Post-op care

Post-op care US Medical PG Question 1: A previously healthy 35-year-old woman is brought into the emergency department after being found unresponsive by her husband. Her husband finds an empty bottle of diazepam tablets in her pocket. She is stuporous. At the hospital, her blood pressure is 90/40 mm Hg, the pulse is 58/min, and the respirations are 6/min. The examination of the pupils shows normal size and reactivity to light. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. All 4 extremities are hypotonic. The patient is intubated and taken to the critical care unit for mechanical ventilation and treatment. Regarding the prevention of pneumonia in this patient, which of the following strategies is most likely to achieve this goal?

• A. Nasogastric tube insertion
• B. Daily evaluation for ventilator weaning
• C. Subglottic drainage of secretions (Correct Answer)
• D. Oropharynx and gut antibacterial decontamination
• E. Prone positioning during mechanical ventilation

Post-op care Explanation: ***Subglottic drainage of secretions*** - This is a highly effective strategy to prevent **ventilator-associated pneumonia (VAP)** by continuously removing secretions that pool above the endotracheal tube cuff before they can be aspirated. - Endotracheal tubes with a **subglottic secretion drainage port** reduce VAP incidence by preventing microaspiration of contaminated oropharyngeal secretions into the lower respiratory tract. - This is a **specific mechanical intervention** that directly addresses one of the key pathogenic mechanisms of VAP. *Nasogastric tube insertion* - While an NG tube may be needed for feeding or gastric decompression, it does not directly prevent VAP and may **increase aspiration risk** by compromising the lower esophageal sphincter. - NG tubes can promote gastroesophageal reflux and provide a conduit for bacterial migration. *Daily evaluation for ventilator weaning* - This is also a **critical component of VAP prevention** as part of the ventilator bundle, since reducing duration of mechanical ventilation is the most effective overall strategy to prevent VAP. - However, in this question asking for a strategy to prevent pneumonia in an intubated patient, subglottic drainage is the more specific technical intervention, whereas daily weaning assessment is a broader protocol that reduces exposure time. - Both strategies are important; subglottic drainage addresses the "how" of prevention during intubation, while weaning protocols address the "duration" of risk exposure. *Oropharynx and gut antibacterial decontamination* - Selective digestive decontamination (SDD) aims to reduce bacterial colonization, but evidence for routine use is mixed and raises concerns about **antimicrobial resistance**. - Not universally recommended as a primary VAP prevention strategy in most guidelines. *Prone positioning during mechanical ventilation* - **Prone positioning** is primarily indicated for improving oxygenation in **Acute Respiratory Distress Syndrome (ARDS)**, not for VAP prevention. - While it may improve secretion drainage, it is not a standard VAP prevention measure and carries its own risks and logistical challenges.

Post-op care US Medical PG Question 2: A 37-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He suffered multiple deep lacerations and experienced significant blood loss during transport. In the emergency department, his temperature is 98.6°F (37°C), blood pressure is 102/68 mmHg, pulse is 112/min, and respirations are 22/min. His lacerations are sutured and he is given 2 liters of saline by large bore intravenous lines. Which of the following changes will occur in this patient's cardiac physiology due to this intervention?

• A. Increased cardiac output and unchanged right atrial pressure
• B. Decreased cardiac output and increased right atrial pressure
• C. Increased cardiac output and decreased right atrial pressure
• D. Increased cardiac output and increased right atrial pressure (Correct Answer)
• E. Decreased cardiac output and decreased right atrial pressure

