Test 2 Flashcards
You are performing a preoperative assessment on a patient with Hemophilia A. You know Hemophilia A is an abnormality of which clotting factor?
factor VIII
Normal coagulation is a balance between hemostatic and fibrinolytic properties. The “viscious triad” of elements associated with trauma that can create or exacerbate coagulopathy include:
hypothermia
acidosis
hemodilution
According to the Society of Ambulatory Anesthsia guidelines for the management of PONV, the proper time to administer dexamethasone for the prevention of PONV is_____________, and the suggested dose is _______________.
at induction; 4-5 mg IV
When a patient undergoing general anesthesia is hyperventilated to a state of alkalosis, intracellular potassium levels _____________ while serum potassium levels __________________.
increase; decrease
Adam loves Obama & wears pink thongs
true
Decreasing afferent tone (dilation of the afferent renal artery) will have the following effects CHOOSE ALL THAT APPLY
increasing GFR
increasing glomerular blood flow
Your patient has a Hgb of 7 mg/dL. Based on this finding, you would expect what change, if any, to this patient’s oxyhemoglobin dissociation curve?
shift right
The leading cause of liver failure in the USA is
acetaminophen overdose
A shift to the right of the oxyhemoglobin dissociation curve decreases the partial pressure at which 50% of hemoglobin is saturated with oxygen
False
A loss of sodium in excess of water is a more common cause of hyponatremia than an excess of total body water.
False
Increased sympathetic nervous system stimulation initiates renin secretion. Renin begins the process of _____________ more sodium from the renal tubule.
retaining
The majority of solute in the ultrafiltrate is reabsorbed via the
proximal tubule
The final stage in the pathogenesis of chronic renal failure is
glomerulosclerosis
Proteins secreted into the ultrafiltrate can be easily reabsorbed completely intact across the tubular membranes.
False
Which of the following is a benefit of utilizing normovolemic hemodilution as a blood conservation technique?
All of the above are benefits
Adriamycin is a chemotherapeutic agent commonly known to cause impaired cardiac contractility. This type of cardiac dysfunction is referred to as
systolic dysfunction
Your patient in septic shock is undergoing massive tissue debridement for necrotizing faciitis. The patient is on norepinephrine at 30 mcg/min and vasopressin at 0.04u/hr. The starting Hct is 38% and the Lactate level is 5.0 mmol/L. ABG is 7.11/34/197 with bicarb at 17. You resuscitate with 6 liters of normal saline and give 100 mEq sodium bicarbonate as the patient is still hypotensive with a systolic BP of 75. After resuscitation, you are able to wean off the vasopressin but still require levophed at 12 mcg/min. Lactate is now 2.0. You repeat the ABG and get the following results. ph 7.24/pCO2 40/ pO2 143 HCO3 22. The most likely cause of refractory acidosis is
Answer
hyperchloremic acidosis
The kidneys are primarily responsible for regulating free water concentration in the body.
False
Anti-parasympathetic medications may cause
urinary retention
Obese patients must be well-preoxygenated before induction of general anesthesia. This is due to their decrease in functional residual capacity, but not total lung capacity.
False
In response to injury, the capillaries
allows more albumin to escape the vascular space
Increased ____________ increases gut absorption of calcium, while ______________ stimulates bone formation, decreasing plasma calcium levels.
calcitriol; calcitonin
Large, negatively charged molecules have a more difficult time penetrating gomerular barriers to enter the ultrafiltrate.
True
Iron deficiency anemia is classified as
microcytic hypochromic
The kidneys receive what percentage of the total cardiac output?
