Preoperative Evaltuation & Optimization

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A 65-year-old male with a history of hypertension and diabetes mellitus is scheduled for an elective cholecystectomy. What is the most important preoperative consideration regarding his hypertension?

Discontinue antihypertensive medication 24 hours before surgery D)

Ensure blood pressure is well controlled within the target range before surgery

Increase the dose of antihypertensive medications on the day of surgery

Administer high-dose antihypertensive medication just before surgery

A 70-year-old female with severe osteoarthritis and chronic pain is scheduled for hip replacement surgery. What is the most appropriate preoperative management for her chronic pain?

Discontinue all pain medications for 48 hours before surgery

Switch to non-opioid analgesics to reduce opioid consumption before surgery

Continue her current opioid regimen and adjust postoperatively as needed

Start high-dose opioids to prevent pain flare-ups during surgery

In a patient with chronic obstructive pulmonary disease (COPD) undergoing elective surgery, which preoperative measure is most likely to reduce postoperative pulmonary complications?

Administering systemic corticosteroids to reduce inflammation

Preoperative pulmonary function testing to guide anesthesia management

Encouraging preoperative smoking cessation for at least 1 week

Initiating preoperative antibiotics to prevent infection

A 72-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) is undergoing major abdominal surgery. What is the best approach for perioperative fluid management in this patient?

Restrict fluids to prevent fluid overload

Administer large volumes of intravenous fluids to maintain blood pressure

Use a restrictive fluid strategy, with careful monitoring of urine output

Administer high doses of diuretics preoperatively to prevent heart failure exacerbation

Which of the following laboratory tests is most important to assess preoperatively in a diabetic patient who is scheduled for surgery?

Serum albumin levels

Blood glucose levels

Serum potassium levels

Prothrombin time (PT)

A 60-year-old male with chronic renal disease (CKD stage 3) is scheduled for an elective knee replacement. What is the most appropriate preoperative measure to optimize his renal function?

Start intravenous hydration to flush the kidneys

Discontinue all medications except diuretics 24 hours before surgery

Consult with a nephrologist to optimize renal function and medications

Administer high doses of antihypertensive medications before surgery

In a 55-year-old diabetic patient undergoing elective surgery, what is the key goal regarding insulin management during the perioperative period?

Discontinue insulin therapy the morning of surgery

Maintain blood glucose levels in the target range to prevent hyperglycemia or hypoglycemia C)

Administer an extra dose of insulin before surgery to prevent post-surgical hyperglycemia

Increase the dose of insulin on the day of surgery to cover the stress response

A patient with a history of deep vein thrombosis (DVT) is scheduled for surgery. What is the most important preoperative intervention to reduce the risk of perioperative venous thromboembolism (VTE)?

Start warfarin therapy 2 days before surgery

Initiate mechanical prophylaxis with compression stockings

Administer heparin 24 hours before surgery

Delay surgery until the patient is no longer on anticoagulation

10.

A 68-year-old male with chronic liver disease is scheduled for elective cholecystectomy. What is the most important preoperative consideration regarding his liver function?

Discontinue all medications to avoid liver metabolism

Monitor liver function tests and correct any abnormalities before surgery

Administer prophylactic antibiotics to prevent infections

Avoid giving blood products during the surgery

11.

In a patient with severe obstructive sleep apnea (OSA) undergoing surgery, which preoperative measure is most likely to reduce postoperative complications?

Use of continuous positive airway pressure (CPAP) therapy during the perioperative period

Sedation to ensure the patient sleeps deeply before surgery

Administering higher doses of anesthetic agents to counteract respiratory depression

Discontinuing all OSA medications 24 hours before surgery

12.

A 45-year-old male with a history of well-controlled asthma is scheduled for an elective procedure. What is the most important preoperative consideration for this patient?

Discontinue all bronchodilators before surgery

Ensure the patient’s asthma is well controlled, and consider using a short-acting beta-agonist preoperatively

Administer systemic corticosteroids preoperatively to prevent an asthma attack

Restrict the use of inhalers to prevent drug interactions during surgery

13.

A 70-year-old female with a history of diabetes mellitus and hypertension is scheduled for elective surgery. What is the most important preoperative measure regarding her antihypertensive medications?

Discontinue all antihypertensive medications 24 hours before surgery

B) Continue antihypertensive medications as usual, except for ACE inhibitors and ARBs

C) Increase the dose of antihypertensive medications to ensure optimal control

D) Start beta-blockers preoperatively to prevent perioperative hypertension

14.

. A 75-year-old male with a history of atrial fibrillation (AF) is scheduled for an elective surgery. What is the most important consideration for perioperative anticoagulation management?

