APA 2 Final Exam Review (From Outpatient Anesthesia On)

Question 1

60-70% of all procedures in the United States are performed on a/an ___ basis

Answer 1

Outpatient

Question 2

Outpatient anesthesia has a/an ___ (increased/decreased) need for the anesthetist and ___ (short/long) acting anesthetics

Answer 2

Increased need for the anesthetist and short-acting anesthestics

Question 3

___% of outpatients are less than the age of 12

Answer 3

30%

Question 4

___% of all outpatients are greater than 60 years of age

Answer 4

10%

Question 5

There is no age limit to outpatient surgery, with the exception of premature babies—T/F?

Answer 5

True

Question 6

Outpatient surgery is usually less than ___ hours and rare to exceed ___ hours

Answer 6

Usually less than 2 hours and rare to exceed 4 hours

Question 7

Most common outpatient procedures are ___

Answer 7

Opthalmologic

Question 8

Second most common outpatient procedures are ___ surgeries

Answer 8

Gynecological

Question 9

Substance abuse and outpatient surgery—acute abuse/intoxication has no effect on surgery—T/F?

Answer 9

False—surgery should be cancelled

Question 10

Substance abuse and outpatient surgery—consider ___ (general/regional) technique with use of ___ to alleviate need for narcotics

Answer 10

Consider regional technique with use of NSAIDs to alleviate need for narcotics

Question 11

Premature infant = ___ weeks or earlier gestation

Answer 11

37 weeks or earlier gestation

Question 12

Unacceptable premature infant candidates for outpatient surgery—___mia; underdeveloped ___ reflex; immature ___ control; ___nea

Answer 12

Anemia; underdeveloped gag reflex; immature temperature control; apnea

Question 13

Unacceptable premature infant candidates for outpatient surgery—anemia—normal drop to ___-___g/100ml 1 to 3 months after birth; < ___% hematocrit warrants further evaluation

Answer 13

Normal drop to 7-8g/100ml 1 to 3 months after birth; < 30% hematocrit warrants further evaluation

Question 14

Unacceptable premature infant candidates for outpatient surgery—anemia—increased incidence of ___ episodes

Answer 14

Apnea

Question 15

Unacceptable premature infant candidates for outpatient surgery—anemia—consider ___ therapy for anemic premature infants and re-evaluation before outpatient surgery

Answer 15

Consider iron therapy and re-evaluation

Question 16

Apnea in premature infant—short = ___-___ seconds

Answer 16

6-15 seconds

Question 17

Apnea in premature infant—prolonged = greater than ___ seconds

Answer 17

15 seconds

Question 18

Apnea in premature infant—periodic breathing = ___ or more periods of apnea of ___-___ seconds separated by < ___ seconds of normal breathing

Answer 18

3 or more periods of apnea of 3-15 seconds separated by < 20 seconds of normal breathing

Question 19

Apnea in premature infant—all episodes can lead to ___emia and ___cardia

Answer 19

Hypoxemia and bradycardia

Question 20

Apnea in premature infant can develop as late as ___ hours post-op

Answer 20

12 hours

Question 21

Postconceptual age = ___ age + ___ age

Answer 21

Gestational age + postnatal age

Question 22

Healthy former premature infants should be greater than ___-___ weeks postconceptual age

Answer 22

Greater than 50-60 weeks

Question 23

Premature infant—infants displaying bronchopulmonary ___ should NOT be considered for surgery

Answer 23

Bronchopulmonary dysplasia

Question 24

Premature infants are at ___ (increased/decreased) risk of SIDS—particularly, children with history of ___nea/___cardic events; siblings with ___ (4-5x greater risk)

Answer 24

Premature infants are at increased risk of SIDS—particularly, children with history of apnea/bradycardic events; siblings with SIDS (4-5x greater risk)

Question 25

Premature infants should not be considered for outpatient surgery until ___ months to ___ year of age

Answer 25

6 months to 1 year of age

Question 26

Children with prior history of apnea/bradycardic events should be free of apnea/bradycardia for ___ months prior to surgery

Answer 26

6 months prior to surgery

Question 27

Healthy full-term infant is greater than ___ weeks gestation

Answer 27

37 weeks

Question 28

Healthy full-term infants may be candidates for outpatient surgery if they do not exhibit any respiratory, failure to thrive, feeding, or apneic problems—T/F?

Answer 28

True

Question 29

If healthy full-term infant is free of any complications, they can be considered for outpatient surgery case by case at ___ to ___ weeks of age

Answer 29

2 to 4 weeks of age

Question 30

Geriatric patients are those greater than ___ years of age

Answer 30

65

Question 31

Geriatric patients—you should consider their physiologic age, not their chronologic age—T/F?

Answer 31

True

Question 32

Geriatric patients—those aged ___ years or greater are at greater risk for hospital admission and death within the week following surgery

Answer 32

85 years or greater

Question 33

Geriatric patients must have their existing comorbidities evaluated, adequate home care and transportation in order to be candidates for outpatient surgery—T/F?

