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APA II > final review > Flashcards

final review Flashcards

1
Q

side effects of histamine include

A

increased myocardial contractility

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2
Q

all of the following are considered early signs of bladder performation durint TURP of bladder tumor in the patient under spinal anesthesia

A

poor return of irrigating fluid
hypertension
tachycardia
NO HYPOTENSION

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3
Q

what are vitamin K dependent factors?

A

II, VII, IX, X

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4
Q

the extrinsic pathway of the hemostatic response is initiated by the release of a group of proteins know as

A

Tissue Factor

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5
Q

You are providing general endotracheal anesthesia to a patient undergoing laparoscopic cholecystectomy and intraoperative cholangiogram study. During the procedure, the surgeon states that he is unable to perform the cholangiogram due to spasm of the Sphincter of Oddi. Which of the following medications would potentially relieve spasm of the Sphincter of Oddi?

A

glucagon

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6
Q

True or False-Cholecystokinin is produced by cells in the mucosa of the small intestine and is released in response to the presence of fats in the intestinal contents.

A

True

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7
Q

Which of the following are associated with an anaphylactic reaction?

A

Histamine release, Compliment activation, prostaglandin release-all of the above

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8
Q

Which of the following statements regarding hemophilia is false?
A-Hemophilia A is a sex linked disorder
B-Hemophilia B is also known as Christmas Disease
C-Patients with hemophilia A are deficient in Factor VIII
D-Factor VIII is known as Christmas Factor

A

D-Factor VIII is known as Christmas Factor

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9
Q

A patient scheduled for vascular surgery has evidence of myocardium at risk for ischemia on preoperative diagnostic imaging studies. How can you decrease the risk of perioperative ischemia?

A

Perioperative Beta Blockade

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10
Q

Antibodies are specific proteins called ___________ that can recognize and bind to a specific antigen

A

Immunoglobulins

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11
Q 
Which of the following bladder irrigation solutions may cause hyperglycemia?
A-Sorbitol
B-Glycine
C-Mannitol
D-0.9%NS
A

Sorbitol-hyperglycemia
Glycine-blindness
Mannitol-osmotic diuresis causing hypervolemia

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12
Q 
Which of the following enzyme tests is most specific for the liver?
LDH
GST
AST
ALT
A

ALT-liver
AST-pancreas
GST-found to be an indicator of hepatocyte injury in transplantation, toxicity and viral infections (not the right answer)
LDH-released during tissue damage

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13
Q

A patient undergoing TURP begins to exhibit widening of the QRS complex and ST segment elevation on the electrocardiogram. Based on this evidence, you would estimate the serum sodium to be:

A

115

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14
Q

Cerebral autoregulation is effective over what range of mean arterial pressures (MAP) in the healthy patient?

A

MAP=60-160

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15
Q

Which of the following is associated with the highest incidence of postoperative renal failure in the patient undergoing abdominal aortic aneurysm repair?

A

Suprarenal clamping

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16
Q 
Which anesthesia related factor does not increase patient risk for gastric aspiration?
A-lithotomy
B-Reverse trend
C-Smoking
D-pregnancy
A

B-reverse trendelenberg

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17
Q

Bladder perforation in the patient undergoing transurethral surgery is clinically manifest in all of the following ways except:
A-referred pain to abdominal or shoulder region
B-N/V
C-sweating
D-hypertension
E-all of the above

A

E-All of the above

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18
Q

What is the cause of transient blindness after transurethral resection of the prostate (TURP)?

A

Systemic Absorption of Glycine

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19
Q

A patient received a subarachnoid block for a TURP. What dermatome level needs to be reached in order to provide surgical anesthesia for this procedure?

A

T-10 sensory

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20
Q 
Which of the following cyclooxygenase inhibitors irreversibly affects the function of the platelet?
A-Tylenol
B-Motrin
C-Aspirin
D-Celebrex
A

C-Aspirin

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21
Q 
All of the following treatments can be given to a patient with von Willebrand's disease to raise von Willebrand's factor (vWF) levels except: (select two)
A-DDAVP
B-six pack of platelets
C-cryoprecipitate
D-Factor VII
A

Factor VII and Six pack of platelets will not raise vWF but cryo and DDVAP will

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22
Q

Which of the following blood pressure changes occurs in response to aortic cross clamping?

