RANDOM FACTS for SEE 4

Question 1

All local anesthetics cause vasodilation except for

Answer 1

ROLICO

cocaine, lidocaine, and ropivacaine.

Question 2

The duration of action of which local anesthetic would be prolonged the least by the addition of epinephrine prior to injection?

Answer 2

Bupivacaine

Question 3

Action of sodium bicarbonate

Answer 3

It also prolongs the duration of action and reduces pain on injection.

Question 4

Which of the following is a contraindication to performing a peripheral nerve block on a patient?

Answer 4

Bleeding diathesis

Question 5

The femoral nerve maintains a lateral position in the femoral canal. In order from lateral to medial the structures are remembered by the acronym NAVEL

Answer 5

(nerve, artery, vein, empty space, and lymphatics).

Question 6

Studies have shown that C fibers (which are unmyelinated and transmit pain and temperature impulses) are

Answer 6

more resistant to blockade than A-delta fibers and B fibers.

Question 7

Which nerve fibers would you expect to be more resistant to the effects of local anesthetics?

Answer 7

A-delta fibers

Question 8

A patient has experienced a high spinal and exhibits hypotension, bradycardia, and weakened respirations. Which intervention would be most appropriate to help prevent further cephalad spread of the local anesthetic?

Answer 8

Flex the head at the neck

Question 9

Which of the following ECG changes is an indication of subendocardial ischemia?

Answer 9

ST depression

Question 10

Hypertension without signs of end-organ damage is termed

Answer 10

‘hypertensive urgency’.

Question 11

HTN with evidence of end organ damage?

Answer 11

hypertension with evidence of end-organ damage such as myocardial ischemia, dissecting aortic aneurysm, renal insufficiency, pulmonary edema, encephalopathy, eclampsia, or intracerebral hemorrhage.

Question 12

Patients with Hypertensive emergency would present with?

Answer 12

These patients often present with hypertension and symptoms such as headache, epistaxis, or anxiety.

Question 13

Hypertensive emergency is defined as Hypertension without signs of end-organ damage is termed ‘hypertensive urgency’. The exception to the rule is

Answer 13

parturients. A parturient with a diastolic blood pressure greater than 109 mmHg is defined as being in a state of hypertensive emergency even if no other symptoms are present.

Question 14

A poorly-controlled hyperthyroid patient is undergoing emergency surgery for an appendectomy. At what point would the patient be most likely to experience a thyrotoxic crisis?

Answer 14

6 to 18 hours postoperatively.

Question 15

Following induction and intubation of a patient with hypothyroidism, the blood pressure falls to 80/40 mmHg. The most appropriate intervention for this patient would be to administer? and why?

Answer 15

In patients with hypothyroidism, the administration of alpha agonists such as phenylephrine could substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. The best option for these patients is to administer epinephrine, ephedrine, or dopamine.

Question 16

The best options of vasopressors for hypothyroidism

Answer 16

DEE) epinephrine, ephedrine, or dopamine.

Question 17

What is the predominant serum protein in fetal blood?

Answer 17

alpha-1 fetoprotein

Question 18

Which anatomic structure is responsible for formation of aqueous humor?

Answer 18

Ciliary body

Question 19

Aqueous humor production

Answer 19

Two-thirds of the aqueous humor in the eye is formed by the ciliary body in the posterior chamber of the eye. The remaining third is formed by passive filtration from vessels through the anterior surface of the iris.

Question 20

Nasal intubation is contraindicated in which of the following surgeries?

Answer 20

LeFort II fracture repair

Question 21

Nasal intubation is acceptable and occasionally preferable in most oral and dental surgeries, but is specifically contraindicated in LeFort II and LeFort III fractures why?

Answer 21

because of the risk of a coexisting basilar skull fracture and CSF rhinorrhea.

Question 22

What is the most important action to take after the surgeon has placed a mouth gag in a patient undergoing tonsillectomy?

Answer 22

Check Breath sounds.

Question 23

What is the most appropriate fluid for volume resuscitation during the first 24 hours following a burn injury?

Answer 23

Crystalloids (after you can give LR or albumin 5%)

Question 24

A patient with myasthenia gravis presents for surgery. She takes pyridostigmine. What is the primary risk of underdosing pyridostigmine in this patient?

Answer 24

respiratory compromise

Question 25

Pyridostigmine is an

Answer 25

anticholinesterase drug used to treat the symptoms of myasthenia gravis.

Question 26

Underdosing vs Overdosing Pyridostigmine can lead to

Answer 26

myasthenic crisis (severe muscle weakness that can result in respiratory compromise). Overdosing can produce a depolarizing block at the neuromuscular junction because of too much acetylcholine and result in weakness as well.

Question 27

Medications class that increase insulin secretion by beta cells,), and a

Answer 27

Sulfonylureas

Question 28

Medications class that enhance tissue sensitivity to insulin

Answer 28

thiazolinediones and metformin (a biguanide)

Question 29

Decrease postprandial glucose absorption.

Answer 29

Alpha-glucosidase inhibitors

Question 30

Which of the following is associated with paradoxical embolus?

Answer 30

ASD

Question 31

In addition to positive Mantoux skin tests, chest pain, night sweats, and nonproductive cough, tuberculosis is associated with chest x-ray findings such as

Answer 31

bilateral upper lobe infiltrates (often with cavitation), apical and subapical infiltrates, and vertebral osteomyelitis (Pott’s disease) which is common in advanced extrapulmonary tuberculosis.

Question 32

Vertebral osteomyelitis (Pott’s disease) which is common in

Answer 32

advanced extrapulmonary tuberculosis.

Question 33

Which of the following statements regarding muscular dystrophy is true? Death due to

Answer 33

Death usually occurs due to congestive heart failure or pneumonia

Question 34

Muscular dystrophy is a T Death usually occurs due to congestive heart failure or pneumonia.

Answer 34

sex-linked, recessive trait observed in males.

Question 35

What is the onset is typically between the ages of

Answer 35

2 and 5 years.

Question 36

Muscular dystrophy It is characterized by

Answer 36

painless, progressive muscle degeneration.

Question 37

Muscular dystrophy cardiac symptoms are

Answer 37

mitral valve prolapse, mitral regurgitation, decreased contractility, and diminished R wave progression.

Question 38

What is the most dramatic and consistent effect of aortic cross-clamping?

Answer 38

Increased systemic vascular resistance

Question 39

With AORTIC CROSS clamping, The blood pressure can increase by ______with an infrarenal clamp

Answer 39

2-10%

Question 40

With AORTIC CROSS clamping, The blood pressure can increase by and as much as 50% with a

Answer 40

supraceliac clamp.

Question 41

Which of the following conditions is associated with chronic renal failure?

Answer 41

Hyperlipidemia

Question 42

Which of the following conditions is associated with a progressive, ascending paralysis following an infectious process?

Answer 42

GBS (GBASCENDING)

Question 43

The most important factor determining the rate of diffusion of a drug across a membrane is

Answer 43

concentration gradient across the membrane

Question 44

According to the Fick equation, the most important factor in determining the rate of diffusion of a drug across a membrane is the

Answer 44

concentration gradient of the drug. 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 the concentration gradient.

Question 45

Compared to resection of another portion of the liver, a right hepatic lobectomy places the patient at risk for an increased incidence of____why>

Answer 45

Air embolism

Question 46

A patient undergoing a total knee replacement asks why he is required to wear a sequential compression device. You explain that without prophylaxis, the risk of deep vein thrombosis associated with his surgery is

Answer 46

40-80 percent

Question 47

NSA1Ds inhibit which COX

Answer 47

COX-1 receptor

Question 48

COX-1 receptor inhibition by NSAIDs is responsible for the

Answer 48

gastric irritation, decrease in renal blood flow, and platelet inhibition associated with nonselective NSAIDs.

Question 49

COX-2 inhibitors and protein binding are

Answer 49

highly protein bound

Question 50

COX-2 inhibitors and protein binding

Answer 50

highly protein bound

Question 51

COX-2 inhibitors inhibit

Answer 51

prostaglandin synthesis

Question 52

COX-2 inhibitors and GI effect

Answer 52

have a lower incidence of gastrointestinal side effects than non-selective NSAIDs

Question 53

A CricoThyrotomy is performed by inserting a cannula into

Answer 53

thyroid cartilage and cricoid cartilage TC

Question 54

A coupling gel must be placed between the skin and a Doppler probe when assessing for the presence of a pulse because

Answer 54

air reflects ultrasound waves

Question 55

Approximately what fraction of administered fentanyl is available for transfer across the placenta to the fetus?

Answer 55

30%

Question 56

What sensory level block would be appropriate for performing a cesarean section under epidural anesthesia?

Answer 56

T4

Question 57

It is the only benzodiazepine approved by the FDA for use in neonates

Answer 57

Midazolam

Question 58

During induction for a parathyroidectomy for relief of hyperparathyroidism, which ECG alteration would you most expect to see?

Answer 58

shortened QT Interval and prolonged PR interval. (SQI-PPI)

Question 59

The most common causative agent of acute epiglottitis is

Answer 59

Haemophilus influenza type B

Question 60

Hypotension in carcinoid patients: What should be avoided?

Answer 60

Administration of vasoactive drugs should be avoided in episodes of hypotension

Question 61

The popliteal fossa is bounded by all of the following structures

Answer 61

semitendinosus tendon
semimembranosus tendon
biceps femoris tendon

Question 62

The elevated serotonin level frequently results in

Answer 62

Right-sided heart failure

Question 63

Huntington’s chorea is characterized by Decreased plasma cholinesterase may prolong the effect of succinylcholine. There are no specific contraindications to the use of any inhaled or intravenous anesthetics with Huntington’s chorea.

Answer 63

choreiform movements, athetosis, and dystonia resulting from genetically-linked neuronal atrophy.

Question 64

Huntington’s chorea, As the disease progresses, weakness of the pharyngeal muscles predisposes the patient to

Answer 64

aspiration pneumonia, a common cause of death.

Question 65

Drugs that _______reduce the severity of chorea

Answer 65

dopaminergic transmission such as thioxanthines, butyrophenones, and phenothiazines reduce the severity of chorea.

Question 66

Which of the following statements regarding the use of epidural steroids for the treatment of low back pain is true?

Answer 66

Epidural steroids reduce the degree of leg pain and sensory deficit

Question 67

A caudal epidural is inserted in the

Answer 67

sacral hiatus just inferior to S5.

Question 68

Which of the following precautions should be taken in the patient with Wolff-Parkinson-White syndrome about to undergo anesthesia? (select two)

Answer 68

Instruct the patient to continue taking antidysrhythmics up to the day of surgery
Avoid hypovolemia

Question 69

When preparing the patient with WPW for anesthesia, have the patient continue taking antidysrhythmics up to the day of surgery, avoid situations that could result in sympathetic outflow such as pain or hypovolemia, avoid verapamil or digoxin (which could enhance anterograde conduction through an accessory pathway) in the treatment of any arising dysrhythmia, and have

Answer 69

adenosine, and/or amiodarone available for treatment of tachydysrhythmias.

Question 70

Patients with Alzheimer’s disease are often prescribed cholinesterase inhibitors such as.

Answer 70

tacrine, donepezil, galantamine, and rivastigmine to slow the progression of cognitive deterioration

Question 71

are utilized to reverse nondepolarizing muscle relaxant blockade.

Answer 71

Anticholinesterase drugs

Question 72

Which of the following is a known risk factor for the development of postoperative visual loss following spine surgery?

