Surgery Flashcards
1
Q
3 aspects of clinical presentation for anaphylaxis in a peri-operative patient?
A
Hypotension, bronchospasm, skin rash
2
Q
Sign of bronchospasm in patient who has just been intubated?
A
Increased peak pressure
3
Q
Sign of decreased cardiac output in patient who has just been intubated?
A
Decreased end-tidal CO2
4
Q
Most common anesthetic agent responsible for anaphylaxis in a peri-operative patient?
A
Rocuronium
5
Q
What is the preferred method of intubation in patients with difficult airways (i.e. upper airway obstruction)?
A
Awake intubation
6
Q
Anesthetic agent used in setting of Awake intubation?
A
Ketamine
7
Q
2 additional benefits of using ketamine in setting of awake intubation?
A
Increased BP, Bronchodilation
8
Q
Preferred airway in setting of patient who “can’t intubate, can’t oxygenate” due to upper airway obstruction?
A
Cricothyrotomy
9
Q
Preferred airway in setting of patient who “can’t intubate, CAN oxygenate” due to upper airway obstruction?
A
Additional intubation attempts, Bag-valve mask ventilation
10
Q
2 aspects of clinical presentation for carbon monoxide (CO) poisoning?
A
HA, nausea
11
Q
Best treatment of carbon monoxide (CO) poisoning?
A
High-flow oxygen through non-rebreather mask
12
Q
2 aspects of anaphylaxis seen in severe cases?
A
Protracted duration of symptoms, Multiple doses of epinephrine required
13
Q
Best management of severe anaphylaxis?
A
Admission + observation
14
Q
Why should severe cases of anaphylaxis be treated with admission + observation?
A
Increased risk of biphasic (recurrent) anaphylaxis
15
Q
Most significant factor in predisposition of elderly patients to increased incidence of perioperative drug adverse reactions?
A
Multiple medications
16
Q
Definition of mild hypothermia?
A
T = 90-95°F
17
Q
Clinical presentation of mild hypothermia?
A
Tachycardia, tachypnea
18
Q
Best treatment for mild hypothermia?
A
Passive external warming (remove wet clothing)
19
Q
Definition of moderate hypothermia?
A
T = 82-90°F
20
Q
Clinical presentation of moderate hypothermia?
A
Hypotension, bradycardia, hyporeflexia
21
Q
Best treatment for moderate hypothermia?
A
Active external warming (heated blankets, warm baths); IV hydration
22
Q
Definition of severe hypothermia?
A
T < 82°F
23
Q
Clinical presentation of severe hypothermia?
A
Hypotension, areflexia, coma
24
Q
Best treatment for severe hypothermia?
A
Active core warming (warm O2, warm peritoneal lavage)
25
Best treatment for unconscious hypothermia?
Intubation
26
Biochemical abnormalities associated with hypothermia?
Metabolic and respiratory acidosis, hyperglycemia, hyperkalemia, leukopenia, thrombocytopenia
27
Next step of work-up for elderly patient who reports 1+ episode of fall?
Perform postural stability test
28
Example of postural stability test that should be performed in elderly patients who report fall?
“Get Up and Go” test
29
Indication for IVC filter placement?
Patients with DVT how have contraindication to anti-coagulation
30
3 contraindications to anti-coagulation in patients with DVT?
Recent surgery, hemorrhagic CVA, active bleeding
31
3 acute complications of IVC filter placement?
Insertion site thrombosis, hematoma, AV fistula
32
2 long-term complications of IVC filter placement?
Recurrent DVT, IVC thrombosis
33
Clinical presentation of organophosphate poisoning?
DUMBELS … diarrhea, urination, miosis, bradycardia, emesis, lacrimation, salivation
34
MOA of organophosphate?
ACH-E inhibition
35
Complication of organophosphate poisoning?
Bronchospasm, bronchorrhea … leading to intubation, respiratory failure
36
Best management of organophosphate poisoning?
Resuscitation, decontamination (removal of clothing)
37
2 DOC for treatment of organophosphate poisoning?
Atropine, Pralidoxime
38
Most common cause of sudden death due to steering wheel injuries during MVA?
Aortic injury
39
Description of Stage 1 pressure ulcer?
Non-blanching erythema of skin
40
Description of Stage 2 pressure ulcer?
Ulcers causing partial loss of epidermis/dermis
41
Description of Stage 3 pressure ulcer?
Full thickness ulcer, NOT extending into bone/muscle (beyond underlying fascia)
42
Description of Stage 4 pressure ulcer?
