Unit 1 Module 1 (Exam 1)

Question 1

New year, new semster, new challenges.
Ready?

Answer 1

Slide 7

Question 2

What was the population of the United States in 2022?

A. 330 million
B. 331.1 million
C. 350 million
D. 310.2 million

Answer 2

B. 331.1 million

Slide 8

Question 3

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%

Answer 3

C. 20% (one out of five people)

In 2022 only 17.5% were over the age of 65

Slie 8

Question 4

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

Answer 4

B. Frail skin
E. Movable veins

Slide 9

Question 5

Why are thrombus risks increased in elderly patients undergoing orthopedic procedures?

A. Frequent physical activity
B. Decreased cortisol
C. Hyperhydration
D. Sedentary lifestyle

Answer 5

D. Sedentary lifestyle

Slide 9

Question 6

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

Answer 6

A. Coronary artery disease, anemia

Slide 9

Question 7

Preoperative assessments for elderly patients should include questions about ______ therapy.

A. Antibiotic
B. Anticoagulant
C. Vitamin
D. Pain management

Answer 7

B. Anticoagulant

Slide 9

Question 8

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

Answer 8

D. Joint stiffness, bone fragility

slide 9

Question 9

Which hormone increases in osteoporosis, contributing to bone density loss?

A. Growth hormone
B. Parathyroid hormone
C. Insulin-like growth factor
D. Estrogen

Answer 9

B. Parathyroid hormone

Slide 11

Question 10

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

Answer 10

B. Decreased growth hormone
C. Postmenopausal

Slide 11

Question 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

Answer 11

A. Diminished insulin-like growth factors
C. Decreased vitamin D levels

Slide 11

Question 12

Which bones are commonly fractured in patients with osteoporosis? (Select 3)

A. Proximal femur
B. Humerus
C. Skull
D. Wrist
E. Cervical Spine

Answer 12

A. Proximal femur
B. Humerus
D. Wrist

Slide 12

Question 13

The thoracic and lumbar spine are prone to ______ fractures in patients with osteoporosis.

A. Stress
B. Compression
C. Spiral
D. Greenstick

Answer 13

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

Question 14

Which medication is NOT used to manage osteoporosis?

A. Fosamax
B. Actonel
C. Osteona
D. Reclast
E. Boniva

Answer 14

C. Osteona - completely made up name by me :)

Slide 12

Question 15

Osteoarthritis is characterized by a loss of ______ cartilage, leading to inflammation.

A. Articular
B. Elastic
C. Compact
D. Spongy

Answer 15

A. Articular

“Bone on bone”

Slide 13

Question 16

______% of patients over 65 with osteoarthritis experience physical limitations due to pain.

A. 5
B. 8
C. 12
D. 15

Answer 16

B. 8

Slide 13

Question 17

What are common symptoms of osteoarthritis? (Select 3)

A. Pain
B. Crepitus
C. Increased joint strength
D. Decreased mobility
E. Improved circulation

Answer 17

A. Pain
B. Crepitus
D. Decreased mobility

Slide 14

Question 18

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

Answer 18

D. A scraping or popping sound

Either it’s between bone and cartilage or bone and bone

Slide 14

Question 19

Which medications are used to manage osteoarthritis symptoms? (Select 3)

A. Fosamax
B. Celebrex
C. Opioids
D. NSAIDs
E. Antibiotics

Answer 19

B. Celebrex
C. Opioids
D. NSAIDs

Slide 14

Question 20

Heberden nodes in osteoarthritis are characterized by swelling of the:

A. Proximal interphalangeal joints
B. Distal interphalangeal joints
C. Wrist joints
D. Metacarpophalangeal joints

Answer 20

B. Distal interphalangeal joints

Slide 15

Question 21

Bouchard nodes are associated with swelling and spurring of the ______ interphalangeal joints.

A. Distal
B. Wrist
C. Metacarpophalangeal
D. Proximal

Answer 21

D. Proximal

Slide 15

Question 22

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

Answer 22

D. Acupuncture, occupational

Slide 16

Question 23

______ therapy and ______ are non-pharmacologic strategies used to manage osteoarthritis symptoms.

A. Occupational , TENS
B. Physical, corticosteroids
C. Massage, NSAIDs
D. TENS, opioids

Answer 23

A. Occupational, TENS

Slide 16

Question 24

TENS stands for ______ Electro Nerve Stimulation.

