Review Flashcards
(100 cards)
1
Q
What is the etiology of Systemic Lupus Erythomatosus?
A
The etiology is unknown.
SLE is an autoimmune disorder with diverse clinical an immunologic manifestations.
2
Q
Where is CSF secreted in the body?
A
Choroid Plexus
CSF is secreted by the ependymal cells of the choroid plexus within the ventricular system @ a rate of approx. 30 ml/hr
3
Q
What is the primary function of the pneumotaxic center?
A
Limit the depth of inspiration
The primary function of the pneumotaxic center is to limit the depth of inspiration.
4
Q
The brain and spinal cord are enveloped in 3 meningeal layers:
A
Dura mater, arachnoid mater, and the pia mater
The dura, arachnoid, and pia mater surround the brain and spinal cord.
5
Q
Multiple Sclerosis is characterized by each of the following except:
A
decreased levels of albumin in the CSF
Elevated levels of IgG and albumin in the CSF are characteristic of MS. MRI is a sensitive diagnostic tool for MS and provides direct evidence of the location of demyelinated plaques in the CNS.
6
Q
Acute tubular necrosis ATN is classified as what type of acute renal failure ARF?
A
Renal Failure
Prerenal failure =hemodynamic or endocrine factors that impair renal function
Renal failure = tissue damage
Post renal failure = urinary tract obstruction
7
Q
Uremia in ESRD patients can lead to atherosclerosis by:
A
Increasing serum triglycerides
Uremia causes changes in lipid metabolism that lead to increased concentration of serum triglycerides & reduce lvls of protective HDLs. ESRD accelerates the progression of atherosclerosis
8
Q
Which of the following nerves can be electrically stimulated at the ankle to produce flexion of the toes?
A
Posterior tibial nerve
Stimulation of Post tibial nerve causes flexion of the toes by stimulating the flexor digitorum brevis muscles and abduction of the first toe by stimulating the abductor halluces muscles. PTN is also sensory to most of the plantar part of the foot.
ANKLE BLOCK: Deep peroneal, superficial peroneal, posterior tibial, sural, and saphenous.
9
Q
What percentage ____ of calcium exist in the boney skeleton and what percentage ____ exist extracellular space?
A
99% exist in the bony skeleton and 1% exist in the extracellular space
10
Q
The internal carotid arteries enter the skull through which foramen?
A
Foramen Lacerum
The internal carotid arteries enter the skull through the foramen lacerum and bifurcate near the lateral border of the optic chiasm, forming the anterior and middle cerebral arteries.
11
Q
Bilateral renal calculi seen in a plain abdominal radiograph could lead to:
A
Post Renal Azotemia
Azotemia due to urinary tract obstruction is referred to as post-renal azotemia. Obstruction of urinary flow from both kidneys is usually necessary for azotemia and oliguria.
12
Q
The anterior and posterior spinal arteries originate from the:
A
Vertebral, radicular arteries and the posterior inferior cerebellar arteries, respectively
- The one anterior spinal artery supplies about 75% of the blood flow to the spinal cord(motor tracts) and arises from the vertebral arteries and radicular arteries from the aorta. It descends in front of the anterior longitudinal sulcus of the spinal cord.
- The two posterior spinal arteries supply abt 25% of the blood flow to the spinal cord (sensory tracts) and arise from the posterior and inferior cerebellar arteries, the vertebral arteries, and the radicular arteries.
13
Q
Common anesthetic problems encountered when the patient has a current or recent URI include: (select 2)
A
Bronchospasm, laryngospasm, hypoxemia, atelectasis, and stridor are all possible problems w URI.
14
Q
The blood-gas partition coefficient of nitrous oxide:
A
0.46
15
Q
All of the following agents are acceptable for use in a Bier block except:
a. 0.5% Lidocaine
b. 0.5% Mepivacaine
c. 0.25% Bupivacaine
d. 0.5% Procaine
e. 0.25% Procaine
A
0.25% Bupivacaine
Because of the potential for cardiotoxicity and because bupivacaine has no advantages over other local anesthetics in this setting, it is no longer recommended for use in IV anesthesia.
16
Q
Which of the following not a metabolic effect of epinephrine:
a) bronchodilation
b) increase in blood glucose
c) increase in lactate
d) increase in free fatty acids
A
Bronchodilation
Epi has endocrine and metabolic effects that include increasing the levels of blood glucose, lactate, and free fatty acids.
