EXAM OPTIONAL Flashcards
The hemodynamic changes that should be avoided in the patient with mitral valve regurgitation include
bradycardia
Indicate the changes that occur when the thoracic aorta is cross-clamped during repair of an aortic aneurysm? Afterload PCWP CO HR
B Afterload Increased PCWP Increased CO Decreased HR Decreased
GeneraL anesthesia with nitrous oxide and fentanyl was used for hernia repair. Postoperatively, the patient develops truncal rigidity. Oxygen saturation falls to 45%. ‘What should be done?
Give succinylcholine (paralysis / intubation best treatment)
The patient with Eaton-Lambert syndrome responds to muscle relaxants in what way?
Increased sensitivity to both depolarizing to non-depolarizing muscle relaxants. Defect of decreased Ach release affect pre-synaptic neurons. MG affects post synaptic receptors.
The patient has Parkinsons disease. Which drug would you AVOID?
D. Droperinol (dopamine antagonists) [pg 376 APEX}
HIGH Ach less dopamine
The soda lime changes color during the case. What should you do?
B. Increase the FGF rate, change the canister after the case
Which of the following is appropriate preoperative anesthetic management of the patient with cardiac tamponade? HR, NSR, preload and a
Positive inotrope
Maintain HR, NSR, maintain or increase preload, maintain or increase afterload (make sure beck’s triad, low BP , distended neck )
Accidental subarachnoid injection occured during an intended epidural. Which of the following is a rapid, early sign?
Dyspnea(pg 607) because of a total spinal . Epidural dose injected into the subdural space, leads to a larger dose neither aspiration or test dose would rule it out. Patient will experience symptoms of cephalad spread, and block height will be much higher, rapid sensory block will occur. Sx are Dyspnea, difficulty phonating and hypotension.
Oozing of blood after a massive blood transfusion is probably due to
Thrombocytopenia (because dilutional effect can lead to 50% fall in platelet count) each unit of platelet increase count by 5000.
What is the maximum doses of dantrolene for treating malignant hyperthermia?
10 mg/kg pg 395. (2.5mg/kg up q 5-10minutes)
What is the most common hematologic disorder in the alcoholic?
Megaloblastic anemia (vit B12 / folate deficiency)
Shown in the following graph is the uptake of four volatile agents:
Nitrous Oxide (Top of chart)
The purpose of the pin index system is to
Keep cylinders with different gases from being used interchangeably
In PACU. the patient says he remembers some things that were said in the intraoperative period? What should you do?
Tell the patient what happened. Awareness prevented by having MAC of 0.5
Hemorrhage is the most common complication of mediastinoscopy. What is the next most common complication of this procedure?
Pneumothorax
Stimulation of what receptor explains why arterial diastolic blood pressure may decrease when epinephrine is administered with a local anesthetic?
Beta-2 adrenergic receptor (vasodilation and bronchodilation) Alpha blood vessels.
Alpha 2 p.g 96.
Which of the following neural tracts modulates pain?
Dorsolateral fasciculus
Trigger agents for malignant hyperthermia include
Halothane
At the neuromuscular junction aminophylline
Increase the release of ach from the motor nerve terminal
What is the necessary treatment for the patient with sickle cell disease who goes into sickle cell crisis
during surgery?
Give the patient an exchange transfusion (partial exchange , to increase NORMAL HGB to 50%).
During surgery for a subdural hematoma, a cerebral vasospasm develops. A drug that is appropriate for
treating this probLem is
Nimodipine
Pneumothorax is most commonly associated with which approach to the brachial plexus?
Supraclavicular
The patient’s hemiplegia resuLted from an accident six months ago. How will the twitches elicited by a
nerve muscle stimulator on the paralyzed side compare with those on the non-paralyzed side during
nondepolarizing neuromuscular blockade?
Twitches on the paralyzed side will be larger.
Which drug stimulates alpha-i, alpha-2 and beta-i receptors?
Norepinephrine
A patient is given 400mg of drug. Sixteen hours later, 25mg remain. How much drug is lost in the next
B hours?
18.75 (check valley)
The voltage-gated sodium channel is in the inactivated state in all but which of the following situations?
