Exam 3 questions Flashcards
1
Q
A 58-year-old male with undiagnosed OSA is scheduled for a laparoscopic cholecystectomy under general anesthesia. Which volatile anesthetic is most likely to minimize the risk of postoperative respiratory complications in this patient?
A
Sevoflurane (As per Dr. Palmer)
2
Q
You are managing a patient with severe OSA and morbid obesity undergoing general anesthesia. What is the primary risk of using nitrous oxide in this patient?
A
Atelectasis -> respiratory failure (As per Dr. Palmer)
3
Q
A patient with OSA requires general anesthesia for bariatric surgery. During the maintenance of anesthesia, which agent is most likely to exacerbate hypoventilation?
A
“The suppressant effects of anesthetics, sedatives, & analgesics on airway patency, respiratory drive, and arousal” (P. 11)
4
Q
A 65-year-old patient with a history of COPD and OSA is undergoing surgery under general anesthesia. Which volatile anesthetic would you avoid to minimize airway irritation and desaturation during emergence?
A
Desflurane p.27
5
Q
In patients with OSA, the use of volatile anesthetics often contributes to postoperative respiratory depression. Which factor makes Sevoflurane more suitable for these patients?
A
Rapidly eliminated (p. 27- although talking about COPD here, it still says Sevo is rapidly eliminated).
6
Q
A patient with severe OSA is scheduled for surgery. Which opioid-sparing strategy is most appropriate to minimize the risk of postoperative respiratory complications?
A
Multimodal pain approach- Consider regional first. Use non-opioid pain options like NSAIDs, Tylenol, Tramadol, Ketamine, Gabapentin (Table 1.5 on P. 13)
7
Q
In an OSA patient undergoing major abdominal surgery, which opioid administration strategy poses the highest risk of postoperative ventilatory impairment?
A
Opioids and Sedatives given together have a synergistic effect of decreasing respiratory drive. (Slide 3 & 7)
8
Q
A patient with OSA is receiving general anesthesia. Which factor increases the risk of opioid-induced respiratory depression in the postoperative period?
A
Not wearing CPAP, combining opioids + sedatives- synergistic effect, not properly monitoring in PACU. (slide 7 & p. 14) ? weird question.
9
Q
In a patient with both OSA and chronic opioid use, what is the primary mechanism by which opioids worsen sleep apnea?
A
Opioids shift CO2 response curve to the right. This increases CO2 threshold to breathing worsening sleep apnea. There is lag in sensation to altered CO2. The brainstem respiratory center has a decreased responsiveness to CO2. (Slide 10)
10
Q
After an uneventful surgery, an OSA patient develops significant postoperative hypoxemia while on intravenous hydromorphone PCA. What is the most appropriate immediate intervention?
A
Stop PCA pump. Apply oxygen and assist ventilation if needed. Apply CPAP/BiPap. Administer Narcan if no resolution. (Common sense. Not in book or PPT).
11
Q
A 45-year-old obese male with a history of hypertension presents for a preoperative assessment. He reports loud snoring and daytime sleepiness. Using the STOP-Bang questionnaire, which factor would not increase his risk for OSA?
A
Age less than 50 (slide 4).
12
Q
A patient with untreated OSA is undergoing surgery. What is the most appropriate action regarding his CPAP use postoperatively?
A
CPAP/BiPap use should be protocol even if they are alert and oriented. It cuts back on delayed PACU time. (slide 8)
13
Q
Which of the following statements is true regarding the pathophysiology of OSA?
A
“Pathogenesis of OSA include (1) anatomic and functional upper airway obstruction, (2) a decreased respiratory-related arousal response, and (3) instability of the ventilatory response to chemical stimuli.
The respiratory-related arousal response is stimulated by (1) hypercapnia, (2) hypoxia, (3) upper airway obstruction, and (4) the work of breathing, which is the most reliable stimulator of arousal.” (Ch 1, p. 4-5).
Intermittent hypoxia → SNS stimulation, inflammation, and oxidative stress → HTN → Arrhythmia (A fib most common), CAD & HF (slide 6)
14
Q
A 35-year-old woman with OSA is about to undergo surgery. Which intraoperative strategy minimizes her risk of respiratory complications?
