Clinical Cases in Anesthesia

Clinical Cases in Anesthesia
Subject : Clinical Cases in Anesthesia

Cardiopulmonary Resuscitation
1. Cardiopulmonary Resuscitation - Answer (click here)
2. What is the initial response to a cardiac arrest? - Answer (click here)
3. How do chest compressions produce a cardiac output? - Answer (click here)
4. What are the recommended rates of compression and ventilation? -
Answer (click here)
5. What are the complications of CPR? - Answer (click here)
6. What is the optimal dose of epinephrine? - Answer (click here)
7. What is the indication for vasopressin in CPR? - Answer (click here)
8. What are the indications for sodium bicarbonate (NaHCO3)
administration? - Answer (click here)
9. What are the indications for calcium salt administration? - Answer (click
here)
10. What is the antidysrhythmic therapy of choice in VF/pulseless VT? -
Answer (click here)
11. What are the management strategies in bradycardias? - Answer (click here)
12. What is the treatment of supraventricular tachydys-rhythmias? - Answer
(click here)
13. What are the indications for magnesium therapy? - Answer (click here)
14. What are the indications for a pacemaker? - Answer (click here)
15. Why is it important to monitor serum glucose? - Answer (click here)
16. What are the indications for open cardiac massage? - Answer (click here)
17. What is the management strategy for pulseless electrical activity (PEA)?
- Answer (click here)
Coronary Artery Disease

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18. Coronary Artery Disease - Answer (click here)
19. What are the determinants of myocardial oxygen supply? - Answer (click
here)
20. What are the determinants of myocardial oxygen consumption
(demand)? - Answer (click here)
21. What are the pharmacologic alternatives for treating myocardial
ischemia in this patient? - Answer (click here)
22. What is coronary steal and what agents might induce it? - Answer (click
here)
23. Should this patient receive perioperative β-adrenergic blockade? - Answer
(click here)
24. How should this patient be monitored intraoperatively? - Answer (click
here)
Recent Myocardial Infarction

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25. Recent Myocardial Infarction - Answer (click here)
26. How do you evaluate the cardiac risk in a patient scheduled for
noncardiac surgery? - Answer (click here)
27. What is the cardiac risk in this patient? What additional investigations
should be performed? - Answer (click here)
28. What are the implications for anesthetic management when coronary
revascularization is performed before noncardiac surgery? - Answer (click
here)
29. What intraoperative monitors would you use? - Answer (click here)
30. What additional drugs would you have prepared? - Answer (click here)
31. What anesthetic technique would you use? - Answer (click here)
32. How would you manage this patient postoperatively? - Answer (click here)
Congestive Heart Failure

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33. Congestive Heart Failure - Answer (click here)
34. What are possible etiologies for dilated cardio-myopathy? - Answer (click
here)
35. What is the pathophysiology of dilated cardiomyopathy? - Answer (click
here)
36. How would you monitor this patient during the perioperative period? -
Answer (click here)
37. How would you anesthetize this patient? - Answer (click here)
Aortic Stenosis
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38. Aortic Stenosis - Answer (click here)
39. What are the symptoms and long-term prognosis of aortic stenosis? -
Answer (click here)
40. What is the etiology of aortic stenosis? - Answer (click here)
41. How is the aortic valve area calculated? - Answer (click here)
42. Why is it important to maintain sinus rhythm? - Answer (click here)
43. What is the treatment for supraventricular tachy-dysrhythmias or
bradydysrhythmias? - Answer (click here)
44. How is hypotension best treated in the patient with aortic stenosis? -
Answer (click here)
45. How would you anesthetize this patient for cardiac or noncardiac
surgery? - Answer (click here)
Mitral Stenosis
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46. Mitral Stenosis - Answer (click here)
47. What is the etiology and pathophysiology of mitral stenosis? - Answer
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48. How should preload, afterload, heart rate, and contractility be managed
in a patient with mitral stenosis? - Answer (click here)
49. How would you optimize this patient’s condition preoperatively? -
Answer (click here)
50. What intraoperative monitoring would be appropriate? - Answer (click here)
52. How should hypotension be treated in a patient with mitral stenosis? -
Answer (click here)
53. What is the treatment for perioperative right ventricular failure? - Answer
(click here)
Eisenmenger Syndrome Subacute Bacterial Endocarditis

Prophylaxis
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54. Eisenmenger Syndrome (Subacute Bacterial Endocarditis Prophylaxis) -
Answer (click here)
55. What are the anesthetic considerations for a patient with Eisenmenger
syndrome? - Answer (click here)
56. What is the association between bacterial endocarditis and structural
heart disease? - Answer (click here)
57. Which patients should receive endocarditis prophylaxis? - Answer (click
here)
58. What are the most likely pathogens involved in subacute bacterial
endocarditis and what are the antibiotics of choice for its treatment? -
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Hypertrophic Obstructive Cardiomyopathy

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59. Hypertrophic Obstructive Cardiomyopathy - Answer (click here)
60. Describe the anatomic abnormalities in HOCM - Answer (click here)
61. What changes in preload, afterload, heart rate, and contractility will
optimize hemodynamic performance in a patient with HOCM? - Answer
(click here)
62. What are the treatment options for HOCM? - Answer (click here)
63. What monitoring would be required in HOCM patients? - Answer (click
here)
64. What considerations should be given in planning the anesthetic
management of a patient with HOCM? - Answer (click here)
65. What are the special considerations for anesthetic management of labor
and delivery in a patient with HOCM? - Answer (click here)
Cardiac Pacemakers and Defibrillators

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66. Cardiac Pacemakers and Defibrillators - Answer (click here)
67. What do the first three letters of the pacemaker code represent? - Answer
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68. What is the difference between a demand and an asynchronous
pacemaker? - Answer (click here)
69. What is the difference between ventricular (single-chamber) and dual-
chamber pacemakers? - Answer (click here)
70. Is a unipolar or bipolar pacemaker more sensitive to electrocautery
interference? - Answer (click here)
71. How is pacemaker interference by electrocautery prevented? - Answer
(click here)
72. What is pacemaker hysteresis? - Answer (click here)
73. What causes myopotential inhibition of a pacemaker? - Answer (click here)
74. What is an automatic implantable cardioverterdefibrillator (AICD)? -
Answer (click here)
75. How is the patient with an AICD managed in the perioperative period? -
Answer (click here)
Cardiac Tamponade
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76. Cardiac Tamponade - Answer (click here)
77. What is the pathophysiology of cardiac tamponade? - Answer (click here)
78. What are the clinical signs and symptoms of cardiac tamponade? -
Answer (click here)
79. What is the initial management of this patient’s condition? - Answer (click
here)
80. What intraoperative monitoring techniques should be used? - Answer
(click here)
81. Describe the implications for the conduct of general anesthesia in this
patient - Answer (click here)
Cardiomyopathy Managed With A Left Ventricular Assist Device

