Preoptimization
Antibiotics
Clots
Injuries
Potpourri
100
How many days before non cardiac surgery should aspirin be discontinued?
5-7 days prior to surgery
100
Which antibiotic should be used for a laparoscopic ovarian cystectomy
None
100
Which risk assessment model can be used to guide preoperative VTE prophylaxis?
The Caprini VTE risk assessment model or Rogers score
100
Which bowel preparation has been shown to decrease bowel injury?
None
100
Patient's can ingest clear liquids up to how many hours prior to anesthesia induction?
2 hours
Solids up to 6 hours prior to surgery
200
How many weeks prior to surgery should you recommend smoking cessation?
4 weeks
200
You are performing a hysterectomy and your patient reports a history of hives with penicillin. What agents and dose do you select?
Gentamycin 5mg/kg
Clindamycin 900mg
200
List 5 risk factors for VTE
Age > 40, major surgery, BMI, swollen legs, varicose veins, pregnancy/postpartum, RLD, OCPs/HRT, recent sepsis, recent serious lung disease, MI, CHF, IBD, bed rest / immobility, major surgery, malignancy, central venous access, hx of VTE, FH VTE, factor V leiden, prothrombin 20210A, lupus anticoagulant, anticardiolipin, heparin induced thrombocytopenia
200
What is used to test the integrity of a cystotomy repair?
instillation of dye or sterile milk
200
List 3 early signs of lidocaine toxicity
Circumoral numbness
Tongue tingling
Tinnitus
Blurred vision
Dizziness
300
What preoperative Hgb A1c level is associated with postoperative wound infection
> 7
300
Provide 2 scenarios when cefazolin needs to be redosed
Surgery >4hrs
EBL >1500cc
300
What VTE prophylaxis is used for patient with a low risk of VTE?
Mechanical prophylaxis / intermittent pneumatic compression
Graduated compression stockings are reasonable alternative
Should be placed before initiation of surgery and continued until patient is fully ambulatory
300
This is how you repair a cystotomy that is >3cm at the bladder dome
Repair in 2 layers using absorbable synthetic suture, nonlocked, running
Catheter decompression 5-14 days
300
What is the most likely site of ureteral injury during hysterectomy
the distal ureter at the level of the uterine arteries
400
Your patient is on warfarin for A-fib and you are planning a laparoscopic hysterectomy. When should she hold her warfarin, and when can she restart?
Hold 5 days prior to surgery
Restart 12-24 hrs after surgery
400
At which weight in kilos do you have to increase dose of cefazolin during gynecologic procedures.
120 kg > 3g cefazolin
400
Name one of the most common mutations found in patients with VTE
Factor V Leiden and prothrombin gene mutation G20210A
400
What is the appropriate technique for a 5mm full thickness small bowel injury.
2 layer closure using 3-0 vicryl or PDS
400
What is the maximum dose of lidocaine without epinephrine that can be used?
4 mg/kg
With epinephrine 7mg/kg
500
List 3 patient conditions that would lead you to order a preoperative EKG
HTN, heart failure, coronary artery disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, diabetes or other significant structural heart disease
500
What is an effective alternative to cefazolin for hysterectomy?
Amoxicillin–clavulanic
500
What VTE prophylaxis is recommended for a patient with a high risk for VTE?
Mechanical prophylaxis and heparin vs LMWH
500
Which nerve is injury results from excessive hip flexion or abduction?
Femoral nerve
Self retaining retractors are most common culprit
500
What is the maximum intraabdominal pressure allowed in order to ensure central venous return and diaphragmatic excursion
20-24mmHg
600
You are planning surgery for a patient is taking metoprolol, amlodipine, lisinopril, and lasix. When should she stop taking each medicine?
metoprolol = continue incl day of surgery
amlodipine = continue incl day of surgery
lisinopril = hold 24 hours before surgery
lasix = hold dose day of surgery
600
Provide 2 gynecologic scenarios in which doxycycline is indicated
Uterine evacuation
Hysterosalpingogram Chromopertubation with PID or hydrosalpinx
600
What BMI cuttoff is considered higher risk for VTE?
BMI >25
600
How should a ureteral injury that occurred a the level of the IP be repaired?
Ureteroureterostomy
600
Which incision allows for more space by releasing the rectus muscle tendons at their inferior tendinous insertion?
Cherney