Surgery EOR Exam [PAEA Blueprint]
_______is the most important anesthetic complication. Malignant hyperthermia
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.
If patient is hyperkalemic (normal range 3.8-5.0), how treat with glucose/insulin, and calcium +/-bicarb
should you treat the patient?
_______is the reversing agent for opiods. Naloxone
_______is the reversing agent for benzodiazipines. Flumazenil
What is the best indicator used to monitor nutritional prealbumin - every 2-3 days
status?
Intervention: TPN - total peripheral nutrition
_________require central access and indicated when no
enteral feeding for > 7 days.
The _________is the most important part of the history cardiac history -- history of MI, unstable angina, valvular disease
before surgery.
In patients with known cardiac disease, aggressive beta blockers
intraoperative lowering of myocardial oxygen demand
with ____ has been shown in RCT's to improve
outcomes and should be used.
When accessing cardiac disease prior to surgery, what is aortic stenosis -- crescendo diastolic rumble at apex
the most important thing to access?
Guidelines for the use of antibiotics include 1 hour
administration within _______ of surgery and redosing Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
after 4 hours. What is the abx of choice?
Pre-op -- Metabolic disease/syndrome -- what are the 5 3/5 to diagnose:
criteria? 1 - diabetes
2 - central obesity
3 - HTN
4 - high serum triglycerrides
5 - low HDL levels
______should be monitored before surgery bc it is a Cocaine
stimulant and vasoconstrictor -- can lead to severe
tachycardia
Pre-Op -- What are the indications for EKG and CXR? 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? W - wind (atelectasis)
W - water (UTI)
W - wound (wound infection)
W - walking (DVT/thrombophlebitis)
W - wonder drugs (drug fever)
, Surgery EOR Exam [PAEA Blueprint]
If the post op fever occurs within the first 24 hours of wind/atelectasis
surgery, what is the most likely cause?
If the post op fever occurs within days 3-5 post op, what water/UTI, catheter related phlebitis, pneumonia
is the most likely cause?
If the post op fever occurs within days 5-10 post op, what wound infection, pneumonia, abscess, infected hematoma, C diff colitis,
is the most likely cause? anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis
_______is the most common pathogen in wound Staph aureus
infections and around foreign bodies.
_______invades the inner ear and enteric tissues as well Klebsiella
as the lung.
______organisms are often found together with Enteric organisms ie. enterobacteriaceae and enterococci
anaerobes.
Among the anaerobes, ___&___are often present in Bacteroides & Peptostreptococci; Clostridium
surgical infections and _____species are major
pathogens in ischemic tissue.
___&___are usually nonpathogenic surface Pseudomonas & Serratia
contaminants but may be opportunistic.
Some fungi and yeast cause abscesses in sinus tracts.
History of recent surgery, trauma, cancer, prolonged DVT - deep vein thrombosis
immobilization, or oral contraceptive use increases the
risk of ____.
What is Homan's sign? pain on passive dorsiflexion of ankle
What is the test of choice for DVT? doppler ultrasound
How is the D-dimer text useful? It is good at ruling a DVT out (if the text is negative) but not rule it in
Tx of DVT -- DVT
1. Initiate use of ____or____to what dose? 1. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring.
2. Overlap with the use of ____to what therapeutic 2. Overlap with warfarin to INR between 2-3.
range? 3. Overlap therapies to decrease changes of hypercoagulable state.
3. Why overlap therapies?
The most common cause of SIRS (systemic At least 2 of the following:
inflammatory response syndrome) is sepsis. What are 1. temp >38C or <36C
the criteria for dx of SIRS? 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 pancreatitis and drugs
of SIRS?
, Surgery EOR Exam [PAEA Blueprint]
What is the difference between hypovolemia and hypovolemia is loss of both water and sodium while dehydration is loss of
dehydration? 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 tachycardia, hypotension, pale skin, increased capillary refill time, dizziness,
hypovolemia? faintness, nausea, thirst, decreased urine output -- in hypovolemia, urine will
demonstrate low sodium concentration
What are 2 common conditions with dehydration? diabetes insipidus (lack of ADH or unable to respond to ADH), fever with
increased water loss
Hyponatremia Causes Hypervolemic, Euvolemic, Hypovolemic
_______ = 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
What are the two most common treatments for salt tabs and fluid restriction; vasopressin receptor antagonist in SIADH, CHF,
hyponatremia? and cirrhosis
Other less common treatment?
Hypernatremia is almost always due to _______. dehydration; rehydrate!
Therefore, what is the treatment?
What s/s can result in a hyperkalemic patient? cardiac arrhythmias (tall peaked T waves) and weakness
If the potassium level is above 6meq/L or the patient has calcium gluconate, sodium bicarbonate, insulin and glucose, kayexalate (takes
EKG changes, what treatments can lower K temporarily? longer to be effective)
______&______ is extremely effective in decreasing Dialysis and furosemide
potassium.