A
Minimize sedative hypnotics and use opioid sparing techniques. Encourage regional. Use continuous capnography in all cases and use CPAP during MAC cases. (Slide 8).
15
Q
Which patient is most likely to benefit from a tonsillectomy and adenoidectomy for OSA?
A
Pediatric patient with OSA from adenotonsillar hypertrophy (slide 9)
16
Q
What is the role of EEG arousal in the resolution of apnea episodes in OSA?
A
The respiratory-related arousal response is stimulated by (1) hypercapnia, (2) hypoxia, (3) upper airway obstruction, and (4) the work of breathing, which is the most reliable stimulator of arousal.” (Ch 1, p. 5).
17
Q
A patient with severe OSA has an apnea-hypopnea index (AHI) of 45. How would you categorize the severity of his OSA?
A
Severe (Slide 4)
18
Q
In pediatric OSA, what is the primary cause of upper airway obstruction?
A
Adenotonsillar Hypertrophy (Slide 9)
19
Q
In patients with OSA, which of the following cardiovascular consequences is most commonly associated with the condition?
A
A fib (Slide 6)
20
Q
What is the recommended method for diagnosing OSA in adults?
A
Polysomnography (PSG) and Home Sleep Apnea Testing (slide 4)
21
Q
Which is the primary difference between OSA and central sleep apnea (CSA)?
A
OSA has a respiratory effort being blocked by an obstruction, whereas CSA has no respiratory effort due to brain’s failure to signal the respiratory muscles (slide 10).
22
Q
A 65-year-old man with heart failure presents with Cheyne-Stokes breathing. Which treatment is most likely to improve his condition?
A
CPAP + nocturnal O2. Meds: Theophylline or Acetazolamide. (pg.11)
23
Q
Which of the following conditions is most commonly associated with central sleep apnea due to high-altitude periodic breathing?
A
Altitude Sickness (slide 11)
24
Q
A patient with long-term opioid use develops central sleep apnea. What is the underlying mechanism of opioid-induced CSA?
A
Opioids shift CO2 response curve to the right. This increases CO2 threshold to breathing worsening sleep apnea. There is lag in sensation to altered CO2. The brainstem respiratory center has a decreased responsiveness to CO2. (Slide 10)
25
What is the recommended approach for managing primary idiopathic central sleep apnea?
CPAP at night (per Palmer on slide 10)
26
In a 5-year-old child with OSA, which clinical symptom is most commonly observed?
Hyperactivity, ADHD & behavior changes. Slide 9
27
A 6-year-old child with severe OSA is scheduled for surgery. What is the most appropriate perioperative management strategy?
Management is the same as adults with OSA. PPV + Nasal steroids. Slide 9
28
A child with OSA presents for preoperative evaluation. What finding is most likely to increase his risk for perioperative respiratory complications?
Obesity, STOP BANG > 3, Use of CPAP/BiPAP
29
A 4-year-old child with severe OSA is scheduled for tonsillectomy. Which postoperative complication is most common in pediatric patients with OSA?
Tonsillectomy should cure the OSA…. But, apnea, upper airway obstruction, hypoventilation, oxygen desaturation, respiratory depression (went to Peds book).
30
Which factor is most important in determining the need for postoperative monitoring in children with OSA after surgery?
Severity of OSA (GOOGLE, couldn’t find in book or PPT)
Pre op lowest O2 saturation
31
A 55-year-old male with obesity hypoventilation syndrome (OHS) presents for surgery. Which of the following best explains the pathophysiology of OHS?
Hypoventilation during wakefulness with daytime CO2 > 45, which worsens in the supine position and during sleep.
Clinical features of OHS include:
(1) marked obesity,
(2) somnolence,
(3) twitching,
(4) cyanosis,
(5) periodic respiration,
(6) secondary polycythemia,
(7) right ventricular hypertrophy, and
(8) right ventricular fail- ure/cor pulmonale. (pg. 6)
32
What is the most common comorbidity associated with obesity hypoventilation syndrome (OHS)?