Full thickness ulcer, extending into bone/muscle (beyond underlying fascia)
43
3 aspects of initial management for pressure ulcers?
Reposition patient to reduce pressure, Pain control, Nutritional support
44
Best dressing for shallow ulcers?
Occlusive + semi-permeable dressing
45
Best management for full-thickness ulcers?
Debridement, specialized wound dressing
46
What is standard calorie intake for enteral feeding?
30 kcal/kg
47
What is standard protein intake for enteral feeding?
1 g/kg
48
Ideal calorie + protein intake for malnourished patients receiving enteral feeding?
15 kcal/kg + 2 g/kg (protein)
49
60 yo male presents for pre-operative evaluation before knee replacement; Reports HX of HTN, asthma, 25 pack-year smoking; Patient reports mild SOB when walking more than 4 blocks – what additional studies should be performed?
None … but patient needs to stop smoking 4+ weeks before surgery
50
2 immediate benefits for Physical Therapy for hospitalized patients?
Pulmonary improvement (decreased secretions, atelectasis), Cognitive (restoration of NML sleep-wake cycle)
51
Clinical presentation of post-operative urinary retention?
Suprapubic TTP + abdominal distension
52
2 etiologies of post-operative urinary retention?
Anesthesia AE, Intraoperative administration of IV fuids
53
Diagnostic test for post-operative urinary retention?
Placement of urinary catheter
54
Best management of post-operative urinary retention?
Placement of urinary catheter
55
Etiology of anaphylactic transfusion reaction?
Recipient anti-IgA directed against IgA in donor blood
56
Clinical presentation of anaphylactic transfusion reaction?
Anaphylactic reaction … angioedema, hypotension, wheezing
57
Etiology of acute hemolytic transfusion reaction?
ABO incompatibility (usually a clerical error)
58
Clinical presentation of acute hemolytic transfusion reaction?
Fever, flank pain, hemoglobinuria
59
Coomb’s test in acute hemolytic transfusion reaction?
(+)
60
Etiology of febrile non-hemolytic transfusion reaction?
Cytokine accumulation during blood storage
61
Clinical presentation of non-hemolytic transfusion reaction?
Fever + Chills
62
Etiology of urticarial transfusion reaction?
Recipient IgE against blood product components
63
Clinical presentation of urticarial transfusion reaction?
Urticaria
64
Etiology of transfusion-related acute lung injury (TRALI) transfusion reaction?
Donor WBC antibodies
65
Clinical presentation of transfusion-related acute lung injury (TRALI) transfusion reaction?
Respiratory distress, non-cardiogenic pulmonary edema with bilateral pulmonary infiltrates
66
Etiology of delayed hemolytic transfusion reaction?
Anamnestic Ig response
67
Clinical presentation of delayed hemolytic transfusion reaction?
Asymptomatic, but (+) Coomb’s test
68
Etiology of graft vs. host transfusion reaction?
Donor T cells
69
Clinical presentation of graft vs. host transfusion reaction?
Rash, fever, GI symptoms, pancytopenia
70
Lead concentration seen in mild lead toxicity?
5-45
71
Best management of mild lead toxicity?
No medication needed; Repeat lead levels in 1 month
72
Lead concentration seen in moderate lead toxicity?
45-70
73
Best management of moderate lead toxicity?
DMSA, Succimer
74
Lead concentration seen in severe lead toxicity?
> 70
75
Best management of severe lead toxicity?
Dimercaprol + EDTA
76
2 DOCs for treatment of organophosphate poisoning?
Atropine, Pralidoxime
77
Role of Atropine in treatment of organophosphate poisoning?
Reverses muscarinic receptor effects
78
Role of Pralidoxime in treatment of organophosphate poisoning?
Reactivates cholinesterase
79
Medication associated with increased risk of falls + mortality in elderly patients?
Benzodiazepines
80
Clinical presentation of Benzodiazepine withdrawal?
Confusion, restlessness, tremors, psychosis, autonomic instability
81
Best management of Benzodiazepine withdrawal?
Begin benzodiazepine treatment (diazepam)
82
Which 2 types of surgical procedures do NOT warrant ABX to prevent infective endocarditis in patients with high-risk cardiac conditions?
GU and GI procedures
83
Etiology of hypocalcemia after massive blood transfusion?
A large amount of citrate used to anticoagulate blood, citrate chelate with calcium, leading to hypocalcemia
84
3 types of procedures that DO warrant ABX prophylaxis for infective endocarditis in patients with high-risk cardiac conditions?
