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UBP Question 2

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Question 2




(Short Form)




A 26-year-old female presents for biopsy of an anterior mediastinal mass. Her medical history is significant for smoking, Down Syndrome, moderate to severe asthma, and severe gatroesophageal reflux. Her mother states that her daughter does get short of breath at times and sometimes has difficulty swallowing. She is a poor historian and was minimally cooperative during intravenous line placement. Her medications include pyridostigmine, 3,4-diaminopyridine, and Tums. VS: P = 87, BP = 110/70 mmHg, R = 12, T = 36.6 °C


Pre-operative Management


1) What do you think about her shortness of breath?

UBP Answer: Complete answer is found in the UBP Practice Set #1

2) What is Myasthenic syndrome?

UBP Answer: Complete answer is found in the UBP Practice Set #1

3) The CT scan shows 50% tracheal compression by the mediastinal mass. Does this concern you? What would you do?

UBP Answer: Complete answer is found in the UBP Practice Set #1

4) Would you order an echocardiogram?

UBP Answer: Complete answer is found in the UBP Practice Set #1

5) Would Flow Volume Loops be beneficial?

UBP Answer: Complete answer is found in the UBP Practice Set #1



(Long Form)


A 26-year-old female presents for biopsy of an anterior mediastinal mass.


PMH: The patient’s mother says that her daughter is a smoker, has Down syndrome, and gets short of breath at times. She has always attributed her shortness of breath to her smoking or asthma. The patient’s asthma is moderate to severe and she goes to the emergency room every few months with severe asthmatic attacks. For the past six months she has had occasional difficulty swallowing. Her mother says she has severe acid reflux and that her meds include Tums, pyridostigmine, and 3,4-diaminopyridine.

Anesth. Hx: The patient had an appendectomy 9 years ago without complication.

PE: VS: P = 87, BP = 110/70 mmHg, R = 12, T = 36.6 °C
General: The patient becomes mildly dyspneic when placed in the supine position and exhibits bilateral ptosis.
Airway: Mallampati II, large tongue
CV: RRR
Lungs: Expiratory wheezing

Lab: Normal

PFTs: FEV1 and PEF less than 50% of expected in the supine position

CT: Large anterior mediastinal mass with 50% tracheal obstruction at the level of the carina


Intra-operative Management


1) How would you provide anesthesia for this case?

UBP Answer: Complete answer is found in the UBP Practice Set #1

2) The surgeon explains that the patient has absolutely refused to go through the procedure with just local anesthesia. What would you do?

UBP Answer: Complete answer is found in the UBP Practice Set #1

3) The surgeon reports that the mass has been unresponsive to radiation or chemotherapy and it is vitally important to make a tissue diagnosis and begin treatment. Will you perform a general anesthetic?

UBP Answer: Complete answer is found in the UBP Practice Set #1

4) How will you intubate and induce this patient?

UBP Answer: Complete answer is found in the UBP Practice Set #1

5) The patient refuses to allow you to perform an awake intubation. What will you do?

UBP Answer: Complete answer is found in the UBP Practice Set #1

6) Shortly after induction and placement of the ETT, the patient stops breathing and you are unable to ventilate her. What will you do?

UBP Answer: Complete answer is found in the UBP Practice Set #1


Post-operative Management


1) You apply positive pressure, deepen your anesthetic, and administer a ß2-agonist to break the bronchospasm. Would you extubate this patient immediately following the completion of the procedure? How?

UBP Answer: Complete answer is found in the UBP Practice Set #1

2) The patient is extubated. Later, you are called because she has become dyspneic. What is your differential?

UBP Answer: Complete answer is found in the UBP Practice Set #1

3) Would an edrophonium test be helpful?

UBP Answer: Complete answer is found in the UBP Practice Set #1

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