Exam 2 questions

Question 1

A patient with cirrhosis is undergoing an elective cholecystectomy. Preoperative labs show INR 2.2, Platelets 78,000, Albumin 2.5 g/dL, and AST/ALT ratio >2. What is your primary concern before induction?

Answer 1

Elevated INR and low platelets cause an increased risk of bleeding especially if varices are present.

Low albumin will have less protein binding and increased free drug with risk of toxicity so less anesthetic dose will be needed. Albumin infusion will be beneficial.

Cirrhosis patients often have portal HTN so be cautious with use of PEEP on ventilator. Increased PEEP = increased portal HTN. (slide 6 & 9)

Question 2

Which of the following anesthetic agents is preferred in a patient with severe hepatic dysfunction?

Answer 2

Isoflurane for anesthetic gas (slide 16).

Induction with Propofol or Etomidate at reduced doses. (pg. 356).

Remifentanil is opioid of choice per Palmer (slide 5).

NMBs: Cisatracurium & Succinylcholine. (p. 356).

Question 3

You are managing a patient with hepatic encephalopathy undergoing an emergent procedure. What drug would you avoid preventing worsening encephalopathy?

Answer 3

Avoid Sedatives, Opioids, & Anesthetic Drugs (p. 355).

Question 4

In a patient with cirrhosis and portal hypertension, which sign would most likely indicate worsening liver disease?

Answer 4

Portal HTN >6 mmHg, decreased albumin and prolonged PT, increased LFTs and ALP. (slide 9).
Varices, splenomegaly, ascites (slide 11).
Increased MELD Score (p. 253).
Table 17.5: hepatic encephalopathy, hepatorenal and hepatopulmonary syndrome.

Question 5

A patient with liver disease is scheduled for surgery. His labs include INR 2.4, Platelets 65,000, and low albumin. What intervention is most appropriate preoperatively?

Answer 5

Give FFP or Vitamin K to correct coagulation abnormalities as well as albumin replacement since hypoalbuminemia will cause prolonged anesthetic effects. (Slide 6).

To optimize preoperatively, the patient may need an Echo with EF. Draw a BMP to assess creatinine, glucose, and electrolytes (slide 15).

Question 6

Which factors do NOT reduce hepatic blood flow during anesthesia?

Answer 6

Isoflurane, Normocapnia, Regional anesthesia & PEEP < 5. (slide 16).

Question 7

A chronic alcoholic patient has increased MAC requirements for volatile anesthetics. What is the primary mechanism behind this?

Answer 7

Accelerated metabolism of drugs (slide 17).

Question 8

A patient with alcoholic cirrhosis is found to have spontaneous bacterial peritonitis (SBP) and severe ascites. Which anesthetic management strategy is most appropriate?

Answer 8

Initiation of Antibiotic Therapy (p. 354).

Question 9

Which statement is TRUE regarding the use of volatile anesthetics in patients with liver disease?

Answer 9

Volatiles reduce hepatic blood flow (slide 22). However, Isoflurane preserves hepatic blood flow the best (slide 16).

Question 10

A patient develops delirium tremens (DT) three days after admission. Which treatment is most appropriate?

Answer 10

Diazepam and beta-blockers (slide 19).

Question 11

During surgery on a cirrhotic patient, what is the best method to avoid reducing hepatic blood flow?

Answer 11

Maintain CO/Avoid HoTN and normocapnia. Use Isoflurane. Keep Peep < 5 and decrease SNS stimulation (slide 20).

Question 12

Which of the following patients is at the highest risk for hepatic encephalopathy during surgery?

Answer 12

TIPS procedure (slide 14). GI bleed, infection and portosystemic shunts (p. 355).

Question 13

In managing a patient with alcohol withdrawal syndrome, which drug combination is most appropriate?

Answer 13

Benzodiazepines, Beta-blockers and alpha 2 agonists (slide 19 & p. 622).

