Simulation Exam 2

Question 1

Which of the following agents does not decrease cerebrospinal fluid production?

Answer 1

Desflurane can increase CSF production.

Question 2

Which inhalation anesthetic possesses a blood-gas partition coefficient of 0.42?

Answer 2

Desflurane
Desflurane has a wake-up time that is about 50% less than isoflurane, primarily to a blood-gas partition coefficient of 0.42. Nitrous oxide has a blood/gas partition coefficient of 0.47, sevoflurane is 0.65, and isoflurane is 1.4. Note: some sources cite a blood/gas partition coefficient of 0.46 for nitrous oxide and 0.69 for sevoflurane.

Question 3

Which of the following local anesthetics is most reliant on plasma levels of pseudocholinesterase for its metabolism?

Answer 3

Procaine

Procaine is an ester anesthetic, all but one of which rely on pseudocholinesterase for their metabolism. Prilocaine, lidocaine, and etidocaine are both amide anesthetics, all of which are metabolized by microsomal enzymes in the liver.

Question 4

Your anesthetic plan for a patient includes spinal anesthesia. The patient takes several herbal medications. Which herbal agent would disrupt platelet aggregation for the longest period of time after discontinuation?

Answer 4

Garlic
Garlic can disrupt platelet aggregation for up to 7 days after discontinuation. Ginkgo and ginseng both impair coagulation for about 36 hours after discontinuation.

Question 5

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

Answer 5

Gastroschisis

Gastroschisis, omphalocele, congenital diaphragmatic hernia, tracheoesophageal fistula, intestinal obstruction, and myelomeningocele are all typically repaired within the first week following delivery. Pyloric stenosis, necrotizing enterocolitis, ligation of a PDA, and inguinal hernia repair are typically addressed within the first month of life.

Question 6

You have extubated a pediatric patient following tonsillectomy and the patient exhibits inspiratory stridor. You know that inspiratory stridor most commonly represents

Answer 6

upper airway obstruction

Inspiratory stridor results from upper airway obstruction. Lower airway obstruction results in expiratory stridor.

Question 7

You are performing a preoperative evaluation on a 4 month-old patient. You inform the mother that she should not breastfeed the infant for at least how many hours prior to anesthesia?

Answer 7

4 Hours

Breast milk should not be ingested for at least 4 hours prior to anesthesia.

Question 8

Which of the following laboratory abnormalities is associated with hypoaldosteronism?

Answer 8

Hyperchloremic metabolic acidosis

Hypoaldosteronism is associated with hyperkalemia, hyponatremia, hyperchloremic metabolic acidosis, and often, hyperglycemia.

Question 9

Which of the following statements regarding insulin is NOT true?

Answer 9

Normal insulin production in the adult is about 40 to 50 units per day, is metabolized by both the liver and kidneys, facilitates the transport of glucose and potassium into the cell, and is important for the cellular uptake of glucose with the exception of the brain and liver where it does not affect glucose transport.

Question 10

All of the following are associated with Addison’s disease (adrenal insufficiency) except:

Answer 10

Increased androgen production

Addisons disease is characterized by autoimmune destruction of the adrenal glands causing a decrease in glucocorticoid and mineralocorticoid production. This results in hyperpigmentation, hyperkalemia, increased urinary sodium excretion, and decreased androgen production.

Question 11

All of the following could precipitate hepatic encephalopathy in patients with cirrhosis except:

Answer 11

Gastrointestinal hemorrhage, diuretics, azotemia, constipation, increased dietary protein intake, and hypokalemia can all produce an increase in serum ammonia levels which can precipitate hepatic encephalopathy in patients with cirrhosis.

Question 12

Which of the following are associated with an anaphylactic reaction?

Answer 12

Complement activation

The underlying physiology of an anaphylactic reaction involves the degranulation of mast cells and basophils with the release of histamine, leukotrienes, and prostaglandins with activation of the complement system.

Question 13

Dose-response curves provide information about all of the following aspects of pharmacologic effects except:

Answer 13

Steady-state plasma concentration

The slope of a dose-response curve demonstrates the rate of increasing effect with an increased dose. The dose-response curve also demonstrates the efficacy, or maximal effect of a drug as well as the potency (ED50). A dose-response curve can also demonstrate variability in drug effect if it measures multiple subjects. The steady-state plasma concentration (CPss50) is determined by a concentration-response curve using a continuous infusion of a drug.

Question 14

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

Answer 14

Diazepam

In the elderly patient, total body water decreases while total body fat increases. Thus, the volume of distribution for water-soluble drugs such as glycopyrrolate, succinylcholine, and gentamicin decreases while the volume of distribution for lipid-soluble drugs such as barbiturates, benzodiazepines, and volatile anesthetics increases.

