Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Methods 2: Final Exam > Anesthesia Consultation I > Flashcards

Anesthesia Consultation I Flashcards

1
Q

What is the purpose of the preoperative consultation?

A

To reduce the patient’s surgical and anesthetic perioperative morbidity or mortality, and to return the patient to desirable level functioning as quickly as possible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

“Perioperative risk” is multifactorial and a function of: (3)

A
  • the preoperative medical condition of the patient
  • the invasiveness of the surgical procedure
  • the type of anesthetic administered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Surgical procedures and administration of anesthesia are associated with a complex stress response that is proportional to: (4)

A

the magnitude of injury
total operating time
amount of intraoperative blood loss
degree of postoperative pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the key factor in improving outcome and lowering the length of hospital stay as well as the total costs of patients care?

A

Decreasing the stress response to surgery and trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the goals of preoperative evaluation? (7)

A
  • Documentation condition(s) for which surgery is needed.
  • Assessment overall health status.
  • Uncovering of hidden conditions.
  • Perioperative risk determination.
  • Optimization of pt health status.
  • Development perioperative care plan.
  • Education of the patient about surgery/recovery.
  • Reduction of costs/shortening hospital stay.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most important component of the preoperative evaluation?

A

patient history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should the patient history include? (8)

A
  • a past and current medical history
  • a surgical history
  • a family history
  • a social history (use of tobacco, alcohol and illegal drugs)
  • a history of allergies
  • current and recent drug therapy
  • unusual reactions or responses to drugs and any problems or complications associated with previous anesthetics.
  • family history of adverse reactions associated with anesthesia should also be obtained.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A focused pre-anesthesia physical examination includes: (2)

A
  • an assessment of the airway
  • lungs and heart, with documentation of vital signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is a complete blood count needed? (4)

A
  • major surgery
  • chronic cardiovascular, pulmonary, renal, or hepatic disease, or malignancy
  • known or suspected anemia, hemorrhage, or myelosuppression
  • less than 1 y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is an PTT/INR indicated? (3)

A

anticoagulant therapy

bleeding diathesis (hemorrhage)

liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When are electrolytes and creatinine labs indicated? (5)

A

HTN

renal disease

diabetes

pituitary or adrenal disease

digoxin or diuretic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

An EKG is indicated prior to surgery for these patients:

A
  • heart disease, HTN, diabetes
  • other risk factors for cardiac disease
  • subarachnoid or intracranial hemorrhage, CVA, head trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is a CXR indicated preoperatively?

A

cardiac or pulmonary disease

malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When should MAO be withdrawn prior to surgery?

Why?

A

2-3 weeks

risk of interactions with anesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should oral contraceptives be discontinued before elective surgery?

Why?

A

6 weeks

increased risk of venous thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should patients discontinue their herbal supplements?

A

2 weeks prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When should aspirin be discontinued prior to surgery?

A

7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should thienopyridines (such as clopidogrel) be discontinued prior to surgery?

A

2 weeks before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When should oral anticoagulants be discontinued prior to surgery?

What should INR level be?

A

4-5 days

1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are major clinical predictors of increased risk for perioperative cardiac complications?

A

recent MI

unstable or severe angina

decompensated CHF

significant arrhythmias

severe valvular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are intermediate clinical predictors of increased risk for perioperative cardiac complications?

A

mild angina

prior MI history

compensated CHF

diabetes

renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are minor clinical predictors of increased risk for perioperative cardiac complications?

A

advanced age

abnormal ECG

rhythm other than sinus

poor functional capacity

history of stroke

uncontrolled HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are high risk predictors for perioperative cardiac complications?

A

emergency surgery

aortic and major vascular surgery

prolonged surgical procedures with large fluid shifts or blood loss

unstable hemodynamic situations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are intermediate risk procedures for perioperative cardiac complications?

