Pathyophys final review part 3

Question 1

What product carries the lowest risk for patients with hemophilia A?

Answer 1

desmopressin b/c it is synthetic rather than cryo and factor concentrates as they carry risk of infectious disease transmission

Question 2

FFP contains

Answer 2

all of the clotting factors
does not have RBCs/Hgb so it does not increase oxygen carrying capacity & is not indicated for plasma volume augmentation

Question 3

Cryoprecipitate contains

Answer 3

fibrinogen, VII, XIII, and vWF

Question 4

Treatment of vWF can contain

Answer 4

desmopressin, factor VIII, cryo, & FFP

Question 5

Erythropoietin is formed in the

Answer 5

kidneys

Question 6

Methemoglobinemia producing oxidizing agents include

Answer 6

LAs, nitrates, & nitric oxide

nitrous oxide does not produce methemoglobinemia

Question 7

Methemoglobinemia is a disorder characterized by

Answer 7

the presence of >1% metHb in the blood
methemoglobin is an oxidized form of hemoglobin (contains Fe3+ in place of Fe2+ in Hb) & has slightly greater affinity for oxygen due to its chemical structure

Question 8

Double vision and worsening weakness can be indicative of

Answer 8

myasthenia gravis

Question 9

The treatment of choice for myasthenia gravis is

Answer 9

anticholinesterase inhibitors

Question 10

Describe the use of paralytics for patients with myasthenia gravis.

Answer 10

sensitive to rocuronium, resistant to succinylcholine

Question 11

Anesthetic management of a patient with mitochondrial disease includes

Answer 11

no need to reduce opioid requirements 
regional & locals are controversial
avoid nitrous LR & propofol infusions
can still use volatiles
Ketamine> propofol for induction

Question 12

______ should be avoided in patients with Parkinson’s

Answer 12

metoclopramide- dopamine antagonist

Question 13

Any condition that decreases oxygen transport to tissues will stimulate

Answer 13

erythropoietin

Question 14

Chronic blood loss is the result of

Answer 14

inability to absorb enough iron from the gut to make hemoglobin as rapidly as it is lost

Question 15

Acute blood loss.

Answer 15

body replaces fluid portion of plasma in 1-3 days

RBCs within 3-6 weeks

Question 16

There is clear evidence to support hemoglobin levels below ________ benefit from transfusion

Answer 16

6 mg/dL

Question 17

The lifespan of RBCs is

Answer 17

120 days

Question 18

Blood tests for hemolytic anemia include

Answer 18

increased immature erythrocytes, unconjugated hyperbilirubinemia/jaundice, increased lactate dehydrogenase, decreased haptoglobin

Question 19

For patients with sickle cell, blood transfusion

Answer 19

before surgery desires more HbA than HbS

Question 20

The sickle cell trait

Answer 20

does not increase morbidity & mortality

Question 21

With erythroblastosis fetalis, the fetus is

Answer 21

RhD-antigen positive and the mother is RhD antigen negative

Question 22

Rhesus factor is

Answer 22

a protein found on the surface of RBCs (antigen)

Question 23

Anesthetic risks for development of hemolysis for patients with G6PD deficiency includes

Answer 23

metoclopramide
penicillin
sulfa
methylene blue

Question 24

Concentrated polycythemia is a result of

Answer 24

dehydration, diuretics, or vomiting

Question 25

Physiologic polycythemia

Answer 25

does not result in symptoms | its an environmental adaption

Question 26

Polycythemia vera may be as high as 60-70% instead of normal & many die from

Answer 26

thrombus complications

Question 27

Hemoglobin A is made up of

Answer 27

2 alpha & 2 beta

Question 28

Methemoglobin is formed when

Answer 28

the iron in HB is oxidized from the ferrous (Fe2+) to the ferric (Fe3+) state

Question 29

_________ is contraindicated in someone with G6PD deficiency

Answer 29

methylene blue

Question 30

Anesthesia management for the patient with thalassemia includes

Answer 30

risk of difficult intubation due to oro-facial malformations, risk for infection-broad spectrum antibiotics, DVT prophylaxis, blood bank alerted that patient has thalassemia

Question 31

Sickle cell disease is when

Answer 31

the amino acid valine is substituted for glutamic acid at one point in each of the 2 beta chains

Question 32

Factor VIII level should be brought to at least

Answer 32

>50% prior to surgery

Question 33

The half life of factor VIII is approximately

Answer 33

12 hours in adults, 6 in children

Question 34

The treatment for hemophilia can include

Answer 34

FFP, cryo, TXA, desmopressin, & factor VIII concentratie

Question 35

Treatment for vWF includes

Answer 35

FFP, cryo, & factor concentrate

Question 36

Causes of DIC include

Answer 36

sepsis, burns, trauma, & obstetric complications

Question 37

Blood tests in DIC show

Answer 37

low platelets, low fibrinogen, high INR & PT, High PTT, high d-dimer

Question 38

In presenting hyperfibrinolysis DIC

Answer 38

give TXA with blood products

Question 39

In presenting procoagulant DIC

Answer 39

consider anticoagulation first & blood product support for bleeding or invasive procedures

Question 40

Upper motor neurons are

Answer 40

motor pathways that begin in the cerebral cortex & end in the ventral horn of the spinal cord

Question 41

The corticospinal tract

Answer 41

supplies the voluntary muscles of the trunk & extremities

Question 42

75-90% of the corticospinal tract

Answer 42

decussates in the medulla & forms the lateral corticospinal tract

Question 43

The corticobulbar tract

Answer 43

supplies the voluntary muscles of the head & follows the corticospinal tract until they reach the brainstem

Question 44

Lower motor neurons are

Answer 44

located in the brain stem or spinal cord

Question 45

Lower motor neurons send axons out through

Answer 45

nerves in the peripheral nervous system to synapse & control skeletal muscles

Question 46

The lower motor neurons that pass through the spinal nerves

Answer 46

primarily control muscles of the limbs & the trunk

Question 47

The lower motor neurons that pass through cranial nerves

Answer 47

primarily control the skeletal muscles of the head & neck

Question 48

The upper motor neuron motor cortex is

Answer 48

muscle groups affected minimal disuse muscle atrophy hypertonia spasticity & babinski

Question 49

The lower motor neuron cortex involves

Answer 49

``` individual muscles may be affected marked muscle atrophy fasciculations decreased muscle stretch reflex hypotonia flaccidity ```

Question 50

Cerebral palsy does not

Answer 50

cause progressive intellectual disability

Question 51

This type of anesthetic technique should be avoided for patients with MS

Answer 51

spinal

Question 52

Succinylcholine should be avoided in patients with

Answer 52

MS, Huntington's & LEMs

Question 53

Treatment for myasthenia gravis includes

Answer 53

cholinesterase inhibitor

Question 54

The difference between Duchenne's & Becker's is

Answer 54

the age of diagnosis