Endocrine/Hepatic

Question 1

Vitamin K dependent coagulation factors include factors:

Answer 1

II, VII, IX & X

With the exception of factor VIII, all coagulation factors are synthesized in the liver. Vitamin K is a necessary cofactor in the synthesis of factors II, VII, IX and X.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 2

Normal daily insulin production in the adult is approximately:

Answer 2

50 units

Adults normally secrete approximately 50 U of insulin each day from the beta cells of the islets of Langerhans in the pancreas.

pg. 802
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 3

In patients with hepatorenal syndrome, pathophysiologic changes commonly include:

Answer 3

hypokalemia

Hepatorenal syndrome is characterized by progressive oliguria, avid sodium retention with secondary alkalosis and hypokalemia, azotemia and intractable ascites.

pg. 795
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 4

Compared to triiodothyronine (T3), thyroxine (T4):

Answer 4

is released in greater quantities than T3

The thyroid gland releases more T4 than T3. However, T3 is more potent and less protein bound.

pg. 807
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 5

Function of Kupffer cells:

Answer 5

function as macrophages

The Kupffer cells line the hepatic sinusoids and are part of the monocyte-macrophage (reticuloendothelial) system.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 6

The half-life of levothyroxine is approximately

Answer 6

7 - 8 days

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 7

Unconjugated hyperbilirubinemia is associated with:

Answer 7

hemolysis

Unconjugated hyperbilirubinemia may be seen with hemolysis or congenital defects in bilirubin conjugation.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 8

Calcitonin is produced by the:

Answer 8

parafollicular C-cells of the thyroid

In lower animals, calcitonin lowers serum calcium and has the opposite effect of parathyroid hormone. Calcitonin is secreted by the parafollicilar C-cells of the thyroid, but a physiologic effect has not been shown in humans.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 9

Clinical manifestations of hyperaldosteronism include:

Answer 9

metabolic alkalosis

Clinical manifestation of hyperaldosteronism include an elevation in blood pressure, hypervolemia, hypokalemia muscle weakness and metabolic alkalosis.

pg. 811
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 10

The normal adult liver weighs approximately:

Answer 10

1500 gm

pg. 773
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 11

Phase II hepatic drug biotransformation includes:

Answer 11

conjugation with glucuronic acid

Phase II reactions, which may or may not follow phase I reactions, involve conjugation of the substance with glucuronide, sulfate, taurine or glycine. Conjugated compounds are more readily eliminated in the urine or bile.

pg. 778
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 12

Patients with diabetic autonomic neuropathy often display a(n):

Answer 12

inability to compensate for blood volume changes intraoperatively

Clinical signs of diabetic autonomic neuropathy include hypertension, silent myocardial ischemia, orthostatic hypotension, lack of heart rate variability, reduced response to atropine or propranolol, resting tachycardia, early satiety, neurogenic bladder, lack of sweating and impotence.

pg. 805
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 13

The most common cause of postoperative jaundice is:

Answer 13

hematoma resorption

Postoperative jaundice can result from a variety of factors, but the most common cause is overproduction of bilirubin from resorption of a large hematoma or red cell breakdown following transfusion.

pg. 782
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 14

Addisonian crisis (acute adrenal insufficiency) is characterized by:

Answer 14

hypoglycemia

Clinical features of acute adrenal insufficiency include hypotension, metabolic acidosis, hyperkalemia, fever, hypoglycemia and mental status changes.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 15

Does Glycogen contribute to intracellular osmolarity

Answer 15

does not contribute to intracellular osmolarity

Glycogen is a readily available source of glucose that does not contribute to intracellular osmolality. Only the liver and muscle are able to store significant amounts of glycogen. Insulin enhances glycogen synthesis.

pg. 776
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 16

A decreased production of parathyroid hormone can result from:

Answer 16

hypomagnesemia

Parathyroid gland function and PTH secretion are inhibited by chronic and severe hypomagnesemia. PTH secretion is also reduced with hypercalcemia as can occur with Paget’s disease, malignancy and chronic immobility.

pg. 746
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

Question 17

Carcinoid syndrome is associated with:

Answer 17

tricuspid valve lesions

Carcinoid syndrome is associated with right-sided heart disease caused by valvular and myocardial plaque formation. Lung metabolism of serotonin evidently prevents involvement of the left side of the heart.

pg. 815
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 18

The laboratory finding that is the most sensitive indicator of hepatobiliary disease is:

Answer 18

an elevated GGTP

Elevated serum gamma-glutamyl transpeptidase is the most sensitive indicator of hepatobiliary disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 19

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can be caused by:

Answer 19

all of the above

SIADH has been associated with head injuries, intracranial tumors, pulmonary infection, small cell carcinoma of the lung and hypothyroidism.

pg. 1149
Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.