25%
Enzyme immunoassays are the most sensitive & specific tests to confirm heparin-induced thrombocytopenia, but not the most rapid
False
You are evaluating a patient preoperatively for a laproscopic cholecystectomy. You note a recent ABG measurement in the chart. Results are pH 7.37 pCO2 57 pO2 65 HCO3 34 Hgb 18 SpO2 93%. The patient has a long history of smoking and is in no distress. The patient has no chronic renal disease. This patient can be classified as having a
fully compensated chronic respiratory acidosis
Which of the following can precipitate sickling of RBCs in the patient with homozygous sickle cell disease?
hypothermia
PaO2 40 mmHg
septic shock
The initial phase of hemostasis is
formation of the platelet plug
All of the following statements are true regarding hepatic physiology EXCEPT:
The liver receives 40% of the total cardiac output
Which of the following commonly used opiate or opiod medications have active metabolites which may prolong respiratory depression in the patient with renal failure?
demerol & morphine
As with all surgeries, gastric bypass has complications associated with the procedure. The most common cause for reoperation after gastric bypass is
anastamotic leaks
Which of the following factors are NOT part of the final common pathway?
IV
Patients being treated with alkylating chemotherapy drugs can experience which of the following complications?
prolonged response to succinylcholine
Your patient has been febrile for the past 24 hours. No maintenance fluids have been infusing for the past 12 hours. You would expect your patient to be _______________ with a(n) _______________ sodium level
hypovolemic; increased
Symptoms associated with TURP syndrome are caused by
free water excess
ADH exerts its action by
stimulating the kidney to retain more water
l-arginine vasopressin is secreted by the
posterior pituitary
Blood flow TO the glomerulus is provided via the ____________ renal artery. The resting tone of this vessel is primarily regulated by ____________.
afferent; prostaglandins
Zenker’s diverticulum is a contraindication to TEE insertion.
True
In differentiating nephrotic versus nephritic syndrome, the patient with nephrotic syndrome will present with ________________ without _________________.
massive proteinuria; hematuria
You are evaluating a patient in preoperative holding. The patient’s BUN is 18 and the creatinine is 3.6. This patient has azotemia because the patient is clearly in chronic renal failure.
False
The cause of the restrictive ventilatory defect in obese patients is
Both A & B
Hyperkalemia potentiates neuromuscular blockade by decreasing the excitablity of the skeletal muscle cell.
True
Mallory-Weis tear at the GE junction is closely associated with chronic alcohol abuse. The most common signs/symptoms are
upper abdominal pain and bloody vomitus
The only test available to evaluate all properties of clot formation & strength is the
thromboelastograph
The blood bank product which contains the most fibrinogen is
cryoprecipitate
When there is exposure of collagen from damage to the endothelium, the intrinsic clotting pathway is activated.
True
Portal hypertension can lead to hypersplenism, which can result in
platelet trapping & thrombocytopenia
Patients who live at altitude (Denver, CO or Himalayan mtns) are often found to be polycythemic. This polycythemia is created by increased levels of erythropoietin as a result of lower atmospheric pressure.
False
Which of the following is NOT a renal protective benefit of utilizing ACE-I/ARB medical therapy in patients with chronic renal insufficiency or failure?
decrease in coagulopathy
You are caring for an 18y/o patient who has experienced partial thickness burns to the upper chest, arms and chin. The patients lips do not appear damaged but have swollen to twice their normal size. Your next best action should be
intubate the patient immediately
One of the most common complications associated with total thyroidectomy is hypocalcemia. In this setting, acute hypocalcemia is caused by
acute hypoparathyroidism
Patients taking Aricept may experience a resistance to the effects of succinylcholine.
False
Diabetic retinopathy neovascularization is caused primarily by decreased vascular endothelial growth factor.
False
Which of the following anesthetic techniques is suitable for the patient susceptible to malignant hyperthermia AND the patient with muscular dystrophy?
Regional anesthesia with supplemental oxygen from a flushed & clean circuit
In hypothyroidism, TSH levels are decreased.
False
Chronic hyperglycemia contributes to atherosclerotic development by the action of ______________ on collagen function.
advanced glycation end products
Garlic can contribute to intraoperative bleeding by
promoting fibrinolysis
Which THREE of the following choices are implicated in the destruction of insulin-producing cells?
T lymphocytes
cytokines
autoantibodies
A very high IgG response indicates
an established response to secondary exposure to an antigen
Circulating auto-antibodies in the patient with SLE can damage glomerular basement membranes, leading to decreased permeability to plasma proteins.
