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surgery > Test 1: General > Flashcards

Test 1: General Flashcards

1
Q

of days beforehand to stop ASA preop

A

7

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2
Q

coumadins antidose

A

vit k (takes 1-2 days to reverse)

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3
Q

a faster antidote to coumadin than vitamin k

A

FFP

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4
Q

herbal medicines have what more common adverse affect….

A

make you bleed

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5
Q

which of of these is not a risk factor for surgical/anesthesia complication? copd, obesity, tobacco history, neuromuscular disease, coma, history of cancer, age

A

history of cancer

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6
Q

preop for pulmonary disease should include…

A

baseline arterial blood gas, oxygen saturation, and a pulmonary function tests

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7
Q

which of these is not a treatment for pulm patients preop? 1. nebulized SABAs 2. steroids 3. chest PT 4. incentive spirometry

A

incentive spirometry

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8
Q

in a pulmonary preop workup using PFTs, if the FCV/FEV1 ratio is less than 50% you should think what about their intra-op period?

A

this patient has a higher risk of surgical complications

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9
Q

T or F, diabetics in the OR are at increased risk for infection?

A

true

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10
Q

Gatroparesis can cause…

A

aspiration

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11
Q

who gets neurogenic bladder more commonly

A

diabetics

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12
Q

does hypothyroidism or hyperthyroidism put you at risk for a-fib intra op?

A

hyperthyroidism

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13
Q

in a trauma, a lab test that can tell what specific clotting factors are working is called…

A

Thromboelastography

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14
Q

Routine pre-op labs for bleeding include…

A

PT, PTT (not INR)

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15
Q

a paitient with a history of kidney problems present to you for pre-op evaluation, you notice a fistula in the patients arm, what should you do?

A

Renal specific: obtain baseline labs (electrolytes, BUN, Cr) and order nephro consult. Additional items: patient weight, CBC, coag profile, and U/A

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16
Q

at what age is an EKG and Xray mandatory preop?

A

50+

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17
Q

Low potassium and a low magnesium can cause what?

A

arrythmias

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18
Q

patients must be NPO _____ hours preop

A

8

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19
Q

Abx should be given _____ hours pre-incision

A

1

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20
Q

Call MD if Systolic blood pressure drops below…

A

90

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21
Q

Call MD if pulse is between ___&____

A

60, 110

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22
Q

Call if respiration’s exceed

A

30

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23
Q

Call if temp exceeds

A

101.5

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24
Q

Call if urine output is less than

A

250 ml per shift (or less than .5/kg/hr)

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25
Q

ADCVANDISAL stands for…

A

Admit, Diagnosis, Condition, Vitals, Allergies, Nursing, Diet, IV/I&O, Special orders (consults), Activity, Labs

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26
Q

acute abdomen accounts for what % of all ER visits

A

5%

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27
Q

Appys reveal themselves within ____ hours after onset of pain

A

24 hours

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28
Q

which of these is not a potential cause of extra-abdominal pain. 1) Diabetic Ketoacidosis 2) Systemic Lupus Erythmatosus 3) Sickle Cell Crisis 4) Divertiulitis 5) Herpes Zoster 6) Pneumonia 7) Myocardial Infarcation

A

Diverticulitis

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29
Q

flank echymosis d/t pancreatitis is called

A

Gray Turners sign

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30
Q

periumbilical echymosis d/t pancreatitis is called

A

Cullens Sign

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31
Q

Perforation of esophagus from vomiting is called

A

Boehave’s Syndrome (oh behave) LIFE THREATENING

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32
Q

preop imaging study to r/o abdominal perforation

A

plain film (abdominal xray)

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33
Q

dilated loops of small bowel d/t nearby inflammation such as pancreatitis or appendicitis are called

A

sentinel loops

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34
Q

best imaging study for intusucception

A

barium or air enema (diagnostic and therapeutic) (also good for to eval a volvulus or diverticulum)

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35
Q

currant jelly stools mean

A

intussuception

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36
Q

definitive test for acute choly

A

HIDA (MRI in pregnancy)

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37
Q

pain out of proportion to the exam

A

ischemic bowel. patient will likely have a vascular history.

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38
Q

tx for ischemic bowel

A

emergency laparotomy (correct the metabolic acidosis, check lactate hopefully < 2.)

