Surgery

Question 1

alcohol, NSAIDs, chemotherapeutic agents, and a/b all cause ?

Answer 1

increased bleeding tendencies… also herbal meds

Question 2

most important preoperative evaluations

Answer 2

history and physical

Question 3

preoperative creatinine levels in all patients ?

Answer 3

over 40 years old

Question 4

bypass grafting for peripheral vascular disease, abdominal aortic aneurysm repair, or coronary artery bypass grafting all need ?

Answer 4

blood glucose obtained

Question 5

coagulation factors may be abnormal in severe ? or ? dysfunction

Answer 5

hepatic, biliary

Question 6

EKG recommended in all older than ?

Answer 6

40 years old

Question 7

silent MI more common in ? 2

Answer 7

elderly, diabetics

Question 8

CXR indicated in all w/ heart or pulmonary dz; all patients older than ?

Answer 8

60 y.o.

Question 9

spirometry for pts evaluated for ? surgery or history of smoking or dyspnea

Answer 9

thoracic or abdominal

Question 10

Virchow’s triad? (DVT)

Answer 10

stasis, intimal damage, hypercoagulability

Question 11

DVT prophylaxis ?

Answer 11

unfractionated heparin 5,000 units sQ q 8 or 12 hours until patient fully ambulatory or enoxaprin (LMWH) 40mg sQ 12 hrs before or soon after surgery up to 14 days after

Question 12

? associated with lower incidence of DVT in hip surgery; blocks activated factor X

Answer 12

fondaparinux, 2.5mg sQ starting 6h post-op

Question 13

preferred DVT prophylaxis for trauma pts or those w/ abdominal/pelvic cancer

Answer 13

enoxaprin (LMWH)

Question 14

? are not recommended in DVT prophy and can actually promote a tourniquet effect

Answer 14

non fitted thromboembolic stockings

Question 15

? devices are beneficial in all pt populations for DVT trophy from on way to OR until fully ambulatory

Answer 15

sequential compression devices

Question 16

prophy of clots only from lower extremities, for CI to other prophy or undergoing CNS procedures

Answer 16

Greenfield filter insertion

Question 17

prophy DVT not associated with sig decreases in incidence of DVT but associated with heart failure, renal failure and difficulty in cross-matching blood

Answer 17

dextran

Question 18

malnourished pt- lost more than ? and no adequate nutritional intake for more than 7 days

Answer 18

10% body weight

Question 19

occurrence of bacterial translocation from gut linked with depletion of ?

Answer 19

amino acid glutamine

Question 20

w/ severe malnutrition ? or ? may develop

Answer 20

marasmus, kwashiorkor

Question 21

basal energy expenditure calculated using ?

Answer 21

Harris-Benedict equation

Question 22

pts who are elderly, have marasmus, kwashiorkor, anorexia nervosa, or undergoing chemotherapy at risk for development of?

Answer 22

refeeding syndrome

Question 23

abnormal glucose and lipid metabolism, thiamine deficiency, hypophosphatemia, hypomagnesemia, and hypokalemia

Answer 23

refeeding syndrome

Question 24

? probs include air embolus, sepsis, pneumothorax, hemothorax, hydrothorax, and cardiac rupture

Answer 24

catheter-related problems

Question 25

leading cause of death between ages 1 and 44

Answer 25

unintentional and violence related injuries

Question 26

leading cause of accidental deaths in US

Answer 26

motor vehicle accidents

Question 27

permissive hypotension prevents the ? and further exsanguination

Answer 27

dislodgment of 'fresh clot'

Question 28

MC indication for intubation?

Answer 28

AMS

Question 29

? intubation requires the patient be awake

Answer 29

nasotracheal

Question 30

cricothyroidotomy only by experienced operators and not under ? bc of risk of developing ?

Answer 30

12 yo, subglottic stenosis

Question 31

paradoxical breathing

Answer 31

flail chest

Question 32

open chest wounds- never be completely occluded with dressing because this may confer the wound into a ?

Answer 32

tension pneumothorax

Question 33

each liter of ringer's lactate solution contains ?

Answer 33

4 mEq of potassium

Question 34

high riding prostate in association with blood in urinary meatus may imply ?

Answer 34

pelvic fracture

Question 35

trauma eval not complete until ?

Answer 35

finger or tube inserted in every orifice

Question 36

cribiform plate injury suspected- avoid ? and use ?

Answer 36

nasogastric tube, orogastric tube

Question 37

? largely replaced diagnostic peritoneal lavage as diagnostic test of choice for intra-abdominal injury

Answer 37

FAST- focused assessment with sonography for trauma

Question 38

? indicated if a patient exhibits any signs of shock, peritoneal irritation, or evisceration

Answer 38

immediate laparotomy

Question 39

FAST reveals free intraperitoneal air or fluid- ? is indicated

Answer 39

laparotomy

Question 40

Glascow Coma score - intubate at ? - normal? - mild head injury? - moderate? - severe?