A. Transcutaneous
B. Transient
C. Temporary
D. Transitional

Answer 24

A. Transcutaneous

Slide 16

Question 25

Which NSAID is commonly prescribed for osteoarthritis? A. Ibuprofen B. Celecoxib C. Meloxicam D. Acetaminophen

Answer 25

C. Meloxicam *(Castillos mom takes it)* ## Footnote slide 17

Question 26

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.

Answer 26

B. They can cause peptic ulcer disease **and systemic side effects.** ## Footnote Slide17

Question 27

Celecoxib is classified as a: A. COX-2 inhibitor B. NSAID C. Topical analgesic D. Chondroprotective agent

Answer 27

A. COX-2 inhibitor ## Footnote slide 17

Question 28

Intra-articular therapy involves: A. Oral NSAIDs B. Topical treatments C. Steroid injections D. Acupuncture

Answer 28

C. Steroid injections *Can cause GI symptoms* ## Footnote slide 17

Question 29

______ and ______ are examples of chondroprotective agents used in osteoarthritis management. A. Glucosamine, chondroitin B. Celecoxib, Voltaren C. Meloxicam, acetaminophen D. Ibuprofen, steroids

Answer 29

A. Glucosamine, chondroitin *Stop at least 2 weeks prior to surgery* *Can also inculde Garlic, Ginko* ## Footnote Slide 17

Question 30

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

Answer 30

A.Chronic disease E. Systemic inflammatory disease ## Footnote Slide 18

Question 31

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

Answer 31

A. Synovial, bone erosion ## Footnote Slide 18

Question 32

______ 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

Answer 32

D. Cartilage destruction, impaired joint integrity ## Footnote Slide 18

Question 33

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

Answer 33

A. Wrists, metacarpophalangeal ## Footnote Slide 19

Question 34

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

Answer 34

D. Surrounding joints and on extensor surfaces ## Footnote Slide 19

Question 35

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.

Answer 35

A. They are nonspecific and not limited to certain joints. ## Footnote Slide 19

Question 36

Systemic symptoms of rheumatoid arthritis include ______, ______, and weakness. A. Weight gain, insomnia B. Fatigue, anorexia C. Joint swelling, cartilage growth D. Increased mobility, strength

Answer 36

B. Fatigue, anorexia ## Footnote Slide 19

Question 37

______ 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

Answer 37

A. Rheumatoid factor, anti-immunoglobulin antibody ## Footnote Slide 20

Question 38

______ 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

Answer 38

C. Erythrocyte sedimentation rate, C-reactive protein ## Footnote Slide 20

Question 39

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

Answer 39

B. Hydrocortisone *Usually...hydrocortisone, dexamethasone, or another mineralcorticoid could be of lesser dose range.* **Glucocorticoids --> Stress Dose 100mg Hydrocortisone** ## Footnote Slide 21

Question 40

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

Answer 40

A. DMARD, first-line treatment ## Footnote Slide 21

Question 41

______ 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

Answer 41

A. Infliximab (Remicade), Etanercept (Enbrel) ## Footnote Slide 21

Question 42

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

Answer 42

D. DMARDs, inflammation ## Footnote Slide 21

Question 43

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

Answer 43

C. TMJ mobility, cervical spine range of motion ## Footnote Slide 22

Question 44

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

Answer 44

A. Hoarseness, glottic narrowing ## Footnote Slide 22

Question 45

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

Answer 45

A. Neck motion B. Mouth opening C. Voice changes ## Footnote Slide 23

Question 46

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

Answer 46

A. Odontoid, impingement ## Footnote Slide 23

Question 47

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

Answer 47

A. Compression of the vertebral artery Displaced odontoid process (dens) --> impingement on C-spine & medulla --> vertebral artery compression ## Footnote Slide 23

