Basic Flashcards

Question

Causes of postoperative fever

Answer 1

Response to surgical trauma Atelectasis SSI RTI , UTI Anastomotic leak DVT

Answer 2

🪷Enteral feeding 1.Sip feeding 2.NGT Rhyl tube 3.Feeding gastrostomy 4.Feeding jejunostomy 🪷Parenteral feeding 1/Central IJV SCV 2/Peripheral 3/ PICC , Peripherally inserted central venous catheter

Answer 3

🌿Early Hematoma Seroma SSI EVISCERATION DEHISCENCE 🌿late Hypertrophic scar Keloid Ugly chronic scar Contracture Marjolin ulcer Stitch sinus Stitch marks

Answer 4

🌹The patient Improving general condition DM control ttt of malnutrition Anemia correction Ttt of any septic focus Skin antiseptics Hair trimming just preoperative 🌹The surgery Good hemostasis Avoid hematoma and seroma Avoid dead space Appropriate abs Remove any necrotic tissue or FBs Shorten post op stay Delayed primary closure of contaminated wound 🌹==>Proper strelization of surgical instruments Antibiotics High concentration in required tissue No liver or kidney toxicity Suitable for organism

Answer 5

A. Hyperkalemia, if blood is old and hemolysis occurs releasing intracellular potassium, may cause cardiac arrhythmia and arrest. B. Hypocalcemia, due to excess citrate, which is used as anticoagulant, it binds to the calcium C. Circulatory overload (heart failure), due to expansion of the intravascular volume. D. Hypothermia, as the blood is stored at 4 degrees, it may cause coagulopathy and acidosis. E. Coagulopathy and DIC, as stored blood is deficient on platelets and coagulation factors F. Metabolic acidosis, due to the hyperkalemia and hypothermia

Answer 6

1) location and vascularity 2) immobilization and shearing forces 3) infection 4) surgical technique 5) presence of fbs or necrotic tissue

Answer 7

Open wounds Stab , puncture , cut , incised , abrasion friction burn Laceration degloving traction avulsion Closed wounds Compartment S Crush S Contusion , bruises and hematoma

Answer 8

Smoking Old age Obese Hypoproteinemia Uper bdominal or thoeacic surger HF Chronic steroid use

Answer 9

**preoperative** Stop smoking for at leaset 8 wka b4 surgery Ab prophylaxis and delay surgery if there is chest infection Education of the patient to do respiratory exercise after surgery Ttt of any rt obstruction in COPD and asthma **Intraoperative** Limit the time of surgery to less than 3 hrs Avoid use of pancournium Use laparoscopic procedure when possible Use spinal or epidural anesthesia **Postoperative** The patient should do extensive respiratory exercise CPAP Use epidural analgesia Intercosral nerve block **Postoperative**

Answer 10

Delayed wound healing Infection Regurgitation, difficult intubation Bed sore MI DVT cerebrovascular accident respiratory compromise Mechanical problems

Answer 11

Child A 10% Child B 31% Child C 76

Answer 12

★Tight MS or AS untill surgically corrected ★SBP>160 DBP>95 ★MI in past 6mns ★HF until controlled ★PTA Within 6 wks ★Chronic smoking until patient stops at least 8 wks

Answer 13

Post operative fever Complications of thermal regulation DVT cardiovascular Circulatory collapse Neurological Renal Suprarenal Thyroid Pulmonary

Answer 14

Paralytic illius,acute gastric dilatation Gi bleeding Post operative nausea and vomiting

Answer 15

Curling ulcer dt stress Gastritis dt postoperative NSAIDs as analgesia Mallory wise s dt excessive vomiting technical errors in anastomotic surgery or stapling

Answer 16

Female sex Operation in a young adults Preoperative vomiting Motion sickness and migraine NSAID Postoperative Poor pain control Acute gastric dilatation Paralytic illius

Answer 17

**CVS** PE MI heart failure Stroke Arrhythmia **RESPIRATORY** Failure to reverse anesthesia Respiratory depression by drugs Respiratory infection **METABOLIC** Acute adrenal insufficiency Hypo or huperglycemia Electrolytes distubance **INFECTION** Sepsis Septic shock Ssi **SURGICAL** Slipped ligature Acute blood loss without compensation Decompensated dehydration **DRUG REACTION AND ANAPHYLAXIS**

Answer 18

_In first 2 days_ Effect of surgical trauma Atelectasis _From 3 to 5_ Superficial and deep SSI _5th day_ UTI Especially è catheter RTI especially in patients with COPD Central line infection _The 7th day_ Anastomotic leak Intracavitary collection Abcesses

Answer 19

Morphine Epidural or spinal anaesthesia MI Dehydration Blood loss

Answer 20

Neural response Endocrinal response Microcirculatory changes Cellular damage and acute inflammatory response SIRS early reversible , late irreversible

Answer 21

Temperature ≥38 or ≤36 Tachycardia>90 Tachypnea>20 Pco2 ≤32 mmhg Need of mechanical ventilation Leukocytes ≥12000 or ≤4000 Or band cells >10%

