Surgery EOR Exam [PAEA Blu
g g g g
eprint] @ 2023 g g
isgthegmostgimportantganestheticgcomplication.gAnesthesiagcausesganguncont
rolledgincreasegingskeletalgmusclegoxidativegmetabolism,gwhichgoverwhelmsgthegbody'
sgcapacitygtogsupplygoxygen,gremovegCO2,gandgregulativegbodygtemperature.g-
gAnswergMalignantghyperthermia
Ifgpatientgisghyperkalemicg(normalgrangeg3.8-5.0),ghowgshouldgyougtreatgthegpatient?g-
gAnswergtreatgwithgglucose/insulin,gandgcalciumg+/-bicarb
isgthegreversinggagentgforgopiods.g-gAnswergNaloxone
isgthegreversinggagentgforgbenzodiazipines.g-gAnswergFlumazenil
Whatgisgthegbestgindicatorgusedgtogmonitorgnutritionalgstatus?g-gAnswergprealbuming-
geveryg2-3gdays
Intervention:
requiregcentralgaccessgandgindicatedgwhengnogenteralgfeedinggforg>g7gdays.
g-gAnswergTPNg-gtotalgperipheralgnutrition
Theg isgthegmostgimportantgpartgofgtheghistorygbeforegsurgery.g-
gAnswergcardiacghistoryg--ghistorygofgMI,gunstablegangina,gvalvulargdisease
Ingpatientsgwithgknowngcardiacgdisease,gaggressivegintraoperativegloweringgofgmyocar
dialgoxygengdemandgwithg
hasgbeengshowngingRCT'sgtogimprovegoutcome
sgandgshouldgbegused.g-gAnswergbetagblockers
Whengaccessinggcardiacgdiseasegpriorgtogsurgery,gwhatgisgthegmostgimportantgthinggt
ogaccess?g-gAnswergaorticgstenosisg--gcrescendogdiastolicgrumblegatgapex
Guidelinesgforgthegusegofgantibioticsgincludegadministrationgwithing
ofgsurgery
andgredosinggafterg4ghours.gWhatgisgthegabxgofgchoice?g-gAnswerg1ghour
g
Abxgofgchoice:gcefazolingforgallgexceptgcolorectalgthengcefazolin/metronidazole
Pre-opg--gMetabolicgdisease/syndromeg--gwhatgaregtheg5gcriteria?g-
gAnswerg3/5gtogdiagnose:
1 -gdiabetes
2 -gcentralgobesity
,3 -gHTN
4 -ghighgserumgtriglycerrides
5 -glowgHDLglevels
shouldgbegmonitoredgbeforegsurgerygbcgitgisgagstimulantgandgvasoconstrictorg-
-gcangleadgtogseveregtachycardiag-gAnswergCocaine
Pre-Opg--gWhatgaregthegindicationsgforgEKGgandgCXR?g-gAnswergEKGg-
gmeng>40,gwomen>50,gknowngCAD,gDM,gorgHTN
CXRg-gageg>50,gknowngcardiacgorgpulmonarygdisease
Whatgaregtheg5gclassicg"W's"gofgpostgoperativegfever?g-gAnswergW g-
gwindg(atelectasis)gW g-gwaterg(UTI)
W g-gwoundg(woundginfection)
Wg-
gwalkingg(DVT/thrombophlebitis)gW g-
gwondergdrugsg(druggfever)
Ifgthegpostgopgfevergoccursgwithingthegfirstg24ghoursgofgsurgery,gwhatgisgthegmostglikelyg
cause?g-gAnswergwind/atelectasis
Ifgthegpostgopgfevergoccursgwithingdaysg3-5gpostgop,gwhatgisgthegmostglikelygcause?g-
gAnswergwater/UTI,gcathetergrelatedgphlebitis,gpneumonia
Ifgthegpostgopgfevergoccursgwithingdaysg5-10gpostgop,gwhatgisgthegmostglikelygcause?g-
gAnswergwoundginfection,gpneumonia,gabscess,ginfectedghematoma,gCgdiffgcolitis,gan
astomoticgleak,gDVT,gperitonealgabscess,gdruggfever,gPE,gparotitis
isgthegmostgcommongpathogengingwoundginfectionsgandgaroundgforeigngbodies.g
-gAnswergStaphgaureus
invadesgtheginnergeargandgentericgtissuesgasgwellgasgtheglung.g-
gAnswergKlebsiella
organismsgaregoftengfoundgtogethergwithganaerobes.g-
AnswergEntericgorganismsgie.genterobacteriaceaegandgenterococci
g
Amonggtheganaerobes,g & aregoftengpresentgingsurgicalginfectionsgand
speciesgaregmajorgpathogensgingischemicgtissue.g-
gAnswergBacteroidesg&gPeptostreptococci;gClostridium
& aregusuallygnonpathogenicgsurfacegcontaminantsgbutgmaygbegopportunistic.
