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UWorld > Surgery > Flashcards

Surgery Flashcards

1
Q

3 aspects of clinical presentation for anaphylaxis in a peri-operative patient?

A

Hypotension, bronchospasm, skin rash

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2
Q

Sign of bronchospasm in patient who has just been intubated?

A

Increased peak pressure

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3
Q

Sign of decreased cardiac output in patient who has just been intubated?

A

Decreased end-tidal CO2

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4
Q

Most common anesthetic agent responsible for anaphylaxis in a peri-operative patient?

A

Rocuronium

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5
Q

What is the preferred method of intubation in patients with difficult airways (i.e. upper airway obstruction)?

A

Awake intubation

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6
Q

Anesthetic agent used in setting of Awake intubation?

A

Ketamine

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7
Q

2 additional benefits of using ketamine in setting of awake intubation?

A

Increased BP, Bronchodilation

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8
Q

Preferred airway in setting of patient who “can’t intubate, can’t oxygenate” due to upper airway obstruction?

A

Cricothyrotomy

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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

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10
Q

2 aspects of clinical presentation for carbon monoxide (CO) poisoning?

A

HA, nausea

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11
Q

Best treatment of carbon monoxide (CO) poisoning?

A

High-flow oxygen through non-rebreather mask

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12
Q

2 aspects of anaphylaxis seen in severe cases?

A

Protracted duration of symptoms, Multiple doses of epinephrine required

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13
Q

Best management of severe anaphylaxis?

A

Admission + observation

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14
Q

Why should severe cases of anaphylaxis be treated with admission + observation?

A

Increased risk of biphasic (recurrent) anaphylaxis

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15
Q

Most significant factor in predisposition of elderly patients to increased incidence of perioperative drug adverse reactions?

A

Multiple medications

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16
Q

Definition of mild hypothermia?

A

T = 90-95°F

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17
Q

Clinical presentation of mild hypothermia?

A

Tachycardia, tachypnea

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18
Q

Best treatment for mild hypothermia?

A

Passive external warming (remove wet clothing)

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19
Q

Definition of moderate hypothermia?

A

T = 82-90°F

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20
Q

Clinical presentation of moderate hypothermia?

A

Hypotension, bradycardia, hyporeflexia

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21
Q

Best treatment for moderate hypothermia?

A

Active external warming (heated blankets, warm baths); IV hydration

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22
Q

Definition of severe hypothermia?

A

T < 82°F

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23
Q

Clinical presentation of severe hypothermia?

A

Hypotension, areflexia, coma

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24
Q

Best treatment for severe hypothermia?

A

Active core warming (warm O2, warm peritoneal lavage)

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25
Q

Best treatment for unconscious hypothermia?

A

Intubation

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26
Q

Biochemical abnormalities associated with hypothermia?

A

Metabolic and respiratory acidosis, hyperglycemia, hyperkalemia, leukopenia, thrombocytopenia

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27
Q

Next step of work-up for elderly patient who reports 1+ episode of fall?

A

Perform postural stability test

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28
Q

Example of postural stability test that should be performed in elderly patients who report fall?

A

“Get Up and Go” test

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29
Q

Indication for IVC filter placement?

A

Patients with DVT how have contraindication to anti-coagulation

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30
Q

3 contraindications to anti-coagulation in patients with DVT?

A

Recent surgery, hemorrhagic CVA, active bleeding

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31
Q

3 acute complications of IVC filter placement?

A

Insertion site thrombosis, hematoma, AV fistula

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32
Q

2 long-term complications of IVC filter placement?

A

Recurrent DVT, IVC thrombosis

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33
Q

Clinical presentation of organophosphate poisoning?

A

DUMBELS … diarrhea, urination, miosis, bradycardia, emesis, lacrimation, salivation

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34
Q

MOA of organophosphate?

A

ACH-E inhibition

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35
Q

Complication of organophosphate poisoning?

A

Bronchospasm, bronchorrhea … leading to intubation, respiratory failure

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36
Q

Best management of organophosphate poisoning?

A

Resuscitation, decontamination (removal of clothing)

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37
Q

2 DOC for treatment of organophosphate poisoning?

A

Atropine, Pralidoxime

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38
Q

Most common cause of sudden death due to steering wheel injuries during MVA?

