True Learn Main points 3 Flashcards
A 33-year-old female is taken to the operating room for laparoscopic cholecystectomy. During the surgery, the ventilator alarms indicating elevated pressures. Both the peak inspiratory pressure and plateau pressure are increased. Which of the following is MOST likely the cause?
Both peak inspiratory and plateau pressure increase when elastic resistance (compliance) increases. Only peak inspiratory pressure increases when airway resistance increases. Bronchospasm, for example, will cause an increase in peak inspiratory pressure with a mostly unchanged plateau pressure.
A 68-year-old male with 70% left internal carotid stenosis is undergoing right carotid endarterectomy under general anesthesia. During surgery, blood pressure acutely drops to 80/40 mm Hg and heart rate decreases from 85 to 42 beats per minute. You quickly notify the surgeon, who stops what she is doing and the blood pressure promptly returns to baseline. Which of the following is MOST likely true?
Hemodynamic changes during CEA are common and are related to surgical manipulation, denervation, and impaired sensitivity of the carotid sinus baroreceptors. Stimulation of baroreceptors results in increased parasympathetic discharge with decreased sympathetic discharge. This leads to hypotension and bradycardia, which can potentially be prevented by local anesthetic infiltration.
TrueLearn Insight : Think “sinus pressure” to help differentiate the roles of the carotid sinus and carotid body.
Which of the following is NOT a metabolic effect of the stress response during the operative period?
During the stress response, a metabolic cascade of events occurs in an attempt to provide the body with needed energy. This puts the body in a relative catabolic state. In modern medicine, these often are a detriment to the patient. In the surgical period, decreasing the degree of the stress response can help influence postoperative outcome.The anterior pituitary secretes all hormones except antidiuretic hormone (ADH, vasopressin) and oxytocin.
Anterior –> Thyroid stimulating hormone (TSH), adrenocorticotrophic hormone (corticotropin, ACTH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), growth hormone (GH), and prolactin.
Posterior –> antidiuretic hormone (ADH, vasopressin) and oxytocin.
Which of the following statements describes the hepatic arterial buffer response?
With a functioning hepatic arterial buffer response, hepatic arterial tone is modulated by portal venous flow, via adenosine, in order to maintain hepatic perfusion.
TrueLearn Insight : Glucagon causes dose-dependent hepatic arterial vasodilation. Angiotensin II causes vasoconstriction of hepatic arterial and portal venous systems. Vasopressin increases splanchnic vasoconstriction while decreasing resistance to portal venous flow.
Which of the following statements is TRUE regarding inhaled anesthetic blood solubilities?
Higher blood:gas partition coefficients (or blood solubilities) correspond with greater degrees of volatile agent uptake and thus, a slower onset of action.
Which of the following opioids would be the BEST choice for the treatment of chronic neuropathic pain?
Opioid use for treating chronic pain is controversial. Methadone, however, is effective for chronic pain since in addition to its opioid analgesic effects, it has NMDA and serotonin reuptake antagonistic properties. The NMDA receptor antagonism also makes methadone effective for neuropathic pain