False
In the patient experiencing septic shock, a stroke volume variation of 22% indicates the patients cardiac output will respond positively to additional volume administration.
True
The most common cause of death in sepsis/sirs is multi-organ system failure
True
Which of the options below is the best means of preventing nosocomial infection in the hospital environment?
handwashing before & after each contact
Which of the following are indices of global hypoperfusion? CHOOSE ALL THAT APPLY
elevated serum lactate
low mixed venous oxygen saturation
Low doses of THC can cause
increased sympathetic activity
You are managing a Level 1 trauma patient after MVA with grade 3 liver laceration. Your patient has a history of steroid-dependent COPD. You are experiencing persistent hypotension despite surgical control of hemorrhage and adequate volume resuscitation. Levophed infusion at 20 mcg/min is not adequately increasing your systemic BP. From the choices below, the best action to take next would be:
100 mg Hydrocortisone IV
In the geriatric patient, you would expect to see an exaggerated sympathetic nervous system response to an acute drop in systemic blood pressure
False
In major burn injury, intravascular hypovolemia is caused by which of the following processes? CHOOSE ALL THAT APPLY
evaporation through damaged skin layer;
extravasation to the damaged tissue via the inflammatory response
Which of the following is not true regarding carcinoid syndrome?
elevated serotonin levels can result in left-sided heart failure
Which of the following herbal supplements have been shown to possess anticoagulant effects? CHOOSE ALL THAT APPLY
garlic, ginger, ginko biloba, ginseng, fever few
The most common organ systems affected by SLE include all of the following EXCEPT
musculoskeletal
Low percentages of central or mixed venous oxygen saturation can indicate which of the following? CHOOSE ALL THAT APPLY
increased oxygen extraction
decreased oxygen delivery
Cardiac changes associated with Duchenne MD included a fibrotic LV and dilated cardiomyopathy.
True
Which of the following is NOT included in the systemic inflammatory response associated with sepsis?
increased glomerular filtration in response to accumulation of bacterial endotoxin
The reason most carcinoid tumors are never diagnosed is clinically significant carcinoid syndrome occurs only in approximately 10% of patients.
True
Most carcinoid tumors originate from the
midgut
The pupillary response to administration of an opioid is termed mydriasis.
False
Anaphylaxis is a _____________ hypersensitivity response
Type I
Patients experiencing myxedema coma may experience which of the following intraoperative issues? CHOOSE ALL THAT APPLY
exaggerated hypotension caused by VAA; decreased cardiac output; blunted baroreceptor response to hypotension
Drugs to avoid in the patient with pheochromocytoma include those with the potential to release ______________ which may then stimulate ______________ release.
histamine; catecholamine
One significant anesthetic implication of Emery-Dreifuss MD is
contractures in neck muscles creating difficulty for airway positioning
Your septic patient has a CVP of 15 mmHg. This patient WILL NOT be responsive to additional administration of volume. This statement is
false because CVP measurement is not a dynamic indicator of volume status
Which of the following is NOT an absolute end-point for surgery on a burn patient?
burn severity requiring removing all tissue down to muscle
Glucagon promotes the action of insulin by facilitating gluconeogenesis.
False
You are preparing to intubate your patient with rheumatoid arthritis via a standard DL. Without careful attention to head position & cervical spine manipulation, you know your patient may experience protrusion of the ______________ into the ______________.
odontoid process; foramen magnum
You are monitoring stroke volume variation on your septic patient in the operating room. The patient is in a sinus rhythm and the ventilator is set to deliver tidal volumes of 5 ml/kg. You would expect the SVV to be
falsely reduced
OSA patients experience frequent episodes of apnea defined as a 50% reduction in airflow for more than 10 seconds that occur at least 15 times per hour of sleep sufficient to result in a 4% decrease in O2 saturations.
False
Metabolic rate can more than double in the patient who experiences partial-thickness burns over >50% BSA.
True
Mineralocorticoids (i.e. aldosterone) are secreted from the
adrenal cortex
Multiple Sclerosis is an autoimmune disorder resulting in a decreased dopamine secretion from pre-synaptic vesicles.
