Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles of Anesthesia 1 - (Summer 2024) > Clinical Monitoring Part 2 (Ericksen) Exam 1 > Flashcards

Clinical Monitoring Part 2 (Ericksen) Exam 1 Flashcards

1
Q

Which of the following analyzers are used for gas mixture analysis? (Select all that apply - 4)

A. Side-stream analyzer
B. Mainstream analyzer
C. Diverting analyzer
D. Non-diverting analyzer
E. Carbon dioxide analyzer

A

A. Side-stream analyzer
B. Mainstream analyzer
C. Diverting analyzer
D. Non-diverting analyzer

side stream - diverting
main stream - non-diverting

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In which type of analyzer is gas brought to the analyzer rather than the analyzer being brought to the gas?

A. Mainstream analyzer
B. Non-diverting analyzer
C. Side-stream analyzer
D. Direct analyzer

A

C. Side-stream analyzer

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which type of analyzer is positioned directly in the airway for gas mixture analysis?

A. Side-stream analyzer
B. Mainstream analyzer
C. Diverting analyzer
D. Indirect analyzer

A

B. Mainstream analyzer

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which factors affect the transit time in a side-stream analyzer? (Select all that apply - 3)

A. Inner diameter of the sampling tubing
B. Length of the sampling tubing
C. Patient’s heart rate
D. Analyzing machine’s power
E. Gas sampling rate

A

A. Inner diameter of the sampling tubing
B. Length of the sampling tubing
E. Gas sampling rate

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A fuel cell oxygen analyzer is an example of which type of analyzer?

A. Side-stream analyzer
B. Diverting analyzer
C. Mainstream analyzer
D. Indirect analyzer

A

C. Mainstream analyzer

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which statements are true about rise time in a gas analyzer? (Select all that apply - 3)

A. It is the time taken by the analyzer to react to changes in gas concentration.
B. It is instantaneous in a side-stream analyzer.
C. It can fluctuate when reading ETCO2.
D. It depends on how much gas is being read and drawn out by the sampling line.
E. It remains constant regardless of patient exhalation.

A

A. It is the time taken by the analyzer to react to changes in gas concentration
C. It can fluctuate when reading ETCO2
D. It depends on how much gas is being read and drawn out by the sampling line

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does transit time refer to in the context of gas sampling?

A. The time taken by the patient to exhale completely
B. The time lag for the gas sample to reach the analyzer
C. The time taken by the analyzer to react to changes in gas concentration
D. The time taken to switch between different gas samples

A

B. The time lag for the gas sample to reach the analyzer

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is rise time in the context of gas analysis?

A. The time lag for the gas sample to reach the analyzer
B. The time taken by the analyzer to react to changes in gas concentration
C. The time taken for the gas analyzer to warm up
D. The time taken by the patient to inhale

A

B. The time taken by the analyzer to react to changes in gas concentration

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What will happen to the rise time and transit time if a patient is not exhaling properly?

A. Both rise time and transit time will increase
B. Both rise time and transit time will decrease
C. Rise time will increase and transit time will decrease
D. Rise time will decrease and transit time will increase

A

A. Both rise time and transit time will increase

slide 48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which of the following are potential issues with mainstream ETCO2 sampling?
Select all that apply: 3

A) Water vapor condensation in airway tubing
B) Faster breath-by-breath analysis
C) Secretions clogging the sampling line
D) Additional interfaces for disconnections
E) Reduced chance of condensation in sampling line

A

A) Water vapor condensation in airway tubing
C) Secretions clogging the sampling line
D) Additional interfaces for disconnections

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is one of the benefits of mainstream ETCO2 sampling sites?

A) Reduced condensation in the sampling line
B) Faster breath-by-breath analysis
C) Fewer disconnections
D) Easier to manage secretions

A

B) Faster breath-by-breath analysis

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which of the following connections can contribute to disconnections in mainstream ETCO2 monitoring?

A) Sampling line to the vapor analyzer
B) Elbow to the y-piece
C) Mainstream analyzer to the monitor
D) Endotracheal tube to the ventilator

A

B) Elbow to the y-piece

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which of the following are potential issues with side-stream ETCO2 sampling?
Select all that apply: 4

A) Kinking of sampling tubing
B) Water vapor condensation
C) Faster response time
D) Failure of sampling pump
E) Leaks in the line

A

A) Kinking of sampling tubing
B) Water vapor condensation
D) Failure of sampling pump
E) Leaks in the line

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which of the following factors can lead to leaks in the side-stream ETCO2 sampling line?
Select all that apply: 3

A) Overtightening the connection
B) Reusing the line multiple times
C) Faster breath-by-breath analysis
D) Water vapor condensation
E) Kinking of sampling tubing

A

A) Overtightening the connection
B) Reusing the line multiple times
E) Kinking of sampling tubing

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a common problem when the sampling pump fails in side-stream ETCO2 monitoring?

A) Slow response time
B) No waveform at all
C) Enhanced accuracy of ETCO2 measurements
D) Increased waveform amplitude

A

B) No waveform at all

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a disadvantage of side-stream ETCO2 monitoring compared to mainstream?

A) Increased likelihood of condensation
B) Faster response time
C) Fewer interfaces for disconnections
D) Slow response time

A

D) Slow response time

slide 49

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

According to Dalton’s Law, which of the following statements are true?

A) The total pressure exerted by a mixture of gases is less than the sum of the partial pressures of each gas.
B) The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas.
C) Each gas in a mixture exerts its own pressure independently.
D) At sea level, the total pressure of all anesthetic gases in the system is 760 mm Hg.
E) The partial pressure of a gas is always expressed in volumes %.

A

B) The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each gas

slide 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can gases be expressed in measurement units?
Select all that apply: 2

A) Partial pressure (mm Hg)
B) Density (g/L)
C) Volumes %
D) Molarity (mol/L)
E) Weight percent

A

A) Partial pressure (mm Hg)
C) Volumes %

slide 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If the partial pressure of oxygen (O2) in room air is 160 mm Hg, what is its volume percent?

A) 16%
B) 21%
C) 25%
D) 50%

A

B) 21%

slide 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which of the following statements about mass spectrometry are true?
Select all that apply: 3

A) Concentration is determined according to the mass/charge ratio.
B) It measures the volume percent of gases directly.
C) Abundance of ions at specific mass/charge ratios is related to the fractional composition of the gas mixture.
D) It can identify and calculate up to eight different gases in a sample.
E) It is currently the primary method used, replacing infrared technology.

A

A) Concentration is determined according to the mass/charge ratio.
C) Abundance of ions at specific mass/charge ratios is related to the fractional composition of the gas mixture.
D) It can identify and calculate up to eight different gases in a sample.

slide 51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which of the following are characteristics of Raman Spectroscopy?
Select all that apply: 2

A) It uses a highly powered argon laser.
B) It measures gas concentrations using infrared technology.
C) Scattered photons are measured in a spectrum to identify each gas.
D) It determines concentration based on mass/charge ratios.
E) It is used to identify gases like Sevo, O2, and Nitrous.

