Advanced | Pre-operative Evaluation, Ambulatory Anesthesia, and Office Based Anesthesia Flashcards
ASA for adult on regular hemodialysis:
A. 1
B. 2
C. 3
D. 4
C. 3
A patient with a BMI of 55 presents for middle ear surgery. If Propofol is to be used as an inducting agent, the bolus induction dose for obese should be based on:
A. Lean body weight
B. Total body weight
C. Ideal body weight
D. Ideal body weight + 70%
A. Lean body weight
Lean body weight
IBW = Height - 100
LBW = IBW x 1.3
Breast feeding is contraindicated after receiving which of the following:
A. Codeine
B. Midazolam
C. Paracetamol
D. Tramadol
A. Codeine
In an ambulatory setting, how long would a patient be kept on NPO status if they had consumed a light meal?
A. 4 hours
B. 6 hours
C. 8 hours
D. no need to place them on NPO
B. 6 hours
TRUE or FALSE
ASA III and IV patients can undergo ambulatory surgery as per ASA guideline.
TRUE
Medically stable ASA physical status III or IV patients may be appropriate candidates for ambulatory surgical procedures
A 60 year old male with a significant history of thyroid disorder and hypertension is scheduled for a cataract removal. The following medications should be taken on the day of surgery EXCEPT:
A. beta blockers
B. Antiarrhythmics
C. Diuretics
D. Pulmonary inhalers
E. Hyperthyroid medications
C. Diuretics
Mr. Mamintal is scheduled for ambulatory procedure. He is classified as ASA II for in take of “VAPE”. He is also on several hypertensive medications. Which of the following should be AVOIDED on the day of surgery?
A. ACE Inhibitors
B. Diuretics
C. ARBs
D. Vitamin E
D. All of the above
D. All of the above
- Patients taking supplement like VITAMIN E should be discontinued on the day of surgery. - They have effects of platelets.
TRUE or FALSE
A 10 month old infant with mild URTI can be reasonably operated on in an ambulatory clinic.
FALSE
An anxious child came in for an ambulatory procedure. Which of the following oral dose of midazolam may administered in the preoperative holding area.
A. 0.25mg/kg
B. 1mg/kg
C. 0.1 mg/kg
D. 0.5mg/kg
A. 0.25mg/kg
Barash | 9th edit
Which of the following is MOST accurate pertaining to PDPH after spinal anesthesia?
A. PDPH is believed to result from a loss CSF into the epidural space
B. The symptom is from the decreased hydrostatic pressure in the epidural space causing traction to the meninges
C. Blunt pointed needles will result to higher incidence
D. Supine position will NOT relieve the symptom
A. PDPH is believed to result from a loss CSF into the epidural space
Barash |9th edit
Read
This is the most common anesthetic drug used in the ambulatory clinic:
A. Midazolam
B. Propofol
C. Atropine
D. Fentanyl
B. Propofol
This is the most important
factor contributing to a delay in discharge of patients and an increase in unanticipated admissions of both children and adults after ambulatory
surgery.
A. nausea with or without vomiting
B. PONV
C. Post-operative pain
D. Hypersensitivity Reaction
A. nausea with or without vomiting
A 18 year old female, ASA-PS I is scheduled for elective excision of breast mass in your ambulatory clinic. To decrease her chances of developing PONV, the following can be done EXCEPT:
A. Use regional anesthesia alone if possible
B. Use of sugammadex instead of neostigmine
C. Minimize opioids
D. Avoid nitrous oxide
D. Prophylactic steroids
D. Prophylactic steroids
TRUE or FALSE
Neuromuscular blocking agent is a necessary component of endotracheal intubation in the ambulatory clinic.
FALSE
TRUE or FALSE
As per recommendation, ASA II and III physical status is allowed in an office based setting anesthesia, given a hemodynamically stable status.
FALSE
The American Society of Plastic Surgeons acknowledged that
the ideal patient for an office-based procedure has an American Society of Anesthesiology (ASA) physical status of 1 or 2.
According to close claims project, on which phase of the peri-operative period does office-based related injuries most frequently happen?
