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General, cardiac, & pulm preop Flashcards | StudBud
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General, cardiac, & pulm preop
General, cardiac, & pulm preop
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1
A pt with HF gets palpitations and angina after walking to the mailbox. What NY class HF?
class I
class II
class III
class IV
2
Your preop assessment begins at ______
the patient walking into the clinic
beginning of review of systems
asking name, DOB
the introduction, "hello"
3
A patient is scheduled for a TURP. What risk is this surgical procedure?
intermediate
high
low
4
A pt with high risk for periop MI should be started on beta blocker the morning of surgery
True
False
5
What type surgical risk is a renal transplant?
high
intermediate
6
A pt with HF is fatigued and feels palpitations while walking the golf course. What class NY HF?
class II
class IV
class I
class III
7
neck circumference is a ________ risk factor for OSA
modifiable
non-modifiable
8
You have a hypertensive patient scheduled for a cataract surgery. What preop orders?
schedule stress test
get EKG but no labs
get labs and EKG
no labs/EKG
9
Bayes theorem:
a test is useful to find undiagnosed disease in an assumed healthy pt
a test is most useful in a population that is likely to have the disease
10
You are reviewing patient labs and see the patient is anemic. What 3 disease process would you expect?
COPD
GI bleeding
diverticulosis
malignancy
11
A patient has an asymptomatic UTI scheduled for total knee Sx
Need to delay surgery
Do not need to delay surgery
12
What lung capacities are affected postoperatively
functional residual capacity
Inspiratory reserve volume
vital capacity
tidal volume
13
Risk factors for postop respiratory failure include
cocaine/meth use
impaired cognitive function
increased BMI
renal failure
14
A patient for a scheduled hysterectomy has a history of hypothyroidism and controlled HTN. What ASA?
ASA IV
ASA II
ASA III
ASA II E
15
A patient is able to walk around their one story house but is unable to climb their neighbors stairs.
5 MET, appropriate functional capacity for surgery
3 MET, poor functional capacity not appropriate for surgery
16
A COPD patient has a preop hgb of 7.1, HR 108, and RR 29. Should they get blood preop?
yes transfuse 1 u PRBC
give 500cc NS
yes transfuse 1 u FFP
no transfusion preop
17
The pt has a mean PAP 30mmHg. They are at risk of ______ heart failure and sudden periop cardiac death
right
left
18
Patient had a STEMI and is scheduled for a CABG in two days. What ASA?
ASA IV E
ASA IV
ASA V E
ASA V
19
asymptomatic, no Hx, 34 yo F patient with scheduled for general anesthesia. What preop orders?
no labs
HCG, H/H
HCG, H/H, EKG
HCG only
20
A dobutatmine ECHO is recommended for patients that
history of arrhythmias
can't reach target HR on exercise stress test
reactive asthma with bronchospasm
severe carotid stenosis
21
The patient with heart failure saw cardiology 9 months ago and echo 9 months ago. No new symptoms present
don't order echo preop
order echo preop
22
What is
not
an essential element of preop H&P?
medication and allergies
political status
exercise tolerance
pregnancy status
23
A 22yo female without medical hx, hgb 7.4, should she get blood preop for ACL repair?
yes give 1 unit preop
no blood preop
24
What valve disorder is most common to find in an 80yo patient
Aortic stenosis
mitral regurgitation
tricuspid stenosis
aortic regurgitation
25
What electrolyte abnormalities would you expect with a CKD patient?
hypercalcemia
hypervolemia
hyperkalemia
hyperphosphatemia
26
When trying to establish if a patient has diastolic or systolic HF, you would need to order a
stress test
echocardiogram
EKG
labs
27
_______ dysfunction has higher rates of MACE, prolonged length of stay, and higher rates postop HF
systolic
diastolic
28
A decrease in the functional residual capacity postop can lead to
atelectasis
decreased CO2 ventilatory drive
V/Q mismatch
hypoxemia
29
What is assessed in a STOP-BANG questionnaire?
blood pressure
BMI
tired/fatigue
blood sugar
30
You have a RBC of 4.2, what is your likely hgb and hct?
hgb 8.4
hct 37.8
hgb 12.6
31
A patient with ESRD has a ruptured AAA. What ASA are they?
ASA IV E
ASA V
ASA IV
ASA V E
32
A ______ BUN implies impaired kidney function
high
low
33
you have an asymptomatic 58 yo female schedule for general anesthesia. What preop orders?
EKG only
H&H, EKG, Renal panel
H&H, EKG, Renal panel, CXR
H&H and EKG
34
Most important procedure related risk factor for pulm complication
duration of surgery
emergency surgery
type of NMB used
surgical site
35
MOST IMPORTANT clinical evaluation for cardiac risk
cholesterol levels
preop BP
insurance status
baseline functional status
36
The echo you order for pt with AS shows jet velocity 3.4, mean gradient 29, and valve area 1.2 what grade severity?
the patient does not have AS, normal values
severe
moderate
mild
37
A patient is taking sublingual NTG every day after evening for the last week.
stable angina
unstable angina
38
60 yo male patient, asymptomatic controlled DM, scheduled for a nerve block. What preop orders?
