General Surgery Board Review Risk Assessment & Management 4

Question 1

Which of the following best describes the purpose of perioperative beta-blockade in non-cardiac surgery?

Accepted Answer

Should be continued in patients already on beta-blockers; routine new initiation is not supported

Answer

Current ACC/AHA guidelines support continuing beta-blockers in patients already taking them but do not support routine new initiation perioperatively due to risk of stroke and hypotension (POISE trial).

Question 2

A 45-year-old woman with a known factor V Leiden mutation requires elective laparoscopic hysterectomy. Which VTE prophylaxis strategy is most appropriate?

Accepted Answer

LMWH plus mechanical prophylaxis, continued postoperatively for extended duration

Answer

Factor V Leiden with major surgery places patients in high VTE risk — combined pharmacological and mechanical prophylaxis with extended duration LMWH (up to 4 weeks) is indicated.

Question 3

The MELD score is used to risk-stratify cirrhotic patients for surgery. A MELD score of 20 carries an approximate 30-day perioperative mortality of:

Accepted Answer

20%

Answer

MELD score of 20 corresponds to approximately 20% 30-day perioperative mortality for major abdominal surgery in cirrhotic patients.

Question 4

Which of the following intraoperative scenarios represents a class IV hemorrhagic shock?

Accepted Answer

HR 155, BP 60/40, UO 0 mL/hr, unconscious

Answer

Class IV hemorrhagic shock (>40% blood volume loss) presents with HR >150, systolic BP <70, negligible urine output, and altered consciousness requiring immediate massive transfusion.

Question 5

A patient taking long-term prednisone 10 mg/day requires urgent colectomy. Which perioperative steroid management is most appropriate?

Accepted Answer

Administer stress-dose hydrocortisone 50 mg IV q8h perioperatively

Answer

Patients on chronic steroids ≥5 mg/day for >3 weeks have suppressed HPA axis and require stress-dose steroids (hydrocortisone 50-100 mg IV q8h) for major surgery to prevent adrenal crisis.

General Surgery Board Review Practice Test

General Surgery Board Review Practice Test

General Surgery Board Review Risk Assessment & Management 4