A. Pre-operative
B. Intra-operative
C. Post-operative
D. After discharge
B. Intra-operative
The Closed Claims Project database reveals that injuries during office based procedures occur throughout the perioperative period and are multifactorial in etiology. The majority, 64%, occurred intra-operatively,
while 14% occurred in the post-anesthesia care unit (PACU) and 21% after discharge
In an office-based procedure, patients with OSAS should receive at least ____ of PACU observation before discharge.
A. 6 hrs
B. 12 hrs
C. 3 hrs
D. 2 hrs
C. 3 hrs
The ASA recommends that patients with OSAS undergoing ambulatory surgery receive at least 3 hours of postoperative observation before discharge to ensure adequate
recovery and minimize airway compromise.
As per ASA recommendation, The following conditions/disease states are unsuitable candidates for an office based procedure EXCEPT:
A. NPO less than 8 hrs
B. No escort home
C. Severe OSAS
D. Poorly controlled DM
E. History of crustacean allergy
E. History of crustacean allergy
You are about to conduct an anesthesia to a 30 year old obese patient in an office-based anesthesia clinic. You plan to give proton pump inhibitor and histamine-2 blocker to lower the risk of gastric content aspiration. The dose of the medications you plan to give preoperatively should be based on:
A. LBW
B. Actual body weight
C. Ideal body weight
D. Predicted body weight
C. Ideal body weight
In general, an office liposuction should be limited to ___ mL of total aspirant which includes supernatant fat and fluid:
A. 1,000 ml
B. 2,000 ml
C. 5,000 ml
D. 500 ml
C. 5,000 ml
READ
A 20 year old female, ASA I - PS is scheduled for laparoscopic cholecystectomy. She has no smoking history and reported to have had few episodes of vomiting on her travel abroad. At the PACU, she was given IV opioid on top of intrathecal morphine. Which of the following should be given, considering her PONV risk?
A. Ondansetron, Dexamethasone, Metoclopromide
B. Ondansetron, Dexamethasone, Metoclopromide, Propofol(anti-emetic dose)
C. Ondansetron, Dexamethasone, Diphenhydramine
D. Ondansetron and Dexamethasone only
B. Ondansetron, Dexamethasone, Metoclopromide, Propofol(anti-emetic dose)
MELD score includes all of the following EXCEPT:
A. Creatinine
B. Bilirubin
C. INR
D. Albumin
E. ALT
E. ALT
Which of the following, if taken by a patient prior to OR should NOT be considered a clear liquid:
A. Gatorade
B. Guava juice without pulp
C. Diet Coke
D. Alcohol
D. Alcohol
Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee.
- Clear liquids do not
include alcohol.
Which of the following H-2 antagonist is more potent and long acting?
A. Cimetidine
B. Ranitidine
C. Famotidine
B. Ranitidine
The effect of PPI on gastric PH typically last for ___
A. 24 hrs
B. 48 hrs
C. 72 hrs
D. 12 hrs
A. 24 hrs
30 minutes prior to surgery, you give a single IV dose of metoclopromide to your patient. Which of the following mechanism is NOT expected when Metoclopromide is given:
A. Inhibit upper gastrointestinal motility
B. Increases gastroesophageal sphincter tone
C. Relaxes the pylorus and duodenum
D. Reduce gastric volume
Metoclopramide is a dopamine antagonist with antiemetic properties that:
- Stimulates upper gastrointestinal motility
- Increases gastroesophageal sphincter tone
- Relaxes the pylorus and duodenum
- Reduce gastric volume
Barash | 9th edit
Smoking cessation for 12 - 24 hours will correspond to which of the following physiologic effect:
A. Rightward shift of hgb P50
B. decreased secretions and less reactive airway
C. Immune system and metabolism normalize
D. Improved mucociliary transport and smaller airway function
A. Rightward shift of hgb P50
An elderly patient with scopolamine patch presented at the ambulatory clinic with delirium, restlessness, confusion, and obtundation. What medication can be given to reverse the symptoms?
