Surgery Rotation exam with verified
answers
how do you assess perioperative cardiac risk? - .......🔷ANSWERS🔶......✔✔ American College of
Cardiology (ACC) / American Heart Association (AHA):
Major risk-
1) unstable/severe angina
2) MI within past week-month
3) decompensated CHF
4) sig arrhythmias
5) severe valvular dz
Intermed risk-
1) mild angina
2) previous MI
3) compensated CHF
4) DM
Minor risk-
1) adv age
2) abnl ECG
3) nonsinus rhythm (afib)
4) exercise intol
5) smoking hx
6) uncontrolled HTN
classify the cardiac risks for noncardiac surg proc - .......🔷ANSWERS🔶......✔✔ High risk-
1) emergent maj operations in elderly
2) aortic reconstr
,3) maj periph vasc proc
4) proc w maj fluid shifts or blood loss
Intermed risk-
1) carotid endarterectomy
2) maj head/neck resections
3) laparotomy
4) thoracotomy
5) maj orthopedic proc
6) open prostatectomy
Low risk-
1) endoscopy
2) breast proc
3) cataract extraction
how do you categorize anesthesia risk? - .......🔷ANSWERS🔶......✔✔ American Society of
Anestheiologists (ASA):
class 1 - nl healthy pt
class 2 - pt w mild systemic dz and no functl limitations
class 3 - pt w mod-sev systemic dz w some functl limitations
class 4 - pt w sev systemic dz; const threat to life and functl incapac
class 5 - moribund pt who is not expected to survive 24 hrs w/wo surg
class 6 - brain-dead pt whose organs are being harvested
class E - proc is an emergency
what are the adv/disadv of local, spinal and general anesthesia? - .......🔷ANSWERS🔶......✔✔ local -
fewer phys conseq; may fail to provide good anesthesia, causing incr pain that needs to be offset with
large doses of IV sedatives, which incr risk
spinal - fewer pulm conseq, but more dangerous in pts w CAD, marginal cardiac reserve w low EF,
valv heart dz, or diab periph neurop due to loss of periph vasoconstr ability or ability to incr CO
, when necessary; HYPOTENSION may result, which needs to be stabilzed by IV drugs, which incr
risk; may fail to provide good anesthesia, causing incr pain that needs to be offset with large doses of
IV sedatives, which incr risk
general - excellent analgesia and amnesia, maintains good phys control; incr incidence of pulm
complications and mild cardiodepression
how do you surg assess/proceed for a pt taking aspirin/NSAIDs? - .......🔷ANSWERS🔶......✔✔
(blood thinners); aspirin and NSAIDs cause platelet dysfunction due to inhib COX, preventing PG
synthesis;
aspirin irrev affects platelet aggregation for 7-10 days; d/c 7-10 days before elective surg
NSAIDs rev affect platelet aggregation for 2 days; d/c 2 days before elective surg
how do you surg assess/proceed for pt w elev serum choles? - .......🔷ANSWERS🔶......✔✔ incr risk
CAD, but as a single factor, doesn't postpone surg
how do you surg assess/proceed for a pt whose ECG shows evidence of previous MI?