Question 48

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

Answer 48

A. Headache B. Neck pain D. Bladder and bowel dysfunction ## Footnote Slide 24

Question 49

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

Answer 49

B. Lower extremity paresthesia D. Upper extremity paresthesia ## Footnote Slide 24

Question 50

______ 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

Answer 50

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."* ## Footnote Slide 24

Question 51

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

Answer 51

D. Dysphagia, transient loss of consciousness ## Footnote Slide 25

Question 52

______ 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

Answer 52

B. Nausea and vomiting, blurred vision ## Footnote Slide 25

Question 53

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

Answer 53

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* ## Footnote Slide 26

Question 54

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

Answer 54

A. Restrictive ventilation pattern B. Diffuse interstitial fibrosis ## Footnote Slide 26

Question 55

What vascular condition is associated with rheumatoid arthritis? A) Thrombocytopenia B) Vasculitis C) Varicose veins D) Peripheral arterial disease

Answer 55

B) Vasculitis ## Footnote Slide 27

Question 56

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

Answer 56

B) Pericarditis D) Caridac tamponade ## Footnote Slide 27

Question 57

Patients with rheumatoid arthritis have an increase risk of which gastrointestinal complication? A) Peptic ulcers B) Intestinal perforation C) Constipation D) Diverticulitis

Answer 57

A) Peptic ulcers ## Footnote Slide 27

Question 58

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

Answer 58

C) Chronic kidney insufficiency ## Footnote Slide 27

Question 59

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

Answer 59

A. Pain level B. Neurovascular assessment E. Joint involvement ## Footnote slide 31

Question 60

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

Answer 60

B. Protecting nerve structures and bony prominences *Surgical positioning / mobility - protect nerves with padding* ## Footnote Slide 31

Question 61

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

Answer 61

B. To ensure the patient remains still during the procedure C. To manage postoperative pain levels E. To enhance patient comfort *Consider regional* ## Footnote Slide 31

Question 62

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

Answer 62

B. To prevent the risk of aspiration during anesthesia induction ## Footnote Slide 33

Question 63

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

Answer 63

C. Retroperitoneal space bleeding *Pelvic fractures --> iliac artery --> retroperitoneal space bleeding.* *Will need massive transfusion protocol* ## Footnote Slide 33

Question 64

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

Answer 64

B. Thromboembolic hypoxic respiratory failure *Long bone fractures --> bone marrow fat emboli --> venous circulation --> thromboembolic hypoxic respiratory failure* ## Footnote Slide 33

Question 65

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

Answer 65

B. To prevent aspiration during induction ## Footnote Slide 34

Question 66

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

Answer 66

C. 3 minutes ## Footnote Slide 34

Question 67

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

Answer 67

B. Apnea ventilation (Boyles law) C. Application of the Sellick maneuver (cricoid pressure) ## Footnote Slide 34

Question 68

The pressure applied during the Sellick maneuver should be approximately __________ pounds. A. 10 B. 15 C. 18 D. 20

Answer 68

A. 10 (30 Newtons) ## Footnote Slide 34

Question 69

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

Answer 69

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."*

Question 70

Induction medications for RSI in **trauma** patients often include __________ or etomidate. A. Ketamine B. Propofol C. Midazolam D. Fentanyl

Answer 70

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"* ## Footnote Slide 34

Question 71

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

Answer 71

B. Rocuronium and succinylcholine ## Footnote Slide 34

Question 72

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

Answer 72

A. After three failed intubation attempts ## Footnote Slide 34

Question 73

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

Answer 73

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* ## Footnote Slide 36

Question 74

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

Answer 74

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.* ## Footnote Slide 36

Question 75

How many clinicians are typically required to perform MILI effectively? A. One B. Two C. Three D. Four

Answer 75

C. Three 1. * Stabilize and align head in neutral position without applying cephalad traction 1. * Stabilize shoulders/cricoid pressure 1. * Intubate ## Footnote Slide 36

Question 76

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

Answer 76

D. Reduced visibility of the larynx *Prepare for difficult airway* ## Footnote Slide 36

Question 77

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

Answer 77

B. To prevent significant hypotension during anesthesia induction ## Footnote Slide 37

Question 78

Beta-blockers are typically __________ during the perioperative period to maintain cardiovascular stability. A. Continued B. Discontinued C. Repaced D. Doubled

Answer 78

A. Continued ## Footnote Slide 37

Question 79

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

Answer 79

A. Increased risk of bleeding C. Delayed clotting time *Coumadin and LMWH* ## Footnote Slide 37

Question 80

Which medications may affect pain management during preoperative evaluation? (Select 2) A. Coumadin B. Opioids C. NSAIDs D. Beta-blockers

