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Levi's Bonus Question > 2014 Bonus Questions > Flashcards

2014 Bonus Questions Flashcards

1
Q

Which of the following local anesthetics carry a risk of methemoglobinemia? (Choose 2) A. Prilocaine B. Bupivicaine C. Benzocaine D. Mepivacaine

A

A. Prilocaine C. Benzocaine

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2
Q

Which of the following is an appropriate perioperative goal in the child with epiglottis?A. Force the child the stay stillB. Encourage the parents to stay out of the child’s room to prevent excitementC. Intubate with the largest oral ETT to prevent hypoxemia and subglottic closureD. None of the above

A

D. None of the above

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3
Q

As the brachial plexus emerges below the clavicle, the fibers combine again to form three cords that are named according to their relationship to which of the following ?A. Brachial arteryB. Axillary ArteryC. Median NerveD. Musculocutaneous nerve

A

B. Axillary artery

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4
Q

The cricothyroid muscle is innervated by which of the following? A. Superior laryngeal nerve B. Recurrent laryngeal nerve C. Glossopharyngeal nerve D. Facial nerve

A

A. Superior laryngeal nerve

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5
Q

According to the phenomenon termed “differential blockade,” when nerves are exposed to local anesthetics, the loss of which function would be LAST to be seen?a. motor functionb. superficial painc. temperatured. proprioception

A

d. proprioception

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6
Q

When using EMLA cream prior to placing an IV on an 8 year old female, after what period of time is maximal analgesia seen? a. Immediatelyb. 30 minutes to 1 hourc. 2 to 3 hoursd. 12 hours

A

C. 2-3 hrs

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7
Q

You are working at an outpatient surgery center. Your 35 year old, healthy male patient is undergoing an elective procedure at 2pm. He reveals to you that he had a light meal for breakfast, including toast and a glass of water at 6am. What action do you take?a. Tell him to go home, that his surgery will need to be rescheduled.b. Proceed with the scheduled elective surgery.c. Tell him he will need to wait an additional 4 hours in the waiting room prior to surgeryd. Administer your patient 30 mL sodium citrate and procedure with the surgery

A

b. Proceed with the scheduled elective surgery.

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8
Q

Which orbital muscle and cranial nerve combination is responsible for adduction of the eye?a. Superior rectus, CN IIIb. Lateral rectus, CN VIc. Medial rectus, CN IIId. Medial rectus, CN VI

A

c. Medial rectus, CN III

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9
Q

A 55-year-old male is in the pre operative holding area to undergo hernia repair surgery. He is characterized as overweight, which of the following risk factors would be increased for this patient related to his obesity?a. Diabetes mellitusb. Ischemic heart diseasec. Deathd. All of the above

A

d. All of the above

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10
Q

The “three-in-one” block blocks the following nerves: (select three)a. Femoralb. Sciaticc. Sural d. Lateral femoral cutaneouse. Genitofemoral f. Obturator

A

Answers:

a. Femoral,
d. Lateral Femoral Cutaneous,
f. Obturator

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11
Q

Obesity-hypoventilation syndrome or Pickwickian syndrome is characterized by all of the following except: a. Hypercapniab. Cyanosis-induced polycythemiac. Respiratory alkalosisd. Right-sided heart failure

A

c. Respiratory alkalosis

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12
Q

A 34 year old male patient is in the emergency room suffering from a burn injury. He burned his front and back left leg at home after drinking and accidentally stepping into a bonfire. His leg appears white and cherry red with spots of black and the surface is dry with a tissue-paper like appearance. What classification is his burn? a. Superficial, first-degree burnb. Fourth degree burnc. Partial-thickness, second degree burnd. Full-thickness, third-degree burn.

A

d. Full-thickness, third-degree burn.

