Stop Transfusion,give diphenydramine, if it resolves continue w/ transfusio

A Pt just got out of an abd. hernia repair & cant get ahold of his surgeon. He asks when he can resume his Warfarin

Tell him that he can resume 12-24 hours after surgery

Expand my lungs to prevent Atelectasis

What is the recommended VTE prophylaxis for High Risk Orthopaedic Surgery?

Compression Stockings and Lovenox

WOTF signs or symptoms might make you worry about Orbital Cellulitis

Pain with Extraocular movements

Fracture of the base of the skull

Which of the following is most at risk for developing Neurogenic Shock

a 25 y/o with spinal cord injury at T1

What is the recommended regimen for someone undergoing surgery and history of Prosthetic heart valve?

Amoxicillin one hour prior to procedure

WOTF needs DVT prophylaxis for surgery?

Patient in reverse trendelenburg position

Which of the following procedures requires patients to discontinue all NSAIDs for life?

Roux Y Gastric Bypass aka Mini Bypass

Considering the most common life threatening injury in a child(per lecture), what symptoms would be most concerning?

Unilateral absent breath sounds

What is the treatment for this?

Hydrocolloidal Dressing and Compression Stockings

Segmental rib Fxs is allowing a section of the thoracic cage to move freely

Which of the following patients has the least risk for developing a wound infection?

A 30-year-old female who had an episiotomy after childbirth

see below (Pick the closest number to your answer)

621 in first 8 hours, 621 in next 16 hours

D/C Abx and start Oral Vancomycin

Which of the following will need a Tetanus toxoid booster?

A bite wound with last TT 8 years ago

Resuscitate with bolus Crystalloids

Which of the following is true of Neurogenic Shock

parasympathetic nervous is being unopposed causing a loss of vasomotor tone

If a surgeon need a patient to be unconscious and needed only the entire left arm numb. Which of the following is needed

