Tex-Wes-Reference_Guide Flashcards

Question

What is the normal PaCO₂ range in an arterial blood gas (ABG)? A) 25 - 35 mmHg B) 30 - 40 mmHg C) 35 - 45 mmHg D) 40 - 50 mmHg

Answer 1

Answer: C) 35 - 45 mmHg Rationale: The normal partial pressure of carbon dioxide (PaCO₂) is 35-45 mmHg. Levels above this range indicate respiratory acidosis, while levels below suggest respiratory alkalosis.

Answer 2

Answer: B) 22 - 26 mEq/L Rationale: Normal bicarbonate levels in blood gas analysis range from 22 to 26 mEq/L. Bicarbonate acts as a buffer to maintain pH balance in the body.

Answer 3

Answer: D) 90 - 100 mmHg Rationale: The normal partial pressure of oxygen (PaO₂) in arterial blood is 90-100 mmHg. Values below this range may indicate hypoxemia.

Answer 4

Answer: B) -2 to 2 mEq/L Rationale: Base excess reflects the metabolic component of acid-base balance. A normal range of -2 to 2 mEq/L indicates balanced metabolic status.

Answer 5

Answer: C) VO₂ = 10 x kg^(3/4) Rationale: The formula for oxygen consumption (VO₂) is 10 x kg^(3/4). This accounts for metabolic rate and body weight.

Answer 6

Answer: B) PAO₂ = FiO₂ x (Pb - PH₂O) - PaCO₂/0.8 Rationale: The alveolar gas equation estimates the partial pressure of oxygen in the alveoli, accounting for atmospheric pressure (Pb), water vapor pressure (PH₂O), and PaCO₂.

Answer 7

Answer: A) CaO₂ = (Hgb x 1.34 x SaO₂) + (PaO₂ x 0.003) Rationale: The arterial oxygen content formula accounts for both oxygen bound to hemoglobin and dissolved oxygen in the plasma.

Answer 8

Answer: D) 95% - 98% Rationale: The normal range for SaO₂ is 95% to 98%. This value indicates the percentage of hemoglobin that is saturated with oxygen. Levels below 90% are typically considered hypoxemic and may require intervention.

Answer 9

Answer: B) MAP = (SBP + 2 × DBP)/3 Rationale: The MAP formula averages the pressure throughout the cardiac cycle, giving more weight to the diastolic pressure because the heart spends more time in diastole.

Answer 10

Answer: B) 4 - 8 L/min Rationale: Cardiac Output measures the volume of blood the heart pumps per minute. The normal range is 4-8 L/min, depending on the patient's size and metabolic needs.

Answer 11

Answer: B) 2 - 6 mmHg Rationale: CVP reflects the pressure in the thoracic vena cava, indicating right atrial pressure. Normal values range from 2 to 6 mmHg (up to 12 in some sources), helping assess a patient’s volume status.

Answer 12

Answer: B) 2.5 - 4.0 L/min/m² Rationale: Cardiac Index adjusts Cardiac Output for body surface area (BSA), providing a more individualized assessment of heart function. The normal range is 2.5-4.0 L/min/m².

Answer 13

Answer: B) 8 - 12 mmHg Rationale: PCWP estimates left atrial pressure and is used to assess left ventricular function. Normal values are 8-12 mmHg.

Answer 14

Answer: C) 700 - 1400 dynes·sec/cm⁵ Rationale: SVR is a measure of the resistance the heart must overcome to pump blood through the systemic circulation. The normal range is 700-1400 dynes·sec/cm⁵.

Answer 15

Answer: D) 55% - 70% Rationale: Ejection Fraction measures the percentage of blood pumped out of the left ventricle with each heartbeat. Normal values range from 55% to 70%, indicating efficient heart function.

Answer 16

Answer: C) SI = (Heart Rate/SBP); SI > 1 indicates increased morbidity and mortality Rationale: The Shock Index is calculated as Heart Rate divided by Systolic Blood Pressure (SBP). An SI > 1 suggests significant hemodynamic instability and increased risk of poor outcomes.

Answer 17

Answer: B) 50 - 350 dynes·sec/cm⁵ Rationale: PVR indicates the resistance in the pulmonary circulation and helps assess right ventricular afterload.

Answer 18

Answer: A) Systolic: 15-30 mmHg, Diastolic: 5-15 mmHg, Mean: 10-15 mmHg Rationale: PAP measures the pressure in the pulmonary artery, reflecting right ventricular function and pulmonary circulation status. I just remember quarter over dime 25/10.

Answer 19

Answer: C) Increased risk of morbidity and mortality Rationale: The Shock Index is calculated as Heart Rate divided by Systolic Blood Pressure. An SI > 1 suggests hemodynamic instability and may indicate shock.

Answer 20

Answer: C) Opioids Rationale: Opioids, particularly morphine and fentanyl, can cause spasm of the Sphincter of Oddi due to their effect on smooth muscle contraction, increasing biliary pressure.

Answer 21

Answer: C) Meperidine Rationale: Meperidine (Demerol) is less likely to cause Sphincter of Oddi spasm compared to other opioids. It is sometimes preferred for patients undergoing biliary procedures.

Answer 22

Answer: B) Nitroglycerin 50mcg IV Rationale: Nitroglycerin, a smooth muscle relaxant, can help relieve Sphincter of Oddi spasm by reducing smooth muscle tone, lowering biliary pressure.

Answer 23

Answer: B) Elevated biliary pressures Rationale: During ERCP, increased biliary pressures may suggest a spasm of the Sphincter of Oddi, especially if the patient reports biliary colic symptoms.

Answer 24

Answer: C) 2 mg Rationale: Glucagon at a dose of 2 mg IV helps relax the smooth muscle of the Sphincter of Oddi, alleviating the spasm and reducing biliary pressure.

Answer 25

Answer: B) Naloxone Rationale: Naloxone, an opioid antagonist, is given at 40 mcg IV to counteract the opioid-induced increase in Sphincter of Oddi tone.

Answer 26

Answer: B) 0.2 mg Rationale: Atropine at a dose of 0.2 mg IV may help alleviate Sphincter of Oddi spasm by reducing vagal stimulation and relaxing the smooth muscle.

Answer 27

Answer: D) Epinephrine Rationale: Epinephrine is not used for treating Sphincter of Oddi spasm. Instead, smooth muscle relaxants (e.g., Nitroglycerin) and opioid antagonists (e.g., Naloxone) are preferred.

Answer 28

Answer: B) Applying positive pressure ventilation with 100% oxygen Rationale: The initial treatment for laryngospasm involves applying continuous positive airway pressure (CPAP) with 100% oxygen to help open the airway and relieve the spasm. Turn APL valve up to 40-70mmHg.. DO NOT BAG

Answer 29

Answer: B) Larson’s maneuver Rationale: Larson’s maneuver involves firm pressure applied to the area behind the earlobe (mastoid process- larson's Point), helping to break the laryngospasm by stimulating a deep breath and relaxing the vocal cords.

Answer 30

Answer: D) 0.1 mg/kg IV or 10-20mg IV.. note that up to 1mg/kg has been reported to be given in extreme cases. Rationale: Succinylcholine, a depolarizing neuromuscular blocker, is given at a dose of 0.1 mg/kg IV to quickly relax the vocal cords and resolve a severe laryngospasm.

Answer 31

Answer: B) 4 mg/kg IM Rationale: When IV access is not established, succinylcholine can be administered intramuscularly at a dose of 4 mg/kg for effective treatment of laryngospasm.

Answer 32

Answer: C) Applying excessive force during positive pressure ventilation Rationale: Excessive force during positive pressure ventilation can worsen laryngospasm by increasing airway irritation. Gentle, controlled pressure should be used.

Answer 33

Answer: C) 70 mL/kg Rationale: The EBV for an adult male is approximately 70 mL/kg. This estimation helps determine blood loss and fluid replacement needs during surgery.