A

Hypertension proximal to clamp

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23
Q 
Induction of general anesthesia for this procedure carries the highest risk for aspiration:
A-airway mgmt for epiglotitis
B-Tonsillectomy
C-Parathyroidectomy
D-Zenkers
A

Zenker’s diverticulectomy

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24
Q

Red blood cells begin to sickle in the patient with sickle-cell disease when the partial pressure of oxygen falls below:

A

PaO2=30-40mmHG

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25
Q

HIV belongs to which of the following family of viruses?

A

retorviridae

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26
Q 
During laparoscopic surgery on a healthy patient, what hemodynamic effect would you expect to see as a result of insufflation of the abdomen to a pressure of 12-15 mmHg?
A-decrease in CVP
B-decrease in pulse pressure
C-decrease in CO
D-none of the above
A

Decrease in CO

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27
Q

Which of the following clotting factors are corralled by Antithrombin III, thus inhibiting further thrombin activity by sequestering them.

A

XII, XI, X, IX

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28
Q

The most common cause of death, secondary to opportunistic infection in the HIV/AIDS patient is

A

Pneumocystis Carini/Jirovici

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29
Q 
Higher insufflation pressures during laparoscopic surgery (greater than 25cm H2O) may result in
A-increased preload
B-decreased BP
C-Increased FRC
D-Hypocarbia
A

B-decreased BP

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30
Q

Which patient characteristic increases the risk for gastric reflux and decreases the risk for post-operative nausea and vomiting?

A

Smoking

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31
Q

The patient is placed in lithotomy position prior to his ureteroscopy, pressure on the medial tibial condyle can damage which nerve?

A

Saphenous Nerve

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32
Q

A patient undergoing carotid endarterectomy demonstrates bradycardia (23bpm) which you successfully treat with atropine. What would be the most appropriate action to prevent a subsequent bradycardic episode?

A

Ask the surgeon to infiltrate the carotid sinus area with lidocaine

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33
Q

TURP syndrome is characterized by

A

Acute hyponatremia

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34
Q

Unclamping the thoracic aorta will commonly result in:

A

Decreased systemic vascular resistance

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35
Q

Which of the following clinical findings contribute to the development of disseminated intravascular coagulation (DIC)?
A-excessive depletion of coagulation factors
B-excessive fibrinolysis
C-Microvascular clotting
D-all of the above

A

all of the above

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36
Q

Anaphylactic reactions are related to prior sensitization by exposure to an antigen with production of antigen-specific:

A

IgE antibodies

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37
Q 
Patients with a compromised immune system include which of the following: (select three)
A-patient on chemo
B-A patient with HIV
C-one month old infant
D-hashimotos thyroiditis
E-patient with acute RF
A

patient on chemo, patient with HIV, one month old

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38
Q

With what EKG segment is the delivery of shock waves timed during an extracorporeal shock wave lithotripsy (ESWL) procedure?

A

Shock waves are usually time to occur 20 milliseconds after the R wave.

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39
Q

In the intrinsic pathway, what component is required to convert factor XII to factor XI

A

prekallikrein

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40
Q 
Which of the following are the most common causes of pancreatitis? (select two)
a-hypoparathyroidism
b-alcoholism
c-penetrating abdmonial trauma
d-gallstones
A

alcoholism, gallstones

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41
Q

Which of the following statements represents an inaccurate understanding of the anesthetic implications of the patient with a small bowel obstruction?
a-patient will be alkalotic
b-reglan and H2 antagonists are useful preinduction adjuncts
c-RSI should be considered
d-patient will be hypovolemic

A

reglan and H2 antagonists are not useful preinduciton adjuncts

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42
Q 
A patient who is severely ill from chronic ulcerative colitis is scheduled to have a colon resection.  You anticipate that this patient's preoperative lab work would likely reveal:
a-decreased albumin
b-thrombocytopenia
c-hyperkalemia
d-hyponatremia
A

decreased serum albumin level

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43
Q

he surgeon is preparing to remove the aortic cross-clamp after successfully repairing an open abdominal aneurysm. all of the following interventions are appropriate, except:
a-stop or decrease vasodilators
b-give diuretics prior to clam removal and maintain hypovelemia to increase blood volume to brain
c-have vasopressors ready for declamping shock
d-increase minute ventilation to decrease acidosis

