Pathophys final review

Question 1

Describe eosinophilic esophagitis.

Answer 1

reaction due to T cell mediated response that causes strictures & patient may present with difficulty swallowing
eosinophils build up in lining of esophagus

Question 2

Extrinsic asthma is when

Answer 2

reaction is triggered by an allergen; response by IgE

intrinsic asthma is triggered by non-allergic factors such as stress, cold air, infection, & airway manipulation.

Question 3

Treatment of acute angioedema include

Answer 3

FFP (replace the deficient enzyme)

Question 4

A type I allergic reaction is an

Answer 4

IgE anaphylaxis reaction of mast cells & basophils

Question 5

The epinephrine dose for anaphylaxis is

Answer 5

1-10 mcg/kg IV bolus

Question 6

Common allergens in the OR include:

Answer 6

latex, antibiotics, & rocuronium & succinylcholine (paralytics)

Question 7

Latex allergies present

Answer 7

in ~30 minutes (can take up to this long) because it has to cross through the skin

Question 8

The following antibiotics are cross-reactive

Answer 8

penicillin & cephalosporin

Question 9

Treatments for anaphylaxis include:

Answer 9

beta 2 agonists
corticosteroids
epinephrine
antihistamines

Question 10

Can you give propofol for patients who have anaphylaxis reaction to eggs?

Answer 10

yes

Question 11

True or false, the FDA requires all latex products to be marked.

Answer 11

True

Question 12

How does cricoarytenoid joint arthritis affect our anesthetic and what is it?

Answer 12

cricoarytenoid joint arthritis is when the cricoarytenoid joint is malpositioned and stiff
might need to downsize our tube
can occur in rheumatoid arthritis & lupus
may present without clinical symptoms

Question 13

Graft versus host disease may develop

Answer 13

1 month after bone marrow transplants

and conditions seen may include diarrhea, elevated liver enzymes & skin conditions

Question 14

A HMEF filter should be used with patients who have

Answer 14

an infectious disease such as

SARS or active TB

Question 15

Anesthetic considerations for scleroderma include

Answer 15

pHTN, difficult IV access, difficult intubation due to limited mouth opening, systemic HTN, at risk for aspiration because off hypotonia of LES, renal dysfunction

Question 16

Lupus is an

Answer 16

autoimmune disease of T & B lymphocyte hyperreactivity

Question 17

The four types of lupus include:

Answer 17

systemic lupus- affects the whole body, autoimmune disease
drug-induced lupus- goes away when trigger is stopped
cutaneous lupus- reactive to UV light, cutaneous changes, pigment changes, & loss of hair
neonatal lupus- from moms antibodies attacking baby- most serious result for neonates is heart block

Question 18

Antiphospholipid syndrome is

Answer 18

acquired hypercoagulability leading to embolism
symptoms may include blood clots PE, MI, CVA
related to SLE

Question 19

Rheumatoid arthritis is an

Answer 19

autoimmune, morning stiffness lasting more than 30 minutes

symmetrical & involves inflamed synovium

Question 20

Describe atlantoaxial instability.

Answer 20

involves C1 & C2- need inline stabilization to prevent severance of the spinal-cord
may occur in RA

Question 21

Sinusoids are where

Answer 21

the portal vein & hepatic artery come together to feed hepatocytes

Question 22

If you have a clot in the celiac artery, then you have

Answer 22

poor perfusion to the hepatic artery, stomach, spleen, & pancreas

Question 23

Arterial blood flow is dependent on

Answer 23

metabolic demand & autoregulation

Question 24

The portal vein supplies

Answer 24

50% of the livers O2 requirement

Question 25

Blood flow to the liver has

Answer 25

low resistance & high flow

Question 26

Kuppfer cells are responsible for

Answer 26

absorbing bacteria & cleaning the blood

Question 27

Bridging fibrosis leads to

Answer 27

decreased portal vein blood flow

Question 28

The following may decrease hepatic artery blood flow

Answer 28

alpha 1 adrenergic beta blockers hypotension

Question 29

When high pressure in the right atrium exists, the liver is affected because

Answer 29

it produces back pressure in the liver so it expands to 0.5 to 1 L and acts as a blood reservoir

Question 30

Pores in the sinusoids are

Answer 30

very permeable & allow easy pass of fluid & protein so lymph is similar to plasma

