Surgery EOR: Preoperative/Postoperative Care
2024/ 205 Questions with Correct Answers/
Graded A+
When can a patient eat prior to a major surgery? - Answer >NPO after midnight
or at least 8 hours
-What risks should be discussed with all patients and documented on the
consent form for a surgical procedure? - Answer >Risk: Bleeding, infection,
anesthesia, scars
-If a patient is on anti-HTN meds should the patient take them on the day of
the procedure? - Answer >Yes
-Should a patient who smokes cigarettes stop before an operation? - Answer
>Yes - improvement is seen in just 2-4 weeks of smoking cessation
-What lab test must all women of childbearing age have before entering the
OR? - Answer >B-Hcg and CBC
-What is a preop colon surgery "bowel prep"? - Answer >Bowel prep with a
colon cathartic (GoLYTELY), oral abx (neomycin, erythromycin), IV antibiotic
before incidsion
-What must you always order preoperatively for you patient undergoing a
major surgery? - Answer >1. NPO/IVF
2. Preop abx
3. Type and cross blood (PRBCs)
-What electrolyte must you check preoperatively if a patient is on
hemodialysis? - Answer >Potassium
-Who gets a preop EKG? - Answer >Patients over 40 or undergoing cardiac
procedure
-What is the most important preoperative eval performed by the surgical
team? - Answer >H&P - no documentation exists linking a reduction in
mortality and morbidity to routine lab testing in otherwise healthy patients
undergoing elective procedures
,-Detailed H&P prior to surgery including special attention to... - Answer >Hx of
CVA, heart dz, pulm dz, renal dz, liver dz, GI d/o, DM, prior surgeries, bleeding
problems, clotting problems, difficulty w/ anesthesia, nutrition, etoh, illicit
drugs
-What is an ASA score? - Answer >American Society of Anesthesiologists (ASA)
classification system which stratifies the degree of perioperative risk for
patients
-Describe the ASA classification system - Answer >ASA 1: Normal healthy
patient
ASA 2: Patient with mild systemic disease
ASA 3: Patient with severe systemic disease
ASA 4: Patient with severe systemic disease with a constant threat to life
ASA 5: Moribound patient who are not expected to survive without an
operation
ASA 6: Brain dead patient
-Mouth PE important to note - Answer >Teeth - if loose worry about
intubation
Tongue - think sleep apnea if large
Jaw - TMJ could be difficult intubation
Mallampati score
-Airway concerns with surgery - Answer >Tracheal deviation - can be issue for
maintaining airway during surgery
-Neck concerns with surgery - Answer >If >17in there is concern for sleep
apnea, masses, deformities, ROM
-Mallampati score - Answer >Classifies how open the airway is
1 - Can see the uvula, no prob w/ intubation
IV- No uvula, hard intubation
-Routine preop labs/tests for patients with cardiac disease/vascular disease? -
Answer >CBC
EKG
, -What are major cardiac risk factors for surgery? - Answer >Unstable coronary
syndromes
Recent MI
Severe valvular disease
Ventricular arrhythmias
-What are minor cardiac risk factors for surgery? - Answer >Hx of CVA
Uncontrolled HTN
-What is the Goldman Criteria for Cardiac Risk? - Answer >Assesses risk of
perioperative fatal and nonfatal cardiac events. Another used is Detsky's
-What are moderate cardiac risk factors for surgery? - Answer >Asymptomatic
MI
DM
Compensated CHF
-What is Lee's revised cardiac risk index? - Answer >Validated way to predict
risk in patients who undergo elective noncardiac procedures. There are 6
predictors (each get one point):
History of ischemic heart disease
CHF
Hx of CVA
High-risk operation
Preoperative treatment with insulin
Preoperative SCr >2.0 mg/dL
-Goldman criteria points - Answer >0-5 = Class I
6-12 = Class 2
13-25 = Class 3
>25 = Class 4
-Preop lab assessment for cardiac disease? - Answer >Resting LV function
Ambulatory EKG monitoring
Exercise stress test or nuclear stress test
Stress echo
-Patients with an EF <___% are at greatest risk for complications during
