Exam 1/ Lecture1: Pre-Op Unit 1

Question 1

Lecture 1/16/23

Which system would lead to serious perioperative adverse events and account for almost the perioperative mortalities?

Answer 1

Cardiovascular system

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Question 2

Lecture 1/16/2023

What type of interventions can modify risks for cardiovascular morbidity and mortatlity?

Answer 2

Perioperative

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Question 3

Lecture 1/16/23

What are the 2 biggest cardiovascular complication that acconet for almost half the perioperative mortalities?

Answer 3

MI and ischemic event

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Question 4

Lecture 1/16/23

What is the parameters to set when monitoring a patients baseline BP?

Answer 4

20% above and below the patients baseline

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Question 5

Lecture 1/16/23

Which 2 population of individals that may present ishchemic heart disease symptoms (adominal pain or fatigue) differnently than the regular population ?

This is mostly discovered in the operating room

Answer 5

Diabetic patients and female patients

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Question 6

Lecture 1/16/23

Related to Heart Failure: What 2 types of cardiovacular disorder if discovered within a patient that we do not want to take into the OR?

Answer 6

Unstable angina and decompensating heart failure

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Question 7

Lecture 1/16/23

Instead of foucusing on EF of a pateint heart what cardiovascular disorder should we focus on

Answer 7

Valvular Heart disease

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Question 8

Lecture 1/16/23

When it comes to patients with rhythm disturbances what are the 2 things that we tend to forget?

Answer 8

atrial kick and electrolyte imbalance

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Question 9

Lecture 1/16/23

What are some of the question that a CRNA should ask regarding a patient with a coronary stent?

Answer 9

What type of stent
How long the stent been place
If they are on any anticoagulation

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Question 10

Lecture 1/16/23

What type of Anesthesia effects the respiratory function and lung physiology and mechanics

Answer 10

General Anesthesia

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Question 11

Lecture 1/16/23

What type of adverse respiratroy event can occur during anesthesia

Answer 11

Hypoxemia

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Question 12

Lecture 1/16/23

What is an example of a situration given during lecture of an adverse respiratory event?

Answer 12

Patient that would receive propfol infusion on room air

may cause periods of apnea and peri- apnea

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Question 13

Lecture 1/16/23

What are the predictors of respiratory function outcomes following anesthesia and surgery?

Answer 13

Intergrative measures

back-up plan if stop breathing, open airway with chin

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Question 14

Lecture 1/16/23

What type of pulmonary disorder that we are now starting to see more cases in adults than children?

Answer 14

Upper respiratory tract infection

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Question 15

Lecture 1/16/23

What pulmonary disorder the CRNA may not know the extent of the disorder until the patient is in the OR

Answer 15

Asthma and COPD

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Question 16

Lecture 1/16/23

True or False. Current the CRNAs are starting to see less chronic smokers

Answer 16

True

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Question 17

Lecture 1/16/2023

Which pulmonary disorder is most likely to obstruct their airway when given propfol?

Answer 17

Obstructive sleep apnea

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Question 18

Lecture 1/16/23

True or False: A CRNA may see a decrese in young people needing lung resections?

Answer 18

False

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Question 19

Lecture 1/16/23

What is the most common endocrine disorder that a CRNA encounter in pre-op?

Answer 19

Diabetes Mellitus

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Question 20

Lecture 1/16/23

What is the second most common endocrine disorder a CRNA may encounter in pre-op and what are some other things to take in consideration regarding this endocrine disorder?

Answer 20

Thyriod disorders

May cause physical difficults due to mass or change in body habitus

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Question 21

Lecture 1/16/23

What would be a concern of a CRNA regarding adminstering GA to a patient with Hypothalamic, pituitary and /or adrenal disorders?

Answer 21

A very strange feed back system
( their medication would interact with our medication ot the GA medication would interact with their disease process)

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Question 22

Lecture 1/16/23

True or False: Surgical stress and anaestheic agent tend to increase GFR

Answer 22

False

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Question 23

Lecture 1/16/23

Sedatives/ opioids might have exaggerated effects on patient with what 4 types of advance liver diseases?

Answer 23

• Hepatitis
• Alcohol liver disease
• Obstructive jaundice
• Cirrhosis

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Question 24

Lecture 1/16/23

What type of diseases or disorder have an significant impact on drug metabolism and pharmacokinetics?

Answer 24

Liver diseases / Hepatic disorder

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Question 25

# Lecture 1/16/23 What are the 4 types of hematologic disorders that may be concerning to a CRNA during pre-op?

Answer 25

* Anemia * Sickle cell disease * G6PD deficiency * Coagulopathies ## Footnote Slide 18

Question 26

# Lecture 1/16/23 What are the neurologic diseases that may be concerning to a CRNA during pre-op? | There are 7 neurologic disease listed in the lecture

Answer 26

* Cerebrovascular disease * Seizure disorders * Multiple sclerosis * Aneurysm and AV malformation * Parkinson disease * Neuromuscular junction disorders * Muscular dystrophy and myopathy ## Footnote Slide 19

Question 27

# Lecture 1/16/23 What are the musculoskeletal and connective tissue disorders that may be concerning to a CRNA during pre-op?

Answer 27

* Rheumatoid Arthritis * Ankylosing Spondylitis * Systemic Lupus Erythematosus * Raynaud Phenomenon ## Footnote Slide 20

Question 28

# Lecture 1/16/23 What are the miscellaneous conditions that may be concerning to a CRNA during pre-op? | 4 conditions

Answer 28

* Morbidly obese patient * Patient with transplanted organs * Patient with allergies * Patient with substance abuse ## Footnote Slide 21

Question 29

# Lecture 1/16/23 What are specific group of patients that may be concerning to a CRNA during pre-op?

Answer 29

Children Pregnant patient Breast feeding patient Elderly patient ## Footnote Slide 22

Question 30

# Lecture 1/16/23 What type of document inform the patient about the risk and alternatives to treatment, procedures, and consequences?

Answer 30

Informed consent ## Footnote Slide 23

Question 31

# Lecture 1/16/23 What is the court case that helped to establish the practice of inform consent in the practice of modern medicine?

Answer 31

Salgo v. Leland Stanford Jr. University Board of Trustees  ## Footnote Slide 23

Question 32

# Lecture 1/16/23 What are some beneifits from share decision making for the patient?

Answer 32

Communicating with pts about the risks and benefits of possible interventions Eliciting pts’ goals, values, and concerns Assisting pts in how to conceptualize the risks and benefits/how to approach the decision ## Footnote Slide 23

Question 33

# Lecture 1/16/23 What type of do-not-resuscitate order in the perioperative period that may refuse certain/specific resuscitation procedures, anesthesia should inform pt/surrogate about which procedures are essential and not essential for the success of the anesthetic and proposed surgery ?

Answer 33

Limited attempt at resuscitation defined with regard to specific procedures ## Footnote Slide 24

Question 34

# Lecture 1/16/23 What type of do-not-resuscitate order in the perioperative period allows the anesthesia and surgical teams to use clinical judgment in determining appropriate resuscitation procedures?

