FU(14): Infectious Diseases & Diseases related to Immune System Dysfunction

Question 1

During a routine abdominal surgery, a 55-year-old patient with a history of diabetes mellitus type 2 and recent antibiotic therapy presents with an unexpected operative finding of a small abscess in the peritoneal cavity. Culture results are pending, but initial gram stain suggests a gram-positive organism. Given the patient’s history and the increasing prevalence of antibiotic-resistant pathogens, which antibiotic regimen would be most appropriate for perioperative prophylaxis?

A.) Vancomycin and piperacillin-tazobactam
B.) Cefazolin and metronidazole
C.) Amoxicillin-clavulanate
D.) Clindamycin and gentamicin

Answer 1

A.) Vancomycin and piperacillin-tazobactam

Question 2

A 65-year-old patient undergoes elective hip replacement surgery. Despite receiving prophylactic antibiotics within 1 hour before incision and adherence to surgical aseptic techniques, the patient develops signs of a deep surgical site infection (SSI) two weeks post-operatively. Which of the following factors is most likely to have contributed to the development of this infection?

A.) Inadequate duration of antibiotic prophylaxis
B.) Poor blood glucose control in the immediate postoperative period
C.) Lack of perioperative corticosteroid administration
D.) Use of internal prosthetic material

Answer 2

Use of internal prosthetic material

Question 3

A postoperative patient exhibits signs of a superficial surgical site infection. Culture of the wound exudate grows coagulase-negative staphylococci. Considering the pathophysiology of SSIs and the organism identified, which of the following treatment strategies is most appropriate?

A.) Immediate surgical debridement of the wound
B.) Broad-spectrum antibiotics pending further sensitivity testing
C.) Topical application of antibiotics directly to the wound site
D.) Initiation of targeted antibiotic therapy against gram-negative organisms

Answer 3

B.) Broad-spectrum antibiotics pending further sensitivity testing

Question 4

A 60-year-old patient scheduled for elective abdominal surgery has been identified as a carrier of S. aureus in the anterior nares. Which of the following preoperative interventions is most appropriate to reduce the risk of surgical site infection (SSI)?

A.) Systemic administration of a broad-spectrum antibiotic
B.) Preoperative smoking cessation for 4 weeks
C.) Preoperative alcohol abstinence for 1 month
D.) Application of topical mupirocin to the anterior nares

Answer 4

D.) Application of topical mupirocin to the anterior nares

Question 5

During a prolonged (>4 hours) colorectal surgery, which of the following prophylactic antibiotic strategies is most appropriate to minimize the risk of surgical site infections?

A.) A second dose of cefazolin administered 4 hours after the initial dose
B.) A single dose of cefazolin administered within 1 hour of incision
C.) Administration of vancomycin throughout the duration of the surgery
D.) Continuous infusion of a broad-spectrum antibiotic during the entire procedure

Answer 5

A.) A second dose of cefazolin administered 4 hours after the initial dose

Question 6

For a patient undergoing elective surgery, which of the following intraoperative management strategies is most effective in reducing the incidence of surgical site infections?

A.) Administering 80% oxygen only during the operation
B.) Inducing mild intraoperative hypercapnia to increase oxygen tension in subcutaneous tissue
C.) Ensuring perioperative blood glucose is within the high normal range
D.) Maintaining normothermia to increase subcutaneous oxygen tension

Answer 6

D.) Maintaining normothermia to increase subcutaneous oxygen tension

Question 7

In the preoperative planning for a patient requiring central venous catheter placement, which of the following strategies is considered most effective in reducing the incidence of CLABSIs according to evidence-based practices?

A.) Utilizing full-barrier precautions during catheter insertion
B.) Choosing the femoral site for catheter insertion to reduce pneumothorax risk
C.) Applying regular dressings instead of chlorhexidine-impregnated dressings
D.) Delaying catheter removal until signs of infection are evident

Answer 7

A.) Utilizing full-barrier precautions during catheter insertion

Question 8

For a critically ill patient undergoing a complex surgical procedure that necessitates both central venous catheter placement and potential blood transfusions, which of the following integrated management strategies is most effective in simultaneously minimizing the risk of central line-associated bloodstream infections (CLABSIs) and transfusion-related bloodstream infections?

A.) Preferring the femoral site for central venous catheter placement to minimize mechanical complications and using autologous blood transfusion when possible
B.) Using chlorhexidine impregnated dressing for the central line site and implementing leukodepletion for all transfused blood components
C.) Applying a standard sterile dressing at the catheter site and relying on routine blood product screening protocols without leukodepletion
D.) Delaying the initiation of prophylactic antibiotic therapy until after catheter placement and blood transfusion to target identified pathogens

Answer 8

B.) Using chlorhexidine impregnated dressing for the central line site and implementing leukodepletion for all transfused blood components

Question 9

A patient with sepsis is scheduled for urgent source control surgery. Which of the following preoperative goals is essential to optimize the patient’s condition and improve surgical outcomes?

