Test Review Flashcards
What Will Increasing Partial Pressure do to induction speed
Increasing partial pressure will increase induction
Anesthetic uptake from the lungs into the blood is a product of
Anesthetic solubility
CO
Difference in partial pressure of alveolar gas and venous blood.
- 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
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
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.
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
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
During which stage of anesthesia is the pt at most risk for laryngospasm
Stage 2
- Muscle pain is associated with the administration of:
Nondepolarizing paralytic
Depolarizing paralytic
Benzo
Dissociative anesthetic
lidocaine
Depolarizing paralytic
Narcan has a _______ duration of action
Short
Ketamine produces a dissociative mental state which include
Amnesia
Catalespy
Analgesia
Sedation
Which of the following is a depolarizing paralytic
Pancuronium
Succinylcholine
Pyridostinmine
Succinylcholine
What i a weak anesthetic and good anaglesic
Nitrous Oxide
True or False Barbituates are more potent than benzodiazepenes
True
- Naloxone is an antagonist of the following drugs
Morphine
Diazapam
A or B
Neither A or B
Morphine
Loading dose of Propofol
3 -5 mg/kg
- 1 - 0.25 mg/kg
- 3-0.5 mg/kg
1 - 2.5 mg/kg
1 - 2.5 mg/kg
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
Reduce MAC include all but one
83 year old patient
Acute ETOH intoxication
PaO2 of 38 mmHg
Temperature of 39.2 C
Temperature of 39.2 C
True or False
Rapidly achieving alveolar concentration of volatile agent and size of FRC has an inverse relationship
True
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
- 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
Diffusion hypoxia
- 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
Of modern inhalation anesthetic agent which has the most potency-
ISoflurane
Nitrous oxide
Sevoflurane
Desflurane
ISoflurane
- 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
All of the above
- Generally, Morphine will have these effects on respiration
Normal Vt
Decreased RR
A or B
Neither A or B
A or B
- 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
- What is the loading dose for rocuronium (Zemuron)?
- 1 - 0.2 mg/kg
- 3 -0.5 mg/kg
3-5 mg/kg
1 mg/kg
0.3 -0.5 mg/kg
- 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
- ______ anesthesia refers to the use of mixture of agents to achieve the anesthetic state
General
Balanced
Conscious
Local
Balanced
- 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
- Which of the following Anesthetic gases may be contraindicated for patient with chronic renal failure
Enflurane
Nitrous Oxide
Isoflurane
Desflurane
Enflurane
- 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
- Which of the following anesthetic gases has a low boiling point requiring a heated and pressurized container?
Enflurane
Isoflurane
Sevoflurane
Desflurane
Desflurane
- 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
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Bain
O2/N2O controller has the following O2:N2O ratio
1: 1
1: 2
1: 3
1: 4
1:3
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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
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
- 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
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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
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
3
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
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