Anesthesia Flashcards
Preoperatively anxiety is most effectively relieved by which of the following?
Good anesthesiologist
H2 antagonists help prevent aspiration pneumonitis by doing which of the following?
Increasing pH of gastric contents
What is the most common complication immediately following extubation of the trachea?
Laryngospasm
What is the proper drug injection site for a spinal anesthesia?
B/w the arachnoid and the pia mater of the spinal cord
What is true of a headache that is likely to be diagnosed as a spinal headache?
Goes away when lying down
What is the most common cause of hypotension in the postanesteshia care unit?
Hypovolemia
What is the most effective way to preserve myocardial perfusion in an ischemic heart?
Heart rate as low as possible
A patient who has a mitral valve prolapsed is at increased risk because what is likely to occur?
Fatal arrhythmia
If a patient quits smoking 3 days prior to surgery, what is likely to occur with regards to anesthesia effect?
Improved O2 delivery to the tissues
Tight control of blood glucose (90-120mg/dl) throughout the surgical period benefits the patient with type I diabetes by decreasing the likelihood of what?
Wound infection
Which of the following is of great concern to the anesthesiologist when dealing with a patient who has untreated hyperthyroidism?
Response to stress may be severe arrhythmia and hypertension
Which of the following anesthetic conditions increases Sickling and vascular occlusion?
Hypovolemia
What usually causes central nervous system excitement after the injection of Local anesthetic?
IV injection
What is the most potent opioid currently available?
Sufentanil
Which narcotic causes the least respiratory depression in equianalgesic doses?
All are alike
What anesthetic would most likely cause anterograde amnesia?
Midazolam
Which induction agent permits the earliest return of normal functioning?
Propofol
What is the most reliable monitor of adequacy of ventilation?
Capnograph
Which of the following, when monitored continuously, can show ischemic episodes during anesthesia?
Leads II and V5
Why is patient controlled analgesia superior to intermittent opioid administration?
Patient does not experience wide swings in level of pain
A 70 year old man with a history of tobacco abuse, hypertension, prior stroke, and laryngeal Cancer is brought to the emergency department after found unresponsive at his home. It is estimated by family members that he lost consciousness approximately one hour earlier. He underwent a total laryngectomy 10 years prior with no subsequent evidence of recurrent Cancer. His current medications include ramipril and a daily aspirin. On physical examination, the patient is nonresponsive to voice or painful stimuli and his respirations are shallow. Vital signs are: Temperature 37.9 C (98.9 F), blood pressure 200/100 mmHg, pulse is 93/min, respirations are 13/min, and an O2 saturation level of 87%. There are no apparent signs of trauma secondary to a fall. The pupils are small, but equal and reactive. The patient’s tracheostomy is widely patent; breath sounds are distant but present bilaterally without crackles. An arterial blood gas reveals pH 7.25, PaO2 45. What is the most appropriate next step in management?
Place endotracheal tube in patient’s tracheostomy and begin mechanical ventilation
A 69 year old man had a gastric tube placed a day ago. The patient has a long history of dementia secondary to Alzheimer’s disease and was admitted to the hospital for failure to thrive (FTT). A full evaluation revealed only severe dementia but no obvious cause for FTT. A swallowing study was performed that indicated likely aspiration of all foods. After discussion with the family, a decision was made to place a gastric tube for the purposes of feeding. The surgery was uneventful and the patient appears to be doing well during a routine postoperative check. Later that evening, the patient is found severely obtunded. He is now 34 hours postoperative. He has been getting tube feedings for the past five hours and had minimal gastric residuals at the 2 hour check time. On arrival, he is cyanotic with labored breathing. His pulse oximeter reads 85% on 100% non-rebreather mask. On inspection of the patients mouth and oropharynx, there are tube feedings visible. What is the most likely cause of the patients respiratory distress?