A.) Achieving a mean arterial pressure (MAP) above 65 mmHg through fluid resuscitation and vasopressor support
B.) Targeting a central venous pressure (CVP) of 15 mm Hg to ensure adequate preload
C.) Maintaining a mixed venous oxygen saturation (SvO2) below 65% to avoid oxygen toxicity
D.) Ensuring a metabolic acidosis is present to stimulate increased oxygen delivery

Answer 9

A.) Achieving a mean arterial pressure (MAP) above 65 mmHg through fluid resuscitation and vasopressor support

Question 10

For a patient with severe sepsis undergoing emergency surgery, which intraoperative strategy is paramount to minimize the risk of worsening sepsis and supporting organ function?

A.) Liberal fluid administration to achieve a central venous pressure of 18 mm Hg for maximal preload
B.) Comprehensive invasive monitoring, including intraarterial blood pressure and central venous pressure, to guide fluid and vasopressor therapy
C.) Minimal invasive monitoring with reliance on non-invasive blood pressure measurements
D.) Aggressive diuresis to prevent fluid overload and pulmonary edema

Answer 10

B.) Comprehensive invasive monitoring, including intraarterial blood pressure and central venous pressure, to guide fluid and vasopressor therapy

Question 11

In the immediate postoperative period for a patient with sepsis, which of the following is a critical priority to reduce the risk of further organ dysfunction and support recovery?

A.) Rapid de-escalation of antimicrobial therapy within the first 24 hours to minimize resistance development
B.) Immediate discontinuation of all vasopressor support to assess true hemodynamic status
C.) Focus solely on antimicrobial therapy, with minimal emphasis on organ support to avoid overuse of resources
D.) Continuation of goal-directed therapy, including targeted antimicrobial therapy and support of failing organ systems

Answer 11

D.) Continuation of goal-directed therapy, including targeted antimicrobial therapy and support of failing organ systems

Question 12

For a patient undergoing surgery due to fulminant C. difficile colitis, which intraoperative management strategy is paramount to minimize the risk of exacerbating the infection and supporting patient stability?

A.) Avoiding all use of opiates due to their impact on intestinal motility, regardless of the patient’s pain level
B.) Utilizing opiates judiciously to manage pain without significantly decreasing intestinal motility, which may exacerbate toxin-mediated disease
C.) Exclusive reliance on non-opiate analgesics, irrespective of their efficacy in managing severe pain
D.) Aggressive fluid resuscitation without close monitoring of electrolyte balance and acid-base status

Answer 12

B.) Utilizing opiates judiciously to manage pain without significantly decreasing intestinal motility, which may exacerbate toxin-mediated disease

Question 13

A patient presenting with necrotizing soft tissue infection shows signs of septic shock. Which of the following preoperative interventions is most appropriate for optimizing hemodynamic status?

A.) Administer IV fluids to achieve a CVP of 8-12 mmHg, aiming to optimize preload before surgical debridement
B.) Increase vasopressor support to rapidly achieve a mean arterial pressure (MAP) of >65 mm Hg, prioritizing perfusion pressure over volume status
C.) Delay fluid resuscitation until the extent of infection is surgically assessed to avoid fluid overload
D.) Utilize inotropic support exclusively to enhance myocardial contractility and improve cardiac output

Answer 13

A.) Administer IV fluids to achieve a CVP of 8-12 mmHg, aiming to optimize preload before surgical debridement

Question 14

When choosing an induction agent for anesthesia in a patient with tetanus undergoing emergency surgery, which consideration is paramount to minimize risk and optimize patient stability?

A.) Choose propofol for its rapid onset and favorable profile for smooth induction, despite potential for hypotension
B.) Select ketamine for its ability to maintain hemodynamic stability through sympathetic stimulation
C.) Use etomidate to minimize cardiovascular effects, given the concern for hemodynamic instability in tetanus
D.) Prefer midazolam for its anxiolytic properties, overlooking its minimal impact on hemodynamics

Answer 14

B.) Select ketamine for its ability to maintain hemodynamic stability through sympathetic stimulation

Question 15

Following surgical debridement for necrotizing soft tissue infection, how should antibiotics be managed to effectively combat infection while preventing resistance?