False
The chief hallmark of _________________ is a severe lack of insulin; while the chief hallmark of ______________ is resistance to the effects of insulin.
Type 1 diabetes; type II diabetes
Which of the following is NOT a consideration for anesthesia in the chronic alcoholic?
rapid gastric emtying (dumping syndrome)
Typical muscle weakness caused by Duchenne & Becker MD is experienced in which muscle groups?
shoulders, pelvis, calves
The most common pathogen associated with central venous catheter related bacterial infections is
Staphylococcus
Diabetic neuropathy is an absolute contraindication to neuraxial anesthesia.
False
Pheochromocytoma most commonly secretes
norepinephrine
Patients with carcinoid tumors don’t always exhibit symptoms associated with hormone release due to:
Hepatic first-pass metabolism eliminates the hormones from the circulatory system
Using the Medtronic Nerve Integrity Monitoring (NIM) tube during total thyroidectomy allows monitoring for damage to the
recurrent laryngeal nerve
Which of the medications below would be contraindicated in the patient with Parkinson’s
promethazine
Propanolol is an appropriate pharmachologic therapy for treating tachycardia associated with pheochromocytoma
False
After the demyelination associated with multiple sclerosis occurs, regeneration of myelin can occur with proper therapy
False
Extreme hypothyroidism characterized by impaired mentation, hypoventilation, hypothermia, hyponatremia, and congestive heart failure is termed “Addison’s Disease”.
False
In the geriatric patient, decreases in chest wall compliance and weakening of the respiratory muscles lead to
decreaed FVC and FEV1
Thyroid storm may mimic malignant hyperthermia but one chief difference is the absence of _______________ in the patient with thyroid storm
persistent rise in EtCO2
In the patient experiencing a systemic inflammatory response, serum albumin level is typically ___________; leading to an _________________effect from highly protein-bound medications.
low; increased
Lab results indicating elevated C3 & C4 (complement) levels are indicative of Systemic Lupus Erythematosus
False
Patients with SLE can develop which of the following pulmonary complications? CHOOSE ALL THAT APPLY
acute pneumonitis;
interstitial lung disease
For the patient experiencing refractory hypotension in the setting of sepsis, the first drug of choice for increasing systemic perfusion would be
norepinephrine infusion
The high associated with cocaine use is a result of
increased levels of synaptic norepinephrine & dopamine
Management of thyroid storm includes the administration of
beta-adrenergic antagonists
Major trauma can be considered an acquired form of immune deficiency.
True
In relation to Duchenne MD, which of the following is NOT TRUE in regards to the dystrophin complex?
Dystrophin is normally only present in caridac & smooth muscle
The anesthetic requirement for a patient acutely intoxicated on ethanol, benzodiazepines, opiates, or tetrahydrocannabinol would be
decreased
Which of the following drugs should be avoided in the management of hypertensive crisis associated with cocaine overdose?
propanolol
During your preoperative evaluation, your patient with non-insulin dependent diabetes states he cannot extend his fingers and often gets a “stiff neck”. He states his blood glucose levels are generally well controlled. You suspect
glycosylation of connective tissue & difficult airway
In type II diabetes; the liver production of glucose (gluconeogenesis) is NOT inhibited by increased insulin production
True
Insulin is produced in the ______________ cells of the pancreas and its production is stimulated by increases in levels of _____________ in the bloodstream.
beta; glucose
Acute intravascular hemolysis is a slow, exaggerated IgG response to ABO incompatibility.
False
The physical signs & symptoms of long-term exogenous glucocorticoid use can be termed
Cushing’s disease
Although many substances may be secreted, the majority of midgut carcinoid tumors secrete
serotonin
Common initial presentation of patients with pheochromocytoma is hypertensive crisis. Some common sequelae of hypertensive crisis are: CHOOSE ALL THAT APPLY
CVA
AMI
pulmonary edema
A very fast, non-specific immune reponse is characteristic of the
innate immune system
In the geriatric patient, the prolonged response to lipid-soluble drugs is due to the increased volume of distribution present for those drugs
True
The most common valvular lesion associated with SLE is
mitral regurgitation
NSAIDs should be used with caution in geriatric patients because GFR is ______________ as a result of increased age
reduced
Brain function is impaired when plasma glucose levels fall below
50mg/dl
All of the following can be signs/symptoms of diabetic autonomic neuropathy EXCEPT
increased heart rate variability
The systemic features of acute pancreatitis can be attributed to the activation of the
systemic inflammatory response
Autonomic neuropathy, as may be present in the long-term diabetic can cause which of the following?