Answer 33

True

Question 34

Patients with convulsive disorders—schedule procedures very ___ (early/late) in the day to provide for optimal observation; should have minimum of ___ to ___ hours of postoperative evaluation

Answer 34

Schedule procedures very early in the day to provide for optimal observation; should have minimum of 4 to 8 hours of postoperative evaluation

Question 35

Patients with convulsive disorders—ensure proper delivery of anticonvulsant medications; uncontrolled seizure activity is not acceptable in the outpatient setting—T/F?

Answer 35

True

Question 36

Patients with cystic fibrosis—___ function is the primary predictor of candidacy for outpatient surgery

Answer 36

Pulmonary

Question 37

Patients with cystic fibrosis—need to consider ability to manage respiratory distress and hydration in the outpatient setting with these patients—T/F?

Answer 37

True

Question 38

Malignant hyperthermia susceptibility—must have at least 1 of the following criteria: 1) previous ___ episode; 2) ___ rigidity with previous anesthesia; 3) relative (___ degree) with previous MH episode or positive muscle biopsy

Answer 38

1) previous MH episode
2) masseter rigidity with previous anesthesia
3) relative (1st degree) with previous MH episode or positive muscle biopsy

Question 39

Patients with MH susceptibility—trigger free anesthesia must be provided (that means no depolarizing muscle relaxant succs and no volatile agents used for anesthesia) with at least a ___ hour post-op observation

Answer 39

4 hour post-op observation

Question 40

Preparation for outpatient surgery in MH susceptible patients—have adequate monitoring available; at minimum, ___ vials of dantrolene; schedule patient ___ (early/late) in the day to allow for a minimum of 4 hours of observation

Answer 40

At minimum, 36 vials of dantrolene; schedule patient early in the day to allow for a minimum of 4 hours of observation

Question 41

Outpatient surgery in MH susceptible patients—overnight observation in the 23 hour outpatient has been advocated—T/F?

Answer 41

True

Question 42

Morbid obesity and outpatient surgery—acceptable candidates are ASA class ___ and ___

Answer 42

1 and 2

Question 43

Morbid obesity and outpatient surgery—patients with comorbidities such as cardiac, endocrine, hepatic, renal, or pulmonary should be done inpatient—T/F?

Answer 43

True

Question 44

Morbid obesity and outpatient surgery—___ (increased/decreased) risk of difficult airway and sleep apnea; need to do thorough ___ evaluation pre-op; have __ available if patient uses at home

Answer 44

Increased risk of difficult airway and sleep apnea; need to do thorough airway evaluation pre-op; have CPAP available if patient uses at home

Question 45

Morbid obesity and outpatient surgery—prepare for short PACU admission—T/F?

Answer 45

False—prepare for prolonged PACU admission

Question 46

Reactive airway disease and outpatient surgery—___ status and ___ of disease should be determined prior to admission

Answer 46

Baseline status and severity of disease should be determined prior to admission

Question 47

Reactive airway disease and outpatient surgery—patient should not experience acute symptoms, should continue routine medications until time of surgery, and should expect possible admission—T/F?

Answer 47

True

Question 48

Reactive airway disease and outpatient surgery—two tests that can be performed prior to surgery = ___ x-ray and ___

Answer 48

Chest x-ray and ABG

Question 49

Sickle cell disease—crisis may occur if patient is subject to ___ia, ___osis, or ___

Answer 49

Hypoxia, acidosis, or dehydration

Question 50

Sickle cell disease—criteria for outpatient surgery—no major ___ disease (as a result of sickle cell); no sickle crisis for a minimum of ___ year; compliant medical care; schedule ___ (early/late) appointment for optimum observation post-op

Answer 50

No major organ disease; no sickle crisis for a minimum of 1 year; compliant medical care; schedule early appointment for optimum observation post-op

Question 51

Sickle cell disease should be considered in every African American patient—T/F?

Answer 51

True

Question 52

Those with sickle cell trait are not susceptible to sickle cell crisis if they are hypoxic—T/F?

Answer 52

False—those with sickle cell trait are still susceptible to sickle cell crisis if they are hypoxic

Question 53

Patients with sickle cell anemia will usually have surgery done inpatient rather than outpatient—T/F?

Answer 53

True

Question 54

Unacceptable patient conditions for SDS—ASA ___ or ___ (unstable conditions); ___ (current/previous) substance/ETOH abuse; ___ problems; ___ seizures; newly diagnosed or untreated ___; uncontrolled ___; ___ necessary (sepsis or infectious disease); post-op pain not controlled with ___ meds

Answer 54

ASA 3 or 4; current substance/ETOH abuse; psychosocial problems; uncontrolled seizures; newly diagnosed or untreated OSA; uncontrolled diabetes; isolation necessary (sepsis or infectious disease); post-op pain not controlled with oral meds

Question 55

History and physical for outpatient surgery—for stable patient, should be within ___ days; within ___ hours for the high risk patient

Answer 55

For stable patient, should be within 30 days; with 72 hours for the high risk patient

Question 56

Preop lab testing for outpatient surgery has not been found to reduce morbidity—T/F?