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82. Cardiomyopathy Managed With A Left Ventricular Assist Device -
Answer (click here)
83. What is a cardiomyopathy? - Answer (click here)
84. Distinguish dilated cardiomyopathy from other cardiomyopathies -
Answer (click here)
85. Explain the treatment options for dilated cardiomyopathies - Answer (click
here)
86. What is an LVAD? - Answer (click here)
87. What are the important anesthetic considerations for patients supported
by LVADs? - Answer (click here)
88. What intra-anesthetic monitoring might be required for patients with
LVADs? - Answer (click here)
Noncardiac Surgery After Heart Transplantation

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89. Noncardiac Surgery After Heart Transplantation - Answer (click here)
90. Describe the physiology of transplanted hearts - Answer (click here)
91. Is reinnervation of the transplanted heart a concern? - Answer (click here)
92. Which immunosuppressive medications are typically used following
cardiac transplantation? - Answer (click here)
93. Explain the pre-anesthetic concerns for patients with a transplanted heart
94. What anesthetic techniques are applicable to patients with cardiac
transplants? - Answer (click here)
95. What intraoperative monitors should be used in the patient with a
transplanted heart? - Answer (click here)
96. What emergency drugs are likely to be effective in the patient with a
97. For patients with a transplanted heart, is it necessary to administer
anticholinergics when antagonizing neuromuscular blockade? - Answer
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Coronary Artery Bypass Grafting

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98. Coronary Artery Bypass Grafting - Answer (click here)
99. What are the major determinants of myocardial oxygen supply and
demand? - Answer (click here)
100. What types of medications are used to treat coronary artery disease? -
Answer (click here)
101. What are the pre-anesthetic concerns in the patient with coronary artery
disease? - Answer (click here)
102. What intraoperative monitoring techniques can be used for the patient
undergoing cardiac surgery using cardiopulmonary bypass (CPB)? -
Answer (click here)
103. What are the common intraoperative monitors for myocardial ischemia?
104. What are the effects of CPB on the lungs, the brain, and the kidneys? -
Answer (click here)
105. What are the effects of CPB on hemostasis? - Answer (click here)
Do Not Resuscitate Order

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106. Do-Not-Resuscitate Order - Answer (click here)
107. What is meant by temporary revocation of do-not-resuscitate (DNR)
orders in the operating room? - Answer (click here)
108. What did you discuss with the patient prior to surgery regarding
resuscitation efforts in the operating room? - Answer (click here)
109. What options are available to the patient and clinician in order to more
fully define a patient’s DNR wishes? - Answer (click here)
110. What would you do in this case, if the patient could not be adequately
ventilated with a mask? - Answer (click here)
111. If this patient were intubated for the resuscitation but did not regain
consciousness for 48 hours, is it ethical to withdraw mechanical
ventilation at this time? - Answer (click here)
One Lung Anesthesia

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112. One-Lung Anesthesia - Answer (click here)
113. Describe the anesthetic evaluation before lung resection - Answer (click
here)
114. How are ventilation and oxygenation monitored noninvasively during
surgery, and how do these monitors work? - Answer (click here)
115. What are the indications for one-lung ventilation? - Answer (click here)
116. Describe the use of single-lumen endotracheal tubes for one-lung
ventilation - Answer (click here)
117. Which sided double-lumen endobronchial tube should be used for this
patient? - Answer (click here)
118. Describe the proper technique for placing a double-lumen endobronchial
tube - Answer (click here)
119. How is correct positioning of the double-lumen endobronchial tube
assessed? - Answer (click here)
120. What clinical problems are associated with the place-ment and use of
double-lumen endobronchial tubes? - Answer (click here)
121. What complications are related to placing the patient in the lateral
decubitus position? - Answer (click here)
122. How are pulmonary perfusion and ventilation altered during one-lung
ventilation? - Answer (click here)
123. What is the treatment for hypoxemia during one-lung anesthesia? -
Answer (click here)
124. Describe the role of a thoracostomy tube following pulmonary resection,
and describe the system used for pleural drainage - Answer (click here)
125. Describe a commonly used pleural drainage system - Answer (click here)
126. Discuss potential post-thoracotomy complications - Answer (click here)
Thoracoscopy
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127. Thoracoscopy - Answer (click here)
128. What types of operations can be done with VAT? - Answer (click here)
129. What are the advantages of performing the surgery utilizing VAT in
comparison with traditional thoracotomy? - Answer (click here)
130. What anesthetic techniques can be utilized for VAT? - Answer (click here)
131. How can hypoxemia due to shunting during one-lung ventilation be
treated? - Answer (click here)
132. What complications can occur with VAT? - Answer (click here)
Intracranial Mass Intracranial Pressure Venous Air Embolism

