Unit 1 Module 4 (Exam 1) Flashcards
Which of the following is NOT a patient right emphasized by the first AANA Standards of Care?
A) Autonomy
B) Privacy
C) Financial compensation
D) Safety
C) Financial compensation
Slide 4
For the second AANA Standards of Care assessments, what is part of the pre-anesthesia assessment/evaluation aka METS?
Select 2
A) Heart function
B) Lung function
C) Number of family members
D) Where they live
A) Heart function
B) Lung function
Cardiopulmonary fitness
Slide 4
The second AANA Standards of Care pre-anesthesia assessment typically evaluates ________, EKG, and coagulation levels
A) Intraocular pressure
B) Skin Turgor
C) Potassium
D) Bladder pressure
C) Potassium
Slide 4
What value defines one metabolic equivalent (MET) in terms of oxygen uptake?
A) 3.5 mL of oxygen per kg/min
B) 4.0 mL of oxygen per kg/min
C) 4.5 mL of oxygen per kg/min
D) 5.0 mL of oxygen per kg/min
A) 3.5 mL of oxygen per kg/min
Slide 4
At what METS level is ok or cleared for surgery?
A) 1
B) 2
C) 3
D) 4
D) 4 - greater than 4 METs is ok for surgery
Can they complete the activity without complication. E.g. walking without stopping
Castillo - Mets that is less than 5 is poor. 5 - 8 is fair. 9 to 11 is good, and 12 or more is excellent
Slide 4
The third AANA Standards of Care require that a patient-specific plan is formulated by the healthcare team and if needed a ________.
A) Nutritionist
B) Legal representative
C) Pharmacist
D) Administrative assistant
B) Legal representative
Slide 5
True or False
Patient should give consent prior to any procedure starting
True
Check your hospital policy, if patient does not sign consent, two licensed professionals might be able to sign
Slide 5
How is the synthetic graft placed in the described procedure?
A) Surgically implanted through an incision
B) Inserted through a vessel using a catheter
C) Applied topically
D) Injected intramuscularly
B) Inserted through a vessel using a catheter
Slide 5
What is the key requirement for anesthesia equipment before use according to the sixth AANA Standards of Care?
A) Calibration by a technician
B) Immediate replacement
C) Verification of functionality
D) Warranty check
C) Verification of functionality
- Mobile carts/machines
Slide 6
According to the seventh AANA Stardard of Care, plan/modification of plan, the CRNA must provide anesthesia care until ________ accepts responsibility for the patient.
A) The patient’s family
B) The primary nurse
C) Another anesthesia professional
D) The attending physician
C) Another anesthesia professional
…we can get charged with abandonment of care
Slide 6
According to the eighth AANA Stardard of Care, patient positioning is primarily a responsibility of the ________ team.
A) CRNA
B) Surgical
C) Nursing
D) Post-operative
B) Surgical
Slide 6
For the ninth AANA Stardard of Care, what aspects of patient condition are continuously monitored in anesthesia care with monitors/alarms?
Select 5
A) Cardiovascular status
B) Oxygenation
C) Thermoregulation
D) Emotional state
E) Ventilation
F) Neuromuscular
G) Hearing function
A) Cardiovascular status
B) Oxygenation
C) Thermoregulation
E) Ventilation
F) Neuromuscular
Slide 7
Alarms should have a ________ pitch to indicate varying levels of patient status, such as oxygen saturation.
A) Static
B) Variable
C) Monotone
D) Silent
B) Variable
Slide 7
The maximum allowable time for muting alarms on most anesthesia machines is ________.
A) 5 minutes
B) 3 minutes
C) 2 minutes
D) 10 minutes
C) 2 minutes
Slide 7
In monitoring, ________ is a potential anesthetic complication that requires temperature regulation.
A) Hypoxia
B) Malignant hyperthermia
C) Hypotension
D) Hyperglycemia
B) Malignant hyperthermia
Slide 7
True or False:
For the tenth AANA Stardard of Care, for infection control and prevention, it is acceptable to share leftover medications drawn into a syringe with another provider to reduce waste.
False
One syringe, one needle, one patient, one time.
Slide 8
For the eleventh AANA Stardard of Care, a thorough post-anesthesia handoff includes details about the patient’s ________.
Select 3
A) Family members
B) Vital signs
C) Upcoming appointments
C) Diet restrictions
D) Procedure
E) Anesthesia plan
B) Vital signs
D) Procedure
E) Anesthesia plan
GA needs appropriate recovery
slide 8
Which components are assessed in the Modified Aldrete Scoring System?
Select 3
A) Respirations
B) Consciousness
C) Intake and output
D) Surgical bleeding
E) Pain
F) Activity
A) Respirations
B) Consciousness
F) Activity
- Oxygen Saturation
- Circulation
Slide 9
What is the minimum acceptable score required for discharge from PACU using the Modified Aldrete or Post-Anesthesia Discharge Scoring System?
