Tex-Wes-Reference_Guide Flashcards
In the Mallampati classification, what is visible in a Class I airway?
A) Only the soft palate
B) Soft palate, fauces, uvula, and tonsillar pillars
C) Soft palate and fauces only
D) Soft palate, uvula, and base of the tonsils
Answer: B) Soft palate, fauces, uvula, and tonsillar pillars
Rationale: Class I in the Mallampati classification indicates that the mouth is fully open and unobstructed, allowing visualization of the soft palate, fauces, uvula, and both anterior and posterior tonsillar pillars. This classification often correlates with easier intubation.
In the Mallampati classification, what is visible in a Class II airway?
A) Only the soft palate
B) Soft palate, uvula, and fauces
C) Soft palate, fauces, uvula, and tonsillar pillars
D) Soft palate and base of the uvula only
Answer: B) Soft palate, uvula, and fauces
Rationale: A Class II airway allows visualization of the soft palate, fauces, and uvula but not the tonsillar pillars. This suggests a moderate level of difficulty for intubation, as not all structures are clearly visible.
What is visible in a Class III Mallampati airway classification?
A) Only the soft palate
B) Soft palate and fauces
C) Soft palate and base of the uvula
D) Uvula and tonsillar pillars
Answer: C) Soft palate and base of the uvula
Rationale: In a Class III classification, only the soft palate and the base of the uvula are visible. This classification is associated with more challenging airway management because of limited visibility.
In a Class IV Mallampati classification, which structures are visible?
A) Only the soft palate
B) None of the oropharyngeal structures
C) Uvula and soft palate
D) Soft palate and tonsillar pillars
A) Only the soft palate
Which Mallampati class is associated with the easiest intubation?
A) Class I
B) Class II
C) Class III
D) Class IV
Answer: A) Class I
Rationale: Class I classification indicates the maximum visibility of airway structures, suggesting that intubation should be easier compared to other classes, which have progressively more restricted views
What is visible in a Grade I Cormack-Lehane classification?
A) Only the epiglottis
B) Only the arytenoids
C) Entire glottis, including the vocal cords
D) Only the soft palate
Answer: C) Entire glottis, including the vocal cords
Rationale: Grade I indicates a full view of the glottis opening, including the vocal cords. This is the easiest scenario for intubation, as all critical structures are clearly visible.
Which structures are visible in a Grade II Cormack-Lehane classification?
A) Entire glottis
B) Posterior portion of the glottis
C) Epiglottis only
D) No visible structures
Answer: B) Posterior portion of the glottis
Rationale: Grade II indicates that only the posterior portion of the glottis is visible, making intubation moderately difficult. The anterior glottis may not be seen, but the arytenoids are typically visible.
What is visible in a Grade III Cormack-Lehane view?
A) Epiglottis only, no glottis visible
B) Full view of the vocal cords
C) Posterior glottis and epiglottis
D) Entire glottis
Answer: A) Epiglottis only, no glottis visible
Rationale: Grade III is associated with a difficult airway because only the epiglottis is visible, and the glottis is not seen at all. This view typically requires advanced techniques for successful intubation.
What does a Grade IV Cormack-Lehane classification indicate?
A) Full glottis visualization
B) Visible posterior glottis
C) Only the epiglottis is seen
D) Neither the epiglottis nor the glottis is visible
Answer: D) Neither the epiglottis nor the glottis is visible
Rationale: Grade IV is the most challenging view, where neither the epiglottis nor the glottis can be visualized. This situation often requires alternative airway management techniques, such as video laryngoscopy or a surgical airway.
Which Cormack-Lehane grade is associated with the highest risk of difficult intubation?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
Answer: D) Grade IV
Rationale: Grade IV indicates the most limited view with no visualization of the epiglottis or glottis. This is considered a “cannot intubate, cannot ventilate” scenario and is associated with the highest risk of complications.
What does ASA Class I indicate about a patient’s health status?
A) The patient has severe systemic disease
B) The patient has mild systemic disease without functional limitations
C) The patient is a normal, healthy individual
D) The patient has severe systemic disease that is a constant threat to life
Answer: C) The patient is a normal, healthy individual
Rationale: ASA Class I represents a healthy patient with no systemic disease, indicating the lowest risk for complications during anesthesia.
Which description best fits ASA Class II?
A) A patient with severe systemic disease that is a constant threat to life
B) A patient with mild systemic disease and no functional limitations
C) A moribund patient who is not expected to survive without surgery
D) A patient who is brain-dead and undergoing organ donation
Answer: B) A patient with mild systemic disease and no functional limitations
Rationale: ASA Class II includes patients with mild systemic diseases (e.g., controlled diabetes or hypertension) that do not affect their daily activities.
What characterizes an ASA Class III patient?
A) A healthy individual
B) A patient with mild systemic disease and no functional limitations
C) A patient with severe systemic disease with some functional limitations
D) A patient with severe systemic disease that is a constant threat to life
Answer: C) A patient with severe systemic disease with some functional limitations
Rationale: ASA Class III is assigned to patients with severe systemic disease that limits daily activities (e.g., poorly controlled diabetes, angina). These patients have an increased risk during anesthesia.
What does ASA Class IV indicate about a patient’s condition?
A) A healthy patient with no systemic disease
B) A patient with severe systemic disease that is a constant threat to life
C) A patient with mild systemic disease and no functional limitations
D) A brain-dead patient undergoing organ donation
Answer: B) A patient with severe systemic disease that is a constant threat to life
Rationale: ASA Class IV patients have severe, life-threatening systemic diseases (e.g., advanced heart failure, end-stage renal disease), posing a high risk for anesthesia-related complications.
What is the definition of ASA Class V?
A) A healthy patient undergoing an elective procedure
B) A patient with mild systemic disease that is well-controlled
C) A moribund patient not expected to survive without surgery
D) A patient with severe systemic disease but no functional limitations
Answer: C) A moribund patient not expected to survive without surgery
Rationale: ASA Class V is reserved for patients in critical condition who are unlikely to survive without immediate surgical intervention.
For which patient is ASA Class VI designated?
A) A healthy individual scheduled for elective surgery
B) A patient with severe systemic disease that is life-threatening
C) A patient with mild systemic disease but no functional limitations
D) A brain-dead patient whose organs are being removed for donation
Answer: D) A brain-dead patient whose organs are being removed for donation
Rationale: ASA Class VI applies to brain-dead patients undergoing organ donation, reflecting their non-viable status rather than surgical risk.
What is the correct sequence of the 4 stages of anesthesia?
A) Analgesia, Excitement, Surgical Anesthesia, Overdose
B) Surgical Anesthesia, Analgesia, Excitement, Overdose
C) Overdose, Surgical Anesthesia, Excitement, Analgesia
D) Excitement, Analgesia, Surgical Anesthesia, Overdose
Answer: A) Analgesia, Excitement, Surgical Anesthesia, Overdose
Rationale: The stages proceed in order from initial induction (Analgesia), through a period of increased excitement, to a stable surgical anesthesia, and finally to an overdose stage if anesthesia is too deep.
During which stage of anesthesia is it safest to intubate the patient?
A) Stage 1 (Analgesia)
B) Stage 2 (Excitement)
C) Stage 3 (Surgical Anesthesia)
D) Stage 4 (Overdose)
Answer: C) Stage 3 (Surgical Anesthesia)
Rationale: Stage 3, Surgical Anesthesia, is characterized by stable respiration, absent reflexes, and relaxed muscles, making it the safest time for intubation.
Which of the following signs indicates that a patient has entered Stage 2 (Excitement) of anesthesia?
A) Regular breathing and fixed pupils
B) Agitation, irregular breathing, and increased muscle tone
C) Complete muscle relaxation and stable hemodynamics
D) Apnea and dilated pupils
Answer: B) Agitation, irregular breathing, and increased muscle tone
Rationale: Stage 2 (Excitement) is marked by hyperactive reflexes, irregular respiration, and involuntary movements. Intubation and extubation during this stage can trigger laryngospasm. Eyes might be darting around.
When is it appropriate to perform a deep extubation?
A) During Stage 1 (Analgesia)
B) During Stage 2 (Excitement)
C) During Stage 3 (Surgical Anesthesia)
D) During Stage 4 (Overdose)
Answer: C) During Stage 3 (Surgical Anesthesia)
Rationale: Deep extubation is performed while the patient is still under deep anesthesia (Stage 3) to avoid coughing, gagging, or laryngospasm. The patient should have adequate muscle relaxation and stable vitals.
Which sign indicates that the patient has entered Stage 4 (Overdose)?
A) Increased heart rate and blood pressure
B) Tachypnea and regular breathing pattern
C) Severe hypotension, apnea, and dilated, non-reactive pupils
D) Increased muscle tone and gag reflex
Answer: C) Severe hypotension, apnea, and dilated, non-reactive pupils
Rationale: Stage 4 (Overdose) is marked by significant CNS depression, including respiratory and cardiovascular collapse. This stage is life-threatening and requires immediate intervention.
What is the ideal stage for extubation when performing a standard awake extubation?
A) Stage 1 (Analgesia)
B) Stage 2 (Excitement)
C) Stage 3 (Surgical Anesthesia)
D) Fully awake and following commands (Stage 1 emergence)
Answer: D) Fully awake and following commands (Stage 1 emergence)
Rationale: Extubation is safest when the patient is fully awake, protecting their own airway and following commands (head lift). Extubation in Stage 2 (Excitement) can lead to complications like laryngospasm.
What physical sign might indicate that a patient is moving from Stage 2 (Excitement) to Stage 3 (Surgical Anesthesia)?
A) Gag reflex reappears
B) Pupils become dilated and non-reactive
C) Regular, rhythmic breathing resumes
D) Increased tear production
Answer: C) Regular, rhythmic breathing resumes- (eyes midline)
Rationale: The transition from Stage 2 to Stage 3 is marked by a return to regular breathing patterns, loss of reflexes, and muscle relaxation, indicating readiness for surgical procedures.
What is the normal range for arterial pH in a blood gas analysis?
