Lernkartei Anesthesiology 2020 (Seite 1 von 3)

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Sprache	Deutsch
Kategorie	Medizin
Stufe	Universität
Erstellt / Aktualisiert	08.02.2020 / 11.02.2020
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1 All of the following are examples of distributive shock, EXCEPT: (unsure)

Drugs that cause vasodilatation

Hemorrhage

Sepsis

Anaphylaxis vasodilatation

2 ET CO2 is increased in the following conditions, EXCEPT:

Hyperthermia

COPD

Malignant Hyperthermia

Hyperventilation

3 Which of the following laboratory values are most likely to confirm adequate synthetic hepatic function? (unsure)

Partial thromboplastin time

Prothrombin time

Serum alanine aminotransferase concentration

Total serum bilirubin concentration

4 If you are having difficulty in ventilating a patient and a foreign body has been ruled out, which of the follwing maneuvers may assist you in mask ventilation? (unclear)

Head tilt, Jaw lift

Oral airway

Nasopharyngeal airway

All of the above

5 Oxygen delivery is directly dependent on: (unsure)

Central venous oxygen content

Haemoglobin concentration

Systemic vascular resistance

Oxygen extraction rate

6 The major difference between cardiogenc (CS) and septic shock (SS) is... (unsure )

CS patients are more tachycardic

SS patients have more often severe lactic acidosis

Diastolic pressure is very low in patients with CS

SS patients are usually more vasodilated.--- (skin feels warm and looks pinkish...)

7 What is the definition of cardiac output (CO)?

CO = BP x HR

CO = HR x SVR

CO = BP x SVR

CO = HR x SV

8 A sudden fall in end-expiratory PCO2 in capnometry may be triggered by all, EXCEPT: (unsure)

Acute pulmonary embolism

Pneumonia

Pulmonary edema

Alveolar hypoventilation

9 The cornerstones of therapy of hyperglycaemic emergencies include: (Unsure)

1 Fluid restriction

2 Correction of acidosis

3 Normalization of blood glucose with insulin

4 Correction of electrolyte levels

1, 3 and 4

2, 3 and 4

2 and 3

all of the above

10 The acute treatment of life-threatening hyperkalaemia include:

1. IV magnesium

2. IV calcium

3. Glucose/insulin infusion

4. IV lidocaine

1, 2, 3

1, 3

2, 3

3, 4

11 Pathophysiologic changes observed in sepsis are ...

impaired endothelial function of blood vessels leading to increased vascular permeability and extensive(?) tissue swelling

hemostasis disorders, reduced energy production in the mitochondria

circulatory insufficiency and hypotension

a, b , c

12 In patients with sepsis an increased fibrin formation associated with impaired fibrinolysis may contribute to... (unsure)

loss of barrier function of endothelium leading to widespread tissue edema

vasodilatation leading to a decreased systemic vascular resistance

increased leukocyte adhesion to endothelium with increased transmigration of the leukocytes into tissues

vascular occlusion, organ ischemia, organ damage and development of multiple organ dysfunction syndrome (MODS)

13 The current, full definition of sepsis is as follows:

Sepsis is a life threatening organ dysfunction caused by a dysregulated host's response to a bloodstream infection. Organ dysfunction can be identified as an acute change in total SOFA score >4 p. consequent to the infection.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total SOFA score >2p.consequent to the infection.

Sepsis is defined as life-threatening syndrome shaped by pathogen factors and host factors e.g.sex, race, other genetic determinants, age, comorbidities, environment

Sepsis is a life-threatening organ dysfunction identified as an acute change in total SOFA score <4 p.

14 The current full definition of septic shock is as follows..

Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. Patients with septic shock can be indentified with aclinical construct of sepsis with persisting hypotension, requiring vasopressors to maintainMAP>65mmHg and serum lactate>2mmol/L (18mg/dL)despite adequate volume resuscitation.

Septics shock is a ...(the same as above) ... patients with septic shock can be identified with a clinical construct of sepsis and hypotension requiring vasopressors to maintain MAP>65mmHg.

Septic shock is a ...(same) ... patients with septic shock can be identified based on the presence of hypotension requiring vasopressors to maintain MAP>85mmHG and having a serum lactate level >2,5mmol/mL.

Septic shock is a ...(same)... patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP>100mmHg and having a serum lactate level >2,5mmol/mL.

15 A patient with COPD admitted for surgery. On admission his labwork reveals an arterial blood gas with the following values:

ph: 7,35 PaCO2: 48mmHg HCO3: 28mmol/L

Based on those parameters, this patient can be diagnosed with:

fully compensated metabolic acidosis

fully compensated metabolic alkalosis

fully compensated respiratory alkalosis

fully compensated respiratory acidosis

16 40 y. old male has been admitted to the Emergency Department with a severe asthma attack. He has been experiencing increasing shortness of breath since admission. His ABG showed the following results:

pH: 7,22 PaCO2: 55mmHG HCO3: 25mmol/L

Based on this, the patient can be diagnosed with:

uncompensated metabolic acidosis

uncompensated metabolic alkalosis

uncompensated respiratory alkalosis

uncompensated respiratory acidosis

17 Hypoxemia refers to any state in which the O2 content of arterial blood is reduced. It may result from...

impaired oxygenation (low PaO2)

low hemoglobin level (anemia)

reduced affinity of Hb for O2 (e.g. CO posioning)

a,b,c

18 Measurement of the concentration of Procalcitonin in patients treated in the ICU is useful...

for the diagnosis of severe fungal infections

for the diagnosis of serious viral infections

for the diagnosis and monitoring of treatment of serious bacrerial infections

for the diagnosis and monitoring of severe coagulation disorders (DIC)

19 Indicate a false statement

in systemic bacterial infections, procalcitonin is produced in all parenchymal tissues and excreted into the bloodstream, where it reaches a high concentration.

in severe viral infections, procalcitonin is produced in all parenchymal tissues and excreted into the bloodstream, where it reaches a high concentration.

the level of procalcitonin may increase after major surgery, reaching the highest values after 24-48h. PCT returns to normal values within a few days if there were nocomplications after surgery.

Daily measurement of the concentration of PCT in patients with bacterial sepsis allows monitoring the progress of treatment.

20 qSOFA is considered positive if the patients has at least 2 of the following clinical criteria.
Which of them is not included in qSOFA?

respiratory rate 22/min or greater

altered mental state/ GCS <15

systolic blood pressure of 100mmH or less

body temperatur >38 degrees or more

21 The best indicator of adequate fluid resuscitation in trauma patients is...

arterial pH

blood pressure

core temperature

serum lactate level

22 The patient with confirmed sudden cardiac arrest presents PEA on ECG tracing. You should...

administer 3mg of atropine as soon venous access is achieved

defibrillate the patient with 360J energy

administer 1mg of adrenaline as soon as venous access is achieved

perform cardioversion with 150J energy

23 In the case of the need for additional hemodynamic shock evaluation, as the preferred method of initial assessment, it is recommended to use: (unsure)

Echocardiography

Pulmonary artery catheter (Swan-Ganz)

Intrapulmonary thermodilution (PiCCO)

Computer tomography

24 In shock states, the serum lactate concentration is typically:

>0,5 mmol/L

>1 mmol/L

>1,5 mmol/L

>2 mmol/L

25 In patients being treated fo AHF it is incorrect to say that... (unsure)

in patients with decompensated HF who have not yet received diuretic medication orally the initial dose: 20-40mg i.v. furosemide or similar should be given

inotropic drugs should be used in every case because they prevent organ hypoperfusion

I.V. vasodilators should be considered in patients with AHF and SAP >90mmHg (without symptomatic hypotension)

an intravenous infusion of levosimendan or PDE III inhibitors may be considered to reverse the beta blockers if they are considered to be one of the causes of subsequent hypoperfusion.