Discontinue all anticoagulants 48 hours before surgery

Maintain anticoagulation therapy with a direct oral anticoagulant (DOAC) through the perioperative period

Use bridging therapy with heparin if the patient is on warfarin

Switch to low-dose aspirin only, and stop all other anticoagulants

15.

A 50-year-old male with a history of severe chronic kidney disease (CKD) is scheduled for surgery. What preoperative step is most likely to reduce the risk of postoperative renal complications?

) Initiate dialysis immediately before surgery

Administer intravenous fluids to improve renal perfusion

Start angiotensin-converting enzyme inhibitors (ACE inhibitors) for better kidney function

Restrict fluids and avoid any vasopressor support during surgery

16.

A 64-year-old diabetic patient undergoing major surgery is at risk for hyperglycemia. What is the most appropriate way to manage glucose levels during the perioperative period?

Avoid insulin administration, as it is not needed during surgery

Administer a fixed dose of insulin regardless of blood glucose levels

Monitor blood glucose frequently and administer insulin as needed to maintain levels between 140-180 mg/dL

Start insulin only after hyperglycemia occurs during surgery

17.

A 60-year-old female with a history of deep vein thrombosis (DVT) and pulmonary embolism (PE) is undergoing elective surgery. What is the most important preoperative intervention for VTE prophylaxis?

Initiate anticoagulation therapy with low-molecular-weight heparin (LMWH)

Use mechanical prophylaxis with compression stockings only

Administer aspirin to prevent thromboembolic events

Start warfarin therapy 5 days before surgery

18.

A patient with a history of gastroesophageal reflux disease (GERD) is scheduled for surgery. What is the most important preoperative consideration to minimize aspiration risk?

Ensure the patient has fasted for at least 12 hours before surgery

Administer an H2 blocker or proton pump inhibitor (PPI) the night before surgery

Use a rapid-sequence induction technique for anesthesia induction

Perform a preoperative endoscopy to assess the degree of reflux

19.

A 52-year-old male with well-controlled hypertension is scheduled for elective surgery. What is the most appropriate preoperative blood pressure target?

Blood pressure should be maintained below 130/80 mmHg

Blood pressure should be less than 160/90 mmHg for safe anesthesia

Blood pressure should be within 10-20% of the patient’s baseline

Blood pressure should be normalized to prevent complications

20.

A 60-year-old female with a history of deep vein thrombosis (DVT) and pulmonary embolism (PE) is undergoing elective surgery. What is the most important preoperative intervention for VTE prophylaxis?

Initiate anticoagulation therapy with low-molecular-weight heparin (LMWH)

Use mechanical prophylaxis with compression stockings only

Administer aspirin to prevent thromboembolic events

Start warfarin therapy 5 days before surgery

21.

A patient with a history of gastroesophageal reflux disease (GERD) is scheduled for surgery. What is the most important preoperative consideration to minimize aspiration risk?

Ensure the patient has fasted for at least 12 hours before surgery

Administer an H2 blocker or proton pump inhibitor (PPI) the night before surgery

Use a rapid-sequence induction technique for anesthesia induction

Perform a preoperative endoscopy to assess the degree of reflux

22.

A 52-year-old male with well-controlled hypertension is scheduled for elective surgery. What is the most appropriate preoperative blood pressure target?

Blood pressure should be maintained below 130/80 mmHg

Blood pressure should be less than 160/90 mmHg for safe anesthesia

Blood pressure should be within 10-20% of the patient’s baseline

Blood pressure should be normalized to prevent complications

23.

A 56-year-old male with a history of myocardial infarction (MI) is scheduled for elective surgery. What is the most important preoperative evaluation to assess his cardiac risk?

Perform an echocardiogram to assess left ventricular function

Order a stress test to assess for ischemia

Obtain an electrocardiogram (ECG) to check for arrhythmias

Measure serum troponins to evaluate recent myocardial injury

24.

A 68-year-old patient with a history of chronic obstructive pulmonary disease (COPD) is undergoing major surgery. Which of the following is the most appropriate preoperative step?

Administer high-flow oxygen to optimize oxygen saturation

Preoperative pulmonary function testing to assess baseline respiratory function

Discontinue bronchodilators to avoid interaction with anesthetic drugs

Start prophylactic antibiotics to prevent postoperative respiratory infections

25.

A 72-year-old female with a history of chronic kidney disease (CKD) and hypertension is scheduled for surgery. What is the most appropriate strategy to manage her renal function perioperatively?

Avoid all nephrotoxic drugs, including contrast agents and NSAIDs

Give a loading dose of intravenous fluids to ensure optimal renal perfusion

Administer a loop diuretic preoperatively to reduce fluid retention

Start hemodialysis before surgery to improve renal clearance

26.

