Orthopedic Surgery

Question 1

Med history:

1. should all antihypertensive and cardiac meds be continued day of surgery?
2. should diuretics be taken or held day of surgery?
3. antibiotics should be administered within how many minutes of incision?

Answer 1

1. yes
2. held
3. 30 minutes

Question 2

LAST:

1. avoid what 4 drugs? (V, CCBs, BBs, LA)
2. reduce epinephrine dose to less than what mcg/kg?
3. bolus what mL/kg of lean body mass of 20% lipid emulsion over how many minutes?
4. start a continuous gtt after the bolus at what mL/kg/min?
5. if BP remains low, how should you increase the gtt rate?
6. continue the gtt at least how many minutes after attaining circulatory stability?
7. recommended upper limit: what mL/kg over the first how many minutes?

Answer 2

1. vasopressin, ca channel blockers, beta blockers, local anesthetics
2. 1 mcg/kg
3. 1.5 mL/kg, over 1 minute
4. 0.25 mL/kg/min
5. double it
6. 10 minutes
7. 10 mL/kg first 30 minutes

Question 3

what are the 2 most common back surgeries? (DH, SS)

Answer 3

disc herniation, spinal stenosis

Question 4

cervical spine surgery:

1. ensure to keep what stable by avoiding flexion and extension? (N)
2. what 2 types of monitoring are often used? (S, E)
3. what type of anesthesia technique is used? (N)

Answer 4

1. neck
2. SSEP, EMG
3. narotic

Question 5

scoliosis:

1. what method is used to measure the spine angle
2. fusion is recommended for curvature greater than what degrees?
3. bracing is suggested for curve of what degree range?
4. resp impairment is proportional to the angle of what curvature?
5. VC greater than what predicted % represents adequate respiratory reserve?
6. VC less than what predicted % represents the risk of postop ventilation requirements?

Answer 5

1. Cobb method
2. > 60
3. 20-30
4. lateral
5. > 70%
6. < 40%

Question 6

Scoliosis:

1. high incidence of what valve prolapse and htn where?
2. ECHO shows dilation where and hypertrophy where?
3. avoid plt inhibitor for what week range prior to surgery?
4. encourage what type of blood donation? (A)
5. what are 3 techniques to maintain hemodynamic stability in this surgery? (CH, CSD, VE)

Answer 6

1. mitral valve, pulmonary htn
2. right atrium, right ventricle
3. 2-3 weeks
4. autologous
5. controlled hypotension, cell saver device, volume expanders

Question 7

if a high thoracic approach is used, what type of ETT should be used?

Answer 7

double lumen endotracheal tube

Question 8

what 2 tables and one frame is used for prone positioning? (J, A, W)

Answer 8

jackson table, andrews table, wilson frame

Question 9

Prone positioning:

1. pooling of blood where? (E)
2. increased or decreased total lung compliance
3. increased or decreased work of breathing?
4. increased or decreased cerebral venous drainage and cerebral BF?
5. compression of abd muscles may decrease what 3 C/V things?

Answer 9

1. extremities
2. decreased
3. increased
4. decreased
5. preload, BP, CO

Question 10

Latreal decubitus:

1. is CO changed (unless venous return is obstructed)?
2. increased or decreased volume in dependent lung?
3. increased or decreased perfusion to dependent lung?
4. pulse ox on up or down arm?

Answer 10

1. no
2. decreased
3. increased
4. down

Question 11

Sitting:

1. at what point is art line zeroed?
2. pooling of blood where decreased central blood volume?
3. increased or decreased cerebral BF?
4. increased or decreased lung volumes and residual capacity?
5. what 2 C/V things decrease and what 2 C/V things compensate for that?

