When can a patient eat before major surgery? - ANSWER The patient should be NPO
after midnight the night before or for at least 8 hours before surgery
If a patient is on antihypertensive medications, should the patient take them on the day of
the procedure? - ANSWER Yes
If a patient is taking insulin, should the patient take it on the day of surgery? -
ANSWER No, only half of the long-acting insulin (e.g., Lente) and start D5NS IV; check
glucose levels often preoperatively, operatively, and postoperatively
Should a patient who smokes cigarettes stop before an operation? - ANSWER Yes,
improvement is seen in just 2 to 4 weeks after smoking cessation
What laboratory test must all women of childbearing age have before entering the O.R.? -
ANSWER B-HCG and CBC because of the possibility of pregnancy and anemia from
menses
What must you always order preoperatively for your patient undergoing a major operation?
- ANSWER NPO/IVF, Preoperative antibiotics and type and screen blood
What electrolyte must you check preoperatively if a patient is on hemodialysis? -
ANSWER Potassium
Who gets a preoperative ECG? - ANSWER Patients age >40 years
1
,Beck's triad? - ANSWER JVD decreased or muffled heart sounds and decreased ВР
Beck's triad is seen in patients with? - ANSWER Cardiac Tamponade
Charcot's triad? - ANSWER Fever, Jaundice and RUQ pain
Charcot's triad is seen in pt with? - ANSWER Cholangitis
What's Cullen's sign? - ANSWER Bluish discoloration of the periumbilical area due to
retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial
planes (e.g., acute hemorrhagic pancreatitis)
What's Hamman's sign/crunch? - ANSWER Crunching sound on auscultation of the
heart resulting from emphysematous mediastinum; seen with Boerhaave's syndrome,
pneumomediastinum, etc.
Pheochromocytoma SYMPTOMS triad? - ANSWER Palpitations, Headache, and Episodic
diaphoresis
Reynolds' pentad - ANSWER Fever, Jaundice, RUQ pain, mental status change, and
shock/sepsis
What's Virchow's node? - ANSWER Metastatic tumor to left supraclavicular node
Virchow's node is commonly seen with which cancer? - ANSWER Gastric cancer
What is blind loop syndrome? - ANSWER Bacterial overgrowth of the intestine caused
by stasis
2
,What is Boerhaave's syndrome? - ANSWER Esophageal perforation
What is Budd-Chiari syndrome? - ANSWER Thrombosis of hepatic veins
What is Cushing's syndrome? - ANSWER Excessive cortisol production
When is the dumping syndrome seen? - ANSWER After vagotomy and gastric drainage
procedure (pyloroplasty/gastrojejunosto my)
What is Fitz-Hugh-Curtis syndrome? - ANSWER Perihepatic gonorrhea infection
(perihepatic adhesions)
HITT syndrome often results in? - ANSWER Loss of limb or life
What is Leriche's syndrome? - ANSWER Claudication of buttocks and thighs, Impotence,
Atrophy of legs (seen with an iliac occlusive disease)
What is Mendelson's syndrome? - ANSWER Chemical pneumonitis after aspiration of
gastric contents
What is Mirizzi's syndrome? - ANSWER Extrinsic obstruction of the common hepatic bile
duct from a gallstone in the gallbladder or cystic duct
What is RED reaction syndrome? - ANSWER Syndrome of rapid vancomycin infusion,
resulting in skin erythema
What is refeeding syndrome? - ANSWER Hypokalemia, hypomagnesemia, and
hypophosphatemia after refeeding a starved patient
3
, What is short-gut syndrome? - ANSWER Malnutrition resulting from <200 cm of viable
small bowel
What is toxic shock syndrome? - ANSWER Staphylococcus Aureus toxin- induced
syndrome marked by fever, hypotension, organ failure, and rash
Three types of wound healing? - ANSWER Primary closure, secondary intention, and
tertiary intention
What is the primary intention? - ANSWER When the edges of a clean wound are closed
in some manner immediately
How long does the sutured wound epithelialize? - ANSWER 24 to 48 hours. Shower
after that
What inhibits wound healing? - ANSWER Infection, ischemia, diabetes mellitus,
malnutrition, anemia, steroids, cancer, radiation, and smoking
For non-cardiac pt for surgery Ejection fraction must be? - ANSWER >35%
Single worst cardiac risk finding? - ANSWER JVD (CHF) treat w BB, ACE, digitalis and
diuretics before surgery
Worst hepatic signs? - ANSWER Ascites, encephalopathy, albumin<2, INR x2 normal,
bili>4
Which metabolic risk is an absolute contraindication for surgery? - ANSWER Diabetic
coma
4
after midnight the night before or for at least 8 hours before surgery
If a patient is on antihypertensive medications, should the patient take them on the day of
the procedure? - ANSWER Yes
If a patient is taking insulin, should the patient take it on the day of surgery? -
ANSWER No, only half of the long-acting insulin (e.g., Lente) and start D5NS IV; check
glucose levels often preoperatively, operatively, and postoperatively
Should a patient who smokes cigarettes stop before an operation? - ANSWER Yes,
improvement is seen in just 2 to 4 weeks after smoking cessation
What laboratory test must all women of childbearing age have before entering the O.R.? -
ANSWER B-HCG and CBC because of the possibility of pregnancy and anemia from
menses
What must you always order preoperatively for your patient undergoing a major operation?
