final Flashcards by Kelsey Coventry Buchanan

“Patients who are premedicated with midazolam experience a difference in anxiety on arrival in the OR than patients that were not premedicated” is an example of:

A. Directional hypothesis

B. Null hypothesis

C. Nondirectional hypothesis

D. None of the above

C. Nondirectional hypothesis

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TRUE or FALSE: According to the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA), an anesthesiologist must personally participate in the most demanding phases of the anesthesia plan, including induction and emergence.

True

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Maximum cuff inflation for a size 4 LMA is:

A. 20 ml

B. 30 ml

C. 50 ml

D. 40 ml

30ml

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Current NPO guidelines state that breast milk can be consumed up to ___ hours before surgery.

A. 6 hours

B. 2-3 hours

C. 8 hours

D. 4 hours

D. 4 hrs.

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Which of the following describes a Mallampati III airway?

A. Full visualization of the entire oropharynx, including soft palate, uvula, fauces, and tonsillar pillars

B. Visualization of the soft palate and base of the uvula

C. Visualization of the soft palate, fauces, and uvula

D. Visualization of the hard palate only

B. Visualization of the soft palate and base of the uvula

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Which of the following are risk factors for postoperative nausea and vomiting (PONV)?

A. Age < 50 years old

B. Female

C. Gynecological surgery

D. Postoperative opioids

E. All of the above

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A 54-year-old female patient with hypertension and a BMI of 38 would have a STOP-BANG score of:

A. 4

B. 5

C. 3

D. 1

C. 3

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A patient with severe systemic disease affecting at least one organ system that causes functional limitation (i.e., unstable angina) would be which ASA Physical Status classification?
A. ASA PS V

B. ASA PS III

C. ASA PS IV

D. ASA PS I

E. ASA PS II

B. ASA PS III

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A thyromental distance less than ____ cm is indicative of a potentially difficult airway/intubation.

A. 5 cm

B. 6 cm

C. 8 cm

D. 3 cm

B. 6cm

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During direct laryngoscopy, which of the following is considered a Grade II Comack/Lehane view?

A. Only the epiglottis can be visualized; no portion of the glottic opening can be seen

B. Only the posterior portion of the glottic opening can be visualized; anterior commissure not seen

C. Most or full view of the glottic opening

D. Epiglottis cannot be seen; only view is of the soft palate

B. Only the posterior portion of the glottic opening can be visualized; anterior commissure not seen

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TRUE or FALSE: On the morning of a surgical procedure, avoid short-acting insulin unless blood sugar > 200 mg/dL (and > 3 hours preoperatively).

True

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True or false: PAP/PCWP is used to assess right ventricular filling.

False- left atrial filling

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Which is the resolution of objects perpendicular to the beam’s orientation?

a. Elevational resolution

b. Axial resolution

c. Diagonal resolution

d. Lateral resolution

D. Lateral resoultion

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The resistance the heart must overcome to pump blood into the rest of the body is known as …
a. SVR

b. CO

c. PVR

d. CVP

A. SVR

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Hypothermia can predispose a patient to which of the following effects?

a. Higher LVESV

b. Greater right ventricular stroke volume

c. Decreased solubility of volatile anesthetics

d. Rightward shift in the oxy-hgb dissociation curve

a. Higher LVESV

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ST segment elevation in II, III, aVF indicated an MI in which Coronary artery

Inferior, RCA

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What cannulation site for an arterial line is safest?

a. Radial

b. Femoral

c. Dorsalis pedis

d. None of the above

D. None of the above

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What is the most common form of heat transfer in humans? (Answer must be capitalized and spelled correctly)

Radiation

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What is the primary pressure that drives blood flow to organs?

a. Critical closing pressure

b. Mean arterial pressure

c. Systolic

d. Diastolic pressure

b. Mean arterial pressure

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All of the following are relative contraindications to having a TEE performed EXCEPT:

a. Recent gastric bypass surgery

b. Esophageal strictures

c. History of a GIB

d. Limited neck mobility

b. Esophageal strictures

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What alters CVP reading?

a. Fluid status

b. Venous compliance

c. Right heart function

d. All of the above

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Systemic vascular resistance and cardiac output have what kind of relation?

a. Equal

b. Inverse

c. Direct

d. Negative

b. Inverse

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Which condition may not be indicated for PA catheterization?

a. High risk surgery

b. Uncomplicated myocardial infarction

c. Cardiogenic shock

d. Severe refractory heart failure

b. Uncomplicated myocardial infarction

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Fat conducts heat 3 times as readily as other subcutaneous tissue.

