Pre And Post Op Care

Question 1

Earliest indication of hypermagnesemia

Answer 1

Loss of deep tendon reflexes

Question 2

What level and symptoms is symptomatic hyponatremia

Answer 2

120 mEq/L

HA, seizure, coma, ICP

Question 3

How to treat hyponatrmia- moderate vs symptomatic

Answer 3

Mild- free water restriction

Symptomatic- hypertonic saline

Question 4

Complication of jejunoileal bypass

Answer 4

Lose ileum–>calcium and oxalate can’t form insoluble compounds –> oxalate gets too absorbed –> hyperoxaluria

Question 5

FENa less than 1 indicates

Answer 5

Prerenal etiology for oliguria

Question 6

Magnesium deficiency symptoms

Answer 6

Potassium wasting by kidney

Functional hypoparathyroidism–> hypocalcemia

Prolonged qt, torsades

Question 7

Hypocalcemia symptoms

Answer 7

Paresthesia
Hyperreflexia
Muscle spasm, tetany

Prolonged qt, heart blocks

Question 8

When to give antibiotics to prevent surgical site infection in an elective procedure?

Answer 8

Single dose Pre-op no more than one hour before incision

Question 9

What cardiac test should man with history of peripheral vascular disease and MI have before surgery?

Answer 9

Persantine thallium stress test and echo - assess need for stent and angiogram

Question 10

Overdose of what can lead to tinnitus plus mixed metabolic acidosis-resp alkalosis

Answer 10

Aspirin

Question 11

Treatment of Heoarin induced thrombocytopenia

Answer 11

Stop heparin plus start direct thrombin inhibitor and convert to warfarin when appropriate

Question 12

bleeding post-op should first make you think of this etiology

Answer 12

bleeding blood vessel in surgical field

Question 13

biggest risk factors for perioperative MI

Answer 13

**recent MI
CHF evidence
frequency of ectopic beats

Question 14

diagnostic test of choice for acute mesenteric ischemia

Answer 14

angiography

Question 15

suspected symptoms of actue mesenteric ischemia

Answer 15

sudden development of abdominal pain out of proportion of physical findings

systemic manifestations of arteriosclerotic disease or low CO states

Question 16

treatment of acute mesenteric ischemia

Answer 16

emergent revascularization or resectional surgery

lapartomy if peritoneal signs

Question 17

peritoneal signs include

Answer 17

acute abdominal pain, abdominal tenderness and abdominal guarding, which are exacerbated by moving the peritoneum, e.g., coughing (forced cough may be used as a test), flexing one’s hips,

Difficulty passing gas or pooping, fever, vomiting

Question 18

diagnostic modality of choice for infrainguinal DVT

Answer 18

duplex US and heparin + warfarin (if not pregnant)

Question 19

which bleeding disorder is indicated with elevated PTT and abnl bleeding time but normal PT?

Answer 19

von Willebrand (prevents inactivation of factor 8)

Question 20

treatment of vWD and when given

Answer 20

desmopressin- activates receptors from storage sites to release vWF

only given before surgery or if severely injured

Question 21

Systemic inflammatory response syndrome (SIRS) criteria

Answer 21

2 or more:

• temp over 38 (100) or below 36 (97)
• HR >90
• resp rate >20 or PaCO2 <32
• WBC >1,2,000 or <4000 or >10%immature PMNs

Question 22

sepsis criteria

Answer 22

SIRS + documented infection

Question 23

severe sepsis conditions

Answer 23

sepsis + organ dysfunction or hypoperfusion (lactic acdisos, oliguira, altered mental)

Question 24

septic shock criteria

Answer 24

sepsis + organ dysfunction + hypotension (systole<90)

Question 25

class IV hemorrhagic shock (loss of >40% blood volume) treatment

Answer 25

infusion of packed RBCs and early administration of frozen plasma and platelets before lab values

Question 26

type of nutrition form that is recommended for patients with predicted prolonged recovery postop abdominal surgery

Answer 26

enteral nutrition within 24 hrs post op (better than parenteral because decreased risk of infections, and better than oral because stomach is uncoordinated for 24 hours post op)

Question 27

woman on heparin gets retroperiotoneal hematoma. treatment?