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39
Q

how you best dx an ischemic bowel

A

angiogram

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40
Q

Whats it called when pain in the shoulder is referred from splenic rupture

A

Kehr’s sign

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41
Q

appendicitis, gradual or acute onset?

A

gradual

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42
Q

MCC of appy?

A

appendicolith

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43
Q

what kind of appy presents with dysuria and hematuria?

A

retrocecal appendix

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44
Q

gold standard modality for ruptured ectopic

A

TVUS

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45
Q

tx for diverticulitis

A

bowel rest, antibiotics flagyl, zosyn, and cipro.

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46
Q

most common site of divertic?

A

sigmoid colon

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47
Q

tx for diverticulitis abcess

A

Drain it in VIR

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48
Q

dilated loops of small bowel, and air fluid levels in a stepladder like fashion on xray?

A

SBO. MCC: adhesions.

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49
Q

what is the transitional point in an SBO

A

where we think the obstruction is

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50
Q

what scoring tool evaluates the extent of liver disease

A

Child Pugh Criteria

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51
Q

scoring tool that evaluates the mortality from pancreatitis

A

Ranson’s Criteria

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52
Q

Tx for acute pancreatitis

A

NPO, fluid resuscitation, TPN, and admit for obs

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53
Q

Charcot’s triad

A

Fever, Jaundice, Abdominal Pain (Hallmark of acute cholangitis)

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54
Q

What labs do you expect to see elevated in acute choly?

A

Bili, alk/phos, and white count.

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55
Q

You would admit for any 1 of what 4 symptoms of a choly?

A

Fever, intractible vomiting, jaundice, intractible pain (FIJI)

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56
Q

white blood cell casts in the urine

A

pyelonephritis

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57
Q

cervical motion and adnexal tenderness

A

salpingitis

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58
Q

abrupt colicky, intermittent sharp pain, unilateral, could be a growing pain, pallor, diaphoretic

A

Renal colic (calcium oxalate stone)

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59
Q

stones < 4mm will pass _______% of the time

A

90%

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60
Q

alpha blockers increase chance of passing stone ______% of the time

A

60%

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61
Q

most common ulcer

A

duodenal ulcer (relieved by food)

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62
Q

tx for perf’d ulcer

A

ELAP (exploratory laparotomy)

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63
Q

Describe each… ASA 1 ASA 2 ASA 3 ASA 4 ASA 5 ASA 6 E

A

ASA 1: normal healthy adult ASA 2: adult with mild diabetes ASA 3: adult with severe diabetes ASA 4: adult with severe diabetes constant in life ASA 5: dying patient who will not survive w/o surgery ASA 6: brain dead patient to be harvested E: emergent

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64
Q

what 2 drugs in combo have a higher chance of causing Malignant Hyperthermia (MH)?

A

Succinylcholine (paralytic) and Halothane (inhaled anesthetic). Tx with IV Datrolene

65
Q

If a normal albumin is 4. And that patients shows an albumin of 3. You need to raise the patients Calcium by how much for each drop of 1 point value in albumin?

A

.8 (point 8) So if the patient had a Calcium of 8, they should now try to be at 8.8

66
Q

we do the ____ minute scrub, with ___ strokes to each side

A

3 minute scrub, 8 strokes each side

67
Q

how does the 4-2-1 rule work of maintenance fluid

A

for the first 10 kg, you give them 40ml/hr for the 2nd 10 kg, you give them another 20ml/hr everything above 20 kg, they get 1:1. so a 60 kg person, is 100ml/hr (or 1200 for the day)

68
Q

how many ml’s of urine output should you expect post op minimum

A

.5 ml//kg/hr (minimum 30)

69
Q

LV failure and pulmonary edema occur to what % of surgical patients under 40?

A

40%

70
Q

peristalsis returns after how many hours after surgery?

