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Nagelhout Anesthesia Review > c1. BASIC SCIence A (1-74) > Flashcards

c1. BASIC SCIence A (1-74) Flashcards

0
Q
  1. sickling may occur with the sickle cll disease when the Po2 falls below how many mmHg?
    a. below 70 mmHg
    b. below 60 mmHg
    c. below 80 mmHg
    d. below 50 mmHg
A

d. below 50 mmHg

low concentrations of oxygen precipitate hgb into elongated crystals which results in sickle cell crisis

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1
Q
  1. Symptoms of anemia are unlikely to manifest in a healthy patient until the Hgb falls below:
    a. 6 g/dL
    b. 8 g/dL
    c. 7 g/dL
    d. 9 g/dL
A

c. 7 g/dL
rationale: compensatory mechanisms prevent symptoms from occuring as long as the anemia is slow developing and chronic until the hgb falls to around 7 or lower.

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2
Q
  1. In the patient with sickle cell disease, what percentage of the total Hgb pool is Hgb S?
    a. greater than 70%
    b. greater than 50%
    c. greater than 60%
    d. greater than 80%
A

a. greater than 70%
rationale: Hgb S is caused by an abnormal composition of the beta chanis which in a person with sickle cell disease frequently exceeds 70%

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3
Q
  1. the major vascular flow of blood to the liver is through the:
    a. portal artery
    b. portal vein
    c. hepatic vein
    d. hepatic artery
A

b. portal vein
rationale: approximately 1100 ml of blood flows from the portal vein into the liver sinusoids each minute in addition to 350 ml that flows into the sinusoids from the hepatic artery. This is approximately 29% of the cardiac output.

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4
Q
  1. From what vessel does the hepatic artery arise?
    a. renal artery
    b. splenic artery
    c. celiac artery
    d. gastric artery
A

c. celiac artery
rationale: the hepatic artery brings blood from the celiac artery and accounts for 25% of total hepatic blood flow but 45-50% of the oxygen supply. The hepatic vein brings the remaining blood and oxygeni

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5
Q
  1. approximately what percentage of cardiac output goes through the liver?
    a. 15%
    b. 25%
    c. 20%
    d. 10%
A

b. 25%
rationale: 25-29% of the cardiac output flows to the liver per minute through the portal vein and sinusioids of the hepatic artery

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6
Q
  1. what process is least used by the liver in biotransformation?
    a. oxidation
    b. reduction
    c. synthesis
    d. hydrolysis
A

d. hydrolysis

rationale: hydrolysis generally occurs outside the liver in the plasma, tissues and red blood cells

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7
Q
  1. the blood gas partition coeffecient (BGPC) is an indication of an inhalation anesthetic’s:
    a. lipid solubility
    b. protein binding
    c. potency
    d. speed of induction and emergence
A

d. speed of induction and emergence
rationale: BGPC is an indication of the uptake of anesthesia into the lungs and thus into the brain; therefore it is a measure of speed of onset of inhaled anesthetic

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8
Q
  1. what agents should be used with caution when administering halothane anesthesia?
    a. alpha-1 agonists
    b. catecholamines
    c. beta-1 agonists
    d. angiotensin-converting enzyme inhibitor
A

b. catecholamines
rationale: Halothane sensitizes the myocardium to sympathomimetic medications; therefore catecholamines and catecholamine like drugs should be used with extreme caution

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9
Q
  1. the addition of halogen to an inhalation anesthetic structure:
    a. increases blood solubility
    b. increases lipid solubility
    c. decreases potency
    d. decreases flammability
A

d. decreases flammability
rationale: the addition of halogens (chlorine, flourine, bromine or iodine) increases the stability of the molecule (decreasing flammability)

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10
Q
  1. the ventilatory pattern known as “rocking boat ventilation” is caused by:
    a. loss of intercostal muscle function
    b. loss of diaphragm muscle function
    c. loss of abdominal muscle function
    d. loss of accessory muscle function
A

a. loss of intercostal muscle function
rationale: with improper intercostal muscle strength, the chest is unable to expand during inspiration resulting in chest retraction in abdominal breathing. The combination of strained abdominal expansion and intercostal paralysis mimics a boat rocking on the water.