A

b-do not give diuretics 20 minutes prior to declamoing to maintain hypovolemia and bood volume to brain

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44
Q 
Which monitoring/diagnostic aid would most accurately reflect an interruption of anterior spinal cord perfusion in a patient undergoing surgery-involving cross clamping of the thoracic aorta?
a-EEG
b-Motor evoked potentials
c-SSEPs
d-A line
A

motor evoked potentials

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45
Q

A complication of aortic surgery is paraplegia that is most commonly due to:

A

spinal cord ischemia

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46
Q

Patient’s with von Willebrand’s disease bleed more readily due to

A

decreased FVIII activity

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47
Q

The most common cause of death following abdominal aortic aneurysm is:

A

myocardial infarction

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48
Q

During carotid endarterectomy surgery, carotid clamping results in an ipsilateral slowing of the EEG amplitude signal. What does this mean and how can it be treated? (select three)
a-EEG evidence of cerebral ischemia
b-EEG evidence of adequate cerebral perfusion
c-parmacologically elevate BP to shunt blood to brain on affected side
d-pharmacologically decrease BP to assist burst suppression
e-ask surgeon to place carotid shunt

A

EEG evidence of cerebral ischemia
pharmacologically elevate BP to shut blood to brain on affected side
ask surgeon to place a carotid shunt

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49
Q

An optically clear, non-conductive, non-hemolytic, non-toxic solution is required for TURP to:

A

distend the bladder

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50
Q

In preparing the anesthetic for a patient with advanced rheumatoid arthritis, you anticipate:

A

potential difficult airway

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51
Q

Your patient has been discharged from Stage I to Stage II. They are requesting to use the bathroom and upon standing get very dizzy and light headed. They had a breast augmentation and extensive liposuction of flanks performed. What is the most likely cause?

A

the patient has not been given enough fluid

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52
Q

Read the following discharge requirements and select the correct discharge stage…
-Ambulation assistance with caregiver, no respiratory distress, minimal bleeding, pain controlled with oral medication, nausea minimal or absent, taking in orals, voiding

A

Stage II to home

53
Q

You are covering the OB unit at the hospital and are in the OR caring for your c-section patient. The baby has been delivered and is on the warming cart. You patient is hypotensive and the surgeon is having a difficulty with the placenta resulting in a large amount of blood loss. The nurses caring for the baby yell that they baby is not breathing and we need to intubate now. They are calling for the neonatologist who is 5 minutes away. What do you do?

A

Continue caring for the mother and wait for the neonatologist to intubate the baby

54
Q 
What are the main reasons for inpatient admission following a procedure in outpatient surgery? Select all that apply.
a-hypothermia
b-PONV
c-pain
d-hypotension
A

pain, PONV

55
Q

our patient is a 5 month old female that was born prematurely at 28 weeks gestation. Patient had a history of apnea with no apnea episodes noted in the last 2 months. The patient is scheduled to be at the surgery center for bilateral ear tubes. Is your patient a successful candidate?

A

No, the patient post-conceptual age is inappropriate-gestational age +postnatal age
healthy former premies need to be greater than 50-60 weeks postconceptual age

56
Q

Select all of the following that are appropriate for outpatient surgery
a-ASA 1,2,3 controlled comorbidities
b-patient picked up by taxi
c-patient with family member not present
d-patient ASA 2 age 102
e-patient that just had pneumonia and finished antibiotic

A

asa 1,2,3 with controlled comorbidities

ASA 2 age 102

57
Q

After placing a SAB, your patient begins to tell you that she is really having a hard time breathing and begins to gasp for air, then just starts shaking her head vigorously. Which of the following would you do first?
a-assist her ventilations with the mask and circuit on anesthesia machine
b-reassure her that it is normal
c-start 2nd IV of fluid administration and support BP
d-immediately place ETT

