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Questions and Answers
A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital. Which of the following newly developed conditions would most significantly alter the initial prognosis and necessitate an immediate reassessment of the patient's care plan?
A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital. Which of the following newly developed conditions would most significantly alter the initial prognosis and necessitate an immediate reassessment of the patient's care plan?
- Development of mild pedal edema, attributed to prolonged sitting and reduced mobility during the ambulance transport.
- A reported single episode of non-bloody emesis after transport, with no further occurrences and clear lung auscultation.
- Onset of acute delirium superimposed on her baseline dementia, accompanied by productive cough with purulent sputum. (correct)
- Discovery of a previously undocumented, resolving hematoma on the left forearm, likely from a minor, unnoticed trauma.
In the context of initial patient assessment upon hospital admission, which of the following factors represents the most critical change in a patient's pre-existing condition that would necessitate an immediate and comprehensive re-evaluation of their prognosis?
In the context of initial patient assessment upon hospital admission, which of the following factors represents the most critical change in a patient's pre-existing condition that would necessitate an immediate and comprehensive re-evaluation of their prognosis?
- A patient with well-managed hypertension experiencing a transient elevation in blood pressure marginally above their established baseline.
- A patient with chronic stable angina reporting a single episode of chest pain after physical exertion, relieved by rest and nitroglycerin.
- A patient previously diagnosed with stable heart failure exhibiting a sudden increase in dyspnea and lower extremity edema over 24 hours. (correct)
- A patient with controlled type 2 diabetes mellitus presenting with a slightly elevated fasting blood glucose level on the morning of admission.
An elderly patient with a known history of well-managed Parkinson’s disease is admitted for an elective procedure. Post-admission, which of the following findings would necessitate the MOST urgent re-evaluation of their pre-operative management and overall prognosis?
An elderly patient with a known history of well-managed Parkinson’s disease is admitted for an elective procedure. Post-admission, which of the following findings would necessitate the MOST urgent re-evaluation of their pre-operative management and overall prognosis?
- Sudden onset of visual hallucinations and fluctuating cognitive function, not present prior to admission. (correct)
- A report of intermittent orthostatic hypotension, resolving spontaneously without intervention.
- Mild constipation reported by the patient, which is managed with a prescribed stool softener.
- A slight increase in resting tremor, noted only during focused neurological examination.
A patient is admitted following a fall at home. Initial assessment reveals a fractured femur and several superficial lacerations. Which of the following post-admission developments would most significantly alter the patient's initial prognosis and necessitate an urgent multidisciplinary team review?
A patient is admitted following a fall at home. Initial assessment reveals a fractured femur and several superficial lacerations. Which of the following post-admission developments would most significantly alter the patient's initial prognosis and necessitate an urgent multidisciplinary team review?
A patient with a complex medical history, including end-stage renal disease (ESRD) managed with hemodialysis, is admitted for elective arteriovenous fistula (AVF) revision. Post-admission, which of the following findings would most urgently warrant a re-evaluation of the patient's overall prognosis and immediate intervention?
A patient with a complex medical history, including end-stage renal disease (ESRD) managed with hemodialysis, is admitted for elective arteriovenous fistula (AVF) revision. Post-admission, which of the following findings would most urgently warrant a re-evaluation of the patient's overall prognosis and immediate intervention?
In the context of pre-operative assessment, which of the following reflects the MOST nuanced understanding of its multifaceted objectives?
In the context of pre-operative assessment, which of the following reflects the MOST nuanced understanding of its multifaceted objectives?
When formulating an investigative strategy for a patient presenting with a complex constellation of symptoms, what principle should MOST comprehensively guide the selection and sequencing of diagnostic tests?
When formulating an investigative strategy for a patient presenting with a complex constellation of symptoms, what principle should MOST comprehensively guide the selection and sequencing of diagnostic tests?
In the context of diagnostic test selection, what BEST encapsulates the principle of 'simple investigations first', considering resource allocation and patient safety?
In the context of diagnostic test selection, what BEST encapsulates the principle of 'simple investigations first', considering resource allocation and patient safety?
A patient with known severe COPD is scheduled for an elective total hip arthroplasty. Pre-operative pulmonary function testing reveals an FEV1 of 30% predicted and an arterial PaCO2 of 55 mmHg. Which of the following interventions represents the MOST evidence-based strategy to optimize this patient's respiratory status prior to surgery?
