Exam 3 Flashcards
HIV, Immunity, MSK
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
Answer: B. Age greater than 60 years
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
Answer: B. Risk of brachial plexus stretch injury
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
B. Continuous epidural analgesia
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
C. Airway evaluation for atlantoaxial subluxation
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
Answer: B. Hypoxemia
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)
Answer: B. Vital capacity (VC)
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
Answer: B. Deep venous thrombosis and thromboembolism
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
Answer: B. To evaluate neurological function and ensure spinal cord integrity
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
Answer: C. Immediate decompressive laminectom
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
Answer: B. Somatosensory evoked potentials (SSEP)
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
Answer: B. Decreased number of functional acetylcholine receptors
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
Answer: B. Nondepolarizing muscle relaxants
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
Answer: C. Both depolarizing and nondepolarizing muscle relaxants
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
Answer: A. Succinylcholine
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
Answer: B. Exaggerated potassium release
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
Answer: B. Exaggerated release of potassium leading to hyperkalemia
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
Answer: C. Decreasing the dose of muscle relaxants
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
Answer: B. Corticosteroid therapy
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
Answer: B. Decreased dose requirement of muscle relaxants
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
Answer: C. Responses at the orbicularis oculi muscle
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
Answer: C) Succinylcholine
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
Answer: C) It causes complete block of conduction in demyelinated nerves
Question: What percentage of functional acetylcholine receptors can be lost in patients with myasthenia gravis?
* A) 10%
* B) 50%
* C) 80%
* D) 100%
Answer: C) 80%
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
Answer: C) Type IIb