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Self-Assessment Questions Select the single letter response that most correctly answers the question or completes the sentence. Chapter 1 1. Infrarenal crossclamping of the aorta causes: a. 75% increase in renal vascular resistance b. 75% decrease in renal vascular resistance c. 50% decrease in renal vascular resistance d. no change in renal vascular resistance 2. MAC for endotracheal intubation free of coughing and straining is: a. 2 x MAC for surgical anesthesia b. 3.2 x MAC for surgical anesthesia c. 1.3 x MAC for surgical anesthesia d. 0.5 x MAC for surgical anesthesia 3. Hypoxic or ischemic events in the spinal cord during infrarenal aortic crossclamping can be recognized by: a. intraoperative assessment of foot extension unresponse to stimu- lation of the lateral peroneal nerve b. monitoring of somatosensory evoked potentials c. continuous EEG recording d. calculation of a large arteriol-venous oxygen difference 4. In a patient with a ruptured aortic aneurysm, anesthesia should be started: a. as soon as the patient arrives in the operating room, to prevent psychological trauma b. as soon as ECG electrodes and the blood pressure monitor are in place c. only after the patient is prepared surgically and draped d. after placement of the Swan-Ganz pulmonary artery catheter and intraarterial cannula
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Page 1: Self-Assessment Questions - Springer Link

Self-Assessment Questions

Select the single letter response that most correctly answers the question or completes the sentence.

Chapter 1

1. Infrarenal crossclamping of the aorta causes: a. 75% increase in renal vascular resistance b. 75% decrease in renal vascular resistance c. 50% decrease in renal vascular resistance d. no change in renal vascular resistance

2. MAC for endotracheal intubation free of coughing and straining is: a. 2 x MAC for surgical anesthesia b. 3.2 x MAC for surgical anesthesia c. 1.3 x MAC for surgical anesthesia d. 0.5 x MAC for surgical anesthesia

3. Hypoxic or ischemic events in the spinal cord during infrarenal aortic crossclamping can be recognized by: a. intraoperative assessment of foot extension unresponse to stimu-

lation of the lateral peroneal nerve b. monitoring of somatosensory evoked potentials c. continuous EEG recording d. calculation of a large arteriol-venous oxygen difference

4. In a patient with a ruptured aortic aneurysm, anesthesia should be started: a. as soon as the patient arrives in the operating room, to prevent

psychological trauma b. as soon as ECG electrodes and the blood pressure monitor are in

place c. only after the patient is prepared surgically and draped d. after placement of the Swan-Ganz pulmonary artery catheter and

intraarterial cannula

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5. The most common cause of death following intact abdominal aortic aneurysm repair is: a. uncontrolled bleeding intraoperatively or in the immediate post­

operative period b. disseminated intravascular coagulopathy following massive blood

transfusion c. myocardial infarction d. acute pulmonary embolism

6. Infrarenal crossciamping of the abdominal aorta causes: a. increased cardiac output by 15-20% b. decreased cardiac output by 15-35% c. no significant change d. decreased pulmonary resistance by 40%

7. Deleterious effects of unciamping the aorta during AAA repair can best be prevented by: a. titrating the infusion of a vasopressor such as phenylephrine

hydrochloride (Neo-synephrine®) to maintain the blood pressure near the preoperative level

b. raising the PCWP to 4-5 mm above the control value by infusion of intravenous fluids before the clamp is released

c. intravenous administration of ephedrine 10-25mg doses intermit­tently

d. norepinephrine infusion to maintain peripheral resistance near normal

8. The chance of rupture of an abdominal aortic aneurysm of 7cm diameter is: a. 10% per year b. 40% per year c. 15% per year d. same chance of rupture as an aneurysm of 5cm diameter

9. A patient complains of bounding abdominal pulsations between the umbilicus and xiphoid areas. Thus: a. he has an abdominal aortic aneurysm at least 10cm in diameter

that is beginning to rupture b. he possibly has an aneurysm, but it is impossible to tell the size c. it is a sign of nervousness d. he probably does not have an aneurysm as pulsations from

abdominal aortic aneurysm should be felt between the umbilicus and symphysis pubis

10. Infrarenal crossciamping of the aorta causes: a. an increase in venous return from the inferior extremities b. no change in venous return c. a decrease in venous return from the pelvis but an increase from

the inferior extremities d. a decrease in venous return both from the pelvis and the inferior

extremities

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Chapter 2

1. Choose the one incorrect statement below: a. Pituitary tumors cause increased hormone secretion. b. Pituitary tumors cause decreased hormone secretion. c. The gland lies in close proximity to cranial nerve VIII. d. Tumors of the pituitary may produce headaches and blindness.

2. The posterior lobe of the pituitary secretes: a. antidiuretic hormone (ADH) and growth hormone (GH) b. oxytocin and ADH c. thyroid-stimulating hormone (TSH) and adrenocorticotropic hor­

mone (ACTH) d. follicle-stimulating hormone (FSH) and prolactin

3. Hormone secretion by the pituitary is controlled by all of the following except: a. neurotransmitters b. releasing factors c. hypertension d. circulating levels of hormone

4. Choose the one correct statement below: a. ACTH controls release of cortisol from the adrenals. b. Luteinizing hormone (LH) stimulates skeletal development. c. FSH is essential for lactation. d. GH regulates the synthesis of thyroid hormone.

5. ADH is: a. released by the anterior pituitary b. an essential factor in the control of fluid balance c. the hormone that produces dilute urine concentration d. important for its role in the delivery process

6. Panhypopitutitarism results in all of the following except: a. hypotension b. cortisol deficiency c. hyperthermia d. short stature

7. Cushing's disease is caused by: a. tumors of the adrenal gland b. excess secretion of ACTH by pituitary microadenomas c. ectopic production of ACTH by nonpituitary tumors d. longterm treatment with steroids

8. Choose the one incorrect statement below: a. Phenothiazine therapy may elevate serum prolactin. b. Elevated serum prolactin causes suppression of the menstrual

cycle. c. Males with elevated prolactin levels report increased libido. d. Galactorrhea is found in up to 50% of cases of prolactin-secreting

tumors.

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9. Acromegaly includes all of the following features except: a. hypoglycemia b. cardiomegaly c. coarse facial features d. osteoarthritis

10. Perioperative complications of pituitary surgery may include which of the following: a. hypertension and dysrhythmias b. air embolism c. diabetes insipidis d. all of the above

Chapter 3

1. HbS differs from HbA in all of the following ways except: a. it has two hydrophobic areas on its surface when deoxygenated b. its beta-6 amino acid is valine c. it forms long polymerized chains d. small amounts confer resistance to Falciparum malaria

2. The delay seen before onset of HbS gelation can be explained by: a. the time needed for the cell to assume a sickled shape b. the time needed for synthesis of HbF c. the time needed for cell division d. the time needed for formation of nucleation sites for polymer

generation 3. Sequestration crises are not usually seen in patients beyond the age

of 5 years because: a. the bone marrow has matured by that age b. patients are functionally asplenic beyond that age c. the incidence of viral infections has decreased d. the MCHC increases after repeated cycles of sickling

4. A 35-year-old SCA patient with pneumonia and a temperature of 102.5°F is receiving I. V. fluids at a rate of 75mllhr. His urine output is 75ml/hr, with a specific gravity of 1.007. What can we conclude about this patient's fluid status? a. he is in neutral fluid balance b. severe dehydration is present c. a pulmonary artery catheter should be placed to answer the

question d. the amount of urine excreted does not indicate fluid status

5. The mechanism of action of cytarabine and hydroxyurea may be: a. elimination of the mutant HbS stem cell b. induction of extramedullary hematopoiesis c. induction of secondary erythropoiesis with a predominance of

HbF synthesis d. a direct effect on HbS, with formation of ketoamine derivatives

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6. Drugs that increase membrane permeability inhibit sickling because: a. they decrease the intracellular concentration of HbS b. they decrease splenic removal of sickled cells c. they cause systemic alkalosis d. they increase levels of glyceraldehyde

7. Nitrous oxide-narcotic-relaxant techniques are preferred for SCA patients because: a. muscle relaxation decreases oxygen consumption b. the premise is false; any well-conducted general anesthetic

technique is acceptable c. use of hepatotoxic volatile anesthetics is avoided d. high inspired concentrations of oxygen can be administered

8. The presence of valine in position 6 of the beta chain of HbS allows polymerization because: a. it binds less tightly to the heme group b. it destroys tactoids, c. it is a nonpolar amino acid which can interact with a hydrophobic

area on adjacent molecules d. its aromatic ring structure leads to resonance stabilization of

polymerized HbS 9. With respect to Hb electrophoresis and the sickle cell prep, all of the

following are true except: a. both allow quantitation of the amount of HbS present b. electrophoresis depends on differences in mobility of Hb mole­

cules in electric fields, while the sickle cell prep depends on morphologic criteria

c. the sickle cell prep relies on addition of a reducing agent d. the sickle cell prep does not distinguish SCA from sickle trait

10. An SCA patient with signs of right-sided heart failure, right ventricu­lar hypertrophy, and a loud pulmonic component of the second heart sound is likely to have all of the following except: a. elevated pulmonary artery pressures b. occlusion of significant amounts of the pulmonary vascular bed c. ECG evidence of right ventricular hypertrophy d. a ruptured papillary muscle of the mitral valve

Chapter 4

1. Myocardial O2 demand is increased by all of the following except: a. tachycardia b. coronary spasm c. increased contractility d. increased wall tension

2. The best prognostic indicator of short- and longterm survival in patients with CAD is: a. ejection fraction

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b. triple-vessel disease c. history of congestive heart failure d. unstable angina

3. The percentage of CABG candidates who are candidates for PTCA is: a. 15% b. 10% c.30% d.25%

4. After failed PTCA and the need for emergency CABG, the best intervention to preserve myocardial function is: a. dopamine b. intravenous nitroglycerin c. combination of dopamine and nitroglycerin d. intraaortic balloon pump

5. For a 60-year-old man, after failed PTCA for LAD disease, with an ejection fraction of 38% and L VEDP of 22mmHg, the acceptable anesthetic technique includes all of the following except: a. fentanyl102/vecuronium b. sufentanil/02/pancuronium c. halothane/02/pancuronium d. fentanyl102/atracurium

6. A normal ECG is present in the following percentage of patients with CAD: a. 25-50% b. 30-60% c. 40-60% d. 10-20%

7. After failed PTCA with streptokinase, appropriate placement of central venous access may be performed via all of the following routes except: a. external jugular vein b. subclavian vein c. brachial vein d. cephalic vein

8. Acute withdrawal of clonidine causes: a. myocardial ischemia b. arrhythmias c. rebound hypertension d. myocardial infarction

9. The two-year mortality rate for a 65-year-old woman with triple­vessel disease and an ejection fraction of 48% is: a.20% b.36% c.40% d.25%

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10. Significant coronary artery stenosis is present when narrowing of a major coronary artery is: a.70% b.60% c.65% d.50%

Chapter 5

1. Meningomyelocele: a. has an incidence of 5-10 per 1000 live births in the United States b. has an increased risk of occurring in families who have had a

previous child with meningomyelocele c. is slightly more common in males and higher socioeconomic

populations d. has a specific teratogen, polyvinyl chloride, which is associated

with an increased incidence of the defect 2. Meningomyelocele is commonly associated with other congenital

defects; choose the one correct statement below. a. The Chiari II malfunction is rare, occurring in only 25% of

patients with meningomyelocele. b. Hydrocephalus occurs in almost 99% of patients with meningo­

myelocele. c. Congenital abnormalities such as cardiac defects or diaphrag­

matic hernias have rarely been reported in association with a meningomyelocele.

d. Orthopedic malformations are common with meningomyelocele, the most severe of which are kyphosis and scoliosis.

3. Hydrocephalus in patients with meningomyelocele: a. often worsens after closure of the back defect b. rarely appears if the infant did not have it at birth c. commonly causes acute rises in intracranial pressure (lCP) in

infants d. is a direct cause of decreased intelligence in patients with

meningomyelocele 4. Surgery for meningomyelocele:

a. should not be delayed beyond 48 hours as the infant has an increased risk of developing ventriculitis or sepsis

b. if completely withheld, does not change the mortality rate of these infants

c. has the same effect on the recovery of neurologic deficits associated with the lesion whether it is performed early or late

d. if done on all infants who present with meningomyelocele, will guarantee a high percentage of surviving patients unable to function at all socially

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5. Preoperative evaluation of the infant by the anesthesiologist is essential, and must consider all of the following except: a. Patients with meningomyelocele delivered by cesarean section

have less injury than those delivered vaginally. b. Infants with high thoracic or cervical lesions may have paralysis

of intercostal and abdominal musculature and limited respiratory reserve.

c. Meningomyelocele infants presenting for surgery rarely have problems with fluid status or temperature control.

d. Meningomyelocele infants may have stridor, apnea, and gastro­esophageal reflux associated with Chiari II malformations.

6. Effects of atropine, often used as a preoperative medication in infants with meningomyelocele, has the effect of: a. increasing vagal tone b. increasing lower esophageal sphincter tone c. decreasing gastric acidity while increasing gastric fluid volume d. decreasing oral and pharyngeal secretions

7. The following statements all apply to temperature control in infants with meningomyelocele except: a. The central nervous system control of temperature in infants with

meningomyelocele is normal. b. These infants cannot shiver, and must use brown fat to generate

heat. c. Paralysis, if present, decreases the metabolic rate and thus the

ability to generate heat. d. Infants lose heat rapidly because of a high surface area to volume

ratio. 8. The following methods of inducing anesthesia in infants with menin­

gomyelocele are all acceptable except: a. awake intubation with the patient left side down followed by an

inhalation induction via the endotracheal tube b. an I. V. induction with sodium thiopental followed by a nonde­

polarizing muscle relaxant to facilitate intubation c. intramuscular ketamine followed by establishing an LV. route

and giving succinylcholine to facilitate intubation d. an inhalation induction by mask followed by establishing an I. V.

route and giving a nondepolarizing muscle relaxant to facilitate intubation

9. Infants with meningomyelocele commonly have problems intra­operatively with all of the following except: a. significant blood loss requiring transfusion b. hypothermia requiring active measures to maintain normal tem­

perature c. ventilatory compromise from incorrectly placed thoracic or ab­

dominal bolsters

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d. life-threatening increases in ICP 10. Postoperatively, the infant with meningomyelocele:

a. will be nursed in the prone position b. can always be extubated immediately c. has the same risk of apnea postanesthetically as any other infant

of similar gestational age d. does not need further protection against hypothermia

Chapter 6

1. Which condition is most likely to be associated with poor outcome in a child with tracheoesophageal fistula (TEF)? a. birth weight between 1800gm and 2500gm b. tetralogy of Fallot c. anal atresia d. radial limb dysplasia

2. Gastrostomy is indicated initially: a. in all patients b. only in babies under 2500gm c. in critically ill babies under 1800gm d. in babies with pure esophageal atresia

3. The most common type of TEF and EA is: a. type A b. type B c. type C d. type D

4. Primary definitive repair is performed: a. in infants over 1800gm b. only when no cardiac anomalies are present c. after treatment of aspiration is completed d. as an elective procedure after hyperalimentation

5. Preoperatively, during transport and for endotracheal intubation the infant with TEF and EA should be positioned in the: a. Trendelenburg position b. reverse Trendelenburg position c. right lateral decubitus position d. left lateral decubitus position

6. The anesthetic plan for the infant with TEF and EA includes: a. awake intubation b. continuous suctioning of the proximal pouch c. intravenous atropine prior to induction d. all of the above

7. The most common cardiac lesion associated with TEF and EA is: a. ventricular septal defect b. pUlmonic stenosis

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c. coarctation of the aorta d. aortic stenosis

8. The definitive finding for the diagnosis of TEF and EA is: a. inability to pass a soft rubber catheter through the nose b. demonstration by chest x-ray of a catheter curled in the upper

esophagus c. large amounts of thick secretions noted at birth d. choking with feedings