Answer 34

Answer: A) ABL = (HCT_initial - HCT_final) × EBV / HCT_initial Rationale: This formula estimates the maximum allowable blood loss before requiring transfusion, based on changes in hematocrit and the patient’s estimated blood volume.

Answer 35

Answer: B) 100 - 150 mL Rationale: A fully soaked surgical lap sponge typically holds about 100-150 mL of blood. This estimation is used intraoperatively to gauge blood loss.

Answer 36

Answer: C) 1:3 (3mls of crystalloid for 1 ml blood) Rationale: Crystalloid fluids are replaced at a 3:1 ratio for blood loss. This accounts for the distribution of crystalloids into the interstitial and intracellular compartments.

Answer 37

Answer: B) 4,200 mL Rationale: Using the standard EBV for an adult male (70 mL/kg), the calculation is: 70 kg × 70 mL/kg = 4,200 mL.

Answer 38

Answer: D) Packed red blood cells (PRBCs) Rationale: PRBCs are used for blood replacement in cases of significant blood loss, especially when the patient is hemodynamically unstable, as they provide oxygen-carrying capacity.

Answer 39

Answer: C) 30% Rationale: The target final hematocrit is often set at 30%, which aligns with common transfusion guidelines and ensures a minimum safe level of hematocrit.

Answer 40

Answer: B) 1,750 mL Rationale: ABL = EBV × (HCT_initial - HCT_final) / HCT_initial = 5,250 mL × (45 - 30) / 45 = 1,750 mL.

Answer 41

Answer: B) To provide an immediate visual indicator of when allowable blood loss is reached Rationale: Calculating the number of mops or gauze helps alert the surgical team when the allowable blood loss has been exceeded, prompting timely decisions about blood transfusions.

Answer 42

Answer: B) 3,900 mL Rationale: Using the standard blood volume for an adult female (65 mL/kg), the calculation is: 60 kg × 65 mL/kg = 3,900 mL.

Answer 43

Answer: A) 975 mL 3900 x (40 -30) / 40 = 975mL

Answer 44

Answer: C) 85 mL/kg Rationale: Full-term neonates have an estimated blood volume of 85 mL/kg due to their higher blood volume relative to body weight.

Answer 45

Answer: B) 60 mL/kg Rationale: For morbidly obese patients, the EBV is reduced to 60 mL/kg to account for their increased body fat, which has lower blood volume per unit of weight.

Answer 46

Answer: C) 3:1 Rationale: Crystalloids (e.g., normal saline, lactated Ringer's) are typically replaced at a 3:1 ratio because they distribute into both the intravascular and interstitial compartments.

Answer 47

A) 65-75 mL/kg adult/child female is 65mL/Kg while the male is 75mL/Kg

Answer 48

Answer: B) Colloids, D) Albumin Rationale: Colloids (e.g., albumin, hydroxyethyl starch) are replaced at a 1:1 ratio because they remain in the intravascular space, providing efficient volume expansion.

Answer 49

Answer: D) 95 mL/kg Rationale: Premature neonates have a higher estimated blood volume of 95 mL/kg due to their immature physiology and higher relative blood volume needs.

Answer 50

Answer: A) 500 mL Rationale: PRBC's are replaced at a 0.5:1 ratio, so 1,000 mL of blood loss requires 500 mL of PRBC replacement.. If it was whole blood we would use 1:1 so 1000mL.

Answer 51

Answer: B) 550 mL Rationale: A fully soaked 4 x 4 gauze pad holds approximately 10 mL of blood, and a fully soaked lap sponge holds around 100-150 mL of blood. The calculation is: 10 gauze pads × 10 mL = 100 mL 3 lap sponges × 150 mL = 450 mL Total estimated blood loss = 100 mL + 450 mL = 550 mL.

Answer 52

Answer: D) 65 mL/hr Rationale: Using the 4-2-1 rule: First 10 kg: 10 kg × 4 mL/kg/hr = 40 mL/hr Next 10 kg: 10 kg × 2 mL/kg/hr = 20 mL/hr Remaining 5 kg: 5 kg × 1 mL/kg/hr = 5 mL/hr Total = 40 + 20 + 5 = 65 mL/hr

Answer 53

Answer: B) 880 mL Rationale: Calculate the maintenance rate first using the 4-2-1 rule: First 10 kg: 10 kg × 4 mL/kg/hr = 40 mL/hr Next 10 kg: 10 kg × 2 mL/kg/hr = 20 mL/hr Remaining 50 kg: 50 kg × 1 mL/kg/hr = 50 mL/hr Total = 40 + 20 + 50 = 110 mL/hr NPO Deficit = 110 mL/hr × 8 hours = 880 mL

Answer 54

Answer: C) 4-8 mL/kg/hr Rationale: Major abdominal surgery is associated with significant evaporative and third-space fluid losses, typically replaced at a rate of 4-8 mL/kg/hr.

Answer 55

Answer: C) Replace 50% of the deficit in the first hour Rationale: The standard approach is to replace 50% of the NPO deficit in the first hour, followed by 25% in the second hour, and the remaining 25% in the third hour.

Answer 56

Answer: B) 6 mL/hr Rationale: For minor surgery, the replacement rate for evaporative losses is typically 0.2 mL/kg/hr. Using 30 kg × 0.2 mL/kg/hr = 6 mL/hr. moderate evaporative Loss is 2-4mL/Kg/hr

Answer 57

Answer: B) 25 - 29.9 kg/m² Rationale: The overweight category is defined by a BMI between 25 and 29.9 kg/m², indicating excess body weight.

Answer 58

Answer: C) 35- 40 kg/m² Rationale: A BMI of 35-40 kg/m² is classified as morbid obesity (Obesity Class III), associated with significant health risks.

Answer 59

Answer: A) 22.9 kg/m² the calculation yields a BMI of 22.9 kg/m², which is within the normal weight range.

Answer 60

Answer: C) Obese Rationale: A BMI between 30 and 34.9 kg/m² falls into the Obesity Class I category

Answer 61

Answer: B) 18.5 - 24.9 kg/m² Rationale: The normal weight range (18.5 - 24.9 kg/m²) is associated with the lowest risk for obesity-related health issues.

Answer 62

Answer: A) Height (cm) - 100 = kg Rationale: The formula for men is IBW=Height (cm)−100, reflecting typical body composition standards.

Answer 63

Answer: B) Height (cm) - 105

Answer 64

Answer: C) 80 kg IBW=180cm−100=80kg.

Answer 65

Answer: B) Ephedrine Rationale: Ephedrine acts on both alpha and beta receptors, making it effective for increasing blood pressure in cases of hypotension.

Answer 66

Answer: C) 100 mcg Rationale: The typical dose for Neosynephrine is 100 mcg, which acts as a potent alpha agonist to increase blood pressure by vasoconstriction.

Answer 67

Answer: D) 50 mg/mL Rationale: The on-hand concentration for Ephedrine is 50 mg/mL, allowing for easy dilution and administration of the standard 5 mg dose.

Answer 68

Answer: C) Labetalol Rationale: Labetalol is a beta antagonist used to lower blood pressure in cases of hypertension.

Answer 69

Answer: B) 5 mg Rationale: The standard dose for Labetalol is 5 mg, and it is typically administered as an intravenous push for acute blood pressure control.

Answer 70

Answer: B) 10 mg/mL Rationale: Neosynephrine (Phenylephrine) is typically available in a concentration of 10 mg/mL. You will need to dilute.

Answer 71

Answer: A) 5 mg Rationale: The typical dose for Hydralazine is 5 mg, used for its arterial vasodilatory effects in managing elevated blood pressure.

Answer 72

Answer: D) 20 mg/mL Rationale: Hydralazine is available at an on-hand concentration of 20 mg/mL, allowing for accurate dosing in hypertensive crises

Answer 73

Answer: B) Esmolol Rationale: Esmolol is a short-acting beta-blocker commonly used for acute hypertension, dosed at 10 mg.

