Unit 1 Module 2 (Exam 1) Flashcards
What is the main reason for obtaining baseline vital signs during pre-op assessment for shoulder surgery?
A. To assess patient hydration
B. To monitor for Bezold-Jarisch reflex
C. To measure respiratory rate trends
D. To identify allergies
B. To monitor for Bezold-Jarisch reflex
“we really need to make sure that we are
monitoring our hemodynamics, especially our heart rate and blood pressure. Hence we
need our baseline”
Slide 7
Which of the following diagnoses is NOT commonly associated with shoulder surgeries?
A. Rotator cuff tear
B. Glenohumeral instability
C. Labral tear
D. Subacromial stenosis
D. Subacromial stenosis
Slide 7
What should be prioritized in pre-op planning for shoulder surgeries?
Select 2
A. Pre-existing nerve conduction
B. Assessing airway
C. Monitoring body temperature
D. Assessing for Carpal tunnel syndrome
A. Pre-existing nerve conduction
B. Assessing airway
slide 7
Which are the main positioning options for shoulder surgeries? Select 3
A. Beach chair
B. Sitting Position
C. Supine
D. Prone
E. Lateral decubitus
A. Beach chair
B. Sitting Position
E. Lateral decubitus
“the beach chair we use, because as you can see in the picture on the right, the knees are flexed, the legs are elevated and it
prevents the pulling of the hamstrings to the gluteal muscles and then our lower
back muscles.”
Slide 8
What is a critical consideration for securing the patient during shoulder surgery positioning?
A. Positioning the arms for IV access
B. Rotating the patient frequently
C. Securing the head, neck, hips, and legs
D. Keeping the patient supine at all times
C. Securing the head, neck, hips, and legs
Slide 8
Securing the head and neck during positioning for shoulder surgeries prevents __________.
A. Muscle strain
B. Airway obstruction
C. Blood pooling
D. Skin breakdown
B. Airway obstruction
Slide 8
True or False
The ultimate responsibility with positioning lies only with the surgeon and the anesthesia provider.
False
“it is a shared responsibility”
* Surgeon
* Anesthesia provider
* Operating room nurses
* PA/RNFA
* Scrub Tech
* Other O.R. personnel
Slide 9
Positioning the patient in surgery involves __________ and potential risks.
A. Physiologic changes
B. Extended surgical time
C. Reducing blood flow
D. Increasing airway resistance
A. Physiologic changes
Slide 9
What happens to central blood volume in the sitting position?
A. It increases due to improved venous return
B. It decreases due to pooling in the lower body
C. It remains unchanged
D. It increases due to elevated heart rate
B. It decreases due to pooling in the lower body
Slide 10
Due to pooling of blood in the lower body during the sitting position, which parameters might increase in response to BP and CO decreasing?
A. Heart rate and systemic vascular resistance
B. Cardiac output and arterial blood pressure
C. Functional residual capacity and CBF
D. Blood pressure and respiratory rate
A. Heart rate and systemic vascular resistance
Slide 10
How does the sitting position affect lung volumes and functional residual capacity (FRC)?
A. Both decrease
B. Both remain unchanged
C. Both increase
D. Lung volumes decrease, while FRC increases
C. Both increase
Slide 10
What is a neurovascular consideration in the sitting position?
A. Increased cerebral blood flow
B. Increased intracranial pressure
C. No change in cerebral blood flow
D. Decreased cerebral blood flow
D. Decreased cerebral blood flow
Slide 10
What is the incidence rate of venous air embolism in patients in the sitting position?
A. 10%
B. 25%
C. 40%
D. 63%
C. 40%
Slide 11
Which of the following positions are associated with venous air embolism?
A. Supine, lateral decubitus, reverse Trendelenburg
B. Sitting, prone, reverse Trendelenburg
C. Supine, prone, Trendelenburg
D. Sitting, lateral decubitus, Trendelenburg
B. Sitting, prone, reverse Trendelenburg
Slide 11
To prevent venous air embolism, it is important to maintain __________ at the wound site.
A. Negative pressure
B. Neutral pressure
C. Venous pressure above 0
D. Arterial pressure above 0
C. Venous pressure above 0
Slide 11
What increases the risk of venous air embolism in the sitting position during surgery?
A. Open venous vessels above the heart level
B. Use of mechanical ventilation
C. Reduced systemic vascular resistance
D. High central venous pressure
A. Open venous vessels above the heart level
Slide 12
Approximately what percentage of the population has a patent foramen ovale, increasing the risk of severe VAE?
A. 10–20%
B. 20–30%
C. 30–40%
D. 40–50%
B. 20–30%
Air may reach the cerebral and coronary circulation via a patent foramen ovale
Slide 12
Venous air embolism occurs when air enters open venous vessels and travels to the __________ and interfers with blood flow to the pulmonary artery.
A. Left atrium
B. Superior vena cava
C. Pulmonary veins
D. Right ventricle
D. Right ventricle
Slide 12
Which of the following are potential consequences of venous air embolism?
Select 3
A. Pulmonary edema
B. Reflex bronchoconstriction
C. Increased arterial blood pressure
D. Acute cardiovascular collapse
E. Reflex bronchodilation
F. Decreased venous blood pressure
A. Pulmonary edema
B. Reflex bronchoconstriction
D. Acute cardiovascular collapse and arterial hypoxemia
Slide 12
What is the first step in managing a suspected venous air embolism?
A. Apply bilateral compression of the jugular veins
B. Discontinue nitrous oxide
C. Inform the surgeon
D. Place the patient in a head-down position
C. Inform the surgeon and prevent further air entrainment
They can prevent it by further entraining air, by irrigating with whatever irrigant fluid that they have on the table, and applying an occlusive dressing. An occlusive dressing can be in the form of any wetsponge or such as with open craniotomies, they can apply bone wax to secure or to close that areas to avoid further entrainment or further absorption of air from the incision site
Slide 13
What is the purpose of placing the patient in a head-down position during venous air embolism treatment?
A. To increase venous return
B. To trap air in the right atrial apex
C. To reduce arterial pressure
D. To increase systemic vascular resistance
B. To trap air in the right atrial apex and prevent pulmonary artery entry
Slide 14
What can be used to directly remove air during venous air embolism management?
