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Prodigy Quick Review > Preoperative Assessment > Flashcards

Preoperative Assessment Flashcards

1
Q

What structures are visible on a Mallampati I

assessment?

A

The soft palate, uvula, and tonsillar pillars.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 587.

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2
Q

What structures are visible on a Mallampati II

assessment?

A

Soft palate and uvula
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 587.

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3
Q

What structures are visible on a Mallampati III

assessment?

A

Soft palate
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 587.

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4
Q

What structures are visible on a Mallampati IV

assessment?

A

Only the hard palate is visible on a Mallampati IV airway
assessment
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 587.

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5
Q

What laboratory abnormalities are consistent with a

preoperative diagnosis of chronic alcoholism?

A

Hypomagnesemia is common with chronic alcoholism as is
hypokalemia and metabolic alkalosis (from frequent vomiting).
As the liver becomes damaged, the prothrombin time may
become increased.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 712.

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6
Q

What characteristic of the relationship between the
incisors of the mandible and maxilla can be
predictive of a difficult airway?

A

A patient unable to bring the mandibular incisors anterior to the
maxillary incisors has an increased incidence of difficult
intubation.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 587.

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7
Q

What two disease processes are associated with the

highest incidence of silent MI?

A

Silent MI’s are most common in patients with diabetes and
hypertension.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 591.

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8
Q

What is the incidence of dental injury during

intubation?

A

0.02% - 0.07%
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 349.

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9
Q

What thyromental distance is considered the

threshold for predicting a difficult intubation?

A

A thyromental distance less than 7 cm (about three
fingerbreadths) is associated with difficult intubation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 347-348.

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10
Q

What is the formula for body mass index?

A

BMI is calculated as the weight in kilograms divided by the
height in meters squared. To obtain the weight in kilograms,
divide the weight in pounds by 2.2.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1050.

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11
Q

What electrolyte abnormalities are most likely to be
seen in the preoperative assessment of a patient
with chronic renal failure? What other conditions
may be seen?

A

Hypocalcemia and hyperkalemia are consistent with a diagnosis
of chronic renal failure. Because of the potential for fluid
overload from decreased urinary output, pulmonary edema, left
ventricular hypertrophy, pericardial effusion, and dependent
edema are also signs consistent with the diagnosis.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 661.

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12
Q

What is the definition of neutropenia?

A

Neutropenia is defined as an absolute granulocyte count

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13
Q

What would be the critical assessment to perform on

a patient with Down syndrome regarding the airway?

A

Patients with Down syndrome have an increased incidence of
cervical spine instability which can make intubation difficult.
Patients with rheumatoid arthritis are also prone to cervical
spine instability.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 904.

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14
Q

A patient’s preoperative labwork reveals
hypokalemia. What drugs can precipitate or worsen
hypokalemia?

A

Drugs that can result in hypokalemia include: thiazides, loop
diuretics, mineralocorticoids, glucocorticoids, and high-dose
antibiotics such as penicillin and ampicillin. Aminoglycosides,
which are associated with magnesium depletion are also
associated with hypokalemia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 364.

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15
Q

What medications can affect the white blood cell

count?

A

Glucocorticoid therapy (such as prednisone) results in
granulocytosis. Patients on 60-100 mg/day of prednisone
typically have a white blood cell count between
15,000/microliter to 20,000/microliter. Folic acid deficiency
limits the ability of the bone marrow to produce new neutrophils
and can produce granulocytopenia. Phenothiazines, tricyclic
antidepressants, indomethacin, propylthiouracil, injectable gold
salts, and chloramphenicol can produce neutropenia.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 523-524.

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16
Q

A patient with new onset rhinorrhea presents for

surgery. Should you cancel the case?

A

Rhinorrhea can be caused by a number of factors including
allergies, vasomotor rhinitis, bacterial infection, or a flu
syndrome. Rhinorrhea that has developed within the past 12 to
24 hours or chronic rhinorrhea in an otherwise healthy child is
not an indication to cancel the anesthetic. If the patient exhibits
purulent discharge or other symptoms of an upper respiratory
infection such as cough or fever, then further investigation is
warranted and the procedure may need to be delayed.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 939.

17
Q

What patient group is at the greatest risk for

postoperative nausea?

A

Young female patients are the patient class most likely to
experience postoperative nausea. Other factors associated
with an increased risk of postoperative nausea and vomiting
include: large body habitus, prior history of postoperative
vomiting, and a history of motion sickness. Surgeries
associated with an increased risk of nausea and vomiting
include: strabismus repair, ear surgery, laparoscopy,
orchiopexy, ovum retrieval, and tonsillectomy.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1263.

18
Q

What are the primary factors that are associated with
an increased risk for the development of deep vein
thrombosis and pulmonary embolism?

A

Factors associated with an increased risk for the development
of DVT and PE include obesity, advanced age, hypotension,
surgical procedures lasting longer than 70 minutes, previous
DVT or PE, congestive heart failure or myocardial infarction
(low cardiac output states), hypothermia, and indwelling venous
catheters.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 633.

19
Q

What are the two strongest predictors of

postoperative pulmonary complications?

A

The site of surgery is the strongest predictors of postoperative
pulmonary complications with thoracic, open aortic, or and
upper abdominal surgery associated with the highest risk.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 594.