Answer 74

Answer: B) 10 mg/mL Rationale: Esmolol is provided at a concentration of 10 mg/mL, suitable for titrating doses during blood pressure management.

Answer 75

Answer: B) 37 - 47 g/dL

Answer 76

Answer: C) 42 - 52 g/dL

Answer 77

Answer: D) 15 - 16 g/dL

Answer 78

Answer: C) 14 - 18 g/dL

Answer 79

Answer: B) 4,000 - 11,000/μL

Answer 80

Answer: C) 150,000 - 450,000/μL

Answer 81

Answer: C) 3.5 - 5.0 mEq/L

Answer 82

Answer: B) 1.5 - 2.5 mEq/L

Answer 83

Answer: C) 8.5 - 10.5 mg/dL

Answer 84

Answer: B) 1.1 - 1.3 mmol/L

Answer 85

Answer: C) 1.8 - 2.6 mEq/L

Answer 86

Answer: B) 100 - 108 mEq/L

Answer 87

Answer: C) 10 - 20 mg/dL

Answer 88

Answer: B) 0.6 - 1.3 mg/dL

Answer 89

Answer: C) 3.5 - 5.5 g/dL

Answer 90

Answer: B) 11 - 14 sec Rationale: PT measures the extrinsic pathway of coagulation, specifically assessing factors I (fibrinogen), II (prothrombin), V, VII, and X. It is crucial for monitoring patients on warfarin therapy. An elevated PT may indicate a bleeding risk and can be treated with fresh frozen plasma (FFP) or vitamin K.

Answer 91

Answer: C) 21 - 34 sec Rationale: PTT evaluates the intrinsic and common pathways of coagulation, assessing factors I, II, V, VIII, IX, X, XI, and XII. It is used to monitor heparin therapy. Prolonged PTT may indicate the need for protamine administration if the patient is on heparin.

Answer 92

Answer: B) 1 Rationale: INR standardizes PT values across different labs and is used to monitor warfarin therapy. An elevated INR indicates an increased risk of bleeding and may require reversal with vitamin K or FFP.

Answer 93

Answer: C) 80 - 120 sec Rationale: ACT is used to monitor high-dose heparin therapy, especially during cardiopulmonary bypass. Prolonged ACT may indicate excessive anticoagulation and can be treated with protamine.

Answer 94

Answer: B) <10 μ/dL Rationale: FSPs are fragments from the breakdown of fibrin, indicating active clot degradation. Elevated levels suggest disseminated intravascular coagulation (DIC) or thrombolysis and may require treatment with antifibrinolytic agents.

Answer 95

Answer: B) 160 - 450 mg/dL Rationale: Fibrinogen is a key factor in clot formation. Low fibrinogen levels may indicate liver disease or DIC and often require replacement with cryoprecipitate or FFP.

Answer 96

Answer: C) 62 - 130% Rationale: Plasminogen is converted to plasmin, which helps break down clots. Low plasminogen levels can lead to poor clot resolution and may necessitate thrombolytic therapy.

Answer 97

Answer: D) <250 ng/dL Rationale: D-dimer is a marker of fibrin degradation and is elevated in conditions with active clotting, such as DVT, PE, or DIC. High levels warrant further investigation and possible anticoagulation therapy.

Answer 98

Answer: B) 0.4 - 4.0 μ units/mL Rationale: TSH regulates thyroid function. Elevated TSH suggests hypothyroidism, while low TSH indicates hyperthyroidism. Treatment may include thyroid hormone replacement or antithyroid medications.

Answer 99

Answer: C) 90 - 230 ng/dL Rationale: T3 is an active thyroid hormone. Abnormal levels may indicate thyroid dysfunction and may require adjustments in thyroid hormone therapy.

Answer 100

Answer: B) 13 - 15 mg/dL Rationale: T4 is a precursor to T3. Abnormal levels indicate thyroid dysfunction and may require hormone replacement or antithyroid treatment.

Answer 101

Answer: C) <35 IU/L Rationale: AST and ALT are liver enzymes. Elevated levels indicate liver damage and may require further investigation and management of liver function.

Answer 102

Answer: C) <10 μ/mL Rationale: FDPs are fragments produced from the breakdown of fibrin during fibrinolysis. Elevated levels indicate increased fibrin breakdown, commonly seen in disseminated intravascular coagulation (DIC) or active thrombolysis. Management may include addressing the underlying cause and possibly administering antifibrinolytics. like TXA or amicar

Answer 103

Answer: B) Halothane Rationale: Halothane is a potent volatile anesthetic known to trigger MH, along with other inhaled agents like isoflurane, sevoflurane, and desflurane, as well as succinylcholine.

Answer 104

Answer: C) Succinylcholine Rationale: Succinylcholine is a depolarizing neuromuscular blocker that can trigger MH by causing uncontrolled calcium release in skeletal muscles.

Answer 105

Answer: C) Rapidly increasing ETCO2 Rationale: An early sign of MH is a rapid rise in end-tidal CO2 (ETCO2), indicating increased metabolic activity and hypermetabolism in the body.

Answer 106

Answer: B) Stop the triggering agent immediately Rationale: The first step in managing MH is to immediately stop the administration of any triggering agents (volatile anesthetics and succinylcholine).

Answer 107

Answer: B) 2.5 mg/kg IV Rationale: The initial dose of dantrolene for MH treatment is 2.5 mg/kg IV, and it may be repeated every 5-10 minutes until symptoms are controlled, with a maximum dose of 10 mg/kg. Immediately discontinue all triggering agents, hyperventilate with 100% oxygen, administer dantrolene (2.5 mg/kg IV bolus, repeat as needed), manage hyperkalemia and acidosis with appropriate medications, and initiate cooling measures (remove volatiles from anesthesia machine but mine were never there for this case). For a 78kg patient this would be about 10 syringes of 60mL syringes containing 20mg of Dantrolene with a total volume of 600mL.

Answer 108

Answer: B) Hyperkalemia Rationale: Hyperkalemia occurs due to massive muscle breakdown (rhabdomyolysis) and the release of intracellular potassium into the bloodstream.

Answer 109

Answer: B) Actively cool the patient using ice packs and cold IV fluids Rationale: Active cooling measures, including the use of ice packs and cold saline, help reduce the patient’s core temperature quickly.

Answer 110

Answer: C) >2 mL/kg/hr Rationale: Maintaining a urine output of >2 mL/kg/hr helps prevent kidney damage from myoglobinuria due to muscle breakdown. Hydration, mannitol, or Lasix may be used to achieve this.

Answer 111

Answer: C) Laboratory values (e.g., potassium, blood gases) Rationale: Frequent lab checks are critical to monitor for hyperkalemia, acidosis, and other metabolic abnormalities that require prompt correction.

Answer 112

Answer: B) 2.5 Rationale: For preemies weighing less than 1 kg, a 2.5 ETT is typically used due to their small airway size.

Answer 113

Answer: B) 3.0 Rationale: A 3.0 ETT is generally appropriate for preemies weighing between 1 and 2.5 kg.

Answer 114

Answer: B) 3.0 - 3.5 Rationale: For term neonates, a size 3.0 to 3.5 ETT is commonly used, depending on the infant’s weight and airway size. Pediatric tube sizes- over 1 year old I guess. size = ((age/4) +4) for uncuffed ETTs, with cuffed tubes being one-half size smaller.

Answer 115

Answer: C) 3.5 - 4.0 Rationale: Infants in this age range typically require a 3.5 to 4.0 ETT, adjusted based on airway anatomy and clinical judgment.

Answer 116

Answer: C) 4.0 - 4.5 Rationale: Children aged 1 to 2 years usually need a 4.0 to 4.5 ETT, based on typical airway size for this age group.

Answer 117

Answer: C) (Age + 16) / 4 Rationale: The formula (Age+16)/4 is commonly used to estimate the correct ETT size for children over 2 years old.

