Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Comps > Vally Pretest > Flashcards

Vally Pretest Flashcards

1
Q

Cyanosis is most likely to be seen in which patient?

a. Anemic
b. Polycythemic
c. Hypovolemic
d. Hypervolemic

A

b. Polycythemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What solution should NOT be given to a patient undergoing carotid endarterectomy?

a. Normosol
b. D5W
c. Lactated Ringer’s
d. Normal Saline

A

b. D5W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the initial dose of dantrolene for treating malignant hyperthermia?

a. 0.25 mg/kg
b. 0.5 mg/kg
c. 1.5 mg/kg
d. 2.5 mg/kg

A

d. 2.5 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percent of a soda lime canister should be air?

a. 30%
b. 50%
c. 75%
d. 90%

A

b. 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Shown in the following graph is the uptake of four volatile agents: Curve C is?

a. Enflurane
b. Desflurane
c. Halothane
d. Isoflurane

A

d. Isoflurane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A patient emerged from general anesthesia with brachial plexus palsy. In litigation, the judge placed the burden of proof on the defendant anesthetist. The judge acted on what doctrine?

a. Respondeat superior
b. Borowed servant
c. Res ipsa Loquitur
d. Harrison

A

c. Res ipsa Loquitur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Two IV solutions, A and B, are placed on the same pole at the same height. The IV needles have the same length, but the needle of solution A is 0.50 mm in diameter and the needle of solution B is 0.25 mm in diameter. The flow through needle B is:

a. 1/81 the flow through needle A
b. 1/16 the flow through needle A
c. 1/4 the flow through needle A
d. 3/4 the flow through needle A

A

b. 1/16 the flow through needle A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common complication of mediastinoscopy?

a. Damage to the phrenic nerve
b. Venous air embolism
c. Hemorrhage
d. Pneumothorax

A

c. Hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which of the following neural pathways carries pain?

a. Corticospinal
b. Anterolateral
c. Dorsolateral
d. Cuneatus/gracilis

A

b. Anterolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the best ECG lead for initial assessment?

a. I
b. II
c. V5
d. aVL

A

b. II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which situation explains the following capnogram?

a. Hypoventilation
b. Incompetent expiratory valve
c. Esophageal intubation
d. Kinked endotracheal tube

A

c. esophageal intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pneumothorax is most commonly associated with which approach to the brachial plexus?

a. Interscalene
b. Supraclavicular
c. Axillary
d. Subscapular

A

b. Supraclavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The ophthalmologist plans to inject sulfur hexafluoride into the aqueous humor to treat retinal detachment. You should AVOID:

a. succinylcholine
b. neostigmine
c. nitrous oxide
d. hypercarbia

A

c. nitrous oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cardiac T-type calcium channels are maximally open during _____ of the cardiac action potential.

a. phase 1
b. phase 2
c. phase 3
d. phase 4

A

b. phase 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What muscle relaxant has antimuscarinic actions?

a. d-Tubocurarine
b. Rocuronium
c. Pancuronium
d. Mivacurium

A

c. pancuronium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The patient who cannot abduct the thumb has had what nerve blocked by local anesthetic?

a. Radial
b. Median
c. Ulnar
d. Musculocutaneous

A

a. Radial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

You determine that magnesium should be given to the patient with pregnancy-induced hypertension(pre-eclampsia/eclampsia). What plasma concentration of magnesium(mEq/L) will you want to achieve?

a. 1-4
b. 4-6
c. 8-12
d. 12-16

A

b. 4-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

During the case, the blood pressure of the patient with pregnancy-induced hypertension(preeclampsia/eclampsia) increases to 190/125. Of the following, which drug is LEAST appropriate for treating this hypertension?

a. Hydralazine
b. Labetalol
c. Esmolol
d. Nitroprusside

A

c. Esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The patient with HELLP syndrome exhibits:

a. hematuria, elevated leukocytes, lipidosis, and proteinuria
b. hematuria, elevated liver enzymes and low platelets
c. hemolysis, elevated leukocytes, lipidosis, and proteinuria
d. hemolysis, elevated liver enzymes and low platelets

A

d. hemolysis, elevated liver enzymes, and low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thrombocytopenia may be associated with each of the following conditions EXCEPT:

a. cancer
b. liver disease with splenomegaly
c. pregnancy-induced hypertension(pre-eclampsia)
d. chronic renal failure

