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Anaesthesiology > 9th June 2023 - Variant 1 > Flashcards

9th June 2023 - Variant 1 Flashcards

1
Q

Which one of the following best describes the reason for the rapid offset of effect of the induction agents?

A. Ester hydrolysis
B. Liver metabolism
C. Renal excretion
D. Redistribution

A

D. Redistribution

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2
Q

Advantages of a Laryngeal mask airway include ALL BUT ONE of the following. Indicate the exception:

A. It frees up the anesthesiologist’s hands.
B. It protects against aspiration.
C. It can allow mechanical ventilation.
D. It can be readily inserted without the use of muscle relaxants

A

B. It protects against aspiration.

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3
Q

What is the primary purpose of denitrogenation prior to anesthetic induction?

A. Improving matching of ventilation and perfusion

B. Increasing oxygen reserve in the functional residual capacity

C. Increasing contribution of second gas effect to rate of induction

D. Maximizing arterial oxygen content

A

B. Increasing oxygen reserve in the functional residual capacity

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4
Q

Which of the following anesthetic agents does NOT trigger malignant hyperthermia?

A. Halothane
B. Isoflurane
C. Suxamethonium
D. Thiopental

A

D. Thiopental

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5
Q

A patient with diabetic ketoacidosis is scheduled for an emergent laparotomy. Which of the following best explains the decrease in serum potassium concentration that occurs in this patient following administration of insulin?

A. Dilutional hypokalemia follows free water retention from decreased osmotic diuresis

B. Intracellular potassium is exchanged for extracellular glucose

C. Extracellular potassium is actively transported with glucose into cells

D. Insulin enhances renal excretion of potassium

A

C. Extracellular potassium is actively transported with glucose into cells

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6
Q

** A 52-year-old male complains of nausea and a headache at work. He subsequently has an acute decline in wakefulness. His coworkers bring him to the emergency department. On evaluation, he opens his eyes to painful stimuli, makes incomprehensible sounds and localizes to pain.

Select the patient’s GCS from the list below.

A. 6
B. 7
C. 8
D. 9

A

D. 9

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7
Q

A 60-year old man for minor surgery has a BP of 170/100 mmHg in the pre-operative clinic. In retrospect, he admits that his blood pressure has been consistently high when he checks it at the drugstore.

Assign an ASA class.

A. ASA I
B. ASA II
C. ASA III
D. ASA IV.

A

D. ASA IV.

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8
Q

** Which one of the following drugs is administered as an antiemetic?

A. Ketamine
B. Ondansetron
C. Glycopyrrolate
D. Neostigmine

A

B. Ondansetron

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9
Q

Oxygen stores:

A. are increased slightly by pre-oxygenation

B. are large because oxygen is so important for cellular function

C. depend in part on blood volume and haemoglobin concentration

D. are large in pregnant women compared to non-pregnant women

A

C. depend in part on blood volume and haemoglobin concentration

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10
Q

** Respiratory center depression owing to overdose, spinal cord disease and muscle fatigue would be what classification of causes of respiratory failure?

A. Diffusion impairment
B. Impaired Ventilation (Hypoventilation)
C. Airway obstruction
D. V/Q Mismatch

A

B. Impaired Ventilation (Hypoventilation)

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11
Q

In the normal pulmonary vascular bed:

A. the mean pulmonary arterial pressure is half the mean aortic pressure

B. the pulmonary vascular resistance is lower than the systemic vascular resistance

C. there is always 50% of the blood volume

D. the pulmonary capillary wedge pressure equals capillary pressure

E. hypoxia causes dilatation of blood vessels

A

B. the pulmonary vascular resistance is lower than the systemic vascular resistance

D. the pulmonary capillary wedge pressure equals capillary pressure

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12
Q

Which of the following criteria are part of the qSOFA (Quick SOFA) Score?

