NMS Q&A Family Medicine

230 NMS Q&A Family Medicineascites, encephalopathy, and gastrointestinal bleeding?(A) Direct-acting bilirubin(B) Presence or absence of ascites(C) Level of serum albumin(D) Preoperative Child–Turcotte–Pughclassification of cirrhosis score16 A 34-year-old woman is being prepared for hysterectomy,indicated by menometrorrhagia in a womanwho is gravida 4, para 4, and desires no more pregnancies.In preparing for surgery, you are aware thather hemoglobin (Hgb) may be decreased as a resultof an iron deficiency, which at various periods overthe past 3 years has required iron therapy. She hasbeen inconsistent in her compliance with the prescriptions.Which of the following is felt to be thepoint below which the risk of perioperative complicationsin otherwise healthy individuals is significantlyincreased?(A) 12 g/dL(B) 10 g/dL(C) 8 g/dL(D) 6 g/dL(E) 4 g/dL17 A 65-year-old man has been diagnosed with a symptomaticventricular septal defect (VSD), but surgicalcorrection is indicated because of the emergence ofconcentric cardiomegaly (diastolic dysfunction). Theblood pressure is 140/65. The patient is also diagnosed,in the course of his overall evaluation and thediscovery of a bruit over the right carotid artery, ashaving a 75% right carotid artery stenosis caused byatherosclerosis. While awaiting repair of the septaldefect, the patient experiences a 2-minute bout of avisual scotoma involving the right lower quadrant ofboth fields homonymously. Which of the following isthe most logical sequence of actions?(A) Perform repair of the VSD followed by carotidendarterectomy.(B) Perform coronary bypass grafting procedurefollowed by repair of the VSD.(C) Perform carotid endarterectomy followed byrepair of the VSD.(D) Carotid artery angiography followed byreevaluation before making further decision.(E) Treat the cardiac hypertrophy aggressivelymedically followed by carotid endarterectomywhen the cardiac status is stable and satisfactory.18 Which of the following ranks as the most specific andearnest preoperative preparation for an electiveabdominal operation on a 55-year-old man who is inchronic renal failure on dialysis?(A) Preoperative ECG within 24 hours of theoperation(B) Blood urea nitrogen and creatinine levels within24 hours of the surgery(C) CBC within 1 week of surgery(D) Dialysis within 24 hours and electrolytes studiesjust before surgery19 A 35-year-old female patient with chronic diarrheahas been diagnosed as having Crohn disease and isbeing considered for exploratory laparotomy. Consideringthe recent severe diarrhea, the patient’s stateof nutrition is a factor in preparing for surgery andplanning postoperative care. Below what level ofserum albumin, may she be considered to be severelymalnourished?(A) 4 g/dL(B) 3.5 g/dL(C) 2 g/dL(D) 1.5 g/dL20 A 63-year-old woman is being scheduled for an operationto relieve partial bowel obstruction that is dueto a descending colon carcinoma. Her symptomsconsist of alternating constipation (cessation ofmovements, normally daily) for periods of 2 to3 days, followed by diarrhea for 1 to 2 days. She says herappetite has waned during the period of these symptoms,approximately 6 weeks. Her weight is 120 lb(54.4 kg) at a height of 5 ft, 6 in. (1.68 m). In evaluatingher for the possible need of supplemental feeding,at least orally, before surgery to take place in1 week, what dietary intake should she be able toingest (caloric and percentage of protein oral intake),which would be adequate to obviate the need for anoral supplement (e.g., Ensure)?(A) 35 kcal/kg, of which 20% should be protein(B) 30 kcal/kg, with 30% protein(C) 40 kcal/kg, with 80 g of protein(D) Adequate oral intake as confirmed subjectivelyby the patient will suffice to ensure that thepatient is taking in an adequate amount to carryher through major surgery.(E) This calculation is not needed as long as thepatient’s serum albumin and transferrin levelsare within normal limits.