Unit 1 Module 1 (Exam 1) Flashcards
New year, new semster, new challenges.
Ready?
Slide 7
What was the population of the United States in 2022?
A. 330 million
B. 331.1 million
C. 350 million
D. 310.2 million
B. 331.1 million
Slide 8
By 2030, what percentage of the U.S. population is projected to be over 65 years old?
A. 17%
B. 18%
C. 20%
D. 25%
C. 20% (one out of five people)
In 2022 only 17.5% were over the age of 65
Slie 8
Which factor contributes to IV access difficulties in elderly orthopedic patients? Select 2
A. Overhydration
B. Frail skin
C. Improved vein elasticity
D. Enhanced skin integrity
E. Movable veins
B. Frail skin
E. Movable veins
Slide 9
Why are thrombus risks increased in elderly patients undergoing orthopedic procedures?
A. Frequent physical activity
B. Decreased cortisol
C. Hyperhydration
D. Sedentary lifestyle
D. Sedentary lifestyle
Slide 9
Common comorbidities in elderly orthopedic patients include ______ and ______.
A. Coronary artery disease, anemia
B. Diabetes, enhanced immunity
C. Arthritis, overhydration
D. Hypertension, improved bone density
A. Coronary artery disease, anemia
Slide 9
Preoperative assessments for elderly patients should include questions about ______ therapy.
A. Antibiotic
B. Anticoagulant
C. Vitamin
D. Pain management
B. Anticoagulant
Slide 9
Intraoperative positioning challenges in elderly patients are often due to ______ and ______.
A. Blood pressure, oxygenation issues
B. Enhanced mobility, vascular health
C. Muscle flexibility, hydration levels
D. Joint stiffness, bone fragility
D. Joint stiffness, bone fragility
slide 9
Which hormone increases in osteoporosis, contributing to bone density loss?
A. Growth hormone
B. Parathyroid hormone
C. Insulin-like growth factor
D. Estrogen
B. Parathyroid hormone
Slide 11
What are common causes of osteoporosis and fractures? (Select 2)
A. Decreased parathyroid hormone
B. Decreased growth hormone
C. Postmenopausal
D. Increased vitamin D levels
B. Decreased growth hormone
C. Postmenopausal
Slide 11
What factors contribute to decreased bone density in osteoporosis?
(Select 2)
A. Diminished insulin-like growth factors
B. Decreased parathyroid hormone levels
C. Decreased vitamin D levels
D. Premenopausal
A. Diminished insulin-like growth factors
C. Decreased vitamin D levels
Slide 11
Which bones are commonly fractured in patients with osteoporosis? (Select 3)
A. Proximal femur
B. Humerus
C. Skull
D. Wrist
E. Cervical Spine
A. Proximal femur
B. Humerus
D. Wrist
Slide 12
The thoracic and lumbar spine are prone to ______ fractures in patients with osteoporosis.
A. Stress
B. Compression
C. Spiral
D. Greenstick
B. Compression
Vertebral compression fractures in the spine are treated with a minimally invasive procedure called kyphoplasty
Stress fractures are tiny cracks in a bone. They’re caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances, usually happen in the lower legs or feet.
Slide 12
Which medication is NOT used to manage osteoporosis?
A. Fosamax
B. Actonel
C. Osteona
D. Reclast
E. Boniva
C. Osteona - completely made up name by me :)
Slide 12
Osteoarthritis is characterized by a loss of ______ cartilage, leading to inflammation.
A. Articular
B. Elastic
C. Compact
D. Spongy
A. Articular
“Bone on bone”
Slide 13
______% of patients over 65 with osteoarthritis experience physical limitations due to pain.
A. 5
B. 8
C. 12
D. 15
B. 8
Slide 13
What are common symptoms of osteoarthritis? (Select 3)
A. Pain
B. Crepitus
C. Increased joint strength
D. Decreased mobility
E. Improved circulation
A. Pain
B. Crepitus
D. Decreased mobility
Slide 14
What is crepitus in the context of osteoarthritis?
A. Tendons breaking
B. A type of bone fracture
C. Joint laxity
D. A scraping or popping sound
D. A scraping or popping sound
Either it’s between bone and cartilage or bone and bone
Slide 14
Which medications are used to manage osteoarthritis symptoms? (Select 3)
A. Fosamax
B. Celebrex
C. Opioids
D. NSAIDs
E. Antibiotics
B. Celebrex
C. Opioids
D. NSAIDs
Slide 14
Heberden nodes in osteoarthritis are characterized by swelling of the:
A. Proximal interphalangeal joints
B. Distal interphalangeal joints
C. Wrist joints
D. Metacarpophalangeal joints
B. Distal interphalangeal joints
Slide 15
Bouchard nodes are associated with swelling and spurring of the ______ interphalangeal joints.
A. Distal
B. Wrist
C. Metacarpophalangeal
D. Proximal
D. Proximal
Slide 15
Non-pharmacologic treatments for osteoarthritis include ______ and ______ therapy to improve mobility and reduce joint pain.
A. Massage, opioid
B. Hydrotherapy, steroid
C. Surgical, NSAIDs
D. Acupuncture, occupational
D. Acupuncture, occupational
Slide 16
______ therapy and ______ are non-pharmacologic strategies used to manage osteoarthritis symptoms.
A. Occupational , TENS
B. Physical, corticosteroids
C. Massage, NSAIDs
D. TENS, opioids
A. Occupational, TENS
Slide 16
TENS stands for ______ Electro Nerve Stimulation.
A. Transcutaneous
B. Transient
C. Temporary
D. Transitional
A. Transcutaneous
Slide 16
Which NSAID is commonly prescribed for osteoarthritis?
A. Ibuprofen
B. Celecoxib
C. Meloxicam
D. Acetaminophen
C. Meloxicam
(Castillos mom takes it)
slide 17
What is a key concern with overuse of topical treatments like Voltaren (Diclofenac)?
A. They do not provide effective pain relief.
B. They can cause peptic ulcer disease
C. They are not absorbed into the body.
D. They promote cartilage regrowth.
B. They can cause peptic ulcer disease and systemic side effects.
Slide17
Celecoxib is classified as a:
A. COX-2 inhibitor
B. NSAID
C. Topical analgesic
D. Chondroprotective agent
A. COX-2 inhibitor
slide 17
Intra-articular therapy involves:
A. Oral NSAIDs
B. Topical treatments
C. Steroid injections
D. Acupuncture
C. Steroid injections
Can cause GI symptoms
slide 17
______ and ______ are examples of chondroprotective agents used in osteoarthritis management.
A. Glucosamine, chondroitin
B. Celecoxib, Voltaren
C. Meloxicam, acetaminophen
D. Ibuprofen, steroids
A. Glucosamine, chondroitin
Stop at least 2 weeks prior to surgery
Can also inculde Garlic, Ginko
Slide 17
Rheumatoid arthritis is primarily characterized as a:
Select 2
A. Chronic disesase
B. Acute with localized cartilage destruction
C. Temporary autoimmune condition
D. Chronic adipose disease
E. Systemic inflammatory disease
F. Lupus
A.Chronic disease
E. Systemic inflammatory disease
Slide 18
In rheumatoid arthritis, connective and ______ tissue inflammation leads to ______.