A

assist her ventilations with the mask and circuit on anesthesia machine

58
Q 
You have a 68 year old male scheduled for a right rotator cuff repair in the sitting position.  He has a 50 year ppd smoking history, right lobe lung resection due to cancer, and COPD controlled with medications; but he wears oxygen 2L during the day and 4L at night ATC. You are considering an interscalene block for postoperative pain control and GETA for your anesthetic plan-what should you do?
GETA only
Continue with plan as mentioned
interscalene block and sedation only
LMA anesthesia and interscalene block
A

GETA only

59
Q 
All of the following are considered when preparing for a c-section except?
a-patient has a full stomach
b-patient has a difficult airway
c-patient has a decreased FRC
d-patient is an ASA 3
A

patient is an ASA 3 is not immediately relevant

60
Q 
You have a 2 year old male scheduled for adenotonsilectomy. His mother and father both smoke. Select all that apply.
a-less prone to breath holding
b-increased risk of secretions
c-increased risk of laryngospasm
d-decreased risk of nausea
A

increased secretions, increased risk of laryngospasm

61
Q

Your male patient is 35 years old with a family history of Malignant Hyperthermia, scheduled for an inguinal hernia repair. He has a history of asthma with seasonal allergies, controlled with an albuterol inhaler prn. Is he a suitable candidate for outpatient surgery?

A

Yes we can provide trigger free anesthetic early in the day

62
Q

You have a 35 year old male patient scheduled for a bilateral mammoplasty (breast reduction) for gynecomastica and abdominoplasty with flank liposuction, after losing 200 pounds post gastrectomy 1 1/2 years ago. He has reflux controlled with medication and has no problems with anesthesia. His BMI is 35. Is he an acceptable candidate?
a-yes he has no uncontrolled comorbdities
b-no, surgery will take longer than recommended 4 hours
c-yes but he needs to be scheduled early in day for more observation time
d-no patients BMI is unacceptable for outpatient surgery

A

No, this surgery will take longer than the recommended 4 hours

63
Q

You have a 24 year old female scheduled for a D&C hysteroscopy. She has a BMI of 40. Otherwise, she has an unremarkable history and takes no medications. She has never had surgery before. When you are interviewing your patient, you inquire about OSA. Her significant other says that she snores, but denies any apnea and she has not had a sleep study or knowledge of OSA. Is she a successful candidate?
A-no, she needs a sleep study
B-no her BMI is too high
c-yes she denies daytime sleepiness
d-Yes, she can receive an anesthetic utilizing an airway or LMA or ETT and receive light dose of fentanyl and NSAIDS for pain control

A

Yes, she can receive an anesthetic utilizing an airway or LMA or ETT and receive light dose of fentanyl and NSAIDS for pain control

64
Q

The purpose of left uterine displacment is?

A

to displace the uterus to the left, thus relieving pressure on the inferior vena cava and abdominal aorta, maintaining uterine blood flow

65
Q

A cesarean section is a complex psychosocial procedure with one of the main differences from other procedures being?

A

The patient is awake

66
Q

What surgical procedure has the highest risk for postoperative delirium in elderly patients?

A

orthopedic surgery

67
Q

Which statement is TRUE regarding the cardiovascular system in the geriatric patient?
A-Geriatric patients have an increase in elasticity of arteries, an increase in afterload, and an increase in systolic pressure.
B-Geriatric patients have a decrease in adrenergic activity, an increase in heart rate, and a decrease in baroreceptor response.
c-Geriatric patients have a decrease in baroreceptor response, left ventricular hypotrophy, and an increase in systolic pressures.
D-Geriatric patients have an increase in afterload, a decrease in adrenergic activity, and a decrease in baroreceptor response.

A

Geriatric patients have an increase in afterload, a decrease in adrenergic activity, and a decrease in baroreceptor response.

