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001 Respiratory Therapy > Test Review > Flashcards

Test Review Flashcards

1
Q

What Will Increasing Partial Pressure do to induction speed

A

Increasing partial pressure will increase induction

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2
Q

Anesthetic uptake from the lungs into the blood is a product of

A

Anesthetic solubility

CO

Difference in partial pressure of alveolar gas and venous blood.

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3
Q
  1. What effect will a small gradient between Part and Pvenous have on induction using anesthetic gas

Speed induction

Slow induction

No effect on induction

Depends on anesthetic gas

A

Speed induction

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4
Q

Blood–gas partition coefficient

A

The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood, when the partial pressure in both compartments is equal.

The more soluble the inhaled anesthetic is in blood compared to in air, the more it binds to plasma proteins in the blood and the higher the blood–gas partition coefficient

It is inversely related to induction rate

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5
Q

Why Does it take a gas with a high solubility longer to induce the patient

A

If an anesthetic has a high coefficient, then a large amount of it will have to be taken up in the body’s blood before being passed on to the fatty (lipid) tissues of the brain where it can exert its effect.

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6
Q

Plane 3 of surgical anesthesia occurs:

  1. From the return of regular respirations to the cessation of REM
  2. From the cessation of REM to onset of paralysis of the intercostal muscles
  3. From partial intercostal to full
A

From partial intercostal to full

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7
Q

Planes of Anesthesia

A

These planes are a part of the third stage of anesthesia

Plane 1 is the regular respiration to the cessation of REM

Plane 2 is from the cessation of REM to the partial paralysis of intercostal muscle

Plane 3 is from partial intercostal muscle paralysis to full intercostal muscle paralysis.

Plane 4 is from full intercostal paralysis to diaphragmatic paralysis

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8
Q

During which stage of anesthesia is the pt at most risk for laryngospasm

A

Stage 2

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9
Q
  1. Muscle pain is associated with the administration of:

Nondepolarizing paralytic

Depolarizing paralytic

Benzo

Dissociative anesthetic

lidocaine

A

Depolarizing paralytic

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10
Q

Narcan has a _______ duration of action

A

Short

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11
Q

Ketamine produces a dissociative mental state which include

A

Amnesia

Catalespy

Analgesia

Sedation

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12
Q

Which of the following is a depolarizing paralytic

Pancuronium

Succinylcholine

Pyridostinmine

A

Succinylcholine

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13
Q

What i a weak anesthetic and good anaglesic

A

Nitrous Oxide

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14
Q

True or False Barbituates are more potent than benzodiazepenes

A

True

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15
Q
  1. Naloxone is an antagonist of the following drugs

Morphine

Diazapam

A or B

Neither A or B

A

Morphine

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16
Q

Loading dose of Propofol

3 -5 mg/kg

  1. 1 - 0.25 mg/kg
  2. 3-0.5 mg/kg

1 - 2.5 mg/kg

A

1 - 2.5 mg/kg

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17
Q

Why would atropine be given near the end of the operative case?

To balance oncotic pressure within normal ranges

To reduce blood pressure during adrenal crisis

Reduce hypersecretion associated with muscle relaxant reversal agent

Help reverse effects of muscle relaxants

A

Reduce hypersecretion associated with muscle relaxant reversal agent

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18
Q

Reduce MAC include all but one

83 year old patient

Acute ETOH intoxication

PaO2 of 38 mmHg

Temperature of 39.2 C

A

Temperature of 39.2 C

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19
Q

True or False

Rapidly achieving alveolar concentration of volatile agent and size of FRC has an inverse relationship

A

True

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20
Q

Ketamine produces a dissociative mental state. This include

Amnesia, catalepsy, pain reduction, sedation

Unconsciousness, analgesia, paralysis, sedation

Hypoventilation, amnesia, sedation, catalepsy

Retrograde amnesia, deep sedation, analgesia, paralysis

A

Amnesia, catalepsy, pain reduction, sedation

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21
Q
  1. A Patient has been anesthetized using nitrous oxide as primary means of induction. When the patient’s procedure is completed the anesthesiologist emerges the patient from the anesthetic state. During the emergence the anesthesiologist forgot to provide the patient with supplemental oxygen. The patient experienced a significant drop in their SpO2. What term is used to describe this circumstance