A. Synovial, bone erosion
B. Ligament, joint repair
C. Muscle, ligament repair
D. Cartilage, increased mobility
A. Synovial, bone erosion
Slide 18
______ and ______ are progressive outcomes of untreated rheumatoid arthritis.
A. Muscle regeneration, ligament repair
B. Bone erosion, enhanced mobility
C. Synovial thickening, improved flexibility
D. Cartilage destruction, impaired joint integrity
D. Cartilage destruction, impaired joint integrity
Slide 18
Rheumatoid arthritis commonly affects the ______ and ______ joints, causing pain and stiffness.
A. Wrists, metacarpophalangeal
B. Knees, shoulders
C. Distal interphalangeal, proximal interphalangeal
D. Spine, hip
A. Wrists, metacarpophalangeal
Slide 19
Rheumatoid nodules are typically found:
A. On muscle surfaces and on flexor surfaces
B. Only on distal interphalangeal joints
C. Around tendons in the spine
D. Surrounding joints and on extensor surfaces
D. Surrounding joints and on extensor surfaces
Slide 19
What is a distinguishing feature of subcutaneous rheumatoid nodules compared to Heberden and Bouchard nodes?
A. They are nonspecific and not limited to certain joints.
B. They are always found on the distal interphalangeal joints.
C. They are always proximal to the wrist.
D. They are associated with cartilage regrowth.
A. They are nonspecific and not limited to certain joints.
Slide 19
Systemic symptoms of rheumatoid arthritis include ______, ______, and weakness.
A. Weight gain, insomnia
B. Fatigue, anorexia
C. Joint swelling, cartilage growth
D. Increased mobility, strength
B. Fatigue, anorexia
Slide 19
______ and ______ are lab tests that help confirm the diagnosis of rheumatoid arthritis.
A. Rheumatoid factor, anti-immunoglobulin antibody
B. C-reactive protein, calcium
C. Erythrocyte sedimentation rate, glucose
D. Hematocrit, hemoglobin
A. Rheumatoid factor, anti-immunoglobulin antibody
Slide 20
______ and ______ are tests used to monitor systemic inflammation in rheumatoid arthritis patients.
A. Anti-immunoglobulin antibody, calcium
B. Rheumatoid factor, hemoglobin
C. Erythrocyte sedimentation rate, C-reactive protein
D. Platelet count, creatinine
C. Erythrocyte sedimentation rate, C-reactive protein
Slide 20
Which first line medication is commonly administered as a stress dose prior to procedures for rheumatoid arthritis patients?
A. Acetaminophen
B. Hydrocortisone
C. Celecoxib
D. Ibuprofen
B. Hydrocortisone
Usually…hydrocortisone, dexamethasone, or another mineralcorticoid could be of lesser dose range.
Glucocorticoids –> Stress Dose 100mg Hydrocortisone
Slide 21
Methotrexate (MTX) is a ______ that helps suppress the immune system and is classified as a ______.
A. DMARD, first-line treatment
B. NSAID, pain reliever
C. Biologic agent, chondroprotective agent
D. Glucocorticoid, TNF inhibitor
A. DMARD, first-line treatment
Slide 21
______ and ______ are biologic agents that target tumor necrosis factor (TNF) in rheumatoid arthritis treatment.
A. Infliximab (Remicade), Etanercept (Enbrel)
B. Methotrexate (MTX), Hydroxychloroquine
C. Sulfasalazine, Leflunomide
D. NSAIDs, opioids
A. Infliximab (Remicade), Etanercept (Enbrel)
Slide 21
Sulfasalazine and leflunomide are classified as ______, which are commonly used to manage ______ in rheumatoid arthritis.
A. Opioids, joint mobility
B. Biologic agents, pain
C. NSAIDs, cartilage degeneration
D. DMARDs, inflammation
D. DMARDs, inflammation
Slide 21
Preoperative evaluation for a rheumatoid arthritis patient should include ______ and ______ to assess for airway challenges.
A. Neck circumference, vocal resonance
B. Nasal airflow, jaw alignment
C. TMJ mobility, cervical spine range of motion
D. Glottic flexibility, shoulder extension
C. TMJ mobility, cervical spine range of motion
Slide 22
Cricoarytenoid arthritis can cause ______ and ______, requiring careful airway management in rheumatoid arthritis patients.
A. Hoarseness, glottic narrowing
B. Jaw pain, spinal curvature
C. Nasal congestion, throat swelling
D. Vocal resonance, synovial fluid accumulation
A. Hoarseness, glottic narrowing
Slide 22
What should be assessed preoperatively in rheumatoid arthritis patients with potential cervical spine instability? (Select 3)
A. Neck motion
B. Mouth opening
C. Voice changes
D. Vertebral artery perfusion
E. Pupillary distance
A. Neck motion
B. Mouth opening
C. Voice changes
Slide 23
Atlantoaxial instability in rheumatoid arthritis can cause displacement of the ____________ process, leading to ________ on the medulla and cervical spine during neck flexion.
A. Mastoid, narrowing
B. Odontoid, impingement
C. Transverse, decompression
D. Odontoid, stretching
A. Odontoid, impingement
Slide 23
Atlantoaxial instability can lead to which of the following complications during neck flexion?
A. Compression of the vertebral artery
B. Widening of the spinal canal
C. Increased range of motion in the cervical spine
D. Improved glottic opening
A. Compression of the vertebral artery
Displaced odontoid process (dens) –> impingement on C-spine & medulla –> vertebral artery compression
Slide 23
Atlantoaxial instability in rheumatoid arthritis can result in what type of symptoms? (Select 3)
A. Headache
B. Neck pain
C. Improved vertebral artery flow
D. Bladder and bowel dysfunction
E. Widened glottic opening
A. Headache
B. Neck pain
D. Bladder and bowel dysfunction
Slide 24
What are symptoms does atlantoaxial instability in rheumatoid arthritis show? (Select 2.)
A. Dysconjugate gaze
B. Lower extremity paresthesia
C. Ringing in ears
D. Upper extremity paresthesia
E. Improved cervical range of motion
B. Lower extremity paresthesia
D. Upper extremity paresthesia
Slide 24
______ and ______ are recommended interventions for evaluating cervical spine instability in rheumatoid arthritis.
A. Flexion X-rays, extension X-rays
B. Cervical MRI, lumbar CT
C. Thoracic ultrasound, neck traction
D. Bone densitometry, cranial X-rays
A. Flexion X-rays, extension X-rays
Castillo “This helps determine if we are going to do direct versus video, if we are going to do manual inline stabilization versus awake fibre optic laryngoscopy which could be the last resort of course.”
Slide 24
Vertebral artery occlusion in rheumatoid arthritis can cause ______ and ______, requiring careful cervical spine assessment.