A.) Switch to oral antibiotics immediately postoperatively to facilitate hospital discharge and outpatient management
B.) Narrows the antibiotic spectrum based on preliminary culture results, but reassess and adjust as final sensitivities become available
C.) Continue empirical broad-spectrum antibiotics indefinitely until all signs of infection have resolved
D.) Transition to targeted antibiotic therapy based on culture and sensitivity results as soon as they are available

Answer 15

D.) Transition to targeted antibiotic therapy based on culture and sensitivity results as soon as they are available

Question 16

A patient with diagnosed community-acquired pneumonia requires urgent non-thoracic surgery. Which of the following preoperative assessments is most critical to guide anesthesia management and optimize patient outcomes?

A.) Sputum culture to identify the causative organism of pneumonia
B.) A complete blood count to identify leukocytosis as a marker of bacterial infection
C.) Chest radiography to confirm the presence of diffuse infiltrates indicative of atypical pneumonia
D.) Evaluation of arterial oxygen saturation to assess the extent of intrapulmonary shunting

Answer 16

D.) Evaluation of arterial oxygen saturation to assess the extent of intrapulmonary shunting

Question 17

In managing anesthesia for a patient with a recent history of aspiration pneumonia, which consideration is paramount to minimize the risk of exacerbating the condition?

A.) Careful airway management to prevent further aspiration, especially during induction and extubation
B.) Utilization of high TV to ensure adequate ventilation& prevent atelectasis
C.) Strictly avoiding NSAIDS due to their potential to worsen pulmonary inflammation
D.) Administration of prophylactic abx immediately before anesthesia to prevent infection spread

Answer 17

A.) Careful airway management to prevent further aspiration, especially during induction and extubation

Question 18

For a patient with ventilator-associated pneumonia (VAP) scheduled for a tracheostomy, which of the following anesthesia management strategies is most appropriate to maintain pulmonary status and minimize postoperative complications?

A.) Switching to low PEEP settings during the procedure to minimize airway pressure and reduce the risk of barotrauma
B.) Performing the tracheostomy under deep sedation with spontaneous breathing to improve patient comfort and respiratory dynamics
C.) Ensuring continuity of the patient’s ICU ventilator settings, including PEEP, to avoid de-recruitment of alveoli
D.) Using intermittent manual ventilation with 100% oxygen throughout the procedure to maximize oxygenation and minimize lung injury

Answer 18

C.) Ensuring continuity of the patient’s ICU ventilator settings, including PEEP, to avoid de-recruitment of alveoli

Question 19

In managing anesthesia for a patient presenting with symptoms suggestive of influenza requiring emergency non-respiratory surgery, which of the following strategies is crucial to minimize transmission and optimize patient outcomes?

A.) Switching to regional anesthesia to avoid airway manipulation and reduce the need for infection control measures
B.) Implementing droplet precautions and using a high-efficiency particulate air (HEPA) filter between the anesthesia circuit and the patient’s airway
C.) Using a simple surgical mask on the patient during induction and intubation to minimize droplet spread
D.) Administering prophylactic antibiotics preoperatively to reduce the risk of influenza-related complications

Answer 19

B.) Implementing droplet precautions and using a high-efficiency particulate air (HEPA) filter between the anesthesia circuit and the patient’s airway

Question 20

A patient with a history of SARS now presenting with symptoms of a new respiratory illness requires urgent surgery. In addition to standard preoperative assessment, which of the following is most critical to ensure safe anesthesia management?

A.) Repeating a TB skin test to exclude coexisting TB as a complicating factor
B.) Detailed history taking to identify potential recent exposure to known outbreaks or travel to endemic areas
C.) Obtaining a detailed dietary history to assess for potential zoonotic sources of the new respiratory illness
D.) Chest radiography to evaluate for residual lung damage from previous SARS infection

Answer 20

B.) Detailed history taking to identify potential recent exposure to known outbreaks or travel to endemic areas

Question 21

For a patient with active TB undergoing an urgent surgical procedure, which of the following anesthesia management strategies is paramount to minimize the risk of transmission?

A.) Using droplet precautions and standard surgical masks for all OR staff during the procedure
B.) Placing a HEPA filter in the anesthesia circuit without additional ventilation controls
C.) Performing the surgery in a standard operating room while limiting the number of personnel to reduce exposure risk
D.) Ensuring all the operating room staff use N95 respirators and implementing negative pressure ventilation in the OR

Answer 21

D.) Ensuring all the operating room staff use N95 respirators and implementing negative pressure ventilation in the OR

Question 22

When evaluating an HIV-positive patient for elective surgery, which of the following assessments is most critical in determining the patient’s readiness and optimizing perioperative management?