A

A) It uses a highly powered argon laser.
C) Scattered photons are measured in a spectrum to identify each gas.

slide 51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does mass spectrometry measure to determine the concentration of gases?

A) Volume percent
B) Mass/charge ratio
C) Scattered photons
D) Infrared absorption

A

B) Mass/charge ratio

slide 51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What technology is now commonly used instead of mass spectrometry for analyzing gas samples?

A) Raman Spectroscopy
B) Mass/charge spectrometry
C) Infrared technology
D) Electron microscopy

A

C) Infrared technology

slide 52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which of the following statements about non-dispersive infrared analyzers are true?
Select all that apply: 3

A) They measure the concentration of gases by absorbing energy from a narrow band of IR wavelengths.
B) They can measure the concentration of O2.
C) They are used to measure CO2, nitrous oxide, water, and volatile anesthetic gases.
D) O2 does not absorb IR radiation and cannot be measured by this method.
E) They use a wide-band pass filter to transmit IR light.

A

A) They measure the concentration of gases by absorbing energy from a narrow band of IR wavelengths.
C) They are used to measure CO2, nitrous oxide, water, and volatile anesthetic gases.
D) O2 does not absorb IR radiation and cannot be measured by this method.

slide 52 & 53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why can’t non-dispersive infrared analyzers measure oxygen (O2)?

A) O2 absorbs IR radiation too strongly.
B) O2 does not absorb IR radiation.
C) O2 molecules are symmetric and do not have an IR absorption band.
D) O2 is a polyatomic molecule and absorbs IR light at multiple wavelengths.

A

B) O2 does not absorb IR radiation

slide 52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the relationship between the amount of IR light that reaches the detector and the concentration of the gas being measured in non-dispersive infrared analyzers?

A) Directly proportional
B) Not related
C) Logarithmically related
D) Inversely proportional

A

B) Inversely proportional

slide 53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which of the following statements about water vapor and gas analyzers are true?
Select all that apply:3

A) Side-stream analyzers report results as ATPD values.
B) Analyzers should report results at BTPS values.
C) Saturated H2O vapor pressure is 47 mm Hg.
D) BTPS values do not account for water vapor.
E) When calculating partial pressures, water vapor should always be accounted for.

A

A) Side-stream analyzers report results as ATPD values.
B) Analyzers should report results at BTPS values.
C) Saturated H2O vapor pressure is 47 mm Hg.

slide 54

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the partial pressure of oxygen (O2) at 30% when considering water vapor saturation?

A) 214 mm Hg
B) 228 mm Hg
C) 205 mm Hg
D) 200 mm Hg

A

A) 214 mmHg

(760mmHg - 47mmHg) x (0.3)

slide 54

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which of the following statements about the fuel or galvanic cell used in breathing tubes are correct? Select all that apply (3)

A. Measures the current produced when nitrogen diffuses across a membrane.
B. The current is proportional to the partial pressure of the oxygen in the fuel cell.
C. Has a long life span lasting several years.
D. It is best to monitor O2 concentration in the inspiratory limb.
E. The oxygen battery has a slow response time of approximately 30 seconds.
F. The infrared analyzer is able to read O2 because of the fuel cell.

A

B. The current is proportional to the partial pressure of the oxygen in the fuel cell.
D. It is best to monitor O2 concentration in the inspiratory limb.
E. The oxygen battery has a slow response time of approximately 30 seconds.

slide 55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What actions can prolong the life of the oxygen fuel cell? Select all that apply (2)

A. Turn off O2 at the end of the case.
B. Increase oxygen exposure.
C. Keep O2 always on.
D. Use lower oxygen flows.

A

A. Turn off O2 at the end of the case.
D. Use lower oxygen flows.

slide 55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Where is the best location to monitor O2 concentration using a fuel cell in the breathing tube?

A. In the inspiratory limb, to know the concentration of O2 going to the patient.
B. In the expiratory limb, to measure what the patient is exhaling.
C. Outside the breathing tube, to avoid exposure to oxygen.
D. At the end of the breathing tube, to get a cumulative reading.

A

A. In the inspiratory limb, to know the concentration of O2 going to the patient.

slide 55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which of the following statements about the paramagnetic properties of oxygen are correct? Select all that apply: (3)

A. Oxygen is highly paramagnetic due to the magnetic energy of unpaired electrons in their outer shell orbits.
B. Paramagnetic oxygen detection measures the change in sample line pressure resulting from the attraction of oxygen by switched magnetic fields.
C. Paramagnetic detection is used in mainstream gas analyzers.
D. Paramagnetic detectors have a slow response time compared to fuel cells.
E. Paramagnetic detectors provide rapid, breath-by-breath monitoring.

A

A. Oxygen is highly paramagnetic due to the magnetic energy of unpaired electrons in their outer shell orbits.
B. Paramagnetic oxygen detection measures the change in sample line pressure resulting from the attraction of oxygen by switched magnetic fields.
E. Paramagnetic detectors provide rapid, breath-by-breath monitoring. main advantage over the fuel cell

slide 55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the main advantages of using paramagnetic detection over fuel cells in multi-gas analyzers? Select all that apply: (3)

A. Slow response time.
B. Rapid, breath-by-breath monitoring.
C. Correlates signal changes with O2 concentration.
D. Used in mainstream sampling analyzers.
E. Provides early indication for necessary changes in gas/FiO2 levels.

A

B. Rapid, breath-by-breath monitoring.
C. Correlates signal changes with O2 concentration.
E. Provides early indication for necessary changes in gas/FiO2 levels.

slide 55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which of the following statements about oxygen monitoring are correct? Select all that apply: (4)

A. Oxygen monitoring is arguably the least important of all monitors.
B. The O2 analyzer in the inspiratory limb ensures oxygen delivery to the patient.
C. Oxygen monitoring can analyze hypoxic mixtures.
D. ET O2 above 90% is considered inadequate.
E. Oxygen monitoring is not possible with all masks and cannulas.
F. High O2 concentrations are a concern for patients on chemotherapeutic drugs like bleomycin.

A

B. The O2 analyzer in the inspiratory limb ensures oxygen delivery to the patient.
C. Oxygen monitoring can analyze hypoxic mixtures.
E. Oxygen monitoring is not possible with all masks and cannulas.
F. High O2 concentrations are a concern for patients on chemotherapeutic drugs like bleomycin.

slide 56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can trigger a low O2 alarm? (select 3)

A. Pipeline crossover
B. Correctly filled tanks
C. Failure of a proportioning system
D. Incorrectly filled tanks
E. All masks and cannulas monitoring O2 concentration accurately

A

A. Pipeline crossover
C. Failure of a proportioning system
D. Incorrectly filled tanks

slide 56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which patients are at risk from high oxygen concentrations?

