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Physical & Health Assessment - Spring 2025 > Pre-Operative Evaluation (Exam I) > Flashcards

Pre-Operative Evaluation (Exam I) Flashcards

1
Q

What is the (metric) formula for BMI?

A

BMI = weight (kg) / [height (m)]²

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2
Q

What is the (imperial) formula for BMI?

A

BMI= 703 · weight (lbs) / [height (inches)]²

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3
Q

What mnemonic guides an emergent physical examination?

A

AMPLE
- Allergies
- Medications
- Past medical history
- Last meal eaten
- Events leading up to the need for surgery/procedure

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4
Q

What factors are worth one point on the Revised Cardiac Risk Index (RCRI)?

A
  • High risk surgery
  • Ischemic heart disease
  • Hx of CHF
  • Hx of CVA
  • DM w/ insulin dependence
  • Creatinine > 2 mg/dL (176 umol/L)
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5
Q

What group of surgeries has the highest risk?

A

High (>5% mortality risk)

Vascular (Aortic, major, & peripheral)

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6
Q

What sort of risk would be seen on the Revised Cardiac Risk Index with a score of 0?
What about with a score of 3 or greater?

A
  • RCRI score of 0 = 0.4% risk of major cardiac events
  • RCRI score of 3 = 5.4% risk of major cardiac events
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7
Q

What are METs?

A
  • Metabolic Equivalent of Tasks (measurement of rate of energy consumption).
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8
Q

What is one MET equal to?

A
  • 1 MET = 3.5 mLO₂ /kg/min
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9
Q

How would one assess functional capacity?

A
  • Through METs
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10
Q

What is the range of this assessment?

A
  • MET of 1 = eating, working at computer,
  • MET of 3 = walking 1 or 2 blocks on level ground
  • MET of 8 = rapidly climbing stairs or jogging slowly
  • MET of 12 = running rapidly for long distances
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11
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 patients.
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12
Q

What is ASA Physical status (APA-PS)?

A

A commonly used method by anesthesiologists to assess the overall perioperative risk.

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13
Q

What ASA level would an otherwise healthy 22 year old who got in a car wreck with massive trauma necessitating emergent surgery have?

A
  • ASA V (won’t live without sx)
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14
Q

What ASA level would a healthy non-smoking 27 year old with diabetes have coming in for an EGD?

A
  • ASA II (healthy but has well-controlled DM)
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15
Q

What ASA level would a 56 year old male who had an MI 2 months ago have for his follow up TEE today?

A
  • ASA IV (MI less than 3 months ago)
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16
Q

What ASA level would a 12 year old girl with no hx have coming in for a routine tonscillectomy?

A
  • ASA I (no hx, healthy, routine sx)
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17
Q

What ASA level would a 42 year old male with COPD and poorly controlled DM have?

A
  • ASA III (COPD, poorly controlled DM)
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18
Q

Define ASA I

A

A normal healthy patient

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19
Q

Examples of ASA I

A

healthy, non-smoking, no or minimal alcohol use

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20
Q

Define ASA II

A

A patient with mild systemic disease w/o substantive functional limitations

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21
Q

Examples of ASA II

A

Current smokers, social alcohol drinkers, pregnancy, obesity (BMI range of 30-40), mild lung disease, controlled DM/HTN

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22
Q

Define ASA III

A

A patient with severe systemic disease with substantive functional imitations. (one or more moderate to severe diseases)

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23
Q

Example of ASA III

A

poor controlled DM, HTN, COPD, BMI = or > 40, pacemaker, ESRD w/ dialysis

24
Q

Define ASA IV

A

A patient with severe systemic disease that is a constant threat to life

25
Q

Define ASA V

A

A moribund patient who is not expected to survive without an operation.

26
Q

Define ASA VI

A

A declared brain-dead patient whose organs are being removed for donor purposes.

27
Q

What is the most common anaphylactic drug allergy?

A
  • NMBs
28
Q

What other two drugs have really common allergies?

A
  • Antibiotics & chlorhexidine
29
Q

What condition makes one more prone to latex allergy?

A
  • Spina Bifida
30
Q

What three things discussed in the lecture would prompt you to order coagulation studies?

A
  1. Known or suspected coagulopathy
  2. Known bleeding disorder, hepatic disease, or anticoagulant use.
  3. ASA 3-4; undergoing moderate - major surgery
31
Q

Is Lidocaine and amide or an ester?
How can you tell?

A
  • Lidocaine = Amide
  • Two “i’s” would indicate and amide (ex. bupivicaine)
32
Q

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

A
  • Neostigmine & Morphine
33
Q

What medications need to be discontinued for surgery?

A
  • Aspirin & P2Y12 Inhibitors
  • Topical Medications
  • Diuretics
  • Sildenafil (unless for CHF, then continue)
  • NSAIDs
  • Warfarin
  • Hormone Replacement Therapy
  • Non-insulin DM meds
34
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.
35
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
36
Q

What is a normal dosing regimen of stress-dose steroid for a major surgery?
Why is this necessary?

A
  • 100mg Hydrocortisone Q8 for 24hrs
  • Stress dose steroid regimen’s replace physiologic cortisol levels. (thus prevent adrenal crisis)
37
Q

What is the HPA Axis?

A
  • Hypothalamus, Pituitary, & Adrenal glands.
38
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”)

39
Q

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

A
  • Kava
  • St. John’s Wort
  • Valerian
40
Q

Which herbs/supplements carry an increased risk of hypoglycemia?

A
  • Ginseng
41
Q

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

A
  • Ephedra (ma huang)
  • Basically ephedrine = ↑ HR & BP
42
Q

Which herbs/supplements boost immune system response?

A
  • Echinacea
43
Q

If a patient just ate a full, fatty meal, how long until they can have surgery?

A
  • 8 hours
44
Q

If an infant needs an anesthetic procedure in the morning at 8AM when can their last feeding prior to this occur?

A
  • 4AM
45
Q

If a patient has toast with coffee and milk in the morning, how long will it be until they can have surgery?

A
  • 6 hours
46
Q

If a patient had a gatorade at 6AM when are they clear for their anesthetic procedure?

A
  • 8AM
47
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.
48
Q

What can be done to prevent aspiration pneumonitis?

A
  • ↓gastric volume and ↑gastric pH
49
Q

What drugs are given to help prevent aspiration pneumonitis?

A
  • Antacids (↑pH)
  • H2 Antagonists (ex. famotidine; ↑pH)
  • PPI’s (ex. omeprazole; ↑pH)
  • D2 Antagonist (ex. metaclopramide; reduces gastric volume)
50
Q

What scoring tool is used to determine PONV risk?

A
  • Simplified Apfel Score
51
Q

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

A
  • Female
  • Hx of PONV/motion sickness
  • Non-smoker
  • Post-op opioids
52
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.
53
Q

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

A
  • Severe risk
  • Avoid volatiles, use propofol. No opioids if possible, use 2-3 antiemetics.
54
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)
55
Q

What should be known about presurgical antibiotics?

A
  • Prophylactic abx should be given within 1 hour before incision
  • Vanc & fluoroquinolone should be given within 2 hours of incision.
56
Q

What chance of cross-reactivity exists with cephalosporins and penicillin?

A
  • 10%

Physical & Health Assessment - Spring 2025 (24 decks)

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