Answer 34

Limited attempt at resuscitation defined with regard to the pt’s goals and values ## Footnote Slide 24

Question 35

# Lecture 1/16/23 What is an example of the high (> 5%) surgical risk of procedures?

Answer 35

Aortic and major vascular Peripheral Vascular ## Footnote Slide 27

Question 36

# Lecture 1/16/23 What is an example of the Intermediate (1% - 5%) surgical risk of procedures?

Answer 36

Intraabdominal surgery Intrathoractic surgery Carotid endarterectomy Head/neck surgery ## Footnote Slide 27

Question 37

# Lecture 1/16/23 What is the amount of points that is assigned to components of revised cardiac risk index?

Answer 37

1 ## Footnote Slide 28

Question 38

# Lecture 1/16/23 What is the risk major cardiac events percentage with a revised cardiac risk index score of 0?

Answer 38

Risk of Major Cardiac Events 0.4% ## Footnote Slide 28

Question 39

# Lecture 1/16/23 What is the risk major cardiac events percentage with a revised cardiac risk index score of 1?

Answer 39

Risk of Major Cardiac Events 1.0% ## Footnote Slide 28

Question 40

# Lecture 1/16/23 What is the risk major cardiac events percentage with a revised cardiac risk index score of 2?

Answer 40

Risk of Major Cardiac Events 2.4% ## Footnote Slide 28

Question 41

# Lecture 1/16/23 What is the risk major cardiac events percentage with a revised cardiac risk index score of >/ = 3?

Answer 41

Risk of Major Cardiac Events 5.4% ## Footnote Slide 28

Question 42

# Lecture 1/16/23 What is an assessment of cardiopulmonary fitness that estimates pt risk for major post-op morbidity or mortality to determine if further testing is necessary?

Answer 42

Functional Capacity ## Footnote Slide 29

Question 43

# Lecture 1/16/23 What tool is use to measure functional capacity?

Answer 43

Measured in METs (metabolic equivalent of task) Rate of energy consumption at rest 1 MET = 3.5 mL/kg/min >4 METs ## Footnote Slide 29

Question 44

# Lecture 1/16/23 What is the equivalent level of exercise with a MET of 1?

Answer 44

Eating, working at computer, or dressing ## Footnote Slide 29

Question 45

# Lecture 1/16/23 What is the equivalent level of exercise with a MET of 12?

Answer 45

Running rapidly for moderate to long distances ## Footnote Slide 29

Question 46

# Lecture 1/16/23 What MET level is ok for surgery?

Answer 46

3 to 4 METs ## Footnote Slide 29

Question 47

# Lecture 1/16/23 What type of urgency of surgery involves life or limb that would be threatened if surgery did not proceed within 6 hours or less?

Answer 47

Emergency ## Footnote Slide 30

Question 48

# Lecture 1/16/23 What type of urgency of surgery involves life or limb that would be threatened if surgery did not proceed within 6 to 24 hour?

Answer 48

Urgent ## Footnote Slide 30

Question 49

# Lecture 1/16/23 What type of urgency of surgery involves delays exceeding 1 to 6 weeks would adversely affect patient ouctomes?

Answer 49

Time-sensitive ## Footnote Slide 30

Question 50

# Lecture 1/16/23 What are the 6 steps of the preoperative cardiac risk assessment algorithmACC/AHA guidelines?

Answer 50

Step 1: Emergerncy Surgery Step 2: Active Cardiac Conditions Step 3: Estimate risk of perioperative death or MI Step 4: Assess function capacity Step 5: Assess whether further testing will iimpact care Step 6: Proceed to surgery or consider alternative strategies ## Footnote Slide 31

Question 51

# Lecture 1/16/23 Who described ‘six degree’ ASA PS grading of a patient’s physical state as just one of the components of the operative risk?

Answer 51

Meyer Saklad et al- 1941 ## Footnote Slide 32

Question 52

# Lecture 1/16/23 What are 4 components that Meyer Saklad et al- 1941 discuss that may be an operative risk as well?

Answer 52

1. The planned surgical procedure 2. The ability and skill of the surgeon in the particular procedure contemplated 3. The attention to postoperative care 4. The past experience of the anesthetist in similar circumstances ## Footnote Slide 32

Question 53

# Lecture 1/16/23 What population of patients needs: * to inform of surgical risk and identify targets for pre-op optimization * Goal is to identify modifiable risk factors to optimize surgical outcomes * Malnutrition, poor physical function, anxiety, and social isolation * Functional and cognitive impairment = poor post-op outcomes * Function decline is associated with morbidity, mortality, and loss of function after surgery * Assess ADLs, history of falls * Cognitive impairment = delirium, complications, functional decline, and death post-op * Mild cognitive impairment can critically impact decision-making capacity

Answer 53

Elderly and frailty ## Footnote Slide 25

Question 54

# Lecture 1/16/23 What population of patients as: * Poor nutritional status = infectious complications, wound complications, and increased length of stay * Ex: surgical site infections, pneumonia, UTIs, dehiscence, anastomotic leaks * Associated with adverse health outcomes post medical and surgical interventions and decreased life expectancy * Underdiagnosed - anxiety, depression, substance abuse, and social isolation

Answer 54

Elderly and frailty ## Footnote Slide 26

Question 55

# Lecture 1/16/23 What 3 factors can effect anesthesia that can influence various components on poor perioperative outcome?

Answer 55

* Provider characteristics * Errors in Judgement * Mishaps ## Footnote Slide 33

Question 56

# Lecture 1/16/23 What 3 factors can effect a patient disease that can influence various components on poor perioperative outcome?

Answer 56

* Surgical disease * Age and Sex * Comorbidity ## Footnote Slide 33

Question 57

# Lecture 1/16/23 What 2 factors can effect a surgery that can influence various components on poor perioperative outcome?

Answer 57

* Errors in judgement * Location of postoperative care ## Footnote Slide 33

Question 58

# Lecture 1/16/23 What are some examples of poor perioperative outcomes that was influence by various compents?

Answer 58

* Death * Major morbidity * Minor morbidity * Readamission * Satifaction ## Footnote Slide 33

Question 59

# Lecture 1/16/23 How many ASA Physical Status (PS) are there?

Answer 59

6 ## Footnote Lecture

Question 60

Which ASA -PS will always have a E (emeregency) mark with it when identifying risk factors?