A 65-year-old diabetic patient undergoing surgery is at risk for hypoglycemia during anesthesia. What is the most appropriate strategy to manage his glucose levels intraoperatively?

Discontinue insulin therapy and rely on glucose administration during surgery

Administer a fixed dose of insulin regardless of blood glucose levels

Monitor blood glucose every hour and administer insulin as needed to maintain levels between 140-180 mg/dL

Start a continuous infusion of dextrose during the surgery to prevent hypoglycemia

27.

A 60-year-old male undergoing major surgery is on anticoagulation therapy for atrial fibrillation. What is the most appropriate perioperative anticoagulation management strategy?

Discontinue all anticoagulation therapy for 48 hours before surgery

Bridging therapy with low-molecular-weight heparin (LMWH) should be used in patients on warfarin

Continue anticoagulation therapy without interruption for minor surgeries

Start aspirin therapy only, and discontinue all other anticoagulants

28.

A 78-year-old female with a history of hypertension and coronary artery disease (CAD) is scheduled for elective surgery. What is the most important preoperative test to assess her risk for cardiac complications?

Perform an exercise stress test

Order a chest X-ray to assess cardiac enlargement

Obtain an electrocardiogram (ECG) and assess for ischemia

Measure brain natriuretic peptide (BNP) levels to evaluate heart failure risk

29.

A 55-year-old male with a history of gastroesophageal reflux disease (GERD) is scheduled for surgery. What is the best preoperative intervention to minimize aspiration risk?

Administer antacids 1 hour before surgery

Perform a preoperative endoscopy to assess the degree of reflux

Use a rapid-sequence induction (RSI) during anesthesia induction

Avoid all medications that could increase gastric acidity

30.

A 45-year-old patient with chronic alcoholism is scheduled for elective surgery. What is the most important preoperative consideration?

Ensure alcohol is withheld for 24 hours before surgery

Administer alcohol substitutes (e.g., benzodiazepines) to prevent withdrawal symptoms

Discontinue all medications and supplements to avoid drug interactions

31.

A 70-year-old female with a history of severe osteoarthritis is undergoing knee replacement surgery. What is the most important preoperative consideration regarding her pain management?

Use only opioid analgesics for pain management

Consider regional anesthesia (e.g., femoral nerve block) to minimize opioid use

Administer corticosteroids preoperatively to reduce inflammation

Avoid using local anesthetics due to potential systemic toxicity

32.

A 62-year-old patient with a history of chronic heart failure is undergoing surgery. What is the most important preoperative consideration?

Restrict fluid intake to prevent volume overload

Administer prophylactic inotropes to maintain cardiac output

Optimize heart failure treatment with diuretics and ACE inhibitors before surgery

Continue all heart failure medications without any changes

33.

A 70-year-old female with a history of hypertension and type 2 diabetes mellitus is scheduled for surgery. What is the most important consideration regarding her insulin therapy perioperatively?

Discontinue insulin therapy on the morning of surgery

Administer a reduced dose of insulin on the morning of surgery and monitor blood glucose closely

Increase insulin doses to avoid postoperative hyperglycemia

Use only oral hypoglycemic agents during the perioperative period

34.

A 62-year-old male with severe asthma is scheduled for surgery. Which of the following is the best preoperative management to reduce perioperative respiratory risks?

Administer inhaled corticosteroids and short-acting beta-agonists (SABA) before surgery

Schedule surgery after optimizing asthma control with oral steroids for 1-2 weeks

Discontinue asthma medications 24 hours before surgery to prevent drug interactions

Administer systemic corticosteroids preoperatively in all patients with asthma

35.

A 50-year-old male with a history of obstructive sleep apnea (OSA) is scheduled for surgery. What is the most important consideration during the perioperative period?

Avoid using sedatives or opioids postoperatively

Ensure the patient undergoes overnight polysomnography before surgery

Continue CPAP therapy throughout the perioperative period

Perform a preoperative evaluation with a sleep specialist

36.

A 55-year-old male with severe hypertension is scheduled for elective surgery. Which of the following is the best approach for managing blood pressure perioperatively?

Perform blood pressure measurement only preoperatively and once during surgery

Start intravenous antihypertensive therapy to maintain normal blood pressure during surgery

Allow blood pressure to rise naturally, as long as it is below 180/110 mmHg

Administer antihypertensive drugs before surgery and continue them as usual

37.

A 75-year-old female with a history of stroke is scheduled for surgery. What is the most important preoperative evaluation to assess her risk for perioperative stroke?

Perform a carotid Doppler ultrasound to evaluate for carotid stenosis

Order a CT scan to assess for evidence of recent stroke

Review her anticoagulation therapy and adjust as necessary

Perform an echocardiogram to assess for any thromboembolic source

38.