Severe Hypokalemia (LA is open and close (inactivated) but not resting
The patient who cannot adduct the thumb has had what nerve blocked by local anesthetic?
Ulnar (adduct) (adductor policis is innervated by ulnar)
radial (abduct)
You determine that magnesium suLfate should be given to the patient with pregnancy-induced hyper tension (pre-eclampsia/eclampsia). At what plasma concentration of magnesium (mEq/L) will toxicity begin to manifest?
8-12
What set of data correctly describes the actions of magnesium in the patient with pregnancy-induced hypertension (preeclampsia/eclampsia)?
(ACH release, Sensitivty to motor end plate, uterine tone, Vascular smooth muscle tone.
Ach released from MNT is decreased
Sensivity of motor end plate to ACH decreased
Uterine tone is decrease
Vascular smooth muscle tone is decreased.
There is a misunderstanding about the amount of magnesium sulfate that should have been adminis
tered to the patient with pregnancy-induced hypertension (pre-eclampsia/eclampsia). You are con cerned about magnesium toxicity. If magnesium toxicity is developing, you might see each of the following signs EXCEPT:
Tachycardia
You will see Loss of DTR, sedation, hypotension
The degree of aortic regurgitation is largely determined by what factors? Select three.
Diastolic pressure gradient
Duration of diastole
Incompetent aortic valve.
During the case, the blood pressure of the patient with pregnancy-induced hypertension (preeclamp sia/eclampsia) increases to 190/125. Of the following, which drug is LEAST appropriate for treating this hypertension?
Esmolol
Good ones are Hydralazine, labetalol, nitroprusside
Aspiration is a risk associated with anesthesia for patients with each of the following diseases EXCEPT:
Multiple sclerosis (demyelination of neurons)
Immediate delivery of the fetus is imperative if fetal heart rate decelerations are
Late with no beat to beat variability
You are appLying cricoid pressure to a patient that has lost consciousness; how much pressure should be
used (kg)?
4 kg (2 kg before , 4 kg after)
At least 98% of the drug will be gone after how many half-times of elimination?
6 half lives
25 mL of solution containing 1% lidocaine and 1:200,000 epinephrine contains how much of each drug?
250 mg and 125 mcg
The patient has a left ventricular ejection fraction of 0.22. This indicates
Cardiomyopathy
The patient who has been taking digitalis develops a prolonged PR interval and premature ventricular
contractions during anesthesia. What drug should you give?
Phenytoin (It is a class 1B antiarrhythmic)
What is the most common cause of acute myocarditis?
Viral infection
The shift in Starling curve shown by the arrow in the figure at right is consistent with administration of: (Select three)
Nipride
Digitalis
Inocor
(Reduce afterload, increase inotropy)
ANSI standards for reservoir bags require that the pressure not exceed 50cm H,O when the bag is dis tended to how many times its normal capacity?
4 times (each bag with volumegreater 1.4 should not exceed a pressure of
Cerebrospinal fluid passes from the lateral ventricles to the third ventricle through the foramina of
Munro
What substance manufactured by vascular endothelial cells (formerly called endothelium-derived
relaxation factor, EDRF) diffuses into the smooth muscle layer and causes vasodilation?
Nitric oxide
The most important factor determining whether or not a patient will file a malpractice law suit is the
Anesthetist’s rapport with the patient.
The American National Standards Institute Z79.9 1979 standard was replaced in 1988 with:
ASTM standard
“What size endotracheal tube should be placed in a 2-year-old child and what size suction catheter
should be used to keep this endotracheal tube clean!
A
Hemodynamic data for the patient are: arterial blood pressure, 130/70 mm-Hg; intracranial pressure, 15 mm-Hg; LVEDP, 10mm-Hg; right atrial pressure, 5; heart rate, 80. What are cerebral perfusion and coronary artery perfusion pressures?
75mmHg cerebral 60 mmHg (coronary) Coronary pressure (Arterial diastolic pressure minus -LVEDP
What site should not be used for insertion of a pulmonary artery catheter in a patient with a right pneu mothorax?