A patient with known severe COPD is scheduled for an elective total hip arthroplasty. Pre-operative pulmonary function testing reveals an FEV1 of 30% predicted and an arterial PaCO2 of 55 mmHg. Which of the following interventions represents the MOST evidence-based strategy to optimize this patient's respiratory status prior to surgery?
A 78-year-old patient with a history of well-controlled hypertension and type 2 diabetes is scheduled for a laparoscopic cholecystectomy. Pre-operative ECG reveals non-specific ST-T wave changes. The patient denies any chest pain, shortness of breath, or palpitations. Which of the following represents the MOST appropriate next step in the pre-operative cardiac assessment?
A 78-year-old patient with a history of well-controlled hypertension and type 2 diabetes is scheduled for a laparoscopic cholecystectomy. Pre-operative ECG reveals non-specific ST-T wave changes. The patient denies any chest pain, shortness of breath, or palpitations. Which of the following represents the MOST appropriate next step in the pre-operative cardiac assessment?
A 68-year-old patient is admitted for an emergency surgical procedure. According to the provided criteria, how many points would this patient accumulate based solely on the 'Age' and 'Chronic Health' factors?
A 68-year-old patient is admitted for an emergency surgical procedure. According to the provided criteria, how many points would this patient accumulate based solely on the 'Age' and 'Chronic Health' factors?
A researcher aims to refine a predictive model incorporating the provided data. How would the introduction of interaction terms between 'Age' and 'Chronic Health' most likely impact the model's performance, assuming a complex, non-linear relationship?
A researcher aims to refine a predictive model incorporating the provided data. How would the introduction of interaction terms between 'Age' and 'Chronic Health' most likely impact the model's performance, assuming a complex, non-linear relationship?
Considering a Bayesian framework for assessing patient risk, how would the 'Chronic Health' factor, specifically the distinction between elective and emergency postoperative admissions, influence the prior probability of adverse outcomes?
Considering a Bayesian framework for assessing patient risk, how would the 'Chronic Health' factor, specifically the distinction between elective and emergency postoperative admissions, influence the prior probability of adverse outcomes?
In the context of survival analysis, how might Cox proportional hazards modeling be employed to evaluate the independent and interactive effects of 'Age' and 'Chronic Health' (elective vs. emergency admission) on long-term patient outcomes, while accounting for potential confounding variables?
In the context of survival analysis, how might Cox proportional hazards modeling be employed to evaluate the independent and interactive effects of 'Age' and 'Chronic Health' (elective vs. emergency admission) on long-term patient outcomes, while accounting for potential confounding variables?
Assuming an ensemble learning approach is used to predict patient outcomes, which combines multiple models trained on different subsets of the data, how can the 'Age' and 'Chronic Health' variables be leveraged to improve the diversity and robustness of the ensemble?
Assuming an ensemble learning approach is used to predict patient outcomes, which combines multiple models trained on different subsets of the data, how can the 'Age' and 'Chronic Health' variables be leveraged to improve the diversity and robustness of the ensemble?
In the perioperative management of a patient with a complex medical history including long-term excessive alcohol use, a bleeding disorder, and liver disease, which of the following coagulation marker patterns would MOST strongly suggest an acute decompensation of liver function necessitating immediate intervention beyond standard pre-operative optimization?
In the perioperative management of a patient with a complex medical history including long-term excessive alcohol use, a bleeding disorder, and liver disease, which of the following coagulation marker patterns would MOST strongly suggest an acute decompensation of liver function necessitating immediate intervention beyond standard pre-operative optimization?
A patient on chronic warfarin therapy is scheduled for an elective surgical procedure. Pre-operative guidelines dictate discontinuation of warfarin and measurement of PT/INR on the morning of surgery. Assuming a stable warfarin dose and consistent adherence, which of the following PT/INR values would necessitate postponement or cancellation of the procedure, irrespective of perceived clinical stability?
A patient on chronic warfarin therapy is scheduled for an elective surgical procedure. Pre-operative guidelines dictate discontinuation of warfarin and measurement of PT/INR on the morning of surgery. Assuming a stable warfarin dose and consistent adherence, which of the following PT/INR values would necessitate postponement or cancellation of the procedure, irrespective of perceived clinical stability?