A. Increased reflexes, nausea
B. Hyperextension, increased blood flow
C. Joint instability, improved perfusion
D. Dysphagia, transient loss of consciousness
D. Dysphagia, transient loss of consciousness
Slide 25
______ and ______ are the most common symptoms of vertebral artery occlusion in rheumatoid arthritis.
A. Increased neck flexibility, improved airway patency
B. Nausea and vomiting, blurred vision
C. Hyperreflexia, joint mobility
D. Paresthesia, reduced airway narrowing
B. Nausea and vomiting, blurred vision
Slide 25
What symptoms are associated with Sjögren’s syndrome in patients with rheumatoid arthritis? Select 3
A. Dry eyes
B. Moist skin
C. Decreased saliva production
D. Increased tear production
E. Chronic dryness of mucosal surfaces
A. Dry eyes
C. Decreased saliva production
E. Chronic dryness of mucosal surfaces
Make sure the patient’s eyes are covered, maybe put protective drops in
Slide 26
Which pulmonary complications may occur in rheumatoid arthritis patients?
Select 2
A. Restrictive ventilation pattern
B. Diffuse interstitial fibrosis
C. Increased functional residual capacity
D. Bronchial hyperreactivity
A. Restrictive ventilation pattern
B. Diffuse interstitial fibrosis
Slide 26
What vascular condition is associated with rheumatoid arthritis?
A) Thrombocytopenia
B) Vasculitis
C) Varicose veins
D) Peripheral arterial disease
B) Vasculitis
Slide 27
Which cardiac condition is a potential complication of severe rheumatoid arthritis? Select 2
A) Atrial fibrillation
B) Pericarditis
C) Endocarditis
D) Caridac tamponade
E. Aortic stenosis
B) Pericarditis
D) Caridac tamponade
Slide 27
Patients with rheumatoid arthritis have an increase risk of which gastrointestinal complication?
A) Peptic ulcers
B) Intestinal perforation
C) Constipation
D) Diverticulitis
A) Peptic ulcers
Slide 27
What renal condition might develop in rheumatoid arthritis patients due to the disease or its treatments?
A) Renal calculi
B) Acute renal failure
C) Chronic kidney insufficiency
D) Glomerulonephritis
C) Chronic kidney insufficiency
Slide 27
What components are essential during a preoperative evaluation for an orthopedic procedure? (Select 3)
A. Pain level
B. Neurovascular assessment
C. Assessment of reflexes
D. Bone marrow volume
E. Joint involvement
A. Pain level
B. Neurovascular assessment
E. Joint involvement
slide 31
What is a critical consideration when positioning a patient for orthopedic surgery?
A. Ensuring the patient’s body is immobilized postoperatively
B. Protecting nerve structures and bony prominences
C. Assessing range of motion preoperatively
D. Maintaining the patient’s pain level throughout the procedure
B. Protecting nerve structures and bony prominences
Surgical positioning / mobility - protect nerves with padding
Slide 31
Why is it important to consider the type of anesthesia for orthopedic procedures? (Select 3)
A. To increase intraoperative nerve damage
B. To ensure the patient remains still during the procedure
C. To manage postoperative pain levels
D. To make the surgical team comfortable
E. To enhance patient comfort
B. To ensure the patient remains still during the procedure
C. To manage postoperative pain levels
E. To enhance patient comfort
Consider regional
Slide 31
Why is it important to recognize that patients with emergent orthopedic injuries may have full stomachs?
A. To anticipate the need for rapid blood transfusion
B. To prevent the risk of aspiration during anesthesia induction
C. To ensure adequate padding during surgical positioning
D. To minimize the risk of thromboembolic events
B. To prevent the risk of aspiration during anesthesia induction
Slide 33
What is a significant risk associated with pelvic fractures during surgery?
A. Pulmonary aspiration
B. Fat embolism syndrome
C. Retroperitoneal space bleeding
D. Respiratory depression
C. Retroperitoneal space bleeding
Pelvic fractures –> iliac artery –> retroperitoneal space bleeding.
Will need massive transfusion protocol
Slide 33
Which condition is most likely to occur with long bone fractures?
A. Hemodynamic stability
B. Thromboembolic hypoxic respiratory failure
C. Retroperitoneal hemorrhage
D. Air embolism
B. Thromboembolic hypoxic respiratory failure
Long bone fractures –> bone marrow fat emboli –> venous circulation –> thromboembolic hypoxic respiratory failure
Slide 33
What is the primary purpose of cricoid pressure during rapid sequence induction (RSI)?
A. To ensure preoxygenation is effective
B. To prevent aspiration during induction
C. To facilitate visualization of the vocal cords
D. To improve intubation success rates
B. To prevent aspiration during induction
Slide 34
Preoxygenation at 100% during RSI should be performed for at least how many minutes?
A. 1 minute
B. 2 minutes
C. 3 minutes
D. 5 minutes
C. 3 minutes
Slide 34
What are the key steps involved in rapid sequence induction (RSI)? (Select 2)
A. Giving Propofol and Vecuronium
B. Apnea ventilation
C. Application of the Sellick maneuver
D. Ventilating the patient prior to intubation
B. Apnea ventilation (Boyles law)
C. Application of the Sellick maneuver (cricoid pressure)
Slide 34
The pressure applied during the Sellick maneuver should be approximately __________ pounds.
A. 10
B. 15
C. 18
D. 20
A. 10 (30 Newtons)
Slide 34
Why is modified RSI controversial in trauma anesthesia?
A. It involves the use of different medications than standard RSI
B. It allows for ventilating the patient, increasing aspiration risk
C. It requires less preoxygenation time than standard RSI
D. It does not involve cricoid pressure
B. It allows for ventilating the patient, increasing aspiration risk
Castillo - A modified radical rapid sequence induction where they ventilate the patient, just like, oh, let’s just try with one breath and if we see chest rise, then yes, we can ventilate. So they call it modified RSI.”
Induction medications for RSI in trauma patients often include __________ or etomidate.
A. Ketamine
B. Propofol
C. Midazolam
D. Fentanyl
A. Ketamine
Castillo - “…not propofol, because there could be bleeding or dehydration that has already occurred with the patient and we don’t want to bottom out their pressures”
Slide 34
Which of the following muscle relaxant medications are most appropriate for induction during RSI anesthesia?
A. Propofol and rocuronium
B. Rocuronium and succinylcholine
C. Etomidate and midazolam
D. Propofol and vecuronium
B. Rocuronium and succinylcholine
Slide 34
When should an LMA or Combitube be considered during trauma anesthesia?
A. After three failed intubation attempts
B. When the patient is unresponsive to muscle relaxants
C. During preoxygenation for rapid sequence induction
D. Before administering induction medications
A. After three failed intubation attempts
Slide 34
What does MILI stand for in the context of trauma anesthesia and rapid sequence induction (RSI)?
