EDAIC Hepatic, Renal and Endocrine Anesthesia 4

Question 1

A patient with hepatic encephalopathy grade III requires emergency surgery. Which agent is MOST appropriate for induction?

Accepted Answer

Propofol 1-2 mg/kg with cautious titration

Answer

Propofol, carefully titrated to effect, is preferred in hepatic encephalopathy as it reduces cerebral metabolic rate without significantly worsening encephalopathy; ketamine raises ICP and thiopental/etomidate are less favorable.

Question 2

Which coagulation factor is synthesized exclusively in the liver and has the shortest half-life, making it the most sensitive marker of acute hepatic synthetic failure?

Accepted Answer

Factor VII

Answer

Factor VII has the shortest half-life (~4-6 hours) and is exclusively hepatically synthesized, making PT/INR the most sensitive early indicator of acute liver failure.

Question 3

A patient on chronic lithium therapy for bipolar disorder presents for elective surgery. What is the primary anesthetic concern regarding renal function?

Accepted Answer

Lithium-induced nephrogenic diabetes insipidus causes hypovolemia and hypernatremia

Answer

Chronic lithium causes nephrogenic diabetes insipidus by antagonizing ADH in collecting ducts, leading to polyuria, dehydration, and hypernatremia that must be corrected before anesthesia.

Question 4

During laparoscopic cholecystectomy in a patient with Child-Pugh C cirrhosis, which hemodynamic pattern is characteristic of the hepatorenal syndrome type 1 that may develop perioperatively?

Accepted Answer

Low SVR, high CO, marked renal vasoconstriction

Answer

HRS type 1 occurs in the context of cirrhotic hyperdynamic circulation (low SVR, high CO) with paradoxical intense renal vasoconstriction, causing rapid deterioration of renal function.

Question 5

A patient with a known pheochromocytoma is inadequately alpha-blocked prior to emergency appendectomy. Intraoperative hypertensive crisis occurs. What is the FIRST-LINE treatment?

Accepted Answer

IV phentolamine 1-5 mg bolus titrated

Answer

Phentolamine, a short-acting non-selective alpha-blocker, is first-line for acute hypertensive crises from pheochromocytoma; beta-blockers like labetalol must never be given before adequate alpha-blockade as they worsen hypertension.

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 4