9. The incidence of TEF and EA is: a. 113000-114000 live births b. 1110,000-1111,000 live births c. 111000 live births d. 118000 live births

10. The percentage of infants with TEF who are premature is approxi­mately: a.50% b.80% c.30% d. no association; TEF is related to the sex of the child

Chapter 7

1. Hypotension in bum patients occurs because of: a. increased vascular permeability leading to decreased intravascu-

lar volume b. release of histamine and prostaglandins c. loss of skin barrier leading to hypoproteinemia d. all of the above

2. Volume replacement: a. should be given as rapidly as possible for the first 24 hours of

hospitalization after thermal injury b. should contain 10% dextrose c. may result in generalized edema because of increased vascular

permeability d. can cause edema that is limited to the bum site

3. Routine therapy for bum patients includes all of the following except: a. tetanus prophylaxis b. full-thickness-wound biopsy to identify organisms prior to clinical

evidence of infection c. prophylactic intravenous antibiotics d. monitoring of antibiotic level after intravenous antibiotics are

started 4. Mortality in bum patients is most directly affected by:

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a. age b. percent of body surface area affected c. inhalation injury d. depth of burn

5. A difference between pediatric and adult patients is that: a. adults require more glucose during resuscitaton b. adults are more likely to have airway obstruction after inhalation

injury c. adults have higher baseline relative O2 and metabolic demands,

which are increased with large surface burns d. adults have more respiratory reserve, and fatigue less rapidly

with the increased work associated with respiratory tract injury 6. Carbon monoxide:

a. is a foul-smelling gas with a high affinity for hemoglobin b. inhalation causes a fall in Pa02 c. in the blood may cause nausea, dizziness, and headache d. can result in coma at concentrations of 5% carboxyhemoglobin

7. Intraoperative management of the burn victim should include all of the following except: a. warmed intravenous fluids to avoid hypothermia b. ready use of surgical placement of intravenous cannulae if there

are extensive skin burns c. central venous pressure measurements d. urinary catheter

8. Anesthetic management of the burn victim should include: a. heavy sedation prior to examination of possibly injured airways b. avoidance of narcotics because of patient's altered metabolism c. avoidance of positive end-expiratory pressure (PEEP) in the

presence of airway injury d. inflation of endotracheal cuff just enough to prevent a leak

9. In burn patients: a. use of succinylcholine should be completely avoided because of

risk of hyperkalemia b. use of all muscle relaxants should be avoided because of their

prolonged action c. nondepolarizing muscle relaxants can be safely used up to 25% of

the usual dose d. reversal of muscle relaxants requires the usual dose

10. All of the following regarding topical antibiotics in burn patients are true except: a. Topical antibiotics have been found to increase bacterial superin­

fection. b. Mafenide can cause a metabolic acidosis and pain upon appli­

cation

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c. Silver nitrate often stains skin and clothing. d. Silver sulfadiazine has less toxicity and intermediate absorption

when compared to other topical agents.

Chapter 8

I. The definitive treatment for paranasal sinusitis related to nasotra­cheal intubation is: a. surgical drainage of the maxillary sinus b. instillation of antibiotics through the tube c. antibiotic treatment alone d. removal of the nasal tube and a course of antibiotics

2. Complement activation in sepsis is associated with: a. a diffuse maculopapular rash b. peripheral, symmetric polyneuropathy c. aggregation of granulocytes d. disturbances of GI tract motility

3. The myocardial depression seen in sepsis may be caused by: a. a circulating depressant factor b. global myocardial ischemia c. bacterial invasion of the heart d. hypoxic myocardial dysfunction

4. Survivors of human septic shock differ from non survivors in that: a. they show less severe metabolic acidosis b. their pulmonary compliances remain normal c. they show a reversible decrease in ejection fraction d. they maintain adequate cerebral perfusion

5. The incidence of sepsis is rising for all the following reasons except: a. the increased use of invasive procedures b. the prevalence of acquired immunodeficiency syndrome c. the aging of the patient population d. the emergence of multiply resistant bacteria

6. A patient who does not have fever during a bacteremic episode: a. has only a minor bacteremia b. has high levels of endogenous cortisol c. probably has a superficial infection d. is at high risk of dying

7. The first step in treating sepsis is: a. ventilation with 100% oxygen b. starting a norepinephrine infusion c. making the diagnosis of sepsis d. starting antibiotics

8. Acute acalculous cholecystitis is best diagnosed by: a. PIPIDA scintigraphy

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b. clinical criteria alone c. percutaneous samples of bile for smear and culture d. gallium scan of the abdomen

9. The nutritional support of the septic patient involves all of the following except: a. 35-40 kcallkg/day b. 1.5-2gm protein/kg/day c. 70% of total calories as lipid d. not more than 5-6mg carbohydrate/kg/min

10. Corticosteroids in septic shock: a. slow the clearance of bacteria from the circulation b. may be of use in certain patients if used early c. increase serum levels of prostacyclin d. reduce the inflammatory response to endotoxin

Chapter 9

1. The most common types of lung tumors are: a. hamartomas b. benign lesions c. adenocarcinomas d. squamous cell carcinomas

2. With appropriate staging, the incidence of unnecessary thoracotomy is about: a.40% b.20% c.5% d. less than 1%

3. Candidates for surgical resection of lung tumors include patients with: a. small-cell carcinomas b. extrathoracic metastases c. ipsilateral hilar and peribronchial involvement d. malignant pleural effusions

4. Lobectomy: a. is the treatment of choice for lung carcinoma b. can be performed if there is involvement of the mainstem

bronchus c. has a mortality rate of 10% d. is considered in all patients with small-cell carcinoma

5. Which of the following is least useful in treating post-thoracotomy pain? a. transcutaneous electrical nerve stimulation (TENS) b. epidural opioids c. cryoanalgesia

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d. intrapleural local anesthetics 6. Patients with the greatest risk for lung resection include all of the

following except: a. PaC02 > 45 mmHg b. recent myocardial infarction c. cor pulmonale d. recent coronary artery bypass graft (CAB G)

7. Cessation of smoking one week prior to surgery will: a. improve pulmonary function studies b. precipitate withdrawal c. reduce carboxyhemoglobin levels d. increase Pa02

8. Signs of decompensated cor pulmonale include all of the following except: a. tender liver b. raIes c. peripheral edema d. jugular venous distention

9. True statements about intraoperative monitoring include all the following except: a. An arterial line should be used with double-lumen endobronchial

tubes. b. Pulmonary diastolic pressures may be substantially elevated

above pulmonary wedge pressures with severe lung dise~se. c. Central venous pressure always provides accurate information

about left heart filling pressures in patients with pulmonary disease.

d. A spirometer is useful for determining pulmonary compliance. 10. Correct steps to prevent arterial hypoxemia include all of the

following except: a. maintaining dual lung ventilation as long as possible b. using a tidal volume of 10mllkg during one-lung ventilation c. avoiding N20 during one-lung ventilation d. maintaining hypocapnea to maximize hypoxic vasoconstriction

Chapter 10

1. The percentage of cardiac output that travels to the liver is: a.5% b. 15% c.25% d.40%

2. The best biochemical index to assess the severity of hepatocellular dysfunction in a patient with chronic liver disease is: a. prothrombin time

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b. partial thromboplastin time c. Factor VIII level d. serum albumin

3. The effect of systemic hypotension on hepatic blood volume is: a. an increase b. a decrease c. no effect d. dependent on acid-base balance

4. The cardiovascular system of a patient presenting for hepatic transplantation can typically be characterized by: a. extreme instability b. decreased pulse pressure c. increased systemic vascular resistance d. a high cardiac index and wide pulse pressure

5. The thromboelastograph can: a. indicate platelet count b. pinpoint the cause of bleeding disorders c. detect the presence of heparin d. differentiate coagulopathy from surgical bleeding

6. The postanhepatic phase of a liver transplant begins with: a. application of the vascular clamps to the blood supply of the

native liver b. removal of the native liver c. reperfusion of the donor liver d. the onset of the venovenous bypass

7. All of the following factors contribute to ascites formation except: a. increased plasma colloid oncotic pressure b. portal hypertension c. impaired water excretion d. increased flow of hepatic lymph

8. Advantages of venovenous bypass include all of the following except: a. enhancement of cardiovascular stability during the anhepatic

phase b. decreased intraoperative acidosis c. increased venous stasis in the gut d. increased time available for the surgical revascularization

9. Deleterious side effects of vasopressin include: a. coronary ischemia b. thrombocytopenia c. decreased portal venous pressure d. all of the above

10. Prothrombin time is sensitive to all of the following coagulation factors except: a. Factor II

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b. Factor VII c. Factor IX d. Factor X

Chapter 11

1. Short acting barbiturates administered prior to ECT: a. raise the seizure threshold b. lower the seizure threshold c. have no interactions with antidepressants d. have no interactions with phenothiazines

2. Hypertensive patients during ECT may show: a. exaggerated pressor response b. blunted pressor response c. same response as in a normotensive patient d. none of the above

3. The most common induction agent used in ECT is: a. methohexital b. thiopental c. diazepam d. midazolam

4. Medications that should be discontinued prior to ECT are: a. calcium channel blockers b. beta-adrenergic blockers c. antiarrhythmic agents d. MAO inhibitors

5. The anticholinergic premedication of choice in patients on pheno­thiazines is: a. atropine b. scopolamine c. glycopyrrolate d. anticholinergic medication is contraindicated

6. Tricyclic antidepressants: a. interfere with intraneuronal metabolism of catecholamines b. increase the rate of synthesis of dopaminergic precursors c. interfere with neuronal reuptake of norepinephrine d. increase intraneuronal metabolism of catecholamines

7. Monoamine oxidase inhibitors: a. decrease the rate of synthesis of norepinephrine b. need not be discontinued prior to general anesthesia c. interfere with intraneuronal enzymatic degradation of catechol­

amines d. decrease neuronal reuptake of norepinephrine

8. Administration of succinylcholine to modify ECT:

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a. precedes administration of a short-acting barbiturate b. follows administration of a short-acting barbiturate c. requires pretreatment with a non-depolarizing agent d. is frequently associated with post-fasciculation muscle pain

9. A patient on phenothiazine and tricyclic antidepressant therapy who is scheduled for ECT may have the following response to anesthesia: a. severe hypotension b. severe hypertension c. cardiac arrhythmias d. all of the above

10. The proper choice and dosage of muscle relaxant for ECT in a patient on lithium therapy is: a. 0.5mg/kg of succinylcholine b. a decreased dose of succinylcholine because of anticipated

increased sensitivity to the drug c. an increased dose of succinylcholine in the range of double the

calculated dose d. pancuronium O.lmg/kg

Chapter 12

1. Immersion into the lithotriptor water bath is associated with all of the following changes except: a. an increase in cardiac output b. an increased incidence of dysrhythmias c. an initial increase in mean arterial pressure d. an increase in central venous pressure

2. Of the 250,000 patients hospitalized each year with renal calculi, the majority: a. are admitted for pain control b. are black women c. have congenital anomalies d. have calculi lcm in size

3. All of the following are factors contributing to stone formation except: a. paraplegia b. dehydration c. sex d. anemia

4. Shock wave characteristics that make ESWL suitable as a nonin­vasive treatment include: a. its sinusoidal pressure variation b. its ability to be generated outside the body c. rapid attenuation on encountering biological tissue

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d. its exclusively high-frequency composition 5. All of the following are true of shock waves except:

a. they should preferably pass through fluid-air transition zones b. they are focused onto a circular area, located 24cm above the

electrode at the second focus c. they cause shear and tear forces when encountering a change in

acoustic impedance d. they are 1000x more powerful than ultrasonic waves

6. Regional anesthesia: a. must encompass segments T12-L4, which are the renal tract

innervation b. allows the patient to assist with his position, thereby decreasing

the number of lifting personnel needed c. provides inadequate anesthesia d. has a shorter preparation time

7. The advantages of general anesthesia include all of the following except: a. superior postoperative pain relief b. greater patient acceptance c. ability to allow more precise localization and fixation of the

urinary calculus, especially when high-frequency jet ventilation (HFJV) is utilized

d. greater predictability 8. Dysrhythmias associated with ESWL:

a. are observed in 80% of all patients b. may include premature ventricular contractions as well as su­

praventricular contractions c. may be prevented by maintaining a fast rate with atropine d. are prevented by triggering the shock wave to be delivered

20msec after the R wave 9. The hemodynamic changes associated with immersion into a water

bath are such that: a. a patient with valvular disease is best given regional anesthesia

and fluid boluses b. a pulmonary artery catheter may be indicated for a patient with

ischemic heart disease c. a patient with a history of congestive heart failure and a pace­

maker should never undergo ESWL d. there is very little change in the intrathoracic blood volume

10. The least likely complication associated with the use of ESWL is: a. perinephric hematomas b. neurologic injury c. urosepsis d. intractable pain

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Chapter 13

1. The most probable cause of early (first trimester) abortion is: a. nutritional disorders b. infection c. fetal genetic abnormalities d. cervical incompetence

2. The critical period of organogenesis in gestational days is: a. 2-8 b. 8-15 c. 13-60 d. 56-112

3. Which anesthetic agents have been found to be teratogenic in animal studies? a. halothane b. nitrous oxide c. both d. neither

4. Which anesthetic agents have been shown to be teratogenic in humans? a. halothane b. nitrous oxide c. both d. neither

5. The most important consideration in deciding patient position for cerclage is: a. aortocaval compression; therefore, the uterus should be dis­

placed to the left b. aspiration prophylaxis; therefore, the patient should be po­

sitioned in the head-up position c. pressure on the fetal membranes; therefore, the patient should be

placed in the Trendelenberg position d. uterine perfusion; therefore, the patient should remain in the

sitting position 6. Which is the vasopressor of choice during pregnancy?

a. ephedrine b. phenylephrine c. epinephrine d. methoxamine

7. Which of the following statements about the preoperative as­sessment is incorrect? a. It is important to ask the patient about nutritional status and

possible metabolic disorders. b. A preoperative chest film should be obtained in all cases.

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c. Appropriate lab evaluation consists of hemoglobin, platelets, and glucose.

d. One should auscultate for new murmurs and inquire about dyspnea, since the cardiac output begins to rise in the first trimester.

8. Which choice of anesthetic is appropriate for a woman in the 13th week of gestation without significant preoperative findings? a. spinal anesthesia at L4-5 with a 25-gauge needle using 6mg

hyperbaric tetracaine b. epidural anesthesia at L3-4 with 10ml of 3% chloroprocaine c. general anesthesia with rapid-sequence-induction endotracheal

intubation and maintenance with nitrous oxide and halothane d. all of the above

9. For general anesthesia for cerclage, which induction sequence can be recommended for the otherwise healthy patient? a. thiamylal-succiny1choline b. ketamine-atracurium c. midazolam-vecuronium d. all of the above

10. Which of the following should be recommended to the gravida requesting the anesthetic method with the least drug exposure to the fetus? a. general anesthesia b. spinal anesthesia with bupivacaine c. epidural anesthesia with lidocaine d. spinal anesthesia with tetracaine

Chapter 14

1. Of the following, choose the statement that is true about brain tumors. a. Primary tumors occur most often in patients between 30 and 40

years of age. b. Lung and breast are the most common primary sites of metastatic

intracranial tumors. c. They occur most commonly in the posterior fossa. d. Glioblastomas have uniformly good prognoses with surgical

excision. 2. Of the following, choose the least true statement concerning present­

ing signs and symptoms of brain tumors. a. Altered neuronal excitability may be manifested as generalized

seizures. b. Characteristically, patients will complain of a headache that

worsens with ambulation.

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c. Direct local tissue destruction produces neurologic deficits that are immediately dense and complete.

d. Classic symptoms of raised ICP include diplopia and an occipital headache on awakening.