A. Pyridostigmine
B. Naloxone
C. Flumazenil
D. Diazepam
A. Pyridostigmine
Scopolamine and atropine (tertiary amines) may cause central nervous
system toxicity, known as central anticholinergic syndrome. This syndrome is most likely to occur after the administration of scopolamine, but can be seen
after high doses of atropine and may include symptoms such as delirium, restlessness, confusion, and obtundation.
- Elderly patients and patients with
pain appear to be particularly susceptible; the syndrome has been noted to be potentiated by inhalation anesthetics. - The administration of 1 to 2 mg of
physostigmine intravenously can successfully treat the syndrome.
METS score of someone who can participate in a SINGLE tennis match:
A. more than 10 METS
B. more than 7 METS
C. more than 12 METS
D. more than 4 METS
A. more than 10 METS
A 55 year old male is scheduled for elective hernia surgery. His ASA classification is III for uncontrolled DM with a creatinine of 2.2 mg/dL. Pro-BNP and cardiac enzymes were all normal. Based on the recent RCRI, the risk of perioperative cardiovascular complication for this patient is:
A. 6%
B. 0.9%
C. 0.4%
D. 11%
A. 6%
What is the oxygen consumption equivalent to 4METS in a 40 year old?
A. 4-8 ml/kg/min
B. 8-12 ml/kg/min
C. 12-16 ml/kg/min
D. 16-20 ml/kg/min
C. 12-16 ml/kg/min
1 MET = 3.5 ml/kg/min, therefore 4 METS = 3.5 x 4 = 14ml/kg/min
A 52-year-old woman, classified as ASA I (74 kg, 168 cm), with a medical history of subtotal thyroidectomy, was scheduled for carpal tunnel syndrome surgery using a tourniquet in an ambulatory clinic. She received an ultrasound-guided infraclavicular brachial plexus block for perioperative anesthesia. Forty minutes into the procedure, signs and symptoms indicative of Horner’s syndrome were observed. Which of the following symptoms is consistent with Horner’s syndrome?
A. proptosis, miosis, anhidrosis
B. proptosis, mydriasis, anhidrosis
C. ptosis, miosis, anhidrosis
D. ptosis, mydriasis, anhidrosis
E. ptosis, miosis, hyperhidrosis
C. ptosis, miosis, anhidrosis
A 2 year old with leukemia is scheduled for intrathecal chemotherapy. She have had previous history of post procedure nausea and vomiting. Which of the following prophylactic drug can potentially lead to tumor lysis syndrome?
A. Haloperidol
B. Dexamethasone
C. Ondansetron
D. Promethazine
E. Metaclopramide
B. Dexamethasone
Dexamethasone is highly associated with tumor lysis syndrome. Beware in giving them to patients undergoing chemotherapy because these patients have increased risk of tumor lysis syndrome.
A 30 year old female is scheduled for elective surgery. She is Obese class II without hypertension. During pre-op rounds, she mentioned that she underwent polysomnography abroad with a AHI (apnea–hypopnea
index) of 12 events per hour. This means that her OSA is:
A. Mild
B .Moderate
C. Severe
D. Normal
A. Mild
The diagnosis of OSA can only be made in patients who undergo polysomnography, or a home sleep study.
Results of polysomnography are reported as the apnea–hypopnea
index (AHI), which is derived from the total number of apneas and hypopneas divided by the total sleep time or the respiratory disturbance index (RDI).
Most sleep centers commonly use an AHI between 5 and 10 events per hour as a normal limit.
Mild Disease: AHI of 5 to 15 events per hour
Moderate Disease: AHI of 15 to 30 events per hour
Severe Disease: AHI of greater than 30 events per hour
A 35-year-old, 91-kg woman with no medical history presents for liposuction using the tumescent technique. Which of the following is the MAXIMUM VOLUME of tumescent solution, consisting of lidocaine 0.5%, epinephrine 1:1,000,000 that can be administered to this patient?