Left IJ
Identify ECG
RIGHT BBB
Digitalis slows heart rate by working on what phase of the cardiac action potential?
D. Phase 4 (REVIEW) pg 124 (CARDIAC ACTION POTENTIAL)
What probLem is indicated by the solid-line pressure-volume loop shown at right?
Acute Mitral regurgitation (REVIEW)
While the patient is breathing room air, blood gasses were: Pa02, 50mm-Hg; PaC02, 55 mm-Hg; PAO2 — Pa02 gradient, 10mm-Hg. This patient
Hypoventilating
What should be given to treat a prolonged bleeding time?
Platelets (Review) Nagelhout and Valley
What would cause the P50 to increase from 20 to 33 mm-Hg?
Respiratory acidosis
What is the most common cause of death in the patient with chronic renal failure?
Sepsis (infection 1st)
Shortly after induction, the patient begins wheezing. The concentration of inhaled agent is increased and the airway is checked for obstruction with negative finding. The wheezing continues. What should be done now?
Give Terbutaline ( β2 adrenergic receptor agonist, used as a “reliever” inhaler in the management of asthma symptoms)
A 57-year-old male who was involved in a motor vehicle accident is undergoing surgery to repair a fractured pelvis. The patient was taking nitroglycerin for angina. During the case SaO2 falls abruptly from 85% to 40%? Petechiae are noted on the chest and arms. What happened?
Fat embolism
In what situation will CVP be greater than PCWP?
Pulmonary Arterial hypertension
What muscle dilates the cords?
Posterior CricoArytenoids.
Compare PAO2 and PACO2 in Zones land 111 when the patient is sifting.
A
Zone 1, PAO2, is high
Zone 3 , PAO2
The patient has an FEV1 of2.O liters and an FVC of 2.5 liters. These data suggest
B , Restrictive *both normal but both reduced
know normal FEV and normal FVC
Total body sodium content is controlled primarily by
Aldosterone
lpratropium works by decreasing the concentration of what second messenger?
Inositol triphosphate (IP3) (Leading to less calcium)
The patients medial thigh is resting on support straps while in the lithotomy position. Numbness along the medial calf would suggest compression of what nerve?B
Saphenous
Where does the spinal cord end in the child?
L3 (Lower border of L3)
The signs and symptoms of Homer’s syndrome include: (Select 4)
C,E,F,H Ipsilateral miosis Ipsilateral ptosis Isilateral nasal congestion Isilateral enophtalmos (posterior displacement of eye)
What area of the brain responds to opioids to promote spinal analgesia?
Periventricular/periaquaductal gray matter
The patient’s episode of intraoperative malignant hyperthermia resolves with dantrolene treatment. This patient remains at risk for each of the following EXCEPT:
Liver failure
Why are chronic renal disease patients anemic?
Erythropoietin production is low
What should be avoided in the patient with sickle cell disease?
Hypotension
Which bleeding disorder obeys an X-linked recessive pattern of inheritance?
Hemophillia B
What is the most common cause of sudden death in the pediatric and young adult population?
Hypertrophic cardimomyopathy
An inhalational agent that is potent is
Lipid soluble
After partial thyroidectomy, the patient has one floppy vocal cord and is hoarse. Why?
Unilateral damage to the recurrent laryngeal nerve
Ongoing monitoring, problem identification, development and implementation of soLutions, re-evaluation, and documentation” are the five components of
Quality assurance
What happens to blood flow and the diameter of arterial blood vessels in ischemic region of the brain when the patient is hyperventilated? Blood flow, arterial diameter?
Increase Blood flow)
Arterial vessel diameter no change
Autonomic hyperreflexia may develop if the spinal cord lesion is above what level and if what period of
time has elapsed since the injury?
Above T6, 3 months since lesion)
The patient is weak and exhibits hypotension with hyperkalemia, hyponatremia, and hypoglycemia..
You suspec
Addison’s Disease (hypotension, hyperkalemia, hyponatremia, hypoglycemia)
What is the major benefit of stopping smoking two days prior to anesthesia and surgery?
Decreased carboxyhemoglobin
Which flow-volume loop would be exhibited by
a patient who has smoked two packages of cigarettes
per day for 4 years?
