Pre-Op Assessment

Question 1

What is the BMI cutoff to be considered underweight?

Answer 1

less than 18.5

Question 2

What is the BMI cutoff to be considered normal weight?

Answer 2

18.5-24.9

Question 3

What is the BMI cutoff to be considered overweight?

Answer 3

25-29.9

Question 4

What is the BMI cutoff to be considered obese?

Answer 4

30 and above

Question 5

What is the BMI formula for metric scale?

Answer 5

Weight in kgs divided by m squared

Question 6

What is the BMI formula for imperial scale?

Answer 6

Weight in lbs divided by inches squared

Question 7

If you have an emergent case how are you going to do an emergent physical exam?

Answer 7

AMPLE
Allergies
Meds
Past Mhx
Last meal eaten
Events leading up to the need for sx

Question 8

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is Ortho sx?

Answer 8

Low

Question 9

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is urology sx?

Answer 9

Low

Question 10

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is skin sx?

Answer 10

Low

Question 11

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is cataract sx?

Answer 11

Low

Question 12

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is Endoscopic procedures?

Answer 12

Low

Question 13

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is Breast sx?

Answer 13

Low

Question 14

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is ambulatory sx?

Answer 14

Low

Question 15

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is head/neck sx?

Answer 15

Intermediate

Question 16

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is carotid endardectomy?

Answer 16

Intermediate

Question 17

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is intrathoracic sx?

Answer 17

Intermediate

Question 18

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
Which category is Intraabdominal sx?

Answer 18

Intermediate

Question 19

There are 3 categories of riskiness of procedures.
High greater than 5%
Intermediate 1-5%
Low < 1 %
What are the two high risk procedures?

Answer 19

Aortic and major vascular
Peripheral vascular

Question 20

What are the SIX components of the revised cardiac risk index?

Answer 20

High risk sx (intra peritoneal or thoracic or suprainguinal vascular procedure)
Ischemic heart dz
Hx of CHF
Hx of cerebrovascular dz
DM requiring insulin
Scr > 2.0

Question 21

Even with an RCRI of 0 what is your risk of major cardiac events?

Answer 21

Still 0.4%

Question 22

What is your risk of major cardiac events with an RCRI of 1?

Answer 22

1%

Question 23

What is your risk of major cardiac events with an RCRI of 2?

Answer 23

2.4 %

Question 24

What is your risk of major cardiac events with an RCRI of 3 or greater?

Answer 24

5.4 %

Question 25

What does a MET stand for?

Answer 25

Metabolic equivalent of task

Question 26

You measure functional capacity by __

Answer 26

METs

Question 27

METs give us an idea of energy consumption at rest T or F

Answer 27

T

Question 28

1 MET =

Answer 28

3.5 mL/kg/min

Question 29

This is a definition and example or ASA. State which ASA described. A normal healthy pt. Ex: Healthy, nonsmoking, none or minimal alcohol use

Answer 29

ASA 1

Question 30

This is a definition and example or ASA. State which ASA described. A pt with mild systemic dz Ex: current smoker Social alcohol drinker pregancy BMI greater than 30 Well controlled DM/HTN mild lung dz

Answer 30

ASA 2

Question 31

This is a definition and example or ASA. State which ASA described. A pt with severe systemmic dz Ex: One or more moderate to severe dz's Pt has functional limitations Poorly controlled DM, HTTN, COPD morbid obesity greater than 40. Active hepatitis, alcohol dependence or abuse Implanted PM Moderate reduction of EF ESRD undergoing regular scheduled HD Premature infant postconceptual age < 60 weeks Hx of (more than 3 moths ago) MI, CVA, TIA, or CAD/stents Peritoneal dialysis

Answer 31

ASA 3

Question 32

This is a definition and example or ASA. State which ASA described. A pt with sever systemic dz that is a constant threat to life Ex: RECENT hx (less than 3 months ago) of MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia, or severe valve dysFXN, SEVERE reduction of EF, sepsis, DIC, ARDS, ESRD not getting regularly scheduled HD!!!!

Answer 32

ASA 4

Question 33

This is a definition and example or ASA. State which ASA described. A moribund pt who is not expected to survive without the operation Ex: Ruptured abdominal or thoracic aneurysm Massive trauma Intracranial bleed with mass effect Ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysFXN. Pt needing a PM or will die due to arrhythmia

Answer 33

ASA 5

Question 34

This is a definition and example or ASA. State which ASA described. A declared brain dead pt whose organs are being removed for donor purposes

Answer 34

ASA 6

Question 35

List the 5 most common allergies in order from most common to least.

Answer 35

Muscle relaxants Latex CHG ABX Opioids

Question 36

P2Y12 inhibitor Clopidogrel (Plavix) and Ticagrelor (Brilinta) should be D/C's how many days before sx?

Answer 36

5-7 days

Question 37

P2Y12 inhibitor Prasugrel should be D/C'd how many days before sx?

Answer 37

7-10 days

Question 38

P2Y12 Inhibitor Ticlopidin (Ticlid) should be D/C'd how many days before sx?

Answer 38

10 days

Question 39

Apfel score of _ means you are high risk for PONV

Answer 39

3

Question 40

What are the 4 criteria of Apfel?

Answer 40

Female gender Hx of PONV/motion sickness Nonsmoking status Post-op opioids

Question 41

What are the 2 criteria to meet for Mendelson syndrome?

Answer 41

Greater than 25 cc of residual volume Ph of stomach content less than 2.5

Question 42

Pt can have a full meal how many hours before sx and stilll be considered NPO status at sx? What could they eat?

Answer 42

Fatty foods, full meal, enteral tube feeds

Question 43

Pt can have a light meal how many hours before sx and still be considered NPO status? What could they eat?

Answer 43

6 Toast and liquids, instant formula, nonhuman milk, coffee with milk

Question 44

Pt can have breast milk how many hours before sx and still be considered NPO status?

Answer 44

4

Question 45

Pt can have clear liquids how many hours before sx and still be considered NPO? What could they drink?

Answer 45

2 Water, sports drink, carbonated beverages, coffee, tea, juice without pulp

Question 46

Why does diabetes cause delayed gastric emptying?

Answer 46

Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of the food moving through the digestive tract normally, it is retained in the stomach.