Test 4 Bringing it all together part 1

Question 1

those with genetic predisposition to MH have a mutation in the ____________ receptor of skeletal muscle –> uncontrolled elevation of _______

Answer 1

ryanodine (RYR1); intracellular calcium

Question 2

times (in lifespan) when you expect a decrease in enzymatic activity of pseudocholinesterase

Answer 2

pregnancy
newborn
infants

Question 3

what drug therapies can cause pseudocholinesterase def?

Answer 3

echothiophase iodide
neostigmine
chlorpromazine
oral contraceptives
cyclophosphamide
pancuronium bromide
phenylzine
trimethaphan camsylate

Question 4

disease states that can cause a pseudocholinesterase deficiency

Answer 4

hepatic failure
acute MI
acute infection
uremia
malnutrition
myxedema
collagen vascular dz
carcinoma
TB

Question 5

what is the expected apnea time in minutes for someone with a dibucaine number of 20

Answer 5

480 minutes (8 hours)
(atypical homozygte for pseudocholinesterase def: A-A)

Question 6

what is the expected apnea time in minutes for someone with a dibucaine number of 60

Answer 6

10-30 minutes
(heterozygote for pseudocholinesterase def : W-A)

Question 7

what is the expected apnea time in minutes for someone with a dibucaine number of 80?

Answer 7

10 minutes (this is a typical homozygote for pseudocholinesterase def : W-W)

Question 8

someone who is an atypical homozygote (A-A) for pseudocholinesterase deficiency will have a dibucaine number of ___________

Answer 8

20

Question 9

someone who is a heterozygote (W-A) for pseudocholinesterase deficiency will have a dibucaine number of ______________

Answer 9

60

Question 10

someone who is a typical homozygote (W-W) for pseudocholinesterase deficiency will have a dibucaine number of _____________

Answer 10

80

Question 11

what is the dibucaine number

Answer 11

The Dibucaine Number is the PERCENT INHIBITION of pseudocholinesterase activity.

Question 12

________________ is a local anesthetic that can detect individuals with abnormal pseudocholinesterase

Answer 12

dibucaine

Question 13

T/F: all patients susceptible to MH will show signs of MH upon exposure to triggering agents

Answer 13

false

Question 14

which med given for prophylactic tx of PONV in pts with increased risk is not an anti-emetic, but allows the anesthesia provider to give less opoids thus reducing chance of PONV

Answer 14

pregabalin

Question 15

pt is at increased risk of PONV, you tell them to apply scopolamine patch _________ hours prior to surgery

Answer 15

4

Question 16

who do you NOT give reglan to ? (like in the prophylactic tx of PONV)

Answer 16

parkinsons
bowel obstruction

Question 17

what is the concern with using droperidol for PONV prevention in high risk patient?

Answer 17

has sedation effects lastin up to 12 horus

Question 18

what are some of the different drugs used to preventatively tx PONV if at increased risk?

Answer 18

1. zofran
2. reglan
3. droperidol
4. decadron
5. scopolamine transdermal
6. pregabalin

Question 19

if pt has 3-4 risk factors for PONV they are __________________ risk, and it should be attempted to be prevented with what interventions?

Answer 19

severe; avoid GA or use propofol based anesthetic, minimize opoids, prevention with 3 drugs from different classes

Question 20

if pt has 1-2 risk factors for PONV they are __________________ risk and anesthetic plan should consist of prevention with ___________ drugs from different classes

Answer 20

moderate - to - severe; 2-3

Question 21

what is the scoring mechanism use to stratify risk and preventative management of PONV

Answer 21

simplified apfel score

Question 22

anesthesia related risk factors for PONV

Answer 22

1. volatile anesthetics
2. N2O
3. intra/postoperative opoids

Question 23

surgery related risk factors for PONV

Answer 23

1. increased duration (>3 hrs)
2. type of surgery: intrabdominal, breast, laparoscopy, gyno, ENT
3. being NPO

Question 24

pt related risk factors for postoperative N/V

Answer 24

1. female gender
2. non-smoker
3. hx of PONV/motion sickness
4. childhood/young adulthood (age)

Question 25

diagnostic test results are deemed current if within ___________ of scheduled surgery

Answer 25

6 months

Question 26

what is the initial tx for malignant hyperthermia

Answer 26

dantrolene 10 mg/kg

Question 27

tx for malignant hyperthermia

Answer 27

1. dantrolene 10 mg/kg 2. hyperkalemia protocol 3. refrigerated IV crystalloid infusion 4. icepacks

Question 28

what are triggering agents for malignant hyperthermia

Answer 28

volatile inhalation anesthetics succinylcholine exposure to heat/exercise (rare)

Question 29

what are the symptoms/signs you will see with malignant hyperthermia

Answer 29

hypercarbia tachycardia elevated core temp muscle rigidity metabolic acidosis rhabdomylosis hyperkalemic arrhythmias

Question 30

a patient with severe systemic dz or more than one systemic dz would recieve what physical status class?

Answer 30

ASA III

Question 31

a brain dead pt who is only presenting for organ procurement would recieve what physical status class?

Answer 31

ASA VI

Question 32

patient with severe systemic disease that is a constant threat to life would recieve what physical status class

Answer 32

ASA IV

Question 33

a moribund pt who is not expected to survive without the operation would be given what physical status class ?

Answer 33

ASA V

Question 34

what physical status class would you give a pt who is presenting with any of the following: current smoker, social etoh, pregnancy, obesity (BMI btwn 30 and 40), well controlled DM/HTN and or mild lung dz

Answer 34

ASA II (PS II)

Question 35

what physical status class would you give to a patient that is young, no comorbidities, non smoker, and 0 - minimal etoh use?

Answer 35

ASA I (PS I)

Question 36

what type of anesthesia should be done for the placement of an AV fistula/block?

Answer 36

local anesthesia and/or brachial plexus block

Question 37

techniques for skilled interviewing

Answer 37

1. active listening 2. empathetic responses 3. guided questioning 4. nonverbal 5. validation 6. reassurance 7. partnering 8. summarization 9. transitions 10. empowering pt 11. humor

Question 38

what are the goals of the preoperative assessment and preparation of the pt?

Answer 38

1. optimize patient care, satisfaction, comfort and conviencence 2. minimize perioperative morbidity and mortality 3. minimize surgical delays or preventable cancellations on dos 4. determine appropriate postoperative disposition of the patient 5. evaluate the patients health status, determining which if any preop investigation/specialty consults are required 6. optimize preexisting medical conditions 7. formulate a plan for most appropriate perianesthetic care and postop support 8. communicate patient management issues effectively among care providers 9. communicate and provide specific instructions to patients for preop prep 10. educate pt on surgery, anesthetis, periop care 11. ensure time/cost efficient patient eval