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Flashcards in INBR 7 - Critical care Deck (100)
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1

1. Berapakah umur-paruh dari phenobarbital
A. 6 jam
B. 12 jam
C. 24 jam
D. 100 jam
E. 140 jam

D.
The half-life of phenobarbital is generally between 98 and 120 hours in the average adult. Phenobarbital is largely metabolized by the liver, although 20 to 30% of the drug can be excreted unchanged in the urine. Barbiturates bind the GABAA receptor in the CNS, which facilitates Cl-mediated inhibitory postsynaptic potentials. Phenobarbital is often used in the treatment of partial and generalized tonic-clonic seizures in neonates (Katzung, pp. 3 7 , 358-359, 393-394)

2

2. Terapi awal manakah yang paling dipilih untuk pasien dengan gejala hyperkalemia yang disertai dengan perubahan EKG?
A. Furosemida
B. Insulin/Glukosa
C. Bikarbonat
D. Kayeaksalat
E. Kalsium glukonat

E.
Calcium gluconate is the initial treatment of choice for symptomatic hyperkalemia because it rapidly antagonizes the effects of hyperkalemia directly at the plasma membrane level. The effects of calcium gluconate are short-lived, however, and other therapies should be insti tuted simultaneously. Loop diuretics (furosemide) can i ncrease renal potassium excretion, Kavexalate enhances gastrointestinal potassium excretion, and bicarbonate and insulin/glucose induce intracellular shifts of potassium primarily into muscle cells. Sodium bicarbonate is less effective in patients with renal failure, however, and can actually bind calcium; therefore its utility is limited. The definitive treatment for patients with chronic hyperkalemia is hemodialysis ( M arino, pp. 655-658) .

3

3. Perawatan manakah yang dipilih untuk takikardia supraventrikular paroksimal (SVT)
A. Kardioversi listrik
B. Adenosin
C. Antagonis-antagonis kalsium
D. Bloker β
E. Dogoksin

B.
Paroxysmal supraventricular tachycardia (AV-nodal re-entrant tachycardia) results from re-entry of impulses from an ectopic source. Adenosine blocks the posit.ive inotropic effects of catecholamines, slows conduction at the AV node, and dilates coronary arteries. Additionally, the effects of adenosine are short-lived, so it does not elicit significant myocardial depression. It is these characteristics of adenosine that make it the drug of choice in the treatment of paroxysmal SVT m•er calcium antagonists ( Marino, pp. 329-330)

4

4. Gangguan-gangguan manakah yang paling lazim berasosiasi dengan ‘prominent leucocyt cast’ pada analisa urin secara mikroskopik?
A. Nepritis interstitial akut
B. Nekrosis tubular akut
C. Penyakit perubahan minimal
D. Grioglobulinemia
E. Jawaban A, B, C dan D semuanya salah

A.
Acute interstitial nephritis (AIN) is a common cause of acute renal failure and is usually associated with infections or hypersensiti\'ity drug reactions. AIN is characterized by a decrease in the glomerular filtration rate , often with oliguria . Urinalysis often exhibits hematuria, mild proteinuria, an elevated fractional excretion of sodium, eosinophilia, and leukocyte casts with AIN. Acute tubular necrosis (ATN) most commonly result

5

5. Lemah otot, status mental berubah, gelombang U pada EKG
A. Hiponatremia
B. Hipokalsemia
C. Hipomagnesemia
D. Hipokalemia
E. Hipofosfatemia
F. Hipokloremia

D
Symptomatic hyponatremia (usually 120 mEq/L or less) can result in generalized seizures, metabolic encephalopathy, depressed level of consciousness, acute respiratory distress syndrome, muscle weakness, and even cerebral edema and elevated intracranial pressure. Hypokalemia can result in muscle weakness, altered mental status, and ECG changes (prominent U waves, T-wave inversion, prolonged QT interval) ; however, isolated hvpokalemia does not result in significant cardiac arrhythmias. Hvpomagnesemia is very common in the I C U setting and is often associated with depletion of other electrol

6

6. Berasosiasi dengan kelainan-kelainan elektrolit lainnya dan torsades de pointes
A. Hiponatremia
B. Hipokalsemia
C. Hipomagnesemia
D. Hipokalemia
E. Hipofosfatemia
F. Hipokloremia

C
Symptomatic hyponatremia (usually 120 mEq/L or less) can result in generalized seizures, metabolic encephalopathy, depressed level of consciousness, acute respiratory distress syndrome, muscle weakness, and even cerebral edema and elevated intracranial pressure. Hypokalemia can result in muscle weakness, altered mental status, and ECG changes (prominent U waves, T-wave inversion, prolonged QT interval) ; however, isolated hvpokalemia does not result in significant cardiac arrhythmias. Hvpomagnesemia is very common in the I C U setting and is often associated with depletion of other electrol