A. Manual Inline Immobilization
B. A prefix in the metric system that means one-thousandth ((10^{-3})) of a unit
C. Manual Inline Intubation
D. Mechanical Inline Immobilization
E. Modified Intubation and Laryngoscopy
A. Manual Inline Immobilization
(can also be MILS, S is for stabilization)
Stabilization of head, neck, and torso in the neutral position for those
Patients who have not been cleared
Slide 36
Which of the following airway maneuvers is avoided during MILI to prevent cervical spine movement?
A. Direct laryngoscopy
B. Cricoid pressure
C. Jaw thrust
D. Apneic ventilation
C. Jaw thrust
Castillo - we can’t do jaw thrust
because it would flex the neck and can result in some cervical spine movement, which could be an aggravating component for this patient.
Slide 36
How many clinicians are typically required to perform MILI effectively?
A. One
B. Two
C. Three
D. Four
C. Three
- Stabilize and align head in neutral position without applying cephalad traction
- Stabilize shoulders/cricoid pressure
- Intubate
Slide 36
What is a significant disadvantage of MILI during intubation?
A. Increased aspiration risk
B. Reduced oxygenation during preoxygenation
C. Higher likelihood of hyperextension injuries
D. Reduced visibility of the larynx
D. Reduced visibility of the larynx
Prepare for difficult airway
Slide 36
Why are ACE inhibitors typically held the night before surgery?
A. To reduce the risk of perioperative hypertension
B. To prevent significant hypotension during anesthesia induction
C. To enhance the effects of anticoagulants
D. To reduce the risk of opioid-related side effects
B. To prevent significant hypotension during anesthesia induction
Slide 37
Beta-blockers are typically __________ during the perioperative period to maintain cardiovascular stability.
A. Continued
B. Discontinued
C. Repaced
D. Doubled
A. Continued
Slide 37
What are the risks associated with anticoagulant use in the preoperative period? (Select 2)
A. Increased risk of bleeding
B. Risk of hypotension
C. Delayed clotting time
D. Reduced oxygenation levels
A. Increased risk of bleeding
C. Delayed clotting time
Coumadin and LMWH
Slide 37
Which medications may affect pain management during preoperative evaluation? (Select 2)
A. Coumadin
B. Opioids
C. NSAIDs
D. Beta-blockers
B. Opioids
C. NSAIDs
Slide 37
Why is it critical to establish a baseline cognitive status during preoperative evaluation?
A. To identify patients with a history of substance abuse
B. To assess for age-related cardiovascular risks
C. To predict the likelihood of anesthesia-related hypotension
D. To monitor for potential postoperative delirium and confusion
D. To monitor for potential postoperative delirium and confusion
Slide 38
Which factors increase the risk of postoperative delirium? (Select 3)
A. Advanced age
B. ETOH use or withdrawal
C. Preoperative dementia
D. Beta-blocker therapy
E. NSAID use
A. Advanced age
B. ETOH use or withdrawal
C. Preoperative dementia
Slide 38
Which of the following are triggers for delirium in the perioperative period? (Select 3)
A. Pain
B. Hypoxemia
C. Hypertension
D. Hypovolemia
E. Cholinergic use
F. Hypervolemia
A. Pain
B. Hypoxemia
F. Hypervolemia
Slide 39
Triggers for delirium include infection, ____ and ____
A. Hypocarbia, hypotension
B. Sleep deprivation, hypocarbia
C. Hypovolemia, pain
D. Hypercarbia, sleep deprivation
D. Hypercarbia, sleep deprivation
Slie 39
Administration of __________ and __________ may increase the risk of postoperative delirium.
A. Benzodiazepines, anticholinergics
B. Opioids, beta-blockers
C. ACE inhibitors, NSAIDs
D. Benzodiazepines, beta-blockers
A. Benzodiazepines, anticholinergics
Slide 39
What actions can anesthesia providers take to reduce the risk of postoperative delirium?
A. Optimize oxygenation
B. Avoid unnecessary benzodiazepine administration
C. Correct electrolyte imbalances preoperatively
D. Minimize postoperative pain
All of the above
Slide 39
Which symptoms should be assessed postoperatively to monitor for CNS changes? (Select 3)
A. Attention and awareness deficits
B. Muscle weakness and anxiety
C. Paranoia and hallucinations
D. Irritability and anxiety
E. Bradycardia and hypotension
A. Attention and awareness deficits
C. Paranoia and hallucinations
D. Irritability and anxiety
Slide 40
Pre-operative evaluation
What happens to forced expiratory volume in one second (FEV₁) as part of the normal aging process?
A. It increases by 10% for each decade
B. It decreases by 10% for each decade
C. It remains constant throughout life
D. It decreases by 5% for each decade
B. It decreases by 10% for each decade
Slide 41
Which age-related respiratory changes should anesthesia providers consider during preoperative evaluation? (Select 2)
A. Progressive decrease in PaO₂
B. Increased closing volume
C. Increase in FEV₁
D. Increased respiratory drive
E. Reduced total lung capacity
A. Progressive decrease in PaO₂
B. Increased closing volume
Slide 41
Why is obesity a significant factor in preoperative respiratory evaluation?
A. It is strongly associated with obstructive sleep apnea
B. It increases the risk of bronchospasm
C. It leads to permanent lung damage
D. It causes immediate airway obstruction
A. It is strongly associated with obstructive sleep apnea
Slide 41
According to ACC/AHA guidelines, when is preoperative cardiac testing necessary for intermediate-risk surgery?
A. Only when the patient has a history of coronary artery disease
B. When the results will change perioperative management
C. For all patients over the age of 65
D. If the patient has a history of smoking
B. When the results will change perioperative management
Slide 42
Which is NOT a key consideration when evaluating cardiac risk preoperatively for intermediate-risk surgery?
A. Functional capacity
B. Presence of coronary stents
C. Antiplatelet medication management
D. Age over 65 as a sole determinant
E. Orthopedic disease
D. Age over 65 as a sole determinant
Slide 42
Which beta-blocker is most appropriate for immediate, short-term control of tachycardia in the operating room?
A. Labetalol
B. Metoprolol
C. Esmolol
D. Propranolol
C. Esmolol
Slide 42
Why should beta-blockers be continued for patients already on them during the perioperative period?
A. To prevent rebound hypertension and tachycardia
B. To improve respiratory function during anesthesia
C. To reduce the risk of postoperative delirium
D. To manage anticoagulant effects
A. To prevent rebound hypertension and tachycardia
Slide 42
What is the recommended target heart rate when using beta-blockers for high-risk cardiac patients?
A. Less than 100 bpm
B. Less than 90 bpm
C. Less than 80 bpm
D. Less than 70 bpm
C. Less than 80 bpm
Slide 43
Which of the following complications does regional anesthesia aim to reduce? (Select 5 that apply)
A) Deep Vein Thrombosis (DVT)
B) Pulmonary Embolism
C) Estimated Blood Loss (EBL)
D) Respiratory Complications
E) Death
F) Increased surgical time
A) Deep Vein Thrombosis (DVT)
B) Pulmonary Embolism
C) Estimated Blood Loss (EBL)
D) Respiratory Complications
E) Death
Slide 44
What is the primary goal of regional anesthesia compared to general anesthesia?