Answer 80

B. Opioids C. NSAIDs ## Footnote Slide 37

Question 81

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

Answer 81

D. To monitor for potential postoperative delirium and confusion ## Footnote Slide 38

Question 82

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

Answer 82

A. Advanced age B. ETOH use or withdrawal C. Preoperative dementia ## Footnote Slide 38

Question 83

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

Answer 83

A. Pain B. Hypoxemia F. Hypervolemia ## Footnote Slide 39

Question 84

Triggers for delirium include **infection**, ____ and ____ A. Hypocarbia, hypotension B. Sleep deprivation, hypocarbia C. Hypovolemia, pain D. Hypercarbia, sleep deprivation

Answer 84

D. Hypercarbia, sleep deprivation ## Footnote Slie 39

Question 85

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

Answer 85

A. Benzodiazepines, anticholinergics ## Footnote Slide 39

Question 86

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

Answer 86

All of the above ## Footnote Slide 39

Question 87

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

Answer 87

A. Attention and awareness deficits C. Paranoia and hallucinations D. Irritability and anxiety ## Footnote Slide 40

Question 88

# 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

Answer 88

B. It decreases by 10% for each decade ## Footnote Slide 41

Question 89

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

Answer 89

A. Progressive decrease in PaO₂ B. Increased closing volume ## Footnote Slide 41

Question 90

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

Answer 90

A. It is strongly associated with obstructive sleep apnea ## Footnote Slide 41

Question 91

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

Answer 91

B. When the results will change perioperative management ## Footnote Slide 42

Question 92

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

Answer 92

D. Age over 65 as a sole determinant ## Footnote Slide 42

Question 93

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

Answer 93

C. Esmolol ## Footnote Slide 42

Question 94

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

Answer 94

A. To prevent rebound hypertension and tachycardia ## Footnote Slide 42

Question 95

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

Answer 95

C. Less than 80 bpm ## Footnote Slide 43

Question 96

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

Answer 96

A) Deep Vein Thrombosis (DVT) B) Pulmonary Embolism C) Estimated Blood Loss (EBL) D) Respiratory Complications E) Death ## Footnote Slide 44

Question 97

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

Answer 97

B) Improved pain management ## Footnote Slide 45

Question 98

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

Answer 98

C) Single shot vs. indwelling catheter ## Footnote Slide 45

Question 99

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

Answer 99

B) Blocks progression to chronic pain syndrome *Preemptive analgesia* ## Footnote Slide 45

Question 100

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

Answer 100

B) By increasing participation in rehab, physical, and occupational therapy ## Footnote Slide 45

Question 101

# IntraOP Which fractures are most commonly associated with fat embolism? A) Skull fractures B) Pelvic and femoral fractures C) Rib fractures D) Clavicle fractures

Answer 101

B) Pelvic and femoral fractures ## Footnote Slide 48

Question 102

# 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.

Answer 102

B) Fat droplets entering the venous system after long bone trauma. ## Footnote Slide 48

Question 103

# 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.

Answer 103

B) They release mediators that alter lipid solubility. ## Footnote Slide 48

Question 104

# 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

Answer 104

A) Intramedullary rod placement; femoral medullary canal | Incidence < 1% Mortality: 10-20% ## Footnote Slide 49

Question 105

# 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

Answer 105

C) 12-72 ## Footnote Slide 49

Question 106

# 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

Answer 106

A) Dyspnea B) Confusion C) Petechiae ## Footnote Slide 49

Question 107

# 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

Answer 107

A) Fat macroglobulinemia B) Anemia C) Thrombocytopenia D) Elevated sedimentation rate (SED rate) ## Footnote Slide 50

Question 108

# 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

Answer 108

C) Fat emboli; bone marrow particulates ## Footnote Slide 51

Question 109

# IntraOP Fat in Fat Embolism Syndrome (FES) is metabolized into _____. A) Ketone bodies B) Free fatty acids C) Cholesterol D) Triglycerides

Answer 109

B) Free fatty acids ## Footnote Slide 51

Question 110

# 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

Answer 110

B) Systemic inflammatory response results ## Footnote Slide 52

Question 111

# 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

Answer 111

A) Inflammatory cell invasion B) Cytokine release C) Pulmonary endothelial injury D) Pulmonary edema F) ARDS (in < 10% of cases) ## Footnote Slide 52