A. 250 ml
B. 2,500 ml
C. 5,000 ml
D. 10,000 ml
D. 10,000 ml
Liposuction using the tumescent technique involves the injection of large volumes of very dilute local anesthetic (typically 0.05% lidocaine with 1:1,000,000 epinephrine) into large amounts of subcutaneous fat to provide local anesthesia and analgesia and to facilitate liposuction without the use of general anesthesia. While the typical recommended dose of lidocaine with epinephrine is < 7 mg/kg, the use of very dilute solutions permits the use of up to 55 mg/kg safely.
- In the above example, 91 kg x 55 mg/kg= 5,005 mg maximum lidocaine dose 5,005 mg/0.5 mg/mL= 10,010 mL Although up to 10,000 mL 0.05% lidocaine could be used in this patient, volumes are often stopped at 7,000 mL. The ability to use such high doses of lidocaine is thought to be due to the dilute solution, the slow speed of infiltration, the avascularity of the plane of injection, and the high lipid solubility of lidocaine. A review by Tierney et al. as well as a large study by Boeni both concluded that tumescent liposuction using lidocaine up to 55 mg/kg was safe when proper guidelines were followed. Boeni showed no injuries, nerve damage, lymphedema, deep vein thrombosis, seroma, or local anesthetic toxicity. The most common complications of tumescent liposuction are allergic reactions to antibiotics used prior to surgery and hematoma formation.
A patient who is able climb 1 flight of stairs would have a MET score of:
A. 5
B. 9
C. 3
A. 5
In preoperative assessment of patients, physical activity is graded in terms of metabolic equivalents (METs). The value that corresponds to oxygen consumption of 1 MET in an adult is:
A. oxygen consumption of 3.5 mL/min/kg
B. oxygen consumption of 2.5 mL/min/kg
C. oxygen consumption of 1.5 mL/min/kg
A. oxygen consumption of 3.5 mL/min/kg
A patient’s ASA physical status (ASA-PS) classifcation
correlates with:
(A) risk of cancellation of surgery
(B) cost of surgery
(C) unplanned admission after surgery
(D) adverse cardiopulmonary complications
(E) surgical procedure risk
(D) adverse cardiopulmonary complications
A Cormack and Lehane grade 2 view is best described
by which of the following?
(A) Full view of vocal cords
(B) view of epiglottis only
(C) view of soft palate only
(D) view of arytenoid cartilages only
(E) no view of vocal cords
(D) view of arytenoid cartilages only
A Cormack and Lehane grade 2 view includes a partial view of the vocal cords and a full view of the arytenoid cartilage. The modified Cormack/Lehane grading system is shown in the figure:
- Grade 1: Full view of vocal cords
- Grade 2a: Partial view of vocal cords
- Grade 2b: View of arytenoid cartilages only
- Grade 3a: View of epiglottis only, no vocal cords
(epiglottis able to be lifted of posterior hypopharynx
What is the ASA physical status (ASA-PS) or a patient
who is moribund and not expected to survive without
the operation?
(A) 2
(B) 3
(C) 4
(D) 5
(E) 6
(D) 5
A patient is given clonidine preoperatively in an effort to improve postoperative pain management. What is a likely side effect of administering clonidine as a preoperative medication?
(A) tachycardia
(B) amnesia
(C) respiratory depression
(D) increased gastric fluid volume
(E) hypotension
(E) hypotension
Alpha-2 agonists (clonidine, dexmedetomidine) can be
administered as premedication to cause sedation, blunt
the hemodynamic changes associated with laryngoscopy
or awake fiberoptic intubation, and improve analgesia.
The common side effects of alpha-2 agonists
include: hypotension and bradycardia.
Clinically, alpha-2 agonists are not felt to have significant effect on memory, respiratory depression, or gastric fluid
volume.
Barash | 9th edit
Which of the following is NOT a component of Modified Child–Pugh Scoring:
A. Albumin
B. Prothrombin time
C. ALT
D. Ascites
E. Encephalopathy
C. ALT
Which of the following is ACCURATE regarding Modified Child–Pugh Score as a preoperative tool for liver assessment?
A. For cholestatic diseases, the bilirubin level of 4 mg/dL is equivalent to 2 points
B. Grade I-II encephalopathy is equivalent to 2 points
C. Tense/severe ascites is equivalent to 5 points
D. the 3-month mortality for hospitalized patients not undergoing surgery was 14% for Child A.
B. Grade I-II encephalopathy is equivalent to 2 points
- The 3-month mortality for hospitalized patients not undergoing surgery was 4% for Child A, 14% for Child B, and 51% for Child C.