Answer 60

ASA 5 ASA 6

Question 61

# Lecture 1/16/23 What is the definition of ASA 1 and example?

Answer 61

Definition: A normal healthy patient Example: Healthy, nonsmoker , no alcohol ## Footnote Slide 34

Question 62

# Lecture 1/16/23 What is the definition of ASA 2 and example?

Answer 62

Definition: A patient with mild systemtic disease Example: pregenacy, Obesity, smoker, drinker, HTN/DM ## Footnote Slide 34

Question 63

# Lecture 1/16/23 What is the definition of ASA 3 and example?

Answer 63

Definition: A patient with serve systemic disease Example: Poorly controlled DM or HTN COPD, (> 3 months) MI, CVA , TIA CAD/ stent ## Footnote Slide 34

Question 64

# Lecture 1/16/23 What is the definition of ASA 4 and example?

Answer 64

Definition: A patient with severe systemic disease that is a contstant threat to life Example: (< 3 months) of MI, CVA, or CAD/sents, ongoing cardiac ## Footnote Slide 34

Question 65

# Lecture 1/16/23 What is the definition of ASA 5 and example?

Answer 65

Definition: A moribund patient who is not expected to survive without the operation Example: ruptureed abdominal/ thoractic aneurysm ## Footnote Slide 34

Question 66

# Lecture 1/16/23 What is the definition of ASA 6?

Answer 66

Definition: A delcared brain - dead patient whose organs are being removed for donor purposes ## Footnote Slide 34

Question 67

# Lecture 1/16/23 What are the 10 laboratory studies that can be done pre-op?

Answer 67

* CBC/ Hemoglobin/ Hematocrit * Renal Function testing * Electrolytes * liver Funtion testing * Coagulation testing * Serum Glucose and Glycates Hemoglobin (HbA1c) * Urianalysis * Pregnancy Test * ECG * Chest X-ray ## Footnote Slide 36 - 40

Question 68

# Lecure 1/16/23 What type of laboratory study would be order during pre -op: * Surgery, potential blood loss, individualized pt clinical indications * Hx of increased bleeding, hematologic disorders, anti-coagulant therapy, poor nutritional status * ASA-PS 3 or 4 undergoing intermediate-risk procedures * All pts undergoing major procedures

Answer 68

CBC/Hemoglobin/Hematocrit ## Footnote Slide 36

Question 69

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * DM, HTN, cardiac disease, dehydration (N/V, diarrhea), renal disease, fluid overload * ASA-PS 3 or 4 undergoing intermediate-risk procedures * ASA-PS 2, 3, or 4 undergoing major procedures

Answer 69

Renal Function Testing ## Footnote Slide 36

Question 70

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Suspected undiagnosed or worsening condition that will affect peri-op management * Renal or hepatic disease, malnutrition, malabsorption, ETOH abuse, HF, arrhythmias, medications that may cause an imbalance

Answer 70

Electrolytes ## Footnote Slide 37

Question 71

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Liver injury and physical exam findings * Hepatitis, jaundice, cirrhosis, portal HTN, biliary disease, gallbladder disease, bleeding disorders

Answer 71

Liver Function Testing ## Footnote Slide 37

Question 72

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Known or suspected coagulopathy identified on pre-op evaluation * Known bleeding disorder, hepatic disease, and anticoagulant use * ASA-PS 3 or 4; undergoing intermediate, major, or complex surgical procedures; known to take anticoagulant medications or chronic liver disease

Answer 72

Coagulation Testing ## Footnote Slide 38

Question 73

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Known DM (or family history), obesity (BMI > 50), cerebrovascular or intracranial disease, or steroids history * HbA1c long-term measurement of glucose control (3 months) * Better assessment of diabetic therapy > random/fasting blood sugar * HbA1c = ½ from previous 30 days + ½ the time period of 2 to 3 months before * All diabetic patients

Answer 73

Serum Glucose and Glycated Hemoglobin (HbA1c) ## Footnote Lecture 1/16/23

Question 74

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Suspected UTI and unexplained fever or chills * instilling hardware

Answer 74

Urinalysis ## Footnote Slide 49

Question 75

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Sexual activity, birth control use, and date of last menstrual period * Recommendation… all women of childbearing potential of the possibility of pregnancy and women possibly pregnant made aware of the risks of anesthesia/surgery to the fetus

Answer 75

Pregnancy Test ## Footnote Slide 39

Question 76

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Ischemic heart disease, HTN, DM, HF, chest pain, palpitations, abnormal valvular murmurs, dyspnea on exertion, syncope, arrythmia * Known IHD, significant arrhythmia, PAD, CV disease, significant structural heart disease undergoing intermediate- risk or high-risk procedures * Routine in ASA-PS 3 or 4 undergoing intermediate- risk * Routine ASA-PS 2, 3, or 4 major/high-risk procedures

Answer 76

ECG ## Footnote Slide 40

Question 77

# Lecture 1/16/23 What type of laboratory study would be order during pre -op: * Based on abnormalities identified during pre-op evaluation * Advanced COPD, bullous lung disease, pulmonary edema, pneumonia, mediastinal masses, suspicious physical exam findings (rales, tracheal deviation)

Answer 77

Chest Xray ## Footnote Slide 40

Question 78

# Lecture 1/16/23 What type of anesthesia: * Total loss of consciousness and airway control * ET or LMA used * Ex: major surgeries… total joints, open-heart surgery, bowel surgery

Answer 78

General ## Footnote Slide 42

Question 79

# Lecture What is General Anesthesia

Answer 79

* Total loss of consciousness and airway control ## Footnote Slide 42

Question 80

# Lecture 1/16/23 What type of anesthesia: * Level of sedation ranges… minimal (drowsy, able to talk) to deep (sleeping, may not remember surgery/procedure * NC or face mask * Ex: minor surgeries/procedures or shorter, less complex procedures… biopsy, colonoscopy

Answer 80

IV/Monitored Sedation ## Footnote Slide 42

Question 81

# Lecture 1/16/23 What type of respiratory device is use during General Anesthesia

Answer 81

ET/ LMA ## Footnote Slide 42

Question 82

# Lecture 1/16/23 What is an example(s) of surgeries that will be done under General Anesthesia?

Answer 82

major surgeries… total joints, open-heart surgery, bowel surgery ## Footnote Slide 42

Question 83

# Lecture 1/16/23 What is an example(s) of surgeries that will be done under IV/ Monitored Anesthesia?

Answer 83

minor surgeries/procedures or shorter, less complex procedures… biopsy, colonoscopy ## Footnote Slide 42

Question 84

# Lecture 1/16/23 What type of respiratory device is use during IV/ Monitored Anesthesia?

Answer 84

NC or face mask ## Footnote Slide 42

Question 85

# Lecture 1/16/23 What type of Anesthesia: Pain management method that numbs a large part of the body using a local anesthetic Epidural or spinal Ex: childbirth or joint replacements in elderly pts

Answer 85

Regional ## Footnote Slide 43

Question 86

# Lecture 1/16/23 What are 2 examples procedures that regoinal can be use?

Answer 86

childbirth or joint replacements in elderly pts ## Footnote Slide 43

Question 87

# Lecture 1/16/23 What are the 2 types of regional anesthesia?

Answer 87

Epidural or spinal ## Footnote Slide 43

Question 88

# Lecture 1/16/23 What is the type of Anesthesia: * Pain management method, usually a one-time injection of local anesthetic that numbs a small area of the body * Can be used with general or conscious sedation depending on the surgery and pt history * Ex: skin or breast biopsy, bone/joint repair

Answer 88

Local

Question 89

# Lecture 1/16/23 What type of anesthesia can be paired with general or conscious sedation depending on the surgery?

Answer 89

Local ## Footnote Slide 43

Question 90

# Lecture 1/16/23 What are 2 examples procedures that local can be use?

Answer 90

skin or breast biopsy, bone/joint repair ## Footnote slide 43

Question 91

# Lecture 1/16/23 What are 4 things to take in consideration when planning for postoperative pain management?

Answer 91

* All patients have the right to appropriate assessment and treatment of pain * A preoperative evaluation should include baseline pain assessment * Provides an important opportunity to discuss and plan for the management of acute postoperative pain * Specific issues include their tolerance to usual doses of opioid analgesics and the potential for acute withdrawal reactions should be assessed ## Footnote Slide 44

Question 92

# Lecture 1/16/23 What are the most common agents that causes anaphylaxis regarding allergies?

Answer 92

Neuromuscular blockers Antibiotics Chlorhexidine ## Footnote Slide 45

Question 93

# Lecture 1/16/23 Fill in the blanks: When a patient describes a symptom (s) from an allergie(s) a CRNA must determine if the symptom will cause ___________ vs ____________.