Answer 118

Answer: B) 5.0 Rationale: Using the formula (4+16)/4=5. The closest standard size might be 4.5, depending on availability and clinical assessment.

Answer 119

Answer: C) 4.5 Rationale: For a child aged 2 years, the formula suggests (2+16)/4=4.5

Answer 120

Answer: B) Size 1 Rationale: An LMA size 1 is used for infants weighing up to 5 kg.

Answer 121

Answer: B) Size 1.5 Rationale: For children weighing 5 to 10 kg, a size 1.5 LMA is recommended.

Answer 122

Answer: B) 10 mL Rationale: The maximum cuff volume for a size 2 LMA is 10 mL.

Answer 123

Answer: C) Size 2.5 Rationale: A size 2.5 LMA is recommended for children weighing between 20 and 30 kg.

Answer 124

Answer: C) Size 3 Rationale: For children weighing more than 30 kg, a size 3 LMA is typically used.

Answer 125

Answer: C) 20 mL Rationale: The maximum cuff volume for a size 3 LMA is 20 mL.

Answer 126

Answer: C) Size 4 Rationale: A size 4 LMA is commonly used for adult patients, with a maximum cuff volume of 30 mL.

Answer 127

Answer: C) 7 mL Rationale: The maximum cuff volume for a size 1.5 LMA is 7 mL.

Answer 128

Answer: B) 0.1 mg/kg Rationale: The standard IV dose of Diazepam for sedation is 0.1 mg/kg. It can also be given orally at 0.2 mg/kg.

Answer 129

Answer: C) 1 - 5 min Rationale: The onset time for all benzodiazepines are similar to each other at approx. 1 - 5 minutes when given intravenously.

Answer 130

Answer: D) 6 - 10 hr Rationale: Lorazepam has a longer duration of action compared to other benzodiazepines, lasting 6 - 10 hours.

Answer 131

Answer: B) 15 - 80 min Rationale: Midazolam has a relatively short duration of action, typically lasting between 15 and 80 minutes, making it suitable for short procedures.

Answer 132

Answer: C) 1 - 5 mg (0.05 mg/kg) Rationale: The IV dose of Midazolam typically ranges from 1 - 5 mg, based on a weight-based dose of 0.05 mg/kg.

Answer 133

Answer: C) 3 mg Rationale: The maximum recommended dose of Flumazenil, a benzodiazepine reversal agent, is 3 mg.

Answer 134

Answer: C) 0.2 mg Rationale: The initial dose of Flumazenil is 0.2 mg IV, followed by repeat doses of 0.1 mg every minute until the desired effect is achieved.

Answer 135

Answer: C) 1 - 5 min Rationale: Flumazenil has a rapid onset of action, typically occurring within 1 - 5 minutes. (same as the benzos onset)

Answer 136

Answer: C) 30 min Rationale: The duration of action for Flumazenil is about 30 minutes, which may be shorter than the duration of some benzodiazepines, necessitating close monitoring for re-sedation.

Answer 137

Answer: C) Midazolam Rationale: Midazolam has a shorter duration (15 - 80 minutes) compared to Diazepam (2 - 6 hours) and Lorazepam (6 - 10 hours).

Answer 138

Answer: C) 0.04 mg/kg Rationale: The standard IV dose of Lorazepam is 0.04 mg/kg. It is a potent benzodiazepine with a longer duration of action, making it useful for sustained sedation but requiring careful dosing due to its potency and duration.

Answer 139

Answer: B) 1 - 10 mg Rationale: The intraoperative dose of Morphine typically ranges from 1 to 10 mg for pain management.

Answer 140

Answer: C) 5 - 20 mg Rationale: Morphine's postoperative dosing is higher to manage sustained pain relief, typically 5 - 20 mg.

Answer 141

Answer: B) 10 - 20 min Rationale: Morphine has a relatively slow onset time of 10 - 20 minutes when given IV. (slowest of all opioids listed)

Answer 142

Answer: C) 4 - 5 hr Rationale: The duration of Morphine is 4 - 5 hours (longest of all opioids listed), providing sustained analgesia.

Answer 143

Answer: B) 1 - 3 μg/kg Rationale: Fentanyl is commonly dosed at 1 - 3 μg/kg for intraoperative analgesia.

Answer 144

Answer: C) 30 - 60 sec Rationale: Fentanyl has a rapid onset of action, occurring within 30 - 60 seconds.

Answer 145

Answer: B) 1 - 1.5 hr Rationale: Fentanyl’s duration is typically 1 - 1.5 hours, making it suitable for short procedures.

Answer 146

Answer: B) 0.3 - 1 μg/kg Rationale: Sufentanil is more potent than Fentanyl, with an intraoperative dose range of 0.3 - 1 μg/kg.

Answer 147

Answer: B) 0.125 - 0.375 μg/kg/min Rationale: Remifentanil is typically infused at a rate of 0.125 - 0.375 μg/kg/min due to its rapid onset and short duration.

Answer 148

Answer: C) 30 - 60 sec Rationale: Sufentanil has a similar onset time to Fentanyl and remifentanil, typically within 30 - 60 seconds.

Answer 149

Answer: D) 12.5 mg Rationale: Meperidine is often used at a dose of 12.5 mg IV to treat postoperative shivering.

Answer 150

Answer: B) 2 - 4 hr Rationale: Hydromorphone has a duration of action lasting between 2 and 4 hours, making it effective for moderate to severe pain management.

Answer 151

Answer: C) 40 - 80 mcg Rationale: Naloxone is dosed at 40 - 80 mcg for the reversal of opioid-induced respiratory depression.

Answer 152

Answer: C) 30 min Rationale: Naloxone has a duration of action of about 30 minutes, which may be shorter than the duration of the opioids it is reversing, necessitating close monitoring.

Answer 153

Answer: D) Remifentanil Rationale: Remifentanil has an extremely short duration of action (6 - 8 minutes), making it useful for procedures where rapid recovery is needed.

Answer 154

Answer: B) 0.5 - 1 μg/kg/hr Rationale: The infusion rate for Sufentanil is typically 0.5 - 1 μg/kg/hr, given its high potency and duration of action. (Note this infusion rate is per hour and remifentanil is per min bc of the differences in duration).

Answer 155

Answer: B) 1 - 1.5 hr Rationale: Sufentanil has a duration of action lasting between 1 and 1.5 hours, same as Fentanyl but with greater potency.

Answer 156

Answer: C) 1 - 5 min Rationale: Naloxone typically has an onset time of 1 - 5 minutes, allowing for rapid reversal of opioid effects.

Answer 157

Answer: C) 1.5 - 2.5 mg/kg Rationale: The standard induction dose of Propofol is 1.5 - 2.5 mg/kg, providing rapid onset and smooth induction of anesthesia.

Answer 158

Answer: B) 25 - 100 μg/kg/min Rationale: Propofol is typically infused at 25 - 100 μg/kg/min for sedation to maintain an adequate depth of anesthesia. (Conscious sedation)

Answer 159

Answer: B) 100 - 300 μg/kg/min Rationale: During TIVA, Propofol is infused at a higher rate of 100 - 300 μg/kg/min to maintain general anesthesia.

Answer 160

Answer: C) 30 - 60 sec Rationale: Propofol has a rapid onset of action, typically occurring within 30 - 60 seconds.

Answer 161

Answer: B) 1 - 8 min Rationale: The duration of Propofol is short, lasting between 1 and 8 minutes, making it ideal for induction and short procedures.

Answer 162

Answer: C) 0.3 mg/kg Rationale: Etomidate is typically dosed at 0.3 mg/kg for induction, known for its hemodynamic stability.

Answer 163

Answer: C) 1 min Rationale: The onset of Etomidate is rapid, occurring within approximately 1 minute. (You can use this for RSI)

Answer 164

Answer: B) 0.5 - 1.5 mg/kg Rationale: Ketamine is typically given at a dose of 0.5 - 1.5 mg/kg for induction, providing dissociative anesthesia.

