Pre-operative Physical Assessment

Question 1

Which types of surgeries are category 1? (8)

Answer 1

1. ) breast bx
2. ) removal of minor skin or subcutaneous lesions
3. ) myringotomy tubes
4. ) hysteroscopy
5. ) cystoscopy
6. ) vasectomy
7. ) circumcision
8. ) fiberoptic bronchoscopy

Question 2

Which types of surgeries are category 2? (12)

Answer 2

1. ) diagnostic laparoscopy
2. ) dilation and curettage
3. ) fallopian tubal ligation
4. ) arthroscopy
5. ) inguinal hernia repair
6. ) laparoscopic lysis of adhesions
7. ) T&A
8. ) umbilical hernia repair
9. ) septoplasty/ rhinoplasty
10. ) percutaneous lung bx
11. ) laparoscopic cholecystectomy
12. ) extensive superficial procedures

Question 3

Which types of surgeries are category 3?

Answer 3

1. ) thyroidectomy
2. ) hysterectomy
3. ) myomectomy
4. ) cystectomy
5. ) cholecystectomy
6. ) laminectomy
7. ) hip/knee replacement
8. ) nephrectomy
9. ) major laparoscopic procedures
10. ) resection/ reconstructive sx of digestive tract

Question 4

Which types of surgeries are category 4? (4)

Answer 4

1. ) major orthopedic spinal reconstruction
2. ) major reconstruction of the GI tract
3. ) major genitourinary sx
4. ) major vascular repair w/o ICU stay

Question 5

Which type of surgeries are category 5?

Answer 5

1. ) cardiothoracic procedure

2. ) intracranial procedure

Question 6

General conditions for which pre-op evals are recommended prior to the day of sx

Answer 6

1. ) medical condition inhibiting ability to engage in normal daily activity
2. ) medical conditions necessitating continual assistance or monitoring at home w/in past 6 months
3. ) admission w/in the past 2 months for acute or exacerbation of chronic condition

Question 7

Cardio circulatory conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 7

1. ) hx of angina, CAD, MI
2. ) symptomatic arrthymias
3. ) poorly controlled HTN
4. ) hx of CHF

Question 8

Respiratory conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 8

1. ) asthma or COPD
2. ) history of major and/or lower airway tumor or obstruction
3. ) upper and/or lower airway tumor or obstruction
4. ) hx of chronic respiratory distress requiring home ventilator assistance of monitoring

Question 9

Neuromuscular conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 9

1. ) hx of seizure disorder or other significant CNS disease
2. ) hx of myopathy or other muscle disorders

Question 10

hepatic conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 10

any active hepatobiliary disease or compromise

Question 11

musculoskeletal conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 11

1. ) kyphosis and/or scoliosis causing functional compromise
2. ) temporomandibular joint disorder
3. ) cervical or thoracic spine injury

Question 12

oncology conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 12

1. ) pts receiving chemotherapy drugs (affect preoxygenation)
2. ) other oncology process

Question 13

GI conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 13

1. ) massive obesity
2. ) hiatal hernia
3. ) symptomatic gastroesophageal reflex

Question 14

endocrine conditions which pre-op evals are strongly recommended prior to the day of sx

Answer 14

1. ) non-diet controlled diabetes
2. ) adrenal disorders
3. ) active thyroid disease

Question 15

Which drugs should be stopped 2 WEEKS before sx? (12)

Answer 15

1. ) Aspirin
2. ) antiplatelet
3. )anti-inflammatory/NSAIDs
4. ) arthritis medications
5. ) migraine/headache meds
6. ) pain meds
7. ) all diet meds
8. ) all herbal meds
9. )diet supplements (check with PCP before stopping)
10. )meds for ulcerative colitis (check with PCP prior to stopping)
11. ) psy meds/ anxiety/ sleep
12. ) MAO inhibitors

Question 16

Which meds should you check with surgeon about stopping?

Answer 16

selective COX-2 inhibitors

Question 17

When should alcohol be stopped prior to sx?

Answer 17

48 hrs

Question 18

When should tobacco be stopped prior to sx?

Answer 18

24 hours

Question 19

When should illicit/street drugs be stopped prior to sx?

Answer 19

72 hours before sx

Question 20

What should be included in an anesthesia history?

Answer 20

1.) past probs w/ anesthesia (known difficult airway, PONV, any adverse or even pleasant rxns)
2.) hereditary disorders
(Malignant hyperthermia and pseudocholinesterase deficiency)

Question 21

Symptoms of malignant hyperthermia (10)

Answer 21

1. ) hypercarbia
2. ) tachycardia
3. ) tachypnea
4. ) hyperthermia
5. ) HTN
6. ) cardiac disrhythmias
7. ) hypoxemia
8. ) hyperkalemia
9. ) skeletal muscle rigidity
10. ) myoglobinuria

Question 22

Diagnostic test for MH

Answer 22

1. ) halothane-caffeine contracture test

2. ) future- genetic testing for ryanodine receptor

Question 23

results in abnormally slow breakdown of choline ester drugs such as succinylcholien

Answer 23

pseudocholinesterase deficiency

Question 24

How could you recognize pseudocholinesterase deficiency?

Answer 24

respiratory paralysis unexpectedly persists for a prolonged period of time following a standard dose of succinylcholine

Question 25

Risk factors for ischemic heart disease (4)

Answer 25

1. ) Age male > 45 Female >55
2. ) family hx of premature CHD
3. ) current cigarette smoking
4. ) hypertension >140/90

Question 26

4 D’s of airway evaluations

Answer 26

1. ) Dentition
2. ) Distortion
3. ) Disproportion
4. ) Dysmobility