Variant 1B (2020/21) Flashcards
A new intravenous anesthetic is found to
have a very large volume of distribution. This
drug is most likely to have which of the
following properties?
A. Hydrophilic with a high degree of plasma protein binding
B. Lipophilic with a high degree of tissue protein binding
B. Hydrophilic with a large nonionized
fraction
C. Hydrophilic with a low degree of tissue
protein binding
B. Lipophilic with a high degree of tissue protein binding
Each of the following drugs causes enhanced activity of the gamma-aminobutyric
acid receptor except:
A. Etomidate
B. Midazolam
C. Ketamine
D. Propofol
C. Ketamine
What is the primary purpose of
denitrogenation prior to anesthetic induction?
A. Improving matching of ventilation and perfusion
B. Increasing oxygen reserve in the functional residual capacity
C. Increasing contribution of second gas effect to rate of induction
D. Maximizing arterial oxygen content
B. Increasing oxygen reserve in the functional residual capacity
Increased Alveolar–arterial oxygen gradient can be caused by:
A. Endotracheal intubation
B. Decreased cardiac output
C. Atelectasis
D. Second gas effect
B. Decreased cardiac output
A patient with diabetic ketoacidosis is
scheduled for an emergent laparotomy.
Which of the following best explains the decrease in serum potassium concentration that occurs in this patient following administration of
insulin?
A. Dilutional hypokalemia follows free water retention from decreased osmotic diuresis
B. Extracellular potassium is actively transported with glucose into cells
C. Insulin enhances renal excretion of potassium
D. Intracellular potassium is exchanged for extracellular glucose
B. Extracellular potassium is actively transported with glucose into cells
Lung compliance is increased in:
A. Idiopathic pulmonary fibrosis
B. The presence of intra-alveolar fluid
C. Emphysema
D. Fibrosing alveolitis
C. Emphysema
A patient with a head injury becomes
unconscious and develops signs of raised ICP.
Management in the acute phase includes:
A. Performing an immediate lumbar puncture
B. Obtaining an electroencephalogram
C. Treatment with mannitol
D. Ordering a digital subtraction angiogram.
C. Treatment with mannitol
Maternal hypotension in the supine position
during pregnancy is most often due to:
A. Compression of the vena cava
B. Decreased peripheral vascular resistance
C. Decreased hematocrit
D. Decreased blood volume
A. Compression of the vena cava
Which one of the following best describes
the reason for the rapid offset of effect of the
induction agents?
A. Ester hydrolysis
B. Liver metabolism
C. Renal excretion
D. Redistribution
D. Redistribution
If 50% Nitrous oxide is inhaled for 3 days:
A. The lymphocyte count falls
B. Vit. B12 deficiency anaemia develops
C. Megaloblastic bone marrow changes occur
D. Peripheral neuropathy develops
C. Megaloblastic bone marrow changes occur
Physiological right-to-left shunt (venous admixture) is:
a) partly flow from bronchial veins into pulmonary veins
b) partly from Thebesian veins
c) 20% of total pulmonary blood flow
d) mainly through giant subpleural capillaries
e) increased during general anaesthesia
a) partly flow from bronchial veins into pulmonary veins
b) partly from Thebesian veins
c) 20% of total pulmonary blood flow
e) increased during general anaesthesia
Sudden blood loss of 30% during surgery results in:
a) immediate fall in CVP
b) reduced urine output despite adequate maintenance of systolic BP
c) stimulation of baroreceptors
d) should be replaced if blood loss =15% blood volume
e) transfusion is only required if blood
pressure falls
a) immediate fall in CVP
b) reduced urine output despite adequate maintenance of systolic BP
Spinal anaesthesia for fractured neck of
femur repair compared with general anaesthesia:
a) decreases mortality
b) reduces hospital stay
c) decreases the incidence of thromboembolism
d) provides better immediate postoperative pain relief
e) decreases intraoperative blood loss.