Answer 56

True

Question 57

Lab values good within ___ days of surgery if patient status is stable

Answer 57

60 days

Question 58

Potassium level should be obtained within ___ days for patients on diuretics/digitalis

Answer 58

7 days

Question 59

Glucose should be taken ___ of surgery

Answer 59

Morning of surgery

Question 60

Chest x-ray indications—previous ___ film; history of malignancy with ___; severe ___, ___, ___ or ___ disease; intra___ tumors; history of congenital ___ disease; history of prematurity with residual broncho-pulmonary ___; severe ___ (? cardiomegaly); ___ syndrome (asymptomatic subluxation of atlantoaxial junction); ___ infection

Answer 60

Previous abnormal film; history of malignancy with metastasis; severe asthma, COPD, pulmonary or CV disease; intrathoracic tumors; history of congenital heart disease; history of prematurity with residual broncho-pulmonary dysplasia; severe OSA (? cardiomegaly); Down syndrome; pulmonary infection

Question 61

Indications for EKG—CV disease—___tension; renal disease; circulatory disease; ___ disease; ___ (40 years or older); significant ___ disease; history of unevaluated pathological-sounding ___ or ___; family history of prolonged ___ syndrome; history of moderate to severe ___; chronic anatomic airway ___ (Pierre Robin Syndrome) at risk for ___-sided heart strain

Answer 61

Hypertension; renal disease; circulatory disease; thyroid disease; diabetes (40 years or older); significant pulmonary disease; history of unevaluated pathological-sounding murmur or palpitation; family history of prolonged QT syndrome; history of moderate to severe OSA; chronic anatomic airway obstruction (Pierre Robin Syndrome) at risk for right-sided heart strain

Question 62

All cardiopulmonary medication should be taken on the morning of surgery—T/F?

Answer 62

True

Question 63

Coumadin—if held, should be minimum of ___-___ days

Answer 63

4-5 days

Question 64

Coumadin—PT should be drawn ___ of surgery

Answer 64

Morning of

Question 65

Coumadin—restart within ___-___ days post-op

Answer 65

1-7 days post-op

Question 66

Diabetes and outpatient surgery—patient should be ___ controlled or considered for ___ only

Answer 66

Patient should be well controlled or considered for inpatient only

Question 67

Diabetes and outpatient surgery—schedule ___ (early/late); NPO after midnight; monitor serum glucose closely ___-, ___-, and ___-op; consider giving ___ of insulin dose day of surgery

Answer 67

Schedule early; NPO after midnight; monitor serum glucose closely pre-, intra-, and post-op; consider giving 1/2 of insulin dose day of surgery

Question 68

Rhinorrhea—20-30% of children have on/off rhinorrhea most of the year—T/F?

Answer 68

True

Question 69

Rhinorrhea—children 2 years and younger have 5-10 respiratory infections annually—T/F?

Answer 69

True

Question 70

Recently acquired rhinorrhea 12-24 hours prior to surgery or chronic rhinorrhea ___ (is/is not) contraindicated for outpatient surgery in an otherwise healthy child

Answer 70

Is not

Question 71

May consider postponing outpatient surgery ___-___ weeks in a locally infected child

Answer 71

1-2 weeks

Question 72

Symptoms of URTI—WBCs > ___-___k; muco___ nasal secretions; ___/___ mucosa; ___ (positive/negative) chest findings; temperature ___ C or >; tonsillitis; ___ ulcers in oropharynx; conjunctivitis; ___ (productive/nonproductive) coughing; fatigue; itching; laryngitis; malaise/myalgias; sneezing; ___ throat; ___/___ cultures

Answer 72

WBCs > 12-15k; mucopurulent nasal secretions; inflamed/reddened mucosa; positive chest findings; temperature 38 C or >; tonsillitis; viral ulcers in oropharynx; conjunctivitis; nonproductive coughing; fatigue; itching; laryngitis; malaise/myalgias; sneezing; sore throat; throat/nasal cultures

Question 73

Performing surgery for questionable URTI—symptomatic should be rescheduled at least ___ weeks later

Answer 73

At least 4 weeks later

Question 74

Performing surgery for questionable URTI—asymptomatic can be done if the following are met—child older than ___ year, otherwise healthy and surgery is not on ___ or ___; ___ is not planned

Answer 74

Child older than 1 year, otherwise healthy and surgery is not on thorax or abdomen; ETT intubation is not planned

Question 75

There is an 11-fold increased risk of adverse respiratory complications if surgery requires ETT intubation and child has a URTI—T/F?

Answer 75

True

Question 76

Anesthesia increases respiratory complications 2-7 fold—T/F?

Answer 76

True

Question 77

Kids with URTI are more prone to ___-holding, ___spasm, coughing, ___emia, ___ (increased/decreased) secretions, ___spasm, ___onia, ___asis, croup, stridor

Answer 77

Breath-holding, bronchospasm, coughing, hypoxemia, increased secretions, laryngospasm, pneumonia, atelectasis, croup, stridor

Question 78

Risk factors for respiratory complications during surgery in kids = ___ tube; < ___ years; history of ___; history of ___ airway disease; ___ smoke; ___ secretions; ___ congestion; ___ surgery

Answer 78

ETT; < 5 years; history of prematurity; history of reactive airway disease; second-hand smoke; copious secretions; nasal congestion; ENT surgery

Question 79

Pulmonary aspiration prophylaxis is indicated in patients who are at high risk for ___

Answer 79

Aspiration

Question 80

Pulmonary aspiration prophylaxis is not indicated in patients not at risk—T/F?

