EXAM OPTIONAL Flashcards
The hemodynamic changes that should be avoided in the patient with mitral valve regurgitation include
bradycardia
Indicate the changes that occur when the thoracic aorta is cross-clamped during repair of an aortic aneurysm? Afterload PCWP CO HR
B Afterload Increased PCWP Increased CO Decreased HR Decreased
GeneraL anesthesia with nitrous oxide and fentanyl was used for hernia repair. Postoperatively, the patient develops truncal rigidity. Oxygen saturation falls to 45%. ‘What should be done?
Give succinylcholine (paralysis / intubation best treatment)
The patient with Eaton-Lambert syndrome responds to muscle relaxants in what way?
Increased sensitivity to both depolarizing to non-depolarizing muscle relaxants. Defect of decreased Ach release affect pre-synaptic neurons. MG affects post synaptic receptors.
The patient has Parkinsons disease. Which drug would you AVOID?
D. Droperinol (dopamine antagonists) [pg 376 APEX}
HIGH Ach less dopamine
The soda lime changes color during the case. What should you do?
B. Increase the FGF rate, change the canister after the case
Which of the following is appropriate preoperative anesthetic management of the patient with cardiac tamponade? HR, NSR, preload and a
Positive inotrope
Maintain HR, NSR, maintain or increase preload, maintain or increase afterload (make sure beck’s triad, low BP , distended neck )
Accidental subarachnoid injection occured during an intended epidural. Which of the following is a rapid, early sign?
Dyspnea(pg 607) because of a total spinal . Epidural dose injected into the subdural space, leads to a larger dose neither aspiration or test dose would rule it out. Patient will experience symptoms of cephalad spread, and block height will be much higher, rapid sensory block will occur. Sx are Dyspnea, difficulty phonating and hypotension.
Oozing of blood after a massive blood transfusion is probably due to
Thrombocytopenia (because dilutional effect can lead to 50% fall in platelet count) each unit of platelet increase count by 5000.
What is the maximum doses of dantrolene for treating malignant hyperthermia?
10 mg/kg pg 395. (2.5mg/kg up q 5-10minutes)
What is the most common hematologic disorder in the alcoholic?
Megaloblastic anemia (vit B12 / folate deficiency)
Shown in the following graph is the uptake of four volatile agents:
Nitrous Oxide (Top of chart)
The purpose of the pin index system is to
Keep cylinders with different gases from being used interchangeably
In PACU. the patient says he remembers some things that were said in the intraoperative period? What should you do?
Tell the patient what happened. Awareness prevented by having MAC of 0.5
Hemorrhage is the most common complication of mediastinoscopy. What is the next most common complication of this procedure?
Pneumothorax
Stimulation of what receptor explains why arterial diastolic blood pressure may decrease when epinephrine is administered with a local anesthetic?
Beta-2 adrenergic receptor (vasodilation and bronchodilation) Alpha blood vessels.
Alpha 2 p.g 96.
Which of the following neural tracts modulates pain?
Dorsolateral fasciculus
Trigger agents for malignant hyperthermia include
Halothane
At the neuromuscular junction aminophylline
Increase the release of ach from the motor nerve terminal
What is the necessary treatment for the patient with sickle cell disease who goes into sickle cell crisis
during surgery?
Give the patient an exchange transfusion (partial exchange , to increase NORMAL HGB to 50%).
During surgery for a subdural hematoma, a cerebral vasospasm develops. A drug that is appropriate for
treating this probLem is
Nimodipine
Pneumothorax is most commonly associated with which approach to the brachial plexus?
Supraclavicular
The patient’s hemiplegia resuLted from an accident six months ago. How will the twitches elicited by a
nerve muscle stimulator on the paralyzed side compare with those on the non-paralyzed side during
nondepolarizing neuromuscular blockade?
Twitches on the paralyzed side will be larger.
Which drug stimulates alpha-i, alpha-2 and beta-i receptors?
Norepinephrine
A patient is given 400mg of drug. Sixteen hours later, 25mg remain. How much drug is lost in the next
B hours?
18.75 (check valley)
The voltage-gated sodium channel is in the inactivated state in all but which of the following situations?