A) Improved surgical efficiency
B) Improved pain management
C) Faster recovery times
D) Reduced cost of care
B) Improved pain management
Slide 45
What are the two techniques commonly used in regional anesthesia?
A) General anesthesia vs. spinal anesthesia
B) Local anesthesia vs. preemptive analgesia
C) Single shot vs. indwelling catheter
D) Epidural vs. conscious sedation
C) Single shot vs. indwelling catheter
Slide 45
Which of the following describes a potential benefit of regional anesthesia in pain management?
A) Delays the need for physical therapy
B) Blocks progression to chronic pain syndrome
C) Eliminates the need for analgesics
D) Reduces surgical time
B) Blocks progression to chronic pain syndrome
Preemptive analgesia
Slide 45
How can regional anesthesia potentially improve recovery?
A) By decreasing blood pressure fluctuations
B) By increasing participation in rehab, physical, and occupational therapy
C) By reducing surgical errors
D) By eliminating the need for sedation
B) By increasing participation in rehab, physical, and occupational therapy
Slide 45
IntraOP
Which fractures are most commonly associated with fat embolism?
A) Skull fractures
B) Pelvic and femoral fractures
C) Rib fractures
D) Clavicle fractures
B) Pelvic and femoral fractures
Slide 48
IntraOP
Which of the following is a key characteristic of fat embolism?
A) Fat droplets entering the arterial circulation.
B) Fat droplets entering the venous system after long bone trauma.
C) Lipid accumulation in the lymphatic system.
D) Fat embolism only occurring in minor fractures.
B) Fat droplets entering the venous system after long bone trauma.
Slide 48
IntraOP
What effect do fractures have on the solubility of lipids in the bloodstream?
A) They cause lipid breakdown.
B) They release mediators that alter lipid solubility.
C) They prevent lipid absorption.
D) They decrease lipid circulation entirely.
B) They release mediators that alter lipid solubility.
Slide 48
IntraOP
The most common procedure associated with Fat Embolism Syndrome (FES) is ____ in the ____.
A) Intramedullary rod placement; femoral medullary canal
B) Total knee replacement; tibial plateau
C) Spinal fusion; vertebral column
D) Plate fixation; humeral shaft
A) Intramedullary rod placement; femoral medullary canal
Incidence < 1% Mortality: 10-20%
Slide 49
IntraOP
Symptoms of Fat Embolism Syndrome typically appear within ____ hours after the procedure.
A) 1-6
B) 6-12
C) 12-72
D) 72-120
C) 12-72
Slide 49
IntraOP
The classic triad of symptoms associated with Fat Embolism Syndrome (FES) includes which of the following? (Select all that apply-3):
A) Dyspnea
B) Confusion
C) Petechiae
D) Tachycardia
E) Fever
F) Chest pain
A) Dyspnea
B) Confusion
C) Petechiae
Slide 49
IntraOP
Which of the following lab findings are associated with Fat Embolism Syndrome (FES)? (Select 4 that apply):
A) Fat macroglobulinemia
B) Anemia
C) Thrombocytopenia
D) Elevated sedimentation rate (SED rate)
E) Leukocytosis
F) Hypercalcemia
A) Fat macroglobulinemia
B) Anemia
C) Thrombocytopenia
D) Elevated sedimentation rate (SED rate)
Slide 50
IntraOP
In Fat Embolism Syndrome (FES), end-organ capillaries are obstructed by _____ and _____.
A) Air emboli; bone marrow particulates
B) Fat emboli; blood clots
C) Fat emboli; bone marrow particulates
D) Platelets; free fatty acids
C) Fat emboli; bone marrow particulates
Slide 51
IntraOP
Fat in Fat Embolism Syndrome (FES) is metabolized into _____.
A) Ketone bodies
B) Free fatty acids
C) Cholesterol
D) Triglycerides
B) Free fatty acids
Slide 51
IntraOP
When fat becomes metabolized in Fat Embolism Syndrome (FES), it can lead to ____.
A) Hypovolemic shock
B) Systemic inflammatory response results
C) Obstructive shock
D) Hyperlipidemia
B) Systemic inflammatory response results
Slide 52
IntraOP
Which of the following are pathophysiological features of FES due to Systemic inflammatory response results ? (Select 5 that apply):
A) Inflammatory cell invasion
B) Cytokine release
C) Pulmonary endothelial injury
D) Pulmonary edema
E) Acute Respiratory Distress Syndrome (ARDS) in >50% of cases
F) ARDS in < 10% of cases
A) Inflammatory cell invasion
B) Cytokine release
C) Pulmonary endothelial injury
D) Pulmonary edema
F) ARDS (in < 10% of cases)
Slide 52
IntraOP
Which of the following are clinical and pathological features of (FES) resulting from respiratory insufficiency? (Select 4 that apply):
A) Mild hypoxemia
B) Bilateral alveolar infiltrates
C) Dyspnea and edema
D) Progression to ARDS in < 10% of cases
E) Pulmonary hypertension
A) Mild hypoxemia
B) Bilateral alveolar infiltrates
C) Dyspnea and edema
D) Progression to ARDS in < 10% of cases
Slide 53
IntraOP
Which of the following are clinical and pathological features of Fat Embolism Syndrome (FES) resulting from neurological effects? (Select 4 that apply):
A) Drowsiness
B) Confusion
C) Obtundation
D) Coma
E) Seizures
A) Drowsiness
B) Confusion
C) Obtundation
D) Coma
Slide 54
IntraOP
Where does the petechial rash caused by Fat Embolism Syndrome (FES) typically occur? (Select 5 that apply):
A) Conjunctiva
B) Oral mucosa
C) Skin folds of the chest
D) Neck
E) Axilla
F) Lower extremities
A) Conjunctiva
B) Oral mucosa
C) Skin folds of the chest
D) Neck
E) Axilla
Slide 54
IntraOP
Which of the following are considered minor features of Fat Embolism Syndrome (FES)? (Select 4 that apply):
A) Fever ( > 100.4°F )
B) Tachycardia ( > 120 bpm)
C) Petechial rash
D) Jaundice
E) Renal changes
F) Dyspnea
A) Fever ( > 100.4°F )
B) Tachycardia ( > 120 bpm)
D) Jaundice
E) Renal changes
Slide 55
IntraOP
What is the primary goal of treating Fat Embolism Syndrome (FES)?
A) Administering antibiotics
B) Early recognition and stabilization of the fracture
C) Using high-flow nitrogen
D) Surgical intervention only
B) Early recognition and stabilization of the fracture
Slide 56
IntraOP
Which of the following is NOT part of supportive management in FES?