A patient with ASA physical status > IV is approximately equivalent to which MELD points?
A. 5
B. 3
C. 10
A. 5
Other than the MELD score, other important predictors of perioperative mortality in cirrhotics were age (age >70 equated to 3 MELD points) and coexisting disease (ASA physical status > IV equated to 5 MELD points).
MELD score is a mathematical formula used for Liver transplant candidates with the following parameters:
INR
Bilirubin
Creatinine
A patient with liver disease can be safely anesthetized with which of the following inhaled anesthetics?
A. Sevoflurane
B. Isoflurane
C. Enflurane
D. Desflurane
A. Sevoflurane
Halothane hepatitis, described earlier in this chapter, is
largely responsible for these concerns. However, there is little evidence to suggest that other volatile anesthetics are responsible for hepatic complications. With the exception of sevoflurane, volatile anesthetics undergo metabolism that yields reactive TFA intermediates. These bind to
hepatic proteins and produce an immunologic reaction.
Sevoflurane undergoes more extensive metabolism than isoflurane or desflurane, rapidly producing detectable plasma concentrations of fluoride and hexafluoroisopropanol (HFIP), which are conjugated by the liver and excreted by the kidney. In distinction to the other agents, sevoflurane does not produce reactive TFA metabolites or fluoroacetylated liver proteins.
- This fact led to the suggestion that patients sensitized to other volatile anesthetics could be safely anesthetized with sevoflurane.
Barash | 9th edit
TRUE or FALSE
The clearance of Propofol in the systemic circulation is prolonged in cirrhotic patients.
FALSE!
Most induction agents, including ketamine, etomidate, propofol, and thiopental, are highly lipophilic and have high extraction ratios. Although elimination should be prolonged in the presence of liver disease,** clearance in cirrhotics is similar to normal patients. **
However, the pharmacodynamic effects are more pronounced, and in some cases, as with dexmedetomidine
and the benzodiazepines, the duration of action can be prolonged.
Mitral stenosis typically has a mid-diastolic opening snap, low-pitched rumble type of murmur. Which of the following anatomical location can this murmur be heard?
A. Apex
B. 5th ICS MCL
C. 2nd parasternal interspace
D. Base of the heart
A. Apex
TRUE or FALSE
Corticosteroid supplementation is not required for individuals who have received less than 5 mg prednisone (or its equivalent) daily or less than 3 weeks of corticosteroids (regardless of dose).
TRUE
Perioperative corticosteroid supplementation is
needed only when a patient is likely to have suppression of the hypothalamic-pituitary-adrenal axis. Thus, supplementation is not required for individuals who have received less than 5 mg prednisone (or its equivalent) daily or less than 3 weeks of corticosteroids (regardless of dose).
Based on the current ASA guideline, a patient diagnosed with ESRD undergoing regular dialysis treatment can be classified as:
A. ASA IV
B. ASA II
C. ASA III
C. ASA III
Cannabinoids should IDEALLY be discontinued ___ prior to anesthetic exposure:
A. 1 week
B. 2 weeks
C. 3 days
D. 5 days
B. 2 weeks
Discontinue at least 3 days but ideally 2 weeks.
Minimum: 3 days
Ideal: 2 weeks
Which of the following oral hypoglycemic drugs MUST be discontinued 24 hours prior tp surgery?
A. SGLT-2
B. Biguanides
C. DDP-4
D. GLP-1 agonist
A. SGLT-2
Valeria as an anxiolytic should be ___ prior to surgery.
A. continued
B. discontinued 24 hrs
C. discontinued 12 hrs
A. continued
MOA: Mild sedative and anxiolytic
Preoperatively, it is continued prior to surgery.
Which of the following medications must be withheld 48 hours prior to surgery?
A. NSAIDS
B. Metformin
C. Thiazides
D. Sildenafil
A. NSAIDS
A patient is scheduled for a major surgery, which of the following is an accurate pre-operative plan considering the steroid dose of this patient?
