Test Review Flashcards by Megan Lesinszki

What Will Increasing Partial Pressure do to induction speed

Increasing partial pressure will increase induction

How well did you know this?

Not at all

Perfectly

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

Anesthetic solubility

Difference in partial pressure of alveolar gas and venous blood.

How well did you know this?

Not at all

Perfectly

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

Speed induction

How well did you know this?

Not at all

Perfectly

Blood–gas partition coefficient

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

How well did you know this?

Not at all

Perfectly

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

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.

How well did you know this?

Not at all

Perfectly

Plane 3 of surgical anesthesia occurs:

From the return of regular respirations to the cessation of REM
From the cessation of REM to onset of paralysis of the intercostal muscles
From partial intercostal to full

From partial intercostal to full

How well did you know this?

Not at all

Perfectly

Planes of Anesthesia

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

How well did you know this?

Not at all

Perfectly

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

Stage 2

How well did you know this?

Not at all

Perfectly

Muscle pain is associated with the administration of:

Nondepolarizing paralytic

Depolarizing paralytic

Benzo

Dissociative anesthetic

lidocaine

Depolarizing paralytic

How well did you know this?

Not at all

Perfectly

Narcan has a _______ duration of action

Short

How well did you know this?

Not at all

Perfectly

Ketamine produces a dissociative mental state which include

Amnesia

Catalespy

Analgesia

Sedation

How well did you know this?

Not at all

Perfectly

Which of the following is a depolarizing paralytic

Pancuronium

Succinylcholine

Pyridostinmine

Succinylcholine

How well did you know this?

Not at all

Perfectly

What i a weak anesthetic and good anaglesic

Nitrous Oxide

How well did you know this?

Not at all

Perfectly

True or False Barbituates are more potent than benzodiazepenes

True

How well did you know this?

Not at all

Perfectly

Naloxone is an antagonist of the following drugs

Morphine

Diazapam

A or B

Neither A or B

Morphine

How well did you know this?

Not at all

Perfectly

Loading dose of Propofol

3 -5 mg/kg

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

1 - 2.5 mg/kg

How well did you know this?

Not at all

Perfectly

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

Reduce hypersecretion associated with muscle relaxant reversal agent

How well did you know this?

Not at all

Perfectly

Reduce MAC include all but one

83 year old patient

Acute ETOH intoxication

PaO2 of 38 mmHg

Temperature of 39.2 C

How well did you know this?

Not at all

Perfectly

True or False

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

True

How well did you know this?

Not at all

Perfectly

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

Amnesia, catalepsy, pain reduction, sedation

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

True of Midazolam

Causes retrograde amnesia

Causes pain at injection site

0.1-0.3 mg/kg dose

1-3 mg/kg dose

0.1-0.3 mg/kg dose

How well did you know this?

Not at all

Perfectly

Of modern inhalation anesthetic agent which has the most potency-

ISoflurane

Nitrous oxide

Sevoflurane

Desflurane

ISoflurane

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

17. Generally, Morphine will have these effects on respiration Normal Vt Decreased RR A or B Neither A or B

A or B

18. 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

Dose related bradycardia

19. What is the loading dose for rocuronium (Zemuron)? 0. 1 - 0.2 mg/kg 0. 3 -0.5 mg/kg 3-5 mg/kg 1 mg/kg

0.3 -0.5 mg/kg

20. The u-receptor that moderate pain relief observed with Oxycodone can also cause Increase respiratory effort Increased INR Euphoria Diarrhea All of the above

Euphoria

21. ______ anesthesia refers to the use of mixture of agents to achieve the anesthetic state General Balanced Conscious Local

Balanced

22. 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

Priming

Which of the following is the most potent opioid? Morphine Fentanyl Sufentanil Codeine

Sufentanil

24. Which of the following Anesthetic gases may be contraindicated for patient with chronic renal failure Enflurane Nitrous Oxide Isoflurane Desflurane

Enflurane

25. Alveolar uptake of inhaled agents is enhanced by Using a highly blood/gas soluble agent Low CO Large FRC Decreased alveolar ventilation

Low CO

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

Sevoflurane → non pungent and does not cause bronchoconstriction

Nitrous Oxide is a Strong analgesic and strong anesthetic Weak analgesic and weak anesthetic Strong analgesic and weak anesthetic Weak analgesic and strong anesthetic

Strong analgesic and weak anesthetic

28. Which of the following anesthetic gases has a low boiling point requiring a heated and pressurized container? Enflurane Isoflurane Sevoflurane Desflurane

Desflurane

29. 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

Myathensia Gravis; some recovery of muscle function

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

Is capable of delivering low or minimum flow anesthesia

Bain

O2/N2O controller has the following O2:N2O ratio 1: 1 1: 2 1: 3 1: 4

1:3

Variable bypass

Signs of malignant hyperthermia include all fo the following EXCEPT: Increased etCO2 Hypokalemia Pyrexia Muscle rigidity

Hypokalemia

A pt is 60 kg and is developing signs of malignant hyperthermia what is the appropriate treatment ## Footnote 120mg IV Dantrolene 60mg IV Dantrolene 120mg IV Diamox 60mg IV Diamox

120mg IV Dantrolene

7.Which anesthetic agent is the most likely cause of the malignant hyperthermia crisis? Fentanyl Propofol Rocuronium Sevoflurane

Sevoflurane

8. All of the following are appropriate monitoring interventions for this patient EXCEPT: Nasopharyngeal temperature Arterial line PA catheter EtCO2

PA catheter

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

Increase the concentration of the anesthetic agent

. 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

Patient undergoing surgery for a perforated bowel

Further classification of the ASA risk assessment is possible by considering Patient age Patient sex Patient prior drug use Type of surgery