A) 100% FiO₂
B) Administration of nitrous oxide (N₂O)
C) Agressive and early respiratory and circulatory resuscitation
D) Minimizing the stress response
B) Administration of nitrous oxide (N₂O)
NO NITROUS OXIDE
Minimize stress response R/T hypoxia, hypotension & decreased end-organ perfusion
Slide 56
IntraOP
Which of the following is used to treat Fat Embolism Syndrome (FES)?
A) Aspirin
B) Heparin
C) Nitrous Oxide
D) Antibiotics
B) Heparin
Slide 56
IntraOP
How long do symptoms of Fat Embolism Syndrome (FES) typically take to resolve?
A) 1-2 days
B) 3-7 days
C) 7-14 days
D) Over 14 days
B) 3-7 days
Slide 56
IntraOP
Which of the following are risk factors for Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE)? (Select 6 that apply):
A) Obesity
B) Age > 60 years
C) Procedure length > 30 minutes
D) Use of tourniquet
E) Lower extremity fractures
F) Immobilization > 4 days
G) Without prophylaxis, occurrence is 10-20%
A) Obesity
B) Age > 60 years
C) Procedure length > 30 minutes
D) Use of tourniquet
E) Lower extremity fractures
F) Immobilization > 4 days
Without prophylaxis: occurs 40-80%
Slide 57
IntraOP
Which of the following conditions are associated with the greatest risk for Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE)? (Select 3 that apply):
A) Hip surgery
B) Total knee arthroplasty (TKA)
C) Lower extremity trauma
D) Upper extremity fractures
E) Appendectomy
A) Hip surgery
B) Total knee arthroplasty (TKA)
C) Lower extremity trauma
Slide 58
IntraOP
Which of the following are strategies for preventing Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE)? (Select 5 that apply):
A) Prophylaxis with anticoagulants
B) Early ambulation
C) Use of Sequential Compression Devices (SCDs)
D) Prolonged bed rest
E) TED hose
F) Periop anticoagulation
A) Prophylaxis with anticoagulants
B) Early ambulation
C) Use of Sequential Compression Devices (SCDs)
E) TED hose
F) Periop anticoagulation
Slide 59
IntraOP
To prevent DVT, it is important to ___ limb blood flow, reduce ____ stasis, and use ____ or no tourniquet during procedures.
A) Augment; arterial; increased
B) Decrease; venous; less
C) Augment; venous; less
D) Stabilize; arterial; more
C) Augment limb flow
reduce venous stasis
use less or no tourniquet
Slide 59
IntraOP
Which of the following medications should be assessed to determine if a patient is at risk for Deep Venous Thrombosis (DVT) or Pulmonary Embolus (PE)? (Select 5 that apply):
A) Antiplatelet agents
B) Thrombolytics
C) Fondaparinux
D) Direct thrombin inhibitors
E) Therapeutic low molecular weight heparin (LMWH)
F) Antibiotics
A) Antiplatelet agents
B) Thrombolytics
C) Fondaparinux
D) Direct thrombin inhibitors
E) Therapeutic low molecular weight heparin (LMWH)
Slide 60
IntraOP
Thromboprophylaxis with low molecular weight heparin (LMWH) is typically initiated ____ preoperatively and ___ postoperatively.
A) 12 hours; 24 hours
B) 12 hours; 6 hours
C) 12 hours; 12 hours
D) 18 hours; 12 hours
C) 12 hours; 12 hours
Slide 61
IntraOP
What type of anticoagulant is commonly used for short-acting thromboprophylaxis in DVT and PE prevention?
A) IV or SQ heparin
B) Low molecular weight heparin (LMWH)
C) Aspirin
D) Warfarin
A) IV or SQ heparin
Slide 61
IntraOP
When is it considered safe to perform neuraxial procedures after the previous dose of ONCE DAILY LMWH?
A) 4-6 hours
B) 8-10 hours
C) 10-12 hours
D) 24 hours
C) 10-12 hours
Slide 62
IntraOP
What is the guideline for removing a neuraxial catheter when administering LMWH in a twice-daily dosing regimen?
A) Remove the catheter immediately after the first dose
B) Remove the catheter 2 or more hours before the first dose
C) Remove the catheter 24 hours before the first dose
D) It is not necessary to remove the catheter
B) Remove the catheter 2 or more hours before the first dose
Slide 63
IntraOP
What is the acceptable INR level for performing neuraxial anesthesia in patients on warfarin for thromboprophylaxis?
A) ≤ 1.0
B) ≤ 1.5
C) ≤ 2.0
D) ≤ 2.5
B) ≤ 1.5
Slide 64
ASRA Guideline
Which of the following are common considerations for anticoagulants in neuraxial procedures? (Select 4 that apply):
A) Timing cessation of medication based on the drug’s half-life
B) Monitoring lab values such as INR, aPTT, or creatinine clearance
C) Using reversal agents when necessary (e.g., Vitamin K for warfarin, protamine for heparin)
D) Avoiding neuraxial procedures while on antiplatelet agents such as aspirin
E) Adjusting timing based on renal clearance for drugs like Dabigatran
F) Minimizing time between drug cessation and catheter removal
G) Most are contrainidicated to use in patients with Indwelling Neuraxial Catheters
A) Timing cessation of medication based on the drug’s half-life
B) Monitoring lab values such as INR, aPTT, or creatinine clearance
C) Using reversal agents when necessary (e.g., Vitamin K for warfarin, protamine for heparin)
G) Most are contrainidicated to use in patients with Indwelling Neuraxial Catheters
except Heparin and Aspirin/NSAIDs
Slide 65
NOT A QUESTION
Differences between Traditional Anticoagulants
Warfarin
- Differences: Requires INR ≤ 1.5 for safe neuraxial procedures.
- Long-acting anticoagulant, requiring significant time for reversal.
- Catheter Removal Timing: Contraindicated if INR > 1.5.
- Next Dose: Minimum 2 hours after catheter removal.
Heparin (IV/SubQ)
Low-dose (≤5000 Units):
- Differences: No contraindications; safe with indwelling catheters.
- Catheter Removal Timing: No specific restriction.
- Next Dose: 1 hour after catheter removal.
Full-dose
- Differences: Requires aPTT < 40 or 6 hours after the last dose for catheter procedures.
- Catheter Removal Timing: Wait ≥6 hours after the last dose.
- Next Dose: 2 hours after catheter removal.
Low Molecular Weight Heparin (e.g., Enoxaparin)
Prophylactic (once daily):
- Differences: Safer than full-dose regimens; preferred for prevention.
- Catheter Removal Timing: 12 hours after the last dose.
- Next Dose: 6-8 hours after catheter removal.
Therapeutic (twice daily):
- Differences: Higher bleeding risk than once-daily dosing.
- Catheter Removal Timing: 24 hours after the last dose.
- Next Dose: 24 hours after catheter removal.
Fondaparinux
Prophylactic (< 2.5 mg):
- Differences: Long half-life; limited use in neuraxial procedures.
- Catheter Removal Timing: 36-42 hours after the last dose.
- Next Dose: 6-12 hours after catheter removal.
Full-dose: Contraindicated for neuraxial procedures.
