Should all Reproductive age women require Pre Op UPT

This is my past year professional III exam question. The statement is,

"Urine for pregnancy test is a necessary investigation in all female patients in the reproductive age group"

The answer is false because

1) The American Society of Anesthesiologist (ASA) committee on Ethic stated that patient should be offered but not required to undergo pregnancy test unless there is compelling medical reason to know that patient is pregnant

2) Pregnancy test should be offered to female patients of childbearing age and for whom the result would alter patient's management

3) Detailed history should be obtained in all reproductive age group female patient and urine pregnancy test should be done if indicated from the history

4) A task force by ASA in 2002 entitled "Practice Advisory for Preanesthesia Evaluation" agree that preoperative test should not be ordered routinely. Preoperative should be done or required on a selective basis for purpose of guiding and optimizing perioperativemanagement. Indication for testing should be documented and based on medical and physical examination. Since the history could be unrelieble, the recommend that the urinary pregnancy test should be offered to all woman in reproductive age group rather than require to undergo the testing.

Reference:

Lee A. Fleisher, " Evidence-Based Practice of Anesthesiology, 2nd Edition", Saunders Elsevier, 2009

Beta blocker in patient undergoing surgery

This is some argument in respond to my past year Professional III examination regarding preoperative preparation of patients. The statement is like this

"Beta blocker medication should be stopped in the day of surgery"

The answer is false because.

1) Class I indication for perioperative beta-blocker use exists for continuation of a beta blocker in patients already taking the drug

2) several Class IIa recommendations exist for patients with inducible ischemia, coronary artery disease, or multiple clinical risk factors who are undergoing vascular (i.e., high-risk) surgery and for patients with coronary artery disease or multiple clinical risk factors who are undergoing intermediate-risk surgery

3) Initiation of therapy, particularly in lower-risk groups, requires careful consideration of the risk:benefit ratio for an individual patient

4) Initiation well before a planned procedure with careful titration perioperatively to achieve adequate heart rate control while avoiding frank bradycardia or hypotension is also suggested.

5) In light of the POISE results, routine administration of perioperative beta blockers, particularly in higher fixed-dose regimens begun on the day of surgery, cannot be advocated

** Notes: POISE trial showed that, though preoperative beta blockers prevented 15 MI’s for every 1000 patients treated, there was an increased risk of stroke and an excess of 8 deaths per 1000 patients treated

Reference:

Joshua A. Beckman, Christopher E. Buller, Hugh Calkins et al, "2009 ACCF/AHA Focused Update on Perioperative Beta Blockade", Journal of the American College of Cardiology, 2009

Hypermetabolic response during anesthesia

Malignant hyperthermia
Acute sepsis
Pheochromocytoma
Thyrotoxicosis