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Special Pops II > Exam 3 > Flashcards

Exam 3 Flashcards

HIV, Immunity, MSK

1
Q

A 70-year-old patient with a hip fracture is scheduled for surgery. Which of the following factors increases their risk for deep venous thrombosis (DVT) postoperatively?

A. Use of regional anesthesia
B. Age greater than 60 years
C. Surgery lasting less than 30 minutes
D. Early mobilization post-surgery

A

Answer: B. Age greater than 60 years

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2
Q

A patient undergoing surgery for scoliosis is placed in the prone position. Which of the following is a significant concern associated with this positioning?

A. Decreased venous return
B. Risk of brachial plexus stretch injury
C. Hypothermia
D. Increased intracranial pressure

A

Answer: B. Risk of brachial plexus stretch injury

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3
Q

During a total knee arthroplasty, which regional anesthetic technique offers significant advantages for postoperative pain management and rehabilitation?

A. Single-injection femoral nerve block
B. Continuous epidural analgesia
C. General anesthesia
D. Local infiltration anesthesia

A

B. Continuous epidural analgesia

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4
Q

A patient with rheumatoid arthritis (RA) presents for elective surgery. Which preoperative evaluation is essential due to the patient’s condition?

A. Complete blood count (CBC)
B. Electrocardiogram (ECG)
C. Airway evaluation for atlantoaxial subluxation
D. Renal function tests

A

C. Airway evaluation for atlantoaxial subluxation

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5
Q

Which of the following signs during general anesthesia may indicate fat embolism syndrome in a patient?

A. Increased end-tidal CO2
B. Hypoxemia
C. Hypotension
D. Bradycardia

A

Answer: B. Hypoxemia

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6
Q

A patient with severe scoliosis is at risk for postoperative respiratory complications. What is the best predictor of perioperative respiratory reserve?

A. Forced expiratory volume (FEV1)
B. Vital capacity (VC)
C. Total lung capacity (TLC)
D. Peak expiratory flow rate (PEFR)

A

Answer: B. Vital capacity (VC)

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7
Q

Which of the following is a major cause of morbidity and mortality following orthopedic operations on the pelvis and lower extremities?

A. Fat embolism syndrome
B. Deep venous thrombosis and thromboembolism
C. Chronic pain
D. Surgical site infection

A

Answer: B. Deep venous thrombosis and thromboembolism

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8
Q

During a scoliosis surgery, the wake-up test is performed. Which of the following is the primary purpose of this test?

A. To assess the patient’s pain levels
B. To evaluate neurological function and ensure spinal cord integrity
C. To determine the effectiveness of anesthesia
D. To check for postoperative complications

A

Answer: B. To evaluate neurological function and ensure spinal cord integrity

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9
Q

What is the recommended treatment if a spinal hematoma is suspected postoperatively in a patient who received neuraxial anesthesia?

A. Immediate anticoagulation therapy
B. Close monitoring and pain management
C. Immediate decompressive laminectomy
D. Administration of corticosteroids

A

Answer: C. Immediate decompressive laminectom

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10
Q

Which of the following intraoperative monitoring techniques is used to promptly diagnose neurologic changes during scoliosis surgery?

A. Electrocardiography (ECG)
B. Somatosensory evoked potentials (SSEP)
C. Capnography
D. Pulse oximetry

A

Answer: B. Somatosensory evoked potentials (SSEP)

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11
Q

What is the primary cause of marked sensitivity to nondepolarizing muscle relaxants in myasthenia gravis patients?

A. Increased number of functional acetylcholine receptors
B. Decreased number of functional acetylcholine receptors
C. Enhanced plasma pseudocholinesterase activity
D. Increased muscle mass

A

Answer: B. Decreased number of functional acetylcholine receptors

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12
Q

Which type of muscle relaxant should have its initial dose decreased by one-half to two-thirds in myasthenia gravis patients?

A. Depolarizing muscle relaxants
B. Nondepolarizing muscle relaxants
C. Steroidal muscle relaxants
D. Anticholinesterase drugs

A

Answer: B. Nondepolarizing muscle relaxants

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13
Q

In Lambert-Eaton myasthenic syndrome (LEMS), patients are sensitive to the effects of which types of muscle relaxants?

A. Depolarizing muscle relaxants only
B. Nondepolarizing muscle relaxants only
C. Both depolarizing and nondepolarizing muscle relaxants
D. Steroidal muscle relaxants only

A

Answer: C. Both depolarizing and nondepolarizing muscle relaxants

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14
Q

Which neuromuscular blocking agent may cause a prolonged response in patients treated with anticholinesterase drugs due to impaired plasma pseudocholinesterase activity?