FALSE

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High peak airway pressures, low tidal volumes, and impaired ventilation are signs of a lower airway obstruction.

TRUE

EXTRA CREDIT: Which of the following factors can predispose a patient to aspiration? a. Emergency surgery b. Obesity c. Lithotomy position d. Difficult intubation/airway e. All of the above

E. All of the above

Which of the following describes a Mallampati III airway? a. Visualization of the hard palate only b. Visualization of the soft palate and base of the uvula c. Visualization of the soft palate, fauces, and uvula d. Full visualization of the entire oropharynx, including soft papate, uvula, fauces, and tonsillar pillars

b. Visualization of the soft palate and base of the uvula

What is the great STEMI imposter?

Wolf-Parkinson's White syndrome

What is TEE used for? a. Assessing volume status b. Calculation of ejection fraction c. Assessment of thrombi in the heart d. All of the above

D. all of the above

Determining which type of temperature monitoring to use during a case depends on: a. Type of surgical procedure b. Patient condition c. Anesthetist preference d. Type of anesthesia e. All of the above

E. all of the above

The recurrent laryngeal nerve provides innervation to all of the following intrinsic muscles of the larynx EXCEPT: a. Thyroarytenoids and vocals b. Posterior cricoarytenoids c. Aryepiglottic d. Lateral cricoarytenoids e. Cricothyroids

E. Cricothyroids

While using the Color-Flow Doppler, the red hues seen on the screen indicate flow away from the transducer.

FALSE

When advancing the TEE probe and significant resistance is met, you should first: a. Keep advancing the probe b. Deepen sedation c. STOP advancing and adjust the patient's neck d. None of the above

C. Stop advancing and adjust the ts neck

According to the ASA fasting guidelines, clear liquids may be consumed up to 2 hours before surgery.

TRUE

Halothane, Isoflurane, Sevoflurane, Atropine, Glycopyrrolate, Ondansetron, and Methadone can prolong QT

TRUE

The onset of postoperative delirium is delayed by weeks or months.

FALSE

For patients with thoracic outlet syndrome, the arms should be placed at their sides in prone position.

TRUE

To prevent brachial plexus injury, the patient's arms should be abducted > 90° on padded arm boards.

FALSE

Common causes of radial nerve injury include: A. Pressure on the lateral aspect of the arm by an anesthesia screen B. Excessive cycling of the BP cuff C. Compression of the midhumerus by restrictive towels or sheets used to tuck the arms D. In the lateral position, arm boards and slings can exert direct pressure on the radial nerve E. All of the above

E. All of the above

When discussing anesthesia morbidity, serious distress prolonging hospital stay without permanent complications is an example of A. Intermediate morbidity B. Minor morbitiy C. Major morbidity D. None of the above

A. Intermediate morbidity

Which of the following is NOT a domain of frailty in the geriatric population? A. Weak grip strength B. Rapid walking speed C. Unintentional weight loss > 4 kg in the last year D. Low physical activity E. None of the above

B. Rapid walking speed

In the Trendelenburg position, the functional residual capacity (FRC) increases as the degree of Trendelenburg increases.

FALSE

In the lithotomy position, if the fibular neck rests against the vertical bar of the stirrup, it can result in injury to the ________ nerve. A. Popliteal B. Peroneal C. Sciatic D. Femoral

B. Peroneal

Which of the following factors contribute to position-related nerve injuries? A. Obesity B. Procedure length of 4-5 hours C. Malnutrition D. Neuromuscular blockade E. All of the above F. None of the above

E. All of the above

Which of the following are signs and symptoms of compartment syndrome? A. Ischemia B. Hypoxic edema C. Decreased tissue pressure within fascial compartment D. Extensive rhabdomyolysis E. A, B, and D F. All of the above

E. A, B, D

There are ___ thoracic vertebrae. A. 12 B. 7 C. 4 D. 5

A. 12

When performing a test dose after inserting an epidural catheter, the patient experiences warmth and tingling of the legs and feet and loss of sensory perception of cold and pinprick, indicating an intrathecal injection has occurred.

