Questions and Answers
Which postoperative day is most likely associated with a urinary tract infection as a differential diagnosis for fever?
What physiological mechanism primarily responsible for atelectasis after surgery occurs in the early postoperative period?
Which of the following complications is most commonly linked to postoperative day 5 fever?
Which of the 5 W's is associated with drug reactions leading to fever in the postoperative period?
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On which postoperative day is a thrombus most likely to develop leading to a risk of pulmonary embolism?
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What condition is characterized by the inability of the lungs to fully inflate, often seen postoperatively?
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Which of the following surgical procedures is most likely to contribute to atelectasis due to decreased pulmonary excursion?
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When managing a patient with suspected pneumonia postoperatively, what is the most critical element to assess for differentiation from atelectasis?
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What is a common precipitating factor for urinary tract infections (UTIs) in postoperative patients?
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What preventative measure is most effective for reducing the risk of deep vein thrombosis (DVT) in postoperative patients?
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Which diagnostic method is most appropriate for evaluating suspected deep vein thrombosis (DVT)?
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What is the primary management strategy for an infected wound following surgery?
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Which postoperative complication is characterized by fever and can occur within the first 24 hours?
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In regard to postoperative fever, what is considered a likely infectious cause five days post-surgery?
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Which of the following factors significantly increases the risk of deep vein thrombosis (DVT) in surgical patients?
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What is the primary diagnostic tool used for identifying a pneumonia that may not be visible on an X-ray?
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Which treatment option is recommended for pneumonia in high-risk individuals before obtaining culture results?
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What complication might arise from poorly managed hydration in a patient suspected of pneumonia?
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What is the recommended approach for a patient with a suspected anastomotic leak postoperatively?
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Study Notes
Pathophysiology of Postoperative Fever
- Fever ≥ 102.2°F (39°C) often indicates postoperative complications.
- Recognize the "5 W’s" to identify differential diagnoses of post-op fever.
Differential Diagnosis of Post-op Fever: The 5 W’s
- Wind (POD 1-3): Typically indicates atelectasis or pneumonia.
- Water (POD 3): Commonly points to urinary tract infection (UTI) or anastomotic leak.
- Wound (POD 5): Suggests surgical site infection or abscess.
- Walking (POD 7): Usually related to deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Wonder (Any time): Refers to drug reactions or complications from transfusions.
W #1: Wind
- Main cause is atelectasis due to incomplete lung inflation during anesthesia.
- Pain, sedation, COPD increase risk of atelectasis.
- Most patients experience atelectasis in dependent lung areas post-anesthesia.
- Management includes incentive spirometry and early ambulation.
W #2: Water
- UTIs are prevalent post-surgery due to catheter use and urinary retention during anesthesia.
- Increased risk in females, older patients, and individuals with diabetes.
- Diagnosis involves urinalysis and culture; treatment should start if UTI is suspected.
- Prevention includes removing indwelling catheters promptly.
W #3: Wound
- Wound infections are most common by POD 5.
- Treatment usually involves incision and drainage, followed by antibiotics targeting strep and staph.
W #4: Walking
- DVT/PE risk increases mainly due to immobility and vascular damage during surgery.
- Prevention strategies include ambulation, TED hose, and low-dose anticoagulation when necessary.
- Diagnosis relies on clinical suspicion and imaging like ultrasound or CT pulmonary angiograms.
W #5: Wonder Drugs
- Various medications can trigger febrile responses postoperatively.
- Blood transfusions may also lead to fevers.
Acute Fever and Immediate Causes
- Killers: Necrotizing fasciitis, malignant hyperthermia, anastomotic leak, or allergic reactions can cause immediate fevers.
- Indicators include unusual wound drainage, rash, hypotension, and rising temperature.
Delayed Fever Differential Diagnosis
- Infectious causes are common after ~5 days post-op.
- Most likely: wound infection, UTI, pneumonia, C. difficile colitis, and intra-abdominal abscesses.
- Less common: sinusitis, meningitis, and endocarditis.
Initial Assessment for Post-op Fever
- Review vitals, perform a physical exam focusing on surgical sites, lung sounds, and other systems.
- Gather patient history, including type of surgery and any medications given.
Take Home Points
- Understand the "5 W's" and their timing in relation to post-op fever.
- Ask critical questions regarding possible causes and assess for life-threatening conditions.
- Formulate a working diagnosis before proceeding with further tests and treatments.
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Description
This quiz explores the pathophysiology and differential diagnosis of postoperative fever. Learn about the 5 W's of fever causes and the timeline for potential complications after surgery. Assess your knowledge about common postoperative issues that may arise.