A.) Confirming the pt’s adherence to highly active HAART for at least 6 mo prior to surgery
B.) Obtaining a recent CD4+ count to assess the degree of immunosuppression & risk for opportunistic infections
C.) Ensuring viral load has been undetectable for a consecutive period to minimize periop viral transmission risk
D.) A comprehensive review of systems to ID any subclinical manifestations of opportunistic infections or neoplasms

Answer 22

B.) Obtaining a recent CD4+ count to assess the degree of immunosuppression & risk for opportunistic infections

Question 23

In selecting an anesthetic technique for an HIV-positive patient with a moderate CD4+ count undergoing minor outpatient surgery, which of the following considerations is paramount to minimize postoperative complications?

A.) Selection of local anesthesia with sedation to reduce the potential for respiratory complications
B.) Preference for general anesthesia to provide complete control of the airway and minimize stress response
C.) Administration of intravenous immunoglobulin preoperatively to boost immune function
D.) Use of regional anesthesia to avoid systemic immunosuppressive effects of general anesthetics

Answer 23

D.) Use of regional anesthesia to avoid systemic immunosuppressive effects of general anesthetics

Question 24

For an HIV-positive patient on HAART scheduled for surgery, which of the following is the most important consideration to manage potential HAART-related anesthetic drug interactions?

A.) Switching the patient to an alternative HAART regimen with fewer drug interactions 1 week before surgery
B.) Temporarily discontinuing HAART 24 hours before surgery to reduce drug interaction risk
C.) Reviewing the patients HAART regimen for potential interactions with planned anesthetic drugs
D.) Increasing the dose of an anesthetic agents to overcome reduced efficacy due to HAART- induced enzyme induction

Answer 24

C.) Reviewing the patients HAART regimen for potential interactions with planned anesthetic drugs

Question 25

In considering perioperative corticosteroid supplementation for an HIV-positive patient undergoing major surgery, which of the following factors is most critical in guiding this decision?

A.) The patient’s current viral load and risk of opportunistic infections
B.) Evidence of adrenal insufficiency due to either HIV infection or concurrent opportunistic infections
C.) The presence of HAART-related lipid and glucose metabolism disorders
D.) The duration and intensity of the patient’s HAART regimen

Answer 25

B.) Evidence of adrenal insufficiency due to either HIV infection or concurrent opportunistic infections

Question 26

In the postoperative monitoring of an HIV-positive patient who initiated HAART shortly before undergoing elective surgery, which of the following is most important for early identification and management of immune reconstitution inflammatory syndrome (IRIS)?

A.) Routine postop administration of prophylactic abx to prevent opportunistic infections associated with IRIS
B.) Daily assessment of CD4+ count & viral load in the immediate postop period
C.) Immediate d/c of HAART at the 1st sign of any postop infection to prevent exacerbation of IRIS
D.) Vigilant monitoring for the paradoxical worsening of general clinical symptoms or unmasking of opportunistic infections

Answer 26

D.) Vigilant monitoring for the paradoxical worsening of general clinical symptoms or unmasking of opportunistic infections

Question 27

For a pediatric patient with cyclic neutropenia scheduled for elective surgery during a neutrophil nadir, which preoperative measure is essential to mitigate the increased risk of infection?

A.) Applying a strict neutropenic diet starting two weeks before the surgery to reduce exposure to potential pathogens
B.) Postponing surgery until the patient’s neutrophil count naturally recovers to a safer level
C.) Administration of granulocyte colony-stimulating factor (G-CSF) one week prior to surgery to elevate neutrophil counts
D.) Initiating prophylactic broad-spectrum antibiotics 24 hours before surgery to minimize infection risk

Answer 27

Initiating prophylactic broad-spectrum antibiotics 24 hours before surgery to minimize infection risk

Question 28

In preparing for surgery in an adult patient experiencing chemotherapy-induced neutropenia, what is the most critical consideration to ensure the patient’s safety and minimize the risk of infection?

A.) D/C chemo at least 4 was before the planned surgery to allow bone marrow recovery
B.) Scheduling the surgery based on detailed monitoring of the patient’s neutrophil count to avoid periods of profound neutropenia
C.) Utilizing hyperbaric O2 therapy preop to enhance immune function & neutrophil activity
D.) Preoperative administration of G-CSF for a duration sufficient to achieve a significant increase in neutrophil count

Answer 28

B.) Scheduling the surgery based on detailed monitoring of the patient’s neutrophil count to avoid periods of profound neutropenia

Question 29

In managing anesthesia for a patient with chronic granulomatous disease (CGD) scheduled for elective surgery, which of the following is the most critical strategy to minimize the risk of postoperative infections?