Question 20

The right and left lobes of the liver are connected by the:

Answer 20

falciform ligament

pg. 773
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 21

Bile flow from the common bile duct to the duodenum is controlled by the:

Answer 21

sphincter of Oddi

Biliary flow from the common bile duct into the duodenum is controlled by the sphincter of Oddi. Cholecystokinin causes contraction of the gallbladder, relaxation of the sphincter of Oddi and propulsion of bile into the small intestine.

pg. 778
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 22

Physiologic effects of insulin include:

Answer 22

inhibition of ketogenesis

Insulin has anabolic effects such as promoting glycogenesis, increasing cholesterol synthesis, increasing protein synthesis, promoting glycolysis and promoting triglyceride storage. Insulin also has anticatabolic effects such as inhibiting glycogenolysis, inhibiting ketogenesis and inhibiting gluconeogenesis.

pg. 803
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 23

Epidemiological risk factors that are associated with “halothane hepatitis” include:

Answer 23

repeat exposure to the inhalational agent

Epidemiological studies have identified several risk factors that are associated with halothane-associated hepatitis, including middle age, obesity, female sex and repeat exposure.

pg. 782
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 24

A 32-year-old female is scheduled for laparoscopic cholecystectomy. Her past medical history is significant for toxic multinodular goiter treated with propylthiouracil. Preoperatively, the patient’s propylthiouracil therapy should be:

Answer 24

continued through the morning of surgery

Antithyroid medications and beta-blockers should be continued through the morning of surgery. Administration of PTU and methimazole is particularly important because of their relatively short half-lives.

pg. 807
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 25

Inhibition of gluconeogenesis occurs with the administration of:

Answer 25

insulin

Glucocorticoids, catecholamines, glucagon and thyroid hormone greatly enhance gluconeogenesis, whereas insulin inhibits it.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 26

Inhalation induction may be faster in the hypothyroid patient because:

Answer 26

cardiac output is depressed

Decreased cardiac output may speed the rate of induction with an inhalation anesthetic, but hypothyroidism does not significantly decrease MAC.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 27

Pathophysiologic changes seen during the anhepatic phase of liver transplantation include:

Answer 27

hyperfibrinolysis

Hyperfibrinolysis is commonly present and appears to be due to a marked increase in TPA and a decrease in plasminogen activator inhibitor and α1-antiplasmin.

pg. 800
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 28

The increase in INR seen in acute hepatic failure is the result of:

Answer 28

decreased factor VII levels

The short half-life of factor VII (4 - 6 hours) makes the INR useful in evaluating hepatic synthetic function in patients with acute liver disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 29

Competitive aldosterone antagonists include:

Answer 29

spironolactone

The aldosterone inhibitor spironolactone is effective as a potassium-sparing diuretic and antihypertensive. It is also used in the treatment of hepatic insufficiency and CHF.

pg. 811
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 30

Sinusoidal capillaries and hepatocytes are separated by:

Answer 30

the space of Disse

pg. 774
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 31

During metabolism of hemoglobin, degradation of the heme ring occurs primarily in the:

Answer 31

Kupffer cells

Bilirubin is primarily the end-product of hemoglobin metabolism. It is formed from degradation of the heme ring in Kupffer cells.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 32

A 62-year-old man is scheduled for a transurethral prostatectomy for urinary obstruction. His past medical history is significant for type II diabetes mellitus treated with 2000 mg of metformin daily in divided doses. Preoperative recommendations regarding his metformin therapy should include:

Answer 32

holding the metformin for 24 - 48 hours prior to surgery

In patients receiving oral hypoglycemic agents, the drug can be continued until the day of surgery. However, sulfonylureas and metformin should not be used for 24 - 48 hours before surgery because of their long half-lives.

pg. 806
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 33

The incidence of chronic active hepatitis following infection with hepatitis C is approximately:

Answer 33

50%

The incidence of chronic active hepatitis is 3 - 10% following infection with hepatitis B virus and at least 50% following infection with hepatitis C virus.

pg. 790
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 34

In the adult under maximum physiologic stress, cortisol production is approximately:

Answer 34

300 mg/day

Adults normally secrete 20 mg of cortisol daily, this may increase to over 300 mg under conditions of maximal stress.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 35

Only glucose, and not fatty acids, can be use as a fuel source by:

Answer 35

red blood cells

Glucose, and not fatty acids, can only be utilized by erythrocytes and cells in the renal medulla.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 36

In the preoperative preparation of the patient with a pheochromocytoma, beta-blockade:

Answer 36

should only be used after the initiation of alpha-blockade

If β-blockade is initiated first, catecholamine will produce unopposed α-stimulation and severe vasoconstriction. This may explain the paradoxical hypertension produced in a few patients treated with labetelol.

pg. 253
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 37

The incidence of malignancy associated with pheochromocytomas is approximately:

Answer 37

10 - 15%

Pheochromocytoma accounts for about 0.1% of all cases of hypertension and has an incidence of malignancy of 10 - 15%.

pg. 813
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 38

A decrease in hepatic blood flow is seen with:

Answer 38

all of the above

Hepatic blood flow decreases with all forms of anesthesia, including epidural and spinal anesthesia.

