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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. A morbidly obese patient (BMI 52) is scheduled for Roux-en-Y gastric bypass. Which preoperative assessment is uniquely critical compared to non-bariatric patients?

    Answer: Polysomnography to evaluate for OSA, pulmonary hypertension screening, and assessment for obesity hypoventilation syndrome

    Polysomnography to diagnose OSA severity, pulmonary hypertension screening, and ruling out obesity hypoventilation syndrome are uniquely critical in morbidly obese patients before bariatric surgery.

  2. Which statement regarding preoperative fasting (NPO) guidelines for adult elective surgery is most accurate per current ASA recommendations?

    Answer: Clear liquids are permitted up to 2 hours before anesthesia; solids require 6–8 hours depending on meal content

    ASA guidelines permit clear liquids until 2 hours before anesthesia; light meals require 6 hours and heavy/fatty meals require 8 hours of fasting.

  3. A patient with type 2 diabetes has an HbA1c of 11.2% before elective total hip replacement. What is the most appropriate course of action?

    Answer: Postpone surgery to optimize glycemic control and target HbA1c <8% before proceeding

    Poor glycemic control (HbA1c >8–8.5%) is associated with increased surgical site infection and poor wound healing; postponing elective surgery to improve glycemic control is recommended.

  4. A patient on warfarin for chronic atrial fibrillation (CHA₂DS₂-VASc score of 4) requires elective cholecystectomy. What perioperative anticoagulation strategy is most appropriate?

    Answer: Hold warfarin 5 days preoperatively; bridging with LMWH is not routinely recommended for non-valvular AF based on BRIDGE trial evidence

    The BRIDGE trial demonstrated no reduction in thromboembolism with bridging therapy for non-valvular AF and increased bleeding complications, so bridging is not routinely recommended.

  5. Which of the following represents a Class I indication (highest certainty of benefit) for preoperative echocardiography before non-cardiac surgery per ACC/AHA guidelines?

    Answer: Known or suspected moderate-to-severe valvular disease in patients whose clinical assessment suggests hemodynamic significance

    Preoperative echocardiography is indicated (Class I) when moderate-to-severe valvular disease is suspected and clinical assessment suggests hemodynamic compromise that would alter perioperative management.

  6. A patient with severe pulmonary hypertension (mean PAP 52 mmHg) requires emergent cesarean section. Which hemodynamic perturbation is most immediately life-threatening?

    Answer: Sudden decrease in systemic vascular resistance (SVR) causing right ventricular failure from loss of coronary perfusion pressure

    In pulmonary hypertension, the right ventricle depends on adequate systemic pressure to maintain coronary perfusion; a sudden SVR drop leads to RV ischemia and acute cor pulmonale.

  7. Which preoperative assessment tool is specifically validated to predict 30-day postoperative mortality and morbidity in surgical patients using 20 clinical variables?

    Answer: ACS NSQIP Surgical Risk Calculator

    The ACS NSQIP Surgical Risk Calculator uses 20 patient and procedural variables to provide individualized estimates of 30-day postoperative mortality and specific morbidities.