A. Premature infants
B. Patients on chemotherapeutic drugs like bleomycin
C. Patients with lung comorbidities
D. All of the above

A

D. All of the above

slide 56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Where is the best location to sample oxygen for ensuring complete preoxygenation and denitrogenation?

A. Inside the inspiratory limb
B. Outside the breathing circuit
C. Inside the expiratory limb
D. At the auxiliary sites

A

C. Inside the expiratory limb

slide 56

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which of the following are true about airway pressure monitoring? (Select all that apply - 3)

A. It is a key component in measuring ventilation.
B. It is always invasive.
C. It helps detect circuit disconnections and ETT occlusions.
D. It relies solely on alarm systems for monitoring.
E. It assesses mechanical or spontaneous ventilation.

A

A. It is a key component in measuring ventilation
C. It helps detect circuit disconnections and ETT occlusions
E. It assesses mechanical or spontaneous ventilation

slide 58

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What issues can airway pressure monitoring detect? (Select all that apply - 4)

A. Fresh gas hose kink or disconnection
B. Collection of water vapor in the circuit
C. Electrical failures in ventilators
D. Low scavenging system pressures
E. High scavenging system pressures

A

A. Fresh gas hose kink or disconnection
B. Collection of water vapor in the circuit
D. Low scavenging system pressures
E. High scavenging system pressures

slide 58

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which of the following are characteristics of mechanical pressure gauges? (Select all that apply - 4)

A. Requires no power
B. Always on and highly reliable
C. Records data for future reference
D. Has no alarm system
E. Must be continually scanned

A

A. Requires no power
B. Always on and highly reliable
D. Has no alarm system
E. Must be continually scanned

slide 58

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Electronic pressure gauges are built within which devices?

A. Mechanical pressure gauges
B. Manual resuscitators
C. Ventilators or anesthesia machines
D. Oxygen tanks

A

C. Ventilators or anesthesia machines

slide 58

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which of the following statements about the breathing circuit low pressure alarm are true? (Select all that apply - 3)

A. It is required by AANA/ASA standards.
B. It is a fail-safe mechanism for all types of disconnections.
C. Its primary purpose is the identification of circuit disconnections or leaks.
D. It can detect all partial disconnections and misconnections.
E. It may need a new setup during the case.

A

A. It is required by AANA/ASA standards
C. Its primary purpose is the identification of circuit disconnections or leaks
E. It may need a new setup during the case.

sldie 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Where do 70% of circuit disconnections typically occur?

A. At the ventilator connection
B. At the gas supply hose
C. At the Y-piece
D. At the scavenging system

A

C. At the Y-piece

slide 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What should the low-pressure limit be set to?

A. Above the normal peak airway pressure
B. At the same level as the normal peak airway pressure
C. Just below the normal peak airway pressure
D. Below the minimum airway pressure

A

C. Just below the normal peak airway pressure

slide 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a limitation of the breathing circuit low pressure alarm?

A. It may not detect misconnections or obstructions
B. It always detects partial disconnections
C. It never needs a new setup during the case
D. It does not require monitoring airway or circuit pressure

A

A. It may not detect misconnections or obstructions

slide 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which of the following are functions of the sub-atmospheric pressure alarm? (Select all that apply - 2)

A. Measures and alerts negative circuit pressure
B. Detects high circuit pressure
C. Alerts potential for reverse flow of gas
D. Monitors patient heart rate
E. Measures oxygen levels in the blood

A

A. Measures and alerts negative circuit pressure, C. Alerts potential for reverse flow of gas

slide 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the potential consequences of negative circuit pressure? (Select all that apply - 3)

A. Pulmonary edema
B. Atelectasis
C. Hypoxia
D. Hypertension
E. Bradycardia

A

A. Pulmonary edema
B. Atelectasis
C. Hypoxia

slide 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are possible causes of sub-atmospheric pressure in the breathing circuit? (Select all that apply - 3)

A. Active (suction) scavenging system malfunctions
B. High fresh gas flow
C. Patient inspiratory effort against a blocked circuit
D. Dry CO2 absorbent
E. Suction to misplaced NGT/OGT

A

A. Active (suction) scavenging system malfunctions
C. Patient inspiratory effort against a blocked circuit
E. Suction to misplaced NGT/OGT

also inadequate FGF & moisture in CO2 absorbent

slide 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which of the following statements about high-pressure alarms are true? (Select all that apply - 3)

A. Activated if the pressure exceeds a certain limit
B. Cannot be adjusted by the user
C. Particularly valuable in pediatrics
D. Only important for adult patients
E. Can be user-adjustable or automated

A

A. Activated if the pressure exceeds a certain limit
C. Particularly valuable in pediatrics
E. Can be user-adjustable or automated

slide 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are possible causes of high-pressure alarms? (Select all that apply - 4)

A. Obstructions in the circuit
B. Increased patient compliance
C. Coughing or straining
D. Kinked endotracheal tube (ETT)
E. Endobronchial intubation

A

A. Obstructions in the circuit
C. Coughing or straining
D. Kinked endotracheal tube (ETT)
E. Endobronchial intubation

reduced compliance also

slide 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are potential causes of continuing pressure alarms? (Select all that apply - 3)

A. Scavenging system occlusion
B. Activation of oxygen flush system
C. Proper functioning of the adjustable pressure relief valve
D. Malfunctioning PEEP
E. High fresh gas flow rate

A

A. Scavenging system occlusion
B. Activation of oxygen flush system
D. Malfunctioning PEEP

other cause: malfunctioning APL

slide 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When is a continuing pressure alarm triggered?

A. When circuit pressure drops below 10 cm H2O for 15 seconds
B. When circuit pressure exceeds 10 cm H2O for more than 15 seconds
C. When there is no fresh gas flow
D. When the patient’s heart rate increases

A

B. When circuit pressure exceeds 10 cm H2O for more than 15 seconds

slide 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What must be done to resolve a continuing pressure alarm when the vent is turned off and flipped to APL valve?