Answer 27

reverse heparin with antidote-protamine sulfate

Question 28

indications for IVC filter

Answer 28

- failure or complciation of anticoagulation - known free floating venous clot - prior history of PE

Question 29

complications of refeeding syndrome

Answer 29

hypophosphatemia, hypokalemia, hypomagnesemia (as insulin shifts electrolytes into cells) hypoglycemia, hyperchloremic acidosis, volume overload --> HF

Question 30

acute adrenal insufficiency signs

Answer 30

``` changing mental status, increased temp CV collapse hypoglycemia hyperkalemia ```

Question 31

causes of adrenal insuff

Answer 31

severe stress infection trauma cessation of chronic gluocorticoids

Question 32

treatment of adrenal insuff

Answer 32

IV steroids | volume rescucitation

Question 33

transusions of FFP to replenish vit K dep clotting factors should be administered when for patient with abnl coag factors going into surgery

Answer 33

on call to the operating room- transfusion complete prior to incision

Question 34

most common post op nosocomial infection?

Answer 34

UTI

Question 35

factors that predispose to fistula formation

Answer 35

FRIENDS ``` foreign body radiation inflammation epithelization of tract neoplasms distal obstruction steroids ```

Question 36

hemolytic vs allergic nonhemolytic transfusion reactions

Answer 36

hemolytic: preexisiting antibodies against ABO incompatible blood

Question 37

symptoms of hemolytic transfusion reactions

Answer 37

fever, chills, pain, redness along infused veins, oozing from IV sites, resp distress, anxiety, hypotension, oliguria

Question 38

treatment for bleeding complication in surgery with someone with mild vs severe hemophilia A

Answer 38

mild: desmopressin (increases factor 8 and vWF) severe: desmopressin plus e-aminocaproic acid (inhibits fibrinolysis)

Question 39

when should you stop NSAIDs vs aspirin before surgery?

Answer 39

NSAIDs- 3-4 days before aspirin: 7 days before

Question 40

treatment of megaloblastic anemia post gastrectomy

Answer 40

IV vit B12 (cyanocobalamin) every 3-4 months for life

Question 41

tests you could do post-op when you suspect a ureteral injury

Answer 41

pyelogram or nuclear medicine scan

Question 42

treatment for mild vs severe hypocalcemia post thyroid surgery

Answer 42

mild: oral calcium gluconate severe: continuous infusion of calcium gluconate for few days

Question 43

which type of fluid is appropriate for replacing enteric losses?

Answer 43

ringer lactate solution

Question 44

which med counteracts effects of potassium (cardio) without decreasing the amount of potassium?

Answer 44

calcium gluconate

Question 45

which deficiency: alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, skin rash

Answer 45

zinc

Question 46

which deficiency: cardiomyopathy

Answer 46

selenium

Question 47

molybdenum deficiency

Answer 47

encephalopathy- toxic accumulation of sulfur containing amino acids

Question 48

chromium deficiency

Answer 48

difficult hypoglycemia, peripheral neuroapthy encephalopathy commonly occurs in long term TPN

Question 49

thiamine def

Answer 49

beri beri- encephalopathy, peripheral neuropathy CV symptoms and HF

Question 50

malignant hyperthermia antidote

Answer 50

dantrolene- stop the anesthetic

Question 51

typical case of malignant hyperthermia

Answer 51

after induction of anesthesia fever, shaking rigors, rhabdo (blood-tinged urine)

Question 52

how to replace blood loss in jehovas witness

Answer 52

lactated ringers or normal saline in 3:1 ratio

Question 53

whats a good solution for maintenance fluid?

Answer 53

0.45% normal saline with or without KCl (depends on kidney function)

Question 54

early signs of sepsis

Answer 54

``` changing mental status tachypnea --> resp alkalosis flushed skin (dilated peripheral arteries) ```

Question 55

treatment for non-anion gap metabolic acidosis

Answer 55

fluid replacement and stool bulking agents

Question 56

treatment for transfusion reactions

Answer 56

stop transfusion. replace fluids inducing diuresis to clear hemolyzed RBC membranes alklanize urine to prevet Hgb clumping-->renal damage

Question 57

do you use antidiarrheal agents for c dif?

Answer 57

no!

Question 58

should you take in more or less calories post starvation?

Answer 58

less

Question 59

how many calories should you increase (relative to baseline) in following situations: - post routine operation - multiple organ failure or severe injury - more than 50% surface area burns

Answer 59

- post routine operation: 1.1 - multiple organ failure or severe injury: 1.5 - more than 50% surface area burns: 2.0