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Surgery (Clin med) Summer 2021- Study Guide
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Surgery (Clin med) Summer 2021- StudyGuide
The patient; therefore clinicians role in medically optimizing the patient before surgery is paramount to
a successful outcome. - ANS Know the basic determinants of patient outcome in the perioperative
period. Which is most important?
● Normal = w/in 2 SD of the mean (95%)
● Those whose may still fall under the bell curve of normal, but are just outside 2 SD of the mean will be
flagged as abnormal by the lab, however are not truly abnormal - ANS Understand the meaning of a
laboratory "normal" value. Is every "abnormal" result reflective of a patient abnormality?
● Hb: in pts >/65 & whenever significant blood loss is expected, h&p suggest anemia, dialysis - ANS
When would you check Hb?
in pts ≥ 50 y/o, chemotherapy, dialysis - ANS When would you check creatinine/eGFR?
● Pregnancy testing in all female patients from menarche to menopause - ANS When do you do
pregnancy testing preoperatively?
● with in 7 days of surgery if on lithium, digoxin, diuretics, dialysis - ANS When do you check potassium
preop?
overt diabetes getting vascular surgery or undergoing a CABG - ANS When do you check blood sugar pre
op?
● In pts undergoing invasive urologic procedure, or implantation of foreign material (ortho) - ANS When
do you check UA preop?
>60 y/o, or if there is suspected pulm complications post op - ANS When do you do a CXR pre op?
, positive history, predisposition towards bleeding, anticoag tx, dialysis - ANS When do you do do coag
studies pre op?
○ High risk surgery
○ Intermediate risk surgery + risk factor
○ BMI of >/40 + risk factor
○ Those with signs and symptoms of CVD
○ NO testing in low risk surgery [like cataracts surgery] - ANS When do you do EKG preop?
usually don't - ANS When do you check sodium preop?
if severe levels suspected or known disease (will typically be able to see signs in the H&P) - ANS When
do you check transaminase preop?
Creatinine/GFR - ANS Which is the one lab test most likely to be useful in a majority of perioperative
patients (if stranded on a desert island with only one test available)?
● Pre-op CXR: Pt > 60 y/o
● Pre-op EKG:
○ Pt w BMI ≥ 40 kg/m2 and at least 1 other risk fx
○ Pt undergoing intermediate risk surgery w at least 1 risk factor
○ All pts undergoing high risk surgery - ANS When is a pre-operative chest x-ray and EKG likely to be
warranted?
NSQIP Risk Calculator - ANS What piece of patient history (or non-laboratory diagnostic finding) is the
best predictor of peri-operative morbidity
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