467 Med Eval

Question 1

True or false: healthy patients of any age who are undergoing elective surgical procedures without co existing medical conditions still require testing.

Answer 1

False. Only when the degree of Surgical stress may result in unusual changes from baseline state

Question 2

Six identifiable predictive factors in the revised cardiac risk index

Answer 2

High risk sugrery
Ischemic heart disease
Congestive heart failure
Cerebrovascular disease
Diabetes Mellitus treated with insulin
Serum creatinine more than 2.0 mg/dl

Question 3

Defined as inability to walk four blocks or climb two flights of stairs at normal pace

Answer 3

Poor exercise tolerance

Question 4

True or false. Coronary revascularization before non cardiac surgery may be done to reduce perioperative cardiac events

Answer 4

False. Not recommended. No difference in perioperative and long term cardiac outcomes with or without preoperative coronary revascularization

Question 5

How long should elective non cardiac surgery be done after placement of bare metal intracoronary stent?

Answer 5

30 days

Question 6

How long should elective non cardiac surgery be done after placement of drug eluting intracoronary stent?

Answer 6

6 months

Question 7

Coronary revascularization choice is patient must undergo surgery as early as 14 days after PCI

Answer 7

Ballon angioplasty without stent placement

Question 8

Agents that reduced perioperative stimulation, ischemic and inflammation during perioperative period

Answer 8

Beta adrenergic antagonist
Statins
Antiplatelets

Question 9

Study that provided the bedrock data supporting the use of beta blockers perioperatively

Answer 9

Dutch echocardiographix cardiac risk evaluation apply stress echocardiography
(DECREASE)

Question 10

Key points in the DECREASE study

Answer 10

1. Continue beta blockade in patients undergoing surgery and who havs been receiving such therapy chronically
2. Avoidance of stopping or starting beta blocker on day of surgery
3. Initiation of beta blockers far in advance for patient with immediate or high ischemia or three or more RCRI risk factors

Question 11

True or false. Beta blockers should be stopped on day of surgery

Answer 11

False. According to the DECREASE study, continue or not do not withdraw beta blocker on day of surgery

Question 12

True or false. Statin therapy should be continued to reduce perioperative cardiac risk.

Answer 12

True. Number of studies support that perioperative prophylactic use of statin reduce cardiac complications in patients with established atherosclerosis

Question 13

True or false. Unlike beta blocker, ACEI should be discontinued during and after the perioperative period

Answer 13

False. It importabt to maintain continuity of ACEI.

Question 14

Constitute the time period of greatest risk for the development of stent thrombosis following implantation of an intracoronary stent

Answer 14

4 to 6 weeks following implantation

Question 15

How long should DAPT be given for patient who underwent intracoronary stenting?

Answer 15

Ischemic heart disease: at least 6 months

Acute coronary syndrome: at least 12 months

Question 16

After how mnay days/months can DAPT be interrupted in patients undergoing noncardiac surgery and who underwent intracoronary stenting?

Answer 16

Bare metal stent, (BMA): 30 days after

Drug eluting stent (DES): 6 months after

Question 17

True or false. Alpha agonist can be given for prevention of cardiac events

Answer 17

False. Clonidine was noted to increase rate of nonfstal cardiac arrest and clinically important hypotension

Question 18

Noncardiac surgeries associated with higher Mortality risk

Answer 18

Emergent major operation esp elderly
Aortic and other noncarotid major vascular surgery
Prolonged surgery associated with large fluid shift/blood loss

Question 19

Noncardiac surgery associated with intermediate mortality risk

Answer 19

Major thoracic surgery
Major abdominal surgery
Carotid endarterectomy
Head/neck surgery
Orthopedic surgery
Prostate surgery

Question 20

Noncardiac surgery associated with lower mortality risk

Answer 20

Eye, skin and superficial surgery

Endoscopic procedures

Question 21

Predisposing factors for pulmonary complications perioperatively (14)

Answer 21

URTI
Age more than 60 years old
COPD
Cigarette use
American Society of Anesthesia Class more than 2
Functional dependence
CHD
Serum albumin less than 3.5 g/dl
OSA
Impaired sensorium
Abnormal findings on chest examination
Alcohol use
Weight loss
Spirometry abnormality

Question 22

Spirometry threshold before lung resection (5)

Answer 22

FEV1 less than 2L
Maximal Voluntary Ventilation less than 50% of predicted
PEF less than 100 L or 50% of predicted value
PCO2 more than 45 mmHg
PO2 less than 50 mmHg

Question 23

How long should cigarettes smoking be stopped before and after surgery at least?

Answer 23

Cessation of smoking for at least 8 weeks before and until at least 10 days after surgery

Question 24

How should perioperative hyperglycemia be treated?

Answer 24

IV infusion of short acting insulin or SC sliding scale insulin

Question 25

Which patients should receive infective endocarditis prophylaxis prior to dental procedures? (5)

Answer 25

Those with prosthetic cardiac valves
Prosthetic materials for valve repair
Previous infective endocarditis
Cardiac transplant with valvular regurgitation
Unrepaired cyanotic congenital heart diease
Repaired congenital heart disease with residual shunt/regurgitation