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Flashcards in Endocrine/Hepatic Deck (70):
1

Vitamin K dependent coagulation factors include factors:

II, VII, IX & X

With the exception of factor VIII, all coagulation factors are synthesized in the liver. Vitamin K is a necessary cofactor in the synthesis of factors II, VII, IX and X.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

2

Normal daily insulin production in the adult is approximately:

50 units

Adults normally secrete approximately 50 U of insulin each day from the beta cells of the islets of Langerhans in the pancreas.

pg. 802
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

3

In patients with hepatorenal syndrome, pathophysiologic changes commonly include:

hypokalemia

Hepatorenal syndrome is characterized by progressive oliguria, avid sodium retention with secondary alkalosis and hypokalemia, azotemia and intractable ascites.

pg. 795
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

4

Compared to triiodothyronine (T3), thyroxine (T4):

is released in greater quantities than T3

The thyroid gland releases more T4 than T3. However, T3 is more potent and less protein bound.

pg. 807
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

5

Function of Kupffer cells:

function as macrophages

The Kupffer cells line the hepatic sinusoids and are part of the monocyte-macrophage (reticuloendothelial) system.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

6

The half-life of levothyroxine is approximately

7 - 8 days

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

7

Unconjugated hyperbilirubinemia is associated with:

hemolysis

Unconjugated hyperbilirubinemia may be seen with hemolysis or congenital defects in bilirubin conjugation.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

8

Calcitonin is produced by the:

parafollicular C-cells of the thyroid

In lower animals, calcitonin lowers serum calcium and has the opposite effect of parathyroid hormone. Calcitonin is secreted by the parafollicilar C-cells of the thyroid, but a physiologic effect has not been shown in humans.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

9

Clinical manifestations of hyperaldosteronism include:

metabolic alkalosis

Clinical manifestation of hyperaldosteronism include an elevation in blood pressure, hypervolemia, hypokalemia muscle weakness and metabolic alkalosis.

pg. 811
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

10

The normal adult liver weighs approximately:

1500 gm

pg. 773
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

11

Phase II hepatic drug biotransformation includes:

conjugation with glucuronic acid

Phase II reactions, which may or may not follow phase I reactions, involve conjugation of the substance with glucuronide, sulfate, taurine or glycine. Conjugated compounds are more readily eliminated in the urine or bile.

pg. 778
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

12

Patients with diabetic autonomic neuropathy often display a(n):

inability to compensate for blood volume changes intraoperatively

Clinical signs of diabetic autonomic neuropathy include hypertension, silent myocardial ischemia, orthostatic hypotension, lack of heart rate variability, reduced response to atropine or propranolol, resting tachycardia, early satiety, neurogenic bladder, lack of sweating and impotence.

pg. 805
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

13

The most common cause of postoperative jaundice is:

hematoma resorption

Postoperative jaundice can result from a variety of factors, but the most common cause is overproduction of bilirubin from resorption of a large hematoma or red cell breakdown following transfusion.

pg. 782
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

14

Addisonian crisis (acute adrenal insufficiency) is characterized by:

hypoglycemia

Clinical features of acute adrenal insufficiency include hypotension, metabolic acidosis, hyperkalemia, fever, hypoglycemia and mental status changes.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

15

Does Glycogen contribute to intracellular osmolarity

does not contribute to intracellular osmolarity

Glycogen is a readily available source of glucose that does not contribute to intracellular osmolality. Only the liver and muscle are able to store significant amounts of glycogen. Insulin enhances glycogen synthesis.

pg. 776
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

16

A decreased production of parathyroid hormone can result from:

hypomagnesemia

Parathyroid gland function and PTH secretion are inhibited by chronic and severe hypomagnesemia. PTH secretion is also reduced with hypercalcemia as can occur with Paget's disease, malignancy and chronic immobility.

pg. 746
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

17

Carcinoid syndrome is associated with:

tricuspid valve lesions

Carcinoid syndrome is associated with right-sided heart disease caused by valvular and myocardial plaque formation. Lung metabolism of serotonin evidently prevents involvement of the left side of the heart.

pg. 815
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

18

The laboratory finding that is the most sensitive indicator of hepatobiliary disease is:

an elevated GGTP

Elevated serum gamma-glutamyl transpeptidase is the most sensitive indicator of hepatobiliary disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

19

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can be caused by:

all of the above

SIADH has been associated with head injuries, intracranial tumors, pulmonary infection, small cell carcinoma of the lung and hypothyroidism.

pg. 1149
Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.