Answer 93

Anaphylaxis vs adverse side effects ## Footnote Slide 45

Question 94

# Lecture 1/16/23 What are the 5 most common agents that can be listed as an allergies in the patient cart?

Answer 94

1. Latex 2. Antibotics 3. Local Anesthetics 4. Neuomuscular block agents 5. Opiods ## Footnote Slide 46 - 47

Question 95

# Lecture 1/16/23 The describtion below is an example of an allergy to what type of agent: * Amide vs ester * Ester reactions… due to preservative - para-aminobenzoic acid (PABA) * Epinephrine in LA causes adverse side effects, not an allergy

Answer 95

Local anesthetics ## Footnote Slide 47

Question 96

# Lecture 1/16/23 The describtion below is an example of an allergy to what type of agent: * Quaternary ammonium compounds * Cross-reactivity possible with allergy to neostigmine and morphine * Ammonium ions

Answer 96

Neuromuscular blocking agents ## Footnote Slide 47

Question 97

# Lecture 1/16/23 The describtion below is an example of an allergy to what type of agent: * True allergy is rare… related to side-effects (ex. nausea and vomiting)

Answer 97

Opioids ## Footnote Slide 47

Question 98

# Lecture 1/16/23 The describtion below is an example of an allergy to what type of agent: * Risk factors – history of multiple surgeries, occupational exposure to latex (healthcare workers, food handlers), food allergies that cross-react (mango, kiwi, avocado, passion fruit, banana, and chestnuts) * Notify surgical team immediately

Answer 98

Latex ## Footnote Slide 46

Question 99

# Lecture 1/16/23 The describtion below is an example of an allergy to what type of agent: * PCN and cephalosporins most common causes of anaphylaxis * Small risk of cross-reactivity, usually rashes * Avoid in true IgE –mediated allergy * Vancomycin… distinguish between allergy and “red man syndrome” * Histamine-induced side

Answer 99

Antibiotics ## Footnote Slide 46

Question 100

# Lecture 1/16/23 What are the 15 categories of medications that a patient should continue taking pre-operatively?

Answer 100

* Antihypertensive medications * Cardiac medications (ex. Beta-blockers, digoxin) * Anti-depressants, anxiolytics, and other psychiatric medications * Thyroid medications * Oral contraceptive pills * Eye drops * GERD medications * Opioid medications * Anti-convulsant medications * Asthma medications * Corticosteroids (oral and inhaled) * Statin medications * ASA * COX-2 inhibitor medications (celecoxib) * Monamine oxidase inhibitor (MAOIs) medications ## Footnote Slide 48 - 49

Question 101

# Lecture 1/16/23 What type of antihypertensive medications may be discontinue 24 hours before surgery?

Answer 101

angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) ## Footnote Slide 48

Question 102

# Lecture 1/16/23 What anti -depressant medication should the CRNA order an ECG to assess what part of the patient heart rhythm?

Answer 102

order an ECG d/t prolonged QT interval ## Footnote slide 48

Question 103

# Lecture 1/16/23 A female that is taking oral contraceptive pills is at a high - risk in developing what disorder? How soon before surgery should a female stop taking oral contraceptive pills?

Answer 103

High-risk pt for post-op venous thrombosis... d/c 4 weeks prior to sugery ## Footnote Slide 48

Question 104

# Lecture 1/16/23 A patient with this type of disease/ disorder should continue taking ASA until how many days prior to surgery?

Answer 104

Cont in pts w/ prior percutaneous coronary intervention, high-grade ischemic heart disease, significant cardiovascular disease Typically, d/c 10-14 days prior to surgery ## Footnote Slide 49

Question 105

# Lecture 1/16/23 What medication should be discointued prior to surgery if there are concerns that the medication will effect bone healing?

Answer 105

monamine oxidase inhibitor (MAOIs) medications ## Footnote Slide 49

Question 106

# Lecture 1/16/23 True or False: Adjust anesthesia plan to avoid meperidine and in-direct acting vasopressors (ephedrine)

Answer 106

True ## Footnote Slide 49

Question 107

# Lecture 1/16/23 How soon pre-operatively should the medcations be disconinue: * Clopidogrel, ticagrelor * Prasugrel * Ticlopidine

Answer 107

* Clopidogrel, ticagrelor… d/c 5-7 days * Prasugrel… d/c 7-10 days * Ticlopidine… d/c 10 days ## Footnote Slide 50

Question 108

# Lecture 1/16/23 True or False: Do not d/c a P2Y 12 inhibitor drug-eluting stents until 6 months of dual antiplatelet therapy is completed

Answer 108

True ## Footnote Slide 50

Question 109

# Lecture 1/16/23 True or False: Discontinue P2Y 12 inhibitors and wrfarin in pt for cataract symptoms w/ topical or general anesthesia

Answer 109

False ## Footnote Slide 50 -51

Question 110

# Lecture 1/16/23 How soon pre-operatively should the medcations be disconinue: * Topical medications * Diuretics * Sildenafil

Answer 110

* Topical medications… d/c day of surgery * Diuretics… d/c day of surgery * Sildenafil… d/c 24 hours before surgery ## Footnote Slide 50

Question 111

# Lecture 1/16/23 Which class of diurectics should not be discontinue pre-operative

Answer 111

Thiazide ## Footnote Slide 50

Question 112

# Lecture 1/16/23 How soon pre-operatively should the medcations be disconinue: * NSAIDs * Warfarin * Post-menopausal HRT * Non-insulin anti-diabetic medications * SGLT2 inhibitors

Answer 112

* NSAIDs… d/c 48 hours before surgery * Warfarin... d/c 5 days before surgery * Post-menopausal HRT… d/c 4 weeks prior to surgery * Non-insulin anti-diabetic medications… d/c on day of surgery * SGLT2 inhibitors... d/c 24 hours before surgery ## Footnote Slide 51

Question 113

# Lecture 1/16/23 How soon pre-operatively should short -acting (regular) insulin be disconinue:

Answer 113

day of surgery ## Footnote Slide 52

Question 114

# Leecture 1/16/23 True or False: If the patient as an inulin pump, continue at basal rate

Answer 114

True ## Footnote Slide 52

Question 115

# Lecture 1/16/23 What type and how much insulin should a type 1 DM take pre- operatively?

Answer 115

Take a small amount (approx 1/3) of usual dose of morning long-acting insulin on day of surgery ## Footnote Slide 52

Question 116

# Lecture 1/16/23 What type and how much insulin should a type 2 DM take pre- operatively?

Answer 116

Take none or up to half of long-acting or combination insulin dose on day of surgery ## Footnote Slide 52

Question 117

# Lecture 1/16/23 What are 5 things to take in consideration when managing steroids and HPA suppression pre - operatively?