A. Increase fresh gas flow
B. Squeeze the bag to move the flow through the scavenging system
C. Turn off the oxygen supply
D. Disconnect the patient from the ventilator

A

B. Squeeze the bag to move the flow through the scavenging system

slide 61

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which of the following are characteristics of electrical nerve stimulation in peripheral nerve monitoring? (Select 2)
a) Most commonly used
b) Less painful
c) Requires physical contact
d) No TOF stimulation

A

a) Most commonly used
c) Requires physical contact

Slide 63

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which characteristics are associated with magnetic nerve stimulation? (select all that apply)
a) Less painful
b) No physical contact required
c) Bulky and heavy
e) Difficult to achieve supramaximal stimulation

A

All of the above
No TOF capability
Not used in clinical practice anymore

Slide 63

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the reaction pattern of a single muscle fiber to a supramaximal stimulus?
a) Gradual increase
b) All-or-none
c) Variable response
d) Decreasing response

A

b) All-or-none
Electrical Nerve Stimulator

Slide 63

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The effectiveness of whole muscle response to electrical stimulation depends on the activation of how many ________ fibers.
a) Nerve
b) Muscle
c) Bone
d) Skin

A

b) Muscle

Slide 63

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which nerve is considered the gold standard for peripheral nerve stimulation?
a) Median nerve
b) Ulnar nerve
c) Posterior tibial nerve
d) Facial nerve

A

b) Ulnar nerve

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the advantages of using easily accessible sites for nerve stimulation? (Select 2)
a) Allow quantitative monitoring
b) Avoid direct muscle stimulation
c) Increase the need for muscle relaxants
d) Reduce the effectiveness of nerve stimulation

A
  • a) Allow quantitative monitoring
  • b) Avoid direct muscle stimulation

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is true about using the ulnar nerve-adductor pollicis muscle for nerve stimulation?
a) Highest risk of direct muscle stimulation muscle stimulation
b) Easily accessible and lowest risk of direct muscle stimulation
c) Not accessible
d) Highest recovery rate

A

b) Easily accessible and lowest risk of direct muscle stimulation

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Which muscles can be accessed for nerve stimulation when the arms are unavailable? Select 2
a) Adductor pollicis
b) Biceps
c) Orbicularis oculi
d) Corrugator supercilii
e) Quadriceps

A

c) Orbicularis oculi
d) Corrugator supercilii

Both part of the facial nerve

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which muscle is most resistant to depolarizing and nondepolarizing neuromuscular blocking drugs (NMBDs)?
a) Adductor pollicis
b) Diaphragm
c) Corrugator supercilii
d) Orbicularis oculi

A

b) Diaphragm
*Shorter onset than adductor pollicis, recovers quicker than peripheral muscles *

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

The corrugator supercilii muscle is better than the adductor pollicis muscle at reflecting the extent of neuromuscular block of which muscles? Select 2
a) Arm muscles
b) Laryngeal adductor
c) Leg muscles
d) Facial muscles
e) Abdominal muscles

A

b) Laryngeal adductor
e) Abdominal muscles

Slide 64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

At what frequency can single stimuli be applied in single twitch stimulation?
a) 1.0 Hz (every second) to 0.1 Hz (every 10 seconds)
b) 2.0 Hz (every second) to 0.2 Hz (every 10 seconds)
c) 0.5 Hz (every second) to 0.05 Hz (every 10 seconds)
d) 5.0 Hz (every second) to 1.0 Hz (every 10 seconds)

A

a) 1.0 Hz (every second) to 0.1 Hz (every 10 seconds)

Single twitch is the earliest and simpliest pattern

Slide 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Why is a reference value mandatory prior to administering NMBDs when using a single twitch nerve stimulator?
a) To adjust anesthesia depth
b) To determine baseline
c) To monitor heart rate
d) To measure blood pressure

A

b) To determine baseline muscle response

Slide 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is required to perform single twitch nerve stimulation?
a) An intravenous line
b) A monitoring device
c) A catheter
d) An oxygen mask

A

b) A monitoring device

Slide 65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What does the TOF ratio compare?
a) The first response to the second response
b) The first response to the fourth response
c) The second response to the third response
d) The third response to the fourth response

A

b) The first response to the fourth response

TOF ratio – 4th response/1st response

Slide 66

68
Q

What is the primary advantage of using the Train of Four (TOF) method for neuromuscular blockade monitoring?
a) Requires no setup
b) Provides reliable information
c) Needs constant recalibration
d) Only works in the initial phase of blockade

A

b) Provides reliable information throughout all phases of blockade without a monitoring device

Reliable assessment of onset and moderate blockade

Slide 66

69
Q

How often are the supramaximal stimuli applied in the TOF method?
a) Every second
b) Every 2 seconds
c) Every 0.5 seconds
d) Every minute

A

c) Every 0.5 seconds
evaluate TOF count or fade in the muscle response

Slide 66

70
Q

In a partial nondepolarizing block, what happens to the TOF ratio?
a) It increases
b) It remains constant
c) It decreases
d) It fluctuates

A

c) It decreases (fade)

Slide 66

71
Q

In a partial depolarizing block, what does the TOF ratio typically indicate?
a) There is fade
b) The ratio is 1.0
c) The ratio is 0.5
d) The response is absent

A

b) The ratio is 1.0

No fade, ratio is 1.0
If fade, phase II block developed

Slide 66

72
Q

Double Burst Stimulation (DBS) uses ________ bursts of ________ Hz tetanic stimulation.
a) One, 20
b) Two, 50
c) Three, 40
d) Four, 30

A

b) Two, 50
*Two short muscle contractions with fade in the 2nd burst, 1st is the comparison *

Not used in clinical practice anymore

Slide 67

73
Q

The separation between the two bursts in DBS is ________ ms and the duration of each square wave impulse in the burst is ________ ms.
a) 500, 0.1
b) 750, 0.2
c) 1000, 0.3
d) 1250, 0.4

A

b) 750ms, 0.2ms

Slide 67

74
Q

What are the modes of DBS and their respective impulse configurations? (Select 2)
- a) DBS3,3 mode: 3 impulses in each burst
- b) DBS3,2 mode: 3 impulses in first burst, 2 impulses in second burst
- c) DBS2,3 mode: 2 impulses in each burst
- d) DBS4,2 mode: 4 impulses in first burst, 2 impulses in second burst
- e) DBS3,4 mode: 3 impulses in each burst

A
  • a) DBS3,3 mode: 3 impulses in each burst
  • b) DBS3,2 mode: 3 impulses in first burst, 2 impulses in second burst

Slide 67

75
Q

In the case of non-depolarizers, tetanic stimulation results in one strong sustained muscle contraction with ________ after stimulation.
a) No response
b) Immediate relaxation
c) Fade
d) Prolonged contraction

A

c) Fade

Slide 68

76
Q

Tetanic stimulation is given at ________ Hz for ________ seconds.
a) 20, 2
b) 30, 3
c) 40, 4
d) 50, 5

A

d) 50, 5

Not used as frequently

Slide 68

77
Q

Depolarizers cause a strong sustained muscle contraction ________ fade during tetanic stimulation.
a) With
b) Without
c) Followed by
d) Preceded by

A

b) Without

*Phase II block – fade occurs
*

Slide 68

78
Q

Why is tetanic stimulation limited in value for assessing recovery?
a) It is not reliable
b) It is very painful
c) It requires special equipment
d) It is too short

A

b) It is very painful

Slide 68

79
Q

What is the composite stimulation pattern used in post-tetanic stimulation?
a) 20 Hz for 2 seconds followed by 5 single twitches
b) 30 Hz for 3 seconds followed by 7 single twitches
c) 50 Hz for 5 seconds followed by 10 to 15 single twitches
d) 50 Hz for 6 seconds followed by 10 to 20 single twitches

