Preoperative and postoperative care

Question 1

Ischemic heart disease, congestive heart failure, cerebrovascular disease, a high-risk operation, preoperative treatment with insulin, and preoperative serum creatinine greater than 2.0 mg/dL is a predictive of complication?

Answer 1

surgical cardiac complication

Question 2

what is the percentage of postoperative MI in a patient with prior hx of MI?

Answer 2

5 to 10%

Question 3

What type of testing is indicated in non cardiac operations in patients with active cardiac conditions such as unstable angina, recent MI, or severe vascular dz?

Answer 3

Noninvasive stress testing

Question 4

What should you do before non cardiac operations in pts with: L main coronary artery stenosis, stable angina with three-vessel coronary dz, L anterior descending coronary artery stenosis?

Answer 4

Coronary revascularization

Question 5

Why may it be dangerous to give a patient with chronic COPD supplemental oxygen?

Answer 5

This patient uses relative hypoxia for respiratory drive, and supplemental O2 may remove this drive!

Question 6

Optimally, when should patients who smoke stop smoking before scheduled surgery?

Answer 6

at least 8 weeks before surgery

Question 7

What type of respiratory conditions are absolute contraindications for elective surgery?

Answer 7

Acute lower respiratory tract infections.

Question 8

What type of testing should patients get with a history of DM prior to surgery?

Answer 8

blood glucose testing

Question 9

The risk of a surgical site infection increases with the degree of hyperglycemia, with levels greater than what mg/dL being the sole predictor of surgical site infection

Answer 9

140mg/dL

Question 10

What is the best medicine for perioperative glucose control and why?

Answer 10

IV insulin d/t rapid onset of action, short half-life, immediate availability

Question 11

Is the preferred range for post op glycemic control?

Answer 11

Normal: 90-100 mg/dL

Moderate: 120 - 200 mg/dL

Question 12

What is in Virchow’s triad?

Answer 12

Stasis, hyper coagulable states, trauma

Question 13

What is the first-line imaging test for suspected DVTs?

Answer 13

venous duplex ultrasound

Question 14

What is the gold standard dx for a DVT?

Answer 14

Venography

Question 15

How do you treat DVTs?

Answer 15

IV Heparin and switch to warfarin

Question 16

Women older then 35 and smoke cigarettes are at increased risk for what and what should they avoid?

Answer 16

Increased risk of a venous thrombosis and should avoid oral contraceptive pills. Progestin-only methods are ok.

Question 17

If bridging for patients on warfarin, when should the last dose be given?

Answer 17

day 6

Question 18

what day do you begin bridging with a different anti coag with patients taking warfarin?

Answer 18

different anti coag like enoxaparin or dalteparin begins 3 days pre op

Question 19

Patients who smoke should stop smoking at least how long before scheduled surgery?

Answer 19

8 weeks

Question 20

what percent of the population have alcohol or drug dependence?

Answer 20

5-10%

Question 21

What is the most common cause of fever in the first 48 hours post?

Answer 21

Atelectasis

Question 22

Is the most common cause of a post-op infection in the 48-72 hour time window

Answer 22

UTI

Question 23

When do surgical site wound infections arise?

Answer 23

classically, days 5-7

Question 24

What is the most common bacteria to cause a post op wound infection?

Answer 24

Staph. aureus

Question 25

What bacteria will cause a post op infection that has a bone-brown weeping tender wound?

Answer 25

Clostridium