Answer 117

* Cortisol is produced by the adrenal gland * Hydrocortisone is an equally potent synthetic version * Exogenous glucocorticoids suppress cortisol secretion at HPA axis * May lead to adrenal insufficiency and adrenal atrophy (Adrenal recovery occurs gradually after steroid therapy is tapered and d/c’d) * May blunt the normal cortisol hypersecretion associated with surgery ## Footnote Slide 53

Question 118

# Lecture 1/11/24 What are the 3 main goals of a pre -operative evaluation

Answer 118

* Ensure patients can safely tolerate anesthesia for surgery * Mitigate perioperative risks * Clinical examination = history and physical examination ## Footnote Slide 2

Question 119

# Lecture 1/11/24 What are 5 examples that can cause a surgery to be delayed

Answer 119

* optimize concerns discused * refer to othe specialists * refer for specialized testing * initiate interventions intneded to decrease perioperative risk * identify previously recongnized comorbid condition ## Footnote Slide 2

Question 120

# Lecture 1/11/24 What are 5 ways that a patient benefits from a pre- op evaulation

Answer 120

* Reduces anxiety * Provides education * Discusses medications * Reduces post-op morbidity * Answers questions ## Footnote Slide 4

Question 121

# Lecture 1/10/24 What are 4 watys that an anestheris provider benefits from at pre -op evaluation?

Answer 121

* Learn of medical conditions * Devise an anesthetic plan intra-op and post -op * Time for consultants * DNR ## Footnote Slide 4

Question 122

# Lecture 1/11/24 What are 3 ways that a suregeon/ Hospital benefit frm pre-op evaluation?

Answer 122

* Decreases cost of peri-operative care * Improves efficiency * Decreases cancellations/delays ## Footnote Slide 4

Question 123

# Lecture 1/11/24 What are 9 health care components that will need to be address during pre-op?

Answer 123

* Underlying condition requiring surgery * Known medical problems/past medical issues * Previous surgeries/anesthetic history * Anesthetic-related complications * Review of systems * Medications * Allergies * Tobacco/ETOH/Illicit drug use * Functional capacity ## Footnote Slide 5

Question 124

# Lecture 1/11/24 What are 2 main concerns from previous surgeries/ anesthetic history regarding side effects of anesthesia?

Answer 124

* malignant hyperthermia * Pseudocholinesterase deficiency ## Footnote Slide 5

Question 125

# Lecture 1/11/24 If a certain medication was not taken by the patient pre -opertively what would be concerning to the CRNA?

Answer 125

* Repercussion of not taking the medication ## Footnote Slide 5

Question 126

# Lecture 1/11/24 True or False: Pain medication can be given to a patient pre-opertively to manage their pain.

Answer 126

True ## Footnote Slide 5

Question 127

# Lecture 1/11/24 What is functional capacity in correlation to anesthesia?

Answer 127

What are you able to do ## Footnote Slide 5

Question 128

# Lecture 1/11/24 What tool is use to classify risk for anesthesia

Answer 128

ASA 1-5 (E) ## Footnote Slide 6

Question 129

# Lecture 1/11/24 What are the formulas for calculating the BMI in metric and imperial?

Answer 129

## Footnote Slide 7

Question 130

# Lecture 1/11/24 Base on the body mas index ranges what is the weight status of the patients? * BMI < 18.5 * BMI 18.5 -24.9 * BMI 25.0 - 29.9 * BMI 30 and above

Answer 130

* BMI < 18.5 = Underweight * BMI 18.5 -24.9 = Normal * BMI 25.0 - 29.9 = Overweight * BMI 30 and above = Obese ## Footnote Slide 7

Question 131

# Lecture 1/11/24 Who develop the BMI?

Answer 131

insurance companies ## Footnote Slide 7

Question 132

# Lecture 1/11/24 BMI do not take in account of what type of mass of a patient?

Answer 132

Muscle mass ## Footnote Slide 7

Question 133

# Lecture 1/11/24 What are 4 elements that a CRNA should focous on regarding physical examinatin of neruo

Answer 133

* Establish a baseline neuro exam based upon surgery or procedure * Seizures * CVA * TIA ## Footnote Slide 8

Question 134

# Lecture 1/11/24 What are 4 cardiovascular diseases that a CRNA should focous on regarding physical examinatin of cardiovasular system

Answer 134

* CAD * MI * HTN *CHF ## Footnote Slide 8

Question 135

# Lecture 1/11/24 What are 2 diseases examples that a CRNA should focous on regarding physical examinatin of the pulmonary system.

Answer 135

Asthma/ COPD ## Footnote Slide 8

Question 136

# Lecture 1/11/24 What are 2 "cardiovascular diseases" (hard stop) that are containdicated for anesthesia?

Answer 136

unstable angina (Chest pain) decompensated heart failure ## Footnote Slide 8

Question 137

# Lecture 1/11/24 What are other items of an physical examination that a CRNA can focus on other than neuro, CV and pulmonary for pre-op ? | 7 other items

Answer 137

Airway Endocrine Hepatobiliary disorders Renal Musculoskeletal disorders Immunocompromised Obesity ## Footnote Slide 8

Question 138

# Lecture 1/11/24 A CRNA would be very concern about taking a patient to surgery if they found out that a patient had this type of adrenal disorder that would affect the way the CRNA managed their BP ?

Answer 138

pheochromocytoma ## Footnote Slide 8

Question 139

# Lecture 1/11/24 Why would a CRNA be concern with patients that have bad liver disease?

Answer 139

due to cloting factors ## Footnote Slide 8

Question 140

# Lecture 1/11/24 Why would a CRNA be concern with patients that have bad kidney disease?

Answer 140

Blood pressure related to fluid status Medication clearance ## Footnote Slide 8

Question 141

# Lecture 1/11/24 A patient that has this type of muscloskeletal disorders do not breath very well and my not tolerate muscle relaxants?

Answer 141

myasthenia gravis ## Footnote Slide 8

Question 142

# Lecture 1/11/24 What problems may a CRNA run into regarding treating pateints with immunocompromised patients?

Answer 142

Limited to what limb can be use ## Footnote Slide 8

Question 143

# Lecture 1/11/24 What does A.M.P.L.E stand for regarding an emerengent physical examination?

Answer 143

A = Allergies M = Medications P = Past medical history L = Last meal eaten E – Events leading up to need for surgery/procedure Think about the things you would want or need to know! ## Footnote Slide 9

Question 144

# Lecture 1/11/24 What are 6 reasons why a CRNA would do an airway examination?

Answer 144

* Mallampati classification * Inter-incisors gap * Thyromental distance * Forward movement of mandible * Range of cervical spine motion: flexion and extension * Document loose or chipped teeth, tracheal deviation ## Footnote Slide 10

Question 145

# Lecture 1/11/24 Which of the following is a common sign of COPD? ## Footnote Kahot

Answer 145

Barrel Chest ## Footnote Slide 1

Question 146

# Lecture 1/11/24 Butterfly rashes are assoicated with what auto immune disorder? ## Footnote Kahot

Answer 146

Systemic Lupus Erthematous ## Footnote Slide 2

Question 147

# Lecture 1/11/24 Clubbing of finger is assocciated with what 4 congenital heart defects? ## Footnote Kahot

Answer 147

* Ventricular spetal defect * pulmonary stenosis * overriding of aorta * right ventricular hypertrophy ## Footnote Slide 3

