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Clin Med V and VI > Surgery > Flashcards

Surgery Flashcards

1
Q

Urine output should be maintained at what rate?

A

0.5 CCs per kg per hour (Or 30CCs per hour)

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2
Q

What imaging studies are safe for pregnant patients?

A

MRI

Ultrasound

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3
Q

Patient in the hospital is vomiting blood. What is the first question we need to ask of the nursing staff?

A

How much is he vomiting?

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4
Q

Patient in the hospital is vomiting blood. You want to know how much he’s vomiting. How can you check this?

A

NG tube output

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5
Q

Patient presents with bright red blood per rectum and epigastric tenderness. What diagnostic maneuver can help determine the source of the bleeding?

A

NG Tube. If you get bile back, you know it’s not coming from the upper GI tract. But if you get blood back, then you know it’s an upper GI bleed

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6
Q

MCC of nonsurgical perioperative death

A

Respiratory complications

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7
Q

Functions of the kidney

A
  • Regulation of salt/water balance
  • Excretion of water-soluble metabolic end products
  • Excretion of toxins
  • Production of hormones
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8
Q

Patient presents with severe pancreatitis and is in shock. pH is 7.3 and he has very low bicarb levels. What is the metabolic abnormality?

A

Metabolic acidosis (remember that just the fact that he arrived in shock indicates that he’s going to be in metabolic acidosis because of the increased anaerobic respiration and lactate production)

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9
Q

Patient presents needing emergency surgery and is hypotensive. In addition to fluids, what else does the patient require?

A

Vasopressors (NE, Dopamine)

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10
Q

65yo male presents 5 years post renal transplant and needs surgery for a perforated gastric ulcer. What do we need to know about the patient?

A

We need to know if he’s on steroids

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11
Q

If a patient is on steroid therapy, what do we need to give them before surgery?

A

A large dose of hydrocortisone

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12
Q

What do we need to institute in a patient in acute renal failure? Why?

A
  • Restrictions of: Fluids, Na+, K+, Mg+, and Phosphates

- Because the kidneys can’t clear them

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13
Q

What things might impair wound healing?

A
  • Radiation
  • Hypovolemia
  • Obesity
  • Uncontrolled blood sugars
  • Chemotherapy
  • Smoking
  • Malnutrition
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14
Q

Physiologic complications that can occur when inflating the abdomen with CO2

A
  • Decreased venous return –> Decreased CO
  • Increased SVR
  • Hypercapnia
  • Decreased lung volume
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15
Q

Contraindications to tube feeding

A
  • Obstruction
  • Fistula
  • GI tract bleeding
  • Inflammatory bowel disease
  • Short bowel syndrome
  • Hemodynamically unstable
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16
Q

Post-op patient has SVT. What’s the first thing you check?

A

Mg and K+ levels

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17
Q

Fecaloid vomiting is associated with what?

A

Distal small bowel obstruction

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18
Q

What metabolic derangement is associated with gastric outlet obstruction?

A

-Hypochloremic, hypokalemic metabolic alkalosis (because of the associated vomiting)

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19
Q

Does IV (parenteral) or enteric feeding have more functional complications?

A

IV feeding; there are more functional problems for TPN

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20
Q

MC inherited bleeding disorder

A

von Willebrands disease

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21
Q

What are some of the many systems hypovolemia has deleterious effects on?

A
  • Wound healing
  • Immune function
  • Nutritional status
  • Kidney function
  • Cognitive function
  • Acid/Base balance
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22
Q

What’s the best way to prevent a DVT?

A

Early mobilization

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23
Q

Other than early mobilization, what are other ways to protect against DVT development?

A
  • Compression stockings
  • Sequential compression devices
  • Heparin
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24
Q

What hormones are involved in the immediate response to hypovolemia?

A
  • NE
  • Epi
  • Aldosterone
  • ADH
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25
Q

Aside fromt he fact that elderly patients have a “limited reserve”, why are they more prone to hypotension when they’re hypovolemic than an younger patient?

A

Because their kidneys have a decreased renin response to volume contraction

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26
Q

MCC of hypokalemia?

A

Loop diuretics

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27
Q

What’s the best way to assess for bleeding tendencies?

A
  • Family/Medical history

- Ask about easy bruising, gingival bleeding, hematuria, heavy menstrual bleeding, epistaxis

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28
Q

If a patient has a fever on post-op day #6, what is the likely cause?

A

Wound infection

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29
Q

If a patient has a fever on post-op day #10, what is the likely cause?

A

Abdominal abscess

30
Q

If a patient has a fever on post-op day #1, what is the likely cause?

A

Atelectasis

31
Q

If a patient has a fever on post-op day #3, what is the likely cause?

