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Category: Cardiology--->Assessment for Surgery
Page: 2

Question 6#Print Question

You refer a patient for consideration of aortic valve replacement.

Which one of the following patients is least likely to need coronary angiography?

a. A 38-year-old man who smokes 40 cigarettes a day
b. A 42-year-old man with no cardiac risk factors
c. A 48-year-old woman with diabetes
d. A 48-year-old woman with no cardiac risk factors
e. A 38-year-old man with diabetes


Question 7#Print Question

A 75-year-old woman is admitted with an episode of unstable angina. She develops anterior T-wave inversion on her ECG and serum troponin is elevated. Initial treatment includes aspirin and clopidogrel. She undergoes coronary angiography which demonstrates a culprit lesion in the mid-course of the LAD. This is treated with a drug-eluting stent with good results. LV function is preserved.

Forty-eight hours post-procedure she has an episode of frank haematuria and then develops clot retention. The urology registrar reviews her and recommends stopping her antiplatelets.

What is your response?

a. Stop aspirin but continue clopidogrel—the benefits of aspirin are unproven
b. Stop aspirin and clopidogrel—the risks from bleeding outweigh risks of a further coronary event
c. Stop clopidogrel and continue aspirin—the half-life of clopidogrel is longer
d. Stop neither—the risks of stent thrombosis outweigh the risks of bleeding
e. Stop anti-platelets and replace with an IV heparin infusion since the effects are more predictable


Question 8#Print Question

A 74-year-old woman undergoes emergency laparotomy after presenting with sepsis and peritonism. In the postoperative period you are asked to review her since she has developed atrial fibrillation and blood tests reveal a raised serum troponin.

Which one of the following is most likely to be the appropriate decision?

a. The troponin elevation is of no significance in the postoperative period in someone who has been so unwell
b. The troponin elevation is related to the atrial fibrillation but is not otherwise significant
c. The troponin elevation indicates a myocardial infarction and she should undergo urgent angioplasty
d. The troponin elevation indicates a worse perioperative prognosis but does not dictate the management
e. The troponin elevation indicates myocardial ischaemia and she should be treated with dual-antiplatelet therapy


Question 9#Print Question

A 54-year-old man is seen in the orthopaedic pre-assessment clinic. He has had stable angina and, in addition to medical therapy, has had disease in a dominant RCA treated with a zotarolimus-eluting stent 5 months previously. He is taking aspirin, clopidogrel, simvastatin, ramipril, and bisoprolol. He is free from angina, has a resting BP of 113/80 mmHg, and a heart rate of 48 bpm. His blood results are within normal limits, including a fasting total cholesterol of 3.2 mmol/L.

You are asked about changes to his medication.

Which one of the following would you agree with?

a. Stop aspirin and clopidogrel; the risks of bleeding outweigh the risks of stent thrombosis ase the angioplasty was >1 month ago
b. Continue aspirin and clopidogrel; the risks of stent thrombosis outweigh the risks of bleeding even after >1 month
c. Stop the beta-blocker because perioperative use is associated with increased stroke risk
d. Stop the ramipril since he is hypotensive
e. Stop the simvastatin since his lipid level is satisfactory


Question 10#Print Question

You refer a patient for aortic valve replacement. Angiography demonstrates coronary disease. 

In which one of the following situations would they also need CABG?

a. An 80% lesion in the left anterior descending artery
b. A 65% lesion in the circumflex artery
c. A 55% lesion in the right coronary artery
d. A 55% lesion in the right coronary artery
e. A 45% lesion in the right coronary artery and a 55% lesion in the circumflex artery




Category: Cardiology--->Assessment for Surgery
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