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13
Q

The specific gravity of CSF is : a. 1.004-1.009b. 1.100-1.019 c. 1.0 – 1.9 d. 1.04 – 1.09

A

a. 1.004-1.009

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14
Q

Place in order the following tissues ranked from highest to lowest blood flows:

a. Subcutaneous
b. Tracheal
c. Paracervical
d. Epidural
e. Brachial Plexus
f. Intravenous
g. Intercostal
h. Caudal
i. Subarachnoid, Sciatic, Femoral

A

f. Intravenous……1
b. Tracheal………2
g. Intercostal……..3
h. Caudal………4
c. Paracervical….5
d. Epidural………6
e. Brachial Plexus….7
i. Subarachnoid, Sciatic, Femoral…….8
a. Subcutaneous…..9

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15
Q

Which of the following patients will have the highest risk of developing systemic toxicity from local anesthetics?

a. A patient who received 20cc of 0.5% bupivacaine injection
b. A patient who received 40cc of 0.25% bupivacaine injection
c. A 50kg patient who received 100 mg of bupivacaine injection
d. All of the above patient have the same risk.

A

d. All of the above patient have the same risk.

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16
Q

Calculate the maximum dose (in mL) of plain Lidocaine that your surgeon can use for his local injection given that your patient is a 55 kg female and that you only have 1% lidocaine available. Provide answer in whole number.

A

Answer: 25mL

Rationale: Dosage for plain lidocaine is 4.5mg/kg with a maximum total dose of 300mg. 55kg x 4.5mg/kg = 247.5mg 1% = 10mg/cc 247.5mg/10mg/cc = 24.75 cc = 25cc

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17
Q

Adding 0.1cc of epinephrine to 10cc of local anesthetic yields a __________ concentration, which means there are _________ of epinephrine per 1cc of local anesthetic.

a. 1:10000; 10mg
b. 1:10000; 10mg
c. 1:100000; 10 mg
d. 1:100000; 10 mCg

A

d. 1:100000; 10 mCg

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18
Q

In the dorsal lemniscal system: the axons of ____________ and ___________ travel medially in the fasciculus gracilis, whereas the axons of _________and_________ travel in the fasciculus cuneatus.

a. Thoracic and lumbar; cervical and sacral
b. Cervical and sacral; thoracic and lumbar
c. Lumbar and sacral; cervical and thoracic
d. Cervical and thoracic; lumbar and sacral

A

c. Lumbar and sacral; cervical and thoracic

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19
Q

Which of the following sentences is not true regarding epidural?

a. Caudal block is an form of epidural block
b. Less local anesthetics is needed for cervical epidural block comparing to thoracic epidural block
c. Less local anesthetics is needed when performing epidural block on pregnant patients or patients with ascites.
d. Kyphoscoliosis does not effect the amount of local anesthetics used in epidural

A

d. Kyphoscoliosis does not effect the amount of local anesthetics used in epidural

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20
Q

When performing emergent eye surgery on a patient with a ruptured open globe, which of the following anesthetic techniques will help decrease IOP and reduce the risk of further ocular damage? (Select 2)

a. Performing a rapid sequence intubation using succinylcholine and propofol
b. Lowering arterial blood pressure by utilizing the reverse trendelenberg position
c. Increasing PaO2 through hyperventilation

A

b. Lowering arterial blood pressure by utilizing the reverse trendelenberg positionc. Increasing PaO2 through hyperventilation

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21
Q

What is the BMI of a male patient who is 6’2” tall and weighs 231 lbs.?

a. 27.41
b. 35.34
c. 29.75
d. 32.08

A

c. 29.75

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22
Q

Immediately following a liver transplant, which of the following is indicative of proper function?

a. Increased systemic vascular resistance
b. Lower cardiac output
c. Normailizing base deficit
d. All of the above are correct

A

d. All of the above are correct

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23
Q

When performing a spinal on a patient via the paramedian approach which of the following structures are not encountered by the spinal needle during advancement? (select 2)

a. Supraspinous ligament
b. Ligamentum flavum
c. Interspinous ligament
d. Dura mater

A

a. Supraspinous ligamentc. Interspinous ligament

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24
Q

Which of the following nerves innervate the dorsal motor and sensory of the arm, forearm wrist and hand?

a. Musculocutaneous nerve
b. Radial nerve
c. Ulnar nerve
d. Median

A

b. Radial nerve

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25
Q

The patient is in the operating room awaiting an interscalene block. What drug listed would be used for shortening the length of onset for the block?-

A. Lidocaine-	
B. Bupivicaine-	
C. Mepivacaine-	
D. Sodium Bicarbonate-	
E. Xylocaine
A

C. Mepivacaine

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26
Q

What choice below provides a lipophilic characteristic to a local anesthetic?

