RANDOM FACTS for SEE 3

Question 1

SVR and pregnancy

Answer 1

Decrease by 21% by term

Question 2

Which of the following drugs used in the treatment of rheumatoid arthritis can prolong the duration of succinylcholine?

Answer 2

Cyclophosphamide

Question 3

The use of cyclophosphamide can

Answer 3

inhibit plasma cholinesterase and prolong the duration of action of succinylcholine.

Question 4

Agents used in the treatment of rheumatoid arthritis.

Answer 4

Etanercept and adlimumab are anticytokine

Question 5

The five categories of scoliosis are based on their etiology. They are:..

Answer 5

idiopathic, congenital, neuropathic, myopathic, and traumatic

Question 6

Neuropathic scoliosis is caused by diseases such as

Answer 6

polio, cerebral palsy, and syringomyelia

Question 7

Myopathic scoliosis is caused by conditions such as

Answer 7

muscular dystrophy and amyotonia.

Question 8

Is the most prevalent form of Scoliosis

Answer 8

Idiopathic scoliosis

Question 9

What is the appropriate dose of 0.3 M sodium citrate in mL for a 20 kg pediatric patient? (provide your answer accurate to a single decimal place)

Answer 9

The pediatric dose of 0.3 M sodium citrate is 0.4 mL/kg. For this patient, the dose would be 8 mL.

Question 10

What is the appropriate volume of 1:1000 epinephrine to add to a spinal anesthetic to prolong the duration of the block?

Answer 10

0.1-0.2 mL

Question 11

The subarachnoid space of the spinal canal normally contains between —to —ml of CSF

Answer 11

30 and 80 mL of cerebrospinal fluid.

Question 12

The spinal cord is enlarged in two locations. Where are the enlarged areas? (select two)

Answer 12

The cervical enlargement occurs at C4-T1 and the lumbar enlargement which occurs from L2-S3.

Question 13

The 2 cervical enlargement is due to the

Answer 13

nerve roots that produce the brachial plexus and the lumbar enlargement produces the lumbar plexus.

Question 14

BAEPs are not significantly affected by b.

Answer 14

Benzodiazepines, ketamine, propofol, muscle relaxants, N2O, or barbiturates

Question 15

Can Inhalation agents affect BAEPs?

Answer 15

BAEPs mildly, affect is proportional to the dose administered.

Question 16

Nitroprusside administration will result in a decrease in (select three)

Answer 16

Preload
Afterload
cardiac filling pressures

Question 17

Damage to central or peripheral neural structures that results in abnormal processing of painful stimuli is characteristic of

Answer 17

Neuropathic pain

Question 18

Hypotonic solutions : Name 2

Answer 18

D5W

1/2 NS

Question 19

Mannitol should be avoided in patients with which of the following conditions? (select two)

Answer 19

Depressed cardiac function

Intracranial hematoma

Question 20

Radial artery monitoring during hypothermic cardiopulmonary bypass on aortic pressure

Answer 20

Underestimation

Question 21

Air in the transducer tubing aortic pressure

Answer 21

Underestimation

Question 22

Parathyroid hormone on serum calcium ?

Answer 22

increases serum calcium levels by increasing bone resorption of calcium, limiting its renal excretion, and enhancing the gastrointestinal absorption of calcium by activating vitamin D.

Question 23

PTH on serum phosphate?

Answer 23

It decreases serum phosphate by increasing the renal excretion of phosphate.

Question 24

How is ondansetron metabolized and eliminated?

Answer 24

metabolized by liver

Question 25

Thiazide-type diuretics include:

Answer 25

hydrochlorothiazide, chlorthalidone, metolazone, and indapamide.

Question 26

The normal glomerular filtration pressure is about

Answer 26

60% of the mean arterial pressure or about 60 mmHg.

Question 27

It is opposed by plasma oncotic pressure which exerts a pressure of about ______ mmHg and bowman's capsure pressure which exerts about ___mmhg

Answer 27

32 mmHg and Bowman's capsule pressure which exerts about 18 mmHg.

Question 28

Pressure : Glomerular filtration, plasma oncotic pressure and bowman's capsule

Answer 28

Bowman's Capsule 18 Plasma oncotic pressure 28-32 Glomerular filtration 60

Question 29

COPD heart signs

Answer 29

Heart sounds Split S2, pulmonary/tricuspid insufficiency

Question 30

COPD Blood gas exchange

Answer 30

Reduced DLCO; Hypoxemia (most characteristic of | prominent emphysema

Question 31

Glomerular filtration is also dependent on several physiologic factors: •s

Answer 31

The pressure inside the glomerular capillaries • The pressure in the Bowman capsule • The colloid osmotic pressure of the plasma protein

Question 32

Myogenic mechanism -->

Answer 32

When arterial pressure rises, the arterial wall is stretched, the vessel constricts, and blood flow remains normal. When arterial pressure decreases, the opposite effect occurs. Therefore, renal blood flow remains constant over a wide range of pressure changes

Question 33

is an inward force that tends to hold fluid within the glomerulus.

Answer 33

The colloid osmotic pressure created by proteins in the glomerulus (28 mm Hg)

Question 34

Pressure in the_______ opposes filtration.

Answer 34

Bowman capsule (18 mm Hg)

Question 35

2 byproducts of sevoflurane

Answer 35

Compound A | Fluoride

Question 36

Apex of the lumbar curve

Answer 36

L3-L4

Question 37

The FiO2 delivered by a nasal cannula can vary significantly, but the ranges you can predict that would be delivered by varying flow rates are:

Answer 37

2L/min: 0.26 and 4L/min: 0.36

Question 38

What postoperative anesthetic complication is common in infants after surgery to treat pyloric stenosis? why?

Answer 38

Ventilatory depression; It is thought this may be due to alkalosis of the cerebrospinal fluid. Because of this potential complication, these patients must be fully awake and responsive prior to tracheal extubation.

Question 39

2 murmurs associated with MVP

Answer 39

Midsystolic click | Late systolic murmur

Question 40

What valvular is associated with opening snap?

Answer 40

Mitral stenosis

Question 41

Pulsus paradoxus is more common in patients with tamponade.

Answer 41

Pulsus paradoxus Prominent y-descent on a CVP tracing Kussmaul's sign Ventricular discordance

Question 42

Constrictive pericarditis is similar to cardiac tamponade in many of its features. They both exhibit

Answer 42

pulsus paradoxus and Kussmaul's sign (jugular vein distention during inspiration) which are signs of ventricular discordance.

Question 43

Constrictive pericarditis also exhibits Freidreich's sign, which is a

Answer 43

prominent y-descent on the central venous pressure tracing.

Question 44

Constrictive pericarditis also exhibits Freidreich's sign, which is a

Answer 44

prominent y-descent on the central venous pressure tracing.

Question 45

Which of the following signs and symptoms are consistent with hypoaldosteronism? (select four)

Answer 45

Hyponatremia Hyperkalemia Metabolic acidosis Orthostatis hypotension

Question 46

How does aldosterone regulate potassium levels?

Answer 46

Aldosterone affects the body's ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine.

Question 47

Low aldosterone will lead to high or low K+

Answer 47

High

Question 48

Plasma cortisol levels less than______indicate adrenal insufficiency (Addison's disease). Hyperkalemia and hyponatremia are also symptoms.

Answer 48

20 mcg/dL

Question 49

Adrenal insufficiency is called _____Disease

Answer 49

Addison's

Question 50

Metabolic disturbance with addison's disease | K+, Na+, BP, volume, metabolic disturbance.

Answer 50

``` Hyperkalemia Hyponatremia Hypotension, Hypovolemia, Metabolic acidosis ```

Question 51

Cushing's syndrome metabolic disturbance

Answer 51

HYPOKALEMIC METABOLIC ALKALOSIS

Question 52

When the adrenal glands make too much aldosterone. T

Answer 52

Conn's syndrome

Question 53

Conn's disease is

Answer 53

HYPERALDOSTERONISM

Question 54

Hyperaldosteronism (conn's disease) what will be the metabolic disturbances what about blood pressure?

Answer 54

SYSTEMIC HTN Sodium retention HYPOKALEMIA (polyuria) METABOLIC ALKALOSIS

Question 55

Most specific test for Pheochromocytoma?

Answer 55

Vanillyl mandelic acid, a catecholamine metabolite.

Question 56

Pheochromocytomas are________derived most commonly from

Answer 56

catecholamine-secreting tumors ; chromaffin cells in the adrenal medulla, and less commonly from extraadrenal catecholamine secreting paragangliomas

Question 57

Pheochromocytomas generally adhere to what is known as the “rule of ten.” They involve both adrenal glands in

Answer 57

approximately 10% of adult patients with the tumor; 10% to 15% of the tumors arise from extraadrenal chromaffin cells; and at least 10% of the tumors are malignant.

Question 58

Malignant pheochromocytomas are primarily

Answer 58

extraadrenal

Question 59

Biochemical testing and subsequent diagnosis of a catecholamine- secreting tumor is based on findings of

Answer 59

elevated concentrations of - fractionated catecholamines (epinephrine, norepinephrine, dopamine), - fractionated metanephrine and normetanephrine, and VMA in urine or plasma.

Question 60

What is the primary imaging modality used for diagnosis of pheochromocytoma?

Answer 60

CT of the abdomen and pelvis

Question 61

Inherited syndromes that have been linked to | pheochromocytoma include vone.180,183 A

Answer 61

Hippel-Lindau syndrome, MEN type 2A and MEN type 2B, neurofibromatosis type 1 (formerly known as von Recklinghausen disease), and familial pheochromocytoma/ paraganglioma syndrom

Question 62

pproximately 50% of patients with | MEN type 2A or 2B develop

Answer 62

pheochromocytomas and these tumors secrete predominantly epinephrine177

Question 63

A number of drugs and conditions can precipitate hypertension in pheochromocytoma patients/

Answer 63

Dopamine antagonists (metoclopramide, droperidol), radiographic contrast media indirect-acting amines (ephedrine, methyldopa), drugs that block neuronal catecholamine reuptake (tricyclic antidepressants, cocaine), and histamine may enhance the physiologic effects of tumor product

Question 64

The most common postoperative adverse event with pheorchromocytoma is

Answer 64

sustained hypertension

Question 65

Elevated T3 and T4 levels, in turn, feedback to suppress | the secretion of both

Answer 65

TRH and TSH. TSH

Question 66

Elevated T3 and T4 levels, in turn, feedback to suppress | the secretion of both

Answer 66

TRH and TSH.

Question 67

2 intermediate acting insulin

Answer 67

Human NPH | Lente

Question 68

Thoracic cross clamping effect on ICP

Answer 68

increased cerebrospinal fluid pressure

Question 69

Thoracic cross clamping effect on PVR

Answer 69

increased pulmonary vascular resistance

Question 70

Thoracic cross clamping effect on renal artery blood flow

Answer 70

decreased renal artery blood flow

Question 71

Thoracic cross clamping effect on cranial vault

Answer 71

vascular engorgement in the cranial vault

Question 72

Cross-clamping the thoracic aorta is associated with significant decreases in blood flow in the

Answer 72

distal anterior spinal artery and renal artery.

Question 73

Pulmonary complications can arise from aortic cross-clamping due to T

Answer 73

increased pulmonary vascular resistance with resulting increased pulmonary capillary permeability and pulmonary edema.

Question 74

The cross clamp results in redistribution of the blood volume with

Answer 74

vascular engorgement in the cranial vault. The increased pressure forces cerebrospinal fluid into the spinal compartment and increases CSF pressure.

Question 75

A spinal fluid drain is sometimes used to help prevent inordinant increases in CSF pressure during what

Answer 75

Thoracic cross-clamping

Question 76

Supraventricular tachycardia is any tachycardia.

Answer 76

originating above the ventricles, thus, sinus tachycardia, junctional tachycardia, and atrial tachycardia are all forms of SVT.

Question 77

SVT most commonly occurs due to a

Answer 77

reentry circuit consisting of anterograde conduction over the slower AV nodal pathway and retrograde conduction over a faster accessory pathway

Question 78

It can also occur due to enhanced automaticity of secondary pacemaker cells.

Answer 78

SVT

Question 79

Hyperthyroidism symptoms include

Answer 79

tachycardia Anemia Thrombocytopenia Elevated triiodothyronine

Question 80

You are preparing to administer ketamine orally to a 33 pound three year-old. Which of the following doses would be appropriate?

Answer 80

75 mg 75 mg

Question 81

Following a fiberoptic bronchoscopy, the PaO2 of the patient is approximately 20 mm Hg below his PaO2 prior to the procedure. You know that

Answer 81

. this normally occurs and will resolve in 1-4 hours

Question 82

What hemodynamic change would you expect to see when the anhepatic phase of a liver transplant is initiated?

Answer 82

Hypotension

Question 83

What government agency issues guidelines as to how medical apps on mobile phones should be regulated?

Answer 83

FDA (Food and Drugs adminstartion)_

Question 84

Under normal conditions, approximately 93% of the hormone released from the thyroid gland is ___and 7% is is

Answer 84

T4 ; T3.

Question 85

One of the side effect of atorvastatin

Answer 85

Myalgia

Question 86

The presence of a bicuspid aortic valve predisposes the patient to the development of

Answer 86

Aortic Stenosis

Question 87

Which of the following would be most likely to produce hypokalemia? Diuretics type medication

Answer 87

Thiazide diuretics

Question 88

Extreme flexion at the thigh can result in injury to the

Answer 88

sciatic, obturator, and femoral nerves.

Question 89

What is the most common postoperative complication in the pediatric patient who has undergone tonsillectomy?

Answer 89

Bleeding

Question 90

Which of the following statements describes the age-related changes in glomerular function accurately?

Answer 90

The glomerular filtration rate decreases by 1 mL/min each year after age 40

Question 91

Highly protein-bound drugs display a higher concentration of the free form of the drug in the elderly population. Why is this?

Answer 91

Elderly patients have lower albumin levels

Question 92

Which of the following would be most likely to increase the risk for bradycardia during strabismus surgery?

Answer 92

Hypercapnia, however, increases the risk of bradycardia due to the oculocardiac reflex which can occur due to traction on the ocular muscles.

Question 93

Positioning for ERCP

Answer 93

Lateral | Prone

Question 94

Fibers Believed to exhibit dysfunctional activity in the setting of neuropathic pain.

Answer 94

A and C fibers

Question 95

Eisenmenger's syndrome is defined by the

Answer 95

Reversal of a left-to-right shunt when pulmonary vascular resistance increases above that of systemic vascular resistance.

Question 96

Patent ductus arteriosus is a communication between the

Answer 96

descending aorta and the left pulmonary artery. It normally closes within 48 hours of birth. Prostaglandin inhibition by nonselective COX receptor antagonists such as indomethacin can help promote closure of the defect.

Question 97

Can can help promote closure of the defect. PDA

Answer 97

Indomethacin

Question 98

Widened pulse pressure in the ARMS is associated

Answer 98

Coarctation of the aorta

Question 99

The formula for sevoflurane is .

Answer 99

C4H3F7O.

Question 100

The formula for desflurane is

Answer 100

C3H2F6O.

Question 101

The formula for isoflurane is

Answer 101

C3H2ClF5O

Question 102

The key to distinguishing between them is to count the number of fluorides. Isoflurane has ___desflurane has,___ and sevoflurane has

Answer 102

5,6, 7 fluorides.

Question 103

To remember the number of flurodise

Answer 103

5,6,7 IDS

Question 104

The most common congenital abnormality that can result in aortic dissection is

Answer 104

BICUSPID AORTIC VALVE

Question 105

2 conditions are associated with increased risk for aortic aneurysm and dissection

Answer 105

Although Marfan syndrome and Ehlers-Danlos syndrome are associated with an increased risk for aortic aneurysm and dissection,

Question 106

Following thoracic aortic surgery, a patient exhibits anterior spinal artery syndrome. What symptoms are associated with this disorder? (select two)

Answer 106

Bowel and bladder dysfunction | Flaccid paralysis of the lower extremities

Question 107

Tricuspid atresia is a congenital heart defect that is characterized by a

Answer 107

Small right ventricle Enlarged left ventricle decreased pulmonary blood flow (that occurs via a ventricular septal defect, patent ductus arteriosus, or bronchial vessels), and arterial hypoxemia.

Question 108

In tricuspid atresia, Blood passes from the

Answer 108

right atrium to the left atrium (right-to-left shunt) via an atrial septal defect prior to ejection into the systemic circulation causing a cyanotic defect.

Question 109

Which of the following disorders would be most likely to produce cerebral edema?

Answer 109

Hyponatremia causes the extracellular fluid to become hypotonic. As this occurs, water begins moving into the brain cells causing cerebral edema and intracranial hypertension.

Question 110

Metabolic alkalosis can be the result of

Answer 110

hyperaldosteronism

Question 111

Peripheral neuropathies are most common in patients treated with

Answer 111

vincristine

Question 112

In caucasians, neutropenia is defined as an absolute granulocyte count less than

Answer 112

1500/microliter

Question 113

Most intraoperative drug reactions are due to exposure to

Answer 113

MUSCLE RELAXANTS

Question 114

Define preeclampsia

Answer 114

Systolic HTN 140 mmHg or higher or diastolic of 90 mmhg or highter after 20 weeks of gestation with PROTEINURIA

Question 115

In the absence of proteinuria, the diagnosis can be made when the

Answer 115

new onset HTN with platelet <100K, impaired liver function, renal insufficiency, pulmonary edema, new onset cerebral

Question 116

Manifestations of preeclampsia include:

Answer 116

hypertension, hypovolemia, oliguria, decreased colloid oncotic pressure, pulmonary edema, arterial hypoxemia, decreased uterine blood flow, disseminated intravascular coagulation, cerebral edema, cerebral hemorrhage, acute tubular necrosis, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).

Question 117

What is the most common cause of hypotension in the postanesthesia care unit?

Answer 117

Hypovolemia

Question 118

The critical temperature of nitrous oxide is ___What does it mean?

Answer 118

36.5 degrees Celsius. This means that because its critical temperature is above room temperature, it will remain in liquid form without a refrigeration system.

Question 119

The vessel-rich group is composed of the T

Answer 119

brain, heart, liver, kidneys, and endocrine glands.

Question 120

Vesse; rich It comprises _____of the body mass but receives ___% of CO

Answer 120

10% ; 75% of the cardiac output.

Question 121

The muscle group is comprised of.

Answer 121

muscle and skin

Question 122

Muscle group accounts for % of body mass and receives _% of CO

Answer 122

50% of the body mass and receives 19% of the cardiac output.

Question 123

The fat group is comprised of_____ accounts for the ______body mass, and receives __% CO.

Answer 123

adipose tissue; 20%; 6% of the cardiac output.

Question 124

The vessel-poor group is comprised of ___, __ and ______ accounts for __% of the body mass, and receive ____of the CO

Answer 124

bone, ligament, and cartilage, accounts for 20% of the body mass, and receives a negligible amount (0%) of the cardiac output.

Question 125

The maximum dose of neostigmine is

Answer 125

0.07 mg/kg.

Question 126

The usual dose of pyridostigmine is.

Answer 126

0.1 to 0.3 mg/kg

Question 127

Has the shortest duration of action of the reversal agents.

Answer 127

Edrophonium

Question 128

Physostigmine has a________ chemical structure.

Answer 128

tertiary amine

Question 129

Anticholinergic agents like atropine and scopolamine can produce

Answer 129

cycloplegia, which is paralysis of the ciliary muscle of the eye, resulting in mydriasis (pupillary dilation).

Question 130

Anticholinergic agents like They can decrease

Answer 130

gastric secretions, motility, and peristalsis.

Question 131

Anticholinergic agents They also decrease the muscle tone in the

Answer 131

bladder (detrusor muscle) which can lead to urinary retention.

Question 132

Dextran 40 has been shown to improve microcirculation by:

Answer 132

decreasing blood viscosity thereby improving laminar flow in the microcirculatory beds.

Question 133

Administration of anticholinergics in general results in a ___________gastric secretions, ______peristalsis and intestinal motility, _______Gastric emptying time, ___________esophageal sphincter tone.

Answer 133

``` decrease in gastric secretions decreased Peristalsis decreased intestinal motility prolonged gastric emptying time reduced Lower esophageal sphincter tone ```

Question 134

Anticholinergic and ventricular function or PVR?

Answer 134

There is no significant effect on ventricular function or peripheral vascular resistance.

Question 135

The pharmacological theory that states that the magnitude of the effect of a drug is proportional to the number of receptors it occupies is known as the

Answer 135

Occupancy theory

Question 136

Which of the following muscles is responsible for preventing the tongue from falling back against the posterior pharynx and occluding the airway when performing a jaw-thrust maneuver?

Answer 136

Genioglossus

Question 137

Gas exchange occurs in the airways across which type of cells?

Answer 137

Squamous epithelium

Question 138

Side effects of histamine include:

Answer 138

increased capillary permeability

Question 139

When administered concurrently with metoclopramide, those meds increase the likelihood that the patient will experience extrapyramidal symptoms.

Answer 139

phenothiazine derivatives such as thioridazine and chlorpromazine and butyrophenones (droperidol)

Question 140

Is used in the treatment of extrapyramidal disorders

Answer 140

Benztropine mesylate (Cogentin)

Question 141

Meds that can antagonize the gastrointestinal effects of metoclopramide.

Answer 141

Anticholinergics such as atropine, glycopyrrolate, and scopolamine

Question 142

Which of the following is a potential side effect of 5-HT3 receptor antagonists?

Answer 142

QT interval prolongation. They do not produce sedation, extrapyramidal symptoms, or respiratory depression, but can prolong the QT interval slightly and should be used cautiously in patients who already have a prolonged QT interval

Question 143

Name some 5HT3 receptor antagonists

Answer 143

ondansetron, dolasetron, and granisetron

Question 144

Which of the following statements regarding buprenorphine is true?

Answer 144

It can produce naloxone-resistant respiratory depression

Question 145

It can cause respiratory depression that is resistant to naloxone.

Answer 145

buprenorphine

Question 146

It can produce withdrawal symptoms in patients who are physically dependent on morphine.

Answer 146

buprenorphine

Question 147

Intentional lung collapse on the operative side is commonly used to enhanced visualization of the operative field. Side effects are primarily due to the large intrapulmonary shunt that develops because the upper lung is still being perfused but not ventilated. Th

Answer 147

The PA-a gradient widens and hypoxemia typically ensues. One-lung ventilation does not appreciably change the arterial CO2 tension.

Question 148

Intentional collapse of the lung on the operative side and one-lung ventilation during thoracic surgery results in

Answer 148

widening of the PA-a (alveolar to arterial) gradient

Question 149

The primary causes of respiratory acidosis can be divided into two categories:

Answer 149

those due to alveolar hypoventilation and those due to increased CO2 production.

Question 150

Other factors that can produce a normal anion gap acidosis include

Answer 150

hypoaldosteronism, renal tubular acidosis, carbonic anhydrase inhibitors or the administration of large volumes of bicarbonate-free intravenous fluids.

Question 151

The higher the blood:gas partition coefficient is, the more the onset will be slowed

Answer 151

increase in cardiac output

Question 152

If you're using an agent with a HIGH blood:gas partition coefficient, the onset will be _______ if there is an increase in CO and ________if there is a decrease in CO

Answer 152

SLOWER; FASTER

Question 153

Despite having a lower blood:gas solubility coefficient, the rate of rise of the FA/Fi ratio is higher for nitrous oxide than for desflurane. This is due primarily to the what effect?

Answer 153

Concentration effect

Question 154

Agents with a lower blood:gas partition coefficient exhibit a ________in the FA/Fi ratio.

Answer 154

faster rate of rise

Question 155

The exception is that nitrous oxide will exhibit a faster rate of rise than desflurane despite the fact that it has a blood:gas partition coefficient of 0.47 and desflurane has a blood:gas partition coefficient of 0.42. The increase with nitrous oxide is due to the fact that it is administered in doses of

Answer 155

50-70% compared to 3-9% for desflurane. This is referred to as the concentration effect.

Question 156

Which statement is a correct summary of the Meyer-Overton rule?

Answer 156

Potency of an anesthetic is proportional to its lipid solubility

Question 157

Which blood vessel brings blood into the glomerulus?

Answer 157

Afferent arteriole

Question 158

Blood enters the glomerulus via the ____artery and leaves via thearteriole. An easy way to remember this is with the letters each words begins with:

Answer 158

afferent ; efferent; A-fferent arteriole A-pproaches the glomerulus and the E-fferent arteriole E-xits the glomerulus.

Question 159

Typical findings in a patient with cirrhosis include:

Answer 159

Right-to-left shunting, decreased systemic vascular resistance, increased cardiac output, elevated alkaline phosphatase, prolonged INR, thrombocytopenia, hypoalbuminemia, and hypoglycemia.

Question 160

SVR and CO in a patient with Cirrhosis

Answer 160

Decrease, Increase CO

Question 161

Albumin and BS in patient with cirrhosis

Answer 161

Hypoalbuminemia and HYPOGLYCEMIA>

Question 162

Elevated also in cirrhosis

Answer 162

Elevated alkaline phosphatase.

Question 163

The normal response to the increased venous return in the Trendelenburg position is vaso_____and _____in HR , why?

Answer 163

asodilation and a decrease in the heart rate due to baroreceptor reflex stimulation.

Question 164

Pt who are hypotensive response to Trendelenburg?

Answer 164

Variable response

Question 165

Platelet count during pregnancy is

Answer 165

Decreased

Question 166

GFR and pregnancy

Answer 166

The glomerular filtration rate increases by as much as 50%.

Question 167

Peripheral vascular resistance and pregnancy

Answer 167

Decreased

Question 168

The cardiac output, stroke volume, and heart rate all _____during pregnancy

Answer 168

Increase

Question 169

4 parameters that are decreased during pregnancy

Answer 169

systolic blood pressure, diastolic blood pressure, peripheral vascular resistance, and pulmonary vascular resistance decrease

Question 170

By which exchange mechanism do large molecules such as immunoglobulins cross the placental barrier?

Answer 170

Pinocytosis

Question 171

The primary mechanisms of placental exchange are: 12), and

Answer 171

1) Passive Transport 2) Active Transport 3) Pinocytosis 4) Facilitated diffusion

Question 172

Passive transport for placental exchange are: transport, by which

Answer 172

small ions, respiratory gases, and most drugs under 600 daltons cross,

Question 173

Active transport for placental exchange, which is responsible for the transfer of

Answer 173

amino acids, vitamins, calcium, and iron

Question 174

Pinocytosis transport for placental exchange,, which is ho

Answer 174

larger molecules such as immunoglobulins cross the placental barrier,

Question 175

Facilitated diffusion for placental exchange , which is

Answer 175

mediated by a carrier and includes substances such as glucose.

Question 176

You are reviewing the preoperative record for a patient about to undergo anesthesia for eye surgery. Which of the following ocular medications will prolong the duration of action of succinylcholine? How long will it lasts

Answer 176

Echothiophate; The duration of paralysis usually does not exceed 20-30 minutes

Question 177

Appropriate precautions for fire prevention during laser airway surgery include:

Answer 177

- reducing the FiO2 as low as the patient can tolerate - fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat, - limit the laser intensity and duration as much as possible, and keep a source of saline on hand in case of fire.

Question 178

Appropriate precautions for fire prevention during laser airway surgery include:

Answer 178

- reducing the FiO2 as low as the patient can tolerate - fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat, - limit the laser intensity and duration as much as possible - keep a source of saline on hand in case of fire.

Question 179

What is the most common injury after anesthesia?

Answer 179

Corneal ABrasion

Question 180

What are 4 factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: (select four)

Answer 180

``` Obesity Estrogen therapy Prolonged immobilization Pregnancy Advanced age, major surgical procedures lasting longer than 30 minutes, hereditary thrombophilias, spinal cord injury, malignancy, previous thromboembolism, estrogen therapy, pregnancy, and prolonged immobilization. ```

Question 181

factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: Surgery time?

Answer 181

major surgical procedures lasting longer than 30 minutes,

Question 182

One hereditary disease putting the patient at risk for DVT?

Answer 182

hereditary thrombophilias

Question 183

What surgical procedure has the highest risk for postoperative delirium in elderly patients?

Answer 183

Orthopedic surgery

Question 184

Which inhaled anesthetic produces the highest levels of carbon monoxide when exposed to dessicated cabon dioxide absorbent?

Answer 184

Desflurane (next is ISOFLURANE)

Question 185

Which monitors reliably detect a disconnection in the breathing system? (select two)

Answer 185

End-tidal CO2 monitor | Respirometer

Question 186

If the breathing circuit is disconnected, the oxygen analyzer would

Answer 186

continue to detect oxygen entrained from ambient air and would not necessarily indicate that a disconnection has occurred.

Question 187

Useless in telling you if the breathing circuit is disconnected?

Answer 187

Oxygen analyzer

Question 188

Position is associated with RHABDOMYOLOSIS

Answer 188

Lateral decubitus

Question 189

Factors that result in an increased SVO2 include:

Answer 189

``` Cyanide toxicity Left-to-right shunts Sepsis Wedged pulmonary artery catheter Hypothermia ```

Question 190

Factors that result in a decreased SVO2 include:

Answer 190

``` Hyperthermia Hemorrhage, Shivering decreased cardiac output decrease in the pulmonary transport of oxygen. ```

Question 191

With a right-to-left shunt, the shunted blood mixes with and dilutes the blood coming from the ventilated alveoli resulting in a _______of alveolar partial pressure of the anesthetic. Effect on the the rise in alveolar concentration _____? How does it affect induction _____?

Answer 191

reduction of alveolar partial pressure of the anesthetic. The decrease in the rise in alveolar concentration slows induction of anesthesia.

Question 192

The extent of slowing a right-to-left shunt will produce in the rate of increase in the alveolar concentration, varies with the

Answer 192

solubility of the anesthetic

Question 193

``` The rate of rise of the alveolar concentration of an insoluble agent (low blood/gas coefficient) will be affected (more or less ) with a RIGHT TO LEFT SHUNT ```

Answer 193

more than that of a soluble anesthetic (high blood/gas coefficient).

Question 194

In patients undergoing surgical debridement for burns, placement of the ECG leads can be challenging. In situations where the adhesive pads cannot be placed due to the damage they would cause to the burned tissue, the leads should be

Answer 194

stapled to the patients skin or needle electrodes should be used.

Question 195

When the anesthesia machine ventilator is in use, the amount of fresh gas flow that contributes to the tidal volume during inspiration is increased by

Answer 195

higher I:E ratios

Question 196

What is the most reliable method of confirming placement of the endotracheal tube in the trachea?

Answer 196

Detection of exhaled CO2

Question 197

Which anti-epileptic drug is least likely to produce aplastic anemia?

Answer 197

Gabapentin

Question 198

Antiepileptic drugs associated with APLASTIC ANEMIA They are most commonly seen with

Answer 198

valproate, carbamazepine, and phenytoin.

Question 199

Valproate, carbamazepine and phenytoin are all associated with

Answer 199

Aplastic anemia

Question 200

A child with tetralogy of FALLOT having a test spell? what can you do to help?

Answer 200

Squatting increases peripheral vascular resistance and relieves the right-to-left shunt.

Question 201

Relieves the _______ shunt for patient with tetralogy of fallot can be done by having the patient ______

Answer 201

right to left shunt | squatting

Question 202

Name 3 short acting insulin

Answer 202

Human regular Humalog Novolog.

Question 203

Glargine lantus peak

Answer 203

NO PEAK

Question 204

Which of the following surgical conditions is common in patients with acromegaly?

Answer 204

Carpel tunnel syndrome

Question 205

According to the Occupational Health and Safety Administration (OSHA), the first step a facility should take to decrease the incidence of workplace violence and disruptive behavior is

Answer 205

perform an organization-wide assessment

Question 206

EGD allowed in pregnant patients?

Answer 206

yes

Question 207

Versed, pregnancy and fetal

Answer 207

Midazolam crosses the placenta and results in fetal depression, so it is not indicated for pregnant patients.

Question 208

Depression of the ST segment is typically associated with

Answer 208

subendocardial ischemia

Question 209

ECG signs is typically associated with transmural ischemia.

Answer 209

ST segment elevation

Question 210

In mitral regurgitation, your goal is to maintain an ____HR and Afterload.

Answer 210

increased heart rate and decreased afterload,

Question 211

While the goal in mitral stenosis is to HR and afterload.

Answer 211

maintain a normal or decreased heart rate and normal afterload.

Question 212

Mitral regurgitation and stenosis: In both disorders, you should maintain

Answer 212

normal sinus rhythm, avoid increases in pulmonary vascular resistance, and maintain preload at normal to increased levels.

Question 213

Associated with an 'opening snap' that occurs in early diastole and a rumbling diastolic murmur heard best at the axilla or apex. .

Answer 213

Mitral stenosis is associated

Question 214

A holosytolic murmur at the apex that radiates to the axilla is associated with

Answer 214

mitral valve regurgitation

Question 215

Mitral valve prolapse is associated with a

Answer 215

midsystolic click and a late systolic murmur.

Question 216

By what principal mechanism does morphine produce nausea?

Answer 216

. Stimulation of the chemoreceptor trigger zone

Question 217

Many central nervous system neurotransmitters decline with age. Which one is most closely associated with the development of Alzheimer's disease

Answer 217

Acetylcholine

Question 218

Neurotransmitters and aging?

Answer 218

CNS concentrations of dopamine, serotonin, GABA, and acetylcholine all decrease with age.

Question 219

Should not undergo MEP via magnetic stimulation.

Answer 219

Patients with spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy

Question 220

Motor evoked potentials (MEPs) are useful in the monitoring of functional integrity of ______

Answer 220

motor tracts, namely, the corticospinal tract.

Question 221

Motor evoked potentials monitor integrity of the

Answer 221

Corticospinal

Question 222

The Bullard laryngoscope is what kind of laryngococope? What mouth opening does it require? What sizes are available?

Answer 222

indirect fiberoptic laryngoscope that provides direct visualization of the vocal cords. It allows the patient to remain in anatomic position, only requires a mouth opening of 0.64 cm, and is available in adult and pediatric sizes.

Question 223

Bullard laryngoscope available in pediatric sizes?

Answer 223

Yes

Question 224

3 that are all associated with the loss of the 'a' wave on a CVP waveform.

Answer 224

Atrial fibrillation, ventricular pacing, and asystole

Question 225

The x descent follows the a wave and represents the

Answer 225

start of atrial systole.

Question 226

CVP: occurs as a result of the downward pull of the ventricular septum during systole.

Answer 226

The x descent

Question 227

CVP represents the opening of the tricuspid valve.

Answer 227

y descent

Question 228

All associated with large 'v' waves on the CVP waveform.

Answer 228

VTMR | Tricuspid regurgitation, mitral regurgitation, or a sudden, dramatic increase in intravascular volume are

Question 229

P wave represents on ECG

Answer 229

Atrial depolarization

Question 230

End of P to beginning of QRS

Answer 230

Atrial depolarization is completed

Question 231

QRS is

Answer 231

Ventricular depolarization is beginning and the atria are repolarizing

Question 232

Isometric line after QRS represents

Answer 232

Ventricular depolarization is completed

Question 233

T wave of the QRS represents

Answer 233

Ventricular repolarization

Question 234

Isometric line : Time from T wave to P wave represents

Answer 234

Ventricular repolarization is completed.

Question 235

A single epidural injection of 80 mg of methylprenisolone can suppress plasma cortisol and the ability to secrete it for how long after injection?

Answer 235

3 weeks after the injection.

Question 236

Which steroid would be most likely to produce an embolism from inadvertent arterial particulate injection during an epidural steroid injection?

Answer 236

Methylprednisolone

Question 237

Steroid with the largest particle size?

Answer 237

Methylprednisolone has the largest particle size and would be more likely to produce a significant embolus if injected arterially.

Question 238

Steroid with the smallest particle size?

Answer 238

Betamethasone has the smallest particles and triamcinolone is between the two.

Question 239

Steroid with the NO PARTICLE AT ALL ?

Answer 239

Dexamethasone contains no particles at all.

Question 240

Patients with type _______blood can receive any type of blood.

Answer 240

AB

Question 241

Because the cells of type O blood don't contain

Answer 241

contain the A or B surface antigens, it can be administered universally.

Question 242

The most common reaction from the mixing of type A blood with type B blood is the

Answer 242

agglutination (clumping together) of the cells.

Question 243

A patient who has the D antigen is referred to as_____If the D antigen is absent, they are called Rh______

Answer 243

Rh positive; RH negative.

Question 244

Approximately 90% of Americans are Rh ______

Answer 244

positive

Question 245

The first exposure of an Rh negative patient usually produces _______ Then, what happens? What happens when the patient receives another transfusion of RH positive,

Answer 245

no reaction.Over the next 2-4 weeks, however, the patient develops enough antibodies to produce agglutination of the previously transfused cells still circulating. This is referred to as a delayed transfusion reaction. If the patient receives another transfusion of Rh positive blood, the reaction is as quick and severe as a transfusion of mismatched type A or type B blood.

Question 246

Thoracic paravertebral block (TPVB) produces both a

Answer 246

somatic and sympathetic block on the side of the injection

Question 247

Most common complication of a Thoracic paravertebral block?

Answer 247

The most common is pneumothorax.

Question 248

all potential complications of a thoracic paravertebral block

Answer 248

Although intravascular injection Nerve damage Failed block

Question 249

Axillary Block : A well-defined, localized pulsation of the

Answer 249

Axillary artery is more important to successful blockade than the point at which needle insertion occurs within theaxilla.

Question 250

Axillary Typically, the median nerve is

Answer 250

anterior to the axillary artery

Question 251

Provides sensation to lateral aspect of the FA

Answer 251

MCN

Question 252

What mandates a chest film to evaluate for pneumothorax when performing TPVB?

Answer 252

The aspiration of air

Question 253

During a TPVB, Once the needle contacts the bone, it should be

Answer 253

walked off the process superiorly and advanced until a loss of resistance is encountered as the needle crosses the superior costotransverse ligament. Usually, this is another 1-1.5 cm beyond the transverse process.

Question 254

Which ventilator setting guidelines would be the most appropriate for the patient with sepsis?

Answer 254

The current recommended protocol is a low tidal volume, low inspiratory pressure, and the application of PEEP.

Question 255

The most common cause of hyperphosphatemia is T

Answer 255

renal failure.

Question 256

Can be used as a temporary treatment for hyperphosphatemia.

Answer 256

The administration of saline and acetazolamide

Question 257

Will increase gastrointestinal losses of phosphate.

Answer 257

Aluminum hydroxide w

Question 258

Which conditions will increase the chances of a paradoxical embolus in a patient with a right-to-left cardiac defect? (select two)

Answer 258

Pulmonary hypertension | Valsalva maneuver

Question 259

In congestive heart failure, sympathetic activation is______(increased or decreased).

Answer 259

increased, which results in increased secretion of norepinephrine

Question 260

CHF and Circulating vasopressin levels

Answer 260

nearly twice the normal value in patients with congestive heart failure.

Question 261

Natriuretic peptide levels and CHF,

Answer 261

increase as the ventricles become the principal source of the hormone's release.

Question 262

In CHF , there is a chronic increase in

Answer 262

Circulating catecholamines

Question 263

The chronic increase in circulating catecholamines seen in CHF produces widespread______Then what happens to blood flow to the kidneys?

Answer 263

arteriolar vasoconstriction which shunts blood away from the skin, gastrointestinal tract, heart, and brain. As blood flow to the kidneys decreases, the renin-angiotensin-aldosterone axis is activated which results in sodium retention and interstitial edema.

Question 264

Which of the following is an oral nonparticulate antacid?

Answer 264

Sodium citrate

Question 265

MOA of sodium citrate

Answer 265

Increase gastric pH

Question 266

In the intrinsic pathway, what is the component required to convert factor XII to factor XI?

Answer 266

Prekallikrein

Question 267

Factor XII reacts with these two to activate Factor XI.

Answer 267

Prekallikrein and other components like High Molecular Weight Kininogen

Question 268

A patient who is severely ill from chronic ulcerative colitis is presenting for colon resection. You know that this patient's labwork would likely reveal

Answer 268

Decrease serum albumin

Question 269

Antacids can slow the absorption of 2 drugs

Answer 269

cimetidine and digoxin

Question 270

Antacids SPEED the absorption

Answer 270

NSAIDs, like asa, naproxen,

Question 271

Patients with COPD, the total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC) are all

Answer 271

normal or increased.

Question 272

Lung parameters most decreased in patients with COPD

Answer 272

FEV25-75 is decreased the most.

Question 273

The FEV1/FVC ratio is _______in COPD

Answer 273

Decreased

Question 274

Hypocalcemia in the presence of a low or normal phosphate level is usually indicative of a 2 things

Answer 274

vitamin D or magnesium deficit.

Question 275

Which of the following would you expect to see with a myocardial contusion?

Answer 275

Increased serum troponin

Question 276

Enzymes that may be elevated with y

Answer 276

Chest pain, palpitations, dysrhythmias, ST and T wave abnormalities, and elevated LDH, creatine kinase, and troponin levels

Question 277

Autonomic dysreflexia 2 main things

Answer 277

Vasoconstriction below the level of spinal cord injury | Vasodilation above the level of spinal cord injury

Question 278

During acute phase of a high-level SCI patients often develop this shock ______Characterized by

Answer 278

Neurogenic shock | Hypotension requires inotropic support

Question 279

Autonomic dysreflexia occur s with lesion

Answer 279

above T6

Question 280

Stimuli that can cause autonomic dysreflexia

Answer 280

Bladder or COLORECTAL DISTENTION

Question 281

Management of autonomic dysreflexia is to

Answer 281

correct the noxious stimuli | Rapid reduction of BP with nitrates , CAPTOPRIL, hydralazine, and labetalol.

Question 282

Maximum dose of sodium nitroprusside is

Answer 282

10 mcg/kg per min

Question 283

Sodium nitroprusside main hemodynamic effect

Answer 283

Decrease both afterload and preload Decrease cardiac filling pressure Increase SV and CO

Question 284

Left ventricular volume are _____With sodium nitroprusside

Answer 284

Decreased

Question 285

The chemical structure of sodium nitroprusside contains

Answer 285

5 cyanide ions. One binds to methemoglobin to form CYANmethemoglobin. The other 4 undergoes rhodanese-catealyzed conversion to THYOCYANATE By the liver, which thyocyanate undergo renal elimination

Question 286

To decrease the risk of THYOCYONATE toxicity what should be used with what medications

Answer 286

Infusion pump always with sodium nitroprusside

Question 287

Name the 3 classes of Calcium channel blockers?

Answer 287

``` 1, 4 Dihydropyridine derivatives (Nifedipine) Benzothiazepines derivatives (Cardizem) Phenylakalanine derivatives (Verapamil) ```

Question 288

Non DHPs CCBs are

Answer 288

Verapamil and cardizem

Question 289

All CCBs have

Answer 289

negative inotropic and chronotropic effects

Question 290

CCBs on the conduction system

Answer 290

Depress electrical impulses in the SA and AV nodes

Question 291

CCB and coronary and systemic

Answer 291

They produce coronary and systemic vasodilation.

Question 292

What is the first sign of adult respiratory distress syndrome?

Answer 292

Hypoxemia resistant to oxygen therapy

Question 293

2 antibiotics that potentiates NMB

Answer 293

Aminoglycosides (Clindamycin) | Tetracycline

Question 294

What is it and Why is there a cross reactivity with PCN and cephalosporins?

Answer 294

10% . Because of their common beta lactam ring.

Question 295

What is it and Why is there a cross reactivity with PCN and cephalosporins?

Answer 295

10% . Because of their common beta lactam rings.

Question 296

Drug of choice for many surgeries

Answer 296

Cefazolin

Question 297

Cefazolin is effective against

Answer 297

Streptococcus Methicillin susceptible Staphylococci Gram NEGATIVE BACTERIA.

Question 298

A patient has a higher risk for allergic reaction to protamine if he/she has a known allergy to (select two)

Answer 298

Protamine insulin | Fish products

Question 299

Guillain-Barre syndrome is associated with (select two)

Answer 299

Previous infection by Campylobacter bacteria | Arreflexia

Question 300

The clinical presentation of GBS usually includes.

Answer 300

symmetrical paresthesias and weakness starting at the distal extremities and progressing to the proximal extremities and cranial muscles

Question 301

Pain often accompanies the syndrome as well as

Answer 301

sensory loss and arreflexia. GBS is self-limiting and full recovery usually occurs.

Question 302

Guillain-Barre syndrome (GBS) is often preceded by a

Answer 302

mild course of gastrointestinal or influenza-like illness caused by the Campylobacter jejuni bacteria, Epstein-Barr virus, or cytomegalovirus. I

Question 303

Angiotensin converting enzyme inhibitors are associated with

Answer 303

increased bradykinin levels produce angioedema and cough

Question 304

During laparoscopic surgery on a healthy patient, what hemodynamic effect would you expect to see as a result of insufflation of the abdomen to a pressure of 12-15 mm Hg?

Answer 304

A decrease in stroke volume

Question 305

During what period following general anesthesia are premature neonates most likely to exhibit apnea and bradycardia?

Answer 305

4-6 hours following surgery

Question 306

End stage liver disease is generally associated with a very low SVR, increased cardiac index, and increased mixed venous oxygen saturation.

Answer 306

Increase in CI

Question 307

Within the first hour of the neohepatic period, the patient exhibits a decrease in cardiac output and an increase in systemic vascular resistance. What does this change indicate?

Answer 307

The graft is functioning well

Question 308

Change during NEOHEPATIC PERIOD Indicative that the graft is functioning well,

Answer 308

Decrease in CO | Increase in SVR

Question 309

When use Posttetanic count (PTC) use?

Answer 309

When there is no response to the commonly used tests due to 100% paralysis

Question 310

The value of the PCT is to

Answer 310

attempt to give a rough time estimate as to when recovery may occur.

Question 311

PTC involves the use of a

Answer 311

50-Hz tetanic stimulation for 5 seconds. followed in 3 seconds by a series of single 1-Hz twitch stimulation.

Question 312

PTC : you must first understand this

Answer 312

Posttetanic stimulation or potentiation

Question 313

What is the POSTTETANIC STIMULATION or potentiation?

Answer 313

When the 50-Hz tetanus is applied, there is no response because the patient is 100% blocked. However, application of the 50-Hz tetanus TRANSIENTLY MOBILIZES EXCESS ACH so that after a 3 second pause, you are able to produce a short series of single-twitch response in the hand. Because they only occur after tetanus is applied, that 's why its called posttetanic stimulation. The # of twich elicited is counted, THE HIGHER THE COUNT, the less intense the block. Usual count is between 0 (deep block) and 8 (less intense)

Question 314

With Posttetanic stimulation, the higher the count,

Answer 314

The less intense the block

Question 315

For rocuronium, for example neogstimine reversal of an intense block where the PTC was 1 to 2 takes

Answer 315

50 minutes

Question 316

At a PTC of 6 to 8, reversal should occur in

Answer 316

less than 10 minutes.

Question 317

How is a two-level combined spinal-epidural performed?

Answer 317

The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural

Question 318

When performing an epidural using the 'Hanging Drop' technique, you know that the use of this technique helps verify that the epidural needle

Answer 318

has entered the epidural space. A visible drop of fluid is placed on the hub of the epidural needle. Because the epidural space has a slightly negative pressure, as the needle enters the epidural space, the drop of fluid will be sucked into the epidural space.

Question 319

Elderly and receptor response changes

Answer 319

a diminished cardiac response to beta-receptor stimulatio

Question 320

Severely obese patients often have elevated liver enzymes. Which enzyme is elevated due to the blockage of bile canaliculi by triglyceride depositions?

Answer 320

Alanine aminotransferase

Question 321

ECG changes consistent with obesity.

Answer 321

Low QRS voltage LVH criteria left atrial enlargment t-wave flattening in the inferior and lateral leads, and prolonged QT interval

Question 322

What is the recommended dose of intravenous nalbuphine in a laboring parturient?

Answer 322

10 mg

Question 323

What is the recommended route and dosage of butorphanol for a laboring parturient? (select two)

Answer 323

1-2 mg IM | 1-2 mg IV

Question 324

Neonate dose of naloxone

Answer 324

0.1mg

Question 325

Butorphanol and nalbuphine are which class of medication

Answer 325

Opioid agonist-antagonist

Question 326

2 meds associated with a ceiling effect?

Answer 326

Butorphanol and Nalbuphine

Question 327

Butorphanol and nalbuphine are associated with a "CEILLING EFFECT" what does that mean?

Answer 327

incrementally higher doses do not result in increasing respiratory depression.

Question 328

Advantages of butorphanol and nalbuphine

Answer 328

Less respiratory depression.

Question 329

Typical Butorphanol dose for labor

Answer 329

1-2 mg IV or IM.

Question 330

Butorphanol vs morphine

Answer 330

5 times as potent than morphine. | Butorphanol increases PULMONARY artery presure and myocardial work.

Question 331

Nalbuphine dose for labor

Answer 331

5-10 mg IV, IM or SC

Question 332

Nalbuphine 5-10mg is equivalent to

Answer 332

10mg of morphine

Question 333

In pregnancy, insulin resistance

Answer 333

increases due to the effects of lactogen

Question 334

In pregnancy , insulin resistance is due to the effect of

Answer 334

Lactogen

Question 335

Caudal anesthetic dosage for kids

Answer 335

0.5 to 1 mL of solution per kg of bodyweight should be injected in a caudal anesthetic to achieve an umbilical level of anesthesia.

Question 336

Blockade of the medial branch of the _____can relieve pain from sacroiliac joint syndrome.

Answer 336

dorsal rami of L5 and S1-S3 via a facet joint injection

Question 337

Which evoked potential test is used the LEAST in surgical patients?

Answer 337

VEP

Question 338

Hypothermia is defined as a core temperature below

Answer 338

Anything less than 36 degrees Celsius (96.8 degrees Fahrenheit) i

Question 339

What drug is the standard opioid for the treatment of cancer pain?

Answer 339

MORPHINE

Question 340

What are the two leading causes of end-stage renal disease? (select two)

Answer 340

HTN | DM

Question 341

The most common congenital heart defect in infants and children

Answer 341

Ventricular septal defects

Question 342

Which of the following parameters would you expect to increase upon release of an aortic cross-clamp ?

Answer 342

Pulmonary artery pressure

Question 343

Motor evoked potentials are contraindicated in patients with

Answer 343

spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy.

Question 344

What is the most common symptom of overmedication with phenoxybenzamine in the treatment of pheochromocytoma?

Answer 344

ORTHOSTATIC HYPOTENSION

Question 345

Which of the following is a precipitating factor for acute intermittent porphyria?

Answer 345

PROLONGED NPO TIMES

Question 346

Identified as a precipitating factor for Acute Intermittent Porphyria.

Answer 346

Fasting

Question 347

Neuroleptic malignant syndrome closely resemble

Answer 347

MH

Question 348

When is the optimal time to perform an epidural block for the treatment of postherpetic neuralgia?

Answer 348

Within 2 weeks of the appearance of the rash

Question 349

May be activated by low blood pressure, increased tubular chloride concentration, or by sympathetic stimulation.

Answer 349

Renin release

Question 350

Select two ways in which renin release is triggered.

Answer 350

Hypotension | Increased tubular potassium concentration

Question 351

Renin release may be activated by which 3 mechanisms (HIS)

Answer 351

HoTN (low BP) Increased tubular chloride concentration Sympathetic stimulation.

Question 352

The highest rehabilitation success rate for substance abuse occurs with a minimum of ___ inpatient treatment days and at least ___ treatment days total.

Answer 352

28 and 90

Question 353

The elimination half life of CO is.

Answer 353

4-6 hours

Question 354

Elimination half life of CO, therefore, after 3 half lives

Answer 354

3 half lives, and existing CO blood levels would have fallen by over 80%.

Question 355

May take several weeks to begin to function normally after cessation of smoking.

Answer 355

Mucociliary function

Question 356

3 factors that determine the regurgitant volume in mitral regurgitation.

Answer 356

The size of the mitral valve opening The heart rate, and the pressure gradient across the valve

Question 357

How does an increase in the diastolic blood pressure affect the severity of aortic regurgitation? (select two)

Answer 357

It results in an increase in the backward pressure gradient across the valve It increases the left ventricular regurgitant volume An increase in the diastolic blood pressure increases the backward pressure gradient which results in an increase in the proportion of stroke volume that regurgitates back into the left ventricle.

Question 358

Hemophilia A is a________ disorder but affects is

Answer 358

sex-linked recessive. both males and females (males are just much more likely to have the disease). It

Question 359

Decrease in Factor VIII levels

Answer 359

Hemophillia A

Question 360

Hemophilia B is also known as

Answer 360

Christmas disease because Factor IX

Question 361

Patients with hemophilia A will exhibit a______PTT

Answer 361

prolonged

Question 362

The addition of hyaluronidase in LA facilitates the

Answer 362

spread of the local anesthetics into the tissue and speeds the onset of the block.

Question 363

The addition of dextran to a local anesthetic solution

Answer 363

increases the duration of action. Studies indicate that this effect is most pronounced when the pH of the solution is high.

Question 364

The addition of a vasoconstrictor such as epinephrine and phenylephrine will

Answer 364

prolong the effect of local anesthetics.

Question 365

Opioids shift the CO2 response curve to the

Answer 365

RIGHT

Question 366

There are four types of indicators:.

Answer 366

nonrotating float skirted float Ball float Plumb bob float.

Question 367

Are referred to as rotating indicators because they have vanes or grooves cut into the top portion that causes them to spin while they float in the tube. This allows the anesthetist to be certain that the float has not simply become stuck in the tube and is accurately measuring the gas flow

Answer 367

The skirted float and plumb bob float

Question 368

The worst case scenario would be a ______float in the tube giving the impression that adequate oxygen flow is being delivered, when in fact the patient may be in jeopardy of hypoxia.

Answer 368

non-rotating or ball float stuck

Question 369

Descending bellows are attached to the top of the cylinder. The bellows fall during_____ and rise during the_________ The bottom plate of the bellows is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.

Answer 369

exhalation ; inhalation phase.

Question 370

The local anesthetic with the highest degree of protein binding is

Answer 370

bupivacaine

Question 371

LAs with the have the highest degree of protein binding (97%).

Answer 371

Bupivacaine and levobupivacaine

Question 372

The bottom plate of the DESCENDING bellows and why it isn't ideal if there is a disconnection?

Answer 372

It is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.

Question 373

The rapid onset of chlorprocaine is because of the

Answer 373

HIGH Concentration that is used.

Question 374

The rapid onset of chlorprocaine is because of the

Answer 374

HIGH Concentration that is used because its pka is far from physiologic pH

Question 375

A properly inserted laryngeal mask airway will

Answer 375

protect the airway from pharyngeal secretions

Question 376

Will show a decline in EEG activity.

Answer 376

Hypoxia and cerebrovascular ischemia

Question 377

Subanesthetic doses of inhalation agents with nitrous oxide and subanesthetic doses of intravenous anesthetic drugs can

Answer 377

increase EEG activity.

Question 378

Ketamine administration on EEG activity

Answer 378

increase EEG activity.

Question 379

Placing a blood pressure cuff on an extremity that is below the level of the heart will

Answer 379

Overestimation of the actual BP

Question 380

Phospholipase A2, which is the rate-limiting enzyme in the conversion of

Answer 380

arachidonic acid into prostaglandins and leukotrienes, is the primary inflammatory mediator implicated in disc herniation

Question 381

Cervical epidural steroid injections should be performed at

Answer 381

C6-C7 or C7-T1 and no higher.

Question 382

Which of the following agents used in controlled hypotension techniques is most likely to produce myocardial depression?

Answer 382

Esmolol

Question 383

The Kell antigen system is related to

Answer 383

autoimmune diseases.

Question 384

Type O blood have what antibodies>? T

Answer 384

anti-A antibodies and anti-B antibodies, and patients with Type AB have neither.

Question 385

The most common reaction from the mixing of type A blood with type B blood is theT

Answer 385

agglutination (clumping together) of the cells.

Question 386

The type D Rh antigen is____ ____ than the other Rh subtypes.

Answer 386

more antigenic

Question 387

What increases the risk of postoperative pneumonia by 300%?

Answer 387

Chronic respiratory disease

Question 388

Factors other than respiratory diseases that increase the risk of postop pna?

Answer 388

Obesity | Age greater than 70 years, and surgery lasting longer than 2 hours

Question 389

PPV on venous return decreases right ventricular stroke volume during inspiration, and decreases LVEDV during expiration.

Answer 389

Positive pressure ventilation reduces venous return,

Question 390

PPV on ventricular afterload?

Answer 390

increases right ventricular afterload,

Question 391

PPV on venous return

Answer 391

Positive pressure ventilation reduces venous return,

Question 392

PPV on LVEDV?

Answer 392

decreases LVEDV during expiration.

Question 393

PPV and RV SV

Answer 393

decreases right ventricular stroke volume during inspiration

Question 394

Most common cause of hyperphosphatemia.

Answer 394

Renal failure is the

Question 395

Carbohydrate loading can induce _____hosphatemia via an insulin-mediated uptake of phosphorus.

Answer 395

hypophosphatemia. This is the most common form of hypophosphatemia seen in hospitalized patients.

Question 396

Respiratory alkalosis from

Answer 396

hyperventilation decreases phosphate levels.

Question 397

Respiratory alkalosis is also presumed to be the cause of hypophosphatemia associated with

Answer 397

gram-negative sepsis and salicylate poisoning.

Question 398

What is the most common cardiac defect through which a paradoxical embolus will occur?

Answer 398

Patent foramen ovale

Question 399

It can also occur in other right-to-left cardiac defects such as a

Answer 399

patent ductus arteriosus or atrial septal defect.

Question 400

The triple therapy drug regimen used for patients with congestive heart failure consists of an

Answer 400

ACE inhibitor, a beta-blocker, and a diuretic (which is often an aldosterone antagonist).

Question 401

are the compensatory mechanisms that occur in the presence of heart failure. As heart failure ensues, the ejection fraction decreases. As the left ventricle dilates, it accommodates more volume. Thus, the same ejection fraction of an increased volume will still be a normal stroke volume. As venous congestion and ventricular dilatation continues, however, clinical deterioration will eventually occur.

Answer 401

Increased preload and sympathetic tone Ventricular hypertrophy Activation of the renin- angiotensin system

Question 402

are the compensatory mechanisms that occur in the presence of heart failure.

Answer 402

Increased preload and sympathetic tone Ventricular hypertrophy Activation of the renin- angiotensin system

Question 403

As heart failure ensues, what happens to EF?

Answer 403

The ejection fraction decreases. As the left ventricle dilates, it accommodates more volume. thus, the same ejection fraction of an increased volume will still be a normal stroke volume. As venous congestion and ventricular dilatation continues, however, clinical deterioration will eventually occur.

Question 404

Drugs that are known to decrease the LES and potentially increase the risk for gastric aspiration include: TAD POTS

Answer 404

``` Thiopetnal Anticholinergics Dopamine, Propofol, Opioids Tricyclic antidepressants Sodium nitroprusside. ```

Question 405

Drugs that are known to decrease the LES and potentially increase the risk for gastric aspiration include: Drugs that are known to increase the LES and reduce the risk of aspiration include: metoclopramide, prochlorperazine, edrophonium, neostigmine, pancuronium, alpha-adrenergic agents, and antacids. Succinylcholine increase the LES, but also increases gastric pressure during fasciculations, so the overall barrier pressure is left unchanged.

Answer 405

anticholinergics, dopamine, thiopental, opioids, propofol, tricyclic antidepressants, and sodium nitroprusside.

Question 406

LES and Dopamine

Answer 406

Decrease

Question 407

LES and thiopental

Answer 407

Decrease

Question 408

LES and opioids

Answer 408

Decreae

Question 409

LES and propofol

Answer 409

Decrease

Question 410

LES and propofol

Answer 410

decrease

Question 411

LES and tricyclic antidepressants

Answer 411

Decrease

Question 412

LES and sodium nitroprusside

Answer 412

Decrease

Question 413

Drugs that are known to increase the LES and reduce the risk of aspiration include:

Answer 413

``` metoclopramide alpha-adrenergic agents prochlorperazine, neostigmine edrophonium antacids pancuronium ```

Question 414

The extrinsic pathway of the hemostatic response is initiated by the release of a group of proteins known as

Answer 414

Tissues factor

Question 415

The intrinsic pathway of the hemostatis response is initiated by

Answer 415

Tissue exposure to collagen

Question 416

Patients with ulcerative colitis are most at risk for the development of which potentially urgent surgical condition?

Answer 416

Toxic megacolon requiring urgent colectomy

Question 417

Define hypopnea

Answer 417

A 50% decrease in airflow for more than 10 seconds that occurs more than 15 seconds per hour of sleep that is sufficient to result in a 4% decrease in oxygen saturation is the definition of

Question 418

OHS is a syndrome that results from chronic OSA and occurs in about 5-10% of patients with OSA. It is characterized by

Answer 418

obesity, awake arterial hypercapnia, and insufficient alveolar impairment independent of any other pulmonary disease. It progresses to right ventricular failure.

Question 419

Hct in emphysema vs chronic bronchitisatients with emphysema typically have a normal resting carbon dioxide level.

Answer 419

The hematocrit is elevated in patients with chronic bronchitis and normal in patients with emphysema.

Question 420

Hct in emphysema vs chronic bronchitisat

Answer 420

The hematocrit is elevated in patients with chronic bronchitis and normal in patients with emphysema.

Question 421

Patients with emphysema typically have a normal

Answer 421

resting carbon dioxide level.

Question 422

Which of the following statements regarding atropine is false?

Answer 422

Maternally administered atropine can produce significant tachycardia in the fetus

Question 423

Atropine and placenta

Answer 423

Although atropine can cross the placenta (glycopyrrolate cannot), there is no significant change in fetal heart rate after intravenous administration to the mother.

Question 424

All anticholinergics combine reversibly with the

Answer 424

muscarinic cholinergic receptors and prevent acetylcholine from binding to the receptor.

Question 425

Anticholinergic drugs

Answer 425

increase the heart rate and shorten the PR interval.

Question 426

ISA minimizes the

Answer 426

risk of bronchoconstriction in patients with reactive airway disease who require β-blockade. Pindolol, acebutolol, penbutolol, and carteolol are β-adrenergic blocking agents that possess ISA.

Question 427

3 facts about pericarditis

Answer 427

It is often relieved by sitting forward It initially produces diffuse ST segment elevation It is commonly preceded by a viral infection

Question 428

2 β-blockers with membrane-stabilizing activity.

Answer 428

Propranolol and pindolol

Question 429

ARDS patients and PEEP

Answer 429

PEEP is extremely useful in these patients and should be titrated as high as possible while keeping the plateau pressure less than 28-30 cm H2O.

Question 430

Other potential problems arise with β2-receptor blockade in patients with

Answer 430

peripheral vascular disease and Raynaud phenomenon, because of the possible potentiation of peripheral vasoconstriction.

Question 431

Long-term therapy with β-blockers leads to _______of β-receptors or ________in the absolute number and activity of receptors.

Answer 431

up-regulation; increase

Question 432

Serum potassium levels may also become elevated with______, because

Answer 432

β2-blockade; uptake into skeletal muscle | is inhibited.

Question 433

BETA BLOCKERS and diabetic patients caution

Answer 433

signs of hypoglycemia may be masked, and the patient’s ability to increase serum glucose levels may be impaired.

Question 434

Cardiac effects of β-adrenergic blocking drugs.

Answer 434

``` Negative chronotropic Negative dromotropic. Negative inotropic. Antiarrhythmic. Anti-ischemic ```

Question 435

A breathing pattern in an infant that consists of recurrent pauses in ventilation that last no longer than 5-10 seconds is consistent with a diagnosis of

Answer 435

Periodic breathing

Question 436

The defining characteristics of Hepatorenal syndrome are the

Answer 436

presence of portal hypertension, an increased alveolar-arterial oxygen gradient, and intrapulmonary vasodilation.

Question 437

During which phase of a liver transplant surgery would you expect to see the greatest degree of hemodynamic instability?

Answer 437

Neohepatic phase

Question 438

During which phase of a liver transplant surgery would you expect to see the greatest degree of hemodynamic instability?

Answer 438

Neohepatic phase; The greatest hemodynamic changes are typically seen during the neohepatic period when the transplanted liver is reperfused. Reperfusion of the portal vein is associated with a drop in the systemic vascular resistance that is even greater than that seen with vena cava cross-clamp. Severe bradycardia may also be seen, although it is becoming less common due to changes in the preservative solutions used.

Question 439

Hypocalcemia is a common occurrence following a parathyroidectomy. When would you expect the patient to experience the lowest serum calcium levels?

Answer 439

Hypocalcemia can occur in the immediate postoperative period, but the lowest calcium level seen is usually 3-7 days after surgery.

Question 440

Which of the following statements correctly describes how to elicit a post-tetanic count? 5-50-3-1

Answer 440

A 5-second 50 Hz tetanic stimulation followed by a 3-second pause, then 1 Hz twitch stimulations

Question 441

2 associated with CHD

Answer 441

Lung hypoplasia | Tacheapnea

Question 442

Preoperative autologous donation of blood is most effective

Answer 442

when combined with erythropoetin therapy

Question 443

Acute normovolemic hemodilution

Answer 443

is performed electively to reduce surgical blood loss

Question 444

A popliteal block disrupts neurotransmission in the

Answer 444

sciatic nerve

Question 445

SSEPs assess

Answer 445

integrity of the dorsal spinal column | integrity of the sensory cortex

Question 446

The addition of epinephrine prolongs the duration of

Answer 446

tetracaine the most, lidocaine moderately, and has almost no effect on the duration of action of bupivacaine.

Question 447

2 things making the solution hyperbaric

Answer 447

5% and 8% dextrose

Question 448

What nerve roots contribute to the sciatic nerve? (select two)

Answer 448

L4 and L5 | S1-S2

Question 449

You are performing a combined spinal/epidural anesthetic. You have already administered the spinal anesthetic and are preparing to inject local anesthetic through the epidural catheter. How will this affect the spinal block?

Answer 449

It will increase the height of the spinal block

Question 450

Injection of solution through the epidural catheter is known to I

Answer 450

increase the spread of the spinal anesthetic.t is believed that the increased volume injected into the epidural space compresses the subarachnoid space, resulting in an increase in pressure that 'pushes' the local anesthetic in the subarachnoid space higher. Another cause is the leakage of local anesthetic from the epidural space into the subarachnoid space via the dural puncture made for the spinal anesthetic.

Question 451

What structure forms the anterior border of the epidural space?

Answer 451

The posterior longitudinal ligament

Question 452

During a cardiac catheterization for an ablation, for which change in the patient's condition would you need to immediately notify the electrophysiologist?

Answer 452

An increase in core temperature of 0.2 degrees Celsius

Question 453

ou are performing a MAC anesthetic for a patient undergoing a cardiac catheterization. The cardiologist is having difficulty placing a stent and has used an extensive amount of contrast dye. In what patient population would this concern you the most?

Answer 453

Patients with diabetes mellitus

Question 454

The decrease in total body water that occurs with aging is primarily due to

Answer 454

A decrease in muscle mass

Question 455

In what ways does the hyperinsulinemia associated with obesity contribute to cardiovascular disease? (select two)

Answer 455

It results in chronic activation of the sympathetic nervous system It results in sodium retention

Question 456

Which drugs cause vasodilation in the fetus when administered to the mother? (select tw

Answer 456

Magnesium | Nifedipine

Question 457

Most cellular drug receptors are located

Answer 457

Within the cell membrane

Question 458

Results from a medial branch block can have a relatively long duration (3-6 months). If the results from a medial branch block are short-lived, a

Answer 458

radiofrequency rhizotomy should be performed.

Question 459

A patient complains of chronic pain that begins in the lower back, radiates through the posterior thigh, and ends at the knee. Examination reveals paraspinal tenderness and reproduction of the pain with extension and rotation of the lower back. This is consistent with a diagnosis of

Answer 459

facet syndrome

Question 460

What is capnometry?

Answer 460

Any and all measurements of carbon dioxide levels

Question 461

Which of the following monitors would be most prudent in a patient with cardiac disease undergoing a posterior cervical laminectomy in the sitting position? (select two)

Answer 461

Central venous pressure catheterCentral venous pressure catheter Precordial doppler

Question 462

A decompressive laminectomy is performed via a

Answer 462

posterior, midline approach either prone or in a sitting position with the head secured either in pins or a horseshoe headrest.

Question 463

Posterior procedures performed in the sitting position place the patient at risk for air embolism. It is prudent in these cases to monitor what?

Answer 463

-Monitor heart sounds with a precordial Doppler and place a central venous line prior to surgery in order to aspirate air should an embolism occur.

Question 464

What is the principal neurotransmitter responsible for activation of dorsal horn neurons in the transmission of noxious stimuli?

Answer 464

glutamate

Question 465

Which of the veins listed below does contribute to the portal vein?

Answer 465

Superior mesenteric vein Inferior mesenteric vein Splenic vein

Question 466

According to the American Society for Testing and Materials (ASTM), the maximum pressure a standard 1.5 liter breathing bag can exert if expanded as much as 4 times its normal size is

Answer 466

50 cm H2O

Question 467

According to the standards set by the ASTM, 3-liter reservoir bags (also called breathing bags) that are distended to. T

Answer 467

four times their normal size should not exert a pressure less than 35 cm H2O or greater than 60 cm H2O.

Question 468

Bags that are 1.5 L in size or smaller shall not exert a pressure

Answer 468

less than 30 cm H2O or greater than 50 cm H2O when distended to this extent

Question 469

The lowest pressure to be exerted is to

Answer 469

ensure that the bag is capable of exerting enough minimum pressure to ventilate a patient, and the highest pressure is to limit the amount of barotrauma that a patient may be exposed to when using the breathing bag.

Question 470

The TOF is 2 Hz stimulation of a series of four twitches applied

Answer 470

every half-second for a total of 2 seconds. You should wait at least 10-12 seconds between assessments.

Question 471

Which of the following anesthetic agents would be least likely to precipitate a carcinoid crisis in a patient with a carcinoid tumor?

Answer 471

Etomidate

Question 472

MAC in Cp patients

Answer 472

Decrease

Question 473

What type of shunt is associated with acyanotic congenital heart disease?

Answer 473

Left-to-right intracardiac shunt

Question 474

What are the MOST common causes of ACUTE MITRAL REGURGITATION? (MI-PCT)

Answer 474

``` Myocardial infarction Infectious endocarditis Papillary muscle dysfunction Chordae tendinae rupture, Trauma to the chest ```

Question 475

In respiratory alkalosis and acidosis, which value is primarily increased or decreased?

Answer 475

PaCO2

Question 476

What resource was created by the AANA in 1983 to help provide support on issues surrounding substance abuse?

Answer 476

Peer Assistance Advisors Committee

Question 477

Which volatile agent doesn't decrease the cerebral metabolic rate?

Answer 477

Nitrous oxide

Question 478

All that are able to decrease cerebral metabolic oxygen requirements to an equal degree. VAs

Answer 478

Isoflurane, desflurane, and sevoflurane

Question 479

Anesthesia for a computed tomography scan vs anesthesia for MRI

Answer 479

exposes the anesthetist to a greater amount of ionizing radiation than an MRI

Question 480

Which of the following agents produces irreversible inhibition of platelet function by preventing the synthesis of thromboxane A2?

Answer 480

Acetylsalicylic acid

Question 481

Cyclooxygenase inhibitors such as_____ cause i

Answer 481

aspirin ; irreversible inhibition of platelet cyclooxygenase which prevents synthesis of thromboxane A2.

Question 482

ADP receptor antagonists such as____and______MOA is

Answer 482

ticlopidine and clopidogrel block the ADP receptor non-competitively and irreversibly inhibit IIb/IIIa platelet aggregation

Question 483

Phosphodiesterase inhibitors such as dipyridamole act by.

Answer 483

inhibiting phosphodiesterase which results in an increase in cyclic AMP which is an inhibitor of platelet aggregation

Question 484

cAMP and platelet aggregation?

Answer 484

Increase in cyclic AMP inhibit platelet aggregation

Question 485

Glycoprotein Iib/IIIa receptor antagonists such as abciximab reversibly block the

Answer 485

Iib/IIIa site by which fibrinogen crosslinks platelets together.

Question 486

Which disorder exhibits a higher incidence of mitral valve prolapse?

Answer 486

Marfan syndrome

Question 487

MVP has a higher occurrence in patients with

Answer 487

Marfan syndrome, systemic lupus erythematosus, rheumatic carditis, thyrotoxicosis, and myocarditis.

Question 488

Patients with polycythemia exhibit (select two)

Answer 488

Increased blood viscosity | Increased risk for thrombosis

Question 489

Which of the following are associated with the development of interstitial nephritis? (select two)

Answer 489

Allergic reaction to antibiotics | Lupus erythematosus

Question 490

Acute chest syndrome is associated with what disease process?

Answer 490

Sickle cell disease

Question 491

What is the second most common cause of hospitalization in sickle cell patients and accounts for 25% of all sickle cell related deaths..

Answer 491

Acute chest syndrome

Question 492

How is acute chest diagnosed?

Answer 492

the development of new infiltrates on chest film and may be caused by atelectasis, pulmonary microembolic episodes, or pulmonary infection

Question 493

Acute chest syndrome is a potential complication of sickle cell disease. When it develops, it is typically how long after surgery? how do you treat it?

Answer 493

2-3 days following surgery and requires aggressive hydration, oxygenation, transfusions to treat anemia, antibiotics to treat pulmonary infection, and occasionally nitric oxide may be used to treat pulmonary hypertension.

Question 494

Diagnosing hemophillia A and B with PT and PTT

Answer 494

Both hemophilia A and hemophilia B exhibit a prolonged PTT and a normal PT. The clinical course of the diseases is virtually identical except that they are treated with different clotting factors. They are both X-linked recessive disorders.

Question 495

Hemophillia A and B dominant or recessive

Answer 495

recessive

Question 496

What treatment regimens are effective in ameliorating the symptoms of von Willebrand disease? (select two)

Answer 496

Desmopressin | vWF concentrate

Question 497

Factor IX-PCC is used in the treatment of

Answer 497

hemophilia B.

Question 498

3 drugs: rocuronium, Succinylcholine and Propofol inductios doses which one for which body weight Total body weight: Ideal body weight: Lean body weight:

Answer 498

Succinylcholine --> Total body weight Propofol induction --> Lean body weight Rocuronium --> Ideal body weight.

Question 499

Vd is calculated as

Answer 499

Vd = Amount of drug in body/Plasma concentation of the drug.

Question 500

The FA:FI difference of a volatile anesthetic is d, but

Answer 500

directly proportion to its rate of uptake

Question 501

The rate of induction with a volatile anesthetic is

Answer 501

inversely proportional to its rate of uptake.

Question 502

Which of the following respiratory effects may occur with the administration of local anesthetics?

Answer 502

Decreased ventilatory response to hypoxia

Question 503

Local anesthetics such as lidocaine can depress the ventilatory response to hypoxia. Systemic absorption of bupivacaine, however,

Answer 503

increases the ventilatory response to CO2.

Question 504

COX-2 receptor inhibition has been shown to O

Answer 504

Reduce prostacyclin release from the vascular epithelium and can result in increased platelet aggregation. C

Question 505

COX-1 receptor inhibition results in.

Answer 505

inhibition of thromboxane A2. By doing so, it disrupts thromboxane A2's ability to promote platelet aggregation

Question 506

West Lung Zone 1 is

Answer 506

rarely present normally

Question 507

West Lung Zone 1 only present with

Answer 507

pulmonary hypotension, excessive PEEP, or large tidal volumes during positive-pressure ventilation.

Question 508

A patient with a history of tuberculosis is currently taking isoniazid. What diagnostic tests may be seriously altered due to this drug?

Answer 508

Liver function tests

Question 509

Which of the following anesthetic risks are associated with muscular dystrophy?

Answer 509

Aspiration of gastric contents

Question 510

Gastric hypomotility and decreased laryngeal reflexes predispose the patient to pulmonary aspiration. What patients?

Answer 510

Patients with muscular dystrophy

Question 511

Which of the following agents will not produce a significant change in the latency or amplitude of somatosensory evoked potentials? (select two)

Answer 511

Ketamine and Fentanyl

Question 512

On what principle do the mechanical flowmeters on anesthesia machines function?

Answer 512

Flow past a resistance is proportional to the pressure

Question 513

Cannon a waves are extremely large 'a' waves in a CVP waveform. Dysrhythmias such as

Answer 513

``` junctional rhythms complete AV block PVCs, and disorders such as triscupid stenosis, mitral stenosis, myocardial ischemia, diastolic dysfunction, and ventricular hypertrophy are all associated with the presence of cannon 'a' waves on the CVP waveform. ```

Question 514

Most anesthetic agents will alter the latency or amplitude of somatosensory evoked potentials except for

Answer 514

OKE (opioids, ketamine, and etomidate)

Question 515

hat effect will volatile anesthetics have on somatosensory evoked potential (SSEP) monitoring?

Answer 515

DAIL Decrease Amplitude Increase latency

Question 516

The administration of epidural steroids can produce an antiinflammatory effect primarily by the inhibition of (select two)

Answer 516

Cytokines | Phospholipase A2

Question 517

What is the minimum time to wait after an epidural steroid injection before attempting a second injection?

Answer 517

2-3 weeks

Question 518

A single dose of methylprednisolone will suppress cortisol secretion for

Answer 518

3 weeks.

Question 519

Triamcinolone will suppress ______secretion for how long?

Answer 519

cortisol; one week.

Question 520

Dexamethasone is non-particulate and is recommended as the preferred agent for

Answer 520

transforaminal injections.

Question 521

Of the Rh antigens, which one is responsible for the most common and strongest Rh-related transfusion reactions?

Answer 521

D

Question 522

The cervical plexus block is unique in that the

Answer 522

Sensory fibers (superficial cervical plexus block) can be blocked separately from the motor fibers (deep cervical plexus block (SS, DM)

Question 523

A superficial cervical plexus block only provides anesthesia to the cutaneous sensation of the skin between the

Answer 523

face and the T2 dermatome.

Question 524

Cervical plexus block does not protect against

Answer 524

the carotid sinus reflex and local injection of the carotid sinus at the point where the carotid artery bifurcates is often necessary.

Question 525

Complications of a cervical plexus block.

Answer 525

Intravenous injection, spread of the local anesthetic into the epidural or subarachnoid space, and blockade of the phrenic or superior laryngeal nerves are potential

Question 526

The rate of systemic absorption of local anesthetic is proportionate to the vascularity of the site of injection: i

Answer 526

IvTICPEBS | Intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > subcutaneous.

Question 527

The most common organism responsible, but numerous other organisms can also result in pneumonia.. and patients with contact with birds may contract Chlamydia pneumonia.

Answer 527

Streptococcus pneumoniae

Question 528

2 tests that can often provide information about the cause of pneumonia?

Answer 528

Sputum specimens and a detailed history

Question 529

Hotels and whirlpools associated with what kind of pneumonia?

Answer 529

Legionnaire's disease (Legionella)

Question 530

Immunocompromised patients are at greater risk for

Answer 530

fungal and Pneumocystis pneumonia,

Question 531

What are three primary factors that influence the renal absorption of phosphate? DIP

Answer 531

Dietary intake of phosphate Insulin-like growth factor Parathyroid hormone

Question 532

When does the anterior fontanelle normally close?

Answer 532

Between 9 and 18 months

Question 533

In 96% of children, the anterior fontanelle closes by

Answer 533

2 years of age.

Question 534

The posterior fontanelle closes at approximately

Answer 534

4 months

Question 535

Which reflex would help influence the tidal volume and respiratory rate of an infant by inhibiting deep inspiration?

Answer 535

Hering-Breuer reflex

Question 536

The cessation of inspiration in response to lung inflation.

Answer 536

The Hering-Breuer reflex

Question 537

Which patient should not proceed with a scheduled liver transplant?

Answer 537

Patients with portopulmonary hypertension have an extremely high perioperative mortality rate with liver transplant surgery. In fact, a mean PA pressure greater than 50 mmHg is considered an absolute contraindication to liver transplant surgery.

Question 538

A Common diagnosis in patients presenting for liver transplantation

Answer 538

Renal failure

Question 539

Absolute contraindications to LIVER TRANSPLANT SURGERY

Answer 539

PA pressure greater than 50 mmHg

Question 540

Which of the following is true of hepatorenal syndrome?

Answer 540

Norepinephrine is useful in maintaining renal function in this syndrome

Question 541

Hepatorenal syndrome is functionally related to extreme

Answer 541

Renal vasoconstriction

Question 542

Diagnostic criteria for hepatorenal syndrome

Answer 542

Cirrhosis with Ascites | Serum Cr>1.5 in the absence of parenchymal kidney disease, shock, or treatment with nephrotoxic drugs.

Question 543

Types of hepatorenal syndrome and differentiate between the two

Answer 543

Type 1 is more severe, rapid decline in GFR, median survival 2 weeks Type2 more progressive, slower course of renal failure.

Question 544

The significance of hepatorenal syndrome presentation

Answer 544

Ominous sign and signals the need for IMMEDIATE TRANSPLANTATION evaluation.

Question 545

Eyes muscle , extremities, diaphragm correct order in which they would become paralyzed by a nondepolarizing muscle relaxant.

Answer 545

Eyes , Extremities, diaphragm.

Question 546

The lethal triad that produces a vicious cycle of hemorrhage in the trauma patient is (HAD)

Answer 546

Hypothermia Acidosis Dilutional coagulopathy.

Question 547

The administration of 'washed' red blood cells helps reduce the incidence of reactions mediated by

Answer 547

IgA Antibodies

Question 548

The most common bone to encounter when performing a subarachnoid block via a paramedian approach is the

Answer 548

vertebral lamina.

Question 549

The sciatic nerve innervates the muscles of the back of the thigh which are?

Answer 549

BSSA (biceps femoris, semitendinosis, semimembranosus, and adductor magnus)

Question 550

From the back of the thigh to down, As the sciatic nerve continues, it innervates the muscles of the lower leg and foot with the exception of the

Answer 550

with the exception of the extensor digitorum brevis which innervates the 2nd-4th toes and derives from the peroneal nerve).

Question 551

Which of the following is not decreased in elderly patients?

Answer 551

Circulatory time (is increased)

Question 552

What is the ideal body weight in kilograms for a 55 year-old male patient who is 6 foot 3 inches tall? (calculate your answer to the nearest whole number)

Answer 552

91 kg

Question 553

Overweight BMI

Answer 553

25 to 29 kg/m2

Question 554

BMI is calculated by

Answer 554

Weight in Kg / Height in m2

Question 555

BMI is the accepted measure of

Answer 555

Body habitus that describes adiposity normalized for height

Question 556

Underweight BMI

Answer 556

Less than 18.5

Question 557

Normal BMI

Answer 557

18.5 to 24.9

Question 558

Obesity Class I BMI

Answer 558

30-34.9

Question 559

Obesity Class II BMI

Answer 559

35-39.9

Question 560

Extreme Obesity BMI

Answer 560

>40

Question 561

Ropivacaine is better suited than bupivacaine for a lumbar epidural for a laboring parturient because (select two)

Answer 561

It produces less motor block than bupivacaine | It causes less central nervous system toxicity than bupivacaine

Question 562

Which of the following drugs would cross the placenta more easily? (select two) Charge and proteins

Answer 562

Drugs with no ionic charge | Drugs that bind to albumin (albumin decreases with pregnancy)

Question 563

Pain in the area of the sacroiliac joint with radiation to the groin, medial buttocks, and posterior thigh with occasional radiation below the level of the knee is consistent with what syndrome?

Answer 563

Pyriformis syndrome

Question 564

Useful for monitoring basic brainstem function

Answer 564

Brainstem auditory evoked potentials

Question 565

What is the primary advantage of using an Andrews frame for lumbar spine surgery?

Answer 565

Decreased bleeding.

Question 566

How does the Andrews Frame decrease the risk of bleeding during lumbar spine surgery?

Answer 566

The Andrews frame secures the patient in knee-chest position with the abdomen hanging freely which reduces intra-abdominal pressure and contributes to decreased blood loss. Because the legs are below the level of the heart, venous return is decreased and severe hypotension can result.

Question 567

Studies have shown that the efficacy of epidural steroid injections lasts for no longer than

Answer 567

3 months

Question 568

The nerves that contribute to the lumbar plexus are the

Answer 568

``` SIgILFO subcostal iliohypogastric genitofemoral, Ilioinguinal, lateral femoral cutaneous, femoral, and obturator. ```

Question 569

The nerves that contribute to the lumbar plexus are the

Answer 569

subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator.

Question 570

Magnesium level 5–7 = SIgns and symptoms

Answer 570

Hypotension

Question 571

Magnesium level 10 =Signs and symptoms

Answer 571

Respiratory paralysis, coma

Question 572

Magnesium level 10–15 =SIgns and symptoms

Answer 572

Heart block

Question 573

Magnesium level 10–24=SIgns and symptoms

Answer 573

Cardiac arrest

Question 574

Magnesium level 10–24=

Answer 574

Cardiac arrest

Question 575

At level of mag 10 and up

Answer 575

Respiratory paralysis Coma Heart block and cardiac arrest.

Question 576

A 37 year-old, healthy male suffered a high-voltage electrical burn and fell from a ladder while repairing an electrical line. He is undergoing surgery for repair of a fracture. He also has burns to most of his torso and arms. What is the minimum urinary output you would attempt to maintain in this patient intraoperatively?

Answer 576

1 mL/kg/hour

Question 577

A vaporizer that splits fresh gas flow between the vaporizing chamber and the bypass chamber is referred to as a

Answer 577

variable-bypass vaporizer

Question 578

An HME should not be used with a

Answer 578

heated humidifier. The combination of the two can produce a dangerous resistance to airflow.

Question 579

The most common symptom of carcinoid syndrome is

Answer 579

flushing | 2nd is Diarrhea

Question 580

A reversal of a left-to-right intracardiac shunt due to an increase in the pulmonary vascular resistance is associated with

Answer 580

Eisenmenger's syndrome

Question 581

Eisenmenger's syndrome is a reversal of a

Answer 581

left-to-right intracardiac shunt due to an increase in the pulmonary vascular resistance. Once the pulmonary vascular resistance reaches a level that is equal to or exceeds systemic vascular resistance, the shunt reverses to a right-to-left shunt.

Question 582

In pharmacokinetics, steady-state refers to a situation in which

Answer 582

All of the tissues in the body have had time to reach equilibrium. The concentration of drug differs between organs, but no longer varies from moment-to-moment.

Question 583

What is the greatest contributor to the risk of morbidity following a carotid endarterectomy?

Answer 583

With an incidence of 2-5%, myocardial infarction is the greatest contributor to the risk of morbidity following a carotid endarterectomy.

Question 584

Are anesthetized during an ankle block.

Answer 584

The deep peroneal, saphenous, posterior tibial, sural, and superficial peroneal

Question 585

The sudden onset of seizures during administration of a retrobulbar block is most likely due to

Answer 585

retrograde injection of local anesthetic through the circle of Willis

Question 586

Seizures probably represent the inadvertent intravascular injection of the local anesthetic during the procedure. Accidental injection into the opthalmic artery will drive the local anesthetic in r

Answer 586

etrograde fashion through the internal carotid artery and then to the circle of Willis.

Question 587

Cytochrome P450 enzymes are involved ins. Tr. Drugs such as remifentanil, esmolol, succinylcholine, and ester local anesthetics undergo hydrolysis.

Answer 587

oxidation, reduction, and conjugation reaction

Question 588

The only metabolic pathway in which CYP 450 enzymes are not present is____, which typically occurs

Answer 588

hydrolysis ; outside of the live

Question 589

Epidural anesthesia has been reported to be effective in preventing autonomic hyperreflexia from occurring due to uterine contractions, but, because epidurals may spare the sacral segments,

Answer 589

spinal anesthesia is more protective.

Question 590

Best anesthesia maintenance for hypertrophic cardiomyopathy and why?

Answer 590

Anesthesia is usually maintained by controlled myocardial depression using volatile anesthetics. T

Question 591

Hypertrophic cardiomyopathy involves

Answer 591

enlargement of the interventricular septum which results in left ventricular outflow obstruction.

Question 592

Things that worsen Hypertrophic cardiomyopathy?

Answer 592

his obstruction is worsened by increased heart rate or increased myocardial contractility as well as decreases in preload or afterload.

Question 593

Occurs frequently in patients under the age of 30

Answer 593

Hypertrophic cardiomyopathy

Question 594

Hypertrophic cardiomyopathy is associated with ______dysrfunction. Symptoms ?

Answer 594

associated with diastolic dysfunction | Patients are typically asymptomatic at rest

Question 595

The first manifestation of hypertrophic cardiomyopathy in patients younger than 30 years is

Answer 595

often sudden cardiac death, which is also the most common cause of death.

Question 596

Patients with hypertrophic cardiomyopathy typically suffer from diastolic dysfunction which is exhibited by

Answer 596

increased left ventricular end-diastolic pressures despite an often hyperdynamic left ventricular function.

Question 597

Hyperdynamic LV function is associated with which cardiomyopathy?

Answer 597

Hypertrophic

Question 598

Which of the following valvular lesions is most likely to result in eccentric left ventricular hypertrophy?

Answer 598

Aortic Regurgitation

Question 599

The hallmark characteristic of aortic regurgitation is what kind of LVH?

Answer 599

eccentric left ventricular hypertrophy.

Question 600

Which of the following agents will precipitate when combined in an intravenous line with thiopental?

Answer 600

If administered shortly after thiopental, vecuronium can react with thiopental to produce barbituric acid, a precipitate that can obstruct the IV.

Question 601

Electrocardiographic signs consistent with cor pulmonale include.

Answer 601

peaked P waves in leads II, III, and aVF which are consistent with right atrial hypertrophy and right axis deviation and right bundle branch block which are consistent with right ventricular hypertrophy

Question 602

Lead is helpful in the detection of anterolateral ischemia.

Answer 602

The V5

Question 603

To create a modified V5 lead,

Answer 603

place the left leg and right arm leads in their normal positions, then place the left arm lead over the anterior axillary line at the level of the fifth intercostal space and select Lead I as the monitoring lead.

Question 604

Which form of hemoglobin is most commonly found in the normal, adult bloodstream?

Answer 604

Hemoglobin A

Question 605

Hemoglobin A comprises about

Answer 605

97% of all the hemoglobin found in the normal, adult bloodstream. , and

Question 606

Hemoglobin C is implicated in a

Answer 606

type of hemolytic anemia

Question 607

hemoglobin S is found in patients with

Answer 607

sickle cell anemia.

Question 608

Hemoglobin F is found in

Answer 608

fetuses

Question 609

Chronic hypertension leads to a contracted fluid volume status, which results in a

Answer 609

concentration of the red blood cells in a smaller space, thereby increasing the hematocrit.

Question 610

Sickle cell results in the

Answer 610

destruction of red blood cells which lowers the hematocrit.

Question 611

Dehydration also concentrates

Answer 611

the red blood cells in a smaller fluid space, resulting in an increased hematocrit.

Question 612

Polycythemia is a condition resulting in an

Answer 612

elevation of the hematocrit due to an overproduction of red blood cells.

Question 613

Which of the following conditions does not lead to an elevated hematocrit?

Answer 613

Sickle cell crisis

Question 614

Massive proteinuria (exceeding 750 mg/day) would be consistent with extensive damage to what renal structure?

Answer 614

Glomerulus

Question 615

You are consulted by the emergency department for a patient exhibiting inspiratory stridor, drooling, sore throat, dysphagia, tachycardia, fever, and prefers a sitting, sniffing position to breathe easier. You suspect that this patient suffers from

Answer 615

Inflammation of the supraglottic airway structures

Question 616

Which of the following findings is NOT consistent with the respiratory changes you would expect to see with morbid obesity?

Answer 616

Obstructive (it is usually restrictive)

Question 617

Which of the following findings consistent with the respiratory changes you would expect to see with morbid obesity? 3

Answer 617

Increased alveolar ventilation Increased CO2 production Increased oxygen demand

Question 618

Which of the following classes of drugs inhibits platelet function by increasing the level of cyclic AMP?

Answer 618

Phosphodiesterase inhibitors

Question 619

What is the primary anesthetic concern when inducing a patient with pyloric stenosis?

Answer 619

Pulmonary aspiration

Question 620

Which of the following is true regarding the saphenous nerve? It can be blocked by

Answer 620

injecting local anesthetic anterior to the medial malleolus

Question 621

Multiple sclerosis is characterized by

Answer 621

demyelination of neurons in the central nervous system (peripheral nerves are not affected). think Multiple CENTROSIS

Question 622

For Multiple sclerosis, You should avoid increases in

Answer 622

body temperature as they may result in relapses. Pregnancy is associated with a decrease in the rate of relapse.

Question 623

Which of the following symptoms would you expect to be consistent in a patient with systemic lupus erythematosus (SLE)? (select two)

Answer 623

Nephritis | Cognitive dysfunction

Question 624

SLE is very likely if a patient exhibits three of the following characteristic manifestations:

Answer 624

antinuclear antibodies, nephritis, serositis, thrombocytopenia, or a characteristic rash.

Question 625

In all muscular dystrophies, there is a ______and NO ______

Answer 625

ymmetric atrophy of skeletal muscle tissue, however, there is no denervation of skeletal tissue, meaning that sensation and reflexes are intact

Question 626

Cardiac muscle characteristically degenerates with Duchenne muscular dystrophy and may result in what kind of cardiac issues?

Answer 626

mitral regurgitation due to papillary muscle dysfunction.

Question 627

Cardiac muscle characteristically degenerates with Duchenne muscular dystrophy and may result in what kind of cardiac issues?

Answer 627

mitral regurgitation due to papillary muscle dysfunction.

Question 628

About 30% of deaths in patients with Duchenne muscular dystrophy are due to

Answer 628

pulmonary causes.

Question 629

A key difference between latex allergies and sensitivity to other allergens is that the onset of symptoms from latex allergy

Answer 629

do not begin until about 30 minutes after exposure compared to 5-10 minutes for other allergies.

Question 630

It accounts for approximately 15% of all intraoperative allergic reactions, is mediated by IgE antibodies, and is

Answer 630

Latex

Question 631

Latex allergy is more common in patients with

Answer 631

more common in patients with fruit allergies, spina bifida, a history of multiple surgeries, and healthcare workers.

Question 632

Which of the following parameters would be most appropriate for use in calculating the propofol induction dose for an obese patient?

Answer 632

Lean body weight

Question 633

IM Succinylcholine dose for children

Answer 633

4mg/kg

Question 634

What is the most sensitive indicator of cardiac ischemia during thoracic surgery when the aorta is cross-clamped?

Answer 634

Transesophageal echocardiography

Question 635

Which of the following are reduced in patients with severe kyphoscoliosis? (select two)

Answer 635

Residual volume | D. Vital capacity

Question 636

Which of the following are reduced in patients with severe kyphoscoliosis? (select two)

Answer 636

Residual volume | Vital capacity

Question 637

What chemical is the starting point for the Kreb's cycle?

Answer 637

Acetyl coenzyme A

Question 638

The Kreb's cycle (also called the tricarboxylic acid cycle and citric acid cycle) is a series of energy-producing reactions that begins with a

Answer 638

Two-carbon molecule derived from acetyl coenzyme A. Most of the energy made available by the oxidative steps of the cycle is transferred as energy-rich electrons to NAD+, forming NADH. For each acetyl group that enters the citric acid cycle, three molecules of NADH are produced.

Question 639

What is the most common cause of secondary hypertension?

Answer 639

Renal artery stenosis

Question 640

Which two hemodynamic changes would increase the severity of aortic regurgitation? (select two)

Answer 640

An increase in the diastolic blood pressure

Question 641

The decrease in heart rate and effect on aortic regurgitation?

Answer 641

increases the diastolic time which adversely affects the patient's condition by increasing the proportion of the stroke volume that regurgitates backward through the aortic valve.

Question 642

How does increase in diastolic BP affect aortic regurgitation?

Answer 642

An increase in the diastolic blood pressure increases the backward pressure gradient which results in an increase in the proportion of stroke volume that regurgitates back into the left ventricle.

Question 643

Which of the following is a likely complication of antiretroviral regimens in the treatment of HIV?

Answer 643

lipodystrophy, dyslipidemia, and insulin resistance.

Question 644

What is the most common cause of acute glomerulonephritis?

Answer 644

Antigen-antibody complex deposition

Question 645

The plasma half-life of a drug is______ ______ to its rate of clearance

Answer 645

inversely proportional

Question 646

Membrane thickness is an important factor in the rate of diffusion as is molecular weight, which affects the diffusion coefficient (p) in the equation, but neither of these variables are as important as

Answer 646

the concentration gradient.

Question 647

The plasma half-life is inversely proportional to its rate of clearance. Enzyme induction reduces the

Answer 647

plasma half-life of agents that are metabolized by that particular metabolic pathway.

Question 648

Zero-order kinetics refers to metabolism in which the

Answer 648

amount of the drug eliminated over time is constant.

Question 649

The administration of what drugs have been shown to reverse the bile duct spasm that can occur from opioid administration? (select two)

Answer 649

Glucagon | Naloxone

Question 650

An increase in hydrogen ion concentration on neuronal activity ?..

Answer 650

depresses neuronal activity. It also causes an increase in blood flow to the brain

Question 651

'wash away' the hydrogen ions, carbon-dioxide, and other acid precursors away from the brain which

Answer 651

returns the hydrogen ion concentration back to normal.

Question 652

What organism is responsible for causing tuberculosis?

Answer 652

Mycobacterium tuberculosis

Question 653

Which of the following radiographic changes are consistent with cor pulmonale? (select two)

Answer 653

Decreased vascular markings in the peripheral fields | Decreased retrosternal space on the lateral film

Question 654

Patients taking levodopa for the treatment of Parkinson's disease may exhibit (select two)

Answer 654

dyskinesias | Orthostatic hypotension

Question 655

What is a precursor to dopamine?

Answer 655

Levodopa

Question 656

Carbidopa is combined with a decarboxylase inhibitor to prevent the

Answer 656

peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.

Question 657

Orthostatic hypotension is also common in these individuals and levodopa therapy may result in

Answer 657

nausea and vomiting as a result of stimulation of the chemoreceptor trigger zone.

Question 658

It is combined with a decarboxylase inhibitor to prevent the

Answer 658

peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.

Question 659

Side effects of Levodopa

Answer 659

include dyskinesias (in over 80% of patients after one year of treatment), hallucinations, paranoia, and mania. Increases in cardiac contractility and heart rate occur.

Question 660

Why is levodopa combined with Carbidopa?

Answer 660

Decarboxylase inhibitor.Peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.

Question 661

Which of the following would be the most appropriate anesthetic technique for a patient with multiple sclerosis?

Answer 661

Epidural anesthesia with bupivacaine

Question 662

Pt with multiple sclerosis most common choice for anesthesia? Epidural anesthesia is considered less of a risk than spinal anesthesia.

Answer 662

General anesthesia is the most common choice for anesthesia, but succinylcholine can potentially result in a hyperkalemic response.

Question 663

Pt with multiple sclerosis most common choice for anesthesia type (spinal, vs. epidural, vs. GA)

Answer 663

General anesthesia is the most common choice for anesthesia but succinylcholine can potentially result in a hyperkalemic response.

Question 664

Multiple sclerois, what type of anesthesia?

Answer 664

Spinal anesthesia is typically avoided as there is speculation that the lack of myelin predisposes the neurons to the effects of local anesthetic toxicity.

Question 665

Multiple sclerosis, what type of anesthesia should be avoided?

Answer 665

Spinal anesthesia is typically avoided as there is speculation that the lack of myelin predisposes the neurons to the effects of local anesthetic toxicity.

Question 666

MS: spinal vs epidural anesthesia

Answer 666

Epidural anesthesia is considered less of a risk than spinal anesthesia.

Question 667

Which of the following factors is associated with an increased risk for postoperative ventilation following general anesthesia for THYMECTOMY, in patients with myasthenia gravis? (select two)

Answer 667

Daily pyridostigmine dose greater than 750 mg Disease duration greater than 6 years COPD A negative inspiratory pressure less than -25 cm H2O, Vital capacity less than 2.9 L.

Question 668

Which of the following statements regarding Duchenne muscular dystrophy is true? (select two) ":: Muscle relaxants

Answer 668

Succinylcholine is contraindicated | The response to nondepolarizing muscle relaxants is normal

Question 669

The Tec 6 vaporizer is heated to ______and pressurized to______.

Answer 669

39 degrees Celsius; 2 atmospheres

Question 670

Is the TEC 6 Vaporizer a variable bypass vaporizer?

Answer 670

It is not a variable bypass vaporizer and unlike these devices, no fresh gas flows through the sump.

Question 671

Medical gas tanks connect to the anesthesia machine using a safety mechanism called the

Answer 671

PISS two 5 mm pins that have to align the matching connector to prevent the inadvertent connection of a wrong gas cylinder to an anesthesia machine.

Question 672

2 true statements regarding the vaporizer pumping effect? (select two)

Answer 672

It can result in elevated vaporizer output | It is more prominent at high respiratory rates

Question 673

The pumping effect is an

Answer 673

intermittent back pressure caused by positive pressure ventilation or use of the oxygen flush valve, results in elevated vaporizer output.

Question 674

Pumping effect is more prominent with

Answer 674

``` low flows low vaporizer dial settings low levels of anesthetic in the vaporizer chamber high respiratory rates, high peak inspiratory pressures. ```

Question 675

Which electroencephalogram (EEG) findings would be consistent with light anesthesia or profound surgical stimulation?

Answer 675

HFLV | High Frequency , Low voltage

Question 676

Which of the following are associated with an increased central venous pressure reading? (select two)

Answer 676

Pulmonary hypertension | Heart failure

Question 677

are all associated with increased central venous pressure readings.

Answer 677

Right ventricular failure, tamponade, tricuspid stenosis, tricuspid regurgitation, pericarditis, pulmonary hypertension, chronic left ventricular failure, and hypervolemia

Question 678

Other factors that can increase the

Answer 678

CVP include mechanical ventilation, PEEP, tension pneumothorax, and pulmonary embolism.

Question 679

What is the purpose of using a leukoreduction filter when administering a blood transfusion?

Answer 679

Reducing the risk of nonhemolytic transfusion reaction

Question 680

Which of the following are disadvantages to storing blood? (select two)

Answer 680

Adenosine triphosphate levels decrease in stored blood | 2, 3 DPG levels decrease in stored blood

Question 681

When large doses of blood are administered through rapid infusion devices, the sudden increase in

Answer 681

potassium can be hazardous and sudden cardiac arrests have been attributed to it.

Question 682

What two factors are the primary determinants of the duration of action of a spinal anesthetic? (select two)

Answer 682

The specific drug used | The dose of the drug given

Question 683

Which of the following statements are true regarding cardiac arrest during a spinal anesthetic? (select two)

Answer 683

It is usually preceded by bradycardia | It is associated with a drop in preload

Question 684

Which anesthetic types would be appropriate for an anticoagulated patient undergoing cataract surgery? (select two)

Answer 684

General anesthesia | Topical anesthesia

Question 685

What muscles of the hand receive their motor innervation from the median nerve?

Answer 685

The muscles of the thenar eminence

Question 686

The area incised for the hamstring graft is innervated by the

Answer 686

Sciatic nerve

Question 687

You are preparing to perform an intercostal nerve block. After preparing the skin with antiseptic solution, you make a skin wheal

Answer 687

directly over the rib near the midaxillary line

Question 688

Intercostal nerve block Ideally, the patient is in the

Answer 688

prone position, but can be performed with the patient lying on the unaffected side.

Question 689

Intercostal nerve block??

Answer 689

The correct rib is identified by palpation, a skin wheal is made directly over it at the level of the midaxillary line, and then a 22 gauge B-bevel needle is walked off the inferior border of the rib and advanced about 0.5 cm. After careful aspiration for blood or air, 3 to 5 mL of local anesthetic is injected

Question 690

Which of the following statements concerning total laryngectomy are false? (select two)

Answer 690

A tracheostomy tube is necessary | It is necessary to remove the thyroid gland as a part of this procedure

Question 691

What nerves are most at risk for damage or temporary dysfunction from a carotid endarterectomy? (select three)

Answer 691

Superior laryngeal Hypoglossal Recurrent laryngeal

Question 692

You are performing anesthesia for a 70 kg patient undergoing a carotid artery stent procedure. What dose of heparin would you expect to administer as an intravenous bolus during the case?

Answer 692

Heparin in the range of 50 to 100 units per kilogram is typically administered as a bolus for a carotid artery stent procedure.

Question 693

Which location would be least appropriate for placement of an arterial line in a patient undergoing surgery on the distal aortic arch?

Answer 693

Left wrist.Because the left subclavian artery may be manipulated during the operation, which would disrupt monitoring in the left radial artery, monitoring pressures via another site would be preferred. The right radial is often used.

Question 694

Which of the following statements is true regarding the cardiac system of the premature infant?

Answer 694

The heart has a greater dependence upon extracellular calcium concentrations

Question 695

The fetal heart contains more .

Answer 695

connective tissue, the contractile elements are less organized, and contractility has a greater dependence upon the extracellular calcium concentration.

Question 696

Infants and autoregulation

Answer 696

Autoregulation is not yet matured, so the heart rate does not respond sufficiently to hypovolemia

Question 697

The heart of the premature infant is less sensitive to

Answer 697

catecholamines because it is already near the maximum level of beta-adrenergic stimulation.

Question 698

Digitalis is contraindicated in

Answer 698

premature infants because no resulting increase in contractility or ventricular ejection occurs, but the heart rate does slow down, resulting in a decrease in cardiac output.

Question 699

Dopamine and neonates

Answer 699

. Neonates exhibit resistance to the cardiac effects of dopamine. Term neonates exhibit resistance to the cardiac effects of dopamine and may not exhibit increased blood pressure and urine output until doses of 50 mcg/kg/min are reached.

Question 700

Neonates:Myocardial concentrations of digoxin can be as much as ____that of adults at the same serum concentration.

Answer 700

6 times higher than

Question 701

Which of the following changes occurs during pregnancy? (select two)

Answer 701

Plasma renin activity increases | The left ventricular end-diastolic volume increases

Question 702

Which of the following obstetric conditions likely warrants a crash induction for emergency cesarean section?

Answer 702

Placenta abruptio

Question 703

Which of the following thyroid hormones are increased during pregnancy?

Answer 703

Total T3 and T4 levels

Question 704

Which of the following drugs will cross the placenta? (Vasodilator)

Answer 704

Nitroprussie

Question 705

Succinylcholine Heparin Protamine which one cross the placenta?

Answer 705

None

Question 706

Which anesthetic technique is most likely to reduce uterine blood flow in an obstetric patient?

Answer 706

Administration of a paracervical block

Question 707

What is one reason many geriatric patients are more susceptible to hypothermia?

Answer 707

They are more prone to hypothyroidism

Question 708

Which of the following characteristics do geriatric patients share with neonates?

Answer 708

A higher body surface area to body mass ratio

Question 709

Which of the following contribute to the prolonged elimination half-life of many drugs in geriatric patients? (select two)

Answer 709

Decreased renal blood flow | Increased lipid stores

Question 710

A patient is suffering from an exacerbation of chronic ventilatory failure and exhibits severe acidosis (pH = 7.19). You are about to intubate the patient and place him on the ventilator. Which of the following statements are true?

Answer 710

This patient will exhibit a decreased response to exogenous catecholamines

Question 711

Hypermagnesemia can result from

Answer 711

excess dietary intake of magnesium, excess ingestion of oral antacids, hypothyroidism, hyperparathyroidism, Addison's disease, and lithium therapy.

Question 712

One method of treating hypermagnesemia.

Answer 712

Forced diuresis with saline and loop diuretics is

Question 713

Which cholinesterase inhibitor has the shortest duration of action?

Answer 713

Edrophonium

Question 714

What is the determining factor in degree of muscle stimulation when using a peripheral nerve stimulation?

Answer 714

Current

Question 715

The risk for dural puncture, vascular injury, and neural damage is greatest when performing

Answer 715

Cervical epidural blocks

Question 716

A MAZE procedure is performed to treat

Answer 716

atrial fibrillation

Question 717

Hyperglycemia results in

Answer 717

hyponatremia, hypophosphatemia, hypokalemia, and hypomagnesemia.

Question 718

What electrolye abnormalities usually occur with diabetic ketoacidosis? (select four)

Answer 718

hyponatremia, hypophosphatemia, hypokalemia, and hypomagnesemia.

Question 719

Which of the following is a cause of secondary hyperparathyroidism?

Answer 719

Chronic renal failure

Question 720

What percent of healthcare workers' mobile phones test positive for bacteria?

Answer 720

90%

Question 721

Which of the following does not decrease significantly with age?

Answer 721

. Baseline hepatic function

Question 722

By age 80, the number of functioning nephrons has .

Answer 722

decreased by 50 percent.

Question 723

Lean muscle mass with age

Answer 723

decreases

Question 724

Bone density with age, increasing the risk for fractures.

Answer 724

decreases significantly

Question 725

Although hepatic mass decreases significantly,

Answer 725

baseline hepatic function remains well preserved with age.

Question 726

Which pediatric condition would require surgical intervention the soonest after delivery?

Answer 726

Gastrochisis

Question 727

Baseline hepatic function and aging

Answer 727

does not significantly change

Question 728

Which of the following drugs affects coagulation by inhibiting cyclooxygenase?

Answer 728

ASA

Question 729

Lean muscle mass with age

Answer 729

decreases

Question 730

Bone density with age, increasing the risk for fractures.

Answer 730

decreases significantly

Question 731

Although hepatic mass decreases significantly,

Answer 731

baseline hepatic function remains well preserved with age.

Question 732

Which pediatric condition would require surgical intervention the soonest after delivery?

Answer 732

Gastrochisis

Question 733

Dipyridamole class

Answer 733

phosphodiesterase inhibitor,

Question 734

Both normal plasma osmolarity and urine osmolarity indicates an

Answer 734

excellent ability of the tubules to concentrate urine. A situation wherein the plasma and urine osmolality become fixed together indicates serious damage to the renal tubules.

Question 735

What is the normal tissue PO2 in the brain?

Answer 735

35-40 mmHg

Question 736

Normal urine osmoloarity is about

Answer 736

around 1400 mOsm/Kg

Question 737

The normal plasma osmolality of about

Answer 737

290 mOsm/Kg)

Question 738

What is the normal tissue PO2 in the brain?

Answer 738

. 35-40 mmHg

Question 739

Parathyroid hormone increases serum calcium levels by.

Answer 739

promoting the breakdown of bone, regulation of renal calcium excretion, and altering the GI absorption of the mineral

Question 740

Analyzers that can't detect oxygen content true regarding infrared gas analyzers?

Answer 740

infrared gas analyzers

Question 741

Which of the following acid-base disorders would you expect to see in the patient with pyloric stenosis?

Answer 741

Hypochloremic, hypokalemic metabolic alkalosis

Question 742

Too rapid administration of DDAVP IV can cause

Answer 742

hypotension.

Question 743

Analyzers that can't detect oxygen content true regarding infrared gas analyzers?

Answer 743

infrared gas analyzers?

Question 744

The sensation that non-painful stimuli is painful

Answer 744

Allodyia

Question 745

Which of the following are associated with supraventricular tachycardia? (select two)

Answer 745

Syncope | Polyuria

Question 746

Chronic renal disease can produce renal osteodystrophy (changes in the mineralization of bone). The most important contributors to this are

Answer 746

secondary hyperparathyroidism and a decrease in the production of vitamin D by the kidneys.

Question 747

Which of the following are indications for the use of pyridostigmine? (select two)

Answer 747

Myasthenia gravis | Nondepolarizing muscle relaxant reversal

Question 748

As cholinesterase inhibitors can result in

Answer 748

bradycardia,

Question 749

Which of the following statements is true regarding flumazenil?

Answer 749

Flumazenil administration is not associated with cardiovascular changes

Question 750

Flumazenil half life is

Answer 750

It has a half-life of about 1 hour, so it is possible that re-sedation can occur with benzodiazepines that have a longer half-life than this.

Question 751

Flumazenil is metabolized where?

Answer 751

in the liver

Question 752

The effects of these three anticholinergics can be understood as follows: Antisialogogue:

Answer 752

Scopolamine>Glycopyrrolate>Atropine,

Question 753

The effects of these three anticholinergics can be understood as follows: Increased Heart Rate:

Answer 753

Atropine>Glycopyrrolate>Scopolamine,

Question 754

The effects of these three anticholinergics can be understood as follows: Sedation:

Answer 754

Scopolamine>Atropine>Glycopyrrolate

Question 755

SA nodes action potential phase 4 is initiated and propelled primarily by

Answer 755

An inward flow of both sodium ions and calcium ions

Question 756

An SA node action potential contains three distinct phases:

Answer 756

Phase 4: the spontaneous depolarization that triggers the action potential once the transmembrane potential reaches threshold (about -45 millivolts). Phase 0: depolarization phase of the action potential Phase 3: repolarization

Question 757

Disadvantages of using a heat and moisture exchanger (HME) include (select two)

Answer 757

Increased work of breathing | Can result in airway obstruction

Question 758

The primary disadvantages of HMEs are that they are not nearly as effective at

Answer 758

warming and humidifying the patient airway as water-based, electrical devices They also increase deadspace and can increase the work of breathing.

Question 759

If increased airway resistance is experienced during an anesthetic, t

Answer 759

he peak pressure should be measured both with and without the HME in place.

Question 760

Which disease process is not associated with increased risk for nephrolithiasis?

Answer 760

SLE

Question 761

Most kidney stones are formed from

Answer 761

calcium oxalate and the potential for and causes of hypercalcemia should be evaluated in patients undergoing anesthesia for kidney stone removal including cancer, sarcoidosis, and hyperparathyroidism.

Question 762

About half of the patients who develop stones formed from

Answer 762

uric acid suffer from gout.

Question 763

A patient with a history of spinal cord injury is undergoing a cesarean section. Which anesthetic modality would be the most effective at preventing autonomic hyperreflexia?

Answer 763

Spinal

Question 764

The roof of the ethmoid sinus is the ______and ______Piercing this sinus can result in a

Answer 764

cribriform plate and anterior skull base. | Communication between the airway and the cranial vault and CSF may be seen leaking from the nose.

Question 765

A panendoscopy includes _____(3)To provide adequate visualization for the surgeon, intubation with a

Answer 765

laryngoscopy, bronchoscopy, and esophagoscopy. microlaryngeal tube may be used as can jet ventilation. If jet ventilation is used, then a TIVA anesthetic would need to be employed because of the inability to deliver anesthetic gas to the patient.

Question 766

During general anesthesia for endoscopic surgery of the ethmoid sinus, the surgeon indicates he may have pierced the ethmoid roof. Which of the following actions are contraindicated on emergence?

Answer 766

Vigorous bag mask ventilation to reduce the end-tidal CO2

Question 767

In pregnant patients, the gastric emptying time is______ ; the gastric secretions are

Answer 767

is not increased; more acidic.

Question 768

The lower esophageal sphincter pressure can decrease due to the effects of progesterone. The gravid uterus can also increas

Answer 768

the intragastric pressure, making reflux more likely.

Question 769

Magnesium and Uterine blood flow

Answer 769

increases uterine blood flow in both hypertensive and normotensive subjects

Question 770

The lower esophageal sphincter pressure can decrease due to the effects of progesterone. The gravid uterus can also increas

Answer 770

e intragastric pressure, making reflux more likely.

Question 771

Sevoflurane, isoflurane, and desflurane have been shown to exert no change on uterine blood flow between 0.5 and 1.5 MAC. Although with higher levels of inhaled anesthetic (2 MAC or greater), uterine blood flow may be decreased, there have been no reports of impaired fetal gas exchange. Verapamil 0.2mg/kg has been shown to decrease maternal blood pressure and decrease uterine blood flow. Local anesthetics exert a vasoconstrictor property that can reduce uterine blood flow. The normal concentrations used do not normally have this effect with two exceptions: 1) inadvertent intravenous injection of a local anesthetic, and 2) paracervical block. Bupivacaine exerts a greater vasoconstrictor effect than either chloroprocaine or lidocaine.

Answer 771

increases uterine blood flow in both hypertensive and normotensive subjects

Question 772

Magnesium on uterine blood flow. Even though it may magnify hypotension in patients undergoing epidural anesthesia, magnesium still does

Answer 772

not decrease uterine blood flow.

Question 773

VA and uterine blood flow

Answer 773

Sevoflurane, isoflurane, and desflurane have been shown to exert no change on uterine blood flow between 0.5 and 1.5 MAC.

Question 774

Although with higher levels of inhaled anesthetic (2 MAC or greater), uterine blood flow may be decreased, there have been no

Answer 774

reports of impaired fetal gas exchange.

Question 775

Uterine Blood flow and Verapamil.

Answer 775

Verapamil 0.2mg/kg has been shown to decrease maternal blood pressure and decrease uterine blood flow.

Question 776

Local anesthetics exert a vasoconstrictor property that can reduce do what on uteribe blood flow?

Answer 776

uterine blood flow

Question 777

With Uterine blood flow, The normal concentrations used do not normally have this effect with two exceptions:

Answer 777

1) inadvertent intravenous injection of a local anesthetic, and 2) paracervical block. Bupivacaine exerts a greater vasoconstrictor effect than either chloroprocaine or lidocaine.

Question 778

All of the lung parameters below increase with age except for

Answer 778

TOTAL LUNC CAPACITY .

Question 779

Which of the following increases as a result of the aging process?

Answer 779

Catecholamine levels

Question 780

As a result of aging, the response to beta-receptor stimulation and and parasympathetic activity increase or decrease?

Answer 780

Efficacy of blood pressure control by the baroreflex decreases with age.

Question 781

Aging: Efficacy of blood pressure control by the baroreflex

Answer 781

decreases with age.

Question 782

Which statement regarding obesity hypoventilation syndrome (OHS) and obstructive sleep apnea (OSA) is true?

Answer 782

Both have nocturnal respiration program

Question 783

Which of the following will reduce the hemodilution and dilutional coagulopathy attributed to cardiopulmonary bypass (CPB) priming fluid?

Answer 783

Miniaturized cardiopulmonary bypass circuits

Question 784

Proper understanding of the appropriate anesthetic management of a patient undergoing a high tracheal resection? What position should be maintained?

Answer 784

. The patient should be maintained in a head-down position during the procedure

Question 785

During tracheal resection, FIO2? and why?

Answer 785

a high FiO2 should be maintained throughout the case to ensure adequate oxygenation of the functional residual capacity so temporary interruptions in ventilation are tolerated without hypoxia

Question 786

The primary interventions to improve cerebral perfusion pressure (CPP) in a trauma patient with intracranial hypertension are to maintain a

Answer 786

mean arterial pressure of at least 70-75 mmHg to ensure a CPP of at least 60 mmHg and promote oxygenation and adequate glucose levels without hyperglycemia.

Question 787

Measures to reduce intracranial pressure may include

Answer 787

reverse Trendelenburg position, short-acting sedatives such as propofol, midazolam or fentanyl, CSF drainage via a ventriculostomy, and neuromuscular blockade.

Question 788

The primary interventions to improve cerebral perfusion pressure (CPP) in a trauma patient with intracranial hypertension are to maintain a mean arterial pressure of

Answer 788

at least 70-75 mmHg to ensure a CPP of at least 60 mmHg and promote oxygenation and adequate glucose levels without hyperglycemia.

Question 789

The induction dose of propofol in infants between 1-6 months of age is

Answer 789

3 mg/kg.

Question 790

The induction dose of propofol in infants between 1-6 months of age is

Answer 790

3 mg/kg.

Question 791

For children 1-12 years old, it is

Answer 791

1.3-1.6 mg/kg.

Question 792

Hypotension, tachycardia, cutaneous hyperemia, and hypoxia are signs of mesenteric traction syndrome which is caused by

Answer 792

the release of vasoactive amines (principally prostacyclin) from the vascular bed of the mesentery. As a result, serum prostaglandin levels increase substantially. Non-steroidal anti-inflammatory agents such as aspirin and ketorolac ameliorate these symptoms.

Question 793

According to the standards set by the American Society for Testing and Materials (ASTM), a reservoir bag of 3 liters that is distended to four times its size shall not exert pressures that are (select two)

Answer 793

Less than 35 cm H2O | Greater than 60 cm H2O

Question 794

According to the standards set by the ASTM, 3-liter reservoir bags (also called breathing bags) that are

Answer 794

distended to four times their normal size should not exert a pressure less than 35 cm H2O or greater than 60 cm H2O.

Question 795

Bags that are 1.5 L in size or smaller shall not exert a pressure less than

Answer 795

30 cm H2O or greater than 50 cm H2O when distended to this extent. The lowest pressure to be exerted is to ensure that the bag is capable of exerting enough minimum pressure to ventilate a patient and the highest pressure is to limit the amount of barotrauma that a patient may be exposed to when using the breathing bag.

Question 796

Gastrochisis Covering membrane

Answer 796

NO

Question 797

Omphalocele Covering membrane

Answer 797

yes

Question 798

Gastrochisis -->Location of defect

Answer 798

Right of umbilicus

Question 799

Omphalocele -->Location of defect

Answer 799

Midline including umbilicus

Question 800

Umbilical cord insertion: Gastrochisis

Answer 800

Body wall at normal | location

Question 801

Umbilical cord insertion: Omphalocele

Answer 801

Omphalocele membrane

Question 802

Herniated abdominal organs : Gastrochisisl Bowel and sometimes liver

Answer 802

Bowel

Question 803

Herniated abdominal organs : Omphalocele

Answer 803

Bowel and sometimes liver

Question 804

Associated anomalies Gastrochisis vs Omphalocele

Answer 804

Uncommon with G | Very common with Omphalocele

Question 805

Prognostic factors Gastrochisis

Answer 805

condition of bowel

Question 806

Omphalocele prognostic factors

Answer 806

Associated anomalies

Question 807

TEC 6 vaporize filling?

Answer 807

Although the Tec 6 vaporizer is unique in that | it can be filled while in operation,106 it is safer to turn it off momentarily

Question 808

Filling a variable bypass vaporizers?

Answer 808

All variable-bypass vaporizers must be shut off while they are being filled

Question 809

Vaporizers and overfilling

Answer 809

Overfilling may result in discharge of liquid anesthetic from the vaporizer outlet, which has caused patient injuries

Question 810

TEC 6 no OUTPUT alarms sound when?

Answer 810

The No Output alarms are activated if the agent level is less than 20 mL, if the vaporizer is tilted more than 10 degrees from the vertical, if there is a power failure lasting longer than 10 seconds, or if an internal malfunction occurs

Question 811

Hazards of Modern Vaporizers

Answer 811

Incorrect (unintended) agent administration • Tipping • Overfilling with agent • Reliance on breath-by-breath gas analysis rather than performing regular preventive maintenance

Question 812

Responsible for the majority of heat loss.

Answer 812

Radiant heat loss i

Question 813

Which of the following would decrease the incidence of postoperative hoarseness due to intubation?

Answer 813

The use of low-pressure, high-volume cuffs

Question 814

When CO2 waveform does not return to baseline?

Answer 814

accumulation of CO2 in the patient due to an incompetent expiratory valve exhausted CO2 absorbent the rebreathing of CO2 under the drapes by a spontaneously ventilating patient or potentially, an incompetent inspiratory valve.

Question 815

A circuit disconnect will generally manifest as

Answer 815

loss of the ETCO2 waveform altogether.

Question 816

CO2 waveform does not return to baseline, incompetent _____valve

Answer 816

Expiratory.

Question 817

Which approach to a brachial plexus block is the only one that will provide sufficient analgesia for surgery on the shoulder and upper extremity?

Answer 817

Interscalene

Question 818

Defined as any abnormal sensation that is unpleasant to the patient?

Answer 818

Dyesthesia

Question 819

An increased response to a painful stimuli.

Answer 819

Hyperalgesia

Question 820

Onset of LA is related to what characteristics

Answer 820

Pka

Question 821

Duration of LA is related to what characteristics

Answer 821

Protein binding (di)

Question 822

Potency of LA is related to what characteristics

Answer 822

Lipid solubility ( SLP)

Question 823

You are preparing to perform a Bier block for a procedure that may take longer than 45 minutes. Which of the following methods would be appropriate to help alleviate the pain from the tourniquet?

Answer 823

Use a double tourniquet

Question 824

In the fetus, the percentage of cardiac output directed to the placenta is approximately:

Answer 824

50%

Question 825

In the fetus, the lungs receive little blood flow. The placenta receives

Answer 825

nearly one-half of the fetal cardiac output and is responsible for respiratory gas exchange.

Question 826

Which of the following will exacerbate local anesthetic toxic reactions? (select two)

Answer 826

Hypoxia | Hypercapnia

Question 827

Utmost importance in the management of inadvertent local anesthetic overdose.

Answer 827

airway control

Question 828

A patient is in steep Trendelenburg position during a laparoscopic cholecystectomy. The patient suddenly exhibits a decrease in oxygen saturation, subcutaneous crepitation over the chest, and an increase in end-tidal CO2. The first step you should take is

Answer 828

Tell the surgeon to turn off the insufflator.The symptoms listed in the question describe a pneumothorax with entry of the CO2 used for abdominal insufflation entering the lungs. The appropriate immediate measures are to cease insufflation of the abdomen, discontinue nitrous oxide if it is being utilized, increase ventilation, and call for assistance.

Question 829

Which type of laser produces the greatest amount of smoke and may create the greatest need for protective masks?

Answer 829

CO2 laser

Question 830

Which of the following complications carries an increased risk in obstetric patients who underwent bariatric surgery prior to conception?

Answer 830

Premature rupture of membranes

Question 831

Obstetric patients who have undergone bariatric surgery exhibit increased risk for

Answer 831

premature rupture of membranes, small bowel ischemia, nutrient deficiencies, fetal abnormalities, and an increased risk for requiring a cesarean section.

Question 832

Obstetric patients who have undergone bariatric surgery exhibit

Answer 832

There was a decreased risk for gestational diabetes and pregnancy-induced hypertension and no significant difference in placental abruption, previa, or perinatal complications.

Question 833

Prior to inducing anesthesia for a patient who has suffered major trauma, changes in the patient's phonation during the interview may indicate an increased risk for

Answer 833

neurological damage during intubation

Question 834

Hepatic B vs Hepatitis C in blood transfusion?

Answer 834

The risk of contracting hepatitis B is greater than hepatitis C

Question 835

can be transmitted by transfusion

Answer 835

The Epstein-Barr virus

Question 836

Which of the following statements regarding transtracheal block is correct? HOW MUCH AND WHAT % LA

Answer 836

The appropriate dose is 3-5 mL of 2% lidocaine

Question 837

Which of the following would you expect to occur with a neuraxial anesthetic? (select two) WITH BOWELS?

Answer 837

Generalized constriction of the bowel | Increased peristalsis

Question 838

Which of the following actions would be appropriate choices for prolonging the duration of a spinal anesthetic? (select two)

Answer 838

Increasing the dose of the local anesthetic injected | Adding 5 mcg of sufentanil to the local anesthetic

Question 839

You are preparing to perform an intercostal nerve block for a patient suffering from shingles. From superior to inferior, match the structures with the position it maintains in the intercostal neurovascular bundle.

Answer 839

SUPERIOR MIDDLE INFERIOR vein, artery, nerve. (VAN -SMI)

Question 840

A patient is undergoing surgery on the lower leg and wishes to avoid general anesthesia. You have successfully performed a popliteal block. What other block should be performed to provide complete anesthesia distal to the knee?

Answer 840

Femoral nerve block

Question 841

A popliteal block spares the

Answer 841

medial anterior calf and medial aspect of the foot. A supplementary femoral nerve block is required to block its terminal saphenous branch which innervates the medial anterior calf and the medial aspect of the foot.

Question 842

What of the following would decrease the amount of prolapse in patients with mitral valve prolapse? (select two)

Answer 842

Increased intravascular volume | Hypertension

Question 843

Overall, What decrease the degree of prolapse?.

Answer 843

Any factor that maintains a larger ventricular volume will decrease the degree of prolapse

Question 844

will decrease the degree of prolapse.

Answer 844

Hypertension, vasoconstriction, drug-induced myocardial depression, and increased preload

Question 845

Which of the following interventions would be appropriate in the management of a patient with symptomatic cardiac tamponade until a pericardiocentesis can be performed? (select four)

Answer 845

Administering a colloid solution intravenously Administering a crystalloid solution intravenously Administration of isoproterenol to prevent bradycardia Administration of atropine to prevent vagal reflexes

Question 846

The primary goals in the management of a patient with symptomatic cardiac tamponade include:

Answer 846

- expanding intravascular volume by administering crystalloids or colloids - maintaining heart rate and contractility by administering catecholamines (including isoproterenol), - administering dopamine to increase systemic vascular resistance if necessary - administering atropine to prevent vagal reactions to the increased intrapericardial pressure - correcting metabolic acidosis (metabolic acidosis can have detrimental effects on cardiac contractility).

Question 847

Correct this electrolyte disturbance in the cardiac tamponade patient?

Answer 847

metabolic acidosis can have detrimental effects on cardiac contractility).

Question 848

Correct this electrolyte disturbance in the cardiac tamponade patient?

Answer 848

metabolic acidosis can have detrimental effects on cardiac contractilit

Question 849

According to Poiseuille's law, if a patient's airway diameter decreases by half during an asthma attack, then the airway resistance

Answer 849

increases 16-fold

Question 850

Temperature and decreases in CMRO2

Answer 850

CMRO2 decreases 6-8% for every 1 C drop in temperature.

Question 851

The perioperative mortality rate for a carotid endarterectomy is

Answer 851

0.5-2.5 percent.

Question 852

You are performing an anesthetic for a patient undergoing an MRI that is receiving gadolinium contrast dye. What are the most likely side effects of its administration?

Answer 852

Nausea

Question 853

Biliary stones are considered a posthepatic cause of hepatic dysfunction and are associated with an

Answer 853

increased conjugated fraction of bilirubin, normal to slightly increased aminotransferase enzymes, and most notably, markedly increased alkaline phosphatase levels.

Question 854

Hepatic dysfunction due to biliary tract obstruction would be consistent with which laboratory finding?

Answer 854

Markedly increased alkaline phosphatase levels

Question 855

Upon what receptors does nalbuphine act? (select two)

Answer 855

MU, and Kappa

Question 856

Conditions that warrant postponement of elective procedures for further evaluation include

Answer 856

symptomatic mitral stenosis, new onset ventricular tachycardia, symptomatic ventricular arrhythmias, unstable angina, MI within the past 30 days, severe aortic stenosis, symptomatic bradycardia, and high-grade heart block.

Question 857

What is the only additive to the local anesthetic for a Bier block that has been proven effective?

Answer 857

Ketorolac

Question 858

Cisatracurium what you should know

Answer 858

Although a small amount of cisatracurium may be metabolized by plasma esterases, the primary route of metabolism is Hofmann elimination.

Question 859

Which nondepolarizing muscle relaxant is metabolized predominantly by ester hydrolysis?

Answer 859

Atracurium

Question 860

A trigger point injection would be most appropriate for the treatment of

Answer 860

myofascial pain

Question 861

What diagnostic parameter is the most sensitive indicator of the effect of obesity on pulmonary function?

Answer 861

Expiratory reserve volume

Question 862

It has been shown that the endotracheal tube has a higher likelihood of moving in laparoscopic surgeries in the

Answer 862

morbidly obese patient population.

Question 863

Patients taking HMG-CoA reductase inhibitors may exhibit (select two)

Answer 863

Elevated creatine kinase | Elevated serum aminotransferase activity

Question 864

Fibrate anti-lipid medications such as

Answer 864

gemfibrozil and fenofibrate may result in decreased white blood cell counts.

Question 865

The nerve distribution of the median nerve, which can be blocked by the injection of local anesthetic at the wrist between the

Answer 865

flexor carpi radialis and the palmaris longus tendons.

Question 866

Which of the following solutions has the highest sodium concentration?

Answer 866

NS

Question 867

Normal saline has a sodium of

Answer 867

154 mEq/L.

Question 868

Lactated Ringer's solution has a sodium of

Answer 868

130 mEq/L

Question 869

Normosol-R contains ____mEq/L of sodium.

Answer 869

140

Question 870

Plasma has a sodium concentration of

Answer 870

142 mEq/L

Question 871

Significant risk for perineal crush injury is associated with which of the following situations?

Answer 871

On traction table to reduce a femur fracture

Question 872

Arnold-Chiari malformation almost always coexists with Surgical correction is usually performed by a decompressive suboccipital craniectomy with cervical laminectomies to relieve the compression. Because of cranial nerve and brainstem dysfunction, children with this disorder may have abnormal responses to hypoxia and hypercarbia.

Answer 872

yelodysplasia and involves the caudal displacement of the cerebellar vermis, fourth ventricle, and lower brainstem below the level of the foramen magnum.

Question 873

Medullary cord compression can occur, particularly with

Answer 873

extension of the neck, and patients may present with symptoms such as vocal cord paralysis, swallowing dysfunction, and chronic pulmonary aspiration

Question 874

Surgical correction is usually performed by a: | Arnold-Chiari malformation

Answer 874

decompressive suboccipital craniectomy with cervical laminectomies to relieve the compression. Because of cranial nerve and brainstem dysfunction, children with this disorder may have abnormal responses to hypoxia and hypercarbia.

Question 875

You are evaluating a patient who has survived breast cancer and is now presenting for a mammoplasty. Which of the following chemotherapy agents would warrant further investigation into her current hepatic function?

Answer 875

Methotrexate

Question 876

Which areas of the lower leg would still have sensation after the successful performance of a popliteal block on a patient? (select two)

Answer 876

The medial anterior calf | The medial aspect of the foot

Question 877

Which of the following indicates a proper understanding of how to apply the thumb and forefinger against the cricoid cartilage when performing the Sellick maneuver?

Answer 877

Pressing backward, upward, and to the right until the fingers blanch directly on the cricoid cartilage

Question 878

The termination of a large tidal volume breath by signals from stretch receptors within the lung tissue is a result of the

Answer 878

Hering-Breuer reflex

Question 879

Which of the following conditions are associated with a deficiency of alpha-1 acid antitrypsin?

Answer 879

Emphysema

Question 880

Transthecal block of the digits: injection

Answer 880

It requires only a single injection

Question 881

Which diuretic works by decreasing sodium reabsorption and hydrogen ion secretion in the proximal tubules?

Answer 881

Acetazolamide

Question 882

Which of the following side effects can occur due to the intravenous administration of mannitol? (select two)

Answer 882

Exacerbation of congestive heart failure | A transient decrease in the hematocrit

Question 883

Which of the following symptoms of cardiac tamponade are indications of ventricular discordance? (select two)

Answer 883

Kussmaul's sign | Pulsus paradoxus

Question 884

High airway pressure is a hazard when using a self-inflating manual resuscitator if a pressure relief valve is not utilized. The risk is

Answer 884

greater with endotracheal tubes than with mask or supraglottic devices such as the LMA or laryngeal tube which tend to leak at a lower pressure than an endotracheal tub

Question 885

Hyperglycemic hyperosmolar syndrome signs

Answer 885

Polyuria, polydipsia, hypotension, tachycardia, hyperosmolarity (>340 mOsm/L) and hypoperfusion of major organs. Intravascular coagulation and mesenteric thrombosis

Question 886

What is the only indication for intravenous levothyroxine?

Answer 886

Myxedema coma

Question 887

What surgical procedure would you expect to have the highest risk for the development of acute pancreatitis postoperatively?

Answer 887

Cardiac thoracic surgery

Question 888

Dressler's syndrome is

Answer 888

pericarditis following a myocardial infarction

Question 889

What are the four types of burns? (select four)

Answer 889

Thermal Electrical Chemical Inhalation

Question 890

Which is a potential disadvantage of using nitroglycerin for controlled hypotension?

Answer 890

It can increase intracranial pressure

Question 891

With age, renal cortical mass decreases by as much as

Answer 891

25%

Question 892

Which of the following is most consistent with Hyperglycemic Hyperosmolar State (HHS)?

Answer 892

dehydration

Question 893

State Alveolar gas equation

Answer 893

pAO2 = FiO2 (Patm – pH20) – (paCO2/RQ

Question 894

Alveolar gas equation: known variables

Answer 894

Patm is the atmospheric pressure (at sea level 760 mm Hg), PH2O is partial pressure of water (approximately 47mm Hg). FiO2 is the fraction of inspired oxygen. PaCO2 is partial pressure of carbon dioxide in alveoli (in normal physiological conditions around 40 to 45 mmHg). RQ is the respiratory quotient. The value of the RQ can vary depending upon the type of diet and metabolic state. RQ is different for carbohydrates, fats, and proteins (average value is around 0.82 for the human diet). Indirect calorimetry can provide better measurements of RQ by measuring the VO2 (oxygen uptake) and VCo2 (carbon dioxide production).

Question 895

Increasing altitude decreases the

Answer 895

atmospheric pressure;

Question 896

Where in the popliteal fossa can the popliteal artery be found?

Answer 896

Immediately lateral to the semitendinous tendon.

Question 897

A Wright respirometer is located where in the circuit?

Answer 897

expiratory limb and contains vanes that cause it to rotate when exhaled gas passes across it.

Question 898

What is the leading cause of death in patients with diabetes mellitus?

Answer 898

Cardiovascular disease

Question 899

hich of the following laboratory results is associated with damage to the renal tubules?

Answer 899

Increased urinary sodium excretion

Question 900

Steep reverse Trendelenburg position for surgery on the head is associated with

Answer 900

a risk for air embolus

Question 901

Abducting the arms less than 90 degrees provides a degree of protection for

Answer 901

stretch injury to the brachial plexus, but has little bearing on the ulnar nerve.

Question 902

Put the patient's at risk for ulner nerve injury

Answer 902

Pronation of the hand positions the ulnar nerve directly against the table surface, making it a high-risk position. . Supinating the hand shifts the ulnar nerve above the table surface and allows the olecranon to bear the weight of the arm.

Question 903

Pt with von willebrand disease not respondiing to DDAVP should be give

Answer 903

Patients with von Willebrand disease should be given desmopressin which increases factor VIII-vWF complex and improves coagulation. If desmopressin doesn't produce a sufficient response, cryoprecipitate should be considered.

Question 904

Heart conditions that are consistent with RA

Answer 904

Aortic regurgitation Pleural effusion Coronary arteritis

Question 905

EMLA cream consists of a 1:1 mixture of

Answer 905

2.5 percent lidocaine and 2.5 percent prilocaine in an oil-in-water emulsion.

Question 906

EMLA cream requires a contact time of at least

Answer 906

It requires a contact time of at least one hour under an occlusive dressing, reaches a depth of analgesia of about 3-5 mm, and has a duration of about 1-2 hours.

Question 907

Injection of 3 mL of 2% lidocaine bilaterally 1 cm below each greater cornu of the hyoid is a

Answer 907

superior laryngeal nerve block which anesthetizes the airway below the epiglottis as well as a portion of the epiglottis itself.

Question 908

The lingual and pharyngeal branches of the glossopharyngeal nerve are blocked by

Answer 908

infiltrating local anesthetic into the base of the palatoglossal arch.

Question 909

The patient with sepsis typically presents with a | Comment on wedge pressure, CO, and SVR

Answer 909

low pulmonary capillary wedge pressure, a high cardiac output, and a low systemic vascular resistance.

Question 910

Select all of the sites where arginine vasopressin exerts its effects (select two)

Answer 910

Renal collecting ducts | Vascular smooth muscles

Question 911

Which substance enhances the sensitivity of nerve endings to painful stimuli but does not directly excite them?

Answer 911

Substance P

Question 912

Sarcoidosis is a disorder of the

Answer 912

immune system.

Question 913

May produce electrical interference that may be interpreted as a ventricular dysrhythmia by an AICD. This could potentially trigger a defibrillation pulse.

Answer 913

Unipolar cautery

Question 914

If your patient has an AICD?

Answer 914

It is best to consult with someone who has experience with the specific device prior to surgery or place a magnet over the device to temporarily disable it.

Question 915

Patients with carcinoid tumors do not always experience symptoms related to the release of hormones from the tumor. Why is this?

Answer 915

Because, Usually, hepatic first-pass metabolism eliminates the hormones from the circulatory system before they can exert any deleterious effects.

Question 916

Side of the heart not affected by carcinoid syndrome.

Answer 916

Left side of the heart not affected.

Question 917

Most CVAs are_____(ischemic vs. hemorrhagic) in nature.

Answer 917

ischemic

Question 918

Hemorrhagic vs ischemic stroke?

Answer 918

Hemorrhagic strokes are four times more lethal than ischemic strokes.

Question 919

The risk for a stroke is higher in men until age

Answer 919

75 when the risk for men and women is the same. Hyperglycemia is associated with poor outcomes in patients with ischemic stroke.

Question 920

Patients with Huntington's Chorea and NMB agents?

Answer 920

have extreme sensitivity to nondepolarizing muscle relaxants, therefore they should be titrated very carefully. Also, because of a decrease in plasma cholinesterase, they exhibit an increased sensitivity to succinylcholine.

Question 921

Dantrolene Full MOA .

Answer 921

e ryanodine type 1 receptor to inhibit the efflux of calcium from the sarcoplasmic reticulum

Question 922

Dandrolene dose and mix information

Answer 922

It is packaged as a lyophilized (freeze dried) powder that must be mixed with 60 cc of sterile water prior to injection. It may be administered in doses of 2.5 mg/kg every 5 minutes to a total dose of 10 mg/kg.

Question 923

Associated with Interstitial nephritis

Answer 923

Proteinuria Decreased ability to concentrate urine Hypertension

Question 924

Interstitial nephritis is a disorder most commonly associated with

Answer 924

allergic reactions to drugs such as sulfonamides, allopurinol, phenytoin, and diuretics.

Question 925

It is also less commonly associated with diseases such as lupus erythematosus and sarcoidosis

Answer 925

Interstitial nephritis

Question 926

Hereditary nephritis is a genetic disorder most commonly seen in _____ and is associated with _____ and _____ abnormalities.

Answer 926

Males; Hearing and ocular abnormalities.

Question 927

Hereditary nephritis is associated with ____and _______. Drug treatment successful or unsuccessful?

Answer 927

systemic hypertension and renal failure. Drug treatment has not proved successful in this class of patients.

Question 928

What is the standard treatment for the condition for Hyperparathyroidism ?

Answer 928

Surgical excision is the standard treatment for the condition.

Question 929

Signs and symptoms of hyperparathyroidism?

Answer 929

These signs and symptoms include renal stones, polyuria, hypertension, ventricular arrhythmias, muscle weakness, and osteoporosis.

Question 930

Drugs to avoid with porphyria

Answer 930

KETT PMN Ketorolac, thiopental, thiamylal, etomidate, pentazocine, methohexital, and nifedipine should all be avoided.

Question 931

The most common cause of respiratory distress syndrome in the premature infant is

Answer 931

insufficient surfactant production

Question 932

3 major contributors to Retinopathy of prematurity

Answer 932

Hyperoxia Hypoxia hypotension

Question 933

Indomethacin is what kind of medication? what is it used for?

Answer 933

Potent prostaglandin inhibitor is administered to stimulate closure of a patent ductus arteriosus.

Question 934

Signs of sepsis.

Answer 934

Low systemic vascular resistance Tissue hypoperfusion Disseminated intravascular coagulation

Question 935

Which of the following is not associated with septic shock?

Answer 935

Low CO (It is a high CO state)

Question 936

Brachial plexus position to the subclavian artery?

Answer 936

the brachial plexus is positioned posterior to the subclavian artery

Question 937

What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream?

Answer 937

Stratum corneum

Question 938

The epidermis is the outer layer of skin. It contains

Answer 938

5 layers.

Question 939

From bottom to top the layers of the SKIN are named:

Answer 939

stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum.

Question 940

When performing a wrist block, you inject 3 mL of local anesthetic at the level of the styloid process on the volar aspect of the arm between the palmaris longus and flexor carpi radialis tendons. What nerve are you anesthetizing when you do this?

Answer 940

Median

Question 941

You are caring for a patient undergoing a posterior cervical laminectomy in the sitting position. You suspect a venous air embolism has occurred. What action should be instituted first?

Answer 941

Have the surgeon flood the surgical field with saline

Question 942

You are caring for a patient undergoing a posterior cervical laminectomy in the sitting position. You suspect a venous air embolism has occurred. What action should be instituted first? second? Third?Fourth

Answer 942

Have the surgeon flood the surgical field with saline Turn off N20 100% O2 Aspirate the CVC to remove air.

Question 943

What are prudent measures prior to beginning the procedure in the sitting position at risk for VAE?

Answer 943

Use of a precordial doppler and placement of a central venous line

Question 944

What is the most common complication that arises from Transphenoidal Hypophysectomy? Is it permanent or temporary? Complications related to this procedure may arise from the need for mucosal injection of epinephrine to prevent bleeding, the accumulation of blood in the pharynx and stomach, risk of injury to the cavernous sinus or internal carotid artery, damage to cranial nerves III, IV, V1, and VI that travel near the pituitary gland, and hypofunction of the pituitary gland.

Answer 944

Diabetes insipidus; Temporary

Question 945

Hormones secreted by the Anterior Pituitary Gland ? FLAG TOP

Answer 945

Follicle-stimulating hormone Luteinizing hormone Adrenocorticotropic hormone (ACTH) Growth Hormone (GH) Thyroid stimulating hormone O MelanOcyte Prolactin

Question 946

The area of myocardium most vulnerable to ischemia is the:

Answer 946

left ventricular subendocardium

Question 947

The elimination half-life of intravenously administered oxytocin in the parturient is approximately:

Answer 947

30 to 120 seconds

Question 948

The posterior pituitary releases

Answer 948

antidiuretic hormone and oxytocin

Question 949

The most common type of functional pituitary tumor produces

Answer 949

hyperprolactinemia.

Question 950

The release of prolactin by the tumor can cause

Answer 950

amenorrhea, galactorrhea, or both, in women. In men, it can result in galactorrhea or infertility.

Question 951

Complications of transphenoidal Hypophysectomy?

Answer 951

need for mucosal injection of epinephrine to prevent bleeding, the accumulation of blood in the pharynx and stomach, risk of injury to the cavernous sinus or internal carotid artery, damage to cranial nerves III, IV, V1, and VI that travel near the pituitary gland, and hypofunction of the pituitary gland.

Question 952

Cranial nerve that travel near the pituitary gland

Answer 952

CN III, IV, V1 and V

Question 953

Which electrolyte disorder would be most likely to worsen cerebral edema following a craniotomy?

Answer 953

Hyponatremia

Question 954

Epidural steroid injections, how long should you wait? | Methylprednisolone contains the largest particles among all steroids used for epidural injections.

Answer 954

The injection should be given at least 2-3 weeks to allow time for the corticosteroid to exert its effects.

Question 955

Epidural steroid injections, how long should you wait?

Answer 955

The injection should be given at least 2-3 weeks to allow time for the corticosteroid to exert its effects.

Question 956

Transforaminal injections vs interlaminar injections?

Answer 956

Transforaminal injections have been shown to be more efficacious than interlaminar injections.

Question 957

contains the largest particles among all steroids used for epidural injections.

Answer 957

Methylprednisolone

Question 958

Three digit pacemaker codes represent the area in which the pacemaker actually generates a pacing impulse, the area in which it senses impulses, and the response it makes when sensing an impulse.

Answer 958

The first two letters of the code, pacing and sensing, can be either O: none, A: atrium, V: ventricle, or D: dual (both atrial and ventricular). The third letter of the code, response, can be either O: none, I: inhibited, T: triggered, or D: dual (both inhibited and triggered).

Question 959

Kyphoscoliosis is a pathology of the spine characterized by

Answer 959

anterior curvature (kyphosis) and lateral curvature (scoliosis) that results in compression of the lung tissue, and decreased vital capacity.

Question 960

The most common causes of death in patients with kyphoscoliosis are

Answer 960

restrictive lung disease and pulmonary hypertension. A poor cough often contributes to an increased risk for pulmonary infections

Question 961

Vital capacity and Kyphoscoliosis

Answer 961

Decreased Vital capacity

Question 962

The ventral decubitus position is the same as the

Answer 962

Prone

Question 963

BMI calculation formula

Answer 963

Weight in Kg/ Height (m^2)

Question 964

Which of the following is considered the gold standard in evaluating cardiac function and volume status?

Answer 964

Esophageal doppler monitoring

Question 965

In aortic stenosis, left ventricular compliance______ as the left ventricle_____ resulting in _______DYSFUNCTION.

Answer 965

decreases; hypertrophies; diastolic dysfunction.

Question 966

AORTIC STENOSIS and myocardial demand?

Answer 966

The myocardial demand is increased due to ventricular hypertrophy and the supply is decreased as the extraordinary compression of intramyocardial vessels during systole restricts arterial flow to the myocardium.

Question 967

Number of fluoride between desflurane, isoflurane, and sevoflurane mnemonic to remember

Answer 967

IDS 5,6,7 Isoflurane 5 Desflurane 6 Sevoflurane 7

Question 968

Elective surgery should be postponed in these patients if they exhibit

Answer 968

severe dyspnea, wheezing, pulmonary congestion, or a PaCO2 greater than 50 mmHg.

Question 969

You are preparing to induce a patient with uncorrected hydrocephalus for placement of a ventriculoperitoneal shunt. Which of the following agents would be least appropriate for this patient?

Answer 969

Desflurane

Question 970

Desflurane and ICP

Answer 970

Desflurane can increase cerebrospinal fluid production and could potentially increase cerebrospinal fluid pressure prior to placement of the shunt.

Question 971

Parotidectomy and the ETT tube

Answer 971

The endotracheal tube should be positioned on the opposite side of the mouth from the surgical site

Question 972

Parotidectomy patient's head position

Answer 972

The patient should be positioned with the head turned towards the opposite side

Question 973

Parotidectomy and paralysis

Answer 973

Surgical paralysis is not necessary for this procedure

Question 974

Drugs such as are associated with INCREASED potassium levels.

Answer 974

BNATS ``` Beta blockers NSAIDs ACE inhibitors Triamterene Spironolactone ```

Question 975

Loop diuretic associated with decreased serum potassium levels

Answer 975

Bumetanide

Question 976

You are about to perform anesthesia for an opthalmic procedure in which the surgeon wishes for the patient to be awake, but able to tolerate the placement of a lid speculum. Blockade of which nerve would prevent the patient from squinting during the procedure?

Answer 976

Facial nerve

Question 977

A patient presents for emergency surgery with an open-globe eye injury. Which of the following would present the greatest risk for further ocular damage?

Answer 977

Succinylcholine can increase intraocular pressure slightly and increase the risk for expulsion of the globe contents. However, intubation during light anesthesia can cause a large increase in the IOP. The risk of further eye damage must be balanced with the risk of aspiration.

Question 978

Silent myocardial infarctions are most common in patients with

Answer 978

diabetes and hypertension.

Question 979

When using a circle anesthesia circuit, the fresh gas flow rate

Answer 979

determines how much of the exhaled gas returns to the patient

Question 980

According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source?

Answer 980

40%

Question 981

The low peak pressure alarm is activated when

Answer 981

the ventilator is on

Question 982

The low peak pressure alarm is activated when the ventilator is turned on. It is designed to

Answer 982

help detect disconnects in the anesthesia circuit. In order to prevent the alarm from triggering, the airway pressure must exceed a preset minimum within a set amount of time (usually about 15 seconds).

Question 983

What are the 3 ECG changes often seen with hypothyroidism?

Answer 983

Flattened T waves Low-voltage P waves Sinus bradycardia

Question 984

Pt with hypothyroidism are more at risk for

Answer 984

Ventricular dysrhythmias.

Question 985

The initial treatment for a chemical burn is irrigation of the affected area with (select two)

Answer 985

Water AND SALINE

Question 986

What is an appropriate volume of local anesthetic for a caudal anesthetic in an adult patient undergoing a procedure that requires anesthesia to the T10 dermatome?

Answer 986

20-30 mL

Question 987

When inducing general anesthesia for a patient with chronic hypertension, you should strive to maintain the mean arterial blood pressure within what percent of normal?

Answer 987

20%

Question 988

When administered for induction, etomidate may cause a slight decrease in blood pressure. If it occurs, this is most likely due to a decrease in

Answer 988

Decrease in SVR

Question 989

What are the 4 major groups tissues are divided into when discussing the transfer of volatile anesthetics to the tissues?

Answer 989

Vessel-poor Vessel-rich Muscle FAT

Question 990

The primary site of action for neuromuscular blocking agents is the

Answer 990

postsynaptic nicotinic cholinergic receptor on the muscle endplate.

Question 991

The half-life of thyroxine (T4) in the circulation is about and (T3) is

Answer 991

7 days

Question 992

The half-life of thyroxine (T3) in the circulation

Answer 992

24-30 hours.

Question 993

How is a patient positioned for splenectomy?

Answer 993

Lateral decubitus

Question 994

Ideally the time-out procedure should be performed

Answer 994

before the induction of anesthesia while the patient is awake

Question 995

Which of the following conditions would explain why a dose of succinylcholine could last for 20-30 minutes?

Answer 995

Pregnancy

Question 996

In response to an increased MAP, cerebral vessels (dilation vs constriction) constrict. This patient's MAP rose to 180, therefore CBF would

Answer 996

increase despite compensatory mechanisms.

Question 997

Between MAPs of 60 and 140 this mechanism is able to keep CBF constant but outside of this range CBF

Answer 997

becomes pressure dependent.

Question 998

Chronic hypertension effect on the cerebral autoregulation of the brain

Answer 998

shift both the lower and upper limits of the cerebral autoregulation curves to the right

Question 999

ntracranial hypertension is defined as a sustained increased in intracranial pressure above:

Answer 999

10-15 mmHg

Question 1000

Intracranial hypertension is defined as a sustained increased in intracranial pressure above:

Answer 1000

10-15 mmHg

Question 1001

Using cricoid yolk studies, the optimum force necessary to effectively occlude the esophagus without obstruction of the trachea is between

Answer 1001

30 and 44 Newtons (3.0 - 4.4 kg).

Question 1002

Cricoid pressure before and after loss of consciousness.

Answer 1002

It is recommended that 2 kg of force be applied prior to loss of consciousness and that pressure be increased to 4 kg of force after loss of consciousness.