A.) Preoperative optimization with recombinant IFN-y to enhance neutrophil function temporarily
B.) Increasing the duration of preoperative fasting to reduce the risk of aspiration and subsequent infection
C.) Prophylactic administration of broad-spectrum antibiotics and antifungals agents tailored to cover organisms commonly associated with CGD
D.) Administration of intravenous immunoglobulin (IVIG) during the perioperative period to boost overall immune function

Answer 29

C.) Prophylactic administration of broad-spectrum antibiotics and antifungals agents tailored to cover organisms commonly associated with CGD

Question 30

For a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency undergoing elective surgery, which preoperative consideration is paramount to avoid intraoperative complications?

A.) Administration of G-CSF to increase neutrophil counts and improve phagocytic function
B.) Avoidance of drugs known to trigger hemolysis in G6PD-deficient patients, such as certain antibiotics and antimalarials
C.) Restriction of oxygen supplementation to prevent oxidative stress on red blood cells
D.) Preoperative blood transfusion to increase the total level of functional G6PD in red blood cells

Answer 30

B.) Avoidance of drugs known to trigger hemolysis in G6PD-deficient patients, such as certain antibiotics and antimalarials

Question 31

When planning surgery for a patient with leukocyte adhesion deficiency, which of the following perioperative management strategies is essential to address the patient’s increased risk of recurrent bacterial infections?

A.) Rigorous aseptic technique and the use of prophylactic antibiotics to prevent postoperative bacterial infections
B.) Administering granulocyte colony-stimulating factor (G-CSF) to boost white blood cell count prior to surgery
C.) Using immunosuppressive therapy perioperatively to reduce the risk of inflammation-related complications
D.) Delaying surgery until the patient’s leukocyte function returns to normal levels

Answer 31

A.) Rigorous aseptic technique and the use of prophylactic antibiotics to prevent postoperative bacterial infections

Question 32

In preparing for major surgery on a patient with marked neutrophilia, potentially indicative of a deep-seated infection or myeloproliferative disorder, which of the following anesthetic considerations is paramount to minimize perioperative risk?

A.) Prioritizing aggressive fluid resuscitation to dilute the high white blood cell count and improve circulation
B.) Avoiding the use of regional anesthesia due to concerns about potential infection spread through the epidural or spinal space
C.) Close monitoring for signs of leukostasis, including splenic infarction and decreasing lung oxygen diffusing capacity, especially if leukocyte counts exceed 100,000/µL
D.) Administering corticosteroids intraoperatively to suppress neutrophil production and minimize inflammation

Answer 32

C.) Close monitoring for signs of leukostasis, including splenic infarction and decreasing lung oxygen diffusing capacity, especially if leukocyte counts exceed 100,000/µL

Question 33

For an elective surgery patient with monocytosis associated with an underlying inflammatory disorder, such as systemic lupus erythematosus, which preoperative management strategy is most important to ensure patient safety?

A.) Immediate initiation of high-dose monoclonal antibody therapy to reduce monocytosis before surgery
B.) Preoperative administration of intravenous immunoglobulin (IVIG) to bolster immune function and address monocytosis directly
C.) Elective splenectomy in the preoperative period to reduce circulating monocyte counts and control inflammation
D.) Comprehensive preoperative evaluation to assess the activity of the underlying inflammatory disorder and adjust immunosuppressive therapy accordingly

Answer 33

D.) Comprehensive preoperative evaluation to assess the activity of the underlying inflammatory disorder and adjust immunosuppressive therapy accordingly

Question 34

For a patient with hereditary angioedema due to C1 esterase inhibitor deficiency undergoing elective surgery, which of the following is the most appropriate prophylactic strategy to prevent an acute angioedema attack triggered by surgical stress?

A.) Administering antihistamines and corticosteroids prior to surgery to suppress allergic reactions and prevent swelling
B.) Administration of C1 esterase inhibitor concentrate prior to surgery to prevent bradykinin-mediated edema
C.) Using a low-dose epinephrine infusion throughout the procedure to prevent vasodilation and subsequent edema
D.) Providing prophylactic tranexamic acid to stabilize fibrin clots and reduce the risk of angioedema attacks

Answer 34

B.) Administration of C1 esterase inhibitor concentrate prior to surgery to prevent bradykinin-mediated edema

Question 35

In managing the airway of a patient presenting with acute ACE inhibitor-induced angioedema and potential upper airway obstruction, which of the following approaches is crucial for maintaining airway patency and ensuring patient safety?