A. Take usual morning steroid dose. No supplementation is needed
B. Take usual morning steroid dose and administer 50 mg hydrocortisone IV prior to induction and 25 mg q8h for 24–36 h
C. Take usual morning steroid dose. Administer 100 mg IV hydrocortisone IV prior to induction and 50 mg IV q8h for 24–36 h
D. Skip the morning dose and Administer 250 mg IV hydrocortisone IV prior to induction and 50 mg IV q8h for 24–36 h
C. Take usual morning steroid dose. Administer 100 mg IV hydrocortisone IV prior to induction and 50 mg IV q8h for 24–36 h
A patient with chronic kidney disease (CKD) requiring
hemodialysis is evaluated preoperatively. Which of the following abnormalities is common or a patient with CKD?
(A) hypercalcemia
(B) polycythemia
(C) secondary hypoparathyroidism
(D) hypovolemia
(E) hypertension
(E) hypertension
A patient with a cecal carcinoma is scheduled or open hemicolectomy. Preoperative assessment identifes a past medical history of COPD. Which of the following is an additional risk actor or postoperative pulmonary complications?
(A) age > 60
(B) asthma
(C) exercise tolerance < 2 blocks
(D) abnormal pulmonary functions tests (PFT’s)
(E) abnormal arterial blood gas (ABG)
(C) exercise tolerance < 2 blocks
A patient with a history o medically managed glaucoma presents or preoperative anesthetic assessment. Which glaucoma treatment may increase the duration of action of succinylcholine?
(A) acetazolamide
(B) brimonidine
(C) cyclopentolate
(D) echothiophate
(E) bimatoprost
(D) echothiophate
Echothiophate is a cholinesterase inhibitor. It will prolong
the duration of action of succinylcholine ( or an additional
2 to 14 minutes).
Acetazolamide inhibits carbonic anhydrase and reduces aqueous humor production. Brimonidine (Alphagan) is an alpha-2 receptor agonist. Cyclopentolate is a muscarinic antagonist. Bimatoprost (Lumigan) is a prostaglandin analog that increases uveoscleral outflow.
A geriatric patient is scheduled or surgery. Which of
the ollowing intravenous premedications is least likely
to require a dosage adjustment?
(A) midazolam
(B) fentanyl
(C) dexmedetomidine
(D) ranitidine
(E) metoclopramide
(D) ranitidine
For a geriatric patient, ranitidine is least likely to require
dosage adjustment. In general, due to pharmacokinetic or
pharmacodynamic changes, elderly patients often require
a decreased dose of medication compared to younger
adults. Ranitidine, due to age related decreases in renal
function, may require a longer interval (q12–24h) or
repeated dosing but the initial dose (50 mg IV) remains
the same.
Mainly due to changes in brain sensitivity, both midazolam and fentanyl require significant dosage reduction or geriatric patients. Dexmedetomidine may have a higher incidence of bradycardia and hypotension in patients younger than 65 years, and a dose reduction may be required. Geriatric patients may be at increased risk of side effects of metoclopramide (sedation, confusion, parkinsonian- like symptoms, and tardive dyskinesia) and a dosage reduction may be required.
Ref: Miller RD. Miller’s Anesthesia | 8th ed.
Which of the following medications should be discontinued at least 24 hours before surgery to reduce the risk o drug-induced LACTIC ACIDOSIS?
(A) glyburide
(B) glipizide
(C) gliclazide
(D) metformin
(E) repaglinide
(D) Metformin
Metformin is a biguanide that decreases hepatic glucose output and enhances the sensitivity of both hepatic and peripheral tissues to insulin. If this fails to control glucose
levels or the diabetes worsens, therapy with insulin and additional oral agents is indicated.
TRUE or FALSE
No oral hypoglycemic medications are administered
or advised on the morning of surgery.
TRUE
SGLT2 inhibitors must be discontinued ___ before surgery.
