perioperative

Question 1

Which of the following regarding anesthesia is FALSE?

(a) anasthesia dulls central receptors to CO2 receptors decreasing the drive to breathe
(b) anasthesia may suppress the cough reflex
(c) anasthesia may suppress the urge to yawn or sigh
(d) all of the above are true

Answer 1

(d)

Question 2

Obese patients are more at risk of pulmonary complications post-op because they have a higher closing capacity threshold T/F.

Answer 2

False - while they do have an increased risk, their closing capacity threshold is the same. The extra effort to inspire means they already are breathing at reduced lung volumes, so they are starting closer to closing capacity before anaesthetic.

Question 3

Closing capacity can be elevated in all EXCEPT:

(a) emphysema
(b) people over 60 years old
(c) inflammation of the airways
(d) anaesthetics
(e) all of the above can elevate closing capacity

Answer 3

(d) anaesthetics drop FRC which brings the patient closer to closing capacity, but does not raise the threshold up per se.

Question 4

V/Q matching is decreased in which situation?

(a) supine position
(b) anaesthetic use
(c) prone position
(d) all of the above decrease V/Q matching

Answer 4

(b) anaesthetic use - inhaled anaesthetics prevent blood vessels from constricting even when there is no ventilation, resulting in more shunting.

Supine and prone positioning do not decrease V/Q matching normally, since both blood and air will travel to the dependent portions of the lung. While positioning can decrease matching, it can also increase it.

Question 5

Which of the following is NOT a patient-related risk factor?

(a) smoking
(b) ASA class 2 and above
(c) receiving anaesthetics for longer than 3 hours
(d) age

Answer 5

(c) anaesthetics for longer than 3 hours

Question 6

In which surgery is the latissimus dorsi left intact?

(a) anterior thoracotomy
(b) posterolateral thoracotomy
(c) thoracoplasty
(d) thoracoabdominal

Answer 6

(a) anterior thoracotomy - cut to the pecs, intercostals, ribs 4-7, and serratus anterior

Question 7

the pleura are removed during a pneumonectomy T/F

Answer 7

True

Question 8

Which of the following conditions may benefit from a chest tube?

(a) pleural effusion
(b) pericardial effusion
(c) following heart surgery
(d) cardiogenic pulmonary edema

Answer 8

(d) cardiogenic pulmonary edema - chest tubes can drain cavities, not the lungs/alveoli themselves.

Question 9

If you could only teach ONE technique to a patient before surgery, the most effective one would be:

(a) diaphragm breathing
(b) huffing
(c) maximal inspiratory hold/incentive spirometry
(d) supported cough

Answer 9

(c) max inspiratory hold/incentive spirometry has been shown to reduce postop complications by 50%.

Question 10

how often should interventions be performed with the post-op patient?

(a) three times a day
(b) once a day
(c) once an hour
(d) twice a week

Answer 10

(c) once an hour

Question 11

what is the MOST COMMON cause of atelectasis following surgery?

(a) hypoventilation
(b) airway obstruction due to secretions
(c) reduced cilia movement due to anaesthetic
(d) decreased FRC

Answer 11

(a) hypoventilation

Question 12

Your patient is receiving supplimental O2 at a FiO2 of 40%. You are seeing him after an hour using his partial rebreathing mask. What percentage of his lower lobes may have atelectasis due to the O2?

(a) 10%
(b) 25%
(c) 35%
(d) 40%

Answer 12

(b) 25%, 40 mins -> 40%. At 100% FiO2, it only takes 5 minutes to reach 25% atelectasis