A) 7.25 - 7.35
B) 7.35 - 7.45
C) 7.45 - 7.55
D) 7.55 - 7.65
Answer: B) 7.35 - 7.45
Rationale: The normal pH range in arterial blood is 7.35 to 7.45. A pH below this range indicates acidosis, while a pH above this range suggests alkalosis.
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: 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.
What is the normal range for bicarbonate (HCO₃⁻) in a blood gas analysis?
A) 18 - 22 mEq/L
B) 22 - 26 mEq/L
C) 26 - 30 mEq/L
D) 30 - 34 mEq/L
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.
Which of the following represents a normal arterial PaO₂ value?
A) 60 - 70 mmHg
B) 70 - 80 mmHg
C) 80 - 90 mmHg
D) 90 - 100 mmHg
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.
What is the normal range for base excess (BE) in an ABG?
A) -4 to 0 mEq/L
B) -2 to 2 mEq/L
C) 0 to 4 mEq/L
D) 2 to 6 mEq/L
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.
What is the formula for calculating the oxygen consumption (VO₂)?
A) VO₂ = 5 x kg
B) VO₂ = 8 x kg
C) VO₂ = 10 x kg^(3/4)
D) VO₂ = 12 x kg^(3/4)
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.
What is the alveolar gas equation used to calculate PaO₂?
A) PAO₂ = (Hgb x 1.34 x SaO₂) + (PaCO₂ x 0.003)
B) PAO₂ = FiO₂ x (Pb - PH₂O) - PaCO₂/0.8
C) PAO₂ = (Pb - PaCO₂) / FiO₂
D) PAO₂ = HCO₃ / PaCO₂
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.
Which formula correctly calculates the arterial oxygen content (CaO₂)?
A) CaO₂ = (Hgb x 1.34 x SaO₂) + (PaO₂ x 0.003)
B) CaO₂ = PaO₂ / FiO₂
C) CaO₂ = HCO₃ x PaCO₂
D) CaO₂ = Hgb / SaO₂
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.
What is the normal range for arterial oxygen saturation (SaO₂) in a blood gas analysis?
A) 85% - 90%
B) 90% - 92%
C) 93% - 95%
D) 95% - 98%
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.
What is the formula for calculating Mean Arterial Pressure (MAP)?
A) MAP = (SBP + DBP)/2
B) MAP = (SBP + 2 × DBP)/3
C) MAP = (DBP + 3 × SBP)/4
D) MAP = SBP - DBP
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.
What is the normal range for Cardiac Output (CO)?
A) 2 - 4 L/min
B) 4 - 8 L/min
C) 6 - 10 L/min
D) 8 - 12 L/min
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.
What is the normal range for Central Venous Pressure (CVP)?
A) 0 - 2 mmHg
B) 2 - 6 mmHg
C) 6 - 10 mmHg
D) 10 - 15 mmHg
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.
Which of the following represents a normal Cardiac Index (CI)?
A) 1.5 - 2.0 L/min/m²
B) 2.5 - 4.0 L/min/m²
C) 4.0 - 5.5 L/min/m²
D) 5.5 - 7.0 L/min/m²
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.
What is the normal range for Pulmonary Capillary Wedge Pressure (PCWP)?
A) 4 - 8 mmHg
B) 8 - 12 mmHg
C) 12 - 16 mmHg
D) 16 - 20 mmHg
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.
Which value represents a normal Systemic Vascular Resistance (SVR)?
A) 200 - 500 dynes·sec/cm⁵
B) 500 - 800 dynes·sec/cm⁵
C) 700 - 1400 dynes·sec/cm⁵
D) 1400 - 1800 dynes·sec/cm⁵
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.
What is the normal range for Ejection Fraction (EF)?
A) 30% - 40%
B) 40% - 50%
C) 50% - 60%
D) 55% - 70%
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.
What is the Shock Index (SI) formula, and what does an SI > 1 indicate?
A) SI = (Heart Rate × SBP); SI > 1 indicates hypovolemia
B) SI = (SBP/DBP); SI > 1 indicates hypertension
C) SI = (Heart Rate/SBP); SI > 1 indicates increased morbidity and mortality
D) SI = (DBP/Heart Rate); SI > 1 indicates bradycardia
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.
What is the normal range for Pulmonary Vascular Resistance (PVR)?
A) 50 - 250 dynes·sec/cm⁵
B) 50 - 350 dynes·sec/cm⁵
C) 100 - 400 dynes·sec/cm⁵
D) 200 - 500 dynes·sec/cm⁵
Answer: B) 50 - 350 dynes·sec/cm⁵
Rationale: PVR indicates the resistance in the pulmonary circulation and helps assess right ventricular afterload.
What is the normal range for Pulmonary Artery Pressure (PAP)?
A) Systolic: 15-30 mmHg, Diastolic: 5-15 mmHg, Mean: 10-15 mmHg
B) Systolic: 20-40 mmHg, Diastolic: 10-20 mmHg, Mean: 15-20 mmHg
C) Systolic: 25-50 mmHg, Diastolic: 15-25 mmHg, Mean: 20-30 mmHg
D) Systolic: 30-50 mmHg, Diastolic: 20-30 mmHg, Mean: 25-35 mmHg
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.
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What does a Shock Index (SI) greater than 1 indicate?
A) Decreased risk of morbidity and mortality
B) Increased volume status
C) Increased risk of morbidity and mortality
D) Normal hemodynamic stability
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.
What is a common cause of Sphincter of Oddi spasm during anesthesia?
A) Inhaled anesthetics
B) Propofol
C) Opioids
D) Local anesthetics
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.
Which opioid is least likely to cause Sphincter of Oddi spasm?
A) Morphine
B) Fentanyl
C) Meperidine
D) Hydromorphone
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.
Which medication can be used to treat Sphincter of Oddi spasm intraoperatively?
A) Epinephrine
B) Nitroglycerin
C) Norepinephrine
D) Lidocaine
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.
Which diagnostic sign might indicate a Sphincter of Oddi spasm during an ERCP procedure?
A) Decreased heart rate
B) Elevated biliary pressures
C) Hypotension
D) Increased gastric motility
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.
What is the recommended IV dose of Glucagon for treating a Sphincter of Oddi spasm?
A) 0.5 mg
B) 1 mg
C) 2 mg
D) 4 mg
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.
Which medication can be administered at a dose of 40 mcg IV to reverse the effects of opioids causing Sphincter of Oddi spasm?
A) Atropine
B) Naloxone
C) Nitroglycerin
D) Glucagon
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.
What is the IV dose of Atropine for treating Sphincter of Oddi spasm?
A) 0.1 mg
B) 0.2 mg
C) 0.5 mg
D) 1 mg
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.
Which of the following medications is NOT commonly used to treat Sphincter of Oddi spasm?
A) Glucagon
B) Nitroglycerin
C) Naloxone
D) Epinephrine
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.
What is the first step in managing a laryngospasm intraoperatively?
A) Administering succinylcholine
B) Applying positive pressure ventilation with 100% oxygen
C) Administering naloxone
D) Starting chest compressions
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
Which maneuver can be used to help relieve a laryngospasm by stimulating deep breaths?
A) Trendelenburg maneuver
B) Larson’s maneuver
C) Valsalva maneuver
D) Heimlich maneuver
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.
What is the recommended dose of succinylcholine for treating a severe laryngospasm?
A) 0.2 mg/kg IV
B) 0.5 mg/kg IV
C) 1 mg/kg IV
D) 0.1 mg/kg IV
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.
If IV access is not available, what is the dose of succinylcholine that can be administered intramuscularly (IM) to treat laryngospasm?
A) 2 mg/kg IM
B) 4 mg/kg IM
C) 6 mg/kg IM
D) 10 mg/kg IM
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.
Which of the following actions should be avoided during a laryngospasm to prevent worsening of the condition?
A) Deepening anesthesia
B) Suctioning the airway
C) Applying excessive force during positive pressure ventilation
D) Using jaw thrust
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.
What is the estimated blood volume (EBV) for an adult male?
A) 50 mL/kg
B) 60 mL/kg
C) 70 mL/kg
D) 80 mL/kg
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.
What is the formula for calculating Allowable Blood Loss (ABL)?
A) ABL = (HCT_initial - HCT_final) × EBV / HCT_initial
B) ABL = (HCT_initial + HCT_final) × EBV / HCT_final
C) ABL = (HCT_initial × EBV) / (HCT_final + EBV)
D) ABL = HCT_initial × HCT_final / EBV
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.
What is the approximate volume of blood in a fully soaked lap sponge?
A) 50 - 75 mL
B) 100 - 150 mL
C) 150 - 200 mL
D) 200 - 250 mL
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.
What fluid replacement ratio is typically used for crystalloid fluids in response to blood loss?
A) 1:1
B) 1:2
C) 1:3
D) 1:4
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.
For a patient weighing 70 kg, what is the estimated blood volume (EBV)?
A) 3,500 mL
B) 4,200 mL
C) 5,000 mL
D) 6,000 mL
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.
Which of the following is an appropriate replacement fluid for blood loss when the patient is hemodynamically unstable?
A) D5W (5% dextrose in water)
B) Normal saline (0.9% NaCl)
C) Lactated Ringer’s solution
D) Packed red blood cells (PRBCs)
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.
What is a typical target final hematocrit (HCT_final) used in the ABL formula?
A) 10%
B) 20%
C) 30%
D) 40%
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.
Using the patient’s information (EBV = 5,250 mL, HCT_initial = 45%), what is the ABL if the target hematocrit (HCT_final) is 30%?
A) 1,250 mL
B) 1,750 mL
C) 2,100 mL
D) 2,625 mL
Answer: B) 1,750 mL
Rationale: ABL = EBV × (HCT_initial - HCT_final) / HCT_initial = 5,250 mL × (45 - 30) / 45 = 1,750 mL.
In the context of the ABL calculation, why is it important to pre-calculate the number of surgical mops or gauze needed based on the estimated blood loss?
A) To ensure that the patient does not lose any blood
B) To provide an immediate visual indicator of when allowable blood loss is reached
C) To replace mops frequently during surgery
D) To prevent the need for suctioning blood
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.
For a patient weighing 60 kg with an initial hematocrit of 40%, what is the EBV if the patient is an adult female?
