Clinical Management Problems

Question 1

What results in an increase in sympathetic output?

Answer 1

Increased blood pressure –> increased stroke volume

Question 2

An IDDM patient is admitted and is found to be disoriented and uncooperative. What is the most likely cause of behavioral changes?

What is the treatment?

Answer 2

Hypoglycemia

Treat with glucose (25 ml of 50% glucose or D50)

Question 3

What is the most appropriate treatment for increased HR from 70 to 110 bpm and BP changes from 144/84 to 135/79?

Answer 3

Esmolol 10-20 mg and wait 5-10 min before redosing.

Question 4

What causes an increase in oxygen consumption?

Answer 4

Increased HR, contractility, afterload, and preload

Question 5

What determines coronary perfusion pressure?

Answer 5

Aortic diastolic pressure - LVEDP

Question 6

What can reduce coronary perfusion pressure?

Answer 6

Decreased aortic pressure or increases in LVEDP

Question 7

What is the oral dose of Plavix?

Answer 7

75 mg/day

Question 8

What should be administered to treat intra-op bleeding?

Answer 8

Platelets

Question 9

Which volatile anesthetic would be the best agent for hepatocellular liver disease?

Answer 9

Nitrous since it is the least metabolized, but since it’s not a volatile, the best agent would be desflurane.

Question 10

What hemodynamic changes related to hepatic failure is most likely to be present in the pt presenting for a mesocaval shunt?

Answer 10

Hyperdynamic –> low SVR –> high CO –>normal to low BP

Question 11

Pt with increasing blood ammonia concentration will result in what?

Answer 11

Hepatic encephalopathy

Question 12

What will result if sterile water is used to dilute PRBCs?

Answer 12

Hemolysis

Question 13

A trauma pt is undergoing emergent exploratory laparotomy during which he receives 10 cell saver units and 12 units of PRBCs. If there are no clots in the surgical field and his venipuncture sites have begun to bleed, what is the most likely cause of his coagulopathy?

Answer 13

Dilutional thrombocytopenia

Question 14

What is the earliest coagulation disturbance seen in massively transfused patients?

Answer 14

Hypofibrinogenemia usually develops after 10-15 units of PRBCs.

Question 15

What do you need to give when there is hypofibrinogenemia due to massive infusion of RBCs?

Answer 15

Cyroprecipitate, 8-10 packs

Question 16

PT/PTT increases ___ times after 8 - 10 units of PRBCs.

Answer 16

1.5 times

Question 17

A 52 year old man with ESRD presents for surgery on Thursday and heis on dialysis MWF. What is the appropriate coars of fluid management for this patient?

Answer 17

Replace insensible and third-space losses only.

Question 18

How many grams of glucose in 1 liter of D5W?

Answer 18

50 grams

Question 19

What acid/base disorder will result from the administration of an excess amount of LR?

Answer 19

metabolic alkalosis

Caution in pts with severe hepatic insufficiency

Question 20

What are the ASA classification definitions?

Answer 20

I. Healthy
II. Mild-moderate systemic disturbances
III. Severe systemic disturbances
IV. Severe with constant threat to life
V. Moribund that is not expected to survive without the operations
VI. Organ donor

Question 21

What is the induction dose of propofol?

Answer 21

1 - 2.5 mg/kg

Question 22

What CVP catheter length is chosen for right IJV and left IJV?

Answer 22

16 cm for right

20 for left

Question 23

What is uniquely associated with central venous catheterization via the left internal jugular vein?

Answer 23

Thoracic duct puncture/laceration may lead to lymph in the lung (chylothorax)

Question 24

What is the distance of the right atrium, right ventricle, and pulmonary artery from the right IJV?

Answer 24

20 cm, 30 cm, 45 cm

Question 25

What is a reasonable lower threshold for platelet transfusion prior to right hemicolectomy?

Answer 25

70,000