68
Q

In a patient who is 65 years of age, you would expect that the mean alveolar concentration for an inhaled anesthetic would be decreased by about:

A

10% (Mac decreases 4% per decade after age 40 so

4% 50+4%60+2%5=10%)

69
Q

Which of the following changes are expected to occur in the elderly as part of the normal aging process? (select two)
A-hepatic microsomal activity decreased
B-pulmonary collagen content increases
C-renal BF decreases
D-alveolar arterial difference for O2 decreases

A

renal BF decreases, pulmonary collagen content increases

70
Q 
All of the lung parameters below increase with age except for:
a-closing capacity
b-FRC
c-TLC
d-RV
A

TLC-decreases or stays the same

71
Q

Many changes in organ function and composition occur by the eigth decade of life. Match the appropriate change with the organ system change or diagnostic characteristic with which it is associated.
Serum creatinine-
Brain mass-
plasma norepi conc.

A

serum creatinine-stays the same
brain mass-decreases
plasma NE-increases

72
Q

Which statement is TRUE regarding the geriatric patient?
a-circulation of IV anesthetic drugs increases and speeds up induction
b-circulation of inhalational anesthetics is slow and speeds induction
c-circulation of IV agents is decreased and speeds induciton
d-circulation of inhalational agents is fast and slows induction

A

circulation of inhalation agents is slow and speeds induction

73
Q

Which statement is FALSE regarding the nervous system of the geriatric patient?
a-increase in thresholds to temp, pain, and touch
b-decrease in thresholds to proprioception, vision, and hearing
c-there is a reduction for general anesthetics and local anesthetic administration
d-geriatric patients need more time to recover cognitively from general anesthesia

A

decrease in thresholds to proprioception, vision, and hearing is false-there is an increase to these

74
Q

Postoperative cognitive dysfunction is most commonly associated with

A

advanced age

75
Q

How are dosage requirements for local anesthetics (Cm) and minimum alveolar concentration (MAC) affected by aging?

A

both are decreased

76
Q 
An 85 year old male with no previous medical history except for cataracts is undergoing a transurethral resection of the prostate gland under spinal anesthesia. Twenty minutes into the procedure the patient becomes restless. Over the next 20 minutes his blood pressure increases from 110/70 to 140/90 mmHg and his heart rate slows from 90-50 beats/min. The patient is noted to have some difficulty breathing. The most likely cause of these symptoms in this patient is:
a-volume overload
b-hyponatremia
c-high spinal
d-autonomic hyperreflexia
e-bladder perforation
A

a-volume overload

77
Q

A patient is scheduled for a TURP, the serum sodium level is 125 mEq/l, you should:

A

post pone procedure if less than or equal to 125

78
Q

First line treatment for a peptic ulcer may include:
a-diphenhydramine and famatodine
b-ranitidine and omeprazole
c-cimetadine and large doses of oral antacids
d-surgical vagotomy

A

ranitidine and omeprazole

79
Q 
Patients with which of the following comorbidities may be more likely to experience Mendelson's syndrome? (select two)
A-gerd
B-hiatal hernia
c-myocardial infarction
d-renal failure
A

gerd, hiatal hernia

80
Q 
Signs and Symptoms of acute pancreatitis include all of the following, except:
a-DIC
b-adult respiratory distress syndrome
c-epigastric pain severe
d-hyponatremia
A

hyponatremia

81
Q

While performing a laproscopic cholecystectomy you note that as the insufflation is initiated that the patients heart rate decreases from 70 to 25. The most likely cause for this is:

A

stimulation of the vagus nerve from abdominal stretching

82
Q 
A patient is scheduled for surgery for upper esophageal cancer. Intraoperative concerns for the patient include all of the following except:
a-hemorrhage
b-anastomotic leak
c-injury to tracheobronchial tree
d-injury to RLN
A

anastomotic leak not an intraop concern

83
Q

Mendelson’s syndrome, perioperative chemical pneumonitis caused by aspiration, is believed to be caused by which of the following risks? (select two)
a-decreased gastrin production
b-gastric pH 25mL
d-increased LES tone

A

increased LES tone and decreased gastric production are wrong-these patients have pH25

84
Q 
Cerebral autoregulatory curve is shifted to right by
a-hypoxia
b-volatile anesthetics
c-hypercarbia
d-chronic HTN
d-fentanyl
A

chronic HTN

85
Q

After the patient has had a carotid endarterectomy, you note the patient has mild CO2 retention and remains hypertensive. You know that these findings are ______ post-CEA findings, which indicate ______.