A) 5
B) 7
C) 9
D) 12
C) 9
Each of the 5 components are worth 2 points, for a total of 10.
Slide 10
Which factors are evaluated in the Post-Anesthesia Discharge Scoring System?
Select 3
A) Circulation
B) Surgical bleeding
C) Oxygen Saturation
D) Wound dressing changes
E) Pain
F) Vital signs
B) Surgical bleeding
E) Pain/Nausea/Vomiting
F) Vital signs
- Intake and output
- Activity and mental status
Slide 10
Which factors are critical for anesthesia monitoring and patient safety in NORA settings?
Select 3
A) Reliable oxygen source
B) Automated inventory tracking system
C) Adequate and reliable suction
D) Two-way communication
E) Inadequate access to medications
F) Battery-operated backup lights
⭐️A) Reliable oxygen source -including backup supply
⭐️C) Adequate and reliable suction
D) Two-way communication
Slide 12
Which features are required for emergency preparedness in a NORA environment?
Select 3
A) Emergency cart with defibrillator
B) Self-inflating resuscitation bag
C) Access to an emergency internet line
D) Observation of bulding safety codes
E) Automated inventory tracking system
⭐️A) Emergency cart with defibrillator and emergency drugs
⭐️B) Self-inflating resuscitation bag
D) Observation of bulding safety codes
Slide 12
Which of the following are part of the ASA guidelines for NORA patients?
Select 3
A) A nursing station nearby
B) Post-anesthesia management area
C) Restricted medication sharing
D) Sufficient space for equipment and personnel
E) Adequate monitoring equipment
B) Post-anesthesia management area
D) Sufficient space for equipment and personnel
⭐️ E) Adequate monitoring equipment
Slide 12
Inadequate emergency power can disrupt anesthesia care in ________ areas of the hospital.
A) Operating room
B) Stockroom
C) Wet
D) Waiting
C) Wet
Sufficient electrical outlets, isolated electrical power or electric circuits with ground fault interruption in ‘wet areas’ like cystoscopy, arthroscopy, labor and delivery suites, with access to emergency power supply
Slide 12
Which of the following are part of the ASA guidelines for NORA patients?
Select 2
A) Small spaces for equipment and personnel
B) Adequate and reliable scavenging system
C) Adequate drugs, supplies and equipment
D) A post-anesthesia staff breakroom nearby
B) Adequate and reliable scavenging system
⭐️C) Adequate drugs, supplies and equipment
Slide 12
Which of the following is a characteristic of conscious sedation?
A) Un-arousable responsiveness
B) Frequently inadequate spontaneous ventilation
C) Purposeful response to verbal or tactile stimulation
D) Cardiovascular function may be impaired
C) Purposeful response to verbal or tactile stimulation
Slide 15
Airway intervention is often ______ in general anesthesia.
A) Unnecessary
B) Required
C) Minimal
D) Prohibited
B) Required
Slide 15
Which of the following are true for conscious sedation?
Select 3
A) Airway intervention is often required
B) Spontaneous ventilation is adequate
C) Cardiovascular function is usually maintained
D) Responsiveness is un-arousable
E) No airway intervention required
B) Spontaneous ventilation is adequate
C) Cardiovascular function is usually maintained
E) No airway intervention required
slide 15
Which of the following are characteristics of general anesthesia?
Select 3
A) Un-arousable responsiveness
B) Purposeful response to tactile stimulation
C) Frequently inadequate spontaneous ventilation
D) Cardiovascular function may be impaired
E) Cardiovascular function is usually maintained
A) Un-arousable responsiveness
C) Frequently inadequate spontaneous ventilation
D) Cardiovascular function may be impaired
Slide 15
Which of the following are characteristics of minimal sedation?
Select 2
A) Anxiolysis
B) Depressed level of consciousness
C) Response to verbal commands
D) Impaired independent ventilation
E) Response to painful stimulation
A) Anxiolysis
C) Response to verbal commands
Slide 16
Which of the following accurately describe moderate sedation?
Select 3
A) Depressed level of consciousness
B) Response to verbal stimulation
C) No response to any stimulation
D) Independent ventilation frequently impaired
E) Response to tactile stimulation
A) Depressed level of consciousness
B) Response to verbal or tactile stimulation
E) Response to tactile stimulation
Slide 16
Which conditions can potentially occur during deep sedation?
Select 2
A) Complete unresponsiveness to all stimulation
B) Difficulty maintaining independent ventilation
C) Response only to painful stimulation
D) Increased level of consciousness
B) Difficulty maintaining independent ventilation
C) Response only to painful stimulation
Slide 16
If a patient loses ______ and the ability to respond ______, the anesthesia care is considered general anesthesia, irrespective of whether airway instrumentation is required. 😴
A) Blood pressure / Physically
B) Reflexes / Purposefully
C) Consciousness/ Purposefully
D) Pain sensation / Automatically
C) Consciousness/ Purposefully
Slide 17
Which of the following are patient factors that may require anesthesia care?
