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Old 04-25-2012
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Question Preoperative evaluation?

A 95 Year old woman is admitted to the hospital because she fratured her right femur when she fell at home. An operation is planned and you are consulted by the orthopedic surgeon for medical clearance. She is a widow with no children who lives alone at home. She has diabetes mellitus that is treated with glyburide. She also takes aspirin, daily, and flurazepam for insomnia. On the night of admission she was noted to be confused and disoriented. She became somewhat agitated and tried to get out of bed. She repeatedly yelled, "you can't keep me in prison against my will".

Today, at the time of the consultation, she is alert and oriented to time, place and person. She does not remember the events of last evening. Vital signs now are temperature 36.7, pulse 78 and regular, RR 14/min, BP 138/84. On physical examination, heart lungs and abdomen are normal. The left leg is shortened and externally rotated. There are strong peripheral pulses bilaterally. Test of the stool for occult blood is positive. Results of laboratory studies are Glucos 183, Normal cbc and electolytes.

Which of the following is the most appropriate action based on this patient's physical examination and laboratory studies?

A. Postpone the operation for 24 to 36 hours to reduce the aspirin effect on platelets
B. Postpone the operation pending results of colonoscopy and upper GI x rays
C. Postpone the operation until her hyperglycemia is under better control
D. Recommend a nonoperative approach because of her age and mental status
E. Schedule the operation today

This is a question from the Practice material on USMLE website. I did not know the answer, it was E! Can anybody explain why?
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Old 04-25-2012
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Default

The other question is

The patient says she has a moderate amount of pain in the hip despite receiving acetaminophen. Which of the following is the most appropriate pharmacotherapy?

A. Amitriptyline, orally
B. Fentanyl patch
C. Hydrocodone orally
D. Meperidine orally
E. Sustained release morphine orally

The answer is E, I also don't know why
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