Surgery EOR Exam [PAEA Blueprint]
_______is the most important anesthetic complication. Anesthesia causes an uncontrolled
increase in skeletal muscle oxidative metabolism, which overwhelms the body's capacity to
supply oxygen, remove CO2, and regulative body temperature. –
Malignant hyperthermia
If patient is hyperkalemic (normal range 3.8-5.0), how should you treat the patient? –
treat with glucose/insulin, and calcium +/-bicarb
_______is the reversing agent for opiods. –
Naloxone
_______is the reversing agent for benzodiazipines. –
Flumazenil
What is the best indicator used to monitor nutritional status? –
prealbumin - every 2-3 days
Intervention:
_________require central access and indicated when no enteral feeding for > 7 days. –
TPN - total peripheral nutrition
The _________is the most important part of the history before surgery. –
cardiac history -- history of MI, unstable angina, valvular disease
In patients with known cardiac disease, aggressive intraoperative lowering of myocardial
oxygen demand with ____ has been shown in RCT's to improve outcomes and should be
used. –
beta blockers
When accessing cardiac disease prior to surgery, what is the most important thing to
access? –
aortic stenosis -- crescendo diastolic rumble at apex
Guidelines for the use of antibiotics include administration within _______ of surgery and
redosing after 4 hours. What is the abx of choice? –
1 hour
Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? –
3/5 to diagnose:
1 - diabetes
2 - central obesity
,3 - HTN
4 - high serum triglycerrides
5 - low HDL levels
______should be monitored before surgery bc it is a stimulant and vasoconstrictor -- can lead
to severe tachycardia –
Cocaine
Pre-Op -- What are the indications for EKG and CXR? - EKG - men >40, women>50, known
CAD, DM, or HTN
CXR - age >50, known cardiac or pulmonary disease
What are the 5 classic "W's" of post operative fever? –
W - wind (atelectasis)
W - water (UTI)
W - wound (wound infection)
W - walking (DVT/thrombophlebitis)
W - wonder drugs (drug fever)
If the post op fever occurs within the first 24 hours of surgery, what is the most likely
cause? –
wind/atelectasis
If the post op fever occurs within days 3-5 post op, what is the most likely cause? –
water/UTI, catheter related phlebitis, pneumonia
If the post op fever occurs within days 5-10 post op, what is the most likely cause? –
wound infection, pneumonia, abscess, infected hematoma, C diff colitis, anastomotic
leak, DVT, peritoneal abscess, drug fever, PE, parotitis
_______is the most common pathogen in wound infections and around foreign bodies. –
Staph aureus
_______invades the inner ear and enteric tissues as well as the lung. –
Klebsiella
______organisms are often found together with anaerobes. –
Enteric organisms ie. enterobacteriaceae and enterococci
Among the anaerobes, ___&___are often present in surgical infections and _____species are
major pathogens in ischemic tissue. –
Bacteroides & Peptostreptococci; Clostridium
___&___are usually nonpathogenic surface contaminants but may be opportunistic.
Some fungi and yeast cause abscesses in sinus tracts. –
,Pseudomonas & Serratia
History of recent surgery, trauma, cancer, prolonged immobilization, or oral contraceptive
use increases the risk of ____. –
DVT - deep vein thrombosis
What is Homan's sign? –
pain on passive dorsiflexion of ankle
What is the test of choice for DVT? –
doppler ultrasound
How is the D-dimer text useful? –
It is good at ruling a DVT out (if the text is negative) but not rule it in
Tx of DVT --
1. Initiate use of ____or____to what dose?
2. Overlap with the use of ____to what therapeutic range?
3. Why overlap therapies? - DVT
1. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring.
2. Overlap with warfarin to INR between 2-3.
3. Overlap therapies to decrease changes of hypercoagulable state.
The most common cause of SIRS (systemic inflammatory response syndrome) is sepsis.
What are the criteria for dx of SIRS? - At least 2 of the following:
1. temp >38C or <36C
2. tachy >90
3. tachypnea > 20 breaths/minute
4. PCO2 <32mmHg
5. WBC > 12,000/uL or <4000/uL
After sepsis, what are the next two most common causes of SIRS? - pancreatitis and drugs
What is the difference between hypovolemia and dehydration? - hypovolemia is loss of
both water and sodium while dehydration is loss of intracellular water or deficit with
hypernatremia -- dehydration occurs when patient can not adjust water intake for water
loss
What are the clinical signs of dehydration and hypovolemia? - tachycardia, hypotension,
pale skin, increased capillary refill time, dizziness, faintness, nausea, thirst, decreased urine
output -- in hypovolemia, urine will demonstrate low sodium concentration
What are 2 common conditions with dehydration? - diabetes insipidus (lack of ADH or
unable to respond to ADH), fever with increased water loss
Hyponatremia Causes
, _______ = cirrhosis, CHF, nephrotic syndrome, massive edema
_______=states of severe pain or nausea, trauma, brain damage, SIADH
_______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency,
malnourished states, primary polydipsia - Hypervolemic, Euvolemic, Hypovolemic
What are the two most common treatments for hyponatremia?