Answer 11

1. external auditory canal
2. lower extremities
3. decreased
4. increased
5. CO and BP, HR and SVR

Question 12

intraoperative spinal surgery:

1. what anesthesia technique is used? (NTWLIA)
2. controlled hypotension is used to decrease what?
3. SSEP monitors the function of part of the cord? (D)
4. SSEP monitoring is very sensitive to what anesthetic agents?
5. is close communication needed between the anesthesia provider and neuromonitoring tech?
6. SSEP indication of SC ischemia should be promptly treated with restoring what and decreasing what? (BP, CT)
7. no what during testing of instrumentation or with EMG monitoring? (MR)

Answer 12

1. narcotic technique with low inhalation agent
2. blood loss
3. dorsal
4. VAs
5. yes
6. blood pressure, cord traction
7. muscle relaxants

Question 13

intraoperative spinal surery:

1. surgeon might request a wake up test which provides info about the anterior or posterior part of the spine?
2. what minute notice is given for a wake up test?
3. what 3 bad things can occur during a wake up test? (AE, ID, AE)

Answer 13

1. anterior
2. 40 minute notice
3. accidental extubation, instrumentation dislodgement, air embolus

Question 14

should anesthesia personnel document neuro status prior to leaving pt in recovery?

Answer 14

yes

Question 15

what are 4 complications of spinal surgery? (BL, ND, ION, SCI)

Answer 15

1. blood loss
2. neuro deficits
3. ischemic optic neuropathy
4. SC ischemia

Question 16

what are 3 decreased things that are benefits of arthroscopy? (BL, PP, LOS)

Answer 16

1. blood loss
2. postop pain
3. length of stay

Question 17

anesthetic management for arthroscopy depends on what 5 things? (PP, PL, P, ASL, PA)

Answer 17

1. proposed procedure
2. procedure length
3. positioning
4. anesthesia skill level
5. patient agreement

Question 18

what are the 4 nerves that innervate the knee? (F, LFC, O, S)

Answer 18

1. femoral
2. lateral femoral cutaneous
3. obturator
4. sciatic nerve

Question 19

femoral nerve, lateral femoral cutaneous, and obturator nerve come arise from what lumbar range?

Answer 19

L1-L4

Question 20

sciatic nerves arise from what spinal range?

Answer 20

L5-S2

Question 21

regional recommendations for knee arthroscopy include blocking which two nerves?

Answer 21

femoral, adductor canal

Question 22

adductor canal blocks sensory and minimizes what weakness in comparison to femoral blocks? (M)

Answer 22

motor weakness

Question 23

what are 7 risks of knee arthroscopy? (BITJ, L/CD, BC, NI, BVI, I, SK)

Answer 23

1. bleeding into the joint
2. ligament/cartilage damage
3. blood clot
4. nerve injury
5. blood vessel injury
6. infection
7. stiff knee

Question 24

ACL reconstruction:

1. repair involves the use of what to replace the ligament? (G)
2. injection of LA is where? (IA)
3. most grafts are auto and are from what 2 places? (PT, H)
4. substantial postop analgesia is required including a what? (FNC)
5. goal is to resume what very quickly? (PT)
6. what is applied postoperatively? (B)

Answer 24

1. graft
2. intra-articular
3. patella tendon, hamstring
4. femoral nerve catheter
5. physical therapy
6. brace

Question 25

what are 6 potential complications after ACL reconstruction? (KP/S, PGH, I, DVT, R, FTASR)

Answer 25

1. knee pain/stiffness 2. poor graft healing 3. infection 4. DVT 5. reinjury 6. failure to achieve symptom relief

Question 26

pneumatic tourniquet: 1. its use increases what and decreases what? (SSV, BL) 2. width of the cuff should cover what % of the extremity? 3. inflation pressure should not exceed what on the upper extremity? (mmHg) 4. inflation pressure should not exceed what on the lower extremity? (mmHg) 5. SBP plus how much mmHg is effective in controlling bleeding? 6. prior to tourniquet inflation, the extremity is exsanguinated with what bandage? (E) 7. is the tourniquet inflated prior to bandage removal?