Answer 72

Obesity

Question 73

Which classes of patients are most at risk for intracranial hemorrhage if thrombolytic therapy is administered in the setting of acute myocardial infarction? (select two)

Answer 73

Patients with uncontrolled hypertension

Patients over the age of 75

Question 74

All of the available neuromuscular blocking agents bear a structural resemblance to what chemical?

Answer 74

Acetylcholine.

Question 75

Where in the human cell does the citric acid cycle (Kreb’s cycle) take place?

Answer 75

Mitochondria

Question 76

Factors known to inhibit hypoxic pulmonary vasoconstriction include:

Answer 76

Nitroprusside infusion
Inhalation anesthetics
Hypocapnia
Very low pulmonary artery pressures
very high or very low mixed venous PO2

BC-VP
Beta Blockers
CCs
Vasodilators (nitroprusside, NTG)
Pulmonary infection

Question 77

The patient’s minute volume when being ventilated by a self-inflating manual resuscitator is dependent upon (select two)

Answer 77

Tidal volume

Respiratory rate

Question 78

hat factors can result in falsely high tidal volume readings when using a Wright respirometer?

Answer 78

The administration of nitrous oxide

low flow rates will register falsely decreased tidal volumes.

Question 79

The loss of sympathetic tone and concomitant administration of corticosteroids in patients with spinal cord injury can predispose the patient to

Answer 79

Peptic Ulceration

Question 80

Which of the following represents the normal cerebrospinal fluid pressure?

Answer 80

. 10-20 cm H2O

Question 81

Hyperthermia is defined as anything exceeding

Answer 81

38 degrees Celsius (100.4 degrees Fahrenheit).

Question 82

Complete the statement. __________ is a product of phosphocreatine breakdown in muscle and is normally completely filtered by the kidneys.

Answer 82

Creatinine

Question 83

The formula for creatinine clearance =

Answer 83

(Urinary Creatinine) X (Urinary Flow Rate)/Plasma Creatinine.

Question 84

An extreme form of thyroid enlargement that results from simple goiter in which the thyroid enlargement is severe enough to produce dysphagia and inspiratory stridor is referred to as

Answer 84

Toxic multinodular goiter

Question 85

Myxedema coma most commonly appears in

Answer 85

elderly females with a long history of hypothyroidism

Question 86

The only condition that epidural steroids have proven efficacious in speeding healing is

Answer 86

sciatica from disc herniation

Question 87

In a patient, the MAP increased from 70 to 120. Normally, the CBF remains constant between MAPs of 60 to 140 mmHg. As the MAP increases within this range, the cerebral vessels_____to keep CBF constant.

Answer 87

constrict

Question 88

What test assesses movement and evaluates the integrity of the motor tracts in the ventral spinal column.

Answer 88

The wake-up test

Question 89

Which of the following tests would be most appropriate for testing neural integrity during posterior fossa surgery?

Answer 89

BAEPs

Question 90

assess the integrity of the 8th cranial nerve and the auditory pathways above the pons.

Answer 90

Brainstem auditory evoked potentials

Question 91

Best for monitoring during spinal surgery, carotid endarterectomy, and aortic surgery.

Answer 91

Somatosensory evoked potentials assess the dorsal spinal column and sensory cortex and are

Question 92

Best for monitoring during pituitary resection and why?

Answer 92

Visual evoked potentials assess the integrity of the optic nerve and upper brainstem and are

Question 93

Which of the following most accurately represents the composition of eutectic mixture of local anesthetic (EMLA) cream?

Answer 93

2.5% lidocaine and 2.5% prilocaine

Question 94

Which of the following is a potential side effect from the use of eutectic mixture of local anesthetic (EMLA) cream?

Answer 94

Decreased O2 sats

Question 95

Bupivacaine and PR interval

Answer 95

Prolonged the PR interval

Question 96

Which of the following are examples of a field block? (select two)

Answer 96

Superficial cervical plexus block

Radial nerve block

Question 97

Bier Block, which cuff is inflated first? DPD

Answer 97

The distal cuff is inflated first followed by the proximal cuff. The distal cuff is then deflated to allow the area under it to become anesthetized. If the proximal cuff of the tourniquet becomes too painful for the patient to tolerate, the distal cuff can be inflated and then the proximal cuff deflated to allow the surgeon more time to complete the procedure.

Question 98

What factors contribute to the development of nausea in patients who receive a subarachnoid block? (select two)

Answer 98

Hypotension

Opioid premedication

Question 99

You would expect serum troponin levels to become elevated within how many hours following the onset of an acute myocardial infarction?

Answer 99

3 hours

Question 100

The diagnosis of AIDS is based on a decrease in the number of which type of cell?

Answer 100

T lymphocyte

Question 101

A diagnosis of AIDS is made when the

Answer 101

CD4 T cell count drops below 200 cells per cubic millimeter or when the patient begins to succumb to opportunistic infections related to the low T cell count.

Question 102

During an emergency airway procedure, a cricothyrotomy has been performed on a patient using a 14-gauge catheter. You are preparing to manage the airway with transtracheal jet ventilation. What driving pressure is necessary with jet ventilation to ensure sufficient gas flow into the lungs?

Answer 102

50psi

Question 103

Which of the following agents would be more likely to result in a dangerous increase in intraocular pressure in the patient with glaucoma?

Answer 103

Scopolamine

Question 104

Adenoidal hyperplasia can result in nasopharyngeal obstruction resulting in obligate)______ breathing.

Answer 104

mouth

Question 105

Both adenoidal and tonsillar hyperplasia are linked to

Answer 105

sleep apnea with the potential for cor pulmonale and failure to thrive.

Question 106

What medications would you be prepared to administer prior to the reperfusion of a newly transplanted liver?

Answer 106

Bicarbonate and calcium. When the liver reperfuses, you should anticipate the administration of bicarbonate and calcium chloride to counteract the effects of acid and potassium on the heart.

Question 107

Methods to decrease the intracranial pressure should be employed when there is a sustained increase in pressure to at least

Answer 107

20 mmHg

Question 108

Which of the following drugs would be least appropriate for use in a patient with advanced Alzheimer’s disease?

Answer 108

Atropine

Question 109

Alzheimer’s is associated with a progressive and selective

Answer 109

decrease in cholinergic neurons in the brain. For this reason

Question 110

Anticholinergic not recommended for alzheimer’s disease and why?

Answer 110

centrally acting anticholinergics such as atropine and scopolamine are not recommended for use.

Question 111

Incomplete diabetes insipidus is associated with.

Answer 111

hypovolemia, hypernatremia, polydipsia, and high output of poorly concentrated urine but is often not as severe as complete diabetes insipidus as there is still a remnant of functioning glandular tissue

Question 112

Incomplete diabetes insipidus can often be treated with the oral hypoglycemic

Answer 112

chlorpropamide, but its use may be limited by its effects on serum glucose.

Question 113

A hypolipidemic medication has also been used in the outpatient setting for the treatment of incomplete diabetes insipidus.

Answer 113

Clofibrate,

Question 114

What is the most common cause of bacterial pneumonia in adults?

Answer 114

Streptococcus

Question 115

For a patient to meet the diagnosis of Adult Respiratory Distress Syndrome (also known as Acute Respiratory Distress Syndrome), four criteria must be met:

Answer 115

Acute onset,
PAO2 to FiO2 ratio <200 regardless of the level of PEEP applied,
Bilateral infiltrates on chest x-ray, and a
PA wedge pressure less than or equal to 18 mmHg.

Question 116

The profound hypotension seen with spinal shock is related to

Answer 116

the level at which the lesion is located (cervical injuries produce more severe hypotension than do lumbar injuries) and is due primarily to a drop in PRELOAD caused by dilation of the capacitance vessels.

Question 117

Dysrhythmias seen with SPINAL shock?

Answer 117

A wide range of cardiac dysrhythmias ranging from PVCs to complete heart block are seen with spinal shock and the hemodynamic changes associated with spinal shock may last for up to 1-3 weeks after the injury occurs.

Question 118

A patient with a spinal cord lesion at C3 would typically exhibit severe hypotension from dilation of the capacitance vessels due to

Answer 118

Loss of sympathetic tone and bradycardia from a lack of sympathetic input from the cardioacceleratory fibers of T1-T4. Due to the drop in preload, the patient would likely exhibit signs of fluid volume deficit which would translate into a decreased urine output.

Question 119

Which of the following conditions is associated with the development of peripheral neuropathies? (Select two)

Answer 119

Diabetes

Porphyria

Question 120

Over 95% of patients with scleroderma experience

Answer 120

Raynaud’s phenomenon.

Question 121

Which of the following would be appropriate in the anesthetic management of a patient with hypertrophic cardiomyopathy? Avoid what

Answer 121

Avoid an increase in myocardial contractility

Question 122

Antidepressants provide analgesia by inhibiting the

Answer 122

presynaptic reuptake of norepinephrine, serotonin, or both.

Question 123

What internal diameter cuffed endotracheal tube would be appropriate for a full-term infant?

Answer 123

For a full-term infant, a 3.0 cuffed endotracheal tube would be appropriate.

Question 124

Tube with premature infants

Answer 124

Uncuffed 2.5-3.0 tubes are recommended for premature infants.

Question 125

Which of the following arterial pressures would you expect to exhibit the widest pulse pressure if measured in the same patient?

Answer 125

Dorsalis pedis artery

Question 126

As the pulse wave moves from centrally to peripherally, the systolic waveform

Answer 126

increases resulting in a wider pulse pressure than in the more central locations. Thus, the systolic pressure as measured in an arterial line placed in the dorsalis pedis artery would be higher than one measured in the femoral artery.

Question 127

You are performing a general anesthetic for a patient undergoing dissection of the lower neck for malignancy when you notice a 20% drop in oxygen saturation, diminished ECG amplitude, a drop in blood pressure, and diminished breath sounds. Based on these findings, you suspect:

Answer 127

Pneumothorax

Question 128

What is the appropriate dosage for oral midazolam in pediatric patients?

Answer 128

0.25-0.75 mg/kg. The dose for oral midazolam in children is 0.25 to 0.75 mg/kg which will peak in about 30 minutes and last for 30 minutes.

Question 129

The initial recommended intravenous dose for children is

Answer 129

0.05-0.015 mg/kg.

Question 130

Which of the following is a likely potential complication of mediastinoscopy?

Answer 130

Mediastinoscopy can result in a wide range of complications such as tearing of great vessels, pneumothorax, chylothorax, bronchospasm from airway manipulation, air embolism, arrhythmias, recurrent laryngeal nerve palsy, esophageal laceration, and obstruction of blood flow through the innominate artery.

Question 131

The most common cause of death following abdominal aortic aneurysm repair is

Answer 131

myocardial infarction

Question 132

During carotid endarterectomy, a distal stump pressure less than what value is an indicator that a shunt should be placed?

Answer 132

40-50 mmHg

Question 133

Contraindications to performing laparoscopic spinal surgery include previous

Answer 133

laparotomy, severe abdominal adhesions, abdominal trauma, and cardiopulmonary disease that would prevent the patient from tolerating hypercarbia associated with CO2 insufflation. Because it is performed in the supine position, an inability to tolerate the prone position would not be a contraindication.

Question 134

Fluid losses are greatest when after a burn ?

Answer 134

in the first 12 hours after the burn

Question 135

Ca and muscle relaxants

Answer 135

increased calcium can antagonize muscle relaxants-

Question 136

Hyperparathyroidism is associated with an increased sensitivity to

Answer 136

succinylcholine and a resistance to nondepolarizing muscle relaxants.