a) decreases mortality
b) reduces hospital stay
c) decreases the incidence of thromboembolism
d) provides better immediate postoperative pain relief
In patients with haemorrhagic shock:
a) physiological dead-space is increased
b) renal blood flow is decreased
c) antidiuretic hormone (ADH) secretion is increased
d) the oxygen dissociation curve is shifted to the left
e) oxygen delivery is decreased
b) renal blood flow is decreased
c) antidiuretic hormone (ADH) secretion is increased
d) the oxygen dissociation curve is shifted to the left
e) oxygen delivery is decreased
During a long operation, reliable monitors
of core temperatures include:
a) a temperature probe at the tympanic membrane
b) a temperature probe in the rectum
c) a quadriceps muscle temperature
d) a temperature probe in the nasopharynx
e) a temperature probe in the oesophagus at the level of the cricoid
b) a temperature probe in the rectum
d) a temperature probe in the nasopharynx
e) a temperature probe in the oesophagus at the level of the cricoid
In a pregnant woman at term:
a) tidal volume is increased
b) functional residual capacity is increased
c) physiological dead-space is decreased
d) total vital capacity is reduced
e) airway resistance is reduced.
a) tidal volume is increased
d) total vital capacity is reduced
e) airway resistance is reduced.
The following findings occur with a large pulmonary embolus:
a) an increase in pulmonary artery pressure
b) an increase in right ventricular pressure
c) an increase in left atrial pressure
d) an increase in physiological dead-space
e) a decrease in right atrial pressure
a) an increase in pulmonary artery pressure
b) an increase in right ventricular pressure
d) an increase in physiological dead-space
In the oxygen dissociation curve, causes of a right shift include:
a) low-molecular-weight dextran
b) digitalis
c) metabolic acidosis
d) respiratory alkalosis
e) hypoxia
c) metabolic acidosis
e) hypoxia
An increased alveolar–arterial (A–a)
gradient is associated with:
a) an increased FiO2
b) a decreased FiO2
c) a decreased FRC
d) an increased V/Q ratio
e) an increased shunt.
a) an increased FiO2
c) a decreased FRC
d) an increased V/Q ratio
e) an increased shunt.
Complications of PEEP include:
a) alteration of the alveolar–arterial (A–a) gradient
b) decreased cardiac output
c) increased renal output
d) pneumothorax in an emphysematous patient
e) hypercarbia
a) alteration of the alveolar–arterial (A–a) gradient
b) decreased cardiac output
d) pneumothorax in an emphysematous patient
e) hypercarbia
[CASE 1]
A 72-year-old man who has just received midazolam for an endoscopic procedure of the
upper gastrointestinal tract. Sedation is easily antagonized by FLUMAZENIL.
A) Although the endoscopist asks to send the patient home in one hour, is it appropriate?
B) What are the possible complications?
C) Why?
A) NO, it’s INAPPROPRIATE! Midazolam has a LONGER»_space; Duration of Action, than Flumazenil
B) Possible Complications include DECREASING the Level of Consciousness
- since Midazolam is a Benzodiazepine, which INHIBITS the CNS Depressive Effect
- VIA INCREASING GABAergic Neurotransmission in the brain, resulting in this
C) INAPPROPRIATE since Midazolam can induce symptoms - Ataxia / Resp Depression
- Putting the px AT RISK of Car Crash / Traumatic Injury en route home
[CASE 2]
A 27-year-old man is brought to the emergency department by ambulance after he sustained
injuries in a one-car motor vehicle collision.
Emergency medical technicians report that the patient was the unrestrained driver of a car that struck a telephone pole head-on.
The patient is immobilized with a cervical collar and spine board. He is conscious and says he has chest pain.
Pulse rate is 130/min, respirations are 40/min, and systolic blood pressure is 80 mmHg.
On physical examination, the neck veins are distended, the trachea is displaced to the right, and the left side of the chest is hyper-resonant to percussion.
Heart sounds are distant.
A) On basis of these findings, what is the most likely cause for this condition?
B) What other information do you require immediately?
C) What would be your initial treatment?
A) Based on the findings, likely cause of this condition would be DUE to, TRAUMATIC PNEUMOTHORAX
B) OTHER INFO REQUIRED IMMEDIATELY:
- ABG
- p02
- HR, BP
- SVR
C) INITIAL TREATMENT:
- Treat the CAUSE of Pneumothorax = EVACUATING the Air
- Tracheal Intubation
- 02 Supplementation
- Mechanical Ventilation
[CASE 3]
A 22-year-old man comes to the emergency department because he has had fever, elevated
blood glucose level, and confusion during the past three hours.
