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Example research essay topic: Coronary Artery Disease Bone Marrow - 1,526 words

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... self from non-self. These cells emerge from their "home" in the bone into the "organ world" to mature. Lymphocytes which differentiate in the Thymus become T-Cells, lymphocytes which mature in bone marrow are B-Cells.

The bone marrow and thymus are primary lymphoid organs. 12. Complete the following table, match the appropriate Blood Types with appropriate antibodies and antigens. Which is the universal donor, and which is the universal recipient? c. O No Antigen A + B Antibodies (Universal Donor) d.

AB Antigens A + B No Antibodies (Universal Recipient) 13. A 24 y / o male is brought in for emergency appendectomy. In the emergency department he had an allergic reaction to his IV antibiotic. Which of the following immunoglobulins was most likely produced during this allergic reaction? 13.

a - IgE is the subclass responsible for allergies; the Ig D and IgM subclasses function as antigen receptors on lymphocytes; the IgG subclass comprises most of the antibodies in the blood; and the IgA subclass is found in external secretions. Questions 14 and 15 are based on the following scenario: Mrs. Jones is a 42 year old female who presented to the emergency department this evening for an acute onset of palpitations, chest pain, and shortness of breath. She has a known history of atrial fibrillation and mitral valve prolapse. Her current medications include Digoxin and hydrochlorothiazide. Currently, her ECG reflects atrial fibrillation with a rapid ventricular response at a rate of 220.

He blood pressure is 90 /palpation, she is cool, pale, and diaphoretic, and you are called to sedate her prior to synchronized cardio version, While reviewing her chart, she becomes acutely hypotension, and lethargic. She is cardioverted @ 100 joules, and converts to normal sinus rhythm, and her vital signs improve. 30 minutes later, Mrs. Jones speech becomes slurred, and she complains of left facial paresthesias and droop, and left upper extremity paresis and paresthesias. 14. What is the most likely cause of Mrs. Jones post-cardio version symptoms? a.

Her brain has re perfused following management of her hypotension b. Her sedation is making her "feel funny" c. She is hyperventilating because of all of the excitement d. A thrombus has cause and area of cerebral ischemia versus infarct 14. d - Chronic atrial fibrillation is often due to hypertrophic atrial muscle through which conduction from sinus to AV node is disrupted, and asynchronous. The result is turbulent flow, and eddy's of blood in the atrium which may fibrinolyses and become a clot.

Once returned to Normal sinus rhythm, this clot likely was ejected and lodged in the microcirculation in the left side of her pain, causing her contralateral sensory and motor symptoms. She certainly has not perfused her brain (a), was cardioverted prior to sedation because of her acute hemodynamic instability (b), there is no respiratory history to determine c. 15. Mrs Jones BP rises to 160 / 100. The ED staff wishes to be aggressive in treating her hypertension with IV Nitrates. You are asked for your opinion.

You recommend: b. With this MAP of 80, her cerebral perfusion pressure she should receive sublingual calcium channel blockers c. Neurological insult has likely compromised her autoregulatry capabilities d. Mrs Jones hypertension is likely compensatory, and an acute decrease may further compromise cerebral perfusion. 15. e - both c and d are correct. Auto regulation via a myogenic reflex exists in the brain to maintain blood flow at 50 - 55 mL/ 100 g of brain tissue if pressure is between 50 - 60 mmHg and 150 - 160 mmHg.

Auto regulation is an intrinsic effect in vascular smooth muscle (mediated by the myogenic reflex) which, in a sudden change in perfusion pressure, returns tissue flow back to normal by vasoactive responses (ie; vasodilation or vasoconstriction. In this case, while auto regulation may likely be compromised in the focal areas of the ischemic or infarcted brain, they are not completely destroyed. The brain retains some auto regulatory capabilities to maintain cerebral perfusion pressure. Hypertension is expected in ischemic events, ant the goal should be to maintain a mean arterial pressure close to her baseline, which we may assume is somewhat elevated in that she is prescribed hydrochlorothiazide, and antihypertensive medication. B is in incorrect; MAP = 1 SBP x 2 DBP/ 3 = 160 + 200 / 3 = 120, and calcium channel blockers may decrease BP by blocking voltage-gated calcium channels, interrupting the physiological compensation attempting to maintain cerebral perfusion pressure (Cerebral perfusion pressure is defined as the difference between MAP and either ICP or CVP, whichever is higher). Nitrates (a) would decrease blood pressure, and ultimately cerebral perfusion pressure as well, essentially decompensation a physiological compensatory response.