A

Aortic injury

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39
Q

Description of Stage 1 pressure ulcer?

A

Non-blanching erythema of skin

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40
Q

Description of Stage 2 pressure ulcer?

A

Ulcers causing partial loss of epidermis/dermis

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41
Q

Description of Stage 3 pressure ulcer?

A

Full thickness ulcer, NOT extending into bone/muscle (beyond underlying fascia)

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42
Q

Description of Stage 4 pressure ulcer?

A

Full thickness ulcer, extending into bone/muscle (beyond underlying fascia)

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43
Q

3 aspects of initial management for pressure ulcers?

A

Reposition patient to reduce pressure, Pain control, Nutritional support

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44
Q

Best dressing for shallow ulcers?

A

Occlusive + semi-permeable dressing

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45
Q

Best management for full-thickness ulcers?

A

Debridement, specialized wound dressing

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46
Q

What is standard calorie intake for enteral feeding?

A

30 kcal/kg

47
Q

What is standard protein intake for enteral feeding?

A

1 g/kg

48
Q

Ideal calorie + protein intake for malnourished patients receiving enteral feeding?

A

15 kcal/kg + 2 g/kg (protein)

49
Q

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?

A

None … but patient needs to stop smoking 4+ weeks before surgery

50
Q

2 immediate benefits for Physical Therapy for hospitalized patients?

A

Pulmonary improvement (decreased secretions, atelectasis), Cognitive (restoration of NML sleep-wake cycle)

51
Q

Clinical presentation of post-operative urinary retention?

A

Suprapubic TTP + abdominal distension

52
Q

2 etiologies of post-operative urinary retention?

A

Anesthesia AE, Intraoperative administration of IV fuids

53
Q

Diagnostic test for post-operative urinary retention?

A

Placement of urinary catheter

54
Q

Best management of post-operative urinary retention?

A

Placement of urinary catheter

55
Q

Etiology of anaphylactic transfusion reaction?

A

Recipient anti-IgA directed against IgA in donor blood

56
Q

Clinical presentation of anaphylactic transfusion reaction?

A

Anaphylactic reaction … angioedema, hypotension, wheezing

57
Q

Etiology of acute hemolytic transfusion reaction?

A

ABO incompatibility (usually a clerical error)

58
Q

Clinical presentation of acute hemolytic transfusion reaction?

A

Fever, flank pain, hemoglobinuria

59
Q

Coomb’s test in acute hemolytic transfusion reaction?

A

(+)

60
Q

Etiology of febrile non-hemolytic transfusion reaction?

A

Cytokine accumulation during blood storage

61
Q

Clinical presentation of non-hemolytic transfusion reaction?

A

Fever + Chills

62
Q

Etiology of urticarial transfusion reaction?

A

Recipient IgE against blood product components

63
Q

Clinical presentation of urticarial transfusion reaction?

A

Urticaria

64
Q

Etiology of transfusion-related acute lung injury (TRALI) transfusion reaction?

A

Donor WBC antibodies

65
Q

Clinical presentation of transfusion-related acute lung injury (TRALI) transfusion reaction?

A

Respiratory distress, non-cardiogenic pulmonary edema with bilateral pulmonary infiltrates

66
Q

Etiology of delayed hemolytic transfusion reaction?

A

Anamnestic Ig response

67
Q

Clinical presentation of delayed hemolytic transfusion reaction?

A

Asymptomatic, but (+) Coomb’s test

68
Q

Etiology of graft vs. host transfusion reaction?

A

Donor T cells

69
Q

Clinical presentation of graft vs. host transfusion reaction?

A

Rash, fever, GI symptoms, pancytopenia

70
Q

Lead concentration seen in mild lead toxicity?

A

5-45

71
Q

Best management of mild lead toxicity?

A

No medication needed; Repeat lead levels in 1 month

72
Q

Lead concentration seen in moderate lead toxicity?

A

45-70

73
Q

Best management of moderate lead toxicity?

A

DMSA, Succimer

74
Q

Lead concentration seen in severe lead toxicity?

A

> 70

75
Q

Best management of severe lead toxicity?

A

Dimercaprol + EDTA

76
Q

2 DOCs for treatment of organophosphate poisoning?

A

Atropine, Pralidoxime

77
Q

Role of Atropine in treatment of organophosphate poisoning?