Hypokalemia is usually due to ________, potassium loss; replacement must be slow!!!
hypomagnesemia, alkalosis, high aldosterone levels. Mild loss: oral KCl supplements or K containing foods
How is it treated? Severe loss: IV supplementation - rate 10mEg/hr
Causes of ________are VITAMIN D METABOLIC hypercalcemia
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
How should hypercalcemia be treated? fluid and diuretics, bisphosphonates, and calcitonin
_______is usually caused by ineffective PTH (chronic Hypocalcemia
renal failure, absent active vit D, ineffective active vit D,
pseudohypoparathyroidism), deficient PTH.
How should hypocalcemia be treated? intravenous calcium gluconate, Tums
, Surgery EOR Exam [PAEA Blueprint]
Increased CO2, hypoventilation, or decreased pH is aka respiratory acidosis
___.
Decreased CO2, hyperventilation, or increased pH is aka respiratory alkalosis
___.
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka metabolic acidosis
___.
Loss of H+ is aka ________. metabolic alkalosis
The d/d of post op ___________can be MI, atelectasis, chest pain
pneumonia, pleurisy, esophageal reflux, PE,
musculoskeletal pain, subphrenic abscess, aortic
dissection, pneumo/chyle/hemothorax, or gastritis.
Who classically gets silent MI's? diabetics
How should syncope be initially evaluated? It is important to distinguish syncope from cardiac arrest from other nonsyncopal
conditions causing LOC
Syncope d/d: Prodrome or aura usually associated with seizures (as is loss of continence)
____.
Cardiac syncope's onset is usually ____without a sudden
prodrome. Monitor vitals regularly, EKG, orthostatic
challenge, neuro exam etc.
In a surgery patient with dyspnea on exertion, what PE or pneumothorax
should be ruled out?
What are some chronic dyspnea on exertion causes? asthma, COPD, interstitial lung disease, myocardial dysfunction, obesity
What are some acute dyspnea on exertion causes? angioedema, anaphylaxis, foreign objects, airway trauma, pulmonary infection,
pleural effusion, peritonitis/ruptured viscous, bowel obstruction
__________is pain, cramping, or both of the lower Claudication
extremity (usually calf muscle) after walking a specific
distance; then resolves for a specific amount of time
while standing.
What is claudication associated with? peripheral vascular occlusion
D/D of lower extremity claudication? neurogenic/nerve entrapment/discs, arthritis, coartation of the aorta, popliteal
artery syndrome, neuromas, anemia, diabetic neuropathy pain
A _________is an abnormal dilation of an artery. Involve aneurysm
all layers of the arterial wall.
_______is the most important anesthetic complication. Malignant hyperthermia
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.
If patient is hyperkalemic (normal range 3.8-5.0), how treat with glucose/insulin, and calcium +/-bicarb
should you treat the patient?
_______is the reversing agent for opiods. Naloxone
_______is the reversing agent for benzodiazipines. Flumazenil
What is the best indicator used to monitor nutritional prealbumin - every 2-3 days
status?
Intervention: TPN - total peripheral nutrition
_________require central access and indicated when no
enteral feeding for > 7 days.
The _________is the most important part of the history cardiac history -- history of MI, unstable angina, valvular disease
before surgery.
In patients with known cardiac disease, aggressive beta blockers
intraoperative lowering of myocardial oxygen demand
with ____ has been shown in RCT's to improve
outcomes and should be used.
When accessing cardiac disease prior to surgery, what is aortic stenosis -- crescendo diastolic rumble at apex
the most important thing to access?
Guidelines for the use of antibiotics include 1 hour
administration within _______ of surgery and redosing Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole
after 4 hours. What is the abx of choice?
Pre-op -- Metabolic disease/syndrome -- what are the 5 3/5 to diagnose:
criteria? 1 - diabetes
2 - central obesity
3 - HTN
4 - high serum triglycerrides
5 - low HDL levels
______should be monitored before surgery bc it is a Cocaine
stimulant and vasoconstrictor -- can lead to severe
tachycardia
Pre-Op -- What are the indications for EKG and CXR? 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? W - wind (atelectasis)
W - water (UTI)
W - wound (wound infection)
W - walking (DVT/thrombophlebitis)
W - wonder drugs (drug fever)
, Surgery EOR Exam [PAEA Blueprint]
If the post op fever occurs within the first 24 hours of wind/atelectasis
surgery, what is the most likely cause?
If the post op fever occurs within days 3-5 post op, what water/UTI, catheter related phlebitis, pneumonia
is the most likely cause?
If the post op fever occurs within days 5-10 post op, what wound infection, pneumonia, abscess, infected hematoma, C diff colitis,
is the most likely cause? anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis
_______is the most common pathogen in wound Staph aureus
infections and around foreign bodies.
_______invades the inner ear and enteric tissues as well Klebsiella
as the lung.
______organisms are often found together with Enteric organisms ie. enterobacteriaceae and enterococci
anaerobes.
Among the anaerobes, ___&___are often present in Bacteroides & Peptostreptococci; Clostridium
surgical infections and _____species are major
pathogens in ischemic tissue.