Question 15

When placing monitors on a patient presenting for mediastinoscopy, which of the following is the most appropriate arrangement?

Answer 15

Radial arterial line and O2 saturation monitor on the right arm and the blood pressure cuff on the left arm

During mediastinoscopy, there is a significant risk of compression of the innominate artery by a mediastinal mass or by the mediastinoscope itself resulting in a drop in right arm blood pressure. If only the right arm blood pressure is monitored, the patient may be treated inappropriately for hypotension. If only the left arm is monitored, the obstruction may go unnoticed. If the pressure in the right arm is less than that of the left arm, you should suspect innominate vessel compression. Placing the arterial line and O2 saturation monitor on the right arm will detect compression of the artery sooner.

Question 16

The administration of albumin will increase both the plasma osmolality and intravascular volume as the negatively charged albumin molecules bind to other ions. This phenomenon is known as the

Answer 16

Donnan effect

The administration of albumin will increase both the plasma osmolality and intravascular volume as the negatively charged albumin molecules bind other ions. This is known as the Donnan-Gibbs or Donnan effect.

Question 17

Which of the following analgesics would be least appropriate to administer for postpartal pain control in a nursing mother?

Answer 17

Although meperidine had been used for postoperative pain in obstetrics in the past, the American College of Obstetricians and Gynecologists and the American Pain Society have discouraged its use due to the accumulation of normeperidine in the neonate.

Question 18

The risk of ischemic damage to the spinal cord caused by cross-clamping the thoracic aorta during aortic aneurysm repair can be reduced by

Answer 18

placing a lumbar cerebrospinal fluid drain

Measures that can reduce the risk of spinal cord ischemia during aortic cross-clamping include a short cross-clamp time, maintaining normal cardiac function, higher perfusion pressures, hypothermia, and drainage of cerebrospinal fluid.

Question 19

Following emergence and extubation, a patient who has undergone tonsillectomy should be transferred to the recovery area

Answer 19

in semi-prone position with the head down

Following emergence from a tonsillectomy, the patient should be placed in ‘tonsil’ position which consists of lateral or semi-prone position with the head down to decrease the risk of aspiration of blood.

Question 20

Which of the following is a likely cause of hypocalcemia?

Answer 20

Hypoalbuminemia

Total blood calcium levels parallel the serum albumin. If the serum albumin decreases, the total blood calcium level will decrease as well. Hypoalbuminemia is the most common cause of hypocalemia.

Question 21

What is the only machine safety device that detects problems downstream from the flowmeters in an anesthesia machine?

Answer 21

The oxygen monitor

The oxygen monitor is the only machine safety device that detects problems downstream from the flowmeters in an anesthesia machine.

Question 22

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

Answer 22

The Schroeder stylet is a plastic, disposable stylet that allows the stylet angle to be adjusted while performing the laryngoscopy.

Question 23

A patient with a suspected cervical spine injury is transported to the emergency department by ambulance. On arrival, an LMA is in place. The patient exhibits no spontaneous respirations and is unconscious, but you are able to bag-ventilate the patient with ease. You should

Answer 23

Replace the LMA with an endotracheal tube

An LMA or Combitube is suitable for placement by paramedics for transport, but it should be replaced with a definitive endotracheal airway as soon as possible.

Question 24

Match the anesthetic agent with its approximate oil:gas partition coefficient.

N20
Des
Iso
Sevo

Answer 24

The oil:gas coefficient values for the inhalation anesthetics are as follows: isoflurane = 99 (some sources cite 98), desflurane = 18.7, sevoflurane = 50 (some source cite 55), and nitrous oxide = 1.4

Question 25

You plan to administer 0.3 M sodium citrate preoperative to a patient presenting for elective surgery. You know that the peak effect of sodium citrate occurs in

Answer 25

15-20 minutes

Because it has an almost immediate and short-lived peak effect (15-20 minutes), sodium citrate is more useful as an adjunct to emergency procedures rather than outpatient procedures where the time between administration of the antacid and induction of anesthesia may be prolonged.

Question 26

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

Answer 26

one month

If not addressed adequately, acute traumatic stress can evolve into posttraumatic stress disorder (PTSD). PTSD is characterized by symptoms of stress that last longer than one month. It can lead to permanent disability and affect the ability to resume patient care.

Question 27

An otherwise healthy patient is in the lateral decubitus position for thoracic surgery. He is mechanically ventilated and you institute one-lung ventilation (OLV). You would expect that when OLV is instituted, the intrapulmonary shunt would be

Answer 27

40%

During two-lung ventilation, about 60% of the pulmonary blood flow goes to the dependent lung. Therefore, when one-lung ventilation is instituted, you would expect the patient to experience approximately a 40% shunt as blood that is unable to be oxygenated travels through the nondependent lung.