Mod8: April's Practice questions Flashcards
A type and cross should be ordered if the patient is expected to lose large amounts of blood.
A. True
B. False
A. True
B. False
The toxic pulmonary side effects of bleomycin include (select two)
A. restrictive changes
B. obstructive changes
C. increased FRC
D. decreased FRC
A. restrictive changes
B. obstructive changes
C. increased FRC
D. decreased FRC
Match the following chemotherapy drugs to its respective systemic toxic effect:
___. cardiotoxic
___.nephrotoxic
___. Pulmonary fibrosis
A.cisplastin
B.doxorubicin
C.bleomycin
_B__. cardiotoxic
_A__.nephrotoxic
_C_. Pulmonary fibrosis
A.cisplastin
B.doxorubicin
C.bleomycin
Ordering electrolytes would be most appropriate for a patient with what preexisting morbidities?
A. a patient receiving anticoagulation therapy
B. an immunosuppressed patient
C. A patient with renal disease and taking diuretics
D. a patient with CHF and COPD
A. a patient receiving anticoagulation therapy
B. an immunosuppressed patient
C. A patient with renal disease and taking diuretics
D. a patient with CHF and COPD
One would anticipate which issue to occur in an extremely anxious patient?
A. hypotension
B. decreased gastric emptying
C. decreased anesthetic requirements
D. all of the above
A. hypotension
B. decreased gastric emptying
C. decreased anesthetic requirements
D. all of the above
Elevation of the legs in the lithotomy position can cause:
A. hypotension
B. acute decrease in VR
C. decrease in MAP
D. exacerbation of CHF
A. hypotension
B. acute decrease in VR
C. decrease in MAP
D. exacerbation of CHF
What ventilatory changes should be made to prevent barotrauma/hypercarbia? (select 2)
A. decrease RR
B. increase RR
C. decrease Vt
D. increase Vt
A. decrease RR
B. increase RR
C. decrease Vt
D. increase Vt
A vulvectomy is:
A. the process of dilating the cervix and removing contents of the uterus
B. the removal of the uterus though the vagina
C. the removal of entire vulva
D. the removal of pelvic organs effected by a malignancy
A. the process of dilating the cervix and removing contents of the uterus
B. the removal of the uterus though the vagina
C. the removal of entire vulva
D. the removal of pelvic organs effected by a malignancy
A dilation and curettage requires what sensory level block?
A. T10
B. T11
C. T12
D. L4
A. T10
B. T11
C. T12
D. L4
A hysterectomy requires what sensory level block?
A. T10
B. T11
C. T4-T6
D. T2-T4
A. T10
B. T11
C. T4-T6
D. T2-T4
At what point of gestation is a woman considered a full stomach?
A. >10 weeks
B. >12 weeks
C. >16 weeks
D. >20 weeks
A. >10 weeks
B. >12 weeks
C. >16 weeks
D. >20 weeks
What is the correct dose of Ergonovine to help stop bleeding after delivery?
A. 20-30 U added to 1L IVF
B. 2.0 mg IM/SQ
C. 0.2 mg IV
D. 0.2 mg IM/SQ
A. 20-30 U added to 1L IVF
B. 2.0 mg IM/SQ
C. 0.2 mg IV
D. 0.2 mg IM/SQ
What would cause the anesthetist to be suspicious of a uterine rupture post-op? (select 2)
A. hypotension
B. severe back pain
C. severe abdominal pain
D. referred shoulder pain
A. hypotension
B. severe back pain
C. severe abdominal pain
D. referred shoulder pain
Select two concerns with the use of lasers.
A. OR fires
B. high sensory block required
C. vaporization of viral particles
D. potential for large blood loss
A. OR fires
B. high sensory block required
C. vaporization of viral particles
D. potential for large blood loss
CO2 beams are more precise than YAG beams in laser fulgurations.
A. True
B. False
A. True
B. False
The preferred approach for a hysterectomy is:
A. abdominal
B. midline incision
C. vaginal
D. bikini incision
A. abdominal
B. midline incision
C. vaginal
D. bikini incision
Younger patients receiving spinal or epidural anesthesia for a hysterectomy are an increased risk for:
A. bleeding
B. post-op pain
C. hypotension
D. post dural puncture headache
A. bleeding
B. post-op pain
C. hypotension
D. post dural puncture headache
Muscle relaxation is required for:
A. abdominal hysterectomy
B. vaginal hysterectomy
C. both
D. neither
A. abdominal hysterectomy
B. vaginal hysterectomy
C. both
D. neither
If a surgeon injects a vasopressor into the submucosa to minimize blood loss, what should you be on the look out for?
A. hypotension
B. reflexive bradycardia
C. reflexive tachycardia
D. bleeding
A. hypotension
B. reflexive bradycardia
C. reflexive tachycardia
D. bleeding
Sources of fluid deficits include (select three)
A. HTN
B. NPO guidelines
C. emesis due to a bowel obstruction
D. tachycardia
E. hypothermia
F. sequestration of water/electrolytes into abdominal structures
A. HTN
B. NPO guidelines
C. emesis due to a bowel obstruction
D. tachycardia
E. hypothermia
F. sequestration of water/electrolytes into abdominal structures
Signs of decreased peripheral perfusion due to hypovolemia include all of the following except:
A. increased skin temperature
B. skin mottling
C. dry mucous membranes
D. decreased skin turgor
A. increased skin temperature
B. skin mottling
C. dry mucous membranes
D. decreased skin turgor
What Hct value is a reflection of a patient having very concentrated serum?
A. 60%
B. 30%
C. 25%
D. 45%
A. 60%
B. 30%
C. 25%
D. 45%
Diarrhea causes metabolic ________ while vomiting causes metabolic _________.
A. acidosis, alkalosis
B. alkalosis, acidosis
C. acidosis, acidosis
D. alkalosis, alkalosis
A. acidosis, alkalosis
B. alkalosis, acidosis
C. acidosis, acidosis
D. alkalosis, alkalosis
Not all patients undergoing abdominal surgery are considered to have a full stomach.
A. True
B. False
A. True
B. False
Blocks of the T2-T4 sensory level will cause:
A. decreased minute to minute ventilation
B. paralysis of intercostal muscles
C. prevention of shoulder pain
D. all of the above
A. decreased minute to minute ventilation
B. paralysis of intercostal muscles
C. prevention of shoulder pain
D. all of the above
Regional anesthesia can cause unopposed PNS activity. How can this be reversed?
A. ensure adequate fluid status
B. proper patient positioning
C. administering glycopyrrolate
D. ensuring complete muscle relaxation
A. ensure adequate fluid status
B. proper patient positioning
C. administering glycopyrrolate
D. ensuring complete muscle relaxation
Longer cases or cases with significant bowel exposure are expected to have ______ ml/kg/hr of evaporative fluid loss.
A. 8-10
B. 10-12
C. 12-15
D. 10-15
A. 8-10
B. 10-12
C. 12-15
D. 10-15
Causes of 3rd spacing include all of the following except:
A. burns
B. infection
C. obstruction
D. ascites
A. burns
B. infection
C. obstruction
D. ascites
Abrupt drainage of ascites can cause acute hypotension due to:
A. an increase of intra-abdominal pressure
B. a reduction in VR
C. bleeding
D. all of the above
A. an increase of intra-abdominal pressure
B. a reduction in VR
C. bleeding
D. all of the above
How many twitches are recommended that relaxants be titrated to in order to provide adequate relaxation for abdominal closure?
A. 1
B. 2
C. 3
D. 4
A. 1
B. 2
C. 3
D. 4
The use of what anesthetic gas is contraindicated in abdominal procedures?
A. N2O
B. NO
C. CO2
D. NO2
A. N2O
B. NO
C. CO2
D. NO2
What prostanoid causes hemodynamic changes due to bowel manipulation?
A. prostaglandin H1a
B. prostaglandin F2a
C. prostaglandin F1a
D. all of the above
A. prostaglandin H1a
B. prostaglandin F2a
C. prostaglandin F1a
D. all of the above
Hypothermia due to convection can be caused by what air flow rates in the OR?
A. 5-10 room volume changes/hr
B. 10-15 room volume changes/hr
C. 15-20 room volume changes/hr
D. 20-25 room volume changes/hr
A. 5-10 room volume changes/hr
B. 10-15 room volume changes/hr
C. 15-20 room volume changes/hr
D. 20-25 room volume changes/hr
Select three physiological changes associated with hypothermia (select 3)
A. increased SVR
B. decreased SVR
C. decreased CBF
D. decreased O2 consumption
E. increased MAC
F. decreased blood viscosity
A. increased SVR
B. decreased SVR
C. decreased CBF
D. decreased O2 consumption
E. increased MAC
F. decreased blood viscosity
Select two treatment options for intraoperative hiccups.
A. decrease depth of anesthesia
B. increase depth of neuromuscular blockade
C. administer chlorpromazine
D. administer metoclopramide
A. decrease depth of anesthesia
B. increase depth of neuromuscular blockade
C. administer chlorpromazine
D. administer metoclopramide
Carcinoid tumors secrete all of the following vasoactive substances except:
A. serotonin
B. kalikrein
C. melatonin
D. histamine
A. serotonin
B. kalikrein
C. melatonin
D. histamine
Serotonin causes ________ while histamine causes _________.
A. vasodilation, vasoconstriction
B. vasoconstriction, vasodilation
C. vasoconstriction, bronchodilation
D. vasodilation, bronchoconstriction
A. vasodilation, vasoconstriction
B. vasoconstriction, vasodilation
C. vasoconstriction, bronchodilation
D. vasodilation, bronchoconstriction
What is the name of the urinary serotonin metabolite that is elevated in patients with Carcinoid tumors?
A. indoleacetic acid
B. 1,2-hydroxyindoleacetic acid
C. 4-hydroxyindoleacetic acid
D. 5-hydroxyindoleacetic acid
A. indoleacetic acid
B. 1,2-hydroxyindoleacetic acid
C. 4-hydroxyindoleacetic acid
D. 5-hydroxyindoleacetic acid
What treatment of carcinoid tumors will reduce the release of vasoactive tumor products?
A. serotonin antagonist
B. surgical resection
C. somatostatin
D. histamine antagonist
A. serotonin antagonist
B. surgical resection
C. somatostatin
D. histamine antagonist
Administration of which agent may activate kallikrein?
A. propofol
B. epinephrine
C. morphine
D. atracurium
A. propofol
B. epinephrine
C. morphine
D. atracurium
Disadvantages of laparoscopic procedures include (select two)
A. increased stress response
B. increased risk for PONV
C. longer hospital stays
D. longer operating time
A. increased stress response
B. increased risk for PONV
C. longer hospital stays
D. longer operating time
Which gas (for insufflation) has the greatest risk of embolization?
A. CO2
B. helium
C. O2
D. air
A. CO2
B. helium
C. O2
D. air
Trendelenburg is used for _______ abdominal laparoscopic procedures while reverse Trendelenburg is used for ________ abdominal laparoscopic procedures.
A. lower, upper
B. upper, lower
C. both upper and lower, lower
D. lower, lower
A. lower, upper
B. upper, lower
C. both upper and lower, lower
D. lower, lower
Immediate CV effects from insufflation of the abdomen include (select two)
A. Increased VR
B. decreased VR
C. Increased SVR
D. decreased CVP
A. Increased VR
B. decreased VR
C. Increased SVR
D. decreased CVP
The direct effect of CO2 absorption from insufflation is increased SNS stimulation
A. True
B. False
A. True
B. False
Select two regional circulatory changes that occur due to CO2 insufflation.
A. decreased CBF/ICP
B. decreased RBF/GFR
C. decreased femoral vein blood flow
D. respiratory alkalosis
A. decreased CBF/ICP
B. decreased RBF/GFR
C. decreased femoral vein blood flow
D. respiratory alkalosis
The displacement of the diaphragm cephalad causes all of the following to decrease except:
A. FRC
B. lung volumes
C. PIP
D. pulmonary compliance
A. FRC
B. lung volumes
C. PIP
D. pulmonary compliance
What ventilatory change can be made to counteract hypercarbia due to CO2 insufflation?