Slide 65
NOT A QUESTION
Differences between Direct Thrombin Inhibitors
Dabigatran (Pradaxa)
- Differences: Timing dependent on renal clearance; requires long cessation.
- Catheter Removal Timing: Contraindicated during treatment; wait 7 days after cessation.
- Next Dose: Unknown.
Argatroban/Bivalirudin/Lepirudin
- Differences: Short-acting, rapid onset.
- Catheter Removal Timing: Safe when aPTT normalizes (< 40).
- Next Dose: Unknown.
Slide 65
NOT A QUESTION
Differences between
Oral Antiplatelet Agents
Aspirin/NSAIDs
- Differences: Minimal risk of neuraxial bleeding compared to anticoagulants.
- Catheter Removal Timing: No restrictions.
- Next Dose: No delay required.
Clopidogrel (Plavix)
- Differences: Reversible platelet inhibitor with a significant bleeding risk.
- Catheter Removal Timing: Wait 7 days after the last dose.
- Next Dose: 2 hours after catheter removal.
Ticlopidine
- Differences: Longer cessation time compared to Clopidogrel.
- Catheter Removal Timing: Wait 14 days after the last dose.
- Next Dose: 2 hours after catheter removal.
Slide 65
NOT A QUESTION
Differences between Glycoprotein IIb/IIIa Inhibitors
Abciximab
- Differences: Long platelet inhibition duration compared to others in the same class.
- Catheter Removal Timing: 48 hours after the last dose.
- Next Dose: 2 hours after catheter removal.
Eptifibatide/Tirofiban
- Differences: Shorter half-life compared to Abciximab.
- Catheter Removal Timing: 8 hours after the last dose.
- Next Dose: 2 hours after catheter removal.
Slide 65
NOT A QUESTION
Differences with Alteplase
Alteplase (full dose)
- Differences: Used for clot dissolution; highest bleeding risk.
- Catheter Removal Timing: 10 days after the last dose.
- Next Dose: 10 days after catheter removal.
Alteplase (2mg)
- May be given. No time restrictions
- max dose 4mg/24 hrs
NOT A QUESTION
Difference with Apixaban (Eliquis)
Apixaban (Eliquis)
unknown for neuraxial procedures but hold for 48 hours for surgery.
Slide 65
NOT.A QUESTION
Commonalities Across Antiplatelet Agents based on NYSORA 2021 guideline
-
Precaution for Neuraxial Blocks:
Most require cessation periods before neuraxial block placement due to bleeding risk. -
Restarting Therapy:
Many can be restarted post-neuraxial catheter removal with specific timing intervals. - Class-Dependent Risks:
Aspirin/NSAIDs: Low bleeding risk, minimal precautions.
P2Y12 inhibitors (e.g., Clopidogrel, Prasugrel, Ticagrelor): Higher bleeding risk, longer cessation periods.
Glycoprotein IIb/IIIa inhibitors (e.g., Abciximab, Tirofiban): Significant bleeding risk, contraindicated during catheterization.
Slide 66
NOT.A QUESTION
Commonalites with Aspirin and NSAIDs based on NYSORA 2021 guideline
No additional precautions for neuraxial block, catheter use, or restarting therapy.
Slide 66
NOT A QUESTION
Differences between P2Y12 Inhibitors based on NYSORA 2021 guideline
Clopidogrel:
- Cessation Period: 5-7 days.
- Restarting with Catheter in Situ: OK for 1-2 days, no loading dose (start 24 hours after surgery).
- Restarting After Catheter Removal: Immediately; loading dose 6 hours after removal.
Prasugrel:
- Cessation Period: 7-10 days.
- Restarting with Catheter in Situ: Not recommended.
- Restarting After Catheter Removal: Immediately; loading dose 6 hours after removal.
Ticlopidine:
- Cessation Period: 10 days.
- Restarting with Catheter in Situ: OK for 1-2 days, no loading dose (start 24 hours after surgery).
- Restarting After Catheter Removal: Immediately; loading dose 6 hours after removal.
Ticagrelor:
- Cessation Period: 5-7 days.
- Restarting with Catheter in Situ: Not recommended.
- Restarting After Catheter Removal: Immediately; loading dose 6 hours after removal.
Slide 66
NOT A QUESTION
Differences between Glycoprotein IIb/IIIa Inhibitors based on NYSORA 2021 guideline
Abciximab:
- Cessation Period: 24-48 hours.
- Restarting Therapy: Contraindicated with catheter in situ.
- Restarting After Catheter Removal: No specific guidance.
Tirofiban/Eptifibatide:
- Cessation Period: 4-8 hours.
- Restarting Therapy: Contraindicated with catheter in situ.
- Restarting After Catheter Removal: No specific guidance.
Slide 66
NOT.A QUESTION
Differences between Other antiplatelet agents based on NYSORA 2021 guideline
Cangrelor:
- Cessation Period: 3 hours.
- Restarting Therapy: Not recommended with catheter in situ.
- Restarting After Catheter Removal: 8 hours.
Dipyridamole (extended-release):
- Cessation Period: 24 hours.
- Restarting Therapy: Not recommended with catheter in situ.
- Restarting After Catheter Removal: 6 hours.
Cilostazol:
- Cessation Period: 2 days.
- Restarting Therapy: Not recommended with catheter in situ.
- Restarting After Catheter Removal: 6 hours.
Slide 66
IntraPO
Which of the following are benefits of neuraxial anesthesia in preventing Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE)? (Select 2 that apply)
A) Decreased venous blood flow due to sympathectomy
B) Increased lower extremity venous blood flow due to sympathectomy
C) Decreased platelet reactivity
D) Systemic pro-inflammatory properties of local anesthetics
B) Increased lower extremity venous blood flow due to sympathectomy
C) Decreased platelet reactivity
Systemic anti-inflammatory properties of local anesthetics
Slide 67
IntraOP
Which of the following surgeries commonly use Tranexamic Acid (TXA) as an antifibrinolytic therapy? (Select 2 that apply)
A) Coronary artery bypass graft (CABG)
B) Total knee arthroplasty (TKA)
C) Total hip arthroplasty (THA)
D) Appendectomy
B) Total knee arthroplasty (TKA)
C) Total hip arthroplasty (THA)
Slide 67
IntraOP
What is the primary purpose of using Tranexamic Acid in the intraoperative setting?
A) Increase clot formation
B) Decrease blood transfusion need
C) Prevent infection
D) Reduce postoperative pain
B) Decrease blood transfusion need
follow facility protocol
Slide 67
IntraOP
Which of the following routes of administration for Tranexamic Acid are considered effective?
A) Intravenous (IV)
B) Topical
C) Oral
D) All of the above
D) All of the above
Slde 67
IntraOP
When should Tranexamic Acid be administered during surgery for optimal effectiveness?
A) Immediately after surgery
B) Before incision
C) During skin closure
D) One hour postoperatively
B) Before incision
Slide 67
IntraOP
Which of the following considerations should be made when using antifibrinolytic therapy, such as Tranexamic Acid, in the surgical setting? (Select 3)
A) Whether a single dose or repeated dose is more appropriate for the patient.
