basics exam 3 rvw for final

Question 1

Although this medication may be given to prevent anesthesia awareness, little scientific evidence exists that supports such treatment

Answer 1

Benzo’s

Question 2

Preop patient is anxious, what dose of diazepam will you give them?

Answer 2

2-5mg of diazepam PO

Question 3

Type One OR fire is located?

Answer 3

In or on the patient

Question 4

What does a BIS monitor assess?

Answer 4

Monitors anesthetic depth

Question 5

What is implicit memory?

Answer 5

Patient can follow commands but has no memory

Question 6

What medication has alpha, minimal beta- used for phentolamine reversal?

Answer 6

Phenylephrine

Question 7

Regional Anesthesia for Ophthalmic Surgery, what would you assume if someone is having seizures? (page 523, table 31.2)

Answer 7

That an intravascular injection has occurred.

Question 8

Regional Anesthesia for Ophthalmic Surgery, what has occurred if you see contralateral mydriasis and contralateral eye block?

Answer 8

Brainstem Anesthesia

Question 9

If all you see occuring during Regional anesthesia during ophthalmic surgery is loss of consciousness, apnea, and cardiac instability, what may be going on?

Answer 9

Most likely you have oversedated the patient, but brainstem anesthesia or intravascular injection is still possible, typically with the latter two you will see other more ominous signs but they have all the same signs as oversedation and then some more s/s.

Question 10

Do you have seizures with brainstem anesthesia?

Answer 10

No, brainstem anesthesia does not have seizures that is only intravascular injection.

Question 11

Most common cause of post op eye pain?

Answer 11

corneal abrasion

Question 12

maint. fluid for 100lb grandma?

Answer 12

85cc/hr

Question 13

LMA for 49kg male

Answer 13

size 3

Question 14

what are some of the risks associated with strabismus surgery?

Answer 14

OCR
MH
PONV

Question 15

Positional considerations for a patient having laminectomy with thoracic outlet?

Answer 15

prone with hands down by side

Question 16

how is the laryngospasm reflex mediated?

Answer 16

vagal stimulation of the SLN.

Question 17

OCR is afferent and efferent, tell me about it?

Answer 17

afferent is trigeminal nerve and efferent is vagal nerve.

Afferent is to the CNS, Efferent is from the CNS. (think A before E, has to go to the CNS before it can come from it)

Question 18

Epiglottitis most likely is caused by which pathogen?

Answer 18

Acute haemophilus influenzae type B

Question 19

What are some things you want to do for a patient who has epiglottitis before intubation actually occurs?

Answer 19

Do NOT attempt to directly visualize the glottis

Have surgeon called to assist with intubation

Do not administer anesthesia until equipment is opened and ready

Question 20

02 levels should be at what percent to avoid OR fire?

Answer 20

LESS than 30%

Question 21

High CO2, Increased inspiratory pressure, decreased O2 may indicate?

Answer 21

ETT dislodgement

Question 22

Concentration of O2 that causes OR fire in less than 1 second?

Answer 22

95%

Question 23

A patient that would benefit from prolonged post op monitoring? (this is bc they are susceptible to airway obstruction as late as 24 hours post op)

Answer 23

Patient less than four years old

Question 24

How long should you wait to have a surgery on someone who had an MI, if the surgery is not an emergency?

Answer 24

6 months

Question 25

Typically in an out patient setting for surgery you will do no lab testing, except for three possible reasons?

Answer 25

UNSTABLE CHRONIC DISEASE POTENTIAL HIGH BLOOD LOSS (A GOOD REASON NOT TO DO PROCEDURE IN ASC/OBA) EXPECTED USE OF CONTRAST DYE (BUN/Cr)

Question 26

Do not perform surgery on the day of surgery if 3 or more of the following are present? (6 possible, you only need 3 to stop)

Answer 26

ISCHEMIC HEART DISEASE HISTORY OF CHF INSULIN-DEPENDENT DIABETES CHRONIC RENAL INSUFFICIENCY (Cr > 2.0 mg/dl) A TRNASIENT ISCHEMIC ATTACK CVA

Question 27

If a patient is wheezing really bad and you fix their wheezing before surgery (no longer symptomatic) can you proceed with the surgery or should it be cancelled?