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 39

The hypothalamus can reduce the production of growth hormone with the release of:

Answer 39

somatostatin

Growth hormone is synthesized and secreted by cells in the anterior pituitary and is under dual control from the hypothalamus. Growth hormone releasing hormone stimulates growth hormone release, and growth hormone inhibiting hormone (somtostatin) is a powerful inhibitor of growth hormone release.

pg. 741
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

Question 40

The percentage of total hepatic blood flow supplied by the portal vein is approximately:

Answer 40

70%

Normal hepatic blood flow is about 1500 mL/min in adults, of which 25 - 30% is derived from the hepatic artery and 70 - 75% from the portal vein.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 41

Most bilirubin created through the metabolism of hemoglobin is:

Answer 41

excreted in the feces

Bilirubin is excreted in the feces. About half of the bilirubin is converted by colonic bacteria into urobilinogen. A small amount of this substance is reabsorbed, only to be excreted into the bile again (enterohepatic circulation).

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 42

Hyperosmolar nonketotic coma is most commonly seen in patients with diabetes type:

Answer 42

II

Type II diabetes mellitus is rarely associated with ketosis or acidosis, but it may be complicated by nonketotic hyperosomolar hyperglycemia. CNS manifestations are secondary to cerebral dehydration from hyperosmolarity.

pg. 760
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

Question 43

In the chronic alcohol abuser, acute alcohol withdrawal for a surgical procedure has been associated with a mortality rate of approximately:

Answer 43

50%

Alcohol withdrawal during surgery may be associated with a mortality rate as high as 50%.

pg. 791
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 44

When comparing malignant hyperthermia to thyroid storm, thyroid storm:

Answer 44

most commonly occurs in the postoperative period

Thyroid storm is characterized by hyperpyrexia, tachycardia and hypotension. The onset is usually 6 - 24 hours after surgery, but can occur intraoperatively. Unlike MH, thyroid storm is not associated with muscle rigidity, elevated creatinine kinase or a marked degree of acidosis.

pg. 808
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 45

Ammonia formed by hepatic deamination of amino acids is mostly converted into:

Answer 45

urea

Through a series of enzymatic steps, the liver combines 2 molecules of ammonia with one molecule of carbon dioxide to form urea. The urea formed is readily excreted by the kidneys.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 46

Intraoperative management of the hypothyroid patient may be complicated by:

Answer 46

difficulty with intubation

Potential problems with the anesthetic management of the hypothyroid patient include hypoglycemia, anemia, hyponatremia, hypothermia and difficulty during intubation because of an enlarged tongue.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 47

The most common cause of hypoparathyroidism is:

Answer 47

parathyroidectomy

Hypoparathyroidism is usually due to deficiency of parathyroid hormone following parathyroidectomy.

pg. 810
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 48

In patients with acute liver failure, serum albumin is often initially normal. This is because the half-life of albumin is:

Answer 48

14 - 21 days

Because its half-life is 2 - 3 weeks, albumin concentration may initially be normal with acute liver disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 49

A 48-year-old female with a long history of rheumatoid arthritis treated with 75 milligrams of prednisone daily is scheduled for a total knee replacement. Anesthetic considerations in this patient include:

Answer 49

hypokalemia

As a result of chronic steroid use, this patient will exhibit Cushing’s syndrome. These patients tend to be volume overloaded with hypokalemic metabolic alkalosis resulting from the mineralocorticoid activity of glucocorticoids.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 50

The percentage of the total hepatic oxygen requirement supplied by the portal vein is approximately:

Answer 50

50%

Although about 70% of the hepatic blood flow comes from the portal vein, its reduced saturation allows it to supply only about 50% of the liver’s oxygen requirement.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 51

The synthetic function of the liver can be assessed with the:

Answer 51

INR

Liver tests that measure hepatic synthetic function include serum albumin, cholesterol, pseudocholinesterase, and the INR (PT).

