12-07-2008, 01:22 AM
A 77-year-old man undergoes a preoperative evaluation for outpatient elective cataract surgery to be performed under local anesthesia with intravenous conscious sedation. His medical history is significant for longstanding diabetes mellitus, coronary artery disease with an inferior myocardial infarction 5 years ago, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. His medications are aspirin; atenolol; felodipine; subcutaneous NPH insulin; simvastatin; and ipratropium, metered-dose inhaler. He has 2-pillow orthopnea, dyspnea when walking more than 30 m (100 ft), and chest pain when climbing more than two flights of stairs, all of which are longstanding symptoms that have not changed in character or intensity during the past 6 months. His physical examination is notable for an increased expiratory phase with occasional wheeze, a grade 2/6 holosystolic murmur heard best at the left lower sternal border, and a left femoral bruit. All of these findings are the same as those recorded during previous examinations.
Which is the most appropriate next step in the management of this patient?
( A ) Proceed with surgery with no further testing.
( B ) Obtain a complete blood count, electrolyte panel, blood urea nitrogen level, and serum creatinine level.
( C ) Perform spirometry.
( D ) Perform electrocardiography.
( E ) Cancel surgery.
vanco no need for a thanks
Which is the most appropriate next step in the management of this patient?
( A ) Proceed with surgery with no further testing.
( B ) Obtain a complete blood count, electrolyte panel, blood urea nitrogen level, and serum creatinine level.
( C ) Perform spirometry.
( D ) Perform electrocardiography.
( E ) Cancel surgery.
vanco no need for a thanks