A

24

71
Q

abcess’ take ____ days to form

A

7

72
Q

most common wound complication

A

hematoma

73
Q

the five w’s of post op fever

A

wind (atelectasis) water (uti) walking (dvt/pe) wound (abcess) wonder drug (anesthesia)

74
Q

What will cause the post-op fever on day…. 1-3 4-5 5-7

A

1-3: PNA, atelectasis 4-5: infection/dehiscence 5-7: leak, abcess, PNA (also check for thrombophlebitis)

75
Q

most likely cause of fever 6 hours post op

A

atelectasis

76
Q

fever of 104 post op think…

A

Malignant Hyperthermia, TRALI (transfusion rxn acute lung injury), xfusion rxn, nec fasciitis

77
Q

_______ is the single most important indicator of critical illness

A

tachypnea (metabolic acidosis is also an important indicator but no the single most)

78
Q

the most common vardiovascular disturbance in the seriously ill is______________?

A

hypotension d/t hypovolemia or sepsis

79
Q

what is the most accurate measurement of organ perfusion?

A

Mean Arterial Pressure

80
Q

what are the 4 determinants of cardiac output according to one of the earlier slides?

A

preload afterload contractilty heart rate

81
Q

where should the tip of a central venous catheter rest?

A

In SVC just proximal to the Right atria (prevent ectopy)

82
Q

shock is NOT associated with which sign… a. hypoperfusion b. altered mental status c. oliguria d. apnea d. acidosis

A

apnea

83
Q

Right atrial pressure normally

A

2-8 mmHg

84
Q

Right ventricular systolic pressure normally

A

20-30 mmHg

85
Q

TRUE or FALSE, right ventricular pressure at diastole should be less than right atrial pressure?

A

true

86
Q

Pulmonary arterial systolic and diastolic pressure should be between

A

20-30 systolic 5-15 diastolic

87
Q

Normal cardiac output range (L/min)

A

4-6 liters per minute

88
Q

SVo2 should be what range? (percentage of oxygen saturation in the pulmonary arterial blood)

A

65-75%

89
Q

what regulates stroke volume? what regulates cardiac output?

A

stroke volume: preload, afterload, contractility (well its HR x SV = CO) Cardiac output: heart rate and rhythm

90
Q

Decreased CO, INCREASED filling pressures, decreased contractility, decreased LV stroke work, and the body adjusts by increasing SVR. What kind of shock am I?

A

Cardiogenic shock

91
Q

Decreased CO, DECREASED filling pressures, and the body compensates by increasing SVR, what kind of shock am I?

A

Hypovolemic shock

92
Q

Normal CO, LOW SVR, and LOW/NORMAL filling pressures is what type of shock?

A

Distributive shock

93
Q

The 4 types of distributive shock

A

Neurogenic, Adrenal, Sepsis, Anaphylaxis (NASA)

94
Q

Which type of distributive shock shows increased CO, decreased SVR, hypotension, and a consumptions of clotting components d/t to hyperinflammation and hypercoagulation

A

septic shock (fill the tank before you give pressors)

95
Q

Decreased CO, increased SVR, VARIABLE filling pressures depending on etiology. What shock am I?

A

Obstructive shock (cardiac tamponade, tension pneumothorax, massive PE)

96
Q

When administering saline, with such a high chloride content you could cause….

A

hyperchloremic acidosis

97
Q

MAP target

A

> 60

98
Q

What dosage of dopamine has a mild inotrope and renal effect

A

2-3 mcg/kg/min

99
Q

What dosage of dopamine has a inotropic effect only?

A

4-10 mcg/kg/min

100
Q

What dosage of dopamine has a strong vasoconstrictive and chronotropic effect?

A

10+ mcg/kg/min

101
Q

What drug would be best to DROP systemic vascular resistance to improve cardiac output and strengthen cardiac contractility at the same time? a. dopamine b. dobutamine c. epinephrine d. norepinephrine

A

b. Dobutamine (DO NOT give this if they are already hypotensive)

102
Q

What is the best inotrope/vasopressor for someone in septic or hypovolemic shock without tachycardia? a. dopamine b. dobutamine c. epinephrine d. norepinephrine

A

d. Norepinephrine (,05mcg, and titrate to effect. its a potent pressor at higher doses)

103
Q

What pressor has both alpha and beta actions for inotropic and vasopressor effecs, but might increase myocardial 02 consumption. a. dopamine b. dobutamine c. epinephrine d. norepinephrine

A

C. Epinephrine

104
Q

Oliguria, a marker of hypoperfusion is defined as…

A

< .5 ml/kg/hr for more than 2 hours.