17
Q
Megaloblastic anemia, aka pernicious anemia, develops when there is a deficiency in either of what two substances?
a) B12 and folic acid
b) Iron and folic acid
c) B6 and folic acid
d) Iron and B12
A
B12 and folic acid
When there is a lack of B12 and folic acid red blood cells fail to mature.
18
Q
What lab values are typically elevated in patients with Duchenne’s muscular dystrophy?
A
Serum creatine kinase
Skeletal muscle cells are prone to necrosis so serum creatine kinase levels may be 20-100 x higher than the normal.
19
Q
Hemodynamic goals for the perioperative treatment of a patient with aortic regurgitation include all of the following except:
a) Increase in afterload
b) Increased preload
c) Decrease in afterload
d) Moderately increased heart rate
A
Increased in afterload
Hemodynamic goals for AR include moderate increase in heart rate, normal sinus rhythm, decrease in afterload, maintain pulmonary vascular resistance and normal to increased preload.
20
Q
C fibers conduct _________ and are the slowest/fastest?
A
Pain and temperature and are the slowest (smallest) of all fibers
21
Q
Impulses in myelinated axons is termed?
A
Saltatory conduction
Impulses in myelinated axons travel from one node of Ranvier to another, bypassing the area between the nodes and increasing the velocity of conduction
22
Q
With a half-life of approximately _______, __% of T3 is produced by the deiodination of T4 in periperial tissues outside of the thyroid gland and __% is produced by direct thyroid secretion.
A
24-30 hours; 80% & 20%
With a half-life of approx. 24-30 hours, 80% of T3 is produced by the deiodination of T4 in peripherial tissues outside of the thyroid gland and 20% is produced by direct thyroid secretion.
23
Q
Which law expresses the relationship of concentration of a gas in solution to the partial pressure of the gas with which the solution is in equilibrium?
A
Henrys’s Law expresses solubility.
Solubility describes the tendency of a gas to equilibrate with a solution, which determines the concentration in the solution
24
Q
If a hypoxemic patient does not respond to an increase in FIO2 with an increase in SaO2, what is the problem?
a) shunt-like situation with V/Q 0.8
c) deadspace-like situation with V/Q 0.8
A
deadspace-like situation with V/Q 0.8 and don’t respond as well to O2 increases since the areas with normal blood flow that are passing the alveoli are already exposed to as much oxygen as it can upload - and the remaining alveoli are not receiving blood flow so gas is entering and leaving the lung w/o coming into contact with the blood.
25
Propofol, when used in an asthmatic patient:
has a bronchodilating effect
Propofol has a bronchodilating effect, in contrast to thiopental (bronchospasm) or ketamine (increased secretions), which have essentially no indication in asthmatic patients. An inhaled induction of anesthesia w isoflurane or sevoflurane is a valid alternative. Des is not recommended bc it increases secretions and irritation of the proximal airway.
26
Albuterol:
a) is long acting
b) is used for acute symptoms of asthma
c) Bradycardia is a dose limiting side effect
d) has both alpha and beta effects
is used for acute symptoms of asthma
Short acting inhaled b2-adrenergic agonists and anticholinergics are potent bronchodilators that are used to treat acute symptoms for all stages of
Albuterol is the preferred selectibe B2 adrenergic agonist for the treatement of acute bronchospasm due to asthma.
Tachcardia and hypokalemia may accompany large doses of albuterol.
27
When placing a central venous catheter which site is the safest for placement?
Right Interal Jugular
Catherization of the subclavian vein is associated with a significant risk of pneumothorax during insertion. The RIJ vein provides a combination of accessibility and safety. L sided catherization increases the risk of vascular erosion, pleural effusions, and chylothorax.
28
Which of the four phases of acute renal failure signifies that tubular function is returning?
a) diuretic phase
b) Phase I
c) Late phase
d) Recovery phase
Diuretic phase
The diuretic phase signifies that tubular function is returning. It is marked by large daily urinary output (more that 3L) 2nd to the osmotic diuretic effect produced by elevated BUN and impaired ability of tubules to conserve sodium and water.
29
Which type of hypersensitivity reactions are known as "delayed hypersensitivity reactions"?
Type IV
Type IV reactions, aka delayed hypersensitivity reactions, result from the interactions of sensitized lymphocytes with specific antigens. This form is important in tissue rejection, graft-vs-host reactions, contact dermatitis, and tuberculin immunity.