Question 14

A patient with known cirrhosis presents with the following labs: AST 220, ALT 195, INR 1.8, Platelets 85,000, Bilirubin 3.4 mg/dL. What is the most concerning complication to manage perioperatively?

Answer 14

bleeding risk

Question 15

Which intervention is appropriate for a patient with hepatic encephalopathy undergoing general anesthesia?

Answer 15

Maybe do a regional PNB to cut back on anesthetics? Use smaller doses of propofol or etomidate. (p. 356). Correct electrolyte disturbances (p. 355).

Question 16

What is the most appropriate anesthetic strategy for a patient with ascites?

Answer 16

Increased risk of reflux and aspiration -> ramp up on intubation & do RSI. (slide 21).

Have decreased oncotic pressure ->give albumin and decrease anesthetic doses. (slide 11)

Reduced pulmonary compliance -> Use Pressure control (slide 12)

Question 17

A cirrhotic patient with portal hypertension develops esophageal varices. Which of the following would help reduce the risk of variceal bleeding during anesthesia?

Answer 17

Keep PEEP < 5, Avoid esophageal instrumentation (slide 4). Nonselective beta blockers (nadalol, propranolol) reduce portal HTN (p. 354).

Question 18

A patient with cirrhosis and refractory ascites is undergoing paracentesis. Which anesthetic consideration is most important during the procedure?

Answer 18

Maintain intravascular volume with colloids like albumin due to risk of HoTN? Not in PPT or book.

Question 19

You are preparing to induce anesthesia in a patient with liver cirrhosis. What is the best anesthetic induction agent to use?

Answer 19

Propofol or Etomidate (p. 356).

Question 20

Which clinical sign or symptom would most likely indicate that a cirrhotic patient is developing hepatic encephalopathy?

Answer 20

Asterixis (p. 355).

Question 21

A patient with advanced liver disease has developed hepatorenal syndrome. What is the best strategy for managing this complication during anesthesia?

Answer 21

Administration of albumin, midodrine, & octreotide (p. 355 & slide 28).

Question 22

A patient with alcoholic cirrhosis presents with the following labs: ALT 45, AST 150, INR 1.6, albumin 2.8 g/dL. What does the AST/ALT ratio suggest?

Answer 22

AST/ALT ratio > 2 suggests alcoholic liver disease (slide 6 & p. 351).

Question 23

A patient with liver failure requires mechanical ventilation. How should positive pressure ventilation (PPV) be managed to minimize adverse effects on hepatic perfusion?

Answer 23

Avoid PEEP or PEEP < 5 to prevent increases in portal HTN (slide 16).

Question 24

A patient with chronic alcohol use is undergoing anesthesia for an elective procedure. What is the most appropriate anesthesia consideration for this patient?

Answer 24

Chronic alcohol abuse will have an Increased MAC requiring more anesthesia. (slide 17)

Question 25

Which of the following would be an appropriate preoperative intervention for a cirrhotic patient with a platelet count of 45,000 and an INR of 1.9 undergoing elective surgery?

Answer 25

Platelet infusion and FFP/Vitamin K (slide 6 he mentions INR)

Question 26

A patient with a history of cirrhosis is experiencing confusion, tremors, and agitation. Labs show elevated ammonia levels. Which treatment should be initiated?

Answer 26

Lactulose (Slide 5)

Question 27

Which of the following volatile anesthetics should be avoided in a patient with liver disease due to its known hepatotoxic effects?

Answer 27

Halothane (slide 13).

Question 28

A patient presents for surgery with ascites, jaundice, and caput medusae. What is the most likely diagnosis?

Answer 28

Cirrhosis—symptoms of cirrhosis are fatigue, malaise, palmar erythema, spider telangiectasis, caput medusae, ascites (more specific and suggestive of liver dysfunction), portal HTN, decreased albumin, prolonged PT increase AST and ALT (slide 9 liver ppt)

Question 29

A patient with severe liver disease is on beta-blockers to manage portal hypertension. Which anesthetic consideration is essential for this patient?

