Pre-op history and physical

Question 1

surgical removal of the lining of an artery

Answer 1

endartectomy

Question 2

most commonly performed peripheral vascular operation in the US

Answer 2

carotid endartectomy

Question 3

Indications for carotid endartectomy

Answer 3

symptomatic dz w/greater than 50% stenosis or asymptomatic dz w/greater than 80% stenosis

Question 4

most important thing about the preoperative history and physical

Answer 4

assessing cardiac risk

Question 5

the leading cause of perioperative death

Answer 5

cardiovascular events

Question 6

Within what timeframe does JCAHO require a full H&P prior to surgery?

Answer 6

within 30 days

Question 7

The decrease in tidal volume caused by general and spinal epidural anesthesia can cause atelectasis. What do you do post-op to prevent this?

Answer 7

incentive spirometry

Question 8

How long can ADH be elevated post-operatively?

Answer 8

one week

Question 9

Common herbal therapies that are platelet inhibitors

Answer 9

ginseng, garlic, gingko

Question 10

What allergy is associated with foods including: bananas, avocados, kiwis, apricots, melons, and chestnuts?

Answer 10

latex

Question 11

great tool to use for assessing functional status. The ability to perform greater than 4 metabolic equivalents has been associated with a lower cardiovascular risk

Answer 11

Duke Activity Status Index

Question 12

What are the components of the Lee Index to assess for major cardiac complications (1 pt each)?

Answer 12

high risk surgery, h/o IHD, h/o congestive heart failure, h/o stroke or TIA, insulin DM, Cr > 2

Question 13

How many points for the Lee Index have a complication rate of 11%?

Answer 13

3 or more

Question 14

In these patients surgery should be delayed until the coronary artery disease is treated, if possible. If recent MI, delay 3-6 months.

Answer 14

high risk patient with CAD

Question 15

significantly increases the risk of perioperative pulmonary edema (15%) and death (2-10%)

Answer 15

decompensated CHF

Question 16

Decreases risk of pulmonary edema and perioperative death for patient with CHF

Answer 16

afterload reducers and diuretics

Question 17

What would you do if you heard a murmur in the patient who has come in for a routine preoperative history and physical?

Answer 17

echo

Question 18

level of HTN associated with a higher risk of cardiac complications

Answer 18

> 180/110

Question 19

risk of developing these complications highest in patients undergoing cardiac, thoracic and upper abdominal surgery

Answer 19

pulmonary

Question 20

the three patient specific factors associated with increased risk of postoperative pulmonary complications are

Answer 20

chronic lung dz, morbid obesity, tobacco use

Question 21

how long must a patient have quit smoking for it to reduce risk of pulmonary complications in patients undergoing CABG?

Answer 21

8 weeks

Question 22

Important in patients with lung disease esp those undergoing pelvic or hip sx

Answer 22

DVT prophylaxis

Question 23

two most common serious neurological side effects of surgery

Answer 23

delirium and stroke

Question 24

Medications associated with delirium

Answer 24

meperidine, anticholinergics, benzos

Question 25

Patients with what condition are at increased risk for post-op infections and MIs

Answer 25

diabetics

Question 26

Goal range for blood sugar levels of diabetics perioperatively

Answer 26

100-250 mg/dL

Question 27

This should be considered in any patient who has been on 7.5 mg of prednisone for three weeks or 20 mg prednisone for a week

Answer 27

glucocorticoid replacement

Question 28

What should a patient receive if there is evidence of adrenocortical insufficiency?

Answer 28

100mg of hydrocortisone every 8 hours beginning on the morning of surgery and continuing for 48-72 hours. Tapering the dose is not necessary.

Question 29

These patients are at high risk for perioperative complications such as postoperative hyperkalemia, pneumonia and fluid overload

Answer 29

renal disease

Question 30

T/F most prescription meds should be continued on the morning of surgery with small sips of water, unless specifically contraindicated

Answer 30

true

Question 31

Medications that are usually withheld the day of surgery because their MOA involves the kidneys

Answer 31

ACE inhibitors and diuretics

Question 32

When should herbal supplements be discontinued prior to surgery?

Answer 32

2 weeks

Question 33

as a general rule, a patient taking warfarin may have surgery as long as the INR is less than what?

Answer 33

1.5

Question 34

What should all patients with cardiovascular risk factors receive perioperatively?

Answer 34

beta blockers