B) Understanding the therapy’s role in improving blood clotting.
C) Assessing the balance of risks (e.g., thrombosis) versus benefits (e.g., reduced blood loss).
D) Avoiding its use in patients undergoing total joint replacement surgeries.
A) Whether a single dose or repeated dose is more appropriate for the patient.
B) Understanding the therapy’s role in improving blood clotting.
C) Assessing the balance of risks (e.g., thrombosis) versus benefits (e.g., reduced blood loss).
Slide 68 - Castillo’s lecture info
IntraOP
Which of the following are common dosing regimens for Tranexamic Acid (TXA) in antifibrinolytic therapy? (Select 4 that apply)
A) 10 mg/kg
B) 15 mg/kg
C) 30 mg/kg
D) Maximum dose of 2.5 g
E) Fixed dose of 1 g regardless of weight
A) 10 mg/kg
B) 15 mg/kg
C) 30 mg/kg
D) Maximum dose of 2.5 g
Slide 69
IntraOP
What are potential concerns associated with the use of Tranexamic Acid (TXA) in antifibrinolytic therapy? (Select 3)
A) Increased risk of venous thromboembolism (VTE)
B) Increased risk of myocardial infarction (MI), cerebrovascular accident (CVA), and transient ischemic attack (TIA)
C) Reduction in postoperative cardiovascular complications
D) Postoperative cardiovascular complications related to anemia and blood transfusion
A) Increased risk of venous thromboembolism (VTE)
B) Increased risk of myocardial infarction (MI), cerebrovascular accident (CVA), and transient ischemic attack (TIA)
D) Postoperative cardiovascular complications related to anemia and blood transfusion
Slide 70
IntraOP
What are some primary benefits of using a pneumatic tourniquet in surgery? (Select 2)
A) Increases blood loss
B) Decreases intraoperative blood loss
C) Provides a bloodless field
D) Increases peripheral blood flow
B) Decreases intraoperative blood loss
C) Provides a bloodless field
Width > ½ diameter; Apply over smooth padding
Slide 71
IntraOP
When does tourniquet pain typically begin?
A) Immediately after application
B) After 15 minutes
C) After 45 minutes
D) After 90 minutes
C) After 45 minutes
Siide 71
IntraOP
What is the purpose of exsanguination with an Esmarch bandage before applying a pneumatic tourniquet?
A) Reduce central blood volume
B) Increase blood volume in the central circulation
C) Decrease the need for anesthesia
D) Prevent venous pooling in the limbs
B) Increase blood volume in the central circulation
Slide 71
IntraOP
Match the right answer
Thigh inflation pressure above systolic BP → E) 100 mmHg
Arm inflation pressure above systolic BP → D) 50 mmHg
Standard inflation pressure for upper extremity → A) 250 mmHg
Standard inflation pressure for lower extremity → F) 300 mmHg
Recommended maximum time for tourniquet use → C) 2 hours
Absolute maximum time for tourniquet use → B) 3 hours (180 min)
Slide 73
IntraOP
What should be documented when using a pneumatic tourniquet during surgery? (Select 4 that apply)
A) Inflation time
B) Deflation time
C) Total inflated time
D) Inflation pressure and any adjustments
E) Patient’s body weight
A) Inflation time
B) Deflation time
C) Total inflated time
D) Inflation pressure and any adjustments
Slide 74
IntraOP
What is the recommended maximum time for pneumatic tourniquet inflation to minimize complications?
A) 30 minutes
B) 1 hour
C) 2 hours
D) 3 hours
C) 2 hours
Absolute maximum time is 3 hours
Slide 75
IntraOP
What are potential complications of prolonged pneumatic tourniquet inflation exceeding 2 hours? (Select 3 that apply)
A) Nerve injury
B) Risk of ischemia and rhabdomyolysis
C) Increased oxygen saturation
D) Mechanical trauma
A) Nerve injury
B) Risk of ischemia and rhabdomyolysis
D) Mechanical trauma
Slide 75
IntraOP
How can the risks associated with prolonged tourniquet inflation be minimized?
A) Keep inflated for 3 hours
B) Deflate for 20–30 minutes
C) Increase inflation pressure
D) Apply without padding
B) Deflate for 20–30 minutes
Slide 75
What physiological changes may occur due to tourniquet pain? (Select 3 that apply)
A) Increased heart rate
B) Increased blood pressure
C) Diaphoresis
D) Reduced respiratory rate
A) Increased heart rate
B) Increased blood pressure
C) Diaphoresis
Slide 76
Which fibers are responsible for pain during prolonged tourniquet inflation?
A) Myelinated A fibers
B) Unmyelinated C fibers
C) Myelinated B fibers
D) Sensory D fibers
B) Unmyelinated C fibers
Slide 76
What is the correct sequence when using a double tourniquet (like Bier block)?
A) Inflate distal → Inflate proximal
B) Inflate proximal → Deflate distal
C) Deflate proximal → Deflate distal
D) Inflate both tourniquets simultaneously
B) Inflate proximal → Deflate distal
Which of the following factors can influence pain during the use of a pneumatic tourniquet?
a. Tourniquet time
b. Dermatomal spread or peripheral nerve coverage
c. Malposition or pressure
d. All of the above
d. All of the above
Slide 77
What aspect of anesthesia plays a role in mitigating pain from a pneumatic tourniquet?
a. Anesthesia type and delivery technique
b. Amount of sedation used
c. Oxygen concentration levels
d. Post-operative opioid administration
a. Anesthesia type and delivery technique
Slide 77
IntraOP
True or False:
The density of the local anesthetic used has NO effect on pain caused by a pneumatic tourniquet.
FALSE
The density of the local anesthetic used has effect on pain caused by a pneumatic tourniquet.
Slide 77
IntraOP
Which of the following is NOT a potential negative effect following the deflation of a pneumatic tourniquet?
a. Metabolic acidosis
b. Hyperkalemia
c. Hypoglycemia
d. Hypotension
c. Hypoglycemia
negative effects:
- Metabolic acidosis (Transient lactic acidosis)
- Hyperkalemia
- Hypercarbia (causes Increased minute ventilation)
- Tachycardia
- Hypotension
Slide 78-79
IntraOP
What cardiovascular responses are commonly observed after tourniquet deflation? (Select 2)
a. Bradycardia
b. Tachycardia
c. Hypotension
d. Arrhythmia
b. Tachycardia
c. Hypotension
Slide 78-79
IntraOP
Which of the following factors is directly alleviated after pneumatic tourniquet deflation?
a. Hypotension
b. Pain
c. Hypercarbia
d. Tachycardia
b. Pain
Slide 79
IntraOP
What happens to the patient’s temperature after tourniquet deflation?
a. Temperature increases
b. Temperature decreases
c. Temperature remains stable
d. Temperature fluctuates unpredictably
b. Temperature decreases
Slide 79