A. Endotracheal suction
B. Pulmonary artery catheter
C. Intravenous cannula
D. Right atrial catheter
D. Right atrial catheter
Slide 14
Which of the following are treatments for venous air embolism? Select 2
A. Use inhalational anesthetics to reduce air expansion
B. Discontinuing nitrous oxide
C. Bilateral compression of jugular veins.
D. Placing the patient in a head-up position
B. Discontinuing nitrous oxide
C. Bilateral compression of jugular veins.
Slide 14
In venous air embolism management, cardiovascular collapse is treated using __________.
A. Vasopressors like ephedrine and phenylephrine
B. Bronchodilators like albuterol
C. Antiarrhythmics like amiodarone
D. Diuretics like furosemide
A. Vasopressors like ephedrine and phenylephrine
Slide 14
Why is the superior vena cava and right atrium junction ideal for CVP catheter placement in VAE? Select 2
A. It minimizes interference with arterial blood flow
B. It is close to the SA node, aiding in identification
C. It is close to the AV node, aiding in identification
D. It is where air tends to accumulate
B. It is close to the SA node, aiding in identification
D. It is where air tends to accumulate
Slide 15
The Doppler Ultrasound transducer is a non-invasive indicator of a venous air Embolism (VAE) in the sitting patient. Where do you place the probe on the chest?
A. over the left ventricle
B. over the mediastinum
C. over the right atrium
D. over the pulmonary artery
C. over the right atrium
Doppler ultrasound at the second or third intercostal space
Slide 16
What is the most sensitive non-invasive indicator of venous air embolism?
A. Mill-wheel murmur
B. Decreased end-tidal CO2
C. Doppler ultrasound
D. Transesophageal echocardiography
C. Doppler ultrasound
the transducer at the second or third intercostal space to the right of the sternum (over the right atrium)
Slide 17
The most definitive tool for diagnosing venous air embolism is __________.
A. Doppler ultrasound
B. Mill-wheel murmur auscultation
C. Transesophageal echocardiography
D. Pulse oximetry
C. Transesophageal echocardiography
Slide 17
The characteristic sound of venous air embolism detected by stethoscope is a __________ murmur.
A. Mill-wheel
B. Pericardial rub
C. Continuous hum
D. Diastolic click
A. Mill-wheel
Slide 17
A sudden drop in end-tidal CO2 during surgery indicates __________.
A. Increased pulmonary perfusion
B. Decreased lung perfusion
C. Improved gas exchange
D. Hyperventilation
B. Decreased lung perfusion due to air embolism
Slide 17
What is a key consideration when positioning a patient in the sitting position?
A. Ensuring pressure on the eyes to stabilize the head
B. Hyperextending the neck to maintain alignment
C. Flexing the neck to secure the airway
D. Padding all pressure points to prevent injury
D. Padding all pressure points to prevent injury
Slide 18
What are key measures to take when positioning a patient in the sitting position?
Select 2
A. To ensure easier access for surgical tools
B. Avoid pressure on the eyes
C. Place the patient’s head in a hyperextended position
D. Secure the head properly to prevent slipping
B. Avoid pressure on the eyes - using goggles if needed
D. Secure the head properly to prevent slipping - ABD pads, coban, Allen head rest
You can see that the head is super
neutral. I love that, not only neutral, right? Super neutral, as you can see with
the figure 26-1
Slide 18
What is the primary reason for intentional hypotension during shoulder surgery?
A. To improve oxygen delivery to the brain
B. To minimize anesthetic drug requirements
C. To prevent retinal ischemia
D. To enhance surgical field visibility
D. To enhance surgical field visibility
slide 19
What is a potential complication of prolonged induced hypotension? Select 2
A. Increased blood flow to the eyes
B. Ischemic optic neuropathy
C. Retinal ischemia
D. Hyperperfusion of the surgical field
B. Ischemic optic neuropathy
C. Retinal ischemia
Slide 19
What are key components of eye protection during surgery? Select 2
A. Preventing blindness
B. Using gauze to cover the eyes
C. Preventing dry eye syndrome
D. Avoiding pressure on the eyes
A. Preventing blindness
D. Avoiding pressure on the eyes
slide 19
How should an arterial line be aligned to monitor cerebral perfusion pressure during surgery?
A. At the level of the sternum
B. At the external meatus of the ear
C. At the level of the wrist
D. At the base of the skull
B. At the external meatus of the ear
Circle of Willis
Slide 19
When using non-invasive blood pressure monitoring, where should the cuff be placed during shoulder surgery?
A. On the non-operative arm
B. On the operative arm
C. On the lower leg
D. On the operative wrist
A. On the non-operative arm
you have your blood pressure, you have your pulse ox, you have your IV, all on the non-operative side
Slide 19
What is the standard decrease in blood pressure per centimeter of height gradient between the heart and brain?
A. 0.57 mmHg
B. 0.67 mmHg
C. 0.77 mmHg
D. 1.07 mmHg
C. 0.77 mmHg
There is a 77% or 0.77 mmHg decrease for every centimeter height gradient between brain and heart
Slide 20
What is the normal distance range between the heart and brain in centimeters?
A. 5–15 cm
B. 10–20 cm
C. 10–30 cm
D. 15–35 cm
C. 10–30 cm
slide 20
What should you do if the calculated cerebral perfusion pressure is too low during surgery?
A. Administer less fluid to decrease blood pressure
B. Reduce diastolic pressure further
C. Tank the patient with fluids to increase diastolic pressure
D. Use nitrous oxide to maintain systolic pressure
C. Tank the patient with fluids to increase diastolic pressure
Tanking means increasing the administration of fluid so that your diastolic increases, but you maintain your systolic below 100 by giving them gas or propofol.
Slide 20
If the BP at the heart/arm is 120/80, and there is 20 cm distance to the head then the BP at the brain is at?
A. 95/55
B. 100/60
C. 105/65
D. 125/75
C. 105/65
20 cm X 0.77=15
120 sBP – 15 = 105
80 dBP -15 = 65
Slide 21
What is the most commonly preferred anesthetic for shoulder procedures?
A. Spinal anesthesia
B. Local anesthesia
C. General endotracheal anesthesia
D. Sedation only
C. General endotracheal anesthesia with muscle relaxation
Slide 25
Which block is most commonly used for shoulder procedures?