20
Q

A patient’s preoperative labwork reveals an elevated
calcium level. What are some common causes of
hypercalcemia?

A

Hypercalcemia results from disorders that result from increased
absorption of calcium from the gastrointestinal tract or
increased calcium resorption from the bones. Conditions that
predispose a patient to hypercalcemia include milk alkali
syndrome, vitamin D intoxication, sarcoidosis,
hyperparathyroidism, malignancy, hyperthyroidism, and
prolonged immobilization.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 367-368.

21
Q

What are critical factors regarding the airway

management plan for patients with diabetes?

A

Patients with diabetes have an increased risk for
gastroesophageal reflux disease and may require intubation.
They also have an increased risk of developing limited-mobility
joint syndrome and a decreased range of motion in the cervical
spine which can make intubation difficult.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 730-731.

22
Q

When is a preoperative chest x-ray indicated?

A

A chest xray is typically beneficial when used for postoperative
comparison, for example in pneumothoraces or fractures. A
meta-analysis by the American Society of Anesthesiologists,
however, demonstrated that a chest xray led to a modification of
the anesthetic plan in less than 10% of patients with significant
pulmonary disorders. Their recommendation was that chest
xrays, and indeed, NO diagnostic tests be ordered in healthy,
asymptomatic patients when the history fails to reveal any other
disorders.
Practice Advisory for Preanesthesia Evaluation. [Online] August
13, 2008
.

23
Q

What gastrointestinal symptoms are most common in
patients with hypothyroidism that may need further
exploration during the preoperative assessment?

A

One of the hallmark gastrointestinal symptoms of
hypothyroidism is delayed gastric emptying. Gastrointestinal
symptoms associated with hypothyroidism include anorexia,
nausea, vomiting, constipation, and epigastric pain. In contrast,
hyperthyroidism is commonly associated with diarrhea.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 876.

24
Q

How would you differentiate a cholinergic crisis from
a myasthenic crisis in a patient with myasthenia
gravis?

A

Myasthenia gravis is characterized by skeletal muscle
weakness and is treated with anticholinesterase drugs. An
overdose of anticholinesterases can also produce excessive
weakness. The administration of edrophonium 10 mg IV can
help distinguish between the two conditions. If the patient
continues to exhibit weakness, then the pathology is cholinergic
crisis. If the weakness resolves then the patient has
myasthenic crisis.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 748-749.

25
Q

A patient’s preoperative labwork reveals an elevated
magnesium level. What are some common causes
of hypermagnesemia? How is it treated? What are
the symptoms of hypermagnesemia?

A

Hypermagnesemia can result from excess dietary intake of
magnesium, excess ingestion of oral antacids, hypothyroidism,
hyperparathyroidism, Addison’s disease, and lithium therapy.
Forced diuresis with saline and loop diuretics is one method of
treating hypermagnesemia. Hypermagnesemia is defined as a
serum magnesium level greater than 2.5 mEq/L. When the
level reaches 4-5 mEq/L, lethargy, nausea, vomiting, and facial
flushing are seen. Above 6 mEq/L, the patient will exhibit
hypotension and loss of deep tendon reflexes. At a magnesium
level of 10 mEq/L or greater, paralysis, apnea, and cardiac
arrest are imminent.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 369.

26
Q

What are the definitions for each of the American

Society of Anesthesiologists’ classifications?

A

The ASA classifications are as follows: 1: a normal healthy
patient, 2: a patient with mild systemic disease (no functional
limitation), 3: a patient with severe systemic disease (with some
functional limitation), 4: a patient with severe systemic disease
that is a constant threat to life (functionally incapacitated), 5: a
moribund patient who is not expected to survive without the
operation, and 6: a brain-dead patient whose organs are being
removed for donor purposes.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 297.

27
Q

Should oral hypoglycemics be withheld on the

morning of surgery?

A

Yes, all oral hypoglycemics should be withheld the morning of
surgery, but adequate hydration should be ensured and glucose
levels should be monitored.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 341.

28
Q

Should diuretics be continued the day of surgery?

A

Hypokalemia and hypovolemia are concerns with the
administration of diuretics prior to surgery. Because patients
rarely become symptomatic if one morning dose is missed, it is
accepted to withhold diuretics unless it is for the treatment of
chronic renal failure.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 341.

29
Q

What are the main criteria for continuing betablockers

on the morning of surgery?

A

Beta-blockers should be continued on the morning of surgery if
they are taken to treat angina, symptomatic arrhythmias, or
hypertension.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 341.

30
Q

What is the best predictor of silent coronary artery

disease in diabetic patients?

A

Autonomic neuropathy
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 856

31
Q

What ECG findings would warrant postponement of
an elective procedure for further diagnostic
evaluation?

A

Conditions that warrant postponement of elective procedures
for further evaluation include new onset atrial fibrillation, atrial
fibrillation with a rate > 100 bpm, symptomatic bradycardia, and
high-grade heart block.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 63.

32
Q

A patient states she is allergic to local anesthetics.
What local anesthetics have the highest incidence of
allergy and why?

A

Most allergic reactions to local anesthetics are to ester
anesthetics because of the metabolite para-aminobenzoic acid.
Although methylparaben, the preservative found in amide
anesthetics is similar to para-aminobenzoic acid, allergic
reactions to it are not as common
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 274.

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