A. Succinylcholine
B. Vecuronium
C. Rocuronium
D. Pancuronium

A

Answer: A. Succinylcholine

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15
Q

What is the potential risk associated with the use of succinylcholine in patients with motor weakness from multiple sclerosis?

A. Decreased sensitivity to muscle relaxants
B. Exaggerated potassium release
C. Increased muscle strength
D. Enhanced plasma pseudocholinesterase activity

A

Answer: B. Exaggerated potassium release

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16
Q

In patients with Duchenne muscular dystrophy, what is the primary concern regarding the use of succinylcholine?

A. Increased sensitivity to nondepolarizing muscle relaxants
B. Exaggerated release of potassium leading to hyperkalemia
C. Resistance to neuromuscular blocking agents
D. Decreased plasma pseudocholinesterase activity

A

Answer: B. Exaggerated release of potassium leading to hyperkalemia

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17
Q

What should be considered when administering muscle relaxants to patients with myasthenic syndrome undergoing bronchoscopy or thoracoscopy?

A. Increasing the dose of muscle relaxants
B. Avoiding the use of muscle relaxants
C. Decreasing the dose of muscle relaxants
D. Using only depolarizing muscle relaxants

A

Answer: C. Decreasing the dose of muscle relaxants

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18
Q

Which factor does not alter the dose requirement for succinylcholine in myasthenia gravis patients?

A. Anticholinesterase therapy
B. Corticosteroid therapy
C. Presence of thymomas
D. Plasma pseudocholinesterase activity

A

Answer: B. Corticosteroid therapy

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19
Q

What is a potential effect of volatile anesthetics in myasthenia gravis patients undergoing surgery?

A. Increased need for muscle relaxants
B. Decreased dose requirement of muscle relaxants
C. No effect on muscle relaxant dosage
D. Enhanced pseudocholinesterase activity

A

Answer: B. Decreased dose requirement of muscle relaxants

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20
Q

What should be closely monitored in myasthenia gravis patients to avoid unrecognized persistent neuromuscular blockade?

A. Blood pressure
B. Heart rate
C. Responses at the orbicularis oculi muscle
D. Plasma cholinesterase levels

A

Answer: C. Responses at the orbicularis oculi muscle

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21
Q

What should be avoided in patients with multiple sclerosis who have motor weakness due to the risk of exaggerated potassium release?
* A) General anesthesia
* B) Spinal anesthesia
* C) Succinylcholine
* D) Epidural anesthesia

A

Answer: C) Succinylcholine

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22
Q

What is the effect of a small increase in body temperature in patients with multiple sclerosis?
* A) It alleviates symptoms
* B) It has no significant effect
* C) It causes complete block of conduction in demyelinated nerves
* D) It improves nerve conduction

A

Answer: C) It causes complete block of conduction in demyelinated nerves

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23
Q

Question: What percentage of functional acetylcholine receptors can be lost in patients with myasthenia gravis?
* A) 10%
* B) 50%
* C) 80%
* D) 100%

A

Answer: C) 80%

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24
Q

Question: Which type of myasthenia gravis is associated with muscles of respiration involvement?
* A) Type I
* B) Type IIa
* C) Type IIb
* D) Type IV

A

Answer: C) Type IIb

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25
Q

Question: Which of the following complications should be monitored in rheumatoid arthritis patients during intubation?
* A) Pulmonary embolism
* B) Cricoarytenoid arthritis
* C) Scoliosis
* D) Fat embolism syndrome

A

Answer: B) Cricoarytenoid arthritis

26
Q

Question: Which symptom is NOT typically associated with bone cement implantation syndrome?
* A) Hypoxia
* B) Pulmonary hypertension
* C) Hyperthermia
* D) Dysrhythmias

A

Answer: C) Hyperthermia

27
Q

Question: Which of the following is a major criterion for diagnosing fat embolism syndrome?
* A) Tachycardia
* B) Retinal fat emboli
* C) CNS depression disproportionate to hypoxemia
* D) Urinary fat globules

A

Answer: C) CNS depression disproportionate to hypoxemia

28
Q

Question: What is the incidence of fatal pulmonary embolism highest in?
* A) Patients undergoing knee surgery
* B) Patients undergoing hip fracture surgery
* C) Patients with rheumatoid arthritis
* D) Patients with multiple sclerosis

