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Clinical Medicine LAB - Professor Sample > Pre-admission Testing > Flashcards

Flashcards in Pre-admission Testing Deck (29)
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1
Q

Pre-admission Testing (PAT) involves ?

A

stratify risk

direct anesthetic choices

guide postoperative management

often are obtained because of protocol rather than medical necessity

2
Q

PAT: making decisions base on ?

A

Clinical history

Comorbidities

Physical examination findings

3
Q

PAT: labs to run ?

A

CXR

ECG PT/PTT/INR

CBC/ H&H

BMP

Hgb A1C

Urinalysis

Urine HCG

Type and screen

4
Q

PAT: quote ?

A

“these tests often do not change perioperative management, may lead to follow-up testing with results that are often normal, and can unnecessarily delay surgery, all of which increase the cost of care. An extensive systematic review concluded that there was no evidence to support routine preoperative testing.”

5
Q

CXR indications acute ?

A

Acute Cardiopulmonary Findings on History or Physical Exam

6
Q

CXR indications chronic ?

A

Chronic cardiopulmonary disease in the elderly (>age 70), previous chest radiograph within 6 months not available.

7
Q

No CXR is ?

A

Patient is <70 yo and without history or physical findings of cardiopulmonary disease

8
Q

EKG for patients with ?

A

Pts with active cardiovascular s/s should undergo ECG

9
Q

The most widely accepted guideline in the United States advocates against ECG in patients undergoing ?

A

low-risk surgery.

10
Q

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: High risk (>5%) ?

A

aortic and major vascular surgery, peripheral vascular surgery

11
Q

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: Intermediate risk (1-5%) ?

A

Intraperitoneal or intrathoracic surgery,

carotid endardectomy

head and neck surgery

ortho surgery

prostate surgery

12
Q

Risk of cardiac death and nonfatal MI for noncardiac surgical procedures: low risk (<1%)

A

ambulatory surgery

breast surgery endoscopic surgery

superficial procedures

cataract surgery

13
Q

Revised cardiac index: RF ?

A

cerebrovascular disease

CHF

Cr > 2.0

DM requiring Insulin

ischemic cardiac disease

Suprainguinal vascular surgery.intrathoracici surgery, intra-abd. surgery

14
Q

Revised cardiac index: RF points ?

A

1 point for each

15
Q

RCI: Risk factors of a major cardiac event - 0 points ?

A

0.4 % risk

16
Q

RCI: Risk factors of a major cardiac event - 1 points ?

A

0.9 % risk

17
Q

RCI: Risk factors of a major cardiac event - 2 points ?

A

6.6 % risk

18
Q

RCI: Risk factors of a major cardiac event - >3 points ?

A

> 11 % risk

19
Q

PAT: UA ?

A

Routine urinalysis is not recommended in asymptomatic patients except in those undergoing surgical implantation of foreign material (e.g., prosthetic joint, heart valve) or invasive urologic procedures.

20
Q

Electrolytes and Cr testing: Compelling historical findings

?

A

hypertension,

heart failure,

chronic kidney disease,

complicated diabetes mellitus,

liver disease

Serum creatinine and BUN on pts >40 yo?

21
Q

Electrolytes and Cr testing: Certain medications ?

A

diuretics,

angiotensin-converting enzyme inhibitors,

angiotensin receptor blockers,

nonsteroidal anti-inflammatory drugs,

digoxin

Serum creatinine and BUN on pts >40 yo?

22
Q

PAT: Diabetes Testing ?

A

Hgb A1C

Random Glucose

BMP

23
Q

In patients with known diabetes, the preoperative ___ value is more likely to be useful if results would change perioperative management

A

A1C

24
Q

Preoperative _______ _________ measurement could be considered in patients at very high risk of undiagnosed diabetes on the basis of history, examination, or use of certain medications (e.g., glucocorticoids), and in patients with signs or symptoms of undiagnosed diabetes.

A

random glucose

25
Q

PAT: CBC/H and H indications testing ?

A

Increased pretest probability of diagnosing anemia (e.g., a chronic inflammatory condition, chronic kidney disease, chronic liver disease, clinical signs or symptoms of anemia)

Procedures in which significant blood loss is anticipated

Consider ordering a type and cross in preparation for a procedure with anticipated blood loss

26
Q

PAT: PT/INR, PTT. Plt testing goal ?

A

Goal is to unmask underlying bleeding disorder

27
Q

PAT: PT/INR, PTT. Plt testing indications ?

A

Should be reserved for patients with medical conditions associated with impaired hemostasis (e.g., liver disease, diseases of hematopoiesis), patients taking anticoagulants

28
Q

PAT: PT/INR, PTT. Plt testing indications cont.. ?

A

Also patients whose history or examination findings suggest an underlying coagulation disorder (e.g., history of spontaneous bruising or excessive surgical bleeding, family history of a known heritable coagulopathy)

29
Q

______ ________ should be obtained from all surgical patients, and appropriate coagulation testing should be considered if the history is abnormal.

A

Bleeding history