Answer 80

True

Question 81

Pulmonary aspiration prophylaxis—this class of drugs reduces gastric volume (example = ___)

Answer 81

Gastrokinetics—reglan

Question 82

Pulmonary aspiration prophylaxis—this class of drugs blocks H+ ion release from cells, but does not alter pH of gastric fluid that is already present (examples = Tagamet, Pepcid, Zantac)

Answer 82

H2 receptor antagonists

Question 83

Pulmonary aspiration prophylaxis—this class of drugs inhibits gastric acid secretion without affecting volume; longer duration than H2 blockers (example = Prilosec)

Answer 83

Proton pump inhibitors

Question 84

Pulmonary aspiration prophylaxis—Prevacid, aciphex, and protonix (all are proton pump inhibitors) are successful in ___ (increasing/decreasing) pH and ___ (increasing/decreasing) gastric volume

Answer 84

Successful in increasing pH and decreasing gastric volume

Question 85

Goals of outpatient anesthesia—___ physiologic changes; provide fast, smooth onset of anesthetic action; promote intra-op ___/___; afford suitable operating circumstances; minimize perioperative anesthetic ___ effects; allow rapid offset of anesthesia while maintaining patient ___

Answer 85

Minimize physiologic changes; provide fast, smooth onset of anesthetic action; promote intra-op amnesia/analgesia; afford suitable operating circumstances; minimize perioperative anesthetic side effects; allow rapid offset of anesthesia while maintaining patient comfort

Question 86

Choice of anesthetic is based on—___ requirements; skill of ___; skill of ___; patient ___; patient ___; ___ status; level of care available to the patient upon ___

Answer 86

Surgical requirements; skill of surgeon; skill of anesthesia provider; patient preference; patient age; ASA status; level of care available to the patient upon discharge

Question 87

___ anesthesia is the most used technique in SDS

Answer 87

General

Question 88

General anesthesia for SDS—use of ___, ___ (short/long) acting, ___ (slow/fast) onset and offset agents

Answer 88

Use of potent, short-acting, rapid onset and offset agents

Question 89

Airway management for outpatient surgery—___ has many advantages if no contraindications exist—___ (more/less) coughing/sore throat, ___ (more/less) analgesic needed

Answer 89

LMA has many advantages if no contraindications exist—less coughing/sore throat, less analgesic needed

Question 90

Airway management for outpatient surgery—ETT has ___ (increased/decreased) incidence of post-extubation croup, sore throat; delayed ability to resume ___ intake; utilize ___ (small/large) tubes

Answer 90

ETT has increased incidence of post-extubation croup, sore throat; delayed ability to resume PO intake; utilize small tubes

Question 91

Selection of regional anesthesia for outpatient surgery—should use the ___- (shortest/longest) acting agent capable of providing adequate blockade without prolonging discharge with neuraxial blockade

Answer 91

Shortest-acting agent

Question 92

Advantages of regional anesthesia—___ (shorter/longer) recovery times; inpatient admission is ___ (increased/decreased); ___ (immediate/delayed) post-op pain relief; GA side effects are ___ (minimized/maximized); patient with fear of GA/loss of control has an alternative

Answer 92

Shorter recovery times; inpatient admission is decreased; immediate post-op pain relief; GA side effects are minimized; patient with fear of GA/loss of control has an alternative

Question 93

Disadvantages of regional anesthesia—___ of patient and surgeon are required; may require ___ (more/less) time than GA; inherent problems to regional anesthesia—sympathetic block associated with spinal and epidural may complicate discharge with orthostatic ___tension, inability to empty ___, ___ headache, ___ neurologic symptoms

Answer 93

Cooperation of patient and surgeon are required; may require more time than GA; inherent problems—orthostatic hypotension, inability to empty bladder, PDP (spinal) headache, transient neurologic symptoms

Question 94

Top 2 postoperative complications after outpatient surgery/reason for inpatient admission = ___ and ___

Answer 94

Nausea/vomiting and excessive pain

Question 95

Major postoperative morbidities—myocardial infarction, stroke, PE, respiratory failure…most common time for these to occur is within first ___ hours postoperatively

Answer 95

Within first 48 hours postoperatively

Question 96

In the geriatric patient, greatest risk for postoperative mortality is ___ week

Answer 96

1

Question 97

Contributors to PONV—___lation; postural ___tension; uncontrolled ___; post-op ___ meds; ___ intake; ___ (low/high) inspired O2 concentration; ___ agents

Answer 97

Ambulation; postural hypotension; uncontrolled pain; post-op pain meds; oral intake; low inspired O2 concentration; reversal agents

Question 98

Who is at risk for PONV?—patients with history of prolonged ___; procedures associated with increased nausea—i.e.:, ___ surgery (wired jaw); procedures where ___ could jeopardize the surgical result (i.e.: ___/___ surgery)

Answer 98

Patients with history of prolonged PONV; procedures associated with increased nausea—i.e.: mandibular surgery (wired jaw); procedures where retching could jeopardize the surgical result (i.e.: plastics/eye surgeries)

Question 99

PONV treatment options—corticosteroids (i.e.: ___)—the earlier received, the better the outcome

Answer 99

Decadron

Question 100

PONV treatment options—butyrophenone/dopamine receptor antagonist (i.e.: ___); give in small doses 20 mcg/kg immediately following induction or 5-10 mg orally

