Review Questions Flashcards
Anaphylactic reactions are related to prior sensitization by exposure to an antigen with production of antigen specific ___________.
- IgE antibodies
Antibodies are specific proteins called __________ that can recognize and bind to a specific antigen.
- immunoglobulins
What types of patients have a compromised immune system?
- chemotherapy
- HIV
- one month old infant
Irritant or contact dermatitis accounts for the majority of latex reactions and is caused by what type of reaction?
- T-cell mediated reactions
What are the molecules capable of stimulating an immune response called?
- antigens
Irritant or contac dermatitis accounts for the majority of latex allergies and is caused by what?
T-cell mediated reactions
Order from of highest to lowest or most common culprits of allergic reactions
#1 muscle relaxants #2 Latex #3 antiobiotics #4 opioids
Aftet induction of anesthesia in the OR your pt experiences hives,flushing, and extensive hupotension, and high peak inspiratory pressures. List 3 interventions
Epinephrine
Benadryl/pepcid
IVF bolus
After incidental needlestick with HIV contaminated needle the incidence of seeoversion is ____
0.3%
Approximately 7 minutes aftet induction of general anesthesia with propofol, fentanyl, lidocaine, rocuronium and successful intubation your patient becomes severely hypotensive and tachycardic. You notice increase in peak airway pressures, a drop in oxygen saturation, and urticaria on the chest and abdomen. Which would you do first?
Administer 50-100mcg epinephrine IV
Which patient populations have the high risk of latex reactions
All of the above
- children with spina bifida
- people with urogenital abnormalities
- people with multiple food allergies
- people with history of atopy
- people with allergies to bananas, avocados, and kiwis
You are performing a cystoscopy on a chronic alcoholic patient who exhibits signs of cirrhosis including ascites. What are two anesthetic considerations that should be made
- Avoid placement of an NG/OG tube
- Placement of an ETT
Which consideration needs to be made for a patient undergoing the Ivor-Lewis procedure for esophagectomy with a thoracic approach?
One lung ventilation
A patient with pancreatic disease is likely to exhibit all of the following EXCEPT?
- Diabetes Insipidus
Will show ileus, hyper/hypoglycemia, electrolyte disorders
You are preparing a patient from the ICU for a projected 8 hour esophagectomy. The patient is receiving TPN. What do you do with the TPN?
Continue TPN throughout the procedure
Which of the following medications used in the patient with GERD will increase gastric volume?
Sodium bicitrate
Which of the following would not be expected change to occur during insufflation for a laparoscopic procedure?
Increased TV
Will see decreased FRC, decreased venous return, increased peak airway pressure
A patient scheduled for surgery for upper esophageal cancer. Intraoperative concerns for the patient include all of the following except:
- Anastomosis leak
Intraoperative concerns are hemorrhage, injury to RLN, injury to tracheobronchial tree
During a carotid endarterectomy the cerebral oximetry reading on the operative side begins to fall to more than 20% baseline. Which of the interventions are appropriate? (Select 3)
A. Decreasing respiratory rate B. Administer a vasodilator C. Asking the surgeon to infiltrate the region with local anesthetic D. Administer glycopyrrolate E. Administer a vasopressor F. Asking the surgeon to place a shunt
A. Decreasing respiratory rate
E. Administering a vasopressor
F. Asking the surgeon to place a shunt
A major risk with the aortic cross-clamp during open AAA is paraplegia. The paraplegia is most likely caused by?
A. Declamping shock syndrome
B. Clamping of the iliac artery
C. Hyperperfusion of the basilar artery
D. Spinal cord ischemia
D. Spinal cord ischemia
The law of Laplace is associated with aneurysm wall tension. As the diameter increases, what happens to the wall tension?
A. Remains unchanged
B. Increases
C. Decreases
D. All of the above
B. Increases
You are called emergently to the ICU for the patient you dropped off following a carotid endarterectomy 2 hours ago. Upon enetering the room, the patient is in obvious respiratory distress with swelling on the operative side of the neck. Your first action is?
A. Placement of ETT
B. Placing the patient on BiPAP
C. Calling the OR to let them know you will be going back to the OR
D. Decreasing the BP
A. Placement of an ETT
In preparing for removal of the aortic cross clamp the anesthesist does all of the following except?
A. Increase the anesthetic depth
B. Increase vasoconstrictors
C. Administer a fluid bolus
D. Decrease vasodilators
A. Increase the anesthetic depth
Which of the following hemodynamic changes occur with the application of an aortic cross clamp during a AAA?
A. Decreased EF
B. Systemic hypotension
C. Increased CO
D. Systemic hypertension
A. Decreased EF
Which of the following intraopertive monitors would be considered necessary for a femoral-popliteal bypass? (Select 3)
A. TEE B. PAC C. CVP D. SpO2 E. A-line F. EKG
D. SpO2
E. A-line
F. EKG
Anestgetic goals for the patient undergoing an endocascular aortic aneurysm repair all of the following except?