OSA pg 7
33
In a patient with sleep-related hypoxemia, what is the hallmark finding on overnight pulse oximetry?
5 minutes of a sleep-related decrease in oxygen saturation to less than 88% with or without hypoventilation. (p. 9)
34
A 45-year-old man with chronic opioid use presents with symptoms of central sleep apnea. Which treatment is most appropriate for his opioid-induced central sleep apnea?
CPAP + Nocturnal O2
35
What diagnostic criteria distinguish sleep-related hypoventilation disorders from other sleep-related breathing disorders?
PSG will demonstrate significant increases in Pco2 during both wakefulness and sleep (p.9)
36
Which form of positive airway pressure (PAP) therapy is most appropriate for managing sleep-related hypoventilation disorders in patients with neuromuscular disease?
NIPPV in one of these three modes: Spontaneous, spontaneous timed, timed modes. (p. 11)
37
A 60-year-old patient with sleep-related hypoventilation presents with chronic hypercapnia. What adjunctive medication may be beneficial for his condition?
Modafinil (p. 11)
38
A patient with sleep-related hypoxemia presents with chronic obstructive pulmonary disease (COPD). What is the most appropriate treatment for his nocturnal hypoxemia?
Nocturnal O2 therapy?
39
Which of the following is a primary treatment goal for congenital central alveolar hypoventilation syndrome (CCAHS)?
It is a form of primary sleep related hypoventilation disorder so NIPPV in one of these three modes: Spontaneous, spontaneous timed, timed modes. (p. 11)
40
What is the primary mechanism leading to hypoventilation in obesity hypoventilation syndrome (OHS)?
Hypoventilation during wakefulness due to obesity pushing up on diaphragm ->progressive desensitization of the respiratory center to nocturnal hypercarbia. (p. 391)
41
A 50-year-old patient with a history of severe OSA presents for elective surgery. Which of the following is the most appropriate anesthesia plan to minimize the risk of postoperative respiratory complications?
Be prepared for difficult airway. Ramp up 30 degrees on induction. Use home CPAP in PACU. Minimize narcotics/sedatives by using a regional approach. Utilize continuous capnography. (slide 8)
42
Which of the following patients is at the highest risk for perioperative complications due to OSA?
(1) increased risk of upper airway obstruction and respiratory depression due to effects of sedative, anesthetic, and narcotic medications;
(2) decreased functional residual capacity (FRC) and decreased oxygen reserve due to obesity; and
(3) the cardiopulmonary effects of OSA- CV disease. (p. 12)
43
A patient with sleep-related hypoventilation is undergoing surgery. Which intraoperative strategy would most effectively mitigate the risk of hypercapnia and hypoxemia postoperatively?
Minimize sedatives and opioids or use short acting ones. Perform Regional. Monitor EtCO2. Extubate fully awake(slide 8)
44
What perioperative risk does the use of sedatives and opioids most significantly increase in patients with OSA?
Decreased respiratory drive (slide 3).
45
A patient with untreated OSA presents for knee replacement surgery. Which postoperative complication is the patient at greatest risk for?
Hypoventilation due to airway obstruction
46
During a preoperative evaluation, a 60-year-old patient is found to have undiagnosed OSA. Which screening tool is most appropriate to assess the likelihood of OSA in this patient?
STOP-BANG (slide 4)
47
In a patient with obesity hypoventilation syndrome (OHS), what is the primary therapeutic goal of perioperative management?
maintain adequate ventilation and prevent respiratory complications by utilizing positive airway pressure (PAP) therapy
48
A patient with central sleep apnea (CSA) is undergoing surgery. What is the most appropriate mode of postoperative respiratory support?
CPAP (P. 12)
49
Which strategy is most effective in reducing perioperative risks in patients with moderate-to-severe OSA undergoing ambulatory surgery?
Nonopioid strategy with CPAP use postop (p. 12)
50
Which hormone is most directly responsible for increasing blood glucose levels by reducing cellular insulin sensitivity?
