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AAframework > 1st Semester Exam > Flashcards

1st Semester Exam Flashcards

1
Q

Morphine relieves pain by its action on the:

A

μ and κ opioid receptors in the CNS

Correct answer is (4)

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2
Q

The single most important factor related to depth for an inhalational anesthetic agent is:

A

Solubility in blood

Correct answer is (1)

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3
Q

All of the following analgesics are appropriate for use on an asthmatic patient except:

A

Morphine

Correct answer is (1)

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4
Q

A patient receives 3 MAC of Sevoflurane on induction of anesthesia. This is:

A

Just right. This amount will increase Δ P across A-C membrane

Correct answer is (●)

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5
Q

Which of the following statements regarding Nitrous Oxide is true?

A

It is used as an anesthetic base to decrease the need for other agents

Correct answer is (●)

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6
Q

Inhalational anesthesia induction:

A

was used first historically

Correct answer is (●)

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7
Q

Which of the following is the reversal agent for benzodiazepines?

A

Flumazenil

Correct answer is (●)

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8
Q

In comparing an intravenous (IV) to inhalational anesthesia induction:

A

Stage II is shortened with IV

Correct answer is (●)

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9
Q

Which of the following barbiturates was historically used in the OR for induction, and was considered to be short-acting?

A

Thiopentone (Pentothal®)

Correct answer is (●)

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10
Q

In order to anesthetize for a surgical procedure involving resection of the esophagus, which of the following types of anesthesia would be required?

A

a general anesthetic

Correct answer is (●)

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11
Q

Which of the following statements describes the mechanism of action for benzodiazepines?

A

enhances GABA binding to its receptor which causes inhibition

Correct answer is (●)

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12
Q

The single most important factor in determining the speed of induction and reversal for an inhalation anesthetic agent is:

A

Solubility in blood

Correct answer is (●)

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13
Q

You must paralyze the patient for a short time to facilitate endotracheal intubation. The drug of choice is:

A

Succinylcholine

Correct answer is (●)

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14
Q

Fasciculations may follow the injection of:

A

Succinylcholine (Anectine®)

Correct answer is (●)

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15
Q

The following drugs are considered opiates:

A

1 & 3

Correct answer is (●)

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16
Q

Acetaminophen (Tylenol):

A

All of the above

Correct answer is (●)

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17
Q

Compounds that are defined as ‘capable of calming an individual and thereby relieving anxiety and tension’ are called:

A

sedatives

Correct answer is (●)

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18
Q

A patient is classified as ASA IIIE if they have:

A

recent diagnosis of diabetes

Correct answer is (●)

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19
Q

The following drugs are considered opioids:

A

All of the above

Correct answer is (●)

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20
Q

A pre-operative assessment in anesthesia:

A

All of the above

Correct answer is (●)

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21
Q

During the maintenance phase in anesthesia:

A

a combination of inhalational and intravenous drugs is used

Correct answer is (●)

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22
Q

The triad of anesthesia has three components, which should be developed separately. These components are:

A

muscle relaxation, analgesia, hypnosis

Correct answer is (●)

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23
Q

Which statement(s) accurately describe neuromuscular blocking agents?

A

1, 2, 3

Correct answer is (●)

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24
Q

1 MAC is:

A

the amount of an inhalational anesthetic agent used to depress movement in ½ of the population

Correct answer is (●)

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25
Q

In delivering 1 MAC, you can administer a mixture containing:

A

0.5 MAC of Isoflurane + 0.5 MAC of Sevoflurane

Correct answer is (●)

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26
Q

Compounds that are defined as ‘capable of putting an individual to sleep’ are classified as:

A

sedatives

Correct answer is (●)

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27
Q

The period of time used to describe the anesthetic phase where the patient is wakening is:

A

emergence

Correct answer is (●)

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28
Q

The stage of anesthesia that involves progressive loss of reflexes and muscle tone and depression of vital function is:

A

Stage III

Correct answer is (●)

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29
Q

The anesthesiologist orders for a dose of 360 mg Mepivacaine. You have a bottle of 3% solution. How many mL of Mepivacaine will you give?

