Anesthesiology
Written Board Exam Sample Questions
Book
1 - 2004
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QUESTION
80.
An orthopedic surgeon has referred a 46-year-old female patient
with a complaint of severe pain involving her right lower
extremity. She explains that she experienced a moderately
severe right ankle sprain approximately 3 months ago that
appeared to have had resolved, but shortly after, began to
experience a burning aching pain that involved her lower extremity.
On
examination her leg is edematous and her skin appears shinny.
She has difficulty flexing her foot.
With
her history and signs and symptoms on examination, the MOST
likely diagnosis is:
A)
Complex Regional Pain Syndrome I
B) Complex Regional Pain Syndrome II
C) Fibromyalgia
D) Peripheral neuropathy
E) Raynaud’s disease
ANSWER
80.
A Complex
Regional Pain Syndrome I
Complex
Regional Pain Syndrome I (CRPS I) is the new term replacing
reflex sympathetic dystrophy (RSD) while CRPS II replaces
the term for the syndrome causalgia. CRPS I usually follow
a noxious event that does not involve nerve injury or follow
a characteristic peripheral nerve distribution. CRPS II has
the same clinical signs and symptoms but the history is significant
for a nerve injury.
CRPS
I presents with a triad of sensory, autonomic and motor signs
and symptoms. Sensory symptoms include pain described as burning
and aching. Allodynia and hyperalgesia is often present. Autonomic
signs and symptoms almost always include edema, skin color
changes (erythema or cyanotic), and even changes in skin temperature
(higher or lower) when compared to the other limb. Motor signs
and symptoms include muscle weakness, spasm, and decrease
range of motion. Other associated signs can include trophic
changes like increase or decrease nail or hair growth.
Fibromyalgia, peripheral neuropathy and Raynaud’s Syndrome
do not include many of these characteristics, especially allodynia,
hyperalgesia, or edema.
1.
Srinivasa RN, et.al., Complex Regional Pain Syndrome I (Reflex
Sympathetic Dystrophy), Anesthesiology, 2002:96:1254-1260.
QUESTION
101.
A 20-year-old man is undergoing a right adrenalectomy for
pheochromocytoma under isoflurane–nitrous oxide and
oxygen. Fifteen minutes in the procedure, his blood pressure
increases acutely from 150/85 to 250/150 with presentation
of premature ventricular contractions.
The
MOST appropriate management includes:
A)
Administration of nitroprusside and propanolol
B) Switching isoflurane to halothane
C) Switching to a long acting muscle relaxant
D) Using propanolol followed by phentolamine
E) Increasing the concentrations of volatile anesthetics
and opioids
ANSWER
101.
A Administration
of Nitroprusside and Propanolol
Pheochromocytoma
is a catecholamine – secreting tumor. More than 95%
are found in the abdominal cavity, 10% originate outside adrenal
medulla, 10% are malignant, and 10% are bilateral. The hallmark
of pheochromocytoma is paroxysmal hypertension associated
with diaphoresis, headache, tremulousness, palpitation, and
weight loss. The triad of diaphoresis, tachycardia, and headache
in a hypertensive patient is highly suggestive of pheochromocytoma.
The mainstay of pharmacologic therapy is alpha blockade with
phenoxybenzamine or prazosin followed by beta blockade with
propanolol. In the above example manipulation of adrenal produced
surge of sympathetic activity and release of catecholamine
as evident by an acute increase in blood pressure and PVC’s.
The best treatment is nitroprusside which dilates peripheral
vessels and propanolol which blocks the action of catecholamine.
1.
Stoelting RK, Dierdorf SF. Anesthedia and Coexisting Disease
4th edition. Churchill Livingstone, New York, NY. 2002:430-434.
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