A

d. chronic renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which agent should be avoided if the patient is taking an MAO inhibitor?(select 2)

a. Meperidine
b. Labetalol
c. Epinephrine
d. Phenylephrine

A

a. Meperidine

d. Phenylephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

The second heart sound occurs when the:

a. aortic and pulmonic valves open
b. aortic and pulmonic valves close
c. mitral and tricuspid valves open
d. mitral and tricuspid valves close

A

b. aortic and pulmonic valves close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How much of the total blood volume is found in the systemic side of the venous circulation?

a. 20%
b. 45%
c. 65%
d. 85%

A

c. 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The most common cause of death associated with carotid endarterectomy is:

a. stroke
b. adult respiratory distress syndrome
c. hemorrhage
d. myocardial infarction

A

d. myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The first positive deflection in the CVP waveform is caused by:

a. right atrial contraction
b. right ventricular contraction
c. closure of the tricuspid valve
d. closure of the pulmonic valve

A

a. right atrial contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cerebrospinal fluid passes from the the fourth ventricle tot he subarachnoid space through the foramina of:

a. Luschka
b. Magendie
c. Munro
d. Sylvia

A

a. Luschka

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where is tissue damage greatest when using a tourniquet?

a. Proximal to the tourniquet
b. Under the tourniquet
c. Distal to the tourniquet
d. Damage is equally great proximal and distal to the tourniquet

A

b. under the tourniquet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

You should correct an error on the anesthesia record by:

a. drawing a line through the error and writing the word “error” over it.
b. erasing the erroneous information
c. blocking the error out with your pen
d. starting a new anesthesia record

A

a. drawing a line through the error and writing the word “error” over it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

You give an axillary block and the patient complains of ringing in the ears and a metallic taste. His speech is slurred. Your first action is to:

a. give Pentothal
b. administer 100% oxygen
c. give succinylcholine and intubate
d. wait to see if the patient convulses

A

b. administer 100% oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What happens during phase 1 of the ventricular muscle action potential?

a. Cl- diffuses into the cell and K+ diffuses out
b. Na+ diffuses into the cell
c. K+ diffuses into the cell
d. Ca++ diffuses into the cell

A

a. Cl- diffuses into the cell and K+ diffuses out(?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does the ECG trace below show?

a. LBBB
b. Wenckebach(Mobitz I)
c. Mobitz II
d. Sinus Rhythm

A

b. Wenckebach(Mobitz I)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should be given to treat a prolonged bleeding time?

a. Cryoprecipitate
b. Desmopressin
c. FFP
d. Platelets

A

d. Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What would cause the P50 to decrease from 27 to 19 mmHg?

a. Hyperthermia
b. Respiratory acidosis
c. Metabolic alkalosis
d. Increased 2,3-DPG

A

c. Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What problem is indicated by the pressure-volume loop shown at right?

a. Acute mitral regurgitation
b. Chronic mitral regurgitation
c. Acute aortic regurgitation
d. Chronic aortic regurgitation

A

d. chronic aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

You are delivering 6% desflurane to your patient? What is the partial pressure of inspired desflurane?

a. 6 mmHg
b. 24 mmHg
c. 46 mmHg
d. 72 mmHg

A

c. 46 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The patient has a PaCO2 of 60 mmHg. How much CO2(in mL) is dissolved in each 100 ml of blood?

(enter your answer in milliliters with 2 decimal point accuracy)

A

4.02 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What muscle tenses the true vocal cords?

a. Thyroarytenoid
b. Posterior cricoarytenoid
c. Lateral cricoarytenoid
d. Cricothyroid

A

d. Cricothyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

The patient weights 60 kg. What is the approximate anatomic dead space?

a. 30 mL
b. 60 mL
c. 120 mL
d. 150 mL

A

c. 120 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Compare PAO2 and PACO2 in zones I and III when the patient is sitting:

zone 1 PAO2 Zone 3 PaO2 Zone 3 PACO2 Zone 1 PACO2

a. High, Low, High, Low
b. Low, High, High, Low
c. High, Low, Low, High
d. Low, High, Low, High

A

a. High, Low, High, Low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Sodium concentration is controlled primarily by:

a. antidiuretic hormone
b. thyroxine
c. cortisol
d. aldosterone

A

a. antidiuretic hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

The virus that is most easily transmitted by a blood transfusion is:

a. hepatitis A
b. hepatitis B
c. Hepatitis C
d. cytomegalovirus

A

d. cytomegalovirus

42
Q

What is the most frequently damaged nerve in the lower extremity?

a. Saphenous
b. Common peroneal
c. Lateral femoral cutaneous
d. Obturator

A

b. Common peroneal

43
Q

Physiologic alterations are least when the patient is in what position?

a. sitting
b. prone
c. supine
d. lateral decubitus

A

c. supine

44
Q

Where does the conus medullaris line in the adult?

a. L1
b. L2
c. L3
d. L4

A

b. L2

45
Q

A 30-year old male undergoing hernia repair became hyperthermic(>103’F), tachycardic and tachypneic during maintenance with Forane after induction with succinylcholine and Pentothal. Master muscle rigidity was noted. What is your first action?

a. turn of the Forane
b. hyperventilate the patient
c. administer dantrolene sodium
d. give sodium bicarbonate

A

a. turn of the Forane

46
Q

What nerve provides motor innervation to the tongue?

a. Vagus
b. Hypoglossal
c. Facial
d. Trigeminal

A

b. Hypoglossal

47
Q

Why are sickle-cell patients anemic?

a. Red cells hemolyze at a rapid rate
b. Erythropoietin production is low
c. Bone marrow is dysfunctional
d. The life-span of the red cell is about 12 days

A

d. the life-span of the red cell is about 12 days

48
Q

What should be avoided in the patient with sickle cell disease?

a. Hypertension
b. Over hydration
c. FiO2 of 1.0
d. Succinylcholine

A

a. hypertension

49
Q

What is the most common inherited bleeding disorder?

a. von Willebrand’s disease
b. Christmas disease
c. Hemophilia B
d. Hageman factor deficiency

A

a. von Willebrand’s disease

50
Q

Goals of risk management do not include preventing:

a. injury
b. litigation
c. employee discontent
d. financial loss

A

c. employee discontent

51
Q

The goal during management of the patient who transected his spinal cord one year ago is to prevent:

a. hypotension
b. bradycardia
c. hypercapnia
d. autonomic hypereflexia

A

d. autonomic hypereflexia

52
Q

What is the problem if serum alkaline phosphatase is elevated four-fold?

a. Biliary tract obstruction
b. Myocardial infarction
c. Pancreatitis
d. Cirrhosis of the liver

A

a. Biliary tract obstruction

53
Q

Which flow-volume loop is normal?

a. Loop A
b. Loop B
c. Loop C
d. Loop D

A

c.

54
Q

It was decided to perform a pneumonectomy on a patient who has smoked two packages of cigarettes per day for 40 years. Which premedication should be AVOIDED?

a. Atropine
b. Fentanyl
c. Midazolam
d. Pentobarbital

A

b. Fentanyl

55
Q

A 20-year-old, otherwise healthy male undergoes transcranial resection of a craniopharyngioma. In PACU, large volumes of dilute urine are forming. What is the appropriate treatment?

a. give spironolactone
b. give lasix
c. give desmopressin
d. give hypertonic saline

A

c. give desmopressin

56
Q

Hormones of of carcinoid tumors generally do not have systemic effects because they:

a. are quickly metabolized by plasma esterases
b. are not released into the circulation
c. undergo the first pass effect
d. are biologically inert

A

c. undergo the first pass effect

57
Q

During cross-clamping of the descending aorta, you would be most concerned about interrupting flow through what blood vessel supplying the spinal cord?

a. Anterior spinal artery
b. Right posterior spinal artery
c. Left posterior spinal artery
d. Artery of Adamkiewicz

A

d. Artery of Adamkiewicz

58
Q

Which of the following conditions will not cause an incorrect reading with the pulse oximeter?

a. Carbon monoxide poisoning
b. Hypotension
c. Fetal hemoglobin
d. Hypothermia

A

c. Fetal hemoglobin

59
Q

The Z79 marking on the endotracheal tube indicates that the tube is:

a. inflammable
b. sterile
c. polyethylene
d. nontoxic

A

d. nontoxic

60
Q

The patient is given 10 mg of drug. The decrease in plasma concentration with time is shown in the following figure. This drug is eliminated by:

a. zero order kinetics
b. first order kinetics, one compartment model
c. first order kinetics, two compartment model
d. second order kinetics

A

c. first order kinetics, two compartment model

61
Q

The tip of the endotracheal tube is inserted into the 30-year-old, 70 kg adult a distance of 22 cm from the lips. Where is the tip located?

a. At the cords
b. Midway between the cords and the carina
c. At the carina
d. In the right or left mainstem bronchus

A

b. midway between the cords and the carina

62
Q

What nerves are blocked first after onset of spinal anesthesia?

a. B fibers
b. C fibers
c. A-delta fibers
d. A-gamma fibers

A

a. B fibers

63
Q

The patient is taking aluminum-based antacids, Carafate and calcium carbonate. These agents were probably prescribed to treat what problem?

a. Hypocalcemia
b. Hypermagnesemia
c. Hypernatremia
d. Hyperphosphatemia

A

d. Hyperphosphatemia

64
Q

You would be most concerned if the patient had an increased

a. prothrombin time
b. partial thromboplastin time
c. bleeding time
d. activated clotting time

A

c. bleeding time

65
Q

A drug company is synthesizing a new local anesthetic that has faster onset of action than present local anesthetics. The pKa of this new anesthetic is probably:

a. 4.0
b. 7.4
c. 8.0
d. 11.0

A

a. 4.0

66
Q

The patient has been shot in the chest. Blood pressure is 60/40 and heart rate is 140. You should elect what agent for induction?

a. Midazolam
b. Propofol
c. Ketamine
d. Fentanyl

A

c. Ketamine

67
Q

Rank the routes of heat lost from greatest to least:

a. Convection->radiation->evaporation->conduction
b. Conduction->convection->evaporation->radiation
c. Radiation->convection->evaporation->conduction
d. Evaporation->radiation->conduction->convection

A

c. Radiation->convection->evaporation->conduction

68
Q

Atelectasis in the patient with ARDS is explained by whose law?

a. Laplace
b. Henry’s
c. Boyle’s
d. Fick’s

A

a. Laplace

69
Q

At what age is the hemoglobin concentration the lowest?

a. Two weeks
b. Three months
c. One year
d. Eighteen months

A

b. three months

70
Q

One reason the neonate needs more succinylcholine than the adult is because:

a. plasma cholinesterase activity is greater in the neonate
b. renal clearance is slower in the neonate
c. the neonate has more adipose tissue
d. the motor end-plate of the neuromuscular junction is immature in the neonate.

A

d. the motor end-plate of the neuromuscular junction is immature in the neonate

71
Q

The requirements for manufacturing and transportation of medical gas cylinders are set by the:

a. Department of Transportation
b. Occupational Safety and Health Administration
c. Food and Drug Administration
d. American National Standards Institute

A

a. Department of Transportation

72
Q

“Triple H” therapy for treating cerebral vasospasm has each of the following goals EXCEPT:

a. decreasing heart rate to 60 beats per minute
b. achieving a target hematocrit of 33%
c. getting central venous pressure above 10 mmHg
d. maintaining a systolic blood pressure between 160 and 200 mmHg

A

a. decreasing heart rate to 60 beats per minute

73
Q

What change will most profoundly increase intraocular pressure?

a. increased arterial blood pressure
b. increased central venous pressure
c. increased PaCO2
d. metabolic alkalosis

A

b. increased central venous pressure

74
Q

What instrument ionized a gas sample and then passes it through a magnetic field?

a. Mass spectrometer
b. Pulse oximeter
c. Capnograph
d. CO2 laser

A

a. Mass spectrometer

75
Q

Where is the ligament flavum located in relation to the epidural space?

a. Cephalad
b. Caudad
c. Posterior
d. Anterior

A

c. posterior

76
Q

Which of the following decreases the seizure threshold?

a. Hypercarbia
b. Hypocarbia
c. Hypokalemia
d. Thiopental

A

b. hypocarbia

77
Q

For routine intubation of an hid-infected patient, the Centers for Disease Control requires all but which of the following?

a. gloves
b. mask
c. goggles
d. gown

A

d. gown

78
Q

What hemodynamic change is most likely to result in myocardial ischemia during surgery if the patient has coronary artery disease?

a. Hypotension
b. Hypertension
c. Bradycardia
d. Tachycardia

A

d. tachycardia

79
Q

The most effect method of keeping the adult patient warm is the

a. heated humidifier
b. heating blanket
c. forced air warmer(Bair hugger)
d. heating lamp

A

c. forced air warmer(Bair hugger)

80
Q

What drugs should be AVOIDED in the patient with Alzheimer’s disease?

