Surgery EOR Exam [PAEA Blueprint]
Questions and answer
_______is the most important anaesthetic 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
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency, malnourished
states, primary polydipsia - correct answer-Hypervolemic, Euvolemic, Hypovolemic
What are the two most common treatments for hyponatremia?
Other less common treatment? - correct answer-salt tabs and fluid restriction; vasopressin
receptor antagonist in SIADH, CHF, and cirrhosis
Hypernatremia is almost always due to _______. Therefore, what is the treatment? - correct
answer-dehydration; rehydrate!
, What s/s can result in a hyperkalemic patient? - correct answer-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? - correct answer-calcium gluconate, sodium bicarbonate, insulin and
glucose, kayexalate (takes longer to be effective)
______&______ is extremely effective in decreasing potassium. - correct answer-Dialysis
and furosemide
Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone
levels. How is it treated? - correct answer-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 - correct answer-hypercalcemia
How should hypercalcemia be treated? - correct answer-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. - correct
answer-Hypocalcemia
How should hypocalcemia be treated? - correct answer-intravenous calcium gluconate,
Tums
Increased CO2, hypoventilation, or decreased pH is aka ___. - correct answer-respiratory
acidosis
Decreased CO2, hyperventilation, or increased pH is aka ___. - correct answer-respiratory
alkalosis
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - correct answer-metabolic
acidosis
Loss of H+ is aka ________. - correct answer-metabolic alkalosis
The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy, esophageal
reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection,
pneumo/chyle/hemothorax, or gastritis. - correct answer-chest pain
Who classically gets silent MI's? - correct answer-diabetics
Questions and answer
_______is the most important anaesthetic 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
Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency, malnourished
states, primary polydipsia - correct answer-Hypervolemic, Euvolemic, Hypovolemic
What are the two most common treatments for hyponatremia?
Other less common treatment? - correct answer-salt tabs and fluid restriction; vasopressin
receptor antagonist in SIADH, CHF, and cirrhosis
Hypernatremia is almost always due to _______. Therefore, what is the treatment? - correct
answer-dehydration; rehydrate!
, What s/s can result in a hyperkalemic patient? - correct answer-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? - correct answer-calcium gluconate, sodium bicarbonate, insulin and
glucose, kayexalate (takes longer to be effective)
______&______ is extremely effective in decreasing potassium. - correct answer-Dialysis
and furosemide
Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone
levels. How is it treated? - correct answer-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 - correct answer-hypercalcemia
How should hypercalcemia be treated? - correct answer-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. - correct
answer-Hypocalcemia
How should hypocalcemia be treated? - correct answer-intravenous calcium gluconate,
Tums
Increased CO2, hypoventilation, or decreased pH is aka ___. - correct answer-respiratory
acidosis
Decreased CO2, hyperventilation, or increased pH is aka ___. - correct answer-respiratory
alkalosis
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. - correct answer-metabolic
acidosis
Loss of H+ is aka ________. - correct answer-metabolic alkalosis
The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy, esophageal
reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection,
pneumo/chyle/hemothorax, or gastritis. - correct answer-chest pain
Who classically gets silent MI's? - correct answer-diabetics
