ABSITE - Preoperative Evaluation – Questions and Answers with Solutions 2025

A 78 year old man is brought to your office in a wheelchair. He says his abdominal wall hernia ha
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s been getting bigger and wonders if he needs surgery. He looks thin and pale, but in no distress.
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OHe is mildly hypertensive (150/90), had a CABG 3 years prior, and is on a statin and a diuretic. H
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e feels weak, his appetite is poor, and he lives in a skilled nursing facility. He has a 10x8 non inca
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rcerated midline incisional hernia. His postoperative risk is best determined by which of the follo
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wing?

A. Echocardiogram
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B. Pulmonary function testing
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C. Frailty index
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D. Serum electrolytes
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E. Abdominal CT scan - ANSWER C.
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Frailty has gained in importance as a predictor of post-
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operative outcomes, especially in the geriatric population. The frailty index includes functional,
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nutritional and Charlson Comorbidity Index. This patient had a moderate cardiac risk. His proced
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ure is elective and a frailty assessment would likely make him a significant risk.
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A 56-year-
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old female is scheduled to undergo a total thyroidectomy for papillary carcinoma. She is currentl
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y taking warfarin (Coumadin) 5 mg daily due to a femoral DVT 4 months ago. Her current INR is 2
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.9. Regarding her anticoagulation regimen, what is the most appropriate course of action before
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surgery?

A. Decrease Coumadin dose to 1 mg daily 7 days before surgery.
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B. Decrease Coumadin dose to 1 mg daily 5 days before surgery.
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C. Stop Coumadin 7 days before surgery.
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D. Stop Coumadin 5 days before surgery.
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E. Stop Coumadin 3 days before surgery. - ANSWER D
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, The usual recommendation is to withhold warfarin starting 4 to 5 days preoperatively (if the INR
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is between 2.0 and 3.0) to allow the INR to decrease to less than 1.5, which is a level considered
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safe for surgical procedures and neuraxial blockade. Only if the INR is greater than 3.0 is it usuall
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y necessary to stop warfarin longer than 4 to 5 days. If the INR is higher than 1.8 the day of surg
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ery, a small dose of vitamin K (1 to 5 mg administrated orally or subcutaneously) can reverse anti
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coagulation.



A 61-year-
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old male with pancreatic cancer presents for preoperative evaluation prior to pancreaticoduode
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nectomy. He is unable to walk two city blocks. His history is significant for GERD, hyperlipidemia
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and diabetes mellitus. Which of the following is an indication that this patient should undergo a
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preoperative echocardiogram? O




A. Inability to walk two blocks
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B. History of diabetes mellitus
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C. History of hyperlipidemia
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D. Age over 60 years
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E. High-risk surgical procedure - ANSWER A
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Echocardiography testing preoperatively should be used selectively in patients at high risk for ca
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rdiac complications perioperatively. This includes patients who are unable to achieve four metab
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olic equivalents (METs), defined as climbing two flights of stairs or walking four city blocks. Achie
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ving less than 4 METs indicates poor cardiac reserve, and echocardiogram is indicated before int
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ermediate or major risk surgery. Diabetes, hyperlipidemia, age, and the operation risk are not re
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asons for preoperative echocardiography.
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A 75-year-
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old man complains of severe rest pain in his right leg. He has no pulse in the femoral artery or b
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elow with an ABI index of .2, but no gangrene. He has pulses in the left leg. His BP is 150/80 mm
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Hg, pulse 60 bpm, RR 18 breaths/min. He is on clopidogrel (Plavix), a beta blocker, and a statin.
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His EKG and echocardiogram show no acute changes and his ejection fraction is 60%. Which of t
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he following medications should he receive the day of surgery?
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A. Beta blocker alone
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