Review from TEST 1

Question 1

Iron deficiency anemia is classified as ________.

Answer 1

microcytic hypochromic (anemia characterized by small red blood cells; pale and relatively colorless)

Question 2

The initial phase of hemostasis is __________.

Answer 2

formation of the platelet plug (hemostasis= process in which to stop bleeding….blood vessels actually vasoconstrict first…. but for the test, the initial step is platelet plug)

Question 3

As with all surgeries, gastric bypass has complications associated with the procedure. The most common cause for reoperation after gastric bypass is ________.

Answer 3

anastomotic leaks

Question 4

Mallory-Weis tear at the GE junction is closely associated with chronic alcohol abuse. The most common signs/symptoms are ________.

Answer 4

upper abdominal pain and bloody vomitus

Question 5

(T/F?) Large, negatively charged molecules have a more difficult time penetrating glomerular barriers to enter the ultrafiltrate.

Answer 5

TRUE

Question 6

All of the following statements are true regarding hepatic physiology EXCEPT:
A: liver receives 40% of total CO
B: 25% of total flow is supplied by hepatic artery
C: the portal vein has partially deoxygenated blood and contains nutrient/compounds absorbed from gut
D: portal vein supplies 75% of total flow to the liver

Answer 6

A: The liver receives 40% of the CO

FACTS= normal hepatic blood flow is 25-30% of CO and is provided by hepatic artery and portal vein…. hepatic artery supplies about 45-50% and portal vein the other 50-55%; ALL coagulation factors with the exception of factor VIII and vWF are produced by the liver; Vit K is necessary for synthesis of prothrombin (factor II), and factors VII, IX, X; albumin

Question 7

Adriamycin is a chemotherapeutic agent commonly known to cause impaired cardiac contractility. This type of cardiac dysfunction is referred to as _______.

Answer 7

systolic dysfunction

Question 8

Decreasing afferent tone (dilation of the afferent renal artery) will have the following effects… Choose ALL THAT APPLY:

Answer 8

correct answers: increasing GFR, increasing glomerular blood flow

Question 9

You are evaluating a patient preoperatively for a laparoscopic cholecystectomy. You note a recent ABG measurement in the chart… results are pH 7.37, PCO2 57, PO2 65, HCO3 34, Hgb 18, SPO2 93%. The patient has a long history of smoking and is in no distress. The patient has no chronic renal disease. This patient can be classified as having a _________.

Answer 9

totally compensated chronic respiratory acidosis

Question 10

The blood bank product which contains the most fibrinogen is _______.

Answer 10

cryoprecipitate (FFP are spun and the precipitate is collected… vWF, fibrinogen, VIII)

Question 11

Hyperkalemia potentiates neuromuscular blockade by decreasing the excitability of the skeletal muscle cells. (T/F)?

Answer 11

TRUE

Question 12

Zenker’s diverticulum is a contraindication to TEE insertion. (T/F)

Answer 12

TRUE

Facts: aka pharyngeal pouch….it is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle–upper sphincter of esophagus–In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.

Question 13

Blood flow TO the glomerulus is provided via the _______ renal artery. The resting tone of this vessel is primarily regulated by _________.

Answer 13

afferent; prostaglandins

prostaglandins: variety of strong physiological effects, such as regulating the contraction and relaxation of smooth muscle tissue. Prostaglandins are not endocrine hormones, but autocrine or paracrine, which are locally acting messenger molecules. They differ from hormones in that they are not produced at a discrete site but in many places throughout the human body. Also, their target cells are present in the immediate vicinity of the site of their secretion (of which there are many).

Question 14

Your patient has been febrile for the past 24 hours. No maintenance fluids have been infusing for the past 12 hours. You would expect your patient to be __________ with a _________ sodium level.

Answer 14

hypovolemic; increased (kidneys conserve Na during states of volume depletion)

Question 15

Which of the following is a benefit of utilizing normovolemic hemodilution as a blood conservation technique? ALL OF THE ABOVE ARE BENEFITS

Answer 15

ALL OF THE ABOVE: decreased total loss of oxygen carrying capacity (Hgb) per mL of surgical blood loss, maintaining normal oxygen delivery by maintaining overall fluid volume status and hemoglobin WNL, ability to transfuse autologous blood as needed

Question 16

Increased _________ increases gut absorption of calcium, while _________ stimulates bone formation, decreasing plasma calcium levels.

Answer 16

calcitriol; calcitonin

calcitriol (hormonally active vitamin D)
calcitonin (hormone produced by parafollicular cells of the thyroid…. reduces blood calcium, opposing effects of PTH…. stimulated by increase in serum calcium)

Question 17

Increased sympathetic nervous system stimulation initiates renin secretion. Renin begins the process of ________ more sodium from the renal tubule.

Answer 17

retaining (renin just LOVES salt)

Question 18

Which of the following commonly used opiate or opioid medications have active metabolites which may prolong respiratory depression in the patient with renal failure?

Answer 18

demerol & morphine

Question 19

T/F?? Proteins secreted into the ultrafiltrate can be easily reabsorbed completely intact across the tubular membranes.

Answer 19

FALSE

Question 20

The cause of the restrictive ventilatory defect in obese patients is ___________.

Answer 20

BOTH A&B: additional weight on the thoracic cage, additional abdominal fat/weight impairing diaphragmatic excursion

Question 21

Patients who live at altitude (Denver, CO or Himalayan mtns) are often found to be polycythemic. This polycythemia is created by increased levels of erythropoietin as a result of lower atmospheric pressure.

Answer 21

FALSE (should be TRUE but answer was false)

polycythemia: disease state in which the proportion of blood volume that is occupied by red blood cells increases

Altitude related - This physiologic polycythemia is a normal adaptation to living at high altitudes. Many athletes train at high altitude to take advantage of this effect — a legal form of blood doping. Some individuals believe athletes with primary polycythemia may have a competitive advantage due to greater stamina. However, this has yet to be proven due to the multifaceted complications associated with this condition.

Secondary polycythemia is caused by either natural or artificial increases in the production of erythropoietin, hence an increased production of erythrocytes

Question 22

l-arginine vasopressin is secreted by the _______.

Answer 22

posterior neural hypophysis (posterior pituitary)

posterior pituitary secretes oxytocin and vasopressin

Question 23

Anti-parasympathetic medications may cause ______.

Answer 23

urinary retention

These are anticholinergics!!! (atropine, glyco); increased body temp, increased HR, urinary retention

Question 24

You are performing a preoperative assessment on a patient with Hemophilia A. You know Hemophilia A is an abnormality of which clotting factor?

Answer 24

factor VIII (because VIII 8 A…. haha)

Hemophilia A is a genetic deficiency in clotting factor VIII, which causes increased bleeding and usually affects males. Usually (approximately 70%) it is inherited as an X-linked recessive trait

Question 25

The final stage in the pathogenesis of chronic renal failure is _____________.

Answer 25

glomerulosclerosis

Glomerulosclerosis refers to a hardening of the glomerulus in the kidney. It is a general term to describe scarring of the kidneys’ tiny blood vessels, the glomeruli, the functional units in the kidney that filter urine from the blood. Proteinuria (large amounts of protein in urine) is one of the signs of glomerulosclerosis. Scarring disturbs the filtering process of the kidneys and allows protein to leak from the blood into urine. However, glomerulosclerosis is one of many causes of proteinuria. A kidney biopsy (removal of tiny part of kidney with a needle) may be necessary to determine whether a patient has glomerulosclerosis or another kidney problem. About 15 percent of people with proteinuria turn out to have glomerulosclerosis.

Question 26

The kidneys are primarily responsible for regulating free water concentration in the body. (T/F?)

Answer 26

FALSE

Facts: blood flow through the kidneys accounts for about 20-25% of the total CO; autoregulation of RBF between 80-180mmHg

Question 27

You are evaluating a patient in preoperative holding. The patient’s BUN is 18 and the creatinine is 3.6. This patient has azotemia because the patient is clearly in chronic renal failure. (T/F??)

Answer 27

FALSE

BUN= 6-20
Creatinine= 0.5-1.0
MUST have increase in BUN and CREAT
azotemia: is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely related to insufficient filtering of blood by the kidneys. It can lead to uremia if not controlled.

Question 28

The only test available to evaluate all properties of clot formation & strength is the _________.

Answer 28

thromboelastograph

Question 29

Enzyme immunoassays are the most sensitive & specific tests to confirm heparin-induced thrombocytopenia, but not the most rapid. (T/F?)

Answer 29

FALSE

ELISA 1st …. then a functional assay (takes longer)

Question 30

Which of the following factors are NOT part of the final common pathway?

Answer 30

IV (calcium)

Question 31

Your patient has a Hgb of 7 mg/dL. Based on this finding, you would expect what change, if any, to this patient’s oxyhemoglobin dissociation curve?

Answer 31

Shift right (less O2 carrying capacity… increase PCO2…. so shift right for low affinity for O2)

Question 32

The kidneys receive what percentage of the total cardiac output?

Answer 32

25%

Question 33

Obese patients must be well-preoxygenated before induction of general anesthesia. This is due to their decrease in functional residual capacity, but not total lung capacity. (T/F?)

Answer 33

FALSE

Per M&M: FRC is directly proportional to height…. obesity however can markedly decrease FRC (primarily as a result of reduced chest compliance)…. Total lung capacity = RV + ERV + VT +IRV….. RV + ERV is FRC…. so if FRC is decreased then the TLC must decrease too!!!

Question 34

Which of the following is NOT a renal protective benefit of utilizing ACE-I/ARB medical therapy in patients with chronic renal insufficiency or failure?

Answer 34

decrease in coagulopathy

so renal protective benefits are: decrease in glomerular HTN… slowing process of glomerulosclerosis…. and thus improving filtering, so decrease in proteinuria

Question 35

When there is exposure of collagen from damage to the endothelium, the intrinsic clotting pathway is activated.

Answer 35

TRUE

Question 36

In response to injury, the capillaries ________.

Answer 36

allows more albumin to escape the vascular space

Question 37

According to the Society of Ambulatory Anesthesia guidelines for the management of PONV, the proper time to administer dexamethasone for the prevention of PONV is_____________, and the suggested dose is _______________.

Answer 37

at induction…… 4-5mg IV

Question 38

Your patient in septic shock is undergoing massive tissue debridement for necrotizing fasciitis. The patient is on norepinephrine at 30 mcg/min and vasopressin at 0.04u/hr. The starting Hct is 38% and the Lactate level is 5.0 mmol/L. ABG is 7.11/34/197 with bicarb at 17. You resuscitate with 6 liters of normal saline and give 100 mEq sodium bicarbonate as the patient is still hypotensive with a systolic BP of 75. After resuscitation, you are able to wean off the vasopressin but still require levophed at 12 mcg/min. Lactate is now 2.0. You repeat the ABG and get the following results. Ph 7.24/pCO2 40/ pO2 143 HCO3 22. The most likely cause of refractory acidosis is _____________.

Answer 38

hyperchloremic acidosis

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and in an increase in plasma chloride concentration. Although plasma anion gap is normal, this condition is often associated with an increased urine anion gap, due to the kidney’s inability to secrete ammonia.

Question 39

The majority of solute in the ultrafiltrate is reabsorbed via the __________.

Answer 39

proximal tubule

Question 40

In differentiating nephrotic versus nephritic syndrome, the patient with nephrotic syndrome will present with ________________ without _________________.

Answer 40

massive proteinuria; hematuria

Nephrotic syndrome is a nonspecific kidney disorder characterised by a number of signs of disease: proteinuria, hypoalbuminemia and edema.It is characterized by an increase in permeability of the capillary walls of the glomerulus leading to the presence of high levels of protein passing from the blood into the urine (proteinuria at least 3.5 grams per day per 1.73m2 body surface area); low levels of protein in the blood (hypoproteinemia or hypoalbuminemia), ascites and in some cases, edema; high cholesterol (hyperlipidaemia or hyperlipemia) and a predisposition for coagulation.

Nephritic syndrome (or acute nephritic syndrome) is a collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders. It is characterized by having a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins (proteinuria) and red blood cells (hematuria) to pass into the urine. By contrast, nephrotic syndrome is characterized by only proteins (proteinuria) moving into the urine. Both nephritic syndrome and nephrotic syndrome involves hypoalbuminemia due to protein albumin moving from the blood to the urine.

Question 41

Normal coagulation is a balance between hemostatic and fibrinolytic properties. The “viscious triad” of elements associated with trauma that can create or exacerbate coagulopathy include:

Answer 41

hypothermia; acidosis

the trauma triad of death: hypothermia, acidosis, coagulopathy

Question 42

Portal hypertension can lead to hypersplenism, which can result in ___________.

Answer 42

platelet trapping & thrombocytopenia

Question 43

The leading cause of liver failure in the USA is _______.

Answer 43

acetaminophen toxicity

Question 44

Symptoms associated with TURP syndrome are caused by __________.

Answer 44

free water excess

Question 45

A shift to the right of the oxyhemoglobin dissociation curve decreases the partial pressure at which 50% of hemoglobin is saturated with oxygen. (T/F?)

Answer 45

FALSE

Question 46

Which of the following can precipitate sickling of RBCs in the patient with homozygous sickle cell disease?
CHOOSE ALL THAT APPLY

Answer 46

hypothermia, PaO2 40mmHg, septic shock

Question 47

A loss of sodium in excess of water is a more common cause of hyponatremia than an excess of total body water. (T/F?)

Answer 47

FALSE

Question 48

Patients being treated with alkylating chemotherapy drugs can experience which of the following complications?

Answer 48

potentiation of benzodiazepines

Question 49

When a patient undergoing general anesthesia is hyperventilated to a state of alkalosis, intracellular potassium levels _____________ while serum potassium levels __________________.

Answer 49

increase; decrease

Question 50

ADH exerts its action by _________.

Answer 50

changing the water permeability of renal collecting ducts