20

The right and left lobes of the liver are connected by the:

falciform ligament

pg. 773
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

21

Bile flow from the common bile duct to the duodenum is controlled by the:

sphincter of Oddi

Biliary flow from the common bile duct into the duodenum is controlled by the sphincter of Oddi. Cholecystokinin causes contraction of the gallbladder, relaxation of the sphincter of Oddi and propulsion of bile into the small intestine.

pg. 778
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

22

Physiologic effects of insulin include:

inhibition of ketogenesis

Insulin has anabolic effects such as promoting glycogenesis, increasing cholesterol synthesis, increasing protein synthesis, promoting glycolysis and promoting triglyceride storage. Insulin also has anticatabolic effects such as inhibiting glycogenolysis, inhibiting ketogenesis and inhibiting gluconeogenesis.

pg. 803
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

23

Epidemiological risk factors that are associated with "halothane hepatitis" include:

repeat exposure to the inhalational agent

Epidemiological studies have identified several risk factors that are associated with halothane-associated hepatitis, including middle age, obesity, female sex and repeat exposure.

pg. 782
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

24

A 32-year-old female is scheduled for laparoscopic cholecystectomy. Her past medical history is significant for toxic multinodular goiter treated with propylthiouracil. Preoperatively, the patient's propylthiouracil therapy should be:

continued through the morning of surgery

Antithyroid medications and beta-blockers should be continued through the morning of surgery. Administration of PTU and methimazole is particularly important because of their relatively short half-lives.

pg. 807
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

25

Inhibition of gluconeogenesis occurs with the administration of:

insulin

Glucocorticoids, catecholamines, glucagon and thyroid hormone greatly enhance gluconeogenesis, whereas insulin inhibits it.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

26

Inhalation induction may be faster in the hypothyroid patient because:

cardiac output is depressed

Decreased cardiac output may speed the rate of induction with an inhalation anesthetic, but hypothyroidism does not significantly decrease MAC.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

27

Pathophysiologic changes seen during the anhepatic phase of liver transplantation include:

hyperfibrinolysis

Hyperfibrinolysis is commonly present and appears to be due to a marked increase in TPA and a decrease in plasminogen activator inhibitor and α1-antiplasmin.

pg. 800
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

28

The increase in INR seen in acute hepatic failure is the result of:

decreased factor VII levels

The short half-life of factor VII (4 - 6 hours) makes the INR useful in evaluating hepatic synthetic function in patients with acute liver disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

29

Competitive aldosterone antagonists include:

spironolactone

The aldosterone inhibitor spironolactone is effective as a potassium-sparing diuretic and antihypertensive. It is also used in the treatment of hepatic insufficiency and CHF.

pg. 811
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

30

Sinusoidal capillaries and hepatocytes are separated by:

the space of Disse

pg. 774
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

31

During metabolism of hemoglobin, degradation of the heme ring occurs primarily in the:

Kupffer cells

Bilirubin is primarily the end-product of hemoglobin metabolism. It is formed from degradation of the heme ring in Kupffer cells.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

32

A 62-year-old man is scheduled for a transurethral prostatectomy for urinary obstruction. His past medical history is significant for type II diabetes mellitus treated with 2000 mg of metformin daily in divided doses. Preoperative recommendations regarding his metformin therapy should include:

holding the metformin for 24 - 48 hours prior to surgery

In patients receiving oral hypoglycemic agents, the drug can be continued until the day of surgery. However, sulfonylureas and metformin should not be used for 24 - 48 hours before surgery because of their long half-lives.

pg. 806
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

33

The incidence of chronic active hepatitis following infection with hepatitis C is approximately:

50%

The incidence of chronic active hepatitis is 3 - 10% following infection with hepatitis B virus and at least 50% following infection with hepatitis C virus.

pg. 790
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

34

In the adult under maximum physiologic stress, cortisol production is approximately:

300 mg/day

Adults normally secrete 20 mg of cortisol daily, this may increase to over 300 mg under conditions of maximal stress.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

35

Only glucose, and not fatty acids, can be use as a fuel source by:

red blood cells

Glucose, and not fatty acids, can only be utilized by erythrocytes and cells in the renal medulla.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

36

In the preoperative preparation of the patient with a pheochromocytoma, beta-blockade:

should only be used after the initiation of alpha-blockade

If β-blockade is initiated first, catecholamine will produce unopposed α-stimulation and severe vasoconstriction. This may explain the paradoxical hypertension produced in a few patients treated with labetelol.

pg. 253
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

37

The incidence of malignancy associated with pheochromocytomas is approximately:

10 - 15%

Pheochromocytoma accounts for about 0.1% of all cases of hypertension and has an incidence of malignancy of 10 - 15%.

pg. 813
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

38

A decrease in hepatic blood flow is seen with:

all of the above

Hepatic blood flow decreases with all forms of anesthesia, including epidural and spinal anesthesia.