Severe Hypokalemia (LA is open and close (inactivated) but not resting
The patient who cannot adduct the thumb has had what nerve blocked by local anesthetic?
Ulnar (adduct) (adductor policis is innervated by ulnar)
radial (abduct)
You determine that magnesium suLfate should be given to the patient with pregnancy-induced hyper tension (pre-eclampsia/eclampsia). At what plasma concentration of magnesium (mEq/L) will toxicity begin to manifest?
8-12
What set of data correctly describes the actions of magnesium in the patient with pregnancy-induced hypertension (preeclampsia/eclampsia)?
(ACH release, Sensitivty to motor end plate, uterine tone, Vascular smooth muscle tone.
Ach released from MNT is decreased
Sensivity of motor end plate to ACH decreased
Uterine tone is decrease
Vascular smooth muscle tone is decreased.
There is a misunderstanding about the amount of magnesium sulfate that should have been adminis
tered to the patient with pregnancy-induced hypertension (pre-eclampsia/eclampsia). You are con cerned about magnesium toxicity. If magnesium toxicity is developing, you might see each of the following signs EXCEPT:
Tachycardia
You will see Loss of DTR, sedation, hypotension
The degree of aortic regurgitation is largely determined by what factors? Select three.
Diastolic pressure gradient
Duration of diastole
Incompetent aortic valve.
During the case, the blood pressure of the patient with pregnancy-induced hypertension (preeclamp sia/eclampsia) increases to 190/125. Of the following, which drug is LEAST appropriate for treating this hypertension?
Esmolol
Good ones are Hydralazine, labetalol, nitroprusside
Aspiration is a risk associated with anesthesia for patients with each of the following diseases EXCEPT:
Multiple sclerosis (demyelination of neurons)
Immediate delivery of the fetus is imperative if fetal heart rate decelerations are
Late with no beat to beat variability
You are appLying cricoid pressure to a patient that has lost consciousness; how much pressure should be
used (kg)?
4 kg (2 kg before , 4 kg after)
At least 98% of the drug will be gone after how many half-times of elimination?
6 half lives
25 mL of solution containing 1% lidocaine and 1:200,000 epinephrine contains how much of each drug?
250 mg and 125 mcg
The patient has a left ventricular ejection fraction of 0.22. This indicates
Cardiomyopathy
The patient who has been taking digitalis develops a prolonged PR interval and premature ventricular
contractions during anesthesia. What drug should you give?
Phenytoin (It is a class 1B antiarrhythmic)
What is the most common cause of acute myocarditis?
Viral infection
The shift in Starling curve shown by the arrow in the figure at right is consistent with administration of: (Select three)
Nipride
Digitalis
Inocor
(Reduce afterload, increase inotropy)
ANSI standards for reservoir bags require that the pressure not exceed 50cm H,O when the bag is dis tended to how many times its normal capacity?
4 times (each bag with volumegreater 1.4 should not exceed a pressure of
Cerebrospinal fluid passes from the lateral ventricles to the third ventricle through the foramina of
Munro
What substance manufactured by vascular endothelial cells (formerly called endothelium-derived
relaxation factor, EDRF) diffuses into the smooth muscle layer and causes vasodilation?
Nitric oxide
The most important factor determining whether or not a patient will file a malpractice law suit is the
Anesthetist’s rapport with the patient.
The American National Standards Institute Z79.9 1979 standard was replaced in 1988 with:
ASTM standard
“What size endotracheal tube should be placed in a 2-year-old child and what size suction catheter
should be used to keep this endotracheal tube clean!
A
Hemodynamic data for the patient are: arterial blood pressure, 130/70 mm-Hg; intracranial pressure, 15 mm-Hg; LVEDP, 10mm-Hg; right atrial pressure, 5; heart rate, 80. What are cerebral perfusion and coronary artery perfusion pressures?
75mmHg cerebral 60 mmHg (coronary) Coronary pressure (Arterial diastolic pressure minus -LVEDP
What site should not be used for insertion of a pulmonary artery catheter in a patient with a right pneu mothorax?
Left IJ
Identify ECG
RIGHT BBB
Digitalis slows heart rate by working on what phase of the cardiac action potential?
D. Phase 4 (REVIEW) pg 124 (CARDIAC ACTION POTENTIAL)