Simulation Exam 1

Question 1

For every 1 degree Celsius that the core body temperature decreases, the cerebral metabolic rate of oxygen consumption

Answer 1

8% decrease

Question 2

During a craniotomy, a patient’s blood pressure decreases from 120/80 to 60/30. Which of the following would happen?

Answer 2

Cerebral vessels would dilate and CBF would decrease

In response to a decreased MAP, cerebral vessels dilate. Between MAPs of 60 and 160 this mechanism is able to keep CBF constant, but outside of this range CBF becomes pressure dependent. The MAP decreased to 40, therefore CBF would decrease despite compensatory mechanisms.

Question 3

Local anesthetics exist as:

Answer 3

weak bases with a positively charged amine group

Question 4

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 4

Encourage the patient to hyperventilate

Question 5

An HIV-positive patient is taking a combination of zidovudine and corticosteroids. You know that this can place the patient at risk for

Answer 5

Respiratory muscle dysfunction

Question 6

You explain to a patient who smokes cigarettes that in order to minimize the effects of carbon monoxide on oxygen-carrying capacity, he/she should refrain from smoking for at least

Answer 6

12-18 hours

The elimination half-life of carbon monoxide is about 4 to 6 hours which means that a smoke free interval of 12 to 18 hours results in marked decreases in carboxyhemoglobin levels and a corresponding increase in oxygen carrying capacity.

Question 7

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

Answer 7

Streptococcal organisms

Question 8

At what age is the MAC for sevoflurane the highest?

Answer 8

3 months old

Question 9

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

Answer 9

Base deficit normalizes with rapid fresh frozen plasma administration

Question 10

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

Answer 10

5’ nucleotidase elevation

Question 11

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

Answer 11

Metabolic acidosis

Glycogen storage disease results in a lack of the enzyme glucose-6-phosphatase. 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.

Question 12

All of the following findings are consistent with a diagnosis of pheochromocytoma except:

Answer 12

Decreased hematocrit

Pheochromocytoma is associated with ECG changes such as left ventricular hypertrophy, nonspecific T wave changes, and evidence of ischemia, urinary excretion of vanillylmandelic acid (a byproduct of catecholamine metabolism), and increased hematocrit due to volume contraction resulting from chronic hypertension. Alterations in serum magnesium levels are not necessarily associated with pheochromocytoma.

Question 13

All of the following are symptoms of hypoglycemia except

Answer 13

Hypotension

Question 14

All of the following pathologies are associated with sarcoidosis except:

Answer 14

B. Chronic extrinsic restrictive lung disease

Sarcoidosis is associated with diffuse granulomatous lesions resulting in intrinsic restrictive lung disease, cor pulmonale, and restrictive cardiomyopathy which may present as heart block and dysrhythmias. Other classic signs are hypercalcemia, hepatic granulomas, splenomegaly, and involvement of the parotid gland and facial and optic nerves.

Question 15

Autonomic hyperreflexia would most likely produce

Answer 15

vasoconstriction below the spinal cord lesion

When a patient experiences autonomic hyperreflexia, a reflex dilation of the tissues ABOVE the level of the spinal cord injury will occur to help offset the sudden increase in blood pressure caused by the unopposed vasoconstriction below the spinal cord lesion.

Question 16

The medial cricoarytenoid muscles are innervated by the

Answer 16

The lateral and medial cricoarytenoids are innervated by the recurrent laryngeal nerve.

Question 17

A child presents to the emergency department with a diagnosis of epiglottitis. He is drooling, complains of sore throat, and exhibits stridor. Your preoperative exam for this patient should include:

Answer 17

A plan for an inhalation induction

In the patient with epiglottitis and symptoms of impending airway obstruction such as drooling, dysphagia, and increasing stridor, it is imperative that airway examination be avoided to prevent additional swelling due to manipulation. 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.

Question 18

Which of the following respiratory parameters is decreased in elderly patients?

Answer 18

Alveolar surface area

In the elderly patient, closing capacity increases, and by age 65 it exceeds tidal volume in the sitting position resulting in airway collapse. The increase in airway collapse increases residual volume as well. The alveolar surface area decreases with age resulting in decreased efficiency of gas exchange.

Question 19

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

Answer 19

Poor return of irrigating fluid

Question 20

A patient is undergoing general anesthesia for strabismus surgery. Which of the following is not true regarding anesthesia during this procedure?

Answer 20

Hyperventilation increases the risk for sudden bradycardia

Question 21

Which of the following statements regarding pyloric stenosis is false?

Answer 21

Preoperative hydration with a crystalloid such as Lactated Ringer’s is appropriate prior to induction

Question 22

Which of the following effects would you expect to see in a patient changing from the erect position to supine? (select two)

Answer 22

Decrease in peripheral vascular resistance

Increase in cardiac output

Question 23

How will the chronic administration of an antagonist affect the number and sensitivity of the receptors it antagonizes?

Answer 23

The number and sensitivity of the receptors both increase

Question 24

The physiologic characteristics of hypoxic pulmonary vasoconstriction include:

Answer 24

The physiologic characteristics of hypoxic pulmonary vasoconstriction include:

Hypoxic pulmonary vasoconstriction is a localized reaction that occurs and resolves quickly in response to episodes of hypoxia within the lungs. It occurs due to alveolar hypoxia, not arterial hypoxemia. It may be inhibited by calcium channel blockers, nitrates, and inhalational anesthetics.

Question 25

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 25

fault in the oxygen pressure failure device

If you have verified that the backup oxygen cylinder is full, connected properly, and opened, but the anesthesia machine still does not pressurize, then there is a problem in the high or intermediate pressure system in the anesthesia machine. The flowmeters, vaporizers, and unidirectional valves are all part of the low pressure system.

Question 26

What lab finding is most associated with hypoaldosteronism?

Answer 26

Hyperkalemia

Question 27

Volatile anesthetics are eliminated from the body primarily by the

Answer 27

aveoli

Question 28

How is a patient positioned for tonsillectomy?

Answer 28

supine