1st Semester Exam Flashcards
Morphine relieves pain by its action on the:
μ and κ opioid receptors in the CNS
Correct answer is (4)
The single most important factor related to depth for an inhalational anesthetic agent is:
Solubility in blood
Correct answer is (1)
All of the following analgesics are appropriate for use on an asthmatic patient except:
Morphine
Correct answer is (1)
A patient receives 3 MAC of Sevoflurane on induction of anesthesia. This is:
Just right. This amount will increase Δ P across A-C membrane
Correct answer is (●)
Which of the following statements regarding Nitrous Oxide is true?
It is used as an anesthetic base to decrease the need for other agents
Correct answer is (●)
Inhalational anesthesia induction:
was used first historically
Correct answer is (●)
Which of the following is the reversal agent for benzodiazepines?
Flumazenil
Correct answer is (●)
In comparing an intravenous (IV) to inhalational anesthesia induction:
Stage II is shortened with IV
Correct answer is (●)
Which of the following barbiturates was historically used in the OR for induction, and was considered to be short-acting?
Thiopentone (Pentothal®)
Correct answer is (●)
In order to anesthetize for a surgical procedure involving resection of the esophagus, which of the following types of anesthesia would be required?
a general anesthetic
Correct answer is (●)
Which of the following statements describes the mechanism of action for benzodiazepines?
enhances GABA binding to its receptor which causes inhibition
Correct answer is (●)
The single most important factor in determining the speed of induction and reversal for an inhalation anesthetic agent is:
Solubility in blood
Correct answer is (●)
You must paralyze the patient for a short time to facilitate endotracheal intubation. The drug of choice is:
Succinylcholine
Correct answer is (●)
Fasciculations may follow the injection of:
Succinylcholine (Anectine®)
Correct answer is (●)
The following drugs are considered opiates:
1 & 3
Correct answer is (●)
Acetaminophen (Tylenol):
All of the above
Correct answer is (●)
Compounds that are defined as ‘capable of calming an individual and thereby relieving anxiety and tension’ are called:
sedatives
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A patient is classified as ASA IIIE if they have:
recent diagnosis of diabetes
Correct answer is (●)
The following drugs are considered opioids:
All of the above
Correct answer is (●)
A pre-operative assessment in anesthesia:
All of the above
Correct answer is (●)
During the maintenance phase in anesthesia:
a combination of inhalational and intravenous drugs is used
Correct answer is (●)
The triad of anesthesia has three components, which should be developed separately. These components are:
muscle relaxation, analgesia, hypnosis
Correct answer is (●)
Which statement(s) accurately describe neuromuscular blocking agents?
1, 2, 3
Correct answer is (●)
1 MAC is:
the amount of an inhalational anesthetic agent used to depress movement in ½ of the population
Correct answer is (●)
In delivering 1 MAC, you can administer a mixture containing:
0.5 MAC of Isoflurane + 0.5 MAC of Sevoflurane
Correct answer is (●)
Compounds that are defined as ‘capable of putting an individual to sleep’ are classified as:
sedatives
Correct answer is (●)
The period of time used to describe the anesthetic phase where the patient is wakening is:
emergence
Correct answer is (●)
The stage of anesthesia that involves progressive loss of reflexes and muscle tone and depression of vital function is:
Stage III
Correct answer is (●)
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?
12 mL
Correct answer is (●)
The important factor(s) related to distribution of intravenous agents is/are:
a, b, c
Correct answer is (●)
Spectrophotometry is used in all of the following monitors except:
Doppler
Correct answer is (●)
Dampening of a hemodynamic pressure waveform would cause the following change:
Lower systolic pressure readings
Correct answer is (●)
Which of the following statements is true for PCWP (PAOP)?
PCWP is indicative of LAP and LVEDP
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According to CAS guidelines, which of the following monitoring devices are additional with the use of the anesthetic gas machine?
low inspiratory pressure alarm, hypoxic mixture prevention device
Correct answer is (●)
Patient blood is backing up into the arterial pressure monitoring lines. All of the following situations are possible causes except:
there is an air bubble in the arterial line
Correct answer is (●)
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:
Fractional saturation
Correct answer is (●)
A normal capnogram includes the following:
zero baseline, rapid sharp uprise, alveolar plateau, well-defined ETCO₂, rapid sharp downstroke
Correct answer is (●)
Arterial oxygen saturation as measured by a pulse oximeter is defined as:
the ratio of hemoglobin molecules bound with oxygen to the total amount of hemoglobin available for binding
Correct answer is (●)
All of the following statements are true when using pulse oximetry, except:
less accurate in infants
Correct answer is (●)
Peripheral nerve stimulators are used to determine the following information:
All of the above
Correct answer is (●)
A co-oximeter can be used to measure all but:
hematocrit
Correct answer is (●)
A true mixed venous sample can be obtained by sampling from:
PA proximal port
Correct answer is (●)
When performing a cardiac output by thermodilution:
The pulmonary artery catheter balloon must be inflated
Correct answer is (●)
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:
the patient is sufficiently blocked for the surgery but not the intubation
Correct answer is (●)
An increased CVP may indicate all of the following situations except:
Bowel prep completed on patient
Correct answer is (●)
According to CAS guidelines, which of the following monitoring devices are required during a conscious sedation anesthetic?