Cortisol via Glucagon plays a primary role by stimulating glycogenolysis and gluconeogenesis and inhibiting glycolysis (p 449)
Also growth hormone
51
In the management of pheochromocytoma, which step is crucial before beta-blockade to avoid a hypertensive crisis?
Alpha blockade (slide 66) alpha blockade appears to protect myocardial performance and tissue oxygenation from the adverse effects of catecholamines ( p 465) blockade of B2 receptors results in unopposed alpha agonism leading to vasoconstriction and hypertensive crises (p 465)
52
Which symptom is most indicative of TURP syndrome in a patient undergoing transurethral resection of the prostate?
Confusion, agitation, visual disturbances, pulm edema, cardiovascular collapse, and seizures (pg 447) ** not directly stated that its the first sign but remember rice saying neuro was first presentation, take that as you will**
* CNS: Restlessness, headache, nausea, seizures, confusion, coma (from hyponatremia and cerebral edema).
* Cardiovascular: Hypertension, bradycardia, arrhythmias, pulmonary edema.
* Respiratory: Dyspnea, hypoxia.
* GI: Nausea, vomiting (can result from fluid shifts or glycine toxicity).
53
A patient with hypothyroidism undergoing surgery may be at increased risk for which anesthesia-related complication?
¨Myocardial function and baroreceptor function may be depressed
¨Plasma volume may be reduced
¨Hepatic metabolism and renal clearance of drugs may be slower prolonging their effect
¨MAC is NOT decreased (ppt 90)
¨Increased risk of aspiration due to slower GI emptying
¨Respiratory depression following opioid administration may be increased
¨Hypotension and myocardial depression with inhalational agents may be increased
¨Pt may be sensitive to non-depolarizers if they are experiencing muscle weakness
¨Supplemental perioperative cortisol may be necessary as there is the potential for adrenal insufficiency with stress (ppt 92)
¨Myxedema coma – end stage of untreated hypothyroidism
- This can be precipitated by surgery
- usually in the elderly pt with severe
hypothyroidism
- medical emergency – surgery only if
Lifesaving! (ppt 93)
54
Which of the following is a common complication in acromegalic patients that may complicate airway management?
Mask fit may be difficult, macroglossia and tissue overgrowth in upper airway, DL difficult from large tongue and teeth, may need smaller ETT due to vocal cord enlargement/subglottic narrowing (ppt 24)
55
In a patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone), which fluid imbalance is most likely to occur?
Hyponatremia from water intoxication (ppt 30)
56
When managing a patient with diabetes insipidus under anesthesia, what is a primary concern?
Hypernatremia and hypovolemia can be severe and life-threatening; frequent monitoring of serum Na and plasma osmolality required; continuous urine output monitoring and hourly Na and osmolality (goal less than 290 mOsm/L; can give preop desmopressin IV bolus 0.1 unit then infusion of 100-200mU/h (0.1-0.2 units/h) (pp 473-474)
57
Excessive secretion of growth hormone in adults can lead to which condition that poses anesthesia challenges?
Acromegaly (secretion after adolescence) and gigantism (secretion before adolescence) = macroglossia, enlarged epiglottis, subglottic narrowing, OSA, enlarged chest wall, LVH, HTN, and arrhythmias, cariomyopathy, skeletal muscle weakness, difficult mask fir, smaller ETT, vocal cord enlargement/subglottic narrowing (ppt 8, 22,24)
58
What is the primary anesthetic concern in a patient with Addison’s disease?
Hemodynamic instability and unresponsive to therapeutic interventions; replace glucocorticoids, fluid replacement and monitor for Na deficits; 100mg hydrocortisone followed by 10mg/h infusion; 100mg hydrocortisone q6 hrs is also acceptable; avoid etomidate (pg 469-470) (ppt 65)
59
Which hormone imbalance is typically observed in Cushing’s syndrome and may affect blood pressure during anesthesia?
Excess/ chronic exposure to glucocorticoids caused by superphysiological doses for arthritis, asthma, autoimmune, allergies etc, or anterior pituitary tumor (ppt 63) (pg 467-468)
60
Which is the preferred initial treatment for acute adrenal insufficiency during surgery?