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11
Q
  1. which inhalation anesthetic inhibits methionine synthetase:
    a. sevo
    b. nitrous
    c. halothane
    d. isoflurane
A

b. nitrous oxide

rationale: nitrous oxide inhibits methionine synthetase by oxidizing the cobalt atom of vitamin B12

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12
Q
  1. what condition results from damage to the posterior pituitary?
    a. acromegaly
    b. SIADH
    c. diabetes insipidus (DI)
    d. Addison’s disease
A

c. DI

rationale: the posterior pituitary gland secretes ADH; lack of this hormone causes diuresis; this is diabetes insipidis

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13
Q

13b. DEFINE these:
a. acromegaly:
b. SIADH
c. DI
d. Addison’s disease

A

a. acromegaly; reflects excess secretion of growth hormone in an adult
b. SIADH; inappropriate secretion of anti diuretic hormone which reflects the effects of TOO MUCH ADH (patients retain water) (inapropriate=too much)
c. DI= not enough anti diuretic hormone; so they diurese
D. addison’s disease is adrenal insuffeciency (absence of cortisol)

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14
Q
  1. In a patient with oliguric renal failure the urine output:
    a. decreases to < 30 ml/hr
    b. decreases to < 0.5 mL/kg/hr
    c. decreases to < 15 ml/kg/hr
    d. decreases to <500 ml/day
A

b. <0.5 ml/kg/hr

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15
Q
  1. Which is the principal mechanism of anterior pituitary hormonal control?
    a. negative feedback
    b. positive feedback
    c. stimulation of mitosis and cell division in various tissues
    d. somatostatins
A

a. negative feedback

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16
Q

15b. DEFINE: what is negative feedback?

A

when releasing factors and the amount of hormone at the target organ influence the release of more hormone. When hormone levels are high, it will inhibit the release of the releasing factors.

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17
Q
  1. the 2 hormones secreted from the posterior pituitary gland are:
    a. ADH and cortisol
    b. ADH and FSH
    c. ADH and oxytocin
    d. ADH and LH
A

c. ADH and oxytocin
rationale: posterior pituitary secretes antidiuretic hormone and oxytocin which is involved in uterine contractions during childbirth

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18
Q
  1. what is the initial and maintenance doses of dantrolene for malignant hyperthermia and what is theraputic blood level?
    a. Initial dose of 5 mg; maint=2 mg/kg up to 10 mg; blood level 2.5 mg/ml
    b. initial dose of 5 mg; maint=2.5mg/kg up to 20 mg; blood level 5 mcg/ml
    c. initial dose of 2.5 mg/kg; maint=0.5 mg/kg; blood level 25 mg/kg
    d. initial dose of 2.5 mg/kg; maint is 1 to 2 mg/kg boluses up to 10 mg; blood level 2.5 mcg/ml
A

d. 2.5 mg/kg initial dose; maintenance dose is 1-2 mg/kg boluses up to 10 mg/kg; blood level is 2.5 mcg/kg

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19
Q

17b. how is dantrolene prepared? How long does it last?

A

mixed with distilled water based on heart rate, body temp, and PACO2. Theraputic levels last up to 4-6 hours after initial dose

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20
Q
  1. what is the earliest sign of MH?
    a. increased ETCo2
    b. tachycardia
    c. increased temperature
    d. tachypnea
A

b. tachycardia
rationale: end tidal CO2 could be the first but it is masked by hyperventilation (which blows it down initially). Tachypnea may be masked by controlled ventilation

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21
Q
  1. what is the most sensitive sign of MH?
    a. increased temp
    b. tachycardia
    c. increased ETCO2 during constant ventilation
    d. overheated CO2 absorber
A

c. increased ETCO2

rationale: however, with hyperventilation of the patient, the cardiac symptoms may be seen first

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22
Q
  1. what is the mortality rate for malignant hyperthermia?
    a. 100%
    b. 10%
    c. 50%
    d. 25%
A

b. 10%
rationale: although the number of reported cases has increased, the detection and treatment has improved decreasing mortality

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23
Q
  1. what condition can mimic malignant hyperthermia?
    a. eaton-lambert syndrome
    b. sudden death syndrome
    c. neuroleptic malignant syndrome
    d. kearns-Sayre syndrome
A

c. neuroleptic malignant syndrome
rationale: which is caused by the use of psychoactive drugs. Dopamine antagonists and serotonin agonists and antagnists can produce this syndrome. It usually does not result in rigidity; however the other signs may be similar