Other less common treatment? - salt tabs and fluid restriction; vasopressin receptor
antagonist in SIADH, CHF, and cirrhosis
Hypernatremia is almost always due to _______. Therefore, what is the treatment? -
dehydration; rehydrate!
What s/s can result in a hyperkalemic patient? - cardiac arrhythmias (tall peaked T waves)
and weakness
If the potassium level is above 6meq/L or the patient has EKG changes, what treatments
can lower K temporarily? - calcium gluconate, sodium bicarbonate, insulin and glucose,
kayexalate (takes longer to be effective)
______&______ is extremely effective in decreasing potassium. - Dialysis and furosemide
Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone levels.
How is it treated? - potassium loss; replacement must be slow!!!
Mild loss: oral KCl supplements or K containing foods
Severe loss: IV supplementation - rate 10mEg/hr
Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH function, primary
hyperparathyroidism, Lithium, malignancy, disorders related to high bone turnover rates
(hyperthyroidism, prolonged immobilization, thiazide use, vit A intoxication, Pagets dz of
bone, multiple myeloma), renal failure - hypercalcemia
How should hypercalcemia be treated? - fluid and diuretics, bisphosphonates, and
calcitonin
_______is usually caused by ineffective PTH (chronic renal failure, absent active vit D,
ineffective active vit D, pseudohypoparathyroidism), deficient PTH. - Hypocalcemia
How should hypocalcemia be treated? - intravenous calcium gluconate, Tums
Increased CO2, hypoventilation, or decreased pH is aka ___. - respiratory acidosis
Decreased CO2, hyperventilation, or increased pH is aka ___. - respiratory alkalosis
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - metabolic acidosis
_______is the most important anesthetic complication. Anesthesia causes an uncontrolled
increase in skeletal muscle oxidative metabolism, which overwhelms the body's capacity to
supply oxygen, remove CO2, and regulative body temperature. –
Malignant hyperthermia
If patient is hyperkalemic (normal range 3.8-5.0), how should you treat the patient? –
treat with glucose/insulin, and calcium +/-bicarb
_______is the reversing agent for opiods. –
Naloxone
_______is the reversing agent for benzodiazipines. –
Flumazenil
What is the best indicator used to monitor nutritional status? –
prealbumin - every 2-3 days
Intervention:
_________require central access and indicated when no enteral feeding for > 7 days. –
TPN - total peripheral nutrition
The _________is the most important part of the history before surgery. –
cardiac history -- history of MI, unstable angina, valvular disease
In patients with known cardiac disease, aggressive intraoperative lowering of myocardial
oxygen demand with ____ has been shown in RCT's to improve outcomes and should be
used. –
beta blockers
When accessing cardiac disease prior to surgery, what is the most important thing to
access? –
aortic stenosis -- crescendo diastolic rumble at apex
Guidelines for the use of antibiotics include administration within _______ of surgery and
redosing after 4 hours. What is the abx of choice? –
1 hour
Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? –
3/5 to diagnose:
1 - diabetes
2 - central obesity
,3 - HTN
4 - high serum triglycerrides
5 - low HDL levels
______should be monitored before surgery bc it is a stimulant and vasoconstrictor -- can lead
to severe tachycardia –
Cocaine
Pre-Op -- What are the indications for EKG and CXR? - EKG - men >40, women>50, known
CAD, DM, or HTN
CXR - age >50, known cardiac or pulmonary disease
What are the 5 classic "W's" of post operative fever? –
W - wind (atelectasis)
W - water (UTI)
W - wound (wound infection)
W - walking (DVT/thrombophlebitis)
W - wonder drugs (drug fever)
If the post op fever occurs within the first 24 hours of surgery, what is the most likely
cause? –
wind/atelectasis
If the post op fever occurs within days 3-5 post op, what is the most likely cause? –
water/UTI, catheter related phlebitis, pneumonia
If the post op fever occurs within days 5-10 post op, what is the most likely cause? –
wound infection, pneumonia, abscess, infected hematoma, C diff colitis, anastomotic
leak, DVT, peritoneal abscess, drug fever, PE, parotitis
_______is the most common pathogen in wound infections and around foreign bodies. –
Staph aureus
_______invades the inner ear and enteric tissues as well as the lung. –
Klebsiella
______organisms are often found together with anaerobes. –
Enteric organisms ie. enterobacteriaceae and enterococci
Among the anaerobes, ___&___are often present in surgical infections and _____species are