A patient with a known history of moderate liver cirrhosis due to chronic alcohol abuse requires an emergency appendectomy. Pre-operative coagulation studies reveal a prolonged PT and an elevated INR. Considering the limitations of Vitamin K administration and fresh frozen plasma (FFP) transfusion in this setting, which of the following represents the MOST appropriate and targeted approach to rapidly improve hemostasis prior to surgery?
A patient with a known history of moderate liver cirrhosis due to chronic alcohol abuse requires an emergency appendectomy. Pre-operative coagulation studies reveal a prolonged PT and an elevated INR. Considering the limitations of Vitamin K administration and fresh frozen plasma (FFP) transfusion in this setting, which of the following represents the MOST appropriate and targeted approach to rapidly improve hemostasis prior to surgery?
A patient with a newly diagnosed bleeding disorder requires surgical intervention. Genetic testing reveals a novel mutation in a gene associated with coagulation. Extensive in-vitro studies suggest the mutation results in a dysfunctional protein with reduced activity, but normal antigen levels. Which of the following assays would be MOST informative in determining the clinical significance and guiding perioperative management of this novel coagulopathy?
A patient with a newly diagnosed bleeding disorder requires surgical intervention. Genetic testing reveals a novel mutation in a gene associated with coagulation. Extensive in-vitro studies suggest the mutation results in a dysfunctional protein with reduced activity, but normal antigen levels. Which of the following assays would be MOST informative in determining the clinical significance and guiding perioperative management of this novel coagulopathy?
In a patient with a complex history of alcohol-induced liver disease and documented factor V Leiden, who now presents with acute upper gastrointestinal bleeding and requires urgent intervention, which comprehensive strategy BEST addresses the multifaceted challenges associated with managing coagulopathy in this high-risk scenario?
In a patient with a complex history of alcohol-induced liver disease and documented factor V Leiden, who now presents with acute upper gastrointestinal bleeding and requires urgent intervention, which comprehensive strategy BEST addresses the multifaceted challenges associated with managing coagulopathy in this high-risk scenario?
Within the framework of pre-operative risk stratification, how does the American Society of Anesthesiologists (ASA) classification system, when juxtaposed against the backdrop of a patient presenting with both albuminuria and glucosuria, influence the surgical team's approach regarding intra-operative fluid management strategies?
Within the framework of pre-operative risk stratification, how does the American Society of Anesthesiologists (ASA) classification system, when juxtaposed against the backdrop of a patient presenting with both albuminuria and glucosuria, influence the surgical team's approach regarding intra-operative fluid management strategies?
In a scenario involving a patient presenting for emergency laparotomy following blunt abdominal trauma, and exhibiting a modified Glasgow Coma Scale (GCS) score indicative of moderate traumatic brain injury (TBI), how should the surgical team reconcile the competing priorities of addressing the intra-abdominal hemorrhage versus mitigating secondary brain injury related to cerebral perfusion pressure (CPP)?
In a scenario involving a patient presenting for emergency laparotomy following blunt abdominal trauma, and exhibiting a modified Glasgow Coma Scale (GCS) score indicative of moderate traumatic brain injury (TBI), how should the surgical team reconcile the competing priorities of addressing the intra-abdominal hemorrhage versus mitigating secondary brain injury related to cerebral perfusion pressure (CPP)?
Considering a patient scheduled for elective liver resection due to hepatocellular carcinoma (HCC) who pre-operatively demonstrates compensated cirrhosis (Child-Pugh A) but also exhibits elevated bilirubin levels fluctuating near the upper limit of normal, formulate the optimal strategy for pre-operative optimization of hepatic function to minimize the risk of post-operative liver failure.
Considering a patient scheduled for elective liver resection due to hepatocellular carcinoma (HCC) who pre-operatively demonstrates compensated cirrhosis (Child-Pugh A) but also exhibits elevated bilirubin levels fluctuating near the upper limit of normal, formulate the optimal strategy for pre-operative optimization of hepatic function to minimize the risk of post-operative liver failure.
Enumerate the key considerations and procedural modifications necessary when performing a laparoscopic cholecystectomy on a patient with a documented allergy to penicillin and a pre-operative diagnosis of acute calculous cholecystitis complicated by a suspected (but unconfirmed) empyema of the gallbladder.
Enumerate the key considerations and procedural modifications necessary when performing a laparoscopic cholecystectomy on a patient with a documented allergy to penicillin and a pre-operative diagnosis of acute calculous cholecystitis complicated by a suspected (but unconfirmed) empyema of the gallbladder.