A

c) 50 Hz for 5 seconds followed by 10 to 15 single twitches

(1 Hz after 3 sec post tetanic stimulation)

Slide 69

80
Q

Which factors influence the response to post-tetanic stimulation? (Select 3)
a) Degree of blockade
b) Frequency and duration of tetanic stimulation
c) The patient’s age
d) Length of time between the end of tetanic stimulation and the first post-tetanic stimulus
e) Length of time between the end of post-tetanic stimulation and the first tetanic stimulus
f) The patient’s weight

A

a) Degree of blockade
b) Frequency and duration of tetanic stimulation
d) Length of time between the end of tetanic stimulation and the first post-tetanic stimulus

Slide 69

81
Q

What are additional factors that affect the response to post-tetanic stimulation? (Select 2)
a) Frequency of the single-twitch stimulation
b) Duration of single-twitch stimulation before tetanic stimulation
c) Duration of double-twitch stimulation before tetanic stimulation
d) Frequency of the double-twitch stimulation

A

a) Frequency of the single-twitch stimulation
b) Duration of single-twitch stimulation before tetanic stimulation

Slide 69

82
Q

True or False

Post-tetanic stimulation is used for deep and surgical blockade assessment.

A

True

Slide 69

83
Q

How long after the intubating dose of a non-depolarizing NMBD does the intense blockade period last?
a) 1-3 minutes
b) 3-6 minutes
c) 6-9 minutes
d) 9-12 minutes

A

b) 3-6 minutes

period of no response

Slide 70

84
Q

What is the recommended dose of sugammadex for reversing intense blockade for a non-depolarizer?
a) 2 mg/kg
b) 4 mg/kg
c) 8 mg/kg
d) 16 mg/kg

A

d) 16 mg/kg

Neostigmine reversal impossible; high dose of sugammadex (16 mg/kg) for reversal

slide 70

85
Q

During the deep blockade period for non-depolarizers, what is typically absent?
a) TOF response
b) Muscle relaxation
c) Pain sensation
d) Post-tetanic count

A

a) TOF response
presence of at least one response to post-tetanic count stimulation

slide 70

86
Q

What dose of sugammadex is used for reversing deep non-depolarizing blockade?
a) 2 mg/kg
b) 4 mg/kg
c) 8 mg/kg
d) 16 mg/kg

A

b) 4 mg/kg

Neostigmine reversal usually impossible; dose of sugammadex (4 mg/kg) for reversal

Slide 70

87
Q

What dose of sugammadex is recommended for reversing moderate blockade for non-depolarizers?
a) 2 mg/kg
b) 4 mg/kg
c) 8 mg/kg
d) 16 mg/kg

A

a) 2 mg/kg
Neostigmine reversal after 4/4 TOF; dose of sugammadex (2 mg/kg) for reversal

slide70

88
Q

What characterizes Phase I of depolarizing blockade?
a) Presence of fade during tetanic stimulation
b) All 4 responses are equal, reduced and disappear simultaneously in TOF
c) All 4 responses are equal, taller and disappear simultaneously in TOF
d) Occurrence of post-tetanic facilitation

A

b) All 4 responses are reduced and disappear simultaneously in TOF

Slide 71

89
Q

In Phase II of depolarizing blockade, what occurs in response to TOF and tetanic stimulation?
a) No fade
b) All responses are equal
c) Fade
d) Normal plasma cholinesterase activity

A

c) Fade

Fade present in response to TOF and tetanic stimulation

Slide 71

90
Q

Which phase of depolarizing blockade shows abnormal plasma cholinesterase activity?
a) Phase I
b) Phase II
c) Both Phase I and Phase II
d) Phase III

A

b) Phase II

Normal Plasma Cholinesterase activity is seen in Phase 1

Slide 71

91
Q

How does the response in Phase II of depolarizing blockade compare to non-depolarizing blockade?
a) It is different
b) It is similar
c) It is less intense
d) It is more intense

A

b) It is similar

Slide 71

92
Q

True or False

Occurrence of post-tetanic facilitation happens in Phase II of depolarizing blockade

A

True

Slide 71

93
Q

Why is it important to keep the patient warm during peripheral nerve monitoring?
a) To cause shivering
b) To prevent delaying nerve conduction
c) To decrease blood flow
d) To maintain muscle strength

A

b) To prevent delaying nerve conduction

Slide 72

94
Q

What are the steps involved in the use of peripheral nerve monitoring in clinical practice? (Select 2)

a) Attach electrodes prior to induction, turn on after patient is unconscious
b) Check for neuromuscular recovery prior to extubation
c) Maintain a moderate level of blockade with 1 or 2 responses to TOF
d) Reverse when all 4 responses are present to TOF

A

a) Attach electrodes prior to induction, turn on after patient is unconscious
d) Reverse when all 4 responses are present to TOF

slide 72

95
Q

Which reliable clinical signs indicate neuromuscular recovery post-reversal? (Select all that apply-3)
a) Sustained head lift for 5 seconds
b) Sustained leg lift for 5 seconds
c) Sustained handgrip for 5 seconds
d) Failed ‘tongue depressor test’
e) Minimum inspiratory pressure

A

a) Sustained head lift for 5 seconds
b) Sustained leg lift for 5 seconds
c) Sustained handgrip for 5 seconds

*Sustained** ‘tongue depressor test’**
Maximum inspiratory pressure *

Slide 72

96
Q

Which actions should be taken to ensure effective peripheral nerve monitoring during surgery? (Select 2)
a) Keep the patient cool to prevent delaying nerve conduction
b) Check for neuromuscular recovery prior to extubation post-reversal
c) Administer reversal agents only when 2/4 responses to TOF are present
d) Maintain a deep level of blockade throughout the surgery
e) Use moderate blockade with 1 or 2 responses to TOF

A

b) Check for neuromuscular recovery prior to extubation post-reversal
e) Use moderate blockade with 1 or 2 responses to TOF

Slide 72

97
Q

EEG measures the summation of which types of potentials in the cerebral cortex?
a) Excitatory
b) Inhibitory
c) Both excitatory and inhibitory
d) Neither excitatory nor inhibitory

A

c) Both excitatory and inhibitory

Slide 74

98
Q

How many channels of information are used in a standard EEG?
a) At least 8
b) At least 12
c) At least 16
d) At least 20

A

c) At least 16
Electrodes placed so that surface anatomy relates to cortical regions

Slide 74

99
Q

EEG can identify which of the following conditions?
a) Consciousness and Unconsciousness
b) Seizure activity
c) Stages of sleep
d) Coma
e) All of the above

A

E) All of the above

Slide 74

100
Q

True or False

EEG’s can identify indequate oxygen delivery to the brain (hypoxemia or ischemia)

A

True

Slide 74

101
Q

What is the term for the number of times per second the EEG signal oscillates or crosses the 0-voltage line?
a) Amplitude
b) Frequency
c) Time
d) Voltage