A.) Administering epinephrine to reduce airway swelling and delay the need for intubation
B.) Placing the patient in a high-flow oxygen face mask and monitoring closely for spontaneous resolution
C.) Immediate cessation of the ACE inhibitor and preparation for potential tracheal intubation, with equipment for tracheostomy ready if intubation fails
D.) Performing awake fiberoptic intubation without preparation for surgical airway intervention

Answer 35

C.) Immediate cessation of the ACE inhibitor and preparation for potential tracheal intubation, with equipment for tracheostomy ready if intubation fails

Question 36

In preparing a pediatric patient with X-linked agammaglobulinemia for elective surgery, which of the following interventions is essential to reduce the risk of postoperative infections?

A.) High-dose intravenous corticosteroids immediately before and after surgery to enhance immunosuppression and reduce inflammation
B.) Administration of prophylactic broad-spectrum antibiotics for one month before surgery to eliminate potential sources of infection
C.) Bone marrow transplantation several months prior to surgery to correct the underlying B-cell maturation defect
D.) Intravenous immunoglobulin (IVIG) therapy within a week before surgery to elevate plasma IgG levels to near 500 mg/dL

Answer 36

D.) Intravenous immunoglobulin (IVIG) therapy within a week before surgery to elevate plasma IgG levels to near 500 mg/dL

Question 37

For a patient with Waldenström macroglobulinemia scheduled for cardiac surgery requiring cardiopulmonary bypass, which of the following preoperative treatments is most appropriate to prevent complications associated with hyperviscosity?

A.) Administration of high-dose intravenous immunoglobulins to competitively inhibit IgM binding and reduce viscosity
B.) Plasmapheresis to decrease the concentration of IgM and reduce plasma viscosity before surgery
C.) Continuous low-dose aspirin therapy starting two weeks prior to surgery to prevent thrombosis without affecting IgM levels
D.) High-volume intravenous hydration with normal saline 24 hours before surgery to dilute plasma IgM concentration

Answer 37

B.) Plasmapheresis to decrease the concentration of IgM and reduce plasma viscosity before surgery

Question 38

During anesthesia, if a patient experiences a sudden onset of bronchospasm, urticaria, and hypotension immediately after administration of a medication, indicating a possible Type I allergic reaction, which of the following is the first-line treatment

A.) Give oral antihistamines immediately to block further histamine release from mast cells
B.) Start an intravenous corticosteroid infusion to prevent late-phase allergic response
C.) Provide a continuous nebulized albuterol treatment for bronchospasm relief
D.) Administer intramuscular epinephrine at a dose of 0.01 mg/kg to the vastus lateralis muscle

Answer 38

D.) Administer intramuscular epinephrine at a dose of 0.01 mg/kg to the vastus lateralis muscle

Question 39

In a patient with a history of drug-induced Type IV hypersensitivity reaction, such as Stevens-Johnson syndrome, which of the following is the most important preventive measure to consider before prescribing medications?

A.) Detailed review of the patient’s drug history to identify and avoid any previously implicated drugs
B.) Routine premedication with intravenous corticosteroids to suppress T-cell activation
C.) Administration of prophylactic antihistamines to prevent histamine release from basophils and mast cells
D.) Pre-treatment with non-steroidal anti-inflammatory drugs (NSAIDs) to mitigate inflammation associated with drug reactions

Answer 39

A.) Detailed review of the patient’s drug history to identify and avoid any previously implicated drugs

Question 40

For a patient with a known history of IgE-mediated anaphylaxis to penicillin undergoing elective surgery, which of the following preoperative measures is most important to prevent recurrence of anaphylaxis?

A.) Preoperative administration of glucocorticoids to suppress any potential immune response
B.) Intravenous immunoglobulin infusion one day prior to surgery to provide passive immunity
C.) Administration of antihistamines and leukotriene receptor antagonists before surgery
D.) Avoidance of all β-lactam antibiotics and use of alternative antimicrobial prophylaxis

Answer 40

D.) Avoidance of all β-lactam antibiotics and use of alternative antimicrobial prophylaxis

Question 41

In a patient developing a severe exfoliative dermatitis suspected to be a drug-induced type IV hypersensitivity reaction, which of the following steps is crucial in the initial management?

A.) Immediate administration of high-dose intravenous corticosteroids to suppress T-cell mediated immune response
B.) Starting antiviral therapy assuming a viral cause for the skin lesions
C.) Administration of intramuscular epinephrine assuming an immediate type I hypersensitivity reaction
D.) Discontinuation of all non-essential medications suspected to be the causative agent

Answer 41

D.) Discontinuation of all non-essential medications suspected to be the causative agent

Question 42

In planning anesthesia for a patient with DiGeorge Syndrome, which of the following considerations is most important given the potential for T-cell dysfunction?

