Test 2 Flashcards by Jon Snow

The most common clinical manifestations of carcinoid syndrome include all of the following except:

b) Constipation due to increased levels of serotonin

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Pharmacologic treatment for carcinoid syndrome symptoms includes all of the following except:

Kilikrien

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Which of the following statements regarding carcinoid tumors is FALSE?

c) Histamine stimulation causes the release of serotonin into the circulation.

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Carcinoid syndrome stimulates the release of excessive amounts of vasoactive substances. Which of the following is not released in carcinoid syndrome?

b) Antidiuretic hormone

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Which of the following is believed responsible for blindness following transurethral resection of the prostate (TURP)?

b) Glycine

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Neuraxial anesthesia is commonly used during extracorporeal shock wave lithotripsy (ESWL). A sensory level at ____ is desired.

d) T6

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Contraindications to extracorporeal shock wave lithotripsy (ESWL) include which of the following?

b) Patient with a urinary obstruction below the stone

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Complications with transurethral resection of the prostate (TURP) include which of the following?

a) Bladder perforation
b) Hypothermia
c) Bleeding
d) Skin burns
e) None of the above
f) All of the above

f) All of the above

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A 61-year-old man receives a spinal anesthetic for transurethral resection of the prostate (TURP). Forty-five minutes after the start of the procedure, he suddenly develops nausea, diaphoresis, and sharp pain in the left shoulder. Which of the following etiologies is the MOST likely cause?

b) Bladder perforation

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Rare instances of transient blindness have been associated with the use of which irrigating fluid following transurethral resection of the prostate (TURP)?

b) Glycine

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Manifestations of TURP syndrome include which of the following?

d) Increased central venous pressures

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A sensory level to ____ provides excellent anesthesia for TURP procedures.

b) T10

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During a transurethral resection of the prostate (TURP), the bladder is continuously irrigated with a solution to maintain visibility through the cytoscope and to distend the urethra. The prostate gland has an extensive plexus of venous sinuses that can absorb the irrigating fluid. All of the following are factors that affect the absorption of irrigating fluids, except:

b) Neuraxial anesthesia

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The stomach is essentially composed of three sections. List the three sections.

Fundus
Body
Pylorus

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Common surgical treatment to correct hiatal hernia is:

a) Nissen fundoplication

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Conditions in which elements from the abdominal cavity herniate through the esophageal hiatus into the mediastinum are known as

d) Hiatal hernia

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A patient presenting for surgery has a history of achalasia. Your primary anesthetic concern for this patient is:

d) Aspiration

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Patients with ulcerative colitis are most at risk for the development of which potentially urgent surgical condition?

d) Toxic megacolon

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Which of the following are the most common causes of pancreatitis? (Select two).

a) Alcoholism
c) Gallstones

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a) H. pylori
b) Proton pump inhibitor
c) Gastric ulcer disease
d) Peptic ulcer disease
e) Gastritis
f) Barrett’s esophagus

Possible Answers:

Chronic and most often solitary, affecting men 45–65 & women older than 55

Abnormal epithelial changes in the esophagus predisposing tissue to developing a malignancy

Most effective antisecretory agent

Occurs anywhere in stomach, may/may not be associated with increased gastric acid secretion

Species of gram-negative spiral bacteria

Inflammatory disorder of the gastric mucosa

a → 5
b → 3
c → 1
d → 4
e → 6
f → 2

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A patient who is scheduled for emergency laparotomy for bowel obstruction has had oliguria for three hours. The patient has had hypertension for 10 years. You decide the patient should have a preoperative fluid challenge which yields an optimal response. Based on this information, you know the patient falls into which AKI (acute kidney injury) classification?

b) Intrinsic AKI

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Urine is formed in a three-step process; which of the following gives the correct order in which these steps take place in the nephron?

c) Glomerular filtration, tubular reabsorption, tubular secretion

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The functional unit of the kidney is the nephron. How many nephron does the average adult human kidney contain?

c) Roughly 1,000,000

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Each of the following improves coagulation in patients with uremia EXCEPT

d) Aminocaproic acid

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A patient is bleeding excessively after routine transurethral resection of the prostate. Re-exploration discloses diffuse oozing. The most appropriate management is administration of:

d) Aminocaproic acid

Cardiovascular changes commonly seen in patients with liver disease include which of the following?

