ABSITE - Preoperative Evaluation -
Questions
A seventy eight-yr-vintage guy is added for your office in a wheelchair. He says his
abdominal wall hernia has been getting larger and wonders if he desires surgery. He seems
skinny and faded, but in no distress. He is mildly hypertensive (a hundred and fifty/ninety),
had a CABG three years prior, and is on a statin and a diuretic. He feels weak, his appetite is
poor, and he lives in a skilled nursing facility. He has a 10x8 non- incarcerated midline
incisional hernia. His postoperative hazard is quality determined with the aid of which of the
subsequent?
A. Echocardiogram
B. Pulmonary function testing
C. Frailty index
D. Serum electrolytes
E. Abdominal CT test - ANSC.
Frailty has gained in importance as a predictor of post-operative consequences, in particular
in the geriatric populace. The frailty index includes practical, dietary and Charlson
Comorbidity Index. This patient had a moderate cardiac hazard. His procedure is optionally
available and a frailty assessment might probable make him a tremendous threat.
A 56-12 months-antique woman is scheduled to go through a complete thyroidectomy for
papillary carcinoma. She is presently taking warfarin (Coumadin) 5 mg every day because of
a femoral DVT 4 months in the past. Her current INR is 2.9. Regarding her anticoagulation
routine, what's the maximum appropriate path of action before surgical procedure?
A. Decrease Coumadin dose to 1 mg each day 7 days earlier than surgical procedure.
B. Decrease Coumadin dose to at least one mg every day 5 days before surgical operation.
C. Stop Coumadin 7 days before surgical operation.
D. Stop Coumadin 5 days before surgery.
E. Stop Coumadin three days earlier than surgical treatment. - ANSD
The traditional advice is to withhold warfarin beginning four to 5 days preoperatively (if the
INR is among 2.0 and three.0) to permit the INR to lower to less than 1.Five, which is a
stage considered secure for surgical strategies and neuraxial blockade. Only if the INR is
extra than three.Zero is it generally important to stop warfarin longer than four to five days. If
the INR is higher than 1.Eight the day of surgical operation, a small dose of vitamin K (1 to
five mg administrated orally or subcutaneously) can opposite anticoagulation.
A sixty one-year-old male with pancreatic most cancers presents for preoperative evaluation
previous to pancreaticoduodenectomy. He is unable to stroll metropolis blocks. His history is
huge for GERD, hyperlipidemia and diabetes mellitus. Which of the following is an indication
that this patient must undergo a preoperative echocardiogram?
A. Inability to stroll two blocks
, B. History of diabetes mellitus
C. History of hyperlipidemia
D. Age over 60 years
E. High-hazard surgical procedure - ANSA
Echocardiography checking out preoperatively have to be used selectively in sufferers at
excessive chance for cardiac headaches perioperatively. This includes patients who're not
able to reap four metabolic equivalents (METs), described as hiking flights of stairs or taking
walks four metropolis blocks. Achieving less than 4 METs indicates negative cardiac reserve,
and echocardiogram is indicated before intermediate or essential threat surgical procedure.
Diabetes, hyperlipidemia, age, and the operation chance are not reasons for preoperative
echocardiography.
A 75-year-old man complains of extreme rest pain in his right leg. He has no pulse inside the
femoral artery or below with an ABI index of .2, but no gangrene. He has pulses within the
left leg. His BP is one hundred fifty/eighty mmHg, pulse 60 bpm, RR 18 breaths/min. He is
on clopidogrel (Plavix), a beta blocker, and a statin. His EKG and echocardiogram show no
acute changes and his ejection fraction is 60%. Which of the subsequent medications must
he obtain the day of surgical procedure?
A. Beta blocker by myself
B. Clopidogrel and statin
C. Beta blocker and statin
D. Beta blocker, statin, and coffee molecular weight heparin
E. ACE inhibitor, aspirin, and statin - ANSD
Beta blockers and statins had been confirmed to decrease cardiac danger and ought to be
continued perioperatively. Clopidogrel (Plavix) is tough to opposite and should be
discontinued preoperatively if there may be a hazard of bleeding. He have to additionally get
hold of low molecular weight heparin for prophylaxis. There isn't any clear indication to add
aspirin.
A 65-12 months-vintage woman desires a mastectomy and reconstruction for breast cancer.
She had coronary artery drug-eluting stents placed 14 months in the past following a STEMI.
She takes warfarin for atrial fibrillation as well as Plavix and aspirin. She has shortness of
breath and ankle edema without chest pain. There are bibasilar rales on chest examination.
She hasn't visible her heart specialist in 3 months. Which of the following is her primary
cardiac hazard component, as determined with the aid of a Revised Cardiac Risk Index?
A. Atrial traumatic inflammation
B. Congestive heart failure
C. Coronary artery ailment
D. The presence of drug-eluting stents - ANSB
Congestive heart failure is the essential contributing element to post-operative essential
cardiac events. The hazard of every other MI decreases after 6 months and has been
handled with stents, which no longer require immediately perioperative anticoagulation.