A

b) Frequency

Slide 74

102
Q

Which of the following describes the amplitude in an EEG signal?
a) Size or voltage of the recorded signal
b) Number of times per second the signal oscillates
c) Duration of the sampling of the signal
d) Location of electrode placement

A

a) Size or voltage of the recorded signal

Slide 74

103
Q

What are the components of signal description in EEG? (Select 3)
a) Amplitude
b) Frequency
c) Time
d) Electrode placement
e) Channel

A

a) Amplitude
b) Frequency
c) Time - *duration of the sampling of the signal *

Slide 74

104
Q

Which of the following is a peri-operative use of EEG?
a) Identifying inadequate blood flow to the cerebral cortex
b) Monitoring orbital blood flow
c) Measuring blood pressure in carotid artery
d) Assessing inadequate blood flow to frontal lobe

A

a) Identifying inadequate blood flow to the cerebral cortex

Slide 75

105
Q

What are the peri-operative uses of EEG? (Select 3)
a) Identifies tumors in the cerebral cortex
b) Guides an anesthetic-induced reduction of cerebral metabolism
c) Predicts neurologic outcome after a brain insult
d) Gauges the depth of the hypnotic state of patients under general anesthesia
e) Monitors heart rate during surgery

A

b) Guides an anesthetic-induced reduction of cerebral metabolism
c) Predicts neurologic outcome after a brain insult
d) Gauges the depth of the hypnotic state of patients under general anesthesia

Slide 75

106
Q

What frequency range is associated with Beta waves in EEG?
a) 8 - 13 Hz
b) 4 - 7 Hz
c) Greater than 13 Hz
d) Less than 4 Hz

A

c) Greater than 13 Hz

*Considered Awake - Alert attentive brain *

Slide 76

107
Q

Alpha waves, with a frequency range of 8 - 13 Hz, are typically observed when the patient has their:
a) Eyes open
b) Eyes closed
c) Mouth open
d) Mouth closed

A

b) Eyes closed

Slide 76

108
Q

Which EEG waves are associated with anesthetic effects?
a) Beta waves
b) Alpha waves
c) Theta waves
d) Delta waves

A

b) Alpha waves

Slide 76

109
Q

Theta waves (4 - 7 Hz) and Delta waves (< 4 Hz) are indicative of what state?
a) Alertness
b) Anesthetic effects
c) Depression
d) High activity

A

c) Depression

Slide 76

110
Q

Processed EEG contains artifact along with the desired EEG signal. How many channels of information does it use?
a) 2 channels
b) 4 channels
c) Less than 4 channels
d) More than 4 channels

A

c) Less than 4 channels

2 channels per hemisphere

Slide 77

111
Q

Why is it necessary for processed EEG to display the activity of both hemispheres?
a) To delineate bilateral changes
b) To delineate unilateral from bilateral changes
c) To increase signal strength
d) To delineate unilateral changes

A

b) To delineate unilateral from bilateral changes

Ex: Regional ischemia d/t carotid clamping (unilateral), EEG depression from anesthetic drug bolus (bilateral)

Slide 77

112
Q

Which of the following statements is true regarding studies comparing EEG (gold standard) vs. processed EEG?
a) There is an adequate number of studies
b) There is not an adequate number of studies
c) Processed EEG is more accurate than standard EEG
d) Processed EEG uses more channels than standard EEG

A

b) There is not an adequate number of studies

Slide 77

113
Q

What does the Bispectral Index (BIS) process to estimate anesthetic depth?
a) Heart rate
b) Blood pressure
c) EEG signal
d) Oxygen saturation

A

c) EEG signal
Uses a computer-generated algorithm/weighting system

Slide 78

114
Q

BIS is proposed as a method to prevent which of the following during surgery?

a) Intraoperative Pain
b) Intraoperative Awareness
c) Intraoperative Nausea
d) Intraoperative Infection

A

b) Intraoperative awareness

*Has not demonstrated to be superior to end-tidal agent concentration monitoring *

Slide 78

115
Q

What is the most common type of evoked potentials monitored intra-operatively?
a) Motor-evoked potentials
b) Auditory-evoked potentials
c) Visual-evoked potentials
d) Sensory-evoked potentials

A

d) Sensory-evoked potentials

Slide 79

116
Q

Sensory-evoked responses are electric CNS responses to which types of stimuli?
a) Electric stimuli
b) Auditory stimuli
c) Visual stimuli
d) All of the above

A

d) All of the above

Slide 79

117
Q

Sensory system stimulus have responses recorded at various sites along the sensory pathway to the cerebral cortex.
At what sites are responses recorded?
a) Cortical only
b) Subcortical only
c) Cortical or subcortical
d) Peripheral

A

c) Cortical or subcortical

Slide 79

118
Q

Sensory-evoked responses are described in terms of which two parameters?
a) Duration and frequency
b) Latency and amplitude
c) Speed and accuracy
d) Voltage and current

A

b) Latency and amplitude

*Latency – time measured from the application of the stimulus to the onset or peak of the response
Amplitude – size or voltage of recorded signal *

Slide 79

119
Q

What is necessary to ensure the reliability of sensory-evoked response monitoring?
a) High sensitivity equipment
b) Experienced technician
c) Reproducible tracings
d) Advanced algorithms

A

c) Reproducible tracings

*Need baseline reproducible, reliable tracings *

Slide 79

120
Q

Which types of sensory-evoked potentials are included in intra-operative monitoring? (Select 3)
a) Somatosensory-evoked potentials (SSEPs)
b) Brainstem auditory-evoked potentials (BAEPs)
c) Visual-evoked potentials (VEPs)
d) Motor-evoked potentials (MEPs)
e) Cortical evoked potentials (CEPs)

A

a) Somatosensory-evoked potentials (SSEPs)
b) Brainstem auditory-evoked potentials (BAEPs)
c) Visual-evoked potentials (VEPs)

Slide 79

121
Q

True or False

Somatosensory-Evoked Potentials monitor the responses to stimulation via sensory nerves to the sensorimotor cortex

A

FALSE
Monitor the responses to stimulation of peripheral mixed nerves (contain motor and sensory nerves) to the sensorimotor cortex

Slide 80

122
Q

What types of waveforms do SSEPs consist of?
a) Short-latency and long-latency
b) High-frequency and low-frequency
c) High-amplitude and low-amplitude
d) Short-latency and short-latency

A

a) Short-latency and long-latency

*Short-latency SSEPs are most commonly recorded intra-op; less influenced by changes in anesthetic drug levels *

Slide 80

123
Q

Which types of factors can alter the appearance of SSEPs? (Select 4)
a) Induction
b) Neurological disease
c) Age
d) Use of different recording electrode locations
e) Gender
f) Emergence

A

a) Induction
b) Neurological disease
c) Age
d) Use of different recording electrode locations

Slide 80

124
Q

What do Brainstem Auditory-Evoked Potentials (BAEPs) monitor?