A) 3,600 mL
B) 3,900 mL
C) 4,200 mL
D) 4,500 mL
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.
Using the above information, calculate the ABL if the target hematocrit (HCT_final) is 30%. Initial is 40% and EBV is 3,900mL.
A) 975 mL
B) 1,040 mL
C) 1,300 mL
D) 1,560 mL
Answer: A) 975 mL
3900 x (40 -30) / 40 = 975mL
What is the estimated blood volume (EBV) for a full-term neonate?
A) 65 mL/kg
B) 75 mL/kg
C) 85 mL/kg
D) 95 mL/kg
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.
What is the recommended estimated blood volume (EBV) for a morbidly obese patient (BMI > 40)?
A) 50 mL/kg
B) 60 mL/kg
C) 70 mL/kg
D) 80 mL/kg
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.
Which fluid replacement ratio is used for crystalloids in response to blood loss?
A) 1:1
B) 2:1
C) 3:1
D) 4:1
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.
What is the estimated blood volume (EBV) for a 10-year-old child?
A) 65-75 mL/kg
B) 70- 80 mL/kg
C) 65 - 85 mL/kg
D) 75- 85 mL/kg
A) 65-75 mL/kg
adult/child female is 65mL/Kg while the male is 75mL/Kg
Which replacement fluid has a 1:1 replacement ratio with blood loss? - select all
A) Crystalloids
B) Colloids
C) D5W (5% dextrose in water)
D) Albumin
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.
What is the EBV for a premature neonate?
A) 75 mL/kg
B) 80 mL/kg
C) 85 mL/kg
D) 95 mL/kg
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.
If a patient has lost 1,000 mL of blood, how much PRBC’s should be given to replace the loss?
A) 500 mL
B) 1,000 mL
C) 2,000 mL
D) 3,000 mL
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.
During surgery, you notice that there are 10 fully soaked 4 x 4 gauze pads and 3 fully soaked lap sponges. How much blood loss (Max) would you estimate based on this count?
A) 250 mL
B) 550 mL
C) 750 mL
D) 1,000 mL
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.
What is the maintenance fluid requirement for a 25 kg child using the 4-2-1 rule?
A) 35 mL/hr
B) 45 mL/hr
C) 55 mL/hr
D) 65 mL/hr
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
A 70 kg patient has been NPO for 8 hours. What is the estimated NPO fluid deficit?
A) 560 mL
B) 880 mL
C) 1,040 mL
D) 1,400 mL
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
Which of the following is an appropriate fluid replacement strategy for evaporative losses in a patient undergoing major abdominal surgery?
A) 0-2 mL/kg/hr
B) 2-4 mL/kg/hr
C) 4-8 mL/kg/hr
D) 8-12 mL/kg/hr
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.
How would you replace the NPO deficit in a 60 kg patient during the first hour of surgery?
A) Replace the entire deficit in the first hour
B) Replace 25% of the deficit in the first hour
C) Replace 50% of the deficit in the first hour
D) Replace the deficit evenly over the entire surgery
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.
For a 30 kg child undergoing minor surgery, what would be the estimated evaporative fluid loss replacement?
A) 0 mL/hr
B) 30 mL/hr
C) 6 mL/hr
D) 120 mL/hr
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
What is the BMI range for a person classified as overweight?
A) 18.5 - 24.9 kg/m²
B) 25 - 29.9 kg/m²
C) 30 - 34.9 kg/m²
D) 35 - 39.9 kg/m²
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.
Which BMI value classifies a person as morbidly obese (Obesity Class III)?
A) ≥ 30 kg/m²
B) ≥ 35 kg/m²
C) >35 kg/m²
D) ≥ 45 kg/m²
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.
A patient weighs 70 kg and is 1.75 m tall. What is their BMI?
A) 22.9 kg/m²
B) 24.5 kg/m²
C) 25.1 kg/m²
D) 27.8 kg/m²
Answer: A) 22.9 kg/m²
the calculation yields a BMI of 22.9 kg/m², which is within the normal weight range.
What is the classification for a BMI of 32 kg/m²?
A) Normal weight
B) Overweight
C) Obese
D) Morbidly Obese
Answer: C) Obese
Rationale: A BMI between 30 and 34.9 kg/m² falls into the Obesity Class I category
Which BMI range is associated with the lowest risk for health complications?
A) < 18.5 kg/m²
B) 18.5 - 24.9 kg/m²
C) 25 - 29.9 kg/m²
D) ≥ 40 kg/m²
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.
What is the formula for calculating the Ideal Body Weight (IBW) for men according to your reference guide?
A) Height (cm) - 100
B) Height (cm) - 105
C) Height (cm) - 110
D) Height (cm) - 95
Answer: A) Height (cm) - 100 = kg
Rationale: The formula for men is
IBW=Height(cm)−100, reflecting typical body composition standards.
What is the formula for calculating the Ideal Body Weight (IBW) for women?
A) Height (cm) - 100
B) Height (cm) - 105
C) Height (cm) - 110
D) Height (cm) - 95
Answer: B) Height (cm) - 105
Using the formula from the spreadsheet, what is the IBW for a male patient who is 180 cm tall?
A) 70 kg
B) 75 kg
C) 80 kg
D) 85 kg
Answer: C) 80 kg
IBW=180cm−100=80kg.
Which rescue drug is used as an alpha and beta agonist for treating hypotension?
A) Labetalol
B) Ephedrine
C) Neosynephrine
D) Dopamine
Answer: B) Ephedrine
Rationale: Ephedrine acts on both alpha and beta receptors, making it effective for increasing blood pressure in cases of hypotension.
What is the standard dose of Neosynephrine (Phenylephrine) for treating hypotension?
A) 50 mcg
B) 75 mcg
C) 100 mcg
D) 150 mcg
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.
What is the on-hand concentration of Ephedrine?
A) 5 mg/mL
B) 10 mg/mL
C) 25 mg/mL
D) 50 mg/mL
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.
Which drug from the list is specifically used to treat hypertension?
A) Neosynephrine
B) Ephedrine
C) Labetalol
D) Norepinephrine
Answer: C) Labetalol
Rationale: Labetalol is a beta antagonist used to lower blood pressure in cases of hypertension.
What is the standard dose of Labetalol for treating hypertension?
A) 2.5 mg
B) 5 mg
C) 7.5 mg
D) 10 mg
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.
What is the on-hand concentration of Neosynephrine?
A) 5 mg/mL
B) 10 mg/mL
C) 15 mg/mL
D) 20 mg/mL
Answer: B) 10 mg/mL
Rationale: Neosynephrine (Phenylephrine) is typically available in a concentration of 10 mg/mL. You will need to dilute.
What is the standard dose of Hydralazine for treating hypertension?
A) 5 mg
B) 10 mg
C) 15 mg
D) 20 mg
Answer: A) 5 mg
Rationale: The typical dose for Hydralazine is 5 mg, used for its arterial vasodilatory effects in managing elevated blood pressure.
What is the on-hand concentration of Hydralazine?
A) 5 mg/mL
B) 10 mg/mL
C) 15 mg/mL
D) 20 mg/mL
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
Which drug is a beta-blocker used for treating hypertension, with a typical dose of 10 mg?
A) Ephedrine
B) Esmolol
C) Neosynephrine
D) Labetalol
Answer: B) Esmolol
Rationale: Esmolol is a short-acting beta-blocker commonly used for acute hypertension, dosed at 10 mg.
What is the on-hand concentration of Esmolol?
A) 5 mg/mL
B) 10 mg/mL
C) 20 mg/mL
D) 40 mg/mL
Answer: B) 10 mg/mL
Rationale: Esmolol is provided at a concentration of 10 mg/mL, suitable for titrating doses during blood pressure management.
What is the normal hematocrit (Hct) range for females?
A) 35 - 45 g/dL
B) 37 - 47 g/dL
C) 40 - 50 g/dL
D) 42 - 52 g/dL
Answer: B) 37 - 47 g/dL
What is the normal hematocrit (Hct) range for males?
A) 37 - 47 g/dL
B) 40 - 50 g/dL
C) 42 - 52 g/dL
D) 45 - 55 g/dL
Answer: C) 42 - 52 g/dL
What is the normal hemoglobin (Hgb) range for females?
A) 12 - 14 g/dL
B) 13 - 15 g/dL
C) 14 - 16 g/dL
D) 15 - 16 g/dL
Answer: D) 15 - 16 g/dL
What is the normal hemoglobin (Hgb) range for males?
A) 12 - 14 g/dL
B) 13 - 17 g/dL
C) 14 - 18 g/dL
D) 15 - 20 g/dL
Answer: C) 14 - 18 g/dL
What is the normal white blood cell (WBC) count range?
A) 3,000 - 10,000/μL
B) 4,000 - 11,000/μL
C) 5,000 - 12,000/μL
D) 6,000 - 13,000/μL
Answer: B) 4,000 - 11,000/μL
What is the normal platelet (Plts) count range?
A) 100,000 - 400,000/μL
B) 120,000 - 450,000/μL
C) 150,000 - 450,000/μL
D) 200,000 - 500,000/μL
Answer: C) 150,000 - 450,000/μL
What is the normal potassium (K⁺) range?
A) 2.5 - 4.5 mEq/L
B) 3.0 - 5.0 mEq/L
C) 3.5 - 5.0 mEq/L
D) 4.0 - 5.5 mEq/L
Answer: C) 3.5 - 5.0 mEq/L
What is the normal magnesium (Mag) range?
A) 1.0 - 2.0 mEq/L
B) 1.5 - 2.5 mEq/L
C) 2.0 - 3.0 mEq/L
D) 2.5 - 3.5 mEq/L
Answer: B) 1.5 - 2.5 mEq/L
What is the normal calcium (Ca⁺⁺) range?
A) 7.5 - 9.5 mg/dL
B) 8.0 - 10.0 mg/dL
C) 8.5 - 10.5 mg/dL
D) 9.0 - 11.0 mg/dL
Answer: C) 8.5 - 10.5 mg/dL
What is the normal range for ionized calcium (Ionized Ca⁺⁺)?