A. Aromatic Ring-
B. Quaternary Amine-
C. Intermediate Chain-
D. Hydrophilicity

A

A. Aromatic Ring

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27
Q

DepoDur an extended release epidural morphine has just been given concomitantly with lidocaine 60 mg. What would the anesthesia provider monitor for in the patient?

A. Nothing, the provider would make sure the patient receives adequate block.-
B. Monitor the patient for cardiovascular collapse due to a local anesthetic intravascular injection.-
C. Watch for a headache due to an inadvertent spinal tap due to the epidural needle piercing the dura matar and going into the arachnoid space. -
D. Respiratory depression due to the opioid effect the DepoDur may have on the patient

A

D. Respiratory depression due to the opioid effect the DepoDur may have on the patient

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28
Q

A problem with epidural anesthesia is an inadequate block, one-sided block, or single sensory dermatome segment that fails to have adequate anesthesia. To avoid this situation you would do what? (check 3)-

A. Use air during loss-of-resistance technique to avoid diluting the local anesthetic-
B. Repositioning the patient with the unblocked side down-
C. Administering more local anesthetic-
D. Use normal saline during loss-of-resistance technique- E. Place sodium bicarbonate in the local anesthetic

A

B. Repositioning the patient with the unblocked side down
C. Administering more local anesthetic
D. Use normal saline during loss-of-resistance technique

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29
Q

The brachial plexus is divided up into division, branches, roots, trunks, and cords. Give the correct order and number of nerves in each section starting at the ventral rami:-

A. 5 Roots, 4 Division, 3 Branches, 2 Cords, and 3 Trunks-
B. 5 Divisions, 3 Cords, 4 Branches, 6 Trunk, and 5 Roots-
C. 4 Branches, 3 Cords, 6 Divisions, 3 Trunks, and 5 Roots-
D. 5 Roots, 3 Trunks, 6 Divisions, 3 Cords, and 4 Branches-
E. 3 Trunks, 2 Cords, 3 Branches, 4 Divisions, and 5 Roots

A

D. 5 Roots, 3 Trunks, 6 Divisions, 3 Cords, and 4 Branches

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30
Q

A decrease in cholinesterase activity has been associated with

  1. Obesity
  2. nephrosis
  3. Alcoholism
  4. Burns
A
  1. Burns
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31
Q

Branches of the femoral nerve anesthetized during an ankle block include the…

a. Deep peroneal nerve
b. Sural nerve
c. Saphenous nerve
d. Posterior tibial nerve

A

c. Saphenous nerve

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32
Q

Choose the 4 nerve branches of the sciatic nerve.. pick 4

1) deep peroneal
2) posterior tibial nerve
3) sural nerve
4) superficial peroneal nerve
5) Saphenous nerve
6) illioinguinal nerve
7) illiohypogastric nerve

A

1)deep peroneal2)posterior tibial nerve3) sural nerve4)superficial peroneal nerve

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33
Q

decrease in pseudocholinesterase activity has been assosciated with use of which drug(pick two)

1) neostigmine
2) esmolol
3) vecuronium
4) rocuronium

A

1)neostigmine2)esmolol

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34
Q

What nerve provides sensation to the larynx below the vocal cords?

1} Internal branch of the superior laryngeal nerve
2} Recurrent laryngeal nerve
3} trigeminal nerve
4} glossopharyngeal nerve

A

2} Recurrent laryngeal nerve

35
Q

When regional anesthesia is used for urethral procedures during a cystoscopy, what level of block is needed?

A. T11-T12
B. T9-T10
C. T8-T9
D. T10-T11

A

B. T9-T10

36
Q
  1. When aberrant conduction pathways are identified during an electrophysiology procedure, how are they ablated?

A. They are ablated using microwave frequencies.
B. They are ablated with a bovie.
C. They are ablated using radiofrequency techniques. D. They are ablated using local anesthetics.

A

C. They are ablated using radiofrequency techniques.

37
Q
  1. A patient with AIDS is taking a non-nucleoside reverse transcriptase inhibitor. The anesthetist gives him a high dose of midazolam for conscious sedation. What effect is most likely to be seen with this patient?