Somegfungigandgyeastgcausegabscessesgingsinusgtracts.g-
gAnswergPseudomonasg&gSerratia
,Historygofgrecentgsurgery,gtrauma,gcancer,gprolongedgimmobilization,gorgoralgcontra
ceptivegusegincreasesgthegriskgofg .g-gAnswergDVTg-
gdeepgveingthrombosis
WhatgisgHoman'sgsign?g-
AnswergpaingongpassivegdorsiflexiongofganklegWhatgisgthegtestgofgchoic
g
egforgDVT?g-gAnswergdopplergultrasound
HowgisgthegD-dimergtextguseful?g-
gAnswergItgisggoodgatgrulinggagDVTgoutg(ifgthegtextgisgnegative)gbutgnotgrulegitgin
TxgofgDVTg--
1. Initiategusegofg or togwhatgdose?
2. Overlapgwithgthegusegofg togwhatgtherapeuticgrange?
3. Whygoverlapgtherapies?g-gAnswergDVT
1. InitiategHeparingtogPTTgofg0.3-0.7gU/mLgorgLMWHgwogmonitoring.
2. OverlapgwithgwarfaringtogINRgbetweeng2-3.
3. Overlapgtherapiesgtogdecreasegchangesgofghypercoagulablegstate.
ThegmostgcommongcausegofgSIRSg(systemicginflammatorygresponsegsyndrome)gisgse
psis.gWhatgaregthegcriteriagforgdxgofgSIRS?g-gAnswergAtgleastg2gofgthegfollowing:
1. tempg>38Cgorg <36C
2. tachyg>90
3. tachypneag>g20gbreaths/minute
4. PCO2g<32mmHg
5. WBCg>g12,000/uLgorg<4000/uL
Aftergsepsis,gwhatgaregthegnextgtwogmostgcommongcausesgofgSIRS?g-
gAnswergpancreatitisgandgdrugs
Whatgisgthegdifferencegbetweenghypovolemiagandgdehydration?g-
gAnswerghypovolemiagisglossgofgbothgwatergandgsodiumgwhilegdehydrationgisglossgofgintra
cellulargwatergorgdeficitgwithghypernatremiag--
gdehydrationgoccursgwhengpatientgcangnotgadjustgwatergintakegforgwatergloss
Whatgaregthegclinicalgsignsgofgdehydrationgandghypovolemia?g-
gAnswergtachycardia,ghypotension,gpalegskin,gincreasedgcapillarygrefillgtime,gdizzine
ss,gfaintness,gnausea,gthirst,gdecreasedgurinegoutputg--
ginghypovolemia,gurinegwillgdemonstrateglowgsodiumgconcentration
Whatgareg2gcommongconditionsgwithgdehydration?g-
gAnswergdiabetesginsipidusg(lackgofgADHgorgunablegtogrespondgtogADH),gfevergwithgincre
asedgwatergloss
HyponatremiagCauses
=gcirrhosis,gCHF,gnephroticgsyndrome,gmassivegedema
=statesgofgseveregpaingorgnausea,gtrauma,gbraingdamage,gSIADH
=prolongedgvomiting,gdecreasedgoralgintake,gseveregdiarrhea,gdiureticguse
, Miscgcausesg=gfactitiousghyponatremia,ghypothyroidism,gadrenalginsufficiency,gmalno
urishedgstates,gprimarygpolydipsiag-gAnswergHypervolemic,gEuvolemic,gHypovolemic
Whatgaregthegtwogmostgcommongtreatmentsgforghyponatremia?
Otherglessgcommongtreatment?g-
gAnswergsaltgtabsgandgfluidgrestriction;gvasopressingreceptorgantagonistgingSIADH,gCH
F,gandgcirrhosis
Hypernatremiagisgalmostgalwaysgduegtog
.gTherefore,gwhatgisgthegtreatment?g
-gAnswergdehydration;grehydrate!