Answer 29

Optimize the patient preop, cardiac clearance, assess coag status, renal function, electrolytes, albumin levels. Continue beta blockers, maintain IV fluid volume and urine output (slide 15 liver ppt)

Question 30

A patient with liver cirrhosis is scheduled for surgery. Labs show low albumin, elevated AST/ALT, and high bilirubin. Which anesthetic drug is most appropriate for induction?

Answer 30

Propofol is acceptable for induction as its metabolism is not significantly altered in liver disease (Slide 22). Pg 356 in the book says Propofol or Etomidate with a decreased dose –Destenee

Question 31

A cirrhotic patient is undergoing surgery. Which intervention is most appropriate to minimize the risk of bleeding?

Answer 31

Assess coags/risk of thrombocytopenia, no instrumentation in the esophagus bc bleeding varices cause 1/3 of cirrhosis deaths (mentioned liver is where coag factors are made, maybe need to give vitamin K, and really emphasized nothing in the esophagus) ppt 9-15

Question 32

During anesthesia management of a patient with acute pancreatitis, what is the main concern when using mechanical ventilation?

Answer 32

ARDS is seen in 20% of patients so use low tidal volumes and higher PEEP? (p. 372).
Increased abdominal pressure will make it harder to ventilate. (slide 47).
Not really sure what they want here.

Question 33

Which electrolyte imbalance is commonly seen in patients with acute pancreatitis and may cause life-threatening cardiac arrhythmias during anesthesia?

Answer 33

Hypocalcemia (Ranson criteria has low calcium as a criterion on pg 372).
Sydney says she talked with JP and he says also hypokalemia..

Question 34

What is the primary goal when managing a patient with acute liver failure undergoing surgery?

Answer 34

Correct coagulation abnormalities with FFP,

Avoid HoTN (slide 25)

Question 35

Which condition is a contraindication for liver transplantation due to its associated high perioperative mortality?

Answer 35

Severe pulmonary HTN (PAP> 50 or > 35 with CO < 6). -slide 27

Question 36

Why should NSAIDs be avoided in patients with liver disease during anesthesia management?

Answer 36

The effect on renal blood flow & need for hepatic metabolism (slide 22)

Question 37

What is the most appropriate induction technique for a patient with a full stomach, experiencing vomiting, and diagnosed with ileus?

Answer 37

RSI with NGT placement before. (slide 42)

Question 38

In managing anesthesia for a patient with GERD, what should be the preoperative medication plan to minimize the risk of aspiration?

Answer 38

Bicitra, Alka-Seltza Gold, Pepcid, Zantac (given within 20 mins of surgery) -Slide 41

Question 39

Which electrolytes should be carefully monitored and corrected preoperatively in patients with acute pancreatitis to prevent respiratory muscle weakness and ventilatory failure?

Answer 39

Calcium p.372

Question 40

Why is regional anesthesia contraindicated in patients with significant coagulopathies related to liver disease?

Answer 40

Risk of spinal hematoma (slide 16)

Question 41

Which symptom is most suggestive of a CO2 embolism during laparoscopic surgery, and what is the immediate intervention?

Answer 41

Rapid loss of EtCO2. Immediately decrease insufflation and place in left lateral Trendelenburg (slide 36).

Question 42

In a patient with acute liver failure, which coagulation test is the most reliable marker of liver synthetic function?

Answer 42

PT/INR (slide 6)

Question 43

Which anesthetic agent should be avoided in patients with a history of carcinoid syndrome due to its potential to release histamine?

Answer 43

Succinylcholine, Mivacurium, Atracurium, Tubocurarine, Epinephrine, Norepi, Dopamine, Isoproterenol, Thiopental (p. 371 Table 18.8) His PPT says Roc/Vec which is wrong…..

Question 44

Why should volatile anesthetics be used cautiously in patients with acute liver failure?

Answer 44

Volatiles reduce hepatic blood blow (slide 22)

Question 45

Which of the following is the primary adverse effect of anemia?

