MAC Preoperative Assessment & Patient Evaluation 2 — Questions and Answers
Question 1: When is a preoperative ECG most indicated before elective non-cardiac surgery?
- In all patients over 30
- In patients with known cardiovascular disease or significant risk factors (Correct answer)
- Only in patients with active chest pain
- In all female patients over 50
Correct answer: In patients with known cardiovascular disease or significant risk factors
Preoperative ECG is recommended for patients with known cardiovascular disease or significant risk factors per ACC/AHA guidelines.
Question 2: What does a Revised Cardiac Risk Index (RCRI) score of 3 or more indicate?
- Low cardiac risk
- Intermediate cardiac risk
- High cardiac risk (Correct answer)
- No additional workup needed
Correct answer: High cardiac risk
An RCRI score ≥3 identifies patients at high risk for major adverse cardiac events perioperatively.
Question 3: Which medication should typically be continued on the morning of surgery?
- Metformin
- ACE inhibitors
- Beta-blockers for chronic use (Correct answer)
- Anticoagulants
Correct answer: Beta-blockers for chronic use
Chronic beta-blockers should be continued perioperatively to avoid rebound hypertension and tachycardia.
Question 4: A patient reports a latex allergy. What is the most important preoperative intervention?
- Prescribe antihistamines preoperatively
- Ensure a latex-free environment in the OR (Correct answer)
- Cancel the surgery indefinitely
- Administer corticosteroids alone
Correct answer: Ensure a latex-free environment in the OR
Creating a latex-free environment with latex-free gloves and equipment is the primary prevention strategy for latex-allergic patients.
Question 5: What finding on a preanesthetic evaluation most warrants postponing elective surgery?
- Blood pressure of 140/90
- Hemoglobin of 11 g/dL
- Recent MI within 60 days (Correct answer)
- Controlled type 2 diabetes
Correct answer: Recent MI within 60 days
Recent myocardial infarction within 60 days significantly elevates perioperative cardiac risk, warranting postponement of elective surgery.
Question 6: Which functional capacity assessment best predicts perioperative cardiac risk?
- Ability to climb two flights of stairs without symptoms (Correct answer)
- Ability to lift 20 pounds
- Ability to walk on flat ground for 10 minutes
- Ability to perform overhead activities
Correct answer: Ability to climb two flights of stairs without symptoms
The ability to climb two flights of stairs corresponds to ≥4 METs, indicating adequate functional capacity and lower cardiac risk.
MAC Preoperative Assessment & Patient Evaluation 2
When is a preoperative ECG most indicated before elective non-cardiac surgery?