And Autoregulation
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133. Intracranial Mass, Intracranial Pressure, Venous Air Embolism, And
Autoregulation - Answer (click here)
134. What is cerebral autoregulation? - Answer (click here)
135. What factors contribute to increased intracranial pressure (ICP)? - Answer
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136. How do anesthetic agents and vasoactive drugs affect cerebral blood
flow (CBF) and ICP? - Answer (click here)
137. What are the signs and symptoms of increased ICP? - Answer (click here)
138. How is ICP monitored? - Answer (click here)
139. How is increased ICP treated? - Answer (click here)
140. How is venous air embolism (VAE) detected and treated? - Answer (click
here)
141. What are the contraindications to the sitting position? - Answer (click here)
142. How would you induce and maintain anesthesia in this patient? - Answer
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Intracranial Aneurysms
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143. Intracranial Aneurysms - Answer (click here)
144. How are patients graded following subarachnoid hemorrhage from a
ruptured aneurysm? - Answer (click here)
145. What are the most serious complications following subarachnoid
hemorrhage from aneurysm rupture? - Answer (click here)
146. What are the treatment options? - Answer (click here)
147. What monitoring is indicated for patients undergoing craniotomy for
clipping of intracranial aneurysm? - Answer (click here)
148. How is arterial blood pressure controlled? - Answer (click here)
149. What is cerebral vasospasm, and how is it treated? - Answer (click here)
150. How is aneurysm rupture during aneurysm clipping managed? - Answer
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Carotid Endarterectomy
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151. Carotid Endarterectomy - Answer (click here)
152. What are the indications for surgical carotid endarterectomy (CEA)? -
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153. What are the alternatives to surgical CEA? - Answer (click here)
154. What are the most serious perioperative complications? - Answer (click
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155. How is the patient’s neurologic status monitored? - Answer (click here)
156. What interventions may reduce the risk of neurologic injury? - Answer
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Electroconvulsive Therapy
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157. Electroconvulsive Therapy - Answer (click here)
158. What are the physiologic effects of ECT? - Answer (click here)
159. What are the anesthetic agents of choice for ECT? - Answer (click here)
160. Describe the preanesthetic evaluation of ECT patients - Answer (click here)
161. What are the anesthetic implications of psychotropic agents used in
patients receiving ECT? - Answer (click here)
162. How would you anesthetize this particular patient for ECT? - Answer
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163. What are the contraindications to ECT? - Answer (click here)
Spine Surgery
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164. Spine Surgery - Answer (click here)
165. What are the considerations for surgery in the prone position? - Answer
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166. What monitors will you use for this case? - Answer (click here)
167. What are somatosensory and motor evoked potentials? - Answer (click here)
168. Describe the effects of anesthetics on somatosensory and motor evoked
potentials - Answer (click here)
169. What is a “wake-up” test? - Answer (click here)
170. What is the bispectral index state (BIS)? Is monitoring the BIS useful in
this case? - Answer (click here)
171. Is this patient at risk for postoperative vision loss? - Answer (click here)
172. What modalities exist for pain relief after spine surgery? - Answer (click
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Transsphenoidal Hypophysectomy
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173. Transsphenoidal Hypophysectomy - Answer (click here)
174. What is acromegaly? - Answer (click here)
175. What symptoms are typical of the disease? - Answer (click here)
176. How is the disease treated? - Answer (click here)
177. What are the anesthetic considerations of acromegaly? - Answer (click here)
178. How would you approach the airway management in this patient? -
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179. What structures lie within the transsphenoidal surgical field? - Answer
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180. What is diabetes insipidus? - Answer (click here)
181. What are the postoperative concerns for this patient? - Answer (click here)
Depolarizing Neuromuscular Blockade

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182. Depolarizing Neuromuscular Blockade - Answer (click here)
183. Describe the anatomy and physiology of normal neuromuscular
transmission - Answer (click here)
184. How does succinylcholine produce muscle relaxation? - Answer (click here)
185. What are extrajunctional receptors? - Answer (click here)
186. How is the action of succinylcholine terminated? - Answer (click here)
187. What factors may decrease the normal metabolism of succinylcholine? -
Answer (click here)
188. Describe a phase II block - Answer (click here)
189. What is the treatment of phase II blockade? - Answer (click here)
190. Describe other recognized side-effects of succinyl-choline - Answer (click
here)
191. What are the contraindications to succinylcholine administration? -
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NonDepolarizing NeuroMuscular Blockade

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192. NonDepolarizing NeuroMuscular Blockade - Answer (click here)
193. Describe the mechanism by which nondepolarizing neuromuscular
blockers produce neuromuscular blockade - Answer (click here)
194. Differentiate between the commonly employed non-depolarizing muscle
relaxants - Answer (click here)
195. Briefly outline the mechanisms by which drugs other than
neuromuscular muscle relaxants affect neuro-muscular blockade - Answer
(click here)
196. What effects do antibiotics have on neuromuscular blockade? - Answer
(click here)
197. How do drugs other than antibiotics affect neuro-muscular blockade? -
Answer (click here)
198. What are the metabolic factors that affect antagonism of neuromuscular
blockade? - Answer (click here)
Antagonism of Nondepolarizing Neuromuscular Blockade

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199. Antagonism of Nondepolarizing Neuromuscular Blockade - Answer (click
here)
200. Describe the overall strategy for terminating the action of
nondepolarizing neuromuscular blockade - Answer (click here)
201. List the clinically relevant acetylcholinesterase inhibitors - Answer (click
here)
202. What is the mechanism of acetylcholinesterase inhibition? - Answer (click
here)
203. List the proper doses of muscle relaxant antagonists and their duration of
action - Answer (click here)
204. Explain the need for antimuscarinics used in conjunction with
acetylcholinesterase inhibitors - Answer (click here)
205. What is the onset of action for acetylcholinesterase inhibitors? - Answer
(click here)
206. Describe the mechanism of muscle relaxant antagonism by cyclodextrins
207. Explain the clinical indices of recovery from neuro-muscular blockade -
Answer (click here)
Monitoring the Neuromuscular Junction