A. Epidural block
B. Brachial plexus block
C. Femoral nerve block
D. Transversus abdominis plane
B. Brachial plexus block
Slide 25
You can use either a _________ or ____________ approach for anesthesia of the shoulder by targeting the brachial plexus.
Select 2
A. Interscalene
B. Lumbar plexus
C. Femoral
D. Supraclavicular
E. Axillary
A. Interscalene
D. Supraclavicular
Slide 25
What is the Bezold-Jarisch reflex characterized by?
A. Bradycardia and hypotension
B. Tachycardia and hypertension
C. Hypertension and increased preload
D. Tachycardia and decreased intraventricular volume
A. Bradycardia and hypotension
Slide 26
What is the primary cause of the Bezold-Jarisch reflex during shoulder surgery in the sitting position?
A. Increased cardiac output
B. Decreased preload
C. Excessive sedation
D. Hypervolemia
E. Overuse of muscle relaxants
B. Decreased preload due to venous pooling
Slide 26
What physiological condition is associated with a hypercontractile ventricle in the Bezold-Jarisch reflex?
A. Increased afterload
B. Increased intraventricular volume
C. Decreased intraventricular volume
D. Decreased myocardial contractility
C. Decreased intraventricular volume
Slide 26
Which intervention can help prevent the Bezold-Jarisch reflex during surgery?
A. Administering preemptive Zofran
B. Reducing muscle relaxant dosage
C. Decreasing the patient’s preload
D. Avoiding the sitting position
A. Administering preemptive Zofran
(from the DSW project)
We usually need to increase preload because this is usually related to venous pooling because of the sitting position
Slide 26
Which nerve is affected in hemidiaphragmatic paresis during a brachial plexus block and can cause respiratory depression?
A. Sciatic nerve
B. Median nerve
C. Vagus nerve
D. Phrenic nerve
D. Phrenic nerve
Side 28
Horner syndrome, a possible side effect of a brachial plexus block, includes all of the following symptoms EXCEPT:
A. Ptosis
B. Miosis
C. Hyperhidrosis
D. Anhidrosis
C. Hyperhidrosis
Slide 28
What is a key concern with hoarseness and dysphagia following a brachial plexus block?
A. Increased risk of airway obstruction
B. Loss of motor function in the arms
C. Increased pain perception
D. Bradycardia
A. Increased risk of airway obstruction
…they don’t have a lot of control over their
secretions or what if there could be passive or active regurgitation… leading to aspiration pneumonitis.
Slide 28
Which postop PACU factors should be addressed in a shoulder surgery patient? Select (3).
A. Pain management plan
B. Presence of nerve injury
C. Postoperative anesthesia type
D. Elderly patient
E. Extent of surgical positioning
F. Length of surgery
A. Pain management plan - opioids vs RA
B. Presence of nerve injury
D. Elderly- delirium/confusion
Admitted vs discharged
Slide 29
What are essential preoperative anesthetic considerations for patients with elbow fractures?
A. NPO status
B. Fracture
C. Nerve injury assessment
D. Typical assessment
All the above
Preop
* Fracture?
* Nerve injury?
* Mobility
* Typical assessment
Slide 31
What are the most common patient positions for elbow procedures?
A. Prone or sitting
B. Supine or Trendelenburg
C. Lateral or prone
D. Supine or lateral
D. Supine or lateral
Slide 32
Why is the infraclavicular or axillary approach preferred for brachial plexus block in elbow surgeries?
A. It provides better coverage for the shoulder.
B. It reduces the risk of respiratory complications.
C. It ensures full coverage of the elbow region.
D. It avoids nerve injury completely.
C. It ensures full coverage of the elbow region
slide 32
What happens to cardiac output in the lateral decubitus position?
A. It increases significantly due to venous pooling.
B. It remains unchanged unless venous return is obstructed.
C. It decreases due to increased vascular resistance.
D. It remains unchanged regardless of positioning.
B. It remains unchanged unless venous return is obstructed.
…venous return is obstructed, such as with the use of a kidney rest
Slide 33
What is a possible effect on arterial blood pressure in the lateral decubitus position?
A. It increases due to venous congestion.
B. It remains constant unless the patient is ventilated.
C. It decreases due to decreased vascular resistance
D. It fluctuates based on lung compliance.
C. It decreases due to decreased vascular resistance
right side > left side
Slide 33
In a ventilated patient in the lateral decubitus position, what is a key concern for the dependent lung? Select 2
A. Hyperventilation
B. Decreased ventilation
C. Increased perfusion
D. Increased ventilation
E. Decreased perfusion
B. Decreased ventilation - dependent lung is relatively underventilated due to compression by the weight of the mediastinum and abdominal contents
C. Increased perfusion -Gravity causes pulmonary blood flow to favor the dependent lung
V/Q Mismatch–> Hypoxemia
Slide 33
What factors further decrease dependent lung ventilation in the lateral decubitus position for ventilated patients?
A. Paralysis and open chest procedures
B. Supine positioning with mechanical ventilation
C. Vascular resistance and venous pooling
D. Spontaneous ventilation and lateral supports
A. Paralysis and open chest procedures
Slide 33
For spontaneously breathing patients in the lateral decubitus position, what is typically observed in the dependent lung?
A. Decreased ventilation
B. Decreased perfusion and ventilation
C. Increased ventilation
D. Increased perfusion with no ventilation changes
C. Increased ventilation
without V/Q mismatch
Slide 33
Ventilation in the ____ lung is increased during mechanical ventilation due to increased compliance.
A. Dependent
B. Non-dependent
C. Lower
D. Middle
B. Non-dependent
The nondependent lung is relatively overventilated because its compliance is increased
Slide 35
What is the primary purpose of placing an axillary roll in the lateral decubitus position?
A. To prevent respiratory compromise in the dependent lung.
B. To maintain proper alignment of the non-dependent shoulder.
C. To elevate the dependent arm for improved circulation.
D. To avoid compression of the neurovascular bundle in the dependent axilla.
D. To avoid compression of the neurovascular bundle in the dependent axilla.
Slide 36
The axillary roll in the lateral decubitus position is placed ______ to the dependent axilla.
A. Above
B. Directly in
C. Just caudad
D. On the shoulder
C. Just caudad
”..of course it’s over the chest level as opposed to the arm level of the patient.
Slide 36
When in the lateral decubitus position, to confirm neurovascular integrity in the dependent arm, the ______ pulse should be checked periodically.