Answer 40

``` less than or equal to 8 15 13-15 9-12 less than 9 ```

Question 41

rhinorrhea, otorrhea, raccoon eyes, battle's sign

Answer 41

basilar skull fracture

Question 42

ecchymosis of lids?

Answer 42

raccoon eyes

Question 43

ecchymosis behind the ear?

Answer 43

battle's sign

Question 44

epidural hematoma - usually injury to ? - herniation triad ? - Dx w/ CT, require ?

Answer 44

middle meningeal artery fixed/dilated pupils, coma, decerebrate posturing emergent craniotomy

Question 45

subdural hematoma - usually injury to ? - chronic more common in ?

Answer 45

bridging veins | elderly, alcoholics

Question 46

burns - first degree? - second degree? - third degree? - fourth degree?

Answer 46

- only epidermis - superficial partial thickness extends into papillary dermis; deep superficial extend into reticular dermis - full thickness (epidermis and dermis) - skin and sQ, further involves fascia, muscle, bone, or other structures

Question 47

most common type of burns

Answer 47

scald burns

Question 48

characteristics first degree- absence of ? second degree- ? walled, fluid filled blisters, pain? third degree- appearance ?, dry skin without presence of ? fourth degree- significant charring, exposure of muscle, fascia, tendons and pigs, extensive damage to nerves results in?

Answer 48

- blisters - thin-walled, painful - white, leathery, or charred, no sensation - loss of sensation

Question 49

fifth degree burns- for coding purposes, result in ?

Answer 49

amputation or loss of body part

Question 50

findings on skin do not correlate with extent of burns when caused by ?

Answer 50

electrical energy

Question 51

if chemical burn, don't use ? but use

Answer 51

water (may cause further burn damage), powder

Question 52

burns caused by white phosphorus may require neutralization with ? and ? to address concomitant hypocalcemia

Answer 52

copper sulfate, calcium gluconate

Question 53

hydrofluoric acid burns- ? for at least 30 min with concomitant application of ? to affected area

Answer 53

copious lavage, calcium gluconate gel

Question 54

parkland formula? (for burns)

Answer 54

percentage of burn area x weight (kg) x 4ml/hr

Question 55

foley catheter & burns - maintained urine output in adult - child

Answer 55

0.5 mL/kg/hr in adult | 1 mL/kg/hr

Question 56

MC used topical burn ointment

Answer 56

sulfadiazine (silvadene)

Question 57

deep dermal burns/full-thickness burns best covered by ?

Answer 57

autograph

Question 58

severe burns - gastric or duodenal ulcerations aka?

Answer 58

curling ulcers

Question 59

most common complication of burns?

Answer 59

infections

Question 60

chrnoic healing burn wounds- transformation into SCC aka?

Answer 60

Marjolin ulcer

Question 61

five Ws in determining cause of post-op fever

Answer 61

``` Wind- atelectasis (MC) (24-48h post-op) Water- UTI (48-72h) Wound- infection (MC fever after 72h) Wondering drugs/Whopper Walking- thrombophlebitis (after 72h) ```

Question 62

thrombophlebitis in post-op fever can be associated with ? (MC), indwelling central lines, or DVT

Answer 62

IV catheters

Question 63

post-op fever... whopper = ?

Answer 63

post-op abscess

Question 64

shifting of mediastinum TOWARD affected side, loss of lung volume on affected side

Answer 64

atelectasis (tension PTX opposite)

Question 65

MC nosocomially acquired infection

Answer 65

UTIs

Question 66

hypertrophic tissue usually regresses without intervention; keloid?

Answer 66

usually requires intervention

Question 67

pts w/ ? are at greatest risk of developing decubitus ulcers

Answer 67

spinal cord injury

Question 68

standard in differentiating between colonization and true infection in ulcers?

Answer 68

deep tissue biopsy/deep tissue cultures

Question 69

char. by rapidly progressing erythema, tissue crepitus, marked tissue tenderness, high temperatures, tachycardia, hypotension, and AMS

Answer 69

necrotizing fasciitis

Question 70

triad of necrotizing fasciitis?

Answer 70

- elevated WBC (15 mg/mL) | - hyponatremia (<135 mmol/L)

Question 71

mainstay of therapy in necrotizing fasciitis

Answer 71

surgical debridement

Question 72

? of anterior chest wall may be seen post-op as a normal variant

Answer 72

subQ emphysema

Question 73

MC method of repair for inguinal surgery

Answer 73

TAPP- TransAbdominal PrePeritoneal Herniorrhaphy

Question 74

MC complication of open appendectomy

Answer 74

wound infection

Question 75

MC complication of laparascopic appendectomy

Answer 75

intra-abdominal abscess