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Exam-Preoperative Evaluation- ABSITE Questions with Complete Solutions
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Exam-Preoperative Evaluation- ABSITE Questions with Complete Solutions
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Exam-Preoperative Evaluation- ABSITE Questions withComplete Solutions
A 78-year-old man is brought to your office in a wheelchair. He says his abdominal wall hernia
has been getting bigger and wonders if he needs surgery. He looks thin and pale, but in no
distress. He is mildly hypertensive (150/90), had a CABG 3 years prior, and is on a statin and a
diuretic. He feels weak, his appetite is poor, and he lives in a skilled nursing facility. He has a
10x8 non- incarcerated midline incisional hernia. His postoperative risk is best determined by
which of the following?
A. Echocardiogram
B. Pulmonary function testing
C. Frailty index
D. Serum electrolytes
E. Abdominal CT scan Correct Answer-C.
Frailty has gained in importance as a predictor of post-operative outcomes, especially in the
geriatric population. The frailty index includes functional, nutritional and Charlson
Comorbidity Index. This patient had a moderate cardiac risk. His procedure is elective and a
frailty assessment would likely make him a significant risk.
, Exam-Preoperative Evaluation- ABSITE Questions with
Complete Solutions
A 56-year-old female is scheduled to undergo a total thyroidectomy for papillary carcinoma.
She is currently taking warfarin (Coumadin) 5 mg daily due to a femoral DVT 4 months ago.
Her current INR is 2.9. Regarding her anticoagulation regimen, what is the most appropriate
course of action before surgery?
A. Decrease Coumadin dose to 1 mg daily 7 days before surgery.
B. Decrease Coumadin dose to 1 mg daily 5 days before surgery.
C. Stop Coumadin 7 days before surgery.
D. Stop Coumadin 5 days before surgery.
E. Stop Coumadin 3 days before surgery. Correct Answer-D
The usual recommendation is to withhold warfarin starting 4 to 5 days preoperatively (if the
INR is between 2.0 and 3.0) to allow the INR to decrease to less than 1.5, which is a level
considered safe for surgical procedures and neuraxial blockade. Only if the INR is greater than
3.0 is it usually necessary to stop warfarin longer than 4 to 5 days. If the INR is higher than 1.8
the day of surgery, a small dose of vitamin K (1 to 5 mg administrated orally or
subcutaneously) can reverse anticoagulation.
, Exam-Preoperative Evaluation- ABSITE Questions with
Complete Solutions
A 61-year-old male with pancreatic cancer presents for preoperative evaluation prior to
pancreaticoduodenectomy. He is unable to walk two city blocks. His history is significant for
GERD, hyperlipidemia and diabetes mellitus. Which of the following is an indication that this
patient should undergo a preoperative echocardiogram?
A. Inability to walk two blocks
B. History of diabetes mellitus
C. History of hyperlipidemia
D. Age over 60 years
E. High-risk surgical procedure Correct Answer-A
Echocardiography testing preoperatively should be used selectively in patients at high risk for
cardiac complications perioperatively. This includes patients who are unable to achieve four
metabolic equivalents (METs), defined as climbing two flights of stairs or walking four city
blocks. Achieving less than 4 METs indicates poor cardiac reserve, and echocardiogram is
indicated before intermediate or major risk surgery. Diabetes, hyperlipidemia, age, and the
operation risk are not reasons for preoperative echocardiography.
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