A. Oversedation due to prolonged half-life of midazolam.
B. Undersedation due to shortened half-life of midazolam.
C. Oversedation due to low albumin levels.
D. No change in sedation level or length.

A

A. Oversedation due to prolonged half-life of midazolam.

38
Q
  1. What is the average life-expectancy of the patient who has been diagnosed with Alzheimer’s disease.

A. 10 years
B. 8 years
C. 5 years
D. 3 years

A

B. 8 years

39
Q
  1. Hirschsprung’s disease is characterized by:

A. Pleural effusions.
B. Tachycardia and HTN.
C. Neurological defects.
D. Contracture of the bowel.

A

D. Contracture of the bowel.

40
Q

Which of the following patients are more likely to be diagnosed with pheochromocytoma?

a. A 29 y/o female with vitals 36.2, 80, 18, 140/92
b. A 78 y/o male with vitals 37.4, 58, 16, 178/102
c. A 45 y/o female with vitals 36.4, 64, 16, 80/52 c/o HA, diaphoresis and tremors
d. A 5 y/o male exhibiting a clumsy, waddling gait that falls frequently

A

a. A 29 y/o female with vitals 36.2, 80, 18, 140/92

41
Q

Which of the following patients are at greatest risk for a pulmonary embolism?

a. A patient with Virchow’s triad
b. A patient with Beck’s triad
c. A patient with Meckler’s triade
d. A patient with Samter’s triad

A

a. A patient with Virchow’s triad

42
Q

When planning to treat a patient with a high incidence of PONV, the following would not be an appropriate treatment option:

a. Ephedrine 0.5 mg/kg IM given at the end of surgery
b. Increased ambulation immediately post-op
c. Increased oral intake immediately post-op
d. Droperidol 10 to 20 mg/kg IV given at the end of surgery

A

a. Ephedrine 0.5 mg/kg IM given at the end of surgery

43
Q

Preferred sites for larger IV catheters in infants and sick children include (select two):

a. Antecubital vein
b. Saphenous vein
c. Femoral vein
d. Internal jugular

A

a. Antecubital veinb. Saphenous vein

44
Q

Benefits of utilizing the EXIT procedure (ex utero intrapartum treatment) include all of the following except:

a. Reduced morbidity compared with those undergoing conventional treatment
b. Allows for controlled delivery and intrapartum assessment strategy to treat fetuses with certain life-threatening diseases
c. Uteroplacental circulation is maintainedd. Continuous oxygenation is maintained at all times

A

a. Reduced morbidity compared with those undergoing conventional treatment

45
Q

When performing a block using local anesthetics, how many successive Nodes of Ranvier on a mylenated nerve generally need to be affected to get a complete block?

a. 1
b. 2
c. 3
d. 4

A

c. 3

46
Q

A pt comes into the PASE clinic for preop evaluation prior to bariatric surgery. The pt is 5’4” tall and has a weight of 250 pounds. Please select the correct Body Mass Index (BMI) and category of obesity this pt belongs. (2 answers)

a. BMI 43
b. BMI 33
c. BMI 23
d. Overweight
e. obese f. morbidly obese

A

a. BMI 43f. morbidly obese

47
Q

What 2 medications need to be dosed according to total body weight versus lean body weight? (choose 2)

a. Succinylcholine
b. Etomidate
c. Rocuronium
d. Vecuronium
e. Cisatricurium

A

a. Succinylcholineb. Etomidate

48
Q

An obese pt comes into the preop area, ready for surgery. On evaluation, you notice this pt has a neck circumference of 41 cm, large upper teeth, and a malampati score of 3. As an astute SRNA, you know that this pt exhibits many variables that indicate this pt will have a difficult airway but which variable will most likely create a difficult airway?

a. obesity
b. abnormal upper teeth
c. malampati score of 3
d. Neck circumference

A

d. Neck circumference

49
Q

When performing a block using local anesthetics, you know that:

a. spinal anesthesia has longer duration of action than plexus blocks
b. subcutaneous injections have a longer duration than spinal blocks
c. spinal blocks and subcutaneous injections have a slower onset than plexus blocks
d. plexus blocks have a slower onset and longer duration than spinal blocks and subcutaneous injections

A

d. plexus blocks have a slower onset and longer duration than spinal blocks and subcutaneous injections

50
Q

A total knee surgical patient is recovering on the floor and is ordered to have continuous pulse ox for the first 24 hours post-op. Of the medications administered in his spinal listed below, which one would require post op continuous pulse ox?

