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Preoperative Evaluation & Risk Assessment Flashcards

7 cards from real BCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. According to the 2014 ACC/AHA guidelines, which patients should NOT routinely receive preoperative coronary revascularization to reduce perioperative cardiac risk?

    Answer: Patients with stable coronary artery disease who do not meet criteria for revascularization independent of surgery

    Prophylactic coronary revascularization is not recommended solely to reduce perioperative risk in patients with stable CAD who would not otherwise meet revascularization criteria.

  2. A patient with end-stage renal disease (ESRD) on hemodialysis is scheduled for AV fistula revision. Which electrolyte abnormality poses the most immediate perioperative risk?

    Answer: Hyperkalemia causing peaked T waves and widened QRS on ECG

    Hyperkalemia with ECG changes (peaked T waves, widened QRS) represents an immediately life-threatening arrhythmia risk requiring treatment before proceeding with any surgery.

  3. A patient with severe COPD (FEV1 45% predicted) requires abdominal aortic aneurysm repair. Which preoperative intervention most effectively reduces postoperative pulmonary complications?

    Answer: Smoking cessation for ≥8 weeks, optimized bronchodilator therapy, and incentive spirometry training

    Smoking cessation of ≥8 weeks, optimized bronchodilator therapy, and preoperative respiratory training are the most evidence-based interventions to reduce postoperative pulmonary complications in COPD patients.

  4. Which of the following patients with hypertension should have elective surgery postponed?

    Answer: Patient with stage 3 hypertension (BP ≥180/110 mmHg) despite appearing otherwise stable

    Stage 3 hypertension (≥180/110 mmHg) warrants postponement of elective surgery to reduce the risk of perioperative cardiovascular complications.

  5. A 72-year-old patient scores 5 on the Mini-Cog test preoperatively. Which perioperative complication risk is most significantly elevated?

    Answer: Postoperative delirium and postoperative cognitive dysfunction (POCD)

    Preoperative cognitive impairment detected by the Mini-Cog or similar screening tools is the strongest predictor of postoperative delirium and POCD in elderly patients.

  6. A patient with mitral stenosis (MVA 0.8 cm²) presents for elective knee arthroscopy. Which hemodynamic goal is most important perioperatively?

    Answer: Maintain heart rate 60–80 bpm and avoid tachycardia to maximize diastolic filling time across the stenotic valve

    Mitral stenosis creates a fixed obstruction to left ventricular filling; tachycardia dramatically reduces diastolic filling time and can precipitate acute pulmonary edema.

  7. A patient with a pacemaker is scheduled for electrocautery-heavy abdominal surgery. Which preoperative measure is most important?

    Answer: Obtain pacemaker interrogation to determine pacing dependency, and program to asynchronous mode or use bipolar/ultrasonic devices

    Pacemaker-dependent patients require reprogramming to asynchronous mode (VOO/DOO) before monopolar electrocautery to prevent inhibition of pacing by EMI.