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

39

The hypothalamus can reduce the production of growth hormone with the release of:

somatostatin

Growth hormone is synthesized and secreted by cells in the anterior pituitary and is under dual control from the hypothalamus. Growth hormone releasing hormone stimulates growth hormone release, and growth hormone inhibiting hormone (somtostatin) is a powerful inhibitor of growth hormone release.

pg. 741
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

40

The percentage of total hepatic blood flow supplied by the portal vein is approximately:

70%

Normal hepatic blood flow is about 1500 mL/min in adults, of which 25 - 30% is derived from the hepatic artery and 70 - 75% from the portal vein.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

41

Most bilirubin created through the metabolism of hemoglobin is:

excreted in the feces

Bilirubin is excreted in the feces. About half of the bilirubin is converted by colonic bacteria into urobilinogen. A small amount of this substance is reabsorbed, only to be excreted into the bile again (enterohepatic circulation).

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

42

Hyperosmolar nonketotic coma is most commonly seen in patients with diabetes type:

II

Type II diabetes mellitus is rarely associated with ketosis or acidosis, but it may be complicated by nonketotic hyperosomolar hyperglycemia. CNS manifestations are secondary to cerebral dehydration from hyperosmolarity.

pg. 760
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

43

In the chronic alcohol abuser, acute alcohol withdrawal for a surgical procedure has been associated with a mortality rate of approximately:

50%

Alcohol withdrawal during surgery may be associated with a mortality rate as high as 50%.

pg. 791
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

44

When comparing malignant hyperthermia to thyroid storm, thyroid storm:

most commonly occurs in the postoperative period

Thyroid storm is characterized by hyperpyrexia, tachycardia and hypotension. The onset is usually 6 - 24 hours after surgery, but can occur intraoperatively. Unlike MH, thyroid storm is not associated with muscle rigidity, elevated creatinine kinase or a marked degree of acidosis.

pg. 808
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

45

Ammonia formed by hepatic deamination of amino acids is mostly converted into:

urea

Through a series of enzymatic steps, the liver combines 2 molecules of ammonia with one molecule of carbon dioxide to form urea. The urea formed is readily excreted by the kidneys.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

46

Intraoperative management of the hypothyroid patient may be complicated by:

difficulty with intubation

Potential problems with the anesthetic management of the hypothyroid patient include hypoglycemia, anemia, hyponatremia, hypothermia and difficulty during intubation because of an enlarged tongue.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

47

The most common cause of hypoparathyroidism is:

parathyroidectomy

Hypoparathyroidism is usually due to deficiency of parathyroid hormone following parathyroidectomy.

pg. 810
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

48

In patients with acute liver failure, serum albumin is often initially normal. This is because the half-life of albumin is:

14 - 21 days

Because its half-life is 2 - 3 weeks, albumin concentration may initially be normal with acute liver disease.

pg. 780
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

49

A 48-year-old female with a long history of rheumatoid arthritis treated with 75 milligrams of prednisone daily is scheduled for a total knee replacement. Anesthetic considerations in this patient include:

hypokalemia

As a result of chronic steroid use, this patient will exhibit Cushing's syndrome. These patients tend to be volume overloaded with hypokalemic metabolic alkalosis resulting from the mineralocorticoid activity of glucocorticoids.

pg. 812
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

50

The percentage of the total hepatic oxygen requirement supplied by the portal vein is approximately:

50%

Although about 70% of the hepatic blood flow comes from the portal vein, its reduced saturation allows it to supply only about 50% of the liver's oxygen requirement.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

51

The synthetic function of the liver can be assessed with the:

INR

Liver tests that measure hepatic synthetic function include serum albumin, cholesterol, pseudocholinesterase, and the INR (PT).

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

52

Systemic manifestations of hypoglycemia include:

diaphoresis

Systemic manifestations of hypoglycemia result from catecholamine discharge and include diaphoresis, tachycardia, nervousness and hypertension.

pg. 804
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

53

Cardiovascular effects of cirrhosis include:

increased cardiac output

Arteriovenous shunting and anemia are responsible for the increased cardiac output seen in cirrhotic patients.

pg. 794
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

54

Pathophysiologic changes seen in patients with pheochromocytoma include:

decreased red cell mass and plasma volume

A decrease in both red cell mass and plasma volume contributes to the severe chronic hypovolemia seen in patients with pheochromocytoma.

pg. 813
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

55

Plasma proteins NOT formed by the liver include:

immunoglobulin G

Nearly all plasma proteins with the notable exception of the immunoglobulins are formed by the liver.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

56

Anesthetic management of the patient with pheochromocytoma should include:

intubation only after a deep level of anesthesia is obtained

Deep anesthesia should be obtained prior to intubation to reduce the catecholamine response. Anticholinergic and sympathomimetic drugs are generally avoided as they will worsen the imbalance of autonomic tone. Because histamine provokes catecholamine release, atracurium should also be avoided. Although droperidol has α-blocking properties, it has been associated with hypertensive crises in some patients.

pp. 253 - 254
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

57

The posterior pituitary gland secretes:

antidiuretic hormone

The posterior pituitary secretes antidiuretic hormone (ADH, vasopressin) and oxytocin.

pg. 645
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

58

The greatest reduction in hepatic blood flow is seen during:

upper abdominal surgery

Hepatic blood flow is decreased by both general and regional anesthetic techniques. However, surgical procedures near the liver can reduce hepatic blood flow by up to 60%.

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

59

The incidence of difficulty with intubation in patients with acromegaly is approximately:

30%

Facial deformities as well as enlarged tongue, thyroid, epiglottis and soft tissues of the throat can make intubation of the patient with acromegaly very difficult. Difficult intubation was found in 31% of patients studied.

pg. 741
Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.

60

In the adult, normal hepatic blood flow is approximately:

1500 mL/min

Normal hepatic blood flow is about 1500 mL/min, which constitutes 25 - 30% of the cardiac output.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

61

Clinically significant hepatocellular dysfunction is commonly associated with a decrease in:

albumin

As a result of diminished synthetic function of the liver, serum albumin, cholesterol, pseudocholinesterase and clotting factors (except factor VIII) are all decreased.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

62

In the adult, an intravenous bolus of 50 mL of 50% glucose is expected to raise the blood glucose level by approximately:

100 mg/dL

Each milliliter of 50% glucose will raise the blood glucose of a 70-kg patient by approximately 2 mg/dL.

pg. 804
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

63

In the cirrhotic patient, common changes found in blood gas analysis include:

respiratory alkalosis

In cirrhotic patient, hyperventilation is common and results in primary respiratory alkalosis. Hypoxemia is frequently present and is due to right-to-left shunting in the pulmonary bed.

pg. 794
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

64

Extra-hepatic synthesis of coagulation proteins occurs with the formation of:

factor VIII

All coagulation factors, with the exception of factor VIII and von Willebrand factor, are produced by the liver.

pg. 777
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

65

Clinical manifestation of hypothyroidism include:

hypoactive deep tendon reflexes

Clinical manifestations of hypothyroidism include weight gain, cold intolerance, muscle fatigue, lethargy, constipation, hypoactive reflexes and depression.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

66

Changes in plasma calcium concentration secondary to increased levels of parathyroid hormone are the result of:

increased bone resorption

Parathyroid hormone is the principal regulator of calcium homeostasis. It increases serum calcium by promoting bone resorption, limiting renal excretion and enhancing GI absorption.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

67

The duration of action of subcutaneously administered regular insulin is approximately:

5 - 7 hours

Subcutaneously administered insulin has an onset of action of 15 - 30 minutes, a peak effect at 1 - 3 hours and a duration of 5 - 7 hours. Insulin has a very short plasma half-life of only about 7 minutes when administered intravenously.

pg. 809
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

68

The major route of chlolesterol elimination is through the formation of:

bile acids

Bile acids are formed by the hepatocytes from cholesterol and represent the major route of cholesterol elimination.

pg. 779
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

69

Spasm of the sphincter of Oddi with subsequent elevation of biliary pressure can be caused by the administration of:

fentanyl

All opioids can potentially cause spasm of the sphincter of Oddi and increase biliary pressure (fentanyl > morphine > meperidine > butorphanol > nalbuphine).

pg. 781
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.

70

In the adult, normal hepatic blood volume is approximately:

450 mL

Normal hepatic blood volume is about 450 mL, which constitutes about 10% of the blood volume. As a result, the liver can act as a blood reservoir, releasing as much as 300 mL or removing as much as 1000 mL from the circulating volume.

pg. 775
Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.