A

12 mL

Correct answer is (●)

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30
Q

The important factor(s) related to distribution of intravenous agents is/are:

A

a, b, c

Correct answer is (●)

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31
Q

Spectrophotometry is used in all of the following monitors except:

A

Doppler

Correct answer is (●)

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32
Q

Dampening of a hemodynamic pressure waveform would cause the following change:

A

Lower systolic pressure readings

Correct answer is (●)

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33
Q

Which of the following statements is true for PCWP (PAOP)?

A

PCWP is indicative of LAP and LVEDP

Correct answer is (●)

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34
Q

According to CAS guidelines, which of the following monitoring devices are additional with the use of the anesthetic gas machine?

A

low inspiratory pressure alarm, hypoxic mixture prevention device

Correct answer is (●)

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35
Q

Patient blood is backing up into the arterial pressure monitoring lines. All of the following situations are possible causes except:

A

there is an air bubble in the arterial line

Correct answer is (●)

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36
Q

You are in the OR with a firefighter who is suffering from smoke inhalation. You are skeptical of the pulse oximetry because you know that pulse oximeters only measure:

A

Fractional saturation

Correct answer is (●)

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37
Q

A normal capnogram includes the following:

A

zero baseline, rapid sharp uprise, alveolar plateau, well-defined ETCO₂, rapid sharp downstroke

Correct answer is (●)

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38
Q

Arterial oxygen saturation as measured by a pulse oximeter is defined as:

A

the ratio of hemoglobin molecules bound with oxygen to the total amount of hemoglobin available for binding

Correct answer is (●)

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39
Q

All of the following statements are true when using pulse oximetry, except:

A

less accurate in infants

Correct answer is (●)

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40
Q

Peripheral nerve stimulators are used to determine the following information:

A

All of the above

Correct answer is (●)

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41
Q

A co-oximeter can be used to measure all but:

A

hematocrit

Correct answer is (●)

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42
Q

A true mixed venous sample can be obtained by sampling from:

A

PA proximal port

Correct answer is (●)

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43
Q

When performing a cardiac output by thermodilution:

A

The pulmonary artery catheter balloon must be inflated

Correct answer is (●)

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44
Q

When using a peripheral nerve stimulator in the OR, you notice that the patient exhibits 1 twitch when performing a train of four (TOF) test. From this, you can conclude:

A

the patient is sufficiently blocked for the surgery but not the intubation

Correct answer is (●)

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45
Q

An increased CVP may indicate all of the following situations except:

A

Bowel prep completed on patient

Correct answer is (●)

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46
Q

According to CAS guidelines, which of the following monitoring devices are required during a conscious sedation anesthetic?

A

1, 2, 3

Correct answer is (●)

47
Q

In a patient incompletely blocked by a paralyzing agent, you would expect to see a capnograph exhibiting the following characteristic:

A

A curare cleft

Correct answer is (●)

48
Q

What characteristic would you expect to see in a capnograph of a patient incompletely blocked by a paralyzing agent?

A

A curare cleft

A curare cleft indicates a pattern in capnography often seen when a patient has partial neuromuscular blockade.

49
Q

What BIS monitor reading indicates moderate sedation?

A

Around 50-75

The Bispectral Index (BIS) monitor is used to assess the depth of anesthesia.

50
Q

What may cause a patient’s PA reading to appear flattened at about 6 mmHg with no identifiable systole or diastole?

A

The catheter has migrated to a wedge position

This can occur with pulmonary artery catheterization and indicates a blockage in blood flow.

51
Q

What does the assessment of micrognathia during an airway assessment indicate?

A

All of the above

This condition may suggest the need for rapid sequence induction (RSI), BURP maneuver, or a fiberoptic bronchoscope (FOB) for intubation.

52
Q

True or False: A patient with a previous history of difficult intubation cannot have an asleep intubation according to the Airway Approach Algorithm.

A

False

The guidelines allow for asleep intubation even with a history of difficult intubation.

53
Q

The tidal volume delivered by the flow-inflating bag on the circle circuit is NOT dependent on which factor?

A

Total gas flow rate

Other factors influencing tidal volume include patient lung conditions and mask seal.

54
Q

What does RSI stand for in the context of intubation?

A

Rapid Sequence Induction

RSI is a technique to secure the airway quickly in patients at risk of aspiration.