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24
Q
  1. What is the ASA status classification of a patient with an incapacitating disease that is a constant threat to life (i.e. heart failure or renal failure).
    a. ASA 5
    b. ASA3
    c. ASA 4
    d. ASA 2
A

c. ASA 4

rationale: patients with high level co morbidities are at high risk for mortality under anesthesia

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25
Q
  1. what is the ASA status of a patient with mild systemic disease such as mild diabetes, controlled HTN, anemia, chronic bronchitis or morbid obesity?
    a. ASA 2
    b. ASA 3
    c. ASA 4
    d. ASA 5
A

a. ASA 2
rationale: a patient with mild systemic or chronic disease that is well controlled is at a slight risk for mortaliy under anesthesia

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26
Q
  1. cyclosporine for immunosuppressant therapy exerts its effect by
    a. suppressing T cells
    b. blocking histhamines
    c. activating beta cells
    d. enhancing steroids
A

a. suppressing T cells
rationale: cyclosporine selectively depresses the activity of T helper cells and CD4 lymphocytes by inhibiting production of IL-2 (interlukin-2) and other cytokines

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27
Q
  1. what is the best position for a postoperative tonsillectomy patient?
    a. lateral position with head lower than hips
    b. supine position with the head of the bed elevated 30 degrees
    c. later position with head elevated 30 degrees
    d. prone with head turned to side and lower than hips
A

a. lateral position with head lower than hips
rationale: lateral head down is also known as “tonsil position”; this helps prevent aspiration of blood and secretions which could irritate the vocal cords and cause laryngospasm

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28
Q
  1. Why should legs be lowered slowly from lithotomy position?
    a. to prevent hip dislocations
    b. the speed at which legs are lowered is not important; only that they are lowered together
    c. to avoid hypotension
    d. to prevent nerve injuries
A

c. to avoid hypotension
rationale: gradally lowering the legs from lithotomy position prevents stress on the lumbar spine as well as allowing for gradual accomodation to the chenges in venous return thus avoiding hypotension

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29
Q
  1. ephedrine stimulates: (rationale)
    a. alpha receptors only
    b. beta receptors only
    c. alpha and beta receptors
    d. dopamine receptors
A

c. alpha and beta receptors
rationale: ephedrine has multiple mechanisms of action including; alpha and beta receptor stimulation, indirect catecholamine release as well as central stimulant activity

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30
Q
  1. Acids ted to be most highly ionized at: (rationale)
    a. low pH
    b. high pH
    c. pH 7.0
    d. equal at all pH levels
A

b. High pH

rationale: acids tend to be ionized or become charged at very basic or high pH;
an acid plus a base will yield a salt + water

31
Q
  1. which enzyme catalyzes the final step in acetylcholine synthesis? (rationale)
    a. carbonic anhydrase
    b. adenylcyclase
    c. choline acetyltransferase
    d. glutamic transferase
A

c. choline acetyltransferase
rationale: acetylcholine is synthesized from choline and acetic acid. The enzyme responsible for this is choline acetyltransferase

32
Q
  1. acetylcholine is the neurotransmitter in all of the following sites except: (rationale)
    a. neuromuscular junction
    b. preganglionic sympathetic neurons
    c. postganglionic sympathetic receptors
    d. preganglionic parasympathetic neurons
A

c. postganglionic sympathetic receptors

rationale: The cohlinergic sites in the sympathetic and parasympathetic terms include both ganglia of the sympathetic and parasympathetic nervous system.
- The postganglionic effector sites of the parasympathetic nervous system include muscarenic receptors and the neuromuscular junction.
- The sympathetic end organs secrete norepinephrine.
- Postganglionic sympathetic receptors use Norepi (not Ach).

33
Q
  1. How many grams of reduced hemoglobin are necessary for cyanosis to occur? (rationale)
    a. 5 mg/100 mL
    b. 5g/1000 mL
    c. 5 mg/1000 mL
    d. 5 g/100 mL
A

d. 5 grams / 100 mL

rationale: Cyanosis will occur when oxygen saturation falls below 80%, which resluts from a Po2 of less than 53 mmHg. At this point, more than 5 grams of hgb will be reduced.
(cyanosis=80-53-5)

34
Q
  1. what is the most common cause of pancreatitis? (rationale)
    a. hepatitis
    b. malnutrition
    c. alcoholism
    d. diabetes
A

c. alcoholism
rationale: Alcoholism is the most frequent cause of pancreatitis, therefore, patients should ve evaluated for malnutrition, abnormal liver function, and signs of etoh withdrawl.

