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5. Lippincot MCQ > Perioperative Evaluation and Management > Flashcards

Perioperative Evaluation and Management Flashcards

1
Q
  1. Preoperative application of scopolamine patch to prevent postoperative nausea and vomiting should be avoided in
    A. Female, 35 years old
    B. Smoker, 20 years old
    C. Patient with a blood pressure of 160/96 mm Hg
    D. Male, 70 years old
A
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2
Q
  1. Which of the following drugs is least likely to be effective for prophylaxis for postoperative nausea and vomiting?
    A. Ondansetron
    B. Scopolamine patch
    C. Aprepitant
    D. Metoclopramide
A
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3
Q
  1. Famotidine, when used for stress ulcer prophylaxis, must be avoided preoperatively in which of the following patients?
    A. Patients with replaced mitral valve on warfarin
    B. Patients with idiopathic thrombocytopenic purpura (ITP) for splenectomy
    C. Patients with achalasia cardia for esophageal myotomy
    D. Patients with a history of coronary stenting on aspirin
A
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4
Q
  1. Which of the following drugs antagonizes substance P in the central nervous system and is used as premedication to prevent postoperative nausea and vomiting?
    A. Palonosetron
    B. Aprepitant
    C. Metoclopramide
    D. Prochlorperazine
A
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5
Q
  1. Which of the following predictors is likely to be associated with lower incidence of perioperative nausea and vomiting?
    A. Female gender
    B. Use of fentanyl for pain relief
    C. Patients with a history of smoking
    D. Patients undergoing laparoscopic surgery
A
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6
Q
  1. All of the following have an antiemetic action, except
    A. Promethazine
    B. Propofol
    C. Etomidate
    D. Haloperidol
A
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7
Q
  1. Cefazolin, as a component of perioperative antimicrobial prophylaxis for surgery, must begin within what time before incision?
    A. Simultaneously with incision
    B. Within 30 minutes prior to incision
    C. Within 60 minutes prior to incision
    D. Within 120 minutes prior to incision
A
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8
Q
  1. Vancomycin, as a component of perioperative antimicrobial prophylaxis for surgery, must begin within what time before incision?
    A. Simultaneously with incision
    B. Within 30 minutes prior to incision
    C. Within 60 minutes prior to incision
    D. Within 120 minutes prior to incision
A
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9
Q
  1. A 65-year-old male with a history of hypertension and diabetes presents to emergency department with altered sensation with a likely subdural hematoma. To assess his cardiorespiratory status, he is asked about his level of physical activity. If he is capable of performing at least which of the following activities independently, he is less likely to have significant cardiopulmonary ailment during surgery?
    A. Walk to washroom on level floor
    B. Play the accordion
    C. Walk one block
    D. Climb a flight of stairs
A
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10
Q
  1. In preoperative assessment of patients, physical activity is graded in terms of metabolic equivalents (METs). The value that corresponds to oxygen consumption of 1 MET in an adult is
    A. 2 mL/kg/min
    B. 7 mL/kg/min
    C. 3.5 mL/kg/min
    D. 5.5 mL/kg/min
A
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11
Q
  1. As per American Society of Regional Anesthesia (ASRA) guidelines, intravenous infusion of unfractionated heparin should be stopped how long prior to a planned epidural?
    A. 1 to 1.5 hours
    B. 2 to 4 hours
    C. at least 12 hours
    D. at least 24 hours
A
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12
Q
  1. For emergent surgery, anticoagulation produced by warfarin can be reversed by using
    A. Fresh-frozen plasma (FFP)
    B. Injectable vitamin K
    C. Prothrombin complex concentrate
    D. Factor VIII concentrate
A
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13
Q
  1. Neuraxial block is not contraindicated for patients on which of the following drugs?
    A. Warfarin
    B. Low-molecular-weight heparin
    C. Aspirin
    D. Clopidogrel
A
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14
Q
  1. All of the following are risk factors for obstructive sleep apnea, except
    A. Obesity
    B. Short neck
    C. Enlarged tonsils
    D. Female gender
A
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15
Q
  1. A 70-year-old male, who is diabetic for the last 20 years, is scheduled for an elective surgery. Which of the following is not a sign of autonomic diabetic neuropathy?
    A. History of recurrent diarrhea
    B. History of postural hypotension
    C. History of recurrent constipation
    D. History of urinary retention
A
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16
Q
  1. Which of the following perioperative factors in patients undergoing dialysis prior to surgery predicts the possibility of hypotension (due to increased volume removed)?
    A. Change in serum sodium
    B. Change in body weight
    C. Change in serum potassium
    D. Change in pH after dialysis
A
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17
Q
  1. A patient with a history of severe asthma is scheduled for an appendectomy. Which of the following induction agents will cause the least respiratory depression?
    A. Ketamine
    B. Propofol
    C. Etomidate
    D. Thiopental
A
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18
Q
  1. Which of the following drugs can significantly prolong the QT interval on the ECG?
    A. Dexamethasone
    B. Droperidol
    C. Aprepitant
    D. Glycopyrrolate
A
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19
Q
  1. Which of the following tests is used to confirm coagulation after stopping low-molecular-weight heparin (LMWH)? A. PT B. aPTT C. ACT D. None of the above
A
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20
Q
  1. Effect of combined administration of midazolam and fentanyl is A. Additive B. Synergistic C. Competitively antagonistic D. Noncompetitively antagonistic
A
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21
Q
  1. Preoperative anesthetic evaluation is likely to bring down the incidence of all the following, except A. Case cancellations B. Patient morbidity C. Preoperative anxiety D. Direct procedural costs
A
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22
Q
  1. For elective procedures, an anesthesia provider must obtain informed and preferably written consent A. Just prior to transferring the patient to the operating room for surgery B. During preoperative anesthetic evaluation C. At the same time that a surgeon obtains consent for the surgical procedure D. Just prior to induction of anesthesia in the operating room
A
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23
Q
  1. An optimal preoperative evaluation is designed
    A. To screen for and properly manage comorbid conditions B. To assess the risk of anesthesia and surgery and lower it C. To identify patients who may require special anesthetic techniques or postoperative care D. All the above
A
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24
Q
  1. ASA classification for risk stratification is validated for predicting preoperative morbidity associated with the following, except A. General or regional anesthesia B. Conscious sedation C. Monitored anesthesia care D. Surgical procedure
A
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25
Q
  1. A healthy pregnant patient in labor has which of the following ASA classifications? A. I B. II C. III D. IV
A
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26
Q
  1. Sedatives, as premedication, must be avoided in which of the following patients? A. Uncontrolled hypertensive B. Toddler for tonsillectomy C. Brain tumor patients
    D. Patients with alcohol abuse
A
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27
Q
  1. As per the American Society of Regional Anesthesia (ASRA) guidelines, which of the following drugs can be continued preoperatively in patients planned for neuraxial blockade for an elective procedure? A. Aspirin B. Clopidogrel C. Warfarin D. Low-molecular-weight heparin
A
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28
Q
  1. As per ASA classification, a controlled hypertensive patient with no target end-organ damage scheduled for elective surgery will be classified as A. ASA I B. ASA II C. ASA III D. ASA VI
A
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29
Q
  1. A brain-dead organ donor undergoing laparotomy for “kidney harvesting” will be classified as an A. ASA III B. ASA IV C. ASA V D. ASA VI
A
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30
Q
  1. A moribund patient who is not expected to survive without the operation is categorized as an A. ASA III B. ASA IV C. ASA V D. ASA VI
A
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31
Q
  1. A patient with a history of uncontrolled hypertension, diabetes, and angina, who is to undergo a laparoscopic cholecystectomy, will be classified as an A. ASA II B. ASA III C. ASA IV D. ASA V
A
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32
Q
  1. A 65-year-old male with a history of mitral valve replacement 2 years back presents for a knee replacement. He is on warfarin since the time of valve replacement. As per ASRA guidelines, the ideal time to stop his warfarin prior to surgery would be A. 12 hours B. 3 days C. 5 days D. 10 days
A
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33
Q
  1. A 26-year-old female, with a history of rheumatic mitral stenosis, is scheduled for an elective cesarean section at 38 weeks of gestation. Just prior to surgery, she is diagnosed to have atrial fibrillation (AF) with no hemodynamic instability. The first step in preparation for surgery is A. Perform an echocardiogram to rule out left-atrial clot B. Synchronized DC cardioversion under sedation C. Antiarrhythmic medication D. Plan for therapy postdelivery
A
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34
Q
  1. A 72-year-old patient with a history of hypertension and angina at moderate activity is to undergo a laparoscopic cholecystectomy. Due to decreased effort tolerance and a significant blockade of left anterior descending coronary artery onstress thallium, a preprocedure coronary intervention is planned. Which of the following procedures performed prior to the elective surgery is least likely to delay the laparoscopic surgery? A. Coronary artery bypass graft (CABG) B. Percutaneous coronary stenting—bare-metallic stent C. Percutaneous coronary stenting—drug-eluting stent D. Percutaneous balloon dilatation
A
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35
Q
  1. Which of the following is not seen as a result of primary renal disease in patients with chronic renal failure? A. Hypocoagulable state B. Hypercoagulable state C. Hyperproteinemia D. Anemia
A
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36
Q
  1. A 2-year-old child is to undergo a tonsillectomy. The child had formula milk 2 hours ago. As per ASA guidelines, optimal NPO status would be to wait another _____ before proceeding to surgery: A. No waiting, since it is a child B. 2 hours C. 4 hours
    D. 6 hours
A
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37
Q
  1. A 45-year-old patient is scheduled for an abdominal hysterectomy. She states that her aunt had a severe reaction to anesthesia and was in the ICU for 1 week. You would avoid which of the following drugs for her general anesthesia? A. Droperidol B. Ketamine C. Sevoflurane D. Etomidate
A
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38
Q
  1. Elective surgery should be postponed after a myocardial infarction for at least A. 30 days B. 6 weeks C. 3 months D. 6 months
A
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39
Q
  1. The most significant risk factor for developing pulmonary complications is A. Site of surgery (abdominal/thoracic) B. Presence of respiratory infection C. Presence of obstructive sleep apnea D. Smoking
A
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40
Q
  1. Maximum international normalized ratio (INR) before proceeding for elective surgery should be A. 1.0 B. 1.2 C. 1.4 D. 1.6
A
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41
Q
  1. A 73-year-old patient has residual weakness on the right arm and leg following a stroke 5 years ago. He is now scheduled for laparoscopic cholecystectomy under general anesthesia. Which of the following sites should be preferably used to monitor the train of four muscle twitches for estimating neuromuscular blockade? A. Right ulnar nerve–innervated muscles B. Right posterior tibial nerve–innervated muscles C. Left ulnar nerve–innervated muscles D. Left facial nerve
A
42
Q
  1. A 32-year-old patient after being involved in a road traffic accident due to alcohol intoxication is taken to the operating room for open fracture reduction of an ankle fracture. His blood alcohol level is above the legal limit. Compared to a patient who is not intoxicated with alcohol, you would expect the minimum alveolar concentration (MAC) of sevoflurane to be A. Higher B. Lower C. Equal D. Unpredictable due to pharmacodynamic variations
A
43
Q
  1. A 55-year-old patient with a history of asthma and heart failure is to undergo a hernia repair. On physical examination, you notice that the patient is wheezing. Following treatment with albuterol, the patient should be monitored for which electrolyte? A. Potassium B. Calcium C. Sodium D. Chloride
A
44
Q
  1. Smoking cessation for 24 hours before a scheduled surgery will lead to A. Improvement of ciliary function B. Decrease in mucous production C. Decrease in airway irritability D. Decrease in level of carboxyhemoglobin
A
45
Q
  1. Which of the following tests is likely to detect clinically relevant bleeding tendency most efficiently? A. Activated partial thromboplastin time B. Prothrombin time C. Activated clotting time D. Thromboelastogram (TEG)
A
46
Q
  1. As per AHA guidelines, which of the following is not a major clinical risk predictor in a patient with cardiac disease scheduled for noncardiac surgery? A. Recent myocardial infarction B. Symptomatic mitral stenosis C. Presence of congestive cardiac failure D. Uncontrolled systolic hypertension
A
47
Q
  1. Glycopyrrolate, when given preoperatively, can cause all of the following, except A. Skin flushing B. Dry mouth C. Bronchoconstriction D. Tachycardia
A
48
Q
  1. Which of the following is true about metoclopramide? A. Decreases lower esophageal sphincter tone B. Delays gastric emptying C. Can cause extrapyramidal side effects D. Useful in preventing postoperative nausea
A
49
Q
  1. Which of the following occurs during the preoxygenation of a patient? A. Increase in functional residual capacity B. Denitrogenation C. Increase in CO 2 clearance from lungs D. Increase in closing capacity of lungs
A
50
Q
  1. Which of the following agents is associated with the highest incidence of hepatitis postoperatively? A. Halothane B. Isoflurane C. Desflurane D. Sevoflurane
A
51
Q
  1. The inhalation agent of choice in a 2-year-old child for ophthalmologic surgery is A. Halothane B. Desflurane C. Sevoflurane D. Nitrous oxide
A
52
Q
  1. Which of the following is true of nitrous oxide? A. Acts on central nervous system GABA receptors B. Lowers pulmonary vascular resistance C. Suppresses EEG pattern in the cerebral cortex D. Precipitates vitamin B 12 deficiency anemia
A
53
Q
  1. The antiemetic effect of propofol is thought to occur due to A. Depressant effect on the chemoreceptor trigger zone B. Inhibition of dopamine activity C. Inhibition of glutamate release D. All of the above
A
54
Q
  1. Which of the following is the preferred intravenous agent of induction of anesthesia for maintaining spontaneous breathing and airway tone? A. Midazolam B. Propofol C. Ketamine D. Diazepam
A
55
Q
  1. Succinylcholine is contraindicated in a patient with A. Chronic renal failure B. Duchene muscular dystrophy C. Myasthenia gravis D. Patient with full stomach
A
56
Q
  1. A 75-year-old patient with a history of hypertension is to undergo laparoscopic colectomy for carcinoma colon. Continuing of which of the following antihypertensive drugs, preoperatively, in the geriatric age group, can be associated with profound hypotension on induction of general anesthesia? A. Metoprolol B. Angiotensin-converting-enzyme (ACE) inhibitors C. Hydrochlorothiazide D. Furosemide
A
57
Q
  1. Which of the following findings in the preoperative evaluation cannot be attributed to obesity with obstructive sleep apnea (OSA) in a patient planned for bariatric surgery? A. Pulmonary artery hypertension B. Congestive heart failure C. Peripheral neuropathy D. Dementia
A
58
Q
  1. All of the following medications can be administered via an epidural anesthesia, except A. Fentanyl B. Sufentanil C. Alfentanil D. Remifentanil
A
59
Q
  1. Ondansetron causes its antiemetic effect by acting as an A. Agonist at 5-HT 2 receptors B. Antagonist at 5-HT 2 receptors C. Agonist at 5-HT 3 receptors D. Antagonist at 5-HT 3 receptors
A
60
Q
  1. Which of the following statements is false regarding scopolamine patch applied preoperatively? A. May produce sedation B. Decreases the risk of nausea C. Adds to the analgesia D. Inhibits muscarinic receptors
A
61
Q
  1. Overdose with dexmedetomidine results in A. Hypertension B. Bradycardia C. Hypertension and bradycardia D. Hypotension and bradycardia
A
62
Q
  1. Abrupt withdrawal of steroids can lead to A. Malignant hypertension B. Sickle cell crisis C. Addisonian crisis D. Psychosis
A
63
Q
  1. Promethazine primarily inhibits which of the following receptors? A. Serotonin B. Dopamine C. Muscarinic D. Acetylcholine
A
64
Q
  1. All of the following surgeries are associated with an increased risk of postoperative nausea and vomiting, except A. Shoulder arthroscopy
    B. Laparoscopic surgery C. Strabismus repair D. Tympanoplasty
A
65
Q
  1. Abrupt stoppage of total parenteral nutrition (TPN) would most likely cause A. Hypoglycemia B. Hyperglycemia C. Hyperphosphatemia D. Hypophosphatemia
A
66
Q
  1. Glycopyrrolate causes all of the following, except A. Sedation B. Tachycardia
    C. Antisialagogue effect D. Lowers lower esophageal sphincter tone
A
67
Q
  1. In general, herbal medications should be stopped before surgery for at least _____ days: A. 3 B. 7 C. 10 D. 14
A
68
Q
  1. Which of the following antibiotics can prolong the action of neuromuscular-blocking drugs? A. Gentamicin B. Penicillin C. Levofloxacin D. Cephalexin
A
69
Q
  1. Estrogen in birth control pills increases the perioperative risk of A. Diarrhea B. Thromboembolism C. Stroke D. Myocardial infarction
A
70
Q
  1. A 42-year-old patient is scheduled for a hernia repair under general anesthesia. His medications include fluoxetine, alprazolam, and lithium for bipolar disorder. In the preoperative area, he appears confused, has tremors, and is ataxic. Your next step would be to A. Cancel the case B. Proceed with the case C. Order a lithium blood level D. Consult a psychiatrist
A
71
Q
  1. A 34-year-old patient is to undergo an appendectomy under general anesthesia. He is taking a monoamine oxidase inhibitor (MAOI) for depression. Intraoperatively, his blood pressure drops to 72/36 mm Hg and a medication is administered. His blood pressure suddenly increases to 220/120 mm Hg. The most likely medicine that was administered is A. Ephedrine B. Meperidine C. Phenylephrine D. Norepinephrine
A
72
Q
  1. All of the following are true about diabetic patients, except A. Patients should take half or one-third of their insulin dose the morning of the surgery B. Patients should continue their oral hypoglycemic agents the morning of the surgery C. Finger-stick blood glucose should be tested before taking the patient to the operating room D. Patient with an insulin pump should continue the insulin at their basal rate
A
73
Q
  1. Digoxin toxicity is most likely exacerbated by A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypocalcemia
A
74
Q
  1. The most common complication of inserting a central venous catheter is A. Carotid artery puncture B. Thrombosis C. Cardiac arrhythmias D. Air embolism
A
75
Q
  1. A patient is administered cephalexin preoperatively. Within 5 minutes of starting the antibiotic, the patient starts to wheeze and develops tachycardia, and the blood pressure drops to 78/42 mm Hg. Your next step would be to administer A. Ephedrine B. Phenylephrine C. Epinephrine D. Oxygen
A
76
Q
  1. All of the following may occur with an interscalene block, except A. Subarachnoid injection B. Radial nerve blockade C. Median nerve blockade D. Ulnar nerve blockade
A
77
Q
  1. An axillary nerve block would not produce loss of sensation of the A. Lateral aspect of the forearm B. Medial aspect of the forearm C. The entire forearm D. None of the above
A
78
Q
  1. The femoral nerve lies A. Medial to the femoral artery B. Anterior to the femoral artery C. Posterior to the femoral artery D. Lateral to the femoral artery
A
79
Q
  1. All of the following nerves are blocked by an ankle block, except A. Sural B. Superficial peroneal C. Deep peroneal D. Anterior tibial
A
80
Q
  1. Sore throat is A. More common after using an endotracheal tube B. More common after using a laryngeal mask airway C. Similar incidence with either endotracheal tube or a laryngeal mask airway D. More common after using an oral airway
A
81
Q
  1. A patient with hypertrophic obstructive cardiomyopathy (HOCM) presents with dyspnea and angina on exertion. Which of the following is the best agent to treat these symptoms? A. Hydrochlorothiazide B. Metoprolol C. Morphine D. Nitroglycerin
A
82
Q
  1. St. John wort (Hypericum perforatum) potentiates the effects of A. Heparin B. Warfarin C. Aspirin D. Clopidogrel
A
83
Q
  1. The most powerful predictor of atrial fibrillation post–cardiac surgery is A. History of diabetes B. History of hypertension C. Age D. Time on bypass
A
84
Q
  1. A patient with Parkinson disease undergoes a general anesthetic. Your plan to treat his nausea would include all of the following, except A. Dexamethasone B. Scopolamine patch C. Metoclopramide D. Ondansetron
A
85
Q
  1. A 65-year-old patient is being treated for congestive cardiac failure. He is able to take a shower but gets dyspneic on mowing the lawn. His New York Heart Association classification is A. Class 1 B. Class 2
    C. Class 3a D. Class 3b
A
86
Q
  1. The percentage of postdural puncture headaches that would resolve spontaneously by 1 week is approximately A. 30% B. 50% C. 50% D. 70%
A
87
Q
  1. A 46-year-old lady is seen at the preoperative assessment clinic. She is taking 180 mg/day methadone. The most likely change to be found in her preoperative ECG is A. Prolonged PR interval B. Prolonged QTc C. U wave D. Tented T-waves
A
88
Q
  1. You are about to anesthetize a 55-year-old man who is undergoing liver resection for removal of metastatic carcinoid tumor. The drug of choice to treat intraoperative hypotension is A. Octreotide B. Dobutamine C. Milrinone D. Vasopressin
A
89
Q
  1. You are performing an interscalene brachial plexus block on an awake 40-year-old patient who is healthy with no significant medical history. Soon after injecting 20 mL of 0.25% bupivacaine the patient becomes agitated, has a seizure, and loses consciousness. Your first step in management is A. Administer intralipid B. Administer midazolam or propofol to control the seizure C. Establish airway and give 100% O 2 via a face mask D. Administer epinephrine
A
90
Q
  1. Patients with dilated cardiomyopathy exhibit all of the following, except A. Decreased myocardial contractility B. Afterload should be maximized C. Increased preload D. Left ventricular hypertrophy
A
91
Q
  1. A septic patient has a central venous pressure of 10 mm Hg, a blood pressure of 80/40 mm Hg, and a pulse rate of 96 beats/min. The best agent to treat the hypotension is A. Dopamine B. Dobutamine
    C. Noradrenaline D. Epinephrine
A
92
Q
  1. Which of the following organs is least tolerant of ischemia for removal for transplantation? A. Cornea B. Heart D. Kidney E. Pancreas
A
93
Q
  1. You have administered a patient 1.2 mg/kg of rocuronium to do an intubation. You are unable to intubate or ventilate the patient and decide to reverse the patient’s paralysis with sugammadex. The dosage you would use is A. 2 mg/kg B. 4 mg/kg C. 8 mg/kg D. 16 mg/kg
A
94
Q
  1. A young female patient with anorexia nervosa has just started eating again. After 4 days, she develops dyspnea and is found to have cardiac failure. Which of the following is most important to correct? A. Potassium B. Phosphate
    C. Glucose D. Sodium
A
95
Q
  1. A pregnant lady is to undergo general anesthesia for acute appendicitis. At what gestational age should you monitor fetal heart rate? A. 16 weeks B. 18 weeks C. 24 weeks D. 28 weeks
A
96
Q
  1. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient? A. Pretracheal tissue volume
    B. Body mass index C. Mallampati score D. Thyromental distance
A
97
Q
  1. A patient with a history of chronic obstructive pulmonary disease presents for lung volume–reduction surgery. Which of the following is a contraindication for surgery? A. Age >60 years B. Chronic asthma C. FEV <25% D. Evidence of bullous disease
A
98
Q
  1. All of the following help increase the excretion of calcium, except
    A. Bisphosphonates B. Calcitonin C. Furosemide D. IV crystalloids
A
99
Q
  1. Which of the following is contraindicated to use during pregnancy? A. Aspirin B. Enalapril C. Metoprolol D. Hydralazine
A
100
Q
  1. During scoliosis surgery, monitoring of somatosensory-evoked potentials indicates monitoring of
    A. Anterior horn B. Anterior corticospinal tract C. Dorsal column D. Spinothalamic tract
A
101
Q
  1. The desflurane vaporizer is heated because of desflurane’s A. High vapor pressure B. High boiling point C. High minimum alveolar concentration D. High volatility
A
102
Q
  1. Which of the following is the most effective way to reduce renal failure in a patient having an abdominal aortic aneurysm repair? A. Fluid bolus prior to aortic clamping B. Fluid bolus after aortic clamp release C. Administration of mannitol D. Minimization of cross-clamp time
A

5. Lippincot MCQ (10 decks)

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