Question 148

# Lecture 1/11/24 Pill rolling Tremors are associated with what neurologic disorder? ## Footnote Kahot

Answer 148

Parkinsons ## Footnote Slide 4

Question 149

# Lecture 1/11/24 What sign, also known as RUQ pain accompanies cholecystitis? ## Footnote Kahot

Answer 149

Murphys Sign ## Footnote Slide 5

Question 150

# Lecture 1/11/24 What vision change accompanies glaucoma? ## Footnote Kahot

Answer 150

Tunnel Vision ## Footnote Slide 6

Question 151

# Lecture 1/11/24 What is the other name for the chest commonly associated with myocardial infarction? ## Footnote Kahot

Answer 151

Levines Sign ## Footnote Slide 7

Question 152

# Lecture 1/16/23 What musculoskeletal and connective tissue disorders may need for the patient to be pre warmed

Answer 152

Raynaud Phenomenon ## Footnote Slide 20

Question 153

# Lecture 1/16/24 What 3 substance that are abuse can be concerning to a CRNA?

Answer 153

Meth cocaine kratom (Stimulant) ## Footnote Slide 21

Question 154

# Lecture 1/16/23 True or False: A patient that does not have any HPA suppression that receive one dose of steroids should start a low dose steriods

Answer 154

False ## Footnote Slide 54

Question 155

# Lecture 1/16/24 True or False, A patient that is receiving > 20mg of prednisone/ day for > 3 weeks pre - operatively or has cushingoid apperance should receive steroid management.

Answer 155

True ## Footnote Slide 54

Question 156

# Lecture 1/16/24 During pre- op, what are the 3 things you should assess if the patient is on steroid and HPA supresion medication?

Answer 156

Duration Dose, and Potencay of all steroids taken during the past year ## Footnote Slide 54

Question 157

# Lecture 1/16/24 What are 2 things to take into consideration when adminstering a stress dose?

Answer 157

* Physiologic replacement doses are required * Dosage varies based on surgical procedures ## Footnote Slide 54

Question 158

# Lecture 1/16/24 What is the go -to amount (mg) of hydrocortisone that a patient could receive pre-opetatively that can be repeated?

Answer 158

100mg ## Footnote Slide 54

Question 159

# Lecture 1/16/24 What are 5 consideration that a CRNA should be aware pre-opertatively regarding Herbals and vitmans?

Answer 159

* Direct effects... intrinsic pharmacologic effects * Pharmacodynamic interactions… alters action of conventional drugs at effector site * Pharmacokinetic interactions… alters absorption, distribution, metabolism, and elimination of conventional drugs * Approximately 50% of pts take multiple herbs * 25% take prescription drugs ## Footnote Slide 56

Question 160

# Lecture 1/16/24 What is **Echinacea** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 160

* Common name = Purple coneflower root * Pharmcologic Effects= Activation of cell mediated immunity * Perioperative Concerns = Allergic reaction, decrease effectiveness of immunosppressants, potential for immunosuppresion with lng -term use * How soon to discontinue before suregery = no data ## Footnote Slide 57

Question 161

# Lecture 1/16/24 What is **Ephedra** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 161

* **Common name **= Ma huang * **Pharmcologic Effects** = increase heart rate and blood direct and indirect sypathomimetic effects * **Perioperative Concerns** = Risk of mycardial ischemia and stroke from tachycardia and hypertension, ventricular arrhymia with halothane, long-term use depletes endogenous catecholamines and may cause intraoperative hemodynamic instability, life- threating interaction with MAO inhibitors * **How soon to discontinue before suregery**= 24 hours ## Footnote Slide 57

Question 162

# Lecture 1/16/24 What is:** Garlic** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 162

* **Common name** = Ajo * **Pharmcologic Effects** = inhibits platelet aggeration (may be irreversible), increase fibrinolysis, Equivocal antihypertensive activity * **Perioperative Concerns** = My increase risk of bleeding, especially when combined with other medication that inhibit platelet aggregation * **How soon to discontinue before suregery** = 7 days ## Footnote Slide 57

Question 163

# Lecture 1/16/24 What is **Ginger** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 163

* **Common name** =none * **Pharmcologic Effects** = antimetic, antiplatelet aggergation * **Perioperative Concerns ** = may increase risk of bleeding *** How soon to discontinue before suregery** = no data ## Footnote Slide 57

Question 164

# Lecture 1/16/24 What is **Ginkgo** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 164

* **Common name** = duck - foot tree, maidenhair tree, silver apricot * **Pharmcologic Effects** = inhibits platelet- activating factor * **Perioperative Concerns** = May increase risk of bleeding, especially when combined with other medications that inhibits platelet aggregation * **How soon to discontinue before suregery** = 36 hour ## Footnote Slide 57

Question 165

# Lecture 1/16/24 What is **Ginseng** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 165

* **Common name** = American, Asian, Chinese, and Korean Ginseng * **Pharmcologic Effects** = Lowers blood glucose, inhibits platelet aggregation (may be irreversible), increase PT/PTT in animals * **Perioperative Concerns** = Hyoglycemia, may increase risk of bleeding, may decrease anticoagulant effect of warfarin * **How soon to discontinue before suregery**= 7 days ## Footnote Slide 57

Question 166

# Lecture 1/16/24 What is Green Tea * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 166

* **Common name** = none * **Pharmcologic Effects** = *inhibits platelet aggregation inhibits thromboxane A2 formation * * **Perioperative Concerns** = May increase risk of bleeding may decrease anticoagulant effect of warfarin * **How soon to discontinue before suregery** = 7 days ## Footnote Slide 57

Question 167

# Lecture 1/16/24 What is** Kava** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 167

* **Common name** = Awa, intoxicating peper, kawa * **Pharmcologic Effects** = sedation , anxiolysis * **Perioperative Concerns** = may increase sedative effects of anestheics, increase in anesthetic requirements with long - term use unstudied * **How soon to discontinue before suregery** =24 h ## Footnote Slide 57

Question 168

# Lecture 1/16/24 What is **Saw** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 168

* **Common name** = palmetto ( dwarf palm, Sabal) * **Pharmcologic Effects** = inhibits 5a reductase, inhibits cyclooxygenase * **Perioperative Concerns ** = may increase risk of bleeding *** How soon to discontinue before suregery** =No data ## Footnote Slide 57

Question 169

# Lecture 1/16/24 What is **St John wort ** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 169

* **Common name** = amber goat weed, hardhay, hypericum, klamath weed * **Pharmcologic Effects** = *inhibits neurotranmitter reuptake, MAO inhibition unlikely* * **Perioperative Concerns** = induction of cytochrome p450 enzymes; affects cyclosporine, warfarin, steroids and protease inhibitors: may affect benzodiazepines, clacium channel blockers, and many other drugs, decreased serum digoxin levels, delayed emergence * **How soon to discontinue before suregery** = 5 days ## Footnote Slide 58

Question 170

# Lecture 1/16/24 What is **Valerain ** * Common name * Pharmcologic Effects * Perioperative Concerns * How soon to discontinue before suregery