H/H, glucose, EKG
H/H, BMP
no preop orders
H/H, EKG, glucose, renal panel
39
Pt had DES stent placed 6mo ago and is scheduled for shoulder surgery
stop plavix 5 days preop, give ASA morning of Sx
take plavix and ASA morning of surgery, have blood product ready
continue plavix but hold day of Sx, give ASA day of
patient is not candidate for surgery
40
Sensitivity of a test
probability of a negative test if a patient does not have the disease
probability of a positive test when the patient has the disease
41
You are doing a preop chart review for a patient on the floor. The patient has a WBC 3.5 (low)
patient is taking IV glucocorticoids, expected
patient is experiencing severe sepsis, not appropriate for surgery
42
A patient is scheduled for a surgery with high risk EBL.
don't order coags preop
Order coags preop
43
Iron deficiency will cause anemia in what patients?
40 yo F
7 mo infant
80 yo M
25 yo F
44
The patient had to walk a mile to your clinic and no signs SOB. Likely has no CAD.
True
False
45
Which picture is systolic heart failure
Empty choice
Empty choice
46
Current health status is established by
exercise tolerance
history of present illness
past surgical history
past medical history
47
Common causes of aortic stenosis
atherosclerosis
trauma
Bicuspid valve
tricuspid valve
48
Specificity of a test:
probability of a negative test if a patient does not have the disease
probability of a positive test when the patient has the disease
49
A patient is having peripheral vascular surgery (ie fem-pop), what risk is this surgery?
high
low
intermediate
50
Pt hx cardiac stent 3y ago and htn. Which of their meds should they take morning of Sx?
losartan
carvedilol
atorvastatin
ASA
51
You are assisting with a bunion surgery for a patient with hx controlled CAD
don't order EKG
order EKG
52
Pain control is part of preventative strategies for postop pulmonary complications
True
False
53
What symptoms would you expect your pt to say they have if they have aortic stenosis?
dyspnea
syncope
impending doom
angina
54
Postop resp failure defined as
inability to extubate within 48hrs
inability to extubate within 24hrs
55
Getting a BMP on a healthy patient with no known history is a useful test
False
True
56
You are seeing a pt in preop clinic 2 weeks b/f Sx that is a smoker
tell patient its safer to smoke through the day of Sx than stop now
tell patient postop to quit but for now they should not smoke morning of Sx
Tell patient to stop smoking now
tell patient to stop smoking 1 week before surgery
57
Pt with history of depression, DM, and HTN. What meds can they take morning of Sx?
metoprolol
ASA
escitalopram (lexapro)
glipizide
58
Abnormal coag lab results in absence of clinical abnormalities is high indication of periop problems
False
True
59
A pt with heart failure is having some SOB while watching TV and palpitations when walking to the bathroom. Class HF?
class II
class IV
class I
class III
60
The pt with HF is able to go on a bike ride for 30 mins. What NY Heart class?
class II
class IV
class I
class III
61
What procedures would you get a baseline H/H for due to EBL >500?
ileostomy
lap cholecystectomy
shoulder replacement
SDH evacuation
62
Elderly pt with dementia has son help with things around the house and scheduled for bowel Sx
order stress test
don't order stress test
63
A patient traveling to Peru but lives in Maine will have the same INR on a coag panel if admitted to the hospital
False
True
64
The pt says they have a problem with aortic valve but doesn't know what kind. You hear a murmur after 2nd heart sound
aortic regurgitation
aortic stenosis
systolic
diastolic
65
aortic stenosis will be most likely to cause what type of HF?
Empty choice
diastolic
systolic
Empty choice
66
What type of heart failure will you not see a decrease in EF%
diastolic
systolic
67
A CXR should be ordered preop for what patients?
smoker 10 years
Patient with colon cancer
age \ge 75
COPD patient
68
Your patient scored a 3 on the revised cardiac risk index
the RCI scale doesn't use numbers
no risk cardiac complications
high risk cardiac complications
low risk cardiac complications
69
A coag panel should be be ordered if:
plan for regional anesthesia
malnutrition
history of Von Willebrand's disease
suspected cirrhosis
70
Most patients have an abnormal lab preoperatively including false positives
False
True
71
You can proceed with an elective surgery if a patient is asymptomatic severe valve disease
False
True
72
Your patient has a high MCV. This patient is likely a
infant with iron deficiency
recent lead poisoning
crohn's/celiac disease (malabsorption)
alcoholic
73
The patient has history of CAD and cardiac stent 2 y ago,
ran
a 5k last weekend
order stress test
don't order stress test
74
Patients with pulmonary disease should avoid surgeries that last longer that ____ hours if able to
4
6
2
8
75
A med student asks you what the MACE risk stands for. You respond:
its the risk of starting a fire due to cauterization tools in the OR
certain surgeries have higher risk of a periop cardiac event
76
A baseline _______ is needed for any procedure with risk of blood loss
platelet
hematocrit