Post-op care Explanation: ***Increased cardiac output and increased right atrial pressure*** - The patient experienced significant blood loss, leading to a **decreased preload** and subsequent **reduced cardiac output**. Volume resuscitation with saline directly increases the **intravascular volume** which bolsters **venous return** and **right atrial pressure**. - According to the **Frank-Starling mechanism**, increased right atrial pressure (a measure of preload) results in an increase in ventricular stretch and a more forceful contraction, thereby increasing **stroke volume** and **cardiac output**. *Increased cardiac output and unchanged right atrial pressure* - While fluid administration will increase **cardiac output** by improving preload, it will also directly lead to an increase in **right atrial pressure** due to the augmented venous return. - An unchanged right atrial pressure would imply no significant increase in central venous volume, which contradicts the effect of a large volume fluid resuscitation. *Decreased cardiac output and increased right atrial pressure* - This scenario is unlikely because increasing **intravascular volume** through fluid resuscitation typically aims to raise **cardiac output** by optimizing preload, not decrease it. - A decrease in cardiac output despite increased right atrial pressure could indicate **cardiac pump failure**, which is not suggested by the clinical picture of hypovolemic shock treated with fluids. *Increased cardiac output and decreased right atrial pressure* - An increase in **cardiac output** as a result of fluid resuscitation is expected, but a **decreased right atrial pressure** would contradict the mechanism of increased venous return and volume expansion. - Decreased right atrial pressure would typically indicate ongoing volume loss or inadequate fluid resuscitation to restore central venous volume. *Decreased cardiac output and decreased right atrial pressure* - Both decreasing **cardiac output** and decreasing **right atrial pressure** indicate a worsening state of **hypovolemia** or an inadequate response to fluid resuscitation. - The administration of 2 liters of saline is intended to correct the hypovolemia and improve cardiodynamics, not to worsen them.

Post-op care US Medical PG Question 3: A 25-year-old previously healthy woman is admitted to the hospital with progressively worsening shortness of breath. She reports a mild fever. Her vital signs at the admission are as follows: blood pressure 100/70 mm Hg, heart rate 111/min, respiratory rate 20/min, and temperature 38.1℃ (100.6℉); blood saturation on room air is 90%. Examination reveals a bilateral decrease of vesicular breath sounds and rales in the lower lobes. Plain chest radiograph demonstrates bilateral opacification of the lower lobes. Despite appropriate treatment, her respiratory status worsens. The patient is transferred to the intensive care unit and put on mechanical ventilation. Adjustment of which of the following ventilator settings will only affect the patient’s oxygenation?

• A. Tidal volume and respiratory rate
• B. FiO2 and PEEP (Correct Answer)
• C. Respiratory rate and PEEP
• D. Tidal volume and FiO2
• E. FiO2 and respiratory rate

Post-op care Explanation: ***FiO2 and PEEP*** - **FiO2 (fraction of inspired oxygen)** directly controls the oxygen concentration delivered to the patient, thus solely impacting **oxygenation**. - **PEEP (positive end-expiratory pressure)** prevents alveolar collapse and recruits collapsed alveoli, improving the **functional residual capacity** and thus **oxygenation** without significantly altering CO2 removal (ventilation). *Tidal volume and respiratory rate* - **Tidal volume (Vt)** directly impacts the amount of air moved with each breath, primarily affecting **ventilation** (CO2 removal). - **Respiratory rate (RR)** also directly determines the total minute ventilation, thus influencing **ventilation** more than oxygenation. *Respiratory rate and PEEP* - As mentioned, **respiratory rate** significantly affects **ventilation** by altering minute ventilation (Vt x RR). - While **PEEP** primarily affects oxygenation, the combination with respiratory rate means it's not exclusively targeting oxygenation. *Tidal volume and FiO2* - **Tidal volume** is a key determinant of **ventilation** (CO2 removal), not solely oxygenation. - **FiO2** does affect oxygenation, but its combination with tidal volume makes this option incorrect for *only* affecting oxygenation. *FiO2 and respiratory rate* - **FiO2** directly impacts **oxygenation**. - **Respiratory rate** primarily affects **ventilation** (CO2 removal), thereby influencing carbonic acid levels and pH.