30
Dialysis is the most effective means of managing perioperative hyperkalemia and is indicated when serum K exceeds 5 meq/L. All of the following are other techniques for treating hyperkalemia except:
a) bicarbonate administration
b) Insulin and glucose administration
c) Hypoventilation
d) Hyperventilation
Hypoventilation
Other techniques include insulin and glucose infusions (25-50 g of glucose with 10-20 units of regular insulin) and administration of bicarbonate. Hyperventilation with respiratory alkalosis lowers serum K concentration by ~0.5 mEq/L for every 10 mm/Hg change in arterial CO2 tension
31
The most potent stimulus for pulmonary vasoconstriction is:
Hypoxemia
generalized alveolary hypoxia is the most potent stimulus for pulmonary vasoconstriction when it occurs locally, it serves to shunt the blood to areas that are better oxygenated. Systemic acidosis also promotes pulmonary vasoconstriction but it is not as potent as hypoxia.
32
The femoral nerve is always _______ to the femoral artery:
Lateral
| The femoral nerve is always lateral to the artery.
33
Causes of metabolic alkalosis include all of the following except:
a) Vomiting
b) Liver failure
c) Citrate in stored blood
d) Hyperaldosteronism
Liver failure
Metabolic alkalosis is present when the pH is higher than 7.45 b/c of gain of bicarbonate ions or loss of hydrogen ions. Causes include: excessive loss of hydrogen ions from vomiting, chloride or potassium loss from diuretics, hypovolemia, hyperaldosteronism, and excessive production of bicarbonate ions from metabolism of lactate in LR solution, citrate in stored blood, and acetate in hyperalimentation solutions
34
The upper third of the esophagus is:
a) Smooth muscle
b) Non-striated
c) Skeletal muscle
d) Under autonomic control
Skeletal muscle
Skeletal muscle tissue includes muscles of the tongue and the soft palate, the extrinsic eye muscles, the muscles that move the scalp, all muscles that attach to the skeleton, and the muscles of the pharynx and upper third of the esophagus.
35
Which of the following nerves is located immediately lateral to the trachea?
a) Vagus
b) Long Thoracic
c) Phrenic
d) Recurrent laryngeal
e) Spinal accessory
Recurrent laryngeal
The structures in the neck from medial to lateral are the recurrent laryngeal nerve, carotid artery, vagus nerve, internal jugular vein, and phrenic nerve.
36
In multiple sclerosis, demyelination of the optic tract and oculomotor pathways result in_____ respectively.
Visual disturbances and nystagmus
Demyelination of the optic tract produces visual disturbances, whereas demyelination of the oculomotor pathways results in nystagmus.
37
Elective tonsillectomy surgery for patients with acute upper respiratory tract infection URTI:
a) Has no increased risk of laryngospasm with airway manipulation
b) Is usually postponed until resolution of the URTI, which is usually ~7-14 days
c) Neosynepherine drops to bilateral nares during induction
d) Proceeds as planned without delay
Is usually postponed until resolution of the URTI which is usually ~ 7-14 days
Patients arriving to the hospital for elective tonsillectomy and adenoidectomy surgery, who have an acute URTI - surgery is usually postponed until the resolution . Laryngospasm with airway manipulation may be more likely to occur
38
Hydrocarbons containing only single bonded carbons are called?
```
Alkanes
single bonded = alkanes
double bonded = alkenes
triple bonded = alkynes
A cyclic hydrocarbon ring may contain a single, double, or triple bonds. A benzene ring is an example of cyclic hydrocarbon ring.
```
39
The major pathophysiologic derangement associated with mitral insufficiency is?
a) Pressure overload of RV
b) Pressure overload of LV
c) Volume overload of RV
d) Volume overload of LV
Volume overload of LV
This occurs b/c the regurgitant fraction (retrograde blood flow ejected into the LA during ventricular systole) delivers and increased diastolic volume to the LV. This increase in LVEDV results in ventricular dilation.
40
What is the Coanda effect?
Tendency of a fluid flow to follow a curved surface upon emerging from a constriction
The Coanda effect (Henry Coanda 1885-1972) explains the tendency of a fluid to follow a curved surface upon emerging from a constriction. This may cause a preferential flow in one tube at a bifurcation just passing a narrowing in a tube . Beyond a narrowing in a tube, pressure will increase corresponding with a decrease in velocity of the fluid flow.
