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JW: Adv Principles A > Unit 1 Module 3 (Exam 1) > Flashcards

Unit 1 Module 3 (Exam 1) Flashcards

1
Q

Which patient group is most likely to undergo spinal decompression due to degenerative spine disease?

A. Patients over 60 years old
B. Patients under 60 years old
C. Patients with sedentary life styles
D. Patients with no history of back pain

A

B. Patients under 60 years old

Slide 3

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2
Q

What is the most common spinal condition in patients over 60 years old?

A. Herniated disc
B. Degenerative disc disease
C. Spinal stenosis
D. Spondylolisthesis

A

C. Spinal stenosis

Slide 3

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3
Q

What type of anesthesia is typically required for most spine surgeries?

A. Regional anesthesia
B. Conscious sedation
C. Local anesthesia
D. General endotracheal anesthesia

A

D. General endotracheal anesthesia

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4
Q

Airway management during spine surgery can be challenging due to surgical __________ and patient __________.

A. equipment; medications
B. monitoring; blood pressure
C. positioning; anatomy
D. sedation; anesthesia type

A

C. positioning; anatomy

Slide 5

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5
Q

Motor and sensory monitoring in spine surgery is critical to avoid __________ of nerve conduction.

A. enhancement
B. severance
C. paralysis
D. relaxation

A

B. severance

MEPs and SSEPs must be monitored

Slide 5

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6
Q

Why are paralytic agents often avoided during spine surgeries?

A. Paralytics cause excessive sedation.
B. Paralytics can impair nerve monitoring
C. Paralytics increase the risk of airway complications.
D. Paralytics are unnecessary for general anesthesia cases.

A

B. Paralytics can impair nerve monitoring

Slide 5

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7
Q

Patients undergoing spine surgery may experience large __________ due to the complexity of the procedure.

A. blood loss
B. electrolyte shifts
C. fluid intake
D. clot formation

A

A. blood loss

Slide 5

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8
Q

Which is NOT a condition that may require reconstructive spine surgery?

A. Scoliosis
B. Kyphosis
C. Kyphoscoliosis
D. Olecranonaplasty

A

D. Olecranonaplasty

Reconstructive surgery
* Scoliosis
* Kyphosis
* Kyphoscoliosis
* Revision of previous thoracolumbar fusions

Slide 6

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9
Q

A __________ is often performed to remove part of a herniated disc that is pressing on a nerve.

A. microdiscectomy
B. spinal fusion
C. kyphoplasty
D. thoracotomy

A

A. microdiscectomy

Slide 6

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10
Q

True or False

Spinal fusion can be performed through either an anterior or posterior approach.

A

True

Slide 6

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11
Q

Which of the following characteristics define scoliosis?
Select 2

A. Lateral rotation of the spine greater than 10°
B. Posterior curvature of the spine
C. Vertebral rotation
D. Degeneration of intervertebral discs

A

A. Lateral rotation of the spine greater than 10°
C. Vertebral rotation

Slide 7

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12
Q

Types of scoliosis include congenital, idiopathic, and __________.

A. degenerative
B. traumatic
C. infectious
D. neuromuscular

A

D. neuromuscular

Slide 7

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13
Q

Back pain in adult scoliosis is often caused by arthritis and __________.

A. spinal cord swelling
B. disc degeneration
C. muscle spasms
D. nerve regeneration

A

B. disc degeneration

back pain because of the misalignment of the vertebrae causing compression of the nerves

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14
Q

Spinal stenosis can cause pain that worsens when a patient is __________.

A. lying down
B. eating
C. swimming
D. standing

A

D. standing or walking

Slide 8

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15
Q

Radiculopathy is caused by the compression or __________ of a nerve at the spinal column.

A. stretching
B. pinching
C. relaxing
D. dissolving

A

B. pinching

Slide 8

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16
Q

What is a common respiratory complication in thoracic scoliosis?

A. Restrictive lung disease
B. Obstructive lung disease
C. Pulmonary embolism
D. Chronic bronchitis

A

A. Restrictive lung disease

Decreased chest wall compliance

Slide 10

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17
Q

What preoperative assessment is crucial for patients with thoracic scoliosis?

A. Neurological testing
B. Exercise tolerance
C. Bone density testing
D. Thyroid function tests

A

B. Exercise tolerance

Slide 10

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18
Q

True or False

Pulmonary function tests (PFTs) are irrelevant in the preoperative assessment of scoliosis patients.

A

False

Pulmonary function tests (PFTs) are relevant in the preoperative assessment of scoliosis patients.

Review: normal values for tidal volume, minute ventilation, functional residual capacity, forced vital capacity are FEV1 and then expiratory flow rates and peak

Slide 10

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19
Q

What is a primary cause of chronic hypoxemia in patients with thoracic scoliosis?

A. V/Q mismatch
B. Obstructive airway disease
C. Coronary artery disease
D. Chronic kidney disease

A

A. V/Q mismatch

Causing chronic hypoxemia

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20
Q

What condition is associated with increased pulmonary vascular resistance in scoliosis patients?

A. Myocardial infarction
B. Cor pulmonale
C. Aortic stenosis
D. Hypotension

A

B. Cor pulmonale

Slide 11

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21
Q

Which cardiac changes may be seen on an EKG in patients with cor pulmonale?
Select 2

A. Left ventricular hypertrophy
B. Right ventricular hypertrophy
C. Right atrial enlargement
D. Atrial fibrillation

A

B. Right ventricular hypertrophy (RVH)
C. Right atrial enlargement (RAE)

Slide 11

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22
Q

Which preoperative test helps assess pulmonary hypertension in scoliosis patients?

