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. - CORRECT ANSWER-Malignant hyperthermia
If patient is hyperkalemic (normal range 3.8-5.0), how should you treat the
patient? - CORRECT ANSWER-treat with glucose/insulin, and calcium +/-bicarb
_______is the reversing agent for opiods. - CORRECT ANSWER-Naloxone
_______is the reversing agent for benzodiazipines. - CORRECT
ANSWER-Flumazenil
What is the best indicator used to monitor nutritional status? - CORRECT
ANSWER-prealbumin - every 2-3 days
Intervention:
_________require central access and indicated when no enteral feeding for > 7
days. - CORRECT ANSWER-TPN - total peripheral nutrition
The _________is the most important part of the history before surgery. -
CORRECT ANSWER-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. - CORRECT ANSWER-beta blockers
When accessing cardiac disease prior to surgery, what is the most important
thing to access? - CORRECT ANSWER-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? - CORRECT
ANSWER-1 hour
Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? - CORRECT
ANSWER-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 - CORRECT
ANSWER-Cocaine
Pre-Op -- What are the indications for EKG and CXR? - CORRECT
ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-wind/atelectasis
If the post op fever occurs within days 3-5 post op, what is the most likely cause?
- CORRECT ANSWER-water/UTI, catheter related phlebitis, pneumonia
If the post op fever occurs within days 5-10 post op, what is the most likely
cause? - CORRECT ANSWER-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. - CORRECT ANSWER-Staph aureus
_______invades the inner ear and enteric tissues as well as the lung. -
CORRECT ANSWER-Klebsiella
______organisms are often found together with anaerobes. - CORRECT
ANSWER-Enteric organisms ie. enterobacteriaceae and enterococci
Among the anaerobes, ___&___are often present in surgical infections and
_____species are major pathogens in ischemic tissue. - CORRECT
ANSWER-Bacteroides & Peptostreptococci; Clostridium
___&___are usually nonpathogenic surface contaminants but may be
opportunistic.
Some fungi and yeast cause abscesses in sinus tracts. - CORRECT
ANSWER-Pseudomonas & Serratia
History of recent surgery, trauma, cancer, prolonged immobilization, or oral
contraceptive use increases the risk of ____. - CORRECT ANSWER-DVT - deep
vein thrombosis
What is Homan's sign? - CORRECT ANSWER-pain on passive dorsiflexion of
ankle
What is the test of choice for DVT? - CORRECT ANSWER-doppler ultrasound
How is the D-dimer text useful? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT
ANSWER-pancreatitis and drugs
What is the difference between hypovolemia and dehydration? - CORRECT
ANSWER-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? - CORRECT
ANSWER-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? - CORRECT
ANSWER-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
_______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. - CORRECT ANSWER-Malignant hyperthermia
If patient is hyperkalemic (normal range 3.8-5.0), how should you treat the
patient? - CORRECT ANSWER-treat with glucose/insulin, and calcium +/-bicarb
_______is the reversing agent for opiods. - CORRECT ANSWER-Naloxone
_______is the reversing agent for benzodiazipines. - CORRECT
ANSWER-Flumazenil
What is the best indicator used to monitor nutritional status? - CORRECT
ANSWER-prealbumin - every 2-3 days
Intervention:
_________require central access and indicated when no enteral feeding for > 7
days. - CORRECT ANSWER-TPN - total peripheral nutrition
The _________is the most important part of the history before surgery. -
CORRECT ANSWER-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. - CORRECT ANSWER-beta blockers
When accessing cardiac disease prior to surgery, what is the most important
thing to access? - CORRECT ANSWER-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? - CORRECT
ANSWER-1 hour
Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? - CORRECT
ANSWER-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 - CORRECT
ANSWER-Cocaine
Pre-Op -- What are the indications for EKG and CXR? - CORRECT
ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-wind/atelectasis
If the post op fever occurs within days 3-5 post op, what is the most likely cause?
- CORRECT ANSWER-water/UTI, catheter related phlebitis, pneumonia
If the post op fever occurs within days 5-10 post op, what is the most likely
cause? - CORRECT ANSWER-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. - CORRECT ANSWER-Staph aureus
_______invades the inner ear and enteric tissues as well as the lung. -
CORRECT ANSWER-Klebsiella
______organisms are often found together with anaerobes. - CORRECT
ANSWER-Enteric organisms ie. enterobacteriaceae and enterococci
Among the anaerobes, ___&___are often present in surgical infections and
_____species are major pathogens in ischemic tissue. - CORRECT
ANSWER-Bacteroides & Peptostreptococci; Clostridium
___&___are usually nonpathogenic surface contaminants but may be
opportunistic.
Some fungi and yeast cause abscesses in sinus tracts. - CORRECT
ANSWER-Pseudomonas & Serratia
History of recent surgery, trauma, cancer, prolonged immobilization, or oral
contraceptive use increases the risk of ____. - CORRECT ANSWER-DVT - deep
vein thrombosis
What is Homan's sign? - CORRECT ANSWER-pain on passive dorsiflexion of
ankle
What is the test of choice for DVT? - CORRECT ANSWER-doppler ultrasound
How is the D-dimer text useful? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT
ANSWER-pancreatitis and drugs
What is the difference between hypovolemia and dehydration? - CORRECT
ANSWER-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? - CORRECT
ANSWER-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? - CORRECT
ANSWER-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
