Practice Exam 1 Flashcards
The loss of ventricular filling as a result of acute atrial fibrillation is approximately:
15 - 25%
Passive flow accounts for about 75 - 85% of ventricular filling. The remaining 15 - 25% occurs as a result of atrial contraction, which is lost during atrial fibrillation.
In the parturient, early decelerations signify:
- cord compression
- vagal stimulation from head compression
- uteroplacental insufficiency
- impending emergency Cesarean delivery
vagal stimulation from head compression
Early decelerations are normal and common. The deceleration pattern matches the contraction with the most deceleration occurring at the peak of the contraction. The FHR rarely goes below 100 beats per minute. The cause of these decelerations is head compression during uterine contractions.
In the diagram below, anesthesia of the 5th digit of the hand can be produced by blocking:
The ulnar nerve is represented by ‘D’, and supplies sensory innervation to medial part of the 4th and entire 5th digits. ‘A’ is the axillary nerve, ‘B’ is the radial nerve and ‘C’ is the median nerve
Proper induction technique for the infant with tracheoesophageal fistula would include:
- preoxygenation with 100% and PPV
- awake intubation
- ketamine 2 mg/kg
- inhalation induction in the sitting position
awake intubation
Awake intubation offers the greatest degree of safety and does not risk insufflation of the stomach.
An acute increase in PaCO2 from 40 mmHg to 80 mmHg will cause an increase in cerebral blood flow of approximately:
85 - 100%
Increasing CO2 causes cerebral vasodilatation and increased cerebral blood flow. Within a range of 20 - 80 mmHg the increase in blood flow is linear. Therefore, doubling the CO2 causes a nearly 100% increase in cerebral blood flow.
Which of the following cardiac malformations is associated with Tetralogy of Fallot?
- Left ventricular hypertrophy
- Pulmonic atresia
- Large ASD
- Overriding aorta
Overriding aorta
Tetralogy of Fallot has four key features. A ventricular septal defect and pulmonic stenosis are the most important. Also, the aorta lies directly over (overrides) the ventricular septal defect and the right ventricle is hypertrophic.
The release of catecholamines from the adrenal medulla is under the control of the autonomic nervous system. The neurotransmitter controlling the release is:
- norepinephrine
- acetylcholine
- dopamine
- 5-HT
acetylcholine
Preganglionic fibers pass directly into the adrenal medulla without synapsing in a ganglion. Acetylcholine is the neurotransmitter causing the release of catecholamines from the adrenal medulla.
The most common cause of postpartum hemorrhage is:
- cervical laceration
- labial hematoma
- placenta accreta
- uterine atony
uterine atony
Which of the following has been associated with causing the release of antidiuretic hormone (ADH)?
- Decreased plasma sodium
- Decreased serum osmolality
- Positive pressure ventilation
- Diabetes insipidus
Positive pressure ventilation
Positive pressure ventilation has been associated with the release of ADH. Decreased serum osmolality and decreased sodium will decrease ADH production. Diabetes insipidus is a disease of decreased ADH production.
Initial closure of the ductus arteriosus following umbilical cord clamping is the result of:
- a rise in arterial oxygen concentration
- a decrease in placental prostaglandin secretion
- a sudden increase in infant’s SVR
- hypercarbia
a rise in arterial oxygen concentration
The ductus provides shunting of blood flow from the left pulmonary artery to the aorta just beyond the origin of the left subclavian artery. The high levels of oxygen which it is exposed to after birth causes it to close.
Manual compression of the reservoir bag is an example of:
- Charle’s Law
- Boyle’s Law
- Gay-Lussac’s Law
- Henry’s Law
Boyle’s Law
With temperature constant, the volume of a gas is inversely proportional to pressure: V is proportional to 1/P or VP = constant. As the gas in the reservoir bag is compressed, the pressure rises and gas is transferred to the patient.
Anesthesia of the epiglottis can be produced by local anesthetic block of the:
- recurrent laryngeal nerve
- external branch of the superior laryngeal nerve
- glossopharyngeal nerve
- internal branch of the superior laryngeal nerve
internal branch of the superior laryngeal nerve
Stimulation of the baroreceptors results in:
- increased sympathetic tone
- increased myocardial contractility
- increased vagal tone
- increased heart rate
increased vagal tone
The baroreceptors, located in the carotid sinus and aortic arch, respond to stretching from elevated mean blood pressure. When stimulated, the baroreceptors reduce sympathetic tone, inotropy, chronotropy, and SVR, as well as increase vagal tone to further reduce heart rate.
Hydrophobic heat and moisture exchangers:
- use a membrane lacking pleating or pores
- are efficient bacterial and viral filters
- have improved performance when used in high ambient temperatures
- are more effect at temperature and heat conservation as compared to hygroscopic heat and moisture exchangers
are efficient bacterial and viral filters
Most heat and moisture exchangers (HME) are of one of two types, hydrophobic or hygroscopic. Hydrophobic HMEs use a pleated hydrophobic membrane with small surface pores. They provide moderately good inspired humidity, but performance may be impaired by high ambient temperatures. Hydrophobic HMEs are also efficient bacterial and viral filters.
The anesthetic incidence of MH in children is approximately one patient in:
15000 - 20000 patients
The incidence of MH is 1:15,000 - 20,000 anesthetics in children and 1:40,000 anesthetics in adults.
The output of a variable-bypass vaporizer, set to deliver 2% is shown below. Possible causes for the variation of the delivered output from the vaporizer include:
a change in the composition of the fresh gas flow
Changes in fresh gas composition can have an effect on vaporizer output. This is the result of uptake and subsequent release of an introduced gas by the liquid volatile agent in the vaporizer. Temperature changes normally encountered in the operating room do not cause a clinically significant change in vaporizer output.
In the evaluation of the patient with pheochromocytoma, 24-hour urine assessment of the metabolic end-products of catecholamines is diagnostic. The major metabolic end-product of catecholamine metabolism is:
vanillylmandelic acid (VMA) Vanillylmandelic acid (VMA) is excreted in the urine and constitutes about 85% of the metabolites of catecholamines.
In the anesthesia machine, components of the low-pressure system include the: (Select 2)
- e-cylinders
- oxygen failure safety device
- flowmeters
- vaporizers
- flush valve
- oxygen pressure alarm
flowmeters, vaporizers
The anesthesia machine can be broadly divided into 3 systems. The low-pressure system contains the flowmeters, the vaporizers, any ancillary oxygen flowmeter and the common gas outlet.
A 36-year-old female presents for a laparoscopic cholecystectomy. Her past medical history is significant for glucose-6-phosphate-dehydrogenase deficiency. Her anesthetic management would include the avoidance of:
-nitroprusside
-lidocaine
-desflurane
-tetracaine
-prilocaine
metabolic alkalosis
-cephalosporins
nitroprusside, prilocaine
In patients with G-6-PD deficiency, drugs that can oxidize hemoglobin to methemoglobin should be avoided. These include: prilocaine, nitroprusside, methylene blue, penicillin, sufonamides, quinidine, and doxorubicin.
Lab values expected to be elevated in a patient with chronic renal failure include:
- platelet count
- hemoglobin
- plasma carbon dioxide content
- bleeding time
bleeding time
Platelet count may be normal to low in the chronic renal failure patient but an increase in bleeding time is noted secondary to platelet dysfunction, specifically from a decrease in platelet aggregation and adhesion.
Determinants of the vapor pressure of volatile anesthetic agents include:
- atmospheric pressure
- altitude
- temperature
- density of the vaporized agent
temperature Vapor pressure (VP) is independent of atmospheric pressure or altitude. VP depends only on the physical characteristics of the liquid and its temperature. VP increases with increases in temperature.
Halogenation of volatile anesthetic agents:
- decreases flammability
- decreases potency
- results in the formation of an ether
- involves the substitution of iodine for hydrogen
decreases flammability
Halogenation refers to the substitution of a halogen atom in place of a hydrogen atom. Although iodine is a halogen, the atom is too big for use in volatile anesthetics. Halogenation decreases flammability and increases anesthetic potency.
The train-of-four tracing below was obtained after the administration of:
- succinylcholine
- vecuronium
- rocuronium
- atracurium
succinylcholine
Characteristics of depolarizing blockade include: decreased twitch height, absence of fade, and minimal reduction in twitch height (T4:T1 > 0.7).
Of the following organs, the most likely to be injured during extracorporeal shockwave lithotripsy is:
- lungs
- heart
- liver
- spleen
lungs
During ESWL, repetitive high energy sound waves are aimed at the nephrolithiasis, causing it to fragment. Because tissue has the same acoustic density as water, damage does not generally occur. However, tissue destruction can occur if the waves are focused at air-tissue interfaces such as in the lung and the intestine.
During intraoral laser surgery, ignition of the endotracheal tube occurs. By dragging & reordering the selections in yellow, match & place in correct order the steps that should be taken.
- Extinguish with saline
- Remove burning material
- Mask ventilate
- Stop gas flow
Remove burning material—Step 1
- Stop gas flow—Step 2
- Extinguish with saline—Step 3
- Mask ventilate—Step 4
The greatest decreases in hepatic blood flow occur with:
- proximity of the operative site to the liver
- isoflurane anesthesia
- regional anesthesia
- desflurane anesthesia
proximity of the operative site to the liver
Inhaled anesthetics and regional anesthesia reduce hepatic blood flow by approximately 20-30%; halothane > isoflurane. Surgical procedures near the liver can reduce HBF up to 60%.
Signs consistent with cardiogenic shock include:
- increased pulmonary artery occlusion pressure
- decreased systemic vascular resistance
- increased cardiac index
- decreased myocardial oxygen demand
- redistribution of the blood volume away from the heart and lungs
- venous congestion
increased pulmonary artery occlusion pressure, venous congestion
Characteristics of cardiogenic shock include increased PAOP, low CI, and increased SVR. Also present are venous congestion, reflex vasoconstriction and a redistribution of blood volume toward the heart and lungs.
Correct statements concerning the geriatric patient include:
- hypothalamic temperature centers remain essentially intact
- body fat decreases with increasing age
- a glomerular filtration rate of 70 mL/min may be within normal limits
- physiologic dead space is decreased in the elderly patient
a glomerular filtration rate of 70 mL/min may be within normal limits
Renal blood flow and GFR decrease by between 1-2% per year after the age of 25 years. (Normal GFR is 125 mL/min.) Aging impairs central temperature regulation. Body fat content and physiologic dead space increase with age.
Major criteria for the diagnosis of fat embolism syndrome include: (Select 3)
- cerebral changes
- retinal fat emboli
- urinary fat globules
- axillary/subconjunctival petechiae
- hypoxemia
- tachycardia
- increased erythrocyte sedimentation rate
- hyperthermia
hypoxemia, cerebral changes, axillary/subconjunctival petechiae
Major diagnostic criteria for fat embolism include axillary/subconjunctival petechiae, hypoxemia, CNS depression and pulmonary edema.
Conditions commonly associated with painless vaginal bleeding include:
- placenta previa
- abruptio placenta
- HELLP syndrome
- pregnancy-induced hypertension
placenta previa
Placenta previa is an obstetric complication that occurs in the second and third trimesters of pregnancy. It is one of the leading causes of painless vaginal bleeding in the second and third trimesters.
A 32-year-old male develops polyuria in the post-operative period following a transphenoidal resection of a pituitary adenoma. Laboratory data includes a urine sodium concentration of 11 mEq/liter and a serum sodium concentration of 145 mEq/liter. The appropriate treatment is:
- administration of ACTH
- administration of hydrocortisone
- administration of DDAVP
- administration of an insulin infusion
administration of DDAVP
Injury to the pituitary gland during transphenoidal surgery can produce deficiencies in any of the hormones from either the anterior or posterior pituitary. In this patient with polyuria with dilute urine in the face of an elevated serum sodium, diabetes insipidus is the most likely diagnosis.
The normal alveolar-to-arterial (A-a) partial pressure gradient for a 70-year-old is approximately:
20 mmHg
The normal A-a partial pressure gradient for oxygen increases from 8 mm Hg at age 20 years to approximately 20 mm Hg at age 70 years.
An estimate of the A-a gradient can be made using:
A-a gradient = (Age +4) / 4
The function of the regulator in line with the input from the oxygen e-cylinders is to:
- reduce variable high pressure input to constant low pressure output
- reduce constant high pressure input to variable low pressure output
- reduce the pressure from the e-cylinders to match the pressure from the wall outlet
- prevent retrograde filling of any other attached oxygen cylinders
reduce variable high pressure input to constant low pressure output
Pressure regulators reduce variable high pressure input to constant low pressure output. The pressure from the cylinders is reduced to below that of the wall outlet gas supplies so that the wall outlets are preferentially used if both sources are available.
As the volume of distribution at steady state of a drug increases:
- half-life increases
- clearance increases
- half-life decreases
- clearance decreases
half-life increases
Half-life = (0.693)(volume of distribution)/clearance. Increases in volume of distribution increase half-life, while increases in clearance decrease half-life.
You are asked to evaluate an 86-year-old man following an inguinal hernia repair performed with monitored anesthesia care and minimal sedation. The rhythm strip below is obtained. The most appropriate therapy is:
- observation
- atropine
- morphine
- transvenous pacing
transvenous pacing
Second degree heart block, type 2 is characterized by constant P-P and R-R intervals prior to the dropped QRS complex. Acute onset second degree heart block, type 2 is usually associated with MI and can rapidly progress to 3rd degree block. Atropine is characteristically not effective and pacing is indicated.
You are asked to evaluate a 37-year-old, 180-kilogram male scheduled for gastric banding. During examination of the airway you are able to visualize the hard palate, soft palate and base of the uvula. The corresponding Mallampati classification is:
III
Visualized oral structures in the Mallampati classification are:
I - soft palate, fauces, uvula, tonsillar pillars
II - soft palate, fauces, uvula
III - soft palate, base of uvula
IV - hard palate only.
A list of adrenergic agonists is shown below. By dragging & reordering the selections in yellow, match the agonist of with its corresponding receptor.
- Phenylephrine -beta(non selective)
- Dexmedetomidine -alpha 1
- Isoproterenol -alpha 2
- Terbutaline -beta 2
- Phenylephrine alpha 1
- Dexmedetomidine -alpha2
- Isoproterenol -beta(non selective)
- Terbutaline -beta 2
Hemodynamic signs commonly seen in the patient with end stage liver disease include:
- bradycardia
- increased cardiac output
- increased systemic vascular resistance
- systolic hypertension
increased cardiac output
Patients with cirrhosis and ESLD often exhibit low SBPs (90 - 110 mmHg) , low PaO2 (
A 56-year-old man is being treated with sodium nitroprusside for control of elevated blood pressure following a craniotomy. He has been treated for the previous 36 hours and the current rate of infusion is 10 micrograms/kg/min. His blood pressure is 165/96 and pulse rate is 115/min. Additional findings you would expect include:
- metabolic acidosis
- respiratory acidosis
- elevated methemoglobin levels
- increased mixed venous oxygen content
- tachyphylaxis
- decreased oxygen saturation as measured by pulse oximetery
tachyphylaxis, metabolic acidosis, increased mixed venous oxygen content
Cyanide intoxication must be suspected when the dose of nitroprusside exceeds 1 mg/kg over a 2-hour period or 0.5mg/kg/hour over 24 hours. Metabolic acidosis, elevated mixed venous oxygen saturation, and tachyphylaxis would indicate toxicity.
The pressure in an e-cylinder of oxygen is found to be 500 psi. If an anesthetic is being delivered using 2 L/min of oxygen flow, the cylinder will last approximately:
80 - 90 minutes
The contents of the oxygen e-cylinder can be estimated by the following formula:
Capacity (L) / Service Pressure = Contents Remaining (L) / Gauge Pressure:
660 L / 1900 psi = Contents Remaining / 500 psi
Contents Remaining = 174 L; @ 2 L/min consumption = 87 minutes of use
Depression of the oxygen flush button delivers approximately:
35 - 75 L/min
Depression of the flush button delivers 35 - 75 L/min at up to 60 psi. Extreme caution is necessary when the oxygen flush is used, so as to avoid barotrauma.
Difficult airway management and intubation is associated with: (choose 3)
- Treacher-Collins
- Pierre-Robin
- Klippel-Feil
- Cystic Fibrosis
Treacher-Collins syndrome, Pierre-Robin syndrome, Klippel-Feil syndrome
Treacher-Collins syndrome consists of mandibulofacial dysostosis. Pierre-Robin syndrome consists of micrognathia and glossoptosis. Klippel-Feil syndrome is characterized by cervical fusion and immobility. All can result in difficulty with airway management and intubation.
In the geriatric patient, a significant prolongation of the elimination half-life is seen with:
- succinylcholine
- diazepam
- propofol
- desflurane
diazepam
Aging increases the volume of distribution for all benzodiazepines, which prolongs their elimination half-lives. Diazepam’s elimination half life may approach 36 - 72 hours. Elderly patients also exhibit enhanced sensitivity to benzodiazepines, which may lead to prolonged postoperative confusion.
The upward slope of Phase III of the capnogram below is secondary to:
- obstructive airway disease
- restrictive airway disease
- exhaled gas from lung units with lower V/Q ratios
- exhaled gas from lung units with higher V/Q ratios
exhaled gas from lung units with lower V/Q ratios
On the capnogram, Phase I is the inspiratory baseline and represents fresh gas from the anesthesia machine. Phase II, or the expiratory upstroke is CO2-rich alveolar gas. Phase III is the expiratory plateau and has an upward slope as lung units with lower V/Q ratios have time to empty. Finally, Phase IV is the inspiratory downstroke as the flow of fresh gas rapidly washes the CO2 away.
An ultrasound of the right ilioinguinal region is shown below. The femoral nerve is best represented by:
B
In the figure above, A represents the iliopsoas muscle, B represents the femoral nerve, C represents the femoral artery and D represents the femoral vein.
Common postoperative complications following carotid endarterectomy include:
- glossopharyngeal nerve injury
- hypertension
- bradyarrhythmia
- esophageal perforation
hypertension
Between 10% - 66% of patients will experience postoperative hypertension following CEA. The cause appears to involve alteration of the carotid sinus baroreceptors. Other common complications include MI and CVA. Hypotension and bradyarrhythmias are much less common. Esophageal perforation as a complication is rare.
You are evaluating a patient for resection of a mandibular tumor under general anesthesia with controlled hypotension. Possible postoperative complications you would inform the patient of include:
- renal failure
- myocardial infarction
- hypercortisolism
- acute pancreatitis
- blindness
- pericarditis with effusion
renal failure, myocardial infarction, blindness
Complications from controlled hypotension include: hemiplegia, CVA, ATN, MI, cardiac arrest, hepatic necrosis, and blindness.
During repair of an ascending aortic arch aneurysm, deep hypothermic cardiac arrest is needed. It is recommended that the patient be cooled to:
15 - 22 degrees C.
Cerebral perfusion must be temporarily interrupted during aortic arch repair. Deep hypothermic cardiac arrest (DHCA) is the most important therapeutic intervention to prevent cerebral ischemia. During DHCA, nasopharyngeal temperatures are measured and the patient is cooled to 15 - 22o C. Arrest periods of up to 25 minutes are generally considered safe.
The primary cause of maternal mortality in patients with pregnancy-induced hypertension is:
- congestive heart failure
- myocardial infarction
- pulmonary edema
- intracerebral hemorrhage
intracerebral hemorrhage
All types of cardiovascular complications can be seen with PIH, however intracerebral hemorrhage is the most common cause of mortality.
During the administration of an intravenous regional block, a double tourniquet is commonly used to:
- increase systemic redistribution of the anesthetic
- increase local anesthetic tissue penetration beneath the tourniquet
- reduce the incidence of tourniquet pain
- allow the use of concentrated local anesthetic solutions
reduce the incidence of tourniquet pain
It is common for tourniquet pain to develop in patients receiving an IV block after about 25 - 30 minutes. If a double tourniquet is used, the distal tourniquet can be inflated and the proximal tourniquet deflated allowing an additional 15 - 20 minutes of relief from the tourniquet pain.