A seventy six-12 months-old male has a painful incisional hernia following an exploratory
laparotomy 10 years in the past. His beyond clinical records is full-size for diabetes mellitus,
Questions
A seventy eight-yr-vintage guy is added for your office in a wheelchair. He says his
abdominal wall hernia has been getting larger and wonders if he desires surgery. He seems
skinny and faded, but in no distress. He is mildly hypertensive (a hundred and fifty/ninety),
had a CABG three years prior, and is on a statin and a diuretic. He feels weak, his appetite is
poor, and he lives in a skilled nursing facility. He has a 10x8 non- incarcerated midline
incisional hernia. His postoperative hazard is quality determined with the aid of which of the
subsequent?
A. Echocardiogram
B. Pulmonary function testing
C. Frailty index
D. Serum electrolytes
E. Abdominal CT test - ANSC.
Frailty has gained in importance as a predictor of post-operative consequences, in particular
in the geriatric populace. The frailty index includes practical, dietary and Charlson
Comorbidity Index. This patient had a moderate cardiac hazard. His procedure is optionally
available and a frailty assessment might probable make him a tremendous threat.
A 56-12 months-antique woman is scheduled to go through a complete thyroidectomy for
papillary carcinoma. She is presently taking warfarin (Coumadin) 5 mg every day because of
a femoral DVT 4 months in the past. Her current INR is 2.9. Regarding her anticoagulation
routine, what's the maximum appropriate path of action before surgical procedure?
A. Decrease Coumadin dose to 1 mg each day 7 days earlier than surgical procedure.
B. Decrease Coumadin dose to at least one mg every day 5 days before surgical operation.
C. Stop Coumadin 7 days before surgical operation.
D. Stop Coumadin 5 days before surgery.
E. Stop Coumadin three days earlier than surgical treatment. - ANSD
The traditional advice is to withhold warfarin beginning four to 5 days preoperatively (if the
INR is among 2.0 and three.0) to permit the INR to lower to less than 1.Five, which is a
stage considered secure for surgical strategies and neuraxial blockade. Only if the INR is
extra than three.Zero is it generally important to stop warfarin longer than four to five days. If
the INR is higher than 1.Eight the day of surgical operation, a small dose of vitamin K (1 to
five mg administrated orally or subcutaneously) can opposite anticoagulation.
A sixty one-year-old male with pancreatic most cancers presents for preoperative evaluation
previous to pancreaticoduodenectomy. He is unable to stroll metropolis blocks. His history is
huge for GERD, hyperlipidemia and diabetes mellitus. Which of the following is an indication
that this patient must undergo a preoperative echocardiogram?
A. Inability to stroll two blocks
, B. History of diabetes mellitus
C. History of hyperlipidemia
D. Age over 60 years
E. High-hazard surgical procedure - ANSA
Echocardiography checking out preoperatively have to be used selectively in sufferers at
excessive chance for cardiac headaches perioperatively. This includes patients who're not
able to reap four metabolic equivalents (METs), described as hiking flights of stairs or taking
walks four metropolis blocks. Achieving less than 4 METs indicates negative cardiac reserve,
and echocardiogram is indicated before intermediate or essential threat surgical procedure.
Diabetes, hyperlipidemia, age, and the operation chance are not reasons for preoperative
echocardiography.
A 75-year-old man complains of extreme rest pain in his right leg. He has no pulse inside the
femoral artery or below with an ABI index of .2, but no gangrene. He has pulses within the
left leg. His BP is one hundred fifty/eighty mmHg, pulse 60 bpm, RR 18 breaths/min. He is
on clopidogrel (Plavix), a beta blocker, and a statin. His EKG and echocardiogram show no
acute changes and his ejection fraction is 60%. Which of the subsequent medications must
he obtain the day of surgical procedure?
A. Beta blocker by myself
B. Clopidogrel and statin
C. Beta blocker and statin
D. Beta blocker, statin, and coffee molecular weight heparin
E. ACE inhibitor, aspirin, and statin - ANSD
Beta blockers and statins had been confirmed to decrease cardiac danger and ought to be
continued perioperatively. Clopidogrel (Plavix) is tough to opposite and should be
discontinued preoperatively if there may be a hazard of bleeding. He have to additionally get
hold of low molecular weight heparin for prophylaxis. There isn't any clear indication to add
aspirin.
A 65-12 months-vintage woman desires a mastectomy and reconstruction for breast cancer.
She had coronary artery drug-eluting stents placed 14 months in the past following a STEMI.
She takes warfarin for atrial fibrillation as well as Plavix and aspirin. She has shortness of
breath and ankle edema without chest pain. There are bibasilar rales on chest examination.
She hasn't visible her heart specialist in 3 months. Which of the following is her primary
cardiac hazard component, as determined with the aid of a Revised Cardiac Risk Index?
A. Atrial traumatic inflammation
B. Congestive heart failure
C. Coronary artery ailment
D. The presence of drug-eluting stents - ANSB
Congestive heart failure is the essential contributing element to post-operative essential
cardiac events. The hazard of every other MI decreases after 6 months and has been
handled with stents, which no longer require immediately perioperative anticoagulation.
A seventy six-12 months-old male has a painful incisional hernia following an exploratory
laparotomy 10 years in the past. His beyond clinical records is full-size for diabetes mellitus,
