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General Surgery > Preop Evaluation > Flashcards

Preop Evaluation Flashcards

1
Q

what is one of the most important features of a surgical history?

A

pain

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2
Q

what is one of the most important aspects of pain?

A

the patient’s reaction to it

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3
Q

what is a common complaint that is often of no significance?

A

change in bowel habits

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4
Q

what should be suspecting if a patient presents with intermittent alterations of constipation and diarrhea?

A

colon cancer

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5
Q

what is the most common error in hematemesis or hematochezia?

A

assuming hemorrhoids

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6
Q

what is the most frequently acquired nosocomial infection?

A

UTI

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7
Q

what are 3 pre-op precautions regarding home medications?

A

continue critical meds with sip of water
do not take ACEI on day of sx
withhold diuretic on morning of sx

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8
Q

when should prophylactic antibiotics be given?

A

within 1 hour of incision

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9
Q

when are prophylactic antibiotics normally discontinued?

A

< 24 hours after surgery

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10
Q

in which 4 operative conditions are prophylactic antibiotics continued for longer in?

A

GI tract
implantation of foreign body
contaminated wounds
immunocompromised patients

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11
Q

in which operative case is a cephalosporin usually given as a pre-op antibiotic and discontinued within 24 hours post-operatively?

elective hernia repair
right-sided colectomy
left-sided hemi-colectomy
pulmonary repair d/t thoracic stab wound
bilateral mastectomy with overlying cellulitis

A

elective hernia repair

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12
Q

classify: healthy patient with no systemic disorder

A

class I

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13
Q

classify: mild to moderate systemic disorder that need not be associated with the surgical problem

A

class II

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14
Q

what is a major cause of morbidity and mortality in surgical patients?

A

cardiovascular complications

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15
Q

what are 6 independent predictors of cardiac complications?

A

hx of ischemic heart disease
CHF
cerebrovascular disease
high risk operation
preop treatment with insulin
preop serum Cr > 2

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16
Q

findings suggestive of ischemic heart disease should be screened by what?

A

stress test

17
Q

how long after an MI should surgery be postponed?

A

> 6 months

18
Q

patients undergoing which surgery would be best evaluated by the Revised Cardiac Risk Index for risk of perioperative major adverse cardiac event (MACE)?

aortic valve replacement
hip surgery
coronary stent placement
coronary artery bypass grafting

A

hip surgery

19
Q

to minimize retained gastric volume and maximize gastric pH before general anesthesia, refrain from drinking clear liquids for at least?

A

2 hours

20
Q

before receiving anesthetics or sedatives, avoid eating light meals for at least ____ hours and fatty meals for ____ hours

A

6
8

21
Q

what increases the risk for multiple complications after elective surgeries?

A

hepatic dysfunction

22
Q

what are the 3 signs of liver failure?

A

spider telangiectasias
jaundice
prolonged bleeding

23
Q

what are 2 things used to treat hepatic/liver dysfunction?

A

vitamin K
fresh frozen plasma

24
Q

what are the two scoring systems used to assess liver function?

A

child-turcotte-pugh (CTP) score
Model for end-stage liver disease (MELD)

25
Q

how to treat worsening encephalopathy due to increased ammonia levels?

A

lactulose

26
Q

what does elevated BUN usually indicate?

A

dehydration

27
Q

elevated creatinine is correlated with increased _______ in surgery patients

A

mortality

28
Q

how to treat post op oliguria?

A

IV fluids

29
Q

treatment for severe renal dysfunction? (2)

A

dialysis
kidney transplant

30
Q

what are the pre-op positioning rules to protect neuro? (2)

A

pad pressure points
avoid overstretching joints

31
Q

high ______ levels have an increased hospital length of stay

A

Hgb A1c

32
Q

what is the best option for perioperative glucose control? what is required?

A

IV insulin

hourly glucose monitoring is required

33
Q

how to manage a chronically hyperglycemic patient that is frequently dehydrated?

A

dextrose containing IV solutions while NPO

34
Q

what are 2 endocrine stress responses to operations?

A

pain
intravascular volume loss (Na and water retention)

35
Q

what can a sudden stoppage of steroids cause?

A

addisonian crisis

36
Q

what can hyperthyroidism lead to during surgery? hypothyroidism?

A

thyroid storm
cardiac failure

37
Q

what 3 medications should be stopped 1 week before an operation?

A

warfarin
aspirin
NSAIDs

38
Q

what does pre-op albumin < 3 indicate?

A

chronic malnutrition

39
Q

what does pre-op albumin < 16 indicate?

A

acute malnutrition

General Surgery (4 decks)

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