A. Electroencephalogram
B. Echocardiogram
C. Pulmonary function test
D. Chest X-ray

A

B. Echocardiogram (echo)

..with a pre-op echo or a Doppler ultrasound result that measures the pulmonary artery systolic pressure…

Slide 11

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23
Q

In surgeries with significant blood loss, platelet abnormalities and __________ coagulopathy may occur.

A. respiratory
B. peripheral
C. chronic
D. dilutional

A

D. dilutional

Slide 12

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24
Q

The breakdown of primary clots, known as __________, can increase the risk of bleeding during surgery.

A. hypercoagulation
B. fibrinolysis
C. thrombocytosis
D. hemostasis

A

B. fibrinolysis

Slide 12

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25
Q

True or False

The number of vertebral levels fused can impact the amount of blood loss during surgery.

A

True

Slide 12

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26
Q

Which factors are associated with anticipated large blood loss during corrective spine surgery?
Select 3

A. Surgical Technique
B. Mean arterial pressure
C. Type of anesthesia
D. Operative time
E. Length of hospital stay

A

A. Surgical Technique
B. Mean arterial pressure
D. Operative time

Slide 12

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27
Q

Which spinal cord level is responsible for partial diaphragm innervation?

A. C5
B. C6
C. C7
D. T1

A

A. C5

Slide 13

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28
Q

What mnemonic helps remember the spinal levels responsible for diaphragm function?

A. C5 through C8 keeps the body straight
B. T1 to T3 stabilizes the spine
C. C3, C4, and C5 keep the diaphragm alive
D. L1 to L3 controls lower limb movement

A

C. C3, C4, and C5 keep the diaphragm alive

Slide 13

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29
Q

Flaccid paralysis due to a C5 spinal cord injury may affect which muscles?
Select 3

A. Deltoid
B. Trapezius
C. Brachialis
D. Brachioradialis
E. Pectoralis major

A

A. Deltoid
C. Brachialis
D. Brachioradialis

Flaccid muscles innervated by C5
* Deltoid
* Biceps
* Brachialis
* Brachio-radialis

Slide 13

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30
Q

What is a common effect of spinal cord injuries at T5 or higher?

A. Physiologic sympathectomy
B. Increased cardiac output
C. Peripheral neuropathy
D. Chronic hypertension

A

A. Physiologic sympathectomy

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31
Q

Hypotension caused by a spinal injury at T5 or higher may be treated with __________.

A. glycopyrrolate
B. nalozone
C. atropine
D. midodrine

A

D. midodrine

Slide 14

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32
Q

What condition may develop in spinal injuries higher than T1 to T4?

A. Hyperthermia
B. Bradycardia
C. Tachypnea
D. Cyanosis

A

B. Bradycardia

Slide 14

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33
Q

In cases of spinal injury-induced bradycardia, direct-acting beta agonists like __________ are recommended.

A. epinephrine
B. atropine
C. lidocaine
D. glycopyrrolate

A

A. epinephrine

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34
Q

What condition can develop with a complete spinal cord transection above T5 or T6?

A. Pulmonary embolism
B. Hypoglycemia
C. Autonomic hyperreflexia
D. Septic shock

A

C. Autonomic hyperreflexia

Slide 15

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35
Q

True or false

Severe transient hypertension occurs below the level of injury in autonomic hyperreflexia.

A

True

Slide 15

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36
Q

Which symptoms occur above the level of injury in autonomic hyperreflexia?
Select 2

A. Bradycardia
B. Tachycardia
C. Vasodilation
D. Dysrhythmias

A

A. Bradycardia
D. Dysrhythmias

Slide 15

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37
Q

What compensatory responses occur above the level of injury in autonomic hyperreflexia?

A. Cutaneous vasodilation
B. Hypotension
C. Blanching of the skin
D. Hypertension

A

A. Cutaneous vasodilation

Slide 15

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38
Q

A common trigger for autonomic hyperreflexia is a full __________ or bowel.

A. stomach
B. bladder
C. lung
D. artery

A

B. bladder

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39
Q

Hypertension in autonomic hyperreflexia is caused by widespread __________ below the level of injury.

A. vasodilation
B. vasoconstriction
C. bleeding
D. ischemia

A

B. vasoconstriction

Massive sympathetic response

Slide 16

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40
Q

Baroreceptors detect increased blood pressure and signal the brain to __________ the heart rate.

A. increase
B. stabilize
C. slow
D. eliminate

A

C. slow

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41
Q

Descending inhibitory signals fail to reach the sympathetic activation site because of the __________.

A. severe hypotension
B. reduced heart rate
C. decreased blood volume
D. blockage at the spinal cord

A

D. blockage at the spinal cord

Slide 16

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42
Q

Noxious stimulation, such as __________, can cause autonomic hyperreflexia.

A. deep sleep
B. low oxygen saturation
C. surgery
D. physical inactivity

A

C. surgery

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43
Q

What are key treatment strategies for autonomic hyperreflexia?
Select 3

A. Perform intubation
B. Remove stimulus
C. Deepen the anesthetic
D. Decrease fluid intake
E. Direct-acting vasodilators

A

B. Remove stimulus
C. Deepen the anesthetic
E. Administer direct-acting vasodilators

Slide 17

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44
Q

Injury to which spinal cord levels is most likely to result in respiratory failure?

A. C3-C5
B. T1-T4
C. C6-C7
D. C5-T7

A

A. C3-C5

Slide 18

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45
Q

Injury to the C5-T7 region may impair abdominal and __________ support of respiration.

A. spinal
B. intercostal
C. sternal
D. scapular

A

B. intercostal

Slide 18

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46
Q

Which interventions may be necessary for spinal cord injury patients with respiratory complications?
Select 3

A. Physical therapy for lower limbs
B. Monitoring for atelectasis
C. Continuous sedation
D. Increased caloric intake
E. Secretion clearance
F. Airway management

A

B. Monitoring for atelectasis - increased risk of infection
E. Secretion clearance - cough assistance
F. Airway management

Slide 18

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47
Q

What term describes the inability to maintain a constant core temperature due to spinal cord injury?

