Simulation Exam 5 Flashcards
During a craniotomy, the patients blood pressure increases from 120/80 to 240/150. Which of the following would happen?
Cerebral vessels would constrict and cerebral blood flow would increase
In response to an increased MAP, cerebral vessels constrict. Between MAPs of 60 and 140 this mechanism is able to keep CBF constant but outside of this range CBF becomes pressure dependent. This patient’s MAP rose to 180, therefore CBF would increase despite compensatory mechanisms.
All of the following local anesthetics exert a vasodilating effect except for
Ropivacaine
All local anesthetics cause vasodilation except for cocaine, lidocaine, and ropivacaine.
A patient has experienced a high spinal and exhibits hypotension, bradycardia, and weakened respirations. Which intervention would be most appropriate to help prevent further cephalad spread of the local anesthetic?
Flex the head at the neck
Total spinal anesthesia occurs when the local anesthetic spreads throughout the subarachnoid space high enough to block sympathetic outflow and produce hypotension, bradycardia, and even cardiac arrest. Blocks as high as the C3-C5 levels will impair respiration and the patient will likely need prompt ventilatory support. To prevent further cephalad spread of the anesthetic, do not place the patient in reverse Trendelenburg as this will worsen hypotension. Instead, flex the patient’s head at the neck.
Which of the following ECG changes is an indication of subendocardial ischemia?
ST depression
Depression of the ST segment is typically associated with subendocardial ischemia. ST segment elevation is typically associated with transmural ischemia.
Which of the following would best exemplify a diagnosis of hypertensive emergency?
A parturient with a blood pressure of 179/110 an no other symptoms
Hypertensive emergency is defined as hypertension with evidence of end-organ damage such as myocardial ischemia, dissecting aortic aneurysm, renal insufficiency, pulmonary edema, encephalopathy, eclampsia, or intracerebral hemorrhage. Hypertension without signs of end-organ damage is termed ‘hypertensive urgency’. These patients often present with hypertension and symptoms such as headache, epistaxis, or anxiety. The exception to the rule is parturients. A parturient with a diastolic blood pressure greater than 109 mmHg is defined as being in a state of hypertensive emergency even if no other symptoms are present.
A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?
12 hours postop
Patients can experience thyrotoxic crisis at any point during an anesthetic, but it is most likely to occur within 6 to 18 hours postoperatively.
Which of the following statements regarding tonsillectomy and adenoidectomy is true?
Adenoidectomy is associated with minimal pain
Although tonsillectomy is associated with severe pain, adenoidectomy is associated with minimal pain. Up to 65% of patients undergoing tonsillectomy experience postoperative vomiting. LMA’s were first described for use in tonsillectomy in 1990 and are especially useful for preventing exposure of the lower airway to blood.
What is the most important action to take after the surgeon has placed a mouth gag in a patient undergoing tonsillectomy?
It is important to verify the placement of the ETT immediately after placement of the mouth gag. The mouth gag can dislodge, kink, or obstruct the ETT, as evidenced by a change in chest movement, breath sounds, and PIP.
Which of the following classes of oral hypoglycemic agents increase insulin secretion?
sylfonylureas
Sulfonylureas increase insulin secretion by beta cells, thiazolinediones and metformin (a biguanide) enhance tissue sensitivity to insulin, and alpha-glucosidase inhibitors decrease postprandial glucose absorption.
Which of the following conditions is associated with chronic renal failure?
Hyperlipidemia
Renal failure is associated with a wide range of conditions including metabolic acidosis, anemia, uremic coagulopathy, peripheral neuropathy, encephalopathy, osteodystrophy, congestive heart failure, hypertension, hyperlipidemia, hypocalcemia, and elevated potassium, magnesium, and phosphate levels.
The most important factor determining the rate of diffusion of a drug across a membrane is
Conc gradient
According to the Fick equation, the most important factor in determining the rate of diffusion of a drug across a membrane is the concentration gradient of the drug. Membrane thickness is an important factor in the rate of diffusion as is molecular weight, which affects the diffusion coefficient (p) in the equation, but neither of these variables are as important as the concentration gradient.
Which of the following statements regarding COX-2 inhibitors is false?
COX-2 inhibitors decrease platelet aggregation
COX-1 receptor inhibition by NSAIDs is responsible for the gastric irritation, decrease in renal blood flow, and platelet inhibition associated with nonselective NSAIDs. COX-2 receptor inhibition is responsible for the decrease in pain and inflammation.
What sensory level block would be appropriate for performing a cesarean section under epidural anesthesia?
A T4 level is sufficient for performing a cesarean section under epidural anesthesia.
During induction for a parathyroidectomy for relief of hyperparathyroidism, which ECG alteration would you most expect to see?
long Pr then short QT
Hyperparathyroidism results in hypercalcemia and hypophosphatemia which can distort the ECG resulting in a shortened QT Interval and prolonged PR interval. It is also associated with hypertension.
The most common causative agent of acute epiglottitis is
The most common causative agent in epiglottitis is Haemophilus influenza type B. The condition typically affects children ages 2-6 years. It can rapidly progress from sore throat to dysphagia to complete airway obstruction. The incidence of epiglottitis has increasingly become a disease of adulthood because of the widespread use of the Haemophilus influenza vaccines in children.