Pulse rate is 140/min, respirations are
30/min, and blood pressure is 80/50 mmHg. Physical examination shows dry mucous membranes and delayed capillary refill.
Laboratory studies show serum potassium level of 3.2 mmol/L and serum glucose level of 26 mmol/L.
Arterial blood gas analysis shows pH of 7.0.
A) Which is the possible cause?
B) Do you need additional information?
C) What would be your initial treatment?
A) Possible causes could be:
- SEPTIC SHOCK, such as Pneumonia
- HYPERGLYCEMIA, due to Diabetes which causes Ketoacidosis, from LACK of Insulin
B) ADDITIONAL INFO:
- ABG
- p02
- Lactic Acid
- HR, Cardiac Output (CO)
- Urine Output
- Blood Culture = For Sepsis
C) INITIAL TREATMENT
- Insulin WITH Potassium = Monitor Hb1Ac + K+ Levels
- Administer ISOTONIC CRYSTALLOID FLUID
- Empiric Antibiotic Treatment = For Septic Shock
[WRITING I] GENERAL Anaesthesia – definition, components
DEF = GENERAL Anaesthesia is the CONTROLLED + REVERSIBLE Induction of a State of Unconsciousness
Characterised by
- Analgesia / Amnesia / Hypnosis / Muscle Relaxation + STABLE Autonomic Regulation
3 COMPONENTS
1) TOTAL INHALATION Anaesthesia = Volatile Compounds, which are HIGHLY Lipid Soluble
2) TOTAL INTRAVENOUS Anaesthesia (TIVA) = Non-Volatile
3) BALANCE Anaesthesia
[WRITING II] Complications of EPIDURAL & SPINAL Anaesthesia – prophylaxis and treatment.
COMPLICATIONS
- Puncture of the DURA MATER, can result in POST-OP Headache
- Epidural / Spinal Haematoma
- Epidural Abscess
- TOTAL Spinal A = Cause Hypotension / Apnoea / Coma
- HIGH Spinal A = Cause Hypotension / Bradycardia / Resp Distress
PROPHYLAXIS / TREATMENT
- For POST-OP Headaches = Rehydration + NSAIDs
- For Epidural / Spinal Haematoma = Surgical DECOMPRESSION
- For Epidural Abscess = Antibiotics
- For Resp Distress = Mechanical Ventilation
- For Hypotension = Haemodynamic Support w/ VASOPRESSORS
- For Urinary VOIDING = Use Urinary Catheters
[WRITING III] Definition and classification of ACIDOSIS
DEF = Blood pH is BELOW 7.35, DUE to Resp / Metabolic Process
CLASSIFICATION
1) Respiratory = pC02 is MORE than 45 mmol / L
- With a LOW pH
- DUE to Resp Failure (COPD / Asthma), Airway Obs, Neuromuscular Disorders, Electrolyte Abnormalities, Sedatives / Anaesthetics or Stroke
2) Metabolic = LOW Bicarbonate; LOWER than 22 mmol / L
- With a LOW pH
- Either be HIGH ANION Gap (HIGH Lvls of Acids such as Lactic, KBs) = Diabetic Ketoacidosis, and Lactic Acidosis
- NORMAL ANION Gap = Diarrhoea, Renal Tubular Acidosis, and Addison’s Disease
[WRITING IV] Acute Respiratory Distress Syndrome in adults (ARDS) – etiology, phases of evolution.
ARDS = State of Resp Distress, which can beb DUE to Trauma, Acute Pancreatitis or Obstetric Complications
ETIOLOGY
1. SYSTEMIC CAUSES = Sepsis, Trauma, Shock and Acute Pancreatitis
- PRIMARY DAMAGE to LUNG = Pneumonia, Aspiration, Inhaled Toxins / Injury or Drowning
PHASES OF EVOLUTION (Pathogenesis)
1) EXUDATIVE = Formation of Pulmonary Oedema
2) FIBROPROLIFERATIVE = Fibrosis, DUE to DECREASED Surfactant + BUIL-UP of FIBRIN from Exudate