A.) Avoidance of neuromuscular blocking agents due to increased risk of anaphylaxis
B.) Administration of intravenous immunoglobulin (IVIG) preoperatively to boost immune function
C.) Preoperative vaccination against common surgical pathogens
D.) Ensuring meticulous infection control measures given the patient’s immunocompromised state

Answer 42

Ensuring meticulous infection control measures given the patient’s immunocompromised state

Question 43

A 45-year-old patient scheduled for elective surgery reports a history of penicillin allergy since childhood, characterized by rash and angioedema. The patient has avoided penicillin since the event. Preoperative evaluation includes planning for antibiotic prophylaxis and potential neuromuscular blockade.
Which of the following strategies is most appropriate for managing this patient’s reported penicillin allergy in the perioperative period?

A.) Automatically substitute penicillin with a macrolide antibiotic without further allergy assessment
B.) Administer a carbapenem for antibiotic prophylaxis without skin testing, given the low cross-reactivity rate
C.) Conduct elective skin testing for penicillin and, if negative, proceed with penicillin or a first-generation cephalosporin for antibiotic prophylaxis
D.) Opt for a broad-spectrum antibiotic such as vancomycin to avoid the risk of cross-reactivity with
β-lactam antibiotics

Answer 43

C.) Conduct elective skin testing for penicillin and, if negative, proceed with penicillin or a first-generation cephalosporin for antibiotic prophylaxis

Question 44

A 60-year-old woman with a history of anaphylaxis to succinylcholine during a previous surgery is scheduled for another surgical procedure. Her medical history is significant for multiple allergies, including latex and certain fruits. The anesthesia team is concerned about potential cross-reactivity with other NMBAs.
Which of the following preoperative assessments is most appropriate for this patient?

A.) Presume cross-reactivity among all NMBAs and avoid their use, relying solely on local or regional anesthesia techniques
B.) Administer a benzylisoquinolinium compound as an alternative, assuming lower cross-reactivity with succinylcholine
C.) Preoperative skin testing for all NMBAs likely to be used during surgery to identify a safe alternative
D.) Use sugammadex preoperatively as a prophylactic measure to prevent any NMBA-induced anaphylaxis

Answer 44

Preoperative skin testing for all NMBA’s likely to be used during surgery to identify a safe alternative

Question 45

A 62-year-old patient undergoing major abdominal surgery develops acute onset hypoxia and bilateral pulmonary infiltrates within 4 hours following the transfusion of fresh frozen plasma. The patient’s history is negative for cardiac failure, and there is no evidence of volume overload. Based on the clinical presentation, TRALI is suspected.
Which of the following is the most appropriate initial management strategy for this patient?

A.) Administer high-dose corticosteroids immediately to suppress the immune response and prevent further lung injury
B.) Initiate rapid diuresis to reduce pulmonary edema, assuming a misdiagnosis of transfusion-associated circulatory overload (TACO)
C.) Initiate supportive care with mechanical ventilation using low tidal volumes and high positive end-expiratory pressure (PEEP) settings, in line with ARDS management protocols
D.) Provide aggressive fluid resuscitation to counteract the hypotension and potential shock state associated with anaphylactic reactions

Answer 45

C.) Initiate supportive care with mechanical ventilation using low tidal volumes and high positive end-expiratory pressure (PEEP) settings, in line with ARDS management protocols

Question 46

A patient receiving a red blood cell transfusion during surgery exhibits sudden onset of fever, hypotension, and dark urine approximately 2 hours post-transfusion. The surgical team suspects an acute hemolytic transfusion reaction (AHTR).
What is the most crucial next step in managing this suspected AHTR?

A.) Immediately stop the transfusion, send blood samples for direct antiglobulin test (DAT), and maintain urine output to prevent acute kidney injury
B.) Continue the transfusion at a slower rate while monitoring for the resolution of symptoms, assuming a mild allergic reaction
C.) Administer an antipyretic to manage the fever and an antihistamine to counteract any potential allergic component of the reaction
D.) Provide intravenous immunoglobulin (IVIG) to neutralize circulating antibodies that may be causing the hemolytic reaction

Answer 46

A.) Immediately stop the transfusion, send blood samples for direct antiglobulin test (DAT), and maintain urine output to prevent acute kidney injury

Question 47

A patient with a long history of systemic lupus erythematosus (SLE) is scheduled for elective surgery. The patient’s medical history is significant for renal involvement and chronic use of corticosteroids. During the preoperative evaluation, the nurse anesthesiologist is most concerned about

