General Surgery Board Review Risk Assessment & Management 2

Question 1

A 68-year-old man with COPD (FEV1 55% predicted) requires elective sigmoid resection. Which preoperative pulmonary optimization is MOST effective in reducing postoperative pulmonary complications?

Accepted Answer

Smoking cessation at least 8 weeks before surgery

Answer

Smoking cessation ≥8 weeks before surgery significantly reduces postoperative pulmonary complications by allowing airway inflammation to resolve and mucociliary function to recover.

Question 2

The Revised Cardiac Risk Index (RCRI) assigns one point for each of six independent predictors. Which of the following is NOT one of those predictors?

Accepted Answer

Hypertension requiring medication

Answer

The six RCRI predictors are: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent diabetes, and creatinine >2.0 mg/dL — hypertension is not included.

Question 3

A patient undergoing elective abdominal aortic aneurysm repair has a dobutamine stress echocardiogram showing new wall motion abnormalities at low heart rates. What is the most appropriate next step?

Accepted Answer

Refer for coronary angiography and possible revascularization

Answer

New wall motion abnormalities at low heart rates indicate significant myocardial ischemia with a large territory at risk, warranting coronary angiography before elective high-risk vascular surgery.

Question 4

Which Child-Pugh class carries an operative mortality of approximately 25-30% for major abdominal surgery?

Accepted Answer

Child-Pugh C

Answer

Child-Pugh C cirrhosis carries approximately 25-30% operative mortality for major abdominal surgery, making elective procedures generally contraindicated.

Question 5

A 72-year-old woman requires emergency appendectomy. Her medications include warfarin (INR 3.2) for atrial fibrillation. What is the most appropriate anticoagulation management?

Accepted Answer

Administer 4-factor PCC (Kcentra) and proceed with surgery

Answer

For emergent surgery requiring rapid INR reversal, 4-factor PCC provides faster, more reliable reversal than FFP with less volume load and is the agent of choice.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Risk Assessment & Management 2