Answer 45

Decrease in oxygen-carrying capacity (slide 2)

Question 46

Which compensation mechanism initially occurs in response to anemia?

Answer 46

Slide 4 says “Right shift of the oxyhemoglobin dissociation curve which allows release of oxygen from HGB to tissues” but book Pg. 477 says increase in cardiac output..

Question 47

Which factor does not directly trigger perioperative blood transfusion in anemic patients?

Answer 47

Hemoglobin level (slide 6)

Question 48

Why is methylene blue contraindicated in patients with G6PD deficiency?

Answer 48

It can be life-threatening if given for methemoglobinemia with a G6PD deficiency because G6PD deficient RBCs can’t protect themselves from oxidative damage causing hemolysis. (P.482 and slide 10)

Question 49

Which of the following anesthetic agents is recommended to avoid in patients with hemolytic anemia?

Answer 49

Isoflurane, sevoflurane, diazepam, lidocaine, prilocaine (slide 10 & P. 482).

Reglan and PCN in book & Silver Nitrate on slide as well but are these really anesthetic agents?…

Question 50

What is the most common cause of microcytic anemia?

Answer 50

Iron deficiency and the thalassemias (p. 479 says both but slide 27 says thalassemia)

Question 51

Which lab test is used to evaluate the intrinsic coagulation pathway?

Answer 51

aPTT (slide 52)

Question 52

What is the main cause of the shortened RBC lifespan in sickle cell disease?

Answer 52

In SCD a substitution of a valine for glutamic acid in the beta globin subunit occurs. In the deoxygenated state, the Hb S undergoes conformational change leading to aggregation and a shortened life span- 10-20 days. (Slide 12).

Question 53

Which of the following is a significant risk factor for perioperative complications in patients with sickle cell disease?

Answer 53

Advanced age, frequent and severe recent episodes of sickling, evidence of end organ damage & concurrent infection. Also, type of surgery (p. 483)

Question 54

Which of the following would most likely precipitate a vaso-occlusive crisis in a sickle cell patient?

Answer 54

The vaso-occlusive crisis is initiated or worsened by dehydration, infection, acidosis, cold, shivering, vascular stasis, hypoxemia, and stress. (Slide 15). Book on page 483 says illness, stress, and dehydration.

Question 55

Why is pulse oximetry unreliable in patients with methemoglobinemia?

Answer 55

“Pulse oximetry is unreliable in this setting because most pulse oximeters can not detect methemoglobin” (pg. 486). It moves the oxyhemoglobin dissociation curve to the left, causing less oxygen to be dropped off at the tissues (p. 486).

Question 56

What is the first line treatment for von Willebrand Disease during a bleeding episode?

Answer 56

DDAVP (slide 46)

Question 57

Which lab finding is expected in a patient with hemophilia A?

Answer 57

Prolonged aPTT,
normal PT/ bleeding time,
and deficiency of Factor VIII. (p. 492 & slide 36 & 37).

Question 58

What is the hallmark of thalassemia on a peripheral blood smear?

Answer 58

Hypochromic and microcytic RBCs- mean corpuscular volume < 80 fL. (p. 479)

Question 59

Which of the following interventions would REDUCE the risk of bleeding in a patient with polycythemia undergoing surgery?

Answer 59

Reduce Hct to 45%,
Withhold aspirin for 7 days prior to surgery,
Give Desmopressin (DDAVP) and Cryoprecipitate to increase vWF. (slide 33)

Question 60

What is the preferred anesthetic approach for a patient with sickle cell disease undergoing a major surgery?

Answer 60

Avoid dehydration, deoxygenation (keep O2 > 95%), hypotension, venous stasis, hypoventilation, stressors such as shivering/pain/anxiety, etc. Make sure Hct is 30% & have PRBCs on standy for exchange transfusion (slide 24).

Question 61

Which of the following would you expect to see in a patient with folate deficiency anemia?

Answer 61

Megaloblastic & Macrocytic RBCs, Hx of alcoholism, Hb level 8-10, increased LDH & bilirubin, normal reticulocyte count (p. 485).

