Anesthesia Clerkship Exam 2023

Anesthesia Clerkship Exam 2023 Signs of mast cell degranulation and/or a histamine mediated reaction (signs of a true allergic rxn) - ANS-Hypotension, hives, bronchospasm, flushing, rash Signs of elevated serum levels of local anesthetic - ANS-Dizziness, seizures, dysrhythmias, tinnitus If a true local anesthetic allergy does exist, it is most likely to an _____ based local anesthetic rather than an ____ based one. - ANS-ester; amide Continue or d/c on day of surgery: H2 blockers - ANS-Continue Continue or d/c on day of surgery: birth control pills - ANS-Continue Continue or d/c on day of surgery: insulin - ANS-d/c because pt will be NPO (hypoglycemic anyway) Continue or d/c on day of surgery: beta-blockers - ANS-Continue Continue or d/c on day of surgery: aspirin - ANS-d/c 2 weeks prior to surgery - antiplatelet effects hang around Continue or d/c on day of surgery: multivitamins - ANS-d/c Continue or d/c on day of surgery: diuretics - ANS-d/c, unless used for hypertension Continue or d/c on day of surgery: antiseizure drugs - ANS-Continue Continue or d/c on day of surgery: antibiotics - ANS-Continue Continue or d/c on day of surgery: particulate antacids - ANS-D/C! Can produce aspiration pneumonitis if aspirated! Continue or d/c on day of surgery: ACEs/ARBs - ANS-Debatable - patients who d/c may have refractory hypotension during general anesthetic Nausea and vomiting are more common in ___ patients. - ANS-Obese pts, females, and after abdominal/ENT/ophtho surgery __ are less likely to experience N/V - ANS-Smokers Prolonged emergence from anesthesia could suggest a deficiency in the metabolic pathway of __ - ANS-Succinylcholine. Atypical cholinesterase will alter the metabolism of drugs metabolized by serum cholinesterase such as SUCCINYLCHOLINE. Myalgias are often due to the use of __ - ANS-Succinylcholine Bleeding history is especially important for __ procedures - ANS-spinal/epidural/regional procedures Hoarseness/croup (child) may suggest that a ___ ET tube is needed or that the patient is prone to such an occurrence due to preexisting ___. - ANS-smaller; subglottic stenosis. Prolonged hoarseness may suggest more severe injury to __, __, or __. - ANS-vocal cord, arytenoid cartilage or recurrent laryngeal nerve Smoking causes increased __ - will require frequent suctioning. - ANS-Secretions. Also increased bronchial reactivity. Increased secretions can cause less gas exchange. Smoking cessation 12-24 hours prior to surgery decreases __ levels and shifts the oxyhemoglobin curve to the __, increasing oxygen availability to tissues. - ANScarboxyhemoglobin; right Ciliary function, small airway function, and decreases in sputum production require __ weeks of abstinence from smoking. - ANS-8-12 The chronic alcoholic generally has __ anesthetic requirements. The acutely intoxicated patient has __ anesthetic requirements. - ANS-increased; decreased (ethanol can exert partial anesthetic effects) Drug use, especially cocaine or methamphetamine abuse, may lead to ___ instability and resultant ___ instability under anesthesia - ANS-autonomic; cardiovascular A patient exposed to organophosphate poisoning may have altered response to drugs metabolized by ___, such as __ - ANS-pseudocholinesterase; succinylcholine MUST seek family history of ___ (anesthesia-specific problem with __ or __, specifically) - ANS-malignant hyperthermia; volatile anesthetics; succinylcholine The term "serum cholinesterase" is generally used in reference to a clinical test that reflects levels of __ and __ enzymes in the blood. - ANS-pseudocholinesterase (primarily in liver), acetylcholinesterase (neuronal) ___ is a familial transmitted disease that can be triggered by barbiturate anesthetics - ANS-Porphyria Why are patients fasted prior to surgery? - ANS- Continues...