AP Exam 4 part VII

Question 1

dramatic improvement of mortality in anesthesia secondary to __________________

Answer 1

safety monitoring

Question 2

what is safety monitoring

Answer 2

extending human senses through electronic monitoring

Question 3

what 3 complications account for the greatest percentage of death in anesthesia

Answer 3

1. adverse effects of anesthesia in therapeutic use (>40%) 2. opioids and analgesics (~20%) 3. unspecified G.A and unspecified anesthetic both (>10%)

Question 4

mortality percentage in OB

Answer 4

3.60%

Question 5

mortality percentage that is due to cardiac complications

Answer 5

2.70%

Question 6

mortality percentage r/t difficult airway

Answer 6

2.30%

Question 7

mortality percentage r/t MH

Answer 7

1%

Question 8

which components of anesthesia are seeing an increase in mortality malpractice claims?

Answer 8

1. regional (16%) 2. chronic pain management (18%) 3. Acute pain (9%)

Question 9

deaths related specifically to surgical anesthesia has ______________

Answer 9

decreased

Question 10

as physical status classification increases, the mortality rate from anesthesia __________________

Answer 10

increases

Question 11

what is the most common complication of anesthesia in the ASA closed claims project data base

Answer 11

death

Question 12

physical status 1

Answer 12

normal healthy patient, no functional limitations

Question 13

physical status 2

Answer 13

mild system dz, but no fx’al limitations (controlled HTN, asthma, DMT2, tobacco, pregnancy)

Question 14

physical status 3

Answer 14

patients with mod-severe dz with some fx’al limitation (poor controlled HTN/COPD/CHF/CAD with old MI, morbid obesity)

Question 15

physical status 4

Answer 15

pts with severe systemic dz that is a constant threat to life, possiblity of death (unstable angina, sx’atic COPD with supplemental O2, hepatorenal failure)

Question 16

physical status 5

Answer 16

pts who are moribound, not expected to survive without the operation

Question 17

physical status 6

Answer 17

pts declared brain dead, organ donors

Question 18

define morbidity

Answer 18

indicative of dz, incorporating any complication during the perioperative period, excluding death

Question 19

most common events leading to injury (morbidity) in anesthesia claims

Answer 19

1. regional (20%) 2. Respiratory events (17%) 3. CV events (13%) 4. equipment problems (10%)

Question 20

minor morbidity

Answer 20

moderate distress without prolonged hospital stay, no permanent complications

Question 21

PONV would be an example of what type of morbidity

Answer 21

minor

Question 22

intermediate morbidity

Answer 22

serious distress prolonging hospital stay, no permanent complications

Question 23

dental injury during surgery would be what type of morbidity

Answer 23

intermediate

Question 24

major morbidity

Answer 24

permanent disability ro complication

Question 25

spinal cord injury or anoxic brain injury are examples of wht type of morbidity

Answer 25

major morbidity

Question 26

which anesthesia morbidity claims are increasing?

Answer 26

1. acute pain (8%) 2. chronic pain (18%) 3. MAC (10%)

Question 27

what morbidity claims in anesthesia are decreasing

Answer 27

obstetrics

Question 28

claims of morbidity in regional anesthesia have had what trend?

Answer 28

remained steady

Question 29

incidence of minor morbidity in anesthesia are ____________ (high/low)

Answer 29

high

Question 30

what are some examples of common minor morbidity (adverse outcomes) with anesthesia

Answer 30

1. hoarsness 2. PONV 3. accidental dural puncture 4. equipment malfunction 5. medication error

Question 31

human errors are the contribution to _______________% of anesthesia related morbidity and mortality

Answer 31

51-77%

Question 32

what factors of human error have been identified as contributing to most anesthesia related morbidity and mortality

Answer 32

1. lack of team work 2. communication breakdown 3. absence of help

Question 33

what is the 7th leading cause of pregnancy related mortality?

Answer 33

anesthesia complications

Question 34

what are important risk factors that increase risk of mortality in anesthesia related maternal (OB) mortality

Answer 34

obesity and AA race

Question 35

what is the greatest challenge anesthesia providers face with pts of advanced age?

Answer 35

preventing, detecting, and managing M&M

Question 36

______________ is characterized by subtle deterioration in cognitive fx such as: memory deficits, difficult concentration, impaired comprehension, and delayed psychomotor speed

Answer 36

POCD

Question 37

POCD has what effects on quality of life

Answer 37

1. inability to work 2. decline in ADLs 3. possibly need for assistance

Question 38

establishing ___________________ in the advanced age population prior to surgery is critical

Answer 38

baseline cognitive fx (b/c cognitive impairment could be present prior to surgery)

Question 39

prevention of POCD

Answer 39

1. maintain oxygenation and perfusion 2. surgeries short and minimally invasive as possible

Question 40

_______________ is a biologic state associated with multisystem physiologic deterioration

Answer 40

frailty

Question 41

primary fraility

Answer 41

intrinsic process of aging

Question 42

secondary frailty

Answer 42

end stage of chronic illness (CHF/COPD), and is caused by inflammation and wasting

Question 43

physiologic parameters for testing fraility

Answer 43

1. grip strength 2. weight loss 3. walking speed 4. energy level 5. physical activity

Question 44

"frail" older adults (those with fraility) are more likely to have _______________ post operatively, and have ________________ resistance to stressors

Answer 44

adverse outcomes; decreased

Question 45

intraoperative cardiac arrest is a _____________ factor, not a ______________ factor

Answer 45

concomitant; causative

Question 46

cardiac arrest during neuraxial anesthesia is _________________ frequent compared to general

Answer 46

less

Question 47

categories of causative factors of perioperative cardiac arrest

Answer 47

1. preoperative complications (65%): comorbidities, inadequate risk estimation, misjudgment/human error 2. surgical procedures (24%): excessive surgical bleeding 3. intraoperative pathologic events (9%): MI, PE, arrhythmia 4. anesthetic management (2%): airway, med error, infusion/transufion mishap

Question 48

_________________ is the leading cause of death in the US with ______% of patients dying before reaching emergency assistance

Answer 48

sudden cardiac arrest ; 95

Question 49

________________ is the most common underlying cause of sudden cardiac arrest in young athletes

Answer 49

hypertrophic cardiomyopathy: long QT syndrome

Question 50

what parts of anesthesia provokes hypertrophic cardiomyopathy (long QT syndrome) in those pts without previous dx or abnormal preoperative clinical finiding

Answer 50

induction/intubation/sympathomimetics