CME Evaluation

CME Questions

This section provides a review. Mark each statement according to the factual material contained in this issue and the opinions of the authors. A score of 70% is required to qualify for CME credit.

Article One (pp. 139–145)

1. Successful implementation of a fast-track protocol requires a team approach with senior clinical and administration buy-in only. True or False?

2. Patient selection is an important cornerstone to any surgical procedure. Commonly reported contraindications for a fast-track protocol include malnourishment (greater than 10% weight loss), immobility or minimally immobile, active alcohol abuse (greater than 5 drinks per day) or dependence, poorly controlled psychiatric disorders, or lack of social support and inability to follow-up for postoperative visits or complications. True or False?

3. What are the most common hormones associated with a surgical stress response?

   • Thyroid hormone

   • VMA

   • Estrogen

   • Pituitary hormones

4. Which perioperative phase is the most critical for decreasing length of stay in a fast track protocol?

   • Counseling phase

   • Preoperative phase

   • Intraoperative phase

   • Postoperative phase

   Article Two (pp. 146–152)

5. According to the major meta-analyses and aggregate reports of randomized clinical trials, mechanical bowel preparation decreases the risk of wound infections and anastomotic leaks. True or False?

6. The modifi ed Nichols/Condon antibiotic is the oral bowel prep that has the greatest tolerability. True or False?

   Article Three (pp. 153–159)

7. All patients who undergo colorectal surgery should undergo pharmacological venous thromboembolism prophylaxis. True or False?

8. Which of the following medications when used in the perioperative period has been shown to reduce risk of thromboembolism in patients with colorectal malignancies?

   • Low-molecular-weight heparin

   • Fondaparinux

   • Heparin

   • Clopidogrel

   Article Four (pp. 160–162)

9. The current literature supports the use of perioperative beta blockade in all patients over age 70 undergoing abdominal colorectal procedures. True or False?

10. In the POISE (Perioperative Ischemic Evaluation) trial, there was an increased risk of stroke and total mortality in the patients who received extended-release metoprolol. True or False?

    Article Five (pp. 163–167)

11. Patients on long-term steroid therapy should routinely receive 200 to 300 mg of hydrocortisone in the perioperative period to account for stress on the hypothalamic–pituitary–adrenal (HPA) axis. True or False?

12. For many years supraphysiologic perioperative glucocorticoid dosing was based primarily on two case reports describing postoperative adrenal crises in patients with rheumatoid arthritis. True or False?

13. The majority of perioperative hemodynamic instability is caused by secondary adrenal insuffi ciency. True or False?

14. Current recommendations state that supraphysiologic doses of corticosteroids are not routinely required in the perioperative period in patients undergoing major surgery while on long-term corticosteroid therapy. True or False?

    Article Six (pp. 168–173)

15. Surgical-site infections (SSIs) are defi ned as infections related to the operative procedure that occurs at or near the surgical incision within 7 days of an operative procedure or within one year if an implant is left in place. True or False?

16. Postoperative administration of preventive systemic antibiotics beyond 24 hours has not been demonstrated to reduce the risk of an SSI. True or False?

17. Prophylactic antibiotics should be administered within 1 hour before incision. True or False?

    Article Seven (pp. 174–177)

18. The practice of using drains in nonpelvic colorectal surgery to reduce the incidence of anastomotic leaks is

    • Not supported by any large randomized trials

    • Supported by evidence from large randomized trials.

    • Useful in animal studies

    • Useful only when metallic drains are used

19. A patient with acute diverticulitis is admitted to the hospital. He is febrile (38°C) despite treatment with broad spectrum antibiotics. A computed tomography scan demonstrates a 7 cm, well-circumscribed pelvic abscess. The next step in management should be

    • Emergency laparotomy and Hartmann procedure

    • Percutaneous drainage

    • Transrectal drainage

    • Colonoscopy

    Article Eight (pp. 178–181)

20. Removal of the urinary catheter on postoperative day 1 is recommended after abdominal bowel resection surgery. True or False?

21. Removal of the urinary catheter while a thoracic epidural is in place for postoperative pain management will result in urinary retention for most patients. True or False?

    Article Nine (pp. 182–185)

22. Name the most common pulmonary complication caused by the routine use of nasogastric decompression in patients recovering from colorectal resection?

    • Aspiration pneumonia

    • Fever

    • Atelectasis

    • Pharyngolaryngitis

23. Nasogastric decompression improves time to resolution of postoperative ileus after elective colorectal resection. True or False?

24. Name the most common pulmonary complication caused by the routine use of nasogastric decompression in patients recovering from colorectal resection?

    • Aspiration pneumonia

    • Fever

    • Atelectasis

    • Gastric distension

    Article Ten (pp. 186–190)

25. Postoperative ileus (POI) is a major factor that prolongs length of stay (LOS) after colorectal surgery. True or False?

26. Alvimopan has been proven eff ective for reducing POI and LOS in laparoscopic surgery. True or False?

27. Prospective randomized controlled trials have demonstrated that chewing sugarless gum reduces POI in laparoscopic colorectal surgery. True or False?

    Article Eleven (pp. 191–196)

28. A multimodal approach to postoperative pain management is recommended for patients undergoing laparoscopic or open colorectal surgery under general anesthesia. True or False?

29. Use of ketorolac in the postoperative period has minimal opioid-sparing effect. True or False?

    Article Twelve (pp. 197–202)

30. A 75 year-old male is undergoing elective laparoscopic sigmoid resection for diverticulitis. His co-morbidities include coronary artery disease (CAD), and chronic renal insufficiency. Which of the following peri-operative management schemes is best supported?

    • Pre-operative mechanical bowel preparation should be avoided to minimize post-operative ileus

    • Intra-operative fl uid administration of either crystalloid or colloid is appropriate

    • Intra-operative Doppler guided fluid administration will optimize post-operative outcomes

    • Fluid minimization as part of an Enhanced Recovery Protocols results in shorter length of stay (LOS)

31. A 45 year-old male undergoes a laparoscopic right colectomy for a cecal mass. He is managed on an Enhanced-Recovery Protocol. Which of the following is least likely to be a component of this protocol?

    • Pre-operative Education

    • Avoidance of mechanical bowel preparation

    • Post-operative epidural pain control with avoidance of narcotics

    • Peri-operative fluid restriction

    • Early exteral feeding

    ANSWERS: You will receive a graded copy of your post-test along with the answer key when you are mailed your CME certificate from the Ochsner Clinic Foundation.