7

7. Lemah otot, cardiac output menurun, anemia hemolitik
A. Hiponatremia
B. Hipokalsemia
C. Hipomagnesemia
D. Hipokalemia
E. Hipofosfatemia
F. Hipokloremia

E
Symptomatic hyponatremia (usually 120 mEq/L or less) can result in generalized seizures, metabolic encephalopathy, depressed level of consciousness, acute respiratory distress syndrome, muscle weakness, and even cerebral edema and elevated intracranial pressure. Hypokalemia can result in muscle weakness, altered mental status, and ECG changes (prominent U waves, T-wave inversion, prolonged QT interval) ; however, isolated hvpokalemia does not result in significant cardiac arrhythmias. Hvpomagnesemia is very common in the I C U setting and is often associated with depletion of other electrol

8

8. Cardiac output menurun, hiperfleksia, tetani
A. Hiponatremia
B. Hipokalsemia
C. Hipomagnesemia
D. Hipokalemia
E. Hipofosfatemia
F. Hipokloremia

B
Symptomatic hyponatremia (usually 120 mEq/L or less) can result in generalized seizures, metabolic encephalopathy, depressed level of consciousness, acute respiratory distress syndrome, muscle weakness, and even cerebral edema and elevated intracranial pressure. Hypokalemia can result in muscle weakness, altered mental status, and ECG changes (prominent U waves, T-wave inversion, prolonged QT interval) ; however, isolated hvpokalemia does not result in significant cardiac arrhythmias. Hvpomagnesemia is very common in the I C U setting and is often associated with depletion of other electrol

9

9. Ensepalopati, edema serebral dan kejang‐kejang
A. Hiponatremia
B. Hipokalsemia
C. Hipomagnesemia
D. Hipokalemia
E. Hipofosfatemia
F. Hipokloremia

A
Symptomatic hyponatremia (usually 120 mEq/L or less) can result in generalized seizures, metabolic encephalopathy, depressed level of consciousness, acute respiratory distress syndrome, muscle weakness, and even cerebral edema and elevated intracranial pressure. Hypokalemia can result in muscle weakness, altered mental status, and ECG changes (prominent U waves, T-wave inversion, prolonged QT interval) ; however, isolated hvpokalemia does not result in significant cardiac arrhythmias. Hvpomagnesemia is very common in the I C U setting and is often associated with depletion of other electrol

10

10. Ethosuximide
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

A
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

11

11. Asam Valpoat
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

F
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

12

12. ACTH
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

B
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

13

13. Penitoin
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

E
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

14

14. Penobarbital
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

D
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

15

15. Karbamasepin
A. Absence
B. Infantile spasms
C. Parsial kompleks
D. Kejang neonatal
E. tonik-klonik umum
F. sindroma LENNOX-GASTAUT
G. Bukan salah satu dari A s/d F

C
Isolated absence seizures (petit mal epilepsy) are generally treated with ethosuximide; however, valproic acid is the agent of choice if the patient also experiences generalized tonic-clonic seizures. LennoxGastaut svndrome is a heterogenous disorder characterized by mental retardation, seizures, and generalized spike-andwave complexes at 1 to 2 l-Iz on EEG. \'alproic acid is the initial treatment of choice for this disorder; howe\•er, less than 1 0% of all patients \\"ith Lennox-Gasraut syndrome achieve effecti\•e seizure control \\•ith single-agen t anticonvulsant therapy. I nfantile spasms (\\'est S\'ndrome) occur in children less than 6 months of age and are associated with tuberous sclerosis, cerebral malionnations. and metabolic disorders. The treatment of choice for infantile spasms is ACTH. Several anticonnllsants are utilized in the treatment of generalized tonic-clonic seizures : hmYe\•er, phenytoin is the traditional first-line agem. Phenobarbital is the drug of choice in the treatment of neonatal seizures, but phenytoin and lorazepam are often added with' inadequate seizure control. Garbamazepine is the agent of choice in the treatment of complex partial seizures and is particularly effective in preventing secondary generalization (Merritt, pp. 813- 826).

16

16. Ciri-ciri manakah yang TIDAK berlaku bagi synchronize itermittent mandatory ventilation (SIMV)
A. Beri pernafasan dengan silus volume
B. Seringkali dipadukan dengan dukungan tekanan untuk mengatasi resistensi ventilator circuit tuning
C. Memungkinkan pernafasan spontan antara pernafasan melalui ventilator
D. Berasosiasi dengan menurunnya kerja pernafasan
E. Berasosiasi dengan pengisian ventricular yang terganggu.