35
Q
  1. How much oxygen is carried by each gram of Hemoglobin?
    a. 3%
    b. 1.34 mL
    c. 5%
    d. 2 mL
A

b. 1.34 mL
rationale: The blood of a normal person contains approximately 15g of hemoglobin in each 100 ml of blood, and each gram is combined with a maximum of 1.34 mL of oxygen.

36
Q
  1. What coagluation factor is deficient in hemophelia A? (rationale)
    a. factor X
    b. factor VII
    c. factor VIII
    d. factor IV
A

c. factor VIII (factor 8)
rationale: factor VIII is missing in persons with classic hemophelia, for which reason it is called antihemophilic factor or antihemophilic factor A

37
Q
  1. What is the most important plasma protein in the binding of drugs? (rationale)
    a. globulin
    b. albumin
    c. fibrinogen
    d. glycine
A

b. albumin
rationale: there are 3 major plasma proteins; albumin, globulin and fibrinogen. Albumin provides the colloid osmotic pressure in the plasma and binds to drugs because of its ability to accept both positive and negative charges of a variety of chemical types.

38
Q
  1. What percentage of CO2 is carried in simple solution (i.e. plasma)? (rationale)
    a. 10%
    b. 5%
    c. 2%
    d. 4%
A

b. 5%

rationale: Pco2 of 40 mmHg is approximately 5% of the 760 mmHg at 1 atmosphere

39
Q
  1. What is the abnormality with megoblastic anemia? (rationale)
    a. vitamin B12 defeciency
    b. presence of Hgb S
    c. short red blood cell span
    d. bone marrow depression
A

a. Vitamin B12 defeciency
rationale: vitamin B12 defeciency leads to abnormal formation of red blood cells. They grow large, odd shaped and are called megablastic

40
Q
  1. The stimulation of what sensory nerve triggers a laryngospasm? (rationale)
    a. hypoglossal
    b. recurrent laryngeal nerve
    c. superior laryngeal nerve
    d. vagus
A

c. superior laryngeal nerve

rationale: the superior laryngeal nerve provides sensory supply to the larynx between the epiglottis and vocal cord. The cricothytroid muscle is supplied by the external laryngeal nerve (a branch of the superior laryngeal nreve) that adducts the vocal cords.
(Sup. Laryngeal>Ext. Laryngeal>cricothyroid)

41
Q
  1. What muscle tenses the vocal cords? (rationale)
    a. thyroarytenoid
    b. cricothyroid
    c. lateral cricoarytenoids
    d. oblique arytenoids
A

b. cricothyroid
rationale: The cricothyroid muscle is responsible for closing the vocal cords in response to sensory stimulation from the superior laryngeal nerve

42
Q
  1. what is the afferent nerve pathway for the carotid sinus body? which direction is afferent? (rationale)
    a. glossopharyngeal
    b. vagus
    c. accessory
    d. hypoglossal
A

a. glossopharyngeal; away

rationale: The neural output from the CAROTID bodies reaches the respiratory center by way of the afferent glossophayrngeal nerve. Output from the AORTIC bodies travels to the medulla via the VAGUS nerve.
(Carotid bodies> glossopharyngeal>medulla) (CGM)

(Aortic bodies>
vagus>medulla) (AVM)

43
Q
  1. what hormine plays a primary role in reglating vascular volume? (rationale)
    a. cortisol
    b. aldosterone
    c. thyrotropin
    d. parathyroid hormone
A

b. aldosterone
rationale: aldosterone is the major regulator of extracellular volume and potassium hemostasis through the rate of absorption of sodium and secretion of potassium in the tissues.

