Perioperative Management Practice Test

A 72-year-old man with hypertension and diabetes is scheduled for elective laparoscopic cholecystectomy. He has exertional chest tightness when walking uphill that resolves with rest; symptoms are unchanged for 6 months. He can climb one flight of stairs but must stop due to chest discomfort.

Physical exam:

• BP 136/80 mm Hg, HR 70
• Normal heart sounds; lungs clear

Pertinent studies:

• ECG: Q waves in V1–V2; no acute changes
• Troponin not obtained

Current medications:

• Metoprolol
• Aspirin
• Atorvastatin
• Metformin

What is the most appropriate preoperative assessment for this patient?

A 67-year-old man is scheduled for elective hip replacement. He has atrial fibrillation on warfarin and a mechanical mitral valve placed 3 years ago. No recent bleeding.

Physical exam:

• BP 126/70 mm Hg, HR 74 irregular
• Mechanical click present

Pertinent labs:

• INR 3.1 today
• Platelets 230k/µL, Cr 1.0 mg/dL

Current medications:

• Warfarin
• Metoprolol

What is the most appropriate strategy for perioperative anticoagulation management?