CROZER-KEYSTONE RESIDENCY
MANUAL – SURGERY EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS LATEST VERSION 2025/2026.
What are indications for the use of antibiotics? - ANS Implants (joint or internal fixation)
Prolonged surgery (>2 h)
Trauma surgery
Revisional surgery
Immunocompromised patient
Extensive dissection required
Intra-operative contamination
Endocarditis (SBE)
What antibiotics are most commonly used? - ANS - Ancef
- Clindamycin if PCN allergy Vancomycin if concerned about MRSA
What pre-op orders are needed for an in-house patient? - ANS NPO after midnight, except
AM meds with sips of water
Hold all AM hypoglycemics and cover with SSI (sliding scale insulin) (if patient with DM)
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Accu-Check on call to OR (if patient with DM)
Begin 1⁄2NSS (normal saline solution) @ 60 mL/h at 0600 (D5W1⁄2NSS if patient with DM)
Labs - CBC with diff, PT/PTT/INR, BMP
Chest X-ray, EKG (if necessary)
Consult medicine for medical clearance (if not already done)
Anesthesia to see patient (if necessary)
What are indications for ordering a chest X-ray?
What are indications for ordering an EKG? - ANS >40 years of age, smoker, any history of
cardiac or pulmonary disease
>40 years of age, any history of cardiac disease
What is the most common time for post-operative myocardial infarction?
How long should elective surgery be delayed following an MI or CABG? - ANS a. Day 3
b. 6 months
How to calculate daily fluid input requirements? - ANS First 10 kg x 100 = 1000 mL/day
Second 10 kg x 50 = 500 mL/day
Remaining kg x 20 = ___ mL/day
(e.g. 70 kg patient requires 1000 + 500 + 1000 = 2500 mL/day)
How to calculate IV fluid input rate? - ANS "421 Rule" calculates IV mL/h
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, First 10 kg x 4 = 40 mL/h
Second10 kg x 20 = 20 mL/h
Remaining kg x 1 = ___ mL/h
(e.g. 70 kg patient requires 40 + 20 + 50 = 110 mL/h)
What other factors should be considered prior to surgery? - ANS Is the patient on any insulin,
anticoagulants, steroids, or anything else that might put them at risk Note: any non-routine
orders should be cleared with patient's primary service
What is the perioperative management for patients with diabetes? - ANS NPO after midnight
Start D5W1⁄2NSS in AM
Accu-Check
If insulin-controlled, hold regular insulin, give 1⁄2 NPH dose, and cover with SSI
If oral-controlled, hold oral meds and cover with SSI
If diet-controlled, cover with SSI
What should be obtained prior to surgery on a patient with rheumatoid arthritis? -
ANS Cervical spine x-ray
What are effects of a long-term, high-dose course of steroids? - ANS Long-term therapy
suppresses adrenal function
- Risk of poor or delayed wound healing. Decreased inflammatory process.
- Risk of infection. Low WBC may mask infection.
What is the perioperative management for patients on long-term, high-dose steroids? -
ANS Peri-op IV steroid supplementation.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
MANUAL – SURGERY EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS LATEST VERSION 2025/2026.
What are indications for the use of antibiotics? - ANS Implants (joint or internal fixation)
Prolonged surgery (>2 h)
Trauma surgery
Revisional surgery
Immunocompromised patient
Extensive dissection required
Intra-operative contamination
Endocarditis (SBE)
What antibiotics are most commonly used? - ANS - Ancef
- Clindamycin if PCN allergy Vancomycin if concerned about MRSA
What pre-op orders are needed for an in-house patient? - ANS NPO after midnight, except
AM meds with sips of water
Hold all AM hypoglycemics and cover with SSI (sliding scale insulin) (if patient with DM)
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Accu-Check on call to OR (if patient with DM)
Begin 1⁄2NSS (normal saline solution) @ 60 mL/h at 0600 (D5W1⁄2NSS if patient with DM)
Labs - CBC with diff, PT/PTT/INR, BMP
Chest X-ray, EKG (if necessary)
Consult medicine for medical clearance (if not already done)
Anesthesia to see patient (if necessary)
What are indications for ordering a chest X-ray?
What are indications for ordering an EKG? - ANS >40 years of age, smoker, any history of
cardiac or pulmonary disease
>40 years of age, any history of cardiac disease
What is the most common time for post-operative myocardial infarction?
How long should elective surgery be delayed following an MI or CABG? - ANS a. Day 3
b. 6 months
How to calculate daily fluid input requirements? - ANS First 10 kg x 100 = 1000 mL/day
Second 10 kg x 50 = 500 mL/day
Remaining kg x 20 = ___ mL/day
(e.g. 70 kg patient requires 1000 + 500 + 1000 = 2500 mL/day)
How to calculate IV fluid input rate? - ANS "421 Rule" calculates IV mL/h
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, First 10 kg x 4 = 40 mL/h
Second10 kg x 20 = 20 mL/h
Remaining kg x 1 = ___ mL/h
(e.g. 70 kg patient requires 40 + 20 + 50 = 110 mL/h)
What other factors should be considered prior to surgery? - ANS Is the patient on any insulin,
anticoagulants, steroids, or anything else that might put them at risk Note: any non-routine
orders should be cleared with patient's primary service
What is the perioperative management for patients with diabetes? - ANS NPO after midnight
Start D5W1⁄2NSS in AM
Accu-Check
If insulin-controlled, hold regular insulin, give 1⁄2 NPH dose, and cover with SSI
If oral-controlled, hold oral meds and cover with SSI
If diet-controlled, cover with SSI
What should be obtained prior to surgery on a patient with rheumatoid arthritis? -
ANS Cervical spine x-ray
What are effects of a long-term, high-dose course of steroids? - ANS Long-term therapy
suppresses adrenal function
- Risk of poor or delayed wound healing. Decreased inflammatory process.
- Risk of infection. Low WBC may mask infection.
What is the perioperative management for patients on long-term, high-dose steroids? -
ANS Peri-op IV steroid supplementation.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
