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Category: Cardiology--->Assessment for Surgery
Page: 3

Question 11# Print Question

A 56-year-old woman is admitted for elective total knee replacement. She has severely limited mobility and surgery is expected to improve this dramatically.

She is known to have hypercholesterolaemia and hypertension. In addition to simvastatin and ramipril, she takes atenolol. In preparation for her surgery she is nil by mouth from midnight. She does not take any of her medications the following morning. Whilst waiting to transfer to surgery she develops chest pain, and an assessment by the ward doctor reveals that she has inferior ST depression on ECG. Subsequent serum troponin measurement is positive.

Which one of the following therapies do you recommend?

A. Restart her normal medication and proceed to surgery as planned
B. Thrombolysis and heparin infusion
C. Urgent angiography and balloon angioplasty
D. Urgent angiography and bare metal stent angioplasty
E. Urgent angiography and drug-eluting stent angioplasty


Question 12# Print Question

A 67-year-old woman with rheumatic mitral valve disease has been under observation for many years. She is asymptomatic. Her most recent investigation reveals a normal-sized and well-functioning left ventricle. The mitral valve area is calculated as 1.3 cm2 . There is mild MR. The left atrium appears dilated. There is moderate TR with a calculated PA pressure of 45 mmHg. She is due to undergo assessment for a total hip replacement.

What recommendation can you give to the anaesthetist?

A. No precautions are needed since the mitral stenosis is not severe
B. She should not undergo non-cardiac surgery without mitral valve replacement
C. The orthopaedic surgery can go ahead, but extra care should be taken with rhythm and rate control and with fluid balance
D. She should not undergo non-cardiac surgery without mitral valvotomy
E. Orthopaedic surgery can go ahead with antibiotic prophylaxis against endocarditis


Question 13# Print Question

A 73-year-old man is referred for review in the cardiac outpatient clinic. He suffers from intermittent claudication and the vascular surgeon has recommended an aorto-bifemoral bypass graft. During the work-up it is discovered that he has an ejection systolic murmur and your opinion regarding operative fitness has been sought. In your consultation you discover that he has no symptoms of chest pain or shortness of breath, and has never had a syncopal episode. Clinically, he has aortic stenosis. An echocardiogram is arranged and demonstrates a peak gradient of 85 mmHg.

What is your recommendation regarding his fitness for the vascular surgery?

A. He has moderate aortic stenosis, and the surgery can go ahead with no precautions
B. He has severe aortic stenosis but no symptoms, and the surgery can go ahead with no precautions
C. He has severe aortic stenosis and should be assessed for valve replacement before the vascular surgery can go ahead safely
D. He has severe aortic stenosis and should have balloon valvuloplasty to enable safe vascular surgery
E. He most likely has extensive arterial disease and, rather than surgery, should take aspirin and a statin


Question 14# Print Question

You are asked to assess a patient prior to elective orthopaedic surgery.

Which one of the following factors merits further risk assessment?

A. Inability to climb two flights of stairs
B. Stable coronary disease
C. Tablet-controlled diabetes mellitus
D. Age >75 years
E. Atrial fibrillation


Question 15# Print Question

Which one of the following sets of findings in patients undergoing non-cardiac surgery is associated with an increase in long-term mortality?

A. Pre-operative evidence of frequent ventricular premature beats or non-sustained VT
B. Peri-operative small elevation in troponin level
C. Post-operative temporary worsening of renal function
D. B and C
E. A, B, and C




Category: Cardiology--->Assessment for Surgery
Page: 3 of 5