Whatgs/sgcangresultgingaghyperkalemicgpatient?g-
gAnswergcardiacgarrhythmiasg(tallgpeakedgTgwaves)gandgweakness
Ifgthegpotassiumglevelgisgaboveg6meq/LgorgthegpatientghasgEKGgchanges,gwhatgtreatme
ntsgcanglowergKgtemporarily?g-
gAnswergcalciumggluconate,gsodiumgbicarbonate,ginsulingandgglucose,gkayexalateg(tak
esglongergtogbegeffective)
& isgextremelygeffectivegingdecreasinggpotassium.g-
gAnswergDialysisgandgfurosemide
Hypokalemiagisgusuallygduegtog
,ghypomagnesemia,galkalosis,ghighgaldosterone
glevels.gHowgisgitgtreated?g-gAnswergpotassiumgloss;greplacementgmustgbegslow!!!
Mildgloss:goralgKClgsupplementsgorgKgcontaininggfoodsgS
everegloss:gIVgsupplementationg-grateg10mEg/hr
Causesgofg
aregVITAMINgDgMETABOLICgDISORDERS,gabnormalgPTHgfun
ction,gprimaryghyperparathyroidism,gLithium,gmalignancy,gdisordersgrelatedgtoghighgb
onegturnovergratesg(hyperthyroidism,gprolongedgimmobilization,gthiazideguse,gvitgAgint
oxication,gPagetsgdzgofgbone,gmultiplegmyeloma),grenalgfailureg-
gAnswerghypercalcemia
Howgshouldghypercalcemiagbegtreated?g-
gAnswergfluidgandgdiuretics,gbisphosphonates,gandgcalcitonin
isgusuallygcausedgbygineffectivegPTHg(chronicgrenalgfailure,gabsentgactivegvitgD
,gineffectivegactivegvitgD,gpseudohypoparathyroidism),gdeficientgPTH.g-
gAnswergHypocalcemia
Howgshouldghypocalcemiagbegtreated?g-gAnswergintravenousgcalciumggluconate,gTums
IncreasedgCO2,ghypoventilation,gorgdecreasedgpHgisgakag .g-
gAnswergrespiratorygacidosis
DecreasedgCO2,ghyperventilation,gorgincreasedgpHgisgakag .g-
gAnswergrespiratorygalkalosis
g g g g
eprint] @ 2023 g g
isgthegmostgimportantganestheticgcomplication.gAnesthesiagcausesganguncont
rolledgincreasegingskeletalgmusclegoxidativegmetabolism,gwhichgoverwhelmsgthegbody'
sgcapacitygtogsupplygoxygen,gremovegCO2,gandgregulativegbodygtemperature.g-
gAnswergMalignantghyperthermia
Ifgpatientgisghyperkalemicg(normalgrangeg3.8-5.0),ghowgshouldgyougtreatgthegpatient?g-
gAnswergtreatgwithgglucose/insulin,gandgcalciumg+/-bicarb
isgthegreversinggagentgforgopiods.g-gAnswergNaloxone
isgthegreversinggagentgforgbenzodiazipines.g-gAnswergFlumazenil
Whatgisgthegbestgindicatorgusedgtogmonitorgnutritionalgstatus?g-gAnswergprealbuming-
geveryg2-3gdays
Intervention:
requiregcentralgaccessgandgindicatedgwhengnogenteralgfeedinggforg>g7gdays.