D (obstruction with exhalation)
Which of the following anesthetics produces the greatest motor blockade when injected into the epidural space?
3% chloroprocaine
The patient is given 10mg of drug. The decrease
in plasma concentration with time is shown in the
following figure. The volume of distribution of this
drugis
200L
When should cricoid pressure be released?
After the cuff of the endotracheal tube has been inflated and bilateral breath sounds are heard.
You might consider mixing phenylephrine instead of epinephrine with your local anesthetic the patient has
Coronary Artery Disease
The patient with chronic renal failure may exhibit each of the following abnormalities EXCEPT:
Prolonged Prothrombin time
What function test best distinguishes renal from prerenal failure?
Fractional Excretion of Sodium (FeNA)
The patient is receiving colloid when he suddenly complains he is dying. Hypotension with tachycardia and vasodilation are noted. What caused these signs and symptoms?
Histamine release
Acid-base data for a patient you are about to anesthetize are: pH = 7.38; PCO2 = 60mm-Hg, and HCO; = 39 mEq/liter. What is the problem?
C (Chronic Metabolic acidosis) . Acute respiratory acidosis – Bicarbonate increases by 1 mEq/L for each 10-mm Hg rise in PaCO2. … Chronic respiratory acidosis – Bicarbonate increases by 3.5 mEq/L for each 10-mm Hg rise in PaCO2.
A 57-year old man with triple coronary artery disease is scheduled for coronary artery bypass grafting (CABG). He had a myocardial infarction 7 months ago. He is taking nitroglycerin, digoxin, propranolol, isosorbide dinitrate (Isordil), and nifedipine. His blood pressure and heart rate are 120/80 mm-Hg and 60 per min, respectively. The patient’s hemoglobin is 11 g/ 100 mL and Sa02 90%. What is the total oxygen content of the arterial blood of this patient?
B 13.45ml {(Hgb x 1.39) (SaO2)/100 + (PaO2) (0.003)
The incidence of perioperative reinfarction for this patient is about
5%
The Swan-Ganz catheter is inserted into the right internal a distance of 45 cm.What trace would you see?
20cm RA
30cm RV
40cm PA
50 Wedge
The most common complication of inserting a Swan-Ganz catheter is
Arrythmias
A healthy 59-year-old (60-kg) woman with a normal preoperative ECG develops wide-complex tachy
cardia under general anesthesia for breast biopsy. Blood pressure is 81147 and heart rate is 220 beats?
mm. The most appropriate therapy would b
Electrical cardioversion
- The patient is heparinized and the ACT is found to be 430 sec. This means that
THrombin and Xa has been elimnated
The left ventricle must be drained during cardiopulmonary bypass because
Thebesians and bronchial veins drain into the LA
After cardiopulmonary bypass, how much protamine sulfate should be administered for each 100 units
of heparin remaining? What kind of bond does protamine form with heparin?
B. 1.1 - 1.3 mg IONIC neutralizes heparin by forming an ionic bond with heparin.
What volume of anesthetic is injected into the arm for a Bier block?
25-50 ml (0.5% lidocaine)
All of the following are anesthetized in a 3-in-1 block except for the:
Sciatic
Femoral, Obturator, and lateral femoral cutaneous nerve
A four-year-old has inspiratory stridor, chest retractions, tachypnea, cyanosis. drooling and difficulty swallowing. This condition probably results from
Infection by Hemophilus influenza type B
The internal diameter of the endotracheal tube for a six-year-old child should be —mm?
5.5 (Age/4 + 4)
35kg child will need how much fluid per hour?
75 ml (4-2-1 rule )
What data set correctly compares gastroschisis and omphalocele?
Omphalocelese hernial sac present
Gastrochisis hernial sac is absent
Gastrochisis Congenital abnormalities is basent ,
Omphaloceles Congenital abnormalities is present
One reason the neonate needs more succinylcholine than the adult is because _______what is another reason?
Greater ED95. Other reason is rapid distribution into an enlarged volume of extracellular fluid rather than an altered response to the action of the drug at postjunctional AChRs.