A) 5.9 - 7.1 mmol/L
B) 1.1 - 1.3 mmol/L
C) 2.3 - 4.5 mmol/L
D) 2.5 - 3.7 mmol/L
Answer: B) 1.1 - 1.3 mmol/L
What is the normal phosphorus (Phos) range?
A) 1.0 - 2.0 mEq/L
B) 1.5 - 2.5 mEq/L
C) 1.8 - 2.6 mEq/L
D) 2.0 - 3.0 mEq/L
Answer: C) 1.8 - 2.6 mEq/L
What is the normal chloride (Cl⁻) range?
A) 95 - 105 mEq/L
B) 100 - 108 mEq/L
C) 102 - 112 mEq/L
D) 105 - 115 mEq/L
Answer: B) 100 - 108 mEq/L
What is the normal BUN (Blood Urea Nitrogen) range?
A) 5 - 15 mg/dL
B) 8 - 18 mg/dL
C) 10 - 20 mg/dL
D) 12 - 22 mg/dL
Answer: C) 10 - 20 mg/dL
What is the normal creatinine range?
A) 0.4 - 1.0 mg/dL
B) 0.6 - 1.3 mg/dL
C) 0.8 - 1.5 mg/dL
D) 1.0 - 2.0 mg/dL
Answer: B) 0.6 - 1.3 mg/dL
What is the normal albumin range?
A) 2.5 - 4.0 g/dL
B) 3.0 - 4.5 g/dL
C) 3.5 - 5.5 g/dL
D) 4.0 - 6.0 g/dL
Answer: C) 3.5 - 5.5 g/dL
What is the normal range for Prothrombin Time (PT)?
A) 10 - 12 sec
B) 11 - 14 sec
C) 15 - 18 sec
D) 19 - 22 sec
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.
What is the normal range for Partial Thromboplastin Time (PTT)?
A) 15 - 25 sec
B) 18 - 28 sec
C) 21 - 34 sec
D) 25 - 40 sec
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.
What is the normal value for the International Normalized Ratio (INR)?
A) 0.8
B) 1
C) 1.2
D) 1.5
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.
What is the normal range for Activated Clotting Time (ACT)?
A) 50 - 100 sec
B) 60 - 110 sec
C) 80 - 120 sec
D) 100 - 150 sec
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.
What is the normal value for Fibrin Split Products (FSP)?
A) <5 μ/dL
B) <10 μ/dL
C) <15 μ/dL
D) <20 μ/dL
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.
What is the normal range for fibrinogen?
A) 100 - 300 mg/dL
B) 160 - 450 mg/dL
C) 200 - 500 mg/dL
D) 250 - 600 mg/dL
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.
What is the normal range for plasminogen activity?
A) 50 - 100%
B) 60 - 120%
C) 62 - 130%
D) 70 - 140%
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.
What is the normal range for D-dimer levels?
A) <100 ng/dL
B) <150 ng/dL
C) <200 ng/dL
D) <250 ng/dL
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.
What is the normal range for Thyroid Stimulating Hormone (TSH)?
A) 0.1 - 0.3 μ units/mL
B) 0.4 - 4.0 μ units/mL
C) 0.5 - 5.0 μ units/mL
D) 1.0 - 6.0 μ units/mL
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.
What is the normal range for T3 (Triiodothyronine)?
A) 70 - 200 ng/dL
B) 80 - 210 ng/dL
C) 90 - 230 ng/dL
D) 100 - 250 ng/dL
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.
What is the normal range for T4 (Thyroxine)?
A) 10 - 12 mg/dL
B) 13 - 15 mg/dL
C) 13 - 19 mg/dL
D) 15 - 20 mg/dL
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.
What is the normal range for SGOT (AST) and SGPT (ALT)?
A) <15 IU/L
B) <25 IU/L
C) <35 IU/L
D) <45 IU/L
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.
What is the normal range for Fibrin Degradation Products (FDP)?
A) <5 μ/mL
B) <8 μ/mL
C) <10 μ/mL
D) <12 μ/mL
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
Which of the following agents is a known trigger for Malignant Hyperthermia (MH)?
A) Propofol
B) Halothane
C) Midazolam
D) Ketamine
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.
Which muscle relaxant is a common trigger for Malignant Hyperthermia?
A) Rocuronium
B) Vecuronium
C) Succinylcholine
D) Atracurium
Answer: C) Succinylcholine
Rationale: Succinylcholine is a depolarizing neuromuscular blocker that can trigger MH by causing uncontrolled calcium release in skeletal muscles.
What is a hallmark early sign of Malignant Hyperthermia during surgery?
A) Bradycardia
B) Decreased ETCO2
C) Rapidly increasing ETCO2
D) Hypothermia
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.
What is the initial treatment step if Malignant Hyperthermia is suspected?
A) Administer dantrolene immediately
B) Stop the triggering agent immediately
C) Give a diuretic
D) Administer propofol
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).
What is the recommended dose of dantrolene for treating Malignant Hyperthermia?
A) 1 mg/kg IV
B) 2.5 mg/kg IV
C) 5 mg/kg IV
D) 10 mg/kg IV
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.
Which laboratory abnormality is commonly seen in Malignant Hyperthermia?
A) Hypokalemia
B) Hyperkalemia
C) Hypoglycemia
D) Hypernatremia
Answer: B) Hyperkalemia
Rationale: Hyperkalemia occurs due to massive muscle breakdown (rhabdomyolysis) and the release of intracellular potassium into the bloodstream.
What is the recommended method for cooling a patient experiencing Malignant Hyperthermia?
A) Passive cooling only
B) Actively cool the patient using ice packs and cold IV fluids
C) Increase room temperature
D) Administer warm fluids
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.
What is the target urine output for a patient being treated for Malignant Hyperthermia?
A) >0.5 mL/kg/hr
B) >1 mL/kg/hr
C) >2 mL/kg/hr
D) >3 mL/kg/hr
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.
What should be checked every 15 minutes during the acute treatment of Malignant Hyperthermia?
A) Blood pressure only
B) Respiratory rate only
C) Laboratory values (e.g., potassium, blood gases)
D) Skin temperature only
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.
What is the recommended ETT size for a preemie weighing less than 1 kg?
A) 2.0
B) 2.5
C) 3.0
D) 3.5
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.
What ETT size is recommended for a preemie weighing between 1 and 2.5 kg?
A) 2.5
B) 3.0
C) 3.5
D) 4.0
Answer: B) 3.0
Rationale: A 3.0 ETT is generally appropriate for preemies weighing between 1 and 2.5 kg.
What is the typical ETT size for a term neonate (up to 6 months old)?
A) 2.5 - 3.0
B) 3.0 - 3.5
C) 3.5 - 4.0
D) 4.0 - 4.5
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.
Which ETT size is recommended for an infant aged 6 months to 1 year?
A) 2.5 - 3.0
B) 3.0 - 3.5
C) 3.5 - 4.0
D) 4.0 - 4.5
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.
For a child aged 1 to 2 years, what is the suggested ETT size?
A) 3.0 - 3.5
B) 3.5 - 4.0
C) 4.0 - 4.5
D) 4.5 - 5.0
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.
What is the formula for estimating the ETT size in children older than 2 years?
A) (Age + 12) / 3
B) (Age + 14) / 4
C) (Age + 16) / 4
D) (Age + 18) / 5
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.
Using the formula, what is the estimated ETT size for a 4-year-old child?
A) 4.0
B) 4.5
C) 5.0
D) 5.5
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.
Which ETT size should be considered for a 2-year-old child?
A) 3.5
B) 4.0
C) 4.5
D) 5.0
Answer: C) 4.5
Rationale: For a child aged 2 years, the formula suggests
(2+16)/4=4.5
What is the recommended LMA size for a pediatric patient weighing up to 5 kg?
A) Size 0.5
B) Size 1
C) Size 1.5
D) Size 2
Answer: B) Size 1
Rationale: An LMA size 1 is used for infants weighing up to 5 kg.
Which LMA size is appropriate for a child weighing between 5 and 10 kg?
A) Size 1
B) Size 1.5
C) Size 2
D) Size 2.5
Answer: B) Size 1.5
Rationale: For children weighing 5 to 10 kg, a size 1.5 LMA is recommended.
What is the maximum cuff volume for an LMA size 2?
A) 7 mL
B) 10 mL
C) 14 mL
D) 20 mL
Answer: B) 10 mL
Rationale: The maximum cuff volume for a size 2 LMA is 10 mL.
Which LMA size should be chosen for a child weighing 25 kg?
A) Size 1.5
B) Size 2
C) Size 2.5
D) Size 3
Answer: C) Size 2.5
Rationale: A size 2.5 LMA is recommended for children weighing between 20 and 30 kg.
What is the recommended LMA size for a child weighing more than 30 kg?
A) Size 2
B) Size 2.5
C) Size 3
D) Size 4
Answer: C) Size 3
Rationale: For children weighing more than 30 kg, a size 3 LMA is typically used.
What is the maximum cuff volume for an LMA size 3?
A) 10 mL
B) 14 mL
C) 20 mL
D) 30 mL
Answer: C) 20 mL
Rationale: The maximum cuff volume for a size 3 LMA is 20 mL.
Which LMA size is typically used for adult patients?
A) Size 2.5
B) Size 3
C) Size 4
D) Size 5
Answer: C) Size 4
Rationale: A size 4 LMA is commonly used for adult patients, with a maximum cuff volume of 30 mL.
What is the maximum cuff volume for an LMA size 1.5?
A) 4 mL
B) 5 mL
C) 7 mL
D) 10 mL
Answer: C) 7 mL
Rationale: The maximum cuff volume for a size 1.5 LMA is 7 mL.
What is the typical IV dose of Diazepam for sedation?
A) 0.05 mg/kg
B) 0.1 mg/kg
C) 0.2 mg/kg
D) 0.5 mg/kg
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.
What is the onset time for all benzos when administered intravenously?
A) 10 - 15 min
B) 5 - 10 min
C) 1 - 5 min
D) 30 - 60 min
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.
What is the duration of action for Lorazepam?
A) 15 - 30 min
B) 1 - 2 hr
C) 2 - 4 hr
D) 6 - 10 hr
Answer: D) 6 - 10 hr
Rationale: Lorazepam has a longer duration of action compared to other benzodiazepines, lasting 6 - 10 hours.
What is the typical duration of action for Midazolam?
A) 15 - 30 min
B) 15 - 80 min
C) 1 - 2 hr
D) 2 - 6 hr
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.
What is the dose range for Midazolam (Versed) when given intravenously?
A) 0.01 - 0.03 mg/kg
B) 0.05 - 0.1 mg/kg
C) 1 - 5 mg (0.05 mg/kg)
D) 5 - 10 mg
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.
What is the maximum dose of Flumazenil for reversing benzodiazepine sedation?
A) 1 mg
B) 2 mg
C) 3 mg
D) 5 mg
Answer: C) 3 mg
Rationale: The maximum recommended dose of Flumazenil, a benzodiazepine reversal agent, is 3 mg.
What is the typical IV dose of Flumazenil for benzodiazepine reversal?
A) 0.05 mg
B) 0.1 mg
C) 0.2 mg
D) 0.5 mg
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.
What is the onset time of Flumazenil when administered IV?
A) 10 - 15 min
B) 5 - 10 min
C) 1 - 5 min
D) 20 - 30 min
Answer: C) 1 - 5 min
Rationale: Flumazenil has a rapid onset of action, typically occurring within 1 - 5 minutes. (same as the benzos onset)
What is the typical duration of action for Flumazenil?
A) 10 min
B) 15 min
C) 30 min
D) 1 hr
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.
Which benzodiazepine has the shortest duration of action based on the table provided?
A) Diazepam
B) Lorazepam
C) Midazolam
D) Flumazenil
Answer: C) Midazolam
Rationale: Midazolam has a shorter duration (15 - 80 minutes) compared to Diazepam (2 - 6 hours) and Lorazepam (6 - 10 hours).
What is the typical IV dose of Lorazepam for sedation?
A) 0.02 mg/kg
B) 0.03 mg/kg
C) 0.04 mg/kg
D) 0.05 mg/kg
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.
What is the typical intraoperative dose range for Morphine?
A) 1 - 5 mg
B) 1 - 10 mg
C) 5 - 20 mg
D) 10 - 30 mg
Answer: B) 1 - 10 mg
Rationale: The intraoperative dose of Morphine typically ranges from 1 to 10 mg for pain management.
What is the standard postoperative dose range for Morphine?
A) 1 - 5 mg
B) 2 - 10 mg
C) 5 - 20 mg
D) 10 - 30 mg
Answer: C) 5 - 20 mg
Rationale: Morphine’s postoperative dosing is higher to manage sustained pain relief, typically 5 - 20 mg.
What is the onset time of Morphine when administered intravenously?
A) 5 - 10 min
B) 10 - 20 min
C) 20 - 30 min
D) 30 - 60 min
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)
What is the typical duration of action for Morphine?
A) 1 - 2 hr
B) 2 - 4 hr
C) 4 - 5 hr
D) 5 - 6 hr
Answer: C) 4 - 5 hr
Rationale: The duration of Morphine is 4 - 5 hours (longest of all opioids listed), providing sustained analgesia.
What is the typical intraoperative dose range for Fentanyl?
A) 0.5 - 1 μg/kg
B) 1 - 3 μg/kg
C) 2 - 5 μg/kg
D) 5 - 10 μg/kg
Answer: B) 1 - 3 μg/kg
Rationale: Fentanyl is commonly dosed at 1 - 3 μg/kg for intraoperative analgesia.
What is the onset time for Fentanyl when given IV?
A) 10 - 20 sec
B) 20 - 30 sec
C) 30 - 60 sec
D) 1 - 2 min
Answer: C) 30 - 60 sec
Rationale: Fentanyl has a rapid onset of action, occurring within 30 - 60 seconds.
What is the duration of action for Fentanyl?
A) 30 - 60 min
B) 1 - 1.5 hr
C) 2 - 3 hr
D) 3 - 4 hr
Answer: B) 1 - 1.5 hr
Rationale: Fentanyl’s duration is typically 1 - 1.5 hours, making it suitable for short procedures.
What is the dose range for Sufentanil during intraoperative use?
A) 0.1 - 0.3 μg/kg
B) 0.3 - 1 μg/kg
C) 1 - 2 μg/kg
D) 2 - 4 μg/kg
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.
What is the infusion rate for Remifentanil?
A) 0.05 - 0.1 μg/kg/hr
B) 0.125 - 0.375 μg/kg/min
C) 0.5 - 1 μg/kg/hr
D) 1 - 2 μg/kg/min
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.
What is the onset time for Sufentanil?
A) 10 - 20 sec
B) 20 - 40 sec
C) 30 - 60 sec
D) 1 - 2 min
Answer: C) 30 - 60 sec
Rationale: Sufentanil has a similar onset time to Fentanyl and remifentanil, typically within 30 - 60 seconds.
What is the typical dose of Meperidine for treating shivering?
A) 5 mg
B) 7.5 mg
C) 10 mg
D) 12.5 mg
Answer: D) 12.5 mg
Rationale: Meperidine is often used at a dose of 12.5 mg IV to treat postoperative shivering.
What is the duration of action for Hydromorphone?
A) 1 - 2 hr
B) 2 - 4 hr
C) 4 - 5 hr
D) 5 - 6 hr
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.
What is the standard dose range for Naloxone for opioid reversal?
A) 10 - 20 mcg
B) 20 - 40 mcg
C) 40 - 80 mcg
D) 80 - 100 mcg
Answer: C) 40 - 80 mcg
Rationale: Naloxone is dosed at 40 - 80 mcg for the reversal of opioid-induced respiratory depression.
What is the duration of action for Naloxone?
A) 10 min
B) 15 min
C) 30 min
D) 45 min
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.
Which opioid has the shortest duration of action?
A) Morphine
B) Fentanyl
C) Sufentanil
D) Remifentanil
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.
What is the typical infusion rate for Sufentanil?
A) 0.1 - 0.3 μg/kg/hr
B) 0.5 - 1 μg/kg/hr
C) 1 - 2 μg/kg/hr
D) 2 - 3 μg/kg/hr
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).
What is the duration of action for Sufentanil?
A) 30 - 60 min
B) 1 - 1.5 hr
C) 2 - 3 hr
D) 3 - 4 hr
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.
What is the onset time of Naloxone when given IV?
A) 10 - 30 sec
B) 30 sec - 1 min
C) 1 - 5 min
D) 5 - 10 min
Answer: C) 1 - 5 min
Rationale: Naloxone typically has an onset time of 1 - 5 minutes, allowing for rapid reversal of opioid effects.
What is the typical induction dose of Propofol?
A) 0.5 - 1 mg/kg
B) 1 - 1.5 mg/kg
C) 1.5 - 2.5 mg/kg
D) 3 - 4 mg/kg
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.
What is the maintenance infusion rate for Propofol when used for sedation?
A) 10 - 50 μg/kg/min
B) 25 - 100 μg/kg/min
C) 100 - 200 μg/kg/min
D) 200 - 300 μg/kg/min
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)
What is the typical maintenance infusion rate for Propofol during Total Intravenous Anesthesia (TIVA)?
A) 50 - 150 μg/kg/min
B) 100 - 300 μg/kg/min
C) 150 - 350 μg/kg/min
D) 200 - 400 μg/kg/min
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.
What is the onset time of Propofol?
A) 10 - 20 sec
B) 20 - 30 sec
C) 30 - 60 sec
D) 1 - 2 min
Answer: C) 30 - 60 sec
Rationale: Propofol has a rapid onset of action, typically occurring within 30 - 60 seconds.
What is the duration of action for Propofol?
A) 1 - 2 min
B) 1 - 8 min
C) 5 - 10 min
D) 10 - 20 min
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.
What is the induction dose of Etomidate?
A) 0.1 mg/kg
B) 0.2 mg/kg
C) 0.3 mg/kg
D) 0.4 mg/kg
Answer: C) 0.3 mg/kg
Rationale: Etomidate is typically dosed at 0.3 mg/kg for induction, known for its hemodynamic stability.
What is the onset time for Etomidate?
A) 10 sec
B) 30 sec
C) 1 min
D) 2 min
Answer: C) 1 min
Rationale: The onset of Etomidate is rapid, occurring within approximately 1 minute. (You can use this for RSI)
What is the induction dose range for Ketamine?
A) 0.1 - 0.5 mg/kg
B) 0.5 - 1.5 mg/kg
C) 1.5 - 2.5 mg/kg
D) 2 - 3 mg/kg
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.
What is the maintenance dose of Ketamine for IV analgesia?
A) 0.1 - 0.3 mg/kg
B) 0.2 - 0.5 mg/kg
C) 0.5 - 1 mg/kg
D) 1 - 2 mg/kg
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.
What is the IM dose range for Ketamine?
A) 2 - 4 mg/kg
B) 3 - 6 mg/kg
C) 4 - 8 mg/kg
D) 5 - 10 mg/kg
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.
What is the onset time for Ketamine when given IV?
A) 10 sec
B) 30 sec
C) 1 min
D) 2 min
Answer: C) 1 min
Rationale: Ketamine has a rapid onset of action, typically occurring within 1 minute when given IV.
What is the duration of action for Ketamine?
A) 5 - 10 min
B) 10 - 20 min
C) 20 - 30 min
D) 30 - 40 min
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.
What is the typical induction dose of Midazolam?
A) 0.05 - 0.1 mg/kg
B) 0.1 - 0.2 mg/kg
C) 0.2 - 0.3 mg/kg
D) 0.3 - 0.4 mg/kg
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.
What is the onset time of Midazolam when larger dose for induction?
A) 10 - 20 sec
B) 20 - 30 sec
C) 30 - 60 sec
D) 1 - 2 min
Answer: C) 30 - 60 sec
Rationale: Midazolam has a rapid onset of action, typically within 30 - 60 seconds.
What is the typical postoperative sedation and analgesia infusion dose for Ketamine, often used in pediatric heart cases?
A) 0.5 - 1 mg/kg/hr
B) 1 - 2 mg/kg/hr
C) 2 - 3 mg/kg/hr
D) 3 - 4 mg/kg/hr
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.
What two drugs are combined to create Ketofol?
A) Ketamine and Fentanyl
B) Ketamine and Midazolam
C) Ketamine and Propofol
D) Ketamine and Etomidate
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.
Why is Ketofol preferred over using Ketamine or Propofol alone for sedation?
A) It reduces the risk of hypotension and respiratory depression
B) It increases the duration of sedation
C) It prevents nausea completely
D) It eliminates the need for airway management
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.
What is a common mix ratio for Ketofol?
A) 2:1
B) 1:1
C) 1:2
D) 3:1
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.
What is the typical dose range for Ketofol in procedural sedation?
A) 0.2 - 0.5 mg/kg
B) 0.5 - 1 mg/kg
C) 1 - 2 mg/kg
D) 2 - 3 mg/kg
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.
Which medication is often administered alongside Ketofol to reduce the risk of excessive salivation from Ketamine?
A) Midazolam
B) Fentanyl
C) Atropine
D) Glycopyrrolate
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.
What effect does the Propofol component of Ketofol provide?
A) Analgesia and muscle relaxation
B) Antiemesis and sedation
C) Vasoconstriction and hypertension
D) Bronchodilation and increased heart rate
Answer: B) Antiemesis and sedation
Rationale: Propofol contributes sedation and antiemetic properties, complementing the analgesic effects of Ketamine.
What is a potential benefit of using Ketofol in pediatric sedation?
A) It eliminates the need for monitoring
B) It provides rapid onset with minimal cardiovascular effects
C) It increases the need for airway interventions
D) It prolongs the recovery time
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).
What is the MAC (Minimum Alveolar Concentration) of Sevoflurane?
A) 1.17%
B) 1.8%
C) 6.6%
D) 104%
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.
What is the blood
partition coefficient of Desflurane?
A) 0.42
B) 0.46
C) 0.69
D) 1.46
Answer: A) 0.42
Rationale: Desflurane has a low blood
coefficient (0.42), indicating rapid onset and recovery due to low solubility in blood.
Which inhalation agent has the highest vapor pressure?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous Oxide
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.
What is the MAC of Nitrous Oxide?
A) 1.8%
B) 6.6%
C) 1.17%
D) 104%
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.
Which inhalation agent has the highest blood
partition coefficient?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous Oxide
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).
What is the vapor pressure of Sevoflurane?
A) 157 mmHg
B) 238 mmHg
C) 669 mmHg
D) 38,770 mmHg
Answer: A) 157 mmHg
Rationale: Sevoflurane has a vapor pressure of 157 mmHg, indicating its volatility and the type of vaporizer needed for administration.
What is the blood
partition coefficient of Nitrous Oxide?
A) 0.42
B) 0.46
C) 0.69
D) 1.46
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).
Which inhalation agent has the lowest MAC, indicating the highest potency?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous Oxide
Answer: C) Isoflurane
Rationale: Isoflurane has a MAC of 1.17%, the lowest among the agents listed, indicating it is the most potent.
What is the vapor pressure of Isoflurane?
A) 157 mmHg
B) 238 mmHg
C) 669 mmHg
D) 38,770 mmHg
Answer: B) 238 mmHg
Rationale: Isoflurane has a vapor pressure of 238 mmHg, requiring specific calibration on an anesthesia vaporizer.
Which agent has the fastest onset and recovery due to its low blood
partition coefficient?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Nitrous Oxide
Answer: B) Desflurane
Rationale: Desflurane’s low blood
coefficient (0.42) contributes to its rapid onset and recovery.
What is the primary advantage of using Nitrous Oxide in anesthesia?
A) High potency as a sole anesthetic
B) Rapid onset and offset due to low blood solubility
C) Minimal cardiovascular effects
D) High vapor pressure for easy administration
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.
What is the significance of a low blood partition coefficient in inhalation agents like Desflurane?
A) Increased potency
B) Slower induction and emergence
C) Rapid induction and emergence
D) Higher risk of cardiovascular depression
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.
What class of drug is Dexmedetomidine?
A) Beta-1 agonist
B) Alpha-1 antagonist
C) Alpha-2 agonist
D) Beta-2 antagonist
Answer: C) Alpha-2 agonist
Rationale: Dexmedetomidine is an alpha-2 adrenergic agonist, providing sedation and analgesia without significant respiratory depression.
What is the on-hand concentration of Dexmedetomidine before mixing?
A) 100 mcg/mL
B) 200 mcg/mL
C) 50 mcg/mL
D) 4 mcg/mL
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.
How is Dexmedetomidine commonly mixed for administration?
A) In 50 mL of D5W
B) In 48 mL of normal saline (NS)
C) In 100 mL of lactated Ringer’s
D) In 10 mL of sterile water
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.
What is the final concentration of Dexmedetomidine after mixing 2mL in 48mL of NS?
A) 1 mcg/mL
B) 2 mcg/mL
C) 3 mcg/mL
D) 4 mcg/mL
Answer: D) 4 mcg/mL
Rationale: After mixing 200 mcg in 48 mL of saline, the final concentration is 4 mcg/mL.
What is the recommended bolus dose of Dexmedetomidine?
A) 0.1 - 0.3 mcg/kg
B) 0.3 - 0.5 mcg/kg
C) 0.5 - 1 mcg/kg
D) 1 - 2 mcg/kg
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.
Over what duration is the bolus dose of Dexmedetomidine administered?
A) 1 minute
B) 5 minutes
C) 10 minutes
D) 15 minutes
Answer: C) 10 minutes
Rationale: The bolus should be given slowly over 10 minutes to reduce the risk of bradycardia and hypotension.
What is the typical maintenance infusion rate for Dexmedetomidine?
A) 0.1 - 0.2 mcg/kg/hr
B) 0.2 - 0.7 mcg/kg/hr
C) 0.5 - 1 mcg/kg/hr
D) 1 - 2 mcg/kg/hr
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)
What is a common side effect of Dexmedetomidine that providers should monitor for during administration?
A) Tachycardia
B) Hypertension
C) Respiratory depression
D) Bradycardia
Answer: D) Bradycardia
Rationale: Dexmedetomidine can cause significant bradycardia due to its alpha-2 agonist effects, requiring careful monitoring.
Why might Dexmedetomidine be a preferred sedative in patients who require frequent neurological assessments?
A) It causes deep sedation with amnesia
B) It allows for easy awakening and minimal interference with neurological exams
C) It has a longer duration of action
D) It increases intracranial pressure
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.
What is the typical dose range for Succinylcholine (Anectine)?
A) 0.5 - 1 mg/kg
B) 0.6 - 1.2 mg/kg
C) 1 - 1.5 mg/kg
D) 2 - 2.5 mg/kg
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.
What is the onset time of Succinylcholine?
A) 10 - 20 sec
B) 30 - 60 sec
C) 2 - 3 min
D) 5 - 10 min
Answer: B) 30 - 60 sec
Rationale: Succinylcholine has a very rapid onset (30 - 60 seconds), making it the drug of choice for emergency intubations.
What is the duration of action for Succinylcholine?
A) 2 - 5 min
B) 5 - 10 min
C) 10 - 20 min
D) 20 - 30 min
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.
What is the typical dose for Cisatracurium (Nimbex)?
A) 0.05 mg/kg
B) 0.1 mg/kg
C) 0.2 mg/kg
D) 0.5 mg/kg
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.
What is the onset time for Cisatracurium?
A) 30 sec
B) 1 min
C) 2 - 3 min
D) 5 min
Answer: C) 2 - 3 min
Rationale: Cisatracurium has an onset time of 2 - 3 minutes, making it suitable for non-emergent intubations.
What is the typical duration of action for Cisatracurium?
A) 15 - 30 min
B) 20 - 40 min
C) 40 - 75 min
D) 60 - 90 min
Answer: C) 40 - 75 min
Rationale: Cisatracurium provides a duration of 40 - 75 minutes, allowing for sustained muscle relaxation during longer procedures.
What is the dose of Vecuronium (Norcuron)?
A) 0.05 mg/kg
B) 0.1 mg/kg
C) 0.2 mg/kg
D) 0.3 mg/kg
Answer: B) 0.1 mg/kg
Rationale: The recommended dose of Vecuronium is 0.1 mg/kg for neuromuscular blockade.
What is the typical onset time for Vecuronium (Norcuron)?
A) 30 sec
B) 1 - 2 min
C) 2 - 3 min
D) 4 - 5 min
Answer: C) 2 - 3 min
Rationale: Vecuronium has an onset time of 2 - 3 minutes, similar to Cisatracurium, making it useful for planned intubations.
What is the duration of action for Vecuronium (Norcuron)?
A) 20 - 30 min
B) 30 - 45 min
C) 45 - 90 min
D) 60 - 120 min
Answer: C) 45 - 90 min
Rationale: Vecuronium’s duration of action is 45 - 90 minutes, providing prolonged muscle relaxation.
What is the dose range for Rocuronium (Zemuron)?
A) 0.1 - 0.3 mg/kg
B) 0.4 - 0.6 mg/kg
C) 0.6 - 1.2 mg/kg
D) 1.0 - 2.0 mg/kg
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.
What is the onset time for a high dose (1.2 mg/kg) of Rocuronium?
A) 30 sec
B) 1 min
C) 1.5 min
D) 2 - 3 min
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
What is the duration of action for Rocuronium?
A) 20 - 40 min
B) 35 - 75 min
C) 60 - 90 min
D) 90 - 120 min
Answer: B) 35 - 75 min
Rationale: The duration of Rocuronium ranges from 35 to 75 minutes, depending on the dose and patient factors.
What is the standard dose for Pancuronium (Pavulon)?
A) 0.05 mg/kg
B) 0.1 mg/kg
C) 0.2 mg/kg
D) 0.3 mg/kg
Answer: B) 0.1 mg/kg
Rationale: Pancuronium is typically dosed at 0.1 mg/kg, known for its long duration of action.
What is the onset time for Pancuronium?
A) 1 - 2 min
B) 2 - 3 min
C) 5 - 7 min
D) 10 min
Answer: B) 2 - 3 min
Rationale: Pancuronium has an onset time of 2 - 3 minutes, similar to other non-depolarizing muscle relaxants.
What is the duration of action for Pancuronium?
A) 20 - 40 min
B) 40 - 60 min
C) 60 - 120 min
D) 90 - 150 min
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.
What is the typical dose range for Neostigmine?
A) 0.02 - 0.05 mg/kg
B) 0.04 - 0.07 mg/kg
C) 0.1 - 0.15 mg/kg
D) 0.5 - 1 mg/kg
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
What is the onset time of Neostigmine?
A) 1 - 2 min
B) 3 - 5 min
C) 5 - 10 min
D) 10 - 15 min
Answer: C) 5 - 10 min
Rationale: Neostigmine has an onset time of 5 - 10 minutes, making it important to administer well before planned extubation.
What is the duration of action for Neostigmine?
A) 20 - 30 min
B) 30 - 45 min
C) 60 min
D) 90 - 120 min
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.
What anticholinergic agent is commonly administered with Neostigmine, and at what dose?
A) Atropine, 0.1 mg per mg of Neostigmine
B) Glycopyrrolate, 0.2 mg per mg of Neostigmine
C) Scopolamine, 0.05 mg per mg of Neostigmine
D) Epinephrine, 0.2 mg per mg of Neostigmine
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.
What is the typical dose range for Sugammadex?
A) 1 - 4 mg/kg
B) 2 - 16 mg/kg
C) 5 - 10 mg/kg
D) 10 - 20 mg/kg
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.
What is the onset time of Sugammadex?
A) 30 sec - 1 min
B) 1 - 4 min
C) 5 - 10 min
D) 10 - 15 min
Answer: B) 1 - 4 min
Rationale: Sugammadex has a rapid onset of 1 - 4 minutes, allowing for quick reversal of neuromuscular blockade.
What is the typical duration of action for Sugammadex?
A) 30 - 60 min
B) 1 - 1.5 hours
C) 1.5 - 3 hours
D) 4 - 6 hours
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.
Which reversal agent does not require the co-administration of an anticholinergic drug?
A) Neostigmine
B) Atropine
C) Glycopyrrolate
D) Sugammadex
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.
What is a potential advantage of using Sugammadex over Neostigmine for reversal?
A) It has a slower onset time
B) It requires an anticholinergic agent
C) It can reverse deep neuromuscular blockades rapidly
D) It has a longer duration of action than Neostigmine
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.
Which of the following side effects is commonly associated with Neostigmine but not with Sugammadex?
A) Hypertension
B) Bradycardia
C) Tachycardia
D) Hypothermia
Answer: B) Bradycardia
Rationale: Neostigmine can cause bradycardia due to its cholinergic effects, necessitating the use of an anticholinergic agent like Glycopyrrolate.
You are preparing to reverse neuromuscular blockade in a 70 kg patient after a procedure. You decide to use Neostigmine. What is the appropriate dose for this patient?
A) 2.5 mg
B) 2.7 mg
C) 3.5 mg
D) 5 mg
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.
A 60 kg patient received 1.2 mg/kg of Rocuronium for rapid sequence induction. You now need to reverse the deep neuromuscular blockade using Sugammadex. What dose would you administer?
A) 120 mg
B) 240 mg
C) 360 mg
D) 960 mg
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.
You plan to use Sugammadex to reverse moderate neuromuscular blockade in a 50 kg patient after using Rocuronium. The patient has 1 twitches on train-of-four (TOF) monitoring post tetanic. What is the appropriate dose of Sugammadex?
A) 50 mg
B) 100 mg
C) 200 mg
D) 400 mg
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
A 90 kg patient is at risk of significant bradycardia during reversal of neuromuscular blockade. You decide to administer Neostigmine with Glycopyrrolate. What is the appropriate dose of Glycopyrrolate if you give 4 mg of Neostigmine?
A) 0.2 mg
B) 0.6 mg
C) 0.8 mg
D) 1.0 mg
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.
You are reversing neuromuscular blockade for a 70 kg patient using Neostigmine and Glycopyrrolate. The standard concentrations available are Neostigmine at 1 mg/mL and Glycopyrrolate at 0.2 mg/mL. You decide to administer 0.05 mg/kg of Neostigmine. Calculate the required volume of Neostigmine and Glycopyrrolate, and determine if they should be mixed in the same syringe. Also, which medication should be given first if administered separately?
A) 3.5 mL of Neostigmine and 0.7 mL of Glycopyrrolate; mix in the same syringe; give the mixture together.
B) 3.5 mL of Neostigmine and 3.5 mL of Glycopyrrolate; mix in the same syringe; give the mixture together.
C) 3.5 mL of Neostigmine and 3.5 mL of Glycopyrrolate; do not mix in the same syringe; give Glycopyrrolate first.
D) 2.5 mL of Neostigmine and 2.5 mL of Glycopyrrolate; do not mix in the same syringe; give Neostigmine first.
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.
A patient’s TEG-ACT is measured at 160 seconds. Which blood product is recommended based on this value?
A) Platelets
B) Cryoprecipitate
C) Fresh Frozen Plasma (FFP)
D) Tranexamic Acid
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.
The R time on a patient’s TEG is found to be 12 minutes. What is the appropriate transfusion recommendation?
A) Cryoprecipitate
B) Platelets
C) Fibrinogen concentrate
D) Fresh Frozen Plasma (FFP)
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.
A patient’s K time is measured at 4 minutes. Which blood product should be administered?
A) Platelets
B) Cryoprecipitate
C) FFP
D) Tranexamic Acid
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.
The α angle on a TEG is recorded at 50 degrees. What is the recommended transfusion based on this value?
A) FFP
B) Platelets
C) Cryoprecipitate ± Platelets
D) Tranexamic Acid
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.
The MA (Maximum Amplitude) on a TEG is 45 mm. Which transfusion product is most appropriate?
A) Cryoprecipitate
B) Platelets
C) FFP
D) Tranexamic Acid
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.
The LY30 (Lysis at 30 minutes) value is measured at 5%. What treatment is recommended?
A) Fibrinogen concentrate
B) Cryoprecipitate
C) Platelets
D) Tranexamic Acid
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.
TEG VALUES Overview:
TEG-ACT: ≤ 140 seconds
R Time: 5 - 10 minutes
K Time: 1 - 3 minutes
α Angle: 53 - 72 degrees
Maximum Amplitude (MA): 50 - 70 mm
LY30 (Lysis at 30 minutes): < 3%
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.
What is the maximum dose of Lidocaine without Epinephrine?
A) 3 mg/kg
B) 5 mg/kg
C) 7 mg/kg
D) 10 mg/kg
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.
What is the maximum dose of Lidocaine when Epinephrine is added?
A) 5 mg/kg
B) 6 mg/kg
C) 7 mg/kg
D) 8 mg/kg
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.
What is the maximum dose of Bupivacaine with or without Epinephrine?
A) 2 mg/kg
B) 2.5 mg/kg
C) 3 mg/kg
D) 3.5 mg/kg
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.
Which local anesthetic has the highest maximum dose when Epinephrine is added?
A) Lidocaine
B) Procaine
C) Chloroprocaine
D) Tetracaine
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.
What is the maximum dose of Ropivacaine without Epinephrine?
A) 2 mg/kg
B) 3 mg/kg
C) 4 mg/kg
D) 5 mg/kg
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.
What is the maximum dose of Prilocaine when Epinephrine is used?
A) 5 mg/kg
B) 6 mg/kg
C) 7.5 mg/kg
D) 8.5 mg/kg
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.
What is the maximum dose of Tetracaine, with or without Epinephrine?
A) 2 mg/kg
B) 3 mg/kg
C) 4 mg/kg
D) 5 mg/kg
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.
A patient weighing 80 kg requires Mepivacaine for a regional block. What is the maximum allowable dose without Epinephrine?
A) 240 mg
B) 300 mg
C) 400 mg
D) 560 mg
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.
For an 70 kg patient, what is the maximum dose of Chloroprocaine when Epinephrine is added?
A) 490 mg
B) 700 mg
C) 840 mg
D) 980 mg
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.
Which local anesthetic is categorized as an ester?
A) Bupivacaine
B) Ropivacaine
C) Procaine
D) Mepivacaine
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
What is the typical concentration range of Bupivacaine used for an epidural in CSE labor analgesia?
A) 0.05 - 0.1%
B) 0.0625 - 0.125%
C) 0.2 - 0.3%
D) 0.5 - 1.0%
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.
What is the typical dose range for Bupivacaine used in a spinal block for CSE labor analgesia?
A) 0.5 - 1 mg
B) 1.25 - 2.5 mg
C) 3 - 5 mg
D) 5 - 10 mg
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.
What is the typical concentration range of Ropivacaine used for an epidural in CSE labor analgesia?
A) 0.05 - 0.1%
B) 0.08 - 0.2%
C) 0.2 - 0.3%
D) 0.3 - 0.5%
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.
What is the typical CSE dose range of Ropivacaine for spinal analgesia during labor?
A) 1 - 2 mg
B) 2.5 - 4.5 mg
C) 5 - 7 mg
D) 8 - 10 mg
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.
What is the dose of Lidocaine with Epinephrine used as a bolus for epidural analgesia in labor?
A) 1% in 3 mL
B) 1.5% in 10 mL
C) 2% in 5 mL
D) 2% in 10 mL
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.
What is the dose range of Fentanyl when used in a spinal block for labor analgesia?
A) 5 - 10 mcg
B) 10 - 25 mcg
C) 25 - 50 mcg
D) 50 - 100 mcg
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.
What is the typical dose range of Sufentanil for spinal analgesia during labor?
A) 0.5 - 1 mcg
B) 1 - 1.5 mcg
C) 1.5 - 5 mcg
D) 5 - 10 mcg
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.
What is the dose range of Morphine used in spinal analgesia for labor?
A) 0.01 - 0.05 mg
B) 0.05 - 0.1 mg
C) 0.1 - 0.2 mg
D) 0.2 - 0.5 mg
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.
What is the typical dose of Droperidol used for postoperative nausea and vomiting (PONV)?
A) 0.1 mg
B) 0.625 mg
C) 2 mg
D) 4 mg
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.