Answer 165

Answer: B) 0.2 - 0.5 mg/kg Rationale: For IV analgesia, Ketamine is typically administered at a maintenance dose of 0.2 - 0.5 mg/kg.

Answer 166

Answer: C) 4 - 8 mg/kg Rationale: Ketamine can be administered intramuscularly (IM) at a dose of 4 - 8 mg/kg, particularly in pediatric or uncooperative patients.

Answer 167

Answer: C) 1 min Rationale: Ketamine has a rapid onset of action, typically occurring within 1 minute when given IV.

Answer 168

Answer: B) 10 - 20 min Rationale: The duration of Ketamine is usually 10 - 20 minutes, making it suitable for short procedures or as an adjunct for analgesia.

Answer 169

Answer: B) 0.1 - 0.2 mg/kg Rationale: Midazolam is commonly dosed at 0.1 - 0.2 mg/kg for induction, often used in conjunction with opioids like Fentanyl 50-100mcg.

Answer 170

Answer: C) 30 - 60 sec Rationale: Midazolam has a rapid onset of action, typically within 30 - 60 seconds.

Answer 171

Answer: B) 1 - 2 mg/kg/hr Rationale: Ketamine can be administered as a continuous infusion at 1 - 2 mg/kg/hr for postoperative sedation and analgesia, particularly in pediatric heart surgery cases due to its analgesic properties and minimal impact on respiratory drive.

Answer 172

Answer: C) Ketamine and Propofol Rationale: Ketofol is a mixture of Ketamine and Propofol, commonly used for procedural sedation due to its balanced effects of analgesia, sedation, and cardiovascular stability.

Answer 173

Answer: A) It reduces the risk of hypotension and respiratory depression Rationale: The combination of Ketamine and Propofol helps counteract each other's side effects. Ketamine maintains cardiovascular stability, while Propofol provides sedation and reduces the risk of emergence delirium.

Answer 174

Answer: B) 1:1 Rationale: Ketofol is commonly mixed in a 1:1 ratio (e.g., 1 mg of Ketamine per 1 mg of Propofol), providing an equal amount of Ketamine and Propofol to balance analgesia and sedation effects.

Answer 175

Answer: B) 0.5 - 1 mg/kg Rationale: The dose of Ketofol for procedural sedation is typically 0.5 - 1 mg/kg, depending on the patient's needs and the procedure being performed.

Answer 176

Answer: D) Glycopyrrolate Rationale: give antisialogogue Glycopyrrolate (0.2 mg) > atropine/scoplamine, anticholinergic agents, are often used to reduce the increased salivation associated with Ketamine.

Answer 177

Answer: B) Antiemesis and sedation Rationale: Propofol contributes sedation and antiemetic properties, complementing the analgesic effects of Ketamine.

Answer 178

Answer: B) It provides rapid onset with minimal cardiovascular effects Rationale: Ketofol is favored in pediatric cases due to its quick onset and stable hemodynamic profile, making it safer for children. (Give Midazolam prior to induction to counteract emergence delirium).

Answer 179

Answer: B) 1.8% Rationale: The MAC of Sevoflurane is 1.8%, which reflects its potency. A lower MAC indicates a more potent anesthetic agent.

Answer 180

Answer: A) 0.42 Rationale: Desflurane has a low blood coefficient (0.42), indicating rapid onset and recovery due to low solubility in blood.

Answer 181

Answer: B) Desflurane Rationale: Desflurane has the highest vapor pressure (669 mmHg), making it more volatile (evaporates easily) and requiring a special vaporizer for administration.

Answer 182

Answer: D) 104% Rationale: Nitrous Oxide has a MAC of 104%, which means it cannot produce surgical anesthesia on its own at normal atmospheric pressure.

Answer 183

Answer: C) Isoflurane Rationale: Isoflurane has the highest blood @ coefficient (1.46), indicating slower onset and recovery compared to other agents (more soluble in the blood).

Answer 184

Answer: A) 157 mmHg Rationale: Sevoflurane has a vapor pressure of 157 mmHg, indicating its volatility and the type of vaporizer needed for administration.

Answer 185

Answer: B) 0.46 Rationale: Nitrous Oxide has a blood coefficient of 0.46, reflecting its relatively low solubility and rapid onset. (can give for second gas effect, take up other volatiles faster or blow off other volatiles faster w/ isoflurane or Sevoflourane.. doesn't really effect desflourane onset/duration).

Answer 186

Answer: C) Isoflurane Rationale: Isoflurane has a MAC of 1.17%, the lowest among the agents listed, indicating it is the most potent.

Answer 187

Answer: B) 238 mmHg Rationale: Isoflurane has a vapor pressure of 238 mmHg, requiring specific calibration on an anesthesia vaporizer.

Answer 188

Answer: B) Desflurane Rationale: Desflurane’s low blood coefficient (0.42) contributes to its rapid onset and recovery.

Answer 189

Answer: B) Rapid onset and offset due to low blood solubility Rationale: Nitrous Oxide has a low blood coefficient (0.46), allowing for quick onset and recovery, making it useful as an adjunct agent.

Answer 190

Answer: C) Rapid induction and emergence Rationale: A low blood coefficient (0.42) indicates low solubility in blood, leading to faster equilibration and quicker changes in anesthetic depth.

Answer 191

Answer: C) Alpha-2 agonist Rationale: Dexmedetomidine is an alpha-2 adrenergic agonist, providing sedation and analgesia without significant respiratory depression.

Answer 192

Answer: B) 200 mcg/2 mL (or 100 mcg/mL) Rationale: The vial typically contains 200 mcg of Dexmedetomidine in 2 mL, resulting in an initial concentration of 100 mcg/mL.

Answer 193

Answer: B) In 48 mL of normal saline (NS) Rationale: The standard mixing instruction is to dilute the 200 mcg/2 mL vial in 48 mL of normal saline, yielding a final concentration of 4 mcg/mL.

Answer 194

Answer: D) 4 mcg/mL Rationale: After mixing 200 mcg in 48 mL of saline, the final concentration is 4 mcg/mL.

Answer 195

Answer: C) 0.5 - 1 mcg/kg Rationale: The typical bolus dose is 0.5 - 1 mcg/kg, administered over 10 minutes to prevent hemodynamic instability.

Answer 196

Answer: C) 10 minutes Rationale: The bolus should be given slowly over 10 minutes to reduce the risk of bradycardia and hypotension.

Answer 197

Answer: B) 0.2 - 0.7 mcg/kg/hr Rationale: The maintenance infusion rate of Dexmedetomidine is generally 0.2 - 0.7 mcg/kg/hr, depending on the desired level of sedation. (1 was the max at my hospital)

Answer 198

Answer: D) Bradycardia Rationale: Dexmedetomidine can cause significant bradycardia due to its alpha-2 agonist effects, requiring careful monitoring.

Answer 199

Answer: B) It allows for easy awakening and minimal interference with neurological exams Rationale: Dexmedetomidine provides light, cooperative sedation, allowing patients to be easily aroused and assessed neurologically.

Answer 200

Answer: C) 1 - 1.5 mg/kg Rationale: Succinylcholine is dosed at 1 - 1.5 mg/kg for rapid muscle paralysis, typically used for rapid sequence intubation due to its quick onset.

Answer 201

Answer: B) 30 - 60 sec Rationale: Succinylcholine has a very rapid onset (30 - 60 seconds), making it the drug of choice for emergency intubations.

Answer 202

Answer: B) 5 - 10 min Rationale: The duration of Succinylcholine is short, typically lasting 5 - 10 minutes, which is why it is ideal for short procedures or quick airway management.

Answer 203

Answer: B) 0.1 mg/kg Rationale: The standard dose for Cisatracurium is 0.1 mg/kg, used for longer muscle relaxation with minimal cardiovascular effects.

Answer 204

Answer: C) 2 - 3 min Rationale: Cisatracurium has an onset time of 2 - 3 minutes, making it suitable for non-emergent intubations.

Answer 205

Answer: C) 40 - 75 min Rationale: Cisatracurium provides a duration of 40 - 75 minutes, allowing for sustained muscle relaxation during longer procedures.

Answer 206

Answer: B) 0.1 mg/kg Rationale: The recommended dose of Vecuronium is 0.1 mg/kg for neuromuscular blockade.

Answer 207

Answer: C) 2 - 3 min Rationale: Vecuronium has an onset time of 2 - 3 minutes, similar to Cisatracurium, making it useful for planned intubations.

Answer 208

Answer: C) 45 - 90 min Rationale: Vecuronium’s duration of action is 45 - 90 minutes, providing prolonged muscle relaxation.

Answer 209

Answer: C) 0.6 - 1.2 mg/kg Rationale: Rocuronium is dosed at 0.6 - 1.2 mg/kg, depending on the urgency of intubation and desired speed of onset.

Answer 210

Answer: C) 1.5 min Rationale: At a high dose (1.2 mg/kg), Rocuronium can have an onset time as short as 1.5 minutes,, approaching the speed of Succinylcholine - which is 30-60 seconds. Normal dose of Rocc has on onset of 2-3 min

Answer 211

Answer: B) 35 - 75 min Rationale: The duration of Rocuronium ranges from 35 to 75 minutes, depending on the dose and patient factors.

Answer 212

Answer: B) 0.1 mg/kg Rationale: Pancuronium is typically dosed at 0.1 mg/kg, known for its long duration of action.

Answer 213

Answer: B) 2 - 3 min Rationale: Pancuronium has an onset time of 2 - 3 minutes, similar to other non-depolarizing muscle relaxants.

Answer 214

Answer: C) 60 - 120 min Rationale: Pancuronium has a long duration of action, lasting between 60 and 120 minutes, making it suitable for lengthy surgical cases.

Answer 215

Answer: B) 0.04 - 0.07 mg/kg Rationale: Neostigmine is dosed at 0.04 - 0.07 mg/kg to reverse non-depolarizing neuromuscular blockade. Make it easy on yourself and just give 0.05 mg/kg

Answer 216

Answer: C) 5 - 10 min Rationale: Neostigmine has an onset time of 5 - 10 minutes, making it important to administer well before planned extubation.

Answer 217

Answer: C) 60 min Rationale: Neostigmine has a duration of action of approximately 60 minutes, which is typically sufficient to maintain reversal until spontaneous recovery.

Answer 218

Answer: B) Glycopyrrolate, 0.2 mg per mg of Neostigmine Rationale: Glycopyrrolate is administered with Neostigmine to counteract muscarinic side effects such as bradycardia. The typical dose is 0.2 mg per mg of Neostigmine.

Answer 219

Answer: B) 2 - 16 mg/kg Rationale: Sugammadex is dosed between 2 - 16 mg/kg, depending on the depth of neuromuscular blockade. Higher doses are used for deeper blockades.

Answer 220

Answer: B) 1 - 4 min Rationale: Sugammadex has a rapid onset of 1 - 4 minutes, allowing for quick reversal of neuromuscular blockade.

Answer 221

Answer: C) 1.5 - 3 hours Rationale: Sugammadex has a duration of action lasting between 1.5 and 3 hours, which is generally sufficient to cover the duration of most surgical procedures.

Answer 222

Answer: D) Sugammadex Rationale: Sugammadex selectively binds to rocuronium and vecuronium, reversing their effects without causing muscarinic side effects, so it does not require an anticholinergic.

Answer 223

Answer: C) It can reverse deep neuromuscular blockades rapidly Rationale: Sugammadex is capable of rapidly reversing deep neuromuscular blockade, including full paralysis from high doses of rocuronium or vecuronium.

Answer 224

Answer: B) Bradycardia Rationale: Neostigmine can cause bradycardia due to its cholinergic effects, necessitating the use of an anticholinergic agent like Glycopyrrolate.

Answer 225

Answer: c) 3.5 mg Rationale: The dose range for Neostigmine is 0.04 - 0.07 mg/kg. For a 70 kg patient, this equates to 2.8 - 4.9 mg.

Answer 226

Answer: D) 960 mg Rationale: For deep blockade reversal (after high-dose Rocuronium), the recommended dose of Sugammadex is 16 mg/kg. For a 60 kg patient, this equals 960 mg.

Answer 227

Answer: C) 200 mg Rationale: For moderate blockade (1-2 twitches on TOF post tetanic), the recommended dose of Sugammadex is 4 mg/kg. For a 50 kg patient, this equates to 200 mg. Routine TOF so 2 twitches is 2mg/kg Deep is 16mg/kg

Answer 228

Answer: C) 0.8 mg Rationale: Glycopyrrolate is dosed at 0.2 mg per mg of Neostigmine. For 4 mg of Neostigmine, the appropriate dose of Glycopyrrolate is 0.8 mg.

Answer 229

Answer: C) 3.5 mL of Neostigmine and 3.5 mL of Glycopyrrolate; do not mix in the same syringe; give Glycopyrrolate first. Mixing and Administration: Neostigmine and Glycopyrrolate should not be mixed in the same syringe due to potential incompatibility. Glycopyrrolate is administered first to mitigate the muscarinic side effects (e.g., bradycardia) of Neostigmine, as it acts faster.

Answer 230

Answer: C) Fresh Frozen Plasma (FFP) Rationale: A TEG-ACT (Activated Clotting Time) greater than 140 seconds indicates a prolonged clotting time, suggesting coagulopathy due to decreased coagulation factors. Fresh Frozen Plasma (FFP) is administered to replenish these factors and reduce the ACT.

Answer 231

Answer: D) Fresh Frozen Plasma (FFP) Rationale: An R time greater than 10 minutes indicates a delay in the initial formation of the clot, often due to a deficiency in clotting factors. FFP is recommended to provide the necessary clotting factors and reduce the R time.

Answer 232

Answer: B) Cryoprecipitate Rationale: A K time greater than 3 minutes suggests inadequate fibrin formation, typically due to low fibrinogen levels. Cryoprecipitate is rich in fibrinogen and helps shorten the K time, improving clot strength.

Answer 233

Answer: C) Cryoprecipitate ± Platelets Rationale: An α angle less than 53 degrees indicates a problem with fibrin polymerization, suggesting low fibrinogen or platelet dysfunction. Cryoprecipitate increases fibrinogen levels, and platelets may be added if there is a suspected platelet deficiency.

Answer 234

Answer: B) Platelets Rationale: The MA value reflects the maximum strength of the clot and is influenced by platelet function. An MA less than 50 mm suggests poor clot strength due to platelet dysfunction or deficiency, warranting the administration of platelets.

Answer 235

Answer: D) Tranexamic Acid Rationale: An LY30 greater than 3% indicates excessive fibrinolysis, leading to premature clot breakdown. Tranexamic Acid is an antifibrinolytic agent that helps inhibit the breakdown of fibrin, stabilizing the clot.

Answer 236

Clinical Relevance: TEG provides a comprehensive view of the entire clotting process, from initial clot formation (R time) to clot strength (MA) and fibrinolysis (LY30). FFP is used to replenish coagulation factors when there is evidence of coagulopathy (prolonged ACT or R time). Cryoprecipitate is indicated for low fibrinogen levels, helping to correct prolonged K time and a decreased α angle. Platelets are administered when the MA is low, indicating insufficient clot strength due to platelet dysfunction. Tranexamic Acid is effective in cases of hyperfibrinolysis, as indicated by an elevated LY30, to prevent excessive clot breakdown.

Answer 237

Answer: B) 5 mg/kg Rationale: The maximum dose of Lidocaine without Epinephrine is 5 mg/kg. Adding Epinephrine can increase the maximum allowable dose due to reduced systemic absorption.