A. Preperation for conversion to an open procedure
B. A quiet surgical field
C. Hemodynamic stability
D. Muscle relaxation
D. Muscle relaxation
Which of the following has the highest correlation to the development of atherosclerotic disease?
A. Obesity
B. DM
C. Hypercholesterolemia
D. HTN
B. DM
Surgical intervention for a AAA is recommended for aneurysms that are at or above what size?
A. 3.0cm
B. 4.2cm
C. 5.5cm
D. 7.0cm
C. 5.5cm
- An 85 year old male with no previous medical history except for cataracts is undergoing a transurethral resection of the prostate gland under spinal anesthesia. Twenty minutes into the procedure the patient becomes restless. Over the next 20 minutes his blood pressure increases from 110/70 to 140/90 mmHg and his heart rate slows from 90-50 beats/min. The patient is noted to have some difficulty breathing. The most likely cause of these symptoms in this patient is:
a-volume overload b-hyponatremia c-high spinal d-autonomic hyperreflexia e-bladder perforation
a. volume overload
How are dosage requirements for local anesthetics (Cm) and minimum alveolar concentration (MAC) affected by aging?
A. Both are increased
B. Both are decreased
C. Cm is increased but MAC is decreased
D. Cm is decreased but MAC is increased
B. Both are decreased
Which of the following changes are expected to occur in the elderly as part of the normal aging process?
A. Hepatic microsomal activity is decreased
B. Pulmonary collagen content increases
C. Renal blood flow increases
D. The alveolar-arterial difference fo O2 decreases
B. Pulmonary collagen content increases
Be careful—this question gets asked to either select one answer or select all that apply. If select all that apply, then the other card has renal blood decreasing
A trauma patient comes to the OR, anesthesia should always consider the patient:
A. Neck injury
B. a full stomach
C. Intoxicated
D. A victim of a violent crime
B. a full stomach
All of the following lab values are indicative of fat embolism labs EXCEPT:
A. Fat in urine
B. Decreased potassium
C. Elevated serum lipase
D. Abnormal PLT count
B. Decreased potassium
T/F
Ketamine is a good anesthetic b/c it increases ICP, which helps in brain perfusion
False
A patient is brought straight from the ED to the OR following a MVA. You note that the patient is hypotensive, has SQ emphysema of the neck, and a tracheal shift to the right. The most likely diagnosis is:
A. A displaced C6 fracture
B. Traumatic aortic rupture
C. Pneumothorax on the left
B. Pneumothorax is on the right
C. Pneumothorax on the left
A traumatic patient suffers a C5 SC injury and is experiencing spinal shock. Spinal shock is characterized by which of the following? (Select 3)
A. Tachycardia B. Hypertension C. Hyperthermia D. Hypothermia E. Hypotension F. Bradycardia
D. Hypothermia
E. Hypotension
F. Bradycardia
Which blood type can be released to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed?
A. O pos
B. O neg
C. AB pos
D. AB neg
B. O neg
T/F
A hemorrhaging patient requires rapid blood transfusion. If the transfusion rate exceeds 1 unit every 5 minutes the patient may develop hypercalcemia
False
Pt would develop hypocalcemia
A traumatic patient is suspected to have a suffered a cervical neck injury in a MVA. Airway management of this patient should include:
A. Manual In-Line Stabilization (MILS)
B. Placement of an emergency airway
C. Intubation w/o medication to maintain consciousness
D. Removal of the c-collar to facilitate intubation
A. Manual In-Line Stabilization (MILS)
All of the following anesthesia interventions may be used to control intracranial hypertension EXCEPT:
A. Administering ketamine
B. Hyperventilating the patient
C. Fluid restriction
D. Administering a diuretic
A. Administering ketamine
Morbidly obsession patients are a challenge at best in any setting. What of the following is the best choice for care of a morbid obese patient in the ASC?
A. Don’t weigh them on admission. It is embarrassing and we would not want to upset them on arrival
B. Check the weight limits on your equipment and prepare to improvise if they don’t meet the patient’s needs
C. Have the patient bring their CPAP with them and use it if necessary
C. Have the patient bring their CPAP with them and use it if necessary
Many things can contribute to PONV. Please which one applies:
A. Length of surgery
B. Ambulation
C. Use of ETT
B. Ambulation
A 6 yr old child presents with acute URTI for tonsillectomy. What is the best decision for this child?
A. Do throat and nasal cultures, place on antibiotic if necessary and reschedule in 2-4 wks
B. Talk with the surgeon and do the case anyway, the child is never going to get well until they get their tonsils out
C. Give an antibiotic and reschedule in 2 days if OK with the surgeon
A. Do throat and nasal cultures, place on antibiotic if necessary and reschedule in 2-4 wks
Anesthesia is known to increase respiratory problems 2-7x fold. Which of the following increase the risk? (Select all that apply)
A. ENT surgery
B. Exposure to 2nd hand smoke
C. MAC anesthesia
A. ENT surgery
B. Exposure to 2nd hand smoke
Which patient is ready for stage II PACU?