Question 112

# 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

Answer 112

A) Mild hypoxemia B) Bilateral alveolar infiltrates C) Dyspnea and edema D) Progression to ARDS in < 10% of cases ## Footnote Slide 53

Question 113

# 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

Answer 113

A) Drowsiness B) Confusion C) Obtundation D) Coma ## Footnote Slide 54

Question 114

# 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

Answer 114

A) Conjunctiva B) Oral mucosa C) Skin folds of the chest D) Neck E) Axilla ## Footnote Slide 54

Question 115

# 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

Answer 115

A) Fever ( > 100.4°F ) B) Tachycardia ( > 120 bpm) D) Jaundice E) Renal changes ## Footnote Slide 55

Question 116

# 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

Answer 116

B) Early recognition and stabilization of the fracture ## Footnote Slide 56

Question 117

# 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

Answer 117

B) Administration of nitrous oxide (N₂O) **NO NITROUS OXIDE** *Minimize stress response R/T hypoxia, hypotension & decreased end-organ perfusion* ## Footnote Slide 56

Question 118

# IntraOP Which of the following is used to treat Fat Embolism Syndrome (FES)? A) Aspirin B) Heparin C) Nitrous Oxide D) Antibiotics

Answer 118

B) Heparin ## Footnote Slide 56

Question 119

# 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

Answer 119

B) 3-7 days ## Footnote Slide 56

Question 120

# 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%

Answer 120

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%*** ## Footnote Slide 57

Question 121

# 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

Answer 121

A) Hip surgery B) Total knee arthroplasty (TKA) C) Lower extremity trauma ## Footnote Slide 58

Question 122

# 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

Answer 122

A) Prophylaxis with anticoagulants B) Early ambulation C) Use of Sequential Compression Devices (SCDs) E) TED hose F) Periop anticoagulation ## Footnote Slide 59

Question 123

# 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

Answer 123

C) **Augment** limb flow reduce **venous** stasis use **less** or no tourniquet ## Footnote Slide 59

Question 124

# 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

Answer 124

A) Antiplatelet agents B) Thrombolytics C) Fondaparinux D) Direct thrombin inhibitors E) Therapeutic low molecular weight heparin (LMWH) ## Footnote Slide 60

Question 125

# 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

Answer 125

C) 12 hours; 12 hours ## Footnote Slide 61

Question 126

# 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

Answer 126

A) IV or SQ heparin ## Footnote Slide 61

Question 127

# 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

Answer 127

C) 10-12 hours ## Footnote Slide 62

Question 128

# 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

Answer 128

B) Remove the catheter 2 or more hours before the first dose ## Footnote Slide 63

Question 129

# 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

Answer 129

B) ≤ 1.5 ## Footnote Slide 64

Question 130

# 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

Answer 130

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* ## Footnote Slide 65

Question 131

# NOT A QUESTION Differences between Traditional Anticoagulants

Answer 131

**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. ## Footnote Slide 65

Question 132

# NOT A QUESTION Differences between Direct Thrombin Inhibitors

Answer 132

**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. ## Footnote Slide 65

Question 133

# NOT A QUESTION Differences between Oral Antiplatelet Agents

Answer 133

**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. ## Footnote Slide 65

Question 134

# NOT A QUESTION Differences between Glycoprotein IIb/IIIa Inhibitors

Answer 134

**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. ## Footnote Slide 65

Question 135

# NOT A QUESTION Differences with Alteplase

Answer 135

**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

Question 136

# NOT A QUESTION Difference with Apixaban (Eliquis)

Answer 136

**Apixaban (Eliquis)** unknown for neuraxial procedures but hold for **48 hours** for surgery. ## Footnote Slide 65

Question 137

# NOT.A QUESTION Commonalities Across Antiplatelet Agents based on NYSORA 2021 guideline

Answer 137

1. **Precaution for Neuraxial Blocks**: Most require cessation periods before neuraxial block placement due to bleeding risk. 2. **Restarting Therapy**: Many can be restarted post-neuraxial catheter removal with specific timing intervals. 3. **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. ## Footnote Slide 66

Question 138

# NOT.A QUESTION Commonalites with Aspirin and NSAIDs based on NYSORA 2021 guideline

Answer 138

No additional precautions for neuraxial block, catheter use, or restarting therapy. ## Footnote Slide 66

