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Nov 11, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1720)
“Review of the literature suggests that PCI before noncardiac surgery is of ___ in preventing perioperative cardiac events, _____ in those patients in whom PCI is independently indicated for an acute coronary syndrome.”
a) great value ; not just
b) proven value ; (MI and and cardiac death) in all patients especially
c) proven value ; (MI but not cardiac death) in all patients especially
d) no value ; except

Nov 10, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1717-18)
“In symptomatic aortic stenosis, elective noncardiac surgery should generally be postponed or canceled. Such patients require aortic valve replacement before elective but necessary noncardiac surgery. . . On the other hand, in patients with severe aortic stenosis who refuse cardiac surgery or are otherwise not candidates for aortic valve replacement, noncardiac surgery can be performed with a mortality risk of approximately __%”
a) 0.5
b) 2
c) 10
d) 30

Nov 9, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1715, 1718)
“functional capacity has been classified as
excellent (greater than 10 METs), good (7 to 10 METs), moderate (4 to 7 METs), poor (less than 4 METs), or unknown.  Using  the “Duke Activity Status Index,” which activity level best approximates 4 METS?
a) “Walk a block or 2 on level ground at 2 to 3 mph
(3.2 to 4.8 kph)?”
b) “Climb a flight of stairs or walk up a hill?”
c) “Do heavy work around the house like scrubbing floors or lifting or moving heavy furniture?”
d) “Participate in moderate recreational activities like golf, bowling, dancing, doubles tennis, or throwing a baseball or football?”

Nov 9, 2011 - Weekly Quiz For the General Public
According to the CDC’s Prescription Painkiller Overdoses in the U.S. Nov 2011
“Many more ___ die of overdoses from prescription painkillers.
________ have the highest prescription painkiller overdose rates.
People in rural counties are about two times as likely to overdose on prescription painkillers as people in big cities.
_______ and American Indian or Alaska Natives are more likely to overdose on prescription painkillers.”
a) women than men ; Older teens ; Hispanics
b) men than women ; Middle-aged adults ; Whites
c) women than men ; Older teens ; Whites
d) men than women ; Middle-aged adults ; Blacks

Nov 8, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1724)
“Implantable cardioverter defibrillator devices should have their tachyarrhythmia treatment algorithms __________ before surgery” “Programming the shock function off with an ICD programmer (and turning it back on after the surgery) is the preferred method of addressing these issues” since magnets have variable effects on the shock function.
a) suspended with a magnet as the preferred method
b) checked but not altered
c) adjusted to “high sensitivity electrocautery detection”
d) programmed off  

Nov 7, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1723-24)
“Patients with permanent pacemakers who are pacemaker dependent should have their device evaluated within 3 to 6 months before significant surgical procedures, as well as after surgery. . . include major abdominal or thoracic surgery, particularly when the surgery involves large amounts of electrocautery. If a patient is pacemaker dependent, the device should be reprogrammed to ___________, or a magnet should be placed over the device during surgery. ”
a) an asynchronous mode during surgery (VOO or DOO)
b) a synchronous mode during surgery (VDD or DDD)
c) a deactivated mode
d) to AAI or VVI demand mode at 60 bpm

Nov 4, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary

(p1715)
Lee’s “Revised Cardiac Risk Index” uses “Six independent risk correlates” and “Increasing numbers of risk factors correlated with increased risk, . . . ”  These risks include ischemic heart disease,
congestive heart failure, high-risk surgery and __
a) cerebral vascular disease (CVD), renal insufficiency (Cr > 2 mg/dl) (RI), “preoperative insulin treatment for diabetes mellitus” (DM)
b) peripheral arterial disease (PAD), RI, DM
c) poor functional capacity (<4 METS), CVD, DM
d) poor functional capacity, PAD, RI

Nov 3, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1714, table 2)
“Active Cardiac Conditions for Which the Patient Should Undergo Evaluation and Treatment Before Noncardiac Surgery” include “unstable coronary syndromes,” new, worsening or class IV HF, “significant arrhythmias” and “severe valvular disease” which includes
a) Severe AS (mean grad>40 mmHg, AVA<1.0cm2 or symptomatic)
b) Symptomatic MS
c) Severe MR with compensated HF history or any of the above
d) (a) or (b)

Nov 2, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
(p1712)
“Elective noncardiac surgery is not recommended within _____ of coronary revascularization with balloon angioplasty.”
“Elective noncardiac surgery is not recommended within ______ of bare-metal coronary stent implantation or within _____ of drug-eluting coronary stent implantation in patients in whom thienopyridine therapy or aspirin and thienopyridine therapy will need to be discontinued perioperatively.” (Class III)
a) 2 weeks ; 4 to 6 weeks ; 9 months
b) 4 weeks ; 4 to 6 weeks ; 12 months
c) 8 weeks ; 3 months ; 12 months
d) 8 weeks ; 3 months ; 18 months

Nov 1, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
http://content.onlinejacc.org/cgi/reprint/50/17/1707.pdf  
(p1712)
“Recommendations for Noninvasive Stress Testing Before Noncardiac Surgery”
“Noninvasive stress testing of patients _______ and poor functional capacity (less than ___metabolic equivalents [METs]) who require________‡ is reasonable if it will change management.”  “Clinical risk factors include history of ischemic heart disease, history of compensated or prior heart failure, history of cerebrovascular disease, diabetes mellitus, and renal insufficiency”
Cr >/= 2.0 is referred to in the full guidelines but not the summary
a) with or without clinical risk factors ; 8 ; any surgery
b) with 1 or more clinical risk factors ; 8 ; vascular surgery
c) with 2 or more clinical risk factors ; 4 ; high-risk surgery
d) with 3 or more clinical risk factors ; 4 ;  vascular surgery

Oct 31, 2011
According to the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary
http://content.onlinejacc.org/cgi/reprint/50/17/1707.pdf  
(p1711)
“Preoperative resting 12-lead ECG is recommended for  . . . ”
a)  asymptomatic persons undergoing low-risk surgical procedures.
b) all patients who are undergoing intermediate-risk or higher surgical procedures.
c) patients with at least 1 clinical risk factor* who are undergoing vascular surgical procedures.
d) patients with at least 2 clinical risk factors* who are undergoing vascular surgical procedures.

(*Clinical risk factors include history of ischemic heart disease, history of compensated or prior heart failure, history of cerebrovascular disease, diabetes mellitus, and renal insufficiency.”)

 

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