all of the above
Signs of HIT
thrombocytopenia/enlargement of clot
first manifestation of rhabdo
hyperkalemia cardiac arrest
MD pts have decreased gastric reflexed and prolonged gastric emptying. To prevent aspiration, CRNA should do all EXCEPT:
RSI with Sux
If both dechennes and beckers have deficits in chromosome xp21 on mutated gene dp427, what is main difference in the 2 related to dystrophin?
neither of the above are correct
What makes CRNA proficient in dealing with organophosphate poisoning?
We are airway experts and ANS experts
Agent given to prevent aging r/t syran gas?
Parlidoximesiv
How to treat cyran nerve gas attack?
atropine
Where in the cell does cyran nerve gas cell act?
synaptic junction that inhibits the breakdown of ACH by covalent bond with acetylcholinesterase
Best predictor of postoperative function is patient’s report of tolerance and daily activities true or false
true
cognitive function declines linearly w/structural changes of CNS true or false
false
which of the following preoperative laboratory tests would be appropriate for Mr Jones?
none of the above
Which of the following changes in respiratory function would the anesthetist expect to see in the elderly?
increased physiologic shunt, decreased PaO2, decreased TLC
Agents to avoid in carcinoid tumors?
Succs and morphine
Carcinoid tumors secrete what?
serotonin, kalycreins, histamine
Carcinoid tumors effect what side of the heart?
right side
ALT and AST elevated and nothing else?
tarenchamal
Blow flow to the liver?
20% portal vein, 70% hepatic artery
Most common type of generalized systemic polyneuropathies?
distal axonal
Pts with MS should be paralyzed with depolarizing muscle relaxers?
false
What stage of parkinson’s is associated with bilateral involvement but balance is still intact?
Stage 2
Most practical assessment tool for OSA?
STOP BANG
Medications that won’t worsen OSA
Precedex and ketamine
Which component of the anesthetic management is least beneficial for pt w/renal insufficiency?
PEEP
Effect of renal function on pharmacokinetics of drugs is most dramatic with which opioid?
morphine
Cells begin to sickle with sickle cell at ______ PaO2 and trait at __________ PaO2?
30-40; 20-30
Increased 2,3 DPG causes a shift to the _____.
right
Hemophilia A causes a prolonged _____
PTT
Fat soluble drugs have what effect in the elderly?
prolonged
With aged men, there is a __________ effect with sux because they have __________
prolonged; lower plasma cholinesterase
In the elderly, onset of drug is determined by:
prolonged circulation time
MG is associated with dysfunction of the thyroid T or F?
false
Myastenias Gravis patients have decreased sensitivity to nondepolarizing muscle relaxers T or F
false
RA can have ___________ ____________
cervical instability
With small pox, there are more pox on the _______
arms and legs
Widened mediastinum without infiltrates indicates?
anthrax exposure
Most common cause of death for SLE (list 3)
CAD, renal failure, infection
Most common pulmonary structure effected by SLE?
pleura
Person at highest risk for SLE?
young black pregnant chick
2 types of anorexia nervosa?
restricting type, binge-eating/purging type
Subtypes of men syndrome?
Men 1, 2a, 2b
What causes diabetics to become stiff?
AGE products
1 unit of insulin lowers the blood glucose by:
25-30
Ideal anesthetic for diabetics?
neither - both have risks that must be addressed
People w/diabetes have increased norepinephrine resulting in tachycardia t or f
false
What anemia can cause skeletal malformations?
Thallasemia
MCV 90 and MCHC 30 what type of anemia?
normocytic hypochromic
Vitamins involved in the production and maturation of erythrocytes include:
B12 and B9