3. In monitoring ICP: a. subdural pressure monitoring IS usually performed over the

occipital region b. intracranial compliance is best derived using subdural pressure

monitoring c. ventricular pressure monitoring carries the lowest risk of hemor­

rhage and infection d. the contralateral laterally displaced ventricle is catheterized for

ventricular pressure monitoring 4. Cerebral blood flow:

a. is constant as increased oxygen demand is met solely by in­creased oxygen extraction

b. increases linearly at a slope of2%/mmHg decrease in Pa02 below a Pa02 of 80mmHg

c. is effectively lowered by hyperventilation, and at a PaC02 of 20mmHg flow is halved

d. is controlled by autoregulation, which is a neurogenic response dependent on an intact sympathetic nervous system

5. In patients with an intracranial mass the least true statement is: a. ECG changes most commonly are tachycardia, prolonged QT

interval, large U waves, and T- and ST-wave changes b. dexamethasone is routinely given because of the highly stressful

nature of a craniotomy c. drug-induced sedation may mask decreasing levels of conscious­

ness that may accompany increases in ICP d. steroid administration may lead to increases in intravascular

volume and hypertension 6. The following is true about venous air embolism (VAE):

a. V AE is a risk only in the sitting position. b. The precordial Doppler is the most sensitive monitor to detect

V AE, detecting air at Imllkg/min. c. Increasing end-tidal nitrogen is a useful means of detecting VAE

if a mass spectrometer is used. d. A paradoxical air embolus may occur through a probe-patent

foramen ovale, which is present in 50% of the population. 7. In considering the effects of anesthetic agents on CBF and ICP:

a. enflurane produces greater cerebral vasodilatation than halothane b. prior hyperventilation is necessary to prevent increased CBF

with isoflurane administration c. enflurane may cause seizure activity on the EEG in the presence

of hypocarbia

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d. N20 effectively decreases CBF but may lead to postoperative pneumocephalus

8. Concerning adjuvants to decrease ICP and provide cerebral protection: a. mannitol is not associated with rebound intracranial hyper­

tension b. disadvantages of urea include venoirritation, renal reabsorption,

and rebound intracranial hypertension c. glucose infusion is necessary to provide cerebral energy intra­

operatively d. phenytoin decreases blood glucose by stimulating insulin se­

cretion 9. Of the following, choose the statement that is true about the

intracranial contents. a. Tumors with a volume less than 200ml have no effect on ICP. b. The critical level of CPP is 25mmHg. c. CSF is secreted by arachnoid villi and reabsorbed by the choroid

plexus. d. Blood in the intracranial vessels constitutes 5% of the intracranial

contents. 10. Of the following, choose the statement that is true concerning

intracranial dynamics. a. Compensation for increased brain bulk is initially via translo-

cation of CSF to the spinal space. b. CSF production decreases acutely as ICP increases. c. A waves are periods of lowered ICP to improve CPP. d. The cardiovascular response to rising ICP is systemic hypoten­

sion to decrease CBF and thus reduce ICP.

Chapter 15

1. Normal intraocular pressure (lOP) is: a. 1O-20mmHg b.3-5mmHg c. greater than 25mmHg d. zero

2. Intraocular pressure is determined by: a. the amount of aqueous humor b. choroidal blood volume c. the amount of vitreous humor d. all of the above

3. Aqueous humor: a. is produced mainly in the anterior chamber b. is produced mainly via an active secretory process involving

carbonic anhydrase

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c. drains through the canal of Schlemm into the circle of Willis d. outflow is inhibited by miotic agents

4. All of the following are true except: a. Coughing can increase lOP 30-40mmHg b. lOP increases with respiratory acidosis due to vasodilation. c. Hypoxia increases lOP. d. A Val salva maneuver lowers lOP.

5. Succinylcholine, when used alone: a. causes a dose-dependent increase in lOP b. has never led to a loss of intraocular contents c. is the muscle relaxant of choice for a rapid-sequence induction d. lowers lOP when used in very high doses

6. All of the following are true except: a. Inhalation agents diminish lOP. b. Free water can lower lOP. c. CNS depressants lower lOP. d. Miotic agents can lessen lOP.

7. The muscle relaxant that lowers lOP most is: a. vecuronium b. succinylcholine c. curare d. gallamine

8. All of the following are true except: a. Nonpenetrating corneal foreign bodies can be removed under

local anesthesia. b. Foreign bodies in the anterior chamber are removed via an

incision at the corneosclerallimbus. c. Metallic foreign bodies can be removed with the aid of a magnet. d. It is best to wait until intraocular foreign bodies have become

enmeshed in fibrin before removing them. 9. Bucking at the time of extubation can raise lOP and place the

surgical closure in jeopardy. Bucking can be safely minimized by all of the following methods except: a. small dose of succinylcholine b. lidocaine 1.5mg/kg intravenously c. adequate narcotization d. deep extubation despite the presence of a full stomach

10. All children with open eye injuries: a. should have preoperative blood work and an intravenous line b. should have their parents remain with them if possible, to prevent

them from crying c. must be separated from their parents before entering the operat­

ing room d. are absolute emergencies and cannot wait several hours for

surgical correction

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Chapter 16

1. Factors that affect airway management in patients with maxillofacia1 trauma include: a. presence of airway obstruction b. cervical and skull fractures c. associated injuries d. all of the above

2. Which portion of the mandible is most frequently broken? a. the condylar neck b. the symphysis c. the ramus d. the coronoid process

3. After a bilatera1 mandibular fracture, airway obstruction results from: a. laryngea1 obstruction b. tracheobronchia1 disruption c. obstruction by the maxilla d. displacement of the tongue against the posterior pharyngeal wall

4. LeFort I fractures: a. never result in airway obstruction b. are denta1-a1veolar fractures c. extend through the orbita1 rim d. are the most common of the LeFort injuries

5. All of the following are true of a LeFort II injury except: a. It can be associated with a fracture of the cribriform plate b. It can cause airway obstruction by posterior displacement of the

maxilla. c. It results in craniofacial dysjunction. d. It results in a pyramid-shaped fracture.

6. A LeFort III fracture: a. is a pyramidal fracture b. causes craniofacial dysjunction c. is a dental-alveolar fracture d. includes bilateral mandibular (Andy Gump) fractures

7. Airway obstruction from maxillofacia1 injuries can result from: a. blood, teeth, dentures, and bony fragments in the oropharynx b. pharyngea1 obstruction from bilatera1 mandibular fractures c. posterior displacement of the mobile maxilla d. a11 of the above

8. Tracheostomy is indicated: a. in all maxillofacial injuries b. as a life-saving maneuver in the emergency room c. if concomitant laryngeal or tracheal disruption is present d. in the presence of any airway obstruction in patients witl1

maxillary fractures

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9. Most repairs of facial lacerations: a. are performed under general anesthesia at the time of injury b. are done with local anesthesia c. do not need to be done in the operating room if sedatives are

given d. require lidocaine without any epinephrine

10. All of the following techniques can be used to minimize intraopera­tive blood loss except: a. reverse Trendelenberg of 15-30° b. controlled hypotension c. positive end-expiratory pressure d. subcutaneous epinephrine

Chapter 17

1. The incidence of hydrocephalus in the pediatric population is: a. approximately 1: 1000 as a single entity b. increased with maternal age c. approximately 8:1000 when associated with meningomyelocele d. decreasing with improved prenatal care

2. CSF production will increase when: a. mean arterial pressure is lowered b. mean arterial pressure is raised c. high-dose steroids are given d. none of the above occurs

3. CSF is absorbed: a. via CNS lymphatics b. via active pumping of ions across choroidal cells c. at the arachnoid villi via vacuoles d. across the dura into the epidural space

4. Of the following, the least likely to be associated with acute hydrocephalus is: a. headache b. pituitary abnormalities c. nausea/vomiting d. coma

5. Which of the following would be a contraindication for shunt placement? a. unresectable lesion b. history of abdominal surgery c. acute ventriculitis d. reversible neurologic defects

6. Normal-pressure hydrocephalus is characterized by: a. sixth nerve palsy, decreased olfaction, dysphagia b. seizures, headaches, vomiting c. papilledema, optic atrophy, mental status changes

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d. gait disturbances, mental status changes, incontinence in adults 7. Complications particular to V A shunts include:

a. infection b. intestinal obstruction c. renal insufficiency d. shunt obstruction

8. Induction agents suitable for patients with hydrocephalus include all of the following except: a. lidocaine b. fentanyl c. ketamine d. thiamylal

9. Maintenance of anesthesia may best be accomplished by: a. 02/N20/halothane b. 02/N20/fentanyl drip c. 02/isofturane/fentanyl drip d. 02/enfturane/fentanyl drip

10. Prior to extubation, all of the following must be accomplished except: a. complete removal of the lesion b. assessment of patient's ability to maintain his airway c. reversal of residual muscle blockade d. return of adequate spontaneous ventilation

Chapter 18

1. Ideal qualities of irrigating solutions for TURP include all of the following except: a. hyposmolar solution b. nonhemolytic c. electrically inert d. nontoxic

2. Approximately what percentage of irrigating solution is absorbed directly into the blood vessels during TURP? a.5% b.97% c.29% d.50%

3. Symptoms of glycine toxicity include: a. seizures b. diaphoresis c. transient blindness d. hearing loss

4. The most significant contributory factor in mortality due to bladder perforation is:

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a. location of perforation b. delay of diagnosis c. type of irrigating solution used d. age greater than 65 years

5. Complications of TURP include all of the following except: a. hyponatremia b. circulatory overload with congestive heart failure c. sepsis d. hypernatremia

6. The amount of absorption of irrigating fluid is least dependent on: a. the height of the container of irrigating fluid above the surgical

table b. the length of time of the resection c. the size of the prostate gland d. the type of irrigating solution used

7. Hyponatremia is least likely to cause: a. bradycardia b. widening of the QRS complex c. tachycardia d. T-wave inversion

8. Rapid correction of hyponatremia may result in all of the following except: a. pulmonary edema b. disseminated intravascular coagulopathy c. pontine myelinolysis d. death

9. Distilled water is not used as an irrigating solution today because: a. it has poor optical qualities b. it facilitates dispersion of high-frequency current from the resec­

toscope c. it causes transient blindness d. it is extremely hypotonic

10. Coagulopathy after TURP is most probably due to: a. DIC with secondary fibrinolysis b. hyponatremia c. thromboplastin destruction d. aspirin ingestion

Chapter 19

1. Patients presenting for thyroidectomy are least likely to be: a. euthyroid b. hypothyroid c. hyperthyroid d. in a fluctuating state

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2. Thioureylenes act by inhibiting: a. iodide uptake b. iodination and coupling c. peripheral deiodination of T4 d. TSH production by anterior pituitary

3. Protein binding of thyroid hormone is inhibited by all ofthe following except: a. thiobarbiturates b. salicylates c. testosterone d. estrogens

4. Most of the thyroid nodules diagnosed as "cold" by thyroid scans are: a. benign b. metastatic disease c. malignant d. abscesses

5. All of the following symptoms are common in hyperthyroid patients except: a. increased nervousness b. increased perspiration c. cold intolerance d. palpitations

6. Antithyroid agents can cause: a. granulocytopenia b. thrombocytopenia c. anemia d. prolongation of coagulation time

7. The anesthetic method of choice for thyroidectomy is: a. local b. high spinal c. general endotracheal d. cervical plexus block

8. The "thyroid storm": a. is best prevented b. has to be differentiated from malignant hyperthermia c. carries a 10% mortality d. is characterized by all of the above

9. The recurrent laryngeal nerves: a. always lie within the body of the gland b. supply only the vocal cords c. are most commonly damaged on one side only d. provide sensory innervation of the larynx

to. The musc1e(s) most sensitive to calcium deficiency is (are): a. the diaphragm

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b. intrinsic muscles of the larynx c. the myocardium d. vascular smooth muscle

Chapter 20

1. Which of the following viruses are herpesviruses? a. cytomegalovirus b. varicella-zoster virus c. Epstein-Barr virus d. all of the above

2. What percentage of adults in the United States is seropositive for chickenpox? a.75% b.22% c.96% d.51%

3. Which age group has the highest incidence of mortality when exposed to chickenpox? a. < 1 year old b. 1-10 years old c. 10-19 years old d. >19 years old

4. The varicella-zoster virus replicates in: a. pacinian corpuscles b. epithelial derivatives of organ systems c. mucoid droplets d. intranuclear inclusion bodies

5. The chest x-ray of varicella pneumonitis demonstrates: a. perihilar nodular densities b. pneumothoraces c. pulmonary edema d. bronchiectasis

6. Lumbar puncture of patients with varicella-induced meningoen­cephalitis reveals: a. increased lymphocytes, PMNs. and granulocytes b. increased glucose and protein c. varicella-zoster particles d. xanthochromia

7. The liver function test that is often elevated in patients with varicella-induced hepatitis is: a. prothrombin time b. total bilirubin c. albumin d. SGOT

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8. VZ globulin is used in chickenpox for: a. curing varicella b. stimulating antibody development c. attenuating the clinical course d. alleviating pulmonary symptoms

9. Acyclovir acts on the VZ virus by: a. prevention of viral attachment to cell membranes b. inhibiting DNA polymerase c. increasing levels of cAMP d. immunosuppressing host defenses

10. A patient exposed to chickenpox is infectious during which period? a. throughout the course of the disease b. 24 hours prior to the appearance of the exanthem c. up to 2 weeks after all lesions are crusted d. 5 days prior to the development of fever

Chapter 21

1. Factors associated with a poor prognosis in RA patients include: a. thrombocytopenia and a hematocrit of more than 35 b. Caucausian race, age of 50 years, and male sex c. combination of hypertension and diabetes d. thrombocytosis, vasculitis, and female sex

2. Potential airway management difficulty is most likely with: a. sleeping stridor and cricoarytenoid arthritis b. visualization of the uvula and dysphagia c. TMJ greater than 3cm and a large tongue d. edentulous mouth with oral candidiasis

3. Laryngeal abnormalities in the RA patient include: a. caudal displacement and rightward deviation b. leftward deviation and caudal displacement c. leftward rotation and rightward deviation d. less mobile vocal cords and leftward deviation

4. Cervical spine involvement in the RA patient includes: a. caudad odontoid migration and subluxation at Cl-2 b. subaxial subluxation and atlantoaxial subluxation c. atlantoaxial subluxation and tracheal elevation d. dizziness with neck movement and a normal TMJ

5. The axial cruciform ligament fixes the odontoid process and includes the following ligaments: a. transverse and horizontal ligaments b. alar ligament and hilar bands c. superior and inferior longitudinal bands d. intermediate and intramediate ligaments

6. Impending neuropathology in the RA patient is indicated by:

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a. cervical subluxation less than 10% b. pain radiating to lumbar spine c. inferior migration of the odontoid process d. an atlas/odontoid interval greater than 3cm

7. Which of the following systems is least likely to be affected by rheumatoid arthritis? a. immunologic b. hematologic c. respiratory d. renal

6. Impending neuropathology in the RA patient is indicated by: a. cervical subluxation less than 10% b. pain radiating to lumbar spine c. inferior migration of the odontoid process d. an atlas/odontoid interval greater than 3 cm

7. Which of the following systems is least likely to be affected by rheumatoid arthritis? a. immunologic b. hematologic c. liver d. kidney

8. Preoperative assessment of the patient with severe RA could reveal all except: a. hypochromic macrocytic anemia b. valvular dysfunction or dysrhythmia c. temporomandibular dysfunction d. renal amyloidosis

9. Medication side effects noted in the RA patient include: a. marrow depression and polycythemia b. renal dysfunction and rigidity c. rigidity and edema d. adrenal suppression and marrow suppression

10. The method of intubation least desirable in the RA patient is: a. fiberoptic b. blind nasal c. tracheostomy d. retrograde

Chapter 22

1. The incidence of cataract disease: a. diminishes with increasing age of the popUlation b. is significant only in industrialized countries c. as shown in the Framingham Study is about 16% d. is not expected to alter over the next 30 years

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2. Causes of cataracts: Which of the following statements is true? a. The most frequent cause of cataracts is congenital problems. b. Diabetes insipidus is associated with increased risk of cataracts. c. Ultraviolet light has been proved to cause cataracts in humans. d. Myotonic dystrophy is associated with increased risk of cata­

racts. 3. Concerning the pathophysiology of cataracts, which of the following

statements is true? a. The physiologic changes of aging in the lens are responsible for

cataracts. b. Exaggeration of normal sclerosis of fibers in the lens nucleus

produces a nuclear cataract. c. Incipient cataracts show decreased fluid content compared to the

normal lens. d. Changes in epithelial cells are not important in the development

of subcapsular cataracts. 4. Opthalmologic assessment of cataract disease includes all of the

following except: a. assessment of lens opacity b. culture and sensitivity of conjunctival fluid c. diagnostic ultrasound d. electronystagmography

5. Concerning treatment of cataract disease, which of the following is true? a. Extracapsular extraction is the most common form of treatment. b. Refractive therapy has no role. c. Optimal blood glucose control is unlikely to improve vision. d. Miotic drugs are of benefit.

