NMS Q&A Family Medicine

228 NMS Q&A Family Medicine(A) Atenolol(B) Amlodipine(C) Clonidine(D) Lisinopril(E) Hctz/tmp5 A 45-year-old male patient is scheduled for electivecholecystectomy and common duct exploration. Hehas neither history nor finding of hypertension, diabetes,heart disease, or bleeding diathesis, nor anyother significant system review. Specifically, he deniesand manifests on examination no excessive bruising.He underwent general anesthesia for emergencyappendectomy in the past. He is athletic and runsroutinely without symptoms of chest pain or unduedyspnea. Which of the following would be the minimallyacceptable set of ancillary studies to order forpreoperative clearance?(A) Complete blood cell (CBC) count, prothrombintime (PT), partial thromboplastin time (PTT),electrocardiogram (ECG), routine liver andkidney function blood studies, and chest x-ray(B) CBC count, PT, PTT, and routine liver andkidney function blood studies (no chest x-ray)(C) CBC count, PT, PTT, and kidney functionstudies (neither liver function studies nor chestx-ray)(D) CBC count, PT, and PTT(E) No ancillary testing6 A 55-year-old white man is scheduled for abdominalsurgery to resect a segment of colon from which anadenomatous polyp was snared, which revealed atleast stage B carcinoma (tumor in muscularis orserosa). All but which one of the following situationssignificantly increases the risk of a MI or other coronaryevent during or after surgery?(A) Angina symptoms limited to strenuous physicalactivity such as shoveling dirt at a rapid pace(B) Angina when walking one or two blocks on levelground(C) History of congestive heart failure (CHF)(D) Anginal pains with any significant physical activity(E) Insulin treatment for diabetes7 A 58-year-old man with a history of angina treatedsuccessfully with percutaneous transluminal angioplasty3 months ago is now asymptomatic. He mustundergo a femoropopliteal graft for peripheral vasculardisease. For a low-risk patient with known coronaryartery disease, the perioperative cardiac mortalityrisk is 4%. Each of the following preoperative measurescan reduce that risk, except for which one?(A) Alpha2 agonist agents (e.g., clonidine)(B) Beta-blocking agents (e.g., metoprolol)(C) Albuterol(D) Statins (e.g., atorvastatin)(E) Smoking cessation8 A 60-year-old woman has been diagnosed with cholelithiasiswithout evidence of common duct involvement.Although she has had several moderately severeattacks of abdominal pain after meals, currently sheis asymptomatic. Elective surgery is indicated, butshe has a history of an uncomplicated MI 2 monthsago. Which of the following is the best preoperativestrategy for maximizing her cardiovascular safetythrough the period of surgery and the 2-week postoperativeperiod?(A) Institute preoperative beta-adrenergic blockingagents for 2 weeks before and 30 days aftersurgery(B) Start calcium channel blocking agents in thepreoperative and the 4-week postoperativeperiods(C) Postpone surgery for 2 to 4 months(D) Start atorvastatin and maintain it throughoutthe postoperative period(E) Institute an alpha-adrenergic agonist beforesurgery and throughout the postoperativep er i o d9 A 56-year-old male patient with cholelithiasis hashad two attacks of abdominal pain caused by gallbladderdisease. Currently, he has been abdominalsymptom free for 2 weeks, but upon system review,he is shown to have a history of anginal pains precipitatedby climbing a single flight of stairs and bywalking one block. His course had been stable, and hehas apparently been in denial of his chest pains untilthe history was extracted as a part of preoperativeclearance for his gallbladder problem. In fact, theanginal pains appear to be precipitated with increasinglyless activity. Which of the following is the beststrategy for minimizing his perioperative cardiovascularrisk?(A) Institute preoperative beta-adrenergic blockingagents for 2 weeks before and 30 days after(B) Proceed with evaluation for coronaryrevascularization(C) Postpone surgery for 2 months(D) Start atorvastatin and maintain it throughoutthe postoperative period(E) Prescribe nitroglycerin sublingually and a longactingnitrate for 2 weeks before proceedingwith surgery10 A 67-year-old black female patient has been treated for3 months for CHF caused by uncontrolled hypertension;her blood pressure readings have been running