Refractory hypoxia

Infusion hypoxia

Diffusion hypoxia

A

Diffusion hypoxia

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22
Q
  1. True of Midazolam

Causes retrograde amnesia

Causes pain at injection site

0.1-0.3 mg/kg dose

1-3 mg/kg dose

A

0.1-0.3 mg/kg dose

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23
Q

Of modern inhalation anesthetic agent which has the most potency-

ISoflurane

Nitrous oxide

Sevoflurane

Desflurane

A

ISoflurane

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24
Q
  1. Which of the following statement regarding propofol is TRUE?

Has anti-emetic properties

Good agent to use for TIVA

Can cause vivid dreams

All of the above

A

All of the above

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25
Q
  1. Generally, Morphine will have these effects on respiration

Normal Vt

Decreased RR

A or B

Neither A or B

A

A or B

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26
Q
  1. What is FALSE of desflurane?

Is has the highest MAC of the halogenated hydrocarbons

Dose related bradycardia

Least potent of the modern inhalation anesthetics

Rapid recovery

A

Dose related bradycardia

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27
Q
  1. What is the loading dose for rocuronium (Zemuron)?
  2. 1 - 0.2 mg/kg
  3. 3 -0.5 mg/kg

3-5 mg/kg

1 mg/kg

A

0.3 -0.5 mg/kg

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28
Q
  1. The u-receptor that moderate pain relief observed with Oxycodone can also cause

Increase respiratory effort

Increased INR

Euphoria

Diarrhea

All of the above

A

Euphoria

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29
Q
  1. ______ anesthesia refers to the use of mixture of agents to achieve the anesthetic state

General

Balanced

Conscious

Local

A

Balanced

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30
Q
  1. A 10% dose of Rocuronium give prior to the actual need for anesthesia allows a smaller dose to be given later. This is known as

Balanced

Priming

Dose splitting

Pre dosing

A

Priming

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31
Q

Which of the following is the most potent opioid?

Morphine

Fentanyl

Sufentanil

Codeine

A

Sufentanil

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32
Q
  1. Which of the following Anesthetic gases may be contraindicated for patient with chronic renal failure

Enflurane

Nitrous Oxide

Isoflurane

Desflurane

A

Enflurane

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33
Q
  1. Alveolar uptake of inhaled agents is enhanced by

Using a highly blood/gas soluble agent

Low CO

Large FRC

Decreased alveolar ventilation

A

Low CO

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34
Q

26.You are in the ICU having difficult ventilating a patient suffering from acute exacerbation of asthma. Conventional ventional strategies have been exhausted, You suggest addition of inhaled anesthetic agent, which are you most likely to select.

Isoflurane

Desflurane

Sevoflurane

Entonox

A

Sevoflurane → non pungent and does not cause bronchoconstriction

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35
Q

Nitrous Oxide is a

Strong analgesic and strong anesthetic

Weak analgesic and weak anesthetic

Strong analgesic and weak anesthetic

Weak analgesic and strong anesthetic

A

Strong analgesic and weak anesthetic

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36
Q
  1. Which of the following anesthetic gases has a low boiling point requiring a heated and pressurized container?