Select 3
A) Seizure disorders
B) Beta Blocker dependence
C) Acute trauma
D) Mild seasonal allergies
E) Increased intracranial pressure
A) Seizure disorders
C) Acute trauma
E) Increased intracranial pressure
slide 18
Which conditions can increase anesthesia risks and require special management?
Select 3
A) Arthritis
B) Extreme ages
C) Cerebral palsy
D) Pain
E) Sugar addictions
B) Extreme ages (neonates or elderly)
C) Cerebral palsy
D) Pain
Slide 18
Which factors could lead to the need for general anesthesia in a patient?
Select 3
A) Stable vital signs
B) Pain-free superficial procedure
C) Alcohol/drug addiction
D) Significant comorbidities
E) Anxiety/panic disorders
C) Alcohol/drug addiction
D) Significant comorbidities
E) Anxiety/panic disorders
Slide 18
True or False
Emergent or Routine procedures outside of the OR may necessitate anesthesia care.
True
slide 18
Which procedures listed below are common procedures done outside of the OR that may need anesthesia or sedation?
Select 3
A) MRI
B) Ultrasound-guided IV placement
C) CT scan guided biopsies
D) Angiograms
E) Physical therapy sessions
A) MRI
C) CT scan guided biopsies
D) Angiograms
Slide 21
Which of the following are considered common procedures that may require anesthesia or sedation outside of the OR?
Select 3
A) Dental cleaning
B) Endovascular treatments
C) Radiofrequency ablations
D) Transjugular Intrahepatic Portosystemic Shunt
E) Bladder scans
B) Endovascular treatments
C) Radiofrequency ablations
D) Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Slide21
The main purpose of the detachable platinum coil in cerebral aneurysm treatment is to provide ______ and ______ to prevent rupture.
A) Blood flow / dilation
B) Clotting / scarring
C) Decompression / pressure relief
D) Bleeding/ scarring
B) Clotting / scarring
Slide 22
Endovascular procedures for aneurysms are considered ______ because they involve minimal incisions.
A) Minimally invasive
B) Moderately invasive
C) High-risk
D) Open surgeries
A) Minimally invasive
Slide 22
True or False
The catheter for an endovascular aneurysm treatment is often inserted through a vessel in the groin.
True
..make sure that these patients are calm, cooperative, collected,
Slide 22
Which medications are commonly recommended during cerebral aneurysm procedures?
Select 3
A) Propofol drip
B) Midazolam drip
C) Volatile anesthetics
D) Dexmedetomidine
E) Fentanyl patch
F) Haloperidol
A) Propofol drip
C) Volatile anesthetics
D) Dexmedetomidine
Don’t forget the LARGE BORE IV to put them through
Slide 23
Cerebral aneurysm treatment may require manipulation of ______ and ______ to control cerebral perfusion and prevent complications.
A) Heart rate / oxygen levels
B) End-tital CO2/ oxygen levels
C) Blood pressure / end-tidal CO2
D) Hemoglobin / hematocrit
C) Blood pressure (get an A-line) / end-tidal CO2
Slide 23
Which of the following are common complications of cerebral aneurysm procedures?
Select 3
A) Blood infection
B) Anaphylaxis to contrast
C) Pulmonary embolism
D) Aneurysm rupture
E) Lung collapse
F) Groin hematoma
B) Anaphylaxis to contrast - or hypersensitivity
D) Aneurysm rupture or dissection
F) Groin hematoma
Slide 23
The procedure for abdominal aneurysms involves inserting a ______ through a vessel, typically in the ______.
A) Catheter / Groin
B) Stent / Neck
C) Central line / Arm
D) Synthetic graft / Abdomen
A) Catheter / Groin
Slide 24
A __________ graft is placed over a catheter wire to create a ______ lumen, preventing rupture of the aneurysm.
A) Peripheral / Elastic
B) Metal / Elastic
C) Synthetic / Non-aneurysmal
D) Surgical / Non-aneurysmal
C) Synthetic / Non-aneurysmal
Slide 24
Which of the following are commonly recommended during abdominal aneurysm procedures?
Select 2
A) Central Lines
B) Heparin
C) Foley Catheter
D) Bronchodilators
B) Heparin
C) Foley Catheter
Slide 25
Which of the following are commonly recommended during abdominal aneurysm procedures?
Select 2
A) Large bore IV
B) Bronchodilators
C) Vasopressors
D) Arterial Line
A) Large bore IV
D) Arterial Line
Slide 25
During abdominal aneurysm procedures, ______ is administered to prevent clotting, while ______ is used as a reversal agent if needed.
