CME questions: perioperative glucose control in the diabetic or nondiabetic patient.1. What are the American Association of Clinical Endocrinologists (AACE) recommended glycemic Glycemic The presence of glucose in the blood. Mentioned in: Cholesterol, High glycemic pertaining to the level of glucose in the blood. targets for noncritically (general wards) ill patients? a. Preprandial preprandial before meals. blood glucose < 126 mg/dL and random BG < 200 b. Preprandial BG < 110 mg/dL and random BG < 180 c. Preprandial BG < 110 mg/dL d. Random blood glucose < 200 mg/dL 2. What are the American Association of Clinical Endocrinologists (AACE) and American Diabetes Association recommended glycemic targets for critically ill (ICU) patients? a. Blood glucose level blood glucose level, n level of glu-cose in the bloodstream, normally about 70 to 115 mg/dL after fasting overnight. Higher levels may indicate diseases such as diabetes mellitus. between 80-110 mg/dL b. Blood glucose level between 100-140 mg/dL c. Blood glucose level less than 180 mg/dL d. Blood glucose level less than 100 mg/dL 3. The stress of surgery and anesthesia can result in the increase of which of the following: a. Catecholamines Catecholamines Family of neurotransmitters containing dopamine, norepinephrine and epinephrine, produced and secreted by cells of the adrenal medulla in the brain. b. Growth hormone c. Tumor necrosis factor-[alpha] d. Free fatty acids e. All of the above 4. Which statement is true as it relates to the influence of anesthesia on glycemic control? a. General anesthesia has been shown to result in a lower blood glucose concentration than local or epidural anesthesia b. Counterregulatory hormones are lower in patients undergoing general anesthesia c. General anesthesia compared to epidural analgesia causes higher blood glucose concentrations in the perioperative period; however, there is no difference in glycemic control in the postoperative period d. Volatile anesthetic agents increase insulin secretion and decrease hepatic glucose production 5. Reasons for poor clinical outcome with high blood glucose levels during the perioperative period remain unclear. Potential mechanisms include which of the following? a. Impaired leukocyte function, phagocytosis phagocytosis: see endocytosis. Phagocytosis A mechanism by which single cells of the animal kingdom, such as smaller protozoa, engulf and carry particles into the cytoplasm. , leukocyte respiratory burst b. Reduced collagen synthesis and neovascularization at the site of injury c. Diminished superoxide generation and inhibition of phospholipase D activity d. A and C only e. All of the above 6. During the perioperative period in patients undergoing general surgery (Pomposelli et al), what blood glucose level on the first postoperative day was associated with an 87.5% positive predictive value Positive predictive value (PPV) The probability that a person with a positive test result has, or will get, the disease. Mentioned in: Genetic Testing positive predictive value for infection? a. > 110 mg/dL b. >120 mg/dL c. >150mg/dL d. >180 mg/dL e. >200 mg/dL 7. What is the most common major complication in the postoperative period in diabetic patients? a. Cardiac ischemia b. Urinary tract infection urinary tract infection (UTI), n infection in one or more of the structures that make up the urinary system. Occurs more often in women and is most commonly caused by bacteria. c. Renal failure d. Cardiac arrhythmia e. Acute respiratory distress syndrome acute respiratory distress syndrome n. See adult respiratory distress syndrome. 8. What factors should be taken into account when considering approaches to inpatient diabetes management? a. Nature and extent of surgery b. Type of diabetes c. Antecedent pharmacological therapy d. Preoperative state of metabolic control e. All of the above 9. Which of the following statements regarding the management of inpatient hyperglycemia is false: a. The risk:benefit ratio of strict glycemic control must take into account the negative implications of more frequent hypoglycemic hypoglycemic /hy·po·gly·ce·mic/ (-gli-sem´ik) 1. pertaining to, characterized by, or causing hypoglycemia. 2. an agent that lowers blood glucose levels. events. b. In critically ill subjects, intravenous insulin therapy results in lower mortality rate independent of the length of hospital stay. c. Sliding scale insulin should not be the sole regimen for patients with type 1 diabetes type 1 diabetes n. See diabetes mellitus. or patients with type 2 undergoing major surgical procedures. d. Continuous intravenous insulin administration is the preferred insulin regimen for most patients with type 1 diabetes during major surgical procedures. e. The use of basal-bolus insulin regimen has been shown to improve glycemic control better than a sliding scale insulin regimen. 10. In addition to optimal preoperative glycemic control, the American Heart Association American Heart Association (AHA), n.pr a national voluntary health agency that has the goal of increasing public and medical awareness of cardiovascular diseases and stroke, and thereby reducing the number of associated deaths and disabilities. (AHA) recommends a low threshold for cardiac testing in diabetic patients with which risk factors: a. Greater than 50 years old b. Hypertension c. Chronically elevated blood glucose (>200 mg/dL) d. Albuminuria albuminuria /al·bu·min·uria/ (al-bu?mi-nu´re-ah) presence in the urine of serum albumin, the most common kind of proteinuria.albuminu´ric al·bu·mi·nu·ri·a n. e. All of the above Answers to CME Questions 1. B, 2. A, 3. E, 4. C, 5. E, 6. E, 7. C, 8. E, 9. B, 10. E As the arteries grow hard, the heart grows soft. --H.L. Mencken |
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