A. Patient tolerating PO pain medicine, alert and oriented x 3, O2 saturation 94% on 3L NC
B. Patient alert and oriented x 3, room air saturation 96%, patient requires IV dilaudid to maintain pain score of 7
C. Patient pain score 4 with PO Lortab. alert and oriented x 3, O2 saturation 97% on room air
C. Patient pain score 4 with PO Lortab. alert and oriented x 3, O2 saturation 97% on room air
Please indicate which of the following surgeries is compatible within an (ASC) acute ambulatory surgery center?
A. ASA 2 tubal ligation with a BMI of 50, and her surgeon is 6 months out of residency
B. ASA 3, 98 year old female, well controlled type II insulin dependent diabetic with a history of controlled fib and dual chamber pacemaker checked 1 week ago for cataract surgery
C. 4 yr old male for adenotonsillectomy who has just finished an antibiotic for an ear infection a week ago. He is lethargic and running a low grade fever upon admission, but his mother says that this is a dramatic improvement from last week
B. ASA 3, 98 year old female, well controlled type II insulin dependent diabetic with a history of controlled fib and dual chamber pacemaker checked 1 week ago for cataract surgery
When your patient arrives for a colonoscopy and she tells you that she was dropped off by the LIFT bus but will be picked up by her daughter for transport home, which of the following would be the safest thing for you to do?
A. Ask the patient for her daughters phone number so that you can confirm with the daughter when she will be picking her mother up and that she will be the responsible caregiver for the next 24 hrs
B. Tell the patient that is unacceptable for her to arrive without a companion and cancel her case
C. Thank the patient for the information and assure her that you will call her daughter immediately after the case is done so that her daughter will be able to arrive shortly thereafter preventing a long wait in recovery
A. Ask the patient for her daughters phone number so that you can confirm with the daughter when she will be picking her mother up and that she will be the responsible caregiver for the next 24 hrs
Who is ready to be discharged from the ASC?
A. Patient who is eating and drinking, VSS, wants to wait outside for caregiver to arrive..it is a nice day and they don’t know what time they are going to done at work
B. Patient whose VSS and family members are present and going over D/C instructions but pain score remains a 10/10 on PO Lortab
C. Patient who is walking to the bathroom, VSS, and taking sips of ginger ale without difficulty. Pain score is a 6 on PO Lortab, but family member is pulling up to exit and is able to get pain medication filled on the way home
C. Patient who is walking to the bathroom, VSS, and taking sips of ginger ale without difficulty. Pain score is a 6 on PO Lortab, but family member is pulling up to exit and is able to get pain medication filled on the way home
How long is an H and P for a healthy patient (ASA 3), well controlled comorbidites not on any blood thinners or potassium depleting drugs good for?
A. 48 hrs
B. 30 days
C. 72 hrs
B. 30 days
Choice of anesthetic at ASC depends on a number of things, select all that apply
A. What day of the week it is
B. Surgeon skill
C. Length of stay
D. Patient preference
B. Surgeon skill
C. Length of stay
D. Patient preference
CV complications related to placement of MMA during orthopedic surgery include which of the following? (select 3)
A. Hypotension B. Bradycardia C. CV collapse D. Hypertension E. Tachycardia
A. Hypotension
B. Bradycardia
C. CV collapse
Which of the following changes would you expect to see as a result of releasing the thigh TQ on a patient that has undergone a 90 minute total knee replacement? (select 5)
A. Tachycardia B. Decreased PaCO2 C. Increased ETCO2 D. Increased serum lactate levels E. Decreased serum potassium levels F. Decreased core temperature G. hypertension H. Decreased central venous pressure
A. Tachycardia C. Increased ETCO2 D. Increased serum lactate levels F. Decreased core temperature H. Decreased central venous pressure
A 28-yr old male involved in a MCC presents emergently to the OR for repair of an open femur fracture. The patient is noted to have cyanotic nail beds, axillary petechiae, and pulmonary edema, and is becoming increasingly lethargic. His trachea is midline, and his chest x-ray was clear and read as normal prior to surgery. Upon placing him on the monitors, his VS’s are: heart rate (HR) = 126, Respiratory Rate (RR) = 40, Blood pressure (BP) = 96/52, O2 saturation (SaO2) = 89%.
What do you suspect?
A. Pericardial tamponade
B. Hemorrhage
C. Liver laceration
D. Pulmonary fat embolus
D. Pulmonary fat embolus
Maximum “safe” tourniquet time on a lower extremity is ____?
A. 1 hour
B. 2 hours
C. 3 hours
D. 4 hours
B. 2 hours
What is the minimum adequate anesthetic level for a patient undergoing total hip arthroplasty (THA) under spinal anesthesia?
A. T6-T8
B. T8-T10
C. T11-T12
D. T12-L2
B. T8-T10