IV hydrocortisone, methylprednisone, or dexamethasone bolus 100mg then continuous infusion of 10mg/hr; avoid etomidate due to inhibition of cortisol synthesis; minimal doses of anesthetic gases and drugs recommended due to myocardial depression and skeletal muscle weakness (pg 470)
Treatment – replace glucocorticoid and mineralocorticoid deficiency (prednisone or hydrocortisone) (ppt 65)
61
Why is rapid sequence induction recommended for diabetic patients with gastroparesis?
Increases risk of aspiration despite NPO status (ppt 46) (pg 456) caused by autonomic neuropathy
62
In the management of hyperthyroidism, what is the primary purpose of administering beta-blockers preoperatively?
Relieve signs and symptoms of increased adrenergic activity such as anxiety, sweating, heat intolerance, tremors and tachycardia (pg460) decrease SNS response (ppt 85)
63
What is the anesthetic concern when a patient has chronic hypercalcemia, as seen in hyperparathyroidism?
Calcifications may be on many organs leading to dysfunction (ex: pancreas, kidney, heart-conduction issues), pt may be dehydrated from N/V, pts may be lethargic, confused so avoid preop sedative, PT SENSITIVE TO NMR (ppt 101-103)
Unpredictable responses to NMB due to hypercalcemia, careful positioning to prevent bone injuries, (pg 471)
64
During surgery for a patient with SIADH, fluid management is critical to prevent which complication?
Central pontine myolysis (ppt 32)
65
In patients with hypothyroidism, which anesthetic consideration is most important due to their decreased metabolic rate?
Decreased gastric emptying increases aspiration risk; hypodynamic CV system with decreased CO, SV, HR, baroreceptor reflex and intravascular volume; hypothermia occurs quickly and hard to treat; can be extremely sensitive to narcotics and sedatives= increased resp depression after admin, increased sensitivity to anesthesia drugs (MAC NOT DECREASED), slower clearance of anesthesia drugs prolonging their effect, difficult airway due to enlarged thyroid, large tongue and myxedematous infiltration of vocal cords, may be sensitive to NDNMB if experiencing muscle weakness, more hypotension and cardiac depression with inhalation agents, decreased beta receptors so response to inotropic is altered(ppt 90-93) pg 461
66
Which of the following symptoms is a classic sign of pheochromocytoma?
Headache, sweating, pallor and palpitations are classic signs, orthostatic hypotension is also common (pg 464
67
Why might an acromegalic patient require a smaller endotracheal tube than expected for their body size?
Overgrowth of soft tissues of the upper airway (enlargement of the tongue and epiglottis), abnormal movement of the vocal cords or paralysis of recurrent laryngeal nerve from stretching caused by overgrowth of cartilaginous structures (pg 472)
¨may require smaller ETT due to vocal cord enlargement/subglottic narrowing (ppt 24)
68
A patient with Cushing’s syndrome is undergoing surgery. Which potential complication should be monitored closely?
Fluid and elecytrolyte imbalance, careful with skin and positioning (osteopenic), increased risk of infection, SKELETAL MUSCLE WEAKNESS so conservative with muscle relaxants, HIGH RISK FOR THROMBOEMBOLI due to obesity, HTN, high hct, and high factor 13 levels (ppt 64)
Perioperative management of HTN, hyperglycemia, fluid volume (usually elevated) and electrolytes (hypokalemia is common), delayed would healing due to increased glucocorticoid levels (pg 468)
69
Which symptom may suggest the onset of TURP syndrome in a patient during surgery?
Confusion, agitation, visual disturbances, pulm edema, cardiovascular collapse, and seizures (pg 447)
70
Which electrolyte imbalance is a primary concern in patients with diabetes insipidus undergoing surgery?
Urine osmolality under 300 mOsm/L (normal is 500-800 mOsm/L) and hypernatremia (ppt 27)
71
In patients with hyperthyroidism, why is it critical to avoid medications that stimulate the sympathetic nervous system?
To prevent triggering thyroid storm (extreme anxiety, fever, tachycardia, CV instability, and altered LOC) (pg 461) (ppt 86-88)
72
Why should hypothermia be avoided in patients with hypothyroidism during surgery?