A. Altered mental status
B. Systolic blood pressure < 100mmHg
C. Leucocytes > 11G/L
D. SpO2 < 92%
E. Respiratory rate > 22 bpm

A

A. Altered mental status
B. Systolic blood pressure < 100mmHg
E. Respiratory rate > 22 bpm

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13
Q

** Lung compliance is decreased in:

A. the presence of intra-alveolar fluid
B. pleural effusion
C. idiopathic pulmonary fibrosis
D. emphysema
E. fibrosing alveolitis

A

A. the presence of intra-alveolar fluid
C. idiopathic pulmonary fibrosis
E. fibrosing alveolitis

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14
Q

Treatment of patients with severe diabetic ketoacidosis includes:
A. hemodialysis
B. crystalloid solutions
C. insulin
D. furosemide
E. colloid solutions

A

B. crystalloid solutions
C. insulin

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15
Q

In a pregnant woman at term:

A. tidal volume is increased
B. functional residual capacity is increased
C. physiological dead-space is decreased
D. total vital capacity is reduced
E. airway resistance is reduced

A

A. tidal volume is increased
C. physiological dead-space is decreased
D. total vital capacity is reduced

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16
Q

Which of the following can cause Acute respiratory distress syndrome (ARDS)?

A. Acute Pancreatitis
B. Acute heart failure
C. Pneumonia
D. Sepsis
E. Massive blood transfusion

A

A. Acute Pancreatitis
C. Pneumonia
D. Sepsis
E. Massive blood transfusion

17
Q

** Chose false statements regarding addition of epinephrine to a local anesthetic:

A. Increases the duration of the block

B. Makes the block not so dense

C. Increases toxicity of the local anesthetic

D. Epinephrin 1:200 000 means 5 mcg/ml

E. Usually reduces the rate of absorption and peak plasma concentration of local anesthetic

A

C. Increases toxicity of the local anesthetic

D. Epinephrin 1:200 000 means 5 mcg/ml

18
Q

Treatment of an anaphylactic reaction includes:

A. norepinephrine
B. antibiotics
C. crystalloid solutions
D. antihistamines
E. corticosteroids

A

C. crystalloid solutions
D. antihistamines
E. corticosteroids

19
Q

In the oxygen dissociation curve, causes of a right shift include:

A. low-molecular-weight dextran
B. digitalis
C. metabolic acidosis
D. respiratory alkalosis
E. hypoxia

A

C. metabolic acidosis
E. hypoxia

20
Q

Hypokalaemia

A. causes ST segment depression on the ECG

B. occurs in untreated hyperosmolar non-ketotic diabetic coma

C. precipitates digoxin toxicity

D. may precipitate muscle paralysis

E. causes mental depression

A

A. causes ST segment depression on the ECG

C. precipitates digoxin toxicity

D. may precipitate muscle paralysis

21
Q

[CASE 1]

A 36-year-old woman is receiveing general anesthesia for a diagnostic laparoscopy in the Trendelenburg position with carbon dioxide insufflation.

During a 15-minute period after induction, her SpO2 decreases from 99% to 90% and PETCO2 increases from 38 to 43 mmHg. FiO2 is 0.3; all ventilator settings have been constant.

A) Which are the possible causes for the decrease in SpO2?

B) Explain the pathogenesis?

C) What would be your initial management?

A

A) Cause for DECREASED Sp02 is DUE to DECREASED Diaphragmatic Movement

B) PATHOGENESIS:
1. Place Px into CEPHALAD Position, which PUTS PRESSURE onto Abdo Viscera, thereby DISPLACING the Diaphragm + impairing it’s Fx

  1. DECREASED Pulmonary Compliance + FRC means, FAILURE of ALVEOLI to ELIMINATE C02 / INCREASE 02
  2. Resulting in HYPERCAPNIA + HYPOXEMIA

C) TREATMENT PLAN:
- Administer 02 = TO MAINTAIN Sp02 ABOVE 90%
- CORRECT the DECREASED Sp02
- NON-INVASIVE Ventilatory Support
- MOVE the Px in REVERSE TRENDELENBURG Position

22
Q

[CASE 2]

A normally fit and well 11-year-old boy (~40 kg) presents to the Emergency department with one-day history of emesis and lethargy. He complains of non-specific abdominal pain. His vital signs are T – 37,2oC, RR – 28; ABP – 98/62 mmHg.

Exam reveals the odor of aceton on the breath, dry lips, he is lethargic, but oriented. Urine shows 3+ glucosae and 2+ ketones.

