NMS Q&A Family Medicine

Preoperative Clearance 229180 to 220/100 to 140. She had been in pulmonaryedema that responded to after-load reducing agentsand loop diuretics. Her blood pressure readings arenow under control at 120 to 125/75 to 80 through theuse of a combination of angiotensin-converting enzymeinhibitors and a potassium-sparing combination of athiazide diuretic and triamterene. Now she is to undergoa semi-urgent uterine suspension for stress incontinence.For the past 8 weeks, she has not been dyspneic,and she exhibits no peripheral edema, hepatomegaly,or neck vein distention. Which of the following is trueor correct regarding the upcoming surgery?(A) The patient should undergo her surgery after anaggressive program of loop diuresis.(B) The patient will be at increased risk for MI.(C) The patient will be at increased risk of the onsetof angina.(D) The patient will be at increased risk ofpulmonary edema.(E) Because the patient is well compensated, shewill be subject to no excess risk.11 A 55-year-old man must undergo laparotomy toresect a descending colon segment at the site of amalignant polyp discovered at routine colonoscopy.He had a MI 6 months ago, which was diagnosed toolate for successful thrombolytic therapy. However, hiscourse has not been complicated by symptoms ofCHF, and he has had no chest pains since then duringan orderly cardiac rehabilitation program. Because ofthis history, the patient’s preoperative clearanceincluded measurement of the cardiac ejection fraction,whose result was 45%. Which of the following istrue or correct regarding the patient’s upcoming surgeryand postoperative period?(A) He should be anticoagulated before surgery.(B) The patient will be at increased risk for MI.(C) The patient will be at increased risk for theonset of angina.(D) The patient will be at increased risk of CHF.(E) Because the patient is well compensated, he willbe subject to no excess risk.12 A 45-year-old man with hypertension must undergoabdominal exploration for an asymptomatic massthat was suggestive of lymphoma. His blood pressurereadings, on hydrochlorothiazide/triamterene andlisinopril, have averaged 145 to 150/95 to 98 over thepast 7 days. CBC and serum electrolyte levels arewithin normal limits. Which of the following decisionsregarding his preoperative and intraoperativemanagement is correct in light of current thinking?(A) Continue the current medications, includingthe dose(s) that is due on the day of surgery,and proceed with the surgery(B) Delay surgery and add a calcium channelblocking drug; proceed with surgery when theblood pressure is consistently below 140/90(C) Add a ganglionic blocking drug for 2 days andproceed with surgery(D) Order an ECG and proceed with surgery if thereis no evidence of left ventricular hypertrophy(E) Consult a cardiologist for preoperativeclearance and advice on management of postoperativehypertension13 If the patient in Question 12 had had a blood pressureof 190/115 without symptoms, which of the followingwould have been the most acceptable therapeuticapproach?(A) Continue the current medications, includingthe dose(s) that is due on the day of surgery,and proceed with the surgery(B) Delay surgery and step up the care of thehypertension, such as adding a calcium channelblocking drug; proceed with surgery when theblood pressure is consistently below 140/90(C) Order a thallium stress test14 A 45-year-old man presents with a left upper lobemass on a chest x-ray, ordered because of bloodymucus production from his previously long-standingcough. The patient has resumed smoking after a periodof cessation lasting 3 weeks. Spirometry is repeatedbecause of the passage of a year since this ongoingsmoker was cleared for surgery and operated upon. Itnow shows a forced expiratory volume in one second(FEV 1 ) of 2.2 L; a Maximal voluntary ventilation(MVV) of 45% of predicted value; and a diffusingcapacity in the lungs for carbon monoxide of 45% ofpredicted value. Because of these findings, a ventilation–perfusion(V/Q) scan is ordered. Which of thefollowing is a criterion that must be met for this patientto qualify for a pulmonary resection without leadingto the probability of ventilator dependency?(A) The contribution of the lobe being consideredfor resection must not exceed 1,400 mL.(B) A V/Q mismatch must not be found.(C) A diagnosis of pneumonia constitutes apermanent contraindication for lobectomy.(D) The V/Q criterion for resectability depends onthe tissue diagnosis of the mass.(E) V/Q results may be interpreted only in thecontext of the spirometric findings.15 A 43-year-old male alcoholic is scheduled for biliarysurgery after discovery of an impacted common bileduct stone. Which of the following preoperativeparameters is the most significant prognostic indicationof his postoperative hepatic status in regard to