Pre-admission Testing

Question 1

Pre-admission Testing (PAT) involves ?

Answer 1

stratify risk

direct anesthetic choices

guide postoperative management

often are obtained because of protocol rather than medical necessity

Question 2

PAT: making decisions base on ?

Answer 2

Clinical history

Comorbidities

Physical examination findings

Question 3

PAT: labs to run ?

Answer 3

CXR

ECG PT/PTT/INR

CBC/ H&H

BMP

Hgb A1C

Urinalysis

Urine HCG

Type and screen

Question 4

PAT: quote ?

Answer 4

“these tests often do not change perioperative management, may lead to follow-up testing with results that are often normal, and can unnecessarily delay surgery, all of which increase the cost of care. An extensive systematic review concluded that there was no evidence to support routine preoperative testing.”

Question 5

CXR indications acute ?

Answer 5

Acute Cardiopulmonary Findings on History or Physical Exam

Question 6

CXR indications chronic ?

Answer 6

Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months not available.

Question 7

No CXR is ?

Answer 7

Patient is <70 yo and without history or physical findings of cardiopulmonary disease

Question 8

EKG for patients with ?

Answer 8

Pts with active cardiovascular s/s should undergo ECG

Question 9

The most widely accepted guideline in the United States advocates against ECG in patients undergoing ?

Answer 9

low-risk surgery.

Question 10

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: High risk (>5%) ?

Answer 10

aortic and major vascular surgery, peripheral vascular surgery

Question 11

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: Intermediate risk (1-5%) ?

Answer 11

Intraperitoneal or intrathoracic surgery,

carotid endardectomy

head and neck surgery

ortho surgery

prostate surgery

Question 12

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: low risk (<1%)

Answer 12

ambulatory surgery

breast surgery endoscopic surgery

superficial procedures

cataract surgery

Question 13

Revised cardiac index: RF ?

Answer 13

cerebrovascular disease

CHF

Cr > 2.0

DM requiring Insulin

ischemic cardiac disease

Suprainguinal vascular surgery.intrathoracici surgery, intra-abd. surgery

Question 14

Revised cardiac index: RF points ?

Answer 14

1 point for each

Question 15

RCI: Risk factors of a major cardiac event - 0 points ?

Answer 15

0.4 % risk

Question 16

RCI: Risk factors of a major cardiac event - 1 points ?

Answer 16

0.9 % risk

Question 17

RCI: Risk factors of a major cardiac event - 2 points ?

Answer 17

6.6 % risk

Question 18

RCI: Risk factors of a major cardiac event - >3 points ?

Answer 18

> 11 % risk

Question 19

PAT: UA ?

Answer 19

Routine urinalysis is not recommended in asymptomatic patients except in those undergoing surgical implantation of foreign material (e.g., prosthetic joint, heart valve) or invasive urologic procedures.

Question 20

Electrolytes and Cr testing: Compelling historical findings

?

Answer 20

hypertension,

heart failure,

chronic kidney disease,

complicated diabetes mellitus,

liver disease

Serum creatinine and BUN on pts >40 yo?

Question 21

Electrolytes and Cr testing: Certain medications ?

Answer 21

diuretics,

angiotensin-converting enzyme inhibitors,

angiotensin receptor blockers,

nonsteroidal anti-inflammatory drugs,

digoxin

Serum creatinine and BUN on pts >40 yo?

Question 22

PAT: Diabetes Testing ?

Answer 22

Hgb A1C

Random Glucose

BMP

Question 23

In patients with known diabetes, the preoperative ___ value is more likely to be useful if results would change perioperative management

Answer 23

A1C

Question 24

Preoperative _______ _________ measurement could be considered in patients at very high risk of undiagnosed diabetes on the basis of history, examination, or use of certain medications (e.g., glucocorticoids), and in patients with signs or symptoms of undiagnosed diabetes.

Answer 24

random glucose

Question 25

PAT: CBC/H and H indications testing ?

Answer 25

Increased pretest probability of diagnosing anemia (e.g., a chronic inflammatory condition, chronic kidney disease, chronic liver disease, clinical signs or symptoms of anemia)

Procedures in which significant blood loss is anticipated

Consider ordering a type and cross in preparation for a procedure with anticipated blood loss

Question 26

PAT: PT/INR, PTT. Plt testing goal ?

Answer 26

Goal is to unmask underlying bleeding disorder

Question 27

PAT: PT/INR, PTT. Plt testing indications ?

Answer 27

Should be reserved for patients with medical conditions associated with impaired hemostasis (e.g., liver disease, diseases of hematopoiesis), patients taking anticoagulants

Question 28

PAT: PT/INR, PTT. Plt testing indications cont.. ?

Answer 28

Also patients whose history or examination findings suggest an underlying coagulation disorder (e.g., history of spontaneous bruising or excessive surgical bleeding, family history of a known heritable coagulopathy)

Question 29

______ ________ should be obtained from all surgical patients, and appropriate coagulation testing should be considered if the history is abnormal.

Answer 29

Bleeding history