Preoperative Assessment

21 Questions | Total Attempts: 1530

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Assessment Quizzes & Trivia

Optimization for surgery, risk reduction, perioperative medication recommendations


Questions and Answers
  • 1. 
    Breast milk should be discontinued for how long prior to surgery?  
    • A. 

      8 hours

    • B. 

      6 hours

    • C. 

      4 hours

    • D. 

      2 hours

  • 2. 
    A 57-year old male is in pre-surgical testing for an elective laparoscopic cholecystectomy.  He has an otherwise unremarkable medical history, and he is scheduled at 1 PM on the day of surgery.  Which of the following is against the ASA guidelines for preoperative fasting?  
    • A. 

      Drinking orange juice at 7 AM

    • B. 

      Eating toast with apple juice at 7 AM

    • C. 

      Coffee with cream at 10 AM

    • D. 

      An omelette with pancakes at 5 AM.

    • E. 

      None of the above

    • F. 

      More than one of the above

  • 3. 
    A 65-year-old man comes to pre-surgical testing for a left hip replacement. He tells you he had a coronary stent placed 6 months ago and takes aspirin and plavix daily, but he does not remember any more details.  Which of the following is a correct statement about this situation?  
    • A. 

      It is safe to schedule the surgery now.

    • B. 

      If the stent is drug eluting, the patient should wait 6 months to schedule the case

    • C. 

      If the stent is bare-metal, the patient should wait 6 months to schedule the case

    • D. 

      If the stent is drug-eluting, the patient should wait 3 months to schedule the case

    • E. 

      If the stent is drug-eluting, the patient should wait 12 months to schedule the case

  • 4. 
    A 68-year-old man comes to pre-surgical testing for a cataract repair.  He has a past medical history significant for type II Diabetes, hypertension, and hyperlipidemia.  He tells you that he has smoked a pack of cigarettes a day for the past 30 years.  He also says that he develops shortness of breath when he walks up stairs and gets chest pain when he exercises.  The last time this happened was two weeks ago when he worked out with his friend in the garage.  His EKG is normal sinus rhythm with a rate of 72 and significant for a left axis deviation and left ventricular hypertrophy.  Which of the following is the best next step in managing this patient?
    • A. 

      Proceed with the surgery without further testing

    • B. 

      Order an echocardiogram

    • C. 

      Order an exercise stress test

    • D. 

      Order a nuclear stress test

    • E. 

      None of the above

  • 5. 
    According current guidelines, which of the following patients should have her breast lumpectomy deferred for further cardiac work-up?
    • A. 

      A 68 yo who cannot walk up stairs without getting short of breath

    • B. 

      A 72 yo with CHF that experiences shortness of breath when he exercises

    • C. 

      A 66 yo who is a lifelong smoker, has type II diabetes with uncontrolled blood sugar, and has a blood pressure of 155 / 91

    • D. 

      A 64 year old with a Mobitz type II rhythm at 64 without ST elevation or T wave changes on her EKG

    • E. 

      E. None of the above

  • 6. 
    Of the following, which surgery has the highest risk of an adverse cardiac event?
    • A. 

      Carotid endarterectomy

    • B. 

      Left hip replacement

    • C. 

      Hemicolectomy

    • D. 

      Left femoral-popliteal bypass

    • E. 

      Cholecystectomy

  • 7. 
    A 65 yo F with type II DM, CHF, and hyperlipidemia is planning to have an abdominal aneurysm repair.  Which of the following medications should she continue on the morning of the surgery?
    • A. 

      Fluvastatin

    • B. 

      Metformin

    • C. 

      Enalapril

    • D. 

      Lasix

    • E. 

      Glipizide

  • 8. 
    A 31 yo M with type II DM takes Lantus, metformin, and glipizide.  Which of the medications should he take on the morning of surgery?
    • A. 

      His normal dose of Lantus

    • B. 

      ½ his normal dose of Lantus

    • C. 

      ½ his normal dose of Lantus and his metformin

    • D. 

      ⅓ his normal dose of Lantus and his Glipizide

    • E. 

      Metformin and Glipizide

  • 9. 
    How many risk factors for obstructive sleep apnea (OSA) are listed here? 1.  Being male 2.  BMI > 30 3.  Feeling tired, fatigued, or sleepy during the daytime 4.  Neck circumference > 40 cm 5.  Being treated for HTN 6.  Insomnia 7.  Age > 40  
    • A. 

      3

    • B. 

      4

    • C. 

      5

    • D. 

      6

    • E. 

      7

  • 10. 
    According to the AHA, which of the following patients should have infectious endocarditis (IE) prophylaxis?
    • A. 

      A 2 yo F who is teething for an emergent appendectomy

    • B. 

      A 65 yo M with a history of a mechanical aortic valve placed in 1996 for the emergent draining of an oral abscess

    • C. 

      A 67 yo M with a history of heart transplant in 2005 for a penile prosthesis insertion

    • D. 