g-gAnswergTPNg-gtotalgperipheralgnutrition
Theg isgthegmostgimportantgpartgofgtheghistorygbeforegsurgery.g-
gAnswergcardiacghistoryg--ghistorygofgMI,gunstablegangina,gvalvulargdisease
Ingpatientsgwithgknowngcardiacgdisease,gaggressivegintraoperativegloweringgofgmyocar
dialgoxygengdemandgwithg
hasgbeengshowngingRCT'sgtogimprovegoutcome
sgandgshouldgbegused.g-gAnswergbetagblockers
Whengaccessinggcardiacgdiseasegpriorgtogsurgery,gwhatgisgthegmostgimportantgthinggt
ogaccess?g-gAnswergaorticgstenosisg--gcrescendogdiastolicgrumblegatgapex
Guidelinesgforgthegusegofgantibioticsgincludegadministrationgwithing
ofgsurgery
andgredosinggafterg4ghours.gWhatgisgthegabxgofgchoice?g-gAnswerg1ghour
g
Abxgofgchoice:gcefazolingforgallgexceptgcolorectalgthengcefazolin/metronidazole
Pre-opg--gMetabolicgdisease/syndromeg--gwhatgaregtheg5gcriteria?g-
gAnswerg3/5gtogdiagnose:
1 -gdiabetes
2 -gcentralgobesity
,3 -gHTN
4 -ghighgserumgtriglycerrides
5 -glowgHDLglevels
shouldgbegmonitoredgbeforegsurgerygbcgitgisgagstimulantgandgvasoconstrictorg-
-gcangleadgtogseveregtachycardiag-gAnswergCocaine
Pre-Opg--gWhatgaregthegindicationsgforgEKGgandgCXR?g-gAnswergEKGg-
gmeng>40,gwomen>50,gknowngCAD,gDM,gorgHTN
CXRg-gageg>50,gknowngcardiacgorgpulmonarygdisease
Whatgaregtheg5gclassicg"W's"gofgpostgoperativegfever?g-gAnswergW g-
gwindg(atelectasis)gW g-gwaterg(UTI)
W g-gwoundg(woundginfection)
Wg-
gwalkingg(DVT/thrombophlebitis)gW g-
gwondergdrugsg(druggfever)
Ifgthegpostgopgfevergoccursgwithingthegfirstg24ghoursgofgsurgery,gwhatgisgthegmostglikelyg
cause?g-gAnswergwind/atelectasis
Ifgthegpostgopgfevergoccursgwithingdaysg3-5gpostgop,gwhatgisgthegmostglikelygcause?g-
gAnswergwater/UTI,gcathetergrelatedgphlebitis,gpneumonia
Ifgthegpostgopgfevergoccursgwithingdaysg5-10gpostgop,gwhatgisgthegmostglikelygcause?g-
gAnswergwoundginfection,gpneumonia,gabscess,ginfectedghematoma,gCgdiffgcolitis,gan
astomoticgleak,gDVT,gperitonealgabscess,gdruggfever,gPE,gparotitis
isgthegmostgcommongpathogengingwoundginfectionsgandgaroundgforeigngbodies.g
-gAnswergStaphgaureus
invadesgtheginnergeargandgentericgtissuesgasgwellgasgtheglung.g-
gAnswergKlebsiella
organismsgaregoftengfoundgtogethergwithganaerobes.g-
AnswergEntericgorganismsgie.genterobacteriaceaegandgenterococci
g
Amonggtheganaerobes,g & aregoftengpresentgingsurgicalginfectionsgand
speciesgaregmajorgpathogensgingischemicgtissue.g-
gAnswergBacteroidesg&gPeptostreptococci;gClostridium
& aregusuallygnonpathogenicgsurfacegcontaminantsgbutgmaygbegopportunistic.
Somegfungigandgyeastgcausegabscessesgingsinusgtracts.g-
gAnswergPseudomonasg&gSerratia
,Historygofgrecentgsurgery,gtrauma,gcancer,gprolongedgimmobilization,gorgoralgcontra
ceptivegusegincreasesgthegriskgofg .g-gAnswergDVTg-
gdeepgveingthrombosis
WhatgisgHoman'sgsign?g-
AnswergpaingongpassivegdorsiflexiongofganklegWhatgisgthegtestgofgchoic
g
egforgDVT?g-gAnswergdopplergultrasound
HowgisgthegD-dimergtextguseful?g-
gAnswergItgisggoodgatgrulinggagDVTgoutg(ifgthegtextgisgnegative)gbutgnotgrulegitgin