surgery - Answer ><35%
2024/ 205 Questions with Correct Answers/
Graded A+
When can a patient eat prior to a major surgery? - Answer >NPO after midnight
or at least 8 hours
-What risks should be discussed with all patients and documented on the
consent form for a surgical procedure? - Answer >Risk: Bleeding, infection,
anesthesia, scars
-If a patient is on anti-HTN meds should the patient take them on the day of
the procedure? - Answer >Yes
-Should a patient who smokes cigarettes stop before an operation? - Answer
>Yes - improvement is seen in just 2-4 weeks of smoking cessation
-What lab test must all women of childbearing age have before entering the
OR? - Answer >B-Hcg and CBC
-What is a preop colon surgery "bowel prep"? - Answer >Bowel prep with a
colon cathartic (GoLYTELY), oral abx (neomycin, erythromycin), IV antibiotic
before incidsion
-What must you always order preoperatively for you patient undergoing a
major surgery? - Answer >1. NPO/IVF
2. Preop abx
3. Type and cross blood (PRBCs)
-What electrolyte must you check preoperatively if a patient is on
hemodialysis? - Answer >Potassium
-Who gets a preop EKG? - Answer >Patients over 40 or undergoing cardiac
procedure
-What is the most important preoperative eval performed by the surgical
team? - Answer >H&P - no documentation exists linking a reduction in
mortality and morbidity to routine lab testing in otherwise healthy patients
undergoing elective procedures
,-Detailed H&P prior to surgery including special attention to... - Answer >Hx of
CVA, heart dz, pulm dz, renal dz, liver dz, GI d/o, DM, prior surgeries, bleeding
problems, clotting problems, difficulty w/ anesthesia, nutrition, etoh, illicit
drugs
-What is an ASA score? - Answer >American Society of Anesthesiologists (ASA)
classification system which stratifies the degree of perioperative risk for
patients
-Describe the ASA classification system - Answer >ASA 1: Normal healthy
patient
ASA 2: Patient with mild systemic disease
ASA 3: Patient with severe systemic disease
ASA 4: Patient with severe systemic disease with a constant threat to life
ASA 5: Moribound patient who are not expected to survive without an
operation
ASA 6: Brain dead patient
-Mouth PE important to note - Answer >Teeth - if loose worry about
intubation
Tongue - think sleep apnea if large
Jaw - TMJ could be difficult intubation
Mallampati score
-Airway concerns with surgery - Answer >Tracheal deviation - can be issue for
maintaining airway during surgery
-Neck concerns with surgery - Answer >If >17in there is concern for sleep
apnea, masses, deformities, ROM
-Mallampati score - Answer >Classifies how open the airway is
1 - Can see the uvula, no prob w/ intubation
IV- No uvula, hard intubation
-Routine preop labs/tests for patients with cardiac disease/vascular disease? -
Answer >CBC
EKG
, -What are major cardiac risk factors for surgery? - Answer >Unstable coronary
syndromes
Recent MI
Severe valvular disease
Ventricular arrhythmias
-What are minor cardiac risk factors for surgery? - Answer >Hx of CVA
Uncontrolled HTN
-What is the Goldman Criteria for Cardiac Risk? - Answer >Assesses risk of
perioperative fatal and nonfatal cardiac events. Another used is Detsky's
-What are moderate cardiac risk factors for surgery? - Answer >Asymptomatic
MI
DM
Compensated CHF
-What is Lee's revised cardiac risk index? - Answer >Validated way to predict
risk in patients who undergo elective noncardiac procedures. There are 6
predictors (each get one point):
History of ischemic heart disease
CHF
Hx of CVA
High-risk operation
Preoperative treatment with insulin
Preoperative SCr >2.0 mg/dL
-Goldman criteria points - Answer >0-5 = Class I
6-12 = Class 2
13-25 = Class 3
>25 = Class 4
-Preop lab assessment for cardiac disease? - Answer >Resting LV function
Ambulatory EKG monitoring
Exercise stress test or nuclear stress test
Stress echo
-Patients with an EF <___% are at greatest risk for complications during
surgery - Answer ><35%