Question 137

Acidosis on calcium levels

Answer 137

increases the serum calcium level, so hypoventilation should be avoided.

Question 138

Hyperparathyroidism patient, what fluid is preferred?

Answer 138

Normal saline is preferred over Lactated Ringer’s solution for fluid management

Question 139

Hypercalcemia and digoxin

Answer 139

The patient may be more sensitive to the effects of digoxin.

Question 140

With parathyroidectomy, As with thyroidectomy, there is a risk of damage to the

Answer 140

recurrent laryngeal nerve during surgery, so a Nim(Registered) tube or similar device should be used to monitor nerve function during surgery. It is important to position patients with a risk of pathologic fractures carefully.

Question 141

Regarding combined spinal and epidural analgesia is true?

Answer 141

The epidural space should be identified with the use of air to prevent confusion of saline with CSF

Question 142

Patients with class III obesity (formerly called morbid obesity)

Answer 142

may metabolize volatile anesthetics more extensively

Question 143

When planning to perform a popliteal block, you recognize that the normal volume of LA for a popliteal block is

Answer 143

35-40 mL

Question 144

The sciatic nerve does divide into the

Answer 144

tibial and common peroneal nerve, but does so at the upper boundary of the popliteal fossa, not inferior to it.

Question 145

The popliteal artery may be found immediately

Answer 145

lateral to the semitendinosus tendon

Question 146

A branch of the femoral nerve

Answer 146

The saphenous nerve

Question 147

It may be helpful to remember the causes of a high anion gap acidosis using SLUMPED mnemonic

Answer 147

SLUMPED = Salicylates, Lactate, Uremia, Methanol, Paraldehyde, Ethanol and Ethylene Glycol, and Diabetic Ketoacidosis.

Question 148

Normal anion gap acidosis:

Answer 148

renal tubular acidosis, carbonic anhydrase inhibitors, lysine or arginine HCl, pancreatic fistula, diarrhea, ammonium chloride, and ureterosigmoidostomy.

Question 149

Complex regional pain syndrome type II is precipitatedby

Answer 149

injury to the nerve

Question 150

Causalgia, the former name of complex regional pain syndrome type II, means

Answer 150

burning pain.

Question 151

Complex regional pain syndrome Type 2 onset

Answer 151

It has an immediate onset

Question 152

CRPS Type 2 is associated with VSAH

WEE

Answer 152

vasomotor and
sudomotor dysfunction
allodynia,
hyperpathia, and in the region of pain, resulting in erythema, edema, and warmth in the area of pain. It is more common in women.

Question 153

CRPS type II is more common in men/ vs women

Answer 153

Women

Question 154

What would be an appropriate dose of intravenous desmopressin for the treatment of uremic bleeding?

Answer 154

0.3 mcg/kg

Question 155

Acidosis and/or hypercarbia on convulsive threshold of LA.

Answer 155

will decrease the convulsive threshold of local anesthetics (more likely to have a seizure)

Question 156

Acidosis on plasma protein binding of LA

Answer 156

decreases the plasma protein binding, which increases the free form of the drug in the bloodstream which results in an increased amount available for diffusion into the brain.

Question 157

Temperature fibers

Answer 157

C

Question 158

Touch fibers

Answer 158

A-Beta

Question 159

Proprioception fibers

Answer 159

A-Alpha

Question 160

Aortic Regurgitation ; It results in a ____in CO ? why?

Answer 160

decrease in cardiac output because of regurgitation of a portion of the ejected stroke volume back into the left ventricle. The left ventricle compensates by becoming hypertrophied and enlarges to accommodate the fluid volume overload.

Question 161

What is the most frequent complication occurring in obstetric patients undergoing central neuraxial blockade?

Answer 161

Hypotension due to sympathectomy

Question 162

Carbon dioxide insufflation during laparoscopic surgery can result in what in HEALTHY patients? SV, HR, SVR< QT , MAP

Answer 162

In healthy patients, stroke volume decreases, heart rate increases, systemic vascular resistance increases, the QT interval may prolong, and mean arterial pressure increases with insufflation.

Question 163

Gas that can increase ICP

Answer 163

Desflurane

Question 164

All of the volatile anesthetic agents and nitrous oxide have been shown to have what effect on ICP?

Answer 164

increase intracranial pressure.

Question 165

2 IV anesthetics that decreases ICP

Answer 165

Etomidate and propofol

Question 166

How does chronic hypertension affect the left ventricle? (select two)

Answer 166

It can reduce left ventricular subendocardial perfusion

It increases left ventricular oxygen demand

Question 167

Factor VIII concentrate should be administered to the patient with what disease ?________ until levels are at or near ___% of normal prior to surgery, which may require a dose of _____ to ____units /kg

Answer 167

hemophilia A until levels are at or near 100% of normal prior to surgery, which may require a dose of 50-60 units/kilogram. Factor IX preparations are for use in patients with hemophilia B.

Question 168

Dose of Factor VIII concentrate for hemophillia A patients

Answer 168

dose of 50-60 units/kilogram.

Question 169

Midazolam preserves the ability of the blood vessels to

Answer 169

vasoconstrict in response to a decrease in blood flow.

Question 170

Midazolam on CPP

Answer 170

Despite a decrease in cerebral perfusion pressure, the intracranial pressure would be relatively unaffected.

Question 171

Midazolam adult IV vs PO dose

Answer 171

The dose for IV or IM midazolam is 0.02-0.04 mg/kg compared to 0.4 to 0.8 mg/kg for the PO dose.

Question 172

Midazolam is water or lipid soluble? It is formuled in what type of solution?

Answer 172

Water-soluble and formulated in an aqueous solution that causes minimal pain on injection.

Question 173

Benzos on swallowing reflex and upper airway reflexes.

Answer 173

Benzodiazepines decrease the swallowing reflex and the upper airway reflexes.

Question 174

What controls water reabsorption in the distal tubule and collecting duct?

Answer 174

ADH

Question 175

Antidiuretic hormone increases the absorption of solute-free water in the

Answer 175

Collecting ducts

Question 176

Antidiuretic hormone (ADH), also known as arginine vasopressin, works in the distal tubule/collecting tubule and duct. ADH is secreted in response to dehydration and renders the lumen of the collecting tubule permeable to water through the expression

Answer 176

of water channel proteins called aquaporin-2 channels.

Question 177

What can suppress the release of ADH, rendering the lumen of the collecting tubule impermeable to water.

Answer 177

Adequate hydration

Question 178

The oxygen supply failure alarm sets off an alarm if the oxygen pressure falls below a standard set by the manufacturer which is typically_____psig

Answer 178

30 psig

Question 179

The oxygen supply failure alarm : How is it engage? Can it be disabled?

Answer 179

must engage within 5 seconds of the disconnect and cannot be disabled by the anesthetist.

Question 180

Oxygen supply failure alarm is designed to help prevent hypoxia from lack of oxygen flow, but does not

Answer 180

prevent the flow of anesthesia gases (and could still possibly allow a hypoxic mixture of gases to be delivered).

Question 181

Heliox is a mixture of helium and oxygen. Helium is less dense than oxygen and improves . .

Answer 181

respiratory mechanics by increasing laminar flow through the airways and decreasing the work of breathing.

Question 182

Reynolds number is an evaluation of

Answer 182

gas flow turbulence

Question 183

As laminar flow increases, the Reynolds number

Answer 183

decreases

Question 184

Heliox can alleviate the symptoms of increased airway resistance, but doesn’t

Answer 184

dilate the airways like a bronchodilator.

Question 185

A chemical carbon dioxide detector changes color when exposed to

Answer 185

carbonic acid

Question 186

Hyponatremia due to hypoaldosteronism is most noted to produce

Answer 186

orthostatic hypotension

Question 187

Which anesthetic agent would be taken up by the bloodstream the SLOWEST TO FASTEST? UPTAKE

Answer 187

Nitrous
Desflurane
Sevoflurane
Isoflurane
Halothane

Question 188

The 3-OH metabolites of both vecuronium and pancuronium possess about.

Answer 188

50% of the neuromuscular blocking activity of parent compound

Question 189

Succinylcholine is metabolized to

Answer 189

choline, succinic acid and succinylmonocholine.

Question 190

Succinylmonocholine also has some

Answer 190

neuromuscular blocking activity.

Question 191

A small amount of rocuronium is metabolized to the

Answer 191

17-OH compound, which lacks activity.

Question 192

Most rocuronium is excreted by the

Answer 192

kidneys and liver as intact drug.

Question 193

Succinylcholine undergoes _______by

Answer 193

Hydrolysis; Plasma cholinesterase

Question 194

Succinylcholine is not metabolized by

Answer 194

True cholinesterase and termination of neuromuscular blockade occurs as succinylcholine diffuses away from the NMJ

Question 195

Atracurium and cis-atracurium both drugs can

Answer 195

undergo ESTER HYDROLYSIS by nonspecific plasma esterases.

Question 196

The rate of seroconversion after exposure of MUCOUS membranes to HIV-infected blood is approximately:

Answer 196

0.09%

Question 197

The rate of seroconversion after exposure NEEDLESTICK exposure to HIV-infected blood is approximately:

Answer 197

0.3%

Question 198

Rocuronium has an ED95 of

Answer 198

0.3 mg/kg. .

Question 199

The ED95 of vecuronium is

Answer 199

0.05 mg/kg.

Question 200

The ED95 of atracurium is

Answer 200

0.25 mg/kg

Question 201

The ED95 of cisatracurium is

Answer 201

0.05 mg/kg.

Question 202

Normal average total cerebral blood flow?

Answer 202

50ml/100g/min

Question 203

For LA, The closer the pKa is to physiologic pH,

Answer 203

the more of it will exist in nonionized form and be able to cross the lipid membrane of the neuron, thus speeding onset.

Question 204

Most allergic reactions to local anesthetics are to

Answer 204

ester anesthetics because of the metabolite para-aminobenzoic acid.

Question 205

Although methylparaben, the preservative found in

Answer 205

amide anesthetics is similar to para-aminobenzoic acid, allergic reactions to it are not as common.

Question 206

What is the preservative found in lorazepam and diazepam?

Answer 206

propylene glycol

Question 207

What is the preservative found in halothane?

Answer 207

Thymol

Question 208

Which peripheral nerve block, when combined with a popliteal fossa nerve block would provide complete anesthesia for foot and ankle procedures?

Answer 208

Saphenous nerve block

Question 209

The anterior spinal and posterior artery ?

Answer 209

vertebral artery and supplies the anterior 2/3 of the cord while the posterior spinal arteries are derived from the posterior inferior cerebellar arteries and supply the posterior 1/3 of the spinal cord.

Question 210

Normally, in the supine position, the most dependent portion of the spinal column occurs at

Answer 210

T4.

Question 211

Severe obesity is commonly associated with

Answer 211

HYPERINSULINEMIA

Question 212

are all associated with severe obesity. T

Answer 212

Hyperinsulinemia, hypertension, and increased mineralocorticoid levels

Question 213

Obesity and CO

Answer 213

The associated increases in circulatory requirements result in an increase in cardiac output of about 0.1 L/min for every additional kilogram of body fat.

Question 214

The presence of a Q wave on the electrocardiogram is considered pathologic when its duration exceeds

Answer 214

0.04 seconds

Question 215

The presence of a Q wave on the electrocardiogram is considered pathologic when its duration exceeds

Answer 215

0.04 seconds corresponds to 1 mm wide on the standard tracing.

Question 216

Which of the following antiplatelet drugs used in patients with a history of myocardial ischemia works by blocking adenosine diphosphate receptors?

