Readings

Question 1

What instances make a patient a candidate for a more sophisticated pulmonary screening?

Answer 1

Pt who cannot climb one flicght of steps with out dyspnea or cannot blow out a match 8 inches away for their mouth with out the pursing of their lips

Question 2

What is the loose cough test?

Answer 2

A rattle heard through the stethoscope when a patient forcible coughs = underlying pulm pathology

Question 3

At the end of passive tidal exhalation where is the patient in regards to PFTs?

Answer 3

FRC- equal to the sum of expiratory reserve capacity and residual volume

Question 4

What is closing volume?

Answer 4

the volume below which the alveoli become so structurally unstable that they cannot remain open, even with the benefit of a surfactant

Question 5

When is CV greater than FRC?

Answer 5

in smokers and obese patients

Question 6

What are the risks of a patient with severe lung pathology after surgery?

Answer 6

not only death and pneumonia, but also a life long req of a ventilator dependance

Question 7

What tests do we run on a patient who is high risk pulmonary disease?

Answer 7

PFT and ABG

Question 8

What is the most commonly used PFT?

Answer 8

FEV1

Question 9

What is a quick way to determine post op FEV1 for a pilm resection pt?

Answer 9

pre-op FEV1 x %of lungs left

Question 10

The patients ability to climb _____ flights of stairs shows they should be ok for pulmonary procedures.

Answer 10

> 2

Question 11

What produces or exacerbates hemorrhoids in over 1/3 of pregnant women?

Answer 11

pelvic venous compression

Question 12

If surgeries are necessary in a pregnant patient, when should they be preformed?

Answer 12

2nd trimester

Question 13

What are the most common reasons for GI surgery in a pregnant pt?

Answer 13

appendicitis and biliary tract disease

Question 14

What test has an increase in false-negatives during pregnancy?

Answer 14

mammography

Question 15

What is the most common cause of nipple discharge?

Answer 15

duct ectasia- nonneoplastic condition characterized by multiple dilated ducts in the subareolar space

Question 16

What gives a definitive histological diagnosis and eliminates the nipple discharge?

Answer 16

ductal excision via circumareolar incision

Question 17

What is the most frequently diagnosed non skin cancer?

Answer 17

breast cancer

Question 18

What is a very common benign tumor of the breast?

Answer 18

fibroadenoma, usually in young women

Question 19

How do you diagnose a fibroadenoma?

Answer 19

fine needle aspiration or core biopsy

Question 20

What may cause a rapid growth in a fibroadenoma?

Answer 20

hormonal stimulation in pregnancy, requires excision

Question 21

What is the most common breast mass in women and when does it occur?

Answer 21

breast cyst, 4-5th decade

Question 22

What causes a fluctuating in the size of he cyst?

Answer 22

menstrual cycle

Question 23

What color is the fluid in the cyst? Do we need cytology?

Answer 23

straw colored or greenish; no

Question 24

What constitutes 90 % of invasive breast cancers?

Answer 24

infiltrating ductal carcinoma

Question 25

What is skin edema of the breast?

Answer 25

peau d’orange

Question 26

What cancer presents with peau d’orange?

Answer 26

inflammatory carcinoma, BAD prognosis

Question 27

How does pagets disease of the breast present?

Answer 27

nipple abnormality: moist or dry and scaly or just thickened

may itch

Question 28

What is the basic physiologic process common to all wounds?

Answer 28

inflammation

Question 29

What is the definition of surgery?

Answer 29

Surgery is the term traditionally used for treatments that involve cutting or stitching tissue.

Question 30

How is a major surgery defined?

Answer 30

usually involves the use of general anesthesia. Major surgery often involves opening one of the major body cavities—the abdomen (laparotomy), the chest (thoracotomy), or the skull (craniotomy)—and can stress vital organs. Stays atleast one night in the hospital.

Question 31

How is a minor surgery defined?

Answer 31

can involve the use of local, regional, or general anesthesia. Major body cavities are not opened. Can be done by one doctor. Can go home the same day.

Question 32

What is informed consent?

Answer 32

the surgeon obtains the patient’s permission to perform the operation, a process called informed consent. The surgeon discusses risks and benefits of the operation and answers questions. The person reads and signs a form documenting consent. It is the verbal explanation NOT the signature that meets the legal requirement for informed consent.

Question 33

Who can get the informed consent?

Answer 33

only the person doing the surgery

Question 34

What is a mandatory time out?

Answer 34

rior to the operation, a “Mandatory Time Out” will be called. This time is used to verify the surgery, patient, and side. The goal is to eliminate any wrong-site, wrong patient, wrong procedure in order to maximize patient safety & minimize complications or errors. This involves the entire team. The surgery is a “no go” unless everyone is in agreement.

Question 35

What is a pre op verification process?

Answer 35

Uses a checklist to confirm appropriate documents are available and correct. Correct patient-correct procedure-correct site

Question 36

What is a surgical site marking?

Answer 36

Unambiguous mark, visible after prep and drape. Take care to mark right/left, multiple structures or levels.

Question 37

Sentinel events also include:

Answer 37

Infant abduction or discharge to the wrong family. Unexpected death of a full term infant.
Severe neonatal jaundice (bilirubin over 30 milligrams/deciliter).
Surgery on the wrong individual or wrong body part.
Surgical instrument or object left in a patient after surgery or another procedure.
Rape in a continuous care setting.
Suicide in a continuous care setting, or within 72 hours of discharge.
Hemolytic transfusion reaction due to blood group incompatibilities.
Radiation therapy to the wrong body region or 25% above the planned dose.