Answer 238

Answer: C) 7 mg/kg Rationale: The maximum dose of Lidocaine increases to 7 mg/kg when combined with Epinephrine, as Epinephrine decreases systemic absorption.

Answer 239

Answer: B) 2.5 mg/kg Rationale: The maximum dose of Bupivacaine is 2.5 mg/kg, regardless of whether Epinephrine is added. It has a narrow safety margin due to its high potency and potential for cardiotoxicity.

Answer 240

Answer: C) Chloroprocaine Rationale: Chloroprocaine has the highest maximum dose when Epinephrine is added, at 14 mg/kg. This high dose is due to its rapid metabolism and low systemic toxicity.

Answer 241

Answer: B) 3 mg/kg Rationale: The maximum dose of Ropivacaine without Epinephrine is 3 mg/kg. It is considered less cardiotoxic than Bupivacaine, making it a safer alternative for regional anesthesia.

Answer 242

Answer: D) 8.5 mg/kg Rationale: The maximum dose of Prilocaine increases to 8.5 mg/kg when Epinephrine is added, allowing for a higher dose due to reduced systemic absorption.

Answer 243

Answer: B) 3 mg/kg Rationale: The maximum dose of Tetracaine is 3 mg/kg, regardless of the addition of Epinephrine. It is a potent ester local anesthetic primarily used in spinal anesthesia.

Answer 244

Answer: C) 400 mg Rationale: The maximum dose of Mepivacaine without Epinephrine is 5 mg/kg. For an 80 kg patient, this equates to a maximum dose of 400 mg.

Answer 245

Answer: D) 980 mg Rationale: With Epinephrine, the maximum dose of Chloroprocaine is 14 mg/kg. For a 70 kg patient, the maximum dose is 980 mg.

Answer 246

Answer: C) Procaine Rationale: Procaine is an ester local anesthetic. Esters are generally metabolized by plasma cholinesterases, while amides are metabolized by the liver. Amides have two I's in their names

Answer 247

Answer: B) 0.0625 - 0.125% Rationale: Bupivacaine is commonly used at low concentrations (0.0625 - 0.125%) for epidural labor analgesia to provide effective pain relief while minimizing motor block.

Answer 248

Answer: B) 1.25 - 2.5 mg Rationale: For spinal anesthesia in labor, a small dose of Bupivacaine (1.25 - 2.5 mg) is used to provide rapid and effective pain relief without excessive motor block.

Answer 249

Answer: B) 0.08 - 0.2% Rationale: Ropivacaine is used at concentrations of 0.08 - 0.2% for epidural analgesia, providing effective pain control with a lower risk of motor block compared to Bupivacaine.

Answer 250

Answer: B) 2.5 - 4.5 mg Rationale: For spinal analgesia, Ropivacaine is typically dosed between 2.5 and 4.5 mg, providing adequate analgesia for labor while minimizing motor block.

Answer 251

Answer: C) 2% in 5 mL Rationale: Lidocaine with Epinephrine (2%) is commonly administered as a 5 mL bolus for epidural analgesia, providing fast onset of pain relief and testing for epidural catheter placement.

Answer 252

Answer: B) 10 - 25 mcg Rationale: Fentanyl is typically dosed between 10 - 25 mcg in spinal anesthesia for labor, providing potent analgesia with minimal side effects.

Answer 253

Answer: C) 1.5 - 5 mcg Rationale: Sufentanil, a highly potent opioid, is used in doses of 1.5 - 5 mcg for spinal labor analgesia, providing effective pain relief with a small dose due to its potency.

Answer 254

Answer: C) 0.1 - 0.2 mg Rationale: Morphine is typically dosed at 0.1 - 0.2 mg in spinal anesthesia for labor, providing long-lasting analgesia due to its hydrophilic nature.

Answer 255

Answer: B) 0.625 mg Rationale: Droperidol is dosed at 0.625 mg for PONV. It is a butyrophenone, which acts as a dopamine D2 receptor antagonist, providing antiemetic effects but with a risk of QT prolongation.

Answer 256

Answer: B) 1 - 5 min Rationale: Promethazine has an onset time of 1 - 5 minutes when given IV. It is a first-generation antihistamine (H1 antagonist) with antiemetic and sedative properties.

Answer 257

Answer: B) 4 mg Rationale: Ondansetron is commonly dosed at 4 mg for PONV. It belongs to the 5-HT3 receptor antagonist class, blocking serotonin receptors in the chemoreceptor trigger zone.

Answer 258

Answer: B) 4 - 9 hr Rationale: Ondansetron has a duration of action lasting 4 - 9 hours, making it effective for both prophylaxis and treatment of PONV.

Answer 259

Answer: C) 4 mg (same as zofran) Rationale: Dexamethasone is dosed at 4 mg for PONV prophylaxis. It is a corticosteroid, believed to reduce inflammation and provide antiemetic effects through multiple mechanisms.

Answer 260

Answer: C) 10 - 30 min Rationale: Dexamethasone has an onset time of 10 - 30 minutes when given IV, providing delayed but prolonged antiemetic effects.

Answer 261

Answer: C) 10 - 20 mg Rationale: Metoclopramide is typically dosed at 10 - 20 mg for PONV. It is a prokinetic agent and dopamine D2 receptor antagonist, increasing gastric motility and reducing nausea.

Answer 262

Answer: B) 1 - 2 hr Rationale: The duration of action for Metoclopramide is 1 - 2 hours, making it effective for short-term relief of nausea and vomiting.

Answer 263

Answer: C) Patch, 72 hr Rationale: Scopolamine is administered as a transdermal patch, providing antiemetic effects for up to 72 hours. It is an anticholinergic agent, reducing nausea by inhibiting muscarinic receptors.

Answer 264

Answer: B) 10 - 15 mg IV bolus, followed by 10 μg/kg/min Rationale: Propofol can be used as an antiemetic at a dose of 10 - 15 mg IV, followed by a low-dose infusion of 10 μg/kg/min. It is a sedative-hypnotic with antiemetic properties, particularly useful for PONV.

Answer 265

Answer: B) 6.25 - 25 mg Rationale: Promethazine is typically dosed between 6.25 and 25 mg for the treatment of nausea and vomiting. It is a first-generation antihistamine (H1 antagonist) with antiemetic, sedative, and anticholinergic properties, making it effective in the management of PONV. Dilution: Promethazine should be diluted before administration to reduce the risk of irritation and tissue injury. It is usually diluted in 10 - 20 mL of normal saline. Slow Administration: The medication should be given slowly over at least 2 minutes to prevent irritation and minimize the risk of complications.

Answer 266

Answer: C) History of motion sickness Rationale: A history of PONV or motion sickness increases the likelihood of experiencing PONV. Other common risk factors include female gender, age under 40, and certain types of surgeries.

Answer 267

Answer: B) Laparoscopic surgery Rationale: Laparoscopic surgery is associated with a higher incidence of PONV due to the insufflation of the abdomen and potential irritation of the peritoneum.

Answer 268

Answer: C) 40% Rationale: According to the PONV treatment algorithm, the presence of two risk factors correlates with a 40% chance of developing PONV. Give 2 drugs

Answer 269

Answer: D) Three or more drugs Rationale: For patients with three or more risk factors, the risk of PONV exceeds 60%, and the recommendation is to use three or more antiemetic medications for optimal prevention.

Answer 270

Answer: C) Avoiding volatile anesthetics Rationale: Non-pharmacologic strategies for PONV prevention include avoiding volatile anesthetics and minimizing opioid use, as these can trigger nausea and vomiting.

Answer 271

Answer: B) 20% Rationale: Having a single risk factor for PONV corresponds to a 20% likelihood of developing symptoms. Additional risk factors increase this percentage.