- .......🔷ANSWERS🔶......✔✔ cardiology consult, exercise stress test, eval signs of ischemia, cardiac
cath, may need coronary revasc
how do you surg assess/proceed for a pt w DM? - .......🔷ANSWERS🔶......✔✔ NPO after midnight;
IVF w dex drip; do not give hypogly meds morning of surg; if pt's serum glu is >250, give 2/3
morning dose of NPH/insulin and postpone surg until serum glu is under control (100-250); if pt's
serum glu is <250, give 1/2 morning dose of NPH/insulin; watch for infxns
how do you surg assess/proceed for a pt w low hematocrit (34%)? - .......🔷ANSWERS🔶......✔✔ surg
needs to be postponed for anemic pts; determine cause of anemia (MC colorectal CA or GI blood
loss)
how do you surg assess/proceed for a pt w high hematocrit (55%)? - .......🔷ANSWERS🔶......✔✔
most likely due to hypovolemia or polycythemia; postpone surg until pt is well hydrated; eval cause
answers
how do you assess perioperative cardiac risk? - .......🔷ANSWERS🔶......✔✔ American College of
Cardiology (ACC) / American Heart Association (AHA):
Major risk-
1) unstable/severe angina
2) MI within past week-month
3) decompensated CHF
4) sig arrhythmias
5) severe valvular dz
Intermed risk-
1) mild angina
2) previous MI
3) compensated CHF
4) DM
Minor risk-
1) adv age
2) abnl ECG
3) nonsinus rhythm (afib)
4) exercise intol
5) smoking hx
6) uncontrolled HTN
classify the cardiac risks for noncardiac surg proc - .......🔷ANSWERS🔶......✔✔ High risk-
1) emergent maj operations in elderly
2) aortic reconstr
,3) maj periph vasc proc
4) proc w maj fluid shifts or blood loss
Intermed risk-
1) carotid endarterectomy
2) maj head/neck resections
3) laparotomy
4) thoracotomy
5) maj orthopedic proc
6) open prostatectomy
Low risk-
1) endoscopy
2) breast proc
3) cataract extraction
how do you categorize anesthesia risk? - .......🔷ANSWERS🔶......✔✔ American Society of
Anestheiologists (ASA):
class 1 - nl healthy pt
class 2 - pt w mild systemic dz and no functl limitations
class 3 - pt w mod-sev systemic dz w some functl limitations
class 4 - pt w sev systemic dz; const threat to life and functl incapac
class 5 - moribund pt who is not expected to survive 24 hrs w/wo surg
class 6 - brain-dead pt whose organs are being harvested
class E - proc is an emergency
what are the adv/disadv of local, spinal and general anesthesia? - .......🔷ANSWERS🔶......✔✔ local -
fewer phys conseq; may fail to provide good anesthesia, causing incr pain that needs to be offset with
large doses of IV sedatives, which incr risk
spinal - fewer pulm conseq, but more dangerous in pts w CAD, marginal cardiac reserve w low EF,
valv heart dz, or diab periph neurop due to loss of periph vasoconstr ability or ability to incr CO
, when necessary; HYPOTENSION may result, which needs to be stabilzed by IV drugs, which incr
risk; may fail to provide good anesthesia, causing incr pain that needs to be offset with large doses of
IV sedatives, which incr risk
general - excellent analgesia and amnesia, maintains good phys control; incr incidence of pulm
complications and mild cardiodepression
how do you surg assess/proceed for a pt taking aspirin/NSAIDs? - .......🔷ANSWERS🔶......✔✔
(blood thinners); aspirin and NSAIDs cause platelet dysfunction due to inhib COX, preventing PG
synthesis;
aspirin irrev affects platelet aggregation for 7-10 days; d/c 7-10 days before elective surg
NSAIDs rev affect platelet aggregation for 2 days; d/c 2 days before elective surg
how do you surg assess/proceed for pt w elev serum choles? - .......🔷ANSWERS🔶......✔✔ incr risk
CAD, but as a single factor, doesn't postpone surg
how do you surg assess/proceed for a pt whose ECG shows evidence of previous MI?
- .......🔷ANSWERS🔶......✔✔ cardiology consult, exercise stress test, eval signs of ischemia, cardiac
cath, may need coronary revasc
how do you surg assess/proceed for a pt w DM? - .......🔷ANSWERS🔶......✔✔ NPO after midnight;
IVF w dex drip; do not give hypogly meds morning of surg; if pt's serum glu is >250, give 2/3
morning dose of NPH/insulin and postpone surg until serum glu is under control (100-250); if pt's
serum glu is <250, give 1/2 morning dose of NPH/insulin; watch for infxns
how do you surg assess/proceed for a pt w low hematocrit (34%)? - .......🔷ANSWERS🔶......✔✔ surg
needs to be postponed for anemic pts; determine cause of anemia (MC colorectal CA or GI blood
loss)
how do you surg assess/proceed for a pt w high hematocrit (55%)? - .......🔷ANSWERS🔶......✔✔
most likely due to hypovolemia or polycythemia; postpone surg until pt is well hydrated; eval cause