Enflurane

Isoflurane

Sevoflurane

Desflurane

A

Desflurane

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37
Q
  1. Endrophonium (Tension) is used to test for _________ and you would expect to see _______-

Myathensia Gravis; some recovery of muscle function

Guillain Barre;some recovery of muscle function

Guillain Barre;worsening muscle function

Myasthenia Gravis; worsening muscle function

A

Myathensia Gravis; some recovery of muscle function

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38
Q

Most popular anesthetic circuit in use today:

Magill circuit

Must have an HME inline to humidify inhaled gases

Is capable of delivering low or minimum flow anesthesia

Is considered low resistance

A

Is capable of delivering low or minimum flow anesthesia

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39
Q
A

Bain

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40
Q

O2/N2O controller has the following O2:N2O ratio

1: 1
1: 2
1: 3
1: 4

A

1:3

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41
Q
A

Variable bypass

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42
Q

Signs of malignant hyperthermia include all fo the following EXCEPT:

Increased etCO2

Hypokalemia

Pyrexia

Muscle rigidity

A

Hypokalemia

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43
Q

A pt is 60 kg and is developing signs of malignant hyperthermia what is the appropriate treatment

120mg IV Dantrolene

60mg IV Dantrolene

120mg IV Diamox

60mg IV Diamox

A

120mg IV Dantrolene

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44
Q

7.Which anesthetic agent is the most likely cause of the malignant hyperthermia crisis?

Fentanyl

Propofol

Rocuronium

Sevoflurane

A

Sevoflurane

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45
Q
  1. All of the following are appropriate monitoring interventions for this patient EXCEPT:

Nasopharyngeal temperature

Arterial line

PA catheter

EtCO2

A

PA catheter

46
Q

Intraoperatively the bispectral index monitor reads 70, what action should you take?

Increase the concentration of the anesthetic agent

Decrease the concentration of the anesthetic agent

Administer additional muscle relaxant

The surgery must be stopped based on this value

A

Increase the concentration of the anesthetic agent

47
Q

. In which of the following patients would RSI be recommended?

Patient scheduled for CABG surgery

Patient undergoing surgery for a perforated bowel

Patient with a BMI of 24

80 year ols male with rheumatoid arthritis

A

Patient undergoing surgery for a perforated bowel

48
Q

Further classification of the ASA risk assessment is possible by considering

Patient age

Patient sex

Patient prior drug use

Type of surgery

A

Type of surgery

49
Q

During intubation in the OR, the patient goes into laryngospasm. Which of the following is an appropriate action?

Continue to carefully advance the ETT through the glottis opening

Administer IV bolus of 40mg of propofol

Cricothyrotomy

Administer narcan

A

Administer IV bolus of 40mg of propofol

50
Q

An increase in the EtCO2 waveform can be attributed to:

Hypothermia

Hyperventilation

Sepsis

None of the above

A

Sepsis

Increased metabolic rate with sepsis

51
Q

Which of the following would create the waveform pictured above:

Bronchospasm

Saturated CO2 absorber

Hypoventilation

Increasing metabolic rate

A

Saturated CO2 absorber

52
Q

Which of the following medications is associated with PVCs? (cause PVCs)

Lidocaine

Amiodarone

Epinephrine

Phenylephrine

A

Lidocaine

53
Q

Which drug is used for the initial treatment of anaphylactic shock?

Dantrolene

Diamox

Epinephrine

Lasix

A

Epinephrine

54
Q

Which of the following controls would you activate or adjust in the event the patient suddenly becomes hypercapnic and hyperthermic?

Rate control on ventilator

Oxygen flush control

APL

Oxygen flow meter

A

Oxygen flush control

55
Q

You are assisting a pre-operative assessment on a patient going for a knee replacement. The patient has a history of moderate COPD. What following considerations would benefit the patient if implemented?

Ensure respiratory medications up to and including the day of surgery

Increase MAC of anesthetic to speed induction

Regional anesthesia should be presented as an option fo the surgery

Choose inhaled halogenated hydrocarbons that are not respiratory depressants

A

Regional anesthesia should be presented as an option fo the surgery

Doing a nerve block (regional) to do their surgery instead of general so that they don’t have to be ventilated

56
Q

True or False: In a flowmeter sequence, oxygen is always downstream from the other gases

True

False

A

True

57
Q

Semi-closed or closed circuits are distinguished by:

The presence of one way valves

In-line vaporizers

The amount of fresh gas flow

None of the above

A

The amount of fresh gas flow

58
Q

Which of the following is FALSEregarding a closed circuit:

Total rebreathing of exhaled gases

Predictable concentrations of anesthetic gases

Economical

Maximum arming and humidification of inhaled gases

A

Predictable concentrations of anesthetic gases

59
Q

An inpatient with severe CHF has fallen on her walk with physio and dislocated her hip. She is seen by the Hospitalist and is sent to the OR for Sx. what is the proper classification for this patient?