41
CSF flows from the ___ of the cerebral hemispheres through the ___ into the __ through the ___ into the midbrain, into the forth ventricle. CSF then enters the subarachoid space through the medial ___ and the paired ___.
Lateral ventricles, foramen of Monro, third ventricle, aquaduct of Sylvus, foramen of Magenie, foramina of Luschka
42
Myelin is produced by which type of cell?
Schwann cells
| Myelin is formed in the vertebral peripheral nervous system by modified glial cells termed schwann cells.
43
A cerebral autoregulation curve is shifted to the _____.
Right
44
Which classes of drugs do not aid in induction of remission, improved function, and maintenance of remission of rheum arthritis?
Opioids
There is no cure for rheumatoid arthritis. The disease process of immunoinflammation that causes rheumatoid arthritis is extremely complex and monotherapy is unlikely to be successful. The goals of therapy are induction of remission, improved function, and maintenance of a remission. There are three groups of drugs used for treatment:
NSAIDS, corticosteroids, and DMARDs (disease modifying antirheumatic drugs. BC NSAIDS do not affect the course of the disease, they are used in conjunction w DMARDS. Corticosteroids are effective but the SE associated w long-term use limit their usefulness. DMARDs are now the first line therapy. Methotrexate has proven to be very effective and is often initial drug of choice. Other DMARDs include, leflonomide, cyclosporine, azathioprine, gold, sulfasalazine, minocycline, and hydroxychloroquine.
45
____ is characterized by a chronic productive cough, decreased PaO2, Increased PaCO2, and marked cor pulmonale.
Chronic bronchitis
CB is characterized by decreased airway lumen, moderate dyspnea, decreased FEV1, marked decrease in PaO2 (blue bloater), increased PaCO2, increased diffusion capacity, increased hematocrit, marked cor pulmonale, and poor prognosis.
46
All volatile gasses _____ CMRO2 but increase _______.
Decrease CMRO2 but increase CBF
47
An epidural or spinal technique for a patient with pheochromocytoma effectively blocks sympathetic activity caused by the tumor. (T or F)
False
Regional block could block sensory and sympathetic discharge in the area of the surgical field. However, the catecholamines would still release with surgical manipulation and be able to bind and activate adrenergic receptors throughout the body.
48
CO2 diffuses 20 times more rapidly than O2.
| T or F
True
| CO2 does diffuse twenty times more rapidly than oxygen.
49
Correct CSF flow in the brain in reverse sequence of foramina is which of the following?
Foramen of Magendie and Luschka then the Aquaduct of Silvius then the Foramen of Monro
CSF flows from the lateral ventricles through the foramen of monro into the third ventricle through the aqueduct of Silvius into the fourth ventricle through the foramen of Luschka and Magendie into the cerebromedullary cistern into the subarachonoid space.
50
Drugs or metabolites that depend on renal elimination should be used cautiously or avoided. These include all of the following except:
a) Remifentanil
b) Morphine
c) Meperidine
d) Pancuronium
Remifentanyl
An estimated 80% of a single dose of pancuronium is eliminated unchanged n the urine. The accumulation of morphine and meperidine metabolites have been repressed and prolong respiratory depression in some pts with renal failure. Remifentanyl pharmacokinetics are unaffected by renal function due to rapid ester hydrolysis.
51
DM Type 1 accounts for ______ % and DM Type 2 accounts for _____% all DM?
5 - 10 % , 90 - 95 %
Type I formerly called insulin-dependent diabetes mellitus
Type II formerly called non-insulin-dependent diabetes mellitus. DMI experiences onset of disease early in life
52
The pore size of the blood brain barrier is _____ that of the periphery and is therefore impermeable to ions and proteins when intact:
1/10th at 0.7 to 0.9 nm
53
What is the body's normal physiologic response to anemia?
a) Increase systemic vascular resistance
b) Decrease cerebral blood flow
c) Increase cardiac output
d) Decrease heart rate
Increase cardiac output
| The normal physiologic response is to increase cardiac output and maintain oxygen delivery
54
What regulates the pituitary gland?
Hypothalamus
| The brain, via the hypothalamus, is an important regulator of pituitary gland secretion
55
Which of the following is not a islet of Langerhans cell type?
a) Delta
b) Alpha
c) Beta
d) PP (pancreatic polypeptide)
e) Gamma
Gamma
Alpha, Beta, Delta, and PP (pancreatic polypeptide) are all islet type pancreatic cells.
56
Whichc explains the cooling effect that occurs with adiabatic expansion of a gas?