In the context of enhanced recovery after surgery (ERAS) protocols, how does the strategic implementation of pre-operative carbohydrate loading, coupled with early post-operative mobilization and opioid-sparing analgesia, modulate the neuroendocrine stress response and impact overall surgical outcomes in patients undergoing colorectal resection for malignancy?
In the context of enhanced recovery after surgery (ERAS) protocols, how does the strategic implementation of pre-operative carbohydrate loading, coupled with early post-operative mobilization and opioid-sparing analgesia, modulate the neuroendocrine stress response and impact overall surgical outcomes in patients undergoing colorectal resection for malignancy?
In the context of evaluating a patient presenting for emergency surgery with a history of chronic alcohol abuse, which of the following pre-operative laboratory test ordering strategies would be MOST judicious, considering both the urgency of the situation and long-term patient management?
In the context of evaluating a patient presenting for emergency surgery with a history of chronic alcohol abuse, which of the following pre-operative laboratory test ordering strategies would be MOST judicious, considering both the urgency of the situation and long-term patient management?
Consider a patient with decompensated cirrhosis secondary to chronic Hepatitis C infection presenting for an elective total hip arthroplasty. Preoperative optimization strategies MUST address which of the following interrelated factors to mitigate the risks of perioperative morbidity and mortality?
Consider a patient with decompensated cirrhosis secondary to chronic Hepatitis C infection presenting for an elective total hip arthroplasty. Preoperative optimization strategies MUST address which of the following interrelated factors to mitigate the risks of perioperative morbidity and mortality?
In a patient with known alcoholic cirrhosis undergoing emergency exploratory laparotomy for a perforated viscus, which intraoperative anesthetic management strategy would MOST directly address the unique physiological challenges posed by their underlying liver disease?
In a patient with known alcoholic cirrhosis undergoing emergency exploratory laparotomy for a perforated viscus, which intraoperative anesthetic management strategy would MOST directly address the unique physiological challenges posed by their underlying liver disease?
Following a massive blood transfusion during a liver transplantation procedure, the surgical team notes persistent oozing from the surgical site despite adequate surgical hemostasis. Which of the following laboratory abnormalities would MOST warrant immediate investigation and targeted treatment to restore normal coagulation?
Following a massive blood transfusion during a liver transplantation procedure, the surgical team notes persistent oozing from the surgical site despite adequate surgical hemostasis. Which of the following laboratory abnormalities would MOST warrant immediate investigation and targeted treatment to restore normal coagulation?
A patient with a history of significant alcohol use disorder is admitted for elective cholecystectomy. Pre-operatively, the patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are mildly elevated. Given this clinical scenario, what is the MOST critical next step in the perioperative management of this patient?
A patient with a history of significant alcohol use disorder is admitted for elective cholecystectomy. Pre-operatively, the patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are mildly elevated. Given this clinical scenario, what is the MOST critical next step in the perioperative management of this patient?
Why is the timing of a preassessment strategically important relative to the surgery date?
Why is the timing of a preassessment strategically important relative to the surgery date?
In which instance would delaying a surgical procedure to allow for comprehensive preassessment have the LEAST benefit regarding patient outcomes?
In which instance would delaying a surgical procedure to allow for comprehensive preassessment have the LEAST benefit regarding patient outcomes?
What is a PRIMARY goal of preassessment in the context of the timing between assessment and surgery?
What is a PRIMARY goal of preassessment in the context of the timing between assessment and surgery?
Which scenario exemplifies a situation where the timing of preassessment requires careful consideration due to the patient's condition?
Which scenario exemplifies a situation where the timing of preassessment requires careful consideration due to the patient's condition?
When might a shorter interval between preassessment and surgery be MOST appropriate, assuming all necessary information is available?
When might a shorter interval between preassessment and surgery be MOST appropriate, assuming all necessary information is available?
Why is risk quantification deemed important in patient care?
Why is risk quantification deemed important in patient care?
What is a key characteristic of prognostic scoring systems like APACHE?
What is a key characteristic of prognostic scoring systems like APACHE?
In what way does the APACHE scoring system contribute to patient management?
In what way does the APACHE scoring system contribute to patient management?
When should risk scores such as APACHE be calculated and interpreted?
When should risk scores such as APACHE be calculated and interpreted?