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208. Monitoring the Neuromuscular Junction - Answer (click here)
209. Why is monitoring of neuromuscular function necessary in the practice
of anesthesia? - Answer (click here)
210. What is the mechanomyograph (MMG)? - Answer (click here)
211. Describe the electromyograph (EMG) - Answer (click here)
212. What kind of nerve stimulator is in common clinical use? - Answer (click
here)
213. Describe accelerography - Answer (click here)
214. What is phonomyography? - Answer (click here)
215. Explain the different patterns of nerve stimulation and the relevance of
pattern choice - Answer (click here)
Myasthenia Gravis
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216. Myasthenia Gravis - Answer (click here)
217. What is the lesion of myasthenia gravis (MG)? - Answer (click here)
218. How is MG diagnosed? - Answer (click here)
219. Explain the treatment alternatives for MG - Answer (click here)
220. Why are patients with MG sensitive to nondepolariz-ing muscle
relaxants and resistant to depolarizing muscle relaxants? - Answer (click
here)
221. How are patients with MG premedicated for surgery? - Answer (click here)
222. Describe a reasonable anesthetic technique for a patient with MG
undergoing transcervical thymectomy - Answer (click here)
223. Following emergence from anesthesia and before extubation, how is
strength assessed? - Answer (click here)
224. What is cholinergic crisis? - Answer (click here)
225. Can preoperative evaluation predict the need for postoperative
Malignant Hyperthermia
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226. Malignant Hyperthermia - Answer (click here)
227. What is malignant hyperthermia (MH)? - Answer (click here)
228. How is susceptibility to MH inherited? - Answer (click here)
229. What is the pathophysiology of MH? - Answer (click here)
230. What characterizes a clinical episode of MH? - Answer (click here)
231. Outline the pharmacology of dantrolene - Answer (click here)
232. How is MH treated? - Answer (click here)
233. How are patients with known MH susceptibility treated? - Answer (click
here)
234. What are the recognized triggering agents? - Answer (click here)
235. What is the significance of masseter muscle rigidity (MMR)? - Answer
(click here)
236. How is MH definitively diagnosed? - Answer (click here)
237. Describe the neurolept malignant syndrome - Answer (click here)
Diabetes Mellitus
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238. Diabetes Mellitus - Answer (click here)
239. Distinguish among the major types of diabetes mellitus (DM) - Answer
(click here)
240. Summarize the physiologic effects of insulin - Answer (click here)
241. Describe the oral hypoglycemic agents and insulin preparations available
to treat DM - Answer (click here)
242. How does DM affect perioperative morbidity and mortality? - Answer
(click here)
243. What are the common causes and associated symptoms of
hypoglycemia? - Answer (click here)
244. Outline perioperative management alternatives for the diabetic patient -
Answer (click here)
245. Explain the acute complications of DM - Answer (click here)
246. Thyroid Disease - Answer (click here)
247. How does the thyroid affect vital organ function? - Answer (click here)
248. How is thyroid hormone synthesized and released? - Answer (click here)
249. How is thyroid hormone regulated? - Answer (click here)
250. How are thyroid disorders evaluated? - Answer (click here)
251. What other conditions are associated with thyroid disorders? - Answer
(click here)
252. What is thyroid storm and how is it treated? - Answer (click here)
253. What are the causes of hyperthyroidism? - Answer (click here)
254. What are the causes of hypothyroidism? - Answer (click here)
255. What are the preoperative considerations in a patient with thyroid
256. What are appropriate preoperative tests for a patient with thyroid
257. What are the intraoperative concerns with coexisting thyroid disease? -
Answer (click here)
258. What are the postoperative concerns? - Answer (click here)
Thyroid Disease
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Calcium Metabolism
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272. Calcium Metabolism - Answer (click here)
273. What is the role of calcium in the body? - Answer (click here)
274. Where is calcium found in the body? - Answer (click here)
275. How is calcium regulated? - Answer (click here)
276. What are the symptoms of hypercalcemia? How is this treated? - Answer
(click here)
277. What are the symptoms of hypocalcemia? How is this treated? - Answer
(click here)
278. What are the causes of hyperparathyroidism? - Answer (click here)
279. What are the anesthetic considerations for parathyroid resection? -
Answer (click here)
280. What are the postoperative concerns after parathyroid resection? - Answer
(click here)
Perioperative Corticosteroid Administration

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281. Perioperative Corticosteroid Administration - Answer (click here)
282. Where and what kind of steroids are naturally produced? - Answer (click
here)
283. What are the physiologic effects of glucocorticosteroids? - Answer (click
here)
284. What steroids are available for administration and what are their
equivalent doses? - Answer (click here)
285. How much cortisol is normally produced and what is Addison’s disease?
286. What are Cushing syndrome and Cushing disease? - Answer (click here)
287. Does this patient require “stress” dose steroids? - Answer (click here)
288. How long after discontinuation of steroids should a patient be considered
adrenally suppressed and treated accordingly? - Answer (click here)
289. What clinical scenarios frequently require steroid administration? -
Answer (click here)
290. How is adrenal reserve evaluated? - Answer (click here)
291. If this patient develops septic shock from a bile leak in the
postanesthesia care unit (PACU), should steroids be withheld or
administered? - Answer (click here)
Pheochromocytoma
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292. Pheochromocytoma - Answer (click here)
293. What is a pheochromocytoma? - Answer (click here)
294. Describe the clinical presentation of and diagnostic criteria for
pheochromocytoma - Answer (click here)
295. Pheochromocytoma is associated with what other syndromes? - Answer
(click here)
296. What conditions may mimic pheochromocytoma? - Answer (click here)
297. How are patients with pheochromocytoma prepared for surgery? - Answer
(click here)
298. Describe the intraoperative management goals - Answer (click here)
299. Outline the anesthetic choices for pheochromocytoma - Answer (click here)
300. What are the special postoperative problems associated with resection of
a pheochromocytoma? - Answer (click here)
301. How is a previously unsuspected and undiagnosed pheochromocytoma
managed following induction of anesthesia? - Answer (click here)
Full Stomach
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302. Full Stomach - Answer (click here)
303. What are the mechanisms a conscious patient has to prevent
regurgitation and pulmonary aspiration? - Answer (click here)
304. What are the risk factors for regurgitation and pulmonary aspiration
under general anesthesia? - Answer (click here)
305. When can aspiration occur during the perioperative period? - Answer (click
here)
306. What are the problems associated with aspiration? - Answer (click here)
307. If aspiration occurs, what are the usual course, treat-ment and prognosis?
308. How should the nasogastric tube (NGT) be managed during induction? -
Answer (click here)
309. What pharmacologic interventions can be made to decrease the risk of
aspiration? - Answer (click here)
310. What is the reason for applying cricoid pressure during a rapid sequence
induction, and what are some of the problems associated with it? - Answer
(click here)
311. What is the effect of commonly used pharmacological agents during
anesthesia on lower esophageal sphincter tone? - Answer (click here)
312. What would be an acceptable anesthetic plan for this patient? - Answer
(click here)
Liver Disease
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313. Liver Disease - Answer (click here)
314. Describe the basic hepatic functions that are of immediate concern to
anesthesiologists - Answer (click here)
315. Explain the liver’s detoxifying and first-pass, metabolic functions -
Answer (click here)
316. Describe common extrahepatic problems associated with chronic liver
failure - Answer (click here)
317. What should a preoperative evaluation of this patient include? - Answer
(click here)
318. What effects do surgery and anesthesia have on normal liver function? -
Answer (click here)
319. What are the concerns associated with viral hepatitis? - Answer (click here)
320. Describe acetaminophen- and halothane-associated hepatitis - Answer
(click here)
321. Is nitrous oxide, enflurane, or isoflurane hepatotoxic? - Answer (click here)
322. List the causes of postoperative hepatic dysfunction - Answer (click here)
323. Are some anesthetic techniques free of hepatotoxic effects? - Answer (click
here)
324. What coagulation problems are anticipated and how are they managed? -
Answer (click here)
325. What intraoperative anesthetic problems occur during liver
transplantation? - Answer (click here)
Abdominal Aortic Aneurysm