A

Expected; dysfunction of reflex carotid responses

86
Q

A 55-year old business executive is scheduled for colonoscopy and polypectomy under general anesthesia. A bruit is auscultated over the right carotid artery on physical examination. The patient is otherwise healthy. Which of the following would be the most appropriate course of action?

A

Cancel surgery, and obtain doppler US carotid blood flow studies

87
Q

Which of the following is the gold standard for monitoring patients undergoing carotid endarterectomy (CEA) under general anesthesia?

A

12-lead EEG

88
Q

Order the common culprits of anaphylactic reactions

latex, antibiotics, muscle relaxants, and opioids

A

muscle relaxants
latex
antibiotics
opioids

89
Q 
Which of the following patient populations has a high risk of latex reactions?
a-kids with spinal bifida
b-urogenital abnormalities
c-multiple food allergies
d-history of atopy
e-allergy to bananas, avocados, kiwis
f-all of the above
A

all of the above

90
Q 
Approximately 7 minutes after induction of general anesthesia with Propofol, fentanyl, lidocaine, rocuronium and successful tracheal intubation your patient becomes severely hypotensive and tachycardic. You also notice and increase in peek airway pressures, a drop in oxygen saturation, and urticaria of the chest and abdomen. Which of the following would you do first?
a-call for someone to start CPR
b-administer benadryl 25-50mg
c-administer epi 50-100mcgIV
d-100mg hydrocortisone IV
e-100-500mcg epi SQ
A

give epi 50-100mcg

91
Q

What are molecules capable of stimulating an immune response called?

A

antigens

92
Q

After incidental needle stick with a HIV contaminated needle the incidence of seroconversion is ____%?

A

0.3%

93
Q

Irritant or contact dermatits accounts for the majority of latex reactions and is caused by which of the following?

A

T cell mediated reactions

94
Q

classic signs of cardiac tamponade include what

A

hypotension, jugular venous distension, tachycardia, muffled heart sounds, pulsus paradoxus, equal CVP and PCWP

95
Q

what does an acute trauma patient usually die of?

A

uncontrolled bleeding

96
Q

what does DIC result from

A

thromboplastin from injured brain, fat, amniotic fluid, etc.
endothelial injury
failure to clear activated coagulation factors
hypothermia

97
Q 
CMRO2 is reduced by all of the following induction agents except 
a-ketamine
b-versed
c-etomidate
d-propofol
e-thiopental
A

a-ketamine has no effect or slightly increases CMRO2

98
Q

thiopental will do which of the following

A

decrease CBF and CMRO2

99
Q

what are effects of inhaled anesthetics to brain

A

increase CBF and decreases CMRO2

100
Q

what is lethal triad observed during trauma

A

acidosis, hypothermia, coagulopathy

101
Q

persistant hypotension following a trauma is usually the result of which of the following

A

bleeding, tension pneumothroax, neurogenic shock, cardiac injury

102
Q

during a head trauma case, clear fluid is seen from patient’s nose, what action would be deleterious to patient?
a-RSI with cricoid pressure
b-cervical stabilization during intubation
c-placing NG tube to reduce aspiration
d-hyperventilation with ETCO2 at 33

A

placing NGT

103
Q

what drug is contraindicated for blunt trauma to head during induction

A

ketamine-it increases CBF, ICP and CMRO2

104
Q

during trauma resuscitation, patient lactate level is 5, what is normal level

A

0.5-1.5

105
Q

what is first intervention for hypovolemic shock

A

crystalloids, with LR preferred over NS, because NS causes mroe UOP, causing mroe fluid requirements, and can make patient at risk for hyperchloremic acidosis or dilutional coagulopathy

106
Q

a patient is rushed back for pericardial window, what would the CRNA expect to see

A

dilated engorged neck veins, hypotension, muffled heart sounds, tachycardia

107
Q

during spinal cord injury, patient treatment would include which of the following

A

vasopressors, fluids, inotropes

108
Q 
during head trauma, CRNA maintains all of the following values except
a-ICP>40
b-MAP >80
c-PAO2>95
d-CPP 50-70
A

ICP should be 7-15

109
Q

LR is often used for initial crystalloid replacement, LR is _____tonic

A

isotonic

110
Q

a head trauma patient has an PAco2 level of 20. what should CRNA do

A

decrease ventilation rate so PACO2 can rise (you want 28-32 to initiate deliberate hypocapnia to cause intracranial HTN)

