General Surgery Board Review General Surgery Board Review Perioperative Care & Complications 1 — Questions and Answers
Question 1: Which ASA physical status classification is assigned to a patient with severe systemic disease that is a constant threat to life?
- ASA II
- ASA III
- ASA IV (Correct answer)
- ASA V
Correct answer: ASA IV
ASA IV denotes a patient with a severe systemic disease that is a constant threat to life, such as recent MI, CVA, TIA, or ongoing cardiac ischemia.
Question 2: A patient on warfarin for atrial fibrillation requires elective colon resection. What is the standard perioperative anticoagulation strategy for high-thromboembolic-risk patients?
- Continue therapeutic warfarin throughout surgery
- Stop warfarin 5 days before and bridge with therapeutic heparin (Correct answer)
- Stop warfarin 1 day before surgery without bridging
- Switch to aspirin perioperatively
Correct answer: Stop warfarin 5 days before and bridge with therapeutic heparin
High-risk patients (e.g., mechanical mitral valve, high-risk AF) should stop warfarin 5 days preoperatively and receive bridging therapy with LMWH or UFH until surgery.
Question 3: Per ASA guidelines, what is the minimum fasting time for clear liquids before elective surgery in healthy adults?
- 1 hour
- 2 hours (Correct answer)
- 4 hours
- 6 hours
Correct answer: 2 hours
The ASA recommends a minimum 2-hour fast for clear liquids (including water, clear juices, carbonated beverages, and black coffee) before elective procedures.
Question 4: Antibiotic prophylaxis for colorectal surgery should target which organisms?
- Gram-positive aerobes only
- Gram-negative aerobes only
- Both gram-negative aerobes and anaerobes (Correct answer)
- Fungi and gram-positive organisms
Correct answer: Both gram-negative aerobes and anaerobes
Colorectal surgery prophylaxis must cover both gram-negative aerobes and anaerobes (e.g., cefazolin + metronidazole, or cefoxitin alone) due to the mixed flora of the colon.
Question 5: Surgical antibiotic prophylaxis with cefazolin should be administered at what time relative to skin incision for optimal tissue levels?
- Within 60 minutes before incision (Correct answer)
- At time of skin closure
- 2 hours before surgery
- Only if the case exceeds 4 hours
Correct answer: Within 60 minutes before incision
Cefazolin should be administered within 60 minutes before skin incision (30–60 minutes recommended) to ensure adequate tissue concentrations at the time of incision.
Question 6: The Revised Cardiac Risk Index (RCRI) includes all of the following EXCEPT:
- History of ischemic heart disease
- History of congestive heart failure
- Uncontrolled hypertension (Correct answer)
- Preoperative creatinine >2.0 mg/dL
Correct answer: Uncontrolled hypertension
The six RCRI factors are: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent diabetes, and creatinine >2.0 mg/dL — uncontrolled hypertension is not included.
General Surgery Board Review General Surgery Board Review Perioperative Care & Complications 1
Which ASA physical status classification is assigned to a patient with severe systemic disease that is a constant threat to life?