Preoperative / Postoperative (12%)

Question 1

Major cardiac risk factors for surgery

Answer 1

Unstable coronary syndrome
Recent MI
Severe valvular disease
Ventricular arrhythmia

Question 2

Intermediate cardiac risk factors for surgery

Answer 2

Asymptomatic MI
DM
Compensated CHF

Question 3

Minor cardiac risk factors for surgery

Answer 3

History of stroke

Uncontrolled HTN

Question 4

Goldman’s Criteria

Answer 4

High risk surgery?
History of ischemic heart disease?
History of CHF?
History of CVD? (CVA/TIA)
Pre-op insulin treatment?
Serum creatinine > 2 mg/dL?

Question 5

Based on Goldman’s, > 2 factors generally yield a > ____% risk of Major Adverse Coronary Events

Answer 5

5%

Question 6

Laboratory testing for cardiac dz prior to surgery

Answer 6

Resting LV Fxn
Ambulatory EKG monitoring
Exercise stress test
Non-exercise stress testing

Question 7

Patients with an ejection fraction of < ____% are at greatest risk for complication

Answer 7

35%

Question 8

Beta blockers before surgery can decrease rate of ____, especially in those at intermediate and high risk

Answer 8

MI

Question 9

Who gets pre-operative resting 12 lead EKG testing?

Answer 9

Asymptomatic women > 50 y/o or men > 45 y/o

Known cardiac history

Question 10

Patient’s with a history of rheumatic heart disease require prophylactic antibiotics to prevent ___________

Answer 10

Endocarditis

Question 11

Postoperative _________ complications are the most common form of postoperative morbidity experienced by pts undergoing abdominal procedures and thorarcotomy

Answer 11

Pulmonary

Question 12

Risk factors for development of pulmonary complications from surgery

Answer 12

Upper abdominal or cardiothoracic procedures
Prolonged anesthesia (> 4 hrs)
Age > 60 y/o
Tobacco abuse
COPD/CHF/OSA

Question 13

All candidates for lung resection should have preoperative ______

Answer 13

LFTs

Question 14

Hormones that increase in the operative period (5), and all of this causes hyperglycemia in the postoperative patient

Answer 14

Catecholamines
Growth hormone
Glucagon
ACTH
Cortisol

Question 15

Hormone release during surgery leads to decreased _________ _______ and decreased _________ ______, leading to more wound infections

Answer 15

Decreased wound healing

Decreased neutrophil function

Question 16

General rule of diabetic patients going in for surgery:

Answer 16

Give 1/2 of the usual dose of injectable insulin the morning of surgery
Give 5 dextrose continuous infusion
Keep BG at 150-200

Question 17

General rule for adrenal insufficient patients going in for surgery:

Answer 17

Give IV drip of hydrocortisone at 10 mg/hr

Question 18

Factors that increase risk of infection of surgical wounds

Answer 18

Malnutrition
Advanced age
Immunosuppressive drugs
Prolonged hospitalization
Recent abx
Obesity

Question 19

Necrotizing fasciitis is most commonly caused by:

Answer 19

Streptococci

Question 20

Treatment of necrotizing fasciitis

Answer 20

Debridement of tissues
ABX: ampicillin/sulbactam + clindamycin + ciprofloxacin
If suspicious of MRSA, give vanco

Question 21

Virchow’s Triad

Answer 21

1. Stasis
2. Vascular injury
3. Hypercoagulability

Question 22

Diagnostic studies for DVT

Answer 22

1. Duplex ultrasonography
2. Doppler analysis
3. Venography
4. D-dimer - negative can eliminate

Question 23

Diagnostic modality if pulmonary emboli is suspected

Answer 23

VQ scan versus spiral CT

Question 24

Treatment of DVT

Answer 24

LMWH
Need heparin until INR is therapeutic for 48 hours
Followed by warfarin - 6 months if initial occurrence or lifelong tx

Question 25

Well's Criteria

Answer 25

Used to determine likelihood of pulmonary embolism Score of > 6 means highly likely Score of < 2 makes diagnosis highly unlikely

Question 26

DVT prophylaxis in surgery

Answer 26

Heparin 5000 units subcutaneously started 2 hours before the operation and continued every 8-12 hours after surgery until fully ambulatory and discharged May also give enoxaparin 40 mg qd

Question 27

Intracellular water is _____ total body water and extracellular is ______

Answer 27

2/3 | 1/3

Question 28

Interstitial water is _____% of extracellular water or ____% of body weight

Answer 28

75% | 15%

Question 29

Intravascular water is ____% of extracellular water or _____% of body weight

Answer 29

25% | 4-7%

Question 30

In the intracellular compartment, ____ is the dominant cation, followed by _____

Answer 30

K+ | Mg+

Question 31

In the extracellular compartment, ___ is the dominant cation

Answer 31

Sodium

Question 32

During laparotomy, estimated evaporative fluid loss is _____ mL/kg/hr

Answer 32

10

Question 33

__________ with accompanying ______ _______ is the most frequent disorder in the preoperative patient

Answer 33

Dehydration | Salt loss

Question 34

Fluid administration in the postop patient can prevent ______ _______ and optimize ________ ______

Answer 34

Renal failure | Cardiac function

Question 35

Excess fluid may cause ______ and _______ and thus inhibit wound healing

Answer 35

CHF | Edema

Question 36

Want to keep urine output > ______ mL/hr

Answer 36

30