342 Obstetrics and Gynecology Board Review •••
❍ What is the most common side effect of peripheral parenteral nutrition?
Phlebitis due to the high osmolarity solution.
❍ What is the most common complication associated with total parenteral nutrition?
Catheter infection, which can be reduced with meticulous care of the catheter.
❍ What is the amount and distribution of total water in the average woman?
Total water constitutes 50% to 55% of body weight with 40% to 66% in the intracellular compartment, and
20% to 33% in the extracellular compartment (one-fourth is in the plasma and three-fourth in the interstitium).
❍ What are the primary electrolytes contributing to the osmolarity in the extracellular fluid compartment?
Sodium and chloride.
❍ How can one calculate the serum osmolarity?
2 × Na + [Glucose (mg/dL)/18] + BUN (mg/dL)/2.8.
❍ What conditions are associated with hyponatremia and extracellular fluid excess?
Cardiac failure, liver failure, and renal dysfunction.
❍ What preoperative conditions predispose to hypokalemia?
Significant gastrointestinal fluid losses, prolonged diuretic use, and prolonged parenteral potassium-free fluids.
❍ What risk factors place the hysterectomy patient at risk of postoperative infection?
Low socioeconomic status, surgical duration >2 hours, malignancy, obesity, malnutrition, immunosuppression,
and increased number of procedures performed.
❍ The Revised Cardiac Risk Index identifies what six independent predictors of major cardiac complications
in patients undergoing elective major noncardiac procedures?
(1) High-risk type of surgery (intraperitoneal, intrathoracic, or suprainguinal vascular surgery).
(2) History of ischemic heart disease (history of myocardial infarction or positive exercise test, significant angina,
use of nitrate therapy, or ECG with pathological Q waves).
(3) History of heart failure.
(4) History of cerebrovascular disease.
(5) Diabetes mellitus requiring treatment with insulin.
(6) Preoperative serum creatinine >2.0 mg/dL.
❍ What physical examination findings are suggestive of cardiovascular disease?
Hypertension, JVD, laterally displaced point of maximal impulse, irregular pulse, third heart sound, pulmonary
rates, heart murmurs, peripheral edema, or vascular bruits.
❍ What is the predictive value of history in diagnosing coronary artery disease?
90%.