A. Radial
B. Brachial
C. Carotid
D. Ulnar
A. Radial
Slide 37
Where is a pulse oximeter placed to monitor for neurovascular compromise in the lateral decubitus position?
A. Non-dependent hand
B. Dependent hand
C. Non-dependent foot
D. Dependent shoulder
B. Dependent hand
Slide 37
To prevent stretching of the brachial plexus, the upper arm should rest on a ______.
A. Foam wedge
B. Rolled towel placed in the axilla
C. Flat surface directly on the patient’s chest
D. Allen arm rest
D. Allen arm rest
Slide 38
Why is it important to decrease pressure on the dependent eye in the lateral decubitus position?
A. To prevent stretching of the extraocular muscles
B. To ensure adequate drainage of tears
C. To maintain proper alignment of the facial structures
D. To avoid blindness, whether temporary or permenant
D. To avoid blindness, whether temporary or permenant
Slide 39
What should be done to the dependent ear during lateral positioning?
A. Ensure it is flat against the head without folding.
B. Cover it with a gel pad to prevent pressure sores.
C. Rotate it slightly away from the head.
D. Place it directly on the bed for stability.
A. Ensure it is flat against the head without folding.
Slide 39
Why is it important to place a pillow between the knees in the lateral decubitus position?
Select 2
A. To prevent venous stasis
B. To pad bony prominences
C. To stabilize the thighs
D. To avoid nerve stretch
B. To pad bony prominences
D. To avoid nerve stretch
the lower leg should be flexed slightly
Slide 39
Which device can be used to maintain the neck in neutral alignment during the lateral decubitus position? Select 3
A. Axilla roll
B. Donut
C. Pillow
D. Shea
E. Bean bag
B. Donut
C. Pillow
D. Shea
Slide 39
True or False
If it looks uncomfortable to you, it is uncomfortable for the patient.
True
Slie 39
Which body parts require special attention to avoid pressure-related injuries in the lateral decubitus position? Select 2
A. Independent eye
B. Independent ear
D. Breast
E. Genitalia
D. Breast
E. Genitalia
Slide 39
Why is it important to ensure proper abdominal excursion when using a beanbag?
A. To prevent hyperventilation
B. To avoid compression of the dependent lung
C. To allow unrestricted diaphragm movement during ventilation
D. To reduce the risk of venous pooling in the abdomen
C. To allow unrestricted diaphragm movement during ventilation
Slide 40/41
What steps should be taken to ensure proper patient positioning when using a beanbag?
Select 3
A. Insert a hand between the chest and the beanbag to confirm adequate space.
B. Monitor chest and abdominal movement visually.
C. Position the patient during expiration to ensure deflation stability.
D. Assess peak inspiratory pressures
E. Use the beanbag only for non-dependent patients.
A. Insert hand between the chest and the beanbag to confirm adequate space.
B. Monitor chest and abdominal movement visually.
D. Assess peak inspiratory pressures
Position the patient during INSPIRATION to ensure deflation stability.
Slide 40/41
At what pressure should a tourniquet typically be inflated to for elbow procedures?
A. 50 mmHg above diastolic blood pressure
B. 100 mmHg above systolic blood pressure
C. 100 mmHg above mean arterial pressure
D. 150 mmHg above baseline blood pressure
E. Equal to systolic blood pressure
B. 100 mmHg above systolic blood pressure
Usually we inflate the tourniquet 100mmHg more than whatever the assessed systolic blood pressure is for our patients, if our patient’s systolic is 120, usually we inflate the tourniquet at 200.
Slide 42
If we are doing an axillary block, we may need a separate block for the __________________ nerve because that is the most common nerve that can be missed.
A. Ulnar
B. Median
C. Radial
D. Musculocutaneous
E. Axillary
D. Musculocutaneous
slide 42
What should be documented when a tourniquet is used during surgery?
Select 4
A. Inflation pressure and any changes
B. Time of deflation
C. Time of inflation
D. Position of the limb during inflation
E. Total time the tourniquet was inflated
F. Total time the tourniquet was deflated
A. Inflation pressure and any changes
B. Time of deflation
C. Time of inflation
E. Total time the tourniquet was inflated
Slide 42
What are the 2 most important aspects of immediate post op care for elbow surgery? (select 2)
A.immobility
B.infection
C.pain management
D. DVT
A. immobility
C. pain management (opioids, NSAIDs, regional)
slide 43
True or false:
During Preop assessment for forearm or hand surgery, you should assess for preexisiting nerve conduction issues
true
slide 45
Which of the following is NOT typically included in a preoperative assessment for forearm to hand surgery?
a) Fracture location
b) nerve impingement
c) Psychological evaluation
d) traumatic amputation
C. psychological evaluation
slide 45
According to lecture what type of positioning equipement/ techniques are indicated for forearm/hand surgery (choose 3)