ASA 3

ASA 3E

ASA 4

ASA 4E

A

ASA 4E

60
Q

. Intraoperative patients with uncontrolled hypertension are at risk of:

Intraoperative hypotension

Post op DVT

Malignant hyperthermia

Aspiration

A

Intraoperative hypotension

61
Q

In the circle circuit, the APL and reservoir bag are bypassed during manual ventilation.

True

False

A

False

62
Q

Train of four is used to monitor:

Heat condition

Level of consciousness

Neuromuscular blockade

MAC level

A

Neuromuscular blockade

63
Q

Which of the following are components of anesthesia?

Unconsciousness, muscle relax, analgesia

Analgesia, excitement phase, muscle relaxation

Muscle relax, REM, unconsciousness

Unconsciousness, REM, muscle relaxation

A

Unconsciousness, muscle relax, analgesia

64
Q

Volatile agents stop moving into the body when:

Ventilation is increased to desired MV

Partial pressure gradients are absent

Renal output starts eliminating agent

Diaphragmatic paralysis begins

A

Partial pressure gradients are absent

65
Q

Which of the following will not affect the alveolar uptake of an anesthetic agent?

FRC

Solubility coefficient

Alveolar MV

Extremes of age

A

Extremes of age

66
Q

Single most important factor determining the speed of anesthetic induction and recovery using volatile agents is

Solubility of the agent in blood

Mean alveolar concentration

Minimal flow rates

Proportion of skeletal muscle tissue to adipose tissue in body composition

A

Solubility of the agent in blood

67
Q

Rate and amount of IV drug uptake is proportional to

Tissue temp

Tissue mass

hematocrit

Gas solubility

A

Tissue mass

68
Q

Relative increase in concentration of remaining volatile agent after alveloar uptake of nitrous oxide, may increase the speed of induction. This is called:

A

Second Gas Effect

69
Q

Which of the following statements regarding fentanyl is true

Chemically similar to midaz

Chemically similar to prop

Less potent than morphine but more potent than sufentanil

Can be delivered as a transdermal patch

A

Can be delivered as a transdermal patch

70
Q

Most inhaled anesthetics are eliminated by:

Liver metabolism

Renal excretion

Exhalation

Sublimation

A

Exhalation

71
Q

Midaz

Is an analgesic

Retrograde amnesic properties

Is a Beta agonist

Is an Anxiolytic

A

Is an Anxiolytic

72
Q

When propofol is used as the induction agent, unconsciousness is tested by:

Signs of cataleptic state

Diminished reaction to an ice cube placed on abdomen

Assessing loss of the eyelash reflex

Unresponsive to trap pinch

A

Assessing loss of the eyelash reflex

73
Q

Which of the following anesthetic gases has a low boiling point requiring a heated and pressurized container:

Isoflurane

Desflurane

Enflurane

Nitrous oxide

A

Desflurane

74
Q

Which of the following will NOT affect the alveolar uptake of an anesthetic agent?

Inspired concentration

FRC

Solubility coefficient of the agent

Age

A

Age

75
Q

Which stage of anesthesia is the target stage for sx?

