General Internal Medicine Board Review1567 Questions with Complete Solutions

General Internal Medicine Board Review1567 Questions with Complete Solutions What are the goals of pre-operative assessment? - CORRECT ANSWER 1. To identify important medical issues in order to - Optimize their treatment. - Inform the patient of the risks associated with surgery. - Ensure care is provided in an appropriate environment. 2. To identify important social issues which may have a bearing on the planned procedure and the recovery period. 3. To familiarize the patient with the planned procedure and the hospital processes. Stopping smoking how long before surgery significantly reduces the risk of complications? - CORRECT ANSWER 6 weeks What are the 3 most widely used methods for DVT prevention? - CORRECT ANSWER 1. Graduated compression stockings: these stockings reduce venous pooling in the lower limbs and prevent venous stagnation. 2. Heparin: this drug can be used in its conventional un- fractionated form or as one of the newer fractionated low-molecular-weight derivatives. The fractionated lowmolecular-weight heparins offer the convenience of once-daily dosing for the majority of patients. It must however be remembered that the anticoagulant effect of the low-molecular-weight heparins cannot easily be reversed and, where such reversal may be important, standard unfractionated heparin should be used. 3. Mechanical calf compression devices: these machines work by intermittent pneumatic calf compression and thereby encourage venous return and reduce venous pooling. What is the risk of post-operative wound infection for the following types of procedures? - Clean - Clean-contaminated - Contaminated - Dirty - CORRECT ANSWER What activity level (in METs) is generally considered fit for surgery? - CORRECT ANSWER An activity level of 4 METs, which is equivalent to carrying shopping bags up two flights of stairs, is generally considered adequate for most surgery What are the normal daily requirements of sodium and potassium? - CORRECT ANSWER Sodium: 100-150 mmol Potassium: 60-90 mmol What are the consequences of gastric dilatation post-surgery? - CORRECT ANSWER Gastric dilatation is rare and when it occurs, tends to be associated with surgery of the upper digestive tract. It may occur suddenly 2-3 days after the operation and is associated with massive fluid secretion into the stomach, with the consequent risk of regurgitation and inhalation. Treatment is by insertion of a nasogastric tube and decompression of the stomach. When does paralytic ileus tend to develop post-surgery? - CORRECT ANSWER In the acutely ill patient who has undergone surgical intervention for peritonitis, paralytic ileus may be present from the first post-operative day.