Chapter·SurgeryAnesthesia and Perioperative medicine

Malignant hyperthermiaDownloads

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1

A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial infarction, and hypertension. He denies any shortness of breath at rest or with exertion. An ECG is performed and is within normal limits. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 6.7 mEq/L HCO3-: 25 mEq/L Glucose: 133 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely cause of this patient's presentation?

AMedication

BAcute renal failure

CHemolysis

DDietary changes

ERhabdomyolysis

2

A 59-year-old female presents to the emergency department after a fall. She reports severe pain in her right hip and an inability to move her right leg. Her past medical history is notable for osteoporosis, rheumatoid arthritis, and has never undergone surgery before. The patient was adopted, and her family history is unknown. She has never smoked and drinks alcohol socially. Her temperature is 98.8°F (37.1°C), blood pressure is 150/90 mmHg, pulse is 110/min, and respirations are 22/min. Her right leg is shortened, abducted, and externally rotated. A radiograph demonstrates a displaced femoral neck fracture. She is admitted and eventually brought to the operating room to undergo right hip arthroplasty. While undergoing induction anesthesia with inhaled sevoflurane, she develops severe muscle contractions. Her temperature is 103.4°F (39.7°C). A medication with which of the following mechanisms of action is indicated in the acute management of this patient’s condition?

ARyanodine receptor antagonist

BAcetylcholine receptor agonist

CSerotonin 1B/1D agonist

DNMDA receptor antagonist

EGABA agonist

3

A 32-year-old man is brought to the emergency department after he was found unresponsive on the street. Upon admission, he is lethargic and cyanotic with small, symmetrical pinpoint pupils. The following vital signs were registered: blood pressure of 100/60 mm Hg, heart rate of 70/min, respiratory rate of 8/min, and a body temperature of 36.0°C (96.8°F). While being assessed and resuscitated, a sample for arterial blood gas (ABG) analysis was taken, in addition to the following biochemistry tests: Laboratory test Serum Na+ 138 mEq/L Serum Cl- 101 mEq/L Serum K+ 4.0 mEq/L Serum creatinine (SCr) 0.58 mg/dL Which of the following values would you most likely expect to see in this patient’s ABG results?

ApH: decreased, HCO3- : increased, Pco2: increased

BpH: increased, HCO3- : decreased, Pco2: decreased

CpH: decreased, HCO3- : decreased, Pco2: decreased

DpH: increased, HCO3- : increased, Pco2: increased

EpH: normal, HCO3- : increased, Pco2: increased

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