Brainscape's Knowledge GenomeTM

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


See full index

Assessment > Exam 1 - Preop Assessment > Flashcards

Exam 1 - Preop Assessment Flashcards

1
Q

What are the components of a complete medical history?

A
  • Past medical history
  • Reason for surgery
  • Review of systems
  • Previous anesthetic complications
  • Medications
  • Allergies
  • Drug use
  • Functional capacity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the (metric) formula for BMI?

A

BMI = weight (kg) / height (m)²

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

What is the (imperial) formula for BMI?

A

703 · BW (lbs) ÷ height (inches)²

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

What is a normal BMI?
What is an obese BMI?
Why is BMI not very accurate?

A

Normal: 18.5-24.9
Obese: > 30.0
BMI does not account for muscle mass

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

Why is it important to complete a baseline neuro exam?

A

To determine patients pre-surgical baseline to be able to catch any new defecits post-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What mnemonic guides an emergent physical examination?

A

AMPLE
- Allergies
- Medications
- Past medical history
- Last meal (assume full stomach)
- Events leading up to need for surgery

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

What are the components of a pre-op airway examination?

A
  • Mallampati
  • Inter-incisors gap
  • Thyromental distance
  • Forward movement mandible
  • Range of cervical spine (flexion and extension)
  • Loose/chipped teeth (ensure patient is aware of danger of loss of teeth during intubation)
  • Tracheal deviation (mass?)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What complications account for almost half of perioperative mortalities?

A

Cardiovascular complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most significant adverse respiratory event that can occur during anesthesia?

A

Hypoxemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What court case helped establish the practice of informed consent in modern medicine?

A

Salgo v. Leland Stanford Jr. University Board of Trustees(1957)

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

What is frailty?

A

A state of increased vulnerability to physiologic stressors

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

What group of surgeries has the highest risk?

A

Vascular (Aortic, major, & peripheral vascular) > 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Revised Cardiac Risk Index (RCRI)?
What are the components?

A

Estimates risk of cardiac complications after surgery

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

What is functional capacity?

A

Assesses cardiopulmonary fitness and estimates risk for major post-op morbidity and mortality

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

How is funcitonal capacity measured?
What is its units?
What level is desired before surgery?

A
  • METs (metabolic equivalent of task)
  • 1 MET = 3.5 mL O2/kg/min
  • > 4 METs is desired (need to climb one flight of stairs without getting short of breath or chest pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the three levels of urgency of surgery?

A
  • Emergent - Life or limb threatened, sx needed within 6 hours, no cardiac pre-op necessary.
  • Urgent - Life or limb threatened, sx needed in 6-24 hours.
  • Time-sensitive - delays exceeding 1-6 weeks would adversely affect patient.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who described the 6 degree ASA Physical Status grading?

A

Meyer Saklad

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

Describe an ASA I patient?

A

A normal healthy patient

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

Describe an ASA II patient?

A

A patient with mild systemic disease without functional limitations (smoker, social drinker, pregnancy)

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

Describe an ASA III patient?

A

A patient with severe systemic disease with substantive functional limitations (poorly controlled DM or HTN, COPD, CVA, morbid obesity)

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

Describe an ASA IV patient?

A

A patient with severe systemic disease that is a constant threat to life (recent <3 months MI, CVA, or stents, sepsis, ARDS, severe valve dysfunction)

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

Describe an ASA V patient?

A

A moribound patient that is not expected to survive without surgery (ruptured AAA, massive trauma, ischemic bowel with MODS)

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

Describe and ASA VI patient?

A

A declared brain-dead patient whose organs are being removed for donation

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

When should pre-op testing be ordered?

A

If it can identify abnormalities, change the diagnosis or management plan, or change the patients outcome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When should CBC or H/H be ordered pre-op?

A
  • Surgery with potential blood loss
  • ASA III or IV
  • All patient undergoing major operations
  • Known coagulopathies
26
Q

When should renal testing be ordered pre-op?

A
  • DM, HTN, cardiac dx, N/V, ESRD
  • ASA III and IV undergoing intermediate risk procedures
  • ASA II, III, IV undergoing major operations
27
Q

What lab test is for wafarin?
What pathway does in test?

A

PT, extrinsic pathway
Warfarin
Extrinsic
PT

28
Q

Fill in the labs in the image below:

29
Q

What condition makes one more prone to latex allergy?

A
  • Spina Bifida
30
Q

What is important to notify women of if they recieve sugammedex?

A

They need to use alternative forms of birth control because sugammadex can inactivate birth control

31
Q

What are the most common anaphylactic drug allergy?
What other two drugs have really common allergies?

A
  • NMBs with rocuronium being the most common
  • Antibiotics & chlorhexidine
32
Q

What antibiotic classes are the most common causes of anaphylaxis?

A

Penicillins and cephalosporins

33
Q

What may a patient be experiencing when they say they have a vancomycin allergy?

A

Red man syndrome - side effect caused by histamine release, not an allergy

34
Q

What are people reacting to when given an ester local anesthetic?

A

The preservative in the solution - para-aminobenzoic acid (PABA)

35
Q

What cross-reactivity allergies are possible for someone who has a known neuromuscular blocking agent allergy?