Answer 100

Droperidol

Question 101

PONV treatment options—indirect-acting sympathomimetic (i.e.: ___); 0.5 mg/kg given IM immediately at end of surgery or 10-25 mg IV

Answer 101

Ephedrine

Question 102

PONV treatment options—gastric suctioning is ___

Answer 102

Controversial—no confirmed benefit

Question 103

PONV treatment options—reglan 0.15 mg/kg IV post-op; advantage is that it causes no ___; disadvantage is ___ side effects

Answer 103

Advantage is that it causes no sedation; disadvantage is extrapyramidal side effects

Question 104

PONV treatment options—selective serotonin type 3 receptor antagonist (i.e.: ___); 0.15 mg/kg IV

Answer 104

Zofran

Question 105

PONV treatment options—phenothiazine/dopamine receptor antagonist (i.e.: ___); 0.5 mg/kg IV/IM—potential for delayed discharge secondary to ___ effects

Answer 105

Phenergan; potential for delayed discharge secondary to sedative effects

Question 106

Postoperative pain requirements are ___ (increased/decreased) with regional, opioid/non-opioid, non-steroidal anti-inflammatories, wound infiltration with local anesthetic

Answer 106

Decreased

Question 107

Postoperative pain—control immediate post-op pain with a ___ (short/long) acting analgesic; once controlled and patient is taking PO, give ___ analgesic intended for discharge—use this to evaluate patient comfort and ability to manage pain post-op

Answer 107

Short-acting analgesic; give oral analgesic intended for discharge

Question 108

Phase 1 of anesthesia recovery—___ VS; no ___ impairment; protective ___ reflexes, ___ present; patient oriented to ___ level; parameters are assumed to not change

Answer 108

Stable VS; no respiratory impairment; protective airway reflexes, cough present; patient oriented to preoperative level; parameters are assumed to not change

Question 109

Phase 2 of anesthesia recovery—___ assistance and capable caregiver; no ___ distress; bleeding ___; pain ___; PONV ___; ___ intake; ___ing (bathroom); responsible ___ present

Answer 109

Ambulation assistance and capable caregiver; no respiratory distress; bleeding minimal; pain controlled; PONV minimal; oral intake; voiding (bathroom); responsible caregiver present

Question 110

MAC sedation = ___

Answer 110

Monitored anesthesia care sedation

Question 111

MAC sedation—patient must be able to protect own ___; patient must be ___ independently without loss of ___

Answer 111

Patient must be able to protect own airway; patient must be breathing independently without loss of consciousness

Question 112

MAC anesthesia—a gentle jaw thrust with initial insult is OK, but prolonged airway management is a ___ anesthetic

Answer 112

General

Question 113

Incidence of brain damage or death are both ___ (higher/lower) in MAC anesthesia over general/regional anesthesia

Answer 113

Higher in MAC anesthesia over general/regional anesthesia

Question 114

26% of adverse outcomes with MAC sedation are ___ related

Answer 114

Respiratory

Question 115

10% of adverse outcomes with MAC sedation are ___ related

Answer 115

Cardiac

Question 116

Deep sedation—patient ___ (is/is not) easily aroused; responds appropriately to ___ stimuli; may need assistance with maintaining ___ airway; CV function is usually unaltered

Answer 116

Patient is not easily aroused; responds appropriately to painful stimuli; may need assistance with maintaining patent airway; CV function is usually unaltered

Question 117

Minimal sedation (anxiolysis)—cognitive function may be impaired, but patient can respond ___; respiratory/CV function are ___ (changed/unchanged)

Answer 117

Cognitive function may be impaired, but patient can respond verbally; respiratory/CV function are unchanged

Question 118

Conscious sedation is an obsolete term and has been replaced by “moderate sedation”—T/F?

Answer 118

True

Question 119

What type of sedation is this?—patient can be directed by physician performing the procedure; depth does not allow loss of protective reflexes

Answer 119

Moderate sedation

Question 120

What type of sedation is this?—similar to moderate sedation but must have anesthesia personnel that can change to general anesthesia

Answer 120

MAC—monitored anesthesia care sedation

Question 121

Types of sedation (in order of least to greatest depth):

Answer 121

1) Minimal sedation (anxiolysis)—patient can respond verbally
2) Moderate sedation—protective reflexes intact
3) MAC sedation—can protect airway and breathe independently (only jaw thrust with initial induction)
4) Deep sedation (responds to pain, needs assistance maintaining patent airway)
5) General anesthetic (comatose)

Question 122

Causes of hypotension post-op—___ is most common cause; ___thermia causing veno___; ___ ventricular dysfunction may occur in sepsis, hypoxemia, or acidosis and cause hypotension

Answer 122

Hypovolemia is most common cause; hypothermia causing venoconstriction; left ventricular dysfunction may occur in sepsis, hypoxemia, or acidosis and cause hypotension

Question 123

PAC/PVC causes—___magnesemia; ___kalemia; ___ (increased/decreased) sympathetic tone; myocardial ___ (least common cause)

Answer 123

Hypomagnesemia; hypokalemia; increased sympathetic tone; myocardial ischemia (least common cause)

Question 124

Postoperative laryngospasm—first line treatment is ___; if unresponsive, give ___ ___ mg/kg IV

Answer 124

First line treatment is positive pressure; if unresponsive, give succs 0.1 mg/kg IV

Question 125

Avoid droperidol (antipsychotic/antiemetic) in patients with pre-existing ___ abnormalities; recommend ___-___ hours monitoring and 12-lead ECG following administration

Answer 125

Pre-existing ECG abnormalities; recommend 2-3 hours monitoring and 12-lead ECG following administration

Question 126

Least effective pain medication routes = ___ or ___ injections

Answer 126

Subcutaneous or IM injections—erratic absorption compared to other routes

Question 127

Preferred route of pain medication administration = ___

Answer 127

IV

Question 128

Secondary routes of pain medication administration = ___, ___

Answer 128

Sublingual, rectal

Question 129

What ambulatory surgical procedure is this?—removal of endometrial lining and any polyps or myomas; used to complete a missed or incomplete spontaneous abortion; treatment of cervical stenosis; diagnose and treat bleeding; less extent, this procedure can be done to terminate pregnancy

Answer 129

D&C—dilation and curettage

Question 130

Positioning for D&C = ___; less than ___ degree abduction is recommended

Answer 130

Dorsal lithotomy; less than 40 degree abduction is recommended

Question 131

Blood loss management for D&C—___ 0.2 mg IM; ___ 10-20 units IV, causes contraction of uterus, found in the ___

Answer 131

Methergine 0.2 mg IM; oxytocin (pitocin) 10-20 units IV, causes contraction of uterus, found in the refrigerator

Question 132

This procedure allows examination of the endometrial cavity; useful in diagnosis of uterine bleeding; common causes of uterine bleeding such as polyps and myomas are often able to be removed through hysteroscope

Answer 132

Hysteroscopy

Question 133

How is hysteroscopy performed?—___ position

Answer 133

Lithotomy

Question 134

Risks with CO2 distention during hysteroscopy—minimize risks with flow less than ___ml/min; intrauterine pressure should be less than ___ mm Hg—reduces risk of cardiac ___; may expect increased risk of ___ pain with insufflation

Answer 134

Minimize risks with flow less than 1200 ml/min; intrauterine pressure should be less than 200 mm Hg—reduces risk of cardiac arrhythmias; may expect increased risk of shoulder pain with insufflation

Question 135

Neuraxial anesthesia for hysteroscopy—risk of ___ headache, increased risk with ___ (young/old) age; use of pencil point needle ___ (increases/decreases) risk of this because it separates fibers of the spinal canal rather than cutting them

Answer 135

Risk of spinal headache (PDPH), increased with young age; use of pencil point needle decreases risk of this because it separates fibers of spinal canal rather than cutting them

Question 136

What is an adequate block level for a hysteroscopy?

Answer 136

T10

Question 137

Risk for ___ damage with lithotomy position

Answer 137

Nerve

Question 138

TMJ arthroscopy complications—___ and ___ nerve damage; partial ___ loss; ___go; ear ___; ___age

Answer 138

Facial and trigeminal nerve damage; partial hearing loss; vertigo; ear fullness; hemorrhage

Question 139

Muscle relaxation and GA always improve mouth opening in TMJ patients—T/F?

Answer 139

False—do not always improve mouth opening in TMJ patients

Question 140

Who needs GA for orthodontic/dental procedures?—mentally ___; young ___; patients with oral ___; patients with poorly controlled ___ disorders; patients presenting for ___ procedures

Answer 140

Mentally retarded; young children; patients with oral sepsis; patients with poorly controlled seizure disorders; patients presenting for TMJ procedures

Question 141

ETT for dental surgeries—___ (endotracheal/nasotracheal) tube is preferred placement in dental surgeries

Answer 141

Nasotracheal

Question 142

Nerve damage from dental surgeries—damage to ___ nerve during surgical tooth extraction = numbness of tongue

Answer 142

Lingual nerve

Question 143

Nerve damage from dental surgeries—damage to the ___ alveolar nerve during surgical tooth extraction = lip numbness

Answer 143

Inferior alveolar nerve

Question 144

Rheumatoid arthritis considerations for dental surgeries—instability/immobility of ___ spine; immobility of the ___ joint

Answer 144

Instability/immobility of cervical spine; immobility of the cricoarytenoid joint

Question 145

Shoulder arthroscopy—preferred anesthetic technique is ___/___ technique

Answer 145

Regional/general technique

Question 146

Positioning for shoulder arthroscopy = semi-___, beach ___ position

Answer 146

Semi-sitting, beach chair position

Question 147

Semi-sitting/beach chair position for shoulder arthroscopy = increased risk of venous ___; postural ___tension can be severe—ease into position to lessen, proper ___ and ___ stockings recommended; maintain adequate BP, MAP < ___, epi 1mg/3ml)

Answer 147

Increased risk of venous air embolism; postural hypotension can be severe—ease into position to lessen, proper hydration and antiembolism stockings recommended; maintain adequate BP, MAP < 80, epi 1mg/3ml)

Question 148

You should use nasal airways for difficult mask ventilation during tonsillectomy/adenoidectomy—T/F?

