Diabetes Mellitus And Chronic Kidney Disease

Diabetes Mellitus And Chronic Kidney Disease
Diabetes Mellitus And Chronic Kidney Disease
1. Which of the following patients should undergo additional cardiac testing before
proceeding for an intraoperative surgical procedure?
A. A 71-year-old man with known untreated 3-vessel coronary disease presenting
for exploratory laparotomy for perforated bowel
B. An 81-year-old woman with chronic kidney disease (creatinine 2.3 mg/dL) and
prior ischemic stroke presenting for lumpectomy for breast cancer
C. A 68-year-old man with type 2 diabetes mellitus and prior ischemic stroke
presenting for revascularization procedure for peripheral arterial disease, which
limits his exercise capacity
D. An otherwise healthy 48-year-old man presenting for median sternotomy for
thymoma resection
2. A patient with type 1 diabetes mellitus and chronic kidney disease, stage III (Cr
2.5 mg/dL) presents for a video-assisted right upper lobe wedge resection for
pulmonary nodule. Which of the following medications is appropriate to initiate
preoperatively?
A. Metoprolol
B. Lisinopril
C. Amlodipine
D. Aspirin
13. When used alone, which ECG lead will most likely detect intraoperative
myocardial ischemia?
A. aVL
B. II
C. V4
D. V5
14. 14. A 59-year-old man with a suspected bowel perforation is scheduled to
undergo exploratory laparotomy. His vitals are as follows: 38.2°C | 122 | 81/43 |
24 | 97% on 3 L nasal cannula. Laboratory analysis is notable for troponin of
0.12 ng/mL, and ECG shows ST depressions in leads V4
-V6
. Which of the
following is the most appropriate diagnosis?
A. Unstable angina
B. Non-ST elevation myocardial infarction (MI), type I
C. Non-ST elevation MI, type II
D. ST elevation MI
15. A 49-year-old man is undergoing retroperitoneal sarcoma resection, which has
been complicated by an injury to the inferior vena cava (IVC) and substantial
blood loss. You note ST depressions in lead II and send an arterial blood gas
revealing the following information:
pH 7.24
PaCO2 34 mm Hg
PaO2 174 mm Hg
14 mEq/L
[HCO3
–
]
Hemoglobin 4.3 g/dL
Which of the following is most likely to resolve the ST depressions?
A. Increasing FiO2
B. Transfusion of 2 units of packed red blood cells
C. Administering rectal aspirin
D. Increasing phenylephrine infusion
16. Which of the following statements is true concerning patients with ventricular
assist devices (VADs) presenting for noncardiac surgery?
A. Noninvasive blood pressure cuffs will not function correctly in a patient with a
VAD.
B. Anticoagulation should be held for at least 48 hours before proceeding to the
operating room (OR).
C. Implantation of a VAD may delay gastric emptying and necessitate a rapid
sequence induction.
D. Regional anesthesia should be utilized whenever possible for VAD patients.
17. Which of the following statements is true with respect to extracorporeal
membrane oxygenation (ECMO) as compared with cardiopulmonary bypass
(CPB)?
A. Arterial line tracing for both ECMO and CPB will lack pulsatility.
B. The membrane oxygenator in CPB is designed for longer-term use compared with
ECMO.
C. The heart is stopped in both ECMO and CPB.
D. Lower flow rates are used in CPB, necessitating a greater degree of
anticoagulation.
18. Which of the following factors places a patient at increased risk of anaphylaxis
to protamine during reversal of heparin following CPB?
A. Prior exposure to protamine
B. Diabetes treated with metformin
C. History of atopy (asthma, eczema)
D. Prolonged heparin time
19. 19. Which of the following is an advantage of traditional, on-pump coronary
artery bypass grafting (CABG) as compared with off-pump coronary artery
bypass grafting (OPCABG)?
A. Lower intraoperative blood loss
B. Reduced risk of postoperative cognitive dysfunction
C. Higher rates of graft patency
D. Reduced risk of thrombotic events
20. Which of the following correctly describes the appropriate timing of inflation of
an intra-aortic balloon pump?
A. Just after the dicrotic notch
B. At the onset of ventricular systole
C. When the P wave is seen on ECG
D. During isovolumetric contraction
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