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