Joule-Thompson effect
The Joule-Thompson effect explains the cooling effect
57
Normal CSF pressure is ____ mmHg?
5-15 mmHg
58
Grahams law describes the diffusion of gas as being inversely proportional to ?
square root of its molecular weight
59
Chronic bronchitis differs from emphysema in that patients with bronchitis:
a) have a decreased elastic recoil
b) have an elevated hematocrit
c) display hyperinflation on chest x-ray
d) have normal PaCO2
Have an elevated hematocrit
Pts with chronic bronchitis typically exhibit frequent cough, copious sputum, elevated HCT, increased markings on CXR, elevated PaCO2, normal elastic recoil and increased airway resistance.
60
According to the 2004 guidelines as proposed by the American College of Endocrinology, the intraoperative recommendation for glycemic control is:
< 150 mg/dL
61
Symptomatic hypocalcemia is a medical emergency and should be treated immediately with intravenous __________
Intravenous calcium chloride (3-5 mL of a 10% solution) or calcium gluconate (10-20 ml of a 10% solution)
62
What drug group is associated with improved graft patency, limb salvage, and decreased amputation rate in patient's undergoing infrainguinal bypass for peripheral vascular disease?
Statins
The use of statins may reduce progression or even cause regression of atherosclerotic plaques, improve endothelial function, and reduce cardiovascular events in high risk patients. Statins are also associated with improved graft patency, limb salvage, and decreased amputation rate
63
Air moves in and out of the lungs due to:
Pressure gradient changes between the atmosphere and the lungs.
The movement of the air in and out of the lungs due to pressure gradient changes secondary to an increase in the intrathoracic cavity size.
64
There are 4 subgroups of (A) nerve fibers. Which subgroup is larges, most heavily myelinated, and thus has the fastest conduction velocity?
a) delta fibers
b) gamma fibers
c) alpha fibers
d) beta fibers
Alpha fibers
There are 3 groups of nerve fibers- A, B, and C
Alpha fibers are responsible for motor functions and proprioception. Alpha fibers are the largest in diameter (15 to 20 micrometers) and the most heavily myelinated: they have the fastest conduction velocity (Recall that large and heavily myelinated means hardest to block)
65
A healthy 27 year old female stepped on a nail and is undergoing debridement of a wound on her right great toe. She is anxious abt gen anest but agrees to and ankle block with mild sedation. Which nerves must bet adequately blocked in order to perform the surgery?
Deep peroneal, posterior tibial, saphenous, superficial peroneal
The great toe is innervated by the deep peroneal, posterior tibial, superficial peroneal, and occasionally the saphenous nerve. All four nerves should be blocked for surgery on the great toe.
66
Transmucosal delivery is characterized by a ____ absorption phase when compared to PO delivery.
Faster
Rapid absorption phase though the buccal mucosa
67
Angiotensin I being converted to Angiotensin II is an example:
a) oxidative phosphorolization
b) intrinsic renal involvement in respiratory regulation
c) hypoxic pulmonary vasoconstriction
d) pulmonary metabolism of vasoactive substances
not sure
| answer is not B
68
Compared to oxygen the affinity of carbon monoxide for hemoglobin is:
200 times greater
Arterial hypoxemia is the most frequent first indicator of aspiration. Other features include tachypnea, tachycardia, cyanosis, hypertension, and dyspnea.
69
All of the following are potent vasodilators except?
a) Corticosteroids
b) Aminophylline
c) Volatile anesthetics
d) Epinephrine
Aminophylline
Epinepherine (0.2-1 mcg/min) is a potent bronchodilator that can be used as a second-line intervention. Methylxanthines, such as theophylline and aminophylline, are weak bronchodilators with significant proarrhythmic effects, and probably should not be used to treat an acute asthma attack nor of acute perioperative bronchospasm. All volatile anesthetics are potent bronchodilators. Corticosteroids are extremely effective bronchodilators. Inhaled corticosteroids are effective in chronic treatment of asthma and IV corticosteroids can be part of treatment in acute bronchospasm
70
A left coronary artery MI is seen in all leads of the EKG except:
a) aVL
b) V1-V4
c) III
d) I
c) III
71
Scoliosis, the most common abnormal curvature, is a ____ curvature of the spine.
Lateral
```
Scoliosis = Lateral curvature
Kyphosis = Posterior curvature
Lordosis = hollowing of the back (may occur as a result of obesity or pregnancy)
```
72
Of the 1500 mL of blood the liver receives per minute, ____% comes from the hepatic artery and ____% from the portal vein?
25 % from hepatic artery
75 % from portal vein
The liver receives approx. 1500 mL of blood per minute, 25-30% from the hepatic artery and 70-75% from the portal vein. This represents 25-30% of the cardiac output
73
Chronic pulmonary hypertension results in:
a) Decreased afterload to right ventricle
b) Increased cardiac output
c) Decreased left ventricular stroke volume
d) Increased left ventricular filling
Decreased left ventricular stroke volume
In chronic pulm htn the increase in the afterload to the right side of the heart causes the right ventricle to progressively dilate, hypertrophy, and eventually lose in systolic function, which decrease the stroke volume and filing of the left ventricle. In addition, dilatation of the right ventricle causes bulging of the interventricular septum into the left ventricular cavity, further compromising it filling. The ultimate result is a decrease in cardiac output, reduced coronary perfusion, and the clinical signs of Right ventricular failure, including peripheral edema, hepatomegaly, jugular vein distention, and eventually hypoxemia and dyspnea.
74
The brachial plexus nerve roots form ___ trunks, ___ divisions & ___ cords
3,2,3
Three distinct trunks are formed between the middle and anterior scalene muscles. As the trunks pass over the lateral border of the first rib and under the clavicle, each trunk divides into anterior and posterior divisions. As the brachial plexus emerges below the clavicle the fibers combine again to form three cords
75
Through which of the following would a spinal needle NOT pass during a midline placement of a subarachnoid block in the L3-L4 lumbar space?
a) Dura Mater
b) Supraspinous ligament
c) Posterior longitudinal ligament
d) Interspinous ligament
Posterior longitudinal ligament
Order is skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, the ligamentum flavum, and finally the dura (posterior)
76
Hypothermia will decrease CMRO2 ____% for every degree centigrade decrease in core body temperature.
7 %
77
When providing anesthesia to a 21 year old quadriplegic patient, you would expect to see autonomic hyperreflexia if the lesion is above what level?
T6
Autonomic hyperreflixia should be expected in patients with lesions above T6 can be precipitated by surgical manipulations.
78
Smoking patients should be advised to stop smoking at least _____ prior to an elective operation to decrease the risk of post-op pulmonary complications.
2 months
79
What is the anesthetic goal for someone with mitral regurgitation ?
promote vasodilation and tachycardia
80
Degeneration of cardiac muscle in patients with muscular dystrophy is common, but results in dilated or hypertrophic cardiomyopathy in ____ of patients.
10 %
81
A patient with myasthenia gravis has a(n) _____ in the number of functional postsynaptic ACh receptors.
a) Decrease
b) Increase
c) No change
Decrease
| A patient with myasthenia gravis has a(n) Decrease in the number of functional postsynaptic ACh receptors
82
Complications of chronic immunosuppression include all of the following except:
a) Increased risk of infection
b) Pancytopenia
c) Hypotension
d) Lowered seizure threshold
Hypotension
Chronic immunosuppression complications include: lowered seizure threshold, diabetes, hypertension, hyperlipidemia, decreased GFR, atherosclerosis, hyperkalemia, hypomagnesaemia, increased risk of infection, increased risk of malignancy, pancytopenia, osteoporosis, and poor wound healing.
83
Oliguria is classified as:
Urine flow rates < 0.5 ml/kg/hr
84
Factors affecting diffusion of local anesthetic infiltration include:
a) concentration of local anesthetic administered
b) pKa
c) all of the above
d) pH of the surrounding tissue and nerve fiber
all of the above
Diffusion can be influenced by such factors ad the ;pKa and the concentration of the local anesthetic, as well as pH of the surrounding tissue and nerve fiber.
85
Each of the following is a potential complication of lumbar sympathetic blocks EXCEPT:
a) S1 nerve block
b) Puncture of the renal pelvis
c) Intravascular injection (aorta)
d) Accidental subarachnoid injection
e) seizure
S1 nerve block
Potential complications from lumbar sympathetic block include subarachnoid injection, puncture of a major vessel (i.e. aorta) or renal pelvis, neuralgia, somatic nerve damage, perforation of a disk, infections, ejaculatory failure, and chronic back pain. Blockade of nerves arising from the lumbar plexus is possible but given the anatomy of the sacral plexus, blockade of an S1 nerve would be extremely unlikely if not impossible
86
The earliest manifestation of bronchial intubation is ?