1

2

3

4

A

3

76
Q

This common IV induction agent has properties of rapid redistribution and elimination, provides no analgesia, and patients have reported vivid dreams during emergence. What is this agent

Propofol

Ketamine

Midazolam

Diazepam

A

Propofol

77
Q

A pre-op patient with a severe, systemic disease that is a constant threat to like would be categorized as ASA:

ASA1

ASA2

ASA3

ASA4

ASA5

A

ASA4

78
Q

The agent with the least plasma solubility is

Sevo

Des

Iso

Nitrous oxide

A

Nitrous oxide

79
Q

Which of the following are appropriate indications for pre-op testing

Cataract sx for a normal healthy patient

Influence decision to postpone or cancel sx

Routine ECG based solely on patient’s age -not done based on age

All the above

A

Influence decision to postpone or cancel sx

80
Q

Which of the following medications is contraindicated in a patient with severe burns?

Fentanyl

Rocuronium

Propofol

Succinylcholine

A

Succinylcholine -increases serum potassium with adds to already high levels of K+

81
Q

This common agent has the properties of anterograde amnesia, and sedative properties

Fentanyl

Midazolam

Lorazepam

Propofol

A

Midazolam- won’t go unconscious but you won’t remember the procedure

82
Q

One of the theories of volatile agent action is that there is a liquefaction of some cell membrane lipids leading to ion channel blockage. It is called:

Oscar meyer effect

Membrane fluidization

Lock and key model

Potentiation of inhibitory neurotransmitters

A

Membrane fluidization

83
Q

Where is the majority of extracellular fluid located:

Interstitial space

Intravascular space

Plasma

Within the blood vessels

A

Interstitial space

84
Q

Which muscle relaxant is characterized by its quick onset of action, intermediate duration of action (up to 45 min), and a loading dose of 0.3-0.5mg/kg

Succ

D-tubo

Pan

Rocuronium

A

Rocuronium

85
Q

Intubation dose for succ is:

1 mg/kg

3 mg/kg

5 mg/kg

10 mg bolus

A

1 mg/kg

86
Q

Some families have an ineffective or reduced production of plasma or pseudocholinesterase. When given succ they may be expected to show

Decreased duration of action

Increased duration of action

No effect

Speedier onset of action

A

Increased duration of action - there’s less of enzyme to breakdown the succs so it’ll last longer.

87
Q

With regard to diffusion hypoxia during recovery:

Likely to occur during emergence from desflurane

Common finding when a high flow of N2O used

May contribute to hypoxemia, 1 hour following cessation of administration

May cause alveolar hyperventilation

A

Common finding when a high flow of N2O used

88
Q

You are working in the OR as an AA. The circulating Anesthetist comes in to seek your advice on the next case. Patient is 77 yo, nonsmoker, morbidly obese man (200 kg) who is suffering from severe unstable angina. This man was noted to be a difficult intubation during a previous OR case. The planned case is a triple CABG

His co morbidities likely include all the following EXCEPT:

Diabetes

Adrenal insufficiency

Restrictive ventilatory pattern

Obstructive sleep apnea

A

Adrenal insufficiency

89
Q

You are working in the OR as an AA. The circulating Anesthetist comes in to seek your advice on the next case. Patientis 77 yo, nonsmoker, morbidly obese man (200 kg) who is suffering from severe unstable angina. This man was noted to be a difficultintubation during a previous OR case. The planned case is a triple CABG

Which position would the patient be placed in for the procedure

Supine

Lithotomy

Trendelenburg

Prone

A

Supine

90
Q

You are working in the OR as an AA. The circulating Anesthetist comes in to seek your advice on the next case. Patient is 77 yo, nonsmoker, morbidly obese man (200 kg) who is suffering from severe unstable angina. This man was noted to be a difficult intubation during a previous OR case. The planned case is a triple CABG

Which pre-surgical test was likely performed?

Spirometry

ABG

CT head

Bronchoscopy

A

ABG

91
Q

Desflurane is identified by the colour:

Orange

Yellow

Purple

Blue

A

Blue

92
Q

In which of the following solution categories is albumin present

Colloid solutions

Crystalloid solutions

Ringers lactate

D5W

A

Colloid solutions

93
Q

Dry mucous membranes and decreased U/O are characteristics of what degree of fluid deficit

Mild

Moderate

Severe

V. severe

A

Mild

94
Q

Nerve blocks fall under the category

Specific anesthesia

Neuroaxial anesthesia

Regional anesthesia

Spinal anesthesia

A

Regional anesthesia

95
Q

Which transfusion reaction is associated w/ high mortality rates, increased capillary permeability, and non-cardiogenic pulmonary edema?

