Preop Care

Front 1

major clinical factors for increased perioperative cardiac risk (4)?

Back 1

valvular dz, sever/unstable angina/recent MI, certain arrhythmias (e.g. high grade AV block), decompensated CHF

Front 2

preop standard tests (7)?

Back 2

CBC, electrolytes, EKG (women>50, men>40), CXR (especially in smokers), LFTs, coags (hx of bleeding?), UA (hx, procedures inv urinary tract)

Front 3

major drawbacks of general anasthesia (2)?

Back 3

risk for pulmonary complications, mild cardiodepression

Front 4

advantages of general ansthesia?

Back 4

analgesia, amnesia, good physiologic control

Front 5

aspirin, NSAIDs, discontinue preop?

Back 5

aspirin (irreversible) d/c for 7-10 days prior to surgery, NSAIDs d/c for 2 days

Front 6

strong family hx of acute MI? what preop tests?

Back 6

EKG, ?stress test, good cardiac history

Front 7

workup for preop patient with previous MI?

Back 7

cardiac eval (stress test, potential cath (revascularization)

Front 8

diabetes preop special care (3)?

Back 8

no hypoglycemic agents AM of surgery, FMI get 1/2-2/3 insulin dose (250 sugar cutoff)

Front 9

reasons for delay of surgery (name 4)

Back 9

1. unexplained anemia
2. poorly controlled diabetes (sugars>250, inc risk for wound infection)
3. polycythemia (e.g. dehydration, COPDm EPO-secreting tumors)
4. UTI
5. malignant HTN (DBP>110), or if not delay, B-blocker on day of surgery)
6. respiratory distress (can use preop bronchodilator in COPD/asthma exacerbation)
6.

Hint 9

think CBC, CMP, vitals

Front 10

prevention of DVT (2)?

Back 10

subQ heparin, SCDs (seq compression stockings)

Front 11

How long after smoking abstinence is there a decreased risk in post-op morbidity?

Back 11

6-8 weeks

Front 12

Smoker w/ new cough has scheduled hernia surgery, what to do if:
1. sputum production (green)
2. blood-tinged sputum

Back 12

1. CXR, rule out pna --> abx
2. CXR, CT, bronchoscopy (rule out lung CA)

Hint 12

rule out what?

Front 13

concerning ABG in pulmonary dz patient pre-op?

Back 13

paO2 < 60 (pulm HTN)
paCo2 > 45 (retaining, inc post-op morbidity)
*high risk for pulm failure with surgery

Hint 13

paO2 and paCO2 values?

Front 14

4 ways to dec risk for pulm failure in emergent surgery for patient with pulm dz (e.g. COPD)

Back 14

1. bronchodilators pre-op
2. incentive spirometry post-op
3. mobilize post-op ASAP
4. lap contraindicated (inc Co2 absoption in blood --> inc pulm work)

Front 15

drugs not to give prior to / on day of surgery. name 5-6

Back 15

1. aspirin (10 days)
2. NSAIDS (day of)
3. diuretics, ?Ace inhibitors
4. insulin
5. antithyroid (stop day of)
6. warfarin (stop 3 days prior, resume 2 days p/o)

Hint 15

bleeding, BP, endocrine

Front 16

Mallampati class I-IV?

Back 16

predicts difficulty of intubates (conmplete visualization of soft palate to no visualization)

Front 17

1. Echo results concerning preop (2)?
2. EKG result concerning preop?

Back 17

1. EF < 35%, aortic stenosis
2. ST depressions

Front 18

Up to 35% of post-op deaths due to pulm complications - name 7 risk factors

Back 18

1. FEV<50% predicted
2. smoker
3. age>60
4. long OR time
5. obesity
6. upper abd / thoracic surgery
7. pulm dz

Front 19

High risk patient for DVT (5-6)?

Back 19

Age, prior DVT, smoker, estrogen/OCP, coagulopathy, obese, immobile

Front 20

prep for bowel surgery?

Back 20

1. bowel prep
2. NPO
3. antibiotics

Front 21

Antibiotics prophylaxis for following surgeries?
1. general
2. colorectal/appy
3. urologic
4. head/neck

Back 21

1. cefazolin
2. cefoxitin
3. cipro
4. clinda/gent

Front 22

stages of wound healing, name impeding factor for first 3?

Back 22

coagulation (anticoags/antiplatelets), inflammation (steroids), collagen synth (VitC deficiency), angiogenesis, epithelialization, contraction

Hint 22

CICSAEC

Front 23

Five risk factors that predict cardiac complications after vascular surgery?
most common cause of death if early post-op LE revascularization procedure is what?

Back 23

1. q waves, ventricular ectopy, angina hx, DM, >70yo
2. MI

Front 24

if reversible ischemia is found on stress test prior to surgery, what is necessary?

Back 24

angioplasty

Front 25

MI prior to noncardiac procedure: timeframe for intermediate versus major (delay surgery) of MI?

Back 25

1. major risk factor: MI within 30 days
2. intermediate: MI < 6 mo earlier (needs full cardiac eval)

Front 26

Proper intervention pre-op with following situations/conditions:
1. hx of PCTA (angioplasty)
2. PTCA within days
3. hx of PVCs
4. A. fib
5. carotid bruits
6. hx of stroke
7. abnormal ABI

Back 26

1. stress test
2. delay surgery (inc risk of coronary thrombosis)
3. ?stress, echo (rule out ventricular dysfnxn)
4. depends on etiology, need to make decisions on anticoagulation decision pre- and post-op
5. high grade stenosis endartererecyomy indicated, especially before LE revascularization
6. carotid duplex
7. revascularization (in severe PVD), CAD workup also
4.

Front 27

small ulcerated area over umbilical hernia, next step?

Back 27

to OR in expedient manner, increased risk of rupture (pressure necrosis)

Front 28

what is the differential diagnosis for mental status change in liver failure? what if preexisting umbilical hernia existed?

Back 28

1. hepatic encephalopathy
2. SBP
3. intracranial/subdural hematoma (low platelets)
4. peritonitis/infxn from umbilical hernia

Front 29

next steps for patient with ascitic fluid leaking from umbilical hernia ulcer

Back 29

Increased risk from SBP --> high mortality
1. IV abx
2. immediate repair of hernia

Front 30

portal HTN can lead to much larger than expect bleeding in what surgery in liver failure patients?

Back 30

hemorrhoidectomy

Front 31

tinnitus + mixed metabolic acidosis w/ resp alkalosis. cause?

Back 31

salicylate intoxication

Front 32

Hep-induced thrombocytopenia; what to do (3)?

Back 32

Stop heparin, start non-heparin anticoagulant (e.g. lepirudin), change to PO coumadin

Front 33

with large amt. of transfusions in trauma (>4-6), what coagulopathy ensues? Treatment?

Back 33

Factor V, VIII deficiency (labile coag factors); FFP (only replacement of factor V)

Front 34

Patient with massive post-op PE is anticoagulated. Pelvic hematoma with hemodynamic instability. what are next steps (2)?

Back 34

1. Heparin reversal with protamine sulfate
2.IV filter