105
Q

If you suspect oliguria, and want to know if its pre-renal, renal, or post-renal, what will a high BUN/Cr tell you?

A

Its pre-renal (same as with hypovolemia)

106
Q

Nl pCo2: 40 Nl pH: 7.4 If pCo2 drops lets say 10 points (to 30), what do you expect the change in pH to be?

A

7.48 (an inverse relationship of .08 change in pH for every change of 10 in pCo2)

107
Q

You evaluate a patients urine and find a BUN/Cr ration of 20:1, specific gravity of 1.020 (heavy), urine osmo of 500, and low urine sodium. What is the likely culprit of this person’s oliguria? a. Pre-renal b. Renal c. Post-renal

A

Pre-renal

108
Q

T or F: in pediatrics, blood pressure is a sufficient way to measure organ perfusion.

A

False

109
Q

First line treatment for peds renal insufficiency

A

Fluid bolus at 20 ml/kg to goal BP or a total of 60 ml/kg.

110
Q

2nd treatment includes using a vasopressor. What is the best one for peds?

A

Epinephrine

111
Q

What is a likely cause of obstructive shock in neonates?

A

Congenital obstructive left heart syndrome (hypoplastic, underdeveloped left ventricle)

112
Q

T or F: serum levels of K+ accurately reflect actual levels?

A

false

113
Q

3 treatments of hyperkalemia?

A

Insulin/glucose combo, SABA, Sodium bicarb

114
Q

What electrolyte is administered in hyperkalemia to prevent cardiac toxicity?

A

Calcium gluconate

115
Q

Which option is least appropriate for reducing serum K+ levels in the body. a. Diuretics b. Sodium Polystyrene Sulfonate c. Dialysis d. Inhaled Corticosteroids

A

d. Inhaled Corticosteroids (A SABA might do it, but not this one)

116
Q

What do you do for hypOvolemic hypOnatremia

A

normal saline (and make sure to r/o adrenal insufficiency)

117
Q

What do you do for hypERvolemic hypOnatremia

A

increase water loss (diuretic)

118
Q

Which action is NOT appropriate to correct for EUvolemic hypOnatremia? a. Restrict water intake b. Increase water loss c. Give normal saline d. Give hypertonic saline e. Administer sodium gluconate

A

e. Administer sodium gluconate

119
Q

What 2 things can happens if you correct sodium too fast?

A

Demyelinating syndromes, and cerebral edema

120
Q

Seizures can occur in peds as a result of hypo or hypernatremia?

A

Hyponatremia

121
Q

Hypocalcemia causes muscle… Hypercalcemia causes muscle…

A

tetany weakness

122
Q

What drug is given to correct hypocalcemia?

A

Calcium gluconate

123
Q

What two actions are best in correcting hypercalcemia?

A

Dilute with NS, and diurese with thiazides

124
Q

A patient comes in to your office c/o non-specific abdominal pain, nausea, and vomiting for last 3 days. He states he feels lightheaded when he gets up too quickly, and has ongoing feelings of palpitations. You obtain labwork and notice a sodium of 82, potassium of 6.5, blood sugar of 73. What is the most likely diagnosis?

A

Acute Adrenal Insufficiency. (Correct any fluid loss, give glucose, give dexamethason or hydrocortisone, and refer for ACTH testing)

125
Q

For hyperglycemic syndromes like DKA and HHNS, once your insulin drip gets them to 250 or so, coadminister ________ to avoid cerebral edema?

A

Glucose (Correct K+ and PO4 too)

126
Q

An exaggerated manifestation of thyroidism is called thyroid storm. List 5 Specific drugs to help them…

A

Propylthiouracil or methimazone Propanolol K+ Dexamethason Sodium Ipodate

127
Q

What is a manifestation of severe hypothyroidism which shows swelling of the face, and what do you do for them?

A

Myxedema coma Tx: Airway, fluids, glucose, warming (they are cold), hydrocortisone, and Levothyroxine

128
Q

What 3 reasons do we give LR instead of NS intraop?

