PreOp & Preparation

Question 1

What is METS?

Answer 1

Metabolic Equivalent of Task; a subjective assessment of a patients cardiopulmonary capacity

Question 2

Poor cardiopulmonary capacity is associated with

Answer 2

Increased perioperative risks

Question 3

1 MET is the rate of

Answer 3

Energy consumed at rest (3.5mL/kg/min)

Question 4

What is a good functional capacity in terms of METS?

Answer 4

Greater than 4=low risk

Question 5

When should you avoid cardiac surgery as it relates to recent MI/CABG or PCI?

Answer 5

BMS> 1mo

DES 3-6 mo, continue ASA

CABG >6 mo

Question 6

Stage 2 HTN range

Answer 6

> 140/>90

Question 7

Which valvular disease is most concerning?

Answer 7

Severe Aortic Stenosis (valve area <1.0)

Question 8

What test is the gold standard for cardiac evaluation?

Answer 8

ECHO

Question 9

Preserved EF>50% is considered to be _____ risk

Answer 9

Lower

Question 10

What are s/s of Left ventricular dysfunction?

Answer 10

SOB

Pulmonary Edema

Tachypnea

Tachycardia

JVD distention

Question 11

What is the definitive test for IHD (ischemic heart disease)?

Answer 11

Cardiac Catheterization

Question 12

What Pulmonary assessment tool can be used to assess function?

Answer 12

STOP-BANG (assessment for OSA)

Question 13

What does STOP BANG stand for?

Answer 13

Snoring
Tired
Observed stop breathing
Blood Pressure

BMI>35
Age>50
Neck circumference>40
Gender Male

Question 15

What is a normal FEV1/FVC ratio?

Answer 15

Greater than or Equal to 80%

Question 16

FEV1/FVC ratio less than 80% suggests

Answer 16

Airflow limitation with an obstructive pattern

Question 17

What are examples of reversible airway diseases?

Answer 17

Asthma

Chronic Bronchitis

Emphysema

Question 18

Steroids can lead to

Answer 18

Adrenal insufficiency

Question 19

With upper respiratory infections, how long should an elective case be post-poned?

Answer 19

6 week in adults; okay to proceed in children due to frequent URI

Question 20

Diabetes is associated with what other diseases?

Answer 20

HTN
CAD
PVD
Renal Insufficiency
Slow GI motility

Question 21

When do you treat a BS?

Answer 21

> 180

Question 22

What medication is used to treat HYOthyroid?

Answer 22

Synthroid

Question 23

What medication is used to treat HYPERthyroid?

Answer 23

Propylthiouracil & Propranolol

Question 24

Should thyroid medication be held?

Answer 24

No, continue them

Question 25

Who is at risk for HPA axis suppression?

Answer 25

Those who take high doses of steroids like 20mg for >5 days in the prior year

Question 26

HPA axis suppression may manifest as

Answer 26

HOTN that is not corrected by fluids or vasopressors

Question 27

With Minor surgeries, what is the target for hydrocortisone?

Answer 27

50mg

Question 28

With Moderate surgeries, what is the target for hydrocortisone?

Answer 28

75-150mg/day

Question 29

With Major surgeries, what is the target for hydrocortisone?

Answer 29

75-150mg/day

Question 30

IBW calculation for Males?

Answer 30

IBW= 50kg + 2.3 kg fir each inch over 5 feet

Question 31

IBW for females?

Answer 31

IBW= 45.5 kg +2.3kg for each inch over 5 feet

Question 32

Advanced RA can cause

Answer 32

Vocal cord restriction & tracheal stenosis

Question 33

How long should anticoags be held for regional

Answer 33

3 days

Question 34

Which populations are at an increase risk for aspiration?

Answer 34

OB GERD Obese DM Pain HYPOthyroid

Question 35

NPO status causes

Answer 35

Dehydration Low BS Hypovolemia Increased Preop anxiety

Question 36

Clear liquids can be consumed up til

Answer 36

2 hours

Question 37

Breast milk minimal fasting time

Answer 37

4 hours

Question 38

Infant formula minimal fasting time

Answer 38

4-6 hours

Question 39

Non human milk minimal fasting time

Answer 39

6 hours

Question 40

Light meal minimal fasting time

Answer 40

6 hours

Question 41

Heavy meal with a lot of fat & meat minimal fasting time

Answer 41

8 hours

Question 42

How is Cisatracurium metabolised?

Answer 42

Plasma Esterase, so independent of organ function

Question 43

What is the optimal time frame to quit smoking

Answer 43

>2 months, but can see changes from even a few days Should stop at least 12-48 hours before surgery

Question 44

Alcohol should be abstained for

Answer 44

4+ weeks before major surgery

Question 45

What tools are used for ETOH assessment?

Answer 45

AUDIT CAGE

Question 46

Those with a heavy consumption of alcohol may require

Answer 46

Increased doses of meds & they metabolize NMB more rapidly

Question 47

Opioid abuse can lead to

Answer 47

A harder time managing pain, especially is they take suboxone or naltrexone

Question 48

Those who abuse opioids are at risk of

Answer 48

Hyperalgesia, so use a multimodal approach

Question 49

Methamphetamine effects on anesthetic

Answer 49

Poor dentation SNS activation

Question 50

Cocaine use risks

Answer 50

The chance of Coronary vasospasm (avoid ephedrine) HTN Tachycardia

Question 51

Which antiemetics should be used for gastric bypass?

Answer 51

Aprepitant Emend

Question 52

Extreme anxiety effects on anesthetic

Answer 52

Increased requirements Delayed discharge High post-op pain

Question 53

What home meds should be taken?

Answer 53

Beta Blockers Inhalers Anti-hypertensives Anti-seizures Parkinsons Opioids

Question 54

What home meds should be HELD?

Answer 54

ACEI ARBS Diuretics Vitamins Herbals Oral Hypoglycemics

Question 55

ASA class 2

Answer 55

Mild systemic disease

Question 56

ASA class 3

Answer 56

Severe systemic disease; 1 or more moderate to severe disease

Question 57

ASA class 4

Answer 57

Severe systemic disease that is a constant threat to life

Question 58

ASA class 5

Answer 58

Moribund; not expected to survive without an operation

Question 59

ASA 6

Answer 59

Declared to be brain dead; organ removal