A

Answer: B) Patients undergoing hip fracture surgery

29
Q
  1. Which demographic is the largest population of persons infected with HIV in the United States?
    o A) Women who have sex with men
    o B) Men who have sex with men
    o C) Heterosexual women
    o D) Children born to HIV-positive mothers
A

o Answer: B) Men who have sex with men

30
Q
  1. What is the hallmark sign of HIV infection that may persist until HAART is initiated?
    o A) Severe fatigue
    o B) Night sweats
    o C) Generalized lymphadenopathy
    o D) Headache
A

o Answer: C) Generalized lymphadenopathy

31
Q
  1. Which diagnostic test is most specific and sensitive for measuring HIV viral load?
    o A) ELISA
    o B) Western blot test
    o C) PCR RNA analysis
    o D) CD4 count
A

o Answer: C) PCR RNA analysis

32
Q
  1. What percentage of HIV-positive patients have abnormal echocardiographic findings?
    o A) 10%
    o B) 25%
    o C) 50%
    o D) 75%
A

o Answer: C) 50%

33
Q
  1. What is the most common early hematologic finding in HIV infection?
    o A) Thrombocytopenia
    o B) Anemia
    o C) Leukopenia
    o D) Lymphopenia
A

o Answer: B) Anemia

34
Q
  1. A 35-year-old HIV-positive male is scheduled for surgery. His CD4 count is 45 cells/mm³, and his viral load is 35,000 copies/mL. Which of the following postoperative concerns is most relevant for this patient?
    o A) Increased risk of wound infection
    o B) Increased risk of postoperative pneumonia
    o C) Increased likelihood of cardiac complications
    o D) Prolonged neuromuscular blockade
A

o Answer: B) Increased risk of postoperative pneumonia

35
Q
  1. During a preoperative assessment of an HIV-positive patient, which test would be important to include given the patient’s potential for cardiac complications?
    o A) Chest radiograph
    o B) Echocardiography
    o C) Coagulation studies
    o D) Liver function tests
A

o Answer: B) Echocardiography

36
Q
  1. An HIV-positive patient is undergoing anesthesia, and you notice signs of autonomic neuropathy. What intraoperative management strategy could be most beneficial?
    o A) Avoiding invasive hemodynamic monitoring
    o B) Administering steroid supplementation
    o C) Increasing the dose of muscle relaxants
    o D) Reducing the depth of anesthesia
A

o Answer: B) Administering steroid supplementation

37
Q
  1. A pregnant woman with HIV is being counseled on delivery options. Which approach is recommended to reduce the risk of vertical transmission of HIV?
    o A) Vaginal delivery with HAART
    o B) Cesarean section
    o C) Vaginal delivery without HAART
    o D) Induction of labor at 37 weeks
A

o Answer: B) Cesarean section

38
Q
  1. In HIV-positive patients, which medication used in HAART is most commonly associated with adverse cardiac effects, such as premature atherosclerosis and diastolic dysfunction?
    o A) Nucleoside reverse transcriptase inhibitors (NRTIs)
    o B) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
    o C) Protease inhibitors (PIs)
    o D) Integrase inhibitors
A

o Answer: C) Protease inhibitors (PIs)