Regurgitation and aspiration of gastric tube feedings
A patient had an anterior neck injury, hoarseness, aborted respirations, subcutaneous emphysema, and laryngeal crepitus following a motor vehicle accident. What is the best method of securing the airway in this situation?
Tracheostomy
A 2.525 lb (1150g) 10 day old boy is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200/min and blood pressure measured through a femoral artery catheter is 45/24 mmHg. The next most appropriate step is the administration of what?
Normal saline infusion
Cardiopulmonary resuscitation is being performed on a patient. After successful intubation, arterial blood gas values are: PaO2 86 mmHg and PaCO2: 63 mmHg, pH is 7.25 at a FiO2 of 1.0. What is the most appropriate next step in the management of this patient at this time?
Hyperventilate the patient
In the majority of cases, fetal heart rate decelerations in a variable pattern are associated with what?
Umbilical cord compression
What laboratory study is sign of Cyanide toxicity during Nitroprusside therapy?
Increased mixed venous pO2
A patient has had a documented severe allergic reaction to ester-type local anesthetics. What is also a member of the ester class and would so be likely to cause an anaphylactic reaction if the patient received it?
Tetracaine
Lorazepam can be safely used as a prosthetic medication in a patient undergoing a liver transplant without Fear of excessive central nervous system depression. What characteristic of lorazepam allows this to occur?
It is conjugated extrahepatically
Anesthesia protocols for outpatient surgery may include sevoflurane because recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid recovery from anesthesia from sevoflurane is associated with which of its characteristics?
Low blood:gas partition coefficient
What preexisting condition predisposes to new-onset third degree heart block during pulmonary artery catheterization?
LBBB
A 25 year old patient with multiple traumas is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium, high serum Osmolality, and normal serum creatinine concentration is best explained by what?
SIADH
A 14 year old African American boy has severe abdominal pain after debridement of an open fracture of the lower extremity. His hemoglobin is 10 g/dL and a peripheral smear shows elongated crescent-shaped erythrocytes. What is the most appropriate initial therapy?
Volume loading with crystalloid
A 209 lb (95 kg) 66 year old woman receives enflurane and pancuronium during a laparoscopic cholecystectomy. Three minutes after the administration of Neostigmine 5 mg and atropine 1.2 mg the twitch returns to normal. Spontaneous tidal volume is 500 ml when the endotracheal tube is removed. In the recovery room, she reports dyspnea and appears distressed. What is the most likely cause of respiratory distress?
Residual muscle paralysis
What patient is considered difficult to Intubate?
Short thyromental distance and prominent incisors
What America Society of Anesthesiologists (ASA) Physical status classification is matched with the correct patient description?
ASA IV- Patient with severe systemic disease that limits activity and is a constant threat to daily life.
A 52 year old man with myasthenia Gravis presents for THYMECTOMY for treatment of his severe weakness and borderline respiratory insufficiency. To improve his preoperative respiratory function, what therapy should used?
Plasmapheresis
What is the most common upper extremity peripheral nerve injury during general anesthesia?
Ulnar
What can pass through the blood brain barrier?
Atropine
Vasoconstriction is least likely to occur with which sympathomimetic?
Isoproterenol
What is he most important factor in determining the spread of local anesthetic after administration of the drug?
Total dose of injected drug
What best describes fetal pulmonary vascular resistance?
It is high compared to systemic vascular resistance
What is most characteristic of a spinal anesthetic?
Has an almost sympathetic blockage before a motor block
What is true of the spinal anesthetic placement procedure?
Intubation equipment should be readily available
A patient is in the post-anesthetic care unit with shallow respirations and pinpoint pupils and responds to painful stimulation. What drug should be administered?
Naloxone
A discussion between anesthesiologists about opioids takes place. One of them makes an incorrect statement. What is most likely that incorrect statement?
Morphine is 10x more potent than fentanyl
What is most characteristic of an epidural anesthetic?
A total spinal could occur with an epidural if you puncture the dura