If a Tec-6 vaporizer calibrated in Los Angeles is brought to Steamboat Springs, Colorado, the percent delivered to the patient
Less than the dial setting
67-year-old man with mild congestive heart failure has during the past month become increasinglylethargic and has had headaches, aphasia, and right-sided weakness. Moderate bilateral papifledema was present. Arteriogram and CT scan suggested the presence of a left convexity meningioma that involved the Supenor sagittal sinus.Making room for the surgeon to work in the head is one of the special requirements of anesthesia for brain tumor removal. Each of the following techniques is acceptable for making room for the surgeon to work in the head EXCEPT:
Phlebotomy
What is the concentration and dose of mannitol for decreasing intracranial volume?
20% 1g/kg (5-10-20-25% containers0
Your major concern with administering the correct dose of mannitol
Pulmonary edema
Who is responsible for quality assurance?
Each hospital employee
The paraplegic patient had spinal cord injury two years ago. What anesthetic technique is best for this
patient?
Spinal anesthesia ( Prevent autonomic hyperreflexia and spasm associated with general anesthesia, provide hemodynamic instability)
The posterior longitudinal ligament is the _____ boundary of the epidural space?
Caudad Pg 407
What drug would you NOT give in the perioperative period to the patient undergoing surgery for pheochromocytoma?
Droperinol (releases catecholamines)
Avoid trimethaphan or any other drugs that release histamine. Histamine triggers the release of catecholamines. Also avoid droperidol because it
releases catecholamines from the adrenal medulla and inhibits catecholamine uptake into chromaffin granules. The release of catecholamines will cause severe hypertension
What monitoring modality is most sensitive for detecting venous air embolism?
Transesophageal Echocardiography (TEE)
A 72-year-old male suffered from benign prostatic hyperplasia. A transurethral
resection of the prostate under epidural anesthesia is planned. Blood pressure is 150/80, pulse 88, and weight 167 lb. . If during the case, the patient suddenly becomes tachycardic and hypertensive and simultaneously
complained of abdominal and shoulder pain, you would suspect
Perforation of the bladder
During the case, the patient becomes very restless, agitated and confused. These signs and symptoms
are generally seen when serum sodium falls below what level?
120 mEq/Liter
What drug for altering hemodynamic status should generalLy be avoided in the patient with idiopathic
subaortic hypertrophic stenosis?
NItroglycerin (the other drugs reduces outflow tract obstruction)
During rigid bronchoscopy, the patient becomes dyspneic and hypotensive. The pulse oximeter shows a
decrease in arterial blood oxygen saturation to 50%. What happened?
Pneumothorax
What drug should be AVOIDED in the patient with cystic fibrosis?
Atropine( make secretions thicker and harder to remove)
The ECG traces at right indicate that the patient has:
Left BBB Dominant S wave in V1 with broad, notched (‘M’-shaped) R wave in V6
V1 : ‘W’
V6: ‘M’
Each of the foIl owing decreases with age EXCEPT:
PaCO2 All go down(CO2 goes up)
Controlled (deliberate) hypotension is appropriate for
Radical cystectomy (removal of the bladder) Blood lost
‘Which of the following pulmonary parameters decreases in the geriatric person?
Total lung capacity
What is the suggested inflation volume for a LMA size 1.5?
10 (apex pg 77)
What is the minimum fasting period after ingesting breast milk (hr)?
4 hours
Calculate the allowable blood loss for a 6-month-old infant who weighs 7kg. Give your answer as a whole number (no decimals), in millilters (mL).
172 (calculate EBV, than ABL) know normal hct for 6month old infants to 1 year EBV is 75-80 ml/kg 70 ml/kg after 1 year Normal hgb 10-15 Normal Hct 33-42
- At what point during pregnancy does the maternal intragastric pressure increase, often resulting in
heartburn?
3rd trimester
How should left ventricular preload be managed in the patient with hypertrophic cardiomyopathy
Increased
Breathing circuit pressure is limited to ______
(cm H20
125 cm (H2O)
Which of the following is NOT an intrinsic laryngeal muscle?
Thyrohyoid
Intrinsic are cricothyroid, Oblique arytenoid, thyroarytenoid