General and regional anesthesia

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ER/Surgery

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Questions 98

Answers

1
What is the recommended instructions for a Type 1 diabetic for the morning of procedure?
1/2 dose of basal insulin
Hold Oral medication and half dose of basal insulin
Usual Dose of Basal insulin
Double the dose of basal insulin
2
see below
Administer acetaminophen and continue transfusion
Stop Transfusion,give diphenydramine, if it resolves continue w/ transfusio
Stop blood tranfusion and give IV hydration to maintain diuresis
Continue with blood transfusion, should resolve on its own
3
You prescribed Orlistat to a patient for weight loss. WOTF do you need to monitor while on this medication?
CBC w/ diff
Monitor for anterograde amnesia
Steatorrhea
Monitor for mood changes
4
On PE you notice bloody drainage. What is your diagnosis?
Seroma
Dehiscence
Infected wound
Hematoma
5
A Pt just got out of an abd. hernia repair & cant get ahold of his surgeon. He asks when he can resume his Warfarin
Tell him "No hablo Ingles"
Tell him he can resume 2 days after surgery
Tell him that he needs to wait 5 days before resuming
Tell him that he can resume 12-24 hours after surgery
6
Which of the following is NOT an indication for a Definitive airway?
50 y/o with GCS of 12
19 y/o with Severe Maxillofacial fracture
69 y/o in PACU status post uneventful endardectomy with neck hematoma
32 y/o with 2.5 L of blood loss
7
see below
Expand my lungs to prevent Atelectasis
Drain excess fluid from my lungs to prevent pneumonia
Promote blood flow to prevent MI
Help my cough reflex to prevent PE
8
What is the recommended VTE prophylaxis for High Risk Orthopaedic Surgery?
Compression Stockings
Lovenox Daily
Aspirin
Compression Stockings and Lovenox
9
What stage is this ulcer? Fat is exposed
Stage 3
Stage 4
Stage 1
Stage 2
10
WOTF signs or symptoms might make you worry about Orbital Cellulitis
Chemosis
Periorbital pain
lid edema
Pain with Extraocular movements
11
see below
Contusion
Fracture of the base of the skull
Open Skull Fracture
Subdural Hematoma
12
How many hours before surgery is patient allowed to drink clear fluids?
8 hours
6 hours
12 hours
2 hours
13
Which of the following should be part of your orders when assessing a crush injury to the lower extremity?
LFTs
Chest Xray
Arterial Blood Gas
Urinalysis
14
WOTF is responsible for preparing the Pts for Sx, helps the Sx team "scrub in" ,passes tools to surgeon and first assist
Circulating Nurse
First assist/PA
Anesthesiologist
Scrub Tech
15
Which of the following is most at risk for developing Neurogenic Shock
55 y/o that took a violent blow to the head
A patient presenting with a STEMI on EKG
a 25 y/o with spinal cord injury at T1
36 y/o with spinal cord injury at T12
16
see below
ESR/CRP
PFTs
Chest Xray
CBC with Diff
17
Using the 4-2-1 rule, calculate the needed maintenance fluid for a person weighing 132 pounds.
172ml/hour
100ml/hour
130ml/hour
1000ml/hour
18
What is the recommended regimen for someone undergoing surgery and history of Prosthetic heart valve?
Vancomycin intraoperatively
Ancef Intraoperatively
Amoxicillin one hour prior to procedure
meropenem 1 hour prior to procedure
19
Which of the following needs to be held the day surgery?
Atorvastatin for dyslipidemia
Lisinopril for HTN
HCTZ for HTN
Amitriptyline for pyschosis
20
How long after the last dose of Coumadin do you start Lovenox if your are bridging for surgery?
12 hours
24 hours
48 hours
36 hours
21
WOTF needs DVT prophylaxis for surgery?
Position in which legs will be in extension for long period of time
Patient going to be placed in trendelenburg position
Patient in prone position
Patient in reverse trendelenburg position
22
Currents Question.....When should a patient stop taking Metformin prior to surgery requiring contrast
The day prior
the day of surgery
1 week prior
Continue taking
23
What is the pre operative dose of Cefazolin for prophylaxis for someone weighing 75 kg?
2 grams
4 grams
3 grams
1 gram
24
Which of the following medications for weight loss is contraindicated with someone with a History of the following ECG?
Phentermine
Semaglutide
Orlistat
Natrexone Buproprion
25
