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Flashcards in Anesthesiology Quiz Deck (47):
1

Preoperative anxiety is most effectively relieved by which of the following? 

Good anesthesiologist

2

H2 antagonists help prevent aspiration pneumonitis by doing which of the following?

Increasing pH of gastric contents.

3

Which of the following is the most common complication immediately after extubation of the trachea?

Laryngospasm

4

What is the proper drug injection site for a spinal anesthesia? 

B/W arachnoid and pia mater of the cord.

5

Which of the following is true of a headache that is likely to be diagnosed as a spinal headache?

Goes away when patient lies down.

6

Which of the following is the most common cause of hypotension in the postanesthesia care unit?

Hypovolemia

7

What is the most effective way to preserve myocardial perfusion in an ischemic heart? 

Heart rate as low as possible

8

A patient who has mitral valve prolapsed is at increased risk because which of the following is likely to occur?

Fatal arrhythmia

9

If a patient quits smoking cigarettes three days before surgery, what is likely to occur with regards to anesthesia effect? 

Improved O2 delivery to tissues.

10

Tight control of blood glucose (90-120 mg/dL) throughout the surgical period benefits the patient with type I diabetes by decreasing the likelihood of which of the following?

Wound infection

11

Which of the following is of great concern to the anesthesiologist when dealing with a patient who has untreated hyperthyroidism?

Response to stress may be severe arrhythmia and hypertension

12

Which of the following anesthetic conditions increases sickling and vascular occlusion?

Hypovolemia

13

What usually causes central nervous system excitement after the injection of local anesthetic?

IV injection

14

What is the most potent opioid currently available?

Sufentanil

15

Which narcotic causes the least respiratory depression in equianalgesic doses?

All are alike

16

Which of the following anesthetics would most likely cause anterograde amnesia?   

Midazolam

17

Which induction agent permits the earliest return of normal functioning?

Propofol

18

What is the most reliable monitor of the adequacy of ventilation?

Capnograph

19

Which of the following, when monitored continuously, can show ischemic episodes during anesthesia?

Leads II and V5

20

Why is patient controlled analgesia superior to intermittent opioid administration?

Patient does not experience wide swings in level of pain

21

A 70-year-old man with a history of tobacco abuse, hypertension, prior stroke, and laryngeal cancer is brought to the emergency department after being found unresponsive at his home. It is estimated by family members that he lost consciousness approximately one hour earlier.  He underwent a total laryngectomy ten years prior with no subsequent evidence of recurrent cancer.  His current medications include Ramipril and a daily aspirin.  On physical examination, the patient is nonresponsive to voice or painful stimuli and his respirations are shallow.  Vital signs are:  Temperature 37.9oC (98.9oF), blood pressure is 200/100 mm Hg, pulse is 93/min, and respirations are 13/min, and an O2 saturation level of 87%.  There are no apparent signs of trauma secondary to a fall.  The pupils are small, but equal and reactive.  The patient’s tracheostoma is widely patent; breath sounds are distant but present bilaterally without crackles.  An arterial blood gas reveals pH 7.25, PaO2 45. Which of the following is the most appropriate next step in management?

Place endotracheal tube in pts tracheostoma and begin mechanical ventilation

22

A 69-year-old man had a gastric tube placed one day ago. The patient has a long history of dementia secondary to Alzheimer disease and was admitted to the hospital for failure to thrive (FTT). A full evaluation revealed only severe dementia but no obvious cause for the FTT.  A swallowing study was performed that indicated likely aspiration of all oral foods.  After discussion with the family, a decision was made to place a gastric tube for the purposes of feeding. The surgery was uneventful, and the patient appears to be doing well during a routine postoperative check.  Later that evening, the patient is found severely obtunded.  He is now 34 hours postoperative.  He has been getting tube feedings for the past five hours and had minimal gastric residuals at the 2-hour check time.  On arrival, he is cyanotic with labored breathing.  His pulse oximeter reads 85% on 100% non-rebreather mask. On inspection of the patient’s mouth and oropharynx, there are tube feedings visible.  What is the most likely etiology of this patient’s respiratory distress?

Regurgitation and aspiration of gastric tube infused tube feedings

23

A patient has an anterior neck injury, hoarseness, labored respirations, subcutaneous emphysema, and laryngeal crepitus following a motor vehicle accident. Which of the following is the best method of securing the airway in this situation? 

