Surgery Pre/Post Op and Emergencies/transplant

Question 1

Hep patient preop check?

Answer 1

ALWAYS CHECK Clotting factors and platelets if liver concern so they don’t bleed out

Question 2

What if on warfarin before surgery?

Answer 2

Stop it 3-4 days before surgery, switch to heparin allow INR to normalize

Restart warfarin postop
Restart heparin 12 hr post op and continue until therapeutic

Question 3

DVT proph?

Answer 3

Aspirin, clop, warfarin, LMWH

Question 4

Postop fever timing?

Pneumonia
UTI
DVT
Wound infection
Drug

Answer 4

Pneumo: day 3
UTI: 3-5 days
DVT: Anytime
Wound infection: 5-8
Meds: Just remember

Sinusitis maybe
Atelectasis ehhh, not specif

Question 5

Post op fever workup?

Answer 5

CXR, CBC, UA and culture, Blood culture, Sputum culture maybe, Exam legs, Doppler US

NO D DIMER (b/c all post op patients have high D dimer)

Question 6

Clean wound is clean skin. Clean contaminated goes into GI or resp or vagina. What is contaminated?

Answer 6

Contaminated wound is perforation.

Dirty is established infection!

Question 7

Delayed primary close is what?

Answer 7

Dirty wounds leaving open before closing

Question 8

Gallstone illeus is what?

Answer 8

Bowel obstruction with gall stone!

Question 9

Diverticulitis tx?

Answer 9

Metronidazole and fluoroquinolone or maybe IV meds if necessary

Question 10

What is papaverine?

Answer 10

Drug for less arterial vasospasm (used for mesenteric ischemia)

Question 11

What is second look laparatomy?

Answer 11

Check a day after resection of dead bowel moved

Question 12

Chronic mesenteric ischemia?

Answer 12

intestinal angina. Sometimes hear bruit. Pain within 2 hours of eating

Question 13

Bone marrow transplant indications?

Answer 13

Aplastic anemia

Induciton chemo

Question 14

Heart transplant indications?

Answer 14

Congen defects, cardiomyopathy, severe CAD

Question 15

Lung transplants indications?

Answer 15

COPD, alph1antitrypsin, primary pulmonary HTN, CF

Question 16

Hyperacute rejection?

Answer 16

24 hours: ANTI DONOR ANTIBODIES. Untreatable

ABO

Question 17

Acute rejection is what? TX?

Answer 17

6 days to a year

Anti donor T cell proliferation

Tx: STEROIDS

Question 18

Chronic rejection is what?

Answer 18

More than a year after transplant. Can’t treat

Question 19

Cyclosporine adverse reaction?

Answer 19

Nephrotoxic. Mannitol can help

Question 20

Azathioprene is what?

Toxicity?

When can’t you use it?

Answer 20

Antirejection

Adverse reaction: Bone marrow suppression

METAB BY XANTHINE OXIDASE

SO NO ALLOPURINOL!

Question 21

Tacrolimus

Answer 21

Nephrotoxic

Question 22

What is muromonab?

Answer 22

Leukopenia

Question 23

Mycophenalate causes what?

Answer 23

Used in lupus

Cause bone marrow suppression

Question 24

Hydroxychloroquine used when? What does it cause?

Answer 24

Anti rejection and lupus

Visual disturbances