A

UTI or phlebitis (Phlebitis is what he told us early in class, but during his review, he said “UTI or phlebitis”)

32
Q

MCC of death immediately after a blood transfusion

A

Wrong transfusion (like, wrong blood type)

33
Q

Patient complains of pencil-thin stools. Diagnosis?

A

Colon cancer

34
Q

Calcium metabolism is mediated by what?

A

PTH and Vitamin D

35
Q

Patient presents needing surgery, but is on Coumadin. What studies do we need?

A

INR and PT

36
Q

What do we need to give to reverse the effects of Coumadin?

A

Fresh frozen plasma

37
Q

Sever, sudden onset of pain is most often caused by what three things?

A
  • Mesenteric vascular occlusion (acute ischemia)
  • Torsion
  • Perforation
38
Q

What operations can be done safely in the first trimester?

A
  • Lap coley
  • Lap appy
  • Diagnostic lap
  • Lap ovarian cystectomy
  • But try to delay the operation to the second trimester if possible
39
Q

Patient complains of awful-smelling, profuse diarrhea. What do you suspect?

A

C. difficile colitis

40
Q

Patient complains of white stool. Suspicion?

A

Common duct obstruction

41
Q

Patient complains of black stool. Suspicion?

A
  • Pepto bismol or iron supplement consumption

- Upper GI bleed

42
Q

Lab value that’s a good indication of a patient’s nutritional status

A

Prealbumin

43
Q

Consequences of immobilization

A
  • V/Q mismatch
  • Slowing of bowel function
  • DVT
  • Pressure ulcers
  • Muscle atrophy
44
Q

MC post-op pulmonary complication

A

Atelectasis

45
Q

Atelectasis tx/prevention

A
  • Incentive spirometry
  • Patient mobilization
  • Control of the patient’s pain
46
Q

What are the first few things you do when you note that a post-op patient has cardiovascular problems?

A
  • After examining vitals, get EKG and draw troponin levels

- Check K+ and Mg+

47
Q

MCC of inadequate cardiac output

A

Hypovolemia

48
Q

Tool you can use to monitor venous return to the heart

A

Central venous pressure

49
Q

What should you suspect if you see clear serous fluid leaking from the wound?

A

Wound dehiscence or a seroma

50
Q

New standard of care for post-op pain management

A

Patient-controlled analgesia (PCA)

51
Q

Unexplained hypovolemia is __________ until proven otherwise

A

Rebleeding

52
Q

Why do we need to replace fluids very quickly in a patient with postoperative pancreatitis?

A

Because there’s a lot of 3rd space sequestration of fluids into the retroperitoneal space

53
Q

C. difficile treatment of choice

A

Flagyl

54
Q

Why can adrenal insufficiency cause hyperkalmia?

A
  • Because aldosterone is produce by the adrenal glands, and aldosterone is responseible for the excretion of K+ in exchange for the retention of Na+
  • Too little aldosterone = Too much K+
55
Q

Hormones produces by the kidneys

A
  • EPO
  • Renin
  • 1,25-DHC
56
Q

Before giving contrast, what lab values do we need to be made aware of?

A

BUN and Creatinine

57
Q

Most common electrolyte disturbance?

A

Hyperkalemia

58
Q

First treatment of hyperkalemia

A

Calcium gluconate

59
Q

What labs do you need to check daily in a patient on heparin therapy

A

Platelet count

60
Q

What platelet count do we consider to be the cutoff for whether a patient is safe for surgery or not?

A

50,000

61
Q

What is the ratio for units of packed cells to units of FFP when transfusing a patient?

A

2 units packed cells to 1 unit of FFP

62
Q

What kind of fluids do we give patients who are severely dehydrated and also need a blood transfusion?

A

Crystalloid fluids

63
Q

What clotting factor do we give hemophilia A patients?

A

VIII

64
Q

What clotting factor do we give hemophilia B patients?

A

IX

65
Q

What blood components do we give to patients with von Willebrands disease?

A

Cryoprecipitate

66
Q

What type of blood substitue do we give patients who are hypoalbuminemic? Why?

A
  • Colloids

- Because we need to “replace” the oncotic pressure of the missing albumin

67
Q

If you really suspect cholecystitis, but the U/S comes back negative, what test can you order next?

A

A HIDA scan with CCK stimulation

68
Q

During an operation, a patient becomes hypotensive, unresponsive to fluid and vasopressors. What should you administer to increase BP, and why?

A
  • Steroids

- In case their adrenals are suppressed or in case they’re already on steroid therapy

69
Q

Definition of shock

A

Inadequate cellular perfusion

70
Q

What drug should you have available if one of your patients is an alcoholic?

A

Lorazepam (Ativan)

71
Q

Are there more TECHNICAL PROBLEMS with Enteral or Total Parenteral Nutrition (TPN)?

A

THERE ARE MORE TECHNICAL COMPLICATIONS WITH ENTERAL NUTRITION

Clin Med V and VI (5 decks)

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