A venous blood gas shows:
pH: 7.10
pO2: 86 mmHg
pCO2: 22 mmHg
HCO3: 9 mmol/l
BE: -18
Lactate: 4.0
Potassium: 5.5 mmol/l
Glucose: 22 mmol/L (395 mg/dL)
Other values within normal range

A) Give a suggestion for diagnosis. What does ABG show?

B) You are going to hospitalize this boy, what investigations are you going to order?

C) Give a suggestion for treatment plan.

A

A) Diagnosis could be - DIABETIC KETOACIDOSIS

  • ABG shows = LOW pH, and HIGH Levels of Lactic Acid + Glucose; ACETONE BREATH; LOW Levels of Bicarbonate

B) GOING TO ORDER:
- The ROTHERA RING Test = Tests for KETONE BODIES
- Check the PATIAL COMPENSATION by Resp ALKALOSIS

C) TREATMENT PLAN:
- Intubate
- CORRECT the ACIDOSIS
- Insulin + IV Fluids
- CORRECT the Electrolytes
- Continuously Test the ABGs

23
Q

[WRITING I] INTRAVENOUS anesthesia - definition. Advantages and disadvantages.

A

DEF = IVA is used to INDUCE a state of REVERSIBLE loss of consciousness, characterised w/ amnesia, hypnosis, muscle relaxation + analgesia

EXAMPLES incl = Thiopental / Propofol / Ketamine

ADV = Easy + Quick Admin / Precise control of Dose / NO Dependence on Breathing

DISADV = Rate of Elimination depends on Organ + Enzyme Function / Risk of Allergies / Risk of Systemic Infections

24
Q

[WRITING II] COMPARATIVE characteristics between epidural and spinal anesthesia

A

1) EPIDURAL Anaesthesia:
- Injected at EPIDURAL Space
- At ANY LEVEL of the Vertebral Column
- Has a SLOWER Onset
- Given 20-30ml of BUPVICAINE
- Has a LESS DENSITY of Block
- Cause Hypotension SLOWLY

2) SPINAL Anaesthesia:
- Injected at SUBARACHNOID Space
- At LEVEL BELOW 1/12, where SPINAL CORD ENDS
- Has a RAPID Onset
- Given 2.5 - 3.5ml of BUPVICAINE
- Has a MORE DENSITY of Block
- Cause Hypotension RAPIDLY
- HEADACHE as POST-OP Complication!

25
Q

[WRITING III] Definition and classification of ACIDOSIS.

A

DEF = Blood pH is BELOW 7.35, DUE to Resp / Metabolic Process

CLASSIFICATION
1) Respiratory = pC02 is MORE than 45 mmol / L
- With a LOW pH

  • DUE to Resp Failure (COPD / Asthma), Airway Obs, Neuromuscular Disorders, Electrolyte Abnormalities, Sedatives / Anaesthetics or Stroke

2) Metabolic = LOW Bicarbonate; LOWER than 22 mmol / L
- With a LOW pH

  • Either be HIGH ANION Gap (HIGH Lvls of Acids such as Lactic, KBs) = Diabetic Ketoacidosis, and Lactic Acidosis
  • NORMAL ANION Gap = Diarrhoea, Renal Tubular Acidosis, and Addison’s Disease
26
Q

[WRITING IV] Circulatory shock - definition, classification, stages of evolution

A

DEF = Life-threatening Condition, defined as a STATE OF HYPOPERFUSION, leading to Cellular + Tissue HYPOXIA

CLASSIFICATION
1. HYPERDYNAMIC - Vasogenic (Septic / Anaphylactic) / Neurogenic

2. HYPODYNAMIC - Hypovolemic / Cardiogenic

STAGES OF EVOLUTION
1. COMPENSATED
- Reversible Stage
- There’s MILD Lab DERANGEMENT
- There’s NO Symptoms - MILD of Shock

2. DECOMPENSATED
- Again, Reversible
- TRUE Shock
- Symptoms of Shock = Such as Organ Failure!

3. IRREVERSIBLE
- There’s Irreversible Organ DYSFUNCTION!
- Leading to MULTI-ORGAN DYSFUNCTION SYNDROME

Anaesthesiology (16 decks)

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