Post-op care US Medical PG Question 4: A 72-year-old man presents to the emergency department after a fall. The patient was found lying down on the floor in his room in his retirement community. The patient has a past medical history of Alzheimer dementia and a prosthetic valve. His current medications include donepezil and warfarin. His temperature is 97.7°F (36.5°C), blood pressure is 85/50 mmHg, pulse is 160/min, respirations are 13/min, and oxygen saturation is 97% on room air. The patient is started on IV fluids and a type and screen is performed. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 39% Leukocyte count: 5,500 cells/mm^3 with normal differential Platelet count: 225,000/mm^3 INR: 2.5 AST: 10 U/L ALT: 12 U/L A chest radiograph and EKG are performed and are within normal limits. A full physical exam is within normal limits. The patient's vitals are repeated. His temperature is 99.5°F (37.5°C), blood pressure is 110/70 mmHg, pulse is 90/min, respirations are 10/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?

• A. CT scan (Correct Answer)
• B. Urgent blood transfusion
• C. Fresh frozen plasma
• D. Exploratory laparoscopy
• E. Exploratory laparotomy

Post-op care Explanation: ***CT scan*** - A patient with a **prosthetic valve** on **warfarin** and a fall is at high risk for **intracranial hemorrhage**, even without focal neurological deficits. - While initial vitals improved after IV fluids, the mechanism of injury (fall) and medication profile warrant a **CT scan** of the head to rule out serious internal injury, especially given the history of dementia which might mask symptoms. *Urgent blood transfusion* - The patient's **hemoglobin (13 g/dL)** and **hematocrit (39%)** are within normal limits, indicating no acute need for blood transfusion due to hemorrhage. - Transfusions are typically reserved for patients with significant blood loss or severe symptomatic anemia. *Fresh frozen plasma* - The patient's **INR of 2.5** is within the therapeutic range for a patient with a prosthetic valve on warfarin. - There is no evidence of active bleeding or supratherapeutic anticoagulation that would necessitate the administration of **fresh frozen plasma (FFP)** to reverse anticoagulation. *Exploratory laparoscopy* - There are no clinical signs or symptoms, such as abdominal pain, distension, or evidence of intra-abdominal bleeding (e.g., declining hemoglobin, peritoneal signs), to suggest an indication for an **exploratory laparoscopy**. - The patient's physical exam was described as normal. *Exploratory laparotomy* - Similar to laparoscopy, there is no clinical evidence of acute abdominal injury or hemorrhage, which would necessitate an **exploratory laparotomy**. - This invasive procedure is reserved for cases with strong suspicion of significant intra-abdominal pathology or trauma.

Post-op care US Medical PG Question 5: Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show: Hemoglobin 12.3 g/dL Leukocyte count 11,200/mm3 Platelet count 210,000/mm3 Bleeding time 4 minutes Prothrombin time 15 seconds (INR=1.1) Activated partial thromboplastin time 36 seconds Serum Urea nitrogen 30 mg/dL Glucose 96 mg/dL Creatinine 1.1 mg/dL AST 48 U/L ALT 34 U/L γ-Glutamyltransferase 70 U/L (N= 5–50 U/L) Which of the following is the most likely cause of this patient's bleeding?

• A. Factor VIII deficiency
• B. Liver dysfunction
• C. Erosion of blood vessels
• D. Insufficient mechanical hemostasis (Correct Answer)
• E. Platelet dysfunction