A. Responses to light-emitting diodes
B. Responses to click stimuli delivered via foam ear inserts
C. Responses to touch stimuli on the skin
D. Responses to visual stimuli through contact lenses

A

B. Responses to click stimuli delivered via foam ear inserts

Monitors the responses to click stimuli that are delivered via foam ear inserts along the auditory pathway from the ear to the auditory cortex

Slide 81

125
Q

Which monitoring technique uses light-emitting diodes embedded in soft plastic goggles?

A. Brainstem Auditory-Evoked Potentials (BAEPs)
B. Somatosensory Evoked Potentials (SSEPs)
C. Visual-Evoked Potentials (VEPs)
D. Motor Evoked Potentials (MEPs)

A

C. Visual-Evoked Potentials (VEPs)
*
Monitors the responses to flash stimulation of the retina using light-emitting diodes embedded in soft plastic goggles through closed eyelids or contact lenses
Least commonly used monitoring technique intra-op *

Slide 81

126
Q

What do Motor-Evoked Potentials (MEPs) monitor?

A. The integrity of the motor tracts along the spinal column, peripheral nerves, and innervated muscle
B. The integrity of the auditory pathway along the spinal column, peripheral nerves, and innervated muscle
C. The integrity of the visual pathway along the spinal column, peripheral nerves, and innervated muscle
D. The integrity of the sensory tracts along the spinal column, peripheral nerves, and innervated muscle

A

A. The integrity of the motor tracts along the spinal column, peripheral nerves, and innervated muscle

Slide 82

127
Q

Which type of MEP is most common?

A. Somatosensory Evoked Potentials (SSEPs)
B. Visual-Evoked Potentials (VEPs)
C. Brainstem Auditory-Evoked Potentials (BAEPs)
D. Transcranial Motor-Evoked Potentials

A

D. Transcranial Motor-Evoked Potentials
*Monitors stimuli along the motor tract via transcranial electrical stimulation overlying the motor cortex *

Slide 82

128
Q

Electromyography (EMG) monitors the responses generated by cranial and peripheral motor nerves to allow early detection of _______ and assessment of the level of nerve function intra-op.

A. visual loss
B. motor cortex damage
C. surgically induced nerve damage
D. auditory damage

A

C. surgically induced nerve damage

Assesses the integrity of cranial or peripheral nerves at risk during surgery

Slide 82

129
Q

What is the primary thermoregulatory control center in the body?

A. Pituitary gland
B. Hypothalamus
C. Thalamus
D. Medulla oblongata

A

B. Hypothalamus

Slide 84

130
Q

Which type of fibers are responsible for detecting heat and warmth?

A. Unmyelinated C fibers
B. Alpha-delta fibers
C. Beta fibers
D. Gamma fibers

A

A. Unmyelinated C fibers

CHOT

Slide 84

131
Q

Which type of fibers are responsible for detecting cold?

A. Unmyelinated C fibers
B. Alpha-delta fibers
C. Beta fibers
D. Gamma fibers

A

B. Alpha-delta fibers

colD

Slide 84

132
Q

Which factors can influence thermoregulatory responses? (Select 2)

A. Circadian rhythm
B. Alcohol
C. Exercise
D. Drugs

A

B. Alcohol
D. Drugs

Slide 84

133
Q

Thermoregulatory response is characterized by _______ (temperature at which a response will occur), _______ (the intensity of the response), and _______ (sweating, vasodilation, vasoconstriction, and shivering).

A. threshold, gain, response
B. response, gain, threshold
C. gain, response, threshold
D. threshold, response, gain

A

A. threshold, gain, response

Slide 84

134
Q

Thermoregulatory responses can be affected by which of the following factors?

A. Anesthesia
B. Age
C. Menstrual cycle
D. All of the above

A

D. All of the above

Slide 84

135
Q

During the initial phase of hypothermia under general anesthesia, what is the approximate decrease in temperature?

A. 0.1 to 0.5°C
B. 0.5 to 1.5°C
C. 1.5 to 2.5°C
D. 2.5 to 3.5°C

A

B. 0.5 to 1.5°C

“Anesthesia-induced vasodilation”

Slide 85

136
Q

During the slow linear reduction phase of hypothermia in GA, what is the approximate rate of temperature decrease per hour?

A. 0.1°C per hour
B. 0.2°C per hour
C. 0.3°C per hour
D. 0.7°C per hour

A

C. 0.3°C per hour

Slide 85

137
Q

How long after anesthesia does the plateau phase of hypothermia typically occur?

A. 1-2 hours
B. 2-3 hours
C. 3-4 hours
D. 4-5 hours

A

C. 3-4 hours

Slide 85

138
Q

Which factors contribute to the slow linear reduction phase of hypothermia in GA? (Select 2)

A. Decrease in metabolic rate by 20-30%
B. Heat loss exceeding production
C. Thermal steady state
D. Vasoconstriction preventing loss of heat from the core

A

A. Decrease in metabolic rate by 20-30%
B. Heat loss exceeding production

Happens 1-2 hours after anesthesia

Slide 85

139
Q

During the **plateau phase **of hypothermia in GA, heat loss equals heat production, resulting in a _______.

Answer Choices:

A. rapid decrease in temperature
B. thermal steady state
C. decrease in metabolic rate
D. increase in heat production

A

B. thermal steady state

Vasoconstriction prevents loss of heat from core, but peripheral heat continues to be lost

Slide 85

140
Q

Why do patients under neuraxial anesthesia typically not complain of feeling cold?

A. They are given warming blankets.
B. Hypothermia does not cause much thermal discomfort.
C. They receive medications to prevent cold sensation.
D. The operating room is kept warm.

A

B. Hypothermia does not cause much thermal discomfort.

Slide 86

141
Q

How does neuraxial anesthesia affect central thermoregulatory control?

A. It enhances thermoregulatory control.
B. It has no effect on thermoregulatory control.
C. It inhibits thermoregulatory control.
D. It only affects peripheral thermoregulation.

A

C. It inhibits thermoregulatory control.

Slide 86

142
Q

What are the autonomic thermoregulatory defenses that are impaired by neuraxial anesthesia? Select 2

A. Shivering and sweating only
B. Vasodilation, sweating
C. Sweating and vasoconstriction only
D. Vasodilation and shivering only
E. Vasoconstriction and shivering

A

B. Vasodilation, sweating
E. Vasoconstriction and Shivering

Slide 86

143
Q

What causes the initial decrease in core temperature during neuraxial anesthesia?

A. Increased metabolic rate
B. Neuraxial blockade-induced vasodilation
C. Decreased metabolic rate
D. Increased heat production

A

B. Neuraxial blockade-induced vasodilation
May not plateau d/t inhibition of peripheral vasoconstriction threshold being altered

Slide 86

144
Q

Which method of heat transfer accounts for approximately 40% of heat loss in a patient?

