WBR0537: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
Line 20: Line 20:
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=A researcher is studying the hemodynamic and respiratory effects of intravenous anesthetics.  In one experiment, he injects a mouse with intravenous ketamine infusion.  Several minutes later, he measures the mouse's heart rate (HR), blood pressure (BP), cerebral blood flow (CBF), and bronchial diameter (BDm) to assess the cardiovascular and respiratory roles of ketamine.  Which of the following hemodynamic and respiratory changes are most likely to occur following ketamine infusion in this experiment?
|Prompt=A researcher, studying the hemodynamic and respiratory effects of intravenous anesthetics, injects a mouse with intravenous ketamine infusion.  Several minutes later, he measures the mouse's heart rate (HR), blood pressure (BP), cerebral blood flow (CBF), and bronchial diameter (BDm) to assess the cardiovascular and respiratory roles of ketamine.  Which of the following hemodynamic and respiratory changes are most likely to occur following ketamine infusion in this experiment?
|Explanation=Ketamine is a PCP analog used as an intravenous anesthetic drug.  Ketamine acts as a non-competitive NMDA receptor blocker.  Ketamine is known to cause dissociative anesthesia, a state of profound analgesia with only superficial sleep and spontaneous ventilation.  It does not usually suppress respiratory drive unless used at very high doses.   
|Explanation=[[Ketamine]], a PCP analog used as an intravenous anesthetic drug, acts as a non-competitive NMDA receptor blocker.  A side effect of [[ketamine]] is dissociative anesthesia, a state of profound analgesia with only superficial sleep and spontaneous ventilation.  It does not usually suppress respiratory drive unless used at very high doses.   


Because ketamine increases intracranial pressure, it is contraindicated in patients with brain injury.  Other systemic effects of ketamine are generally also increased. Following ketamine, there is an increased heart rate, blood pressure, CVP, CO2 baroreceptor function, bronchodilation, respiratory rate, uterine tone, salivation.
Because [[ketamine]] increases intracranial pressure, it is contraindicated in patients with brain injury. Following [[ketamine]] administration, frequently there is an increase in heart rate, blood pressure, CVP, CO2 baroreceptor function, bronchodilation, respiratory rate, uterine tone, and salivation.


Educational Objective: Ketamine causes systemic effects by stimulating hemodynamic and respiratory systems.
|EducationalObjectives= [[Ketamine]] administration may result in systemic effects by stimulating hemodynamic and respiratory systems.
|References= Stevenson C. Ketamine: a review. Update in Anaesthesia. 2005;20:25-9.  


Reference: Stevenson C. Ketamine: a review. Update in Anaesthesia. 2005;20:25-9.
|AnswerA=Increased HR, increased BP, increased CBF, and increased BDm
|AnswerA=Increased HR, increased BP, increased CBF, and increased BDm
|AnswerAExp=Ketamine increases hemodynamic and respiratory systems.
|AnswerAExp=See overall explanation.
|AnswerB=Increased HR, decreased BP, increased CBF, and increased BDm
|AnswerB=Increased HR, decreased BP, increased CBF, and increased BDm
|AnswerBExp=BP increases following ketamine infusion.
|AnswerBExp=BP frequently increases following [[ketamine]] infusion.
|AnswerC=Increased HR, decreased BP, increased CBF, and decreased BDm
|AnswerC=Increased HR, decreased BP, increased CBF, and decreased BDm
|AnswerCExp=BP and BDm increase following ketamine infusion.
|AnswerCExp=BP and BDm frequently increase following [[ketamine]] infusion.
|AnswerD=Increased HR, decreased BP, decreased CBF, and decreased BDm
|AnswerD=Increased HR, decreased BP, decreased CBF, and decreased BDm
|AnswerDExp=BP, CBF, and BDm increase following ketamine infusion.
|AnswerDExp=BP, CBF, and BDm frequently increase following [[ketamine]] infusion.
|AnswerE=Decreased HR, increased BP, increased CBF, and increased BDm
|AnswerE=Decreased HR, increased BP, increased CBF, and increased BDm
|AnswerEExp=HR increases following ketamine infusion.
|AnswerEExp=HR frequently increases following [[ketamine]] infusion.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=ketamine, systemic, effect, hemodynamic, respiratory, side, adverse, drug, reaction, dissociative, analgesia, heart, rate, heart rate, cerebral, blood, flow, cerebral blood flow, pressure, bronchodilation, bronchodilator, bronchial, diameter
|WBRKeyword=ketamine, systemic effect, hemodynamic, respiratory, adverse drug reaction, dissociative analgesia, heart rate, cerebral blood flow, bronchial, side effects, intravenous, trial
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:21, 30 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A researcher, studying the hemodynamic and respiratory effects of intravenous anesthetics, injects a mouse with intravenous ketamine infusion. Several minutes later, he measures the mouse's heart rate (HR), blood pressure (BP), cerebral blood flow (CBF), and bronchial diameter (BDm) to assess the cardiovascular and respiratory roles of ketamine. Which of the following hemodynamic and respiratory changes are most likely to occur following ketamine infusion in this experiment?]]
Answer A AnswerA::Increased HR, increased BP, increased CBF, and increased BDm
Answer A Explanation AnswerAExp::See overall explanation.
Answer B AnswerB::Increased HR, decreased BP, increased CBF, and increased BDm
Answer B Explanation [[AnswerBExp::BP frequently increases following ketamine infusion.]]
Answer C AnswerC::Increased HR, decreased BP, increased CBF, and decreased BDm
Answer C Explanation [[AnswerCExp::BP and BDm frequently increase following ketamine infusion.]]
Answer D AnswerD::Increased HR, decreased BP, decreased CBF, and decreased BDm
Answer D Explanation [[AnswerDExp::BP, CBF, and BDm frequently increase following ketamine infusion.]]
Answer E AnswerE::Decreased HR, increased BP, increased CBF, and increased BDm
Answer E Explanation [[AnswerEExp::HR frequently increases following ketamine infusion.]]
Right Answer RightAnswer::A
Explanation [[Explanation::Ketamine, a PCP analog used as an intravenous anesthetic drug, acts as a non-competitive NMDA receptor blocker. A side effect of ketamine is dissociative anesthesia, a state of profound analgesia with only superficial sleep and spontaneous ventilation. It does not usually suppress respiratory drive unless used at very high doses.

Because ketamine increases intracranial pressure, it is contraindicated in patients with brain injury. Following ketamine administration, frequently there is an increase in heart rate, blood pressure, CVP, CO2 baroreceptor function, bronchodilation, respiratory rate, uterine tone, and salivation.
Educational Objective: Ketamine administration may result in systemic effects by stimulating hemodynamic and respiratory systems.
References: Stevenson C. Ketamine: a review. Update in Anaesthesia. 2005;20:25-9.]]

Approved Approved::Yes
Keyword WBRKeyword::ketamine, WBRKeyword::systemic effect, WBRKeyword::hemodynamic, WBRKeyword::respiratory, WBRKeyword::adverse drug reaction, WBRKeyword::dissociative analgesia, WBRKeyword::heart rate, WBRKeyword::cerebral blood flow, WBRKeyword::bronchial, WBRKeyword::side effects, WBRKeyword::intravenous, WBRKeyword::trial
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