44
Q
  1. Explain why anephric or renal failure patients exibit anemia: (rationale)
    a) these renal patients have altered calcium levels which alters the bone marrows ability to produce large quantities of RBCs
    b) the lack of vitamin B12 or folic acid necessary for RBC formation is common in renal patients
    c) a decrease in GFR decreases the kidneys ability to absorb ferritin (necessary for Hgb formation)
    d) production of erythropoetin is decreased in kidney failure
A

d. production of erythropoetin is decreased in kidney failure
rationale: Erythropoetin stimulates the bone marrow to produce more RBCs. 80-90% of erythropoetin is produced in the kidneys (the rest is produced in the liver). Renal failure or anephric patients have decreased production of erythropoetin.

45
Q
  1. the addition of a florine atom to a hydrocarbon resluts in: (rationale)
    a. decreased stability
    b. increased flammability
    c. more potency
    d. increased stability
A

d. increased stability
rationale: florine is one of the most reactive halogens. It produces exceptionally stable bonds that resist separation by chemical or thermal means.

46
Q
  1. Acetylcholine is what type of ammonium compound? (rationale)
    a. quarternary
    b. primary
    c. tertiary
    d. secondary
A

a. quarternary

rationale: acetylcholine has four carbons attached to the nitrogen molecule making it a quarternary compound

47
Q
  1. muscle relaxants commonly contain what type of chemical group in their structure? (rationale)
    a. tertiary base
    b. quarernary base
    c. secondary acid
    d. primary base
A

b. quarternary base
rationale: like Acetylcholine, muscle relaxants cotain at least one and most commonly two quarternary ammonium molecules within their structure.

48
Q
  1. which of the following beta blockers produces vasodilation? (rationale)
    a. propanolol
    b. labetolol
    c. esmolol
    d. metoprolol
A

b. labetolol
rationale: all beta blockers produce vasoconstiction (by leaving unopposed alpha activity) except for labetolol which also posesses alpha blocking properties; thus producing vasodilation as well.

49
Q
  1. What is an anesthetic consideration in the patient receiving MgSO4 (mag sulfate).
    a. increased requirements of inhalation agent
    b. up regulation of acetylcholine agents
    c. reduced muscle relaxant doses
    d. severe hypertension
A

c. reduced muscle relaxant doses
rationale: an increase in magnesium in skeletal muscle leads to relaxation. Addition of NDMR may yield prolonged paralysis; use reduced doses of MR

50
Q
  1. which drug commonly inhibits the hepatic metabolism of other substances?
    a. neostigmine
    b. glycopyrollate
    c. atropine
    d. cimetadine
A

d. cimetadine

rationale: cimetadine inhibits oxidative drug metabolism by forming a tight complex with heme iron of cytochrome P450

51
Q
  1. Basic compounds tend to be the most ionized in:
    a. in a high pH
    b. they do not ionize
    c. at a low pH
    d. at physiologic pH
A

c. in a low pH
rationale: basic compounds tend to donate charges in an acid environment and visa versa. Therefore, they will be most ionized at a low pH

52
Q
  1. sudden withdrawl from the antihypertensive drug clonidine may produce:
    a. bradycardia
    b. tachyphylaxis
    c. severe rebound hypertension
    d. severe hypotension
A

c. severe rebound hypertension
rationale: clonidine is an antihypertensive that has severe withdrawl syptoms when stopped abruptly. Patients should continue to take clonidine throughout the perioperative period.

53
Q
  1. The well estabilished drug interaction between monoamine oxidase inhibiters (MAOs) and meperidine (demorol) may produce:
    a. hypothermia
    b. tachycardia
    c. hyperpyrexia
    d. bradycardia
A

c. hyperpyrexia
rationale: a severe drug reaction may occur from the metabolite of meperadine (normeperadine), when it is given to a patient that is on a MAO inhibitor. The reaction may also involve serotonin and commonly results in hyperthermia, hypertension, respiratory depression, skeletal muscle rigidity, seizures and coma.

54
Q
  1. In the patient with diabetes insipidus, which of the following is a commonly found problem?
    a. lethargy
    b. hypernatremia
    c. hyponatremia
    d. anuria
A

b. hypernatremia
rationale: Hypernatremia is one of the most common symptoms of DI. It results from excretion of high amounts of dilute urine, allowing sodium levels to rise and the patient’s osmolarity increases.

55
Q
  1. cocaine (anesthetic) would be expected to produce which of the following?
    a. vasodilation
    b. dysphoria
    c. blockade of norepinephrine reuptake
    d. spinal anesthesia
A

c. blockade of norepinephrine reuptake
rationale: cocaine has the unique ability of local anesthetics to block reuptake of norepinephrine causing vasoconstriction along with the topical anesthesia effect.

56
Q
  1. Addition of epinephrine to local anesthetic is contraindicated in which of the following situations?
    a. CHF
    b. intravenous regional anesthesia
    c. hypotension
    d. axillary block
A

b. intravenous regional anesthesia (beir block)
rationale: epinephrine should not be given during intravenous regional anesthesia because of the vascular systemic effects that may be produced both locally in the arm by vasoconstriction and systemically when the cuff is released

57
Q
  1. cyclic adenosine monophosphate (cAMP), a secondary messenger in many cells, causes what to occur in motor nerves?
    a. release of neurotransmitters
    b. opens calcium channels
    c. stimulates intercellular enzymes
    d. increase action potentials
A

b. opens calcium channels
rationale: cyclic adenosine monophosphate opens calcium channels causing synaptic vessicles to fuse with the nerve membrane and release acetylcholine.
(calcium release then NT release).

58
Q
  1. the average blood volume in a premature neonate is?
    a. 110 ml/kg
    b. 95 ml/kg
    c. 65 ml/kg
    d. 40 ml/kg
A

b. 95 ml/kg
rationale: the average blood volume is the highest in premature neonates and decreases through infancy and adulthood.
(90-95)

59
Q
  1. The average blood volume in a full term neonate is:
    a. 105 ml/kg
    b. 95 ml/kg
    c. 85 ml/kg
    d. 40 ml/kg
A

c. 85 ml/kg

full term neonates have second highest blood volume per kg

60
Q
  1. what is the average blood volume for a healthy infant?
    a. 100 ml/kg
    b. 85 ml/kg
    c. 90 ml/kg
    d. 80 ml/kg
A

d. 80 ml/kg

61
Q
  1. what is the average blood volume for an adult male?
    a. 95 ml/kg
    b. 65 ml/kg
    c. 75 ml/kg
    d. 55 ml/kg
A

c. 75 ml/kg

women ar 65 ml/kg

62
Q
  1. which of the following vasoactive substances is not commonly released from carcinoid tumors?
    a. serotonin
    b. kalikrien
    c. calcitonin
    d. histhamine
A

c. calcitonin
rationale: carcinoid syndrome is a complex of signs and symptoms caused by the secretion of vasoactive substances (serotonin, kalikrein and histhamine) from enterochromaffin tumors. Most of these tumors are located in the GI tract but can be present elsewhere and cause a variety of clinical manifestations.

63
Q
  1. which of the following exerts the longest duration of action when given epidurally?
    a. fentanyl
    b. meperidine
    c. sufentanil
    d. morphine
A

d. morphine
rationale: depending on the dosage, morphine can last up to 24 hours when given by this route. The effects of the other three drugs usually last a maximum of 6-8 hours.

64
Q
  1. the definition of multiple endocrine neoplasmia (M.E.N.) is:
    a. a disorder involving pituitary tumor formation
    b. a group of syndromes characterized by tumor formation in various endocrine organs
    c. a muscular dystrophy involving multiple proximal muscle groups
    d. another name for pheochromocytoma
A

b. a group of syndromes characterized by tumor formation in various endocrine organs
rationale: M.E.N. is a group of syndromes characterized by tumor formation throughout the endocrine system. Hypertension can result that is similar to that found in pheochromocytoma. The patients are typically young adults with family history of MEN

65
Q
  1. a patient with carpal tunnel syndrome has sustained injury to which of the following nerves?
    a. ulnar
    b. radial
    c. median
    d. brachial
A

c. median nerve

rationale: carpal tunnel is strain on the median nerve that affects the palmar surface and the first three digits.

66
Q
  1. How does P50 differ between sickle cell hemoglobin (HbS) and normal hemoglobin (HbA)?
    a. The p50 is the same for both
    b. HbS has a lower affinity for oxygen
    c. HbS has a higher affinity for oxygen
    d. clinically, the difference is insignificant
A

b. HbS has a lower affinity for oxygen
rationale: Functionally, sickle cell hgb has a lower affinity for oxygen than normal with the P50 being ~31 mmHg, as well as decreased solubility; on deoxygenation the sickle cell polymerizes and precipitates inside the red blood cell causing sickling.