A. 3 - 4 days before surgery
B. 1 - 2 days before surgery
C. 24 hours before surgery
D. 12 hours before surgery
A. 3 - 4 days before surgery
Common examples of SGLT-2 Inhibitors
Canagliflozin
Dapagliflozin
Empagliflozin
MOA: Inhibits SGLT2 in the proximal nephron and block glucose reabsorption by the kidney thereby increasing glucosuria
A low risk patient with a long standing DM type II should have a glucose monitoring ___ once place on nil per os:
A. every 4 - 6 hrs
B. every 12 hrs
C. every 2 hrs
D. every 8 hrs
Blood glucose levels should be measured before, during, and after surgery. Blood glucose should be monitored every 4 to 6 hours while the patient is nil per os.
Which of the following is reported to be the BEST predictor of silent ischemia?
A. METS <4
B. Arrhythmia
C. Autonomic neuropathy
D. Smoking > 20 years
Autonomic neuropathy has been reported as the best predictor of silent ischemia. Because these patients are at very high risk for a silent MI, a preoperative electrocardiogram (ECG) should be obtained to examine for the presence of Q waves.
A patient with a diet-controlled GDM is classified as:
A. ASA III
B. ASA II
C. ASA I
B. ASA II
ASA II
Normal pregnancy
well-controlled GDM
controlled pre-eclampsia WITHOUT severe features
controlled gestational hypertension
A pediatric patient who is in oncologic remission is classified as:
A. ASA II
B. ASA III
C. ASA IV
A. ASA II
A patient with RCRI score of 0 have ___ of cardiovascular complications:
A. 0.4 %
B. 6.6%
C. 2%
A. 0.4 %
In patients with an RCRI score of 0, the risk of perioperative cardiovascular complications is 0.4% compared to approximately 11% in patients with a score of 3 or more
A patient with previous history of MI less than 3 months ago was scheduled for elective procedure. After preoperative evaluation, it was determined that the patient METS score is <4. What is the NEXT best step in the pre-operative evaluation of this patient?
A. Dobutamine-stress test
B. Coronary angiogram
C. Proceed with the surgery with precaution
D. Revascularization before surgery
A. Dobutamine-stress test
TRUE or FALSE
The ability to exercise without symptoms of ischemia suggests that no further testing is necessary, and exercise ECG stress testing is infrequently indicated.
TRUE
TRUE or FALSE
advanced age is independently associated with an increased risk of MACE.
TRUE
A patient who’ve had a previous ACS in the absence of coronary intervention should have a delayed noncardiac surgery of at least __
A. 60 days
B. 30 days
C. 15 days
D. 2 weeks
A. 60 days
Recent clinical practice guidelines support delaying noncardiac surgery at least 60 days after an MI in the absence of coronary intervention.
Importantly, recent MI within 6 months of noncardiac surgery appears to be a
risk factor for perioperative stroke
What is the OPTIMUM ‘waiting’ period for elective NONCARDIAC surgery after DES (drug-eluting stents)?
A. 2 months
B. 12 months
C. 6 months
12 months
The current 2014 ACC/AHA Clinical Practice Guideline supports the delay of elective noncardiac surgery for 14 days after coronary balloon angioplasty and 30 days after BMS placement.
The optimal waiting period for elective noncardiac surgery after DES placement is 12 months
A patient with coronary balloon angioplasty is scheduled for an elective NONCARDIAC surgery. How long can the procedure be delayed based on ACC/AHA guidelines?
A. 1 week
B. 2 weeks
C. 5 days
D. 1 1/2 months
B. 2 weeks
The current 2014 ACC/AHA Clinical Practice Guideline supports the delay of elective noncardiac surgery for 14 days after coronary balloon angioplasty and 30 days after BMS placement.
Coronary balloon angioplasty -* 14 DAYS *
**BMS (bare metal stent) - 30 DAYS! **
A 50 year old patient with a significant history of DES 3 weeks ago is scheduled for an ‘elective’ hernia repair. What is the optimum period of waiting before doing the surgery?
