Medical Risk Factors

Question 0

Give what to renal-failure related anemia, anemia of chronic disease, autologous donation, refusal of transfusion

Answer 0

EPO

Question 1

What may sickle cell patients develop and what should be maintained perioperatively

Answer 1

Cholelithiasis

Maintain hydration and oxygenation to avoid crisis

Question 2

Tachycardia, oliguria, hypotension, fatigue, syncope, tachypnea, dyspnea, or TIA

Answer 2

Symptomatic anemia

Give tranfusion

Question 3

Leading cause of death after anesthesia and surgery

Answer 3

Perioperative cardiac mortality

Question 4

Recent MI, unstable angina
Decompensated CHF
Significant arrhythmias
Severe valvular disease

Answer 4

Major perioperative CV risk

Question 5

Mild angina
Hx of MI or q waves
Compensated or hx of CHF
Diabetes

Answer 5

Intermediate perioperative CV risk

Question 6

Advanced age
Abnormal ECG
Other than sinus rhythm
Low functional capacity
Hx of stroke
Uncontrolled HTN

Answer 6

Minor perioperative CV risk

Question 7

What type of anesthesia decreases postop MI

Answer 7

Peri and postop epidural versus general

Question 8

Time frame of anticoagulant withdrawal

Answer 8

3 days preop

Restart 2-3 days postop

Question 9

Give preoperatively to patients with increased cardiac risk

Answer 9

Beta-blockers

Question 10

Dental, oral, respiratory, or esophageal procedure abx prophylaxis

Answer 10

Amoxicillin po
or Ampicillin IV

Allergic to PCN then clindamycin or cephalosporin

Question 11

GI/GU procedure abx prophylaxis

Answer 11

High risk: ampicillin + gentamicin or vanc + gent

Moderate: amoxicillin or ampicillin or vancomycin

Question 12

When to stop smoking before elective procedure

Answer 12

6 to 8 weeks

Risk of complications increases if >20 cigarettes per day or 20 pack/year history

Question 13

Given for COPD, asthma to reduce complications (4)

Answer 13

antibiotics, bronchodilators (aminophylline), acetylcysteine, steroids

Question 14

Which procedures decrease TLC, FRC, TV the greatest

Answer 14

Thoracotomy, upper abdominal surgery

for 1-2 weeks postop

Question 15

3 most common pulmonary complications

Answer 15

Atelectasis, pulmonary infection, aspiration of gastric contents

Question 16

Prophylaxis/Tx for aspiration of gastric contents

Answer 16

H2 blockers or PPI

Tx for large aspirates is bronchoscopy

Question 17

Preoperative considerations in chronic renal failure (3)

Answer 17

decreased GFR

change in volume and electrolyte homeostasis impaired metabolism/excretion of medications and dyes

Question 18

Studies for chronic renal failure (5)

Answer 18

BMP
CBC (HCT)
Urinalysis
CXR
ECG

Question 19

Type of hyperparathyroidism in renal failure

Answer 19

Secondary

Question 20

Hematologic changes in renal failure

Answer 20

anemia, coagulation defect

Question 21

When is dialysis required

How long before surgery

Answer 21

When GFR is <5% of normal

24 hours before surgery

Question 22

Complication of peritoneal dialysis

Answer 22

peritonitis

Question 23

Complications of hemodialysis

Answer 23

worsened coagulopathy (heparin), staphylococcal infections

Question 24

Tx for hyperkalemia (>5 mEq/L) (5)

Answer 24

``` IV calcium gluconate Sodium bicarbonate Insulin and glucose Exchange resins (sodium polystyrene sulfonate) Dialysis ```

Question 25

Tx for metabolic acidosis

Answer 25

Bicarbonate or dialysis

Question 26

Tx for coagulopathy (3)

Answer 26

Adequate dialysis Withhold heparin FFP or DDAVP

Question 27

What anesthetic is contraindicated in renal failure | Which one is preferred

Answer 27

Succinylcholine Atracurium is preferred Benzodiazepines will sedate for longer

Question 28

Labile blood pressure, impaired wound healing, postoperative hematomas, shunt thrombosis

Answer 28

Postop complications in renal failure patients

Question 29

Which tests confirm liver disease (8)

Answer 29

AST, ALT, bilirubin, alk phos, albumin, PT, BT, platelet count

Question 30

What do you need to confirm acute hepatitis

Answer 30

liver biopsy

Question 31

When to quit EtOH before elective surgery in alcoholic hepatitis

Answer 31

6 to 12 weeks

Question 32

Management of portal hypertension (3)

Answer 32

beta-blockers octreotide transvenous intrahepatic portosystemic shunting

Question 33

Procedures to decompress cholangitis

Answer 33

Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and biliary stenting or transhepatic cholangicography (THC) with drainage Prevents sepsis

Question 34

Obstructive jaundice causes which complications Decreased Vit K absorption Jaundice Stress gastritis

Answer 34

Coagulation disorders Acute renal failure GI hemorrhage

Question 35

Best inhalant anesthetic for liver disease

Answer 35

Isoflurane

Question 36

Tx for increased PT (Vit K deficiency)

Answer 36

Vitamin K | FFP

Question 37

Why avoid narcotics and sedatives in liver patients

Answer 37

Can cause hepatic encephalopathy

Question 38

Tx of hepatic encephalopathy

Answer 38

``` protein restriction intestinal abx (neomycin) lactulose ```

Question 39

Management of diabetes drugs preoperatively Hypoglycemic agents Sulfonylurea drugs Metformin, why?

Answer 39

No hypoglycemics day of surgery Withhold sulfonylurea 2-3 days before Withhold metformin for 24 hours- risks lactic acidosis

Question 40

Tx for diabetic ketoacidosis

Answer 40

IV fluids insulin bicarbonate potassium

Question 41

Postop complications in diabetics

Answer 41

Infection Impaired wound healing CV complications Sepsis (staphylococcal)