Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

QUESTION NOTES > MISC (pre/post-op, endo, admin) > Flashcards

MISC (pre/post-op, endo, admin) Flashcards

(72 cards)

Start Studying
1
Q

Papaverine

A

vasodilator; also relaxes muscles of digestive system - good for diffuse mesenteric vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pre-op: who gets EKG?

A

typically >50yo but not shown to predict cardiac risk peri-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pre-op: who gets CXR?

A

pts w/ cardiac or pulm sxs; need one within 6mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pre-op: who gets Hct/Hgb checked?

A

elderly w/ major organ dysfxn (liver) or known anemia, or pts undergoing surgery w/ possible signif blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pre-op: ACE inhibitors

A

HOLD - to avoid hypotension with an anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for medication toxicity (even if within therapeutic range)

A
  • low serum albumin (higher free drug concentrations)
  • dehydration
  • obesity (longer storage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Highest risk delayed cx (bleeding, perf) in endoscopy pts

A

coag mode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What monopolar mode should be used (cut/coag) nearby cardiac devices?

A

cut mode - lowest voltage monopolar mode; transfers least amount energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Absolute C/I to most robotic operations

A
  • inability to tolerate pneumoperitoneum
  • ascites
  • gross contamination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mgmt CO2 embolism

A

trendelenberg, left-side down, aspiration of gas thru central line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mech CO2 embolism during laparoscopy

A

trocar insertion into vessel or direct absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effect if give ACEI in pts with HTN 2/2 renal artery stenosis

A

decrease GFR -> acute oliguric or anuric renal failure (hence C/I)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Plain gut suture vs. chromic gut (tensile strength and absorption time)

A

tensile strength: plain 7-10d; chromic 10-14d

absorption: plain 70d; chromic >90d
* both absorbed by proteolytic enzymatic digestive process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Polyglactin 910 (coated vicryl)

A

copolymer slows water penetration
tensile strength: maintains >65% after 14d
absorption: min at 40d, complete at 56-70d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Polyglecaprone 25 (monocryl)

A

tensile strength: 50-60% at 7d, 20-30% at 14d, lost at 21d

absorption: complete at 91-119d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Polydioxanone (PDS)

A

tensile strength: 70% at 14d, 50% at 28d, 25% at 42d

absorption: minimal until 90d, complete within 6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Silk

A

tensile strength: lost when exposed to moisture

absorption: nonabsorbable ~2yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Fothergill sign

A

abdominal wall mass that does NOT cross midline + does NOT move with contraction of abdominal wall muscles -> if pos, then rectus sheath hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Imaging presentation of Echinococcus

A

calcified cystic wall in the lungs and liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mgmt Echinococcal cysts

A

Staged procedure: all w/ lap pads soaked in hypertonic saline, which is toxic to parasite

  1. lobectomy
  2. nonanatomic rsection of liver lobe + entire cyst (avoid spilling)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should pre-op SSI prophylactic Abx be given?

A

within 60 min of incision (except vanc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When should do intra-op repeat of SSI prophylactic Abx?

A

if time of surgery > 2x half-life of drug or there is excessive blood loss during procedure
amp/sulb: 0.8-1.3 hrs
cefoxitin: 0.7-1.1 hrs
cefotetan: 2.8-4.6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pregnant women have what alteration of PaCO2?

A

decreased @ 30mmHg (bc increase in minute ventilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Alpha-receptor cascade