Type of surgery

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

Administer IV bolus of 40mg of propofol

An increase in the EtCO2 waveform can be attributed to: Hypothermia Hyperventilation Sepsis None of the above

Sepsis Increased metabolic rate with sepsis

Which of the following would create the waveform pictured above: Bronchospasm Saturated CO2 absorber Hypoventilation Increasing metabolic rate

Saturated CO2 absorber

Which of the following medications is associated with PVCs? (cause PVCs) Lidocaine Amiodarone Epinephrine Phenylephrine

Lidocaine

Which drug is used for the initial treatment of anaphylactic shock? Dantrolene Diamox Epinephrine Lasix

Epinephrine

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

Oxygen flush control

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

Regional anesthesia should be presented as an option fo the surgery ## Footnote Doing a nerve block (regional) to do their surgery instead of general so that they don’t have to be ventilated

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

True

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

The amount of fresh gas flow

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

Predictable concentrations of anesthetic gases

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

ASA 4E

. Intraoperative patients with uncontrolled hypertension are at risk of: Intraoperative hypotension Post op DVT Malignant hyperthermia Aspiration

Intraoperative hypotension

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

False

Train of four is used to monitor: Heat condition Level of consciousness Neuromuscular blockade MAC level

Neuromuscular blockade

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

Unconsciousness, muscle relax, analgesia

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

Partial pressure gradients are absent

Which of the following will not affect the alveolar uptake of an anesthetic agent? FRC Solubility coefficient Alveolar MV Extremes of age

Extremes of age

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

Solubility of the agent in blood

Rate and amount of IV drug uptake is proportional to Tissue temp Tissue mass hematocrit Gas solubility

Tissue mass

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

Second Gas Effect

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

Can be delivered as a transdermal patch

Most inhaled anesthetics are eliminated by: Liver metabolism Renal excretion Exhalation Sublimation

Exhalation

Midaz Is an analgesic Retrograde amnesic properties Is a Beta agonist Is an Anxiolytic

Is an Anxiolytic

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

Assessing loss of the eyelash reflex

Which of the following anesthetic gases has a low boiling point requiring a heated and pressurized container: Isoflurane Desflurane Enflurane Nitrous oxide

Desflurane

Which of the following will NOT affect the alveolar uptake of an anesthetic agent? Inspired concentration FRC Solubility coefficient of the agent Age

Age

Which stage of anesthesia is the target stage for sx? 1 2 3 4

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

Propofol

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

ASA4

The agent with the least plasma solubility is Sevo Des Iso Nitrous oxide

Nitrous oxide

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

Influence decision to postpone or cancel sx

Which of the following medications is contraindicated in a patient with severe burns? Fentanyl Rocuronium Propofol Succinylcholine

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

This common agent has the properties of anterograde amnesia, and sedative properties Fentanyl Midazolam Lorazepam Propofol

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

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

Membrane fluidization

Where is the majority of extracellular fluid located: Interstitial space Intravascular space Plasma Within the blood vessels

Interstitial space

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

Rocuronium

Intubation dose for succ is: 1 mg/kg 3 mg/kg 5 mg/kg 10 mg bolus

1 mg/kg

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

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

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

Common finding when a high flow of N2O used

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

Adrenal insufficiency

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

Supine

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

ABG

Desflurane is identified by the colour: Orange Yellow Purple Blue

Blue

In which of the following solution categories is albumin present Colloid solutions Crystalloid solutions Ringers lactate D5W

Colloid solutions

Dry mucous membranes and decreased U/O are characteristics of what degree of fluid deficit Mild Moderate Severe V. severe

Mild

Nerve blocks fall under the category Specific anesthesia Neuroaxial anesthesia Regional anesthesia Spinal anesthesia

Regional anesthesia

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

Transfusion related acute lung injury

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

Stronger than expected reaction to inhaled drugs

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 and D

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

B and C

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

Epinephrine -vasoconstriction and keeps anesthetic in the same area

what level of the spine is a spinal block placed Cauda equina Conus medullaris Coccyx Ligamentum flavum

Cauda equina

common agent used in local anesthesia is Propofol Lidocaine Ketamine Midazolam

Lidocaine

During a spinal block, local anesthetic is inserted Subarachnoid space Arachnoid mater Subdural space Dura mater

Subarachnoid space

Place the anesthetic gases in order of highest to lowest MAC NO2, desflurane, sevoflurane Desflurane, NO, Sevoflurane Sevoflurane, desflurane, NO Sevoflurane, NO, desflurane

NO2, desflurane, sevoflurane

barbiturates are more potent than benzodiazepines True False

True

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

Propofol

Which of the following factors decreases MAC? Hyperthermia Hypothermia Young age Acute amphetamine intoxication

Hypothermia- muscle relaxant will require less of the dose ## Footnote *Acute amphetamine intoxication - stimulants decrease MAC while you are intoxicated, chronic drug use will increase MAC*

Which of the following is a depolarizing paralytic? Pancuronium Succinylcholine Edrophonium Pyridostigmine

Succinylcholine

How does an anesthetic gas with a large blood/gas coefficient effect induction? Fast induction Slow induction No effect

Slow induction

The lower the MAC… The more potent that agent The less potent the agent Does not affect potency

The more potent that agent

Weak anesthetic, good analgesic’ best describes which of the following Propofol Isoflurane Sevoflurane Nitrous oxide

Nitrous oxide

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

Myasthenia gravis; some recovery of muscle function

Ketamine produces a dissociative mental state, this includes: Amnesia, catalepsy, analgesia, sedation Unconsciousness, analgesia, paralysis, sedation Hypoventilation, amnesia, sedation, catalepsy Amnesia, analgesia, sedation, paralysis

Amnesia, catalepsy, analgesia, sedation