A. decrease RR
B. increase RR
C. increase Vt
D. add PEEP
A. decrease RR
B. increase RR
C. increase Vt
D. add PEEP
Reverse Trendelenburg causes a decrease in all of the following except:
A. preload
B. MAP
C. CO
D. FRC
A. preload
B. MAP
C. CO
D. FRC
Trendelenburg causes a decrease in all of the following except:
A. pulmonary compliance
B. TLC
C. preload
D. FRC
A. pulmonary compliance
B. TLC
C. preload
D. FRC
Contraindications for laparoscopic procedures include all of the following except:
A. decreased ICP
B. CHF
C. coagulopathy
D. severe COPD
A. decreased ICP
B. CHF
C. coagulopathy
D. severe COPD
Referred shoulder pain cannot be blocked by regional anesthesia
A. True
B. False
A. True
B. False
When the pneumoperitoneum is released, what ventilatory change should you consider making?
A. increase RR
B. decrease Vt
C. decrease RR
D. decrease PEEP
A. increase RR
B. decrease Vt
C. decrease RR
D. decrease PEEP
Patients with preexisting cardiopulmonary disease may show an increase in ETCO2 despite being hypercarbic due to:
A. increased shunting
B. decrease in ventilation
C. increased alveolar deadspace
D. increase in lung perfusion
A. increased shunting
B. decrease in ventilation
C. increased alveolar deadspace
D. increase in lung perfusion
What can decrease the incidence of PONV with laparoscopic procedures?
A. neostigmine
B. TIVA
C. inhalation agents
D. MAC
A. neostigmine
B. TIVA
C. inhalation agents
D. MAC
What can help reduce the incidence of referred shoulder pain due to diaphragmatic irritation? (select two)
A. remove as much CO2 as possible at the end of the case
B. controlling pain intraoperatively with opioids only
C. intraperitoneal instillation of 20 ml of 0.25% bupivacaine between the liver and diaphragm
D. allowing for greater stretching of the intra-abdominal cavity
A. remove as much CO2 as possible at the end of the case
B. controlling pain intraoperatively with opioids only
C. intraperitoneal instillation of 20 ml of 0.25% bupivacaine between the liver and diaphragm
D. allowing for greater stretching of the intra-abdominal cavity
Gastric distention is to NGT as:
A. adhesions are to foley
B. concealed bleeding is to adhesions
C. bladder distention is to foley
D. none of the above
A. adhesions are to foley
B. concealed bleeding is to adhesions
C. bladder distention is to foley
D. none of the above
Excessive IntraAbdominalPressure (IAP) > _____ mmHg can lead to cardiovascular complications.
A. 16
B. 18
C. 20
D. 25
A. 16
B. 18
C. 20
D. 25
Subcutaneous emphysema can occur due to:
A. inadvertent intraperitoneal insufflation
B. sudden decrease in ETCO2
C. decreased area for CO2 diffusion
D. inadvertent extraperitoneal insufflation
A. inadvertent intraperitoneal insufflation
B. sudden decrease in ETCO2
C. decreased area for CO2 diffusion
D. inadvertent extraperitoneal insufflation
Pneumothrorax and pneumomediastinum can be diagnosed by all of the following observations except:
A. decreased SaO2
B. unexpected hypercarbia
C. increased peak airway pressures
D. profound hypertension
A. decreased SaO2
B. unexpected hypercarbia
C. increased peak airway pressures
D. profound hypertension
Select two treatments for a venous gas embolism.
A. hyperventilate
B. slow down gas insufflation
C. increase inhalation agent
D. immediately release pneumoperitoneum
A. hyperventilate
B. slow down gas insufflation
C. increase inhalation agent
D. immediately release pneumoperitoneum
Two effects of the steep Trendelenburg position for robotic procedures include:
A. decreased VR
B. edema
C. decreased FRC
D. decreased CO2
A. decreased VR
B. edema
C. decreased FRC
D. decreased CO2
If a leak is present after you decrease the cuff on the patient’s ETT, then edema is still present and the ETT must remain in place until fluid balance is corrected.
A. True
B. False
A. True
B. False