A.supine
B.hand table
C.tube tree
D.Prone
E. lateral decubitus
A. supine
B. Hand table
C. tube tree (Castillo loves this thing)
slide 46
What is the tube tree NOT used for? according to lecture
A. relives stress/strain at patient connection.
B. slips beneath surgical bad aor bed mattress
C.flexible light weight transparent plastic
D. a place to keep IV easily accessible
E.single adjustment knob for vertical and or 180 degree arc positioning
F.used with disposable or reusable hose
D. place to keep IV easily accessible
slide 47
What are the 2 types of blocks discussed in lecture for forearm to hand surgery (select 2)
A.brachial plexus
B.axillary block
C. ulnar nerve
D. bier block
B. axillary block
D. Bier block
slide 48
True or false: Pain management and mobilization are the 2 things to focus on for post op forearm/hand surgery
FALSE
IMMOBILIZATION
slide 49
Throwback
The bier block is performed by
A. LA injected into the medial nerve
B. IM injection of LA inot extremity and using a tourniquet to isolate it to that muscle
C. IV injection of LA into extremity and letting it circulate before placement of tourniquet
D. IV injection of LA into extremity and isolated using a tourniquet from systemic circulation
D. IV injection of LA into extremity and isolated using a tourniquet from systemic circulation
anesthesia pharm lecture 2nd semester
Place steps in order for Bier Block:
LA injection
exsangusination
IV D/C
IV start
double cuff
IV start
exsanguination
double cuff
LA injection
IV D/C
anesthesia pharm lecture 2nd semester
According to statistical evidence 1 in 50 over the age of _________ will have a hip fracture
A.70
B.65
C.55
D. 60
D. 60
slide 52
Mortality rate for a hip fracture after 1 year is
A. 25-30%
B.22-38%
C.30-35%
D. 20-25%
A. 25-30%
during initial hospitilization its around 10%
slide 52
Mortality rate in the first year of a hip fracture is contributed to all of the following except (according to lecture)
A. cardiac and pulmonary conditions
B. Deep vein thrombosis
C.infection
D. delirium
C. infection
slide 52
For hip fractures pain scores are typically lower with what intervention accoridng to lecture
A. precedex drip
B. spinal block
C.early surgery
D. NSAIDs
C. early surgery
slide 53
True or false:
During preop for hip fracture patients, IVF status, Hgb/Hct, central line/ arterial line needs, baseline VS, and NPO status should be assessed
True
slide 53
During position for hip fracture surgery we will have the patient
A.prone on a prone table
B. supine on a fracture table
C.lithotomy fracture table
D. lateral on a fracture table
B. supine on a fracture table
will move patient after induction
slide 54
Which of the following is NOT a benefit of neuroaxial anesthesia compared to general anesthesia
A. decreased DVT
B. shorter length of hospital stay
C. decreased infection
D. lower incidence of delirium
E. improved post op pain control
C. decreased infection
slide 56
True or false:
Pain management, mental status, blood transfusion needs, and ICU admission are the 4 things to consider for post op hip fracture
true
slide 57
Etiology for total hip arthroplasty includes all the following except
A. arthritis
B. degenerative synovium or cartilage disease
C. avascular necrosis
D. fracture
E. tumors
F. congenital deformity
G. dislocation
H. failed reconstructions
D. Fracture
osteoarthritis
Rheumatoid arthritis
slide 58
During preop for total hip arthroplasty you should assess… (select 3)
A.medications
B.mental status
C. mobility
D. Hgb/hct, coagulation
E. infection
A. medications
B. mental status (confusion/delirium)
D. hgb/hct/coags
slide 58
Life threatining complictions of total hips arthroplasty include (select 3)
A.Venous thromboembolism (VTE)
B. Bone cement implantation syndrome
C. Fracture of the femoral head
D.intra- and postoperative hemorrhage
A. venous thromboembolism
B. bone cement implantation syndrome (BCIS)
D. intra- and postoperative hemorrhage
slide 59
Positioning for Total hip arthroplasty includes (select 3)
A. lateral decubitus
B. supine
C. operative side up
D. operative side down.
E. axillary rolll
F. lithotmy
A. lateral decubitus
C. operative side up
E. axillary role
slide 60
What type of anesthetic will we perform on a total hip arthroplasy
A. MAC
B. general LMA
C. regional only
D. general ETT
D. general ETT
muscle relaxation required
slide 62
What are the 3 benefits for Neuraxial anesthesia for total hip arthroplasty (select 3)
A. decreased awareness intraop
B.decreased EBL
C. decreased DVT and PE
D. decreased incidence of post op delirium
B.decreased EBL
C. decreased DVT and PE
D. decreased incidence of post op delirium
slide 62
What is the primary use of Polymethyl Methacrylate (PMMA) in the context of medical implants?
a) As a bone graft substitute
b) For the fixation of prosthetic implants
c) As a coating for surgical instruments
d) For the manufacture of artificial joints
B. fixation of prosthetic implants
slide 63
Use of Polymethylmethacrylate (PMMA) can result in (select 2)
A. intramedullary HTN >500mmHg
B. increased SVR
C.Cardiac HTN >200mmHg
D. embolization of fat, bone marrow, or cement
A. intramedullary HTN >500mmHg
D. embolization of fat, bone marrow, or cement
slide 63
What does the acronym “PMMA” stand for?
a) Polymethyl Methacrylate
b) Prosthetic Medical Material
c) Polymeric Molten Mechanical Adhesive
d) Post Menopausal Menstrual Attack
e) Plastic Melding Methylizing Agent
A. polymethyl methacrylate
slide 63
True or false: PMMA absorbs in the peripheral circulation
FALSE
systemic absorption
causing vasodilation and decreased SVR
slide 64
PMMA can cause CV instability and
A. bleeding
B. HTN
C.microthrombus in lungs
D. increased SVR
C. microthrombus in the lungs
vasodilation, decreased SVR, platelet aggregation
slide 64
Prevention of Bone cement implantation syndrome (BCIS) includes all of the following except
A. minimize hypotension and hypovolemia
B.maximize FiO2
C.vent hole in femur
D. limit fluids
E.lavage of femoral shaft
F. avoid bone cement
D. limit fluids
slide 65
Signs and symptoms of BCIS include (select 5)
A.arrhythmias
B.hypoxia
C.hypotension
D.hypertension
E.Pulmonary HTN
F. Increased SVR
G. decreased Cardiac output
A. arrythmias
B. hypoxia
C hypotension
E pulmonary hypertension
G decreased CO
slide 66
Treatment for BCIS includes (select 3)
A. vasopressors
B.maintain euvolemia
C. limiting fluid intake
D. increased FiO2
A. vasopressors
B. maintain euvolemia
D. increase FiO2
slide 67
True or False
the most common complications from total hip are cardiac events, PE, infection, pneumonia, respiratory failure, infection
true
slide 69
Hip arthroscopy is considered
A. non invasive
B.minimally invasive
C.invasive
D.open procedure
B. minimally invasive
slide 71
Indications for hip arthroscopy include (select 4)
A.replacement
B.osteoarthritis
C.acetabular labral tears
D.loose bodies
E.Femoro-acetabular impingement
B.osteoarthritis
C.acetabular labral tears
D.loose bodies
E.Femoro-acetabular impingement
slide 71
Positioning for hip arthroscopy includes (select 2)
A. weighted traction
B. prone
C. lateral decubatis
D. supine
A. weighted traction
D. supine
slide 72
Which of the following is a physiological change associated with the supine position in the cardiac system?
a) Decreased right-sided filling
b) Increased heart rate
c) Increased peripheral vascular resistance
d) Equalization of pressures throughout the arterial system
D. equalization of pressures throughout the areterial system
slide 73
How does the supine position affect the respiratory system?