1, 2, 3
Correct answer is (●)
In a patient incompletely blocked by a paralyzing agent, you would expect to see a capnograph exhibiting the following characteristic:
A curare cleft
Correct answer is (●)
What characteristic would you expect to see in a capnograph of a patient incompletely blocked by a paralyzing agent?
A curare cleft
A curare cleft indicates a pattern in capnography often seen when a patient has partial neuromuscular blockade.
What BIS monitor reading indicates moderate sedation?
Around 50-75
The Bispectral Index (BIS) monitor is used to assess the depth of anesthesia.
What may cause a patient’s PA reading to appear flattened at about 6 mmHg with no identifiable systole or diastole?
The catheter has migrated to a wedge position
This can occur with pulmonary artery catheterization and indicates a blockage in blood flow.
What does the assessment of micrognathia during an airway assessment indicate?
All of the above
This condition may suggest the need for rapid sequence induction (RSI), BURP maneuver, or a fiberoptic bronchoscope (FOB) for intubation.
True or False: A patient with a previous history of difficult intubation cannot have an asleep intubation according to the Airway Approach Algorithm.
False
The guidelines allow for asleep intubation even with a history of difficult intubation.
The tidal volume delivered by the flow-inflating bag on the circle circuit is NOT dependent on which factor?
Total gas flow rate
Other factors influencing tidal volume include patient lung conditions and mask seal.
What does RSI stand for in the context of intubation?
Rapid Sequence Induction
RSI is a technique to secure the airway quickly in patients at risk of aspiration.
In order to ensure effective manual ventilation in the OR, the operator must pay attention to which monitor?
The end tidal CO₂ monitor
This monitor provides real-time feedback on the patient’s ventilation status.
A ‘Double-lumen’ ETT may be used for which types of surgeries?
Thoracic cases
Double-lumen endotracheal tubes are specifically designed for surgeries requiring lung isolation.
Which situation does NOT indicate the need for Rapid Sequence Induction (RSI)?
A light meal greater than 6 hours ago
RSI is particularly indicated in situations where the risk of aspiration is high.
Awake intubations over a FOB are indicated for which conditions?
All of the above
This includes severe rheumatoid arthritis, head and neck trauma, and high Mallampati scores.
What could cause a flat line in ETCO₂ after intubation?
A paralyzed patient
Other causes may include esophageal intubation or cardiac arrest.
A ‘nasal preformed’ ETT may be used for what types of operations?
Maxillofacial operations and craniotomies
This type of tube is designed for specific anatomical considerations in surgery.
According to the ASA algorithm, what is the next step after two unsuccessful attempts to intubate?
Allow a 2nd individual opportunity to intubate
This approach is recommended to ensure patient safety and improve chances of successful intubation.
Outside the OR, RSI for intubation is indicated in which situation?
Unresponsive patient
This indicates a need for immediate airway management due to inability to protect the airway.
The reason more specialized endotracheal tubes are used in the operating room is due to:
The type of surgery reflects the type of endotracheal tube used
Surgical procedures often dictate specific airway management needs.
What is the correct order of techniques for successful mask ventilation according to the ASA difficult airway algorithm?
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.
What is a probable explanation for limited chest excursion and a tight feeling during manual ventilation?
Patient is not fully paralyzed
Inadequate paralysis can lead to difficulty in achieving effective ventilation.
Common methods of confirming ETT placement in the OR include all except:
Chest X-Ray
While useful, immediate confirmation methods include exhaled CO₂ and bilateral chest rise.
Blood transfusion is likely required if blood loss exceeds what percentage of the patient’s blood volume?
More than 20%
This threshold is critical for assessing the need for transfusion during surgery.
What could be a rationale for not administering Ringer’s lactate solution with blood products?
Ringer’s lactate has calcium which can cause blood clotting
Calcium can react with stored blood products, leading to complications.
The actual tidal volume delivered from an anesthesia ventilator is not influenced by:
Circuit compliance
Circuit compliance is a factor in how the ventilator functions but does not directly affect the set tidal volume.
