Clinical Monitoring (Exam I)

Question 1

What physics law deals with pulse oximetry and the laws governing absorption of light?

Answer 1

Beer Lambert

Question 2

A low concentration of hemoglobin results in a ____ light absorption rate.

Answer 2

lower

Question 3

What should be utilized if oximetry is determined to be inaccurate?

Answer 3

Co-oximetry

Question 4

What is co-oximetry?

Answer 4

Co-oximetry is the measurement of:
- O₂Hb
- DeO₂Hb
- MetHb
- CarboxyHb
all through differing wavelengths of light

Question 5

Red wavelengths of light measure at ______ nanometers.

Answer 5

660

Question 6

Infrared wavelengths of light measure at ______ nanometers.

Answer 6

940

Question 7

Deoxyhemoglobin preferentially absorbs more ________ than oxyhemoglobin.

Answer 7

red

Question 8

Oxyhemoglobin preferentially absorbs more ________ than deoxyhemoglobin.

Answer 8

Infrared

Question 9

What makes up the AC portion of the graph below?

Answer 9

Light absorption from pulsatile arterial blood.

Question 10

What makes up the DC portion of the graph below?

Answer 10

Light absorption from:

• Non-pulsatile arterial blood
• Venous and capillary blood
• Tissue

Question 11

What formula is used to determine the ratio of AC to DC light absorption? (and thus give our pulse oximetry)

Answer 11

Question 12

What will falsely elevate SpO₂ ?

Answer 12

Elevated carboxyhemoglobin

Question 13

Each __% of COHb (carboxyhemoglobin) will increase SpO₂ by __%.

Answer 13

1 : 1

Question 14

_______ will absorb as much 660nm light at oxyHb does.

Answer 14

COHb

Question 15

What percent carboxyhemoglobin will smokers have?

Answer 15

> 6% usually

Question 16

What are possible reasons for SpO₂ signal artifact and thus incorrect readings?

Answer 16

• Ambient light
• Low perfusion
• Venous blood pulsations
• Dyes (ex. Methylene blue)
• Nail polish

Question 17

Where can a pulse ox be placed if the fingers won’t work?

Answer 17

• Forehead
• Tongue (!)
• Cheek

Question 18

What are Korotkoff sounds related to?

Answer 18

Blood pressure (Through partial occlusion with the BP cuff)

Question 19

How is MAP calculated?

Answer 19

DP + ⅓(SP - DP)

Question 20

What Korotkoff phase is the loudest?
Quietest?

Answer 20

• Phase 1: loudest (SBP) due to turbulence
• Phase 6: Sounds disappear (DBP)

Question 21

How should a cuff fit on a person’s arm?

Answer 21

• 40% of arm circumference
• 80% of length of upper arm
• Centered over artery

Question 22

A BP cuff that is too large will read a blood pressure that is _______.

Answer 22

too low

Question 23

A BP cuff that is too small will read a blood pressure that is _______.

Answer 23

too high

Question 24

Where can a blood pressure be obtained from an obese patient if the upper arm won’t work?

Answer 24

forearm

Question 25

What is the best site for invasive blood pressure monitoring?

Answer 25

Radial artery

Question 26

How does the Transfixion technique for arterial catheter placement differ from the seldinger technique?

Answer 26

Transfixion involves puncturing through the back of the artery and withdrawing until the needle can be removed.

Question 27

Label the various parts of the arterial waveform.

Answer 27

1. Systolic upstroke 2. Systolic peak pressure 3. Systolic decline 4. Dicrotic notch 5. Diastolic runoff 6. End-diastolic pressure

Question 28

What occurs to an arterial waveform as it moves centrally (aorta) to the periphery (ex. femoral artery) ?

Answer 28

- Arterial upstroke steepens - ↑ systolic peak - Dicrotic notch occurs later - Lower EDP

Question 29

How are summation waves formed?

Answer 29

Through the combination of Fundamental and Harmonic waves.

Question 30

How many oscillations should follow a square wave test?

Answer 30

No more than two

Question 31

What would the systolic pressure read in an underdamped system?

Answer 31

↑ SBP

Question 32

What would the characteristics of an overdampened arterial waveform be?

Answer 32

- ↓SBP - Absent dicrotic notch - Loss of detail - Narrowed pulse pressure w/ accurate MAP

Question 33

What occurs with RV and LV afterload during the inspiratory phase?

Answer 33

RV afterload increases LV afterload decreases

Question 34

What occurs with RV and LV preload during the inspiratory phase?

Answer 34

RV preload decreases LV preload increases

Question 35

RV stroke volume ____ during early phase of inspiration.