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326. Abdominal Aortic Aneurysm - Answer (click here)
327. What is the natural history of untreated abdominal aortic aneurysm
(AAA)? - Answer (click here)
328. Outline the preoperative evaluation of the patient with an AAA - Answer
(click here)
329. Which anesthetic techniques are appropriate for AAA surgery? - Answer
(click here)
330. Which monitoring devices are recommended for AAA surgery? - Answer
(click here)
331. Explain the hemodynamic consequences of aortic cross-clamping -
Answer (click here)
332. Describe the options for postoperative analgesia - Answer (click here)
Endovascular Aortic Stent Placement

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333. Endovascular Aortic Stent Placement - Answer (click here)
334. Explain the concept of endovascular aortic repair - Answer (click here)
335. What are the recognized perioperative surgical com-plications associated
with endovascular repairs? - Answer (click here)
336. What are the outcomes following thoracic endovascular aortic repair? -
Answer (click here)
337. What anesthetic techniques are used for endovascular graft insertions? -
Answer (click here)
338. What problems are anticipated during proximal graft deployment? -
Answer (click here)
339. Explain the special role of transesophageal echocar-diography in
endovascular stent placement - Answer (click here)
340. Is the incidence of spinal cord ischemia different after endovascular
thoracic aortic repairs compared to open repairs? - Answer (click here)
341. What is the “post-implantation syndrome”? - Answer (click here)
Transurethral Resection of the Prostate

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342. Transurethral Resection of the Prostate - Answer (click here)
343. Describe the TURP syndrome and its treatment - Answer (click here)
344. What other complications can occur during a TURP? - Answer (click here)
345. What types of irrigating fluids have been used for a TURP? - Answer (click
here)
346. What are the toxicities associated with glycine? - Answer (click here)
347. What are the anesthetic options for a patient under-going a TURP? -
Answer (click here)
348. If a regional anesthetic is selected, what level of anesthesia is required? -
Answer (click here)
349. How would one correct the Na+ level to 135 mEq/L? - Answer (click here)
Morbid Obesity
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350. Morbid Obesity - Answer (click here)
351. How is morbid obesity (MO) defined? - Answer (click here)
352. Name the diseases associated with MO - Answer (click here)
353. Describe the pathophysiology of obstructive sleep apnea - Answer (click
here)
354. How is obstructive sleep apnea diagnosed? - Answer (click here)
355. Outline the effect of MO on functional residual capacity - Answer (click
here)
356. Is MO an indication for awake intubation? - Answer (click here)
357. What special equipment does the anesthesiologist require to anesthetize
patients for bariatric surgery? - Answer (click here)
358. Describe an anesthetic plan for bariatric surgery - Answer (click here)
Laparoscopy
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359. Laparoscopy - Answer (click here)
360. What procedures are amenable to the laparoscopic technique? - Answer
(click here)
361. How is laparoscopy initiated? - Answer (click here)
362. Why is carbon dioxide (CO2) the gas used for insufflation? - Answer (click
here)
363. What are the cardiovascular changes associated with laparoscopic
364. What are the regional circulatory changes that occur during laparoscopy?
365. What are the pulmonary effects associated with laparoscopic surgery? -
Answer (click here)
366. What are the benefits of laparoscopic surgery? - Answer (click here)
367. What are the complications of laparoscopic surgery? - Answer (click here)
368. What anesthetic techniques can be used for laparo-scopic surgery? -
Answer (click here)
369. What is the controversy regarding the use of nitrous oxide? - Answer (click
here)
370. What is the etiology and treatment of post-laparoscopy pain? - Answer
(click here)
Carcinoid Syndrome
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371. Carcinoid Syndrome - Answer (click here)
372. What are carcinoid tumors? - Answer (click here)
373. What is carcinoid syndrome? - Answer (click here)
374. In what locations do carcinoid tumors occur? - Answer (click here)
375. What are the major anesthetic concerns in patients with carcinoid
376. What is the mechanism of action of somatostatin? - Answer (click here)
377. What precautions are prudent for anesthetizing patients with carcinoid
378. How is chemoem bolization used to treat metastatic carcinoid
Kidney Transplantation
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379. Kidney Transplantation - Answer (click here)
380. How does diabetes affect renal transplantation? - Answer (click here)
381. Why is timing of hemodialysis important for renal transplantation? -
Answer (click here)
382. Discuss the treatment of hyperkalemia and its associated metabolic
problems - Answer (click here)
383. What are the major anesthetic concerns for renal transplantation? -
Answer (click here)
384. What are the implications of long ischemic times during renal
Open Eye Injury And Intraocular Pressure

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385. What is the mechanism by which intraocular pressure (IOP) is normally
maintained? - Answer (click here)
386. What pathologic conditions constitute a true ocular emergency versus a
relative urgency? - Answer (click here)
387. How does one minimize the deleterious side-effects of these agents in
the presence of a rup-tured globe? - Answer (click here)
388. What non-anesthetic agents might the ophthalmolo-gist use to maximize
surgical outcome? - Answer (click here)
Retinal Detachment
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389. What are the advantages and disadvantages of general anesthesia for
scleral buckle repair? - Answer (click here)
390. Describe the oculocardiac reflex and its treatment - Answer (click here)
391. What are the potential complications of retrobulbar anesthesia? - Answer
(click here)
392. What types of retinal detachments are amenable to elective repair? -
Answer (click here)
393. Briefly describe the series of events that occur during retinal detachment
surgery - Answer (click here)
394. Reattachment of the retina requires intraocular gas - Answer (click here)
Tympanomastoidectomy
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395. Is the anxious patient a good candidate for surgery under monitored
anesthesia care (MAC)? - Answer (click here)
396. What general anesthetic techniques are most likely to minimize
postopertive nausea and vomiting? - Answer (click here)
397. Are regional anesthetics less likely to result in PONV in this patient? -
Answer (click here)
398. Why is control of blood loss important during middle ear surgery? -
Answer (click here)
399. Are long-acting neuromuscular blockers contraindi-cated in middle ear
400. Describe the conduction of general and regional anesthesia for middle
ear surgery - Answer (click here)
The Difficult Airway