A

abdominal or thoracic surgery

neurosurgery

ENT procedures

minor vascular surgery

orthopedic surgery

prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are low risk procedures for perioperative cardiac complications?
breast surgery superficial surgery eye surgery endoscopic procedures plastic and reconstructive surgery ambulatory surgery
26
What functional capacity, METS: standard light home activities walk around the house walk 1-2 blocks on level ground at 3-5 km/hr
1-4 mets
27
What functional capacity, METS: climb a flight of stairs walk up a hill run a short distance moderate activities like golf, dancing, mounting walking
5-9 METS
28
What functional capacity, METS: ``` strenuous sports (swimming, tennis, bicycle) heavy professional work ```
\>= 10 METs
29
What does METs stand for?
metabolic equivalents of oxygen consumption
30
What are postoperative pulmonary complications? (7)
Pneumonia Atelectasis Bronchitis Bronchospasm Hypoxemia Respiratory failure with prolonged mechanical ventilation Exacerbation of underlying chronic lung disease
31
What ASA status is a patient with mild systemic disease?
ASA 2
32
What ASA status is a patient with severe systemic disease?
3
33
What ASA status is a patient with severe systemic disease that is a constant threat to life?
ASA 4
34
What ASA status is a moribund patient who is not expected to survive w/out the operation?
ASA 5
35
What ASA status is an organ donor?
ASA 6
36
What are risk factors for postoperative pulmonary complications?
procedure-related risk factors length of surgery emergency surgery underlying chronic pulmonary disease smoking age \>60 obesity presence of sleep apnea poor exercise tolerance
37
What patient should be carefully assessed preoperatively for symptoms and signs of peripheral vascular, cerebrovascular and coronary disease?
diabetics
38
What do diabetics have a higher incidence of death after ____ than non-diabetic.
MI
39
What should be administered prior to surgery for a diabetic prior to surgery to limit perioperative ischemia?
beta-blockers
40
When should you treat blood glucose perioperatively?
\> 180 is a good rule of thumb
41
What are perioperative hyperglycemia complications?
dehydration impaired wound healing inhibition of WBC
42
For dental extractions, arthrocentesis, biopsies, ophthalmic operations and diagnostic endoscopy patients need to alter their regimen. True or false?
false do not need to
43
What drugs should be considered for the anticoagulated patient?
IV heparin LMWH (low molecular weight heparin)
44
Invasive surgery is generally safe (from major hemorrhagic complication) when the INR ~\_\_\_.
1.5
45
It takes approximately __ days for the INR to reach 1.5 once oral anticoagulant is stopped preoperatively.
4
46
It takes approximately __ days for the INR to reach 2.0 once oral anticoagulant is restarted postoperatively.
3
47
Regional anesthesia can safely performed in in patients receiving anticoagulant or antiplatelet therapy provided that patient management is based on appropriate timing of needle placement and catheter removal relative to the timing of anticoagulant drug administration. True or false?
true
48
Indwelling catheters should not be removed in the presence of therapeutic anticoagulation, as this appears to significantly increase the risk of _____ \_\_\_\_\_\_\_.
spinal hematoma
49
What does this waveform indicate?
hyperkalemia
50
What does this waveform indicate?
hypokalemia
51
What EKG changes occur with hypocalcemia?
prolongs the QT interval
52
What arrhythmia is associated with a prolonged QT interval?
torsades
53
What waveform is this? What does this waveform indicate?
Osborne Waves severe hypothermia Note: The rhythm is atrial fibrillation. Bradycardia is present. The QT/QTc is prolonged.
54
What does this EKG depict?
Digital effect. Note the downsloping ST segment. Digitalis toxicity is commonly associated with dysrhythmias and AV nodal blocks.
55
What are the following waveforms?
56
What can the following drugs cause to change in an EKG: Sotalol Quinidine Procainamide Disopyramide Amiodarone Dofetilide
prolonged QT interval
57
What can the following drugs cause to change in an EKG: Tricyclic Antidepressants Phenothiazines Erythromycin Quinolone antibiotics Antifungal medications \* Droperidol & Zofran
58
What are the stages of pericarditis found within the EKG?
ST segment elevation T wave inversion which occurs after ST segment moves back to baseline Q waves do not occur in pericarditis and the PR interval is sometimes depressed.
59
Q waves do not occur in pericarditis and the PR interval is sometimes elevated. True or false?
false depressed
60
What condition is indicated by: left ventricular hypertrophy and left axis deviation Q waves in lateral leads I, aVL, V5, and V6
Hypertrophic Obstructive Cardiomyopathy (HOCM)
61
What does this strip indicate?
Hypertrophic Obstructive Cardiomyopathy (HOCM)
62
What does this strip indicate?
myocarditis Note: Any diffuse inflammatory process involving the myocardium can produce a number of changes on the EKG. Most common are conduction blocks especially bundle branch blocks & hemiblocks.
63
What does this strip indicate?
COPD Peaked p waves in leads II, III, aVF, and V1 right axis deviation
64
What changes will you see in a pulmonary embolus?
s waves in lead I q waves in lead III inverted t waves in lead III
65
Unlike an inferior infarction, in which Q waves are seen in at least two of the inferior leads, the Q waves in an acute pulmonary embolus are limited to lead III. True or false?
true
66
What do deeply inverted, wide T waves indicate?
CNS bleed

Clinical Methods 2: Final Exam (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions