LE4 Flashcards
Alcohol dependence CAGE Questionnaire includes the following EXCEPT one:
A. Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover?
B. Have you ever felt you needed more drink to get drunk?
C. Have people annoyed you by criticizing your drinking?
D. Have you ever felt you needed to cut down on your drinking?
E. Have you ever felt guilty about drinking?
B. Have you ever felt you needed more drink to get drunk?
Rationale: The CAGE questionnaire consists of four questions, and the option B is not one of them. The acronym CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener.
Answer: B. Have you ever felt you needed more drink to get drunk?
Rationale: The CAGE Questionnaire is a brief tool used to screen for alcohol dependence. The acronym “CAGE” stands for:
C - Have you ever felt you should Cut down on your drinking?
A - Have people Annoyed you by criticizing your drinking?
G - Have you ever felt Guilty about drinking?
E - Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Blockage of a-adrenoceptor-mediated vascular tone can result to:
A. Fluid sequestration
B. Arrhythmia
C. peripheral vascular collapse
D. CNS depression
E. Hypotension
E. Hypotension
Rationale: α-adrenoceptors are found in the smooth muscle of blood vessels, and their activation generally results in vasoconstriction, which increases blood pressure. If you block α-adrenoceptor-mediated vascular tone, you prevent this vasoconstriction. As a consequence, the blood vessels dilate, leading to a decrease in blood pressure, known as hypotension.
To predict the requirement for isoflurane in milliliters of vapor per minute during closed anesthesia, each of the following is necessary EXCEPT
A. MAC of isoflurane
B. cardiac output
C. Duration of administration
D. Blood-Gas partition coefficient
E. oxygen consumption
C. Duration of administration.
While the duration of administration might influence the total amount of anesthetic used, it’s not directly used to predict the milliliters of vapor per minute requirement.
Flumazenil should not be used in benzodiazepine toxicity for patients with
A. cardiac ailments
B. seizure disorders
C. history of tricyclic antidepressants use
C. history of tricyclic antidepressants use
Rationale: Flumazenil can precipitate seizures, especially in patients with benzodiazepine overdose who have also ingested tricyclic antidepressants.
Alleged to be sex enhancers; can cause dizziness, tachycardia, hypotension, and flushing
A. Sertraline
B. Opioids
C. Metamphetamine
D. Organic nitrates
D. Organic nitrates
Rationale: Organic nitrates, like nitroglycerin, can cause vasodilation leading to the mentioned symptoms. They are sometimes misused for their vasodilatory effects.
Which has no specific antidote?
A. NO
B. HCN-
C. CO
D. Hydrogen sulfide
D. Hydrogen sulfide
Nystagmus, dysarthria and ataxia may be due to poisoning from (Check ALL that apply)
A. Carbamazepine
B. Phenytoin
C. Alcohol
A. Carbamazepine
B. Phenyton
C. Alcohol
Molecular mechanisms of GAB-A is potentiated by the following EXCEPT
A. Etomidate
B. Nitrous oxide
C. Halothane
D. Propofol
B. Nitrous oxide.
While nitrous oxide has anesthetic properties, it does not potentiate GABA-A receptors in the same manner as some other anesthetics. Etomidate, halothane, and propofol are known to potentiate the effects of GABA at the GABA-A receptor.
Compared with lidocaine, bupivacaine is more likely to cause dysrhythmias because
it
A. produces more prolonged block of sodium channels
B. enhances potassium-hydrogen ion exchange
C. sensitizes the myocardium to catecholamines
D. sustains calcium channels open
A. produces more prolonged block of sodium channels.
Bupivacaine’s cardiotoxicity is primarily due to its prolonged blockade of sodium channels in the cardiac myocytes, which can lead to dysrhythmias.
Which of the following is not a hallucinogenic?
A. LSD
B. Isobutyl nitrite
C. MDMA
D. Cannabis
B. Isobutyl nitrite.
Isobutyl nitrite is a type of “poppers,” which are vasodilators. They can cause a brief sensation of warmth and dizziness but are not hallucinogenic. LSD, MDMA, and cannabis have hallucinogenic properties.
Antidote is naloxone
A. Hallucinogens
B. Opioid
C. Metamphetamine
D. Depressant
B. Opioid.
Naloxone is an opioid receptor antagonist and is used to reverse opioid overdoses.
Flunitrazepam, a potent rapid-onset benzodiazepine with marked amnesic properties has been used in “date-rape
A. Stimulant
B. Opioid
C. Depressant
D. Hallucinogen
C. Depressant.
Benzodiazepines, including flunitrazepam, are central nervous system depressants.
Muscular rigidity can be caused by overdosage with (Check all that apply)
A. Theophylline
B. Haloperidol
C. Strychnine
B. Haloperidol
C. Strychnine
Haloperidol, an antipsychotic, can cause neuroleptic malignant syndrome, a side effect that includes muscle rigidity. Strychnine, a poison, causes muscle spasms and rigidity.
Theophylline does not typically cause muscular rigidity.
Which general anesthetic selectively inhibits excitatory NMDA receptors?
A. Desflurane
B. Ketamine
C. Propofol
D. Halothane
B. Ketamine
Ketamine is known for its NMDA receptor antagonism, which contributes to its anesthetic and analgesic effects.
True regarding opioids EXCEPT
A. Among health professionals meperidine and fentanyl are commonly misused
B. Overdose can result to nystagmus, marked hypertension, seizures which may be fatal
C. Most commonly used drugs are heroin, morphine, oxycodone
D. Overdose is managed with intravenous naloxone and ventilatory support
B. Overdose can result to nystagmus, marked hypertension, seizures which may be fatal
Opioid overdose typically results in respiratory depression, pinpoint pupils, and unconsciousness. Nystagmus, marked hypertension, and seizures are not typical symptoms of opioid overdose.
This binds to cytochrome A3 to block cellular oxygen use
A. Cyanide
B. Nitric oxide
C. Rotenone
D. Uncoupler
A. Cyanide
Cyanide poisoning inhibits cytochrome c oxidase (also known as complex IV), a component of the electron transport chain in mitochondria, thereby preventing cellular respiration.
Which of the following is an important factor in substance abuse?
A. Whether the substances are regularly used by other family members
B. Whether you are born in the winter
C. Whether you are a twin
D. Whether you are rich and famous
A. Whether the substances are regularly used by other family members
An 18-year-old female patient is brought to the emergency department due to drug overdose. Which of the following routes of administration is the most desirable for administering the antidote for the drug overdose?
A. Oral
B. Intramuscular
C. Intravenous
D. Subcutaneous
C. Intravenous
This drug is alleged to be a sex enhancer which causes dizziness, tachycardia, hypotension and flushing
A. MDMA
B. Caffeine
C. Isobutyl nitrate
D. Psilocybin
E. Diethyl ether
C. Isobutyl nitrate.
Rationale: Isobutyl nitrate, commonly known as “poppers”, is sometimes used recreationally for its short-lived rush and is also alleged to be a sex enhancer. It can cause side effects like dizziness, tachycardia (increased heart rate), hypotension (low blood pressure), and flushing.
Chronic use may lead to psychotic state (with delusions and paranoia) that is difficult to differentiate from schizophrenia
A. Hallucinogens
B. Sedative hypnotics
C. Stimulants
D. Depressants
A. Hallucinogens
Rationale: Chronic use of hallucinogens, such as LSD and phencyclidine (PCP), can lead to a psychotic state characterized by delusions and paranoia that can be hard to differentiate from schizophrenia. Stimulants can also induce psychotic symptoms, especially with overdose or prolonged use, but hallucinogens are more classically associated with inducing a state that mimics schizophrenia. Sedative hypnotics and depressants are less likely to produce such symptoms.
Hyperthermia as a result of sustained muscular hyperactivity which may led to
ЕХСЕРТ:
A. Hypokalemia
B. renal failure
C. lactic acidosis
D. none of these
A. Hypokalemia
A. Hypokalemia - Possible, but as mentioned earlier, rhabdomyolysis typically first causes hyperkalemia.
B. Renal failure - YES, due to myoglobinuria from rhabdomyolysis.
C. Lactic acidosis - YES, due to anaerobic metabolism.
TRUE regarding initial management in poisoning cases (check all that apply)
A. serum glucose and other determinations can be done from an intravenous line
B. patients with altered mental status should receive a challenge with concentrated dextrose
C. place the patient in lateral decubitus
D. position to move the flaccid tongue out of the airway
TRUE:
A. serum glucose and other determinations can be done from an intravenous line
C. place the patient in lateral decubitus
D. position to move the flaccid tongue out of the airway
Rationale:
A. Blood can be drawn from an IV line for various laboratory determinations, including serum glucose.
C. Placing a patient in the lateral decubitus (side-lying) position can help prevent aspiration, especially in unconscious or semi-conscious patients.
D. Positioning can help move a flaccid tongue out of the airway, which can improve airway patency in unconscious patients.
B. While hypoglycemia (low blood sugar) is a common cause of altered mental status, it’s not appropriate to give concentrated dextrose to all patients with altered mental status without first determining the blood glucose level. Administering concentrated dextrose to a patient who doesn’t have hypoglycemia can cause hyperglycemia (high blood sugar) and other complications.
The following are factors that may increase МАС EXCEPT one:
A. Hyperthermia
B. Age
C. Catecholamine levels
B. Age
Apnea, non-reacted dilated pupils, circulatory failure, and hypertension are most likely associated with this stage of general anesthesia:
A. surgical anesthesia
B. medullary depression
C. amnesia/analgesia
D. delirium
B. medullary depression.
Rationale: The stages of general anesthesia were historically described as four stages. Medullary depression, often referred to as Stage IV, is the stage where there is a danger of respiratory and cardiovascular depression. It is marked by apnea, non-reactive dilated pupils, circulatory failure, and often a decrease in blood pressure (hypotension, not hypertension). This stage is considered dangerous and can be lethal; thus, it is important to prevent patients from entering this stage during anesthesia.
- Stage I: Analgesia (or Induction)
• Amnesia
• Analgesia
• Euphoria- Stage II: Delirium (or Excitement)
• Delirium
• Combative behavior
• Irregular respiration
• Involuntary movements - Stage III: Surgical Anesthesia
• Surgical depth
• Regular respiration
• Loss of eyelash reflex
• Progressive muscular relaxation - Stage IV: Medullary Depression
• Apnea
• Non-reactive dilated pupils
• Circulatory failure
• Danger of death
- Stage II: Delirium (or Excitement)
Pre-Anesthetic Medication is given
A. to make the anesthetic procedure pleasant and safe
B. to decrease the duration of surgery
C. to maintain blood pressure
D. to control the patient’s comorbidity
A. to make the anesthetic procedure pleasant and safe.
Rationale: Pre-anesthetic medication is typically administered to reduce anxiety, prevent adverse responses to the induction of anesthesia, reduce the amount of induction agent needed, and to minimize potential adverse effects of anesthesia. The goal is to make the anesthetic procedure more pleasant for the patient and safer in terms of potential complications.
The minimal alveolar concentration of an inhalational anesthetic is a measure of
A. Efficacy
B. Therapeutic index
C. Diffusibility
D. Potency
D. Potency.
Rationale: The minimal alveolar concentration (MAC) of an inhalational anesthetic represents the concentration of the anesthetic in the alveoli of the lungs at which 50% of subjects do not respond to a standard painful stimulus. It is a measure of the potency of the anesthetic agent, with a lower MAC indicating a more potent agent.
Dissociative anesthesia is induced by
A. midazolam
B. nitrous oxide
C. thiopentone
D. ketamine
The answer is:
D. Ketamine
Rationale:
Ketamine is known to induce dissociative anesthesia, a unique state in which the patient feels detached from their environment and may experience hallucinations or dream-like states. While maintaining some level of consciousness, patients often feel disconnected from their pain. This is different from the profound sedation or traditional anesthesia induced by the other agents listed.
Headache, vomiting, seizures, coma are symptoms. Treatment is 100% O2 administration
A. Cyanide poisoning
B. Halothane overdose
C. Methane poisoning
D. Carbon monoxide poisoning
D. Carbon monoxide poisoning
Rationale: The symptoms described are consistent with carbon monoxide (CO) poisoning. CO binds to hemoglobin with a much greater affinity than oxygen, forming carboxyhemoglobin, which reduces the oxygen-carrying capacity of the blood. This can lead to hypoxia, presenting with symptoms like headache, vomiting, seizures, and in severe cases, coma. The treatment for CO poisoning is to administer 100% oxygen to displace the CO from hemoglobin, allowing it to bind to oxygen instead.
All are true of ether except:
A. Recovery is fast
B. Highly soluble in blood
C. Irritant, inflammable, explosive
D. Potent anesthetic, good muscle relaxant
B. Highly soluble in blood
Rationale: Ether is actually poorly soluble in blood, which contributes to its fast induction and recovery. The other options are accurate descriptions of ether: it’s an irritant, inflammable, explosive, a potent anesthetic, and a good muscle relaxant.
Ecstasy toxicity causes (check all that apply)
A. Trismus
B. Dilated pupils
C. Visual hallucinations
D. Hyperreflexia
A. Trismus
B. Dilated pupils
C. Visual hallucinations
D. Hyperreflexia
Ecstasy, commonly known as MDMA, can have various effects when consumed in toxic amounts. Let’s evaluate the options:
A. Trismus - Apply (Trismus, or jaw clenching, is commonly associated with Ecstasy use.)
B. Dilated pupils - Apply (Dilated pupils are a known effect of Ecstasy use.)
C. Visual hallucinations - Apply (While Ecstasy is primarily an entactogen, it can sometimes produce hallucinations.)
D. Hyperreflexia - Apply (Hyperreflexia can be a symptom of serotonin syndrome, which can be caused by excessive amounts of MDMA.)
Rationale:
Ecstasy (MDMA) is a synthetic drug that alters mood and perception. It is chemically similar to both stimulants and hallucinogens and can produce feelings of increased energy, pleasure, and distorted sensory perceptions. In toxic amounts, it can cause a range of effects including the ones listed above. Trismus or jaw clenching is notably common with its use. The drug can also cause dilated pupils, visual hallucinations, and hyperreflexia, especially in the context of serotonin syndrome.
The following general anesthetic has good analgesic but poor muscle relaxant action:
A. Ether
B. Isoflurane
C. Halothane
D. Nitrous oxide
D. Nitrous oxide
Rationale: Nitrous oxide (often referred to as “laughing gas”) is a general anesthetic that provides good analgesic properties but has poor muscle relaxant action compared to other anesthetics on the list.
Rationale for use of intravenous (fixed) anesthetic agents with inhalational agents (check all that apply)
A. enable lower doses of inhalational agent to be used
B. enhance or provide analgesia
C. reduce visceral reflex responses
A. enable lower doses of inhalational agent to be used
B. enhance or provide analgesia
C. reduce visceral reflex responses
Rationale:
Using intravenous (IV) anesthetic agents in combination with inhalational agents has several advantages:
A. By using IV agents alongside inhalational agents, it’s possible to reduce the dose of the inhalational agent required to achieve the desired depth of anesthesia. This can minimize side effects and complications related to the inhalational agents.
B. Some IV anesthetic agents, like opioids, can provide or enhance analgesia during surgery, which is beneficial for patient comfort and post-operative pain management.
C. Combining IV and inhalational agents can help suppress unwanted physiological reflexes, such as visceral reflex responses, which might occur during surgery.
ANESTHETIC POTENCY
A. MAC values are highly dependent on the nature of the painful stimulus
B. At equilibrium the partial pressure of the anesthetic gas in the lung is usually significantly higher than the partial pressure of the gas in the brain.
C. Concerning anesthetic gases – there is a rapid equilibrium between blood and brain partial pressures
D. MAC values are relatively sensitive to patient gender, height, weight, and anesthesia duration
C. Concerning anesthetic gases – there is a rapid equilibrium between blood and brain partial pressures
Rationale: Anesthetic gases tend to have a rapid onset of action because they achieve equilibrium quickly between the blood and the brain. This property allows inhaled anesthetics to induce and reverse anesthesia efficiently. When the anesthetic is inhaled, it quickly passes from the lungs into the bloodstream and then from the blood to the brain, where it exerts its anesthetic effect. This rapid equilibrium is essential for the precise control of the depth of anesthesia during surgical procedures.
What is the best method of GI decontamination with bags of cocaine ingestion?
A. Gastric lavage
B. Cathartics
C. Activated charcoal
D. Ipecac
E. whole bowel irrigation
E. whole bowel irrigation
Rationale: In cases where packets or bags of drugs (like cocaine) have been ingested, the primary concern is the rupture of a packet, which can lead to a rapid and potentially lethal absorption of the drug. Whole bowel irrigation (WBI) with polyethylene glycol electrolyte solution is recommended to enhance the passage of the packets through the gastrointestinal tract and prevent rupture. The other options listed, like gastric lavage, cathartics, activated charcoal, and ipecac, are not as effective in this specific scenario or might even be contraindicated.
Nitrous oxide anesthesia (TICK ALL POSSIBLE ANSWERS)
A. relative solubility of nitrous oxide prevents rapid absorption of significant quantities of gas
B. typically used in combination with the inducing agent (e.g. thiopental (Pentothal),
C. the skeletal muscle relaxant, and hyperventilation
D. may be associated with diffusional hypoxia
B. typically used in combination with the inducing agent (e.g. thiopental (Pentothal) - TRUE
C. the skeletal muscle relaxant, and hyperventilation - TRUE
D. may be associated with diffusional hypoxia - TRUE
Rationale:
A. Nitrous oxide has a low blood/gas solubility coefficient, which means it’s rapidly absorbed into the bloodstream and quickly eliminated from the body via the lungs. This property allows for quick onset and offset of its anesthetic effects.
B. Nitrous oxide is typically used as part of a balanced anesthesia technique, combined with other agents such as inducing agents like thiopental.
C. Nitrous oxide is often used in combination with skeletal muscle relaxants and can lead to increased ventilation (hyperventilation) due to its stimulatory effects on the sympathetic nervous system.
D. Diffusional hypoxia can occur when nitrous oxide is discontinued, and it rapidly diffuses out of the bloodstream into the alveoli, diluting the oxygen content and leading to a reduced partial pressure of oxygen in the alveoli. This is why it’s important to provide patients with 100% oxygen for a few minutes after discontinuing nitrous oxide to prevent this phenomenon.
Concerning measurement of anesthetic potency:
A. anesthetic potency is determined based on alveolar gas concentration
B. anesthetic potency is determined by measuring brain anesthetic concentration
A. anesthetic potency is determined based on alveolar gas concentration.
Rationale: Anesthetic potency is typically quantified using the minimum alveolar concentration (MAC), which represents the concentration of an anesthetic agent in the alveoli of the lungs at which 50% of subjects do not respond to a standard painful stimulus. The MAC is a standard measure used for volatile anesthetics, and it provides an estimate of the concentration needed to achieve a clinical effect. While the brain is the target organ for anesthetics, it is currently not practical to measure brain anesthetic concentrations directly in routine clinical practice. Instead, the alveolar gas concentration serves as a surrogate marker because it closely reflects the partial pressure of the anesthetic in the brain.
Malignant hyperthermia may be a complication of the of the following anesthetic
A. Propofol
B. Halothane
C. Ether
D. Nitrous Oxide
B. Halothane
Rationale: Malignant hyperthermia is a potentially life-threatening reaction that can be triggered by certain anesthetic agents. Halothane, a volatile inhalation anesthetic, is one of the agents known to be associated with a risk of inducing malignant hyperthermia in susceptible individuals.