A) Heparin / Protamine
B) Epinephrine / Heparin
C) Lidocaine / Midazolam
D) Protamine / Heparin
A) Heparin / Protamine
Slide 25
True or False
Controlled mild hypotension is often maintained during abdominal aneurysm procedures to reduce the risk of vessel rupture.
True
Slide 25
What is the purpose of frequent activated clotting time (ACT) monitoring during abdominal aneurysm procedures?
A) To monitor oxygen levels
B) To assess coagulation
C) To measure blood pressure fluctuations
D) To evaluate electrolyte balance
B) To assess coagulation while on heparin
Slide 25
Which complications are associated with abdominal aneurysm procedures?
Select 2
A) Contrast sensitivity
B) Hemothorax
C) Rupture
D) Pulmonary edema
A) Contrast sensitivity & Anaphylaxis
C) Rupture & Dissection
Slide 25
To minimize radiation exposure during abdominal aneurysm procedures, providers focus on time, distance, and ______.
A) Resistance
B) Positioning
C) Shielding
D) Ventilation
C) Shielding
Slide 25
Which of the following are indications for performing a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure to decompress portal circulation?
Select 2
A) COPD
B) Portal hypertension
C) Kidney failure
D) Recurrent GI bleeds
E) Liver cirrhosis without complications
B) Portal hypertension
D) Recurrent GI bleeds who have failed medical therapy
Slide 26
Through which vein is the catheter inserted during a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure?
A) Portal vein
B) Femoral vein
C) Subclavian vein
D) Internal jugular vein
D) Internal jugular vein
Slide 26
True or False
Transjugular Intrahepatic Portosystemic Shunt (TIPS) can correct pre-existing liver damage.
False
Slide 26
Which of the following are common comorbidities in patients requiring a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure?
Select 3
A) Recent GI bleed
B) Ascites
C) Chronic bronchitis
D) Alcoholic cardiomyopathy
E) Renal encephalopathy
A) Recent GI bleed -most likely from esophageal varices
B) Ascites
D) Alcoholic cardiomyopathy - d/t existing poor perfustion
Slide 27
What conditions may contribute to complications during a Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure?
Select 3
A) Hepatic encephalopathy
B) Allergic rhinitis
C) Increased protein binding
D) Pleural effusion
E) Decreased protein binding
A) Hepatic encephalopathy - Patient could be confused
D) Pleural effusion
E) Decreased protein binding - be very cautious with our drugs that are high in protein binding.
Slide 27
True or False
Coagulopathy is not a concern in patients with portal hypertension.
False
Slide 27
Which of the following are recommended anesthesia measures for Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedures?
Select 3
A) General endotracheal anesthesia
B) Spinal anesthesia
C) Rapid sequence induction
D) Peripheral nerve block
E) Large bore IV access
A) General endotracheal anesthesia
C) Rapid sequence induction (RSI)
E) Large bore IV access and Arterial Line
Slide 28
During TIPS procedures, volume replacement often involves ______ or ______ to address fluid balance and low protein levels.
A) Albumin / PRBCs
B) Heparin / Saline
C) Albumin / Dextrose
D) Vasopressors / Platelets
A) Albumin / PRBCs
Slide 28
True or False
Type and cross is sufficient for emergency blood replacement in TIPS patients.
TRUE, yes, absolutely, 💯
Slide 28
Abdominal aneurysms are treated through a minimally invasive procedure usings a synthetic graft over a wire usually through the_____
A. wrist
B.brachial
C. abdomen
D. groin
D. Groin
slide 24 : “ most likely through the groin”
provides a non aneurysmal lumen to prevent rupture
What type of anesthetic plan is recommended for abdominal aneurysms?
A. GETA
B. LMA
C. MAC
D. Regional
A. GETA
slide 25
What equipment considerations should be with an abdominal aneurysm procedure plan? (select 4)
A. Foley catheter
B.large bore IV
C.arterial line
D. xray lead
E.Prone pillow
F. NG tube
A. Foley catheter
B.large bore IV
C.arterial line
D. xray lead
slide 24
“ time, Distance and shielding”- refering to radiology
What is the reversal for heparin?
A. warfarin
B. Vit K
C. Blood
D. protamine
D. Protamine
(done 5-15mg)
slide 25
During abdmonal aneurysms you should expect… (select 2)
A. hypertension
B. mild hypotension
C. limiting fluids
D. frequent ACTS
B. mild hypotension
D. frequent ACTS
Complications of abdmonal aneurysm surgery includes (select 2)
A. rupture
B. hypertension
C. fluid overload
D.anaphylaxis
A. rupture/dissection
D. Anaphylaxis/contrast sensitivity
slide 25
True/false
transjugular intrahepatic portosystemic shunt will correct the existing liver damage
FALSO
“it cannot correct the existing liver damage, but it will prevent further portal hypertension”
slide 26
What type of patient population is a TIPS procedure for? select 2
A. recurrent GI bleeds
B. cirrhosis
C. acute GI bleeds
D. portal hypertension
A. recurrent GI bleeds
D. portal hypertension
slide 26
What vessel is a TIPS procedure performed through?