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401. What are the predictors of difficult mask ventilation? - Answer (click here)
402. Discuss the risk factors for difficult intubation - Answer (click here)
403. Are the risk factors for difficult intubation reliable predictors of difficult
intubation? - Answer (click here)
404. How is the anticipated difficult intubation approached? - Answer (click
here)
405. Describe the management options for a patient who, after induction of
anesthesia - Answer (click here)
406. Following induction of anesthesia, ventilation by facemask and
intubation are impossible. What maneuvers may help? - Answer (click here)
407. How is successful tracheal intubation verified? - Answer (click here)
408. Following a difficult intubation, how is postoperative extubation
managed? - Answer (click here)
Adenotonsillectomy
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409. What are the indications and contraindications for adenotonsillectomy? -
Answer (click here)
410. Describe the essential elements of preoperative evaluation for
adenotonsillectomy - Answer (click here)
411. How is the patient premedicated for adenotonsillectomy? - Answer (click
here)
412. What anesthetic alternatives are available for patients undergoing
adenotonsillectomy? - Answer (click here)
413. What are the common postanesthesia care unit problems anticipated
following adenotonsillectomy? - Answer (click here)
414. Which patients are suitable candidates for ambulatory
415. Describe the anesthetic management of a patient presenting with post-
tonsillectomy hemorrhage - Answer (click here)
Laser Laryngoscopy
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416. What is a laser? - Answer (click here)
417. Describe the most common types of lasers used in medical practice -
Answer (click here)
418. Which lasers are used in laryngeal and tracheobronchial surgery? -
Answer (click here)
419. What are the indications for laser laryngoscopy? - Answer (click here)
420. What are the hazards of laser laryngoscopy to patients, operating room
personnel, and anesthesia equipment? - Answer (click here)
421. What anesthetic techniques are appropriate for patients undergoing laser
laryngoscopy? - Answer (click here)
422. What maneuvers are instituted to treat an airway fire? Is the risk of fire
any less likely with electrocautery? - Answer (click here)
Transfusion Reaction
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423. How are standards for transfusion practice developed? - Answer (click here)
424. What steps should be taken when a transfusion reaction occurs? - Answer
(click here)
425. How does the laboratory determine which direction the investigation
should take? - Answer (click here)
426. How many different types of crossmatches are there and how does the
laboratory decide which should be performed? - Answer (click here)
427. What are the immediate and delayed adverse effects of blood
transfusion? - Answer (click here)
Intraoperative Coagulopathies
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428. What should be included in the preoperative evaluation? - Answer (click
here)
429. If the screening PT or aPTT are prolonged, which other laboratory tests
should be ordered? - Answer (click here)
430. What are the most common intraoperative coagulopathies? - Answer (click
here)
431. Which blood products are used to treat intraoperative coagulopathies? -
Answer (click here)
Blood Replacement
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432. How is oxygen transported by the circulatory system? - Answer (click here)
433. Describe compensatory mechanisms that take place in response to blood
loss - Answer (click here)
434. What is the minimum acceptable hemoglobin concentration (transfusion
trigger)? - Answer (click here)
435. List the potential sources of autologous blood - Answer (click here)
436. Explain acute isovolemic hemodilution (AIHD) - Answer (click here)
437. Outline the physiologic response to AIHD - Answer (click here)
438. How is AIHD accomplished? - Answer (click here)
439. Which patients are suitable candidates for AIHD? - Answer (click here)
440. What is intraoperative cell salvage and how do modern cell salvage
devices work? - Answer (click here)
441. Outline the characteristics of blood obtained by cell salvage - Answer
(click here)
442. Describe the indications for use of intraoperative cell salvage - Answer
(click here)
443. Explain the controversies and contraindications involving intraoperative
cell salvage - Answer (click here)
444. What is preoperative autologous blood donation (PABD)? - Answer (click
here)
445. Who is eligible and what are the contraindications for PABD? - Answer
(click here)
446. Outline the disadvantages and risks of PABD - Answer (click here)
447. Describe postoperative blood salvage - Answer (click here)
448. Explain the advantages and disadvantages of different autologous blood
sources - Answer (click here)
The Jehovahs Witness Patient

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449. What is scoliosis? - Answer (click here)
450. How is scoliosis classified? - Answer (click here)
451. How is the curvature assessed in the patient with scoliosis? - Answer (click
here)
452. On the issue of blood, what will a JW refuse and accept? - Answer (click
here)
453. What are the medicolegal issues concerning blood transfusion in the JW
who is a minor? - Answer (click here)
454. Describe the preoperative evaluation of the patient with scoliosis - Answer
(click here)
455. Describe the intraoperative anesthetic considerations for posterior spinal
fusion surgery - Answer (click here)
456. What is the “wake-up test”? - Answer (click here)
457. Describe the postoperative anesthetic concerns following scoliosis repair
458. What blood substitutes are available? - Answer (click here)
Hemophilia A
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459. What is the primary deficiency in hemophilia A? - Answer (click here)
460. How does the disease present and what are the laboratory findings? -
Answer (click here)
461. What is the role of factor VIII in the coagulation process? - Answer (click
here)
462. Describe the treatment options - Answer (click here)
463. Discuss von Willebrand disease as another important cause of surgical
bleeding - Answer (click here)
Total Hip Replacement

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464. Briefly describe rheumatoid arthritis and its treatment - Answer (click here)
465. What are the anesthetic considerations for the rheumatoid arthritis
466. How is the rheumatoid arthritis patient evaluated for anesthesia? - Answer
(click here)
467. Discuss the options for induction of anesthesia in a primary hip
arthroplasty - Answer (click here)
468. Several hours into the case the surgeon complains that he is operating on
a moving target. How would you manage this situation? - Answer (click
here)
469. Discuss the causes and management of fat embolus syndrome - Answer
(click here)
470. Discuss thromboembolism prophylaxis and the placement of neuraxial
471. Discuss the options for postoperative pain control after total hip
arthroplasty. Discuss the use of a lumbar plexus block - Answer (click here)
Local Anesthetics
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472. Describe the chemistry of local anesthetics - Answer (click here)
473. Describe the mechanism of action of local anesthetics - Answer (click here)
474. What factors affect the potency, onset, and duration of action of local
anesthetics? - Answer (click here)
475. Discuss the sequence of clinical anesthesia following neural blockade -
Answer (click here)
476. What are the clinical differences between the ester and amide local
477. Describe the pharmacokinetics of local anesthetics - Answer (click here)
478. How do factors such as dosage of local anesthetic, addition of
vasoconstrictors, carbonation and pH adjustment - Answer (click here)
479. Which local anesthetics are appropriate for the various regional
anesthetic procedures? - Answer (click here)
480. Describe the toxic effects of local anesthetics - Answer (click here)
481. How is systemic local anesthetic toxicity treated? - Answer (click here)
482. Is it prudent to use regional anesthesia in a patient who reports a
Novocain allergy? - Answer (click here)
483. What is the treatment for local anesthetic allergic reactions? - Answer
(click here)
Spinal Anesthesia
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484. Other than the spinal kit, what equipment must be immediately available
while performing spinal anesthesia? - Answer (click here)
485. When arranging the spinal tray, where is the antiseptic placed in relation
to the tray’s other constituents? - Answer (click here)
486. What are the advantages of the lateral decubitus position for placing a
subarachnoid block? - Answer (click here)
487. What are the advantages of the sitting position for placing a
488. Describe a technique for placing a spinal anesthesia - Answer (click here)
489. Describe alternative approaches to the subarachnoid space - Answer (click
here)
490. What factors affect the spread of anesthetic within the subarachnoid
space? - Answer (click here)
491. What agents are commonly used for subarachnoid block? - Answer (click
here)
492. Besides local anesthetics, what other agents are administered in the
subarachnoid space? - Answer (click here)
493. What are the advantages of adding a vasoconstrictor to the spinal
anesthetic solution? - Answer (click here)
494. What are the recognized complications of spinal anesthesia? - Answer
(click here)
495. What are the contraindications to spinal anesthesia? - Answer (click here)
496. Describe the advantages of spinal anesthesia over general anesthesia -
Answer (click here)
497. Explain the advantages of spinal anesthesia over epidural anesthesia -
Answer (click here)
498. Outline the advantages and disadvantages of catheter (continuous) spinal
Brachial Plexus Anesthesia

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499. Describe the anatomic course of the brachial plexus - Answer (click here)
500. What are the anatomic landmarks of the axilla? - Answer (click here)
501. What are the major approaches to blocking the brachial plexus and their
indications for use? - Answer (click here)
502. Describe the interscalene approach to blocking the brachial plexus -
Answer (click here)
503. Describe the supraclavicular approach to blocking the brachial plexus -
Answer (click here)
504. Describe the infraclavicular approach to blocking the brachial plexus -
Answer (click here)
505. Describe the axillary approach to blocking the brachial plexus - Answer
(click here)
506. What complications can arise from upper extremity blocks? - Answer
(click here)
507. What is the Bezold-Jarisch reflex? - Answer (click here)
508. What local anesthetics are used for blocks of the brachial plexus and in
what doses? - Answer (click here)
509. Is chronic obstructive pulmonary disease (COPD) a contraindication to
performing an interscalene block? - Answer (click here)
Lower Extremity Anesthesia

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510. What are the anesthetic options for this patient? - Answer (click here)
511. What are the advantages and disadvantages of the various anesthetic
options? - Answer (click here)
512. Describe the innervation of the lower extremity - Answer (click here)
513. Why is a sciatic nerve block necessary for adequate anesthesia for a total
knee arthroplasty? - Answer (click here)
514. How are femoral and sciatic nerve blocks performed? Which local
anesthetic agents would you use? - Answer (click here)
515. Would you sedate the patient for the performance of the femoral and
sciatic nerve blocks and/or during the procedure? - Answer (click here)
516. After performing the block and starting a propofol infusion, the patient
begins to flail about upon surgical incision. Should you induce general
anesthesia? - Answer (click here)
517. Describe the use of the tourniquet in a total knee arthroplasty and its
hemodynamic consequences - Answer (click here)
518. What are the options for postoperative pain control? - Answer (click here)
Labor And Delivery

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519. What options are available to the mother for labor analgesia? - Answer
(click here)
520. Explain the advantages and disadvantages of various regional anesthetic
techniques for labor and delivery - Answer (click here)
521. What is a “walking epidural”? - Answer (click here)
522. Describe the regional anesthetic techniques that can be employed for
cesarean section - Answer (click here)
523. Outline the treatment for postdural puncture headache - Answer (click here)
cesarean section? - Answer (click here)
525. Describe the elements of placental drug transfer - Answer (click here)
526. What techniques can be used for post-cesarean pain relief? - Answer (click
here)
527. Outline the differential diagnosis of postpartum hemorrhage - Answer
(click here)
528. Explain the risk factors, presentation, and treatment of uterine atony -
Answer (click here)
529. Describe the presentation and treatment of retained placenta - Answer
(click here)
Preeclampsia
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530. Classify the hypertensive disorders of pregnancy - Answer (click here)
531. What are the incidence and risk factors of preeclampsia? - Answer (click
here)
532. Explain the etiology of preeclampsia - Answer (click here)
533. Describe the pathophysiology of preeclampsia - Answer (click here)
534. Outline the obstetric management of preeclampsia - Answer (click here)
535. How is preeclampsia prevented from degenerating into eclampsia? -
Answer (click here)
536. Explain the management of preeclampsia-related hypertension - Answer
(click here)
537. What are the potential consequences of epidural anesthesia in the patient
with preeclampsia? - Answer (click here)
538. Describe the anesthetic options for cesarean section for the preeclamptic
539. Outline the anticipated postpartum problems associated with
preeclampsia - Answer (click here)
Abruptio Placenta and Placenta Previa

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540. Summarize the major causes of third-trimester bleeding - Answer (click
here)
541. What is abruptio placenta and what are its risk factors? - Answer (click here)
542. What are the presenting signs and symptoms of abruptio placenta and
how is the diagnosis made? - Answer (click here)
543. Describe the obstetric management of abruptio placenta - Answer (click
here)
544. Describe the effects of pregnancy on coagulation - Answer (click here)
545. What is disseminated intravascular coagulopathy and how is it managed?
546. How is fetal distress diagnosed? - Answer (click here)
547. The patient is given a trial of labor, and the obstetrician requests a
consult for labor analgesia. What are your concerns and how would you
proceed? - Answer (click here)
548. How would you anesthetize this patient for an emergency cesarean
section? - Answer (click here)
549. What is placenta previa? - Answer (click here)
550. What is the clinical presentation of placenta previa and how is the
diagnosis made? - Answer (click here)
551. What is the obstetric management of placenta previa? - Answer (click here)
552. How would you anesthetize the patient with placenta previa for cesarean
Anesthesia For Nonobstetric Surgery During Pregnancy