Answer 26

1. surgical site visualization, blood loss 2. 50% 3. 300 mmHg 4. 500 mmHg 5. 100 mmHg 6. esmarch 7. yes

Question 27

Pneumatic tourniquet: 1. inflation greater than how many minutes causes tourniquet pain? 2. inflation greater than how many hours results in postoperative neuropraxia? 3. what are 3 muscle changes? (CH, A, CL) 4. what 2 systemic pressures increase d/t inflation? (A,P)

Answer 27

1. 60 minutes 2. 2 hours 3. cellular hypoxia, acidosis, capillary leakage 4. arterial, pulmonary

Question 28

systemic effects after tourniquet deflation: 1. metabolic acidosis or alkalosis? 2. transient increase or decrease in BP? 3. transient increase or decrease in ETCO2? 4. transient increase or decrease in core temp?

Answer 28

1. metabolic acidosis 2. decrease 3. increase 4. decrease

Question 29

45-60 minutes post inflation, pts experience: 1. what 3 pain symptoms in order? (A,B,EP) 2. post inflation pain is mediated by myelinated or unmyelinated A-delta or C fibers? 3. tingling post deflation is mediated by myelinated or unmyelinated A-delta or C fibers?

Answer 29

1. aching, burning, excruciating pain 2. unmyelinated C fibers 3. myelinated A-delta fibers

Question 30

what 2 things accelerate tourniquet pain? (H, A)

Answer 30

hypoxia, acidosis

Question 31

tourniquet should not be inflated for more than how many hours?

Answer 31

2 hours

Question 32

shoulder arthroscopy: 1. preop regional block or indwelling perineural catheter where? (I) 2. surgeons prefer controlled BP but be careful since pt is sitting up which decreases what? (CP) 3. BP cuff should always be on arm or leg? 4. transducer should be at level of what? (B)

Answer 32

1. interscalene 2. cerebral perfusion 3. arm 4. brainstem

Question 33

Beach-chair position: 1. enhanced venous pooling occurs d/t dependent extremities increases what tone? (S) 2. combo of venous pooling and paradoxical increased vagal tone results in sudden, profound what 2 things that can be difficult to rapidly reverse? (B, H) 3. prophylaxis to prevent hypotension and bradycardia events include aggressive treatment of what 2 things? (FD, BL) 4. what can be applied to lower extremities to minimize venous pooling? (SS)

Answer 33

1. sympathetic tone 2. bradycardia, hypotension 3. fluid deficits, blood loss 4. supportive stockings

Question 34

Bezold-Jarisch reflex is a hypotensive bradycardic episode which includes: 1. decrease in HR of at least how many beats per minute within how many minutes? 2. any HR less than how many beats per minute? 3. and/or a decrease in SBP more than how many mmHg within how many minutes or any SBP less than what?

Answer 34

1. 30 beats per minute in 5 minutes 2. 50 beats per minute 3. 30 mmHg in 5 minutes, or less than 90 mmHg

Question 35

shoulder arthroscopic anesthesia complications: 1. 3 complications related to positioning (E, NI, CA) 2. what can be perforated during trochar placement? (BV) 3. pressurized irrigation fluid can result in what 3 things? (CHF, PE, VO) 4. what are 4 other complications? (SE, TP, P, H)

Answer 35

1. extubation, nerve injury, corneal abrasion 2. blood vessels 3. CHF, pulmonary edema, volume overload 4. subcutaneous emphysema, tension pneumo, pneumomediastinum, hypothermia

Question 36

S/S of tension pneumo: 1. what are 7 of them? (H, T, ABS, TS, A, H, JVD) 2. increased or decreased airway pressure? 3. increased or decreased CVP?

Answer 36

1. hypoxia, tachycardia, absent breath sounds, tracheal shift, agitation, hypotension, jugular vein distention 2. increased 3. increased

Question 37

hip arthroplasty: 1. what are 5 complications? (I, BC, LI, ND, D) 2. is blood loss significant at this fx site? 3. if hypoxic, what could it be? (FE) 4. what table is used for this surgery? (FT)

Answer 37

1. infection, blood clot, length inequality, nerve damage, dislocation 2. yes 3. fat embolism 4. fracture table

Question 38

prosthesis component of knee arthroplasty is secured with what? (M)

Answer 38

methylmethacrylate

Question 39

methylmethacrylate: 1. increases or decreases PVR? 2. increases or decrease SVR? 3. increases or decreases CO? 4. these changes result in a significant or even complete collapse of what?