D.
SIIviV was developed secondary to complications (e.g. , hyperinflation and overventilation) that can arise in patients on assist-control ventilation (AGV) with rapid respiratorv rates. SIMV delivers \'Olume-cycled breaths at a preselected rate that are synchronized to the patient's spontaneous breaths. Additionally, SIMV allows spontaneous breaths to occur between ventilator-delivered breaths. Spontaneous breaths during SIMV occur through a high-resistance circuit with a unidirectional valve, which results in an increased work of breathing and potential for respiratory muscle fatigue. The addition of pressure support facilitates spontaneous breaths and can limit increases in work of breathing (and respiratory muscle fatigue) with SIIvfV. Any form of positive-pressure mechanical ventilation can be associated with impaired ventricular filling and concomitant reductions in cardiac output ( Marino, pp. 434-438) .

17

17. Karakteristik manakah di bawah ini yang TIDAK behubungan dengan extrinsic positive end-respiratory pressure (PEEP)?
A. Memudahkan pengumpulan alveolar
B. Menurunkan edema pulmonaris
C. Meningkatkan tekanan intratorak rata-rata
D. Menurunkan shunt intrapulmonaris
E. Menurunkan output jantung

B .
Normally, the alveolar pressure a t the end o f expiration is equal to atmospheric pressure. The addition of PEEP (extrinsic PEEP) results in an elevated alveolar pressure at the end of expiration by stopping exhalation when the preselected pressure is reached. PEEP results in increases in endexpiratory and mean intrathoracic pressures. PEEP tends to prevent alveolar collapse and facilitate alveolar reopening ( recruitment) , which results in improved gas exchange (decreased intrapulmonary shunt) and increased lung compliance. The addition of PEEP can result in decreased cardiac filling and cardiac output, especially in hypovolemic patients; this effect is independent of the absolute value of the extrinsic PEEP. The increases in mean intrathoracic pressure that are secondary to extrinsic PEEP are directlv related to the observed decreases in cardiac output. The application of PEEP does not reduce pulmonary edema and can, in fact, exacerbate pulmonarv edema secondarY to ah•eolar overdistention and impaired pulmonary lvmphatic drainage ( Marino, pp. 382-383, 441-44 5 ) .

18

18. Semua hal di bawah ini berasosiasi dengan sindroma distress pernafasan akut (SDPA),
KECUALI
A. Hipoksia
B. Infiltrasi pulmonaris menyebar
C. Hiperkapnia
D. Menambahkan PEEP mencegah keruntuhan alveolar dan memungkinkan penurunan FiO2 ke tingkat non-toksis.
E. Seringkali menunjukkan rasio PAO2/FiO2 > 200 mmHg

E .
ARDS i s characterized b y the acute onset of diffuse pulmonary infiltrates and hypoxemia that is reiractorv to eJe,•ations in Fi02. Lung-protective ,•entilatorv strategies with ARDS include the utilization of lo\\•er tidal ,•olumes ( 7 to 10 cc/kg) than with other traditional forms of ,•entibtion to keep peak inspiratory pressures less than 35 em H20. The addition of PEEP with ARDS prevents ah'colar collapse ( with the lower tidal ,•olumes) and allows the reduction oi the Fi02 to nontoxic levels (

19

19. Di antara ciri-ciri di bawah ini, ciri-ciri manakah yang TIDAK berasosiasi dengan auto-PEEP (PEEP intrinsik atau hiperinflasi)?
A. Volume inflasi besar
B. Frekuensi pernapasan rendah
C. Ventilasi rasio terbalik
D. Asma
E. Pneumotoraks

B.
I n trinsic PEEP (occult PEEP) results from incomplete alveolar emptying during expiration. The development of intrinsic PEEP is associated with l arge inflation volumes, rapid respiratory rates, decreases in exhalation time (inverse ratio ventilation), and airway obstruction (e.g., asthma and COPD). High levels of intrinsic PEEP are associated with decreased cardiac output, alveolar rupture (volutrauma) with possible pneumothorax, increased work of breathing, and ele,•ations in plateau pressures ( M a rino, pp. 462-464 ) .

20

20. Di antara perubahan-perubahan EKG di bawah ini, manakah yang dapat diobservasi pada pasien dengan emboli paru?
1. Takikardia
2. Perubahan-perubahan ST non-spesifik
3. Gelombang Q besar pada lead III
4. Gelombang T terbalik pada lead III

E.
EGG changes in acute pulmonary emboli include sinus tachycardia (most common), inverted T waves in !

21

21. Di antara agen-agen di bawah ini, manakah yang merupakan agen baris-pertama yang
terpilih dalam perawatan takikardia atrial multifokal?
A. Magnesium IV
B. Verapamil
C. Netoprolol
D. Lidokain
E. Kardioversi elektrik

A.
Multifocal atrial tachycardia ( l\'lA T) exhibits multiple P-wave morphologies and variable PR intervals on EGG, with an irregular ventricular rate. l\fAT is associated with chronic lung disease and theophylline, and has been associated with hypokalemia, acute mvocarclial infarction, pulmonary embolism, and congestive heart failure. l\tlAT should initially be treated with IV magnesium; theophylline should be discontinued and any underlying hypokalemia corrected. If these therapies are ineffective, verapamil or metoprolol should be administered ( Marino, pp. 328-329 ) .

22

22. Di antara ciri-ciri di bawah ini, ciri-ciri manakah yang berasosiasi dengan tamponade jantung?
1. Distensi Venus jugular
2. Hipotensi
3. Bunyi jantung lemah
4. Kenaikan dalam tekanan darah stoik (> 10 mmHg) dengan onset inspirasi

A .
Cardiac tamponade i s associated with Beck's triad (jugular venous distention, m uffled heart sounds, hypotension) and pulsus paradoxus (drop in systolic blood pressure of at least 10 mm Hg with the onset of inspiration) . Diastolic pressures (GVP, PGWP, pulmonary artery diastolic pressure) are often equalized with cardiac tamponade, and the diagnosis is often confirmed with transesophageal echocardiography. The treatment of cardiac tamponade entails emergent pericardiocentesis (Marino, pp. 255-256 ) .

23

23. Perempuan berusia 48 tahun dengan tiga anak mengalami onset demam akut tiga jam
setelah menerima transfusi darah, Tindakan pencegahan manakah yang seharusnya
diambil sebelum pemberian transfusi yang kedua?
A. Berikan sel-sel merah yang telah dibersihkan
B. Berikan sel-sel merah kadar leukosit rendah
C. Pra perawatan dengan Tylenol
D. Selidiki adanya defisiensi IgA
E. Jawaban A, B, C dan D semuanya salah.

A
Febrile nonhemolytic reactions are extremely common and accompany approximately 1 % of all transfusions. These reactions are secondary to antibodies in the recipient blood that react to donor leukocytes and are more common in multiparous women and a history of prior transfusions. The fever usually occurs between 1 and 6 hours after the transfusion and is not associated with other symptoms. The majority of patients who experience a febrile nonhemolytic reaction will not experience a second fever with repeat transfusion; however, leukocyte-poor red cells can be utilized 220 Intensive Neurosurgery Board Review in patients with repetitive febrile nonhemolytic reactions. Patients with lgA deficiency can exhibit more severe hypersensitivity reactions to transfusions, including rash and anaphylaxis ( Marino, p p . 702-703).

24

24. Di antara test-test laboratorium di bawah ini, manakah yang abnormal memanjang pada penyakit Willebrand ?
1. waktu protrombin
2. Waktu trombioplastin parsial (PTT)
3. Dilusi Protrombin 1 : 1
4. Waktu pendarahan

C.
Von \Villebrand's disease results in prolongations of the partial thromboplastin time ( PTT) and bleeding time because von \Villebrand factor stabilizes factor VIII and mediates platelet adhesion (Cecil, pp. 993 ) .

25

Jodohkanlah sindroma kejut di bawah ini dg pengukuran-pengukuran/tanda-tanda vital
kateter Swan-Ganz, Catatan – tenakan vena CVP-sentral (mm Hg), PCWP -- tekanan pantek
kapilaris pulmonaris (mm Hg), CI – Indeks jantung (L/ mnt/m2 ) SVR – resistensi vaskular sistemik (Dine/cm2 )
A. Kejut hipovolemik
B. Kejut kardiogenik
C. Kejut septic
25. CPV 16, PCWP 20, CI 1.2, SVR 1250

B
Hypovolemic shock i s characterized by decreased central \'enous and intracardiac pressures, decreased cardiac output, elevated SVR (> 1 200 dynes/cm2) , and concomitant hypotension and tachycardia, with a dampened Swan-Ganz catheter waveform. Cardiogenic shock is characterized by a decreased cardiac index (less than 1 .8 L/min/m2) , elevated PCWP (> 18 mm J-Ig) and CVP, elevated SVR, and decreased systolic blood pressure (

