CAPA Preoperative Evaluation 4 — Questions and Answers
Question 1: A patient undergoing preoperative evaluation is found to have a hemoglobin of 7.8 g/dL. Which action is MOST appropriate for elective ambulatory surgery?
- Proceed; hemoglobin of 8 g/dL is required only for cardiac surgery
- Postpone surgery and refer for anemia workup and treatment (Correct answer)
- Transfuse two units of packed red blood cells preoperatively
- Administer IV iron infusion and proceed same day
Correct answer: Postpone surgery and refer for anemia workup and treatment
Significant anemia in an elective ambulatory patient warrants postponement to identify the cause and optimize hemoglobin before surgery.
Question 2: A patient taking metformin is scheduled for a procedure requiring IV contrast dye. What is the standard preoperative instruction?
- Continue metformin as scheduled
- Hold metformin 48 hours before and after contrast administration (Correct answer)
- Substitute insulin for metformin on the day of surgery
- Administer IV hydration and continue metformin
Correct answer: Hold metformin 48 hours before and after contrast administration
Metformin should be held 48 hours before and after IV contrast to prevent contrast-induced nephropathy and lactic acidosis.
Question 3: Which element of the STOP-BANG questionnaire specifically addresses the BANG component for OSA screening?
- Snoring loudly
- Blood pressure elevation
- Age greater than 50
- Gender (male) (Correct answer)
Correct answer: Gender (male)
The BANG acronym includes BMI >35, Age >50, Neck circumference >40 cm, and Gender (male), which are key risk factors for OSA.
Question 4: A pediatric patient is scheduled for tonsillectomy. Parents report the child had a runny nose and cough that resolved 10 days ago. What is the BEST course of action?
- Cancel surgery for 6 weeks
- Proceed with surgery; the URI has resolved (Correct answer)
- Consult pulmonology before proceeding
- Administer prophylactic bronchodilators and proceed
Correct answer: Proceed with surgery; the URI has resolved
A URI that has fully resolved for more than one to two weeks generally does not increase anesthetic risk and the procedure can proceed.
Question 5: During preoperative assessment, a patient with a known pacemaker is identified. Which information is MOST important to gather?
- Last battery replacement date
- Pacemaker manufacturer, model, and current programming including pacing dependency (Correct answer)
- Patient's surgical history
- Daily heart rate measurements
Correct answer: Pacemaker manufacturer, model, and current programming including pacing dependency
Knowing the pacemaker's manufacturer, model, and programming—especially pacing dependency—is essential for safe perioperative electrocautery planning.
Question 6: A patient with poorly controlled type 1 diabetes has a preoperative blood glucose of 385 mg/dL. What is the MOST appropriate action?
- Administer a sliding scale insulin dose and proceed to the OR
- Postpone elective surgery and contact the physician for glucose management (Correct answer)
- Give IV fluids and recheck glucose in 30 minutes
- Proceed with surgery to avoid further patient fasting
Correct answer: Postpone elective surgery and contact the physician for glucose management
Severely uncontrolled hyperglycemia impairs wound healing and immune function, warranting postponement of elective surgery for glucose optimization.
Question 7: Which preoperative assessment tool is standardized to identify a patient's functional capacity and guide surgical risk stratification?
- Glasgow Coma Scale
- Metabolic Equivalents (METs) (Correct answer)
- Mini-Mental State Examination
- Braden Scale
Correct answer: Metabolic Equivalents (METs)
METs measure functional capacity, with fewer than 4 METs indicating poor reserve and higher perioperative cardiovascular risk.
CAPA Preoperative Evaluation 4
A patient undergoing preoperative evaluation is found to have a hemoglobin of 7.8 g/dL.
Which action is MOST appropriate for elective ambulatory surgery?