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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
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?
Because their kidneys have a decreased renin response to volume contraction
26
MCC of hypokalemia?
Loop diuretics
27
What's the best way to assess for bleeding tendencies?
- Family/Medical history | - Ask about easy bruising, gingival bleeding, hematuria, heavy menstrual bleeding, epistaxis
28
If a patient has a fever on post-op day #6, what is the likely cause?
Wound infection
29
If a patient has a fever on post-op day #10, what is the likely cause?
Abdominal abscess
30
If a patient has a fever on post-op day #1, what is the likely cause?
Atelectasis
31
If a patient has a fever on post-op day #3, what is the likely cause?
UTI or phlebitis (Phlebitis is what he told us early in class, but during his review, he said "UTI or phlebitis")
32
MCC of death immediately after a blood transfusion
Wrong transfusion (like, wrong blood type)
33
Patient complains of pencil-thin stools. Diagnosis?
Colon cancer
34
Calcium metabolism is mediated by what?
PTH and Vitamin D
35
Patient presents needing surgery, but is on Coumadin. What studies do we need?
INR and PT
36
What do we need to give to reverse the effects of Coumadin?
Fresh frozen plasma
37
Sever, sudden onset of pain is most often caused by what three things?
- Mesenteric vascular occlusion (acute ischemia) - Torsion - Perforation
38
What operations can be done safely in the first trimester?
- Lap coley - Lap appy - Diagnostic lap - Lap ovarian cystectomy * But try to delay the operation to the second trimester if possible
39
Patient complains of awful-smelling, profuse diarrhea. What do you suspect?
C. difficile colitis
40
Patient complains of white stool. Suspicion?
Common duct obstruction
41
Patient complains of black stool. Suspicion?
- Pepto bismol or iron supplement consumption | - Upper GI bleed
42
Lab value that's a good indication of a patient's nutritional status
Prealbumin
43
Consequences of immobilization
- V/Q mismatch - Slowing of bowel function - DVT - Pressure ulcers - Muscle atrophy
44
MC post-op pulmonary complication
Atelectasis
45
Atelectasis tx/prevention
- Incentive spirometry - Patient mobilization - Control of the patient's pain
46
What are the first few things you do when you note that a post-op patient has cardiovascular problems?
- After examining vitals, get EKG and draw troponin levels | - Check K+ and Mg+
47
MCC of inadequate cardiac output
Hypovolemia
48
Tool you can use to monitor venous return to the heart
Central venous pressure
49
What should you suspect if you see clear serous fluid leaking from the wound?
Wound dehiscence or a seroma
50
New standard of care for post-op pain management
Patient-controlled analgesia (PCA)
51
Unexplained hypovolemia is __________ until proven otherwise
Rebleeding
52
Why do we need to replace fluids very quickly in a patient with postoperative pancreatitis?
Because there's a lot of 3rd space sequestration of fluids into the retroperitoneal space
53
C. difficile treatment of choice
Flagyl
54
Why can adrenal insufficiency cause hyperkalmia?
- 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
Hormones produces by the kidneys
- EPO - Renin - 1,25-DHC
56
Before giving contrast, what lab values do we need to be made aware of?
BUN and Creatinine
57
Most common electrolyte disturbance?
Hyperkalemia
58
First treatment of hyperkalemia
Calcium gluconate
59
What labs do you need to check daily in a patient on heparin therapy
Platelet count
60
What platelet count do we consider to be the cutoff for whether a patient is safe for surgery or not?
50,000
61
What is the ratio for units of packed cells to units of FFP when transfusing a patient?
2 units packed cells to 1 unit of FFP
62
What kind of fluids do we give patients who are severely dehydrated and also need a blood transfusion?
Crystalloid fluids
63
What clotting factor do we give hemophilia A patients?
VIII
64
What clotting factor do we give hemophilia B patients?
IX
65
What blood components do we give to patients with von Willebrands disease?
Cryoprecipitate
66
What type of blood substitue do we give patients who are hypoalbuminemic? Why?
- Colloids | - Because we need to "replace" the oncotic pressure of the missing albumin
67
If you really suspect cholecystitis, but the U/S comes back negative, what test can you order next?
A HIDA scan with CCK stimulation
68
During an operation, a patient becomes hypotensive, unresponsive to fluid and vasopressors. What should you administer to increase BP, and why?
- Steroids | - In case their adrenals are suppressed or in case they're already on steroid therapy
69
Definition of shock
Inadequate cellular perfusion
70
What drug should you have available if one of your patients is an alcoholic?
Lorazepam (Ativan)
71
Are there more TECHNICAL PROBLEMS with Enteral or Total Parenteral Nutrition (TPN)?
THERE ARE MORE TECHNICAL COMPLICATIONS WITH ENTERAL NUTRITION

Clin Med V and VI (5 decks)

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