Answer 216

Clopidogrel (Plavix)

Question 217

Which of the following pharmacologic treatments may result in increased intracranial pressure when treating hypertensive emergencies associated with encephalopathy?

Answer 217

NItroprusside

Question 218

The termination of action of thiopental is due to

Answer 218

redistribution

Question 219

What does not play a significant role in the duration of action of a single dose of thiopental.

Answer 219

Metabolism

Question 220

The normal intraocular pressure is about and pressures presumably from venous congestion due to the eyes being closed.

Answer 220

10 to 21 mmHg

Question 221

Intraocular HTN is Ocular pressure above

Answer 221

above 22mmHg is considered intraocular hypertension.

Question 222

Intraocular pressure what time of day ?

Answer 222

higher in the morning,

Question 223

All decrease intraocular pressure by

Answer 223

Dextran, mannitol, urea, and sorbitol

Question 224

How does mannitol decrease IOP?

Answer 224

exerting a hyperosmotic effect that decreases aqueous humor formation.

Question 225

You are preparing to perform nasal intubation for a patient undergoing dental surgery and are administering 4% cocaine intranasally to constrict the nasal passages. What is the maximum volume of the cocaine solution that can be administered?

Answer 225

4 mL

Question 226

often necessary to compensate for the large intrinsic air leak around the rigid bronchoscope and maintain adequate ventilation and anesthetic depth.

Answer 226

High gas flows, large tidal volumes, and high inspired volatile agent concentrations are

Question 227

Which of the following routes of administration of midazolam would be least recommended for a five year-old patient?

Answer 227

Intramuscular. The IM route is not recommended because of pain and the risk of a sterile abscess.

Question 228

Carbon MONOXIDE SHIFTS the oxyhemoglobin curve to the

Answer 228

LEFT impairing the unloading of oxygen to the tissues.

Question 229

CO poisoning and mitochondria?

Answer 229

mpairs mitochondrial function, uncouples oxidative phosphorylation and reduces ATP production resulting in metabolic acidosis, and shifts the oxyhemoglobin dissociation curve to the left,

Question 230

A patient with a pacemaker with a program code of VVI has a heart rate of 104 and you see pacer spikes on the ECG. You would most accurately assume that

Answer 230

the pacemaker ventricular sensing is faulty

Question 231

Hyperventilation on ICP

Answer 231

Hyperventilation (to a PaCO2 of no lower than 22-25 mmHg) results in respiratory alkalosis and vasoconstriction. As the degree of vasoconstriction increases, the blood flow to the brain decreases, thus decreasing the volume of the intracranial compartment.

Question 232

The value traditionally used as the threshold for too little urine output (oliguria) is

Answer 232

0.5 mL/kg/hour for at least 6 hours

Question 233

ACROMEGALY AND AIRWAY ISSUES

Answer 233

prolonged mandible, overgrowth of pharyngeal tissue, recurrent laryngeal nerve damage, and decreased subglottic diameter. Hoarseness or stridor are indications that the upper airway is probably involved.

Question 234

Which of the following clinical findings would be consistent with a diagnosis of hyperaldosteronism?

Answer 234

Diastolic blood pressure of 125 mmHg

Question 235

Hyperaldosteronism (Conn’s syndrome) exhibits signs and symptoms including

Answer 235

headache, systemic hypertension (diastolic blood pressure often between 100 mmHg and 125 mmHg), hypokalemia, hypernatremia, hypomagnesemia, and abnormal glucose tolerance.

Question 236

NORMAL magnesium level

Answer 236

Magnesium levels are between 1.5 and 3 mEq/L

Question 237

Pheochromocytoma usually occurs in patients between the ages of

Answer 237

30 and 50 years

Question 238

Pheochromocytoma and malignancy ?

Answer 238

fewer than 10% are malignant,

Question 239

Pheochromocytoma is associated with

Answer 239

multiple endocrine neoplasia (MEN) and although 20% of pheochromocytomas involve multiple sites, fewer than 10% involve both adrenal glands.

Question 240

Patients with Cushing’s disease have increased serum cortisol levels resulting in K+ _______ BG_________ skeletal muscles?

Answer 240

hypokalemia, hyperglycemia, and skeletal muscle relaxation which may require a decreased non-depolarizing muscle relaxant dose.

Question 241

Because patients undergoing bilateral adrenalectomy exhibit a

Answer 241

Rapid decrease of serum cortisol levels, steroid replacement therapy should be initiated prior to or during surgery.

Question 242

Which of the following is most likely to result in an exacerbation of the symptoms of multiple sclerosis following general anesthesia? How ?

Answer 242

An increase in body temperature of 1 degree Celsius. It is possible that the increase in body temperature results in complete conduction block in demyelinated nerves.

Question 243

Which of the following is typically the first sign of Acute Respiratory Distress Syndrome?

Answer 243

Hypoxemia refractory to oxygen therapy

Question 244

The critical level for the development of autonomic hyperreflexia due to a spinal cord lesion is

Answer 244

T6

Question 245

Lesions at or below ____do not consistently produce symptoms of autonomic hyperreflexia.

Answer 245

T10

Question 246

Which of the following agents would be most likely to produce an exacerbation of systemic lupus erythematosus?

Answer 246

Hydralazine

Question 247

Can precipitate an exacerbation of SLE.

Answer 247

Infection, pregnancy, and surgical stresses

Question 248

Over 80 drugs have been reported to precipitate an SLE exacerbation, most common are PHIMD

Answer 248

procainamide
hydralazine,
isoniazid, 
 methyldopa
d-penicillamine, and are drugs most frequently implicated in SLE exacerbation.

Question 249

What is the most common complication of mediastinoscopy?

Answer 249

Hemorrhage

Question 250

What interventions are appropriate for the treatment of complex regional pain syndrome? (select two)

Answer 250

Gabapentin

Sympathetic Blockade

Question 251

The recurrent laryngeal nerve provides sensation to the larynx.

Answer 251

below the vocal cords

Question 252

The recurrent laryngeal nerve also provides motor innervation to all of the laryngeal muscles except for the

Answer 252

cricothyroid muscle, which is innervated by the external laryngeal nerve.

Question 253

Which of the following crystalloid solutions does not contain potassium?

Answer 253

7.5% NaHCO3

Question 254

Lactated Ringer’s and D5LR both contain_____meq potassium,

Answer 254

4 mEq/L of

Question 255

Plasmalyte contains ___mEq/L of potassium.

Answer 255

5

Question 256

7.5% NaHCO3 is extraordinarily ______with ____of sodium but does not contain

Answer 256

hypertonic with 893 mEq/L ; Potassium

Question 257

Correcting hypernatremia too fast lead to

Answer 257

Cerebral edema

Question 258

Correcting Hyponatremia too fast lead

Answer 258

Central pontine myelonosis

Question 259

Correcting Hyponatremia too fast lead

Answer 259

Central pontine myelinoLysis

Question 260

What detect minute increases is serum osmolarity?

Answer 260

OSMORECEPTORS in the hypothalamus.

Question 261

Sodium level” 135-130 symptoms

Answer 261

No s/s mild neuro s/s possible

Question 262

Sodium level 129-125 s/S

Answer 262

Nausea/malaise

Question 263

Sodium level 124-115

Answer 263

HA, letharty altered level of consciousness

Question 264

Sodium level less than 115

Answer 264

Seizures, coma,resp arrest, CEREBRAL HERNIATION

Question 265

Most common electrolyte abnormality in hospitalized patients?

Answer 265

hyponatremia

Question 266

SIADH and water intoxication lead to

Answer 266

Hyponatremia from EXCESS Water not loss of sodium.

Question 267

FeNA less than 1 is

Answer 267

Prerenal

Question 268

FenA> 2

Answer 268

Intrinsic renal

Question 269

Free water deficit formula

Answer 269

Na/140 -1. x TBW

Question 270

Free water deficit formula

Answer 270

(Na/140) -1 x TBW

Question 271

Hypomagnesium on Potassium

Answer 271

Decrease ICV potassium.

Question 272

After inserting a Combitube, you should

Answer 272

inflate both the proximal and distal cuffs

Question 273

What primarily explains the prolonged duration of midazolam in an elderly patient?

Answer 273

decreased hepatic perfusion

Question 274

If a right-to-left shunt is present, an inhalation induction proceeds more

Answer 274

Slowly because the anesthetic concentration of arterial blood increases more slowly. The opposite is true with a left-to-right shunt because the rate of transfer of anesthetic from the lungs to the blood is more rapid. This effect is rarely evident in the clinical setting, however.

Question 275

You are performing a general anesthetic for a patient undergoing an MRI. You know that you should place the ECG leads

Answer 275

close together on the patient’s chest

Question 276

Which statement is true of EEG monitoring during a carotid endarterectomy?

Answer 276

It does not monitor deep brain structures

Question 277

You are preparing to induce a patient undergoing general anesthesia for resection of a carcinoid tumor. If possible, all of the following drugs should be avoided in this patient except:

Answer 277

Vecuronium

Question 278

Adequate understanding of the principles of general anesthesia for a patient undergoing enucleation of the eye

Answer 278

Deep extubation should be considered on emergence
C. Atropine may need to be administered during dissection of the ocular muscles
D. Pretreatment with antiemetics is recommended

Question 279

During repair of a tracheoesophageal fistula,

Answer 279

the bevel of the endotracheal tube should face anteriorly after it is passed through the cords. This is done to prevent ventilation of the fistula.

Question 280

During repair of a tracheoesophageal fistula, the endotracheal tube should be advanced intentionally into the

Answer 280

right mainstem bronchus and then slowly withdrawn until the first point at which breath sounds are heard in both lung fields.

Question 281

The obese patient should be in the

Answer 281

sitting position when the epidural is placed to help in identifying landmarks. Because rostral spread of the anesthetic is more prevalent in obese patients and they are more prone to suffer respiratory symptoms as a result, you should have them sit up for a longer period of time after injection.

Question 282

The normal range for phosphorus is

Answer 282

2.7 to 4.5 mg/dL.

Question 283

The symptoms correspond to hypophosphatemia.

Answer 283

paresthesias, myopathy, delirium, seizures, and com

Question 284

The characteristics consistent with a left bundle branch block are:

Answer 284

QRS > 0.12 secs, lack of septal Q waves in V4-V6, I and aVL, RR’ QRS pattern in I, aVL, and V4-V6, and secondary ST or T wave changes in I, aVL, and V4-V6.

Question 285

RBB signs

Answer 285

A deep, rounded S wave in leads I and aVL is typical of a right bundle branch block,

Question 286

One of the characteristics of left ventricular hypertrophy.

Answer 286

while a V5 amplitude > 26 mm is one of the characteristics of left ventricular hypertrophy.