Question 62

What is the primary cause of death in sickle cell disease patients undergoing surgery?

Answer 62

Acute Chest Syndrome (slide 26)

Question 63

Which of the following laboratory findings would most likely indicate iron deficiency anemia?

Answer 63

Hb concentration 9-12g/dL, decrease in ferritin concentration <41ng/ml, low reticulocyte count, decreased serum iron, reduced transferrin saturation (<20%) pg 479 in book

IDA is a Microcytic anemia- mean corpuscular size <80 fL, caused by chronic blood loss or nutritional deficiency (only infants/small children) pg. 479 book

Question 64

Which patient population is at highest risk for developing vitamin B12 deficiency anemia?

Answer 64

Alcoholics because of poor dietary habits and alcohols interference with folate metabolism (pg 485 book, slide 29 ppt) -Elisabeth

P. 485 says “developing countries where tropical and nontropical sprue are more widespread, malabsorption may increase the frequency of Vit b12 deficiency”-Destenee

Question 65

Which of the following is the most common symptom of thrombocytopenia?

Answer 65

Petechial rash involving skin or mucous membranes (pg 494 book)

Question 66

Which lab result would you expect in a patient with von Willebrand Disease?

Answer 66

Increased PTT with normal PT & Platelet Count (slide 46).

Question 67

Which of the following would most likely precipitate a hemolytic crisis in a patient with G6PD deficiency?

Answer 67

Isoflurane,
sevoflurane,
diazepam,
methylene blue,
lidocaine,
prilocaine, and
silver nitrate (slide 10)

Question 68

Which of the following is the most appropriate goal for preoperative hematocrit in a patient with thalassemia undergoing intermediate-risk surgery?

Answer 68

Doesn’t say a HCT but JP said Hgb 9-10 on slide 27. Also not noted in stoelting’s, hematocrit of 30% on slide 23

Question 69

What is the primary purpose of administering DDAVP in patients with mild hemophilia A?

Answer 69

DDAVP will increase plasma factor VIII:C & vWF concentrations (slide 38)

Question 70

Which of the following patients is most likely to require platelet transfusion before surgery?

Answer 70

Patients undergoing procedures associated with high risk for bleeding or regional/neuraxial anesthesia.

Ø platelet transfusion in HIT patients

Question 71

What is the major risk associated with polycythemia in the perioperative period?

Answer 71

Thromboses and hemorrhage (p. 488)

Question 72

What is the recommended preoperative management for a patient with moderate risk for perioperative sickle cell crisis?

Answer 72

Preop transfusion to target HCT 30% (slide 23)

Question 73

What is the most common cause of macrocytic anemia?

Answer 73

Folate and Vitamin B12 Deficiency (slide 29)

Question 74

Which of the following is a key anesthetic consideration in a patient with thrombocytopenia?

Answer 74

The insulting factor must first be corrected prior to treating thrombocytopenia. Also, if severe, it may be ideal to delay surgery and stabilize coagulation.

Question 75

What is the most common cause of lung cancer?

Answer 75

90% of cases related to cigarette smoking (Slide 12)

Question 76

Which tumor suppressor gene is crucial in preventing cancer progression by monitoring DNA damage?

Answer 76

Slide 2/pg 586: Tumor Suppressor Genes p53 prevents cancer progression but also monitors cellular DNA replication

Question 77

A 65-year-old female patient presents with unexplained weight loss and chronic abdominal pain. Imaging reveals a large ascending colon mass. Which of the following would be the most likely presentation of this type of cancer?

Answer 77

Colorectal cancer; upper socioeconomic class, direct correlation between calories consumed, high intake of animal fat, family history, IBS, and cigarette smoking > 35 years, liquid stool (slides 14-15). P. 598 says they frequently ulcerate leading to blood loss in the stool.

Iron deficiency anemia common with ascending

Question 78

Which of the following cancers is often associated with SIADH (Syndrome of Inappropriate Antidiuretic Hormone)?