A. Convection
B. Radiation
C. Evaporation
D. Conduction

A

B. Radiation

Slide 87

145
Q

Which statements are true regarding radiation as a method of heat transfer? (Select 2)

A. Accounts for approximately 80% of heat loss in patients.
B. Body Surface Area is exposed to environment
C. Infants are particularly vulnerable due to a high BSA/body mass ratio.
D. Involves direct contact between the skin and a cooler material.

A

B. Body Surface Area is exposed to environment
C. Infants are particularly vulnerable due to a high BSA/body mass ratio.

Slide 87

146
Q

What percentage of heat loss in a patient is typically due to convection?

A. 20%
B. 25%
C. 30%
D. 35%

A

C. 30%
*Clothing or drapes decrease heat loss
Greater in rooms with laminar air flow *

Slide 87

147
Q

Which method of heat loss is mainly through sweating and accounts for approximately 8-10% of heat loss?

A. Radiation
B. Convection
C. Evaporation
D. Conduction

A

C. Evaporation
*Latent heat of vaporization of water from open body cavities and respiratory tract, approx. 8-10% *

Slide 87

148
Q

Heat loss due to direct contact of body tissues or fluids with a colder material is known as _______ and is considered negligible.

A. Radiation
B. Convection
C. Evaporation
D. Conduction

A

D. Conduction
*Ex: contact between skin and OR table; intravascular compartment and an infusion of cold fluid *

Slide 87

149
Q

What effect does hypothermia have on platelet aggregation and the activity of enzymes involved in the coagulation cascade?

A. Enhances platelet aggregation and enzyme activity
B. Impairs platelet aggregation and enzyme activity
C. Has no effect on platelet aggregation and enzyme activity
D. Doubles the activity of enzymes involved in the coagulation cascade

A

B. Impairs platelet aggregation and enzyme activity

Slide 88

150
Q

By what percentage does hypothermia increase the need for transfusion?

A. 10%
B. 15%
C. 22%
D. 28%

A

C. 22%

Increases Blood loss by 16%

slide 88

151
Q

Which of the following is a result of decreased oxygen delivery to tissues caused by hypothermia?

A. Increased risk of wound infection
B. Enhanced tissue healing
C. Reduced need for transfusion
D. Decreased cardiac outcomes

A

A. Increased risk of wound infection

Slide 88

152
Q

Hypothermia increases the incidence of morbid cardiac outcomes by three times. Which of the following is NOT a related effect?

A. Increased blood pressure (BP)
B. Decreased heart rate (HR)
C. Increased plasma catecholamine levels
D. Increased oxygen demand due to shivering

A

B. Decreased heart rate (HR)

Slide 88

153
Q

Which of the following are effects of shivering caused by hypothermia? (Select 2)

A. Decreases oxygen demand
B. Decreased drug metabolism
C. Decreases plasma catecholamine levels
D. Increases post-operative thermal discomfort

A

B. Decreased drug metabolism - Increased duration of NMB
D. Increases post-operative thermal discomfort

slide 88

154
Q

Which of the following is a benefit of hypothermia in the context of cerebral ischemia?

A. Increases metabolic rate
B. Decreases oxygen delivery to tissues
C. Protects against cerebral ischemia
D. Impairs platelet aggregation

A

C. Protects against cerebral ischemia

Hypothermia during neurosurgery when brain tissue ischemia is expected

Slide 89

155
Q

By how much does hypothermia reduce metabolism per degree Celsius?

A. 5%
B. 6%
C. 8%
D. 10%

A

C. 8%

Slide 89

156
Q

Which of the following are benefits of hypothermia? (Select 2)

A. Increases cerebral ischemia
B. Increases metabolic rate
C. Improved outcome during recovery from cardiac arrest
D. More difficult to trigger malignant hyperthermia (MH)

A

C. Improved outcome during recovery from cardiac arrest
D. More difficult to trigger malignant hyperthermia (MH)

Slide 89

157
Q

Which patient population benefits more from airway heating and humidification?

A. Adults
B. Infants and children
C. Elderly
D. Children
E. Adolescents

A

B. Infants and children

Slide 90

158
Q

What is the purpose of warming IV fluids and blood during surgery?

A. To increase metabolic rate
B. To decrease metabolic rate
C. To prevent cooling
D. To increase body temperature

A

C. To prevent cooling

Slide 90

159
Q

Which of the following are methods of cutaneous warming? (Select 3)

A. Increase room temperature
B. Insulation
C. Forced air warming
D. Hot water mattresses
E. Lava rocks

A

A. Increase room temperature -Ex: liver transplants, major trauma, pediatrics *
B. Insulation - Single blanket reduces loss by 30%. **Doesn’t increase body temperature **
D. Hot water mattresses -More effective and safer placed on top of pts *

Slide 90

160
Q

What are the benefits of forced air warming during surgery? (Select 2)

A. Prevents heat loss from radiation
B. Uses convection to transfer heat to the patient
C. Increases metabolic rate
D. Reduces oxygen demand

A

A. Prevents heat loss from radiation
B. Uses convection to transfer heat to the patient

Slide 90

161
Q

What is the most common method used for peri-operative temperature management to prevent heat loss from** radiation**?

A. Airway heating
B. Warm IV fluids
C. Forced air warming
D. Hot water mattresses

A

C. Forced air warming

Uses convection to transfer heat to patient

Slide 90

162
Q

Which site is considered the gold standard for temperature monitoring?

A. Tympanic membrane
B. Esophagus
C. Nasopharyngeal
D. Pulmonary artery

A

D. Pulmonary artery
Correlates well with tympanic membrane, distal esophageal, and nasopharyngeal temperatures

Slide 91

163
Q

What is a risk associated with placing a temperature probe in the tympanic membrane?

A. Epistaxis
B. Perforation
C. Artifact resistance
D. Poor correlation with brain temperature

A

B. Perforation
Approximates temp at the hypothalamus

Slide 91

164
Q

Which monitoring site reflects brain temperature but is more prone to error?

A. Pulmonary artery
B. Tympanic membrane
C. Nasopharyngeal
D. Esophagus

A

C. Nasopharyngeal

Risk of epistaxis

Slide 91

165
Q

Which site for temperature monitoring is described as safe, easily accessible, artifact-resistant, and accurate?

A. Pulmonary artery
B. Tympanic membrane
C. Nasopharyngeal
D. Esophagus

A

D. Esophagus
*Placement in distal esophagus, lower 1/3 to ¼ of esophagus *

Slide 91

166
Q

An OR temperature of 70 degrees Fahrenheit is equivalent to _______ degrees Celsius.

Answer Choices:

A. 18
B. 19
C. 20
D. 21

A

D. 21

Slide 92

167
Q

An OR temperature of 65 degrees Fahrenheit is equivalent to _______ degrees Celsius.

Answer Choices:

A. 17
B. 18
C. 19
D. 20

A

B. 18

Slide 92

Principles of Anesthesia 1 - (Summer 2024) (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions