Presentations Flashcards
What is the appropriate initial dose of dantrolene for a patient with malignant hyperthermia?
a. 3.5 mg/kg
b. 2 mg/kg
c. 1.5 mg/kg
d. 2.5 mg/kg
d. 2.5 mg/kg
Which of the following is a LATE sign of malignant hyperthermia?
a. Increased ETCO2
b. Fever
c. Rigidity
d. Tachycardia
b. Fever
Which of the following is NOT a trigger for malignant hyperthermia?
a. Desflurane
b. Succinylcholine
c. Rocuronium
d. Sevoflurane
c. Rocuronium
Mr. Jones presents to pre-op for an open knee arthroplasty, during you pre-anesthetic assessment Mr. Jones discloses that he smokes cannabis daily for his chronic knee pain. What can you reasonably expect during Mr. Jones anesthetic?
a. Increased sputum production
b. Increased coughing on extubation
c. An unreliable BIS reading
d. All of the above
d. All of the above
Cannabis administration pre-disposes vulnerable patients to myocardial ischemia within the first hour of use due to what mechanism(s)?
a. Sympathetic beta-adrenergic stimulation
b. Tachycardia
c. Decreased carboxyhemoglobin levels
d. Both A and B
d. Both A and B
By what mechanism does cannabis potentially cause an increase in anesthetic requirements for agents such as propofol and benzodiazepines?
a. Inhibition of Ach
b. Chronic cannabis use causes down-regulation of the GABA receptor, increased doses of GABA agonist are required due to decreased sensitivity
c. Chronic cannabis use causes up-regulation of the GABA receptor, similar to a MG patient
d. Inhibition of Glutamate
b. Chronic cannabis use causes down-regulation of the GABA receptor, increased doses of GABA agonist are required due to decreased sensitivity
Which medication has been shown to reduce the risk of stroke and myocardial infarction by 25-30%?
a) Warfarin
b) Heparin
c) Aspirin
d) Tranexamic Acid
c) Aspirin
Which risk factor is NOT associated with spinal hematoma?
a) Anticoagulation therapy
b) Liver disease
c) Increasing age
d) Male gender
d) Male gender
When should Clopidogrel be discontinued before a planned neuraxial procedure?
a) It can be continued perioperatively
b) 4 hours
c) 7 days
d) 10 days
c) 7 days
Succinylcholine combined with “statin” therapy increases the risk of myoglobinuria and fasciculations in doses greater than?
a) 0.15 mg/kg
b) 1.5 mg/kg
c) 2.0 mg/kg
d) 0.3 mg/kg
b) 1.5 mg/kg
The most common cardiovascular complication of diuretic therapy in the perioperative period of anesthesia is (choose 2):
a) Hyperthermia
b) Decrease neuromuscular blockade
c) Hypovolemia
d) Hypothermia
e) Decreased Tissue Perfusion
f) Increased Tissue Perfusion
c) Hypovolemia
AND
e) Decreased Tissue Perfusion
Which of the following loop diuretics is associated with severe muscular pain after a 12–24-hour infusion?
a) Torsemide (Demadex)
b) Furosemide (Lasix)
c) Ethacrynic Acid (Edecrin)
d) Bumetanide (Bumex)
d) Bumetanide (Bumex)
What metabolic changes occur related to the neuroendocrine stress response caused by surgery? (Select all that apply)
A.Induces insulin resistance
B.Increases insulin secretion
C.Decrease endogenous glucose production
D.Decrease peripheral glucose utilization
E.Increase lipolysis and protein catabolism
A.Induces insulin resistance
D.Decrease peripheral glucose utilization
E.Increase lipolysis and protein catabolism
Which of these oral diabetic medications are most often held 3-4 days prior to surgery? A.Metformin B.Glipizide C.Pioglitazone D.Canagliflozin
D.Canagliflozin
What is the optimal perioperative glycemia target for the majority of patients? A.140-180 mg/dL B.80-110 mg/dL C.180-200 mg/dL D.70-150 mg/dL
A.140-180 mg/dL
What is the mechanism by which garlic, ginseng, and gingko alter the patient’s coagulation profile?
a. Direct thrombin inhibition
b. Inhibition of platelet aggregation
c. Inhibition of platelet adhesion
d. Elimination of factor VII
b. Inhibition of platelet aggregation
Which of these herbal supplements can reduce MAC (potentiate GA)? Select 2.
a. Kava
b. Valerian
c. St John’s Wort
d. Garlic
a. Kava
b. Valerian
St John’s Wort reduces the clinical effects of which medications?
a. Alfentanil
b. Midazolam
c. Warfarin
d. Calcium Channel Blockers
e. All of the above
e. All of the above
TRUE/FALSE: Inhaled Corticosteroids cause systemic adverse side effects.
False
While you are doing your patient’s preoperative evaluation, you note that s/he is currently taking Prednisone 5mg every other day. You know that this patient most likely has: A. a suppressed HPA axis B. an unknown HPA axis C. a non-suppressed HPA axis D. no HPA axis
C. a non-suppressed HPA axis
All of the following are possible adverse effects of exogenous glucocorticoids EXCEPT:
A. Impaired wound healing
B. Decreased blood glucose
C. Hypothalamic-Pituitary-Adrenal axis suppression
D. Increased risk for infections
B. Decreased blood glucose
Which of the following are most likely to cause an intraoperative anaphylactic reaction? (select 2)
a. Midazolam
b. Rocuronium
c. Fentanyl
d. Cefazolin
b. Rocuronium
d. Cefazolin
How often do you redose epinephrine when treating anaphylaxis?
a. Every 1 minute
b. Every 2 minutes
c. Every 4 minutes
d. Every 5 minutes
b. Every 2 minutes
Which of the following is NOT a characteristic of a Type B (Allergic) adverse drug reaction?
a. Not dose-dependent
b. Unpredictable
c. Related to the pharmacodynamics of the drug
d. Uncommon
c. Related to the pharmacodynamics of the drug
A gravid woman is at greater risk for hypoxemia during induction because of which pulmonary physiological changes? A. decreased tidal volume B. decreased minute ventilation C. decreased FRC D. increased total lung capacity
C. decreased FRC
33 y/o 6 months gravid female presents to ED post MVA with an internal bleed, shoulder dislocation, and a radial fracture. BP 70/52,
HR 59, RR 21, Sat 94%. She’s rushed class A to the OR to manage the bleed what induction agent is most appropriate for this patient?
a. Propofol
b. Etomidate
c. Thiopental
d. Ketamine
d. Ketamine
The occurrence of ”ion-trapping” in the fetus occurs due to which phenomenon?
a. Fetal blood pH in equal to maternal blood pH
b. Fetal blood pH is more acidic than maternal blood pH
c. Fetal blood pH is more alkalotic than maternal blood pH
b. Fetal blood pH is more acidic than maternal blood pH
Which receptor does ketamine NOT act on?
a. Glutamate
b. NMDA
c. GABA
d. Muscarinic
c. GABA
Your patient is undergoing a robotic hysterectomy, at the end of the case you want to give an IV NSAID for pain control. Your patient is 60 kilograms, 50 years old and has normal renal function. The MD has verified ketorolac is okay to be given, what is the typical dose in this case?
a. 15 mg
b. 30 mg
c. 60 mg
d. 20 mg
b. 30 mg
Acetaminophen has all these effects on the body EXCEPT:
a. Analgesic
b. Hepatic Impairment
c. Antipyretic
d. Anti- Inflammatory
d. Anti- Inflammatory
Hormone Replacement Therapy in transgender men includes: (Select 2)
a. progesterone
b. androgens
c. GnRH agonists
d. selective estrogen receptor modulators
b. androgens
c. GnRH agonists
Anesthetic considerations for transgender patients include: (select 3)
a. sugammadex can bind to estrogen or progesterone medications and inactivate them
b. HRT increases their risk of DVTs
c. Feminizing larygoplasty and/or chondroplasty can lead to damage to the vocal cords & recurrent laryngeal nerve
d. they have decreased rates of drug metabolism
a. sugammadex can bind to estrogen or progesterone medications and inactivate them
b. HRT increases their risk of DVTs
c. Feminizing larygoplasty and/or chondroplasty can lead to damage to the vocal cords & recurrent laryngeal nerve
GnRH agonists MOA:
a. inhibit LH/FSH via negative feedback
b. androgen receptor antagonist
c. continuous stimulation of pituitary rather than pulsatile
d. selectively inhibit testosterone action in specific tissues
c. continuous stimulation of pituitary rather than pulsatile
Your patient has a history of Hodgkin’s lymphoma and is coming in for a hip replacement. In her history you see that she has recently been treated with Bleomycin. What would be the MOST important thing to assess pre-operatively?
A. A chest x-ray to determine if the patient has pulmonary toxicity
B. A history of nausea and vomiting
C. Left Ventricular Ejection Fraction
D. Patient’s level of anxiety about the surgery
A. A chest x-ray to determine if the patient has pulmonary toxicity
Your patient has a history of receiving Vincristine and has experienced dose-limiting neurotoxicity (peripheral neuropathy) related to her chemotherapy regimen. Which anesthetic plan would be the BEST for this patient?
A. General Anesthesia with Volatile Agents
B. Monitored Anesthetic Care with local anesthesia
C. Regional Anesthesia (spiral or epidural)
D. Total IV Anesthesia (TIVA)
D. Total IV Anesthesia (TIVA)
Your surgical patient is receiving chemotherapy to treat non-small cell lung cancer. The regimen includes Fluorouracil (5-FU) and Vinblastine. Which toxicity would be most important to monitor for prior to surgery? A. Myelosuppression B. Anxiety C. Alopecia D. Oral mucosal disruptions
A. Myelosuppression
Which drug is not a schedule II controlled substance?
a. Morphine
b. Ketamine
c. Fentanyl
d. Oxycodone
b. Ketamine
All of the following are true about the Controlled Substance Act EXCEPT:
a. It breaks up drugs into schedules based on their abuse potential
b. It improved regulation of manufacturing, importation/exportation, distribution, and dispensing of controlled substances
c. Regulations are the same for prescribing and tracking of schedule 1-5 drugs
d. The main goal is to prevent abuse, trafficking and diversion of controlled substances
c. Regulations are the same for prescribing and tracking of schedule 1-5 drugs
What percent of clinicians experience a substance use problem in their careers?
a. 1-5%
b. 5-10%
c. 10-15%
d. 15-20%
c. 10-15%