A.) Evaluating renal function and adjusting the anesthetic plan to minimize nephrotoxicity, given the patient’s SLE-related renal injury and chronic corticosteroid use
B.) Primarily focusing on the potential for an Addisonian crisis due to chronic corticosteroid use, without consideration for other organ involvement
C.) Avoiding all immunosuppressive medications intraoperatively to reduce the risk of postoperative infection, regardless of the patient’s current immunosuppressive regimen
D.) The exclusive focus on managing potential cardiovascular complications, assuming all SLE patients have a significant risk of accelerated atherosclerosis

Answer 47

A.) Evaluating renal function and adjusting the anesthetic plan to minimize nephrotoxicity, given the patient’s SLE-related renal injury and chronic corticosteroid use

Question 48

A 55-year-old patient with chronic autoimmune hepatitis undergoing non-cardiac surgery is at an increased risk of perioperative cardiovascular complications primarily due to

A.) Direct autoimmune-mediated cardiac damage, assuming all autoimmune disorders inherently lead to cardiac involvement
B.) The exclusive impact of autoimmune hepatitis on liver function, with no consideration for the systemic effects of chronic autoimmune disease and its treatment
C.) The long-term use of corticosteroids contributing to hypertension and diabetes mellitus, which are significant risk factors for cardiovascular disease
D.) An overemphasis on the risk of accelerated atherosclerosis due to autoimmune hepatitis without considering the patient’s specific cardiovascular risk factors or medication history

Answer 48

C.) The long-term use of corticosteroids contributing to hypertension and diabetes mellitus, which are significant risk factors for cardiovascular disease

Question 49

During a complex abdominal surgery, a patient with a history of multiple previous surgeries requiring allogenic blood transfusions is assessed for potential perioperative blood transfusion. Given the known effects of TRIM, the nurse anesthesiologist’s primary consideration to minimize immunosuppression should be

A.) Rely exclusively on autologous blood transfusion irrespective of the patient’s hemodynamic status or availability of autologous blood
B.) Prefer the use of leukoreduced blood products to mitigate the immunomodulatory effects of transfusions, such as decreased NK-cell function and impaired antigen presentation
C.) Avoid any blood transfusion and manage the patient with a restrictive fluid strategy, regardless of the patient’s intraoperative blood loss
D.) Administer prophylactic antibiotics to counteract the increased susceptibility to infection due to TRIM, without considering blood product modification techniques

Answer 49

B.) Prefer the use of leukoreduced blood products to mitigate the immunomodulatory effects of transfusions, such as decreased NK-cell function and impaired antigen presentation

Question 50

A patient undergoing a major surgical procedure requires multiple transfusions of allogenic blood products. Postoperatively, the patient demonstrates signs of immunosuppression. This scenario highlights the necessity for the nurse anesthesiologist to understand the potential for

A.) Immediate hypersensitivity reactions exclusively, focusing solely on the risk of anaphylaxis from blood product transfusion with consideration of long-term immunomodulatory effects
B.) Transfusion-related immunomodulation (TRIM) effects, such as increased susceptibility to infection and impaired antigen presentation, likely mediated by donor leukocytes and soluble HLA peptides present in transfused blood products
C.) Leukoreduction techniques as a completely effective measure to eliminate all TRIM effects, considering the role of soluble mediators like histamine in perpetuating immunosuppression
D.) The exclusive contribution of direct blood-borne pathogens transmitted through transfusion, considering the immunomodulatory effects of transfused blood products themselves

Answer 50

B.) Transfusion-related immunomodulation (TRIM) effects, such as increased susceptibility to infection and impaired antigen presentation, likely mediated by donor leukocytes and soluble HLA peptides present in transfused blood products

Question 51

Considering the potential for anesthesia and surgery to influence tumor progression, a patient with a localized solid tumor is scheduled for surgical excision. The nurse anesthesiologist aims to minimize the impact of surgery and anesthesia on tumor recurrence. Which anesthetic technique is most appropriate for this patient?

A.) Rely exclusively on general anesthesia with volatile anesthetics for all cancer surgeries, due to its benefits on immunomodulatory effects
B.) Administer high-dose opioids intraoperatively to all cancer surgery patients to ensure profound analgesia, prioritizing pain control which has significant positive immunomodulatory effects
C.) Avoid the use of any local anesthetics due to their well documented pro-tumor effects
D.) Preferentially utilize regional anesthesia to attenuate the surgical stress response and reduce requirements for general anesthetics and opioids, potentially mitigating immunosuppressive effects

Answer 51

D.) Preferentially utilize regional anesthesia to attenuate the surgical stress response and reduce requirements for general anesthetics and opioids, potentially mitigating immunosuppressive effects