a) Increases functional residual capacity (FRC)
b) Improves ventilation of the upper lung lobes
c) Displaces the diaphragm downwards
d) Increases perfusion of the dependent lung segments
D. increase perfusion of the dependent lungs
slide 73
Which condition can further exacerbate the respiratory changes associated with the supine position?
a) Pregnancy
b) Anemia
c) Hypothyroidism
d) Dehydration
A. pregnancy (and obesity)
slide 73
Which of the following is NOT a typical cardiac change associated with the supine position?
a) Increased cardiac output
b) Decreased heart rate
c) Increased peripheral vascular resistance
d) Increased right-sided filling
C. increased PVR
decrease PVR
slide 73
In the supine position the diaphragm is displaced ______ by the abdominal viscera
A.posterior
B. lateral
C. cephalad
D. caudad
c. cephalad
slide 73
_____ favors dependent lung segements while _____ favors independent segments
A.SV, CV
B.CV, CV
C.CV, SV
D.SV, SV
A. SV , CV
slide 73
_____ and may fall below CV in older patients
A . TLC increse
B. FRC increases
C.FRC decreases
D. PVR increase
C. FRC decrease (about 800mL)
slide 73
The most common postoperative peripheral neuropathy is
A. ulnar neuropathy
B. brachial plexus injury
C. median nerve injury
D. sciatic nerve compression
A. ulnar neuropathy
slide 74/75
Where are the two major sites of injury at the elbow (select 2)
A. radius
B.humerus
C.condylar groove
D .cubital tunnel
C. condylar groove
D. cubital tunnel
slide 75
Which two structures form the condylar groove?
a) The medial epicondyle of the humerus and the olecranon process of the ulna
b) The lateral epicondyle of the humerus and the radial head
c) The trochlea of the humerus and the coronoid process of the ulna
d) The capitulum of the humerus and the radial head
A. medial epicondyle of the humerus and the olecranon process of the ulna
slide 75
Why is the ulnar nerve at risk of compression injury at the elbow?
a) It is deeply located in the elbow joint
b) It passes through a narrow space called the cubital tunnel
c) It is protected by a thick layer of fat
d) It is not innervated by sensory nerves
b) It passes through a narrow space called the cubital tunnel
especially in Males where there is less protective adipose tissue
slide 75
How should arms be positioned when lying supine
A.supinated
B.pronated
C. lateral
A. supinated
slide 75 (what he said in lecture)
What type on anesthetic will be used on hip arthroscopy
A. general LMA
B. neuroaxial anesthesia
C. general ETT
D. MAC
C. general ETT (due to muscle relaxation requirement)
neuraxial may prolong time to discharge
slide 76
Which of the following is NOT a key consideration in the postoperative care of a patient?
a) Type of surgery (inpatient vs. outpatient)
b) Assessment for potential nerve injury
c) weight of the patient
d) Pain management strategies
C. weight of patient
will consider AGE for mental status
slide 77
Pre op assessment for Hip dislocation include (select 4)
A. Vit C intake
B.NPO status
C. IVF status
D.comorbidities
E.require closed reduction
B.NPO status
C. IVF status
D.comorbidities
E.require closed reduction
slide 78
Hip Dislocation
What type of sedation is typically used for hip dislocation management?
A) Deep sedation
B) Conscious sedation
C) No sedation required
D) General anesthesia
B) Conscious sedation
May be performed in ER
Slide 79
Hip Dislocation
Which combination of drugs is commonly used for “conscious sedation” in hip dislocation cases?
A) Fentanyl and Midazolam
B) Ketamine and Propofol
C) Etomidate and Dexmedetomidine
D) Thiopental and Sevoflurane
B) Ketamine and Propofol
Sldide 79
Hip Dislocation
What medication can be used for muscle relaxation during hip dislocation reduction?
A) Succinylcholine
B) Rocuronium
C) Cisatracurium
D) Pancuronium
A) Succinylcholine
Slide 79
Hip Dislocation
What are key postoperative considerations for patients after a hip dislocation reduction?
(Select 3 that apply)
A) Pain management
B) Admission for observation
C) Monitoring mental status
D) Immediate discharge
E) Surgical wound care
A) Pain management
B) Admission for observation
C) Monitoring mental status
Slide 80
Knee Arthroscopy
What factor determine preoperative considerations for knee arthroscopy?
A) Age of the patient
B) Type of anesthesia used
C) Patient’s health status
D) Surgical equipment availability
A) Age of the patient
Slide 83
Knee Arthroscopy
Which types of patients may undergo knee arthroscopy?
(Select 3 that apply)
A) Healthy young athletes with ligament tears
B) Healthy elderly individuals
C) Patients with comorbidities
D) Pediatric patients with no injuries
A) Healthy young athletes with ligament tears
B) Healthy elderly individuals
C) Patients with comorbidities
Slide 83
Knee Arthroscopy
What is the standard patient positioning during knee arthroscopy?
(Select 2 that apply)
A) Supine
B) Prone
C) Lateral
D) Knee flexed
A) Supine
D) Knee flexed
Slide 84
Knee Arthroscopy
What types of anesthesia can be used for knee arthroscopy?
(Select 3 that apply)
A) General anesthesia
B) Neuraxial / regional anesthesia
C) Local anesthesia only
D) Sedation with extraarticular and intraarticular injections
A) General anesthesia - use LMA?
B) Neuraxial / regional anesthesia -Spinal may delay discharge
D) Sedation with extraarticular and intraarticular injections
Slide 85
Knee Arthroscopy
Which device may be applied during knee arthroscopy depending on the procedure?
A) Catheter
B) Tourniquet
C) Wound vacuum
D) Traction
B) Tourniquet
Slide 85
Knee Arthroscopy
What is the typical surgical setting for knee arthroscopy?
A) Inpatient surgery
B) Outpatient surgery
C) Emergency surgery
D) Trauma center surgery
B) Outpatient surgery
Slide 86
Knee Arthroscopy
What are common postoperative pain management strategies for knee arthroscopy?
(Select all that apply-2)
A) Peripheral nerve block
B) Injections by the surgeon
C) Oral NSAIDs only
D) Spinal anesthesia
A) Peripheral nerve block
B) Injections by the surgeon
Slide 86
Total Knee Arthroplasty
Which preoperative factors are critical for a total knee arthroplasty?
