EDAIC Hepatic, Renal and Endocrine Anesthesia 1

Question 1

Which volatile anesthetic agent is considered MOST hepatotoxic and carries the highest risk of immune-mediated fulminant hepatic necrosis?

Accepted Answer

Halothane

Answer

Halothane undergoes extensive reductive and oxidative hepatic metabolism, producing reactive intermediates that trigger immune-mediated hepatocellular necrosis (halothane hepatitis) at an incidence of ~1:10,000.

Question 2

In a patient with end-stage liver disease, the volume of distribution of highly protein-bound drugs is most likely to:

Accepted Answer

Increase due to hypoalbuminemia increasing free drug fraction

Answer

Hypoalbuminemia in liver failure increases the unbound (free) fraction of protein-bound drugs, effectively increasing their volume of distribution and pharmacodynamic effect.

Question 3

The hepatic artery supplies approximately what percentage of total hepatic blood flow?

Accepted Answer

25%

Answer

The hepatic artery provides approximately 25% of total hepatic blood flow but delivers about 50% of hepatic oxygen supply due to its high oxygen content.

Question 4

During liver transplantation, the anhepatic phase is associated with which hemodynamic change?

Accepted Answer

Hypotension due to inferior vena cava (IVC) occlusion and reduced venous return

Answer

Clamping the IVC during the anhepatic phase dramatically reduces venous return to the right heart, causing significant hypotension that may require venovenous bypass or careful fluid management.

Question 5

Which coagulation abnormality is MOST commonly seen in advanced liver disease?

Accepted Answer

Decreased production of vitamin K-dependent factors II, VII, IX, X

Answer

The liver synthesizes clotting factors II, VII, IX, and X (vitamin K-dependent); advanced liver disease impairs their production, prolonging PT/INR.

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC Hepatic, Renal and Endocrine Anesthesia 1