A 66-year-old patient with a history of severe chronic obstructive pulmonary disease (COPD) is undergoing surgery. What is the best perioperative approach to optimize respiratory function?

Administer supplemental oxygen preoperatively and postoperatively

Perform preoperative pulmonary function testing to assess baseline lung function

Start prophylactic antibiotics to prevent postoperative pneumonia

Avoid administering bronchodilators during the perioperative period

39.

A 48-year-old diabetic patient is scheduled for surgery. What is the best strategy for managing their blood glucose during the perioperative period?

Administer long-acting insulin on the morning of surgery to maintain glucose levels

Administer a short-acting insulin and closely monitor blood glucose levels during the procedure

Withhold all insulin and oral hypoglycemics until after surgery

40.

A 72-year-old male with end-stage renal disease (ESRD) is scheduled for surgery. What is the most appropriate perioperative strategy for managing renal function?

Perform dialysis the day before surgery to optimize renal function

Administer intravenous fluids to improve renal perfusion

Discontinue any medications affecting renal function, including ACE inhibitors

41.

A 66-year-old patient with a history of well-controlled hypertension is undergoing elective surgery. What is the most appropriate preoperative management of his antihypertensive medications?

Discontinue all antihypertensive medications on the morning of surgery

Continue antihypertensive medications on the morning of surgery with a sip of water

Administer extra doses of antihypertensive medications before surgery to maintain optimal control

Switch to intravenous antihypertensive agents on the morning of surgery

42.

A 60-year-old diabetic patient is scheduled for surgery. Which of the following is the best strategy to prevent hyperglycemia during surgery?

Start an intravenous insulin infusion to maintain blood glucose between 140 and 180 mg/dL

Administer a fixed dose of insulin preoperatively regardless of blood glucose levels

Start a high-dose corticosteroid regimen to reduce inflammation

Avoid all sources of carbohydrates until after the surgery

43.

A 50-year-old male with a history of coronary artery disease is undergoing elective surgery. Which preoperative test is most critical to evaluate his cardiac risk?

Electrocardiogram (ECG)

Stress echocardiography

Cardiac catheterization

Troponin levels

44.

A 70-year-old patient with known heart failure is scheduled for surgery. What is the most important preoperative consideration?

Discontinue diuretics to prevent electrolyte imbalances

Optimize heart failure management and assess for decompensation

Perform a routine angiogram to evaluate coronary arteries

Administer preoperative beta-blockers regardless of heart rate

45.

A 45-year-old male with chronic kidney disease is scheduled for surgery. Which laboratory value is the most critical to monitor perioperatively?

Hemoglobin

Serum potassium

Glomerular filtration rate (GFR)

Serum calcium

46.

A 40-year-old obese female with no other comorbidities is undergoing surgery. What is the primary preoperative concern?

Risk of deep vein thrombosis (DVT)

Poor glycemic control

Increased risk of aspiration

Difficulty achieving adequate anesthesia

47.

A 30-year-old pregnant female is undergoing non-obstetric surgery. Which position should be avoided to reduce the risk of aortocaval compression?

Supine position without a left lateral tilt

Lithotomy position

Trendelenburg position

48.

A 65-year-old patient on anticoagulation therapy with warfarin requires urgent surgery. What is the best initial step in management?

Start an intravenous heparin infusion

Reverse anticoagulation with vitamin K and consider prothrombin complex concentrate (PCC)

Proceed with surgery without altering anticoagulation

49.

A 60-year-old male with moderate anemia is scheduled for surgery. What is the best strategy for preoperative optimization?

Administer erythropoiesis-stimulating agents (ESAs) 4 weeks before surgery

Transfuse packed red blood cells preoperatively

Delay surgery until the hemoglobin is >13 g/dL

Start intravenous iron therapy if the anemia is iron-deficient

50.

A 72-year-old female with a history of severe osteoarthritis is scheduled for joint replacement. Which preoperative evaluation is most critical in this patient?

Functional status and ability to perform daily activities

Pulmonary function testing to evaluate respiratory reserve

Bone mineral density assessment

Renal function testing

51.

A 45-year-old patient with a history of heavy alcohol use is scheduled for surgery. What is the most important preoperative concern?

Increased risk of aspiration due to delayed gastric emptying

Increased perioperative bleeding due to impaired coagulation

Risk of alcohol withdrawal and delirium tremens

Decreased anesthetic requirements

52.

A 68-year-old patient with untreated obstructive sleep apnea (OSA) is undergoing elective surgery. What is the primary intraoperative concern?

Hypoxemia due to airway obstruction

Difficult intravenous access

Exacerbation of hypertension

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