Final Exam Flashcards
A 47-year-old woman is scheduled for elective laparoscopic cholecystectomy to treat symptomatic cholelithiasis. She is post menopausal and takes a proton pump inhibitor for reflux symptoms and a thiazide diuretic for nonpitting edema of her lower extremities. She is otherwise healthy and is referred by her primary care provider after an evaluation of typical RUQ symptoms revealed the presence of gallstones on ultrasound. Which of the following would be appropriate for her preoperative evaluation?
A. Analysis of her Hgb concentration.
B. Urinalysis.
C. Serum electrolyte concentration measurement.
D. Scheduling a follow-up visit with her referring provider for clearance.
E. Chest x-ray.
Answer: C
Serum electrolyte concentration measurement is appropriate, given the use of a thiazide diuretic.
Hemoglobin concentration and chest x-ray would be expected to yield little information that would change management.
Clearance is an inaccurate term and should be avoided. Risk stratification by the referring provider, which is a more appropriate term, would not be needed in this patient.
Urinalysis would not be needed because the procedure does not involve the genitourinary tract.
A 72-year-old man who has previously undergone lower extremity revascularization for disabling claudication is being considered for carotid endarterectomy because of symptomatic 85% stenosis of his left internal carotid artery. He quit smoking 5 years ago after smoking one and a half packs per day for 50 years. He no longer has claudication symptoms, but he admits to minimal physical activity. He cannot go up a flight of stairs without experiencing dyspnea.
All of the following should be considered EXCEPT:
A. Electrocardiogram.
B. Chest x-ray.
C. Cardiac stress test.
D. Formal evaluation by a cardiologist.
E. Denying surgery given the excessive risk.
Answer: E
Denying surgery given the excessive risk.
Although the patient does have substantial cardiac risk associated with surgery and anesthesia, the risks may be stratified and possibly mitigated by answers A through D. The surgery should not be categorically denied because of the substantial risks of stroke.
Which of the following is true regarding the pulmonary risk of a patient undergoing abdominal surgery for colon cancer and general anesthesia?
A. Higher ASA classifications appear to predict a higher risk of postoperative pulmonary complications.
B. Thromboprophylaxis is not indicated because the risks of bleeding outweigh the risks of venous thromboembolism.
C. Pulmonary function testing is indicated because of the risk of metastatic disease to the lung.
D. Atelectasis in the postoperative period would be unlikely in this patient.
E. Increased age, chronic lung disease, CHF, and long-term tobacco use do not
appear to increase the risk of perioperative pulmonary complications.
Answer: A
Higher ASA classifications appear to predict a higher risk of postoperative pulmonary complications.
Thromboprophylaxis is important in all patients unless specifically contraindicated. This patient’s risk for thrombotic events is elevated because of the planned procedure and the history of cancer. Metastatic lung disease should be identified prior to deciding on the need for pulmonary function tests and may alter treatment. Major abdominal surgery is a risk for the development of atelectasis. The listed patient- dependent factors do increase the risk of perioperative pulmonary complications
Which of the following is an accurate statement regarding AKI?
A. AKI is a common postoperative occurrence and usually does not result in permanent damage to the kidneys.
B. It is transitioned to the term CKD when the renal dysfunction persists for more than 6 months.
C. AKI is most often due to a prerenal cause.
D. AKI can be made more sever or prolonged by bleeding, hypovokenia, or improper medication dosages.
E. Dialysis is not indicated for the treatment of AKI even for intractable anemia, severe electrolyte imbalance, or volume overload resulting in congestive heart failure.
Answer: D
AKI can be made more severe or prolonged by bleeding, hypovolemia, or improper medication dosages.
Although AKI usually does not result in permanent damage to the kidneys, it is not a common postoperative occurrence.
If renal dysfunction persists for more than 3 months, it is termed CKD.
Renal causes such as ATN are the most common factors for AKI.
Dialysis is warranted for the listed reasons, even if it is not a prolonged or permanent need.
Patients with advanced liver disease are at an increased risk of mortality associated with surgery.
All of the following are true regarding surgery in patients with advanced liver disease EXCEPT:
A. Hypoxemia is a contraindication to elective surgery in a patient with known liver disease.
B. A patient with a Child’s-Pugh Class B cirrhosis has an approximately 40% risk of mortality associated with surgery and should not have the procedure unless it is an emergency.
C. A patient with a MELD score of 10 undergoing an elective knee relacement surgery has a 10% risk of mortality.
D. Large-volume ascutes is an absolute contraindication to abdominal surgery and should be treated by TIPS procedure and salt restriction.
E. Serum bilirubin concentration must be measured to calculated both the Childs-Pugh
Classification and the MELD score.
Answer: D
Large-volume ascites is an absolute contraindication to abdominal surgery and should be treated by TIPS procedure and salt restriction is FALSE.
Although large-volume ascites increases the risk of abdominal wall complications postoperatively and can impair ventilation, the fluid can be drained at surgery and managed as described. The fluid should be expected to accumulate in the first few days after surgery. Surgery can be done if otherwise indicated.