39
Q
  • Which of the following is a common neurologic complication in HIV-positive patients that can affect anesthesia management?
  • A) Cerebral aneurysms
  • B) Peripheral neuropathy
  • C) Subarachnoid hemorrhage
  • D) Epilepsy
A
  • Answer: B) Peripheral neuropathy
40
Q
  • Why might patients with HIV who are undergoing surgery require steroid supplementation?
  • A) To prevent opportunistic infections
  • B) To decrease hemodynamic instability
  • C) To enhance wound healing
  • D) To reduce viral load
A
  • Answer: B) To decrease hemodynamic instability
41
Q
  • What is the primary reason for increased pulmonary complications in HIV patients undergoing surgery?
  • A) Decreased lung compliance
  • B) Increased airway reactivity
  • C) Higher incidence of opportunistic infections
  • D) Enhanced inflammatory response
A
  • Answer: C) Higher incidence of opportunistic infections
42
Q
  • Which of the following cardiac manifestations is specifically exacerbated by the use of protease inhibitors in HIV-positive patients?
  • A) Aortic aneurysms
  • B) Diastolic dysfunction
  • C) Pericardial effusion
  • D) Pulmonary hypertension
A
  • Answer: B) Diastolic dysfunction
43
Q
  • What is the primary reason for avoiding neuraxial anesthesia in patients with AIDS who have focal neurologic lesions?
  • A) Risk of systemic infection
  • B) Increased intracranial pressure
  • C) Potential for severe hypotension
  • D) Risk of spinal cord trauma
A
  • Answer: B) Increased intracranial pressure
44
Q
  • Why is echocardiography particularly important in the preoperative evaluation of HIV-positive patients?
  • A) To assess pulmonary function
  • B) To detect potential renal complications
  • C) To evaluate for left ventricular dilatation and cardiac dysfunction
  • D) To screen for opportunistic infections
A
  • Answer: C) To evaluate for left ventricular dilatation and cardiac dysfunction
45
Q
  • What hematologic complication is commonly observed early in HIV infection and may impact anesthesia management?
  • A) Leukocytosis
  • B) Polycythemia
  • C) Anemia
  • D) Thrombocytosis
A
  • Answer: C) Anemia
46
Q
  • In HIV-positive patients, which factor is a significant predictor of increased postoperative mortality?
  • A) CD4+ cell count < 50 cells/mm³
  • B) Elevated liver enzymes
  • C) Increased BMI
  • D) High hemoglobin levels
A
  • Answer: A) CD4+ cell count < 50 cells/mm³
47
Q
  • Which anesthetic consideration is critical due to the high affinity of HIV for myocardial cells?
  • A) Avoidance of muscle relaxants
  • B) Monitoring for signs of myocardial infarction
  • C) Close monitoring for left ventricular dysfunction
  • D) Minimizing fluid administration
A
  • Answer: C) Close monitoring for left ventricular dysfunction
48
Q
  • Why might invasive hemodynamic monitoring be particularly useful in HIV-positive patients with severe autonomic dysfunction during anesthesia?
  • A) To ensure accurate dosing of neuromuscular blockers
  • B) To manage fluid balance precisely
  • C) To monitor and manage potential hemodynamic instability
  • D) To measure intracranial pressure
A
  • Answer: C) To monitor and manage potential hemodynamic instability
49
Q

What is myasthenia gravis?

A

Chronic autoimmune disorder caused by a decrease in functional acetylcholine receptors at the
NMJ

50
Q

What is the cause(s) of myasthenia gravis?

A

destruction or inactivation by circulating antibodies

51
Q

Myasthenia gravis most often affects what patient population?

A

Thymic hyperplasia (60%)
Thymoma (10%)

52
Q

What cardiac abnormalities may be associated with myasthenia gravis?(4)

A

Myocarditis, Afib, heart block, cardiomyopathy

53
Q

What are the principal treatment options for myasthenia gravis?

A

• Anticholinesterase drugs first line
treatment (Pyridostigmine)
• Thymectomy (Mediastinoscopy ➡️ Induces remission)
• Immunosuppression (Last resort can cause infection)

54
Q

What are the indications for plasmapheresis in patients with myasthenia gravis?

A

vital capacity > 2L

55
Q

What preoperative findings correlate with the need for postoperative mechanical ventilation in patients with myasthenia gravis undergoing thymectomy?

A

(1) disease duration longer than 6 years, (2) presence of COPD unrelated to myasthenia gravis, (3) a daily dose of pyridostigmine of more than 750 mg, and (4) vital capacity less than 2.9 L

56
Q

What are the possible interactions with anesthesia drugs in patients with myasthenia gravis who are taking anticholinesterase medications?

A

Anticholinesterase drugs inhibit not only true cholinesterase but also impair plasma pseudocholinesterase activity, which introduces the possibility of a prolonged response to succinylcholine

57
Q

If succinylcholine is required in the management of a patient with myasthenia gravis, what pharmacologic response can you expect to see?

A

Prolonged response

58
Q

How do patients with myasthenia gravis respond to nondepolarizing muscle relaxants?

A

Marked sensitivity to nondepolarizing
muscle relaxants due to decrease number of functional Ach receptors
• Initial dose of NMB should be titrated according to response at the NMJ as monitored with a peripheral nerve stimulator

59
Q

What antibiotic class is associated with an aggravation of muscle weakness when administered to patients with myasthenia gravis?

A

Cyclosporine

60
Q

Myasthenia gravis response to NMBDs in summation

A
  1. Sensitive to non-depolarizing NMBDs (0.1-0.2 times usual dose)
  2. Resistant to depolarizing NMBDs
  3. Unpredictable response to reversals
61
Q

What other diseases and conditions have an increased risk of occurrence in patients with myasthenia gravis?

A

RA, SLE and pernicious anemia is
common with these patients

Hyperthyroidism in 10% of patients

62
Q

What muscles are especially vulnerable to the effects of myasthenia gravis?

A

Extraocular Muscles
Muscles of respiration

• Pitosis & diplopia
• Dysphagia, dysarthria & difficulty
handling saliva
• High risk for pulmonary aspiration

Special Pops II (6 decks)

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