6. Regional anesthesia is recommended for all patients except: a. patients with myotonic dystrophy b. patients with NYHA class III angina c. patients with severe spasmodic torticollis d. patients with history of cerebrovascular accident

7. The most frequent complications of regional anesthesia for eye surgery are: a. oculocardiac reflex during performance of the block b. minor local problems (ecchymosis) c. brain stem anesthesia d. intraneural injection

8. Physiologic changes of aging include all of the following except: a. loss of cellular free water b. reduced glomerular filtration rate c. increased autonomic end organ responsiveness d. elevated plasma epinephrine

9. Which of the following is true concerning peribulbar anesthesia?

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a. Local anesthetic is placed as close as possible to the ciliary ganglion.

b. It is preceded by use of mydriatic and local anesthetic eye drops. c. It does not cause paresis of orbicularis oculi. d. It has achieved high patient acceptance because of its one­

injection technique. 10. The awake patient undergoing eye surgery

a. requires replacement of the fasting fluid deficit before perfor-mance of the block

b. requires sedation to overcome anxiety c. is easily disturbed by extraneous conversation and noise d. frequently becomes restless because of the prolonged duration of

surgery.

Chapter 23

1. Reduction of hematocrit from a mean of 45.2% to 35% is associated with: a. 35% decrease in calf blood flow at rest b. 56% increase in calf blood flow at rest c. Two fold decrease in peak flow d. mean hemoglobin delivery is increased by 40%

2. Fall in the colloid osmotic pressure of the plasma from 25 mm to 20 mmHg is associated with a volume deficit of: a. 13 liters b. 8 liters c. 5 liters d. no correlation

3. ST depression on ECG is caused by all of the following except: a. left ventricular hypertrophy b. digitalis overdose c. hyperkalemia d. ischemia

4. Thalium redistribution after dipyridamole indicates: a. blood collateral coronary circulation b. poor coronary perfusion to that segment c. improved blood flow to that segment d. A Robinhood effect

5. ECG changes due to ischemia are late signs and are preceeded by: a. reginal wall motion abnormalities b. increase in ventricular compliance c. increase in CVP d. decrease in lung compliance

6. Earliest consequences of myocardial ischemia include all of the following except:

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a. increase in PCWP in the presence of unchanged cardiac output b. appearance of prominent AC waves in PCWP c. appearance of "V" wave in PCWP d. inversion of "T" waves on the ECG

7. Coexisting risk factors in mortality of patients with chronic le!l ischemia are all of the following except: a. smoking b. diabetes c. hypertension d. thyrotoxicosis

8. Atherosclerosis has last predilection for which vessels? a. coronary arteries b. axillary and brachial arteries c. carotid arteries and intracranial cerebral vessels d. aorta and arterial supply to the kidneys and lower legs

9. The elderly heart demonstrates all of the following except: a. increase in resistance to B-adrenergic blockade b. marked reduction of the tachycardic response to atropine c. marked increase in sensitivity to isoproterenol d. less flexibility as a biological pump

10. Mortality in claudicants after 10 years in comparison to the general population is: a. three times that of the general population b. about the same c. 80% that of general population d. at least 10 times higher

Chapter 24

1. Parkinson's disease results from a deficiency of dopamine in the a. third ventricle b. pons c. thalamus d. basal ganglia

2. Surgical implantation of adrenal tissue into the brain of a Parkinso­nian will most likely a. increase dopamine stores in the substantia nigra b. increase secretion of epinephrine via a feedback mechanism to

the adrenal medulla c. increase striatal levels of enkephalins d. decrease urinary homovanilic acid (HV A) levels

3. True statements regarding postural hypotension in the Parkinso­nian are: a. postural hypotension may exist in the untreated Parkinsonian and

in the patient treated with L-DOPA

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b. Postural hypotension in the Parkinsonian may improve with age. c. The mechanism for postural hypotension in the Parkinsonian has

been elucidated d. Postural hypotension can be treated effectively by increasing the

morning dose of L-DOPA. 4. The rate-limiting step in dopamine synthesis is:

a. Decarboxylation of L-DOPA to dopamine b. Deamination of dopamine to HVA c. Hydroxylation of L-tyrosine to L-dopa d. Methylation of L-DOPA to 3-methoxydopa

5. Which of the following agents may cause a Parkinsonian patient to decompensate? a. Ketamine b. Diazepam c. Haloperidol d. Sufentanil

6. Each of the following statements is true except a. Parkinsonian patients who are not optimally managed may suffer

some degree of restrictive lung disease b. Hyperkalemia is a significant problem when succinylcholine is

administered to the Parkinsonian patient. c. Parkinsonian patients may suffer altered mentation as a result of

their disease or treatment. d. Poor nutrition may complicate the routine management of Parkin­

sonians. 7. Which of the following has helped reduce the incidence of untoward

cardiovascular effects in patients maintained on L-DOPA? a. the routine use of ,a-blockers in these patients b. the use of selective MAO-B inhibitors c. the use of reserpine in these patients d. the use of peripheral decarboxylase inhibitors

8. Which of the following best explains the association between Parkin­son's disease and dementia? a. a linked gene governing inheritance of Parkinson's and

Alzheimer's disease b. segregation of function in the caudate nucleus c. degeneration of the frontal cortex d. Lewy Bodies can be found in the ventral thalamus and motor

cortex on the postmortem exam of Parkinsonians. 9. Which represents the best rationale for the use of bromocriptine in

Parkinsonian patients? a. Bromocriptine and L-DOPA enter the eNS to be converted to

dopamine. b. The use of bromocriptine allows patients to better tolerate

untoward effects of L-DOPA.

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c. Bromocriptine allows clinicians to use smaller doses of L-DOPA, thereby delaying the onset of tolerance.

d. Bromocriptine has been shown to reverse the pathological changes in the brains of Parkinsonians.

10. Which statements are true regarding anesthetic management of Parkinsonians? a. They may suffer from a number of system disorders other than

Parkinson's. b. They may be at higher risk of aspiration of gastric contents due to

a central action of L-DOPA. c. They may present airway management problems due to facial

rigidity. d. All of the above.

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Answers to Self-Assessment Questions

Chapter 1 Chapter 2 Chapter 3 Chapter 4

1. a 1. c 1. a 1. b 2. c 2. b 2. d 2. a 3. b 3. c 3. b 3. d 4. c 4. a 4. d 4. d 5. c 5. b 5. c 5. c 6. b 6. c 6. a 6. a 7. b 7. b 7. b 7. b 8. b 8. c 8. c 8. c 9. a 9. a 9. a 9. b

10. d 10. d 10. d 10. a

Chapter 5 Chapter 6 Chapter 7 Chapter 8

1. b 1. b 1. d 1. d 2. d 2. c 2. c 2. c 3. a 3. c 3. c 3. a 4. c 4. a 4. c 4. c 5. c 5. b 5. d 5. b 6. d 6. d 6. c 6. d 7. a 7. a 7. b 7. c 8. c 8. b 8. d 8. a 9. d 9. a 9. d 9. c

10. a 10. c 10. a 10. b

Chapter 9 Chapter 10 Chapter 11 Chapter 12

1. d 1. c 1. a 1. c 2. b 2. d 2. a 2. a 3. c 3. b 3. a 3. d 4. a 4. d 4. d 4. b 5. a 5. d 5. c 5. a 6. d 6. c 6. c 6. b 7. c 7. a 7. c 7. a

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340 Answers to Self-Assessment Questions

8. b 8. c 8. b 8. b 9. c 9. a 9. d 9. b

10. d 10. c 10. b 10. d

Chapter 13 Chapter 14 Chapter 15 Chapter 16

1. c 1. b 1. a 1. d 2. c 2. c 2. d 2. a 3. c 3. d 3. b 3. d 4. d 4. c 4. d 4. b 5. c 5. b 5. a 5. c 6. a 6. c 6. b 6. b 7. b 7. c 7. c 7. d 8. d 8. b 8. d 8. c 9. a 9. d 9. d 9. b

10. d 10. a 10. b 10. c

Chapter 17 Chapter 18 Chapter 19 Chapter 20

1. a 1. a 1. b 1. d 2. b 2. c 2. b 2. c 3. c 3. c 3. d 3. d 4. b 4. b 4. a 4. b 5. c 5. d 5. c 5. a 6. d 6. d 6. a 6. a 7. c 7. c 7. c 7. d 8. c 8. b 8. d 8. c 9. c 9. d 9. c 9. b

10. a 10. a 10. b 10. b

Chapter 21 Chapter 22 Chapter 23 Chapter 24

1. d 1. c 1. b 1. d 2. a 2. d 2. c 2. c 3. d 3. b 3. c 3. a 4. b 4. d 4. b 4. c 5. c 5. a 5. a 5. c 6. d 6. c 6. d 6. b 7. c 7. b 7. d 7. d 8. a 8. c 8. b 8. b 9. d 9. b 9. c 9. c

10. b 10. c 10. a 10. d

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Index

Abdominal aortic surgery, 3 Abdominal distention, 61 Abdominal pain, 29 Abdominal pulsations, 2, 304 Abdominal symptoms, 85 Abdominal vasculature (aortic aneu-

rysm),279 Abducens nerve palsy, 206 Abducens paralysis, 161 Abortion, 155-156 Abortion, habitual, 152-154 Acetaminophen, 160, 182, 244 Acetazolamide, 180, 206 Acetone, 273 Acetylcholine, 79, 178 Acid,28 Acid-base balance, 74 Acidic metabolite, 76 Acidosis, 26, 30, 35, 61, 85, 119,

121, 124, 141,222 Acinetobacter, 85 Acoustic neuroma, 161 Acquired immune deficiency syn-

drome (AIDS), 156 Acquired vascular disease, 3 Acromegaly, 16-19, 168 Acute acalculous cholecystitis, 86,

314 Acute appendicitis, 246 Acute liver dysfunction, 112 Acute pulmonary embolism, 304 Acute ventriculitis, 327

Acyclovir, 250, 332 Adenocarcinoma, 94, 315 Adrenal function, 15 Adrenaloectomy, bilateral, 16 Adrenal tumor, 16, 305 Adrenocorticotropic hormone

(ACTH), 14-15, 167 Adult respiratory distress syndrome

(ARDS), 84, 87-88 Aggressive cytotoxic therapy, 84 Agranulocytosis, 258 Air embolus, 208 Airway, 19,40,45,61,65,79-80,

97, 101-103, 105, 135, 149, 168, 181, 183, 189, 194, 197, 219, 232, 242, 249, 255-256

Albumin, 4, 10, 77, 83, 121, 331 Alfentanil, 212 Alimentation, inadequate, 77 Alkaline phosphatase, 29 Allen's test, 19,42, 284 Allergies, 42, 115, 131-133, 145,209 Alpha-adrenergic blocking action,

129, 133, 156 Alpha-epsilon aminocaproic acid, 42 Alphamethyldopa, 1 Alpha-receptors, 110 Altered sensorium, 167 Althesin, 111 Alveolar-arterial O2 gradient, 87 Alveolar capillary, 88 Alveolar edema, 27

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342 Index

Alveolar exudate, 27 Alveolar minute ventilation, 31, 76 Alveolar wall necrosis, 28 Alzheimer's disease, 291 Amantadine, 289, 292 Amenorrhea, 10 Aminocaproic acid, 122 Aminophylline, 6 Ammonia, 31, 115, 119,222 Ammonium, 119 Ampicillin, 108 Amyloidosis, 257-258 Anaerobic glycolysis, 74 Anal atresia, 61, 64, 311 Analgesia, 105-106, 150, 157, 213,

217, 224, 268 Anaphylotoxins, 87 Anastomotic leaks, 65 Androglus, 14 Andy Gump fractures, 30, 115, 117,

189,220 Anemia, 330 Anencephaly, 46 Anesthesia, general, 43, 55, 90, 146,

149, 156, 158, 179, 181, 183, 194, 197,216,220-221,223, 225, 237, 239

Anesthesia, local, 6, 43, 62, 106, 144, 195-197, 239

Anesthesia, regional, 39, 145-146, 156-158,220-221,225-227

Anesthesia, spinal, 239 Anesthetic ventilators, 80 Aneurysm, 131-132 Aneurysm, abdominal aortic, 1-3 Aneurysm, rupture, 2, 205 Angina pectoris, 3, 33-34, 39-41,43,

93, 98-99, 132, 200, 217, 238, 308

Angiography, 12, 15, 162,247,273, 278,280

Angioma tumor, 94 Angioplasty, 37 Angiotensin-aldosterone system, 114 Ankylosis, 254 Anode endotracheal tube, 20

Anorexia nervosa, 131 Anosmia, 194 Antacid medication, 119 Anterior pituitary, microadenoma of,

16 Antiarrhythmic drugs, 40 Antibiotics, 50, 61, 65, 75-76, 86,

88,93, 100, 119,223, 314 Anticholinergics, 169, 318 Antidepressants, 129-130, 13 2 Antidiurectic hormone (ADH), 28 Antigen, 28 Antihemophilic factor, 112 Antihypertensive drugs, 40 Antimetabolite drugs, 84 Antiplatelet therapy, 36, 42 Anuria, 249 Aorta, surgery of, 1 Aortic aneurysm, 6, 140, 304 Aortic aneurysm repair, 3 Aortic stenosis, 3 Apnea, 48-49, 51, 56, 60, 120, 128,

133, 135-136, 162, 181 Apneic oxygenation, 104 Appendectomy, 244 Aqueous humor (AH), 177-181 Arachidonic acid metabolism, 87 Arnold-Chiari malformation, 48, 204 Arterial blood gas analysis, 7, 40, 65,

67, 74, 77, 83, 93, 99-101, 104, 106, 116, 120, 225

Arterial blood pressure, 54, 101, 114, 120, 163, 180, 197

Arterial cannulation, 147 Arterial catheterization, 53, 62, 83,

89-90, 169 Arterial disease, 3 Arterial oxygenation, 43, 53 Arterial-venous oxygen difference,

303 Arthritis, 246 Ascites, 114, 116-119,317 Aspiration, 118, 156, 182, 195 Aspiration biopsy cytology (ABC),

235 Aspiration pneumonia, 65

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Index 343

Aspirin, 217, 329 Asterixis, 115 Asthma, 40, 65, 97, 220, 229 Astrocytoma, 161 Asystole, 129 Ataxia, 161,247 Atelectasis, 29, 40, 65, 71, 105-106,

108, 116, 120 Atheromatous plaque, 37 Atlantoaxial subluxation, 256 Atlas/odontoid interval, 256 Atracurium, 8,43,53,64, 120, 135,

181, 184,211,251,300,308, 322

Atresia, 63 Atrial contractions, 35, 41 Atrial dysrhythmia, 39, 248 Atrial fibrillation, 35, 238, 241 Atrial flutter, 4 Atrial pressure, 42 Atrial septal defect, 52, 63-64, 124 Atropine, 134, 139, 147, 169, 212,