Answer 22

hypovolemia Hypothermia Malnutrition Psychological stress Pain

Answer 23

Initiated by circulation of 🌿Inflammatory cells pnl mq 🌿Cytokines IL 1 ,6, 8, TNF a 🌿Pro inflammatory mediators ( proteases o free radicals, prostaglandins,kinins ) 🌿Anti inflammatory mediators (IL 10 ,protease enzymes inhibitors, antioxidants) 🌿Complement 🌿Bacteria and toxins These mediators cause endothelial dysfunction and widening of capillary pores ,escape OF plasma proteins to interstitial space dragging water after them leading to hypovolemia and systemic hypoperfusion and may cause MOF

Answer 24

Is failure of 2 or more than organs making it difficult to. maintain homeostasis without external support **Sequence** 1.Lung 2.Liver 3.Intestine 4.Renal 5.Heart

Answer 25

As a part of systemic endothelial dysfunction Pulmonary endothelial cells leak and the alveoli become filled of water this impair ventilation Opening of pulmonary arteriovenous shunts this cause capillaries hypoperfusion ==>impair perfusion Interstitial edema ==> impair diffusion

Answer 26

📌Vancomycin Teicoplanin 📌Linezolid Daptomycin Tigecycline

Answer 27

Otitis media Meningitis Post splenectomy infection COPD exacerbation Bronchopneumonia in susceptible patients

Answer 28

Part of mixed flora present in Intraperitoneal abcess Areas with necrotic tissue as diabetic leg ulcer

Answer 29

Penicillin is DOC It is also sensitive to macrolides like erythromycin and claritheromycin Meningitis Ceftriaxone and vancomycin

Answer 30

Cephalosporins Daptomycin and Linezolid

Answer 31

2&3rd generation cephalosporins,gentamycin and fluroqunolines cipro,levo,moxifloxacin Cephalosporins resistance ==>carbapenem and amikacin Carbapenem resistance ==> colistin

Answer 32

Affects debilitated patient Compound fractures burn catheter 10

Answer 33

Orally effective ttt ciprofloxacin and ofloxacin Ceftazidim, cefepim carbapenem (piperacillin tazobactam)

Answer 34

📌After drainage of perianal abcess or ischiorectal abcess 📌After IM or IV injection

Answer 35

Prevention Adequate wound debridement Ab prophylaxis Blood transfusion to avoid Ischemia Curative Aggressive debridement Systemic ABs penicillin iv 20-40million u per day+gentamycin DM control Fluid nutrition blood transfusion

Answer 36

Streptococcus Ecoli Anaerobic flesh eating bacteria Associated with fournier gangrene of scrotum **Maleny's synersism**

Answer 37

Decrease luminal nutrition of entercytes Mesenteric ischemia Altered intestinal flora This lead to ==>bacterial translocation ==>portal circulation If Kupffer cells of the liver r impaired Systemic sepsis==>MOF

Answer 38

🌻Patient factors Debilitating disease Immunosuppression (chemotherapy, chronic steroid use , DM) Obesity Chronic disease Unfavorable local tissue condition Presence of septic focus 🌻 Exogenous factors Type of surgery Breech of infection control Improper sterilisation of s equipments Presence of hematoma or seroma Presence of dead spce 🌻 surgical factors Presence of Fbs Improper surgical technique Local tissue ischemia and edema

Answer 39

Implant (mesh and graft) Infection will be very severe or life threatening Patient with valvular heart lesion (IEc) Emergency surgery

Answer 40

5-10 Wound pain and postoperative fever

Answer 41

Early massive doses of Abs amoxicillin and metronidazole Semi setting position Late submental curved incision of skin and deep fascia

Answer 42

For mild cases *The overhanging nail fold is pushed away and reduced in size by daily packing of the lateral groove with antiseptic gauze *Antibiotic ointment *Avoid wearing tight shoes *Warm water salt soaks Operative Excision of a wedge including granulation and nail bed In extensive cases removal of the whole nail with it s bed

Answer 43

The condition is very common in battle wounds Muscle wound contaminated by soil feces High volecity gun shot causing bowel perforation Associated with amputation contaminated with stool

Answer 44

Plus hyperbaric oxygen for several hours daily Anti gasgangrene toxin infusion is given

Answer 45

Anticholine esterase action interfere è destruction of ach causing generalized tonic regidity of muscles **Convulsion attacks on exposure to minor stimuli**

Answer 46

Tonic tetanus trismus meningitis Clonic hydrophibia of rabies strychnine poisoning

Answer 47

Local Infection Tissue indury FT SCAR كل الانواع General Hge hypovolemic shock ARF Compartmental s

Answer 48

Local Ischemia Immobilization Irridiation Infection Tension Wound closure method systemic Age Malnutrition Drugs Debilitating disease Chronic diseases A

Answer 49

Pressure application Intralesional steroid In keloid post operative radiation Combination of surgery and RT the best