To prevent triggering a myxedema coma; infection, trauma, cold, and CNS depressants predispose patients to myxedema coma; myxedema coma is rare severe form of hypothyroidism presents with delirium/unconciousness, hypoventilation, hypothermia (80% of pts), bradycardia, hypotension, and severe dilutional hyponatremia (pg 463)
73
Which of the following symptoms is most commonly associated with SIADH?
Nausea, weakness, lethargy, confusion, depressed mental status, and seizures (pg 474) weight gain, anorexia, NO peripheral edema, N/V, irritability, confusion, hallucinations, seizures (Na <125) ( ppt 30)
74
In patients with chronic acromegaly, which anatomical change is most likely to complicate airway management?
Distorted facial anatomy masking difficult mask, enlarged tongue and epiglottis predisposes to upper airway obstruction and interferes with visualizing vocal cords, glottic opening narrowed due to enlarged vocal cords= smaller ETT (pg 473)
75
A patient with hyperparathyroidism is undergoing surgery. Which electrolyte imbalance is likely and requires monitoring?
Hypercalcemia and monitor calcium/PTH levels (ppt 100)
76
During anesthesia, which intervention is essential for a patient with Cushing’s syndrome to manage elevated cortisol levels?
Periop managment of HTN, hyperglycemia, elevated intravascular fluid volume, and electrolytes is extremely important (pg 468). Also caution muscle relaxants if skeletal muscle weakness present, careful positioning (osteopenia), and high risk for thromboemboli (ppt 64)
77
What is the primary concern with hypothyroid patients in terms of drug metabolism during anesthesia?
Hepatic metabolism and renal clearance of drugs are slower, can prolong the effects of drugs (ppt 90)
78
Which symptom is characteristic of hyperthyroidism and relevant to anesthetic management?
Hypermetabolic state: pt is anxious, restless, hyperkinetic, and emotionally unstable, warm moist skin, flushed face, increased sweating/ heat intolerance, WASTING, WEAKNESS, FATIGUE OF PROXIMAL LIMB MUSCLES ARE COMMON, increased CV work with tachycardia, dysrhythmias, increased CO, palpitations, increased contractility, cardiomegaly, overall increased SNS response (pg 460)
79
For a patient with Addison’s disease, the risk of which perioperative complication is highest without proper steroid coverage?
Unable to mount stress response and need stress dose steroid admin??? Pt will be hemodynamically unstable and may need vasopressors; senstive to myocardial depreesion and skeletal muscle weakness frequently seen in these patients (pg 470)
80
What is the primary reason for using beta-blockers preoperatively in patients with hyperthyroidism?
Decrease sympathetic response and prevent thyroid storm (pg 460)
81
In a patient with pheochromocytoma, why is it essential to begin alpha-blockade before beta-blockade?
Alpha blockade (slide 66) alpha blockade appears to protect myocardial performance and tissue oxygenation from the adverse effects of catecholamines ( p 465) blockade of B2 receptors results in unopposed alpha agonism leading to vasoconstriction and hypertensive crises (p 465)
82
TURP syndrome is often characterized by which primary electrolyte disturbance?
Hyponatremia and hyperammonemia (from glycine) (ppt 16)
83
Why should hyperthermia be avoided in patients with hyperthyroidism during surgery?
To prevent increased HR and SNS respone that could trigger thyroid storm (pg 461)
84
In managing SIADH, what is a key goal during the perioperative period?
Managing fluid volume and correcting Na levels to prevent acute loss of brain water and possible permanent neurological damage (ppt 32)
85
Which symptom of Addison’s disease would most concern an anesthesia provider during surgery?
Hemodynamic instability that is unresponsive to usual therapeutic interventions that shows the patient needs repletion of circulating glucocorticoids (pg 469-470)
86
Why is careful positioning critical in patients with acromegaly undergoing anesthesia?