Dental, respiratory tract, placement of prosthetic cardiac materials
85
2 drugs that should be stopped 4 weeks prior to surgical procedures, due to increased risk for venous thromboembolism?
Raloxifene, tamoxifen
86
Raloxifene, tamoxifen belong to which class of medication?
SERMs
87
3 classes of medications that should be continued until immediately prior to surgery?
Diuretics, ACEIs, ARBs
88
18 yo female presents to ED after involved in MVA; Evidence of bleeding from R head; Vitals shows BP 182/98, HR 52, RR 6; R pupil is 7mm with minimal response to light; R eye is deviated out and down; PE shows bilateral papilledema; During exam, patient has episode of generalized body extension - what is next step of management?
Intubation
89
___ is first priority in management of trauma patient with evidence of symptomatic intracranial HTN
Securing airway
90
What is best strategy for confirmation of suspected CO poisoning?
Measurement of carboxyhemoglobin
91
52 yo male presents after suicide attempt by ingestion of acetaminophen tablets, with 1 pint vodka; Which factor is associated with increased risk of acetaminophen-induced hepatotoxicity?
Delayed hospital presentation
92
When does acetaminophen-induced hepatotoxicity become evident?
24-72 hours after ingestion
93
What is the toxic metabolite of acetaminophen?
NAPQI
94
Antidote to acetaminophen-induced hepatotoxicity?
N-acetylcysteine
95
N-acetylcysteine is most effective in treatment of acetaminophen-induced hepatotoxicity when given within ___ hours of acetaminophen ingestion
8
96
Which class of anticoagulants should be stopped 1-3 days before surgery in patient with A-Fib, and do not require bridging?
DOACs
97
73 yo female needs emergent surgery, but is currently taking warfarin – what is the best choice for rapid reversal of anticoagulation … FFP vs. Prothrombin Complex Concentrate?
PCC … Warfarin is used when PCC is unavailable
98
25 yo male presents for persistent LAD, still present 8-10 weeks after diagnosed with infectious mononucleosis; PE shows 3 anterior cervical LNs, 2x2cm in size; LNs are firm, mobile – what is next step in management?
Refer to surgeon for LN biopsy
99
56 yo male admitted to ICU for ARDS due to viral PNA; Develops hypoactive delirium; Discharged to skilled nursing facility, but requires assistance to stand due to diffuse weakness; Becomes irritable and confused in evening; Montreal Cognitive Score is 25/30, deficits in attention and memory; PE shows flat affect, mild psychomotor retardation – diagnosis?
Post ICU syndrome
100
3 domains of clinical presentation for Post ICU syndrome?
Psychiatric (major depression, PTSD), Neurocognitive (decreased memory/attention, executive function), Physical (decreased mobility)
101
Long-term prognosis of Post ICU syndrome?
Most patients require additional home care and never return to work
102
Method pf prevention for Post ICU syndrome?
Early therapy participation in PT/OT
103
Pathophysiology of Post ICU syndrome?
CNS hypoxia, neuroinflammation, metabolic disruption
104
3 risk factors for development of Post ICU syndrome?
ICU delirium, ARDS, prolonged mechanical ventilation
105
56 yo male with cirrhosis presents for EGD to evaluate varices; HX of Hepatitis C; Sedated with midazolam and fentanyl; During procedure, O2 sat drops to 85% on RA; PE shows perioral cyanosis; ABG shows 7.39/142/34, O2 sat 99% - etiology of decreased O2 sat?
Methemoglobinemia
106
Which lab value is suggestive of Methemoglobinemia?
Difference between O2 sat on pulse-ox, and O2 sat on ABG
107
3 medications most associated with Methemoglobinemia?
Dapsone, Nitrates, Benzocaine
108
Treatment for cyanide toxicity due to nitroprusside?
Sodium thiosulfate
109
Clinical presentation for cyanide toxicity?
Skin flushing (cherry red), then cyanosis; HA, seizure, AMS, metabolic acidosis (from lactic acidosis)
110
Which group of patients is at risk for cyanide toxicity from nitroprusside?
Patients with CKD
111
MOA of nitroprusside?
Vasodilator of both arterial and venous circulation
112
What is the most reliable means for determining site of ET tube placement during intubation?
Waveform capnography
113
Absolute contraindication to cardiac transplant?
Active substance or alcohol abuse
114
Relative contraindication to cardiac transplant?
Lack of adequate psychosocial supports