___&___are usually nonpathogenic surface Pseudomonas & Serratia
contaminants but may be opportunistic.
Some fungi and yeast cause abscesses in sinus tracts.
History of recent surgery, trauma, cancer, prolonged DVT - deep vein thrombosis
immobilization, or oral contraceptive use increases the
risk of ____.
What is Homan's sign? pain on passive dorsiflexion of ankle
What is the test of choice for DVT? doppler ultrasound
How is the D-dimer text useful? It is good at ruling a DVT out (if the text is negative) but not rule it in
Tx of DVT -- DVT
1. Initiate use of ____or____to what dose? 1. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring.
2. Overlap with the use of ____to what therapeutic 2. Overlap with warfarin to INR between 2-3.
range? 3. Overlap therapies to decrease changes of hypercoagulable state.
3. Why overlap therapies?
The most common cause of SIRS (systemic At least 2 of the following:
inflammatory response syndrome) is sepsis. What are 1. temp >38C or <36C
the criteria for dx of SIRS? 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 pancreatitis and drugs
of SIRS?
, Surgery EOR Exam [PAEA Blueprint]
What is the difference between hypovolemia and hypovolemia is loss of both water and sodium while dehydration is loss of
dehydration? 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 tachycardia, hypotension, pale skin, increased capillary refill time, dizziness,
hypovolemia? faintness, nausea, thirst, decreased urine output -- in hypovolemia, urine will
demonstrate low sodium concentration
What are 2 common conditions with dehydration? diabetes insipidus (lack of ADH or unable to respond to ADH), fever with
increased water loss
Hyponatremia Causes Hypervolemic, Euvolemic, Hypovolemic
_______ = 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
What are the two most common treatments for salt tabs and fluid restriction; vasopressin receptor antagonist in SIADH, CHF,
hyponatremia? and cirrhosis
Other less common treatment?
Hypernatremia is almost always due to _______. dehydration; rehydrate!
Therefore, what is the treatment?
What s/s can result in a hyperkalemic patient? cardiac arrhythmias (tall peaked T waves) and weakness
If the potassium level is above 6meq/L or the patient has calcium gluconate, sodium bicarbonate, insulin and glucose, kayexalate (takes
EKG changes, what treatments can lower K temporarily? longer to be effective)
______&______ is extremely effective in decreasing Dialysis and furosemide
potassium.
Hypokalemia is usually due to ________, potassium loss; replacement must be slow!!!
hypomagnesemia, alkalosis, high aldosterone levels. Mild loss: oral KCl supplements or K containing foods
How is it treated? Severe loss: IV supplementation - rate 10mEg/hr
Causes of ________are VITAMIN D METABOLIC hypercalcemia
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
How should hypercalcemia be treated? fluid and diuretics, bisphosphonates, and calcitonin
_______is usually caused by ineffective PTH (chronic Hypocalcemia
renal failure, absent active vit D, ineffective active vit D,
pseudohypoparathyroidism), deficient PTH.
How should hypocalcemia be treated? intravenous calcium gluconate, Tums
, Surgery EOR Exam [PAEA Blueprint]
Increased CO2, hypoventilation, or decreased pH is aka respiratory acidosis
___.
Decreased CO2, hyperventilation, or increased pH is aka respiratory alkalosis
___.
Increased H+ or HCO3 loss, DKA, lactic acidosis is aka metabolic acidosis
___.
Loss of H+ is aka ________. metabolic alkalosis
The d/d of post op ___________can be MI, atelectasis, chest pain
pneumonia, pleurisy, esophageal reflux, PE,
musculoskeletal pain, subphrenic abscess, aortic
dissection, pneumo/chyle/hemothorax, or gastritis.
Who classically gets silent MI's? diabetics
How should syncope be initially evaluated? It is important to distinguish syncope from cardiac arrest from other nonsyncopal
conditions causing LOC
Syncope d/d: Prodrome or aura usually associated with seizures (as is loss of continence)
____.
Cardiac syncope's onset is usually ____without a sudden
prodrome. Monitor vitals regularly, EKG, orthostatic
challenge, neuro exam etc.
In a surgery patient with dyspnea on exertion, what PE or pneumothorax
should be ruled out?
What are some chronic dyspnea on exertion causes? asthma, COPD, interstitial lung disease, myocardial dysfunction, obesity
What are some acute dyspnea on exertion causes? angioedema, anaphylaxis, foreign objects, airway trauma, pulmonary infection,
pleural effusion, peritonitis/ruptured viscous, bowel obstruction
__________is pain, cramping, or both of the lower Claudication
extremity (usually calf muscle) after walking a specific
distance; then resolves for a specific amount of time
while standing.
What is claudication associated with? peripheral vascular occlusion
D/D of lower extremity claudication? neurogenic/nerve entrapment/discs, arthritis, coartation of the aorta, popliteal
artery syndrome, neuromas, anemia, diabetic neuropathy pain
A _________is an abnormal dilation of an artery. Involve aneurysm
all layers of the arterial wall.