A. aorta
B. external jugular
C. subclavian
D. internal jugular
D. internal jugular
TIPS= transJUGULAR INTRAhepatic portosystemic shunt
slide 26
TIPS patients are typically confused due to
A. hypotension
B. hepatic encephalopathy
C. dementia
D. stroke
B. hepatic encephalopathy
“most likely have esophageal varices, there could be some hepatic encephalopathy thats already happening so these patients are confused hence DING DING DING”
slide 27
WHat is the anesthesia plan for a patient undergoing a TIPS with ascited pelural effusion? (select 2)
A. RSI
B.MAC
C.GETA
D. regional
A. RSI
C. GETA
“we’re going to use GETA”
slide 27 and 28
During a TIPS with alcholic cardiomyopathy you might expect?
A. decrease perfusion
B. increase CO
C. decrease FRC
C. bleeding
A. decrease perfusion
slide 27
What type of drugs should we use with caution in patients undergoing a TIPS?
A. kidney metabolised
B. high protein binding
C. First pass drugs
D. steroids
B. high protein binding
slide 27
All the following are considerations we would expect for a TIPS procedure except?
A. arterial line
B. large bore IV
C. LMA
D. Albumin
E. radiation protection
F. PRBCs
C. LMA
slide 28
True or false
EPS/EPA is identification and subsequent ablation of dysrhythmias caused by aberrant condution paths
TRUE
slide 32
Select all true statments regarding EP ablation (select 3)
A. minimally invasive
B. short procedure
C. uncomfortable
D. may induce Vtach and Vfib intraop
D. not successful
A. minimally invasive
C. often uncomfortable
D. may induce Vtach and Vfib intraop- have defib pads on at all times (slide 34)
60-85% curative on 1st attempt
lengthy (2-6 hours) (foley cath insertion- slide 34)
slide 33
Why is EP ablation often under sedation case
A. Cardiac insufficiency
B. interference of volatiles and propofol
C. risk for hypotension
D. because we like them talking
B. interfernce of volatiles and propofol
slide 34
What medication should be held for EPA procedure?
A. bronchodilators
B. diuretics
C. seizure medications
D.antiarrythmic
D. antiarrythmics
quinidine, beta blockers, amiodarone, verapamil, diltiazem
sldie 34
Common atrial flutter/ atrial fib procedure?
A. TEE
B. CABG
C. Valve replacement
D. Cardiacscopy
A. TEE
with or without cardioversion
to rule out thrombus
HTN, CHF, valvular disease, cardiothoracic surgery
slide 36
How long should a patient have Afib for a TEE/cardioversion according to guidelines
A. 7 days
B. 14days
C.4 days
D. 24hours
A. <7days
slide 36
Which drug is avoided during cardioversion?
A. lidocaine
B. propofol
C. robinol
D. atropine
A. Lidocaine
according to Dr. Castillo
slide 36
Once a TEE is performed a thrombus is found… now what?
A. cardiovert
B. TXA
C. anticoagulation
D. Cath lab
c. anticoagulation (“lots”)
slide 36
Anticoagulant Mechanism of Action
1. Warfarin
2. Rivaroxaban
3. Dabigatran
A. Directly inhibits thrombin (Factor IIa)
B. Antagonizes vitamin K, reducing synthesis of clotting factors
C. Selectively inhibits Factor Xa
1-B (vit K antagonists)
2-C ( Factor Xa inhibitors)
3-A (direct thrombin inhibitors
slide 37
Lab monitoring
- Warfarin
- Dabigatran
- Apixaban
A. Anti-Xa activity assay (if needed)
B. INR (International Normalized Ratio)
C. dTT (diluted thrombin time) (if needed)
1-B
2-C
3-A
slide 37
Reversal agent
- Warfarin
- Dabigatran
- Rivaroxaban
A. Discontinue
B. Vitamin K
C. Discontinue
1-B
2-C
3-A
discontinue= 3(II, IX, X) or 4 (II, VII, IX, X) factor prothrombin complex
slide 37
food interation (can be used more than once)
- Warfarin
- Dabigatran
- rivroxaban
A. None
B. cabbage cauliflower, leafy greens
1-B
2-A
3- A
slide 37
What are the 3 thrombin parenteral drugs (select 3)
A.Heparin
B.Bivalirudin
C.Fondaparinux
D.argatroban
E. Hirudin
F.LMWH
B. bivalirudin
D. Argatroban
E. hirudin
slide 38
What are the 2 thrombin fXa parenteral drugs (select 2)
A.Heparin
B.Bivalirudin
C.Fondaparinux
D.argatroban
E. Hirudin
F.LMWH
A. Heparin
F. LMWH
slide 38
What is the fXa parenteral drug
A.Heparin
B.Bivalirudin
C.Fondaparinux
D.argatroban
E. Hirudin
F.LMWH
C. Fondaparinux
slide 38
What type of O2 supply is usually needed for TEE/cardioversion
A. mask
B. ETT
C. nasal cannula
D. LMA
C. nasal cannula
and a bite block
slide 39
What drugs do we normally give for TEE with or without cardioversion
A. propofol
B. Zemeron
C. versed
D. lidocain
A. propofol
till loss of gag/lash reflex BUT still breathing
slide 39
If propofol is not a good option for out patient what drugs can we give (select 2)
A. ketamine
B. versed
C. lidocaine
D. fentanyl
A. ketamine
B. versed
sllide 39
true or false
Transcatheter Aortic Valve replacement is for Asymptomatic patients of any age with high surgical risk / predicted post TAVR of <12 months survival
WRONGO
SYMPTOMATIC patient
>12 months
also symptomatic >80y/o and young with life expectancy <10years
slide 40
Which of the following anesthesia options is typically considered for a TAVR procedure?