26 It is not true that a dose of adrenaline to treat anaphylactic shock:

should be given only if there is no response to previous intravenous glucocorticoids delivery.

in adultrs with spontaneous ciculation, it is injected into the lateral surface of the thigh.

can be repeated every 5-15min if there is no improvement of the blood pressure is still too low.

is 0,5mg for adults with spontanous circulation

27 During resuscitation the indication for adrenaline is: (no idea what D is )

any form of cardiac arrest

only asystole

only ventricular fibrillation

something which I cannot read :D Something with 'Only if ... electrical activity of the heart'

33 ECMO (Extracorporal membranc oxygenation) is a method of/for

treatment of cardiogenic shock

treatment of .... hypothermia

ARDS treatment

all listed above

35 Sepsis can develop from

a tattoo

an urinary tract infection

a mosquito bite

all of the above

36 Risk factors for severe sepsis and septic shock include the following: (unsure)

"extreme" age (<10 y. and >70 y.)

primary diseases (e.g. liver cirrhosis, alcoholism, diabetes, cardiopulmonary diseases, solid malignancy, hematologic malignancy)

major surgery, trauma or burns

in most patients with sepsis the source of infection is rarely identified

37 Which of the follwing is accurate about the presentation and physical examination of sepsis?

fever alone is a sensitive indicator of sepsis and is strongly predictive of illness severity and death

tachypnea is rarely associated with sepsis and should suggest an alternativ diagnosis

in early stages of sepsis, cardiac output is well-maintained or even increased

the onset of ARDS in patients with sepsis is typically extremely rapid withing 3-6h of the inciting event.

38 Spinal anesthesia is contraindicated in:

Obstetric patients

Transurethral resection of bladder tumors

Total hip replacement

High intracranial pressure

39 CVP is typically elevated in all, except:

congestive heart failure

cardiac tamponade

hypervolemia

sepsis

40 The following fluids may be used in the management of septic shock, EXCEPT:

isotonic crystalloids e.g. lactated Ringer solution

normal saline 0,9%o NaCl

volume expanders e.g. albumin

colloids based on hydroxyethyl starches

41 Regarding to pulse oximetry find the TRUE statement. (unsure)

1. the presence of CO in the blood (COHb) results in an overestimation of oxygen saturation of hemoglobin (SaO2)
2. the presence of methaemoglobin in the blood (MetHb) resulsts in an overestimation of SaO2
3. fetal Hb results in an overestimation of SaO2
4. a poor pulse oxymetry trace may result in an underestimation of SaO2
5. diathermy may interfere with waveform detection

1, 2

1, 4, 5

1, 2, 3, 4, 5

1, 3,5

42 With regard to capnography, false is..

1. Normal range is approx. 35-45mmHg
2. Absence of endotracheal end-tidal CO2 (EtCO2) during cardiac arrest, is diagnostic of eosophageal intubation
3. PaCO2 is equal to end-tidal CO2 (EtCO2)
4. In healthy subject EtCO2-PaCO2 gradient is usually <5 mmHg

(not quite sure: EtCo2 is supposed to be the PaCO2 at the end of expiration of tidal breathing which is why it is just a little lower than PaCO2)

https://www.capnography.com/56-faqs/capno-faqs/267-a-etco2-difference-and-alveolar-dead-space

1,2,3,4

1,4

2,3

2,4

43 Which of the following are the correct doses for adult cardiac arrest :

1. Atropine 0.5mg i.v.
2. Epinephrine 0.5mg i.m.
3. Epinephrine 1mg i.v.
4. Amiodarone 150mg i.v.
5. Defibrillation (biphasic) 150J

1,5

2,4,5

3,5

2,5

51 34 y old man was admitted to the emergency department after a traffic accident. Physical examination: conscious, in a logical touch, suffering HR 120/min, BP 80/50mmHg, major bleeding due to amputation of the right lower limb.
CT: without head injury. Which is the most appropriate anesthetic agent during transport to operating theater? (unsure)

Propofol

Etomidate

Ketamine

Thiopental

52 Regarding CP, finde false statement:

Mean pressure in VCS(?) or LA (?)

It is increased in hypervolemia

measurement performed with central venours catheter

to estimate the filling of vascular bed and preload of the right heart

53 The false statement concerning cardiogenic shock is:

is characterized by low cardiac output

is characterized by a low systemic vascular resistance

may be caused by papillary muscle rupture

inability of the heart to maintain circulation

Anesthesiology 2020

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