A.) Fentanyl
B.) Sodium BiCarb
C.) Duramorph
D.) Clonidine

A

C.) Duramorph

51
Q

Your patient received a high spinal and is now at risk for respiratory compromise and aspiration. Which nerve “loop” between the ventral rami of C1-C3 that sends branches to the infrahyoid muscles, thyroid and geniohyoid muscles could be affected in this situation?

A.) Endoneurium
B.) Ansa Cervicalis
C.) Phrenic Nerve
D.) Transverse Cervical nerves

A

B.) Ansa Cervicalis

52
Q

3.) When performing an ankle block for foot surgery, you would block which five nerves? (select 5)

A.)	Saphenous Nerve
B.)	Deep Peroneal nerve
C.)	Popliteal Nerve
D.)	Superficial Peroneal Nerve
E.)	Sural Nerve
F.)	Ansa Cervicalis
G.)	Tibial Nerve
A

A.) Saphenous NerveB.) Deep Peroneal nerveC.) Superficial Peroneal NerveD.) Sural NerveE.) Tibial Nerve

53
Q

4.) Your patient has an unknown cardiac left to right shunt. You administered local anesthetic and witness LA toxicity. This is due to the fact that the LA is considerably taken up by the _____ by first pass uptake.

A.) Heart
B.) Lungs
C.) Brain
D.) Liver

A

B.) Lungs

54
Q

5.) The choice of local anesthetic determines the duration of the spinal blockade. Which LA has the shortest duration of action and isn’t currently approved by the FDA for intrathecal injection?

A.) Bupivacaine
B.) Procaine
C.) Preservative free 2-Chloroprocaine
D.) Tetracaine.

A

c. Preservative free 2-Chloroprocaine

55
Q

The nurse anesthetist is preparing to induce a patient undergoing a renal transplant. Which of the following non-depolarizing muscle relaxants is the least appropriate?

a. rocuronium
b. vecuronium
c. pancuronium
d. cisatracurium

A

c. pancuronium

56
Q

A 12 year old boy who is wheelchair bound due to muscle weakness just had a tonsillectomy and starts to bleed in the PACU and needs to return to the operating room. Which is the most appropriate action.

a. standard induction with rocuronium and general anesthesia
b. succinylcholine RSI with general anesthesia
c. RSI with only propofol and TIVAd. standard induction with rocuronium and TIVA

A

c. RSI with only propofol and TIVA

57
Q

The surgeon is debulking a tumor in the gastrointestinal track by using a Nd-YAG laser. You look for eye protection and you see a box a goggles of assorted colors. Which is the appropriate one?

a. clear
b. red
c. yellow
d. green

A

d. green

58
Q

A patient who received an interscalene block is now having symptoms of ptosis, myosis, and anhidrosis. What do you suspect is the cause?

a. blockade of stellate ganglion
b. accidental pneumothorax
c. vertebral artery injection
d. patchy block

A

a. blockade of stellate ganglion

59
Q

the obturator nerve…?

a. is unimportant in arthroscopic surgery of the knee
b. supplies motor innervation to the adductor muscles of the medial thigh
c. supplies sensory innervation to the skin overlying the patella
d. supplies sensory innervation to the lateral aspect of the thigh

A

b. supplies motor innervation to the adductor muscles of the medial thigh

60
Q

In ENT surgery, the head of the patient is often turned away from the anesthesia machine. Turning the patient involves temporarily disconnecting the circuit and other monitors from the patient. What should be done prior to disconnection and turning?

A. Ventilate the patient with 1.5 MAC of volatile anesthetic to maintain anesthesia during disconnection.
B. Ventilate the patient with 100% oxygen and adequate tidal volumes for 3 to 5 minutes prior to disconnection.
C. Ensure that O2 saturation is 99% or higher prior to turning the table.
D. All of the above

A

B. Ventilate the patient with 100% oxygen and adequate tidal volumes for 3 to 5 minutes prior to disconnection.

61
Q

Which orbital muscle is innervated by cranial nerve VI?