226,242, 310, 318 Auscultation, 103, 215 Awake intubation, 19 Azathioprine, 118 Azotemia, 220

Bacteremia, 84, 87, 119,208,217, 223,314

Bacteria, 71, 84, 315 Bacterial endocarditis, 75 Bacteroides, 85 Balloon catheterization, 37 Barbiturate-muscle relaxant, 101 Barbiturates, 53, 80, 128, 133, 135,

169, 171-173, 180,211-212, 225, 318-319

Barium enema (BE), 94 Basal metabolism rate, 234 Basophilic pituitary adenoma, 15 Battle signs, 194 Begeminy, 139 Benzodiazepine, 53, 78, 91, 155,217,

225

Benzoin, 146 Benzotropine, 292 Bepharospasm, 183 Beta-adrenergic blocking agent, 35,

181,277,318,336 Beta-blockers, 41, 129, 134, 14,241,

284,337 Beta endorphins, 14 Beta receptors, 111 Bicarbonate, 28, 30, 100, 166 Bilateral adrenal hyperplasia, 15 Bile duct obstruction, 29 Biliary stricture, 113 Bilirubin, 22, 27, 29,108,111,331 Biperidin, 292 Bladder, 154 Bladder catheterization, 31, 42, 217,

223-224 Bladder irritation, 150 Bladder perforation, 222-223. 328-

329 Bleeding disorders, 113, 140, 223-

224 Bleeding, gastrointestinal, 117-118,

220 Blindness. 13, 253 Blood coagulation, 168 Blood count, 131 Blood dyserasias, 258 Blood flow, 26, 72, 118, 121, 164 Blood gas analysis, 6, 30, 42, 62, 80,

244, 247, 250 Blood glucose, 1, 40 Blood loss, 9, 55, 64, 78, 121, 124,

192, 224, Blood, occult, 223 Blood osmolarity, 180 Blood pressure, 18, 31, 34--35,40,

42,55,63-64,67,73, 78, 80, 83, 89-90,99, 101, 108, 123, 126-127, 129, 134--136, 139, 146, 157, 160, 170--171, 178-179, 187,211,215,217,229, 238-239, 244, 250

Blood sodium level, 225 Blood sugar, 1,6,75,96

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344

Blood supply, 161 Blood transfusion, 28, 53, 226, 249 Blood urea nitrogen (BUN), 28, 62,

108, 117, 131, 167,217,220-221, 244, 248, 273, 289

Blood vessel transposition, 63 Blood volume, 15,34,46, 147, 149 Body surface area (BSA), 7, 68-69,

73-74, 76--77, 81, 313 Bolus, 250 Bone atrophy, 254 Bone fracture, 132 Bone infarction, 27 Bone marrow, 27, 237, 291 Bowel frequency, 238 Bowel obstruction, 208 Bradycardia, 53, 58, 112, 122-124,

146, 167, 169,217,219,223, 225,242,271,329

Bradykinesia, 290-291 Brainstem dysfunction, 48, 54, 56 Breast, 61, Breath, shortness of, 39 Breath sounds, 102,217 Breathing, deep, 40 Bromocriptine, 293, 337-338 Bronchial blockade, 94 Bronchiectasis, 331 Bronchitis, 65, 208 Bronchodilators, 40, 100, 102 Bronchogenic carcinoma, 93 Bronchopleural fistula, 105 Bronchoscopy, 61, 94-95 Bronchospasm, 71 Bronchospastic pulmonary disease,

289 Bronchus, 96, 102 Brucellosis, 153 Brudzinski's signs, 22 Bupivacaine, 106, 269, 322 Bum edema, 72 Bums, facial, 70 Bums, first degree, 67-81 Bums, second-degree, 67-68 Bums, thermal, 70

Index

Bums, third-degree, 67-68, 72, 79 Bums, thoracoabdominal, 70 Bum-wound sepsis, 75 Butyrophenones, 291, 299

Calcium, 63, 79, 120, 124, 141, 221 Calcium channel blockers, 35, 41, 318 Calcium chloride, 127 Calcium deficiency, 330 Camphor, 127 Cancer, 113, 237 Cannulation, 170, 179, 183,259,265,

269, 313 Cannulation, arterial, 149 Capillaries, fenestrated, 201 Capillary collapse, 162 Capillary leakage, 87, 89 Capillary permeability, 162 Capillary pulsation, 114 Capillary stasis, 26 Capnography, 7, 24, 64, 80,101,146,

170, 239-240, 285 Carbidopa, 293 Carbimazole (CBZ), 232 Carbohydrate, 89 Carbohydrate metabolism, 234 Carbonic anhydrase inhibitors, 180-

181, 203, 209 Carbon monoxide, 40, 70-71, 74, 95,

160,221,312 Carborespiratory compromise, 115,

313,316 Carboxyhemoglobin, 71, 100, 313,

316 Carcinoma, 237 Cardiac anomalies, 61, 63 Cardiac arrest, 61, 237 Cardiac catheterization, 33 Cardiac contractility, 88 Cardiac disease, 96, 133, 167 Cardiac dysrhythmias, 6, 99, 118,

124, 133, 140, 145, 209, 283, 319

Cardiac failure, 109, 238

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Index 345

Cardiac glycoside, 41, 203, 238 Cardiac index (CI), 5, 34, 120, 317 Cardiac ischemia, 41 Cardiac output (CO), 7, 9, 27, 31, 34-

35 Cardiac pacemaker, 132, 144-145,

280 Cardiomegaly, 17, 27, 41, 306 Cardiomyopathy, 149 Cardiopulmonary disease, 101 Cardiorespiratory compromise, 30 Cardiotoxicity, 277 Cardiovascular collapse, 31, 271 Cardiovascular depression, 14 Cardiovascular reserve, 55 Carling's ulcer, 72 Carotid disease, 39 Carotid occlusive disease, 22, 197 Cataract disease, 333 Cataract surgery, 39, 261-271 Catecholamines, 73-74, 77, 128,

132-133, 171,234,238,277, 290, 293, 318

Catheterization, 61, 65, 84, 86, 120, 157, 173,208, 312, 323

Caudad odontoid migration, 332 Caudal displacement, 332 Cefotaxime, 108 Central venous pressure (CVP), 7,34-

35, 101, 109, 120, 286, 313, 316, 319, 335

Cerebellitis, 246-247 Cerebral artery aneurysm, 22 Cerebral blood flow, 54, 211, 248,

323 Cerebral edema, 115, 117, 162, 164,

171, 173, 197,219 Cerebral hemorrhage, 276 Cerebral ischemia, 165-166, 275 Cerebral perfusion pressure (CPP),

161, 163, 165-167, 170,314, 324

Cerebral vasodilatation, 172, 323 Cerebral vessels, 3 Cerebrovascular disease, 39, 266

Cervical fracture, 326 Cervical incompetence, 152-153,

321 Cervical plexus block, 330 Cervical subluxation, 333 Cervical tomograms, 257 Cesarean section, 51, 310 Chiari II malformation, 48-49, 51-52,

54, 56, 309-310 Chickenpox, 244-250, 331 Chlorambucil, 259 Chloride, 1,215,273 Chlorine, 71 Chlorioamnionitis, 153 Chloroprocaine, 157, 322 Chloropropamide, 261 Chlorothiazide, 139 Cholecystectomy, 29 Cholecystitis, 29 Cholelithiasis, 29 Cholescintigraphy, 29 Cholesterollinoleate, 275, 297 Cholinesterase inhibitors, 181 Chondroma tumor, 94 Choroid, 178 Choroidal blood flow, 177-178 Choroidal vasodilation, 178-179 Chromophobe adenomas, 17 Chromophobic pituitary adenoma, 15 Chronic acetylcalicylic acid treatment,

258 Chronic bronchitis, 97 Chronic obstructive pulmonary disease

(COPD), 3,41,93,96-97, 100, 215,218,220,267,276,278-279

Cimetidine, 77, 160, 169 Cirrhosis, 84, 113 Cistern dye tracer, 210 Citrate intoxication, 81, Citrate overload, 122 Clindamycin, 108 Clonadine, 4,39, 195,215, 308 Coagulation, 77, 87, 109, 112, 119-

122, 144, 238, 317, 330

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346 Index

Coagulopathy, 38, 115-116, 121-122, 168-169,216,223-224, 317

Cocaine, 19-20, 22, 195 Cofactor demand, 234 Colic, 150 Colloid oncotic pressure, 120 Colloid osmotic pressure, 335 Computerized tomography (CAT), 15,

22,48,52,86,93-94,116,145, 160, 162, 166-167, 179, 182, 187, 199, 205-206, 210, 257, 292

Congestive heart failure (CHF), 1, 3, 33, 42-43, 96, 98-99, 112, 113, 132, 147, 199,208-209,216, 221,225-226,241,257,280, 286, 308, 320, 329

Contralateral orbital block, 268 Cornea, 176-178, 182 Coronary angiography 37, 41 Coronary angioplasty system, 36 Coronary artery bypass graft (CABG),

33-34, 36-37, 42-43, 90, 99, 308,316

Coronary artery disease (CAD), 3, 34-35,39-41,43,96,98-100, 117, 134, 197,217,278,280, 286, 307-308

Coronary vessels, 3 Corpulmonale, 27-28, 96-97, 99-

101,316 Cortical atrophy, 206 Corticosteroids, 15,84,90,239,241,

315 Cortisol, 14, 18, 88, 305 Costochondral arthritis, 257 Coughing, 8,40,58,60-61,96-97,

105-106,213, 247, 325 Cranial nerve deficits, 18 Craniopharyngioma, 17 Craniotomy, 160, 169-170, 199,323 Creatinine, 1,28,40, 108, 117, 131,

167, 212, 215, 220, 244, 248, 273, 277, 283, 289

Cricoarytenoid arthritis, 255, 260, 332

Cricoid pressure, 53, 183, 212, 250 Cricothycotomy, 193, 195 Cryoanalgesia, 106, 315 Cryoprecipitate therapy, 122 Crystalloid, 88, 123, 285 Curare, 127, 158, 181,325 Cushing's disease, 15, 17-18, 167,

305 Cushing's syndrome, 15-16 Cushing's triad, 164 Cyanide, 74 Cyanosis, 58, 60, 63, 209, 247 Cyclophosphamide, 259 Cyclosporine nephrotoxicity, 108,

119, 123 Cyst, 237, 257 Cy~tinuria, 141 Cystoscopy, 139,224 Cytarakine, 306 Cytogenetic abnormalities, 153 Cytomegalovirus, 245, 331 Cytotoxic drugs, 84

Dandy-Walker cyst, 204 Deafness, 161 Debridement procedure, 77-78, 80-

81 Dehydration 28, 89, 100, 134, 180,

209,217,225-226,267,297, 306, 379

Delerium, 241 Dementia, 85, 223, 290, 297, 299,

337 Demyelination 247 Deoxyribonucleic acid, 245 Deoxyribonucleic acid polymerase,

249-250, 332 Dexamethasone, 16, 90, 160, 168,

173, 197, 323 Dextran, 31 Dextrocardia, 63 Dextrose, 64, 75, 171, 283, 312 Diabetes, 39-40, 84, 222, 267, 278-

279, 283, 332, 336 Diabetes insipidis, 19, 168, 304, 334

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Index 347

Diabetes mellitus, 19, 33, 216, 224, 229, 261, 263, 273, 276

Dialysis, 249 Diaphoresis, 328 Diaphragm, rupture of, 194 Diaphragmatic excursion, 55 Diaphragmatic hernia, 48, 309 Diarrhea, 77, 88 Diastolic hypotension, 36 Diazepam, 6,18, 113, 119-120, 134-

135, 169, l76, 180, 196,225, 277,318, 337

Diffuse arthritis, 257 Diffuse interstitial fibrosis, 257 Digitalis, 4, 100, 248, 281, 335 Digoxin, 3-4, 41, 2l7, 277 Diiodotyrosine (DIT), 230-232 Dilated veins, 114 Diltiazem, 33, 93 Dilutional coagulopathy, 117 Dioxide demands, 313 Diphenhydramine, 6 Diphenylhydantion, 225 2,3-Diphosphoglycerate (DPG), 25,

36 Diplopia, 323 Dipyridamole, 36, 280-281, 335 Direct laryngeal trauma, 103 Disseminated intravascular coagula-

tion (DIC), 90, 224, 304, 329 Disseminated neurogenic muscle atro-

phy, 267 Distal disease, 276 Distal renal tubular acidosis, 28 Distal tubule of the kidney, 15 Diuretics, 3, 41-42, 83, 100, 115,

117,119,123,147,170, l73, 197, 209, 217, 225-226

Dizziness, 39, 71,165,257-258,280, 313,333

DNA, see Deoxyribonucleic acid Dobutamine 89, 100, 105 Dopamine, 10, 14, 17,89, 123,290-

297,299,308,318,336-337 Doppler measurement, 19,83, 120,

211,323

Double-lumen endobronchial tube (DLET), 93-94, 101-103, 105, 316

Down's syndrome, 48 D-Penicillamine, 259 Droperidol, 180, 184, 197,299 Dye dilution technique, 35 Dysarthria, 255 Dyskinesia, 282, 293-294 Dysphagia, 160, 255, 327 Dysphoria, 298 Dyspnea, 19, 96, 98, 152, 156, 199,

238,247,257,280, 322 Dysrhythmias, 4, 20, 38-39, 41, 98,

100, 124, 129, 132, l70, 225, 238,250,257,280-281,296, 298-299, 306, 308, 319-320, 333

Dyssynergy, 38, 41

Early graft thrombosis, 284 Ecchynosis, 116, 224, 268, 334 Echocardiography, 41, 88, 117, 170,

280-282 Echothiophate, 181 Edema, 71, 73, 77, 79,108,160,162,

168, 197,293,312,333 Edrophonium, 135, 139 Egophony, 97 Ejection fraction, 38, 41, 43, 87-88,

280-282, 286, 307-308, 314 Elective repair, 2 Elective tracheostomy, 259 Electrocardiagram, 1, 27, 31, 41-42,

53,58,63-64,78,88,93,99-101,116, 126, 128, 131, 135-136, 144, 146-147, 167, l70, 205,209-211,229,238-239, 244, 248, 250, 261, 273, 280-282, 285-286, 299, 303, 307-308,318,323,335

Electrocountershock, 4, 6, 18,42,45, 51,62,68

Electronystagmographs, 334 Elevated C-reactive protein levels, 253

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348 Index

Elevated sedimentation rate, 253, Emphysema, 97, 100 "Empty sella" syndrome, 15 Encephalitis, 246-247, 291 Encephalocele, 46 Encephalopathy, 118,222 End-diastolic pressure, 41 End-diastolic volume, 88 Endoaneurysmorrhaphy, 274 Endobrochial intubation, 102, 213, Endocarditis, 217 Endocrine disease, 15, 40, 133 Endocrine dysfunction, 17 Endogenous cortisol, 314 Endogenous protein catabolism, 88-

89 Endoscopic retrograde cholangiopan-

creatographic (ERCP), 29 Endoscopic sphincterotomy, 29 Endoscopy, 144 Endotoxin, 87-88, 315 Endotracheal intubation, 43, 47, 53,

55, 77, 178, 195,242,255,274, 304

Endotracheal suctioning, 172 End-systolic volume, 88 End-tiday nitrogen, 323 Enflurane, 172, 180, 217, 248, 323,

328 Enkaphalis, 336 Enterobacter, 85 Ephedrine, 156-157, 226, 304, 321 Epidemiology, 86 Epidural anesthesia, 322 Epidural block, 260 Epidural catheter, 106, 286 Epidural narcotics, 315 Epidural opioids, 315 Epilepsy, 127 Epinephrine, 88, 111, 181, 195,269,

299, 321, 327, 334, 336 Epiphenomena, 39 Epistaxis, 258 Epstein-Barr virus, 245, 331 Erbium, 279 Erythema, 68

