Podcast
Questions and Answers
What is the primary purpose of a medical clearance?
What is the primary purpose of a medical clearance?
- To provide a comprehensive treatment plan for existing medical conditions.
- To determine if an individual is medically fit for a specific activity or procedure. (correct)
- To offer preventative care and immunizations to patients.
- To document all past medical history and surgical interventions.
Which of the following is considered a common type of medical clearance?
Which of the following is considered a common type of medical clearance?
- Cosmetic surgery clearance
- Pre-operative clearance (correct)
- Nutritional clearance
- Physical therapy clearance
A 73-year-old female patient with controlled hypertension and osteoarthritis is scheduled for left eye cataract surgery. Her medications include ASA 81 mg OD and Lisinopril 5 mg OD. Her BP is 134/78, HR 72, RR 16, and Temp 97.2. What initial steps are crucial for clearing this patient?
A 73-year-old female patient with controlled hypertension and osteoarthritis is scheduled for left eye cataract surgery. Her medications include ASA 81 mg OD and Lisinopril 5 mg OD. Her BP is 134/78, HR 72, RR 16, and Temp 97.2. What initial steps are crucial for clearing this patient?
- Order a complete blood count and electrolyte panel.
- Determine clinical predictors, ASA classification, and functional capacity. (correct)
- Consult with a cardiologist for a cardiac stress test.
- Immediately prescribe a stronger antihypertensive medication.
According to the ASA Physical Status Classification, a patient with mild systemic disease is classified as:
According to the ASA Physical Status Classification, a patient with mild systemic disease is classified as:
Which of the conditions listed is an example of ASA III classification?
Which of the conditions listed is an example of ASA III classification?
Which of the following best describes a patient classified as ASA V?
Which of the following best describes a patient classified as ASA V?
What does 'functional capacity' primarily assess in the context of medical clearance?
What does 'functional capacity' primarily assess in the context of medical clearance?
Which activity corresponds to a functional capacity of 5-9 METs?
Which activity corresponds to a functional capacity of 5-9 METs?
In pre-operative pulmonary risk assessment, which factor is directly related to increased risk based on the location proximity?
In pre-operative pulmonary risk assessment, which factor is directly related to increased risk based on the location proximity?
Which of the following pre-existing conditions presents the highest pulmonary risk in pre-operative patients?
Which of the following pre-existing conditions presents the highest pulmonary risk in pre-operative patients?
Why is it important to review a patient’s medication list during a medical clearance?
Why is it important to review a patient’s medication list during a medical clearance?
Electrolyte and creatinine levels are crucial when clearing a patient with:
Electrolyte and creatinine levels are crucial when clearing a patient with:
A 68-year-old male patient with a history of MI 5 years ago, hypertension, and diabetes is undergoing a colonoscopy. His medications include Toprol, ASA, Diovan, and Metformin. What is the most important consideration regarding his medications during the pre-operative clearance?
A 68-year-old male patient with a history of MI 5 years ago, hypertension, and diabetes is undergoing a colonoscopy. His medications include Toprol, ASA, Diovan, and Metformin. What is the most important consideration regarding his medications during the pre-operative clearance?
What is the significance of assessing cardiac risk factors as part of a medical clearance?
What is the significance of assessing cardiac risk factors as part of a medical clearance?
A 55-year-old male is scheduled for a right knee replacement. His medical history includes paroxysmal atrial fibrillation (currently in sinus rhythm), asthma, and GERD. He takes Coumadin, Rhythmol SR, and Protonix. What is the most critical consideration regarding this patient’s medication regimen prior to surgery?
A 55-year-old male is scheduled for a right knee replacement. His medical history includes paroxysmal atrial fibrillation (currently in sinus rhythm), asthma, and GERD. He takes Coumadin, Rhythmol SR, and Protonix. What is the most critical consideration regarding this patient’s medication regimen prior to surgery?
A 40-year-old female is scheduled for a thyroidectomy. She reports no medical history and denies taking any medications. What is the most appropriate next step in her medical clearance?
A 40-year-old female is scheduled for a thyroidectomy. She reports no medical history and denies taking any medications. What is the most appropriate next step in her medical clearance?
What is the primary concern when a patient reports taking herbal medications before surgery?
What is the primary concern when a patient reports taking herbal medications before surgery?
A 69-year-old obese male with hypertension and diabetes is seeking medical clearance to start exercising at the gym. He takes Losartan, Toprol, Lipitor, and Metformin. What is the most important initial consideration for this patient?
A 69-year-old obese male with hypertension and diabetes is seeking medical clearance to start exercising at the gym. He takes Losartan, Toprol, Lipitor, and Metformin. What is the most important initial consideration for this patient?
Which of the following is a high-risk surgical procedure with a cardiac complication rate exceeding 5%?
Which of the following is a high-risk surgical procedure with a cardiac complication rate exceeding 5%?
Which condition would necessitate repeating a fasting glucose test on the day of surgery?