A. Superior rectus
B. Superior oblique
C. Medial rectus
D. Lateral rectus

A

D. Lateral rectus

62
Q

What is ideal body weight?

A. A measurement of height and body mass that exhibits the lowest morbidity and mortality for a given population.
B. Height (in centimeters) -105 for men
C. Height (in centimeters) -100 for women
D. All of the above

A

A. A measurement of height and body mass that exhibits the lowest morbidity and mortality for a given population.

63
Q

Pruritis remains a concern with intrathecal fentanyl, especially when administered with which of the following local anesthetics?

A. Prilocaine
B. 2-Chloroprocaine
C. Lidocaine
D. Bupivacaine

A

B. 2-Chloroprocaine

64
Q

When Clonidine is used in combination with opiates, the analgesic effects have been shown to have what effect?

A. Synergistic
B. No effect
C. Additive
D. Detrimental

A

C. Additive

65
Q

Which of the following is the most sensitive indicator of the effect of obesity on pulmonary function?

a. FEV1
b. TLC
c. ERV
d. FVC

A

c. ERV

66
Q

Fentanyl 20 mcg is added to bupivacaine 0.75% when dosing a spinal anesthetic. Fentanyl is added to the bupivacaine due to:

a. Fentanyl is hydrophilic and its onset will be quick
b. Fentanyl is lipophilic and its onset will be delayed
c. Fentanyl is hydrophilic and its onset will be delayed
d. Fentanyl is lipophilic and its onset will be quick

A

d. Fentanyl is lipophilic and its onset will be quick

67
Q

Which of the following is the most important factor in determining the level of spinal blockade?

a. Baricity of the local anesthetic solution
b. Position of the patient during and just after injection
c. Dose of the anesthetic injectedd. All of the above

A

All of the above

68
Q

During the resuscitative phase of a burn injury which of the following would be used during fluid resuscitation?

a. Lactated Ringers solution
b. 5% albumin
c. A combination of 75% Lactated Ringers and 5% albumin
d. A combination of 50% Lactated ringers and 5% albumin

A

a. Lactated Ringers solution

69
Q
  1. Which of the following local anesthetics will have the slowest onset of action?

a. Lidocaine
b. Mepivacaine
c. Chloroprocaine
d. Bupivacaine

A

d. Bupivacaine

70
Q 
When the epidural space is opened by injection of liquid or air, its contents include: (select all that apply)
\_\_ Batson Plexus
\_\_ Lymphatics (Epidural Fat)
\_\_ Segmental Arteries
\_\_ Ligamentum Flavum
\_\_ Vertebral Lamina
A

__ Batson Plexus
__ Lymphatics (Epidural Fat)
__ Segmental Arteries

71
Q

Which of the following statement is true regarding Cerebral Spinal Fluid (CSF)?

(a) CSF is produced by the arachnoid villi
(b) The entire CSF volume is replaced every 2 hours
(c) CSF is produced at a rate of 5-10 mL/hour
(d) CSF cannot be relied on to distribute drugs in the subarachnoid space

A

(d) CSF cannot be relied on to distribute drugs in the subarachnoid space

72
Q

Which of the following statements are false regarding spinal cord anatomy?

(a) The spinal cord extends from the foramen magnum to the end of the sacrum in the first trimester fetus
(b) In 30% of individuals the spinal cord may end at T12, while in 10% it may extend to L3
(c) At birth, the spinal cord ends at about the level of the third lumbar vertebra
(d) All statements are true

A

(d) All statements are true

73
Q

A patient receiving a subarachnoid block experiences a paresthesia. The provider stops advancing the needle, removes the stylet, and confirms the presence of CSF. What is the provider’s next action?

(a) The presence of CSF confirms that the needle encountered a caudaequina nerve root in the subarachnoid space and the needle tip is in good position. The anesthetic is administered.
(b) The paresthesia resulted from contact with a spinal nerve root traversing the epidural space and the needle tip is in good position. The anesthetic is administered.
(c) Immediate removal of spinal needle and re-attempt proper needle placement.
(d) Failed regional attempt, convert to general anesthesia.

