Answers to the CME Quiz for "Preoperative Evaluation of the Gynecologic Patient: Considerations for Improved Outcomes" by Bruce E. Johnson, MD, and Joann Porter, MD (Obstet Gynecol 2008;111:1183-94)

1. The authors state that one of the most important functions of the preoperative evaluation is the identification of women at high risk for:

B. Cardiovascular disease

2. The screening method with the highest yield for preoperative detection of cardiovascular disease is:

A. History

3. When beta-blockers are given prophylactically to reduce the risk of coronary events at the time of surgery, they should optimally be started how far in advance of the procedure?

E. 2-3 weeks

4. When beta-blockers are given prophylactically to reduce the risk of coronary events at the time of surgery, they should be continued for what length of time in the postoperative period?

E. 1 month or longer

5. A 52-year-old woman is being evaluated for an abdominal hysterectomy. Her medical history is unremarkable. The most appropriate screening modality to reduce the risk of pulmonary complications during or after surgery is:

A. History

6. The most effective way to reduce pulmonary complications after surgery is:

B. Incentive spirometry

7. A 23-year-old multiparous woman currently using oral contraceptives is scheduled for an outpatient laparoscopic tubal sterilization procedure. Based on the author’s recommendations, the most appropriate management of this patient for DVT prophylaxis is:

E. No prophylaxis is indicated

8. A 48-year-old multiparous woman with moderately well controlled COPD is scheduled for an abdominal hysterectomy. About 6 weeks before her surgery she had a flair of her pulmonary disease that required a week of high-dose steroid therapy. Based on the author’s recommendations, the most appropriate corticosteroid management is:

D. Intravenous steroid therapy before and during surgery, followed by tapered oral therapy

9. A 43-year-old woman underwent the placement of a drug-eluting coronary stent 6 weeks ago, and she is currently on both aspirin and thienopyridine (clopidogrel) therapy. During her evaluation for that procedure, a strong family history for breast and ovarian cancer was discovered and the patient desires elective prophylactic oophorectomy.

9a. The optimal waiting time before performing this procedure is:

D. 12 months or longer

9b. Following the optimal waiting time before performing this procedure, the most appropriate management of this patient’s antiplatelet therapy is:

C. Stop thienopyridine (clopidogrel) therapy 5 days before surgery but continue aspirin therapy without change

ACCME Accreditation: The American College of Obstetricians and Gynecologists (ACOG) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. (Continuing medical education credit for "Preoperative Evaluation of the Gynecologic Patient: Considerations for Improved Outcomes" will be available through May 2011.)

AMA PRA Category 1 Credit^TM and ACOG Cognate Credit: The American College of Obstetricians and Gynecologists (ACOG) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM or up to a maximum of 2 Category 1 ACOG cognate credits. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Current guidelines state that continuing medical education (CME) providers must ensure that CME activities are free from the control of any commercial interest. All authors, reviewers, and contributors have disclosed to ACOG all relevant financial relationships with any commercial interests. The authors, reviewers, and contributors declare that neither they nor any business associate nor any member of their immediate families has financial interest or other relationships with any manufacturer of products or any providers of services discussed in this program. Any conflicts have been resolved through group and outside review of all content.

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