Surgery

Front 1

Familial Adenomatous Polyposis:
autosomal dominant
mutation in which gene?

Back 1

APC

Front 2

What is PSA?

Back 2

a glycoprotein that liquefies semen

Front 3

In prostate malignancy, there is a _______ free : total PSA

Back 3

lower

Front 4

What has the highest (and 2nd highest) of frequency of DVT post-op?

Back 4

1. stroke
2. THR

Front 5

Mechanism of heparin

Back 5

antithrombin III enhancer

Front 6

Order of best prevention of DVT in general surgery (5)

Back 6

IPC > LMWH > low dose unfractionated heparin > graduated compression stockings > Aspirin

Front 7

Effectiveness of prophylaxis in Orthopaedic surgery

Back 7

Fondaparinux > LMWH

Front 8

Fondiparinux mechanism of action

Back 8

Factor Xa inhibitor

Front 9

Rivaroxiban mechanism of action

Back 9

Factor Xa inhibitor

Front 10

How long do you use LMWH/fondaparinux after hip surgery?

Back 10

4-6wks

Front 11

What constitutes 'major surgery' (and thus requires DVT prophylaxis) (3)

Back 11

intraabdominal surgery
surgery > 45 mins
Pts >40

Front 12

High risk surgery for DVT (5)

Back 12

1. knee replacement
2. hip surgery
3. previous DVT
4. active cancer
5. major surgery

Front 13

Crystalloid solutions (5)

Back 13

1. 0.9% Saline
2. Ringer's Lactate
3. Hartmanns soln
4. Hypertonic saline (7.5%)
5. Dextrose (5%)

Front 14

Blood transfusion required if Hb < ___ (or < _____ in CVD)

Back 14

70
100

Front 15

Normal saline, Ringer's, Hartmanns are all ______ solutions which replenish _____ volume

Back 15

isotonic

extravascular

Front 16

What solution do you use when using fluids in acute brain injury or haemorrhagic shock?

Back 16

Normal saline

Front 17

What is the daily requirement of fluid?

Back 17

2-3L + losses

Front 18

Maintenance fluids for children?

Back 18

"4-2-1" rule (Holliday-Segar formula)
- 4mL/kg/hr for 1st 10kg
- 2mL/kg/hr for 2nd 10kg
- 1mL/kg/hr for remainder

Front 19

Fluid compartments:
2/3 = ______?
1/3 = _______?
1/3 of E/C = ______?

Back 19

I/C
E/C
intravascular (blood)

Front 20

What do you want urine output to be?
(in mL/hr and mL/kg/hr)

Back 20

>30mL/hr
>0.5mL/kg/hr
(but aim for >1mL/kg/hr)

Front 21

What is the maximum concentration of K+ that is saf to infuse via a peripheral line?
Maximum rate?

Back 21

40mmol/L
max rate of 20mmol/hr

Front 22

Normal saline goes rapidly into which compartment and slowly into which?

Back 22

E/C
I/C

Front 23

True or false:
Normal saline is good to use for:
- fluid resus
- maintaining hydration

Back 23

True
True

Front 24

Good maintenance regimen for fluids

Back 24

2 sugars, 1 salt

1L 5% Dextrose over 8h
1L NS over 8h
1L 5% Dextrose over 8h

Front 25

True or false:
5% Dextrose is good for:
- fluid resus
- maintaining hydration

Back 25

false
true

(liver met sugar leaving only H2O => goes rapidly into all compartments)

Front 26

True or false:
Colloid solution is good for:
- fluid resus
- maintaining hydration

Back 26

True
false

(high osmotic content similar to plasma => remains I/V for longer)

Front 27

This reverses heparin?

Back 27

Protamine

Front 28

Early postop haemorrhage due to (2)?

Back 28

- surgical mishap
- anticoags

Front 29

Later (1-2wks) postop haemorrhage due to (1)?

Back 29

infection that has eroded blood vessels

Front 30

Most likely cause of post-op fever in first 48hr?

Back 30

inflammatory response to surgery itself

self limiting, resolves 2-4d

Front 31

6 W for post op fever?

Back 31

Wind (atelectasis) - 1 day post op
Water (UTI) - 3
Walk (DVT) - 5
Wound (infection) - 7
Wonder why (abscess) - 10
Wonder drugs - any day

Front 32

Post op fever >48 hr likely to be ______ cause

Back 32

infectious

Front 33

Most common causes of post op infection (3)

Back 33

UTI (from catheter)
pneumonia (from intubation)
intravascular infection (from IVC)

Front 34

Wound dehiscence can be caused by (4)

Back 34

poor blood supply (diabetics)
antiinflammatory meds (steroids)
physical stress (movement)
bacterial weakening of tissue

Front 35

Mgmt of wound dehiscence

Back 35

- pack wound with gauze and cover with tape
- VAC dressing to remove fluid/bacteria

Front 36

Low risk of bleeding:
when do you stop Warfarin?

Back 36

don't need to

Front 37

High risk of bleeding:
when do you stop Warfarin?

Back 37

3-5 days pre-op
Restart asap after if low risk for VTE

Front 38

If high risk of bleeding from surgery and high risk of VTE (Pt), stop Warfarin 3-5 pre-op and....?

Back 38

bridging Rx of UFH or LMWH
start therapeutic dose when INR <2 after stopping Warfarin
Stop hep and LMWH before surgery (4-6h and 12-24h)

Front 39

Dabigatran mechanism of action

Back 39

direct thrombin inhibitor

Front 40

Low risk of bleeding:
when do you stop aspirin/clopidogrel?

Back 40

You don't need to

Front 41

High risk of bleeding:
when do you stop Aspirin/Clopidogrel?

Back 41

7-10 days before surgery

Front 42

Surgery can be tolerated if Hb > ____ (or >____ in young person)

Back 42

100
80

Front 43

What's most commonly used for blood transfusions for substantial haemorrhage and anaemia?

Back 43

packed red cells

Front 44

What does fresh frozen plasma contain?

Back 44

all clotting factors + other plasma proteins

Front 45

When are platelet replacements required?

Back 45

if plt < 50x 10^9/L

Front 46

Lab Dx of haemolytic rxn after blood transfusion? (2)

Back 46

hyperbilirubinaemia
Positive coombs test

Front 47

S+S of haemolytic rxn after blood transfusion(5)

Back 47

1. pyrexia (rapidly developing)
2. SOB
3. headache
4. loin pain
5. hypotension

Front 48

Metastatic ovarian tumours have a high presponderance for the _________

Back 48

omentum

Front 49

Definitive Dx for cirrhosis?

Back 49

biopsy

Front 50

Pyloric stenosis is caused by what?

Back 50

hypertrophy of pyloric sphincter

Front 51

95% of stomach tumours are what?

Back 51

adenocarcinomas

Front 52

3 branches of coeliac trunk

Back 52

left gastric
common hepatic
splenic

Front 53

What is a pancreatic pseudocyst?

Back 53

Liquefied areas of necrotic pancreatic tissue comes walled off by fibrous tissue to form a cystic space lacking an epithelial lining. Pancreatic secretions drain into it.
Many spont resolve; others can become 2ndarily infected

Front 54

Serous cystadenoma:
benign or malignant?
Mgmt?

Back 54

benign

surgical resection

Front 55

Most pancreatic carcinomas arise in which part of the pancreas?

Back 55

head (60%)

Front 56

Pancreatic carcinoma that presents with jaundice is affecting which part of the pancreas?

Back 56

head

body and tail carcinomas do not impinge on biliary tract and remain silent for some time