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553. What is the incidence of nonobstetric surgery in the pregnant patient? -
Answer (click here)
554. What are the anesthetic concerns when anesthetizing a pregnant patient?
555. What are the physiologic changes during pregnancy and how do they
impact on anesthesia? - Answer (click here)
556. What is a teratogen and which anesthetic agents are known teratogens? -
Answer (click here)
557. What precautions should be taken to avoid intrauterine fetal asphyxia? -
Answer (click here)
558. How is preterm labor prevented? - Answer (click here)
559. What monitors should be used when anesthetizing the pregnant patient? -
Answer (click here)
560. What are the special considerations for laparoscopic surgery? - Answer
(click here)
561. What general recommendations can be made when anesthetizing the
pregnant patient for nonobstetric surgery? - Answer (click here)
Thrombocytopenia In Pregnancy
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562. What are the concerns when placing an epidural catheter if the platelet
count is low? - Answer (click here)
563. Who is at risk for developing an epidural hematoma? - Answer (click here)
564. What is considered a low platelet count from the perspective of epidural
catheter placement? - Answer (click here)
565. What is the expected platelet count during pregnancy? - Answer (click here)
566. Describe coagulation and the role that platelets play in the process -
Answer (click here)
567. What are the causes of thrombocytopenia during pregnancy? - Answer
(click here)
568. What tests are available to evaluate platelet function? - Answer (click here)
569. Describe the bleeding time test and its limitation - Answer (click here)
570. Describe the thromboelastogram and its limitations - Answer (click here)
571. Describe the platelet function analyzer and its limitations - Answer (click
here)
572. What is the overall risk of epidural hematoma? - Answer (click here)
573. Describe the known cases in the literature of epidural hematoma in the
parturient - Answer (click here)
574. What is the evidence that initiating an epidural anesthetic in a woman
with a platelet count <100,000 mm−3 may be safe? - Answer (click here)
575. How do you evaluate the patient who has a platelet count <100,000
mm−3? - Answer (click here)
576. What are some practical recommendations regard-ing neuraxial
anesthesia in the parturient who presents with a low platelet count? -
Answer (click here)
577. What is low-molecular-weight heparin (LMWH) and how does it
compare with and differ from standard heparin? - Answer (click here)
578. Why do some pregnant women take LMWH? - Answer (click here)
579. What has been the anesthetic experience with LMWH and neuraxial
580. What are some of the unique recommendations for anesthetizing the
parturient taking LMWH? - Answer (click here)
Neonatal Resuscitation
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581. Describe the fetal circulation - Answer (click here)
582. What are the physiologic changes that occur at birth? - Answer (click here)
583. How is neonatal resuscitation managed in the delivery room? - Answer
(click here)
584. What is the Apgar score? - Answer (click here)
Gastroschisis and Omphalocele

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585. What are the differences between gastroschisis and omphalocele? -
Answer (click here)
586. How is this neonate managed preoperatively? - Answer (click here)
587. How is the operating room prepared for this newborn? - Answer (click here)
588. What is the anesthetic plan, and what are the intra-operative and
postoperative concerns in this patient? - Answer (click here)
589. Describe the fluid and blood product management for this neonate
intraoperatively - Answer (click here)
Congenital Diaphragmatic Hernia

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590. Describe the embryology and pathophysiology of congenital
diaphragmatic hernia (CDH) - Answer (click here)
591. What are the clinical features of CDH? - Answer (click here)
592. How is CDH diagnosed? - Answer (click here)
593. What is the preoperative management of CDH? - Answer (click here)
594. What is permissive hypercapnia? - Answer (click here)
595. What are the anesthetic considerations for the neonate with CDH? -
Answer (click here)
596. What problems may occur intraoperatively and postoperatively? - Answer
(click here)
597. Describe the techniques for fetal surgery - Answer (click here)
Pyloric Stenosis
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590. Describe the embryology and pathophysiology of congenital
diaphragmatic hernia (CDH) - Answer (click here)
591. What are the clinical features of CDH? - Answer (click here)
592. How is CDH diagnosed? - Answer (click here)
593. What is the preoperative management of CDH? - Answer (click here)
594. What is permissive hypercapnia? - Answer (click here)
595. What are the anesthetic considerations for the neonate with CDH? -
Answer (click here)
596. What problems may occur intraoperatively and postoperatively? - Answer
(click here)
597. Describe the techniques for fetal surgery - Answer (click here)
598. What is pyloric stenosis? - Answer (click here)
599. What is the clinical presentation of pyloric stenosis? - Answer (click here)
600. How is the diagnosis made? - Answer (click here)
601. What are the metabolic derangements and how are they treated? - Answer
(click here)
602. What is the surgical treatment of pyloric stenosis? - Answer (click here)
603. What are the anesthetic considerations? - Answer (click here)
Tracheoesophageal Fistula
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530. Classify the hypertens

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Subject : Clinical Cases in Anesthesia

Coronary Artery Disease

Recent Myocardial Infarction

Congestive Heart Failure

Eisenmenger Syndrome Subacute Bacterial Endocarditis

Hypertrophic Obstructive Cardiomyopathy

Cardiac Pacemakers and Defibrillators

Cardiomyopathy Managed With A Left Ventricular Assist Device

Noncardiac Surgery After Heart Transplantation

Coronary Artery Bypass Grafting

Do Not Resuscitate Order

One Lung Anesthesia

Intracranial Mass Intracranial Pressure Venous Air Embolism

Depolarizing Neuromuscular Blockade

NonDepolarizing NeuroMuscular Blockade

Antagonism of Nondepolarizing Neuromuscular Blockade

Monitoring the Neuromuscular Junction

Perioperative Corticosteroid Administration

Abdominal Aortic Aneurysm

Endovascular Aortic Stent Placement

Transurethral Resection of the Prostate

Open Eye Injury And Intraocular Pressure

The Difficult Airway

The Jehovahs Witness Patient

Total Hip Replacement

Brachial Plexus Anesthesia

Lower Extremity Anesthesia

Labor And Delivery

Abruptio Placenta and Placenta Previa

Anesthesia For Nonobstetric Surgery During Pregnancy

Gastroschisis and Omphalocele

Congenital Diaphragmatic Hernia

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