55
Q

In order to ensure effective manual ventilation in the OR, the operator must pay attention to which monitor?

A

The end tidal CO₂ monitor

This monitor provides real-time feedback on the patient’s ventilation status.

56
Q

A ‘Double-lumen’ ETT may be used for which types of surgeries?

A

Thoracic cases

Double-lumen endotracheal tubes are specifically designed for surgeries requiring lung isolation.

57
Q

Which situation does NOT indicate the need for Rapid Sequence Induction (RSI)?

A

A light meal greater than 6 hours ago

RSI is particularly indicated in situations where the risk of aspiration is high.

58
Q

Awake intubations over a FOB are indicated for which conditions?

A

All of the above

This includes severe rheumatoid arthritis, head and neck trauma, and high Mallampati scores.

59
Q

What could cause a flat line in ETCO₂ after intubation?

A

A paralyzed patient

Other causes may include esophageal intubation or cardiac arrest.

60
Q

A ‘nasal preformed’ ETT may be used for what types of operations?

A

Maxillofacial operations and craniotomies

This type of tube is designed for specific anatomical considerations in surgery.

61
Q

According to the ASA algorithm, what is the next step after two unsuccessful attempts to intubate?

A

Allow a 2nd individual opportunity to intubate

This approach is recommended to ensure patient safety and improve chances of successful intubation.

62
Q

Outside the OR, RSI for intubation is indicated in which situation?

A

Unresponsive patient

This indicates a need for immediate airway management due to inability to protect the airway.

63
Q

The reason more specialized endotracheal tubes are used in the operating room is due to:

A

The type of surgery reflects the type of endotracheal tube used

Surgical procedures often dictate specific airway management needs.

64
Q

What is the correct order of techniques for successful mask ventilation according to the ASA difficult airway algorithm?

A

Two-man mask ventilation, change mask, head repositioning, one-man mask ventilation, insertion of OPA

Correct sequence is crucial for effective airway management in difficult cases.

65
Q

What is a probable explanation for limited chest excursion and a tight feeling during manual ventilation?

A

Patient is not fully paralyzed

Inadequate paralysis can lead to difficulty in achieving effective ventilation.

66
Q

Common methods of confirming ETT placement in the OR include all except:

A

Chest X-Ray

While useful, immediate confirmation methods include exhaled CO₂ and bilateral chest rise.

67
Q

Blood transfusion is likely required if blood loss exceeds what percentage of the patient’s blood volume?

A

More than 20%

This threshold is critical for assessing the need for transfusion during surgery.

68
Q

What could be a rationale for not administering Ringer’s lactate solution with blood products?

A

Ringer’s lactate has calcium which can cause blood clotting

Calcium can react with stored blood products, leading to complications.

69
Q

The actual tidal volume delivered from an anesthesia ventilator is not influenced by:

A

Circuit compliance

Circuit compliance is a factor in how the ventilator functions but does not directly affect the set tidal volume.

70
Q

If the bellows of an anesthetic ventilator do not remain inflated at the end of expiration, what could prevent this?

A

A leak around the bellows canister

This indicates a malfunction that may compromise ventilation effectiveness.

71
Q

What happens if the emergency O2 cylinder is left open during surgery?

A

The O2 supply pressure alarm will be activated when the cylinder pressure falls below 30 psi

This serves as a safety mechanism to alert staff of low oxygen supply.

72
Q

What does the oxygen flush mechanism on the anesthetic machine deliver?

A

Oxygen at a flow of 35-75 lpm

This high-flow delivery is used to rapidly fill the breathing circuit.

73
Q

What is the main purpose of using soda-lime in a circle circuit?

A

To eliminate carbon dioxide

Soda-lime absorbs CO₂, allowing for more effective ventilation and anesthesia management.

74
Q

Chronic exposure to anesthetic gases has been linked to all of the following except:

A

Emphysema

While chronic exposure is concerning, emphysema is not a commonly reported outcome.

75
Q

Malignant hyperthermia can be triggered by which anesthetic agent?

A

Isoflurane

This condition is a life-threatening reaction to certain anesthetics and requires immediate intervention.