Which condition would necessitate repeating a fasting glucose test on the day of surgery?
Flashcards
What is a Medical Clearance?
What is a Medical Clearance?
A specific medical examination to determine if an individual is medically fit for a particular activity or procedure.
What is ASA Classification?
What is ASA Classification?
A classification system used to assess a patient's physical status before surgery.
Functional Capacity
Functional Capacity
The ability to perform daily activities; measured in METs (metabolic equivalents).
Pulmonary Risks
Pulmonary Risks
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Pre-operative testing
Pre-operative testing
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Study Notes
- Medical clearance is a specific medical examination
- It determines if an individual is medically fit for a particular activity or procedure
Common Medical Clearances:
- Pre-operative clearance
- Employment clearance
- Sports clearance
- Mental Health clearance, which includes substance abuse assessments
Pre-Op Clearance Case Study
- Mrs. Johnson is a 73-year-old female patient
- She will be undergoing left eye cataract surgery
- Her Past Medical History (PMH): Hypertension which is controlled and Osteoarthritis
- Medications (Meds): ASA 81 mg OD, Lisinopril 5 mg OD
- Vitals: BP 134/78, HR 72, RR 16, Temp 97.2
History Factors
- Age.
- The Body Mass Index (BMI).
- Medical history.
ASA Classification
- ASA I: Normal healthy patient.
- ASA II: Patient with mild systemic disease, examples include controlled DM/HTN.
- ASA III: Patient with severe systemic disease, examples include poorly controlled DM or HTN, morbid obesity.
- ASA IV: Patient with severe systemic disease that is a constant threat to life, examples include recent MI, CVA, or cardiac ischemia.
- ASA V: Moribund patient who is not expected to survive without the operation, examples include ruptured aneurysm.
- ASA VI: Declared brain-dead patient whose organs are being removed for donor purposes.
Clinical Predictors For Coronary Artery Disease
- Major predictors include myocardial infarction <6 weeks, unstable angina, decompensated heart failure.
- Intermediate predictors include previous myocardial infarction >6 weeks and <3 months, mild angina, diabetes mellitus.
- Minor predictors include age >70 years, ECG abnormalities, hypertension, hypercholesterolemia.
Functional Capacity Measured in METs
- 1-4 METs includes light home activities, walking around the house, and walking 1-2 blocks on level ground at 3-5 km/h.
- 5-9 METs includes climbing a flight of stairs, walking up a hill, and moderate activities like golf or dancing.
- ≥10 METs includes strenuous sports like swimming or heavy professional work.
Risks
- Sleep Apnea.
- Smoking.
- Illicit Drugs.
- EtOH.
Pulmonary Risks
- Procedure-related risk factors: How close the surgery is to the diaphragm, upper abdominal, and thoracic surgery are the highest risk procedures.
- Length of surgery (> 3 hours) and general anesthesia.
- Emergency surgery.
- Underlying chronic pulmonary disease or symptoms of respiratory infection.
- Smoking.
- Age >60 years.
- Obesity.
- Presence of obstructive sleep apnea.
- Poor exercise tolerance or poor general health status.
Cardiac Complication Risk
- High-risk procedures (>5%) include emergency surgery, aortic, and major vascular surgery.
- Intermediate risk procedures (1-5%) include abdominal or thoracic surgery, neurosurgery, and orthopedic surgery.
- Low-risk procedures (<1%) include breast surgery, eye surgery, endoscopic procedures, and ambulatory surgery.
Relevant Medications
- ASA
- Clopidogrel
- Anticoagulation
- Herbal medications
- HTN medications
- DM medications
Testing Considerations
- Complete blood count: For major surgery or suspected anemia.
- INR/aPTT: If on anticoagulant therapy.
- Electrolytes & creatinine: For hypertension, renal disease, or diabetes.
- Fasting glucose: For diabetes.
- Electrocardiograph: For heart disease, hypertension, or diabetes.
- Chest radiograph: For cardiac or pulmonary disease.
Case Study Review Approach
- Determine clinical predictors, ASA classification, functional capacity.
- Determine procedure risks.
- Review medications.
- Review testing.
Case Studies
- A 68-year-old male patient undergoing colonoscopy with PMH of MI 5 years ago, HTN, and DM.
- Medications: Toprol 50 mg OD, ASA 325 mg od, Diovan 160 mg OD, and Metformin 750 mg bid.
- A 55-year-old male patient undergoing right knee replacement with PMH of Paroxysmal Afib, asthma, and GERD.
- Medications include Coumadin 5 mg, Rhythmol SR 225 mg bid, and Protonix.
- A 40-year-old female patient undergoing thyroidectomy who denies medical history or medications.
- A 69-year-old obese male with HTN and DM seeking clearance to start exercise at the gym.
- Medications: Losartan 50 mg, Toprol 50 mg, Lipitor 40 mg, and Metformin 1000 mg bid.
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