Increase in peak inspiratory pressures
87
Which of the following is not a trigger of autonomic hyperreflexia?
a) stimulation of the bowel
b) surgical incision
c) stimulation of the bladder
d) elicitation of patellar reflexes
Elicitation of patellar reflexes
| Stimulation of the bladder and bowel, including pain and noxious stimulation
88
All of the following are considered intrinsic renal causes of oliguria except:
a) Glomerulonephritis
b) Acute tubular necrosis
c) Hypovolemia
d) Acute interstitial nephritis
Hypovolemia
Acute tubular necrosis, glomerulonephritis, and acute interstitial nephritis are intrinsic causes of oliguria
89
This syndrome is caused by the impairment of diastolic filling of the heart because of continual increases in intrapericardial pressure?
a) Pericarditis
b) Costrochondritis
c) Cardiac Tamponade
d) Tracheal Tamponade
Cardiac Tamponade
90
The plateau phase of the cardiac action potential is responsible by what ion?
Slow Ca channels
91
The three types of drug-induced immune hemolysis include all except:
a) Immune complex type
b) Penicillin IgG type
c) Hapten-induced type
d) Autoantibody type
Penicillin IgG type
There are three types of drug induced immune hemolysis: autoantibody type, hapten-induced type, and immune complex type.
92
Why does an anephric or renal failure patient exhibit anemia?
a) the lack of vitamin b12 or folic acid is necessary for RBC maturation
b) pat w RF have altered calcium levels, which alters bone marrow's ability to produce RBC
c) the kidneys normally produce erythropoietin, this is lacking in a RF patient
d) the kidney's normally reabsorb ferritin. This is altered in RF patients therefore they are unable to make RBC
c) the kidneys normally produce erythropoietin, this is lacking in a RF patient
80-90% of all erythropoietin is produced in the kidneys . An anephric lack the ability to stimulate enough RBC production
93
Where in the nephron does aldosterone exert it effects? (list 2)
Late distal tubule & collecting ducts
the late distal tubule and collecting ducts in response to sodium levels
94
What nerves carry the afferent and efferent signals of the Bainbridge Reflex?
Afferent vagus, efferent sympathetic
When the great veins and the right atrium stretch by the increase in venous return, stretch receptors send Afferent signals to the medulla via the Vagus nerve. The medulla then transmits efferent signals via the sympathetic nerves to the heart to increase rate by as much as 75% and thereby increasing myocardial contractility. This is the Bainbridge Reflex, it helps prevent damming up of blood in the veins, the atria, and the pulmonary circulation
95
The initial decrease in temperature during the first hour of general anesthesia is primarily due to?
a) Vasodilation due to anesthetic drugs and inhalation agents
b) Heat loss from the head
c) Procedure related
d) None of the above
Vasodilation due to anesthetic drugs and inhalation agents
Redistribution of heat from warm central components (abdomen and thorax) to cooler peripheral tissues from anesthetic induced vasodilation explains most of the initial decrease in temperature, with actual heat loss being a minor contributor.
96
Which lobe is responsible for auditory function:
Temporal lobe
Frontal is motor, parietal for pain and touch, occipital is vision, and temporal houses hearing
97
The major pathophysiologic derangement associated with mitral regurgitation is?
a) Ventricular Fibrillation
b) Increased afterload of the aortic valve
c) Atrial Fibrillation
d) Volume overload of the LV
Volume overload of the LV
The major pathophysiologic derangement associated with MR is volume overload of the LV
98
The best way to assess a patients cardiac reserve pre-op is by assessing:
a) H&P
b) EKG
c) Presence of a murmur
d) Exercise tolerance
Exercise tolerance
99
Leukotriene receptor antagonists, when used by adult asthmatics:
a) are not indicated for treatment of acute bronchospasms
b) are indicated for treatment of acute bronchospasm s
c) Are not indicated for maintenance of chronic asthma
d) Should be discontinued prior to surgery
a) are not indicated for treatment of acute bronchospasms
Leukotriene receptor antagonists and synthesis inhibitors (e.g. montelukast, zafirlukast, and zileuton) in adults, and cromolyn sodium in children are effective maintenance drugs for chronic asthma.
100
When caring for an HIV/AIDS patient what is important to maintain meticulous implementation of ____ control?
a) airway
b) infection
c) cardiovascular
d) ventilation-perfusion
Infection