TRUE

The spinal cord extends the length of the vertebral canal during fetal life and ends at ____ at birth. A. L1 B. L4 C. L3 D. L2

C. L3

With spinal anesthesia, hypotension is inversely proportional to the degree of sympathetic block achieved.

FALSE

When preparing a patient for epidural or spinal anesthesia, Tuffier’s line correlates with which of the following spinal levels? A. L4 B. L1 C. L3 D. L2

A. L4

The thickest, outermost meningeal layer is the _________________. A. Arachnoid Mater B. Pia Mater C. Dura Mater D. None of the above

C. Dura Mater

There are no absolute indications for subarachnoid or epidural anesthesia.

TRUE

When receiving spinal anesthesia, pregnant patients experience higher sensory blockade.

TRUE

What of the following statements is true regarding neural blockade? A. Sensory blockade > Motor blockade > Autonomic blockade B. Autonomic blockade > Sensory blockade > Motor blockade C. Autonomic blockade > Motor blockade > Sensory blockade D. Motor blockade > Autonomic blockade > Sensory blockade

B. Autonomic blockade > Sensory blockade > Motor blockade

The posterior boundaries of the epidural space are which of the following? A. Ligamentum flavum B. Lamina C. Posterior longitudinal ligament D. A and B E. None of the above

D. A and B

A hyperbaric local anesthetic solution has a specific gravity that is ____ than the specific gravity of cerebrospinal fluid. A. higher than B. equal to C. lower than D. None of the above

A. higher than

Clinical manifestations of hypermagnesemia include all the following EXCEPT: A. Cardiac arrest B. HoTN C. HTN D. decreased deep tendon reflexes E. respiratory paralysis

C. Hypertension

Surgical trauma and tissue injury stimulates local release of cytokines and other inflammatory mediators, which contribute to: A.Hyperthermia B. Increased O2 demand C. regional changes in microcirculatory flow D. All of the above E. None of the above

D. All of the above

Which of the following is the only naturally occurring colloid solution (besides PRBCs)? A. Dextran B. Gelatin C. Hydroxyethyl starch D. Albumin E. None of the above

D. Albumin

During laparoscopic surgery, abdominal insufflation contributes to which of the following? A. A significant decrease in CVP B. An increase in cardiac preload due to increased venous return C. All of the above D. None of the above

D. none of the above

Pulmonary clinical manifestations of hypocalcemia include bronchospasm and laryngospasm

TRUE

Treatment of hypercalcemia includes all of the following EXCEPT: A. Avoidance of loop diuretics B. Volume expansion w normal saline C. Hemodialysis for rapidly developing hypercalcemia w dysrhythmias D. None of the above

A. Avoidance of loop diuretics

Calculate the maximum allowable blood volume (MABL) for a healthy 70 kg adult male w a starting hematocrit of 39 and a lowest allowable hematocrit of 27

1507.69 mL

With mild hyperkalemia (5.5-5.6mEq/L) which of the following ECG changes would you expect to see? A. Peaked T waves B. Prolonged PR segment C. asystole D. A and B E. All of the above

D. A and B

Clinical manifestations of hyponatremia include: A. Nausea and vomiting B. Cramps C. Weakness D. Agitation E. Confusion F. Cerebral edema G. seizures H. All of the above

H. All of the above

Hypovolemia causes an autotransfusion of fluid volume from the interstitial space into the intravascular space

TRUE

Using the 4-2-1 method, what is the hourly maintenance fluid requirement for a 75kg pt? A. 150ml/hr B. 125ml/hr C. 115ml/hr D. 90ml/hr

C. 115ml/hr

Limitations of Nerve stimulation technique

Main limitations of NS technique: -Inconsistent results -Variations in electrical properties of different nerve stimulators Other variables that affect the ability to stimulate nerves: -Conducting area of the electrode (stimulating needle vs. stimulating catheter tip) -Electrical impedance of the tissues -Electrode-to-nerve distance -Current flow -Pulse duration

Risks of regional anesthesia:

Systemic toxicity Infection Bleeding Permanent nerve injury

What supplies should be set up before block?