Post-op care Explanation: ***Insufficient mechanical hemostasis*** - The patient's **coagulation studies are within normal limits** (normal PT, aPTT, bleeding time, and platelet count), ruling out most common intrinsic bleeding disorders. - Given the timing (8 hours post-surgery) and the nature of bleeding (oozing from incision margins and colostomy site), **inadequate surgical closure or ligature** is the most probable cause. *Factor VIII deficiency* - This would present with a **prolonged activated partial thromboplastin time (aPTT)**, which is normal in this patient (36 seconds). His brother's death from a bleeding disorder is a red herring. - Congenital factor deficiencies typically manifest earlier in life and cause more severe, spontaneous bleeding, not just post-operative oozing with normal coagulation factors. *Liver dysfunction* - Severe liver dysfunction would typically lead to **prolonged PT and aPTT** due to impaired synthesis of clotting factors. - While the patient has elevated GGT, indicating some liver stress likely from alcohol, his AST and ALT are only mildly elevated, and his coagulation tests are normal. *Erosion of blood vessels* - This is less likely to cause widespread oozing and would typically present as a more significant, **pulsatile hemorrhage** or hematoma. - While possible in a surgical field, the lack of significant hemodynamic compromise and normal coagulation points away from a major vessel erosion. *Platelet dysfunction* - This would typically result in a **prolonged bleeding time**, which is normal in this patient (4 minutes). - Although the patient was on aspirin, it was stopped 7 days prior to surgery, which is typically sufficient for platelet function to recover.

Post-op care US Medical PG Question 6: Serum studies show a troponin T concentration of 6.73 ng/mL (N < 0.01), and fingerstick blood glucose concentration of 145 mg/dL. The cardiac catheterization team is activated. Treatment with unfractionated heparin, aspirin, ticagrelor, and sublingual nitroglycerin is begun, and the patient's pain subsides. His temperature is 37.3°C (99.1°F), pulse is 65/min, respirations are 23/min, and blood pressure is 91/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Which of the following is the most appropriate additional pharmacotherapy?

• A. Intravenous morphine
• B. Intravenous furosemide
• C. Intravenous insulin
• D. Oral atorvastatin (Correct Answer)
• E. Intravenous nitroglycerin

Post-op care Explanation: ***Oral atorvastatin*** - All patients with **acute coronary syndrome (ACS)** should receive high-intensity statin therapy, such as **atorvastatin 80 mg daily**, as early as possible. - Statins stabilize plaques, reduce inflammation, and improve endothelial function, which are crucial in the acute setting of a myocardial infarction. *Intravenous morphine* - Morphine can be used for persistent chest pain refractory to nitroglycerin, but its routine use is now questioned due to potential adverse effects like hypotension and delayed antiplatelet absorption. - The patient's pain has already subsided with initial treatment, and his blood pressure is already low (91/60 mm Hg), making morphine less appropriate. *Intravenous furosemide* - Furosemide is a loop diuretic primarily used for treating **fluid overload** and **pulmonary edema**, which are not indicated by the patient's current presentation (oxygen saturation 96%, no mention of crackles or dyspnea). - Its use in a patient with **borderline hypotension** could worsen hemodynamic stability. *Intravenous insulin* - While the patient has elevated fingerstick glucose (145 mg/dL), this level does not immediately require intravenous insulin unless there is evidence of **diabetic ketoacidosis** or **hyperosmolar hyperglycemic state**, or persistent severe hyperglycemia. - More moderate hyperglycemia can often be managed with subcutaneous insulin or diet in the acute phase, and focuses remain on cardiac stabilization. *Intravenous nitroglycerin* - Intravenous nitroglycerin is indicated for ongoing ischemic chest pain or uncontrolled hypertension in ACS, but the patient's pain has subsided and he is **hypotensive** (91/60 mm Hg). - Administering more nitroglycerin would likely worsen his hypotension and could compromise coronary perfusion.

Post-op care US Medical PG Question 7: A 14-year-old male presents to the emergency department with altered mental status. His friends who accompanied him said that he complained of abdominal pain while camping. They denied his consumption of anything unusual from the wilderness, or any vomiting or diarrhea. His temperature is 100.5°F (38.1°C), blood pressure is 95/55 mmHg, pulse is 130/min, and respirations are 30/min. His pupils are equal and reactive to light bilaterally. The remainder of the physical exam is unremarkable. His basic metabolic panel is displayed below: Serum: Na+: 116 mEq/L Cl-: 70 mEq/L K+: 4.0 mEq/L HCO3-: 2 mEq/L BUN: 50 mg/dL Glucose: 1010 mg/dL Creatinine: 1.2 mg/dL While the remainder of his labs are pending, the patient becomes bradypneic and is intubated. His ventilator is adjusted to volume control assist-control with a respiratory rate (RR) of 14/min, tidal volume (Vt) of 350 mL, positive end-expiratory pressure (PEEP) of 5 cm H2O, and fractional inspired oxygen (FiO2) of 40%. His height is 5 feet 5 inches. Intravenous fluids and additional medical therapy are administered. An arterial blood gas obtained after 30 minutes on these settings shows the following: pH: 7.05 pCO2 :40 mmHg pO2: 150 mmHg SaO2: 98% What is the best next step in management?

• A. Increase respiratory rate
• B. Increase respiratory rate and tidal volume (Correct Answer)
• C. Increase tidal volume
• D. Increase tidal volume and positive end-expiratory pressure
• E. Increase positive end-expiratory pressure

Post-op care Explanation: ***Increase respiratory rate and tidal volume*** - The patient presents with **severe metabolic acidosis** (pH 7.05, HCO3- 2 mEq/L) due to likely **diabetic ketoacidosis** given the hyperglycemia and altered mental status. - To compensate for metabolic acidosis, the body attempts to lower pCO2 through **hyperventilation**; therefore, increasing both the **respiratory rate** and **tidal volume** will increase minute ventilation and help "blow off" CO2, thus improving the pH. *Increase respiratory rate* - While increasing the respiratory rate will help decrease pCO2 and improve pH, it may not be sufficient on its own to correct the severe acidosis. - **Tidal volume** also plays a crucial role in minute ventilation and CO2 elimination; addressing both components is more effective. *Increase tidal volume* - Increasing tidal volume alone will also increase minute ventilation and help reduce pCO2. - However, combining it with an increased respiratory rate is more effective for severe acidosis, as both parameters contribute to **CO2 clearance**. *Increase tidal volume and positive end-expiratory pressure* - Increasing tidal volume helps reduce pCO2, but increasing PEEP primarily improves **oxygenation** by preventing alveolar collapse and increasing functional residual capacity. - The patient's pO2 is already high (150 mmHg) with 98% SaO2, so **oxygenation is not the primary concern**; the focus should be on correcting the acidosis by reducing pCO2. *Increase positive end-expiratory pressure* - As mentioned, PEEP is primarily used to improve **oxygenation** and manage conditions like acute respiratory distress syndrome (ARDS), which is not the immediate problem here. - The patient's **pO2 is adequate**, and PEEP will not directly address the **severe metabolic acidosis** or aid significantly in CO2 removal.

Post-op care US Medical PG Question 8: A 14-year-old girl presents to the emergency room complaining of abdominal pain. She was watching a movie 3 hours prior to presentation when she developed severe non-radiating right lower quadrant pain. The pain has worsened since it started. She also had non-bloody non-bilious emesis 1 hour ago and continues to feel nauseated. Her temperature is 101°F (38.3°C), blood pressure is 130/90 mmHg, pulse is 110/min, and respirations are 22/min. On exam, she has rebound tenderness at McBurney point and a positive Rovsing sign. She is stabilized with intravenous fluids and pain medication and is taken to the operating room to undergo a laparoscopic appendectomy. While in the operating room, the circulating nurse leads the surgical team in a time out to ensure that introductions are made, the patient’s name and date of birth are correct, antibiotics have been given, and the surgical site is marked appropriately. This process is an example of which of the following human factor engineering elements?

• A. Forcing function
• B. Safety culture
• C. Simplification
• D. Standardization (Correct Answer)
• E. Resilience engineering

Post-op care Explanation: ***Standardization*** - The surgical **time-out** is a prime example of **standardization** in healthcare, as it involves a prescribed, uniform procedure followed in every surgery to enhance safety. - It ensures critical safety checks—like patient identification, site marking, and antibiotic administration—are consistently performed, thus reducing variability and the potential for errors. *Forcing function* - A **forcing function** is a design element that makes it impossible to commit an error, such as a specific connector shape that prevents incorrect device attachment. - The time-out, while a critical safeguard, still relies on human compliance and does not physically prevent an error from occurring if the steps are not followed. *Safety culture* - **Safety culture** refers to the shared beliefs, values, and attitudes that employees have about safety within an organization. - While a time-out contributes to a strong safety culture, it is a specific process or tool, not the overarching culture itself. *Simplification* - **Simplification** aims to reduce complexity in a process to minimize cognitive load and potential for error. - The time-out adds a structured step rather than simplifying an existing process; its purpose is to ensure all necessary checks are systematically completed. *Resilience engineering* - **Resilience engineering** focuses on an organization's ability to anticipate, cope with, and recover from failures, maintaining stability in the face of disruptions. - While the time-out promotes safety, it primarily addresses error prevention rather than the broader organizational capacity to adapt and recover from system failures.

Post-op care US Medical PG Question 9: A regional academic medical center has 10 cases of adenovirus in the span of a week among its ICU patients. A committee is formed to investigate this outbreak. They are tasked with identifying the patients and interviewing the care providers to understand how adenovirus could have been spread from patient to patient. This committee will review charts, talk to the care provider teams, and investigate current patient safety and sanitation measures in the ICU. The goal of the committee is to identify weaknesses in the current system and to put in place a plan to help prevent this sort of outbreak from reoccurring in the future. The committee is most likely using what type of analysis?

• A. Simulation
• B. Root cause analysis (Correct Answer)
• C. Algorithmic analysis
• D. Heuristic analysis
• E. Failure mode and effects analysis

Post-op care Explanation: ***Root cause analysis*** - The committee's goal is to **identify weaknesses** in the current system and **prevent recurrence**, which aligns perfectly with the principles of **root cause analysis (RCA)**. - RCA is a structured method for **identifying the underlying causes** of problems or incidents, rather than just addressing symptoms. *Simulation* - **Simulation** involves creating a model of a process or system to test different scenarios and predict outcomes. - While useful for planning, it's not the primary method for investigating an actual past event or identifying causative factors after an outbreak has occurred. *Algorithmic analysis* - **Algorithmic analysis** is primarily used in computer science to evaluate the efficiency and complexity of algorithms. - It does not apply to investigating the spread of infectious diseases or healthcare system failures. *Heuristic analysis* - **Heuristic analysis** involves using a rule of thumb or an educated guess to solve a problem quickly and efficiently, especially when perfect solutions are not feasible. - This approach is less systematic and comprehensive than what is required to thoroughly investigate an outbreak and identify root causes. *Failure mode and effects analysis* - **Failure mode and effects analysis (FMEA)** is a proactive method used to identify **potential failure modes** in a system and their effects *before* an event occurs. - The committee is investigating an **already existing problem**, making RCA more appropriate than FMEA, which is used for risk assessment of future processes.

Post-op care US Medical PG Question 10: A 30-year-old male gang member is brought to the emergency room with a gunshot wound to the abdomen. The patient was intubated and taken for an exploratory laparotomy, which found peritoneal hemorrhage and injury to the small bowel. He required 5 units of blood during this procedure. Following the operation, the patient was sedated and remained on a ventilator in the surgical intensive care unit (SICU). The next day, a central line is placed and the patient is started on total parenteral nutrition. Which of the following complications is most likely in this patient?

• A. Mesenteric ischemia
• B. Hypocalcemia
• C. Refeeding syndrome
• D. Sepsis (Correct Answer)
• E. Cholelithiasis

Post-op care Explanation: ***Sepsis*** - This patient has undergone **major abdominal surgery** after a **gunshot wound**, which carries a high risk of **peritoneal contamination** and subsequent infection. - He also has several risk factors for sepsis, including **intubation**, central line placement, and possibly prolonged ventilation, all of which increase the risk of nosocomial infections and subsequent sepsis. *Mesenteric ischemia* - While possible in critically ill patients, there is no direct evidence such as advanced age, atherosclerosis, or specific signs of **bowel ischemia** (e.g., severe abdominal pain disproportionate to exam, bloody diarrhea) presenting in this case. - The initial injury was to the small bowel, but the current context points more to systemic complications rather than a focal vascular event. *Hypocalcemia* - Hypocalcemia can occur in critically ill patients due to various reasons, but it is not the *most likely* complication given the patient's presentation primarily focused on surgical trauma and subsequent interventions. - Dilutional effects from massive transfusions or **citrate toxicity** could contribute to temporary hypocalcemia, but sepsis poses a more immediate and widespread threat. *Refeeding syndrome* - Refeeding syndrome occurs when severely malnourished patients are rapidly refed, leading to shifts in **electrolytes** (especially **phosphate**, potassium, magnesium). - Although the patient is starting **total parenteral nutrition (TPN)**, there's no indication of prior severe malnutrition, making sepsis a more prominent immediate concern due to the gunshot wound and surgery. *Cholelithiasis* - **Cholelithiasis** (gallstones) can be a long-term complication of total parenteral nutrition (TPN) due to gallbladder stasis. - However, it is unlikely to develop so acutely within a day of starting TPN and is thus not the most immediate or likely complication for this patient's acute critical state.

Post-op care Flashcard 1 of 10

Question: Short bowel syndrome is most commonly seen in patients who have had _____

Answer: small intestine resection

Post-op care Flashcard 2 of 10

Question: What surgical procedure is associated with iron deficiency anemia?_____ *Why

Answer: Gastrectomy

Post-op care Flashcard 3 of 10

Question: Injury to the iliohypogastric nerve often presents as burning or tingling pain at the _____ radiating to the inguinal and suprapubic region

Answer: surgical incision site

Post-op care Flashcard 4 of 10

Question: Patients who have undergone _____ surgery can sometimes manifest with symptoms of hypoparathyroidism and hypocalcemia.

Answer: Thyroid

Post-op care Flashcard 5 of 10

Question: Bladder irrigation is used for patients with hematuria to prevent the formation of _____

Answer: blood clots

Post-op care Flashcard 6 of 10

Question: A gastrojejunostomy removes the gastric antrum and attaches the gastric body to the _____

Answer: proximal jejunum

Extra Information:  https://onlinemeded.org?ref=anki 

Post-op care Flashcard 7 of 10

Question: How is a large ventricular septal defect treated? _____

Answer: Surgical closure

Extra Information:   Watch Left to Right Shunts [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-cardiac/videos/medical-pathophysiology-cardiac-congenital-heart-disease-left-to-right-shunts?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/cardiology/videos/acyanotic-congenital-heart-defects?index=3] https://onlinemeded.org/spa/pediatrics/congenital-defects/acquire?ref=anki Atlas: 

Post-op care Flashcard 8 of 10

Question: An example of non-facial nerve palsy synkinesis is Freys Syndrome, where the auriculotemporal branch of V3 is cut during an excision of the parotid gland and reinnervates the _____ in front of the ear

Answer: skin sweat glands

Extra Information:  https://onlinemeded.org?ref=anki 

Post-op care Flashcard 9 of 10

Question: Cutaneous healing by _____ intention is when the wound edges are brought together (e.g. suturing a surgical incision)

Answer: primary

Extra Information:   https://onlinemeded.org/spa/inflammation-and-neoplasia/wound-healing/acquire?ref=anki 

Post-op care Flashcard 10 of 10

Question: The _____ nerve may be transected during ligation of the superior thyroid artery during thyroid surgery

Answer: superior laryngeal

Extra Information:  https://onlinemeded.org/spa/endocrine?ref=anki