Hemolytic transfusion reaction

Transfusion related acute lung injury

Sepsis

Non-hemolytic febrile reaction

A

Transfusion related acute lung injury

96
Q

A patients ETOH habit could be of concern regarding ALL of the following except:

Elimination

Cardiac function

Possibly higher MAC concentration needed

Stronger than expected reaction to inhaled drugs

A

Stronger than expected reaction to inhaled drugs

97
Q

Randy’s arthritis may cause which of the following complications

Anemia -RA is autoimmune disorder, can affect RBC production

Sensitivity to muscle relaxants

Delayed elimination of drugs

Difficult intubation

A and D

A

A and D

98
Q

Neostigmine is administered at the end of a procedure. What reason would the patient be administered this med

Reduce oral secretions

Revered effects of depolarizing muscle relaxant

Reverse effects of non-depolarizing muscle relaxant

B and C

A

B and C

99
Q

Which of the following is added to a local anesthetic to prolong its duration of action and reduce bleeding

Epinephrine

Phenylephrine

Ephedrine

Atropine

A

Epinephrine -vasoconstriction and keeps anesthetic in the same area

100
Q

what level of the spine is a spinal block placed

Cauda equina

Conus medullaris

Coccyx

Ligamentum flavum

A

Cauda equina

101
Q

common agent used in local anesthesia is

Propofol

Lidocaine

Ketamine

Midazolam

A

Lidocaine

102
Q

During a spinal block, local anesthetic is inserted

Subarachnoid space

Arachnoid mater

Subdural space

Dura mater

A

Subarachnoid space

103
Q

Place the anesthetic gases in order of highest to lowest MAC

NO2, desflurane, sevoflurane

Desflurane, NO, Sevoflurane

Sevoflurane, desflurane, NO

Sevoflurane, NO, desflurane

A

NO2, desflurane, sevoflurane

104
Q

barbiturates are more potent than benzodiazepines

True

False

A

True

105
Q

Which medication has a loading dose of 1.5 - 2.5 mg/kg and has anti emetic properties?

Thiopental

Midazolam

Propofol

Succinylcholine

A

Propofol

106
Q

Which of the following factors decreases MAC?

Hyperthermia

Hypothermia

Young age

Acute amphetamine intoxication

A

Hypothermia- muscle relaxant will require less of the dose

Acute amphetamine intoxication - stimulants decrease MAC while you are intoxicated, chronic drug use will increase MAC​

107
Q

Which of the following is a depolarizing paralytic?

Pancuronium

Succinylcholine

Edrophonium

Pyridostigmine

A

Succinylcholine

108
Q

How does an anesthetic gas with a large blood/gas coefficient effect induction?

Fast induction

Slow induction

No effect

A

Slow induction

109
Q

The lower the MAC…

The more potent that agent

The less potent the agent

Does not affect potency

A

The more potent that agent

110
Q

Weak anesthetic, good analgesic’ best describes which of the following

Propofol

Isoflurane

Sevoflurane

Nitrous oxide

A

Nitrous oxide

111
Q

Edrophonium is used for ___ and you would expect to see ___

Myasthenia gravis; some recovery of muscle function

Myasthenia gravis; worsening of muscle function

GB. some recovery; some recovery of muscle function

GB; worsening; worsening of muscle function

A

Myasthenia gravis; some recovery of muscle function

112
Q

Ketamine produces a dissociative mental state, this includes:

Amnesia, catalepsy, analgesia, sedation

Unconsciousness, analgesia, paralysis, sedation

Hypoventilation, amnesia, sedation, catalepsy

Amnesia, analgesia, sedation, paralysis

A

Amnesia, catalepsy, analgesia, sedation

001 Respiratory Therapy (53 decks)

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