Which of the following procedures requires patients to discontinue all NSAIDs for life?
Gastric Balloon
Gastric Sleeve AKA Sleeve Gastricectomy
Roux Y Gastric Bypass aka Mini Bypass
Duodenal Switch
26
Which of the following should you order 1st in a hypotensive patient presenting with adominal trauma?
MRI
Xray
FAST exam
CT scan
27
Which of the following is not part of your treatment for chest pain with elevated troponin levels?
Adenosine
Morphine
Oxygen
Nitrates
28
see below
maintain fluid
increase fluid by 1/3
decrease fluid by 1/3
stop the fluid
29
General Consensus exists that transfusion is indicated if HgB is
<6
<8
<7
<9
30
WOTF can provide specialists on call 24/7, a trauma team in house, but lack a research component/Surgical residency team
Level 2 trauma center
Level 3 trauma center
Level 4 trauma center
Level 1 trauma center
31
Considering the most common life threatening injury in a child(per lecture), what symptoms would be most concerning?
Unilateral absent breath sounds
Paresthesia
Muffled Heart tones
Flank Ecchymosis
32
What is the treatment for this?
Excision
Hydrocolloidal Dressing and Compression Stockings
Hyperbaric Oxygen Therapy
Revascularize
33
ST elevation in leads II,III, and AVf
circumflex artery
left coronary artery
Left anterior descending artery
Right coronary Artery
34
When is it safest time to do minimally invasive surgery in pregnancy?
2nd trimester
3rd trimester
4th trimeester
1st trimester
35
see below
free air enters the space between the visceral and parietal lung pleura
Segmental rib Fxs is allowing a section of the thoracic cage to move freely
air accumulates in the pleural space & can't exit due to 1 way valve system
Blood in the thoracic space causing bulging of chest
36
see below
Copious, immediate, profuse irrigation
Give Hydroxycobalamin
Resuscitation with Lactated Ringer
100% oxygen treatment
37
Normal lab results obtained within this time period of elective operation do not need repeating preoperatively
1 month
6 months
4 months
12 months
38
What is the desirable glucose levels for diabetics post operatively?
<90
>180
120-180
80-110
39
Which of the following patients has the least risk for developing a wound infection?
A patient with peripheral vascular disease and an ulcer on the heel
A patient receiving chemotherapy who has a surgical incision
A 30-year-old female who had an episiotomy after childbirth
A 17-year-old patient who has a metal fragment lodged in his thigh
40
55 year old with hx of mitral valve replacement is asking for preop instructions on his Warfarin ? what do you tell him?
Stop Warfarin 6-7 days prior to procedure
Bridge to Lovenox
Stop 1 day prior to procedure
Stop warfarin 5 days prior to procedure
41
A patient in hypovolemic shock loses 1 of 5L of blood, what classification of hypovolemic shock is this?
IV
Class I
Class III
Class II
42
see below (Pick the closest number to your answer)
828 in first 12 hours, 828 in next 16 hours
621 in first 8 hours, 621 in next 16 hours
1035 in first 8 hours, 1035 in next 16 hours
828 in first 8 hours, 828 in next 16 hours
43
WOTF is the most common vascular injury in laporoscopic surgery?
Superior mesenteric artery
Abdominal Aorta
Inferior Vena Cava
Inferior epigastric artery
44
Which of the following signs or symptoms might help you recognize early shock?
HR > 100
BP< 90/60
Confusion
Urine output <20 ml per hour
45
Which type of suture is suitable for a face laceration?
3-0 non absorbable mono
5-0 absorbable mono
Staples
6-0 non absorbable mono
46
see below
Start Trial of Bismuth Subsalicylate
Peritoneal lavage and drainage
D/C Abx and start Oral Vancomycin
NG Tube and NPO
47
Which of the following will need a Tetanus toxoid booster?
A bite wound with last TT 8 years ago
A clean cut by knife with TT 7 years ago
A large abratsion wih TT 1 year ago
A puncture wound with last TT 3 years ago
48
see below
Keep BP lower than physiologic loevels
Give hemostatic adjuncts (Antifibrinolytics I.E. Tranexamic Acid)
Resuscitate with bolus Crystalloids
Start DCR/ immediate release of massive transfusion protocol: ratio 1:1:1
49
see below
Simple Pneumothorax
tension pnuemothorax
Pulmonary Contusion
Flail Chest
50
Which of the following is true of Neurogenic Shock
you will see a reflexive tachycardia compensation