Answer 39

1. increases 2. decreases 3. decreases 4. C/V

Question 40

what are 7 complications from knee arthroplasty? (D, I, ATMC, AI, ND, CKS/LOM, IF)

Answer 40

1. DVT 2. infection 3. allergy to metal components 4. artery injury 5. nerve damage 6. chronic knee stiffness/loss of motion 7. implant failure

Question 41

ankle arthroplasty: 1. is failure rate high? 2. what are 5 complications? (D, I, CRPS, ND, CF)

Answer 41

1. yes | 2. DVT, infection, chronic regional pain syndrome, nerve damage, component failure

Question 42

what neuraxial technique is preferred for hip and knee replacements?

Answer 42

combined spinal/epidural

Question 43

what are 3 complications that can occur when the prosthesis is inserted that can be caused by methylmethacrylate, fat embolism or bone marrow embolism? (H, H, CC)

Answer 43

1. hypotension 2. hypoxia 3. C/V collapse

Question 44

Fat embolism syndrome associated with multiple what type of injuries and surgery involving what type of fractures? (T, LB)

Answer 44

1. multiple traumatic injuries | 2. long bone fractures

Question 45

risk factors for fat embolus syndrome: 1. male or female 2. what age range? 3. what type of shock? 4. what type of arthritis? 5. instrumentation where? (I) 6. what 2 types of surgeries? (BTK, THAWC)

Answer 45

1. male 2. 20-30 3. hypovolemic 4. rheumatoid arthritis 5. intramedullary instrumentation 6. bilateral total knees, total hip arthroplasty with cement

Question 46

major symptoms of fat embolus syndrome: 1. petechiae where? (A/S) 2. edema where? (P) 3. what system depression disproportionate to hypoxemia? 4. what other symptom? (H)

Answer 46

1. axillary/subconjunctival 2. pulmonary edema 3. CNS 4. hypoxemia

Question 47

minor symptoms of fat embolus syndrome: 1. unexplained decrease in what 2 CBC labs? 2. fat globules in what 2 fluids? (U, S) 3. fat emboli where? (R) 4. what other 2 symptoms? (H, T)

Answer 47

1. plt, hematocrit 2. urine, sputum 3. retina 4. hyperthermia, tachycardia

Question 48

fat embolus syndrome occurs is what hour range after injury?

Answer 48

12-40 hours

Question 49

block where for these upper extremity arthroplasties? 1. shoulder 2. elbow

Answer 49

1. interscalene | 2. axillary

Question 50

Upper extremity arthroplasty: 1. IV on same or opposite side of surgical extremity? 2. BP cuff on same or opposite side of surgical extremity? 3. do we use controlled hypotension? 4. is there potential for increased intraoperative blood loss since a tourniquet isn't used? 5. what are the 2 positions for the surgery?

Answer 50

1. opposite 2. opposite 3. yes 4. yes 5. lateral, fowlers

Question 51

what are 3 frequent ankle procedures? (F, JF, ATR)

Answer 51

fractures, joint fusions, achilles tendon repair

Question 52

what are 3 frequent foot procedures? (B, PF, HDC)

Answer 52

bunionectomy, plantar fasciotomy, hammertoe deformity correction

Question 53

what 4 nerves can be blocked for ankle or foot procedures? (FSSP)

Answer 53

femoral, sciatic, saphenous, popliteal

Question 54

what are 3 blocks for forearm and hand surgery? (A, DN, B)

Answer 54

axillary, digital nerve, bier

Question 55

what are 4 common forearm and hand surgeries? (CT, DRF, FF, UNE)

Answer 55

carpal tunnel, distal radius fx, finger fx ulnar nerve entrapment