A. 12 months
B. 6 months
C. 1 month
A. 12 months
OPTIMUM Period
BMS = 30 days
DES = 365 days
Abrupt stoppage of total parenteral nutrition (TPN) would most likely cause:
A. Hypoglycemia
B. Hyperglycemia
C. Hyperphosphatemia
D. Hypophosphatemia
A. Hypoglycemia
this is due to the high circulating level of Insulin
Hyperglycemia in hospitalized patients has been defined as:
A. blood glucose 7.8 mmol/L
B. above 120 mg/dL
C. above 180 mg/dL
A. blood glucose 7.8 mmol/L
Which of the following diagnostic test is associated to have a higher incidence of post-operative pulmonary complications?
A. Reduced Albumin
B. Elevated Creatinine
C. Elevated BNP
D. Reduced CK-MB
Reduced Albumin
laboratory studies identifying a reduction in serum albumin levels and increased levels of blood urea nitrogen (BUN) appear associated with an increased risk of perioperative pulmonary morbidity.
TRUE or FALSE
A laparoscopic surgery, often longer in duration, is associated with DECREASED pulmonary complications compared with an open procedure despite increased anesthesia duration.
TRUE
Mas mataas ang risk ng pulmonary complications sa mga open procedure versus laparoscopic.
How?
Laparoscopic abdominal surgery is considered to cause less pulmonary dysfunction than open abdominal surgery since it causes less incisional pain in the postoperative period and consequently has less effect on postoperative lung oxygenation. While there are many studies in the literature that compared open and laparoscopic surgery regarding their pulmonary effects in procedures such as cholecystectomy, obesity surgery, esophagogastric surgery, and nephrectomy, there are very few such studies on colorectal surgery.
cessation of smoking for ___ can decrease carboxyhemoglobin levels, abolish nicotine effects, and improve mucous clearance:
A. 2 days
B. 2 weeks
C. 12 hours
A. 2 days
- cessation of smoking for 2 days can decrease carboxyhemoglobin levels, abolish nicotine effects, and improve mucous clearance.
- smoking cessation for 4 to 8 weeks appears necessary to reduce the rate of postoperative pulmonary complications.
Cessation from smoking need this optimum time to reduce post-operative pulmonary complications:
A. 2 - 4 weeks
B. 4 - 8 weeks
C. 1 - 2 weeks
B. 4 - 8 weeks
- smoking cessation for 4 to 8 weeks appears necessary to reduce the rate of postoperative pulmonary complications.
Barash | 9th edit (preoperative evaluation)
The image depicted in the dotted line of this flow-volume loop is accurately represented by which pathology?
(A) Bronchial tumor
(B) Chronic asthmatic bronchitis
(C) Morbid obesity
(D) Paralysis of a vocal cord
(E) Subglottic stenosis
(B) Chronic asthmatic bronchitis
Which of the following asthma medications is withheld ON THE DAY of surgery?
A. Bronchodilators
B. Inhaled Corticosteroids
C. Oral Corticosteroids
D. Antibiotics
E. None of the above
E. None of the above
- Bronchodilators, corticosteroids (inhaled and oral), and any antibiotics must be continued on the day of surgery.
β-adrenergic agonists are a useful prophylactic intervention to lower the risk of bronchospasm after induction of anesthesia. This therapy can be supplemented
with a short preoperative course of oral corticosteroids
(prednisone 20 mg-60 mg daily for 3-5 days) in any
newly diagnosed or poorly controlled asthmatic patient
Importantly, some asthmatics on chronic corticosteroid
treatment may need perioperative “stress dose steroids.
Which of the following parameter is least specific in differentiating restrictive and obstructive lung pathology?
A. Forced vital capacity (FVC)
B. FEV1
C. maximum voluntary ventilation
(MVV)
D. FEV1/FVC ratio
C. maximum voluntary ventilation
(MVV)
The ratio FEV1/FVC is useful in differentiating between restrictive and obstructive pulmonary diseases. This ratio is normal in restrictive disease because both FEV1 and FVC decrease, whereas in obstructive disease the ratio is usually
low because the FEV1 is markedly decreased compared to the FVC.
- MVV is a nonspecific test and is an indicator of both restriction and obstruction.
FEV1/FVC ratio - most useful in differentiating obstructive from restrictive.