If the bellows of an anesthetic ventilator do not remain inflated at the end of expiration, what could prevent this?
A leak around the bellows canister
This indicates a malfunction that may compromise ventilation effectiveness.
What happens if the emergency O2 cylinder is left open during surgery?
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.
What does the oxygen flush mechanism on the anesthetic machine deliver?
Oxygen at a flow of 35-75 lpm
This high-flow delivery is used to rapidly fill the breathing circuit.
What is the main purpose of using soda-lime in a circle circuit?
To eliminate carbon dioxide
Soda-lime absorbs CO₂, allowing for more effective ventilation and anesthesia management.
Chronic exposure to anesthetic gases has been linked to all of the following except:
Emphysema
While chronic exposure is concerning, emphysema is not a commonly reported outcome.
Malignant hyperthermia can be triggered by which anesthetic agent?
Isoflurane
This condition is a life-threatening reaction to certain anesthetics and requires immediate intervention.
An MH crisis is identified by all of the following conditions except:
Increased pH
Increased pH is not a common indicator of malignant hyperthermia; rather, metabolic acidosis is typically observed.
What is the correct preparation for the room prior to an MH case?
An MH cart with fluids, monitoring equipment, and drugs
This preparation is critical for immediate response to a malignant hyperthermia crisis.
What is the minimum time recommended for pre-operative preparation?
at least 20 minutes
What equipment is included in an MH cart?
fluids, monitoring equipment, and drugs
What is one method to help cool a patient before surgery?
cooling blanket under the patient
What is a recommended practice for lowering the temperature in the OR?
lowering the temperature in the OR prior to the start of the case
What is the airway management technique selected for Mr. X in the OR?
RSI
What type of airway device is used for Mr. X?
normal ETT
Which drugs are used for Mr. X’s induction and airway management?
propofol, succinylcholine, fentanyl
What is the recommended bag-mask ventilation rate before intubation for Mr. X?
Bag-mask at a slow rate (8-12 bpm)
What does a leak developing around the endotracheal tube cuff indicate?
indicative of a small leak in the cuff or normal due to N2O entering the cuff
What additional intra-operative monitoring is recommended for Mr. X?
would consist of an arterial line
What type of anesthesia may be used for a Caesarian section?
regional, local, conscious sedation, or a combination
What is the airway management technique for the high-risk delivery patient?
RSI
What type of airway device is used for the delivery patient?
normal ETT
What additional intra-operative monitoring is required for the delivery patient?
would consist of an arterial line
What is the most probable cause of severe hypotension during delivery?
drug induced
What is the purpose of administering Narcan® after delivery?
reverses the respiratory depression caused by narcotics crossing the placenta
What monitors are required for the anesthetic of the delivery patient?
Oximeter, Temperature measuring device, Blood Pressure device, BIS
What is the airway management technique for Mrs. Poppins?
normal induction and intubation
What type of airway device is used for Mrs. Poppins?
normal ETT
What drugs are used for Mrs. Poppins’ induction and airway management?
propofol, succinylcholine, fentanyl
What is an indication for bronchoscopy in Mrs. Poppins’ case?
to assist with the intubation of a patient with a possible skeletal concern
What is the incorrect ventilation parameter for one lung ventilation?
an I:E ratio of 2:1
What additional intra-operative monitoring is required for Mrs. Poppins?
would consist of an arterial line
What could cause a poor capnography tracing?
the CO2 absorber needs changing, the exhalation valve is defective, the patient is making an effort to breathe
What is the airway management technique for Mrs. Plump?
normal induction and intubation
What type of airway device is used for Mrs. Plump?
normal ETT
What drugs are used for Mrs. Plump’s induction and airway management?
propofol, rocuronium, fentanyl
What is the patient positioning for Mrs. Plump’s induction?
Semi-Fowlers
What is the airway management technique for Mr. Chin?
normal induction and intubation
What type of airway device is used for Mr. Chin?
normal ETT
What is the patient positioning for Mr. Chin’s surgery?
sitting upright
What is the airway management technique for Mr. Riga?
RSI
What drugs are used for Mr. Riga’s induction and airway management?
propofol, succinylcholine, fentanyl
What pre-operative testing is recommended for Mr. Riga?
ABGs, spirometry, 6-minute walk test, full pulmonary function tests
How would COPD medications most likely be delivered during Mr. Riga’s case?
liquid form through a mini nebulizer
What might a chest assessment reveal during Mr. Riga’s pre-operative evaluation?
decreased air entry to both lungs, crackles on inspiration, wheezes on inspiration