- ANSWER NPO/IVF, Preoperative antibiotics and type and screen blood
What electrolyte must you check preoperatively if a patient is on hemodialysis? -
ANSWER Potassium
Who gets a preoperative ECG? - ANSWER Patients age >40 years
1
,Beck's triad? - ANSWER JVD decreased or muffled heart sounds and decreased ВР
Beck's triad is seen in patients with? - ANSWER Cardiac Tamponade
Charcot's triad? - ANSWER Fever, Jaundice and RUQ pain
Charcot's triad is seen in pt with? - ANSWER Cholangitis
What's Cullen's sign? - ANSWER Bluish discoloration of the periumbilical area due to
retroperitoneal hemorrhage tracking around to the anterior abdominal wall through fascial
planes (e.g., acute hemorrhagic pancreatitis)
What's Hamman's sign/crunch? - ANSWER Crunching sound on auscultation of the
heart resulting from emphysematous mediastinum; seen with Boerhaave's syndrome,
pneumomediastinum, etc.
Pheochromocytoma SYMPTOMS triad? - ANSWER Palpitations, Headache, and Episodic
diaphoresis
Reynolds' pentad - ANSWER Fever, Jaundice, RUQ pain, mental status change, and
shock/sepsis
What's Virchow's node? - ANSWER Metastatic tumor to left supraclavicular node
Virchow's node is commonly seen with which cancer? - ANSWER Gastric cancer
What is blind loop syndrome? - ANSWER Bacterial overgrowth of the intestine caused
by stasis
2
,What is Boerhaave's syndrome? - ANSWER Esophageal perforation
What is Budd-Chiari syndrome? - ANSWER Thrombosis of hepatic veins
What is Cushing's syndrome? - ANSWER Excessive cortisol production
When is the dumping syndrome seen? - ANSWER After vagotomy and gastric drainage
procedure (pyloroplasty/gastrojejunosto my)
What is Fitz-Hugh-Curtis syndrome? - ANSWER Perihepatic gonorrhea infection
(perihepatic adhesions)
HITT syndrome often results in? - ANSWER Loss of limb or life
What is Leriche's syndrome? - ANSWER Claudication of buttocks and thighs, Impotence,
Atrophy of legs (seen with an iliac occlusive disease)
What is Mendelson's syndrome? - ANSWER Chemical pneumonitis after aspiration of
gastric contents
What is Mirizzi's syndrome? - ANSWER Extrinsic obstruction of the common hepatic bile
duct from a gallstone in the gallbladder or cystic duct
What is RED reaction syndrome? - ANSWER Syndrome of rapid vancomycin infusion,
resulting in skin erythema
What is refeeding syndrome? - ANSWER Hypokalemia, hypomagnesemia, and
hypophosphatemia after refeeding a starved patient
3
, What is short-gut syndrome? - ANSWER Malnutrition resulting from <200 cm of viable
small bowel
What is toxic shock syndrome? - ANSWER Staphylococcus Aureus toxin- induced
syndrome marked by fever, hypotension, organ failure, and rash
Three types of wound healing? - ANSWER Primary closure, secondary intention, and
tertiary intention
What is the primary intention? - ANSWER When the edges of a clean wound are closed
in some manner immediately
How long does the sutured wound epithelialize? - ANSWER 24 to 48 hours. Shower
after that
What inhibits wound healing? - ANSWER Infection, ischemia, diabetes mellitus,
malnutrition, anemia, steroids, cancer, radiation, and smoking
For non-cardiac pt for surgery Ejection fraction must be? - ANSWER >35%
Single worst cardiac risk finding? - ANSWER JVD (CHF) treat w BB, ACE, digitalis and
diuretics before surgery
Worst hepatic signs? - ANSWER Ascites, encephalopathy, albumin<2, INR x2 normal,
bili>4
Which metabolic risk is an absolute contraindication for surgery? - ANSWER Diabetic
coma
4
