PreTest

Question 1

Earliest clinical sign of hypermagnesemia

Answer 1

Loss of deep tendon reflexes

Question 2

Initial mgmt of asx hyponatremia

Answer 2

Free water restriction

Question 3

Which pts are at risk for developing hyperoxaluria?

Answer 3

Pt who has lost a lot of ileum.
Usu, FA are absorbed by the terminal ileum, and calcium and oxalate combine in the ileum to form an insoluble cmpd that is excreted. W/o ileum, FAs aren’t absorbed and go to the colon, where they combine with calcium- so there is a lot of free oxalate, and it gets absorbed. Excess oxalate is excreted by the kidneys and promotes calcium oxalate stone formation.

Question 4

Where there is post-op oliguria, what is the first thing you need to determine?

Answer 4

If it’s due to a prenrenal cause (physiological response to hypovolemia) or if it is due to acute tubular necrosis

Question 5

How do you know if oliguria is dt tubular injury or to hypovolemia?

Answer 5

Look at FE-Na.

1 means there is a problem with the tubules.

Question 6

When should you give abx to prevent surgical site infections? And what abx?

Answer 6

Single dose, Within 1 hr before surgery

Cefazolin (against aerobes and anerobes)

Question 7

Biochemical profile of salicylate ingestion (aspirin)?

Answer 7

metabolic acidosis
respi alkalosis
(mixed)
anion gap.

Question 8

Rx for HIT heparin induced thrombocytopenia

Answer 8

Cessation of heparin
Start a non-heparin anticoagulant like lepirudin
Start oral warfarin when appropriate (when platelets are back to at least 100k

Question 9

Significant bleeding in early post-op period is most probably dt what?

Answer 9

Bleeding vessel in the surgical field

Question 10

What is the dx test of choice of acute mesenteric ischemia?

Answer 10

Angiography

Question 11

Dx eval and Rx for DVT in prego

Answer 11

Duplex and heparin (does not cross the placenta. don’t give warfarin to prego)

Question 12

What blood test values show you that someone has vWD?

Answer 12

Prolonged aPTT

Failure to aggregate in presence of risocetin

Question 13

Transfusion of what product can provide vWF?

Answer 13

Cryoprecipitate

Question 14

What drugs can be given to polycythemia vera pts to bring down their Hct and platelets

Answer 14

Busulfan
Chlorambucil
(alkylating agents)

Question 15

When a pt gets a large amt of blood transfusions, what factors do they become deficient in?

Answer 15

V and VIII (the labile factors)
banked blood is also deficient in platelets, so they may become throbocytopenic.
Give them FFP (it replaces the Vit-K dep factors) and give them platelets if they are thrombocytopenic.

Question 16

Rx for heparinized pt w significant hemorrhage

Answer 16

Give protamine sulfate to reverse the heparin anticoagulation
Also place vena cava filter

Question 17

Complications of starting TPN in a malnourished pt

Answer 17

Refeeding syndrome (malnourished pts who are given IV glucose)- can get hypophosphatemia, hypokalemia, hypomagnesemia
Start TPN slowly and replenish Mg, K, P
(can also get hyperglycemia, hyperchloremic acidosis)

Question 18

Pt w tapering of steroids and
nausea, vom, hypotension, hypoglycemia, abd pain

mental status chgs, increased temp, CV collapse

Answer 18

acute adrenal insufficiency