Answer 272

Answer: C) Three Rationale: The patient has three risk factors: female gender, age under 40, and history of motion sickness. Gynecologic surgery is also considered high risk for PONV. Give 3 drugs

Answer 273

Answer: D) A 65-year-old male with getting a hip replacement Rationale: Older age and male gender are associated with a lower risk of PONV. The absence of additional risk factors further reduces the likelihood of PONV in this patient.

Answer 274

Answer: C) Two antiemetic drugs Rationale: When a patient has two risk factors, the algorithm suggests using two prophylactic antiemetic drugs to reduce the risk of PONV.

Answer 275

Answer: A) Laparotomy Rationale: Laparotomy, along with other abdominal and gynecologic procedures, is associated with a higher risk of PONV due to the manipulation of intra-abdominal structures.

Answer 276

Answer: C) 1000 mg q4-6h Rationale: The standard dosing of Acetaminophen for pain relief is 1000 mg every 4 to 6 hours. It is commonly used for its analgesic and antipyretic effects. Max: 3-4g

Answer 277

Answer: B) 3000 - 4000 mg Rationale: The maximum daily dose of Acetaminophen is 3000 to 4000 mg. Exceeding this limit can increase the risk of hepatotoxicity, especially in patients with liver disease or chronic alcohol use.

Answer 278

Answer: B) 15 - 30 mg Rationale: Ketorolac is typically dosed at 15 - 30 mg every 6 hours. It is a nonsteroidal anti-inflammatory drug (NSAID) used for moderate to severe pain, but it should be limited due to the risk of gastrointestinal and renal side effects.

Answer 279

Answer: B) 60 - 120 mg Rationale: The maximum daily dose of Ketorolac is 60 - 120 mg. It should not be used for more than 5 days due to risks of gastrointestinal bleeding, renal impairment, and cardiovascular effects. (Sounds a lot like Tramadol which is an opioid pain killer.. don't get the shit confused).

Answer 280

Answer: B) 200 - 800 mg Rationale: The usual dose of Ibuprofen for pain relief ranges from 200 to 800 mg every 6 hours. It is an NSAID that provides anti-inflammatory, analgesic, and antipyretic effects.

Answer 281

Answer: C) 3200 mg Rationale: The maximum daily dose of Ibuprofen is 3200 mg. Exceeding this dose increases the risk of gastrointestinal ulcers, bleeding, and renal toxicity.

Answer 282

Answer: A) Acetaminophen Rationale: Acetaminophen is the preferred choice for pain relief in patients with a history of peptic ulcer disease, as it does not have the same gastrointestinal risks as NSAIDs like Ketorolac or Ibuprofen.

Answer 283

Answer: B) Ketorolac Rationale: Ketorolac, an NSAID, should be avoided in patients with significant renal impairment due to its potential nephrotoxic effects, especially with prolonged use. Due to its higher potency, Ketorolac carries a greater risk of nephrotoxicity, especially with prolonged use or higher doses. The drug can cause renal vasoconstriction, reducing renal blood flow, which is why it is limited to a maximum of 5 days of use. Other NSAIDS are less of a concern

Answer 284

Answer: C) 1.5 mL/kg Rationale: The initial bolus dose for Intralipid 20% is 1.5 mL/kg given over 1 minute. This provides a rapid infusion of lipids to bind the local anesthetic and reduce toxicity.

Answer 285

Answer: C) Repeat the bolus every 3 - 5 minutes, up to a maximum of 3 mL/kg Rationale: If the patient remains unstable, the bolus can be repeated every 3 - 5 minutes, but the total bolus dose should not exceed 3 mL/kg before increasing the continuous infusion rate.

Answer 286

Answer: D) 8 mL/kg Rationale: The maximum cumulative dose of Intralipid 20% is 8 mL/kg to prevent complications such as fat embolism and metabolic acidosis.

Answer 287

Answer: B) Reduce the bolus to 1 mL/kg and titrate up slowly Rationale: In lower-weight patients, starting with a reduced bolus dose of 1 mL/kg is safer to avoid volume overload and potential complications. The dose can be titrated based on the patient’s response.

Answer 288

Answer: B) 0.25 mL/kg/min Rationale: After the initial bolus, an infusion of Intralipid 20% is started at 0.25 mL/kg/min. If the patient remains hemodynamically unstable, the rate can be increased to 0.5 mL/kg/min.

Answer 289

Answer: B) 35.5°C Rationale: Mild hypothermia is typically defined as a body temperature between 35°C and 35.9°C. At 35.5°C, the patient may exhibit shivering and vasoconstriction as the body attempts to conserve heat.

Answer 290

Answer: C) 37°C Rationale: 98.6°F is the normal body temperature in Fahrenheit and is equivalent to 37°C in Celsius. The formula used is: °C = (°F - 32) / 1.8

Answer 291

Answer: C) 104.9°F Rationale: Using the formula °F = 1.8 × °C + 32, a temperature of 40.5°C converts to approximately 104.9°F, indicating hyperthermia, which can be associated with fever, heatstroke, or malignant hyperthermia.

Answer 292

Answer: C) 34.5°C Rationale: Severe hypothermia is defined as a core body temperature below 35°C. At 34.5°C, the patient may experience altered mental status, decreased heart rate, and an increased risk of arrhythmias.

Answer 293

Answer: C) 38.5°C, Hyperthermia Rationale: 101.3°F converts to 38.5°C, which indicates hyperthermia. This can be a sign of infection, sepsis, or other inflammatory responses. Management involves identifying and treating the underlying cause.

Answer 294

Answer: B) 36 - 37.5°C Rationale: The normal range for body temperature is typically 36 - 37.5°C. Temperatures outside this range may indicate hypothermia or hyperthermia, requiring clinical intervention.

Answer 295

Answer: B) 34.5°C, Severe hypothermia Rationale: 94.1°F converts to 34.5°C, indicating severe hypothermia. This condition can lead to coagulopathy, arrhythmias, and decreased metabolic activity, requiring active warming measures.

Answer 296

Answer: C) 103.1°F, High fever (39.5 x 1.8) + 32 Rationale: 39.5°C converts to approximately 103.1°F. This temperature is consistent with a high fever, which may indicate infection or an inflammatory response.

Answer 297

Answer: C) Fresh Frozen Plasma (FFP) or Prothrombin Complex Concentrate (PCC) Rationale: A prolonged CT suggests a delay in the initiation of clotting, often due to a deficiency in coagulation factors. Administering FFP or PCC helps replenish these factors and reduce clotting time.

Answer 298

Answer: B) MCF (Maximum Clot Firmness); check FIBTEM MCF or give Platelets Rationale: MCF measures the strength of the clot. If MCF is too low, it indicates a weak clot, potentially due to low fibrinogen or platelet dysfunction. Treatment involves assessing FIBTEM MCF; if fibrinogen is low, give Cryoprecipitate. If platelets are deficient, administer Platelets.

Answer 299

Answer: D) Tranexamic Acid (TXA) Rationale: An elevated LI30 indicates excessive clot breakdown (fibrinolysis). Tranexamic Acid, an antifibrinolytic agent, is used to inhibit fibrinolysis and stabilize the clot.

Answer 300

Answer: B) Cryoprecipitate Rationale: A low FIBTEM MCF suggests a deficiency in fibrinogen. Cryoprecipitate is rich in fibrinogen and is the preferred treatment to strengthen the clot.

Answer 301

Answer: C) Administer Platelets Rationale: When FIBTEM MCF is normal, but platelet function is low, the likely cause of weak clot strength is platelet deficiency. Administering Platelets helps restore clot stability.

Answer 302

Answer: B) Delayed clot formation; coagulation factor deficiency Rationale: A prolonged CT indicates delayed initiation of clot formation, often due to a deficiency in coagulation factors. This can be corrected with FFP or PCC.

Answer 303

Answer: C) How fast? → How strong? → For how long? Rationale: The ROTEM flowchart starts with assessing clot formation speed (CT), then evaluates the strength of the clot (MCF), and finally checks for clot lysis duration (LI30).