Answer 78

Small Cell Lung Cancer, intracranial neoplasms (slide 7) but chart 28.4 on Pg. 592 says Duodenal, SCLC, lymphoma, pancreatic, prostate cancers.

Question 79

What is the primary mechanism by which targeted chemotherapy works?

Answer 79

Targeted chemotherapy works by interrupting a link in carcinogenic cell proliferation. Drugs have now been developed that block growth factors, their receptors, or their associated tyrosine kinases. Cancer cells have the ability to mutate and develop resistance to targeted therapies, so targeted therapies are often used in conjunction with traditional chemotherapy. Stoeltings pg 587

Question 80

A 58-year-old male undergoing chemotherapy for metastatic prostate cancer presents for surgery. You are concerned about his immune status post-chemotherapy. Which anesthetic management strategy is most likely to avoid suppression of the immune system?

Answer 80

Ø opioids or volatile anesthetics (slide 6)

Question 81

Which of the following is a well-known side effect of bleomycin, a chemotherapeutic drug?

Answer 81

Bleo blebs = lung blebs, pneumos, pHTN (pg 589) + pulmonary fibrosis

Question 82

Which chemotherapeutic agent is most associated with cardiotoxicity, especially at high cumulative doses?

Answer 82

Doxyrubicin (pg 588)

Question 83

A 55-year-old woman with a history of breast cancer undergoing radiation therapy presents with dyspnea and nonproductive cough. Imaging shows interstitial lung disease. Which cancer treatment is most likely responsible?

Answer 83

Bleomycin (pg 595) or erlotinib (pg 588 table 28.2 says it causes interstitial lung disease)

Question 84

What is the role of propofol in cancer surgery with regards to tumor growth?

Answer 84

Propofol bears a chemical resemblance to the antioxidant alpha-tocopherol and may possess anti-inflammatory and antioxidative properties that tend to inhibit neutrophil, monocyte, and macrophage activity;

recent studies into propofol ester conjugates in the treatment of breast cancer, some studies show it to inhibit cellular adhesion and migration of breast cancer cells and direct cytotoxicity toward some cancer cells (Book p 583)

Question 85

A 60-year-old male presents for elective surgery. He has a history of squamous cell carcinoma of the lung and is currently undergoing chemotherapy with cisplatin. Preoperative labs show hypomagnesemia. Which of the following is the most likely cause of this electrolyte disturbance?

Answer 85

Cisplatin induced nephrotoxicity causing magnesium wasting (p. 589)

Question 86

Which of the following vaccines is considered a preventive cancer vaccine?

Answer 86

HPV and Hepatitis B vaccine (slide 5 and Pg. 591).

Question 87

What is the most common site for colorectal cancer to metastasize?

Answer 87

Cancer generally spreads to lymph nodes and then through portal circulation to the liver
(most common site of metastasis (slide 15)

Question 88

A 50-year-old woman with metastatic breast cancer undergoing treatment with doxorubicin presents with shortness of breath and fatigue. An echocardiogram reveals reduced ejection fraction. What is the most likely diagnosis?

Answer 88

Chronic heart failure 2/2 cardiomyopathy from cardiotoxicity related to doxorubicin use

Question 89

What role does VEGF (vascular endothelial growth factor) play in cancer development?

Answer 89

VEGF is involved in growth and differentiation of normal cells, but they get overexpressed or mutated on cancer cells. When they bind to receptors on cell membranes it induces a cascade of signal transduction events that activate tyrosine kinase. Drugs are being targeted to block these growth factors -> apoptosis (p. 587).

Question 90

A 68-year-old man with a history of prostate cancer is scheduled for robotic prostatectomy. He has received androgen deprivation therapy. During the procedure, his position is steep Trendelenburg, and the surgery is expected to last 4 hours. Which of the following anesthetic considerations is the most relevant for this patient?