76
Q

An MH crisis is identified by all of the following conditions except:

A

Increased pH

Increased pH is not a common indicator of malignant hyperthermia; rather, metabolic acidosis is typically observed.

77
Q

What is the correct preparation for the room prior to an MH case?

A

An MH cart with fluids, monitoring equipment, and drugs

This preparation is critical for immediate response to a malignant hyperthermia crisis.

78
Q

What is the minimum time recommended for pre-operative preparation?

A

at least 20 minutes

79
Q

What equipment is included in an MH cart?

A

fluids, monitoring equipment, and drugs

80
Q

What is one method to help cool a patient before surgery?

A

cooling blanket under the patient

81
Q

What is a recommended practice for lowering the temperature in the OR?

A

lowering the temperature in the OR prior to the start of the case

82
Q

What is the airway management technique selected for Mr. X in the OR?

A

RSI

83
Q

What type of airway device is used for Mr. X?

A

normal ETT

84
Q

Which drugs are used for Mr. X’s induction and airway management?

A

propofol, succinylcholine, fentanyl

85
Q

What is the recommended bag-mask ventilation rate before intubation for Mr. X?

A

Bag-mask at a slow rate (8-12 bpm)

86
Q

What does a leak developing around the endotracheal tube cuff indicate?

A

indicative of a small leak in the cuff or normal due to N2O entering the cuff

87
Q

What additional intra-operative monitoring is recommended for Mr. X?

A

would consist of an arterial line

88
Q

What type of anesthesia may be used for a Caesarian section?

A

regional, local, conscious sedation, or a combination

89
Q

What is the airway management technique for the high-risk delivery patient?

A

RSI

90
Q

What type of airway device is used for the delivery patient?

A

normal ETT

91
Q

What additional intra-operative monitoring is required for the delivery patient?

A

would consist of an arterial line

92
Q

What is the most probable cause of severe hypotension during delivery?

A

drug induced

93
Q

What is the purpose of administering Narcan® after delivery?

A

reverses the respiratory depression caused by narcotics crossing the placenta

94
Q

What monitors are required for the anesthetic of the delivery patient?

A

Oximeter, Temperature measuring device, Blood Pressure device, BIS

95
Q

What is the airway management technique for Mrs. Poppins?

A

normal induction and intubation

96
Q

What type of airway device is used for Mrs. Poppins?

A

normal ETT

97
Q

What drugs are used for Mrs. Poppins’ induction and airway management?

A

propofol, succinylcholine, fentanyl

98
Q

What is an indication for bronchoscopy in Mrs. Poppins’ case?

A

to assist with the intubation of a patient with a possible skeletal concern

99
Q

What is the incorrect ventilation parameter for one lung ventilation?

A

an I:E ratio of 2:1

100
Q

What additional intra-operative monitoring is required for Mrs. Poppins?

A

would consist of an arterial line

101
Q

What could cause a poor capnography tracing?

A

the CO2 absorber needs changing, the exhalation valve is defective, the patient is making an effort to breathe

102
Q

What is the airway management technique for Mrs. Plump?

A

normal induction and intubation

103
Q

What type of airway device is used for Mrs. Plump?

A

normal ETT

104
Q

What drugs are used for Mrs. Plump’s induction and airway management?

A

propofol, rocuronium, fentanyl

105
Q

What is the patient positioning for Mrs. Plump’s induction?

A

Semi-Fowlers

106
Q

What is the airway management technique for Mr. Chin?

A

normal induction and intubation

107
Q

What type of airway device is used for Mr. Chin?

A

normal ETT

108
Q

What is the patient positioning for Mr. Chin’s surgery?

A

sitting upright

109
Q

What is the airway management technique for Mr. Riga?

A

RSI

110
Q

What drugs are used for Mr. Riga’s induction and airway management?

A

propofol, succinylcholine, fentanyl

111
Q

What pre-operative testing is recommended for Mr. Riga?

A

ABGs, spirometry, 6-minute walk test, full pulmonary function tests

112
Q

How would COPD medications most likely be delivered during Mr. Riga’s case?

A

liquid form through a mini nebulizer

113
Q

What might a chest assessment reveal during Mr. Riga’s pre-operative evaluation?

A

decreased air entry to both lungs, crackles on inspiration, wheezes on inspiration

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