(Select 3 that apply)
A) Mental status assessment
B) Laboratory evaluation
C) Preoperative medications review
D) Cardiopulmonary bypass preparation
A) Mental status assessment - Confusion / delirium
B) Laboratory evaluationHgb, Hct, coagulation
C) Preoperative medications review
+ Typical assessment
Slide 88
Total Knee Arthroplasty
What is the standard patient positioning for total knee arthroplasty?
A) Supine
B) Prone
C) Lateral
D) Sitting
A) Supine
Slide 89
Total Knee Arthroplasty
Which types of anesthesia can be used for total knee arthroplasty?
(Select 3 that apply)
A) General anesthesia
B) Neuraxial anesthesia
C) Peripheral nerve block
D) Local anesthesia only
A) General anesthesia
B) Neuraxial anesthesia
C) Peripheral nerve block
Slide 90
Total Knee Arthroplasty
Why is neuraxial anesthesia often preferred for total knee arthroplasty?
(Select 2 that apply)
A) Decreased 30-day mortality
B) Decreased infection rate
C) Faster surgical procedure time
D) Reduced cost
A) Decreased 30-day mortality
B) Decreased infection rate
Slide 90
Total Knee Arthroplasty
What types of peripheral nerve blocks are commonly used in total knee arthroplasty?
(Select 2 that apply)
A) Femoral nerve block
B) Sciatic nerve block
C) Brachial plexus block
D) Popliteal nerve block
A) Femoral nerve block
B) Sciatic nerve block
Slide 90
Total Knee Arthroplasty
What is a key consideration regarding blood loss when a tourniquet is used during total knee arthroplasty?
(Select 2 that apply)
A) Blood loss begins upon tourniquet deflation
B) Blood loss continues for up to 24 hours postoperatively
C) Blood loss is minimized postoperatively
D) Blood loss stops immediately after deflation
A) Blood loss begins upon tourniquet deflation
B) Blood loss continues for up to 24 hours postoperatively
Slide 91
Total Knee Arthroplasty
What is a potential risk associated with tourniquet use during total knee arthroplasty?
A) Increased infection risk
B) Peroneal nerve palsy
C) Delayed wound healing
D) Hypotension
B) Peroneal nerve palsy
Slide 91
Total Knee Arthroplasty
Which of the following is a significant postoperative concern associated with tourniquet use?
A) Mild discomfort
B) Significant postoperative pain
C) Numbness in the contralateral leg
D) Delayed mobility
B) Significant postoperative pain
Slide 91
Total Knee Arthroplasty
Which of the following are components of a total knee replacement (Select 4)?
A) Tibial component
B) Femoral component
C) Patellar component
D) Plastic spacer
E) Meniscus implant
F) Ligament graft
G) Bone cement
A) Tibial component
B) Femoral component
C) Patellar component
D) Plastic spacer
Slide 93
Total Knee Arthroplasty
Which of the following is a major postoperative concern following total knee arthroplasty? (Select 2)
A) Significant pain
B) Liver failure
C) Mental status changes
D) Vision loss
A) Significant pain
C) Mental status changes
Slide 94
Total Knee Arthroplasty
Which pain management techniques are commonly used postoperatively for total knee arthroplasty? (Select 2)
A) Indwelling epidural catheter
B) Continuous peripheral nerve block
C) Spinal cord stimulator
D) Acupuncture
A) Indwelling epidural catheter
B) Continuous peripheral nerve block
Slide 94
Which of the following strategies help reduce the risk of surgical wound infections? (Select 4)
A) Decreasing traffic in and out of the OR
B) Preoperative antibiotics
C) Using proper prep and draping techniques
D) Allowing the wound to air dry before closure
E) Using hoods
A) Decreasing traffic in and out of the OR
B) Preoperative antibiotics
C) Using proper prep and draping techniques
E) Using hoods
Slide 96
Which factor is associated with an increased risk of postoperative wound infections? (Select 3)
A) Poor perioperative glucose control
B) Maintaining normothermia
C) Postoperative hypoxia
D) Postoperative hypothermia
A) Poor perioperative glucose control
C) Postoperative hypoxia
D) Postoperative hypothermia
Slide 96
Amputations
Which preoperative factors should be assessed before an amputation? select 3
A) Presence of comorbidities
B) Psychological support needs
C) Full sensory assessment
D) Type of prosthesis before surgery
A) Presence of comorbidities
B) Psychological support needs
C) Full sensory assessment
Pressure ulcers
Slide 97
Amputations
Which comorbidity is most commonly associated with amputations?
A) Hypertension
B) Diabetes
C) Asthma
D) Hyperthyroidism
B) Diabetes
Slide 97
Amputations
What is the standard patient positioning for an amputation surgery?
A) Supine
B) Prone
C) Lateral decubitus
D) Sitting
A) Supine
Slide 98
Amputations
Which patient group needs padding during amputation surgery? select 2
A) Obese patients
B) Cachectic patients
C) Patients with normal BMI
D) Pediatric patients
A) Obese patients
B) Cachectic patients
Slide 98
Amputations
Which type of anesthesia is considered for amputation surgery? (Select 2)
A) Local anesthesia
B) General anesthesia
C) Neuraxial anesthesia
D) Conscious sedation
B) General anesthesia
C) Neuraxial anesthesia preferred
Slide 99
Amputations
What are potential benefits of neuraxial anesthesia in amputation surgery? (Select 2)
A) Decreased incidence of delirium
B) Faster recovery of limb function
C) Reduced blood loss
D) Potential reduction in phantom limb pain
A) Decreased incidence of delirium
D) Potential reduction in phantom limb pain
Slide 99
Amputations
What is the primary reason for the application of a tourniquet during amputation procedures?