Answer 35

drops

Question 36

How much systolic pressure variation is typical in mechanically ventilated patients?

Answer 36

7 - 10 mmHg

Question 37

What would increases systolic pressure variation be indicative of?

Answer 37

Volume responsiveness (i.e. patient needs fluids)

Question 38

What is the normal change in pulse pressure variation over an entire respiratory cycle?

Answer 38

13 - 17% If greater than 13 - 17% you need to give volume.

Question 39

What is normal Stroke Volume Variation (SVV) ?

Answer 39

10 - 13% If greater, patient will likely respond to fluids.

Question 40

What are the two types of gas sampling systems?

Answer 40

- Side-stream monitoring - Mainstream monitoring

Question 41

What are challenges associated with mainstream CO₂ gas sampling?

Answer 41

- H₂O vapor - Secretions - Blood - Disconnections

Question 42

What are challenges associated with sidestream CO₂ gas sampling?

Answer 42

- Tubing kinking - H₂O vapor - leaks in line - slower response time

Question 43

What is the partial pressure of O₂ at sea level?

Answer 43

160 mmHg

Question 44

What is the P_atm ?

Answer 44

760 mmHg

Question 45

What is the percentage O₂ at sea level? *exclude water vapor*

Answer 45

160 mmHg ÷ 760 mmHg = 21%

Question 46

How are quantities of CO₂, N₂O, H₂O, and VAA's measured?

Answer 46

Infrared Analysis *O₂ cannot be measured via IR analysis.*

Question 47

Which gas cannot be measured via infrared analysis?

Answer 47

O₂ cannot be measured via IR analysis.

Question 48

The less IR light that reaches the sensor means that the gas has a ________ concentration.

Answer 48

higher

Question 49

What is the partial pressure of water vapor?

Answer 49

47 mmHg

Question 50

O₂ is at 30%, what is the partial pressure? *Be sure to take water vapor into account*.

Answer 50

(760 - 47) x 0.30 = 214 mmHg

Question 51

Which type of oxygen analyzer is more rapid and utilized with side-stream sampling analyzers?

Answer 51

Paramagnetic

Question 52

Which type of oxygen analyzer has a slower response time and is best to monitor O₂ concentration in the inspiratory limb?

Answer 52

Fuel or Galvanic cell

Question 53

What two conditions would set off a high O₂ alarm?

Answer 53

- Premature infants - Bleomycin (chemotherapy)

Question 54

What is normal peak airway pressure?

Answer 54

18 - 20 mmhg

Question 55

What nerve is the gold standard for peripheral nerve stimulation monitoring?

Answer 55

ulnar nerve

Question 56

What is the most resistant place to neuromuscular blocking drugs?

Answer 56

Diaphragm

Question 57

What muscle(s) are better indicators (vs the adductor pollicis) of neuromuscular blockade at the laryngeal muscles and abdominal muscles?

Answer 57

- Orbicularis Oculi - Corrugator supercilli

Question 58

Single twitch stimulations occurs every...

Answer 58

1hz every second

Question 59

TOF fade is noted with what drug class?

Answer 59

non-depolarizing NMBD's

Question 60

What is the case if fade has occurred with succinylcholine administration?

Answer 60

Phase II Blockade

Question 61

What are the reversal drugs (and doses) use for intense/extreme blockade?

Answer 61

- Neostigmine N/A - Suggamadex 16 mg/kg

Question 62

What are the reversal drugs (and doses) use for deep blockade?

Answer 62

- Neostigmine usually doesn't work - Succinylcholine 4 mg/kg

Question 63

What are the reversal drugs (and doses) used for moderate blockade?

Answer 63

- Neostigmine after TOF 4/4 - Succinylcholine 2 mg/kg

Question 64

What EEG signals are noted for an awake patient?

Answer 64

- Βeta (>13Hz) waves

Question 65

What EEG signals are noted for patients who are mildly anesthetized?

Answer 65

Αlpha (8 - 13Hz) waves

Question 66

What EEG signals are noted for patients who are fully anesthetized?

Answer 66

Theta and Delta waves

Question 67

What causes the initial decrease of 0.5 - 1.5°C in anesthesia?

Answer 67

Anesthesia induced vasodilation

Question 68

How much will body temp decrease for every hour of surgery?

Answer 68

0.3°C

Question 69

What is the cause of heat loss during anesthesia?

Answer 69

- Anesthesia-induced vasodilation - GA-induced decrease in metabolism

Question 70

21°C = ____°F

Answer 70

70

Question 71

18°C = ____°F

Answer 71

65