Pre-Op Echo Testing

Question 1

The Duke Activity Status Index allows calculation of predicted peak VO2 - T/F?

Answer 1

True. The Duke Activity Status Index represents a simple patient completed questionnaire which ascertains the maximum level of physical activity that an individual is able to perform.

Question 2

1 metabolic equivalent (MET) represents a VO2 of 3.5 ml/kg/min T/F

Answer 2

True. One metabolic equivalent (MET) represents the oxygen consumption of an adult at rest (approximately 3.5 ml/kg/min).

Question 3

4 METs are equivalent to climbing 2 flights of stairs T/F

Answer 3

False. Four METs are equivalent to climbing one flight of stairs (approximately 13 steps).

Question 4

Patients often underestimate their level of fitness T/F

Answer 4

False. Studies show that patients often over estimate their level of fitness.

Question 5

The ability to achieve 4 METs is advisable when contemplating undertaking major surgery T/F

Answer 5

True. Patients should be able to perform greater than 4 METs if they are to consider undertaking major surgery.

Question 6

Cardiopulmonary echo testing (CPET) has a mortality of 2 - 4 / 1000 T/F

Answer 6

False. CPET mortality is 2-4/100 000.

Question 7

CPET is unsuitable for the majority of arthritic patients T/F

Answer 7

False. Whilst some patients with lower limb arthritis will not be able to pedal the cycle ergometer, studies have shown that approximately 50% of patients awaiting a joint replacement can complete CPET.

Question 8

CPET is safe to perform in significantly anaemic patients T/F

Answer 8

False. Significant anaemia (Hb<8 g/dl) is a contraindication to CPET. There will be reduced oxygen transport leading to premature AT and peak VO2.

Question 9

CPET requires a steady rate of ergometer pedalling T/F

Answer 9

True. Prior to the test commencing the patient should be coached in pedalling at a constant speed of between 50 - 60.

Question 10

CPET monitors the 12 lead ECG during exercise

Answer 10

True. Continuous 12 lead ECG, with ST segment analysis is displayed.

Question 11

CPET involves unloaded cycling T/F

Answer 11

True. The intitial 1-3 minute period of unloaded cycling allows the oxygen requirement to simply lift the legs up and down to be measured

Question 12

CPET monitoring is not required in the recovery period T/F

Answer 12

False. Pathological changes can be observed following exercise and so monitoring should be continued for approximately 5 minutes in the recovery period

Question 13

The anaerobic threshold can only be reached at extreme levels of exercise T/F

Answer 13

False. AT is usually reached at low to moderate levels of exercise, approximately half way through a normal RAMP protocol

Question 14

An anaerobic threshold above 11 ml/kg/min is associated with low postoperative mortality after major surgery T/F

Answer 14

True. Other indices such as peak VO2 have also been shown to be prognostic

Question 15

CPET can differentiate the cause of dyspnoea T/F

Answer 15

True. CPET provides a powerful diagnostic and prognostic tool for a variety of medical disorders including coronary artery disease, cardiac failure, restrictive and obstructive lung disease