a) Spinal anesthesia
b) Local anesthesia only
c) General anesthesia or conscious sedation
d) No anesthesia at all
c) General anesthesia or conscious sedation
slide 41
What are the two primary approaches for delivering the TAVR valve?
a) Transapical and transseptal
b) Transfemoral and transapical
c) Transbrachial and transaortic
d) Subclavian and carotid
b) Transfemoral and transapical
slide 41
Which of the following monitoring techniques is commonly used during a TAVR procedure to visualize the heart structures and guide valve placement?
a) Electrocardiogram (ECG) only
b) Fluoroscopy only
c) Transesophageal echocardiography (TEE)
d) Chest X-ray
c) Transesophageal echocardiography (TEE)
slide 41
Why is it important to have a “typed and crossed” blood sample available before a TAVR procedure?
a) To check for pre-existing blood disorders
b) To ensure compatible blood is available for transfusion if needed
c) To measure the patient’s baseline clotting factors
d) To determine the patient’s blood type for medical records
b) To ensure compatible blood is available for transfusion if needed
slide 41
Which of the following best describes the purpose of heparin administration during a TAVR procedure?
a) To lower the patient’s heart rate
b) To prevent blood clot formation during the procedure
c) To reverse the effects of any pre-existing anticoagulants
d) To induce mild hypotension
b) To prevent blood clot formation during the procedure
Acts and protamine reversal
slide 41
What is the role of protamine in relation to heparin during or after a TAVR procedure?
a) It enhances the anticoagulant effect of heparin.
b) It reverses the anticoagulant effect of heparin.
c) It is used to monitor the activated clotting time (ACT).
d) It helps to stabilize the patient’s blood pressure.
b) It reverses the anticoagulant effect of heparin.
slide 41
Which of the following is a standard monitoring component during a TAVR procedure?
a) Continuous blood pressure monitoring via an arterial line (A-line)
b) Frequent neurological assessments
c) Urine output monitoring only
d) All of the above except C
a) Continuous blood pressure monitoring via an arterial line (A-line)
slide 41
“Improved hemodynamic stability” in the context of TAVR refers to:
a) Maintaining a regular heart rhythm.
b) Stabilizing blood pressure and blood flow during and after the procedure.
c) Reducing the need for blood transfusions.
d) Minimizing the use of contrast dye.
b) Stabilizing blood pressure and blood flow during and after the procedure.
slide 41
Which of the following is NOT an indication for EGD or colonoscopy?
A. Biopsy
B. Foreign body retrieval
C. Esophageal varices
D. Feeding tube placement
E. Diagnosis of a stroke
F. Removal of polyps
E. Diagnosis of a stroke
Slide 48
Which of the following diagnoses can be made through EGD or colonoscopy?
A. GI bleed
B. Cancer
C. Stroke
D. Kidney stones
A. GI bleed
B. Cancer
Slide 48
What is the recommended patient position during EGD or colonoscopy procedures?
A. Prone
B. Supine
C. Lateral
D. Sitting
C. Lateral
Slide 49
Which oxygen delivery method is typically sufficient during EGD or colonoscopy procedures?