Answer 170

* **Common name** = all heal, garden heliotrope, vandal root * **Pharmcologic Effects** = *sedation* * **Perioperative Concerns** = may increase sedative effect of anesthetics, benzodiazepine-like acute withdrawal, may increase anesthetic requirements with long -term use * **How soon to discontinue before suregery** = data ## Footnote Slide 58

Question 171

# Lecture 1/16/24 What is the NPO duration in hours for full meals and give an examples?

Answer 171

8 hours Full meals, fatty foods, enternal tube feeds ## Footnote Slide 59

Question 172

# Lecture 1/16/24 What is the NPO duration in hours for light meals and give and examples?

Answer 172

6 hours toast and liquids, infant formula, nonhuman milk, coffee with milk ## Footnote Slide 59

Question 173

# Lecture 1/16/24 What is the NPO duration in hours for clear liquids and give an examples?

Answer 173

2 hours water, sports drinks,carbonated beverages, coffee, tea, juice without pulp ## Footnote Slide 59

Question 174

# Lecture 1/16/24 What is the NPO duration in hours for breast milk?

Answer 174

4 hours ## Footnote Slide 59

Question 175

# Lecture 1/16/24 What is the name of the person that discovered that a person as an increase risk of aspiration if > 25 ml of residual volume is still in the stomach and pH <2.5? | the syndrome was named after him

Answer 175

Curtis Lester Mendelson ## Footnote Slide 60

Question 176

# Lecture 1/16/24 What are 6 ways premedication can prevent aspiration?

Answer 176

* Decrease gastric volume and acidity * Non-particulate antacids (sodium citrate)… increase gastric pH * Histamine-2 receptor antagonists (ranitidine, cimetidine, famotidine… increase gastric pH, decrease gastric acid secretion * Proton pump inhibitors (omeprazole, pantoprazole)… increase gastric pH, decrease gastric acid secretion * Dopamine-2 antagonist (metoclopramide)… reduces gastric volume * how long they take to work ## Footnote Slide 60

Question 177

# Lecture 1/16/24 Which medication to prevent aspiration can cause anxiety to develop in patient? | given a benzo as well

Answer 177

metoclopramide ## Footnote Slide 60

Question 178

# Lecture 1/16/24 What are the 2 scoring systems in the adlut risk scoring system?

Answer 178

Koivuranta Risk Score System (2) Simplified Apfel Sore (3) ## Footnote Slide 61

Question 179

# Lecture 1/16/24 What are the risk factors for PONV: Koivuranta Risk Score System (2) in decreasing order of significance?

Answer 179

* female gender * history of PONV/motion sickness * nosmoking status * age (less than 50 years old) * duration of surgery ## Footnote Slide 61

Question 180

# Lecture 1/16/24 What are the risk factors for PONV: Simplified Apfel Sore (3) in decreasing order of significance?

Answer 180

* Female gender * history of PONV/ montion sickness * nonsmoking status * Postoperative opiods ## Footnote Slide 61

Question 181

# Lecture 1/16/24 If a patient has 1 to 2 PONV risk factors what would be the range class of risk level and how can we prevent it from happening? | Class of risk factors : low, moderated, severe

Answer 181

* 1 to 2 risk factors = moderate-to-severe risk * Prevention with 2 to 3 drugs from different classes ## Footnote Slide 62

Question 182

# Lecture 1/16/24 If a patient has 3 to 4 PONV risk factors what would be the class range risk level and how can we prevent it from happening? | Class of risk factors : low, moderated, severe

Answer 182

* 3 to 4 risk factors = severe risk * Consider avoiding GA or use a propofol-based anesthetic * Minimize opioids * Prevention with 3 drugs from different classes ## Footnote Slide 62

Question 183

# Lecture 1/16/24 What is the name of this PONV medication? * acetylcholine muscarinic antagonist * Crosses blood-brain barrier * TD patch can be applied night before surgery, lasts up to 72 hours * S/E: sedation, dry mouth, blurry vision, confusion, mydriasis… can worsen narrow-angle glaucoma

Answer 183

Scopolamine ## Footnote Slide 63

Question 184

# 1/16/24 What is the name of this PONV medication? * GABA analogue * Effects on PONV unclear, reduces opioid requirement * Administered pre-induction * S/E: visual disturbances

Answer 184

Pregabalin ## Footnote Slide 63

Question 185

What is the name of this PONV medication? * serotonin antagonist * Administer before conclusion of surgery * S/E: blurred vision, headache, prolong QTc

Answer 185

Ondansetron ## Footnote Slide 63

Question 186

# 1/16/24 What is the name of this PONV medication? * histamine H1 antagonist * Administer small doses * S/E: sedation, dry mouth, blurred vision, prolong QTc

Answer 186

Promethazine ## Footnote slide 63

Question 187

# 1/16/24 What is the name of this PONV medication? * steroid * Administer after induction * May modulate release of endorphins or inhibit prostaglandin synthesis * S/E: perineal irritation/burning, increased blood sugars

Answer 187

Dexamethasone ## Footnote Slide 63

Question 188

# 1/16/24 What are 3 things to consider while premedicating a patient to prevent pain

Answer 188

* Baseline pain assessment * Develop pain management plan * Adjunct analgesics ## Footnote Slide 64

Question 189

# Lecture 1/16/24 What is the time frame you should administer antibiotics to the patient?

Answer 189

1 hour before surgical incision ## Footnote Slide 65

Question 190

# Lecture 1/16/24 How soon should a patients receive vancomycin or a fluoroquinolone for prophylactic antibiotic before the surgical incision?

Answer 190

antibiotics initiated within 2 hours before surgical incision ## Footnote Slide 65

Question 191

# Lecture 1/16/24 What is the name of this antibiotic? Most commonly administered antibiotic for surgery Broad-spectrum β-lactam antimicrobial agent Most aerobic gram-positive bacteria that cause surgical site infections Staphylococci, streptococci strains Cross-reactivity to PCN

Answer 191

Cefazolin (cephalosporin) ## Footnote Slide 66

Question 192

# Lecture 1/16/24 What is the name of this antibiotic? * Effective against gram-positive aerobic bacteria Staphylococci, streptococci, pneumococci strains * Most gram-positive and gram-negative anaerobic bacteria * Alternative for a β-lactam allergy or a MRSA infection * Treats infections of the head and neck, respiratory tract, bone, soft tissue, abdomen, and pelvis * Recommended in hysterectomies, cesareans, appendectomies, gastroduodenal tract, biliary tract, small intestine, colon, and rectum

Answer 192

Clindamycin (lincosamide) ## Footnote Slide 66

Question 193

# Lecture 1/16/24 What is the name of this antibiotic? * Gram-positive bacteria * Staphylococci, streptococci strains * Alternative for a β-lactam allergy or MRSA infection * Recommended for distal ilium, colon, appendix surgical sites

Answer 193

Vancomycin (glycopeptide) ## Footnote Slide 66

Question 194

# Lecture 1/16/24 What is **Cefazolin** * Adult dosage * Pediatric dosage (mg/kg) * Half-life in adults (h) * redosing interval (h) * infusion time, minimum

Answer 194

* **Adult dosage** = 2g, 3g, if weight >= 120kg * **Pediatric dosage (mg/kg) **= 30 * **Half-life in adults (h)** = 1.2 - 2.2 * **redosing interval (h)** = 4 * **infusion time, minimum** = 30 min ## Footnote Slide 67

Question 195

# Lecture 1/16/24 What is **Clindamycin** * Adult dosage * Pediatric dosage (mg/kg) * Half-life in adults (h) * redosing interval (h) * infusion time, minimum

Answer 195

* **Adult dosage** = 900 mg * **Pediatric dosage (mg/kg)** = 10 * **Half-life in adults (h) **= 2- 4 *** redosing interval (h)** = 6 ***infusion time, minimum **= 30-60min ## Footnote Slide 67

Question 196

# Lecture 1/16/24 What is **Vancomycin** * Adult dosage * Pediatric dosage (mg/kg) * Half-life in adults (h) * redosing interval (h) * infusion time, minimum

Answer 196

* **Adult dosage **= 15mg * **Pediatric dosage (mg/kg)** = 15 * **Half-life in adults (h)** = 4 -8 * **redosing interval (h)** = NA *** infusion time, minimum **= 15mg/min ## Footnote Slide 67

Question 197

What should be indicated ONLY if it can identify abnormalities, change diagnosis, management plan and pt's outcome?

Answer 197

Testing

Question 198

What 4 criteria should be satisfied for the testing to be useful?

Answer 198

- Diagnostic efficacy - Diagnostic effectiveness - Therapeutic efficacy - Therapeutic effectiveness

Question 199

Which lab study should be done prior to major surgery with potential blood loss as well as for patients w/ ASA-PS 3 or 4, hematologic disorders, poor nutritional status, and/or on anticoagulant therapy?

Answer 199

CBC/Hemoglobin/Hematocrit

Question 200

Which lab study should be done in patients who has DM, HTN, cardiac disease, renal disease, fluid overload, and have ASA 2,3 or 4?

Answer 200

Renal Function Testing

Question 201

What lab study is required for someone with suspected undiagnosed or worsening condition that will affect peri-op management? This study should be done in anyone with renal or hepatic disease, HF, and are on meds that may cause an imbalance?

Answer 201

Electrolytes

Question 202

What lab study is required for someone with liver injury, hepatitis, and jaundice?

Answer 202

Liver Function Testing

Question 203

Who would require a coagulation testing prior to surgery?

Answer 203

Someone with: -Known or suspected coagulopathy - Hepatic disease - Anticoagulant use - ASA- PS 3 or 4 undergoing major surgery

Question 204

Who would require a serum glucose and HbA1c testing done prior to surgery?

Answer 204

- ALL diabeti patients - Obese (BMI >50) - CV or intracranial disease - Hx of steroid use

Question 205

What is HbA1c testing? Hb1C is better assessment of diabetic therapy than random/fasting blood sugar (TRUE/FALSE)

Answer 205

HbA1C is a long-term measurement of glucose control (3 months) TRUE

Question 206

Who needs urinalysis testing done?

Answer 206

Someone with suspected UTI and unexplained fever or chills

Question 207

Who would need a pregnancy test done in pre-op? What should potential pregnant women be aware of going into the surgery?

Answer 207

- all women of childbearing potential. Women possible pregnant should be made aware of the risks of anesthesia/surgery to the fetus.

Question 208

What study/testing should be done in someone with heart disease, chest pain, palpitations, murmurs, arrhythmia? This testing is routine in ASA-PS 2,3,4 undergoing intermediate or high- risk procedures.

Answer 208

ECG

Question 209

Which lab study is required for someone with advanced COPD, pulmonary edema, PNA, mediastinal masses or with any suspicious physical exam findings?

Answer 209

Chest X-ray

Question 210

What is general anesthesia? What type of airway device would you use? What type of surgeries requires GA?

Answer 210

Total loss of consciousness. ETT or LMA used. Major surgeries: open- heart surgery, bowel surgery, etc.

Question 211

What is IV/Monitored sedation? What type of airway device would you use? What type of surgeries requires IV/ Monitored sedation?

Answer 211

Level of sedation ranges: Minimal (drowsy, able to talk) to deep (sleeping, may not rememebr surgery/procedure). NC or face mask used. Minor surgeries/procedures: biopsy, colonoscopy.

Question 212

What is regional anesthesia? What type of procedures would require regional anesthesia?

Answer 212

Pain management method that numbs a large part of the body using a local anesthetic. - Epidural or spinal. Procedures: childbirth or joint replacement in elderly pts.

Question 213

What is local anesthesia? What procedures would you use local anesthesia for?

Answer 213

Pain management method, usually a one-time injection of local anesthetic that numbs a small area of the body. Can be used w/ general or conscious sedation depending on the surgery and pt' hx. Procedures: skin or breast biopsy, bone/joint repair.

Question 214

What should be taken into account when planning postoperative pain management?

Answer 214

Tolerance to usual doses of opioid analgesics.

Question 215

All patients have the right to appropriate assessment and treatment of pain. True or False?

Answer 215

True

Question 216

What should a preoperative evaluation include?

Answer 216

Baseline pain assessment

Question 217

What are the 3 most common agents that may cause anaphylaxis?

Answer 217

-Neuromuscular blockers -Antibiotics -Chlorhexidine

Question 218

What are the risk factors for having a latex allergy?

Answer 218

History of multiple surgeries, occupational exposure to latex (healthcare workers, food handlers), food allergies that cross-react (mango, kiwi, avocado, passion fruit, banana, and chestnuts)

Question 219

What are 2 common antibiotics that would most likely cause anaphylaxis?

Answer 219

PSN and cephalosporins

Question 220

"Red man syndrome" is a reaction known to which antibiotic?

Answer 220

Vancomycin

Question 221

What is the reason for the ester type of allergic reactions in local anesthetics?

Answer 221

due to preservative- para- aminobenzoic acid (PABA)

Question 222

What compound in NMBA can cause allergy?

Answer 222

Quaternary ammonium compound

Question 223

It is rare to have a true allergy to _____, it is mostly related to its side effects of N/V.

Answer 223

Opioids

Question 224

What pre- op medications would you continue?

Answer 224

-Antihypertensives (except ACEi and ARBs- d/ 24hr before) - Cardiac medications (BB, digoxin) - Anti- depressants, anxiolytics, and other psychiatric meds - Thyroid meds - Oral contraceptive pills - Eye drops - GERD meds - Opioid meds -Anti-convulsant meds - Asthma meds - Corticosteroids - Statin meds - ASA (pt w/ prior PCI, ischemic heart disease, CV disease) - COX2 inhibitor meds - MAOIs meds (avoid meperidine and ephedrine)

Question 225

What pre-op meds would you discontinue?

Answer 225

- ASA (10-14 days before). - P2Y inhibitors (clopidogrel, ticagrelor, prasugrel, ticlopidine) - Topical meds - Diuretics ( d/c day of surgery...except Thiazide diuretics- should be cont) - Sildenafil (24 hr before surgery) - NSAIDs (48 hr prior) - Warfarin (5 days before) - Post menstrual HRT (4 weeks prior) - Non- insulin anti- diabetic meds (d/c on day of surgery) - SGLT2 inhibitors d/c 24 hr before surgery. - Short-acting (regular) on day of surgery (if an insulin pump, cont at basal rate)