Example of a third order question:
A 74 year old male is referred to an opthalmologist due to cataracts and is being evaluated for surgery.
His past medical history is notable for Diabetes, diet controlled dyslipidemia, a previous TURP, and a previous remote appendectomy in his twenties.
He denies medication allergies, and he is currently on Sitatliptin mono therapy for diabetes with an A1C of 5.4 at his last checkup with his family physician.
As part of a screening preoperative evaluation he has basic labs and an EKG all of which are unremarkable.
Prior to booking an operative date, the opthalmologist is careful to clarify the following:
1: That the patient had a stress test and cardiac workup preoperatively before surgery due to his age
2: To encourage the patient to have both cataracts done on the same date to reduce recovery time
3: To repeat a hemoglobin A1C to ensure diabetic control is optimal prior to surgery
4: A careful medication history is performed to clarify if the patient was ever on any alpha blocker medications
5: This patient should have an internal medicine preoperativr consultation prior to booking any surgical date
Please provide your thoughts and explanations.
Thanks!
The pt might use alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH). This medication has created a new problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS)
thank you. That is the correct explanation.
All patients undergoing cataract surgery with a history of BPH should have as part of their medication history a check to see if they have been on tamsulosin.
This particular medication can cause intraop issues and is a relatively unknown complication amongst medical professionals who are not in the urology or opthalmology field.
Excellent answers everyone