PAEA Surgery End Of Rotation (EOR) Practice Exam

When should a chest X-ray (CXR) be considered in the pre-operative workup?

1. Patients over 30

2. Patients with asthma

3. Patients over 50 with known cardiac or pulmonary disease

4. Patients with diabetes

The correct answer is: Patients over 50 with known cardiac or pulmonary disease

A chest X-ray (CXR) should be considered in the pre-operative workup primarily for patients over 50 who have known cardiac or pulmonary disease. This is due to the increased risk associated with surgery in this demographic group. The presence of underlying cardiac or pulmonary conditions can significantly influence both surgical risk and perioperative management. A CXR can help identify any potential complications related to these conditions, such as congestive heart failure or pulmonary disease, which could affect anesthetic choices and postoperative recovery. In patients over 50, the anatomical and functional changes in the lungs, along with the higher prevalence of heart disease, make a pre-operative CXR a valuable tool for assessing baseline status and determining if any further interventions are necessary to optimize the patient's condition before surgery. It allows for early identification of issues such as infiltrates, effusions, or other lung pathology that could complicate the surgical procedure. For other populations mentioned, while their clinical histories may warrant further investigation, routine CXR in these specific groups—those with asthma, diabetes, or individuals over 30—does not have the same strong justification. For instance, patients with well-controlled asthma or diabetes typically do not require a CXR unless they exhibit additional symptoms or concerns that would warrant imaging.