The sympathetic nervous system is being unupposed causing bradycardia
parasympathetic nervous is being unopposed causing a loss of vasomotor tone
Systemic Vascular Resistance will be increased
51
If a surgeon need a patient to be unconscious and needed only the entire left arm numb. Which of the following is needed
General and regional anesthesia
General and Neuraxial anesthesia
Neuraxial and Local Anesthesia
Regional and Local Anesthesia
52
Which of the following is NOT part of the criteria of Systemic Inflammatory Response Syndrome?
Temp of < 96.8
Leukocytes > 12,000/mm3
HR > 90
SBP < 90 mm Hg
53
A preop nasal swab test was positive for MRSA colonization prior to surgery. What is the recommended prophylactic ABx?
Vancomycin
Bactrim
Cefazolin
PCN
54
Useless Trivia Time: WOTF is not affected by this type of burn?
Langerhans Cells
Sebaceous Gland
Melanocytes
Merkel Cell
55
Which of the following vitamin deficiences is most prevelant in patients who have underwent Duodenal Switch?
Vitamin C
Vitamin D
Folate
Vitamin B12
56
WOTF is most commonly injured in somone who came in after suffering blunt trauma in a car accident?
Colon
Stomach
Spleen
Diaphragm
57
This is a Currents Bonus question: Someone with a BMI of 37 is considered to be in what class of obesity?
Class II
Class III
Overweight
Class I
58
incoming unnecessary Vignette! see below
Hydroxycobalamin
Aggresive Bolus IV fluid of Lactated ringer
Broad Spectrum ABx
Give Vasopressors
59
see below
Paralytic Ileus
Small Bowel Obstruction
Pseudomembranous Colitis
Acute Peritonitis
60
see below
Obtain Blood cultures
Administer a 500ml IV Crystalloid bolus
Apply Dobutamine
Administer a 1800ml IV crystalloid Bolus
61
Status post endoscopic SX....Acute onset of Abdominal pain w/ gaurding, rigidity, rebound in all quadrants. Leukocytosis
Pseudomembranous Colitis
Pneumonia
Small Bowel Obstruction
Acute PEritonitis
62
see below
Ultrasound Doppler
Chest xray
CT angiography
Flush "pulmonary toilet" aka Chest physiotherapy, incentive spirometry, etc
63
What is the instructions of steroid use for a moderate surgical stress procedure for someone with Primary Adrenal insuff
Morning Dose, 100mg IV before procedure, 50mg IV Q8H for 24hrs with taper
200mg IV prior to procedure
Usual Morning Dose, no further supplementation
Usual Morning Dose, 50mg IV before procedure, 25mg IV Q8H for 24hrs
64
see below
Steroids
Adenosine
Give Norepinephrine
Treatment is only supportive
65
During surgery an incision was made and acute inflammation with purelent drainage encountered. WOTF correlates with this
Dirty Surgery
Contaminated Surgery
Clean-Contaminated Surgery
Clean Surgery
66
Which of the following is the most common cause of pneumonia post operatively?
Klebsiella Pneumonaie
Proteus Mirabilis
Serratia Marcescens
Legeionella pneumophila
67
In addition to irrigation which of the following is appropriate treatment of a Hydroflouric acid burn?
Calcium GLuconate in lubricating jelly
Topical Diclofenac Gel
Alkaline Fluid
Imiquimod
68
Which of the following pulmonary assesments should be assessed in everyone pre operatively?
Chest xray
"STOP BANG" Questionaire
Spirometry
ABGs
69
A patient on Eliquis is getting ready for a kidney biopsy, What is his intructions for Iliquis prior to surgery
stop 5 days prior and start 2 days after
stop 1 day prior and resume 1 day after
stop 2 days prior and resume 2 days after
Consider briding
70
This most common arrythmia in laporoscopic surgery is caused by_____ and is ______and treated with_____
Peritoneal Stretch that causes vasovagal response, Bradycardia, atropine
Compression of arteries, Tachycardia, adenosine
phrenic nerve irritation, SVT, adenosine
Compression of IVC, Bradycardia,propranolol
71
Per our last lecture, what is the perioperative abx for a liver transplant? Which I guess is a dirty procedure....
Piperacillin and Tazobactam
Cefazolin and Metronidazole
Cefazolin
Vancomycin
72
Within what timeframe does dialysis need to be done prior to surgery?
72 hours
48 hours
within the week
24 hours
73
You score a person with Cirrhosis with a MELD score of 9, What is your recommendation for elective surgery?
Recommend against surgery
Undergo Elective surgery
Use Child Pugh Score instead
Undergo Elective surgery with caution
74