Peripheral neuropathy is common and likely reflects trapping of nerves by skeletal, connective and soft tissue overgrowth which could lead to nerve injuries with position; half of these patients have inadequate collateral blood flow throught their ulnar artery to one or both hands (pg 473)
87
Which anesthetic consideration is relevant for diabetic patients with autonomic neuropathy?
pt may have abnormal HR, central and peripheral vascular dynamics. HR fails to respond to exercise is indicative. May have systolic and diastolic dysfunction with reduced EF, dysrhythmias may cause sudden cardiac death. ALSO IMPAIRS GASTRIC MOTILITY CAUSING GASTROPARESIS WHICH INCREASES RISK OF ASPIRATION (pg. 456)
88
In a patient with chronic hypercalcemia, which symptom is most concerning for anesthesia providers?
Profound muscle weakness, bradyarrhythmias, BBB, and heart block, (ppt 101) and unpredicatable response to NMB (pg 471)
89
During surgery, why must patients with SIADH have fluid intake carefully monitored?
Assess fluid status and fluid restriction to prevent severe hyponatremia and central pontine myolysis (pp 32)
Cautious fluid resuscitation with NS recommended, frequent urine osmolality and serum Na necessary (pg 474)
90
A patient in the ICU presents with rapid-onset confusion, muscle twitching, and a serum sodium of 118 mEq/L. What is the primary intervention?
Severe hyponatremia (book says less <115) may require 3% hypertonic saline or normal saline with furosemide. Rate of correction should be 0.5mEq/L/h until Na is 125 mEq/L, then proceed more slowly to prevent central pontine myelinolysis and brain damage (pg 474)
91
What is the most reliable measure of glomerular filtration rate (GFR)?
Creatinine Clearance-endogenous marker of renal filtration produced at a relatively constant rate by hepatic conversion of skeletal muscle creatinine. Freely filtered by the kidney and not reabsorbed. Most reliable measure of GFR. (PPT 3)
92
Which factor can increase Blood Urea Nitrogen (BUN) levels even if GFR is normal?
Dietary intake (high protein diet),
co-existing disease,
fluid volume (dehydration),
GI bleed,
increased catabolism during febrile illness (ppt 5)
93
What condition is suggested by proteinuria that persists and doesn’t resolve with rest?
Significant renal disease (ppt 7)
94
Which electrolyte imbalance can occur due to poor potassium excretion in chronic kidney disease?
Hyperkalemia (ppt slide 15)
95
In myasthenia gravis, what happens at the neuromuscular junction?
DOWN regulation of post junctional nicotinic acetylcholine receptors at the NMJ (ppt slide 22)
Autoimmune disease in which IgG antibodies destroy post-junctional, nicotinic, acetylcholine receptors at the NMJ.
96
Which medication is avoided in patients with myasthenia gravis due to their sensitivity?
Increased sensitivity to NDNMB and a resistance to succs (ppt 23)
97
What syndrome is associated with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia?
Scleroderma (ppt 26) Book 513
Crest syndrome
98
Which autoimmune disorder is most often drug-induced by medications like procainamide or hydralazine?
Systemic Lupus Erythematosus (SLE) (ppt 31)
99
What is the leading cause of end-stage renal disease (ESRD) in the United States?
Diabetes followed by HTN (ppt 13)
100
Which procedure complication is associated with large-volume fluid absorption leading to electrolyte imbalances, particularly hyponatremia?
TURP p 447
101
In the case of acute kidney injury, which symptom would indicate advanced fluid overload?
Generalized malaise, dyspnea, edema, and hypertension (ppt slide 10)
102
In chronic kidney disease, what is a common cause of anemia?
Decreased erythropoietin production leads to a normochromic normocytic anemia (ppt 14)
103
Which electrolyte should be closely monitored in patients undergoing dialysis?
Potassium watch for Hyperkalemia (ppt 15)
104
Which autoimmune disorder commonly presents with a malar “butterfly” rash?
Systemic Lupus Erythematosus ( ppt 31)
105
What treatment is commonly given to scleroderma patients to control hypertension?
ACE inhibitors, will control HTN and improve impaired renal fucntion that accompanies HTN (book 513)
106
Which syndrome increases the risk for spontaneous pneumothorax due to a connective tissue disorder?
