True Learn assessment 1

Question 1

What dose of Prednisone is considered low risk for adrenal insufficiency?

Answer 1

<5 mg/day Prednisone or its equivalent for any duration or <3 weeks for ANY dose

No additional stress dose of steroid is necessary

Question 2

At what dose do you have to worry about stress doses of steroids?

Answer 2

> 20 mg/day of Prednisone for 3 or more weeks with Cushingoid appearance (assumed HPAA suppression)

Cont home dose the morning of surgery (regardless type of surgery) and give additional dose if undergoing moderate to major stress surgery

Question 3

What dose of Prednisone is considered intermediate risk for HPAA suppression?

Answer 3

5-20 mg/day of Prednisone (or its equivalent) for 3 or more weeks

Should undergo preoperative evaluation for HPAA suppression and need for stress steroids with moderate to major stress surgery

Question 4

How do you treat a patient on 5-20 mg Prednisone/day (or more) for minor/ambulatory surgery? (local anesthetic, inguinal hernia, hand surgery, colonoscopy)

Answer 4

take normal AM dose, no stress dose

Question 5

How do you treat a patient at risk for HPAA suppression undergoing MODERATE STRESS surgery (lower extremity revascularization)?

Answer 5

Take normal AM PO dose day of surgery
Before induction give hydrocortisone 50 mg IV
POD 0-2: hydrocortisone 50 mg every 8 hours for 24 hours (or until can take PO)
POD 2: reduce hydrocortisone to 25 mg every 8 hours (if NPO) or PO prednisone 15 mg once a day or prep steroid dose (whichever is higher)
POD 3-4 outpatient dose

Question 6

How do you treat a patient at risk for HPAA suppression undergoing high stress surgery (major cardiac, abdominal, thoracic)?

Answer 6

Take normal AM PO dose day of surgery
Before induction give hydrocortisone 100 mg IV
POD 0-2: hydrocortisone 50 mg every 8 hours (or until can take PO)
POD 2: reduce hydrocortisone 25 mg every 8 hours (if NPO) or PO prednisone 15 mg once a day or prep steroid dose (whichever is higher)
POD 3-4 PO outpatient dose

Question 7

How dose heparin work?

Answer 7

Augments a native anticoagulant

Activating antithrombin III directly which inactivates both thrombin and activated Factor Xa (inhibits coagulation)

Has a pentasaccharide sequence that is essential for binding antithrombin III

Question 8

How does LMWH work?

Answer 8

Augments naturally occurring anticoagulation in the body

Shorter molecule than heparin - still has pentasaccharide sequence - it inactivates Factor Xa but not thrombin

Question 9

How dose Warfarin work?

Answer 9

inhibits production of vitamin K dependent factors of coagulation (II, VII, IX, X), factors C & S

inhibits vitamin K epoxide reductase complex 1

Question 10

How does Argatroban work?

Answer 10

Direct binding of thrombin and inhibition of its activity

Question 11

What is the best initial test for Budd Chiari syndrome?

Answer 11

Duplex US of the liver

Question 12

If a hypothermic patient undergoes arrest, what vitals do they need to have before stopping ACLS?

Answer 12

warmed to 32 degrees celsius
or serum potassium is greater than 12 mmol/L

Question 13

Duodenal atresia and annular pancreas is commonly associated with what?

Answer 13

Down’s syndrome

Question 14

what one thing is associated with jejunal intestinal atresia?

Answer 14

cystic fibrosis ~10% cases

Question 15

what is the MOA of magnesium sulfate?

Answer 15

Competitively inhibits calcium channels
can be used as a tocolytic or seizure prophylaxis in pre-eclampsia
Has similar efficacy as Terbutaline with fewer side effects

Question 16

The 3 year survival rate for patients w/IPMN with high grade dysplasia following surgery is?

Answer 16

75%

Question 17

BD-IPMN can be monitored with serial imaging if?

Answer 17

less than 3 cm and no concerning features

Question 18

How does Calcitonin work?

Answer 18

opposes PTH and decreases calcium levels
increases phosphorous excretion in the kidney

Question 19

What is this?

Answer 19

Perianal condyloma acuminata (genital warts)
Most common STD seen in colorectal surgery office

Question 20

Condyloma acuminate is caused by what?

Answer 20

HPV 6 and 11
HPV 16 and 18 can be more aggressive and progress to dysplasia or carcinoma

Question 21

What is the treatment for condyloma acuminata

Answer 21

Remove macroscopic disease
Recurrence is extremely high
topical agents can be used as adjunts

Question 22

acute adrenal insufficiency (Addisonian crisis) presents with what symptoms?

Answer 22

fever, abdominal pain, vomiting, hypotension

Question 23

Cowden syndrome is associated with what genetic suppressor gene

Answer 23

PTEN

Question 24

What is the most important risk factor for development of heart failure?

Answer 24

CAD

Question 25

What kind of colostomy has the highest risk for parastomal hernia?

Answer 25

end colostomy

Question 26

which nosocomial iatrogenic healthcare infection is most likely to cause mortality?

Answer 26

Pneumonia

Question 27

what is the most common nosocomial infection?

Answer 27

UTI

Question 28

How is pancreatic insufficiency diagnosed?

Answer 28

fecal fat testing

Question 29

What is the screening for BRCA patients <30 years old

Answer 29

annual breast MRI

Question 30

what is the screening for BRCA patients 30-75 years old?

Answer 30

annual breast MRI and mammogram

Question 31

What can you give for antithrombin III deficiency?

Answer 31

FFP

Question 32

When is cryoprecipitate used?

Answer 32

treating factor deficiency (hemophilia A), Von Willibrand Disease, hypofibrinogenemia, may help with uremic bleeding

Question 33

When is FFP used?

Answer 33

replace labile factors in patients with coagulopathy and documented factor deficiency like ATIII deficiency

has factors V, VII, IX, X, XI, protein C and S, plasminogen or antiplasmin

DOES NOT have factor VIII or vWF

Question 34

What are some indications to do a deep inguinal lymph node dissection for melanoma?

Answer 34

positive Cloquet’s node (most superior superficial node),
multiple superficial nodes are positive, or imaging that suggest deep ilioinguinal metastatic disease

Question 35

What is the contraindication for a VRAM flap?

Answer 35

prior c section or ex lap

Question 36

why is a VRAM flap not a good idea after a superficial inguinal node dissection?

Answer 36

the ipsilateral inferior epigastric artery is ligated when the nodes are removed so you have to take the contralateral inferior rectus

Question 37

what is the flap of choice after a superficial inguinal node dissection for melanoma?

Answer 37

Sartorius flap

Question 38

what is the most effective non-surgical treatment for achalasia?

Answer 38

pneumatic dilation