podiatry boards 2

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podiatry boards 2
2011-12-27 09:16:49
chapter 20 pre peri post op LAbs management

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  1. Your patient has a hight bun and CR you do a urine tests, there are epithelial cells. what does this mean?
    tubular damage
  2. you patient who has stomach pain has a WBC of 10,000 with 1,000 eosonophils, what might be the etiology of the stomach pain?
  3. What would you worry about with a patient who has a 6.0 potassium in surgery? what would you see on EKG
    Cardiac excitability.

    Peaked T waves

    normal value should be 3.5 -5.5
  4. WHat does hyponatremia (below 135-145) mean?
    • the blood is watered down so it means there is excess volume.
    • Golgin says restrict water in this situation
  5. your patient has 4,000 platelets what might you do?
    they are likely getting a bone marrow transplant, they may allready be bleeding, give platelets.

    1 bag gives raises the platelet level 5500 in a 200 lb patient. so usually give a couple.
  6. Your patient may die of cancer any day, your anestesiologist says what is ASA American society of anesthesiologists surgical risk classification?
    • I healthy
    • II HTN essensial , DM
    • III, COPD or angina
    • IV may die from an illness any day
    • V expected to die from illness with in 24hours
    • VI allready dead awaiting organ harvest
  7. When CBC and Chem 7 values get to what level elective surgery should be canceled?

    Kreatine Kinase
    • HGB 10 gm/dl this is very controversial, SOME docs wound consider giving whole blood, many docs won't because it has not been shown to be effective in changing the course of
    • HCT 30% or less
    • WBC <2400, > 16,000/mm3
    • Neutropenia <1,000/mm3 Normal was 57-67% of the normal 4-10,000 range
    • Plates <50,000 - 100,000
    • K+ 3.5 -5.1 is normal
    • glucose reccomendation range from <150- <180 <200, I always hear<200, aviod long acting insulins. Dextrose can be given to increase sugar (dex is an isomer of glucose)
    • BUN >18 worry about renal insufficiency >50 cancel surgery according to Pocket Pods (PP)
    • Cr 1.2/3.0 & greater renal insufficiency normal is 0.6-1.2
    • Kreatine Kinase increased levels may indicate malignant hyperthemia
  8. you are operating on a rhematiod patient doing a pan met head ressection what special hormone might you need to give this pt
    if they have been taking 7.5 or greater mg of presnisone for more than a few weeks the pituatary adrenal axis will be shut down. so you better help
  9. What are some risk factors to having cardiac complications?
    • CHF noted by an s3 of jugular venous distension
    • >5 pvc's per minute
    • >70 years oldCoronary disease,
    • MI within last 6 months
  10. Who should get prophylaxed for endocarditis whilst undergoing sugery.
    • those with valvular heart disease
    • Rh fever
    • prostetic valve

    • Meds are
    • iv pen or 1st gen ceph
    • if PCN allergic: Clinda300 preop 150 post op
  11. what are cuases of the following post op fevers?
    0-6 post op

    24-48 hrs

    • intra op -
    • transfusion rxn
    • malignant
    • hyperthermia
    • pre-existing sepsis

    • 0-6
    • post op Pain
    • Rebound from cold OR
    • Anesthesia RXN
    • Endocrine cause
    • 24-48 hrsAtelectasis?? some people say this doesnt really cause fever