TxgofgDVTg--
1. Initiategusegofg or togwhatgdose?
2. Overlapgwithgthegusegofg togwhatgtherapeuticgrange?
3. Whygoverlapgtherapies?g-gAnswergDVT
1. InitiategHeparingtogPTTgofg0.3-0.7gU/mLgorgLMWHgwogmonitoring.
2. OverlapgwithgwarfaringtogINRgbetweeng2-3.
3. Overlapgtherapiesgtogdecreasegchangesgofghypercoagulablegstate.
ThegmostgcommongcausegofgSIRSg(systemicginflammatorygresponsegsyndrome)gisgse
psis.gWhatgaregthegcriteriagforgdxgofgSIRS?g-gAnswergAtgleastg2gofgthegfollowing:
1. tempg>38Cgorg <36C
2. tachyg>90
3. tachypneag>g20gbreaths/minute
4. PCO2g<32mmHg
5. WBCg>g12,000/uLgorg<4000/uL
Aftergsepsis,gwhatgaregthegnextgtwogmostgcommongcausesgofgSIRS?g-
gAnswergpancreatitisgandgdrugs
Whatgisgthegdifferencegbetweenghypovolemiagandgdehydration?g-
gAnswerghypovolemiagisglossgofgbothgwatergandgsodiumgwhilegdehydrationgisglossgofgintra
cellulargwatergorgdeficitgwithghypernatremiag--
gdehydrationgoccursgwhengpatientgcangnotgadjustgwatergintakegforgwatergloss
Whatgaregthegclinicalgsignsgofgdehydrationgandghypovolemia?g-
gAnswergtachycardia,ghypotension,gpalegskin,gincreasedgcapillarygrefillgtime,gdizzine
ss,gfaintness,gnausea,gthirst,gdecreasedgurinegoutputg--
ginghypovolemia,gurinegwillgdemonstrateglowgsodiumgconcentration
Whatgareg2gcommongconditionsgwithgdehydration?g-
gAnswergdiabetesginsipidusg(lackgofgADHgorgunablegtogrespondgtogADH),gfevergwithgincre
asedgwatergloss
HyponatremiagCauses
=gcirrhosis,gCHF,gnephroticgsyndrome,gmassivegedema
=statesgofgseveregpaingorgnausea,gtrauma,gbraingdamage,gSIADH
=prolongedgvomiting,gdecreasedgoralgintake,gseveregdiarrhea,gdiureticguse
, Miscgcausesg=gfactitiousghyponatremia,ghypothyroidism,gadrenalginsufficiency,gmalno
urishedgstates,gprimarygpolydipsiag-gAnswergHypervolemic,gEuvolemic,gHypovolemic
Whatgaregthegtwogmostgcommongtreatmentsgforghyponatremia?
Otherglessgcommongtreatment?g-
gAnswergsaltgtabsgandgfluidgrestriction;gvasopressingreceptorgantagonistgingSIADH,gCH
F,gandgcirrhosis
Hypernatremiagisgalmostgalwaysgduegtog
.gTherefore,gwhatgisgthegtreatment?g
-gAnswergdehydration;grehydrate!
Whatgs/sgcangresultgingaghyperkalemicgpatient?g-
gAnswergcardiacgarrhythmiasg(tallgpeakedgTgwaves)gandgweakness
Ifgthegpotassiumglevelgisgaboveg6meq/LgorgthegpatientghasgEKGgchanges,gwhatgtreatme
ntsgcanglowergKgtemporarily?g-
gAnswergcalciumggluconate,gsodiumgbicarbonate,ginsulingandgglucose,gkayexalateg(tak
esglongergtogbegeffective)
& isgextremelygeffectivegingdecreasinggpotassium.g-
gAnswergDialysisgandgfurosemide
Hypokalemiagisgusuallygduegtog
,ghypomagnesemia,galkalosis,ghighgaldosterone
glevels.gHowgisgitgtreated?g-gAnswergpotassiumgloss;greplacementgmustgbegslow!!!
Mildgloss:goralgKClgsupplementsgorgKgcontaininggfoodsgS
everegloss:gIVgsupplementationg-grateg10mEg/hr
Causesgofg
aregVITAMINgDgMETABOLICgDISORDERS,gabnormalgPTHgfun
ction,gprimaryghyperparathyroidism,gLithium,gmalignancy,gdisordersgrelatedgtoghighgb
onegturnovergratesg(hyperthyroidism,gprolongedgimmobilization,gthiazideguse,gvitgAgint
oxication,gPagetsgdzgofgbone,gmultiplegmyeloma),grenalgfailureg-
gAnswerghypercalcemia
Howgshouldghypercalcemiagbegtreated?g-
gAnswergfluidgandgdiuretics,gbisphosphonates,gandgcalcitonin
isgusuallygcausedgbygineffectivegPTHg(chronicgrenalgfailure,gabsentgactivegvitgD
,gineffectivegactivegvitgD,gpseudohypoparathyroidism),gdeficientgPTH.g-
gAnswergHypocalcemia
Howgshouldghypocalcemiagbegtreated?g-gAnswergintravenousgcalciumggluconate,gTums
IncreasedgCO2,ghypoventilation,gorgdecreasedgpHgisgakag .g-
gAnswergrespiratorygacidosis
DecreasedgCO2,ghyperventilation,gorgincreasedgpHgisgakag .g-
gAnswergrespiratorygalkalosis