Question 139

# NOT A QUESTION Differences between P2Y12 Inhibitors based on NYSORA 2021 guideline

Answer 139

**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. ## Footnote Slide 66

Question 140

# NOT A QUESTION Differences between Glycoprotein IIb/IIIa Inhibitors based on NYSORA 2021 guideline

Answer 140

**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. ## Footnote Slide 66

Question 141

# NOT.A QUESTION Differences between Other antiplatelet agents based on NYSORA 2021 guideline

Answer 141

**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. ## Footnote Slide 66

Question 142

# 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

Answer 142

B) Increased lower extremity venous blood flow due to sympathectomy C) Decreased platelet reactivity *Systemic **anti-inflammatory properties** of local anesthetics* ## Footnote Slide 67

Question 143

# 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

Answer 143

B) Total knee arthroplasty (TKA) C) Total hip arthroplasty (THA) ## Footnote Slide 67

Question 144

# 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

Answer 144

B) Decrease blood transfusion need *follow facility protocol* ## Footnote Slide 67

Question 145

# 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

Answer 145

D) All of the above ## Footnote Slde 67

Question 146

# 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

Answer 146

B) Before incision ## Footnote Slide 67

Question 147

# 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.

Answer 147

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). ## Footnote Slide 68 - Castillo's lecture info

Question 148

# 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

Answer 148

A) 10 mg/kg B) 15 mg/kg C) 30 mg/kg D) Maximum dose of 2.5 g ## Footnote Slide 69

Question 149

# 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

Answer 149

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 ## Footnote Slide 70

Question 150

# 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

Answer 150

B) Decreases intraoperative blood loss C) Provides a bloodless field | Width > ½ diameter; Apply over smooth padding ## Footnote Slide 71

Question 151

# IntraOP When does tourniquet pain typically begin? A) Immediately after application B) After 15 minutes C) After 45 minutes D) After 90 minutes

Answer 151

C) After 45 minutes ## Footnote Siide 71

Question 152

# 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

Answer 152

B) Increase blood volume in the central circulation ## Footnote Slide 71

Question 153

# IntraOP Match the right answer

Answer 153

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) ## Footnote Slide 73

Question 154

# 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

Answer 154

A) Inflation time B) Deflation time C) Total inflated time D) Inflation pressure and any adjustments ## Footnote Slide 74

Question 155

# 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

Answer 155

C) 2 hours Absolute maximum time is **3 hours** ## Footnote Slide 75

Question 156

# 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

Answer 156

A) Nerve injury B) Risk of ischemia and rhabdomyolysis D) Mechanical trauma ## Footnote Slide 75

Question 157

# 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

Answer 157

B) Deflate for 20–30 minutes ## Footnote Slide 75

Question 158

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

Answer 158

A) Increased heart rate B) Increased blood pressure C) Diaphoresis ## Footnote Slide 76

Question 159

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

Answer 159

B) Unmyelinated C fibers ## Footnote Slide 76

Question 160

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

Answer 160

B) Inflate proximal → Deflate distal

Question 161

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

Answer 161

d. All of the above ## Footnote Slide 77

Question 162

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

Answer 162

a. Anesthesia type and delivery technique ## Footnote Slide 77

Question 163

# IntraOP True or False: The density of the local anesthetic used has NO effect on pain caused by a pneumatic tourniquet.

Answer 163

FALSE The density of the local anesthetic used has effect on pain caused by a pneumatic tourniquet. ## Footnote Slide 77

Question 164

# 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

Answer 164

c. Hypoglycemia negative effects: - Metabolic acidosis (Transient lactic acidosis) - Hyperkalemia - Hypercarbia (causes Increased minute ventilation) - Tachycardia - Hypotension ## Footnote Slide 78-79

Question 165

# IntraOP What cardiovascular responses are commonly observed after tourniquet deflation? (Select 2) a. Bradycardia b. Tachycardia c. Hypotension d. Arrhythmia

Answer 165

b. Tachycardia c. Hypotension ## Footnote Slide 78-79

Question 166

# IntraOP Which of the following factors is directly alleviated after pneumatic tourniquet deflation? a. Hypotension b. Pain c. Hypercarbia d. Tachycardia

Answer 166

b. Pain ## Footnote Slide 79

Question 167

# 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

Answer 167

b. Temperature decreases ## Footnote Slide 79