Surgery PEARLS

Question 1

Stress induced hyperglycemia is primarily due to

Answer 1

Peripheral resistance to insulin

Question 2

Basal caloric requirement in mild stress

Answer 2

25-30 kcal/kg/day

Question 3

Basal caloric requirement in moderate stress

Answer 3

30 kcal/kg/day

Question 4

Basal caloric requirement in severe stress

Answer 4

30-35 kcal/kg/day

Question 5

Cancer + severe malnutrition

Answer 5

30 kcal/kg/day

Question 6

Phase of surgical metabolism/injury with reduced REE

Answer 6

EBB phase

Question 7

Primary source of energy during stress

Answer 7

Fat

Question 8

Systemic proteolysis following injury is mediated primarily by

Answer 8

Glucocorticoids

Question 9

% protein catabolised per day

Answer 9

1.5%

Question 10

Dry, scaly dermatitis following prolonged parenteral treatment

Answer 10

Essential fatty acid (EFA) deficiency

Question 11

MC fluid disorder in surgical patients

Answer 11

Extracellular, mainly GI

Question 12

Source of HCO3 in plain LR

Answer 12

Lactate

Question 13

Dextrose in D5-containing IVFs

Answer 13

50 g/L

Question 14

What to request in patients with persistent hypocalcemia/hypokalemia

Answer 14

Serum magnesium

Question 15

Most important treatment of metabolic acidosis

Answer 15

Volume resuscitation, NOT bicarbonate

Question 16

Early acid-base picture of sepsis

Answer 16

Respiratory alkalosis

Question 17

Criteria for SIRS

Answer 17

1) Temp 36C or less OR 38 or more 2) HR 90 or more 3) RR 20 or more 4) WBC 4000 or less OR 12000 or more or 10% or more bands

Question 18

MC organism isolated in G- septicemia

Answer 18

E.coli

Question 19

Adverse changes in G- septicemia is due to

Answer 19

Lipid A release

Question 20

Earliest stage of hemostasis

Answer 20

Vascular constriction (> platelet plug > fibrin > fibrinolysis)

Question 21

Average life span of platelets

Answer 21

7-10 days

Question 22

Inherited disorder of platelet disorder due to lack of gpIIb/IIIa

Answer 22

Glanzmann thrombasthenia

Question 23

Inherited disorder of platelet disorder due to lack of gpIb/IX/V

Answer 23

Bernard-Soulier syndrome

Question 24

MC abnormality of homeostasis in surgical patients

Answer 24

Thrombocytopenia

Question 25

Platelet level when there is spontaneous hemorrhage

Question 26

Treatment of choice in patients with von Willebrand disease

Answer 26

Intermediate purity factor 8/DDAVP

Question 27

Best method of identifying a potential bleeder

Answer 27

Complete history and PE

Question 28

MC indication for blood transfusion in surgical patients

Answer 28

Volume replacement

Question 29

Treatment for bleeding due to fibrinolysis

Answer 29

Aminocaproic acid aka tranexamic acid

Question 30

Most important management for DIC

Answer 30

Treat underlying cause

Question 31

Mechanism of DIC

Answer 31

Excessive plasminogen activator

Question 32

Differentiates DIC from primary fibrinolysis

Answer 32

Protamine test (+) in DIC

Question 33

Diffuse oozing of blood from SSI is most likely due to

Answer 33

Platelet deficiency

Question 34

Most important management of immediate transfusion reaction

Answer 34

Stop the transfusion

Question 35

Delayed transfusion reaction usually occurs within how many days post-transfusion

Answer 35

2-10 days

Question 36

Differentiate delayed from immediate transfusion reaction

Answer 36

Delayed is d/t EXTRAVASCULAR hemolysis and no specific intervention is needed

Question 37

Shock in a setting of adequate intravascular volume

Answer 37

Cardiogenic shock

Question 38

Preferred test in the diagnosis of cardiac tamponade

Answer 38

Echocardiography

Question 39

Immediate step after 2D echo-confirmed cardiac tamponade

Answer 39

Pericardiocentesis

Question 40

Sign seen in echocardiography of patient with cardiac tamponade

Answer 40

Halo sign

Question 41

Persistently elevated base deficit in a trauma patient is usually due to

Answer 41

Ongoing bleeding

Question 42

Caloric content of 1L D5LR

Answer 42

180

Question 43

MCC of death of all individuals aged 1-44

Answer 43

Trauma

Question 44

Widened mediastinum

Answer 44

Aortic dissection

Question 45

Gold standard for determining blunt descending torn aortic injury

Answer 45

CT scan

Question 46

MC indication for intubation

Answer 46

Altered mental status

Question 47

Preferred technique used in establishing a definitive airway

Answer 47

Orotracheal intubation

Question 48

Main difference between tension pneumothorax and simple pneumothorax

Answer 48

Hypotension

Question 49

Multiple sta wounds on right chest, awake, normotensive, tachypneic, tachycardic, absent breath sounds on right. Next best step.

Answer 49

CXR

Question 50

3 contiguous ribs fractured on both right and left hemithorax

Answer 50

Flail chest

Question 51

Lethargic, arousable, palpable femoral pulse. SBP is at least

Answer 51

70 mmHg

Question 52

Cutoff blood volume in a massive hemothorax

Answer 52

1500mL

Question 53

Blood volume that may cause cardiac tamponade

Answer 53

Less than 100 mL

Question 54

Most reliable indicator of organ perfusion

Answer 54

UO

Question 55

Adequate UO in adult

Answer 55

0.5cc/kg/hr

Question 56

Adequate UO in child

Answer 56

1cc/kg/hr

Question 57

Adequate UO in infant

Answer 57

2cc/kg/hr

Question 58

Hypotensive, tachycardic, tachhypneic, anxious, confused. Class of shock

Answer 58

3

Question 59

Estimated blood loss in a class 3 shock

Answer 59

At least 30%

Question 60

Fracture of 3 ribs can result to approximately how much blood loss

Answer 60

300-600

Question 61

Most important radiograph to obtain in the setting of a blunt trauma or motor vehicular accident

Answer 61

1) Cervical 2) Chest 3) Pelvic (SFA NOT included)

Question 62

MC organ injured in blunt trauma

Answer 62

Spleen

Question 63

Next best step in management of symptomatic neck injuries

Answer 63

CT angio of neck and chest