Question 287

Chronic bronchitis differs from emphysema in that patients with bronchitis

Answer 287

have an elevated hematocrit

Question 288

The hallmark pathologic findings in Alzheimer’s such as neurofibrillatory tangles and neuritic plaques are due to

Answer 288

deposition of amyloid plaques

Question 289

A patient undergoing emergency surgery for traumatic injury is in hypovolemic shock. You discover he is on warfarin daily. In addition to crystalloids and packed red blood cells, the most important treatment options would be (select two)

Answer 289

fresh frozen plasma

vitamin K

Question 290

CP aspiration and hypothermia

Answer 290

The patient is at severe risk for gastric aspiration

Patients with cerebral palsy are more at risk for hypothermia

Question 291

Baclofen and CP

Answer 291

Abrupt discontinuation of baclofen can result in withdrawal symptoms such as itching, confusion, hallucinations, and seizures .Even though they may suffer muscle weakness and spasticity, patients with

Question 292

CP and hypothermia

Answer 292

They are susceptible of hypothermia and require close temperature monitoring. Gastric reflux is often severe enough that surgery to correct it is necessar

Question 293

Cerebral palsy and Succinylcholine

Answer 293

do not have an exaggerated hyperkalemic response to succinylcholine, nor are they more susceptible to malignant hyperthermia

Question 294

Patients with systemic lupus erythematosus often exhibit

Answer 294

Restrictive defects

Question 295

A patient is about to undergo repair of a thoracic aortic aneurysm. You are placing an arterial line to monitor systemic blood pressure during the case. The arterial line would most appropriately be placed in the

Answer 295

Right wrist

Question 296

Entonox is a 50:50 mixture of (select two)

Answer 296

oxygen

Nitrous oxide

Question 297

Which of the following oxygen delivery devices is considered a zero-capacity device?

Answer 297

Nasal cannula

Question 298

Ethanol can be

Answer 298

falsely detected as a volatile agent

Question 299

Which alteration would be most likely to produce congestive heart failure or hypotension in the patient with aortic stenosis?

Answer 299

New onset of atrial fibrillation

Question 300

Which diuretic inhibits sodium reabsorption by limiting the number of open sodium channels in the epithelium of the cortical collecting ducts?

Answer 300

amiloride

Question 301

Triamterene and amiloride do not rely on

Answer 301

aldosterone activity.

Question 302

Triamterene and amiloride MOA

Answer 302

They inhibit sodium reabsorption and potassium secretion by limiting the number of open sodium channels in the epithelium of the cortical collecting duct.

Question 303

Which agent can prolong the effect of succinylcholine?

Answer 303

Metoclopramide inhibits plasma cholinesterase and prolongs the duration of succinylcholine.

Question 304

In normal patients, a decrease in blood pressure from 120/60 to 90/60 results in:

Answer 304

As the MAP decreases within this range, the cerebral vessels dilate to keep CBF constant.

Question 305

How are cerebral metabolic rate (CMRO2) and cerebral blood flow (CBF) altered by isoflurane?

Answer 305

decrease in CMRO2 with an increase in CBF

Question 306

A pacemaker that paces the ventricle and does not sense is designated

Answer 306

VOO.

Question 307

Which of the following surgical sites is associated with the highest risk for postoperative pulmonary complications?

Answer 307

UPPER ABDOMEN

Question 308

Hypoaldosterone

Answer 308

hyperchloremic metabolic acidosis, and often, hyperglycemia.

Question 309

INsulin facilitates the transport of glucose and potassium into the cell, and is important for the cellular uptake of glucose with the exception of the

Answer 309

brain and liver where it does not affect glucose transport.

Question 310

A patient with myasthenia gravis is undergoing surgery. This patient would most likely: have a decreased number of

Answer 310

functioning acetylcholine receptors

Question 311

Addisons disease is characterized by autoimmune destruction of the adrenal glands causing a decrease in glucocorticoid and mineralocorticoid production. This results in

Answer 311

hyperpigmentation, hyperkalemia, increased urinary sodium excretion, and decreased androgen production.

Question 312

Which of the following drugs would not exhibit a smaller volume of distribution in the geriatric patient?

Answer 312

Diazepam

Question 313

A patient undergoing a TURP begins to exhibit widening of the QRS complex and ST segment elevation on the electrocardiogram. Based on this evidence, you would estimate the serum sodium to be

Answer 313

115 mEq/L

Question 314

Which of the following methods are most appropriate for securing the airway in a patient undergoing evaluation for cervical spine injury?

Answer 314

. Flexible fiberoptic laryngoscopy

Question 315

Total blood calcium levels parallel the

Answer 315

serum albumin.

Question 316

If the serum albumin decreases, the total blood calcium level will .

Answer 316

decrease as well.

Question 317

Is the most common cause of hypocalemia

Answer 317

Hypoalbuminemia

Question 318

Which of the following would you expect to occur when placing a surgical patient in the sitting position? (select two)

Answer 318

Reduction in central venous pressure

B. Increase in systemic vascular resistance

Question 319

Patients with which of the following conditions would be most likely to suffer an allergic reaction to protamine? (select two)

Answer 319

Allergy to fish products

History of protamine zinc insulin use

Question 320

Meperidine on the beat to beat variability

Answer 320

Tachycardia

Decreased beat-to-beat variability in the heart rate

Question 321

When the thoracic aorta is cross-clamped, blood flow to the tissues distal to the clamp is dependent upon

Answer 321

PERFUSION PRESSURE

Question 322

Which diagnostic aid would most accurately reflect an interruption of anterior spinal cord perfusion in a patient undergoing surgery involving cross-clamping of the thoracic aorta?

Answer 322

Motor evoked potentials

Question 323

The primary site for parathyroid hormone- and vitamin D-mediated calcium reabsorption is the

Answer 323

DISTAL (think DPH)

Question 324

Hypercapnia in the range of 50 to 70 mmHg can produce

Answer 324

A. increased cerebral blood flow

Question 325

A hormone response that initiates signals which amplify the release of the same hormone is referred to as a

Answer 325

positive feedback mechanism

Question 326

Which endotracheal tube stylet allows the stylet angle to be adjusted during laryngoscopy?

Answer 326

Schroeder stylet

Question 327

According to U.S. standards, what is the MAXIMUM contact surface temperature a forced-air device cannot exceed?

Answer 327

48 degrees Celsius

Question 328

What alteration in anesthetic response would you expect to see in a patient who suffers from Conn’s syndrome (hyperaldosteronism)? (NDNMB)

Answer 328

Decreased nondepolarizing muscle relaxant dose requirements

Question 329

LMA or Combitube is suitable for placement by paramedics for transport, but it should be

Answer 329

replaced with a definitive endotracheal airway as soon as possible.

Question 330

Which pharmacokinetic model best illustrates how lipid-soluble drugs are distributed?

Answer 330

2- compartment model

Question 331

In a patient with mitral valve regurgitation, corrective surgery is preferred to be performed when the ejection fraction is

Answer 331

> 60%

Question 332

What induction agent is most useful for the patient with cardiac tamponade undergoing general anesthesia?

Answer 332

Ketamine

Question 333

Patients with chronic renal failure tend to exhibit

Answer 333

hyperventilation

Question 334

You are preparing to anesthetize an 11 year-old patient for tonsillectomy. Which statement indicates an accurate understanding of an appropriate anesthetic plan for this patient?

Answer 334

A cuffed endotracheal tube should be used

Question 335

The arterioles that surround the loop of Henle are known as the

Answer 335

VASA RECTA

Question 336

Posttraumatic stress disorder (PTSD) is characterized by symptoms of stress that last longer than

Answer 336

One month

Question 337

The mental and psychological effect of being awake for a duration of 24 hours is

Answer 337

the equivalent of a blood alcohol content of 0.10%

Question 338

should be avoided in patients with Parkinson’s disease.

Answer 338

Dopamine antagonists (phenothiazines, droperidol, and metoclopramide)

Question 339

Features characteristic of Parkinson’s disease include:

Answer 339

Resting tremor, cogwheel rigidity of extremities, bradykinesia, shuffling gait, stooped posture, and facial immobility.

Question 340

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

Answer 340

Levodopa is a precursor to dopamine.

Question 341

Precursor of dopamine is

Answer 341

LEVODOPA

Question 342

Levodopa is combined with

Answer 342

Tt is combined with a decarboxylase inhibitor to prevent the peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.

Question 343

Common in parkinson’s patients are

Answer 343

Orthostatic hypotension is also common in these individuals and levodopa therapy may result in nausea and vomiting as a result of stimulation of the chemoreceptor trigger zone.

Question 344

Parkinson is a decrease in

Answer 344

A decrease in dopamine levels in the basal ganglia

Question 345

What is the most common cardiac abnormality associated with severe scoliosis?

Answer 345

MVP

Question 346

Scoliosis caused by cerebral palsy or syringomyelia is categorized as

Answer 346

Neuropathic scoliosis

Question 347

Kyphoscoliosis The severe chest wall deformity can result in a reduction in lung volumes with

Answer 347

vital capacity, total lung capacity, functional residual capacity, and residual volume all reduced.

Question 348

What is normal in kyphoscoliosis

Answer 348

The FEV1/FVC is normal unless the patient’s condition is complicated by concomitant pulmonary disease.

Question 349

Administration of anticholinergics in general results in a _______in gastric secretions, _______peristalsis and intestinal motility,______ gastric emptying time, and. There is no significant effect on ventricular function or peripheral vascular resistance.

Answer 349

decrease; decreased; prolonged

Question 350

ATROPINE on LES tone

Answer 350

reduced lower esophageal sphincter tone

Question 351

Anticholinergic that both decrease the lower esophageal sphincter tone and increase the risk for gastric reflux.

Answer 351

atropine and glycopyrrolate

Question 352

Although atropine can cross the placenta (glycopyrrolate cannot), there is

Answer 352

no significant change in fetal heart rate after intravenous administration to the mother.

Question 353

All anticholinergics combine

Answer 353

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

Question 354

Ipratroprium bromide is chemically most similar to

Answer 354

Atropine

Question 355

Mnemonic action of anticholinergic

Answer 355

Can’t see
Can’t pee
Can’t spit
Can’t shit

Question 356

DUMBBBELL Signs of Cholinergics

Answer 356

Diaphoresis
Urination
Miosis (Pin POINT PUPIL)
Bradycardia (decreased HR)
Bronchospasm
Bronchial secretions increase
Emesis (vomiting)
Lacrimation
Loose stool

Question 357

Which agents would be most effective in the treatment of motion-induced nausea and vomiting? (select two)

Answer 357

Dimenhydrinate

Scopolamine

Question 358

Which drug could potentiate the effects of atropine and predispose the patient to central anticholinergic syndrome?

Answer 358

Amitryptiline

Question 359

The typical sequence of CNS symptoms seen from local anesthetic toxicity in order of appearance are

Answer 359

Circumoral numbness,
lightheadedness
tinnitus
visual disturbances
slurring of speech, muscle twitching, irrational conversation, unconsciousness, grand mal seizures, coma, and apnea

Question 360

All local anesthetics are weak bases consisting of a

Answer 360

lipophilic group (often a benzene ring) attached to a positively charged amine group by either an amide or ester linkage.

Question 361

A resting nerve is less sensitive to local anesthetics because

Answer 361

local anesthetics enter active cells more easily.The more a nerve is firing and the more frequently the channel opens, the more opportunities lidocaine has to enter the cell and bind to the sodium receptor. Local anesthetics bind to the sodium channel on the inside of the cell membrane, not the outside.

Question 362

Local anesthetics can only enter the cell when the

Answer 362

sodium channel is in the activated or open state.

Question 363

Following injection of lidocaine during an epidural anesthetic, the patient begins to complain of numbness of her lips, dizziness, and ringing in the ears. Which of the following would be an appropriate intervention?

Answer 363

Encourage the patient to hyperventilate. In the early stages of toxicity, however, hyperventilation (preferably with 100% oxygen) is the treatment of choice.

Question 364

________worsens the toxic effects of local anesthetics by causing cerebral vasodilation and delivering more drug to the brain, reducing plasma protein binding which leaves more free drug available in the circulatory system, and by causing ion trapping within the neuron due to increased intracellular acidosis.

