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SEE EXAM Anesthesia QOD WITH COMPLETE SOLUTIONS LATEST UPDATE
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SEE EXAM Anesthesia QOD WITH COMPLETESOLUTIONS LATEST UPDATE
Three very well-associated risk factors with the development of postoperative ulnar
nerve injury are :
1) Male sex - several reports state that 70 - 90 % of patients suffering from postoperative
ulnar neuropathy are men
2) High body mass index - BMI > or = 38
3) Prolonged postoperative bed rest.
Many patients with postoperative ulnar neuropathy have a high frequency of
contralateral ulnar nerve dysfunction that suggests there is an abnormality before the
surgery. Symptoms of ulnar neuropathy may not appear until more than 48 hours after
surgery. Wrist drop and loss of sensation of the web space between the thumb and
index finger are associated with radial nerve injury.
pp. 809-810
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R. Clinical
Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.
What features BEST distinguish heparin induced thrombocytopenia and
thrombocytopenia induced by other drugs?
a. Drug induced thrombocytopenia is associated with mild thrombocytopenia
b. Heparin induced thrombocytopenia is associated with severe thrombocytopenia with
mucocutaneous bleeding
c. Drug induced thrombocytopenia is associated with significant arterial thrombosis
d. Heparin induced thrombocytopenia is associated with moderate thrombocytopenia
with venous thrombosis
d. Heparin-induced thrombocytopenia presents with moderate thrombocytopenia with
venous thrombosis
,Thrombocytopenia induced by drugs like quinine or vancomycin results in severe levels
of thrombocytopenia, on the order of 10 X 10^9. Mucocutaneous bleeding is a commonly
observed feature. In contrast, heparininduced thrombocytopenia presents with
mild-moderate thrombocytopenia with platelet counts around 50-60 X 10^9 with
coexistent thrombosis.
Which of the following best describes the timing of heparin induced thrombocytopenia?
a. Immediately after heparin administration
b. Within 24 hours of heparin administration
c. 5 to 14 days after heparin administration
d. More than 2 weeks after heparin administration
e. 5 to 14 days after heparin administration
About 70% of the cases of heparin induced thrombocytopenia occur between 5 days to 2
weeks after heparin administration. Both rapid onset (within 24 hours of heparin
administration) and delayed onset are comparatively rare.
The National Institute for Occupational Safety (NIOSH) recommends limiting the
operating room concentration of nitrous oxide to:
a. 0.5 ppm
b. 5 ppm
c. 25 ppm
d. 50 ppm
c (25 ppm)
NIOSH recommends that the room concentration of nitrous oxide not exceed 25 ppm
and that of halogenated agents not exceed 2 ppm (0.5 ppm if nitrous oxide is being used
also).
pp. 652-654
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York:
McGraw Hill, 2012.
,Terbutaline is commonly administered to arrest preterm labor or to inhibit tetanic
uterine contractions impeding fetal oxygenation. Of the following, which is the MOST
likely maternal side effect of terbutaline administered under such circumstances?
A. Bradycardia
B. Hypokalemia
C. Hypoglycemia
D. Hypertension
Terbutaline is an agonist at the beta-adrenergic receptors. Its maternal side effects can
be grouped into the following categories : (1) Cardiopulmonary (pulmonary edema,
myocardial ischemia, hypotension, tachycardia); (2) Metabolic (hyperglycemia,
hyperinsulinemia, hypokalemia, antidiuresis, altered thyroid function) and; (3) others
(tremors, palpitations, nervousness, N/V, fever, hallucinations). The fetal side effects
include tachycardia, hyperinsulinemia, hyperglycemia, myocardial and septal
hypertrophy, and myocardial ischemia. Neonatal side effects that may possibly occur
could include the following: tachycardia, hypoglycemia, hypocalcemia,
hyperbilirubinemia, hypotension, intraventricular hemorrhage. Contraindications to
administration of terbutaline in the parturient include the following: maternal cardiac
dysrhythmias, poorly controlled DM, and poorly controlled thyroid disease.
Concerning preoperative informed consent:
a. it should disclose only life-threatening complications
b. charges of assault and battery are possible if it is not obtained
c. oral consent is insufficient
d. it is not necessary if the procedure is done in an office setting
charges of assault and battery are possible if it is not obtained
Any procedure performed without patient's consent can amount to assault and battery.
Oral consent may suffice, but written consent is advisable for medicolegal purposes. It
is generally accepted that not all risks need to be detailed but risks that are realistic and
have resulted in complications in similar patients should be disclosed.
pp. 29-30
, Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
Magnesium sulfate therapy is considered the gold standard for seizure prophylaxis in
the setting of preeclampsia. Which of the following is the MOST likely side effect of
magnesium?
a. Decreased motor endplate sensitivity to acetylcholine
b. Development of coagulopathy
c. Increased systemic vascular resistance
d. Inhibition of acetylcholinesterase
a. Decreased motor endplate sensitivity to acetylcholine
Magnesium is a divalent cation that competes with calcium and inhibits many
calcium-dependent processes. In terms of muscle relaxation, it is known to: (1)
antagonize calcium either at the motor end plate or cell membrane, reducing calcium
influx into the myocyte; (2) Compete with calcium for low-affinity calcium binding sites
on the outside of the SR membrane and prevent the rise in free intracellular calcium
concentration; and (3) Attenuate the: release of acetylcholine at neuromuscular
junction, sensitivity of the motor endplate to acetylcholine, and excitability of the muscle
membrane. There are many implications for and possible interactions with anesthesia
care. Magnesium can enhance hypotension with epidural use. Limited studies with
gravid ewes have shown that magnesium reduces maternal MAP but does not affect
uterine blood flow or fetal oxygenation during epidural. Magnesium potentiates the
action of depolarizing and non-depolarizing muscle relaxants, probably not as much
with depolarizing agents. It increases both potency and clinical duration; however, it is
still advisable to utilize the same intubating dose since potentiation can be variable,
along with smaller maintenance doses. Magnesium causes hypotension, especially with
the concomitant use of calcium entry-blocking agents such as nifedipine. Sedation is
very common with therapeutic levels of serum magnesium; a 20% decrease in MAC can
be observed with serum magnesium levels 7-11 mg/dL Magnesium theoretically can
affect any calcium-dependent process, but inhibition of coagulation due specifically to
isolated magnesium use is not thought to be clinically significant.
Correct statements concerning the use of benzodiazepines in the geriatric patient
include:
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