Order Essential Hypertension Discussion

Order Essential Hypertension Discussion
Order Essential Hypertension Discussion
 
1. A 59-year-old woman with a history of hypertension presents for total
abdominal hysterectomy for endometrial cancer. She has continued her home
amlodipine and metoprolol up until the day of surgery but has held her lisinopril
for 2 days. In the preoperative day, she is very anxious and her blood pressure
is 179/88. Which of the following is the most appropriate next step?
A. Cancel the case.
B. Administer home lisinopril dose.
C. Proceed with the case and maintain blood pressure within high-normal range.
D. Administer appropriate anxiolysis and reassess.
2. 42. Which of the following statements is true with respect to essential
hypertension?
A. Systolic dysfunction will precede diastolic dysfunction in the progression.
B. LV eccentric hypertrophy is likely to occur.
C. Essential hypertension accounts for >80% of all hypertension diagnoses.
D. Cerebral autoregulation is unchanged with long-standing essential hypertension.
3. Which of the following antihypertensives should be held for 12-24 hours
preoperatively?
A. Captopril
B. Labetalol
C. Amlodipine
D. Clonidine
4. In which of the following scenarios should a β-blocker be initiated
preoperatively?
A. A 60-year-old woman presenting for bilateral mastectomy with poorly controlled
hypertension on lisinopril, amlodipine, and hydrochlorothiazide
B. A 48-year-old man with 100-pack-year smoking history presenting for
thoracoscopic lobectomy
C. A 74-year-old man with coronary artery disease presenting for endovascular
aortic aneurysm repair (EVAR)
D. A 65-year-old woman with hypertension and hyperlipidemia presenting for
laparoscopic cholecystectomy for acute cholecystitis
5. Administration of which of the following drugs is most likely to resolve
intraoperative hypotension refractory to phenylephrine in a patient who took
lisinopril the morning of surgery?
A. Ephedrine
B. Methylene blue
C. Norepinephrine
D. Vasopressin
6. Which of the following monitoring modalities is the gold standard with which to
assess cerebral ischemia during carotid cross-clamp for carotid endarterectomy
(CEA) under general anesthesia?
A. Somatosensory evoked potentials (SSEPs)
B. Electroencephalography (EEG)
C. Transcranial Dopplers (TCDs)
D. Near-infrared spectroscopy
7. Which of the following is a class I recommendation for spinal cord protection
during open and endovascular thoracic aortic aneurysm repair for patients at
high risk of spinal cord ischemia?
A. Cerebrospinal fluid drainage
B. Systemic hypothermia
C. Hyperventilation
D. Hyperosmotic agents
8. Which of the following is true regarding the physiologic changes that ensue
following release of the aortic cross-clamp during aortic surgery?
A. Cardiac output increases.
B. Venous return increases.
C. Mixed venous oxygen saturation rapidly falls.
D. PaCO2 abruptly falls.
9. 49. Which of the following statements is true with respect to EVAR compared
with open abdominal aortic aneurysm repair?
A. Lower rate of operative survival with EVAR
B. Increased hemodynamic shifts with EVAR
C. Worsened intraoperative acid-base status with EVAR
D. Higher rate of secondary interventions with EVAR at 6 years
10. A 69-year-old man with type 2 diabetes mellitus, coronary artery disease after
drug-eluting stent (28 months ago), COPD, and atrial fibrillation presents for
lower limb revascularization for claudication. Which of the following is true
with respect to timing of epidural placement as the primary anesthetic?
A. Clopidogrel should be held for 5 days before epidural placement.
B. The case should be canceled if the epidural placement is bloody.
C. It is unnecessary to check platelet count before epidural removal.
D. Systemic heparin may be administered 1 hour after epidural placement.
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