A

Reverses muscarinic receptor effects

78
Q

Role of Pralidoxime in treatment of organophosphate poisoning?

A

Reactivates cholinesterase

79
Q

Medication associated with increased risk of falls + mortality in elderly patients?

A

Benzodiazepines

80
Q

Clinical presentation of Benzodiazepine withdrawal?

A

Confusion, restlessness, tremors, psychosis, autonomic instability

81
Q

Best management of Benzodiazepine withdrawal?

A

Begin benzodiazepine treatment (diazepam)

82
Q

Which 2 types of surgical procedures do NOT warrant ABX to prevent infective endocarditis in patients with high-risk cardiac conditions?

A

GU and GI procedures

83
Q

Etiology of hypocalcemia after massive blood transfusion?

A

A large amount of citrate used to anticoagulate blood, citrate chelate with calcium, leading to hypocalcemia

84
Q

3 types of procedures that DO warrant ABX prophylaxis for infective endocarditis in patients with high-risk cardiac conditions?

A

Dental, respiratory tract, placement of prosthetic cardiac materials

85
Q

2 drugs that should be stopped 4 weeks prior to surgical procedures, due to increased risk for venous thromboembolism?

A

Raloxifene, tamoxifen

86
Q

Raloxifene, tamoxifen belong to which class of medication?

A

SERMs

87
Q

3 classes of medications that should be continued until immediately prior to surgery?

A

Diuretics, ACEIs, ARBs

88
Q

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?

A

Intubation

89
Q

___ is first priority in management of trauma patient with evidence of symptomatic intracranial HTN

A

Securing airway

90
Q

What is best strategy for confirmation of suspected CO poisoning?

A

Measurement of carboxyhemoglobin

91
Q

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?

A

Delayed hospital presentation

92
Q

When does acetaminophen-induced hepatotoxicity become evident?

A

24-72 hours after ingestion

93
Q

What is the toxic metabolite of acetaminophen?

A

NAPQI

94
Q

Antidote to acetaminophen-induced hepatotoxicity?

A

N-acetylcysteine

95
Q

N-acetylcysteine is most effective in treatment of acetaminophen-induced hepatotoxicity when given within ___ hours of acetaminophen ingestion

A

8

96
Q

Which class of anticoagulants should be stopped 1-3 days before surgery in patient with A-Fib, and do not require bridging?

A

DOACs

97
Q

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?

A

PCC … Warfarin is used when PCC is unavailable

98
Q

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?

A

Refer to surgeon for LN biopsy

99
Q

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?

A

Post ICU syndrome

100
Q

3 domains of clinical presentation for Post ICU syndrome?

A

Psychiatric (major depression, PTSD), Neurocognitive (decreased memory/attention, executive function), Physical (decreased mobility)

101
Q

Long-term prognosis of Post ICU syndrome?

A

Most patients require additional home care and never return to work

102
Q

Method pf prevention for Post ICU syndrome?

A

Early therapy participation in PT/OT

103
Q

Pathophysiology of Post ICU syndrome?

A

CNS hypoxia, neuroinflammation, metabolic disruption

104
Q

3 risk factors for development of Post ICU syndrome?

A

ICU delirium, ARDS, prolonged mechanical ventilation

105
Q

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?

A

Methemoglobinemia

106
Q

Which lab value is suggestive of Methemoglobinemia?

A

Difference between O2 sat on pulse-ox, and O2 sat on ABG

107
Q

3 medications most associated with Methemoglobinemia?

A

Dapsone, Nitrates, Benzocaine

108
Q

Treatment for cyanide toxicity due to nitroprusside?

A

Sodium thiosulfate

109
Q

Clinical presentation for cyanide toxicity?

A

Skin flushing (cherry red), then cyanosis; HA, seizure, AMS, metabolic acidosis (from lactic acidosis)

110
Q

Which group of patients is at risk for cyanide toxicity from nitroprusside?

A

Patients with CKD

111
Q

MOA of nitroprusside?

A

Vasodilator of both arterial and venous circulation

112
Q

What is the most reliable means for determining site of ET tube placement during intubation?

A

Waveform capnography

113
Q

Absolute contraindication to cardiac transplant?

A

Active substance or alcohol abuse

114
Q

Relative contraindication to cardiac transplant?

A

Lack of adequate psychosocial supports

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