Answer 27

you may proceed with the surgery, the only reason you would stop the surgery is if you could not stop their wheezing and they were symptomatic.

Question 28

AV fistulas and outpatient surgery.... tell me what you know?

Answer 28

ARTERIOVENOUS FISTULAS (CREATION OR REVISION) AND UNSTABLE RENAL FAILURE ARE EACH ASSOCIATED WITH A HIGH MORBIDITY RATE AND ARE NOT GOOD CANDIDATES FOR SURGERY IN A FREE STANDING OUTPATIENT FACILITY

Question 29

Biguanides such as metformin needs to be D/C how long before surgery and why?

Answer 29

48 hours preoperative and this is because of possible fatal lactic acidosis.

Question 30

55 year old man with CHF, insulin dependent diabetes and a TIA 1 year ago... is he a good candidate for outpatient surgery?

Answer 30

He is NOT a good candidate for a stand alone clinic surgery.

Question 31

How do propofol and remifentanil benefit hypotension intraoperatively?

Answer 31

Decreased PONV

Question 32

Normal range for IOP?

Answer 32

10-22 mm HG

Question 33

Tell me some things that can increase IOP (not medications)?

Answer 33

Face mask, coughing, laryngoscopy, tracheal intubation, hypoxemia and hypoventilation.

Question 34

Afferent and Efferent.... which one carries stimulus from the CNS and which one carries stimulus to CNS?

Answer 34

A before E afferent carries stimulus to the CNS efferent carries stimulus from the CNS

Question 35

What medication can be given to decrease incidence of oculocardiac reflex?

Answer 35

parasympatholytics

Question 36

Oculocardiac reflex can be abated by what?

Answer 36

Parasympatholytic (atropine/glycopyrrolate)

Question 37

What drug administered during ophthalmic surgery profoundly interferes with metabolism of sux?

Answer 37

echothiophate

Question 38

An Adult with URI is scheduled for surgery. How long would you delay the surgery?

Answer 38

6 weeks

Question 39

A child has an URI: How long would you delay?

Answer 39

2 weeks

Question 40

what combination of anesthesia techniques would improve patient satisfaction?

Answer 40

Combined regional and general anesthesia

Question 41

What medication should be stopped 10 hours before surgery?

Answer 41

ACE inhibitor | Lisinopril

Question 42

A patient with a BMI of 44 is supine for surgery. He has hypoxemia, etc. What would you expect to be a contributing factor?

Answer 42

Decreased FRC

Question 43

Regarding HgbA1C, erythrocytes have a life span of?

Answer 43

120 Days

Question 44

Lidocaine 0.75% is equal to what in mg?

Answer 44

7.5mg

Question 45

What should you do regarding a fire in the OR (in or on the patient)?

Answer 45

Simultaneously stop gases and remove ETT, disconnect circuit. (book states it does not matter which one you do first as long as they are done at the same time, but it would make sense that you would turn the gas off before you pull out the tube bc that creates a blow torch lol)

Question 46

Type 1 OR fire consists of? (EXAM question)

Answer 46

Can include drapes and surgical towels Usually in or on patient

Question 47

What is true regarding O2 rich atmospheres in the OR (Choose 2)

Answer 47

Decreases temperature at which a fuel will ignite Fire will burn more vigorously

Question 48

What can you make sure happens to help decrease fires in the OR?

Answer 48

Make sure the prep dries completely before placing drape

Question 49

What anesthetic gas would you consider NOT using in a patient that experience PONV?

Answer 49

Nitrous (N20)

Question 50

A patient with a past experience of PONV that usually requires pain medications 3-7 days post op, what can you consider using for them?

Answer 50

triple medication therapy | this is bc they have PONV history, and requires pain medication post op for multiple days

Question 51

What will sevoflurane combine with to form an exothermic reaction in the OR(choose 2)

Answer 51

soda lime | baralyme

Question 52

what three things do you need in order to start a fire?