What is the onset time of Promethazine when given IV?
A) 10 - 20 sec
B) 1 - 5 min
C) 10 - 15 min
D) 20 - 30 min
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.
What is the typical dose of Ondansetron used for PONV?
A) 2 mg
B) 4 mg
C) 6 mg
D) 8 mg
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.
What is the duration of action for Ondansetron?
A) 2 - 4 hr
B) 4 - 9 hr
C) 10 - 12 hr
D) 12 - 24 hr
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.
What is the typical dose of Dexamethasone used for PONV prophylaxis?
A) 1 mg
B) 2 mg
C) 4 mg
D) 8 mg
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.
What is the onset time for Dexamethasone when used for PONV prophylaxis?
A) 1 - 5 min
B) 5 - 10 min
C) 10 - 30 min
D) 30 - 60 min
Answer: C) 10 - 30 min
Rationale: Dexamethasone has an onset time of 10 - 30 minutes when given IV, providing delayed but prolonged antiemetic effects.
What is the typical dose range for Metoclopramide in PONV treatment?
A) 2 - 5 mg
B) 5 - 10 mg
C) 10 - 20 mg
D) 20 - 40 mg
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.
What is the duration of action for Metoclopramide?
A) 30 min - 1 hr
B) 1 - 2 hr
C) 2 - 4 hr
D) 4 - 6 hr
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.
How is Scopolamine typically administered for PONV, and what is its duration of action?
A) IV injection, 2 - 4 hr
B) Oral tablet, 4 - 6 hr
C) Patch, 72 hr
D) Sublingual tablet, 24 hr
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.
What is the typical bolus dose of Propofol used for antiemetic effects, followed by an infusion rate?
A) 5 - 10 mg IV bolus, followed by 5 μg/kg/min
B) 10 - 15 mg IV bolus, followed by 10 μg/kg/min
C) 20 - 30 mg IV bolus, followed by 15 μg/kg/min
D) 25 - 50 mg IV bolus, followed by 20 μg/kg/min
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.
What is the typical dose range for Promethazine when used for nausea and vomiting?
A) 2.5 - 10 mg
B) 6.25 - 25 mg
C) 10 - 20 mg
D) 25 - 50 mg
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.
Which of the following is a risk factor for PONV?
A) Male gender
B) Age over 60
C) History of motion sickness
D) Cardiac surgery
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.
Which type of surgery is associated with a higher risk of PONV?
A) Hip replacement
B) Laparoscopic surgery
C) Cardiac catheterization
D) Skin biopsy
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.
What is the chance of experiencing PONV if a patient has two risk factors?
A) 10%
B) 20%
C) 40%
D) > 60%
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
How many prophylactic antiemetic drugs are recommended if a patient has three or more risk factors for PONV?
A) None
B) One drug
C) Two drugs
D) Three or more drugs
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.
Which of the following strategies can be used for patients with risk factors for PONV?
A) Dexamethasone administration
B) Metoclopramide infusion
C) Avoiding volatile anesthetics
D) High-dose Ondansetron
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.
What percentage risk of PONV is associated with a single risk factor?
A) 10%
B) 20%
C) 30%
D) 50%
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.
A 35-year-old female with a history of motion sickness is undergoing gynecologic surgery. How many risk factors for PONV does she have?
A) One
B) Two
C) Three
D) Four
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
Which of the following patients is least likely to experience PONV?
A) A 25-year-old female undergoing laparoscopic surgery
B) A 50-year-old male with a history of PONV
C) A 30-year-old female undergoing strabismus surgery
D) A 65-year-old male with getting a hip replacement
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.
For a patient with two risk factors, which treatment strategy is recommended according to the algorithm?
A) Non-pharmacologic measures only
B) One antiemetic drug
C) Two antiemetic drugs
D) Three or more antiemetic drugs
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.
Which surgical procedure is considered high risk for PONV according to the list of risk factors?
A) Laparotomy
B) Knee arthroscopy
C) Carpal tunnel release
D) Thyroidectomy
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.
What is the typical dose of Acetaminophen (Ofirmev) for pain management?
A) 250 mg q4-6h
B) 500 mg q6h
C) 1000 mg q4-6h
D) 2000 mg q8h
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
What is the maximum daily dose of Acetaminophen to avoid toxicity?
A) 2000 mg
B) 3000 - 4000 mg
C) 5000 mg
D) 6000 mg
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.
What is the recommended dose range for Ketorolac (Toradol) when given every 6 hours?
A) 5 - 10 mg
B) 15 - 30 mg
C) 40 - 60 mg
D) 50 - 100 mg
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.
What is the maximum daily dose of Ketorolac (Toradol) to avoid potential adverse effects?
A) 30 mg
B) 60 - 120 mg
C) 150 mg
D) 200 mg
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).
What is the typical dose range for Ibuprofen (Caldor) when administered every 6 hours for pain management?
A) 100 - 300 mg
B) 200 - 800 mg
C) 400 - 1200 mg
D) 500 - 1000 mg
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.
What is the maximum daily dose of Ibuprofen to prevent adverse effects?
A) 1000 mg
B) 2000 mg
C) 3200 mg
D) 4000 mg
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.
Which non-opioid analgesic is preferred for patients with a history of peptic ulcer disease?
A) Acetaminophen
B) Ketorolac
C) Ibuprofen
D) Aspirin
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.
Which non-opioid analgesic should be avoided in patients with significant renal impairment?
A) Acetaminophen
B) Ketorolac
C) Ibuprofen
D) Dexamethasone
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
What is the initial bolus dose of Intralipid 20% for treating Local Anesthetic Systemic Toxicity (LAST)?
A) 0.5 mL/kg
B) 1 mL/kg
C) 1.5 mL/kg
D) 2 mL/kg
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.
If the patient remains unstable after the initial bolus, what is the next step in the treatment algorithm?
A) Administer another bolus of 1.5 mL/kg immediately
B) Start chest compressions and increase the infusion rate to 0.5 mL/kg/min
C) Repeat the bolus every 3 - 5 minutes, up to a maximum of 3 mL/kg
D) Discontinue lipid infusion and switch to epinephrine
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.
What is the maximum cumulative dose of Intralipid 20% to avoid lipid overload?
A) 5 mL/kg
B) 6 mL/kg
C) 7 mL/kg
D) 8 mL/kg
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.
In patients weighing less than 20 kg, what adjustment should be considered for the initial bolus dose for Intralipid rescue?
A) Increase the dose to 2 mL/kg
B) Reduce the bolus to 1 mL/kg and titrate up slowly
C) Use the standard 1.5 mL/kg dose without adjustments
D) Skip the bolus and start a continuous infusion
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.
What infusion rate should be initiated after the initial bolus of Intralipid 20%?
A) 0.1 mL/kg/min
B) 0.25 mL/kg/min
C) 0.5 mL/kg/min
D) 1 mL/kg/min
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.
Which of the following temperatures indicates mild hypothermia in Celsius?
A) 36.5°C
B) 35.5°C
C) 34.5°C
D) 33°C
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.
What is 98.6°F in Celsius?
A) 35°C
B) 36°C
C) 37°C
D) 38°C
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
A patient’s temperature is measured at 40.5°C. What is this temperature in Fahrenheit?
A) 100°F
B) 103°F
C) 104.9°F
D) 105.8°F
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.
Which temperature corresponds to severe hypothermia?
A) 36°C
B) 35.5°C
C) 34.5°C
D) 37.5°C
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.
A postoperative patient presents with a body temperature of 101.3°F. What is this temperature in Celsius, and what does it indicate?
A) 36.5°C, Normal
B) 37.5°C, Mild fever
C) 38.5°C, Hyperthermia
D) 39.5°C, Severe fever
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.
What is the normal body temperature range in Celsius?
A) 35 - 36.5°C
B) 36 - 37.5°C
C) 37 - 38.5°C
D) 38 - 40°C
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.
A patient’s temperature drops to 94.1°F during surgery. What is this temperature in Celsius, and what are the implications?
A) 34.5°C, Mild hypothermia
B) 34.5°C, Severe hypothermia
C) 35.5°C, Normal
D) 37°C, Normal
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.
If a patient’s temperature is 39.5°C, what is the equivalent in Fahrenheit, and what clinical condition might this suggest?
A) 101°F, Mild fever
B) 102°F, Hyperthermia
C) 103.1°F, High fever
D) 104.3°F, Malignant hyperthermia
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.
If the CT (Clotting Time) is prolonged on ROTEM, indicating delayed clot formation, what is the recommended treatment?
A) Platelets
B) Cryoprecipitate
C) Fresh Frozen Plasma (FFP) or Prothrombin Complex Concentrate (PCC)
D) Tranexamic Acid (TXA)
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.
Which ROTEM parameter indicates the strength of the clot, and what treatment is suggested if it is too low?
A) CT; give FFP
B) MCF (Maximum Clot Firmness); check FIBTEM MCF or give Platelets
C) LI30; give TXA
D) α-Angle; give Cryoprecipitate
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.
What intervention is recommended if the LI30 (Lysis Index at 30 minutes) is elevated, indicating excessive fibrinolysis?
A) Cryoprecipitate
B) FFP
C) Prothrombin Complex Concentrate
D) Tranexamic Acid (TXA)
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.
In a patient with low FIBTEM MCF, what is the recommended blood product to administer?
A) Platelets
B) Cryoprecipitate
C) FFP
D) TXA
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.
If ROTEM shows a normal FIBTEM MCF but a low platelet function, what is the recommended course of action?
A) Give FFP
B) Give Cryoprecipitate
C) Administer Platelets
D) Give TXA
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.
What does a prolonged CT indicate on ROTEM, and which underlying issue does it usually represent?
A) Weak clot strength; low fibrinogen
B) Delayed clot formation; coagulation factor deficiency
C) Rapid clot breakdown; hyperfibrinolysis
D) Normal clotting function; no intervention needed
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.
What is the sequence of assessment on the ROTEM flowchart?
A) How strong? → For how long? → How fast?
B) For how long? → How strong? → How fast?
C) How fast? → How strong? → For how long?
D) How strong? → How fast? → For how long?
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).