All supplies should be assembled and readily available prior to beginning the block: - Oxygen - monitoring equipment - emergency airway equipment - resuscitative equipment Emergency medications: Epinephrine, Atropine, Phenylephrine, Propofol, Succinylcholine, Midazolam, Intralipid

In-plane technique:

the needle is aligned in the plane of a thin ultrasound beam allowing the visualization of the entire shaft and the tip

Out-of-plane technique:

the ultrasound beam transects the needle, and the needle tip or the shaft is observed as a bright spot in the image.

Interscalene block anatomic landmarks:

Subclavian artery and scalene muscles

Supraclavicular block anatomic landmark:

Subclavian artery

Infraclavicular anatomic landmarks:

Subclavian/axillary artery and vein

Axillary anatomic landmarks:

Axillary artery

Post-block discharge to PACU criteria:

Discharge criteria: -Stable vital signs in the PACU -Pain well-controlled upon discharge Advise patient of risks associated with an anesthetized limb: -Potential for pressure neuropathies -Risk of burns when cooking

Absolute contraindications to peripheral nerve blocks:

Patient/parent/guardian refusal

Contraindications to Peripheral nerve blocks

Other contraindications: -Local infection -Systemic anticoagulation -Schizophrenic patients should receive PNB accompanied by general anesthesia Existing neurologic deficits (*potential contraindication) -Clear and thorough documentation of current neurologic deficits before block performance

where does the brachial plexus arise from?

Anterior primary rami of C5-C8 and T1 spinal nerves.

What does the brachial plexus consist of?

* 5 roots * 3 trunks * 6 divisions (2 per trunk) * 3 cords * 5 major terminal nerves

Axillary block indication

Surgery distal to elbow

What is an interscalene block indicated for?

Surgery of shoulder and upper arm

what should be considered when performing an interscalene block?

Block the ipsilateral phrenic nerve. -Careful consideration should be given to patients with severe pulmonary disease or preexisting contralateral phrenic nerve palsy. -Horner’s syndrome May result from proximal tracking of local anesthetic and blockade of sympathetic fibers to the cervicothoracic ganglion Symptoms: myosis, ptosis, anhydrosis • Vertebral artery injection - suspect if immediate seizure activity is observed. • Spinal or epidural injection • Pneumothorax - possible due to close proximity of pleura

Complications of Supraclavicular block

For procedures distal to the elbow Complications: *Pneumothorax *Ipsilateral phrenic nerve palsy in ~50% of patients *Horner’s syndrome *Recurrent laryngeal nerve palsy *Subclavian artery puncture

Indications for Bier Block:

Surgical procedures of short duration (45-60 minutes) * Trigger finger release * Carpal tunnel release

How long should the tourniquet be on to prevent LAST during a Bier Block?

At least 20 mins

Symptoms of LAST

metallic taste in their mouth or ringing in their ears. If they are, keep O2 and monitors on the patient and continue to monitor until it subsides.

Advantages of Lower extremity blocks:

-Reduced recovery room admissions -Decreased PONV -Decreased urinary retention -Improved postoperative analgesia

Nerves of the Lumbar Plexus

*Lateral Femoral Cutaneous Nerve *Obturator Nerve *The femoral nerve- anterior and posterior branch

What's the largest nerve in the lumbar plexus?

Femoral nerve

Anterior branch of femoral nerve innervation:

-Anterior branch: Innervation to the anterior surface of the thigh and the sartorius muscle

Posterior branch of femoral nerve innervation:

Posterior branch: Innervation to the quadriceps muscle, knee joint, and its medial ligament - The origin of the saphenous vein

Position of the femoral nerve

Position: o At femoral crease o Nerve lateral to femoral artery and vein o NAVEL Nerve, Artery, Vein, Empty space, Ligament

5 Nerves at ankle level

*Tibial Nerve *Sural Nerve *Superficial peroneal nerve *Deep peroneal nerve *Saphenous nerve