A. Poikilothermia
B. Hypothermia
C. Hyperthermia
D. Thermoregulation

A

A. Poikilothermia

The word “poikilothermic” comes from the Greek words poikilos which means “varied” and thermos which means “heat”.

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48
Q

Which mechanism is disrupted below the level of a spinal cord injury, contributing to poikilothermia?

A. Vasodilation
B. Vasoconstriction
C. Parasympathetic inhibition
D. Renal function

A

B. Vasoconstriction

Sympathetic disruption of pathways and temperature sensation

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49
Q

Which interventions help manage poikilothermia in spinal cord injury patients?
Select 3

A. Warm air circulation
B. Increase operating room temperature
C. Use of cold compresses
D. Warm IV fluids
E. Lava rocks

A

A. Warm air circulation
B. Increase operating room temperature
D. Warm IV fluidsC. Warm intravenous fluids (IVF)

Slide 19

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50
Q

Airway management issues are more common in which types of spine surgeries?
Select 2

A. Lumbar and thoracic spine surgeries
B. Cervical and lumbar spine surgeries
C. Abdominal and pelvic surgeries
D. Pelvic and cervical spine surgeries
E. Cervical and thoracic spine surgeries

A

E. Cervical and thoracic spine surgeries

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51
Q

Preoperative tests for patients with spinal deformities may include pulmonary function tests (PFTs) and __________ especially if restrictive respiratory patterns are present.

A. arterial blood gases
B. hemoglobin A1c
C. liver enzyme levels
D. urine analysis

A

A. arterial blood gases (ABG)

Slide 22

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52
Q

Severe kyphoscoliosis can lead to __________ compromise, which may require careful preoperative evaluation.

A. gastrointestinal
B. neurological
C. cardiovascular
D. renal

A

C. cardiovascular

…issues such as reduced cardiac output, pulmonary hypertension, and right heart failure, due to the distortion of the thoracic cavity and the impact on heart and lung function…

Slide 22

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53
Q

Preoperative evaluation of _________ involves assessing range of motion and surgical positioning.

A) Neuro
B) Musculoskeletal
C) Cardiac
D) Respiratory

A

B) Musculoskeletal

Slide 23

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54
Q

In the neuro assessment during preop evaluation, you should:

A) Assess reflexes
B) Document pre-existing motor deficits
C) Check surgical equipment
D) Document pre-existing sensory deficits

A

B) Document pre-existing motor deficits
D) Document pre-existing sensory deficits

Flaccid deltoid and biceps –> cervical spine fracture

Slide 23

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55
Q

The preoperative evaluation includes labs based on comorbidities and the __________.

A) Patient’s diet
B) Patient’s dance skills
C) Patient’s occupation
D) Type of procedure

A

D) Type of procedure

Slide 23

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56
Q

Finish this sentence

The 6 P’s
Proper planning preventing p______ p______ performance

A

Proper planning preventing piss poor performance 🤨

Slide 23

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57
Q

Which of the following are components of preoperative cervical spine evaluation?
Select 2

A) C-collar clearance
B) Atlas-axial stability
C) Documentation of TOF
D) Halo device check

A

A) C-collar clearance - Preop c-spine clearance
D) Halo device check 😇

Slide 24

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58
Q

Factors affecting preoperative cervical spine stability include:
Select 2

A) Atlanto-axial instability
B) Range of motion in legs only
C) Horn device check
D) Presence of traction devices

A

A) Atlanto-axial instability
D) Presence of traction devices
😈

Slide 24

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59
Q

Which drug can cause muscle fasciculations during intubation, especially in patients with cervical instability?

A) Succinylcholine
B) Propofol
C) Fentanyl
D) Rocuronium

A

A) Succinylcholine

Rocuronium (NDMB) may be preferable if you need to paralyze

Slide 26

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60
Q

Compared to volatile anesthetics, TIVA typically offers:

A) Increased suppression of MEP and SSEP signals
B) Better neurophysiologic monitoring
C) More rapid recovery
D) Greater risk of airway irritation

A

B) Better neurophysiologic monitoring

Plan must consider need for neurophysiologic monitoring
SSEP / MEP / EMG

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61
Q

Which of the following volatile anesthetics is most likely to affect SSEP and MEP monitoring?

A) Desflurane
B) Propofol
C) Ketamine
D) Etomidate

A

A) Desflurane

Slide 26

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62
Q

Which of the following airway management techniques provides the most visualization and is commonly used in difficult airway cases?

A) Direct laryngoscopy
B) Oral mask ventilation
C) Nasal cannula oxygenation
D) Video laryngoscopy

A

D) Video laryngoscopy

..as soon as we have a cervical collar, it is going to be deemed as a difficult intubation and we go straight to video laryngoscopy

Slide 27

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63
Q

In patients with cervical instability, airway management often involves __________ intubation to minimize movement.
Select 2

A) Rapid sequence
B) Sedated
C) Nasotracheal
D) Awake

A

B) Sedated
D) Awake

Slide 27

64
Q

Which airway devices are used for lung isolation?
Select 2

A) Double-lumen tube (DLT)
B) Bronchial blocker
C) Single-lumen ETT
D) Nasopharyngeal airway

A

A) Double-lumen tube (DLT)
B) Bronchial blocker

Slide 28

65
Q

Which of the following procedures may be performed under neuraxial/regional anesthesia?
Select 2

A) Lumbar laminectomy (2-3 levels)
B) Craniotomy
C) Intervertebral disc surgery
D) Thoracic spine fusion
E) Lumbar laminectomy (1-2 levels)

A

C) Intervertebral disc surgery
E) Lumbar laminectomy (1-2 levels)

Slide 29

66
Q

True or False

The surgeon can provide additional nerve block during spinal surgery under direct visualization of the spinal cord.

A

True

Slide 29

67
Q

The primary goals during a surgical procedure, as indicated in the image, focus on:

A) Speed and efficiency of the procedure.
B) Preventing injury and maintaining low venous pressure to surgical site
C) Minimizing the use of resources and equipment.
D) Ensuring patient comfort post-operatively.

A

B) Preventing injury and low venous pressure to surgical site

slide 31

68
Q

Krista 56-80

According to the lecture, which of the following is a critical anatomical structure to avoid injury to during a procedure?

A) Muscles
B) Peripheral nerves
C) Skin
D) Blood vessels

A

B) Peripheral nerves

eyes and bony prominences

slide 31

69
Q

the specific goals of a surgical procedure:

A) Are universal regardless of the surgical site.
B) Vary depending on the site of the procedure and surgical approach.
C) Primarily depend on the patient’s medical history.
D) Are solely determined by the surgeon’s preference.

A

B) Vary depending on the site of the procedure and surgical approach.

slide 31

70
Q

Which of the following is NOT explicitly mentioned as a goal related to avoiding injury during positioning

A) Protecting the eyes.
B) Minimizing scarring.
C) Avoiding injury to peripheral nerves.
D) Protecting bony prominences.

A

B) Minimizing scarring.

slide 31

71
Q

Which position includes arms tucked neutral and head on a padded head rest according to lecture
A.anterior supine
B. beach chair
C. posterior prone
D.lateral

A

A. anterior supine

slide 32

72
Q

Which positioning includes arms tucked neutral and head in mayfield device
A.anterior supine
B. lithotomy
C.posterior cervical prone
D. lateral

A

C. posterior cervical prone

mayfield device very stimulating

slide 32

73
Q

Why is cervical sitting uncommon position?
A. PE risk
B. uncomfortable
C. DVT risk
D. VAE risk

A

D. VAE risk

slide 35

74
Q

THoracic spine positioning anterior approach requires: select 3
A.lateral position with bean bag
B.Double lumen tube
C.bronchial blocker
D.supine position with arms tucked in neutral

A

A.lateral position with bean bag
B.Double lumen tube (or)
C.bronchial blocker

slide 36

75
Q

Thoracic spine positioning posterior approach can be with (select 3)
A. double lumen ETT
B. gel headrest (prone view)
C. arms tucked or at 90 degrees abduction
D.single lumen ETT
E. arms abducted >90 degrees

A

B. gel headrest (prone view)
C. arms tucked or at 90 degrees abduction
D.single lumen ETT

slide 36

76
Q

For an anterior approach of the lumbar spine which positioning will you use?
A. beach chair
B. lithotomy
C. supine laparotomy
D. lateral

A

c. supine laparotomy

slide 37

77
Q

Posterior approach lumbar spine positioining consits of
A. lithotmy
B. supine
C.beach chair
D. prone

A

d. prone

slide 37

78
Q

What medication should be considered in preop for a patient going prone?
A. neostigmine
B. atropine
C. Atenelol
D. glycopyrolate

A

D. glycopyrolate

anti-sialogogue

slide 38

79
Q

Airway consideration during the prone positioning include all the following except
A. add corrugated adapter
B.assess for +BBS after turning
C. unintentional extubation
D.risk of ETT kinking
E. decreased VT
F. airway edema

A

E. decrease in VT

slide 38

80
Q

Positioning for prone should include considerations for
A. buttox padding
B. posterior head protection
C. posterior calf protection
D. eye protection

A

D. eye protection

slide 39

81
Q

Postoperative visual loss incidence is
A.>/=0.1%
B. </= 1%
C. </= 0.01%
D. </= 0.1%

A

D. </= 0.1%

slide 40

82
Q

Causes of postoperative visual loss includes all the following except
A. cortical brain ischemia
B. retinal artery vein occlusion
C. medulla ischemia
D. ischemic optic neuropathy

A

C. medulla ischemia

slide 40

83
Q

true or false

Ischemic optic neuropathy occus with pressure to the eyes

A

FALSE
without pressure to the eyes
does occur due to decreased blod flow or O2 delivery

slide 41

84
Q

Risk factors for ischemic optic neuropathy include all the following except
A. Wilson frame use
B.decerased colloid use
C.obesity
D.duration of surgery >6 hours
E. increased crystalloid use
F.Male
G. blood loss >100ml

A

E. increased crystalloid use

slide 42

85
Q

Which of the following is NOT a listed treatment for Ischemic Optic Neuropathy (ION)?

A) Acetazolamide
B) Diuretics
C) Beta-blockers
D) Corticosteroids

A

C. beta blockers

slide 44

86
Q

According to the information provided, what are potential treatment strategies for ION? (Select 4)

A) Acetazolamide
B) Increasing Blood Pressure (BP) or Hemoglobin (Hgb)
C) Hypobaric Oxygen
D) Diuretics
E) Corticosteroids

A

A) Acetazolamide
B) Increasing Blood Pressure (BP) or Hemoglobin (Hgb)
D) Diuretics
E) Corticosteroids

slide 44

87
Q

The listed treatments for ION aim to address what primary issue?

A) Reduce intraocular pressure
B) Improve blood flow and oxygenation to the optic nerve
C) Decrease inflammation in the brain
D) Prevent further vision loss

A

B) Improve blood flow and oxygenation to the optic nerve

slide 44 also gemini– i thought it was a good question :)

88
Q

Which of the following treatments for ION focuses on increasing oxygen delivery to the affected area?

A) Acetazolamide
B) Diuretics
C) Hyperbaric Oxygen (O2)
D) Corticosteroids

A

C) Hyperbaric Oxygen (O2)

slide 44

89
Q

Which of the following is NOT explicitly mentioned as a preventative measure or treatment strategy for ION in the provided information?

A) Maintaining the head in a neutral/midline position.
B) Administering corticosteroids.
C) Considering blood transfusion or colloids.
D) Minimizing surgical hypotension or using hypotensive techniques cautiously.

A

B) Administering corticosteroids.

slide 45

90
Q

Central retinal artery occlusion is due to
A.decreased blood supply to entire retina
B. decreased blood supply to part of retina
C. increase pressure to retina
D. decreased O2 to retina

A

A. decreased blood supply to entire retina

slide 46

91
Q

Retinal arterial branch occlusion is due to
A.decreased blood supply to entire retina
B. decreased blood supply to part of retina
C. increase pressure to retina
D. decreased O2 to retina

A

B. decreased blood supply to part of retina

92
Q

What positioning table is this called
A. Jackson Spine table
B.C table
C. straight table
D. Wilson frame

A

D. Wilson frame

slide 47

93
Q

What positioning table is this
A. Jackson Spine table
B.C table
C. straight table
D. Wilson frame

A

A. Jackson Spine table

94
Q

Why do we use prone pillow (select 2)
A. increase pressure to occular nerve
B. prevent pressure on nose and mouth
C. no pressure to ears or breasts
D. limit pressure to forehead

A

B. prevent pressure on nose and mouth
C. no pressure to ears or breasts

slide 50

95
Q

When positioning a patient prone, which of the following is crucial regarding the head and neck?

A) Maintaining alignment of the axis.
B) Encouraging full range of motion.
C) Allowing for extreme flexion and extension.
D) Positioning in lateral rotation.

A

A) Maintaining alignment of the axis.

slide 52

96
Q

Which arm position is generally preferred when a patient is in the prone position?

A) Abduction greater than 90 degrees.
B) Full external rotation.
C) “Superman” or “surrender” position.
D) Allowing arms to hang freely.

A

C) “Superman” or “surrender” position.

slide 52

97
Q

When positioning the arms in the “superman” or “surrender” position, what is a key consideration?

A) Abducting the arms to at least 180 degrees.
B) Considering tension on shoulder musculature.
C) Ensuring the elbows are fully extended.
D) Maintaining the arms in a pronated position.

A

B) Considering tension on shoulder musculature.

slide 52

98
Q

When positioning a patient prone, what is a primary concern regarding the iliac crests and genitalia?

A) Ensuring proper alignment with the spine.
B) Avoiding compression.
C) Maintaining skin integrity.
D) Preventing pressure on bony prominences.

A

B) Avoiding compression.

slide 53

99
Q

According to the lecture, what specific instruction is given regarding the checking of the iliac crests and genitalia?

A) Check before and after the procedure.
B) Someone must check.
C) Check every 15 minutes.
D) No specific instruction is given.

A

B) Someone must check.

slide 53

100
Q

What position should the hips and knees be in when a patient is prone?

A) Fully extended.
B) Slightly flexed.
C) Hyper-extended.
D) In a position of comfort.

A

B) Slightly flexed.

slide 53

101
Q

When using pillows or pads during prone positioning, what specific area should be protected from pressure?

A) Iliac crests.
B) Knees.
C) Fibular heads.
D) Genitalia.

A

C) Fibular heads.

slide 53

102
Q

In the prone positioning what will be increased (select 3)
A. intraabdominal pressure
B. bleeding from epidural veins
C. venous return
D. intrathoracic pressure
E. pulmonary compliance

A

A. intraabdominal pressure
B. bleeding from epidural veins
D. intrathoracic pressure

slide 54

103
Q

In the prone positioning what will be decreased (select 3)
A. intraabdominal pressure
B. FRC
C. venous return
D. intrathoracic presure
E. pulmonary compliance

A

B. FRC
C. venous return
E. pulmonary compliance

slide 54

104
Q

Column A: Prone Positioning Device

Siemens Positioning System
Andrews Frame
Wilson Frame
Jackson Spine Table
Longitudinal Bolster
Column B: Characteristics

a. Chest supported, abdomen hangs free, partial pelvic support, legs below heart level.
b. Chest supported, partial abdominal compression, pelvis supported, legs at heart level.
c. Chest supported, partial abdominal compression, partial pelvic support, legs slightly below heart.
d. Chest supported, abdomen hangs free, pelvis supported, legs supported at thigh, at heart level.
e. Partial chest support, partial abdominal compression, partial pelvic support, legs at heart level.

A

b (Siemens Positioning System - Chest supported, partial abdominal compression, pelvis supported, legs at heart level)
a (Andrews Frame - Chest support, abdomen hangs free, partial pelvic support, legs below heart level)
c (Wilson Frame - Chest supported, partial abdominal compression, partial pelvic support, legs slightly below heart)
d (Jackson Spine Table - Chest supported, abdomen hangs free, pelvis supported, legs supported at thigh, at heart level)
e (Longitudinal Bolster - Partial chest support, partial abdominal compression, partial pelvic support, legs at heart level)

slide 55

105
Q

Prone

Which of the following positioning devices is considered the most stable for head and neck positioning?

A) Prone positioner
B) C-shaped face piece
C) Horseshoe headrest
D) Mayfield tongs

A

D) Mayfield tongs

Slide 56

106
Q

Prone

Select 3 potential cardiac effects of the prone position:

A) Pooling of blood in extremities
B) Increased preload
C) Decreased cardiac output
D) Compression of abdominal muscles

A

A) Pooling of blood in extremities
C) Decreased cardiac output
D) Compression of abdominal muscles

Slide 57

107
Q

Prone

Which of the following are 2 respiratory complications related to the prone position?

A) Decreased lung compliance
B) Increased airway resistance
C) Improved work of breathing
D) Compression of abdomen and thorax

A

A) Decreased lung compliance,

D) Compression of abdomen and thorax

Slide 57

108
Q

Prone

Select all possible neurovascular concerns when the head is positioned incorrectly in the prone position:

A) Increased intracranial pressure
B) Decreased cerebral venous drainage
C) Decreased cerebral blood flow (CBF)
D) Increased venous return from the brain

A

B) Decreased cerebral venous drainage

C) Decreased cerebral blood flow (CBF)

Slide 57

109
Q

Spine Sx

Which 3 surgical procedures or conditions are associated with greater blood loss during spine surgery?

A) Transpedicular osteotomy
B) Minor skin incisions
C) Number of levels included in surgery
D) Surgery for tumors

A

A) Transpedicular osteotomy
C) Number of levels included in surgery
D) Surgery for tumors

Slide 59

110
Q

Spine Sx

Select 3 factors that can elevate intraoperative blood loss during spine surgery:

A) Increased intraabdominal pressure
B) Short surgery duration
C) Age > 50 years
D) Obesity

A

A) Increased intraabdominal pressure
C) Age > 50 years
D) Obesity

Slide 59

111
Q

Spine Sx

Which 3 factors should be considered when deciding on a transfusion during spine surgery?

A) Patient comorbidities
B) Hemodynamic profile
C) Patient height
D) Higher allowable blood loss

A

A) Patient comorbidities
B) Hemodynamic profile
D) Higher allowable blood loss

Slide 60

112
Q

Spine Sx

What is the recommended hemoglobin (Hgb) threshold to consider a transfusion during spine surgery?

A) 5-6 g/dL
B) 7-8 g/dL
C) 9-10 g/dL
D) Above 11 g/dL

A

B) 7-8 g/dL

Slide 60

113
Q

Spine Sx

Cost-effectiveness is a benefit of which surgical strategy for managing blood loss?

A) Use of a cell saver
B) Increased fluid administration
C) Continuous arterial pressure monitoring
D) Application of a tourniquet

A

A) Use of a cell saver

Slide 60

114
Q

Spine Sx

When is preoperative autologous blood donation typically recommended for spine surgery?

A) When the estimated blood loss (EBL) is less than 200 mL
B) When the EBL is anticipated to be 500-1000 mL
C) When no significant blood loss is expected
D) Only in cases of emergency surgery

A

B) When the EBL is anticipated to be 500-1000 mL

Slide 61

115
Q

Spine Sx

Which of the following conditions is a contraindication for preoperative autologous blood donation?

A) Diabetes
B) Obesity
C) Significant cardiac disease
D) Mild anemia

A

C) Significant cardiac disease

Slide 61

116
Q

Spine Sx

Which 2 antifibrinolytic drugs used to reduce blood loss in spine surgery?

A) Tranexamic acid (TXA)
B) Aminocaproic acid (Amicar)
C) Furosemide
D) Albumin

A

A) Tranexamic acid (TXA)
B) Aminocaproic acid (Amicar)

Slide 62

117
Q

Spine Sx

Which of the following are correct regarding the administration of tranexamic acid (TXA) during spine surgery? (Select 3)

A) Initial IV dose is 10 mg/kg
B) Infusion rate is 10-15 mg/kg/hr
C) Infusion rate is 2 mg/kg/hr
D) Infusion is discontinued at the end of the procedure
E) Initial IV dose is 100 mg/kg

A

A) Initial IV dose is 10 mg/kg

C) Infusion rate is 2 mg/kg/hr

D) Infusion is discontinued at the end of the procedure

Slide 62

118
Q

Spine Sx

Which of the following are correct regarding the administration of aminocaproic acid (Amicar) during spine surgery?

A) Initial IV dose is 10 mg/kg
B) Infusion rate is 10-15 mg/kg/hr
C) Infusion rate is 2 mg/kg/hr
D) Initial IV dose is 100 mg/kg
E) Infusion is discontinued at the end of the procedure

A

B) Infusion rate is 10-15 mg/kg/hr

D) Initial IV dose is 100 mg/kg

E) Infusion is discontinued at the end of the procedure

Slide 62

119
Q

Spine Sx

Which of the following statements are correct regarding intraoperative hemodilution in spine surgery? (Select 2)

A) Involves removal of 450-500 mL of blood after anesthesia induction
B) Blood volume is replaced with crystalloid or colloid to maintain normovolemia
C) Blood is removed prior to anesthesia induction
D) It reduces intraoperative bleeding risks
E) No fluid replacement is required after blood removal

A

A) Involves removal of 450-500 mL of blood after anesthesia induction

B) Blood volume is replaced with crystalloid or colloid to maintain normovolemia

S;ide 63

120
Q

Spine Sx

Which of the following are correct regarding intentional (deliberate) hypotension in spine surgery? (Select 2)

A) It is recommended for routine spine surgeries
B) It can increase the risk of end-organ ischemia
C) It is not recommended in spine surgery
D) It helps maintain normovolemia
E) It may cause an increase in blood flow to critical organs

A

B) It can increase the risk of end-organ ischemia,

C) It is not recommended in spine surgery,

Slide 63

121
Q

Neurophysiologic Monitoring

Which of the following statements are correct regarding the intraoperative wake-up test during corrective surgery? (Select 2)

A) It is performed following the completion of instrumentation.
B) It evaluates gross motor movements of the upper and lower extremities.
C) It reduces blood pressure.
D) It is conducted before anesthesia induction.
E) It helps assess the stability of surgical instrumentation.

A

A) It is performed following the completion of instrumentation

B) It evaluates gross motor movements of the upper and lower extremities

Slide 65

122
Q

Neurophysiologic Monitoring

Which of the following are potential complications of the intraoperative wake-up test? (Select 3)

A) Inadvertent extubation
B) Cardiac arrest
C) Air embolism
D) Violent movements causing displacement of instrumentation

A

A) Inadvertent extubation

C) Air embolism

D) Violent movements causing displacement of instrumentation

Slide 65

123
Q

Neurophysiologic Monitoring

Which pathway is monitored using somatosensory evoked potentials (SSEP)?

A) Anterior spinal cord motor pathways
B) Dorsal column pathways of proprioception and vibration
C) Nerve root pathways of pain and temperature
D) Cerebral cortex sensory pathways

A

B) Dorsal column pathways of proprioception and vibration

Slide 66

124
Q

Neurophysiologic Monitoring

Motor evoked potential (MEP) is used to evaluate which part of the spinal cord?

A) Dorsal sensory pathways
B) Posterior nerve roots
C) Anterior motor portion
D) Pain and temperature pathways

A

C) Anterior motor portion

Slide 66

125
Q

Neurophysiologic Monitoring

What is the primary purpose of monitoring electromyograms (EMG) during spine surgery?

A) Evaluate proprioception and vibration pathways
B) Monitor nerve root injury during pedicle screw placement and nerve decompression
C) Detect changes in cerebral oxygen levels
D) Measure cardiac output during surgery

A

B) Monitor nerve root injury during pedicle screw placement and nerve decompression

Slide 66

126
Q

Neurophysiologic Monitoring

What does somatosensory evoked potential (SSEP) monitoring measure?

A) Electrical activity from peripheral nerves measured centrally
B) Pain responses in the spinal cord
C) Blood flow in the spinal cord
D) Nerve root activity during pedicle screw placement

A

A) Electrical activity from peripheral nerves measured centrally

Slide 67

127
Q

Neurophysiologic Monitoring

What is the purpose of motor evoked potential (MEP) monitoring during surgery?

A) To measure peripheral nerve impulses
B) To detect impulses triggered in the brain and monitor specific muscle groups
C) To measure respiratory muscle function
D) To evaluate oxygen levels in the spinal cord

A

B) To detect impulses triggered in the brain and monitor specific muscle groups

Slide 68

128
Q

Neurophysiologic Monitoring

Which of the following are potential adverse effects of motor evoked potential (MEP) monitoring?

A) Cognitive defects
B) Seizures
C) Intraoperative awareness
D) Scalp burns
E) Cardiac arrhythmias
F) Increased oxygen saturation
G) Reduced muscle reflexes
H) Enhanced recovery time

A

A) Cognitive defects

B) Seizures

C) Intraoperative awareness

D) Scalp burns

E) Cardiac arrhythmias

Slide 68

129
Q

Neurophysiologic Monitoring - Bite injuries

Which of the following can prevent tongue and dental injuries during motor evoked potential (MEP) monitoring?

A) Placement of a bite block between the molars
B) Use of muscle relaxants
C) Increased anesthesia depth
D) Cooling the patient’s mouth

A

A) Placement of a bite block between the molars

Slide 69

130
Q

Neurophysiologic Monitoring

MEP monitoring should be avoided in patients with which of the following conditions? (Select 3)

A) Cochlear implants
B) Active seizures
C) Diabetes
D) Vascular clips in the brain

A

A) Cochlear implants

B) Active seizures

D) Vascular clips in the brain

Slide 69

131
Q

Neurophysiologic Monitoring

What does amplitude represent in neurophysiologic monitoring?

A) Time for a signal to travel through the spinal cord
B) Signal strength
C) Body temperature regulation
D) Electrical resistance

A

B) Signal strength

Slide 70

132
Q

Neurophysiologic Monitoring

What is latency in neurophysiologic monitoring?

A) Signal frequency variation
B) Strength of electrical impulses
C) Time it takes for a signal to travel through the spinal cord
D) Heart rate variability

A

C) Time it takes for a signal to travel through the spinal cord

Slide 70

133
Q

Neurophysiologic Monitoring

Which of the following are confounding factors that can affect neurophysiologic monitoring results? (Select 6)

A) Hypotension
B) Hypothermia
C) Hypocarbia
D) Hypoxia
E) Anemia
F) Hyperglycemia
G) Volatile agents
H) Elevated potassium levels

A

A) Hypotension

B) Hypothermia

C) Hypocarbia

D) Hypoxia

E) Anemia

G) Volatile agents

Slide 70

134
Q

Neurophysiologic Monitoring

Volatile anesthetic agents can decrease ____ and increase ____ during neurophysiologic monitoring.

A) blood pressure; heart rate
B) amplitude; latency
C) oxygen saturation; signal transmission speed
D) sensitivity; specificity

A

B) decrease amplitude;
increase latency

Slide 71

135
Q

Neurophysiologic Monitoring

At what level should volatile anesthetic agents be stabilized for neurophysiologic monitoring?

A) 1.0 MAC
B) 0.5 MAC
C) 1.5 MAC
D) 0.25 MAC

A

B) 0.5 MAC

Slide 72

136
Q

Neurophysiologic Monitoring

Why should nitrous oxide (N₂O) be eliminated during MEP monitoring?

A) It increases oxygen delivery
B) It enhances the motor response
C) It reduces signal strength by decreasing amplitude
D) It accelerates signal transmission

A

C) It reduces signal strength by decreasing amplitude

Slide 72

137
Q

Neurophysiologic Monitoring

Which of the following anesthetic agents have the least effect on motor evoked potentials (MEPs) during total intravenous anesthesia (TIVA)?

A) Opioids
B) Ketamine
C) Propofol
D) Midazolam

A

A) Opioids
B) Ketamine
D) Midazolam

Slide 73

138
Q

Neurophysiologic Monitoring

Which anesthetic agent can depress motor evoked potentials (MEPs) during TIVA?

A) Opioids
B) Propofol
C) Ketamine
D) Midazolam

A

B) Propofol

Slide 73

139
Q

Neurophysiologic Monitoring

What is a key anesthetic consideration for motor evoked potentials (MEPs)?

A) Use muscle relaxants throughout the procedure
B) Avoid muscle relaxants after intubation
C) Increase volatile agent concentration
D) Use high-dose nitrous oxide

A

B) Avoid muscle relaxants after intubation

Castillo: Muscle relaxation or muscle relaxance would affect me MEPS because they relax the muscle

Slide 74

140
Q

Neurophysiologic Monitoring

What should be done if there are acute changes in amplitude or latency during neurophysiologic monitoring?

A) Continue surgery without changes
B) Discontinue the surgery
C) Increase volatile anesthetic agents
D) Reduce blood pressure to below baseline

A

B) Discontinue the surgery

Slide 74

141
Q

Neurophysiologic Monitoring

Which of the following actions can help address acute neurophysiologic changes during surgery? (Select 2)

A) Maintain blood pressure within normal limits to 20% above baseline
B) Reduce blood pressure to below baseline
C) Discontinue volatile agents
D) Increase volatile anesthetic concentration

A

A) Maintain blood pressure within normal limits to 20% above baseline

C) Discontinue volatile agents

Castillo: We need to make sure that our baseline and 20% of our blood pressure is still being met.Or we need to discontinue our voltal agents in order to assess this properly

Slide 74

142
Q

PostOp Care

Which factor may indicate the need for postoperative ventilation?

A) Procedure duration of over 4 hours
B) Minimal blood loss
C) Thoracic cavity invasion
D) Presence of facial or laryngeal edema

A

A) Procedure duration of over 4 hours

C) Thoracic cavity invasion

D) Presence of facial or laryngeal edema

Slide 76

143
Q

PostOp Care

What is a recommended practice when extubation is considered after a prolonged procedure?

A) Immediate extubation without assessment
B) Extubate over a tube exchanger
C) Delayed extubation for 24 hours
D) Use a high-dose sedative before extubation

A

B) Extubate over a tube exchanger

Slide 76

144
Q

PostOp Care

Which condition should be assessed when procedures last more than 4 hours?

A) Hyperthermia
B) Edema formation
C) Dehydration
D) Hypotension

A

B) Edema formation

Slide 76

145
Q

PostOp Care

Excessive blood loss greater than ________ may require postoperative ventilation.

A) 200 mL or 5 mL/kg
B) 1000 mL or 15 mL/kg
C) 2000 mL or 30 mL/kg
D) 500 mL or 10 mL/kg

A

C) 2000 mL or 30 mL/kg

Slide 76

146
Q

PostOp Care

What is a key consideration when using NSAIDs for postoperative pain management for multimodal analgesia?

A) Avoid NSAIDs altogether
B) Use NSAIDs in high doses
C) Use NSAIDs cautiously
D) NSAIDs are the primary analgesic

A

C) Use NSAIDs cautiously

Slide 77

147
Q

PostOp Care

Which of the following are methods of postoperative analgesia management? (Select 4)

A) Multimodal analgesia
B) Extreme use of NSAIDs
C) Patient-controlled analgesia (PCA)
D) Wound local anesthetic infiltration
E) Intrathecal morphine
F) Nitrous oxide administration

A

A) Multimodal analgesia

C) Patient-controlled analgesia (PCA)

D) Wound local anesthetic infiltration

E) Intrathecal morphine

Slide 77

148
Q

PostOp Care

What is a common approach for providing postoperative epidural analgesia?

A) Continuous epidural infusion
B) Intermittent epidural bolus every 6 hours
C) Single-dose injection only
D) Oral opioid administration

A

A) Continuous epidural infusion

Slide 78

149
Q

PostOp Care

Which of the following techniques is recommended for managing pain at multiple levels during epidural analgesia?

A) Use of a single epidural catheter
B) Double epidural techniques
C) Peripheral nerve block
D) Subcutaneous opioid injections

A

B) Double epidural techniques

Slide 78

150
Q

PostOp Care

What is the recommended initial dose approach for epidural pain control?

A) Initial dose of local anesthetic only
B) Initial dose of opioids rather than local anesthetic
C) Combination of muscle relaxants and NSAIDs
D) Nitrous oxide administration

A

B) Initial dose of opioids rather than local anesthetic

Slide 78

151
Q

PostOp Care

Which of the following is an appropriate epidural opioid dose for postoperative pain management?

A) Hydromorphone PF 0.1 – 0.3 mg
B) Hydromorphone PF 0.5 – 1 mg
C) Morphine 20 mg
D) Fentanyl 200 mcg

A

B) Hydromorphone PF 0.5 – 1 mg

Slide 78

152
Q

PostOp Care

Which of the following is a type of postoperative peripheral nerve block for Spinal surgeries?

A) Epidural block
B) Sciatic nerve block
C) Erector spinae block
D) Intrathecal block

A

C) Erector spinae block

Slide78

153
Q

Complications

In which surgical procedure is the risk of venous air embolism (VAE) highest?

A) Craniotomy
B) Laminectomy
C) Appendectomy
D) Thyroidectomy

A

B) Laminectomy

Slide 80

154
Q

Complications

Which of the following 2 factors increase the risk of venous air embolism during a laminetom7?

A) Large amount of exposed bone
B) Surgical site above the heart
C) Use of general anesthesia
D) Patient in a supine position

A

A) Large amount of exposed bone

B) Surgical site above the heart

Slide 80

155
Q

Complications

Which of the following are 3 clinical signs and diagnostic indicators of venous air embolism (VAE)?

A) Unexplained hypotension
B) Increase in ETCO₂
C) Decrease in ETCO₂
D) Increased end-tidal nitrogen levels
E) Elevated body temperature

A

A) Unexplained hypotension

C) Decrease in ETCO₂

D) Increased end-tidal nitrogen levels

Prevention & Treatment

Slide 80

JW: Adv Principles A (15 decks)

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