b) Increased cardiac output

In patients with liver cirrhosis, _____ is a major cause of morbidity and mortality.

c) Bleeding from gastroesophageal varices

Diabetes insipidus is diagnosed based on which of the following criteria?

a) Urinary osmolality lower than plasma osmolality

Which of the following is not a symptom of Graves' disease?

c) Cold intolerance

Which of the following statements are true regarding how opioids potentially cause spasm of the sphincter of Oddi? Select two.

b) Meperidine is more likely to cause spasm than glucagon d) Morphine is more likely to cause spasm than nalbuphine

Which portion of the liver is responsible for the phagocytosis of bacteria, endotoxins, and debris?

b) Kupffer cells

All of the following are cardiovascular changes associated with liver disease EXCEPT (Select two):

a) Decreased cardiac output d) Increased arterial blood pressure

A patient with cirrhosis is presenting for surgery requiring GETA. You are considering your medication options for neuromuscular blockade with induction for this patient. You know that __________ is a better paralytic option for this patient secondary to Hoffman elimination.

c) Cisatracurium

The most common cause of AKI is:

a) Prolonged renal hypoperfusion

Fat malabsorption results in deficiencies in the uptake of fat-soluble vitamins. Name the fat-soluble vitamins.

A, D, E, K

A 65-year-old man is disoriented and has a headache and nausea in the PACU 30 minutes after TURP with glycine irrigation performed under spinal anesthesia. HR is 50 bpm and BP is 180/110 mmHg. Which of the following is LEAST likely?

b) Serum sodium concentration 132 mEq/L

Which of the following statements concerning absorption of irrigation fluid during transurethral resection of the prostate is true?

b) Typically 10 to 30 ml of fluid per minute are absorbed

A 50-year-old man with alcoholism and jaundice is scheduled to undergo umbilical hernia repair. An increase of which of the following best indicates impaired synthetic hepatic function?

a) Prothrombin time

A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under sevoflurane/fentanyl general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is:

c) Extrahepatic biliary obstruction

After the first 70 minutes of a transurethral resection of the prostate, a 70-year-old man becomes confused and has tachycardia, hypertension, and shortness of breath. Serum sodium concentration is 116 mEq/L. After informing the surgeon that the procedure should be terminated, the most appropriate next step would be to:

a) Administer furosemide

Each of the following is a recognized complication during a transurethral resection for which glycine is used as an irrigant EXCEPT:

b) Hemolysis

A 65-year-old man has a history of alcohol abuse. Which of the following preoperative serum concentrations would provide the best assessment of synthetic hepatic function?

a) Albumin

A man with alcoholic cirrhosis has a hemoglobin of 10 g/dl and has an intraoperative PaO₂ of 75 mmHg at FiO₂ of 0.5. Which of the following is the most likely cause of the low PaO₂?

b) Hepatopulmonary syndrome (HPS)

A 36-year-old woman who undergoes peritoneal dialysis for chronic renal failure requires emergency surgical exploration for bowel obstruction. Serum creatinine concentration is 9.8 mg/dl, BUN concentration is 124 mg/dl, and potassium concentration is 6 mEq/L. Which paralytic would be the best choice to utilize for induction of this patient?

b) Nimbex

Which of the following factors DECREASES the MAC of isoflurane? (Select two).

c) Symptomatic hyponatremia d) Acute ethanol intoxication

Individuals with chronic renal failure have which of the following?

a) Hypocalcemia

Which is the acute kidney injury (AKI) classification scale that includes changes in GFR as one of its biomarkers for staging in adult patients?

a) RIFLE

A patient with an intestinal obstruction is scheduled for surgery. The patient's history includes pancreatitis and GERD. What is the best approach to airway management?

b) Endotracheal intubation

Pancreatitis has a multifactorial cause with common causes including all of the following; EXCEPT:

a) Hypocalcemia

All of the following medications should be avoided in a patient with carcinoid tumor, EXCEPT:

d) Propofol

Primary hyperparathyroidism may be due to which of the following?

c) Parathyroid adenoma

Parathyroid hormone increases serum calcium by which of the following methods? (Choose two that apply.)

a) Promoting bone resorption b) Enhancing gastrointestinal absorption

Acromegaly is caused by excess secretion of:

c) GH

A patient with acromegaly may be predisposed to multiple airway anomalies, including which of the following? (Choose two that apply.)

b) Vocal cord enlargement d) Subglottic narrowing

Cardinal signs of pheochromocytoma may include all of the following except:

c) Bradycardia

Key signs and symptoms of Addison’s disease include which of the following? (Choose two that apply.)

a) Hypotension c) Hyponatremia

Addison’s disease includes which of the following? (Choose two that apply.)

a) Mineralocorticoid deficiency c) Glucocorticoid deficiency

Cushing’s syndrome is characterized by all of the following, except:

b) Increased glucose tolerance

On an average day, the adrenal gland produces how many milligrams of cortisol?

b) 15–30 mg

Signs and symptoms of myxedema coma include which of the following? (Choose two that apply.)

Treatment of central diabetes insipidus may include which of the following medications? (Choose two that apply.)

a) Aqueous vasopressin d) Desmopressin

Hormone secretion associated with the posterior pituitary includes which of the following? (Choose two that apply.)

c) Antidiuretic hormone d) Oxytocin

A 54-year-old woman is in the preoperative area being prepared for a parathyroidectomy. Her only history is a vaginal hysterectomy 5 years earlier. You expect clinical manifestations of her hyperparathyroidism to include which of the following? (Choose four that apply.)

b) Pancreatitis c) Muscle weakness d) Hypertension e) Shortened QT interval

Sulfonylureas and metformin should not be used for _____ before surgery.

b) 24–48 hours

A 23-year-old male patient has been in an automobile accident and has sustained a traumatic brain injury. He has come to the operating room for repair of a femur fracture. You note that his urinary output is greater than 550 mL/hour. His preoperative labs show no glucose in his urine and his serum blood glucose level is 97 mg/dL. You give the patient aqueous vasopressin 5 units subcutaneously, and his urinary output amount decreases to normal levels. What disease process do you think he has?

d) Central diabetes insipidus (CDI)

A 15-year-old, 65-kg patient with Cushing’s disease is to undergo a hypophysectomy to remove a pituitary adenoma. General anesthesia is induced with Propofol IV & tracheal intubation was facilitated with vecuronium, 0.25 mg/kg IV. Anesthesia is maintained with Sevoflurane & N₂O. Mannitol, 1 gm/kg, is administered IV to reduce intracranial pressure. At the end of the operation, the patient is extubated & taken to ICU. Over the next 6 hours, the patient has a total urine output of 8.3L. Na = 154, K = 4.8, Glucose = 160. Urine specific gravity is 1.003 & urine osmolality is 125 mOsm/L.

e) Central diabetes insipidus

A 73-year-old patient with a history of hypothyroidism is scheduled to undergo emergency cholecystectomy under general anesthesia. The anesthetic management of this patient will include which of the following?

c) The patient is at increased risk for hypothermia.

Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?

a) Renal disease

Renal failure is the most common cause of which type of hyperparathyroidism?

d) Secondary

A patient had a thyroidectomy and now reports tingling around the mouth and has a positive Chvostek sign on postoperative rounds. What laboratory finding would be most helpful to the anesthesia provider?

c) Serum calcium

EKG alterations in hypocalcemia include which of the following?

d) Prolonged QT segment

Which anesthetic intervention is warranted for a patient having transsphenoidal hypophysectomy?

a) Muscle relaxation should be used to avoid patient movement

Hiatal hernias are classified as type I to IV. Please match the type of hiatal hernia with the classification that describes it.

a) Hiatal hernia Type I → 3) Movement of the upper stomach through an enlarged hiatus b) Hiatal hernia Type 2 → 4) All or part of the stomach moves into the thorax assuming a paraesophageal position c) Hiatal hernia Type 3 → 1) Combined features of sliding & paraesophageal position d) Hiatal hernia Type 4 → 2) Involve other organs contained in the hernia sac

A 55-year-old woman with a history of chronic NSAID use and documented gastric ulcer is scheduled for an elective laparoscopic cholecystectomy. She denies current symptoms. During induction, the patient vomits a small amount of clear gastric fluid despite being NPO. What is the most appropriate immediate response?

d) Turn the patient’s head to the side and suction

A 55-year-old woman with a history of chronic NSAID use and documented gastric ulcer is scheduled for an elective laparoscopic cholecystectomy. She denies current symptoms. What is the most appropriate medication to reduce aspiration risk?

c) Ranitidine

Test 2 Flashcards

(75 cards)