Marfan Syndrome (ppt 36)
107
Which electrolyte imbalance can occur with the use of succinylcholine in Duchenne’s muscular dystrophy?
Hyperkalemia (ppt 44)
108
What complication is commonly seen with muscular dystrophy affecting the respiratory system?
Chronic weakness of respiratory muscles and decreased ability to cough results in loss of pulmonary reserve and accumulation of secretions predisposing this patient to pneumonia (ppt 43)
109
What abnormality is frequently seen in Duchenne’s muscular dystrophy affecting the heart?
Degeneration of cardiac muscle,
reduced contractility,
cardiomyopathy,
CHF, JVD, S3/S4 gallop,
displacement of PMI,
EKG changes,
resting tachycardia,
short PR interval,
increased R-wave amplitude in V 1/ deep Q waves in limb leads,
mitral regurg d/t papillary muscle dysfunction (ppt 43)
110
Which electrolyte should be closely monitored in patients undergoing dialysis?
Potassium (ppt 15)
111
In Guillain-Barre Syndrome, what is primarily attacked, leading to muscle weakness?
Assault on myelin in the peripheral nerves, action potential cannot be conducted so the motor endplate never receives the incoming signal (ppt 38)
112
Which electrolyte imbalance can occur with the use of succinylcholine in Duchenne’s muscular dystrophy?
Hyperkalemia (ppt 44)
113
Which antibody is present in nearly all patients with systemic lupus erythematosus (SLE)?
Antinuclear antibodies in over 95% of SLE patients (book 529)
114
Which test is most indicative of hydration status in renal patients?
BUN: Creatinine ratio; ratio of these substances in the blood help to evaluate state of hydration (ppt 5)
115
Why are patients with Eaton-Lambert syndrome at increased risk during anesthesia?
This disease is called Myasthenic Syndrome in the book;
Increased sensitivity to neuromuscular blockers ( both depolarizing and non-depolarizing) which can lead to prolonged muscle weakness and respiratory failure (pg 524, also read an NIH article)
116
Which disease is associated with both cardiac and pulmonary complications, including restrictive lung disease?
Broad question but im thinking scleroderma- book talks about coronary fibrosis and pulm HTN (p. 513) ppt slide 28 says resp complications are major cause of morbidity and mortality
117
What is the primary issue in Marfan syndrome that increases cardiac risk?
¨Connective tissue disorder associated with an elevated risk of aortic dissection, MVP, mitral regurgitation, and aortic insufficiency
¨Dissection of the ascending aorta can extend into the pericardium and increase the risk of cardiac tamponade
¨Beck’s triad – JVD, hypotension, muffled heart tones (ppt 36)
Defective connective tissue (book 515)
118
Which autoimmune disease is characterized by polyarthritis and articular involvement without spinal involvement?
Systemic Lupus Erythematosus (ppt 31-34)
119
What is the risk of using volatile anesthetics in patients with muscular dystrophy?
MH!
Book says dont use succs bc risk of rhabdo, hyperkalemia, and/or cardiac arrest; rhabdo with/without cardiac arrest associated with use of volatiles even in absence of succs; increased incidence of MH; delayed pulm dysfucntion up to 36hrs post op even though skeletal muscle strength has returned to preop level (p 517)
120
Which disease involves inflammation and potential fibrosis of small coronary arteries?
Scleroderma ( ppt 26-28) book 513
121
In a patient with Guillain-Barre Syndrome, which complication is common?
Abnormal ANS function= hypotension, can have exaggerated responses to vasopressors and intubation causing HTN; no succs in these pts bc excessive calcium release and resp failure is common requiring intubation (pg 322)
122
In Duchenne’s muscular dystrophy, which heart complication is commonly seen?
Degeneration of cardiac muscle, reduced contractility, cardiomyopathy, CHF, JVD, S3/S4 gallop, displacement of PMI, EKG changes, resting tachycardia, short PR interval, increased R-wave amplitude in V 1/ deep Q waves in limb leads, mitral regurg d/t papillary muscle dysfunction (ppt 43)