Answer 148

False—nasal airways can increase the risk of bleeding d/t trauma or hypertrophied adenoid tissue

Question 149

Tonsillectomy/adenoidectomy—patients who do not need premedication are those with ___ and upper airway ___

Answer 149

OSA and upper airway obstruction

Question 150

Adult patient arrives for T&A that has fever, nasal secretions, purulent sputum. Should you proceed with the surgery?

Answer 150

No—patient exhibits signs of URI; advise postponement of surgery and reschedule when symptoms subside

Question 151

ETT for tonsillectomy/adenoidectomy—proper securement of ETT is ___ to lower ___

Answer 151

Midline to lower lip

Question 152

How do you know if your patient is still bleeding after T&A?—frequent ___; ensure a maximally protected airway with an ___ intubation

Answer 152

Frequent swallowing; ensure a maximally protected airway with an awake intubation

Question 153

Avoid ___capnia during emergence after T&A because this increases vaso___, which can increase bleeding

Answer 153

Avoid hypercapnia during emergence after T&A because this increases vasodilation, which can increase bleeding

Question 154

Post-op positioning for T&A = ___, head ___ position (tonsillar position)

Answer 154

Lateral, head down position

Question 155

Positioning for T&A—___ with elevation of shoulders using shoulder roll; arms ___ (beware of fingers); slight ___ may be requested

Answer 155

Supine with elevation of shoulders using shoulder roll; arms tucked (beware of fingers); slight reverse trendelenberg may be requested

Question 156

T&A postoperative complications—___spasm; ___ing; retained ___ that can cause upper airway ___; postobstructive pulmonary ___

Answer 156

Laryngospasm; bleeding; retained throat pack that can cause upper airway obstruction; postobstructive pulmonary edema

Question 157

What is the most common arthroscopic procedure performed?

Answer 157

Knee arthroscopy—to diagnose and treat intra-articulation disorders of the knee

Question 158

Most common complication of knee arthroscopy = ___arthrosis

Answer 158

Hemarthrosis

Question 159

Anesthesia for knee arthroscopy = ___ anesthesia; combination of ___ and ___ anesthesia

Answer 159

Regional anesthesia; combination of regional and general anesthesia

Question 160

Goal of sterile technique for central line placement is to prevent ___

Answer 160

Infection

Question 161

Site preparation with chlorhexidine—___ second friction rub, must allow to air dry for ___ minutes

Answer 161

30 second friction rub, must allow to air dry for 2 minutes

Question 162

For children < 2 months old, ___ may be used instead of chlorhexidine gluconate prep for central line insertion

Answer 162

Povidone iodine

Question 163

What is the most common/preferred site for CVC placement?

Answer 163

Right internal jugular

Question 164

Risks of RIJ central line placement—___ damage; venous ___ embolism; carotid ___ puncture

Answer 164

Nerve damage; venous embolism; carotid artery puncture

Question 165

LIJ risks—___thorax (leakage of lymphatic fluid from thoracic duct into pleural space); ___ effusion; carotid ___ puncture; ___ damage; venous ___ embolism

Answer 165

Chylothorax; pleural effusion; carotid artery puncture; nerve damage; venous air embolism

Question 166

Subclavian—lower ___ rate; higher risk of ___

Answer 166

Lower infection rate; higher risk of pneumothorax

Question 167

External jugular—___ make it difficult to thread the catheter; risks = kinking/migration, phlebitis, arterial puncture

Answer 167

Valves

Question 168

Femoral is commonly used for CVC insertion—T/F?

Answer 168

False—it is used only when unable to insert CVC elsewhere

Question 169

Femoral has high incidence of CVC-related ___

Answer 169

Sepsis

Question 170

Right internal jugular vein catheterization has ___ (lower/higher) incidence of pneumothorax compared to left due to lower dome of pleura on right side

Answer 170

Lower incidence

Question 171

Right IJ is ___ (more/less) likely to become contaminated due to respiratory secretions

Answer 171

More likely

Question 172

Ultrasound for CVC insertion—internal jugular vein [compared to the carotid artery] should be more ___ (superficial/deep), ___ (smaller/larger), ___-shaped (oval/round), and ___ (compressible/not compressible)

Answer 172

More superficial, larger, oval-shaped, and compressible

Question 173

If you can’t visualize the internal jugular vein on ultrasound, it might be compressed, so try using lighter pressure with the ultrasound probe. If you still can’t see it, the patient just might be severely hypovolemic.—T/F?

Answer 173

True

Question 174

CVC insertion—blood should not flow higher than the cm of central venous pressure expected—T/F?

Answer 174

True

Question 175

CVC insertion—if shunting is present, venous blood may appear darker than normal—T/F?

Answer 175

False—blood may appear brighter than normal

Question 176

CVC insertion—in certain conditions (i.e.: tricuspid regurgitation and atrial fibrillation), the central venous pressure may appear to be pulsatile—T/F?