major pathogens in ischemic tissue. –
Bacteroides & Peptostreptococci; Clostridium
___&___are usually nonpathogenic surface contaminants but may be opportunistic.
Some fungi and yeast cause abscesses in sinus tracts. –
,Pseudomonas & Serratia
History of recent surgery, trauma, cancer, prolonged immobilization, or oral contraceptive
use increases the risk of ____. –
DVT - deep vein thrombosis
What is Homan's sign? –
pain on passive dorsiflexion of ankle
What is the test of choice for DVT? –
doppler ultrasound
How is the D-dimer text useful? –
It is good at ruling a DVT out (if the text is negative) but not rule it in
Tx of DVT --
1. Initiate use of ____or____to what dose?
2. Overlap with the use of ____to what therapeutic range?
3. Why overlap therapies? - DVT
1. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring.
2. Overlap with warfarin to INR between 2-3.
3. Overlap therapies to decrease changes of hypercoagulable state.
The most common cause of SIRS (systemic inflammatory response syndrome) is sepsis.
What are the criteria for dx of SIRS? - At least 2 of the following:
1. temp >38C or <36C
2. tachy >90
3. tachypnea > 20 breaths/minute
4. PCO2 <32mmHg
5. WBC > 12,000/uL or <4000/uL
After sepsis, what are the next two most common causes of SIRS? - pancreatitis and drugs
What is the difference between hypovolemia and dehydration? - hypovolemia is loss of
both water and sodium while dehydration is loss of intracellular water or deficit with
hypernatremia -- dehydration occurs when patient can not adjust water intake for water
loss
What are the clinical signs of dehydration and hypovolemia? - tachycardia, hypotension,
pale skin, increased capillary refill time, dizziness, faintness, nausea, thirst, decreased urine
output -- in hypovolemia, urine will demonstrate low sodium concentration
What are 2 common conditions with dehydration? - diabetes insipidus (lack of ADH or
unable to respond to ADH), fever with increased water loss
Hyponatremia Causes
, _______ = cirrhosis, CHF, nephrotic syndrome, massive edema
_______=states of severe pain or nausea, trauma, brain damage, SIADH
_______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency,
malnourished states, primary polydipsia - Hypervolemic, Euvolemic, Hypovolemic
What are the two most common treatments for hyponatremia?
Other less common treatment? - salt tabs and fluid restriction; vasopressin receptor
antagonist in SIADH, CHF, and cirrhosis
Hypernatremia is almost always due to _______. Therefore, what is the treatment? -
dehydration; rehydrate!
What s/s can result in a hyperkalemic patient? - cardiac arrhythmias (tall peaked T waves)
and weakness
If the potassium level is above 6meq/L or the patient has EKG changes, what treatments
can lower K temporarily? - calcium gluconate, sodium bicarbonate, insulin and glucose,
kayexalate (takes longer to be effective)
______&______ is extremely effective in decreasing potassium. - Dialysis and furosemide
Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone levels.
How is it treated? - potassium loss; replacement must be slow!!!
Mild loss: oral KCl supplements or K containing foods
Severe loss: IV supplementation - rate 10mEg/hr
Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH function, primary
hyperparathyroidism, Lithium, malignancy, disorders related to high bone turnover rates
(hyperthyroidism, prolonged immobilization, thiazide use, vit A intoxication, Pagets dz of
bone, multiple myeloma), renal failure - hypercalcemia
How should hypercalcemia be treated? - fluid and diuretics, bisphosphonates, and
calcitonin
_______is usually caused by ineffective PTH (chronic renal failure, absent active vit D,
ineffective active vit D, pseudohypoparathyroidism), deficient PTH. - Hypocalcemia
How should hypocalcemia be treated? - intravenous calcium gluconate, Tums
Increased CO2, hypoventilation, or decreased pH is aka ___. - respiratory acidosis
Decreased CO2, hyperventilation, or increased pH is aka ___. - respiratory alkalosis
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - metabolic acidosis