67
Q

65b. what is a normal P50?
what does it mean when the P50 goes up?
what does it mean when the P50 goes down?

A
  • normal P50 is 26.6 mmHg
  • when the P50 goes up, this means there needs to be a higher pressure to maintain 50% oxygenation (lower affinity or shift to the left) P50 may be ~30 mmHg or more
  • when the P50 goes down, this means there needs to be a lower pressure to maintain 50% oxygenation (higher affinity or shift to the right) P50 may be ~25 mmHg or less
68
Q
  1. The normal RBC can last 120 days; how long can a sickled RBC last?
    a. 90 days
    b. 1 week
    c. the same as normal RBCs
    d. 10 to 15 days
A

d. 10-15 days

rationale: sickled cells are more fragile and last significantly less time than normal RBCs

69
Q
  1. excess secretion of glucocorticoids from the adrenal cortex produces:
    a. addison’s disease
    b. diabetes
    c. pheochromocytoma
    d. cushing’s disease
A

d. cushing’s disease

70
Q
  1. hypersecretion of aldosterone by the adrenal cortex is referred to as:
    a. cushing’s syndrome
    b. conn’s syndrome
    c. addison’s disease
    d. diabetes
A

b. conn’s syndrome
rationale: primary aldosteronism is also called Conn’s sndrome. Manifestations include hypertension, hypervolemia, hyperkalemia, muscle weakness and metabolic acidosis
(high aldosterone= high bp, high volume, high K+, weakness, high H+).

71
Q
  1. Destruction of the adrenal gland resulting in a combination of mineralcorticoid and glucocorticoid deficiency is known as:
    a. cushing’s syndrome
    b. carcinoid syndrome
    c. diabetes
    d. addison’s disease
A

d. addison’s disease
primary adrenal insuffeciency is known as addison’s disease. Clinical manifestations include hypotension, hypovolemia, hyperkalemia and metabolic acidosis
(addisons=low bp, low volume, high K+, high H+)

72
Q
  1. what is the most common cause of secondary adrenal insuffeciency?
    a. increased ACTH secretion from pituitary
    b. iatrogenic administration of exogenous glucocorticoids
    c. missed dose of exogenous corticosteroids
    d. general anesthesia with etomidate administration
A 
b. iatrogenic administration of exogenous glucorticoids
adrenal insufficiency (addison's) is usually iatrogenic.  It is a reslut of inadequate ACTH secretion by the pituitary.  Acute adrenal insuffeciency can be precipitated by infection, trauma and surgery.
73
Q
  1. acute adrenal insuffeciency or addisonian crisis is a medical emergency characterized by all of the following except:
    a. circulatory collapse
    b. decreased mentation
    c. fever
    d. hyperglycemia
A

d. hyperglycemia
the clinical features of this medical emergency include all of those listed except for hyperglycemia. Hypoglycemia is a common manifestation in steroid dependent patients

74
Q
  1. What happens when a drug that is a weak base is administered to an acidotic patient.
    a. more drug is nonionized
    b. less drug is nonionized
    c. the pKa increases
    d. the pKa decreases
A

b. less drug is nonionized
rationale: when a base is in an acidiotic environment it tends to ionize, thererfore less drug is nonionized or in lipid soluble form

75
Q
  1. What is the total CO2 content of arterial blood?
    a. 100 mL CO2/dL blood
    b. 48 mL CO2/dL blood
    c. 25 mL CO2/dL blood
    d. 12 mL CO2/dL blood
A

b. 48 mL CO2/dL blood

total CO2 content of arterial blood is made up of the sum of dissolved carbon dioxide and bicarbonate

76
Q
  1. How much CO2 is produced by cellular metabolism in a resting 70 kg person?
    a. 100 to 150 mL CO2/min
    b. 5075 ml CO2/min
    c. 200 to 250 mL CO2/min
    d. over 500 ml CO2/min
A

c. 200-250 mL co2/min
at rest certain tissues generate less co2 than others; the heart results in high co2 production vs. other areas. However, the total production resulting from aerobic metabolism in the body approximates 200-250 mL co2/min.

Nagelhout Anesthesia Review (12 decks)

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