efficiently for about 24 hours after abdominal procedures

Answer 18

stomach

Question 19

The small bowel functions normally within _______ of surgery

Answer 19

• hours
• able to accept nutrients promptly, either by nasoduodenal or percutaneous jejunal feeding catheters
• or after 24 hours, by gastric emptying

Question 20

The colon is stimulated by the gastrocolic reflex but ordinarily is relatively inactive for ___________ after surgery

Answer 20

3 to 4 days.

Question 21

Well-nourished patients who undergo uncomplicated surgical procedures can tolerate ___________ before significant problems with protein breakdown begin to occur

Answer 21

up to 10 days without full nutritional support

Question 22

___________ is a specific antidote to heparin

Answer 22

Protamine sulfate

protamine is also an anticoagulant

Question 23

The indications for inferior vena cava (IVC) filter placement fall into three categories:

Answer 23

failure or complication of anticoagulation
a known free-floating venous clot
prior history of PE.

Question 24

Adrenal insufficiency s/s

Answer 24

classically manifested as AMS, ↑ temperature, cardiovascular collapse, hypoglycemia, and hyperkalemia

Dexamethasone should be used as steroid replacement

Question 25

Transfusions with FFP to replenishes?

Answer 25

vitamin K–dependent clotting factors

The half-life of the most stable factor, (VII) is 4 - 6 hours

consider this timing if using prophylactically before surgery

Question 26

The most common nosocomial infection is ?

Answer 26

a urinary tract infection

Question 27

Causes of Fistulas

Answer 27

foreign body
radiation
inflammation,
epithelialization of the tract
neoplasm
distal obstruction
steroids

“FRIENDS.”

Question 28

Hemolytic transfusion reactions are caused by ____________ of transfused red blood cells by the recipient’s pre existing antibodies

Answer 28

complement-mediated destruction

Question 29

ε-aminocaproic acid is a?

Answer 29

Clotting promoter- an inhibitor of fibrinolysis

sometimes given before an operation to prevent serious bleeding for patients with ↑ chance of bleeding.

Question 30

aspirin permanently acetylates cyclooxygenase and leaves affected platelets dysfunctional throughout their ________ lifespan

Answer 30

7-day

nsaids: 3-4 days