periopMICase - 54 y/o female for left total hip...

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54 y/o female for left total hip arthroplasty M&M May 2005
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Which statement about postoperative myocardial infarction (PMI) is MOST likely true? A . Most PMIs occur on the fifth postoperative day B. Most PMIs are Q-wave infarctions C. Thrombosis caused by plaque fissure is the main mechanism of PMI D. PMIs are frequently associated with prolonged postoperative silent ischemia ASA SEE Vol21A #86, 2005
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The BEST strategy to reduce perioperative cardiac complications in a patient undergoing elective major vascular surgery within the next week is A. preoperative percutaneous transluminal coronary angioplasty (PTCA) B. use of a pulmonary artery catheter C. coronary artery bypass grafting D. perioperative beta-blocker therapy ASA SEE Vol21A #31, 2005
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Which statement about diabetes mellitus and its perioperative management is MOST likely true A. About 10% of patients with type 2 diabetes mellitus do not know that they are diabetic at the time or surgery. B. Current recommendations prior to major surgery are to obtain a stress test for diabetic patients who have one other risk factor (smoking, hypercholesterolemia, hypertension, family history of coronary artery disease, or males 40 years of age). C. In a 70 kg patient, one unit of regular insulin given intravenously will lower the glucose by approximately 25-30 mg/dL. D. Thiazolidinediones such as rosiglitazone (Avandia) or pioglitazone (Actos) increase insulin production. ASA SEE Vol21A #87, 2005
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History Medical osteoarthritis left hip pain score 9 -10 HTN DM II w/o complications lumbar spinal stenosis Surgical - none
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Allergies – none known Medications insulin (Humulin 70/30) 40 U a.m./36 U p.m. (20 U a.m. of surgery) metformin 500 mg BID lisinopril 40 mg QD hydrochlorothiazide 25 mg QD ibuprofen 800 mg TID prn acetaminophen/hydrocodone 500/5 mg Q4-6H prn acetaminophen/codeine 325/5 mg Q6H prn
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Physical Exam Wt 76 kg Ht 155 cm BMI 31.6 BP 134/77 P 99 R 16 T 37 SpO 2 97 Alert Left hip pain Airway – no problem Cardiopulmonary – within normal limits Laboratory Hct 43 Blood glucose 97 ROS Exercise capacity 4-10 METS Heartburn/indigestion
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Are you sure I have coronary artery disease? Do we need to evaluate before my hip surgery?
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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periopMICase - 54 y/o female for left total hip...

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