Escharotomy, 70 Esmolol, 147 Esophageal anastomosis, 62, 64 Esophageal atresia, 58-63, 311 Esophageal intubation, 53 Esophageal motility abnormalities,

65 Esophageal stenosis, 60 Esophagoesophagostomy, 62 Esophagotracheal septum, 59 Estrogens, 330 Etomidate, 80, 101, 111, 180,300 Euthyroidism, 230, 235, 238-239,

329 Exaggerated pressor response, 318 Exophthalmos, 240, Expectorants, 100 Expiratory reserve volume, 97 Exsanguination, 31 Extracapsular surgery, 265 Extracellular fluid (ECF), 218 Extracorporeal shockwave lithotripsy

(ESWL), 139 Extramedullary hematopoieses, 306 Extraocular muscle paresis, 268 Extraocular muscles (EOM), 178-

179, 180 Extrathoracic metastases, 315 Eye injury, 176-185

Factor II, 317 Factor VII, 318 Factor VIII, 111, 317 Factor IX, 318 Factor X, 318 Factor deficiencies, 77 Falciparum malaria, 24, 306 Fasciotomy, 67, 72 Fatigability, 254 Fats, 74, 112 Fatty acid oxidation, 234 Felty's syndrome, 258 Femoro-popliteal disease, 276 Fentanyl, 8, 43, 146, 172, 184, 197,

299-300, 308, 328

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Index 349

Fever, 28, 42, 83, 85, 89, 223, 244, 253, 300, 314, 332

Fiberoptic bronchoscopy, 103, 259 Fiberoptic endoscopy, 67, 195 Fiberoptic intubation, 19, 187, 255 Fibrin, 182 Fibrinogen, 72, 112, 120, 224 Fibrinolysis, 112, 117, 122 Fibrinolytic system, 112 Fibrin split products, 224 Fibrosis, 65, 113, 167, 196 Fibrotic scanning, 27 Fibrous metaplasia, 263 Finapres, 296 Fine-needle aspiration (FNA)

235-236 Flexion contractures, 79 Fluid balance 6, 117,209,285 Fluid boluses, 320 Fluid loss, 68, 73, 89 Fluid replacement, 250 Fluid resuscitation, 70, 72-75, 81 Fluoroscope, 143 Fluoroscopic inspection, 20 Focal necrosis, 247 Focal vasculitis, 257 Fogarty catheters, 94 Folate deficiency, 27 Foley catheters, 285 Folic acid deficiency, 117 Folinic acid, 155, 158 Follicle-stimulating hormone (FSH),

14, 18 Fontanelles, 210 Forced expiratory volume (FEY), 97-

99 Forced expiratory volume in one sec-

ond (FEYI), 277 Forced vital capacity (FYC), 97, 277 Fowler's position, 240 Fraction of inspired oxygen (FI02),

104 Functional residual capacity (FRC),

147 Furosemide, 3, 9, 33, 139, 173,225,

248

Gallamine, 120, 127, 181,325 Gall bladder, 83 Gall bladder, gangrenous, 84 Gallium scan, 86, 315 Gall stones, 113 Gamma globulins, 111 Gangrene, 273, 275 Gas exchange efficiency, 277 Gastric acidity, 60, 310 Gastric distention, 64 Gastric emptying, 77 Gastric erosion, 258 Gastric fluid volume, 390 Gastroesophageal reflux, 48-50, 52,

310 Gastrointestinal endoscopic proce­

dures, 84 Gastrointestinal tract, 2, 75, 84, 86,

119,230 Gastrointestinal tract hemorrhage, 115 Gastrointestinal tract motility, 314 Gastroschisis, 48 Gastrostomy, 61-64, 311 Gated blood pool scan, 280 Genitourinary anomalies, 61 Genitourinary tract, 2, 84 Glaucoma, 132, 265 Glioblastoma, 161, 168-169, 173,

322 Glioma, malignant, 169 Global myocardial ischemia, 314 Globe perforation, 271 Glomerular filtration rate (GFR), 220,

267, 277, 298, 334 Glomerular hypercellularity, 249 Glomerulonephritis, 246, 248 Glucagon, 74, 88, 111 Glucocorticoids, 111 Gluconeogenesis, 234 Glucose, 16-17,24,29, 38,63, 74,

77,88, Ill, 116, 120-121, 128, 131, 152, 159, 166, 168, 171, 215,219,229,234,250,273, 283, 313, 322, 324, 331

Glucose homeostasis, 111 Glutamic acid. 23-24

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350 Index

Glyceraldehyde, 307 Glycine, 216, 219, 222 Glycine toxicity, 328 Glycogenolysis, III Glycolysis, 168 Glycopyrrolate, 134,318 Glycosuria, 74, 168 Goiter, 234, 237-238 Goldman Risk Index, 281 Gold salts, 258-259 Gonadal atrophy, 15 Gout, 141 Gram-negative bacteremia, 84-85, 87 Gram-negative bacteria, 76 Gram-positive bacteremia, 84-85 Granulocyte aggregation 304 Granulocytes, 87, 331 Granulocytopenia, 238, 330 Granulomatoid nodules, coalescent,

257 Granulomatous changes, 257 Graves' disease, 238 Growth Hormone (GH), Ill, 305 Guanethidine, 241 Guiding catheter, 36

Habitual abortion, 321 Hair follicles, 68 Halogen, 158 Haloperidol, 337 Halothane, 64, 139, 155, 180, 212,

248, 299, 308, 321-323, 328 Hamartoma, 315 Hamartoma tumor, 9 Headache, 13,22,71,161,163,205-

206,247,313, 322, 327 Heart disease, 7-8, 241, 257, 278 Heart failure, 105 Heart murmur, 22, 40, 215 Heart rate, 34,55,63,73, 117, 127,

134-135, 139, 156, 170,215, 241, 277, 284

Hemangioma, 140 Hematocrit, 1,6,9,10,12,22,27,

41,45, 51,55-56, 58, 63, 67,

77, 93, 100, 116, 120, 152, 156, 160, 170,215,217, 238, 261, 273,284-285,289,297,332, 335

Hematogenous dissemination, 75 Hematologic cancer, 84 Hematologic consultation, 77 Hematoma, 145, 182, 241 Hematuria, 28, 145, 224 Hemianopia, 161 Hemiparesis, 22, 162 Hemiplagia, 162 Hemochromatosis, 113 Hemodialysis, 221 Hemodynamic instability, 122 Hemodynamic stability, 20, 172-173 Hemoglobin (Hb), 1, 12,22-25,41,

45,51,55,67,70-71,93, 105, 144, 156,213,217,221,238, 273, 313, 322, 335

Hemolysis, 29, 219 Hemolytic anemia, 23, 25-27 Hemopneumothorax, 194 Hemorrhage, 18, 105, 224, 249, 275,

323 Hemostasis, 9, 121, 195 Heparin, 120, 122, 168-169, 229,

269,317 Heparinization, 42 Hepatic blood volume, 317 Hepatic drug clearance, 267 Hepatic dysfunction, 40, 168 Hepatic encephalopathy, 115, 119 Hepatic failure, 113 Hepatic transplantation, 108-124

Anhepatic phase, 121-122, 124 PostJanhepatic phase 121-122 Preanhepatic phase, 121-123

Hepatic venous pressure, 109 Hepatitis, 29, 108, 112-113, 115,

156,246 A, 112 B, 112 Non-A, 112-113 Non-B, 112-113

Hepatocellular dysfunction, Ill, 316

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Hepatocytes, 114, 120 Hepatomegaly, 116 Hepatorenal syndrome (HRS), 114,

122 Herniation of caudad vermis, 48 Herniation of heart, 105 Herpesviruses, 245, 331 Hexoses, 230 High-frequency jet ventilation

(HFJV) , 146 Hilar adenopathy, 93 Hilar oblique tomograms, 94 Histamine, 87, 312 Holium,279 Homeostasis, 54 Homovanilic acid (HV A), 336 Honan cuff, 269 Hormonal stress response, 91 Hormone circulating levels, 305 Hormones, 111 Hormone secretions, 13 Humidification, 79, 100 Hyaluronidase solution, 269 Hydration states, 238 Hydrocephalus, 46, 48-50, 54, 199-

213, 309, 327-328 Hydrochlorothiazide, 1, 160, 199,261 Hydrogen chloride, 71 Hydrophilic polar residues, 24 Hydrostatic pressure, 73 Hydroxychloroquine, 259 Hydroxyethyl starch, 285 5-Hydroxytryptophan, 133 Hydroxyurea, 30, 306 Hydroxyzine, 6 Hyperaldosteronisin, 119, 122 Hyperalimentation, 62, 297, 311 Hyperbaric tetracaine, 322 Hyperbilirubinemia, 63 Hypercalcemia, 122 Hypercapnea, 166 Hypercarbia, 24, 30, 98, 240, 276 Hypercatabolism, 88 Hyperdynamic circulation, 114 Hyperglycemia, 1,6,16, Ill, 122-

123, 168, 263, 283

Index 351

Hyperinflation, 99-100 Hyperkalemia, 53, 79, 91, 211, 283,

299, 313, 335, 337 Hyperlipidemia, 28 Hypermetabolism, 78, 88 Hypernatremia, 41, 168, 220, 329 Hyperoxaluria, 141 Hyperoxia, 62, 178 Hyperparathyroidism, 141 Hyperphagia, 238 Hyperplasia, 127 Hyperprolactinemia, 16 Hyperpyrexia, 241 Hypertension, 1, 3-4, 6-8, 12, 16,

19-20,27-28,39,41-43, 83, 98, 100, 114, 119, 126, 129, 132-134, 136, 152, 157, 160, 162-163,165,168-169, 181, 194, 199-200, 205, 212-213, 215-216, 221-223, 229, 240, 261,267,275-276,278,283-284, 298, 304-306, 308, 318-319, 323, 332, 336

Hyperthyroidism, 16, 230, 232, 234-235, 238-239, 329-330

Hypertonic saline, 73, 225 Hypertonic sodium chloride, 75 Hyperventilation, 79, 114, 156, 158,

164,166,171,197,248,281, 323

Hyperviscosity syndrome, 258 Hypervolemia, 222 Hypoalbuminemia, 111 Hypocalcemia, 63, 121-122 Hypocapnea, 36, 316 Hypocarbia, 156, 172,217,323 Hypochronic macrocytic anemia, 333 Hypochronic microcytic anemia, 258 Hypofibrinogenemia, 224 Hypoglycemia, 40,63, Ill, 122, 156,

306 Hypokalemia, 16,41,117,121-122,

168,238,281 Hypokinesia, 290 Hyponatremia, 41,117,216,218-

219,221, 225, 329

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352 Index

Hypoparathyroidism, 241 Hypophysectomy, 12, 15, 17 Hypopituitarism, 17 Hypoplasia, 127, 253 Hypoproteinemia, 73, 312 Hypoproteinemic edema, 28 Hyposmolar solution, 328 Hyposthenuria, 28, 31 Hypotension, 5, 9, 30-31, 54, 83-85,

87-88, 122-124, 126, 132-133, 145-147, 156, 168-170, 197, 219,222-223,225-226,237, 241-242,312,317,319,327, 336-337

Hypothalamic dysfunction, 52 Hypothalamic injury, 15 Hypothalamic-pituitary disease, 18 Hypothalamic-pituitary-thyroid-axis,

233 Hypothalamopituitary axis, 168 Hypothermia, 51-52, 79, 85, 122,

145, 149, 222, 239, 241, 305, 310, 313, 330

Hypothyroidism, 15, 329 Hypoventilation, 164, 169 Hypovolemia, 41-43, 74, 80, 90,

123-124,217,282 Hypoxemia, 70, 100, 103-104, 178 Hypoxia, 26, 30-31, 35-36, 40, 50,

54,99, 105, 114, 149, 168,211, 221,247,276,283,303

Hypoxic myocardial dysfunction, 314 Hypoxic vasoconstriction (HPV), 104,

316

Idiopathic hypertrophic subaortic ste-nosis, 35

I fibrinogen scans, 168 Immunosuppression, 84, 259, 332 Incentive spirometry, 100 Increased contractility, 307 Increased vascular permeability, 312 Increased wall tension, 307 Indocyanine green, 35

Indwelling arterial pressure catheter, 285

Infarction, 18, 35, 205 Infection, 115, 145, 166, 328 Infiltrates, 116 Infrarenal aortic crossclamping, 303-

304 Infrarenal graft substitution, 274 Inhalation anesthetics, 35 Innovar, 291, 299 Inotropic support, 42 Inotropy, 105, 226 Insulin, 29, 33, 88, 111, 168,273,

283, 324 Intercostal nerve blocks, 106 Interleukin-2 (IL2), 169 Interscalene block, 260 Interstitial oncotic pressure, 72 Intestinal carcinoma, 161 Intestinal obstruction, 328 Intraabdominal pressure, 114, 121 Intraaortic balloon pump, 38, 42, 308 Intraarterial cannulation, 84, 303 Intraarterial catheterization, 78 Intracardiac shunts, 35 Intracranial compliance, 323 Intracranial hypertension, 164, 167-

168, 173 Intracranial pressure (lCP), 48, 54,

115, 161-169, 171, 173, 197, 205-206, 208-212, 247-248, 309,311, 323

Intracranial tumor, 160-173 Intralational bums, 69-71 Intraocular lens implantation, 261 Intraocular physiology, 177-179 Intraocular pressure (lOP), 177-181,

185, 324-325 Intraoperative acidosis, 317 Intraoperative blood loss, 327 Intrapleural catheterization, 106 Intravascular absorption, 218 Intravascular fluid, 73 Intravascular markings, 116 Intravascular volume, 89, 312, 323

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Index 353

Intravenous cannulation, 75, 78, 84 Intravenous heparinization, 36 Intravenous pyelogram (IVP), 94, 144 Intravenous regional block, 260 Intravenous sedation, 36-37 Intubation, 24, 63, 67, 70, 79, 102,

129, 139, 146, 156, 171, 184, 188, 193-195,210,212,220, 253, 255, 257, 259-260, 333

Invasive cardiac monitors, 75, 84 Iodide, 230-232, 234, 239, 241, 330 Iodine, 230, 232, 239, 330 Iodine deficiency, 232 Ionized calcium, 77 Ipsilateral hilar involvement, 315 Ipsilateral peribronchial involvement,

315 Iridocyclitis, 253 Irrigation solution, 216, 218-219,

221-226,251,328-329 Ischemia, 1,4,38,68, 72, 88, 100,

118, 134, 149, 162-164, 168, 171,281, 303, 320, 335-336

Ischemic epiphenomena, 40 Ischemic heart disease, 275 Isoflurane, 120, 139, 171-172, 180,

212, 248, 250, 300, 323, 328 Isoproterenol, 277, 336 Isotonic crystalloid solutions, 55 Isotope brain scan, 162

Jaundice, 108, 248 Jejunostomy tube, 62 Joint deformity, 254 Jugular venous distention, 99, 316 Juvenile arthritis, 253

Ketamine, 10, 80, 102, 120, 155, 171-172, 180,298-299,306, 310, 322, 328, 337

Kidneys 114, 116-117, 123 Kidney stones, 140 Kinin system, 87

Klebsiella, 85 Kyphosis, 45, 48, 51, 309

Labetalol, 4, 8, 172 Lactate, 168 Lactic acidosis, 84 Lactulose, 119 Laparotomy, 84, 86, 187 Laryngeal abnormalities, 332 Laryngeal aditus, 59 Laryngeal edema, 67 Laryngeal nerve injury, 65 Laryngeal obstruction, 326 Laryngoscopy, 19, 171, 179, 196,

211-212,224,258-259 Laryngospasm, 30, 52 Larynx cephalad, 59 Larynx, fracture of, 195 LASER instrumentation, 279-280 Lateral decubitus position (LOP), 101 Lateral profile inspection, 255 L-DOPA, 294, 296-299, 336-338 Lecithin/sphingomyelin ratio, 45 LeFort injuries, 189, 190-192, 194,