A

GPCR -> phospholipase C -> inositol trisphosphate + diacylglycerol -> intracellular Ca -> vasoconstriction of vascular smooth muscle cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Beta-receptor cascade
GPCR -> adenylate cyclase -> ATP to cAMP -> protein kinase A -> ion channels phosphorylated -> increase Ca2+ influx
26
Empiric Abx choice for GAS necrotizing SSI
penicillin (vanc, linezolid) + clindamycin (or zosyn, carbapenum, or ceftriaxone+metro)
27
New-onset a.fib after non-CT surgery is associated with increased risk of...?
stroke
28
Absolute C/I to ERAS (enhanced recovery after surgery)
- undergoing urgent operation - ASA of 4+ - limited or no mobility - severely malnourished - noncompliant or reluctant to participate in protocol
29
In setting of hollow viscus injury, length of post-op Abx to decrease incidence of SSI?
24-hrs
30
When use vancomycin for pre-op prophylactic Abx?
for high-risk pts for MRSA, or have penicillin allergy (must be given over longer time than 60min bc required slow administration)
31
What does the APACHE score evaluate?
(acute physiology and chronic health eval) severity of disease classification system to estimate mortality in ICU
32
What is a quick test to quantify fraility?
Timed Up and Go - mobility instructions; prolonged if takes >12 seconds
33
What does the SOFA score evaluate?
(sequential organ failure assessment) predicts ICU mortality based on lab/clinical data
34
MC organism causing VAP and SSI
S.aureus
35
MC (#1, #2) organism causing central-cath-associated bloodstream infection
``` #1: S. epidermidis #2: S. aureus ```
36
VitC vs. VitD: decreased resus volumes in burns
VitC
37
VitC vs. VitD: antioxidant effect
VitC
38
VitC vs. VitD: decreased MOF after trauma and burns
both
39
PPI decreases absorption of what oral AC?
dabigatran
40
What oral AC has high oral bioavailability?
rivaroxaban, apixaban, edoxaban
41
Renal vs. hepatic elimination: rivaroxaban, dabigatran
rivaroxaban: both dabigatran: renal
42
What is inspiratory resistance training?
inhalation exercise against progressively increasing inspiratory resistance - those who improved pre-op have decreased post-op pulm operation
43
Time of onset, half-life: Oral factor Xa inhib
Time of onset: 2-4hr | Half-life: 7-15hr
44
Time of onset, half-life: Oral direct thrombin inhib
Time of onset: 2-3hr | Half-life: 12-14hr
45
Which pts should receive extended DVT ppx beyond their inpatient stay?
- total hip replacements - total knee replacements - major cancer resections - high-risk gyn resections
46
What does the Frailty Index estimate?
- risk for post-op Cx - length of stay - discharge to SNF
47
Half-life fondaparinux (SubQ)
12-17 hrs
48
RF for periop cardiac events
- increasing age - increasing ASA status - decreasing functional status
49
Ultrasound surgical energy instruments: highest temp, thermal spread, cooling time
Tmax: 200 C Highest thermal spread Longest cooling time (>40sec)
50
Bipolar surgical energy: highest temp, thermal spread, cooling time
Tmax: 90 C (same as monopolar) Least amt thermal spread Cool quickly
51
Neck circumference associated with CAP
>40cm
52
Post-op mgmt for COPD pt s/p thoracic surgery
thoracic epidural pain control + removal of urinary cath POD#1
53
Abx with cross-reactivity for penicillin
cephalosporin, carbapenem (beta-lactam ring)
54
When should warfarin be held pre-operatively for low-risk pts?
5 days
55
After bridging AC to LMWH before surgery, when should LMWH be held pre-operatively? When can you give it post-operatively?
held 24-hours pre-op | held 48-72 hours post-op after high-risk bleeding procedures
56
After drug-eluting coronary stent, at what point can anti-plt therapy be held so these pts can have elective surgery?
at least 6 months - to allow for stent endothelialization
57
Pre-op bundle for pts having colorectal surgery (and possibly intra-op colonoscopy)
PO Abx + mechanical bowl prep (reduces rate SSI) + IV abx
58
When and how give TXA for trauma pt?
Within 3 hours as bolus, then continue for 8-hrs as gtt - can still give even if closed head injury
59
Pre-op anemia is strongly associated ? in pts undergoing noncardiac surgery
mortality (2x greater odds dying within 90d surgery)
60
Promethazine MOA, interaction with metoclopramide?
MOA: H1-R antag in vomiting center of medulla, vestibular nucleus, and chemo-R trigger zone Interaction: blocks cholinergic-R on intestinal muscle fibers -> decreased tone and peristalsis of gut SM (counteracts prokinetic drugs)
61
Ondansetron MOA, best used for...?
MOA: serotonin antag -> effect on 5HT3-R peripheral effects: via enterochromaffin cells of enteric nervous system central effects: via nucleus tractus solitaries + chemo-R trigger zone best used for: chemotherapy-induced emesis
62
Anti-emetic for cerebral edema (2/2 brain mass)
corticosteroids
63
Scopolamine MOA, best used for...?
MOA: anticholinergic via M1-5 R antag | best used for: movement-related nausea, bowel obstruction
64
Elimination of methadone
two-phase: alpha (8-12hr) and beta (30-60h) analgesic effect correlates with alpha-phase. withdrawal sxs held abay with beta-phase.
65
MCC immune deficiency worldwide
malnutrition
66
First cell present during inflammatory phase of wound healing
Neutrophils
67
Laparoscopic insufflator initial flow rate? To obtain pressure of...? Pneumoperitoneum is maintained by constant gas flow of...?
Initial flow rate = 4-6L/min Obtain pressure = 10-20 mmHg Constant gas flow = 200-400 L/min-1
68
Dominant feature of remodeling phase of wound healing
Collagen remodeling (collagen III replaced with collagen I) and scar formation
69
Types of collagen
``` 1 = MC; main type in healed wounds (scars) 2 = cartilage 3 = blood vessels, fetal skin, uterus 4 = basement membrane 5 = cornea ```
70
What is Palmer's technique?
method of abdominal Veress access though left subcostal margin - Palmer's point is 3cm below left subcostal margin @ midclavicular line - C/I hepatosplenomegaly
71
What is Hasson's technique?
open cutdown and direct visualization before placement of primary trocar
72
Bipolar can be used to seal vessels of max. what diameter?
7mm

QUESTION NOTES (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions