外科学复习资料：围手术期

1、1.A patient with a nonobstructing carcinoma of the sigmoid colon is being prepared for elective resection .To minimize the risk of postoperative infectious complications, your planning shoud includea. A single preoperative parenteral dose of antibiotic effective against aerobes and anaerobes.b. Avoi

2、dance of oral antibiotics to prevent emergence of Clostridium difficile.c. Postoperative administration for 2-4 days of parenteral antibiotics effective againse aerobes and anaerobesd. Postoperative administration for 5-7 days of parenteral antibiotics effctive against aerobes and anaerobese. Operat

3、ive time less than 5 h2.A 70-year-old man with aortic and mitral valvula regurgitation undergoes an emergency sigmoid colectomy and end colostomy for perforated diverticulitis.His postoperative course is complicated by a myocardial infarction and atrial fibrillation. Four weeks later,he has improved

4、 and requests elective colostomy closure.You would recommenda. Discontinuation of antiarrhythmic and antihypertensive medications on the morning of surgeryb. Discontinuation of beta-blocking medications on the day prior to surgeryc. Control of congestive heart failure with diuretics and digitalis in

5、 severe casesd. Administration of prophylactic antibiotics,other than ampicillin and gentamicin ,for patients with valvular heart disease who are undergoing gastrointestinal procedurese. Postponement of elective surgery for 6-8 wk after a subendocardial myocardial infarction.3. A 65-year-old man und

6、ergoes a technically difficult abdominoperineal resection for a rectal cancer during which he receives three units of packed red blood cells, Four hours later in the intensive care unit he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrombin, partial t

7、hromboplastin, and bleeding times. The fibrin degradation products are not elevated but the serum fibrinogen content is depressed and the platelet count is 70,000/Ul. The most likely cause of the bleeding is a. Delayed blood transfusion reactionb. Autoimmune fibrinolysisc. A bleeding blood vessel in

8、 the surgical fieldd. Factor VIII deficiencye. Hypothermic coagulopathy4. A 78-year-old man with a history of coronary artery disease and an asymptomatic reducible inguinal hernia requests an elective hermia repair. You explain to him that valid reasons for delaying the proposed surgery includea. Co

9、ronary artery bypass surgery 3 mo earlierb. A history of cigarette smoking c. Jugular venous distensiond. Hypertensione. Hyperlipidemia4. An elderly diabetic woman with chronic steroid-dependent bronchospasm has an ileocolectomy for a perforated cecum. She is taken to the the ICU intubated and is ma

10、intained on broad-spectrum antibiotics, renal-dose dopamine, and a rapid steroid taper. On postoperative day 2 she develops a fever of 39.20C, hypotension, lethargy, and laboratory values remarkable for hypoglycemia and hyperkalemia. The most likely diagnosis of this acute event isa. Sepsisb. Hypovo

11、lemiac. Adrenal insufficiencyd. Acute tubular necrosise. Diabetic ketoacidosis5. A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires an urgent cholecystectomy. A transfusion of fresh frozen plasma is planned to minimize the risk of bleeding due to surg

12、ery. The optimal timing of this transfusion would bea. The day before surgery b. The night before surgeryc. On call to surgeryd. Intraoperativelye. In the recovery room6. On postoperative day 3, an otherwise healthy 55-year-old man recovering from a partial hepatectomy is noted to have scant serosan

13、guineous drainage from his abdominal incision. His skin staples are removed, revealing a 1.0-cm dehiscence of the upper midline abdominal fascia. Which of the following actions is most appropriate?a. Removing all suture material and packing the wound with moist sterile gauzeb. Starting intravenous a

14、ntibioticsc. Placing an abdominal (Scultetus) binderd. Prompt resuturing of the fascia in the operating roome. Bed rest7.Five days after a sigmoid colectomy for cancer , a patients skin staples are removed and a large gush of serosanguineous fluid emerges.Examination of the wound reveals an extensiv

15、e fascial dehiscence. The most appropriate management isa. Wide opening of the wound to assure adequate drainageb. Smear and culture of the fluid and appropriate antibiotics after the amear is reviewedc. Careful reapproximation of the wound edges with taped. Immediate return to the operating roome.

16、Application of a Scultetus binder8.The preoperative characteristis of patients likely to experience postoperative ischemia after noncardiac surgery includea. Anginab. More than three premature ventricular contractions (PVCs)per minutec. Dyspnea on exertiond. Age greater than 60 years9.Compensatory m

17、echanisms during acute hemorrhage includea. Decreased cerebral and coronary blood flowb. Decreased myocardial contractilityc. Renal and splanchnic vasodilationd. Increased respiratory ratee. Decreased renal sodium resorption10.An in-hospital workup of a 78-year-old ,hypertensive, mildly asthmatic ma

18、n who is receiving chemotherapy for colon cancer reveals symptomatic gallstones. Preoperative laboratory results are notable for a hematocrit of 24% and a urinalysis with 18-25 WBCs and gram-negative bacteria. On call to the operating room he receives intravenous penicillin. His abdomen is shaved in

19、 the operating room. An open cholecystectomy is performed and , despite a lack of indications ,The common bile duct is explored. The wound is closed primarily with a Penrose drain exiting a separate stab wound .On postoperative day 3 the patient develops a wound infection.Which of the following chan

20、ges could make this wound a less favorable environment for infection?a. Decreasing the operative time and wound contamination by omitting the common bile duct explorationb. Placing a Penrose drain exiting directly through the lateral corner of the woundc. Using oral rather than intravenous penicillin perioperativelyd. Leaving a seroma in the wound to prevent desiccation of the tissuese. Reinforcing the wound clsure with a sheet of prosthetic p