196 LeFort I fracture, 326 LeFort II fracture, 326 LeFort III fracture, 326 Left ventricle, 35 Left ventricular compliance, 40 Left ventricular dysfunction, 38, 42 Left ventricular dyskinesia, 286 Left ventricular ejection, 35 Left ventricular failure, 39 Left ventricular function, 286 Left ventricular hypertrophy, 281,

335 Left ventricular-outlet obstruction, 39 Left ventricular stroke work index

(LVSWI),7 Leiomyoma tumor, 94 Leukemia, 249 Leukocytosis, 85 Leukopenia, 76, 85, 258-259

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354 Index

Leukotrienes, 73 LH,305 LH-secreting tumors, 16 Lidocaine, 8, 10, 19, 42, 102, 139,

171-172, 184,211-213,240, 250, 269, 322, 325, 327-328

Ligamentous involvement, 254 Lipid metabolism, 234 Lipid-soluble gases, 71 Lipolysis, 14, 88, 234 Lipoma tumor, 94 Lipopolysaccharide, 87 Lithium, 126, 130, 133,231-232,319 Lithotomy, 296 Lithotripsy, 139-150 Lithotriptor bath water, 319 Liver, 94, 99, 109-110, 116, 118,316 Liver blood flow, 109-111 Liver blood volume, 109-110 Liver disease, 109, 133 Liver disease, cholestatic, 112-113 Liver disease, parenchymal, 112-113 Liver disease, systemic pathyophysio-

logic effects, 114-115 Liver dysfunction, 29, 109, III Liver enzymes, 40, 131 Liver function, 108, 111-112 Liver function tests, 29, 331 Liver, rupture of, 194 Liver size, 267 Liver transplantation, 109, 317 Lobectomy, 160, 167, 315 L-tyrosine, 292-293, 297, 337 Lugol's solution, 239 Lumbar laminectomy, 299 Lumbar puncture, 22, 331 Lundberg's plateau, 164 Lung cancer, 94-96 Lung carcinoma, 315 Lung compliance, 335 Lung disease, 62, 93, 316 Lung function, 106 Lung resection, 97-99 Lungs, 26, 45, 59, 71, 73, 97, 161,

167 Lung scan, 247

Lung sounds, 10 1 Lung tumors, 315 Lung volumes, 114 Luteinizing hormone (LH), 14, 18,

305 Lymphocyte, 169, 331 Lymphokine-activated killer cells

(LAK) , 169

Macroadenoma, 17 Macrocytic anemia, 17 Maculopapular rash, 314 Madopar, 293 Mafenide, 76, 313 Magnetic resonance imaging (MRI),

145, 162, 210, 257 Maintenance intravenous fluid, 120 Malaise, 254 Malaria, 108 Malnutrition, 100, 132 Mandible, 188-189 Mandibular fracture, 188-189 Mannitol, 9, 123, 133, 169, 173, 180,

219, 222, 248 Manometry, 179 Marrow depression, 333 Masked acute hepatocellular disease,

113 Massive goiter, 235 Mass spectrometry, 101, 170,285,

323 Maxillary fractures, 189, 190-192 Maxillofacial injury, 187-198 Maximal breathing capacity (MBC),

97 McDonald procedure, 152, 154 Mean arterial pressure (MAP), 7, 35,

39, 149, 163-164, 167,319,327 Mean circumferential fiber shortening

rate, 281 Mean corpuscular hemoglobin concen-

tration (MCHC), 25, 306 Mean corpuscular volume (MCV), 27 Mediastinoscopy, 94-95 Medulloblastoma, 161

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Index 355

Melanoma, 161, Meningeal symptoms, 18 Meningioma, 161, 168, 199 Meningomyecele, 45-56, 200, 204,

309,311, 327 Meperidine, 158 Mesangium, 28 Mesencephalon, 54 Metabolic acidosis, 122,275,313-

314 Metabolic demands, 313 Metabolic rate, 52, 76-77 Metaclopramide, 182 Metaproterenol, 93 Metastatic disease, 96, 167, 330 Metastatic intracranial tumors, 161,

173,322 Methemoglokinemia, 76 Methimazole (MMI), 231-232 Methionine synthase, 155 Methohexital, 53, 126, 135, 183,212,

318 Methotrexate, 169 Methoxamine, 156, 321 3-Methoxydopa, 337 Methylprednisolone, 90 Metoprolol, 229 Metyrapone, 16 Microcirculation, 72 Microcytic hypochronic anemia, 117 Microglial proliferation, 247 Microvascular penneability, 72 Microvasculature, 72 Midazolam, 19, 119,225,277,318,

322 Midmaximal flow rate, 92 Mitochondrial enzymes, 74 Mitral regurgitation, 42, 280 Monckeberg's medial calcific sclero-

sis, 275-276 Monoamine oxidase inhibitors, 129,

293,318 Monoiodotyrosine (MIT), 230-232 Monomicrobial bacteremia, 85 Mononuclear infiltration, 247 Moon facies, 16

Morphine, 106 Morphine sulfate, 67 Motor impainnent, 106 Motor paralysis, 45 Mucocutaneous gold reaction,

259 Mucolytics, 100 Mucosal bleeding, 249 Mucosal necrosis, 70 Multinoduar toxic goiter, 237 Multiple uptake gated acquisition

(MUGA),286 Multiply resistant bacteria, 314 Multisystem degeneration disease,

278,291 Multisystem involvement, 3 Muscle atrophy, 254 Muscle relaxants, 43, 53, 64, 79, 102,

127-128, 132, 135-136, 146, 158, 170, 172, 178, 181, 183-184, 194,217,225,248,250, 300, 313, 325

Muscle rigidity, 241 Myalgia, 254 Myasthenia gravis, 238 Mycoplasmosis, 153 Mydriasis, 167 Myelitis, 246 Myocardial contractility, 35, 36, 124,

219 Myocardial contusion, 194 Myocardial depressants, 74, 257,

314 Myocardial function, 42, 87-88 Myocardial infarction (MI), 3-4, 6,

37-40,43,88-91,98-100,131-132, 149, 170, 196, 199,212, 239,246,271,275,278,280, 281,283,286,295, 304, 308, 316

Myocardial ischemia, 278, 308, 335 Myocardial oxygen supply, 36, 307 Myocardial perfonnance curve, 4-6, Myocardial perfusion, 88 Myoepithelial cells, 15 Myotonic dystrophy, 263, 334

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356 Index

Naloxone, 4, 89, 106 Narcotics, 43,52,78,80,90-91,101,

150, 158, 172, 180, 182-184, 213,217,220,237, 284, 313, 325

Nasal cannula, 225 Nasogastric intubation, 58 Nasotracheal intubation, 19, 75, 86,

182, 196,314 Nausea, 39, 71, 106, 108, 152, 161-

163, 167, 169, 183-184,205-206,209,220,223,297, 313, 327

Needle biopsy, 94-95 Nelson's syndrome, 16 Neodynium, 279 Neomycin, 119 Neoplasm, pituitary, 15 Neoplasm, prolactin-secreting, 16 Neoplastic disorders, 15 Neostigmine, 135 Neo-synephrine, 284, 304 Nephritis, 246 Nephrostomy, 150 Nephrotic syndrome, 28, 253 Nerve injury, 241 Nerve truck block, 90 Neurodermatitis, 131 Neurofibroma, 161 Neurogenic bladder, 47 Neuroleptic malignant syndrome,

132-133 Neuromuscular blockade, 80, 136 Neurotransmitters, depletion of, 267 Nifedipine, 33, 37 Nigrostriatal degeneration, 291 Nitrogen, 120, 122, 170 Nitrogenous compounds, 115 Nitroglycerin, 1,3,9-10,37,39,93,

100, 105, 127, 129, 134, 136, 284,308

Nitropaste, 33 Nitroprusside, 200, 239 Nitrous oxide, 20, 43, 53-54, 64-65,

80, 155, 158, 172, 180, 184,

197,240,242, 300, 307, 321-322, 324, 328

Nomogramy, 180 Nondepolarizing muscle relaxants

(NDMR), 80, 310, 313, 319 Nonelastomeric balloon dilation cathe-

ter, 36 Nonhemolytic, 328 Nonpituitary tumors, 16, 305 Nonsteroidal antiinflammatory drugs

(NSAID), 258 Norepinephrine, 14, 17 Normocarbia, 39, 104, 300 Normokalemia, 41 Normosol, 6, Normotension, 54, 85, 129, 318 Normothermia, 64 Nuchal rigidity, 22, 247 Numbness, 39

Oat cell carcinoma, 96 Obesity, 267 Obligate sodium excretion, 51 Obstructive hydrocephalus, 13 Occipital headache, 323 Occlusion of right coronary artery, 33 Occlusion of vertebral arteries, 257 Occult blood loss, 227 Oculocardiac reflex, 334 Odontoid migration, 257 Oliguria, 85, 114, 249 Olivopontocerebellar atrophy, 291 Omphalocele, 48 Oncotic pressure, 14 One-lung anesthesia (OLA), 101,

103-104 Ophthaine, 269 Ophthalmoscopy, 182 Opiates, 115 Optic atrophy, 268, 327 Optic chiasm, 18, 161 Oral candidiasis, 332 Oral contraceptives, 113 Organ hypoperfusion, 84

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Index 357

Organogenesis, 321 Oronasopharyngeal airway placement,

188 Orthopedic defects, 51 Orthopedic implants, 140 Orthopnea, 98, 280 Orthostatic hypotension, 296 Osmotic diuresis, 19, 74 Osteoarthritis, 266, 306 Osteoporosis, 16, 132, 259 Overhydration, 74 Oxacillin, 273 Oximetry, 211 Oxygen, 9-10, 24, 30-31, 36, 39,

42-43, 54, 62, 65, 79, 89, 90, 100-102, 104, 109-111, 120, 129, 136, 146, 149, 164, 178, 201,234,240-241,250,257, 271,307, 323

Oxygenation, 23, 31, 94, 128, 135, 181, 183,212,247,250

Oxyhemoglobin saturation curve, 24 Oxytocin, 15, 19

Pancuronium, 120, 122,211,250, 319

Panhypopituitarism, 15, 168, 305 Papillary muscle dysfunction, 280 Papillary necrosis, 28 Papilledema, 167, 205-206, 327 Papvovirus infections, 26 Paracentesis, 119 Paralysis, 162,310 Paranasal sinusitis, 86 Paraplegia, 319 Parasinal sinusitis, 314 Parathyroid function, 15 Parkinson's disease, 266, 289-300,

336-337 Parlodel, 299 Paroxysmal atrial tachycardia, 4 Paroxysmal nocturnal dyspnea, 280 Pentylenetetrazol, 127 Perchlorate, 231-232

Percutaneous angioplasty, 279 Percutaneous nephrolithotomy, 150 Percutaneous transhepatic cholangiog-

raphy (PTC), 29 Percutaneous transluminal coronary

angioplasty (PTCA), 33-34 Peribular anesthesia, 270 Peribular block, 262 Pericardial effusion, 257 Pericardia! tamponade, 194 Pericarditis, 248, 257 Perinephric hematoma, 320 Peripheral decarboxylase inhibitors,

337 Peripheral edema, 316 Peripheral nerve stimulator, 170 Peripheral vascular resistance (PVR),

7 Peritoneal cyst, 209 Peritoneal dialysis, 221 Pernicious anemia, 238 Persentine, 281 Petedrial, 258 Phacoemulsification, 261 Phagocytosis, 28, 253 Phenothiazine, 16, 113, 133,291,

299, 305, 318-319 Phenylephrine hydrochloride, 304,

321 Phenytoin, 3, 121, 168-169, 171,

199, 225, 324 Phosphorus, 221 Photophobis, 183 Pilocarpine, 181 Pilonidal cyst, 12 PIPIDA scintigraphy, 314 Pituitary apoplexy, 17-18 Pituitary deficiency, 15 Pituitary function, 15 Pituitary gland, 16 Pituitary gonadotropins, 15 Pituitary neoplasms, 15, 18 Plasma cholinesterase (PCLE), 120 Plasma colloid oncotic pressure, 119 Plasma epinephrine, 267

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358 Index

Plasma norepinephrine, 267 Plasma osmolalities, 123 Plasmapheresis, 259 Plasma ultrafiltrate, 201-202 Platelets, 27,120-122,169,182,224,

249,258 Plethysmography monitor, 170 Pleural effusion, 108, 116 Pneumocephalus, 324 Pneumoencephalography, 15, 210 Pneumomediastinum, 241 Pneumonia, 29, 97, 105, 116, 208,

247, 306 Pneumonitis, 200, 246 Pneumothoraces, 241, 331 Polyarticular arthritis, 253 Polycythermia, 333 Polyvinyl chloride, 309 Pontine myelinolysis, 329 Portal hypertension, 317 Porto systemic bypass, 118 Positive pressure ventilation, 225 Positive rheumatoid factor, 253 Potassium, 1,3, 12,24,28, 117, 120,

122, 215 Prednisone, 108, 119 Pregnancy, 112 Procainamide, 4 Procyclidine, 292 Progressive hepatorenal syndrome,

108 Progressive supranuclear palsy, 291 Prolactin, 12, 14, 16, 18, 305 Propanolol, 1,4, 8, 199, 239 Proparacaine, 269 Propylthiouracil (PTC), 232 Prostacyclin, 315 Prostaglandins, 312 Prostalectomy, 226 Prostatic infection, 223 Protein, 111, 115, 119, 178,234,247,

262-263, 315, 330-331 Proteinuria, 28, 248, 258-259 Prothrombin time, 108, 112, 224,

316,323

Pruritis, 106 Pseudocholinesterase deficiency, 132-

133 Pulmonary artery pressure (PAP), 7 Pulmonary artery wedge pressure

(PAWP),4-5 Pulmonary capillary wedge pressure

(PCWP),7-8 Pulse oximetry, 7, 31, 170,211,239,

250, 259, 285-286 Purified protein derivative tuberculin

test (PPD), 94 Purpura fulminans, 249, 258 Pyridoxine, 293

QRS complex, 329 QT interval, 167

Raccoon eyes, 194 Radial artery, 6 Radial artery cannulation, 120 Radial limb dysplasia, 64, 311 Radial link anomalies, 61 Radial pulse, 284 Radiation therapy, 15, 17, 167 Radiography, 103, 162, 182, 194,210 Radionucleotide, 169 Radiopaque contrast, 6 Radiotelemetry 180, Radio therapy, 161 RaJes, 97, 108, 199,316 Rantidine, 156 Rauwolfia alkaloids, 133 Rebound intracranial hypertension,

325 Receding chin, 255 Recurrent laryngeal nerve palsy, 96 Red blood cells, 22, 24-27, 30, 55,

62, 80, 121,226, 238, 284-285 Reflex bradycardia, 164 Refractive therapy, 32 Regurgitation, 3 Releasing factors, 203

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Index 359

Renal amyloiclosis, 333 Renal anomaly, 65 Renal bicarbonate wasting, 76 Renal blood flow, 73 Renal calculi, 319 Renal cell carcinoma, 161 Renal cortical mass, 277 Renal deformities, 64 Renal disease, 3, 40, 259, 278 Renal drug clearance, 267 Renal dysfunction, 115, 258, 333 Renal failure, 72, 221 Renal function, 76, 124, 167 Renal function tests, 77 Renal insufficiency, 4, 200, 322 Renal lesion, 28 Renal medullary concentration gradi-

ent, 28 Renal parenchymal insufficiency, 220 Renal perfusion, 89 Renal plasma flow, 267 Renal reabsorption, 324 Renal system, 220-221 Renal toxicity, 258 Renal tract, 145 Renal tract innervation, 320 Renal vascular resistance, 303 Renal vessels, 3 Renin, 24 Resectoscope, 216, 219, 222, 329 Reserpine, 241, 291, 337 Residual muscular blockade, 328 Residual volume, 97 Respiratory acidosis, 100, 325 Respiratory alkolosis, 85, 178 Respiratory arrest, 220 Respiratory depression, 30, 106, 149 Respiratory distress syndrome (RDS),