Answer 90

Slide 18 is eventually going to talk about it- P. 609 says to pay attention to padding pressure points to limit the risk of nerve injuries, pneumoperitoneum will decrease pulm compliance and FRC, Increased SVR/MAP/CVP/ICP, risk of laryngeal edema and post-op visual loss.

Question 91

Which of the following anesthetic strategies is associated with better immune preservation in cancer surgery?

Answer 91

Use neuraxial & Regional anesthesia, if possible, decrease opioid and volatile anesthetic use as they are immunosuppressants (p. 596 & slide 6)

Question 92

What is the primary purpose of sentinel lymph node biopsy in breast cancer surgery?

Answer 92

Sentinel node mapping injects a radioactive tracker into the area around the breast tumor and it tracks rapidly to the dominant axillary lymph node. If the sentinel node is tumor free the remaining lymph nodes are also likely to be tumor free and further axillary surgery can be avoided (Book pg. 600)

Question 93

A 55-year-old female is undergoing chemotherapy with cisplatin for ovarian cancer. She presents to the emergency room with confusion and lethargy. Blood tests reveal hyponatremia. Which of the following is the most likely cause of her symptoms?

Answer 93

SIADH? P. 592

Question 94

Which of the following is the most common paraneoplastic syndrome associated with small cell lung cancer?

Answer 94

Lambert Eaton Syndrome, SIADH or Cushing Syndrome? p. 592-3

Question 95

What is the principal factor that increases the risk of breast cancer?

Answer 95

The principle risk factors for development of breast cancer are increasing age (75% of cases occur in patients >50 years) and a family history (first degree relative diagnosed before 50 of breast cancer increases risk 3-4x (book pg 600)

Question 96

A 63-year-old male with prostate cancer presents with back pain and difficulty walking. Imaging reveals bone metastases. What is the most likely cause of his symptoms?

Answer 96

Spinal Cord Compression p. 594

Question 97

What is the mechanism of action for trastuzumab in breast cancer treatment?

Answer 97

Monoclonal antibody binding to HER2 protein to stop proliferation, bonding, cell signaling and causes apoptosis (Took Eli’s word for it coming from Stoelting Pharmacology since it was not in slide of book).

Question 98

A 40-year-old female with BRCA1 mutation presents for a bilateral mastectomy. Which of the following is true regarding her risk of developing breast and ovarian cancer?

Answer 98

BRCA1 is an inherited autosomal dominant mutation, 1st degree relative with breast cancer diagnosed before 50 increases breast cancer risk 3-4x (book pg 600)

Question 99

Which of the following types of anesthesia is associated with reduced opioid consumption and potentially improved outcomes in cancer surgery?

Answer 99

Regional Anesthesia (slide 26)

Question 100

A 55-year-old male is undergoing surgery for colorectal cancer. He has a history of chronic large bowel obstruction. Which of the following should be considered when managing his anesthesia?

Answer 100

There should not be an increased risk of aspiration during induction. However, distention could interfere with adequate ventilation and oxygenation. (Slide 16).

Question 101

What is the most common treatment modality for well-differentiated prostate cancer in younger patients (<65 years)?

Answer 101

Prostatectomy or Radiation (slide 17)

Question 102

A 72-year-old woman with a history of breast cancer treated with radiation presents for elective surgery. Her preoperative evaluation shows normal cardiac function. During surgery, she develops hypotension and jugular venous distension. What is the most likely cause?

Answer 102

Myocardial/Myocardial fibrosis is caused from radiation to the mediastinum. (p. 589). Fibrosis would decrease contractility so it would increase CVP ->JVD.

Question 103

What is the main role of monoclonal antibodies like bevacizumab in cancer therapy?

Answer 103

They act on extracellular receptors such as EGF and VEGF, as well as small molecules that penetrate cell membranes & block intracellular signaling pathways (p. 587).

Question 104

A 65-year-old male with lung cancer is scheduled for mediastinoscopy. Which of the following is a potential intraoperative complication related to this procedure?

Answer 104

Hemorrhage and pneumothorax are the most frequently encountered side effects (slide 13)