Tracheostomy

24

A 2.525 lb (1150 g) 10-day-old boy is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200/min and blood pressure measured through a femoral artery catheter is 45/24 mm Hg. The most appropriate next step is the administration of what?

Normal saline infusion

25

Cardiopulmonary resuscitation is being performed on a patient. After successful intubation, arterial blood gas values are PaO2: 86 mm Hg and PaCO2: 63 mm Hg, pH is 7.25 at a FiO2 of 1.0. What is the most appropriate next step in management of the patient at this time?  

Hyperventilate the patient

26

In the majority of cases, fetal heart rate decelerations in a variable pattern are associated with which of the following?

Old: fetal head compressions during contractions

New: umbilical cord compression

27

Which of the following laboratory studies is a sign of cyanide toxicity during nitroprusside therapy?

Increased mixed venous po2

28

A patient has had a documented severe allergic reaction to ester-type local anesthetics. Which of the following is also a member of the ester class, and so would be most likely to provoke an allergic or anaphylactic reaction if this patient received it? 

Tetracaine

29

Lorazepam can be safely used as a preanesthetic medication in a patient undergoing a liver transplant without fear of excessive central nervous system depression. What characteristic of lorazepam allows this to occur?

It is conjugated extrahepatically 

30

Anesthesia protocols for outpatient surgery may include sevoflurane because recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid recovery from anesthesia with sevoflurane is associated with which of its characteristics?

Low blood:gas partition coefficient  

31

Which of the following pre-existing conditions predisposes to new-onset third degree heart block during pulmonary artery catheterization?

LBBB

32

A 25-year-old patient with multiple traumas is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium, high serum osmolality, and normal serum creatinine concentration is best explained by which of the following? 

SIADH

33

A 14-year-old African American boy has severe abdominal pain after debridement of an open fracture of the lower extremity. His hemoglobin is 10 g/dL and a peripheral smear shows elongated crescent-shaped erythrocytes. What is the most appropriate initial therapy?   

Volume loading with crystalloid

34

A 209 lb (95 kg) 66-year-old woman receives enflurane and pancuronium during a laparoscopic cholecystectomy. Three minutes after administration of the neostigmine 5 mg and atropine 1.2 mg, the twitch returns to normal. Spontaneous tidal volume is 500 ml when the endotracheal tube is removed.  In the recovery room, she reports dyspnea and appears distressed.  Which of the following is the most likely cause of the respiratory distress?

Residual muscle paralysis

35

Which of the following is considered a patient that may be difficult to intubate?   

Short thyromental distance and prominent incisors

36

Which of the following American Society of Anesthesia (ASA) Physical Status Classification is matched with the correct patient description?

ASA IV - Patient with severe systemic disease that limits activity and is a constant threat to life.

37

A 52-year-old man with myasthenia gravis presents for thymectomy for treatment of his severe weakness and borderline respiratory insufficiency. To improve his preoperative respiratory function, which of the following therapies should be used?

Plasmapharesis

38

Which of the following is the most common upper extremity peripheral nerve injury during general anesthesia?   

Ulnar

39

Which of the following can pass through the blood brain barrier?

Atropine

40

Vasoconstriction is least likely following which of these sympathomimetics?

Isoproterenol

41

What is the most important factor in determining the spread of local anesthetic after spinal injection?

Total dose of injected drug

42

Which of the following best describes fetal pulmonary vascular resistance?

It is high compared to systemic vascular resistance.

43

Which of the following is most characteristic of a spinal anesthetic?

Has an almost sympathetic blockage before a motor block.

44

Which of the following is true of a spinal anesthetic placement procedure? 

Intubation equipment should be readily available.

45

A patient is in the post-anesthetic care unit with shallow respirations and pin point pupils and responds to painful stimulation. Which of the follow drugs should be administered?

  1. Naloxone

46

A discussion between anesthesiologists about opioids takes place. One of them makes an incorrect statement. Which of the following is most likely that incorrect statement?  

Morphine is 10x more potent than fentanyl.

47

Which of the following is most characteristic of an epidural anesthetic?

A total spinal could occur with an epidural if you puncture the dura.