A
  • Neostigmine & Morphine
36
Q

What medications should be continued prior to surgery?

A
  • Antihypertensives - not ACEi or ARBs
  • Antidepressants and other psych meds
  • Thyroid medications
  • Opiods
  • Anticonvulsants
  • Asthma meds
  • Corticosteroids
  • Statins

4 A’s To Obtain Cornelius’ Standards

37
Q

How should you adjust your anesthestia plan for someone taking an MAOI?

A

Avoid meperidine and in-direct acting vasopressers (ephedrine)

38
Q

What medications need to be discontinued for surgery?

A
  • Aspirin & P2Y12 Inhibitors (clopidogrel & ticlopidine)
  • Topical Medications
  • Diuretics
  • Sildenafil
  • NSAIDs
  • Warfarin (continue for cataract sx)
  • Post Menopausal Hormone Replacement Therapy
  • Non-insulin DM meds (SGLT2 inhibitors)
39
Q

What insulin should a type 1 diabetic take (or not take) the day of their surgery?

A
  • DC short-acting
  • Continue basal rate if using a pump
  • Take 1/3 of normal long-acting if no pump.
40
Q

What insulin should a type 2 diabetic take (or not take) the day of their surgery?

A
  • DC short-acting
  • Continue basal rate if using a pump
  • 0 - 50% of normal long-acting dose
41
Q

What drug and dose of steroids is standard for a patient having surgery taking gluccocorticoids?
Why is it important to bolus them steroids perioperatively?

A
  • Hydrocortisone 100 mg q6-8h
  • Exogenous gluccocorticoids supress cortisol secretion
  • Stress dose steroid regimens replace physiologic cortisol levels. (thus prevent adrenal crisis)
42
Q

What herbs/supplements carry an increased risk of bleeding?

A
  • Saw Palmetto
  • Garlic
  • Ginger
  • Ginkgo
  • Ginseng
  • Green Tea

(essentially; saw palmetto & anything starting with a “g”)

43
Q

Which herbs/supplements carry an increased risk of excessive sedation/anxiolysis?

A
  • Kava
  • St. John’s Wort
  • Valerian
  • Melatonin
44
Q

Which herbs/supplements carry a cardiovascular risk (especially intraoperatively)? Why?

A
  • Ephedra (ma huang)
  • Basically ephedrine = ↑ HR & BP
45
Q

How long before a procedure should a patient be NPO after a full fatty meal?

46
Q

If a patient just ate toast mith coffee and milk, how long should they be NPO prior to surgery?

47
Q

How long does an infant need to be NPO after having breast milk?

48
Q

How long after drinking water or tea can a patient have surgery?

49
Q

What is Mendelson syndrome?
What two factors increase your risk for this?

A
  • Aspiration Pneumonitis
  • Increased risk of aspiration due to > 25mL of gastric contents and a gastric pH < 2.5.
50
Q

What can be done to prevent aspiration pneumonitis?

A
  • ↓gastric volume and ↑gastric pH
51
Q

What drugs are given to help prevent aspiration pneumonitis?

A
  • Antacids (ex. sodium citrate;↑pH)
  • H2 Antagonists (ex. famotidine; ↑pH, ↓ secretion)
  • PPI’s (ex. omeprazole; ↑pH, ↓ secretion)
  • D2 Antagonist (ex. metaclopramide; reduces gastric volume) - give sedation before this drug d/t dyskinesia
52
Q

What scoring tool is used to determine PONV risk?

A
  • Simplified Apfel Score
53
Q

What are the four risk factors of a Simplified Apfel Score?

A
  • Female
  • Hx of PONV/motion sickness
  • Non-smoker
  • Post-op opioids
54
Q

What sort of risk is conferred by an Apfel score of 1-2?
What would be done with this score?

A
  • Moderate-severe risk
  • Prevention with 2-3 antiemetics & limiting opioids.
55
Q

What sort of risk is conferred by an Apfel score of 3-4?
Treatments?

A
  • Severe risk
  • Avoid volatiles, use propofol. No opioids if possible, use 3 different classes of antiemetics.
56
Q

What drugs are useful in prevention/treatment of PONV?

A
  • Scopolamine (necessary well in advance)
  • GABA analogs (lower opioid usage)
  • Ondansetron (5HT3 antagonist)
  • Promethazine (H1 Antagonist)
  • Dexamethasone (may cause perineal burning)
57
Q

What should be known about presurgical antibiotics?

A
  • Prophylactic abx should be given within 1 hour before incision
  • Vanc & fluoroquinolone should be initiated within 2 hours before incision.
58
Q

What is the most commonly administerd surgical antibiotic?
What does it treat?
Dose?

A
  • Cefazolin
  • Broad-spectrum beta-lactam antimicrobial agent that treats most aerobic gram-positive bacteria
  • 2g; if >120 kg then 3g
59
Q

What does clindamycin treat?
Dose?

A
  • gram-positve and gram negative aerobic bacteria
  • recommended in many intrabdominal procedures
  • 900 mg
60
Q

What does vancomycin treat?
Dose?

A
  • Gram-positive bacteria
  • Recommended for distal ilium, colon, and appendix surgeries
  • 15mg/kg

Assessment (8 decks)

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