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 52

Systemic manifestations of hypoglycemia include:

Answer 52

diaphoresis

Systemic manifestations of hypoglycemia result from catecholamine discharge and include diaphoresis, tachycardia, nervousness and hypertension.

pg. 804
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 53

Cardiovascular effects of cirrhosis include:

Answer 53

increased cardiac output

Arteriovenous shunting and anemia are responsible for the increased cardiac output seen in cirrhotic patients.

pg. 794
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 54

Pathophysiologic changes seen in patients with pheochromocytoma include:

Answer 54

decreased red cell mass and plasma volume

A decrease in both red cell mass and plasma volume contributes to the severe chronic hypovolemia seen in patients with pheochromocytoma.

pg. 813
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 55

Plasma proteins NOT formed by the liver include:

Answer 55

immunoglobulin G

Nearly all plasma proteins with the notable exception of the immunoglobulins are formed by the liver.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 56

Anesthetic management of the patient with pheochromocytoma should include:

Answer 56

intubation only after a deep level of anesthesia is obtained

Deep anesthesia should be obtained prior to intubation to reduce the catecholamine response. Anticholinergic and sympathomimetic drugs are generally avoided as they will worsen the imbalance of autonomic tone. Because histamine provokes catecholamine release, atracurium should also be avoided. Although droperidol has α-blocking properties, it has been associated with hypertensive crises in some patients.

pp. 253 - 254
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 57

The posterior pituitary gland secretes:

Answer 57

antidiuretic hormone

The posterior pituitary secretes antidiuretic hormone (ADH, vasopressin) and oxytocin.

pg. 645
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 58

The greatest reduction in hepatic blood flow is seen during:

Answer 58

upper abdominal surgery

Hepatic blood flow is decreased by both general and regional anesthetic techniques. However, surgical procedures near the liver can reduce hepatic blood flow by up to 60%.

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 59

The incidence of difficulty with intubation in patients with acromegaly is approximately:

Answer 59

30%

Facial deformities as well as enlarged tongue, thyroid, epiglottis and soft tissues of the throat can make intubation of the patient with acromegaly very difficult. Difficult intubation was found in 31% of patients studied.

pg. 741
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

Question 60

In the adult, normal hepatic blood flow is approximately:

Answer 60

1500 mL/min

Normal hepatic blood flow is about 1500 mL/min, which constitutes 25 - 30% of the cardiac output.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 61

Clinically significant hepatocellular dysfunction is commonly associated with a decrease in:

Answer 61

albumin

As a result of diminished synthetic function of the liver, serum albumin, cholesterol, pseudocholinesterase and clotting factors (except factor VIII) are all decreased.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 62

In the adult, an intravenous bolus of 50 mL of 50% glucose is expected to raise the blood glucose level by approximately:

Answer 62

100 mg/dL

Each milliliter of 50% glucose will raise the blood glucose of a 70-kg patient by approximately 2 mg/dL.

pg. 804
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 63

In the cirrhotic patient, common changes found in blood gas analysis include:

Answer 63

respiratory alkalosis

In cirrhotic patient, hyperventilation is common and results in primary respiratory alkalosis. Hypoxemia is frequently present and is due to right-to-left shunting in the pulmonary bed.

pg. 794
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 64

Extra-hepatic synthesis of coagulation proteins occurs with the formation of:

Answer 64

factor VIII

All coagulation factors, with the exception of factor VIII and von Willebrand factor, are produced by the liver.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 65

Clinical manifestation of hypothyroidism include:

Answer 65

hypoactive deep tendon reflexes

Clinical manifestations of hypothyroidism include weight gain, cold intolerance, muscle fatigue, lethargy, constipation, hypoactive reflexes and depression.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 66

Changes in plasma calcium concentration secondary to increased levels of parathyroid hormone are the result of:

Answer 66

increased bone resorption

Parathyroid hormone is the principal regulator of calcium homeostasis. It increases serum calcium by promoting bone resorption, limiting renal excretion and enhancing GI absorption.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 67

The duration of action of subcutaneously administered regular insulin is approximately:

Answer 67

5 - 7 hours

Subcutaneously administered insulin has an onset of action of 15 - 30 minutes, a peak effect at 1 - 3 hours and a duration of 5 - 7 hours. Insulin has a very short plasma half-life of only about 7 minutes when administered intravenously.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 68

The major route of chlolesterol elimination is through the formation of:

Answer 68

bile acids

Bile acids are formed by the hepatocytes from cholesterol and represent the major route of cholesterol elimination.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 69

Spasm of the sphincter of Oddi with subsequent elevation of biliary pressure can be caused by the administration of:

Answer 69

fentanyl

All opioids can potentially cause spasm of the sphincter of Oddi and increase biliary pressure (fentanyl > morphine > meperidine > butorphanol > nalbuphine).

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

Question 70

In the adult, normal hepatic blood volume is approximately:

Answer 70

450 mL

Normal hepatic blood volume is about 450 mL, which constitutes about 10% of the blood volume. As a result, the liver can act as a blood reservoir, releasing as much as 300 mL or removing as much as 1000 mL from the circulating volume.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.