      A 46 yo F with history of endocarditis when she was a child for a total abdominal hysterectomy

    • E. 

      More than one of the above

  • 11. 
    A 76 yo m with PMHx of ACS with 2 stents placed 5 years ago presents for an elective cholecystectomy.  He is 6'2 and weighs 73 kg.  His pre-procedure hematocrit is 35.  According to current guidelines and assuming the patient remains hemodynamically stable, what is the maximal allowable blood loss for this procedure?
    • A. 

      500 ml

    • B. 

      750 ml

    • C. 

      780 ml

    • D. 

      850 ml

    • E. 

      1.0 ml

    • F. 

      None of the above

  • 12. 
    A 33 yo F with PMHx of Lupus presents for a myomectomy.  Since she was 16, she has been taking 20mg prednisone to control the symptoms and has been unable to taper her dose.  Which of the following is consistent with current practice guidelines regarding perioperative steroid replacement?  
    • A. 

      Hold steroids the night before this procedure

    • B. 

      20mg prednisone on morning of procedure

    • C. 

      100mg hydrocortisone on morning of procedure

    • D. 

      Adrenal function testing prior to procedure with dosing deferred

  • 13. 
    A 66 yo m with a PMHx of CAD with two drug eluting stents placed 14 months ago, HTN, HLD, stable angina, and controlled CHF presents for an AV fistula creation.  According to current guidelines, which of the following medications should he discontinue prior to this procedure?
    • A. 

      Aspirin

    • B. 

      Clopidogrel

    • C. 

      Atenolol

    • D. 

      Simvastatin

    • E. 

      Enalapril

    • F. 

      Lantus

  • 14. 
    A 34 yo F with PMHx of hypothyroidism presents for a myomectomy.  She is 5'5" and weights 100kg.  She says she last ate at 8PM the previous evening and took her morning medication with a small sip of water.  If the case starts at 8AM, approximately what is her fluid deficit?
    • A. 

      1.2 L

    • B. 

      1.5L

    • C. 

      1.7L

    • D. 

      > 2.0 L

  • 15. 
    According to the ASA 2011 Guidelines for Preanesthetic Evaluation, at what age should all patients get a screening EKG?
    • A. 

      Age 40 for men and 50 for women

    • B. 

      Age 50 for both men and women

    • C. 

      Age 60 for men and 50 for women

    • D. 

      Age 65 for both men and women

    • E. 

      None of the above

  • 16. 
    A 25 yo m with no PMHx is referred by his primary doctor for resection of a right sided pheochromocytoma.  Which of the following medications should this patient be taking prior to surgery?
    • A. 

      Propranolol

    • B. 

      Phenoxybenzamine

    • C. 

      Labetalol

    • D. 

      Magnesium Sulfate

    • E. 

      Hydralazine

  • 17. 
    A 56 yo F presents to pre-anesthesia testing for a vaginal hysterectomy.  She is 155 cm and weighs 120kg.  She has a PMHx of type II diabetes and hypertension that is controlled with medication.  What is her ideal body weight?
    • A. 

      45 kg

    • B. 

      50kg

    • C. 

      55kg

    • D. 

      60kg

    • E. 

      None of the above

  • 18. 
    A 71 yo M with PMHx of HTN, atrial fibrillation, and obesity presents for a carotid endarterectomy (CEA) after a screening ultrasound showed 75% stenosis on the left side.  He takes aspirin, dipyridamole, and metoprolol.  Which of these medications should he continue throughout the perioperative period?
    • A. 

      Aspirin

    • B. 

      Aspirin and plavix

    • C. 

      Metoprolol

    • D. 

      Aspirin, plavix, and metoprolol

  • 19. 
    A 32 yo F presents for an elective breast reduction.  She says her mother had surgery 10 years ago and had some trouble "waking up."  You decide to perform a dibucaine test.  The patient has a dibucaine number of 81.  What does this mean?
    • A. 

      She is homozygous for a mutant butylcholinesterase gene

    • B. 

      She is heterozygous for a mutant butyl cholinesterase gene

    • C. 

      She has butycholinesterase genes that are within normal limits

    • D. 

      None of the above

  • 20. 
    A patient with a dibucaine number of 21 would experience which of the following?
    • A. 

      Prolonged muscle weakness after a dose of succinylcholine

    • B. 

      Normal duration of muscle weakness after a dose of succinylcholine

    • C. 

      Prolonged muscle weakness after a dose of rocuronium

    • D. 

      Normal duration of muscle weakness after a dose of rocuronium

    • E. 

      None of the above

  • 21. 
    Which of the following procedures is associated with the highest rate of postoperative respiratory failure?
    • A. 

      Carotid endarterectomy

    • B. 

      Abdominal aortic aneurysm repair

    • C. 

      Craniotomy

    • D. 

      Mediastinoscopy

    • E. 

      Femoral-popliteal bypass

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