A) To improve anesthetic depth
B) To minimize variable blood loss
C) To enhance nerve function
D) To maintain body temperature
B) To minimize variable blood loss
Slide 99
Amputations
Which of the following is a key component of postoperative care after an amputation? (Select 2)
A) Pain management
B) Neurological testing
C) Wound drainage placement
D) Psychological support
A) Pain management
D) Psychological support
Slide 100
Amputations
What postoperative mental status changes should be monitored after an amputation? (Select 2)
A) Euphoria
B) Confusion
C) Delirium
D) Hallucinations
B) Confusion
C) Delirium
Slide 100
Amputations
Phantom limb pain is characterized by which of the following? (Select 4)
A) Onset within a few days after surgery
B) Constant and unchanging pain
C) Intermittent pain episodes
D) Pain described as shooting, stabbing, or burning
E) Pain described as squeezing or throbbing
A) Onset within a few days after surgery
C) Intermittent pain episodes
D) Pain described as shooting, stabbing, or burning
E) Pain described as squeezing or throbbing
Slide 101
Amputations
Which of the following are common triggers for phantom limb pain? (Select 3)
A) Weather changes
B) Emotional stress
C) Pressure on the remaining area
D) Increased water intake
A) Weather changes
B) Emotional stress
C) Pressure on the remaining area
Slide 102
Amputations
Which of the following are potential causes of phantom limb pain? (Select 3)
A) Remapping of neural circuitry
B) Damaged nerve endings
C) Scar tissue formation
D) Sleep deprivation
A) Remapping of neural circuitry
B) Damaged nerve endings
C) Scar tissue formation
Slide 103
Amputations
Which imaging techniques can provide insight into the causes of phantom limb pain? (Select 2)
A) X-ray
B) MRI
C) PET scan
D) Ultrasound
B) MRI
C) PET scan
Slide 103
Amputations
How does pain experienced prior to an amputation contribute to phantom pain?
A) It establishes a pain memory that may persist after the limb is removed.
B) It causes increased sensitivity to pain medications post-surgery.
C) It reduces the likelihood of postoperative pain.
D) It eliminates the need for nerve blocks during surgery.
A) It establishes a pain memory that may persist after the limb is removed.
Slide 103
Amputations
Which of the following are treatments for phantom limb pain? (Select 4)
A) Biofeedback
B) Relaxation techniques
C) Massage
D) TENS unit (Transcutaneous Electrical Nerve Stimulation)
E) Acupuncture
F) Cognitive-behavioral therapy (CBT)
G) Nerve blocks
A) Biofeedback
B) Relaxation techniques
C) Massage
D) TENS unit (Transcutaneous Electrical Nerve Stimulation)
Slide 104
Amputations
Which medications are commonly used to manage phantom limb pain? (Select 3)
A) Neuroleptics
B) Antidepressants
C) Sodium channel blockers
D) Corticosteroids
E) Opioids
A) Neuroleptics
B) Antidepressants
C) Sodium channel blockers
Slide 105
Ankle/Foot
Which conditions may require surgical intervention? (Select 3)
A) Achilles tendon rupture
B) ORIF malleolar fracture
C) Hallux valgus (bunion)
D) Tension headache
E) Common cold
A) Achilles tendon rupture
B) ORIF malleolar fracture
C) Hallux valgus (bunion)
Slide 107
Ankle/Foot
Which factors should be assessed during the preoperative phase for ankle/foot surgery? (Select 4)
A) Age of the patient
B) Comorbidities
C) Anxiety levels
D) Pain management needs
E) Eye examination
A) Age of the patient
B) Comorbidities
C) Anxiety levels
D) Pain management needs
Slide 108
Ankle/Foot
What is the correct patient positioning for ankle/foot surgery? (Select 3)
A) Lateral position
B) Prone position
C) Supine position
D) Fowler’s position
A) Lateral position (Achilles tendon)
B) Prone position (Achilles tendon)
C) Supine position
Slide 109
Ankle/Foot
Which anesthesia options are available for ankle/foot surgery? (Select 3)
A) General anesthesia
B) Neuraxial anesthesia
C) Regional anesthesia
D) Local sedation
A) General anesthesia
B) Neuraxial anesthesia
C) Regional anesthesia
Slide 110
Ankle/Foot
What are key considerations for administering Regional Anesthesia for Ankle/Foot surgery? (Select 3)
A) Assessing the current level of sensation
B) Doing ankle block during foot surgery
C) Determining if the podiatrist will perform the injection
D) Avoiding anesthesia to minimize recovery time
A) Assessing the current level of sensation
B) Doing ankle block during foot surgery
C) Determining if the podiatrist will perform the injection
Slide 110
Ankle/Foot
Which 5 nerves are targeted during an ankle block?
A) Posterior tibial nerve
B) Deep peroneal nerve
C) Superficial peroneal nerve
D) Sural nerve
E) Saphenous nerve
F) Sciatic nerve
A) Posterior tibial nerve
B) Deep peroneal nerve
C) Superficial peroneal nerve
D) Sural nerve
E) Saphenous nerve
Slide 111-112
Ankle/Foot
What areas are anesthetized by the posterior tibial nerve?
A) Plantar surface of the foot
B) Medial malleolus
C) Dorsum of the foot
D) Interspace between the great and second toe
A) Plantar surface of the foot
Slide 111
Ankle/Foot
Which of the following statements about the saphenous nerve is true?
A) It provides sensation to the medial malleolus.
B) It is a branch of the posterior tibial nerve.
C) It provides motor innervation to the foot.
D) It plays a role in sensation to the plantar surface of the foot.
A) It provides sensation to the medial malleolus.
Slide 111
Ankle/Foot
Which areas are innervated by the deep peroneal nerve?
A) Plantar surface of the foot
B) Interspace between the great and second toes
C) Dorsum of the foot
D) Medial malleolus
B) Interspace between the great and second toes
Slide 112
Ankle/Foot
The superficial peroneal nerve provides sensation to which areas? (Select 2)
A) Dorsum of the foot
B) Lateral foot and 5th toe
C) Plantar surface of the foot
D) Toes 2 through 5 (dorsal side)
A) Dorsum of the foot
D) Toes 2 through 5 (dorsal side)
Slide 112
Ankle/Foot
The sural nerve provides sensation to which areas of the foot? (Select 2)
A) Lateral foot
B) Medial malleolus
C) Lateral 5th toe
D) Dorsum of the foot
A) Lateral foot
C) Lateral 5th toe
Slide 112
Ankle/Foot
Which are key postoperative considerations for ankle and foot surgery? Select 2
A) Pain management
B) Immobilization
C) Immediate weight-bearing
D) Outpatient surgery
A) Pain management
B) Immobilization
Slide 113
Ankle/Foot
What surgical setting can most ankle and foot procedures be done?
A) Inpatient hospital stay
B) Outpatient surgery
C) Emergency trauma center
D) Rehabilitation clinic
B) Outpatient surgery
Slide 113