A. Bi-flow nasal cannula
B. Non-rebreather mask
C. Endotracheal tube
D. Simple face mask
A. Bi-flow nasal cannula
Slide 49
Which of the following complications might affect anesthesia during a colonoscopy or EGD? (Select 4)
A. Esophageal obstruction
B. Active bleeding
C. Drug synergism
D. Hypoglycemia
E. Active vomiting
A. Esophageal obstruction (Foreign object)
B. Active bleeding
C. Drug synergism Castillo: Each drug can synergize the effects of the other drugs, such as versed and propofol.
E. Active vomiting
Slide 49
Case Study
An 86-year-old female admitted for syncope is scheduled for an EGD/Colonoscopy. She has a history of oxygen-dependent COPD, atrial fibrillation, hypertension, chronic renal insufficiency, and anemia. Current medications include oxygen, digoxin, metoprolol, Coumadin, lisinopril, folate, and Pepcid.
Lab and vital signs:
Hemoglobin: 5 g/dL, Hct: 15%, WBC: 21,000
Sodium: 138, Potassium: 4.1, BUN: 25, Creatinine: 1.8
BP: 84/40, HR: 128, RR: 36, SpO₂: 84% on 2 LPM O₂, Temp: 101.2°F
EKG: Uncontrolled atrial fibrillation
Question:
What is the appropriate anesthetic management decision based on the patient’s condition?
A) Proceed with the procedure and monitor closely
B) Increase oxygen and start vasopressors immediately in the procedure room
C) Administer antibiotics and transfuse blood before proceeding
D) Cancel the procedure and focus on optimizing the patient first
D) Cancel the procedure and focus on optimizing the patient first
Slide 45-54
What does ERCP primarily diagnose and treat?
A) Liver cirrhosis
B) Pancreatic and biliary disorders
C) Esophageal cancer
D) Intestinal polyps
B) Pancreatic and biliary disorders
Slide 55
Which of the following conditions are commonly treated or diagnosed through ERCP?
A) Biliary stenosis, jaundice, common duct stones
B) GERD, gastritis, esophageal varices
C) Peptic ulcer disease, Crohn’s disease, intestinal obstruction
D) Kidney stones, liver abscess, pulmonary embolism
A) Biliary stenosis, jaundice, common duct stones
Slide 55
What is the recommended patient position for an ERCP procedure?
A) Supine
B) Prone with head turned to the side
C) Trendelenburg
D) Lateral decubitus
B) Prone with head turned to the side
Slide 56
True or False
General anesthesia is the preferred method for ERCP due to patient comorbidities.
TRUE
Slide 56
Which of the following medications is commonly used during ERCP to reduce spasms?
A) Neostigmine
B) Glucagon
C) Atropine
D) Propofol
B) Glucagon
Castillo: Glucagon start low, give 0.5 instead of giving the entire 1 milligram because it is used as an anti spasmodic so that they can locate this sphincter of Oddi.
Slide 56
Which of the following medications should NOT be given during an ERCP procedure?
A) Glucagon
B) Narcotics
C) Anti-emetics
D) Propofol
B) Narcotics
Castillo: When they go in there and look for the stones, narcotics can be not allowed because they promote spasm of the sphincter of Oddi.
Slide 56
___ is crucial for post-procedure recovery after an ERCP to monitor for potential complications.
A) Intensive Care Unit (ICU)
B) Emergency Department (ED)
C) Appropriate PACU
D) Outpatient Clinic
E) Radiology Department
C) Appropriate PACU
Slide 56
Which of the following is NOT an indication for electroconvulsive therapy (ECT)?
A) Bipolar disorder
B) Schizophrenia
C) Mild anxiety
D) Suicidal behavior
E) Extreme depression
C) Mild anxiety
Slide 59
What is Electroconvulsive Therapy (ECT)?
A) A form of physical therapy for chronic pain
B) A therapy that uses medication to manage mood disorders
C) A treatment that induces a tonic-clonic seizure to release neurotransmitters
D) A non-invasive therapy that uses relaxation techniques
C) A treatment that induces a tonic-clonic seizure to release neurotransmitters
Slide 59
Electroconvulsive Therapy (ECT) typically involves which treatment schedule?
A) Three times a week for 12 sessions, followed by a gradual weaning
B) Twice a week for 8 sessions, followed by maintenance therapy every other month
C) Three times a day for 7 days, followed by once-weekly sessions for 4 weeks
D) Daily for 14 days with no additional follow-up therapy required
E) Once a month for 12 sessions with no further treatments
A) Three times a week for 12 sessions, followed by a gradual weaning
Slide 59
Which of the following describes the initial physiologic response during Electroconvulsive Therapy (ECT)?
A) Sympathetic stimulation lasting 30-40 minutes
B) Initial parasympathetic activity
C) Rapid onset of incontinence
D) Prolonged headache lasting for 2 weeks
B) Initial parasympathetic activity
Slide 60
What is the typical duration of sympathetic stimulation following ECT?