Answer 364

Acidosis

Question 365

Hyperventilation with 100% oxygen increases the plasma

Answer 365

pH to counteract these effects and denitrogenates the lungs in the event emergency intubation becomes necessary

Question 366

You have performed a Bier block anesthetic with 50 mL of lidocaine 0.5% for a patient undergoing closed reduction of a distal radius and ulna fracture. The procedure is complete, and your current tourniquet time is 20 minutes. An appropriate action would be to

Answer 366

To avoid a rapid bolus of intravenous local anesthetic that could result in local anesthetic toxicity, the tourniquet should remain inflated for a minimum of 20 minutes. If 40 minutes has elapsed, the tourniquet can be deflated in a single maneuver. If the duration is between 20 and 40 minutes, the tourniquet should be deflated, reinflated immediately, and then deflated 1 minute later to prevent the rapid absorption of local anesthetic into the circulation

Question 367

A femoral nerve block will provide anesthesia for the ,

Answer 367

anterior thigh, knee, and a portion of the medial aspect of the foot.

Question 368

would be more appropriate for a lateral thigh procedure

Answer 368

A lateral femoral cutaneous nerve block

Question 369

Which Block would be appropriate for procedures on the medial thigh such excision of a medial thigh mass or a release procedure on the medially located adductor muscles.

Answer 369

Obturator nerve block

Question 370

The sympathetic blockade on peristalsis

Answer 370

produces increased peristalsis

Question 371

Sympathetic blockade from a spinal anesthetic decreases the

Answer 371

stress response and results in lowered production of cortisol as well as producing arterial vasodilation.

Question 372

The formula for calculating ideal body weight is

Answer 372

height in centimeters minus 100 for men and height in centimeters minus 105 for women.

Question 373

The concomitant use of zidovudine and corticosteroids can place the patient at risk for

Answer 373

myopathy and respiratory muscle dysfunction.

Question 374

The elimination half-life of carbon monoxide is about 4 to 6 hours which means that a smoke free interval of _____________results in marked decreases in carboxyhemoglobin levels and a corresponding increase in oxygen carrying capacity.

Answer 374

12 to 18 hours results

Question 375

Patients with cardiac valvular disorders undergoing tonsillectomy are at risk for endocarditis from chronic tonsillar infection by

Answer 375

Streptococcal organisms

Question 376

What is the most common causative diagnosis for patients requiring renal transplant?

Answer 376

TYPE II DIABETES

Question 377

The next three most common causative diagnoses in order AFTER DIABETES are

Answer 377

hypertensive nephrosclerosis, renal graft failure, and type 1 diabetes.

Question 378

What is the earliest sign of graft function after liver transplantation surgery?

Answer 378

Base deficit normalizes with rapid fresh frozen plasma administration

Question 379

Liver transplantation is associated with administration of.

Answer 379

large volumes of fresh frozen plasma to maintain euvolemia and correct bleeding due to hypofibrinogenemia

Question 380

During Liver transplantation, the administration of plasma is associated with

Answer 380

citrate binding of calcium and will require intravenous calcium administration. If a graft is functioning normally, the base deficit will normally resolve within 30 minutes despite continued FFP administration as the new liver begins metabolizing the citrate.

Question 381

If the liver graft is functioning properly , What will happen?

Answer 381

base deficit will normally resolve within 30 minutes despite continued FFP administration as the new liver begins metabolizing the citrate.

Question 382

is the most potent stimulus for pulmonary vasoconstriction.

Answer 382

Generalized alveolar hypoxia

Question 383

When HPV occurs

Answer 383

When it occurs locally, it serves to shunt blood to areas that are better oxygenated. Systemic acidosis also promotes pulmonary vasoconstriction but is not as strong a stimulus as hypoxia.

Question 384

Not as strong as hypoxia but also promotes pulmonary vasoconstriction?

Answer 384

Systemic acidosis

Question 385

Which of the following laboratory changes are most specific for hepatobiliary obstruction?

Answer 385

5’ nucleotidase elevation

Question 386

5’ nucleotidase is a form of alkaline phosphatase that is present in most tissues, but elevated serum levels are always

Answer 386

hepatobiliary in origin and are markedly elevated in intrahepatic or extrahepatic obstruction.

Question 387

5’ nucleotidase is a form of

Answer 387

alkaline phosphatase

Question 388

Attempt to reconstruct ravaged bone

Answer 388

Osteoblasts (build bones)

Question 389

Diagnostic feature of bone disease and Hyperparathyroidism?

Answer 389

Elevated alkaline Phosphatase

Question 390

Advanced sustained elevated PTH leads to

Answer 390

exaggerated osteoclast activity

Question 391

Which of the following lab results would be consistent with glycogen storage disease?

Answer 391

Metabolic acidosis

Question 392

Glycogen storage disease results in a lack of the enzyme. As a result, glycogen cannot be hydrolyzed in hepatocytes and other cells and becomes inappropriately stored in the intracellular space. Hypoglycemia can be severe and metabolic acidosis develops as a consequence.

Answer 392

glucose-6-phosphatase

Question 393

Most common functioning tumor of the pancreas

Answer 393

Insulinoma

Question 394

Insulinoma triad is known as the

Answer 394

WHIPPLE TRIAD
Hypoglycemia (catecholamine release)
Low blood glucose (40-50)
Relief of symptoms after IV glucose.

Question 395

Acromegaly is associated with an increased incidence of

Answer 395

osteoarthritis, systemic hypertension, ischemic heart disease, ventilation-perfusion mismatching, glucose intolerance, neuropathy, skeletal muscle weakness, and thick, oily skin.

Question 396

Hyperaldosteronism is associated with

Answer 396

hypokalemia (serum potassium less than 3.5 mEq/L).

Question 397

Which of the following interventions would be an appropriate initial treatment for the derangement in serum potassium caused by hyperaldosteronism?

Answer 397

Spironolactone is a competitive aldosterone antagonist that, unlike furosemide and bumetanide, will induce diuresis while sparing serum potassium levels.

Question 398

3 associated with pheochromocytoma

Answer 398

INcreased serum metaneprhine levels
Normal magnesium
LVH on ECG

Question 399

Hypoglycemia is associated with a sympathetic response and symptoms such as

Answer 399

hypertension, tachycardia, diaphoresis, and lacrimation.

Question 400

Does multiple sclerosis affect peripheral nerves

Answer 400

NO

Question 401

Multiple sclerosis is associated with prolonged latency of evoked potentials due to

Answer 401

slowed nerve conduction resulting from demyelination of central nerves, including the brainstem and cerebellum.

Question 402

Prolonged LATENCY of EVOKED POTENTIALS is associated with

Answer 402

MS

Question 403

Patients with congestive heart failure often exhibit hyponatremia due to

Answer 403

activation of the vasopressin system.

Question 404

Administration of 10 mL of 10% calcium chloride for HYPERKALEMIA should be over

Answer 404

10 minutes

Question 405

Electrical alternans is a variation in the ECG caused by

Answer 405

the shifting of the heart within the distended pericardium as it beats.

Question 406

Electrial Alternans is seen with

Answer 406

Cardiac tamponade

Question 407

Anaphylactic reactions are related to prior sensitization by exposure to an antigen with production of antigen-specific

Answer 407

IgE

Question 408

Meperidine produces______ respiration depression in neonates than morphine

Answer 408

LESS

Question 409

Naloxone may be administered IV directly into the newborn at a dose of

Answer 409

10 mcg/kg.

Question 410

Hepatic blood flow in the elderly

Answer 410

decreases by as much as 40% by 80 years of age.

Question 411

Shoulder arthroscopies are usually performed in which position?

Answer 411

Beach chair position ; (also known as beach chair, barber chair, or modified Fowler’s position) or lateral decubitus position.

Question 412

Preferred position for shoulder arthroscopies

Answer 412

Semi-sitting position is often preferred as it facilitates maintaining the MAP < 80 mmHg to reduce subacromial bleeding.

Question 413

When the body temperature is less than 20 degrees Celsius, circulatory arrest can be tolerated for

Answer 413

up to about 30 minutes.

Question 414

Profound hypothermia provides greater protection againsts.

Answer 414

cerebral ischemia than oxygen administration or anesthetic agent

Question 415

During neurosurgical procedures where the brain is at risk for ischemic damage, a goal temperature of

Answer 415

35C to 36C is acceptable.

Question 416

The mucous membranes of the nose are innervated by the opthalmic division of the trigeminal nerve

Answer 416

(V1) anteriorly and the maxillary division of the trigeminal nerve (V2) posteriorly. These nerves are also known as the anterior ethmoidal and sphenopalatine nerves respectively.

Question 417

V1: Ophtalmic division is also known as

Answer 417

Anterior ethmoidal nerve

Question 418

V2: Maxillary division is aka

Answer 418

Sphenopalatine nerve

Question 419

The lateral and medial cricoarytenoids are innervated by the

Answer 419

recurrent laryngeal nerve.

Question 420

You are performing a general anesthetic when you notice sustained high circuit pressures. You switch to BAG mode and manually ventilate the patient. The circuit pressures return to normal until you switch back to ventilator mode and they rise again. The patient exhibits adequate muscle relaxation. What is the likely problem?

Answer 420

The ventilator relief valve is malfunctioning

Question 421

If the circuit exhibits sustained high pressures only during mechanical ventilation and not during manual ventilation, then the problem is likely a

Answer 421

malfunctioning ventilator relief valve.

Question 422

If the scavenger was obstructed or the endotracheal tube is obstructed with secretions, then the circuit pressures would remain

Answer 422

elevated during mechanical or manual ventilation.

Question 423

If nitrous oxide is also used, the maximum exposure to halogenated agents allowed by OSHA is

Answer 423

0.5 ppm.

Question 424

If nitrous oxide is NOT used, then the maximum exposure is

Answer 424

2 ppm.

Question 425

The most common critical incidents in anesthesia are due to

Answer 425

circuit disconnection at the y-piece

Question 426

In the patient with epiglottitis, symptoms of impending airway obstruction airway are (3). Also, the importance of a complete blood count and chest x-ray are secondary to securing the airway. The preoperative evaluation should be brief and the efforts of the anesthesia staff should be focused on rapidly securing a difficult airway. Inhalation induction, especially for a pediatric patient, is a suitable induction method.

Answer 426

airway obstruction such as drooling, dysphagia, and increasing stridor, it is imperative that

Question 427

In the patient with epiglottitis, symptoms of impending airway obstruction airway are (3).

Answer 427

airway obstruction such as drooling, dysphagia, and increasing stridor, it is imperative that

Question 428

2nd to airway securement in the child with epiglottitis

Answer 428

Also, the importance of a complete blood count and chest x-ray are secondary to securing the airway.

Question 429

Induction method for epiglottitis

Answer 429

Inhalation induction, especially for a pediatric patient, is a suitable induction method.

Question 430

The mediastinoscope can compress the

Answer 430

Innominate artery which gives rise to the right subclavian, right common carotid, and right vertebral arteries. (THINK I RIGHT SCc V)

Question 431

During carotid endarterectomy, which of the following techniques for management of ventilation would be the most appropriate?

Answer 431

Maintain normocarbia to mild hypocapnea

Question 432

During CEA both can potentially result in alterations in cerebral blood flow. . Hypocapnea can theoretically constrict cerebral blood vessels and potentially reduce blood flow causing a reverse steal effect. There is little clinical data to demonstrate that this occurs, however. In fact, a mild degree of hypocapnea has been shown to reduce the size of the region at risk for ischemia. The common practice is to maintain normocapnea to mild hypocapnea during a carotid endarterectomy.

Answer 432

Both hypercapnea and hypocapnea c

Question 433

During CEA both can potentially result in alterations in cerebral blood flow. . There is little clinical data to demonstrate that this occurs, however.

Answer 433

Both hypercapnea and hypocapnea

Question 434

The common practice is to maintain

Answer 434

normocapnea to mild hypocapnea during a carotid endarterectomy.

Question 435

Hypocapnea can theoretically constrict

Answer 435

cerebral blood vessels and potentially reduce blood flow causing a reverse steal effect.

Question 436

In fact, a mild degree of hypocapnea has been shown to

Answer 436

reduce the size of the region at risk for ischemia.

Question 437

What might be the only indicator that a bladder perforation has occurred during a cystoscopy in a patient under general anesthesia?

Answer 437

Poor return of irrigating fluid

Question 438

Strabismus surgery is also associated with a higher than normal incidence of

Answer 438

malignant hyperthermia

Question 439

Fluid to avoid in a patient with pyloric stenosis

Answer 439

Because lactate is metabolized to bicarbonate, Lactated Ringer’s should not be used.

Question 440

Pyloric stenosis associated electrolyte imbalance

Answer 440

Hypochloremic metabolic alkalosis

Question 441

When performing a brachial plexus block using the axillary approach, it is often necessary to perform separate blocks of the

Answer 441

medial brachial cutaneous and intercostobrachial nerves because the former exits the sheath just below the clavicle and the latter doesn’t travel in the sheath at all. These two nerves provide sensation to the skin of the medial and posterior proximal arm.

Question 442

The most common side effects of intraoperative blood salvage are

Answer 442

air embolism, abnormalities in coagulation, and DIC-like syndrome (also known as salvaged-blood syndrome).

Question 443

Fentanyl undergoes extensive It has a

Answer 443

first-pass metabolism, so the oral route is typically insufficient for administration.

Question 444

Fentanyl half life, Because it has a high lipid solubility and a slow rate of re-entry into the central compartment, it has a relatively

Answer 444

long half-life of 8 hours.

Question 445

Peak effect of fentanyl

Answer 445

peak effect of 3-5 minutes and its effects are terminated principally by redistribution away from the central nervous system.

Question 446

From erect to supine position

Answer 446

Decrease in peripheral vascular resistance

Increase in cardiac output

Question 447

When moving from the erect to supine position, there is a considerable increase in

Answer 447

central blood volume. The resulting stretch of baroreceptors in the central circulation results in a decrease in MAP, heart rate, and peripheral vascular resistance, whereas cardiac output and stroke volume increase.

Question 448

Increased when move from erect to supine

Answer 448

CO and SV

Question 449

Although hepatic and renal blood flow both decrease, this is well preserved

Answer 449

hepatic microsomal enzyme activity is generally well preserved in the elderly.

Question 450

The effect of aging on the pulmonary system is a

Answer 450

decrease in elastic tissue and an increase in the amount of collagen resulting in a 15% reduction in the functional alveolar surface area.

Question 451

The alveolar-arterial difference for oxygen increases from approximately

Answer 451

8 mm Hg at age 20 to approximately 20 mm Hg at age 70.

Question 452

Which of the following effects of succinylcholine administration will not be prevented by the administration of a defasciculating dose of a nondepolarizing muscle relaxant?

Answer 452

Increase in INTRAOCULAR PRESSURE

Question 453

The administration of succinylcholine can raise intraocular pressure up to.

Answer 453

15 mmHg

Question 454

Although there is no documented cases where the administration of succinylcholine has led to blindness or the extrusion of ocular contents, the use of succinylcholine in what type of surgeries is avoided?

Answer 454

open-eye injuries is widely avoided.

Question 455

Are both forms of COPD

Answer 455

Bronchitis and emphysema

Question 456

Associated with decreased elastic recoil of the lungs

Answer 456

Emphysema

Question 457

Bronchitis is associated with

Answer 457

copious sputum production

Question 458

Associated with an elevated hematocrit

Answer 458

Emphysema is

Question 459

Associated with an elevated hematocrit

Answer 459

Emphysema

Question 460

Which region of the epidural space contains no fat?

Answer 460

cervical

Question 461

When chronically exposed to an antagonist, the receptors upregulate, which means that both the

Answer 461

number of receptors and their sensitivity both increase.

Question 462

Principal cells in the cortical collecting duct are primarily responsible for

Answer 462

secreting potassium

Question 463

The principal cells in the cortical collecting duct are primarily responsible for

Answer 463

secreting potassium.

Question 464

They also play a role in the aldosterone-mediated absorption of sodium.

Answer 464

principal cells

Question 465

In the spontaneously breathing, anesthetized patient in the lateral decubitus position, FRC ? The nondependent lung shifts to a position of greater compliance. The dependent lung loses FRC and becomes less compliant. As a result, ventilation is preferentially distributed to the nondependent lung.

Answer 465

the functional residual capacity decreases almost immediately.

Question 466

In the spontaneously breathing, anesthetized patient in the lateral decubitus position, FRC ?

Answer 466

the functional residual capacity decreases almost immediately.

Question 467

In the spontaneously breathing, anesthetized patient in the lateral decubitus position, The dependent lung l

Answer 467

oses FRC and becomes less compliant. As a result, ventilation is preferentially distributed to the nondependent lung.

Question 468

In the spontaneously breathing, anesthetized patient in the lateral decubitus position, The dependent lung l

Answer 468

Loses FRC and becomes less compliant

Question 469

In the spontaneously breathing, anesthetized patient in the lateral decubitus position, ventilation is preferentially distributed to the

Answer 469

nondependent lung.

Question 470

The phenomenon of channeling in a carbon dioxide absorber cannister can be minimized by

Answer 470

Shaking the CO2 cannister prior to use

Question 471

You are testing your anesthesia machine in the morning before cases begin. You disconnect the pipeline supply and turn on the backup oxygen cylinder to make sure it functions correctly. The oxygen cylinder is full and connected correctly, but the anesthesia machine still does not pressurize. You know that the problem could be due to a

Answer 471

. fault in the oxygen pressure failure device

Question 472

What lab finding is most associated with hypoaldosteronism?

Answer 472

Hyperkalemia

Question 473

What is the only laryngeal muscle that does not receive its motor innervation from the recurrent laryngeal nerve?

Answer 473

The cricothyroid muscle, which is innervated by the external laryngeal nerve, is the only laryngeal muscle not innervated by the recurrent laryngeal nerve.

Question 474

Volatile anesthetics are eliminated from the body primarily by the

Answer 474

alveoli

Question 475

What are the components of the vessel-rich group? (select four)

Answer 475

Kidneys
Liver
Brain
Endocrine

Question 476

Where in the nephron is the majority of sodium reabsorbed?

Answer 476

Proximal CT; Sodium is reabsorbed throughout the nephron, but the majority of it (about 65%) is reabsorbed in the proximal convoluted tubule.

Question 477

How is a patient positioned for tonsillectomy?

Answer 477

Supine; The patient is positioned supine and the table is often rotated 45 to 90 degrees away from the anesthesia provider.

Question 478

The clinical picture of hypercortisolism includes

Answer 478

central obesity, hypertension, glucose intolerance, weakness, bruising and osteoporosis.

Question 479

Cushing’s disease–> Mineralocorticoid effects include

Answer 479

fluid retention and hypokalemic alkalosis.

Question 480

The most consistent clinical manifestation of aspiration pneumonitis is:

Answer 480

arterial hypoxemia –> Tachypnea, bronchospasm and pulmonary vasoconstriction with secondary pulmonary hypertension may also be present.

Question 481

Aspiration pneumonitis is:

Answer 481

Inhaled gastric fluid is rapidly distributed throughout the lungs, leading to destruction of surfactant-producing cells, damage to the pulmonary capillary endothelium and resultant atelectasis and pulmonary edema.

Question 482

Absolute contraindications to electroconvulsive therapy (ECT) include: (PRIRU

Answer 482

Pheochromocytoma
Recent MI < 4-6 weeks ago
Intracranial mass lesion 
Recent CVA 3months ago or less 
Unstable cervical spine

Question 483

Replace 1 mL blood with: how much crystalloids, colloids, albumin and whole blood and PRBCs

Answer 483

3 mL crystalloid (i.e. NS, Dextrose, LR) 1 mL colloid (i.e. albumin**, Hespan®, Dextran®) 1 mL whole blood 1 mL PRBC

Question 484

An accurate sampling the mixed venous blood must be done by drawing from the

Answer 484

PA port of the Swan-Ganz catheter.

Question 485

Normal SvO2

Answer 485

60-80%

Question 486

SVV what number predicts preload responsiveness

Answer 486

> 13%

Question 487

Normal SVR

Answer 487

800-1200

Question 488

Normal SV

Answer 488

60-100ml/beat

Question 489

Normal ScVO2

Answer 489

70%

Question 490

Index of pulmonary edema

Answer 490

EVLWI

Extravascular lung water index.

Question 491

Extravascular lung water index normal

Answer 491

3-7 ml/kg

Question 492

What does the extravascular lung water index do?

Answer 492

Measure of fluid filtration into the interstitial space of the lung.

Question 493

Normal A-a gradient

Answer 493

Normal = age/4 + 4

Question 494

if PaO2/FiO2 < 200, shunt fraction

Answer 494

> 20%.

Question 495

Cannot be corrected by 100% oxygen.

Answer 495

Shunt: pneumonia, atelectasis, pulmonary embolism, etc

Question 496

Normal values are Vd/Vt (physiologic dead space to TV)

Answer 496

0.20–0.40.

Question 497

Right to Left (IV): (induction fast or slow)

Answer 497

rapid induction (easy to remember – blood bypasses lungs, straight to brain)

Question 498

Right to Left (volatile): (induction fast or slow)

Answer 498

slower induction

Question 499

Left to Right (IV):(induction fast or slow)

Answer 499

little effect on induction

Question 500

Left to Right (volatile):(induction fast or slow)

Answer 500

little effect on induction

Question 501

Slower induction with this shunt

Answer 501

RIGHT TO LEFT SHUNT

Question 502

The effect of V/Q mismatching on uptake of volatile anesthetics is dependent on the

Answer 502

solubility of the anesthetic agent.

Question 503

Uptake of Inhaled Anesthetics: V/Q mismatch

INSOLUBLE agent

Answer 503

Insoluble agents (desflurane): markedly decreased rise in arterial partial pressure of anesthetic agent

Question 504

Uptake of Inhaled Anesthetics: V/Q mismatch Soluble agents

Answer 504

Soluble agents (isoflurane): decreased rise in arterial partial pressure of anesthetic agent is partially attenuated by relatively higher alveolar partial pressure in ventilated areas

Question 505

Acidosis on HPV

Answer 505

improves HPV

Question 506

HPV takes effect over_____ although peak effect takes up to_____

Answer 506

30 minutes; two hours

Question 507

HPV functions best when

Answer 507

30-70% of the lung is hypoxic

Question 508

Because OLV produces hypoxia in the range of because

Answer 508

30-70% of the total lung volumes, and

Question 509

HPV is thought to reduce blood flow to the operative lung by

Answer 509

50%

Question 510

Importantly, during one lung ventilation, volatile anesthetics can only reach the operative lung through

Answer 510

the bloodstream (not through the alveoli),

Question 511

Why is there more chance of hypoxemia during surgery to the right lung?

Answer 511

Right lung is larger than left so proportionally there is a greater amount of perfusion to the right. therefore hypoxemia is worst with right sided surgery.

Question 512

Lateral positioning with mechanical ventilation

Answer 512

Imbalances V/Q mismatching by giving more ventilation to the NONDEPENDENT LUNG and GRAVITY gives more perfusion to the DEPENDENT LUNG>

Question 513

In fact, PaO2 is found to be significantly worse in procedures withe patient lateral or supine?

Answer 513

SUPINE

Question 514

DURING lateral position ONE LUNG VENTILATION ,what is beneficial

Answer 514

The direction of all ventilation to the DEPENDENT LUNG create a more beneficial match of ventilation and perfusion

Question 515

What improves arterial oxygenation during OLV?

Answer 515

ALVEOLAR RECRUITMENT MANEUVERS

PEEP at 8cm H2O

Question 516

Stepwise response to worsening hypoxemia during OLV

ICE RRT

Answer 516

1. Increase FiO2
2. Confirm tube position with Fiberoptic
3. Ensure adequacy of CO
4. Remedy effects of anemia or vasodilators.
5. Recruitment maneuvers to DEPENDENT LUNG
6. TITRATE PEEP to DL
7. CPAP 5-10 cm to NDL

Question 517

Ventilation with OLV :

TV, RATE(what is acceptable) FIO2, PEEP , I:E ratio

Answer 517

TV : 6-8 ml/kg
rate : 12-15 (permissive HYPERCAPNIA ok) 
FiO2 : 0.4-0.8
PEEP: 5-10cm (2.5 - 5cm if COPD)
I:E ratio: 1:2 (1:3 if COPD )

Question 518

2 medications that can increase perfusion to the dependent lung

Answer 518

N2O 
Inhaled EPOPROSTERONOL (PROSTACYCLIN)

Question 519

Propofol and HPV

Answer 519

(100-200 ucg/kg/min) does not affect HPV

Question 520

VA and HPV

Answer 520

All volatile anesthetics inhibit HPV in a dose-dependent fashion

Question 521

LIVER TRANSPLANT–> The postreperfusion syndrome is a syndrome of severe

Answer 521

hemodynamic compromise, arrhythmia, or asystole that occurs immediately after reperfusion.

Question 522

LIVER TRANSPLANT–> The postreperfusion syndrome DEFINITION

Answer 522

A decrease in systemic mean BP > 30% below baseline for at least 1 minute during the first 5 minutes of liver reperfusion.

Question 523

Management of postreperfusion syndrome includes close communication with the surgical team regarding the

Answer 523

timing of reperfusion, pretreatment of the patient with the antihistamines (ranitidine and diphenhydramine) in the 15 minutes prior to reperfusion, and close hemodynamic monitoring at the time of graft outflow unclamping. Hypotension is treated with volume resuscitation and vasopressor agents, including infusion of phenylephrine, norepinephrine, vasopressin, and epinephrine.

Question 524

Management of postreperfusion syndrome: in cases of hypotension refractory to vasopressors

Answer 524

Methylene blue may be considered

Question 525

Indications for One-Lung Ventilation

Absolute (VCUP_

Answer 525

Protective Isolation (Massive Hemorrhage /Infection
Control of Ventilation Distribution
Bronchopleural or bronchopleural cutaneous fistula
Giant cyst or bullae (risk of rupture with PPV)
Major bronchial disruption or trauma
Unilateral Lung Lavage
VATS

Question 526

Relative (Strong) – Surgical Exposure

INDICATIONS FOR OLV

Answer 526

Thoracic aortic aneurysm
Pneumonectomy
Upper lobectomy

Question 527

Key FOB landmarks in DLT placement include

Answer 527

[tracheal lumen initially]1) lack of herniated bronchial cuff 2) visualization of three orifices in the RUL (only lobe to have three orifices), [bronchial lumen] 3) LUL and RUL orifices

Question 528

The MOST effective method by which PaO2 can be increased during OLV is

Answer 528

application of CPAP to the operative lung

Question 529

PEEP in the Dependent Lung why?

Answer 529

advantages of increasing FRC in the dependent lung, thus improving the V/Q ratio and preventing atelectasis, and does not require cessation of surgery

Question 530

BARASH said keep PACO2 at

Answer 530

PaCO2 of 35 mm Hg, as significant hypocapnia may inhibit the hypoxic pulmonary vasoconstriction response

Question 531

Lower FiO2 should be considered in any patient on this medication

Answer 531

bleomycin.

Question 532

Predict who will desaturate during one lung ventilation intraoperative factors include

Answer 532

1) supine positioning 2) R-sided thoracotomy [

Question 533

Approach to One-Lung Ventilation: primary goal?

GOAL SPO2

Answer 533

hypoxemia is the primary goal, and while there are no evidence-based recommendations regarding the lower limit of acceptable SpO2,

Question 534

Critical to avoiding hypoxemia is an understanding of the basic goal of physiologic management in OLV –

Answer 534

maximizing PVR in the operative lung, and minimizing PVR in the dependent lung.

Question 535

During OLV, FRC occurs at slightly________ volumes due to paralysis, lateral positioning, the open operative hemithorax, and the weight of mediastinal structures

Answer 535

lower-than-normal

Question 536

Bicarbonate therapy for the purpose of improving hemodynamics or reducing vasopressor requirements is not recommended for treatment of hypoperfusion-induced lactic acidemia with

Answer 536

pH > 7.15

Question 537

Steroids antiinflammatory from MOST POTENT TO LEAST

CCFH PPM TBD

Answer 537

Cortisol
Cortisone
Fludrocortisone
hydrocortisone

Prednisone
Prednisolone
Methylprednisolone

Triamcinolone
Betamethasone
Dexamethasone.

Question 538

Subdural hematoma is sickle shaped like a

Answer 538

banana.

Question 539

Subdural hematoma is sickle shaped like a

Answer 539

banana (CRESCENT SHAPE)

Question 540

Epidural hematoma shaped like a

Answer 540

lemon (BICONVEX SHAPE)

Question 541

Bezold-Jarisch reflex results in unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical), leading to the triad of

Answer 541

hypotension, bradycardia, and coronary vasodilation

Question 542

Shoulder joing innervation

Answer 542

Axillary (C5-C6, all trunks)

Suprascapular (C4-C6, upper trunk or C5 root) Subscapular nerves (C5-C6, middle cord),

Question 543

Distributions Missed by the Interscalene Technique

Answer 543

Cephalad cutaneous shoulder (above the clavicle): innervated by the supraclavicular nerves (from the lower cervical plexus, i.e. C3-C4). In order to assure complete analgesia for arthroscopic shoulder surgery, the supraclavicular nerves must be blocked

Inferior trunk: often inadequately blocked
Supplementation
Posterior arthroscopic port: local infiltration Intercostobrachial NERVE BLOCK: Supraclavicular nerves:

Question 544

Intercostobracheal nerve (T2, cutaneous branch of an intercostal nerve, innervates the

Answer 544

upper medial arm, and potentially part of the shoulder. Must be supplemented if a brachial plexus block is used

Question 545

ISB Important landmarks include the

Answer 545

anterior and middle scalene muscles and the subclavian artery.

Question 546

Cutaneous Innervation of the Brachial plexus

Answer 546

Superior lateral cutaneous nerve (continuation of the posterior cord of the axillary nerve, which derives from all three trunks). Innervates lateral shoulder and skin over the deltoid

Medial brachial cutaneous nerve (C8-T1, arises from the medial cord of the brachial plexus): upper medial arm

Intercostobracheal nerve (T2, cutaneous branch of an intercostal nerve, innervates the upper medial arm, and potentially part of the shoulder. Must be supplemented if a brachial plexus block is used

Question 547

The rate limiting enzyme in catecholamine synthesis is

Answer 547

Tyrosine Hydroxylase.

Question 548

Tyrosine Hydroxylase is responsible for the conversion of

Answer 548

tyrosine to L-DOPA, which is readily converted into dopamine.

Question 549

Converts dopamine ot NE

Answer 549

Dopamine Betal Hydroxylase

Question 550

Converts dopamine to NE

Answer 550

Dopamine Betal Hydroxylase

Question 551

Membrane Phospholipids : 1st step in arachidonic acid pathway

Answer 551

Phospholipids reacts with PHOSPHOLIPASE A2 to lead to ARACHIDONIC ACID

Question 552

Membrane Phospholipids : ARACHIDONIC ACID – 2 pathways

Answer 552

CYCLOOXYGENASE PATHWAY

5- LIPOOXYGENASE PATHWAY

Question 553

With the arachidonic acid,5-lipooxygenase pathway leads to

Answer 553

LEUKOTRIENES PRODUCTION

Question 554

CYCLOOXYGNEASE PATHWAY leads to

Answer 554

Cycloendoperoxides
Platelets (Thromboxane A2) 
Endothelium (prostacyclin) vasodilation 
smooth muscle (Prostaglandin, PGE2, PGF)

Question 555

PGE2 is

Answer 555

Vasodilation

Question 556

TXA2 causes

Answer 556

Vasoconstriction

Question 557

PGF2alpha causes

Answer 557

Vasoconstriction

Question 558

Let go current

Answer 558

10-20 mA

Question 559

Complete physiologic damage current

Answer 559

6000 mA

Question 560

Vfib current

Answer 560

100-300 mA

Question 561

Ohms Law

Answer 561

E= IR

E volts I current(ampere) R resistance

Question 562

What does Ohm’s law measure

Answer 562

Resistance to electrical flow

Question 563

Pancreatic somatostatin producing cells in the Islets of Langerhans are:

Answer 563

delta cells

Question 564

Pancreatic alpha cells producing, delta cells producing somatostatin and

Answer 564

glucagon

Question 565

Pancreatic beta cells producing

Answer 565

insulin

Question 566

PP cells producing

Answer 566

pancreatic polypeptide.

Question 567

Late depression of ventilation seen with opioids is due to

Answer 567

ROSTRAL SPREAD in CSF

Question 568

Neuraxial lipophillic causes ____(early vs late) respiratory depression due to

Answer 568

Early , Systemic uptake

Question 569

Supraspinal analgesia is mediated by

Answer 569

Mu-1 (DOMINANT one)

Kappa and delta.

Question 570

With supraspinal analgesia, the patient’s response to pain is

Answer 570

Altered, (I feel the pain, I don’t care)

Question 571

When does spinal analgesia occurs?

Answer 571

Transmission of pain impulses through the substantia gelatinosa (rexed lamina II) is suppressed.

Question 572

Supraspinal dominantly mediated by ______ while spinal dominantly mediated by

Answer 572

Mu-1; Mu-2

Question 573

Mechanisms of renal compensation during acidosis include:

Answer 573

increased production of ammonia

Question 574

The renal response to acidemia is:

Answer 574

increased reabsorption of bicarbonate anion
increased excretion of hydrogen ion in the form of titratable acids
increased production of ammonia

Question 575

Compensatory mechanism in acidemia is ______, it is accomplished by

Answer 575

Increased carbon dioxide elimination Increased alveolar ventilation

Question 576

RSBI is frequently used to help

Answer 576

predict who can be successfully weaned from mechanical ventilation.

Question 577

How is the Rapid Shallow Breathing Index (RSBI) performed?

Answer 577

With the patient breathing spontaneously, the ventilatory rate is divided by the tidal volume (liters).

Question 578

RSBI that predicts successful extubation?

Answer 578

Successful extubation can be predicted by an RSBI of less than 100. (some sources say MORE than 105 likely to fail)

Question 579

RSBI Formula

Answer 579

RSBI (breaths/min/L) = f/VT, where f is respiratory rate and VT is tidal volume in L.