Pre-operative evaluation — MCQs

A 66-year-old man with severe aortic stenosis (valve area 0.7 cm², mean gradient 55 mmHg) and Class III heart failure requires emergent hemicolectomy for perforated diverticulitis with peritonitis. He is hemodynamically stable on pressors. Cardiology states he is high-risk for valve replacement but could undergo TAVR in 2-3 weeks. The surgeon believes he needs surgery within 6-8 hours. Evaluate the management approach.

A 35-year-old woman scheduled for thyroidectomy for papillary thyroid cancer is found to have prolonged aPTT (52 seconds, normal 25-35) on routine preoperative labs. PT/INR is normal. She has history of two first-trimester miscarriages but denies personal bleeding history. Further testing reveals lupus anticoagulant positivity. Evaluate the perioperative hemostatic management.

A 48-year-old woman with newly diagnosed pheochromocytoma (4 cm right adrenal mass) is scheduled for laparoscopic adrenalectomy. Initial blood pressure is 180/110 mmHg with episodes of hypertension to 220/120 mmHg, headaches, and palpitations. Plasma metanephrines are markedly elevated. Evaluate the optimal preoperative preparation timeline and management.

A 70-year-old woman presents for preoperative evaluation before elective abdominal aortic aneurysm repair (5.8 cm). She has no cardiac symptoms but has diabetes, hypertension, and peripheral vascular disease. Her functional capacity is limited by arthritis - she walks only 50 feet before stopping due to joint pain, not dyspnea or chest discomfort. Analyze the appropriate cardiac risk stratification strategy.

A 58-year-old man with Child-Pugh class B cirrhosis (score 8) due to hepatitis C presents with symptomatic inguinal hernia. He has mild ascites controlled with diuretics, no encephalopathy, albumin 2.9 g/dL, bilirubin 2.4 mg/dL, and INR 1.6. He requests surgical repair. Analyze the perioperative risk and management approach.