A) 5 minutes
B) 30 seconds
C) 10-20 minutes
D) 1-2 hours
C) 10-20 minutes
Slide 60
Which symptom may last between 2 to 7 days following ECT treatment?
A) Headache
B) Incontinence
C) Myalgias
D) Emergence agitation
C) Myalgias
Slide 60
Which of the following is NOT a potential physiologic response to ECT?
A) Incontinence
B) Emergence agitation/confusion
C) Hypertension lasting for 24 hours
D) Headache
C) Hypertension lasting for 24 hours
Slide 60
Which preoperative evaluation is emphasized before administering anesthesia for ECT?
A) ECG
B) Complete blood count
C) Pregnancy test
D) Pulmonary function test
C) Pregnancy test
Slide 61
What device is used during general anesthesia for ECT to protect the airway?
A) Endotracheal tube
B) Nasal cannula
C) Bag Valve Mask (Ambu) with a bite block
D) Suction catheter
C) Bag Valve Mask (Ambu) with a bite block
Slide 61
Which of the following medications is used to prevent parasympathetic overactivity, such as bradycardia, during ECT anesthesia? (Select 2)
A) Brevital
B) Anectine
C) Atropine
D) Glycopyrrolate
E) Caffeine
C) Atropine
D) Glycopyrrolate
Slide 61
Which of the following medication combination is commonly used during ECT to provide anesthesia and muscle relaxation?
A) Propofol and Glycopyrrolate
B) Propofol and Anectine
C) Atropine and Anectine
D) Propofol and Brevital
E) Glycopyrrolate and Anectine
B) Propofol and Anectine
Castillo: Brevital. Well, we don’t use that anymore
Side 61
Which of the following is true regarding caffeine use in ECT procedures?
A) Caffeine is administered to prevent headaches post-ECT.
B) Caffeine is used to treat hypotension during ECT.
C) Caffeine is given to enhance seizure duration if needed.
D) Caffeine is contraindicated in all ECT procedures.
E) Caffeine is used to decrease anxiety before ECT treatment.
A) Caffeine is administered to prevent headaches post-ECT.
Slide 61
Why is hyperventilation performed during ECT procedures?
A) To increase oxygen levels in the blood
B) To decrease seizure duration
C) To avoid seizure
D) To prevent emergence agitation
E) To prevent bronchospasm
C) To avoid seizure
Castillo: Avoid the seizures because again, what is the effect of increased EtCO2 to the brain?
increases cerebral perfusion=increase ICP
Slide 61
Why is it important to protect the extremities during an ECT procedure?
A) To prevent loss of sensation
B) To maintain muscle strength after the seizure
C) To avoid fractures or soft tissue injury due to seizure activity
D) To improve seizure efficiency
E) To reduce nerve sensitivity
C) To avoid fractures or soft tissue injury due to seizure activity
Slide 61
Which medications are often on standby to manage agitation during the recovery phase of ECT? (Select 2)
A) Ativan
B) Haldol
C) Metoprolol
D) Epinephrine
E) Ketamine
A) Ativan
B) Haldol
Slide 61
Which of the following is used to treat hypertension (HTN) during anesthesia for ECT?
A) Short-acting beta-blockers
B) Calcium channel blockers
C) ACE inhibitors
D) Long-acting nitrates
A) Short-acting beta-blockers
Slide 61
True or False
IV lines are typically discontinued in the PACU after ECT, even if still in the patient.
True
Slide 61
Which of the following equipment does an anesthesia provider typically bring to a dental office for non-operating room anesthesia? (Select 3)
A) Surgical robots
B) Laryngoscopy equipment
C) Endotracheal tubes
D) Monitoring equipment
B) Laryngoscopy equipment
C) Endotracheal tubes
D) Monitoring equipment
*Castillo: I bring my own endotracheal tubes.I bring my own laryngoscopy equipment.And if their equipment fails, I have my own manual blood pressure cuff.Stethoscope, of course.And then I also have my own pulse oximeter *
Slide 63 - Castillo’s lecture
Which of the following medications may be used by an anesthesia provider during dental procedures under conscious sedation? (Select 3)
A) Fentanyl
B) Propofol
C) Robinal (Glycopyrrolate)
D) Ketamine
A) Fentanyl
B) Propofol
C) Robinal (Glycopyrrolate)
Slide 63 - Castillo’s lecture
What determines whether conscious sedation or general anesthesia can be administered in a dental office setting?
A) The type of dental procedure
B) The number of staff available
C) The permit/license held by the dental surgeon
D) The patient’s insurance coverage
C) The permit/license held by the dental surgeon
Slide 63 - Castillo’s lecture
What is the usual recovery time for patients after undergoing conscious sedation for a dental procedure?
A) 5 minutes
B) 30 minutes
C) 2 hours
D) 24 hours
B) 30 minutes
Slide 63 - Castillo’s lecture
