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  #1  
Old 06-28-2011
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Surgery postoperative complication 3 cases

The response options for the items in this set are the same. Select one answer for each item in the set.

For each postoperative patient, select the most likely cause of fever.


Item 1 of 3

A 61-year-old woman is 2 days status post–sternotomy and coronary artery bypass. She complains of pain at and around the incision site, and is using patient-controlled analgesic (PCA)-delivered morphine every 6 hours. Nurses get her out of bed two- to-three times a day to use the restroom and to sit in a chair. Otherwise, she remains inactive. On day 3, she develops a fever of 38.3°C (101° F). She has no cough, diarrhea, vomiting, or other complaints other than the operative site pain. Her heart rate and blood pressure are within normal limits. Physical examination reveals bi-basilar lung crackles. Laboratory values are as follows:

White blood cell count 8K, 70% polymorphonuclear leukocytes
Hematocrit 35
Platelets Normal
Urinalysis Normal


Answer Choices
A. Pulmonary embolus
B. Wound infection
C. Meningitis
D. Drug reaction
E. Endocarditis
F. Urinary tract infection
G. Postoperative ileus
H. Bacteremia
I. Postoperative atelectasis
J. Surgical error

Item 2 of 3

A 58-year-old woman is 7 hours status post abdominal hysterectomy with bilateral salpingo-oophorectomy. The nurse calls you because the woman has a fever of 38.3°C (101°F) and is complaining of severe abdominal pain despite what should be adequate pharmacologic analgesia. She has put out only 40 mL of urine despite having been given 1000 mL of intravenous fluids. On physical examination, you note an ill-appearing woman. She is tachycardic to 120s, and blood pressure, temperature, oxygen saturation, and respiratory rate are within normal limits. Head, ears, eyes, nose, and throat (HEENT), heart, and lung examination are normal. The abdominal examination reveals involuntary guarding over the lower abdomen, extreme tenderness to palpation, and hypoactive bowel sounds. Extremities are without rash, cyanosis, or edema. Her complete blood count (CBC) is normal. The urinalysis is remarkable only for trace ketones. The operative report indicates that the surgery was performed without incident. An intraoperative cystoscopy was not performed.

Answer Choices
A. Pulmonary embolus
B. Wound infection
C. Meningitis
D. Drug reaction
E. Endocarditis
F. Urinary tract infection
G. Postoperative ileus
H. Bacteremia
I. Postoperative atelectasis
J. Surgical error

Item 3 of 3

A 67-year-old female on day 3 status post open reduction of a femoral fracture complains of suprapubic pain and pain at the site of her Foley catheter. The catheter is removed, and urine is collected from a new catheter before a second Foley catheter is placed. Urinalysis and urine culture are performed. The urinalysis is positive for nitrites and leukocyte esterase, as well as trace blood. The patient begins treatment with Sulfa-Trimethoprim. On postoperative day 4, the patient is noted to have a temperature of 39.4°C (103°F), and blistering of her mouth and nose, as well as a diffuse, papular, nonpruritic rash. The patient's respiratory rate is 25 breaths/minute, and her oxygen saturation is 95% on room air. She is complaining of malaise, sore throat, and headache.

End of set

Answer Choices
A. Pulmonary embolus
B. Wound infection
C. Meningitis
D. Drug reaction
E. Endocarditis
F. Urinary tract infection
G. Postoperative ileus
H. Bacteremia
I. Postoperative atelectasis
J. Surgical error
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  #2  
Old 06-28-2011
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1. It is I: postoperative atelectasis, she has a sternotomy which causes poor ventilation.

2. It is G: postoperative ileus.


3: It is D: Drug reaction: Sulfas, probably Steven Johnsons Syndrome.
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  #3  
Old 06-28-2011
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Default

1. Post op Atelectasis
2. Surgical error
3. Drug reaction
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