A
  1. LR is slighly more neutral than NS 2. LR includes K+ and Bicarb 3. LR has slighly less Na and Cl (preventing hyperchloremia)
129
Q

What type of drain is a closed drain connected to a suction device? a. Blake and/or JP b. Davol c. Penrose

A

Blake and/or JP

130
Q

What type of drain uses a sump with an airflow system to keep the lumen of the drain open when fluid isn’t passing through it? a. Blake/JP b. Davol c. Penrose

A

b. Davol

131
Q

What type of drain is open passively? a. Blake/JP b. Davol c. Penrose

A

c. Penrose

132
Q

What is the preferred local anesthetic for surgical incisions?

A

Marcaine (long-acting) (same as whats in the q-balls…intercostal nerve block)

133
Q

A patient weighs 50 kilograms, what are their hourly maintenance fluid needs?

A

90 ml/hr (40 for 1st 10, 20 for 2nd 10, 30 for last 30) (40 + 20 + 30 = 90)

134
Q

What is a collection of fluid under the skin that can cause a hematoma?

A

Seroma

135
Q

“A hematoma is almost always cause by ___________”

A

“imperfect hemostasis”

136
Q

Best method to reduce risk of atelectasis post-op

A

Incentive spirometry (ambulate also)

137
Q

What is the most common bug implicated in Necrotizing Fasciitis?

A

GABHS (and strep pyogens)

138
Q

Overall, the risk of anesthesia related deaths in health patients are estimated at 1:100k-200k. This is an example of. a. incidence b. prevalence

A

b. Prevalence (is this right?)

139
Q

A helpful way of remembering the Glasgow coma score?

A

EVM 4-5-6 Eye (4 points) Voice (5 points) Movement (6 points) (the first and last are always normal and none, I focused on the buzzwords in the middle)

140
Q

Eye (simplified) 4 of them

A

1 Normal 2 Loud voice 3 Pain 4 None

141
Q

Voice (simplified) 5 of them

A

1 Normal 2 Confused, Disoriented 3 Inappropriate 4 Incomprehensible 5 None

142
Q

Movement (simplified) 6 of them

A

1 Normal 2 Localizes 3 Withdrawls 4 Decorticate 5 Decerebrate 6 None

143
Q

Which thyroid state (hypo/hyper) is associated with decreased metabolic clearance of drugs

A

Hypothyroid

144
Q

In a pre-op patient whom you suspect has a coagulopathy? Which of these is LEAST important to know? a. Easy bruising b. Excessive bleeding after minor surgeries c. History of bleeding from a major laceration d. Family hx or bleeding e. History of liver disease f. Medications

A

c. History of bleeding from a major laceration

145
Q

What % of patients are d/c’d from the ED with a dx of “nonspecific abdominal pain”?

A

34-56%

146
Q

Diverticulitis….gradual or acute onset?

A

gradual (like an appy)

147
Q

What 6 labs are appropriate for abdominal complaints?

A

CDC w/ diff Amylase HCG LFTs hCG U/A

148
Q

Best imaging modality for renal calculi?

A

Non-con CT

149
Q

What is the treatment for an acute bowel obstruction that isn’t a complete obstruction?

A

NG Decompression

150
Q

What is the treatment for an acute and COMPLETE SBO?

A

Surgery

151
Q

MCC of acute pancreatitis?

A

ETOH

152
Q

Which of the following is NOT part of Ranson’s criteria? a. Age b. WBC c. Glucose d. Bun/Cr e. LDH f. ALT

A

d. Bun/Cr (WAAGL: wbc, age, alt, glucose, ldh)

153
Q

malampati score

A

IV

(severe difficulty with intubation)

154
Q

mallampati score

A

II

155
Q

mallampati score

A

III

156
Q

mallampati score

A

I

157
Q

What is the highest risk this patient is at risk for with this kind of anesthesia?

A

Cardiac risk

(spinals, epidural, and peripheral nerve blocks)

(lasts 2 - 5 hours)

158
Q

while closed suction is usually preferred (like witha JP or Blake), when would you need something like a Davol (sump drain)?

A

when the amount of drainage is large or when drainage is likely to plug other kinds of drains

(Davols can be flushed easily)

159
Q

Which is not part of the child-pugh criteria for liver disease?

  1. Encephalopathy
  2. Albumin
  3. Asciites
  4. Lactate Dehydrogenase
  5. PTT
  6. Bilirubin
A

Lactate Dehydrogenase (LDH)

surgery (4 decks)

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