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Surgery > Pre-Test (Pre and Post Op, Critical Care) > Flashcards

Pre-Test (Pre and Post Op, Critical Care) Flashcards

1
Q

Earliest clinical indication of hypermagnesemia

A

Loss of DTR (High Mg generally leads to states of neuromuscular depression)

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2
Q

Initial management of hyponatremia

A

Free water restriction

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3
Q

FeNa of less than 1% in oliguric setting indicates

A

Pre-renal etiology - aggressive Na resorption in the tubules (look urine Na)

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4
Q

Hypomagnesmia effects

A

paresthesia, hyperreflexia

Prlonged QT and PR intervals

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5
Q

Normal EKG in pre-op pt with hx of MI

A

Still do stress test (normal EKG wouldn’t preclude further workup)

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6
Q

When should mix acid-base abnormalities be suspected

A

When pH is normal, but pCO2 and Bicarb levels abnormal OR

If compensatory responses appear to be excessive

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7
Q

Whenever significant bleeding is noted in early post-op period, first presumption should be

A

Error in surgical control of blood vessels in the operative field

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8
Q

Goldman’s index risk #1

A

Recent MI (Up to w/in 6 mo)

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9
Q

In absence of peritoneal signs, dx test of choice for acute mesenteric ischemia

A

Angiography

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10
Q

Pre-op period tx for vWD

A

Desmopressin

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11
Q

What do you give with PRBC

A

FFP - transfusions lead to dilutional thrombocytopenia w/ def in factors V and VII

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12
Q

When do you start enteral nutrition post op

A

After bowel function if PO

If tube that passes stomach, can start w/in 24 hours

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13
Q

1st step in massive bleeding from retroperitoneal hematoma in post op pt

A

Immediate reversal of Heparin w/ protamine sulfate

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14
Q

What is referring syndrome? Major Complication?

A

IV glucose after chronic malnutrition leads to inc insulin levels –> electrolytes shifted back into cells
Hypophosphatemia (also hypokalemia and hypomagnesemia)

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15
Q

Sepsis vs Adrenal insuff

A

Similar presentations, but sepsis generally associated with hyperglycemia and normal K+
(Adrenal insuff -> hypoglycemia and hypokalemia)

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16
Q

When should FFP to replenish Vit K deep clotting factors be administered prior to OR? Why?

A

On the call to the OR

Factor 7 half-life is 4-6 hours (most stable clotting factor)

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17
Q

DIC after blood products likely?

A

Transfusion reaction (hemolytic)

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18
Q

What do you give a hemophilia A pt before surgery

A

Desmopressin and Aminocaproic acid (inhibitor of fibrinolysis)
FFP has F VIII but not in high enough levels to prevent bleeding in hemophiliacs

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19
Q

Most common cause of Zinc def? Symptoms

A

Excessive diarrhea

Alopeica, poor wound healing, night blindness, skin rashes

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20
Q

Ratio of NS or LR to replace blood loss

A

3:1 (3x fluid for 1ml blood lost)

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21
Q

Fluid replacement formula per hour

A

4 ml/kg/h for first 10 kg
2 for second 10
1 for every additional kg

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22
Q

Non-anion gap acidosis management

A

Fluid replacement and stool bulking agents

23
Q

Patients with large ileostomy outputs at risk for?

A

Dehydration with accompanying hyponatremia, hypokaelmia, and non-anion gap metabolic acidosis

24
Q

Hemolytic tranfusion reaction treatment

A

Fluids and mannitol

Indwelling catheter can help and diagnose by showing oliguria and hemoglobinuria

25
Q

Metabolic rate during starvation

A

Decreases by 10%

26
Q

Stress factors relative to basal metabolic rate for routine operation? multiple organ failure or severe injury? >50% burns?

A

Routine operation: 1.1
Multiple organ failure or severe injury: 1.5
>50% burns: 2

27
Q

First step if trach starts bleeding bad

A

Intubate or stop the bleeding before going to OR for median sternotomy

28
Q

Indications for extubation

A
  • Rapid shallow breathing index b/w 60-105 (ratio of of RR to tidal volume)
  • Neg insp force >-20
  • PEEP of 5 or less
29
Q

Major serious complication of hemolysis

A

Renal damage caused by precipitation of hemoglobin in renal tubules

30
Q

Anesthetic to avoid in SBO surgery

A

Nitrous oxide (more absorbable, can increase distention)

31
Q

3 major physiologic altercations of ARDs

A

1) hypoxemia unresponsive to elevations in O2 conc
2) Dec pulmonary compliance
3) Dec FRC

32
Q

3 major things that shift the O2 curve to the right

A

Acidosis, rise in PaCO2, and elevation of temperature

Also 2,3-BPG

33
Q

How does TRALI manifest

A

Respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload

34
Q

Agent of choice in cardiogenic shock

A

Dobutamine

35
Q

Cardiac index formula

A

Cardiac output / Body surface area

36
Q

Tx for acalculous cholecystitis

A

Percutanous drainage of gallbladder

37
Q

Hemodynamics of septic shoc

A

Hyper dynamic state with increase in CO and decrease in peripheral vascular resistance
relatively normal central pressures

38
Q

How does PEEP improve oxygenation

A

Increases FRC by keeping alveoli open at the end of expiration

39
Q

Tx for neurogenic shock

A

IV fluid bolus followed by presser (Phenylephrine or dopa)

40
Q

Prolonged paralysis after intubation likely from? Don’t use what drug?

A

Pseudocholinesterase def

Don’t use succinylcholine or Mivacurium

41
Q

3 criterion for acute transfusion reactions

A
  1. Haptoglobin levels 5

3. + Coombs test (but takes 2-10 days)

42
Q

O2 content variables

A

Hb, O2 sat, and PaO2 (in that order for contribution)

43
Q

Highly reliable indication of alveolar ventilation

A

PcO2 (inc means not good alveolar ventilation)

44
Q

Ideal respiratory quotient

A

0.75-0.85

45
Q

What do you give pre-op pt’s w/ VWD (besides desmopressin)

A

Cryoprecipitate (Has vWF and Factor VIII)

46
Q

Who is not a candidate for ECMO

A

Babies with hypoplastic lungs –> not enough surface area for gas exchange

47
Q

What is indicated for aspiration pneumonitis if there is particulate matter in tracheobronchial tree

A

Bronchoscopy

48
Q

Tx for malignant hyperthermia besides dantrolene

A

Hyperventilate with 100% O2

49
Q

Lab values for cholesterol atheroembolism

A

Eosinophilia
Microscopic hematuria or proteinuria
FeNa >1

50
Q

Metabolite abnormality that succinylcholine can cause

A

Hyperkalemia (worse in burn patients)

51
Q

Warfarin factors

A

II, V, VII, X, C and S

52
Q

What does thrombin time measure

A

Qualitive abnormalities in fibrinogen and presence of inhibitors to fibrin polymerization

53
Q

What can measure both amount of and nature of hypotesion

A

Pulmonary artery cath

54
Q

Measurement of HTN after CEA

A

Art line for beat to beat measurement

Surgery (8 decks)

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