PreOp/PostOp Care 12%

Question 1

(SmartyPance)

normal pH of blood

Answer 1

7.35 - 7.45

Question 2

(SmartyPance)

as pCO2 increases, what happens to pH?

Answer 2

it DECREASES

“As pCO2 increases in the blood, the pH decreases”

Question 3

(SmartyPance)

Decreased resp rate can cause retention of CO2 leading to respiratory acidosis or alkalosis?

Answer 3

RESP ACIDOSIS

“Decreased resp rate can cause retention of CO2 leading to respiratory acidosis”

Question 4

(SmartyPance)

As the HCO3- level increases in the blood, what happens to the pH?

Answer 4

INCREASES

“As the HCO3- level increases in the blood, the pH increases”

Question 5

(SmartyPance)
ABG:
pH 7.52; pCO2 25; HCO3- 22

what type of acid-base disorder?

Answer 5

RESP ALKALOSIS

Question 6

(SmartyPance)

six predictors of surgical cardiac complications

Answer 6

ischemic heart disease
CHF
cerebrovascular disease
high-risk operation
preop trtmt w/ insulin
preop serum Cr >2.0 mg/dL

Question 7

(SmartyPance)

if pt has a hx of rheumatic heart disease, what should be done before surgery?

Answer 7

prophylactic antibiotic therapy

Question 8

(SmartyPance)

if a pt has a PMH of MI, there is _______ percent risk of ____________?

Answer 8

5-10%; postoperative MI

“If the patient has a prior history of MI, there is a 5-10% risk of postoperative MI”

Question 9

(SmartyPance)

if a patient has unstable angina, what must be done before noncardiac operations?

Answer 9

noninvasive stress testing

Question 10

(SmartyPance)

what kinds of pt cardiac situations need coronary revascularization before noncardiac operations (5)?

Answer 10

• left main coronary artery stenosis
• stable angina w/ three-vessel coronary disease
• stable angina w/ two-vessel disease
• significant LAD stenosis with either:
• • • EF <50% or
• • • • ischemia on noninvasive testing
• high-risk unstable angina
• • or NSTEMI
• • • • or acute STEMI

Question 11

(SmartyPance)

Virchow’s triad (risk for clot formation/DVT)

Answer 11

stasis

trauma (sx, cellulitis)

hypercoagulable states (Factor V Leiden, CA, OCP + smoking, pregnancy)

Question 12

(SmartyPance)

what is first line imaging test for suspected DVT?

Answer 12

venous duplex u/s

Question 13

(SmartyPance)

what is the gold standard test for suspected DVT?

Answer 13

venography

Question 14

(RR)

What does an elevated INR that corrects with Vit K administration suggest in the setting of obstructive jaundice?

Answer 14

impaired intestinal absorption of fat-soluble vitamins

Question 15

(RR)
IF a pt has immune thrombocytopenia and is scheduled for an exploratory laparotomy to evaluate a 15 cm ovarian mass, what is the minimum platelet count for this procedure?

Answer 15

50,000/microL

Question 16

(RR)

Central Venous Catheter infection rates - list three central line sites in order of lowest risk of infection to highest

Answer 16

subclavian vein (lowest risk of infection)

Int Jugular (double the risk of infection compared to subclavian)

Femoral Vein (highest risk)

Question 17

(RR)

two common dysrhythmias that may occur in post op period after a cardiac procedure

Answer 17

AFib and A flutter

Question 18

(RR)

if pt is stable with post op AFib or AFlutter, preferred medical treatment is

Answer 18

IV esmolol

typically BB or CCB

Question 19

(RR)

if pt is UNSTABLE with post op AFib or AFlutter, preferred medical treatment is

Answer 19

cardioversion

Question 20

(RR)

MC clinical presentation of primary hyperparathyroidism

Answer 20

asymptomatic hypercalcemia

mean serum Ca conc is typically elevated less than 1.0 mg/dL

Question 21

(RR)

Classical presentations of hyperparathyroidism

Answer 21

bone disease
nephrolithiasis
weakness
fatigue
neurobehavioral symptoms

Question 22

(RR)

first line treatment for hypoparathyroidism

Answer 22

calcium and vit D supplementation

only curative Rx: parathyroidectomy

Question 23

(RR)
which of the following should be stopped one day prior to surgery?
a) ASA
b) atenolol
c) levothyroxine
d) metformin

Answer 23

D) METFORMIN

(“oral diabetic medications such as metformin should be held 24 hrs prior to surgery”

ASA should be stopped 1 week prior to surgery
atenolol and levothyroxine should be continued before and after surgery

Question 24

(RR)

Incentive spirometry is used to prevent what postoperative complication?

Answer 24

atelectasis

Question 25

(RR)

what are MC pathogens causing post op pneumonia?

Answer 25

Pseudomonas aeruginosa
Klebsiella pneumoniae
Acinetobacter species
Staph aureus