A

(a) The presence of CSF confirms that the needle encountered a caudaequina nerve root in the subarachnoid space and the needle tip is in good position. The anesthetic is administered.

74
Q

What statement is false regarding post dural puncture headache (PDPH)?

(a) PDPH is a common complication of spinal anesthesia with a reported incidence as high as 25% in some studies.
(b) The risk of PDPH is less with epidural anesthesia, but it occurs in up to 50% of young patients
(c) The headache is believed to result from the loss of CSF through the meningeal needle hole, resulting in decreased buoyant support for the brain
(d) The use of air, rather than fluid for loss of resistance for epidural anesthesia decreases the risk of PDPH

A

(d) The use of air, rather than fluid for loss of resistance for epidural anesthesia decreases the risk of PDPH

75
Q

Which are relative contraindications to epidural blockade? (select two)

a. increased ICP
b. previous back surgery
c. coagulopathy
d. uncorrected hypovolemia
e. hypertension
f. positioning that compromises respiratory status

A

c. coagulopathye. hypertension

76
Q

Obesity-hypoventilation syndrome is best defined as:

a. BMI > 30 kg/m2 and PaCO2 > 40 mmHg
b. BMI > 40 kg/m2 and PaCO2 > 45 mmHg
c. BMI > 30 kg/m2 and PaCO2 > 45 mmHg
d. BMI > 40 kg/m2 and PaCO2 > 40 mmHg
e. none of the above

A

c. BMI > 30 kg/m2 and PaCO2 > 45 mmHg

77
Q

Which is not true of an increasing ventilation-perfusion relationship?

a. a very low cardiac output
b. the patient develops a pulmonary embolus
c. deadspace ventilation decreases
d. Q ̇ approaches 0

A

c. deadspace ventilation decreases

78
Q

You have just administered a spinal anesthetic (Bupivacaine 0.5% in water) to an obese patient. Which factor affects the spread of the local anesthetic the most?

a. gravity
b. BMI > 30 kg/m2
c. patient sitting up on the bed
d. dose of local anesthetic

A

d. dose of local anesthetic

79
Q

The use of nebulizers is allowed by which?

a. Bernoulli’s Principle
b. Venturi Effect
c. Coanda Effect
d. Laplace’s Law

A

b. Venturi Effect

80
Q

A patient is scheduled to undergo a thoracoscopy; a thoracic epidural is part of your anesthetic plan. The patient received SQ Lovenox for DVT prophylaxis at 0600 today. It is now 0800 what time should the surgery be postponed till?

A) Continue on with surgery as scheduled at 0800
B) Wait until 1000
C) Wait until 1600
D) Cancel and reschedule for tomorrow

A

C) Wait until 1600

81
Q

0.75% Bupivacaine is mixed with 5% dextrose and injected at the site of lumbar lordosis. Where could you expect the local anesthetic to spread?

A) Stay in the area injected
B) Drift towards the sacrum
C) Drift toward T4-T6
D) Spread to both the sacrum and towards T4-T6

A

D) Spread to both the sacrum and towards T4-T6

82
Q

Using the Paramedian approach to a spinal anesthetic, which of the following ligaments should be encountered first?

A) Supraspinous ligament
B) Interspinous ligament
C) Ligamentum flavum
D) Transverse Ligament

A

C) Ligamentum flavum

83
Q

You are performing a femoral block using a nerve stimulator needle. You are at your desired target and see your expected twitch and patellar snap. You start injecting 0.5% Ropivacaine and you see your twitch abruptly disappear, what is your next course of action?

A) Advance the needle until you regain response at 0.1-0.2 mA.
B) Withdraw your needle because you are now giving an intraneural injection
C) This is expected because a needle-tissue electrical interface has been created.
D) This is expected because the local anesthetic is working and blocking the nerve response.

A

C) This is expected because a needle-tissue electrical interface has been created.

84
Q

Your patient has hypertrophic cardiomyopathy, which anesthetic management of this patient’s hemodynamics is incorrect?

A) Treat hypotension aggressively with alpha-adrenergic agents
B) If junctional rhythm occurs, atrial pacing will help
C) Increase contractility with epinephrine
D) Maintain an elevated preload and afterload

A

C) Increase contractility with epinephrine

Levi's Bonus Question (2 decks)

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