Simulation Exam 7 Flashcards
You have just intubated a 70 Kg patient suffering from severe burns of the face and head and entire anterior torso. You start an intravenous line and begin administering fluids. You know that the initial fluid resuscitation volume to be infused over the first 24 hours is about
5000
The most commonly used strategy for fluid resuscitation is to take the percent of body surface area burned, multiply it by 2-4 times the weight in kilograms, and administer that volume during the first 24 hours following the burn. This patient has suffered a 27% burn (18% for the anterior trunk and 9% for the face and head). This creates a range of fluid administration between 3780 and 7560 mLs, making 5,000 mLs the best answer.
Which of the following is false regarding disseminated intravascular coagulation?
DIC is associated with a wide range of disorders including septic shock, placenta previa, abruption, amniotic fluid embolism, presence of a dead fetus late in pregnancy, and tumor lysis syndrome. Prolonged surgery and surgery for certain procedures such as prostatectomy for carcinoma, liver transplantation, and coronary bypass surgery are associated with significant bleeding abnormalities. When associated with septic shock, it is most often caused by gram-negative organisms.
Which of the following groups are at an increased risk for the development of latex allergy?
Spina bifida, spinal cord injury, and congenital abnormalities of the genitourinary tract are associated with an increased risk for developing latex allergy. Persons with chronic exposure to latex (healthcare workers and patients who undergo frequent urinary catheterization) are also at increased risk.
Hepatic dysfunction due to biliary tract obstruction would be consistent with which laboratory finding?
Biliary stones are considered a posthepatic cause of hepatic dysfunction and are associated with an increased conjugated fraction of bilirubin, normal to slightly increased aminotransferase enzymes, and most notably, markedly increased alkaline phosphatase levels.
You are performing general endotracheal anesthesia on a patient undergoing laparoscopic cholecystectomy with a 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 below would NOT potentially relieve spasm of the Sphincter of Oddi?
The use of opioids such as morphine can produce spasm of the sphincter of Oddi, which can make the performance of a cholangiogram difficult. Meperidine is considered to be less likely to cause spasm of the sphincter of Oddi than other opioids. Drugs that have been used to treat the spasm include small amounts of naloxone, glucagon, and nitroglycerin.
A postpartum patient presents for a tubal ligation. What is the most common form of anesthesia for this procedure?
Although general anesthesia, spinal anesthesia, and epidural anesthesia are all acceptable options, 75 percent of all tubal ligations are performed under local anesthesia.
A trigger point injection would be most appropriate for the treatment of
A trigger point injection is the injection of local anesthetic in a muscle to treat myofascial pain.
What diagnostic parameter is the most sensitive indicator of the effect of obesity on pulmonary function?
Expiratory reserve volume
Obesity decreases respiratory compliance due to the accumulation of fat on the chest wall, diaphragm, and abdomen resulting in a decrease in functional residual capacity, vital capacity, and total lung capacity. The reduction in functional residual capacity is due to a reduction in the expiratory reserve volume, which is the most sensitive indicator of the effect of obesity on pulmonary function. Minute ventilation is increased in obese patients to meet the metabolic demand of excess fat.
Which of the following cardiovascular abnormalities are consistent with morbid obesity?
eccentric LVH
Patients with morbid obesity have a larger total blood volume than non-obese patients to supply the excess adipose tissue. The excess blood volume and resulting increase in preload causes ventricular dilation and increased left ventricular wall stress (eccentric hypertrophy). Obese patients have a faster rise in cardiac output in response to exercise than non-obese patients, fueled primarily by an increase in heart rate as the stroke volume changes little with exertion. The chronically elevated cardiac output and increased blood volume may result in an increase in the SVR over time.
Which of the following laws explains how nitrous oxide can expand an existing pneumothorax?
Fick’s law describes the diffusion of gases across biological tissues and states that the diffusion of a gas across a semipermeable membrane is directly proportional to the partial pressure gradient, the membrane solubility of the gas, and the surface area of the membrane and is inversely proportional to the thickness of the membrane and the molecular weight of the gas. Henry’s law states that at constant temperature, the amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the gas-liquid interface. Graham’s law states that the diffusion of a gas through an orifice is inversely proportional to the square root of the molecular weight of the gas. Brownian motion describes the mechanism by which the inherent kinetic energy of particles results in their random movement.
You are performing a general anesthetic for a patient undergoing a carotid endarterectomy. Which statement below best illustrates an understanding of how to manage the mean arterial blood pressure for this procedure?
During a carotid endarterectomy, it is advised to maintain the patient’s MAP slightly above their highest recorded preoperative pressure. For severe hypertension, labetolol may be used, but nitroglycerin is preferred for its swift onset and short duration of action as labetolol could result in postoperative hypotension due to its long duration of action. For hypotension, a pure alpha-agonist such as phenylephrine is preferred because it has minimal dysrhythmogenic potential.
You are evaluating a patient who has survived breast cancer and is now presenting for a mammoplasty. Which of the following chemotherapy agents would warrant further investigation into her current hepatic function?
methotrexate
Methotrexate can produce renal and hepatic dysfunction. Doxarubicin (Adriamycin) can result in cardiomyopathy and congestive heart failure. Cyclophosphamide is an alkylating agent that can produce pulmonary toxicity and pulmonary fibrosis. Paclitaxel is a taxane that can produce peripheral neuropathy.
Which areas of the lower leg would still have sensation after the successful performance of a popliteal block on a patient? (select two)
A popliteal fossa blockade can anesthetize the nerves of the lower leg. However, a supplementary femoral nerve block is required to block its terminal saphenous branch which innervates the medial anterior calf and the medial aspect of the foot.
Which of the following statements is not true of a cervical plexus blockade?
The sensory and motor fibers of the cervical plexus originate from the cervical 2, 3, and 4 nerve roots and are unique in that the sensory fibers separate from the motor fibers early and can be blocked separately. The main potential risk of this procedure is vertebral artery injection, but if the needle is advanced too far medially into the vertebral foramen, epidural or even subarachnoid anesthesia is a potential risk as well, particularly because the dural sleeves of the cervical nerves are longer on these branches. A cervical plexus block does not protect against the carotid sinus reflex and local injection of the carotid sinus at the point where the carotid artery bifurcates is often necessary.
Which of the following symptoms of cardiac tamponade are indications of ventricular discordance? (select two)
Kussmaul’s sign and pulsus paradoxus are both indicative of ventricular discordance (also known as ventricular dyssynchrony) that occurs due to the opposing response of the ventricles to filling during the respiratory cycle.
