questions Flashcards by Abbie Barkley

Fluid therapy during intracranial surgery requires careful monitoring. All of the following are true regarding fluid therapy except?
A. 0.45% NS is safe in modest amounts
B. NS is safe in modest amounts
C. LR is safe in modest amounts

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Blood flow end organ perfusion below an aortic cross clamp is dependent upon?

Perfusion pressure

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Nerve dysfunction after a CEA, though transient, all nerves should be assessed except?
A. Vagus
B. SLN
C. RLN
D. Hypoglossal

look up

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The chances of an increased brain accident associated with HTN after a CEA is three-fold. All of the following medications can be used to treat, except which one?
A. Esmolol
B. Nitroprusside
C. Nitroglycerin
D. Labetalol

A - esmolol

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The MOA that causes HTN after a CEA? (select 2)

Loss of carotid sinus function
&
Denervation of carotid sinus

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Patient present for resection of AAA, common medical complications include all of the following except?

Hypotension

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A patient has an aortic aneurysm, all of the following are true for medical management except?
A. Avoid ACEi
B. Administer BB
C. Administer CCB
D. Avoid strenuous exercise

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B/c it is located right behind the sternum, what is most likley to be damaged from a traumatic chest injury?
A. RV
B. LV
C. RA
D. LA

A - RV (can be found on p. 234)

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The treatment of choice for hypertrophic cardiomyopathy is BB and CCB. The effect of CCB in HCM is?

Improvement of ventricular filling (can be found on 217)

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____ is the single most important risk factor for identifying perioperative cardiac morbidity and mortality?

Heart failure

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If there was concern for hemodynamic volatility during induction, in a patient with HTN, which drug would most likely be used to blunt the SNS response to intubation?
A. Esmolol
B. Nicardipine
C. Labetalol

A - esmolol

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During an acute MI, you give IV Nitro or Morphine, which is necessary to?
A. Decrease catecholamine release
B. Increase O2 consumption
C. Prevent future MI

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Management of anesthesia in noncardiac surgery for a patient with mitral stenosis includes? (choose 2).
A. Prevention of pulmonary edema
B. Prevention of sudden decreases in SVR
C. Avoid spinal/epidural anesthesia
D. Administer excessive fluid volumes

A and B

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Cerebral ischemia as noted by nausea, dizziness, and altered consciousness may be seen with a CPP of?
A. 30-45 mmHg
B. 20-25 mmHg

A. 30-45

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You are performing a preop exam on your patient who is scheduled to have tumor resection in the sitting position. As you go through their chart, you find that they have an extensive cardiac history. What are contraindications to the sitting position? (Choose 2).
A. Patent foramen ovale
B. Cardiac defects
C. MR

A and B

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You are providing anesthesia for a patient undergoing CEA. As an astute almost senior SRNA, you know that you need to maintain the ETCO2 at?
A. 40
B. 30
C. 55

A - 40

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The spinal cord depends on blood supply from one anterior spinal artery and two postierior spinal arteries. The anterior spinal artery supply depends on reinforcement from several radicular arteries, the largest and most important of which is the ______.

Artery of Adamkiewicz

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The SRNA knows that the optimization of systemic hemodynamics represents the most effective measure for protecting the kidneys from ischemic effects produced by aortic cross-clamping. The SRNA also adminsiters medication for renal protection, how does this work? (Choose 2)

Improves Renal blood flow
&
Improves GFR

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You are doing a preop eval on a 78 year old woman scheduled to have a left hip replacement. Upon auscultation of heart sounds, you note a 3+ systolic murmur at the 2nd ICS. This would be indicative of what?

Aortic Stenosis

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Which sympathomimetic/inotrope has a decreased effect in a denervated (transplanted) heart compared with the effect in a normal heart?
A. Ephedrine
B. Epinephrine
C. Isoproternol
D. Dobutamine

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The patient takes their lisinopril the morning of surgery. During the case, the patient becomes hypotensive 86/45 despite the use of crystalloids, ephedrine, and Neo. The patient is diagnosed with refractory hypotension by the CRNA. What is the next best medication to give this patient?
A. Vasopressin
B. Epinephrine

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In kids under the age of 12, the most likely cause of HTN is?
A. Secondary HTN
B. Primary HTN

A - secondary (p. 185)

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Your 58 year old male, ASA 1 patient is complaining of acute substernal chest pain in preop before his scheduled hiatal hernia repair. EKG reveals ST segment elevation indicative of MI. Surgery is cancelled and the patient is rushed to cath lab for cardiac cath and PCI of his LAD. In order to combat myocardial remodeling post MI, you would expect the patient to be prescribed the following as 1st line therapy?
A. Lisinopril
B. Amlodipine
C. Metoprolol

A - Lisinopril/ACI (p. 203)

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The 67 y/o patient shows EKG signs of MI with PCWP 11 mmHg, BP 139/79, and HR 75. Choose the most appropriate medical management for this patient.
A. Neo to increase SVR
B. Neo to decrease SVR

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Which of the following is true regarding good pasture syndrome? A. @50% of patients exhibit signs of pulmonary disease that may precede evidence of renal disease B. Occurs more frequently in young females

A (p. 443)

Which of the following is true regarding renal transplant patients? A. High normal SBP in the presence of euvolemia is required for adequate urine output B. Slow clearance rates of NMBD

A (p. 441-442)

ESRD patients may respond to induction as if they have/were?

Hypovolemic

Intraoperative treatment of patient with AKI would include all of the following except?

Maintaining hypervolemia

Elective surgery should be postponed until an acidosis has been treated. For urgent surgery in a patient with metabolic acidosis which of the following should be considered?

Invasive hemodynamic monitoring

Major adverse consequences of severe systemic acidosis include all the following except?

Seizures (p. 421, table 21.8)

Careful consideration must be taken when weaning a patient with chronic lung disease and carbon monoxide? (choose 2)

1. Get the patient back to the metabolic alkaloticc state in which they presented 2. Get the patient back to the respiratory acidotic state in which they presented

In the obese patient, episodic arterial hypoxemia may occur up to ____ days after surgery?

The most clinically appropriate way to calculate an initial drug dose for an obese patient is ______?

Lean Body Weight

What are 2 ventilatory changes to make with obese patients? (Choose 2)

1. Change I:E ratio 2. Use PC setting

Assessment for upper airway difficulties should include? (choose 2)

1. Fat face 2. Large breasts

PEEP can improve the FRC of an obese patient, however at the expense of?

Decreasing CO

Induction of GA can decrease FRC in obese patients by?

50%

Treatment of Porphyria crisis includes? (choose 2) A. Adequate hydration B. Carbohydrate loading C. Avoid Benzos D. Administer anti-seizure prophylaxis

A and B

All of the following are important in the pre-op history assessment of a patient with gout except? A. PHTN B. Ischemic heart disease C. DM

A - PHTN

All of the following statements are true about preop assessment of patients with possible onset of acute porphyria attack except?

Family history not important when evaluating a patient with possibility of onset of acute porphyria attack

What is the 1st line treatment for bradycardia?

Atropine 0.5 mg every 3-5 minutes

Which has the slowest conduction rate?

AV node

In a patient with a shunting lesion, care must be taken to do which of the following? (choose 2)

1. avoid volume overload 2. avoid air bubbles in the IV line

The better approach with a patient with Eisenmenger's Syndrome is?

Open approach is better than laparoscopy approach

Which of the following decrease pulmonary vascular resistance? (choose 3)

1. Normothermia 2. hypocarbia 3. 100% inspired O2 concentration

The most common nerve injury associated with coarctation of the aorta is? A. Left laryngeal nerve B. Right laryngeal nerve C. Vagus

A - Left

The mainstay medical management for mild to moderate inflammatory bowel disease is?

5-ASA

In nonvariceal bleeding, ____ is the most common cause of upper GI bleed. A. PUD B. GERD

A - PUD

Patient with nonalcoholic Fatty liver disease medical management includes all the following except? A. Hep C vaccination B. weight loss reduction C. Diabetes management D. Treatment of hyperlipidemia

A - hep C vaccination

Patient with liver cirrhosis, fulminant hepatic failure, or late-stage cirrhosis should avoid which of the following procedures? A. Breast enlargement surgery B. Dissecting TAA

A - breast enlargement surgery (p. 356)

You are taking care of a Gullian Barre pateint, which of the following induction drugs should be omitted from your lineup? A. Sux B. Etomidate C. Roc D. Nimbex

A - Sux (p. 322)

When taking care of a Gullian Barre patient, you display knowledge by knowing which of the following to be true? (choose 2) A. CV compensatory responses can be absent B. Profound hypotension occurs with positive airway pressure C. Profound hypotension occurs w/ position changes

A and B (p. 322)

Which is proper anesthesia management for a patient undergoing hyperhidrosis sympathectomy? A. Prepare a double lumen tube B. Prepare a single lumen tube C. Prepare for continuous TEE

A - double lumen tube (p. 317)

Anesthesia management for a patient with Charcot Marie tooth disease includes? A. monitor response of NMBD B. Avoid all MH triggering agents C. Avoid Iso

A. - monitor response of NMBD (p. 319-320)

Which of the following are true regarding a patient with aschalasia (choose 2)? A. must be considered full stomach B. Deep extubation C. Proceed with standard induction D. May fast for 48 hours pre-op

A and D (p. 362)

Which of the following are not true regarding a patient with Gullian Barre?

Minimal response to indirect acting vasopressors, d/t a down-regulation of post-synaptic receptors (p. 322)

Anesthetic management for patients w/ orthostatic intolerance syndrome includes all of the following except? A. Inotropic support for HF B. Adminisier low doses of Neo C. Treat tachycardia w/ Esmolol

A (p. 316)

The hepatic artery and portal vein supply blood flow to the liver. Which of the following is true? A. Hepatic artery provides 25% of the blood flow and 75% of the O2 delivery B. Hepatic artery provides 25% of the blood flow and 50% of the O2 delivery

Patient admitted for cirrhosis of the liver and is having surgery later that day. Which NMBD agents are most likely the safest agents to use since they undergo no hepatic metabolism? (choose 2)

1. Succinylcholine 2. Cisatracurium

Mr. Jones, a 75-year old patient with CKD, HTN, and DM present for surgery. The SRN knows the the NMBD that should be used are? (Choose 2)

Atracurium and Cisatracurium

Hypertensive nephropathy accounts for relatively higher proportion of ESRD among which ethnic group?

African Americans

Loss of DTR and hypotension occur at which level of hypermagnesemia?

7 mEq/L

Which is the best option for immediate treatment of life-threatening dysrhythmias or EKG signs of severe hyperkalemia?

Calcium Chloride

The SRNA is bringing back a patient after permanent pacemaker placement due to 2nd degree type II AV block. The patient was pulled deep in the OR. Upon arrival to the PACU, EKG leads are placed and a V-Fib rhythm is noted. Which of the following actions by the astute SRNA is most appropriate?

Check for a pulse and change lead placement

The astute SRNA knows that which of the following drugs can cause prolongation of the QTc interval and which patient population is more prone to this syndrome?

Zofran; Females

A patient diagnosed with coarctation of the aorta is undergoing surgical repair. Although the patient does not require CPB, they do require a high aortic cross-clamp. What are some potential problems that can arise d/t severe hypotension distal to the aortic cross-clamp? (Choose 3) A. Quadriplegia B. Gut ischemia C. Renal failure D. Heart failure E. Paraplegia

B, C, and E

A premature infant, born at 27 weeks, is found to have a patent ductus arteriosus (PDA). What is the 1st line treatment to facilitate duct closure in this type of patient? A. Indomethacin infusion B. Prostaglandin infusion

A - indomethacin

The most common atrial septal defect , where the defect is located in the middle of the interatrial septum in the same location of the foramen ovale and can vary from single opening to fenestrated septum describes?

Ostium Secundum

A patient presents to the clinic with c/o SOB, swelling of LE, and describing symptoms of ascites. A thorough assessment reveals a systolic ejection murmur heard best at the 2nd ICS and the EKG shows signs of RV hypertrophy and strain. What is most likely cause of this patient's symptoms?

Pulmonic (pulmonary) stenosis

The newly certified CRNA knows that _____ is the mainstay treatment for hemochromatosis? A. Phlebotomy B. Chelating agents

A - phlebotomy (p. 383)

Which of the following would the astute SRNA plan to avoid in a patient that has a diagnosis of hemochromatosis? A. Phlebotomy B. Chelating agents C. PRBC D. Deferoxamine

C - PRBC (p. 383)

SRNA is getting ready to induce a patient with a known history of acute porphyritic attack, which drug should the SRNA omit from the induction lineup?

Etomidate

In a patient with a history of porphyria, the SRNA knows that _____ is a life threatening complication important in the management of anesthesia.

Acute intermittent porphyria

In obesity hypoventilation syndrome, all of the following culminate in Pickwickian syndrome except?

Pulmonary hypotension and hypocarbia

You are carrying for a patient with mild Hemophilia A. He is to have his gallbladder removed this morning. As an astute SRNA, you know that? A. He will need an infusion of DDAVP 30-90 minutes prior to surgery which will increase factor VIII threefold to fivefold. B. He will need an infusion of DDAVP 90-120 minutes prior to surgery which will increase factor VIII three to five fold.

A (30-90 min; factor VIII are the key answers) (p. 492)

Your patient tells you that they have a blood disorder that increases their likelihood of having blood clots. You know this patient could have all of the following disorders except? A. ATIII Deficiency B. Hemolytic Uremic Syndrome C. Factor V Leiden D. Protein C and S Deficiency

B (p. 501, Table 24.5)

The astute SRNA is caring for a patient with DM. The student knows that during the perioperative period, the patient's blood glucose levels should be maintained at _____. A. 180-200 B. 120-180 C. 80-140 D. 70 -110

B. 120-180 (p. 458)

Which one of these would not be included in the perioperative management of a patient undergoing surgery to remove pheochromocytoma?

Limit crystalloid fluids to 1.5 L (p. 466)

You are doing the anesthetic for a thyroidectomy, the BP drops to 87/44. Which of the following would you choose to correctly treat this pressure? A. Neo b/c is a direct-acting vasopressor B. Neo b/c its an indirect-acting vasopressor C. Ephedrine b/c its a direct-acting vasopressor

A (p. 461)

Your patient has failure to progress during a trial of labor after cesarean section. Which of the following increases this risk factor? A. Asian ethnicity B. Hispanic ethnicity C. Fetal weight > 3000 grams

A - hispanic (p. 683)

Your patient has a paraneoplastic syndrome. Which of the following medications does the SRNA know they need to acutely monitor? A. Propofol B. Ancef C. Rocuronium

C - Roc

A parturient w/ myasthenia gravis can expect exacerbation of symptoms during? (choose 2) A. 1st trimester B. 2nd trimester C. 3rd trimester D. Post-partum

A and D (p. 687)

Which of the following has a paradoxical effect of decreasing the risk of preeclampsia? A. smoking tobacco B. drinking alcohol

A - smoking (p. 676)

Which of the following increases the risk for preeclampsia?

African american ethnicity (p. 677, table 31.6)

Which of the following is the correct treatment for Carbamate pesticide poisoning? A. Atropine 2 mg Q 3-5 minutes B. Atropine 2 mg Q 5-10 minutes

B. 2 mg Q5-10 minutes (p. 631)

Your patient comes in for a scheduled lap chole. On the patient's medication list, the SRNA sees that the patient has been taking 40 mg Prednisone daily for the past 4 weeks. When and what stress dose should be given to the patient?

1. hydrocortisone 100 mg IV given at induction 2. Assure hydrocortisone 100 mg is given every 8 hours for 24 hours post-op

Which of the following is not an immediate goal for treatment of anaphylaxis? A. Limit excessive fluid administration B. Reversal of hypotension C. Reversal of hypoxemia D. Inhibition of cellular degranulation

A (p. 575)

Which of the following would be the recommended treatment for a patient experiencing acute angioedema? A. Epinephrine B. Benadryl C. Fresh frozen plasma D. Fresh frozen platelets

C - FFP (plasma) (p. 572)

The most common hereditary form of angioedema results from an autosomal dominant deficiency of?

C1 esterase inhibitor (p. 572)

Which of the following should be available for an acute attack of angioedema? A. Antihistamines B. C1 inhibitor concentrate C. Antifibrinolytics

B (p. 572)

Infants with hypoglycemia that are experiencing convulsions should be treated with? (choose 2) A. 5% dextrose 4 cc/kg IV bolus B. 5% dextrose infusion at 8 mg/kg/min C. 10% dextrose 4 cc/kg IV bolus D. 10% dextrose infusion at 8 mg/kg/min

C - 10% dextrose 4 cc/kg IV bolus D - 10% dextrose infusion at 8 mg/kg/min

A parturient is exhibiting signs of CV compromise during a c-section, which of the following agents would you be most appropriate to administer? (choose 2) A. Dopamine for increased chronotropy B. Dopamine for increased inotropy C. Nitroglycerin for preload/afterload reduction

B and C (p. 686)

Which of the following are part of the extrinsic path? A. Factor II B. Factor III C. Factor VII D. Factor VIII

B - Factor III C - Factor VII

Which of the following puts a patient at increased risk for placenta accreta? A. Female gender of the fetus B. Male gender of the fetus

A - female (p. 681)

If parturient has a history of cocaine abuse, they will show decreased metabolism to? A. Lidocaine B. Prilocaine C. Bupivacaine D. Chloroprocaine

D (p. 690)

While inconclusive, results from studies to date generally suggest that anesthetic exposure at ____ may be associated with subsequent behavioral and learning difficulties. A. <2-4 years B. <3-4 years

B - <3-4 years

Patients with homozygous factor V Leiden have an increased risk of up to ____? A. 10-fold B. 50-fold C. 80-fold D. 100-fold

C - 80-fold (p. 502)

In order to replace important proteins for your patient that has Protein C and S deficiency, you would administer which of the following? A. PLT B. FFP

B - FFP (p. 502)

Anesthesia unmasks certain symptoms to chemotherapeutic drugs such as doxorubicin. Which of the following would not be an anesthetic consideration? A. Assessing the ECHO B. Using high amounts of inspired oxygen concentration C. Considerations of engorgement of great vessels D. Right sided HF