a. Beta adrenergic antagonists
b. Sedatives
c. Diuretics
d. Vasodilators

A

b. sedatives

81
Q

The purpose of unidirectional valves in the circle system is to:

a. protect the patient from a build-up of positive pressure
b. protect the patient from a negative pressure
c. prevent disconnect
d. prevent rebreathing of exhaled gases

A

d. prevent rebreathing of exhaled gases

82
Q

What chemotherapeutic causes severe injury to the lungs?

a. Cisplatin
b. Doxorubicin
c. Bleomycin
d. Methotrexate

A

c. Bleomycin

83
Q

The most frequent lawsuit involving the anesthetist relates to:

a. preoperative treatment
b. positioning
c. postoperative care
d. airway management

A

d. airway management

84
Q

During hypotensive anesthesia with sodium nitroprusside, mean arterial pressure, which had been maintained at 55 mmHg, begins to increase. Blood pressure continues to rise despite an increase in the nitroprusside infusion rate. Your next actions are to turn off the nitroprusside and give all of the following except:

a. sodium bicarbonate
b. sodium nitrate
c. amyl nitrate
d. sodium thiosulfate

A

a. sodium bicarbonate

85
Q

Whose law explains the second gas effect?

a. Henry’s
b. Poiseuille’s
c. Dalton’s
d. Fick’s

A

d. Fick’s

86
Q

What will disinfect the laryngoscope blade after intubating an HIV-infected patient?

a. Hexachlorophene
b. Alcohol
c. Glutaraldehyde
d. Soap

A

c. Glutaraldehyde

87
Q

The dilutional effect occurs during which phase of anesthesia?

a. Emergence
b. Induction
c. Maintenance
d. Plane 3

A

a. Emergence

88
Q

What drug caused the shift from A to B in the left ventricular pressure-volume loop?

a. Phenylephrine
b. Nitroprusside
c. Digitalis
d. Esmolol

A

b. Nitroprusside

89
Q

The duty of the practitioner to do no harm is called:

a. veracity
b. beneficience
c. nonmalficence
d. role fidelity

A

c. nonmalficence

90
Q

Nausea and vomiting caused by anesthesia in the obstetric setting is often closely related to which of the following?

a. hypoxia
b. hypotension
c. opioid administration
d. regional anesthesia

A

b. hypotension

91
Q

Which of the following factors has not effect on MAC(mean alveolar concentration)?

a. age
b. duration of anesthesia
c. hyperthyroidism
d. metabolic acidosis

A

b. duration of anesthesia

92
Q

Which of the following is the correct statement about normal umbilical cord vasculature?

a. one artery, one vein
b. two arteries, one vein
c. two arteries, two veins
d. one artery, two veins

A

b. two arteries, one vein

93
Q

Which of the following components of the gas machine is not under intermediate pressure?

a. the ventilator power inlet
b. flush valve
c. flowmeter tubes
d. oxygen pressure-failure device

A

c. flowmeter tubes

94
Q

Which of the following antilipidemic agents is best described as a “bile-acid sequestrate”?

a. niacin
b. pravastatin
c. gemfibrozil
d. cholestyramine

A

d. cholestyramine

95
Q

All of the following situations may be detected using a minimum pressure alarm except:

a. an increase in resistance
b. a ventilator that is not connected
c. a breathing system that has a major leak
d. a scavenging system that is malfunctioning

A

a. an increase in resistance

96
Q

The patient with type A blood has:

a. anti-A antibodies
b. anti-B antibodies
c. both anti-A and anti-B antibodies
d. neither anti-A or anti-B antibodies

A

b. anti-B antibodies

97
Q

Which of the following valvular lesions would most likely result in concentric left ventricular hypertrophy?

a. aortic stenosis
b. aortic regurgitaion
c. mitral stenosis
d. mitral regurgitation

A

a. aortic stenosis

98
Q

Ankylosing spondylitis has all of the following neurologic implications except:

a. cauda equina syndrome
b. atlanto-occipital subluxation
c. spinal cord compression
d. venous insufficiency

A

d. venous insufficiency

99
Q

When the uvula cannot be visualized, the patient is wondered a Mallampati class

a. I
b. II
c. III
d. IV

A

c. III (PUSH :))

100
Q

Calculate the preoperative fluid deficit(ml) of an 8-kg child who has been NPO for 6 hours. Give your answer in a whole number, no decimals.

A

192 mls

Comps (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions