Exam 1 Reading (N.Ch20)

Question 1

Which of the following are characteristics of unstable angina?
Pain that began when?
Severity / duration?
Changes on ECG?

Answer 1

Bubsternal chest pain that began less than 2 months ago, has progressively increased in severity, duration, or frequency, is less responsive to pharmacologic therapy, occurs at rest, lasts longer than half an hour, or exhibits transient T-wave or ST segment changes.

Question 2

Associated with cigarette smoking

Answer 2

carboxyhemoglobin in the blood, dysfunction of the mucociliary escalator, and an increase in elastase activity in the alveoli that leads to emphysema.

Question 3

Sarcoidosis is a disorder of the

Answer 3

immune system.

Question 4

What is the overall risk for a perioperative MI in the general population undergoing general anesthesia?

Answer 4

0.3%.

Question 5

the best predictor of silent coronary artery disease in diabetic patients,

Answer 5

Autonomic neuropathy

Question 6

A normal intercisor distance is

Answer 6

at least 4 cm.

Question 7

MAC and a history of chronic alcohol abuse would result in

Answer 7

an increased inhalational anesthetic requirement

Question 8

Alcoholic hepatic insufficiency and Albumin

Answer 8

Alcoholic hepatic insufficiency can lead to decreased albumin concentrations.

Question 9

Which medication should be withheld the morning of surgery for all patients

Answer 9

Oral hypoglycemics

Question 10

How long should a patient refrain from smoking before the ability of the lungs to respond to pulmonary infection returns to normal?

Answer 10

8 weeks

Question 11

What improves significantly at about 8 weeks of smoking cessation?

Answer 11

Mucociliary and immune function

Question 12

Airway management may be made even more difficult prior to that amount of time as there is an

Answer 12

increase in pulmonary secretions during the first month of smoking cessation.

Question 13

Elective surgery should be cancelled in patients with chronic bronchitis if they exhibit (select two)

Answer 13

Elective surgery should be postponed in these patients if they exhibit severe dyspnea, wheezing, pulmonary congestion, or a PaCO2 greater than 50 mmHg.

Question 14

Metabolic equivalents (METs) help identify the

Answer 14

quantity of cardiovascular exercise a patient can tolerate.

Question 15

4 METs indicate what?

Answer 15

indicates good functional capacity.

Question 16

Strenuous exercise, such as swimming or playing basketball, represents about

Answer 16

10 METs.

Question 17

Self-care and walking around the house represents____ MET.

Answer 17

1

Question 18

You explain to a patient who smokes cigarettes that in order to minimize the effects of carbon monoxide on oxygen-carrying capacity, he/she should refrain from smoking for at least

Answer 18

12-18 hours
The elimination half-life of carbon monoxide is about 4 to 6 hours which means that a smoke free interval of 12 to 18 hours results in marked decreases in carboxyhemoglobin levels and a corresponding increase in oxygen carrying capacity.

Question 19

Which of the following disorders would be most likely to exhibit evidence of its presence on chest x-ray?

Answer 19

COPD

Question 20

COPD shows those characteristics on XRAY

Answer 20

hyperlucency
bullae, and diaphragmatic flattening.

Question 21

A preoperative finding of nystagmus would be consistent with potential abuse of which drug?

Answer 21

Phencyclidine (PCP)

Question 22

Fentanyl abuse and pupils

Answer 22

Constricted

Question 23

Cocaine abuse and pupils

Answer 23

Midriasis

Question 24

During the perioperative evaluation, you discover that a patient with a pacemaker occasionally experiences dizziness while exercising his chest muscles. Based on this finding, which of the following would you avoid during his anesthetic?

Answer 24

Avoid succinylcholine
This indicates that myopotentials may be inhibiting the pacemaker. From this information, you know that muscle fasciculations from succinylcholine should be avoided to prevent inadvertent pacemaker inhibition.

Question 25

How long after a myocardial infarction is the risk for reinfarction the greatest?

Answer 25

one month ; 30 days; The mortality rate with reinfarction is 50%. Because of these statistics, it is recommended that no patient undergo elective surgery until at least 60 days after the MI.

Question 26

hich herbal medication lowers blood glucose and has the potential to increase bleeding?

Answer 26

Ginseng lowers blood glucose and has the potential to increase bleeding.

Question 27

Which of the following findings would warrant postponement of an elective procedure for further diagnostic evaluation?

Answer 27

Symptomatic mitral stenosis mitral stenosis, new onset ventricular tachycardia, symptomatic ventricular arrhythmias, unstable angina, MI within the past 30 days, severe aortic stenosis, symptomatic bradycardia, and high-grade heart block.