26

Jodohkanlah sindroma kejut di bawah ini dg pengukuran-pengukuran/tanda-tanda vital
kateter Swan-Ganz, Catatan – tenakan vena CVP-sentral (mm Hg), PCWP -- tekanan pantek
kapilaris pulmonaris (mm Hg), CI – Indeks jantung (L/ mnt/m2 ) SVR – resistensi vaskular sistemik (Dine/cm2 )
A. Kejut hipovolemik
B. Kejut kardiogenik
C. Kejut septic
26. CPV 4, PCWP 6, CI 4.5, SVR 350

C
Hypovolemic shock i s characterized by decreased central \'enous and intracardiac pressures, decreased cardiac output, elevated SVR (> 1 200 dynes/cm2) , and concomitant hypotension and tachycardia, with a dampened Swan-Ganz catheter waveform. Cardiogenic shock is characterized by a decreased cardiac index (less than 1 .8 L/min/m2) , elevated PCWP (> 18 mm J-Ig) and CVP, elevated SVR, and decreased systolic blood pressure (

27

Jodohkanlah sindroma kejut di bawah ini dg pengukuran-pengukuran/tanda-tanda vital
kateter Swan-Ganz, Catatan – tenakan vena CVP-sentral (mm Hg), PCWP -- tekanan pantek
kapilaris pulmonaris (mm Hg), CI – Indeks jantung (L/ mnt/m2 ) SVR – resistensi vaskular sistemik (Dine/cm2 )
A. Kejut hipovolemik
B. Kejut kardiogenik
C. Kejut septic
27. CPV 2, PCWP 5, CI 2.0, SVR 1400

A
Hypovolemic shock i s characterized by decreased central \'enous and intracardiac pressures, decreased cardiac output, elevated SVR (> 1 200 dynes/cm2) , and concomitant hypotension and tachycardia, with a dampened Swan-Ganz catheter waveform. Cardiogenic shock is characterized by a decreased cardiac index (less than 1 .8 L/min/m2) , elevated PCWP (> 18 mm J-Ig) and CVP, elevated SVR, and decreased systolic blood pressure (

28

28. Di antara karakteristik di bawah ini, manakah yang TIDAK berasosiasi dengan multipel neoplasia endokrin tipe-2 (Sindroma Sipple)?
A. Keturunan dominan autosomal
B. Peokromositoma
C. Adenoma Hipofise
D. Karsinoma tiroid medularis
E. Hiperplasia paratiroid

C.
Multiple endocrine neoplasia ( li 'IEN ) tYpe 2 ( Sipple syndrome) is an autosomal dominant disorder that localizes to chromosome 10 and is characterized by the development pheochromocytomas and medullar

29

29. Di antara ciri-ciri di bawah ini, ciri-ciri manakah yang berasosiasi dengan embolisme udara pada vena saat operasi ?
1. Kejadian tinggi pada posisi duduk
2. Modalitas diagnostik yang paling peka adalah ekokardiografi trenasesopageal
3. Berasosiasi dengan penurunan pada end tidal CO2
4. Pasien perlu segera ditempatkan pada posisi dekubitus lateral kanan.

A.
Intraoperative venous air embolism (VAE) has a high incidence during procedures performed in the sitting position (up to 25 to 45% of all case s ) . VAE is characterized by the development of bronchoconstriction, hypoxia, hypercarbia, hypotension, shock, cardiac arrhythmias, increased airway pressures, and decreased end-tidal C02 (secondary to increased dead space) . Transesophageal echocardiography is the most sensitiYe diagnostic modality for VAE, detecting volumes as small as 0.02 mL!kg of air entering the venous S\'Stem. The immediate treatment of suspected VAE entails rapid hemostasis \Yith concomitant irrigation of the surgical field, lo\Yering of the patient's head with left lateral decubitus positioning. increasing the FiO" to 1 00%, stopping any concomi tant nitrous oxide administration, manual occlusion of the j ugular veins. and aspiration of air from a multiorifice C\'P catheter ( Greenberg, p . 602 ; Youmans, pp. 614-615; Wilkins, pp. 409-410)

30

Pilihlah karakteristik-karakteristik di bawah ini yang paling lazim tampak dengan CSW/sindroma sekresi ADH yang tidak tepat (SIADH)
A. Pembuangan garam serebral (CSW)
B. SIADH
C. A dan B
D. Bukan A, B atau C

30. Hipovolemia

A
Cerebral salt wasting ( CSW) is characterized bY hYponatremia ( 20 mEq/L ) , elevated urine osmolality, decreased PCWP and CVP (hypovolemia ) , and normal or elevated serum potassium levels. SIADJ-1 is characterized by the presence of hyponatremia and hypervolemia secondary to plasma volume expansion. SIADH is associated with a decreased serum osmolality (