111
Q 
a patient with a SC injury 6 months ago is ready for induction, what drug to avoid in quadraplegic
a-anectine
b-zemuron
c-mivacron
d-neosynephrine
A

anectine-only safe during 1st 48 hours following a SC injury, but after 48 hours is associated with hyperkalemia

112
Q 
You are called to intubate a patient presenting to the emergency department with a spinal cord transection at C3.  You would expect which of the following on first assessment:
1-hypertension
2-bradycardia
c-increase UOP
d-increased preload
A

Bradycardia-A patient with a spinal cord lesion at C3 would typically exhibit severe hypotension from dilation of the capacitance vessels due to loss of sympathetic tone and bradycardia from a lack of sympathetic input from the cardioacceleratory fibers of T1-T4. Due to the drop in preload, the patient would likely exhibit signs of fluid volume deficit which would translate into a decreased urine output.

113
Q

A patient is presenting for cervical fusion for acute cervical spine fracture. The patient describes severe weakness and paresthesias in both arms. Which of the following statements is consistent with an understanding of an appropriate anesthetic management plan for this patient?

A

Keep MAP >80

114
Q

A patient with a suspected cervical spine injury is transported to the emergency department by ambulance. On arrival, an LMA is in place. The patient exhibits no spontaneous respirations and is unconscious, but you are able to bag-ventilate the patient with ease. You should

A

replace LMA with ETT

115
Q

The critical level for the development of autonomic hyperreflexia due to a spinal cord lesion is

A

T6-Autonomic hyperreflexia is seen in approximately 85% of all patients with a spinal cord lesion at or above T6. Lesions at or below T10 do not consistently produce symptoms of autonomic hyperreflexia

116
Q

autonomic hyperreflexia

A

represents return of SC reflexes-It is a massive sympathetic discharge that occurs in response to a cutaneous or visceral stimulation below the level of transection.

117
Q

what type of shock patient might have warm pink extremities

A

spinal shock

118
Q

symptoms of acute SC injury are

A

flaccid paralysis, loss of temperature regulation below level of injury, loss of SC reflexes below level of injury, loss of cutaneous sensation below level of injury

119
Q

Which of the following stimuli can precipitate autonomic hyperreflexia in susceptible patients?

A

bladder cath, childbirth, cutaneous stimulation

120
Q

carbon monoxide

A

greater affinity for HGB than O2
cause metabolic acidosis
impairs mitochondria function

121
Q

The initial treatment for a chemical burn is irrigation of the affected area with

A

water and saline

122
Q

Which is the most appropriate method of fluid resuscitation during the first 24 hours following a burn injury?

A

crystalloids first-During the first 24 hours following a burn injury crystalloids are preferred for fluid resuscitation. In a burn that affects more than 30% of the body surface area, replacement of plasma protein may be accomplished using 5% albumin in LR on the following day.

123
Q

Electrical burns can place patients at risk for renal damage due to

A

myoglobin release

124
Q

During carotid endarterectomy, a distal stump pressure less than what value is an indicator that a shunt should be placed?

A

50

125
Q

What is the most effective means of assessing cerebral blood flow during a carotid endarterectomy?

A

use awake technique with regional anesthetic

126
Q

Carotid surgery can be performed under regional anesthesia by blocking the nerves originating from which spinal levels?

A

C2-C4

127
Q

Which of the following would you expect to occur when the thoracic aorta is cross-clamped? (select four)

A

increased CSF pressure
increased pulm VR
decreased renal artery BF
vascular engorgement in cranial vault

128
Q

How much protamine do you give a patient?

A

0.5mg for every 100U of heparin

129
Q

smile, shrug shoulders, say EEE, stick tongue out, swallow

A

Smile: facial nerve, say “EEE”: superior and recurrent laryngeal nerves, shrug shoulders: spinal accessory nerve, swallow: glossopharyngeal, stick his tongue out: hypoglossal nerve.

APA II (4 decks)

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