Question 31

Glucose is stored as

Answer 31

glycogen

Question 32

Increased hepatic vascular pressure can cause

Answer 32

fluid transudation into the abdominal cavity "liver sweating"--> ascites

Question 33

_____ is indicated in hepatic encephalopathy

Answer 33

ammonia

Question 34

Glycogen is a

Answer 34

readily available source of glucose that does not contribute to intracellular osmolality

Question 35

Phase 1 reactions include

Answer 35

oxidation & halothanation

Question 36

Phase 2 reactions include

Answer 36

glucuronidation & conjugation

Question 37

Conjugation works by

Answer 37

making products more water soluble so they can be excreted

Question 38

How does the liver store iron?

Answer 38

apoferritin + iron--> ferritin

Question 39

Describe the formation of bilirubin.

Answer 39

hemoglobin--> globin + heme--> Fe + pyrrole rings--> biliverdin--> free bilirubin--> bilirubin + albumin

Question 40

_____ bilirubin is toxic to the liver

Answer 40

Conjugated

Question 41

Obstructive jaundice can be due to

Answer 41

gallstone, malignancy or damage to hepatic cells

Question 42

Tests that measure the livers synthetic function include

Answer 42

serum albumin, PT, cholesterol, pseudocholinesterase

Question 43

The liver has a large functional reserve

Answer 43

therefore lab tests may be normal in the presence of cirrhosis

Question 44

The serum transaminase measurement reflects

Answer 44

hepatocellular integrity as opposed to liver function | - tests are not sensitive or specific

Question 45

_______ is a more specific liver function test than AST

Answer 45

alanine aminotransferase

Question 46

_______ is the NMBD of choice for patients with liver disease

Answer 46

Cisatricurium

Question 47

The most common cause of cholestasis is

Answer 47

extrahepatic obstruction & can be due to gallstones, stricture, & tumor in the bile duct intrahepatic obstruction is from liver damage

Question 48

Mechanisms responsible for ascites include

Answer 48

portal hypertension "sweating" sodium retention hypoalbuminemia

Question 49

Hepatorenal syndrome is characterized by

Answer 49

``` progressive oliguria avid Na+ retention azotemia intractable ascites high mortality ```

Question 50

With chronic hepatitis, the lab tests may

Answer 50

show only mild elevation of serum aminotransferases & these correlate poorly with severity of disease

Question 51

The most common cause of acute drug induced hepatitis is

Answer 51

alcohol

Question 52

In acute hepatitis, elevated _____ do not correlated well with the degree of cellular necrosis

Answer 52

transaminases

Question 53

Classify chronic persistent hepatitis, chronic lobular hepatitis, and chronic active hepatitis

Answer 53

chronic persistent hepatitis- eventually resolves and does not progress to cirrhosis; inflammation & preservation of normal cellular architecture chronic lobular hepatitis- resolves with acute exacerbations, does not progress to cirrhosis; characterized by foci of inflammation & cellular necrosis in the lobules chronic active hepatitis- chronic hepatic inflammation with destruction of cellular architecture; evidence of cirrhosis

Question 54

The sphincter of Oddi is affected by

Answer 54

opioids & can cause false positive cholangiograms fentanyl is the worst offender can give glucagon or naloxone to fix it

Question 55

The most common cause of postoperative jaundice is

Answer 55

over-production of bilirubin due to reabsorption of a large hematoma or RBC breakdown following transfusion

Question 56

Hepatic blood flow is decreased by

Answer 56

PEEP, high mean airway pressures, & hypoxemia- best if patient breathes spontaneously

Question 57

All volatile agents decrease

Answer 57

portal blood flow- greatest with halothane, least with isoflurane

Question 58

With intrahepatic or parenchymal dysfunction, we see increased

Answer 58

conjugated bilirubin, increased aminotransferases, no change in alk phosph, prolonged PT, decreased albumin

Question 59

IgE mediated type 1 hypersensitivity involve

Answer 59

mast & basophil degranulation

Question 60

_____ & ______ are not effective treatments in acute episodes of bradykinin mediated/hereditary angioedema

Answer 60

catecholamines & antihistamines

Question 61

Conjugated bilirubin is not conjugated by _____ but it is conjugated by ______ & ______

Answer 61

oxidation | glucuronide & sulfate