63 Respiratory embarrassment, 117,

119 Respiratory failure, 105 Respiratory function, 62 Respiratory monitor, 56 Respiratory obstruction, 189, 196

Respiratory rate, 63, 67, 97,104,127, 160, 187

Respiratory reserve, 313 Respiratory system, 208, 220 Respiratory system injuries, 70 Respiratory tract, 71, 84, 86 Respiratory tract, cilia, 71 Respiratory tract dysfunction, 71 Respiratory tract infection, 208 Responsive epithelium permeability,

15 Restenosis, 34 Reticulocyte counts, 27 Reticulocytes, 26 Reticuloendothelial system, 25, 80 Retinal detachment, 132 Retinopathy 62, 258 Retrobulbar anesthesia, 268-269, 271 Retrolental fibroplasia, 54, 62 Revascularization, 42 Rheology, 31 Rheumatoid arthritis (RA), 253-260,

332-333 Rhinorrhea, 199 Rib, fracture of, 194 Right atrial pressure, 83 Right bundle branch block, 99 Right pleural effusion, 83 Right-sided heart failure, 307 Right upper lobe (RUL), 93 Right upper lobe atelectsis, 58 Right ventricular hypertrophy, 99, 307 Right ventricular stroke work index

(RVSWI),7 Ringer's solution, 4, 6, 75, 171,219,

283 Robinhood effect, 335

Salicylates, 234, 258, 322 Saline, 75, 106, 182, 218, 242 Salmonella, 85 Salt, 31 Scaline node biopsy, 94 Schiotz indentation tonometer, 180

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360 Index

Schizophrenia, 127, 130, 290 Scintigraphic scan, 83 Scintigraphy, 86 Sclera, 182 Scleral capsule, 177 Scleral icterus, 22 Scleral perforation, 268, 271 Scleropathy, 118 Sclerosis, 334 Scoliosis, 45, 48, 51, 309 Scopolamine, 318 Secondary erythropoiesis, 316 Secondary fibrinolysis, 329 Secondary hyperaldosteronism, 117 Sedation, 39, 224 Sedatives, 52, 145, 328 Sellar tomograms, 15 Sellick's maneuver, 158 Semen, 15 Sensory deficit, 248 Sepsis, 27, 50, 83-91, 112,222-223,

227, 304, 314-315, 329 Septic emboli, 208 Septicemia, 223 Septic shock, 314-315 Serotonin, 14, 290 Serratia, 85 Serum acid phosphatase, 221 Serum albumin, 297, 317 Serum ammonium, 216 . Serum bicarbonate, 83 Serum cholesterol, 234 Serum creatinine, 221 Serum electrolytes, 1, 31, 73, 116,

131, 167, 170,210,261,273 Serum glucose, 168, Serum potassium 4, 221, 299-300 Serum prolactin levels, 16, 305 Serum sodium, 215, 219, 226 Serum triglyceride, 234 Severe rheumatoid vasculitis, 259 Shirodkar procedure, 154 Shock, 15, 85, 194 Shock waves, 320 Shunting, 114-115, 123, 149, 197,

199, 206-209, 327

Sickle cell anemia (SeA), 22-28, 31, 306-307

Sickle cell disease, 23-24, 27 Sickle cell trait, 23-24, 30 Silicotic nodules, 257 Silver nitrate, 76, 314 Silver sulfadiazine, 76, 314 Simplex virus, 245 Sinemet, 289, 293 Sinusitis, 75 Sinusoidal pressure, 319 Sinus rhythm, 1, 139, 238 Sjogren's syndrome, 253 Skeletal muscles, 34 Skin atrophy, 254 Skin cancer, 263 Skin changes, 238 Skin grafting, 68 Skull fracture, 194-195, 326 Sky-Drager syndrome, 291 Small-cell carcinoma, 315 Smallpox, 244 Small vessel sclerosis, 276 Smoking, 40, 200, 279, 282 Sodium, 1, 12,73, 75-76, 119-120,

133,217,225,273 Sodium bicarbonate, 10, 79 Sodium metabisulfate, 29 Sodium nitroprusside therapy, 232 Sodium thiopental, 158, 310 Solute toxicity, 218, 222 Somatosensory evoked potential

(SSEP) recordings, 7, 286, 303 Sorbitol, 219, 222 Spasmodic torticollis, 334 Spectrometry, 120 Sphenoid bone, 13 Sphincter control, loss of, 248 Spina bifida, 46-47 Spinal block, 260 Spinal cord, 9, 48, 303 Spinal cord injury, 141 Spinal fluid, 54 Spinal involvement, 248 Spirometry, 30, 101, 105, 107, 200,

316

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Index 361

Spironolactone, 119 Spleenomegaly, 258 Spleen, rupture of, 187 Splenic sequestration, 117 Sputum production, 94, 100 Squamous cell carcinoma, 315 Staphylococcus aureus, 246 Starling forces, 73 Stasis, 26, 31 Steel's rule of thirds, 256 Stenosis, 3, 37, 41 Sternotomy, 43 Steroids, 18, 71, 84, 90, 100, 167,

168, 171, 173,203-204,257, 259, 305, 323, 327

Still's disease, 253 Streptococcus pyogenes, 246 Streptokinase, 42, 308 Stress test, 41 Striatal leu-enkephalin levels, 295 Striatonigral degeneration, 291 Stridor,48-49,51,56,242,255,310,

332 Stroke, 39, 275-276 Stroke index (SI), 7 Stroke volume (SY), 7, 34-35, 88,

217,285 Subarachnoid aneurysm rupture, 18 Subarachnoid catheterization, 286 Subaxial subluxation, 257, 332 Subcutaneous emphysema, 103 Subcutaneous epinephrine, 327 Subcutaneous nodules, 254 Subdural hematoma, 117 Subdural pressure monitoring, 323 Subendocardial ischemia, 8 Subluxation 254, 352 Substantia gelatinosa, 106 Succinylcholine, 41, 53, 79-80, 120,

126-127, 135, 139, 158, 178-179,181, 184,211,283,299, 310,313,318-319,322, 325

Suctioning, 105, 331 Sufentanil, 8, 43, 120, 217, 308, 337 Sulfadoxinelpyrimethamine (Fansi-

dar®) , 108

Sulfur dioxide, 71 Sump catheter, 61 Suppurative thrombophlebitus, 74 Suprapubic cystostomy, 223 Suprasellar tumors, 168 Supraventricular contractions, 320 Supraventricular dysrhythmia, 4 Surgical resection, 315 Surgical revascularization, 317 Swan-Ganz pulmonary artery catheter,

303 Sweating, 39 Symmetrel, 292 Symmetrical joint swelling, 254 Symmetric polyneuropathy, 314 Sympathetic blockade, 90, 106 Sympathetic stimulation, 35 Syncope, 39, 165 Synergistic hypotension, 197 Synthetic estrogens, 113 Systemic alkalosis, 307 Systemic antibiotic prophylaxis, 75 Systemic arterial hypertension, 164 Systemic homeostasis, 171 Systemic hypertension, 99, 109, 161,

201 Systemic hypotension, 109, 324 Systemic hypovolemia, 72 Systemic narcotics, 31 Systemic opioids, 106 Systemic perfusion, 122 Systemic toxicity, 76 Systemic vascular resistance (SYR),

35, 83-84, 114, 123-124,286, 315

Systolic dysfunction, 88 Systolic murmur, 22 Systolic time intervals, 281

Tachycardia, 20, 36,41,43,58, 132, 139,167, 169,223,258,277, 307, 323, 329, 336, 343

Tachypnea, 28, 58, 61, 71, 85, 89, 247

Tactoids, 24

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362

Talipes equinovarus, 48 Tarsorrhaphy, 240 Technetium, 282 Temperature, 23, 64, 83, 101, 120,

211, 239, 241, 250, 310 Temperature homeostasis, 46 Temperature monitoring, 42 Temperature probe, 285 Temporomandibular dysfunction,

333 Temporomandibular joint ankylosis,

255 Teratogen, 46 Teratogenic agents, 321 Testosterone, 234, 330 Tetanus, 75 Tetanus prophylaxis, 312 Tetracmne, 157, 322 Tetraiodothyronine, 18 Tetralogy of Fallot, 63, 311 Thallium, 99, 281, 335 Thallium scan, 280 Theophylline, 93, 100, 215 Thermodilution, 35 Thermoregulatory control mecha-

nisms,78 Thiamylal, 328 Thiobarbiturates, 236, 240, 330 Thiocyanate, 231-232 Thiopental, 19,53, 172,211, 300,

318 Thiopental sodium, 139 Thiouracil, 231 Thioureylenes, 330 Thoracic flexion deformity, 257 Thoracic lesion, 257 Thoracotomy, 62, 64, 96, 105-106,

160, 315 Thrombin clot time, 120 Thrombocyte dilution, 224 Thrombocytopenia, 81, 85,90, 115,

117, 119,238,246,249,259, 317,330,332

Thrombocytosis, 25, 332 Thromboelastograms, 121-122, 317 Thromboelastography, 120

Index

Thromboembolic complications (TEC), 168

Thromboendarterectomy, 274 Thromboins, 108, 112, 208 Thrombolytic therapy, 42 Thrombophlebitis, 132 Thromboplastins, 41, 216, 329 Thromboplastin time, 224, 317 Thrombosis, 168 Thromboxane,87 Thyroid carcinoma, 230 Thyroid disease, 132, 235 Thyroidectomy, 229-242, 329-331 Thyroid hormones, 230-239, 330,

305 Thyroid peroxidase (TPC), 232 Thyroid/plasma (TIP) iodide ratio, 230 Thyroid-stimulating hormone (TSH),

232-235, 305 Thyroid storm, 240-241, 330 Thyronine-binding globulin (TBG),

231 Thyrotoxicosis, 235, 237, 240, 336 Thyrotropin-dependent process

(THS),231 Thyrotropin-releasing hormone

(TRH), 232-233 Thyroxine, 230, 234 Timolal, 181 Tomography, see Computed tomogra-

phy (CT) Tonsillectomy, 108 Toxoplasmosis, 153 Tracheal intubation, 64, 80, 83, 225,

247 Tracheal malacia, 61, 65, 241 Tracheal suctioning, 65 Tracheobronchial rupture, 103, 194 Tracheoesophageal fistula, 58-64, 241 Tracheostomy, 63, 65, 70, 86, 187-

188, 193, 195, 242, 255-256, 326

Transcutaneous electrical nerve stimu­lation (TENS), 106

Transcutaneous oxygen monitoring, 53,55

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Index 363

Transesophageal echocardiography, 42

Transesophageal two dimensional echocariography (2D-TEE), 282

Transient syncope, 280 Transsphenoidal hypophysectomy, 19 Transurethral prostatectomy (TURP),

215-227,328-329 Transverse myelitis, 247 Trauma, 15, 86 Trendelenburg position, 157, 197,

308,321,327,331 Tricyclic antidepressant therapy, 319 Trigeminal neuralgia, 131 Trihexyphenidyl, 292 Triiodothyronine (T3), 18230, 234 Triple vessel disease, 308 Tuberculosis, 257 Tubulointerstitial nephritis, 28 Tumor, 170, 173,324 T wave alteration, 281, 329 Tyrosine amino acid, 232 Tyrosine hydroxylase, 293

Ulceration, 71, 253 Ulcerative colitis, 131 Ultrasonography, 113, 116, 235 Ultrasound scans, 48, 52, 86, 282,

334 Ultraviolet eximer, 279 Ultraviolet light, 334 Upper esophagus, 61, 64 Upper gastrointestinal series (UGI), 94 Urea, 119, 173, 180, 226, 324 Uremia, 220 Ureter stones, 140 Urethrocystogram, 223 Uric acid, 220 Urinalysis, 45, 51, 77, 117, 131,210 Urinary calculi, 140-144, 320 Urinary catheterization, 28, 75, 150,

170,313 Urinary retention, 106 Urinary symptoms, 85 Urinary tract, 75, 86, 139-140

Urine, 15,51,69, 121,215,220,223 Urine concentration, 267, 277, 305 Urine osmolarity, 120 Urine output, 24, 63, 73, 75, 120-

121, 123, 147, 306 Urokinase, 42 Urolithiasis, 140 Urosepsis, 320 Uterine defects, 153 Uterine perfusion, 157, 321 Uterine vascular constriction, 156 Uteroplacental perfusion, 155 Uterus, 155-156 Uveitis, 265

Vaginal mucosa, 154 Valine, 23-24, 30, 307 Valsalva maneuver, 178, 324 Valvular disease, 99, 149,212, 320 Valvular dysfunction, 333 Variceal bleeding, 118 Varicella, 244-250, 332 Varicella immune globulin, 249 Varicella-induced hepatitis, 331 Varicella-induced meningoencephali-

tis, 331 Varicella myocarditis, 248 Varicella pneumonitis, 331 Varicella-zoster (VZ) virus, 244, 249-

250,331-332 Varices, 118 Variola virus, 244 Vasa recta, 28 Vascular contractility, 284 Vascular disease, 3, 197, 278 Vascular instability, 73 Vascular insufficiency, 275 Vascular penneability, 72, 87 Vascular resistance, 101 Vascular shunting, 114 Vascular stasis, 30 Vascular surgery, 3, 274 Vascular system, 86 Vascular volume, 114 Vasculitis, 246, 253, 332

Page 62: Self-Assessment Questions - Springer Link

364 Index

Vasoactive mediators, 72 Vasoconstriction, 164, 166, 178, 195,

197 Vasodilation, 31, 90, 110, 145, 147,

275,325 Vasodilators, 226 Vasodilitation, 164, 166-167 Vasopressin, 14-15,21, 118,317 Vasopressor therapy, 89, 123, 226,

321 Vasospasm, 293 Vasovagal reaction, 268 VATER,61 Vecuronium, 8,43, 135, 181, 183,

211,308, 322, 325 Vena cava, 124 Venoirritation, 324 Venous admixture, 80 Venous air embolism (VAE), 241, 323 Venous statis, 317 Venous tone, 34 Venous vasodilation, 284 Venovenous bypass, 123-124,317 Ventilation, 314 Ventilation, insufficient, 103 Ventilation/perfusion mismatch abnor-

malities, 80, 114, 116, 247 Ventilation/perfusion ratio, 10 1, 147,

267 Ventilatory compromise, 310 Ventilatory depression, 211 Ventilatory support, 77 Ventricular dysrhythmia, 4, 99, 122,

248,283 Ventricular dyssnergy, 43 Ventricular fibrillation, 39 Ventricular function, 43, 88 Ventricular pressure monitoring, 166,

323 Ventricular septal defect, 63, 311 Ventricular tachycardia, 4, 39 Ventricular volume, 281

Ventricular wall tension, 277, 284 Ventriculitis, 50, 54, 206, 309 Ventriculography 37, 41 Ventriculostomy, 207, 217 Verapamil, 4, 37, 147 Vertebral abnormalities, 61, 64 Vertebral subluxation, 256 Vessel access ability, 116 Vessel lumen, 37 Vessel perforation, 208 Vidarabine, 249 Visceral ischemia, 276 Visual field testing, 15 Vitamin B12, 155 Vitamin demand, 234 Vitamin K, 112 Vitamin metabolism, 234 Vitreous humor, 177 Vocal cords, 19 Volume loading, 41 Vomiting, 15,28,106,108,152,161,

163, 167, 169, 183-184,209, 220,223,247,297-298

V wave, 286

Water excretion, 119, 317 Water retention, 118 Weight loss, 238 White blood cells, 1, 58, 63, 87, 238,

244, 258, 274 Wolff-Chaikoff effect, 234

X-rays, 1, 19,41,45,52,58,61-63, 83, 86, 93-94, 108, 116, 126, 131, 144, 156, 160, 199,211, 244,247,255,257,261,273, 289, 312, 331

yttrium-aluminum garnet (YAG), 279