How does risk stratification using scoring systems like APACHE assist in communication among the healthcare team?
How does risk stratification using scoring systems like APACHE assist in communication among the healthcare team?
A patient on long-term aspirin therapy is scheduled for an elective surgery. Which strategy BEST minimizes the risk of bleeding complications while still providing adequate thromboprotection?
A patient on long-term aspirin therapy is scheduled for an elective surgery. Which strategy BEST minimizes the risk of bleeding complications while still providing adequate thromboprotection?
A patient on warfarin requires urgent surgery. Their INR is 3.0. What is the MOST appropriate initial step for managing their anticoagulation?
A patient on warfarin requires urgent surgery. Their INR is 3.0. What is the MOST appropriate initial step for managing their anticoagulation?
A post-menopausal woman considering hormone replacement therapy (HRT) has a strong family history of both breast cancer and venous thromboembolism (VTE). Which approach to HRT is MOST appropriate?
A post-menopausal woman considering hormone replacement therapy (HRT) has a strong family history of both breast cancer and venous thromboembolism (VTE). Which approach to HRT is MOST appropriate?
A 55-year-old patient with a 30-pack-year smoking history is scheduled for an elective hip replacement. What pre-operative intervention is MOST likely to improve their surgical outcome?
A 55-year-old patient with a 30-pack-year smoking history is scheduled for an elective hip replacement. What pre-operative intervention is MOST likely to improve their surgical outcome?
A patient with a history of heavy smoking is undergoing pre-operative assessment. Which finding would warrant the MOST urgent and comprehensive respiratory evaluation before proceeding with elective surgery?
A patient with a history of heavy smoking is undergoing pre-operative assessment. Which finding would warrant the MOST urgent and comprehensive respiratory evaluation before proceeding with elective surgery?
In a patient over 65 scheduled for surgery, presenting with previously stable heart failure but now exhibiting new-onset lower extremity edema, which pre-operative intervention is MOST critical?
In a patient over 65 scheduled for surgery, presenting with previously stable heart failure but now exhibiting new-onset lower extremity edema, which pre-operative intervention is MOST critical?
A 70-year-old patient with a history of well-controlled hypertension, scheduled electively for a total knee arthroplasty, is on chronic low-dose hydrochlorothiazide. Pre-operative labs reveal a potassium level of 3.1 mEq/L. What is the MOST appropriate step in managing this electrolyte imbalance?
A 70-year-old patient with a history of well-controlled hypertension, scheduled electively for a total knee arthroplasty, is on chronic low-dose hydrochlorothiazide. Pre-operative labs reveal a potassium level of 3.1 mEq/L. What is the MOST appropriate step in managing this electrolyte imbalance?
An 80-year-old patient presents for elective cataract surgery and has a history of controlled COPD. Pre-operative assessment reveals an oxygen saturation of 92% on room air and a mild, non-productive cough. What is the MOST appropriate next step in their pre-operative management?
An 80-year-old patient presents for elective cataract surgery and has a history of controlled COPD. Pre-operative assessment reveals an oxygen saturation of 92% on room air and a mild, non-productive cough. What is the MOST appropriate next step in their pre-operative management?
A 72-year-old patient with a history of osteoarthritis and chronic steroid use for asthma presents for an elective hip replacement. Pre-operative investigations reveal a slightly elevated blood glucose of 130 mg/dL, but a normal HbA1c. What is the MOST appropriate next step in managing this finding pre-operatively?
A 72-year-old patient with a history of osteoarthritis and chronic steroid use for asthma presents for an elective hip replacement. Pre-operative investigations reveal a slightly elevated blood glucose of 130 mg/dL, but a normal HbA1c. What is the MOST appropriate next step in managing this finding pre-operatively?
A 68-year-old patient with a history of hypertension and hyperlipidemia is scheduled for an elective inguinal hernia repair. The patient currently takes a thiazide diuretic and a statin medication. During the pre-operative assessment, the patient reports occasional muscle cramps. Which pre-operative investigation should be prioritized in this case?
A 68-year-old patient with a history of hypertension and hyperlipidemia is scheduled for an elective inguinal hernia repair. The patient currently takes a thiazide diuretic and a statin medication. During the pre-operative assessment, the patient reports occasional muscle cramps. Which pre-operative investigation should be prioritized in this case?
In an elderly patient with multiple comorbidities scheduled for an elective hip replacement, which of the following hematological findings from a pre-operative full blood count (FBC) would warrant the MOST immediate further investigation and potential postponement of the surgery?
In an elderly patient with multiple comorbidities scheduled for an elective hip replacement, which of the following hematological findings from a pre-operative full blood count (FBC) would warrant the MOST immediate further investigation and potential postponement of the surgery?
A patient is scheduled for an elective inguinal hernia repair. Pre-operative blood work reveals a slightly elevated prothrombin time (PT) and international normalized ratio (INR). What is the MOST appropriate next step in managing this patient?
A patient is scheduled for an elective inguinal hernia repair. Pre-operative blood work reveals a slightly elevated prothrombin time (PT) and international normalized ratio (INR). What is the MOST appropriate next step in managing this patient?
A patient undergoing pre-operative assessment for a major oncologic resection is found to have a potassium level of 3.1 mEq/L. They are asymptomatic and have normal renal function. Which of the following interventions is MOST appropriate?
A patient undergoing pre-operative assessment for a major oncologic resection is found to have a potassium level of 3.1 mEq/L. They are asymptomatic and have normal renal function. Which of the following interventions is MOST appropriate?
A patient with a known allergy to penicillin is scheduled for an elective laparoscopic cholecystectomy. Which of the following pre-operative antibiotic prophylaxis regimens would be MOST appropriate?
A patient with a known allergy to penicillin is scheduled for an elective laparoscopic cholecystectomy. Which of the following pre-operative antibiotic prophylaxis regimens would be MOST appropriate?
A patient with a history of well-controlled asthma is scheduled for elective surgery. During the pre-operative assessment, the patient reports experiencing increased shortness of breath and wheezing over the past week. Which of the following actions is MOST appropriate?
A patient with a history of well-controlled asthma is scheduled for elective surgery. During the pre-operative assessment, the patient reports experiencing increased shortness of breath and wheezing over the past week. Which of the following actions is MOST appropriate?
What is the PRIMARY reason for obtaining a thorough patient history during pre-operative assessment?
What is the PRIMARY reason for obtaining a thorough patient history during pre-operative assessment?
A patient with multiple comorbidities requires several pre-operative investigations. What strategy is MOST appropriate when deciding on which investigations to perform?
A patient with multiple comorbidities requires several pre-operative investigations. What strategy is MOST appropriate when deciding on which investigations to perform?
An elderly patient is scheduled for an elective hip replacement. Pre-operative assessment reveals a previously undiagnosed heart murmur. What is the MOST appropriate next step in managing this finding?
An elderly patient is scheduled for an elective hip replacement. Pre-operative assessment reveals a previously undiagnosed heart murmur. What is the MOST appropriate next step in managing this finding?
A patient with a known allergy to penicillin is scheduled for an appendectomy. Which of the following pre-operative interventions is MOST critical?
A patient with a known allergy to penicillin is scheduled for an appendectomy. Which of the following pre-operative interventions is MOST critical?
A patient with a history of poorly controlled diabetes mellitus is scheduled for an elective foot amputation due to diabetic foot ulcer. What is the MOST important pre-operative consideration regarding their diabetic management?
A patient with a history of poorly controlled diabetes mellitus is scheduled for an elective foot amputation due to diabetic foot ulcer. What is the MOST important pre-operative consideration regarding their diabetic management?
Flashcards
Differential Diagnosis Exclusion
Differential Diagnosis Exclusion
Ruling out other possible conditions.
Surgical Intervention Appropriateness
Surgical Intervention Appropriateness
Determining if surgery is the right course of action.
Fitness for Surgery
Fitness for Surgery
Evaluating a patient's health to ensure they can undergo surgery.
Simple Investigations First
Simple Investigations First
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Most Probable Diagnoses
Most Probable Diagnoses
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Bleeding Disorder
Bleeding Disorder
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Liver Disease
Liver Disease
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Excessive Alcohol Use
Excessive Alcohol Use
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Anticoagulants
Anticoagulants
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PT/INR
PT/INR
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Why review on admission?
Why review on admission?
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What are prognostic factors?
What are prognostic factors?
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Chest infection impact?
Chest infection impact?
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Weight loss significance?
Weight loss significance?
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Why monitor changes?
Why monitor changes?
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Hepatic Disease Test
Hepatic Disease Test
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Alcoholic Screenings
Alcoholic Screenings
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Hepatitis B & C Screening
Hepatitis B & C Screening
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Emergency Preoperative Blood Group
Emergency Preoperative Blood Group
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Blood Group Test Timing
Blood Group Test Timing
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WBCs Count
WBCs Count
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Age Points
Age Points
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Elective Post-Op Points
Elective Post-Op Points
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Chronic Health
Chronic Health
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Emergency Op Points
Emergency Op Points
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Urine Output
Urine Output
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Albumin
Albumin
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Bilirubin
Bilirubin
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Glucose
Glucose
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ASA System
ASA System
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Preassessment Timing
Preassessment Timing
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Preassessment Purpose
Preassessment Purpose
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Preassessment Stability
Preassessment Stability
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What is preassessment?
What is preassessment?
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Preassessment Gap
Preassessment Gap
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Anticoagulant Drugs
Anticoagulant Drugs
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Aspirin & Warfarin
Aspirin & Warfarin
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Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT)
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Smoking: Dosage & Duration
Smoking: Dosage & Duration
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Differential Diagnosis?
Differential Diagnosis?
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Surgical Intervention?
Surgical Intervention?
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Surgical Fitness?
Surgical Fitness?
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Initial Investigations?
Initial Investigations?
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Test Selection?
Test Selection?
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Preoperative FBC
Preoperative FBC
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FBC: Detect Anemia
FBC: Detect Anemia
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FBC: Detect Infection
FBC: Detect Infection
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FBC: Clotting Assessment
FBC: Clotting Assessment
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FBC: When to Perform
FBC: When to Perform
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Quantifying Risks
Quantifying Risks
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Prognostic Scoring Systems
Prognostic Scoring Systems
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APACHE Scoring System
APACHE Scoring System
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Preoperative Considerations: Age
Preoperative Considerations: Age
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Preoperative Risk: Cardiopulmonary Disease
Preoperative Risk: Cardiopulmonary Disease
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Diuretics Pre-Op
Diuretics Pre-Op
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Steroids Pre-Op
Steroids Pre-Op
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Preoperative Considerations
Preoperative Considerations
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Study Notes
Physical Examination - Additional Information
- Don't depend on others instead rely as changes can occur during the course of the day
Indications for Blood Tests: Additional details
- Incident of unexpected abnormality in fit patients under 40 years old is < 1%.
Coagulogram Studies: Additional Details
- PT/INR should be performed on the morning of surgery if patients have been instructed to discontinue warfarin.
Assessment of Risk of Surgery: APACHE II Classification Details
- The APACHE II classification includes 12 acute physiological variables for scoring, these are: Body Temperature (rectal), Blood pH, Heart Rate (HR), Serum sodium, Respiratory Rate (RR), Serum potassium, Mean Arterial Pressure (MBP), Serum creatinine, FiO2 (alveolar arterial O2 gradient), Hematocrit, Glasgow Coma Scale (GCS) and WBCs count.
- These are all graded according to the patient.
Preoperative Consent & Counselling: Additional Details
- Obtaining consent requires: all available documentation of what happened and also a brief overview of what could occur in an effort to manage expectations
Antibiotic Prophylaxis: Additional Details
- Class IV cases - Require Mechanical preparation with plus parenteral antibiotics plus aerobic and anaerobic cover
Preoperative Management of Coexisting Disease: Diathermy Precautions
- Electrical interference with a device can also cause Rate increase or inhibition
Preoperative Mangement of Endocrine Disease: Diabeties Mellitus
- The use of enough insulin will prevent risk of ketoacidosis from occurring
Interpretation of Child's Classification
- 5-6 points are Class A with 10% mortality, 7-9 points are Class B with 31% mortality and Over > 10 points are Class C with 76% mortality
Coagulopathy: Further Details
- It should be note, that;
- • If pt has In Vit K deficiency or mild liver disease than they will will Present with Prolongation • Prolong, for those with more Severe liver disease will will Tend to prolonged
Perioperative Management of Existing Medication:
- Steroids and their therapy often has impacts on those during in the perioperative period so it is essential that the appropriate dose is administered depending on the magnitude of the operation for them.
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Description
Evaluate patient scenarios to determine which new conditions would most significantly alter initial prognosis and necessitate immediate reassessment of care plans. Focus on identifying critical changes in pre-existing conditions. These changes require urgent re-evaluation of management and overall prognosis.