Whew! 16. Which of the following is not true regarding cerebral aneurysms? a. Aneurysms are thought to result from herniation of the intima through a fragmented internal elastic membrane b.

Factors which may contribute to a rupture include large size and sudden change in trans mural pressure c. Prodromal symptoms of intracranial aneurysms include severe headache, focal neurological signs d. Expansion of an aneurysm may cause third nerve palsy with or without eye pain 16. e - all of the above are true regarding cerebral aneurysms. 17.

All of the following would be expected in a patient with Graves disease EXCEPT a. Increased sensitivity to heat and cold temperatures 17. a - Graves disease (hyperthyroid sims) is caused by overstimulation of the thyroid gland by circulating antibodies to the TSH receptor (which then increases production of thyroid hormone just as TSH would). T 3 increases O 2 consumption by target tissues and, accordingly, increases cardiac output and ventilation rate to match the increased O 2 consumption.

Thyroid hormones cause increased heat production as a result of increased aerobic metabolism. Indiction agents such as Ketamine should be avoided in the patients beacuse of symapthomimietioc properties of this drug. 18. Effects of anesthetic agents on renal function include all of the following EXCEPT: b. General anesthesia declares BP, RBF, GFR, and increases renal vascular resistance, c.

Auto regulation is tightly maintained under general anesthesia d. Drugs which are alpha-receptor antagonists cause the smallest changes in renal hemodynamics and function 18. a - General anesthesia temporarily depresses renal function as measured by urinary output, GFR, RBF, and electrolyte excretion. Real impairment is usually short- lived and completely reversible. Maintainance of systemic blood pressure and especially preoperative hydration lessen the effect on renal function...

Spinal and epidural anesthesia, but not to the same extent as general anesthesia. In this setting, decrements in renal function parallel the magnitude of symaptheitc blockade. Agents that produce myocardial depression (such as volatile anesthesia on renal auto regulation are conflicting, but their indirect effects on renal hemodynamics are probably of greater significance (Duke and Rosenberg, 1996) ed, as evinced by decreases in GFR, RBF and increased renal vascular resistance. D is also a correct response. 19.

How should a patient with suspected coronary artery disease be monitored via ECG intraoperative? 19. e - The most important modality for monitoring this patient intraoperative is a multiple lead ECG system. Up to 89 % of ECG changes that are due to myocardial ischemia that are present on 12 -lead ECG will be detected by a V 5 pre cordial lead alone. Limb lead II and pre cordial lead V have been recommended for simultaneous monitoring to device intraoperative myocardial ischemia. This combination should detect more than 98 % of ischemic episodes. In addition, leads II (inferior) and V 5 (apical, anterolateral) monitor the distribution of the RCA and LCA. 20.

All of the following are considered essentials of preoperative cardiac evaluation EXCEPT: a. History (CAD, Ventricular function, arrhythmias, valvular disease) b. Physical Exam (VS, Heart sounds) c. Laboratory Eval (CXR, ECG, others as indicated) d.

Considering the surgeons history and physical as a complete risk assessment, after carefully noting his documentation. 20. d - While History, physical examination and laboratory studies are a firm foundation on which to build an anesthesia plan of care, deferential trusting in a colleagues assessment while valuable, but should never be considered complete. Disciplines outside anesthesia may share the mutual goal of an optimal patient outcome, but the focal areas of concern for respective disciplines are by neceiisty different. Entrusted with the care of patients demands precision, diligence, and attention to detail.

This begins with the preoperative cardiac evaluation. Preoperative cardiac assessment includes a history, physical examination and labortayru results, as well as historical information should asses the presence, severity and reversibility of coronary artery disease risk factors for coronary artery disease, anginal patterns, and history of myocardial infarction: The left and right ventricular function (exercise capacity, pulmonary edema, pulmonary hypertension; and the present of symptomatic dysrhythmsias (palpitations, syncopal or pre syncopal episodes. Patients with valvular heart disease may be symptomatic for embolic events. On physical examination, particular attention should be paid to VS, HR, BP, and PP (determinants of myocardial O 2 consumption and delivery), JVD, peripheral edema, pulmonary edema, or an S 3 gallup and the presence of murmurs.

Baseline labs include CXR, and ECG. Further evaluation may be determined based on results (Reich and Jaffee) Bibliography:


Free research essays on topics related to: physical examination, coronary artery disease, bone marrow, sudden change, blood pressure

Research essay sample on Coronary Artery Disease Bone Marrow

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