WOTF is a gas-specific effect of CO2 pneumoperitoneum? and what is the treatment/mgmt
hypercarbia/ increased ventilation rate
bradycardia/atropine
Shoulder pain/IV pain mgmt pre operatively
decreased GFR/ increase IV fluids
75
Calculate the Excess Body weight for a female: Wt: 275 Ht: 5'6. Not an obj but just in case
145
115
155
125
76
Which of the following would NOT warrant a need for head CT
GCS of 14 in a 45 y/o male
GCS of 14 with skull fracture
GCS of 13 with persistent vomiting
Glassgow Coma Scale of 7
77
Which of the following is part of the A in the ABCD assesment of trauma?
Ausciltate for breath sounds
Assess for blood volume Status
Completely disrobe the patient, and inspect for burns and toxic exposures.
preventing excessive movement of the cervical spine
78
Most Massive Transfusion protocols have a _____Ratio of Packed RBC:Fresh frozen Plasma: Platelets
2:1:1
3:2:1
1:1:1
3:1:1
79
see below
Gastric Sleeve
Duodenal Switch
Roux Y Gastric Bypass
Gastric Lap band
80
Which of the following would be the most likely to be d/c due to their presentation?
Chest pain that does not improve with rest/normal ECG and troponin WNL
Chest pain that improves with rest and troponin levels WNL
Chest pain with ECG that show ST elevation
Female with abd pain w/ elevated troponin levels but no ST elevation on ECG
81
See below
Folate
Iron
thiamine
Vitamin B12
82
see below
30-40
>60%
20-30
40-50
83
WOTF is the antibiotic of choice for prophylaxis for a colorectal surgery?
Vancomycin
Cefazolin
Clindamycin + Gentamicin
Cefazolin + Metronidazole
84
see below.
Fasciotomy
Splint and Consult Ben (Hospitalist)
Apply turniquet and IV abx
Measure intra compartment pressures
85
see below
Start IV and give Whole blood
Draw labs and wait for HCT/HGB results
Start IV and give lactated ringer
Focused assessment with sonography for trauma(FAST Exam)
86
Which of the following fluid mgmnt strategies should be implemented for a Major Sx with <500ml of expected blood loss
1 - 2 L of balanced electrolyte solution
Goal Directed Fluid Therapy using 1 or more invasive hemodynamic parameters
1L of balanced electrolyte solution
3ml/kg/hour
87
see below
D-Dimer
Chest Xray
FAST exam
EKG
88
A Pt with profound anemia comes in to the ER. HCT:30. what do you order and how many do you give to raise to HCT of 42
2 units PRBC's
3 units whole blood
4 units PRBC's
1 unit of whole blood
89
35 y/o healthy female is getting ready for a knee scope. No PMH. Which of the following will she need preoperatively?
Thyroid Function tests
PT/PTT INR
LFTs
Beta hCG
90
see below
Cardiac Testing
Atenolol and Atorvastatin
Low Risk procedure/nothing needed
Amoxocillin 2 grams on hour prior to procedure
91
Which of the following best describes Shock?
widespread inflammation and organ distresss initiated by a microrganism
Gasping at the season finale of Breaking Bad
severe inflammatory process that leads to alveolar epithelial damage
inadequate perfusion and oxygenation to the body
92
You order EKG and HgA1C for preoperative eval of Diabetic patient. WOTF is also needed?
Creatinine
LFTs
ABGs
Thyroid Functions tests
93
see below
Escharotomy
Decrease IV fluid
Irrigation with breif cool water for 3-5 minutes
Escharotomy and Fasciotomy
94
How soon after Bariatric Sx do you want to do comprehensive lab work to check for Vitamin and Nutrional deficiencies?
3 months post op
1 month post op
6 months post op
annualy
95
Someone who is experiencing hypovolemic shock has decreased cardiac output. The decrease in cardiac output occurs due to
a decrease in vascular resistance
A decrease in cardiac contractility
A decrease in cardiac preload
An increase in stroke volume
96
see below
Order a crossmatch
Give O positive blood
Give O negative blood
Order a Type and Screen
97
WOTF is an absolute contraindication to minimally invasive laparoscopic surgery?
Acute Brain injury with increase ICP
Pregnancy
Multiple previous abdominal surgeries
Abdominal wall infection
98
Hola, Soy Yo, Señor Derm Jep! Absent Capillary Refill, Diminished Pain with pin prick, but complains of deep aching pain
What is a 2nd degree Deep Partial Thickness Burn
What is a 3rd degree burn
What is a 2nd degree Superficial Partial Thickness Burn
What is a 4th degree burn

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