Answer 52

fuel ignition source oxidizer

Question 53

which type of memory is explicit and which is implicit?

Answer 53

explicit is conscious | implicit is unconscious

Question 54

what two patient groups are at greater risk for operative awareness?

Answer 54

OB (crash C section) | Cardiac

Question 55

What MAC or above prevents conscious recall?

Answer 55

0.7 MAC

Question 56

give me examples of the three components to start a fire?

Answer 56

IGNITION SOURCE (SURGEON/BOIVE) FUEL (NURSE/PREP) ANESTHESIA (OXIDIZER/O2)

Question 57

Patient just drank 16 oz of water, how long will you need to delay surgery?

Answer 57

2 hours

Question 58

Patient said he had a steak dinner 3 hours ago, how long must you wait to perform surgery?

Answer 58

5 more hours to total 8 hours NPO

Question 59

What medication would you avoid to prevent IOP. (Induction medication)

Answer 59

SUX

Question 60

What medication needs to be d/c 48 hours before surgery bc of a risk for fatal lactic acidosis?

Answer 60

metformin

Question 61

what system takes over during spinal anesthesia (you are blocking out either SNS or PNS and the other takes over)?

Answer 61

PNS takes over and you can thus have a parasympathetic response during spinal anesthesia.

Question 62

What is true of spinal anesthesia in relation to BP?

Answer 62

hypotension can and often does occur.

Question 63

When performing Sellick maneuver what weight should you apply (in kg and newtons) and where should you push the esophagus?

Answer 63

5kg or 30 newtons and you will push the esophagus posteriorly.

Question 64

Nerves in the anterior 2/3 of the tongue?

Answer 64

Lingual

Question 65

Nerves in the posterior 1/3 of the tongue?

Answer 65

glossopharyngeal

Question 66

what medication can you give to dry up secretions and help visualize the airway?

Answer 66

ANTICHOLINERGICS atropine scopolamine glycopyrolate

Question 67

EXAM QUESTION | Something about cocaine pledgets for nasal/sinus surgery?

Answer 67

Trigeminal → ophthalmic → anterior ethmoidal

Question 68

order of structures you will pass through while doing a spinal?

Answer 68

Skin, subq, supraspinous, interspinous, ligamentum flavum, dura mater, arachnoid space

Question 69

which block has a slower onset and thus considered a disadvantage, retrobulbar block or peribulbar block?

Answer 69

peribulbar block

Question 70

Remifentanil and Propofol combination benefit in relation to ear surgery?

Answer 70

Remifentanil reduces middle ear blood flow, creating a dry surgical field for tympanoplasty. Propofol may help reduce PONV

Question 71

What type of anesthesia has a decreased risk for PONV?

Answer 71

REGIONAL

Question 72

How to identify an ester from an amide?

Answer 72

"one "i" ester"

Question 73

Medication you can give to decrease edema and PONV?

Answer 73

DEXamethasone

Question 74

An inhaled induction and maintenance of anesthesia with ventilation via a face mask is preferred for this brief procedure?

Answer 74

Myringotomy and tube insertion.

Question 75

If a patient had an uncomplicated airway during intubation are they a candidate for deep extubation?

Answer 75

Yes

Question 76

A child presents and the mother states that he has been having fever and very tired acting, he is drooling and leaning forward, what do you suspect is going on?

Answer 76

Epiglottitis

Question 77

If a patient is having eye surgery and all of a sudden their HR falls greatly what has likely occurred and what will you do next?

Answer 77

OCR has likely occurred, you will tell the surgeon to let up on the eye nerve, to let up traction and the HR should come back up. If the HR does not recover in a few short min (may also have dysrhythmia's) then you will want to give atropine or glycopyrrolate.

Question 78

Tell me what OCR is? When is it most often encountered?

Answer 78

oculocardiac reflex, sudden profound decrease in HR in response to traction on the extraocular muscles or external pressure on the globe. Typically occurs during strabismus surgery.

Question 79

Peribulbar block, tell me what you know about it good and bad.

Answer 79

placed more shallow and minimally angled, thus more protection to the internal nerves and structures. larger volumes and more time for diffusion of LA needed.