Answer 176

True

Question 177

If the patient develops an unstable rhythm as you are passing the guidewire, you should ___ the wire immediately

Answer 177

Withdraw

Question 178

For right IJ CVC, the catheter should be secured at around ___ cm, depending on the patient’s height (height/10 cm)

Answer 178

16 cm

Question 179

For right subclavian CVC, the catheter should be secured at around ___ cm, depending on the patient’s height ([height/10 cm]-2 cm)

Answer 179

15 cm

Question 180

For left IJ, the catheter should be secured at around ___ cm, depending on the patient’s height ([height/10 cm]+4 cm)

Answer 180

20 cm

Question 181

For left subclavian, the catheter should be secured at around ___ cm, depending on the patient’s height ([height/10 cm]+2 cm)

Answer 181

19 cm

Question 182

If removal of CVC is planned, place the patient in ___ position, ask the patient to ___ (inhale/exhale) as catheter is removed to prevent ___; apply pressure over the site for 1-2 minutes until hemostasis is achieved

Answer 182

Trendelenberg position, ask the patient to exhale as catheter is removed to prevent air embolism

Question 183

Risk for arterial puncture is greatest with ___ CVC

Answer 183

Femoral > IJ > subclavian

Question 184

Risk for infection is greatest with ___ CVC

Answer 184

Femoral > IJ > subclavian

Question 185

Risk for pneumothorax is greatest with ___ CVC

Answer 185

Subclavian

Question 186

Three areas of anesthesia with highest incidence of recall = ___, ___, and ___

Answer 186

CV, OB, trauma

Question 187

5 criteria for potential cervical spine injury: 1) ___ pain; 2) severe ___ pain; 3) any ___ signs and symptoms; 4) ___cation; 5) loss of ___ at the scene

Answer 187

1) neck pain; 2) severe distracting pain; 3) any neurological signs and symptoms; 4) intoxication; 5) loss of consciousness at the scene

Question 188

To intubate a patient with a cervical spine injury, the best way is ___ (MILS); can be used with glide scope

Answer 188

Manual inline stabilization (MILS)

Question 189

Avoid ___ (what inhalation agent?) in trauma patients with a pneumothorax, pneumocephalus, or pneumoperitoneum

Answer 189

Nitrous oxide (N2O)

Question 190

Succinylcholine can increase serum potassium levels if administered ___ hours after a burn, spinal cord, or crush injury

Answer 190

24 hours

Question 191

Postop after massive transfusions, patients get metabolic ___osis

Answer 191

Alkalosis

Question 192

If transfusion rate exceeds 1 unit every 5 minutes, you can see cardiac ___ caused by ___calcemia

Answer 192

Cardiac depression caused by hypocalcemia

Question 193

In an anesthetized patient, hemolytic reactions are recognized by ___thermia, ___cardia, ___tension, ___globinuria, and ___ at the field

Answer 193

Hyperthermia, tachycardia, hypotension, hemoglobinuria, and oozing at the field

(From last semester)—hypotension and hemoglobinuria will NOT be masked by anesthesia during a true hemolytic reaction

Question 194

Want to give ___ (warm/cold) fluids to trauma patients

Answer 194

Warm!…hypothermia worsens acid/base balance, causes coagulopathies, and risks myocardial function

Question 195

Common cause of bleeding after massive transfusions is ___

Answer 195

Dilutional thrombocytopenia

Question 196

Crystalloids have a half-life of ___-___ minutes

Answer 196

20-30 minutes

Question 197

Colloids have a half-life of ___-___ hours

Answer 197

3-6 hours

Question 198

Fluid resuscitation for trauma—___ is less likely to cause hyperkalemic acidosis than ___

Answer 198

LR is less likely to cause hyperkalemic acidosis than NS

Question 199

Fluid resuscitation—___ in LR makes it incompatible with blood transfusions (why we hang NS, not LR, with blood transfusions)

Answer 199

Calcium

Question 200

Fluid resuscitation—___ solutions are contraindicated in trauma because they may exacerbate ischemic brain damage

Answer 200

Dextrose

Question 201

Fluid resuscitation—LR is slightly ___tonic; giving large volumes can aggravate ___ edema

Answer 201

LR is slightly hypotonic; giving large volumes can aggravate cerebral edema

Question 202

___ (crystalloids/colloids) are effective in rapidly restoring intravascular volumes

Answer 202

Colloids (i.e.: albumin)

Question 203

Dextran and hetastarch may cause ___

Answer 203

Coagulopathy

Question 204

Type ___ blood can be released to the moribund trauma patient requiring immediate blood transfusion that has not been typed and crossed

Answer 204

O negative blood

Question 205

Factor VIII can decrease by ___% after two days in storage; for this reason, dilutional ___ quickly develops when a patient is massively transfused

Answer 205

50%; for this reason, dilutional thrombocytopenia quickly develops when a patient is massively transfused

Question 206

Use ___ (more/less) anesthetic in the hypovolemic patient

Answer 206

Less

Question 207

Alveolar concentration is ___ (increased/decreased) in shock patients d/t a ___ (increase/decrease) in CO and ___ (increased/decreased) ventilation

Answer 207

Alveolar concentration is increased in shock patients d/t a decrease in CO and increased ventilation

Decrease in CO = train is not coming through as frequently; concentration of inhaled anesthetics builds up in alveoli; as patient breathes more frequently, more gas is taken up more quickly…moral of the story: LESS GAS is needed in trauma patients!

Question 208

Trauma patients have ___ (more/less) intravascular volume, so intravenous anesthetics are exaggerated when given

Answer 208

Less intravascular volume

Question 209

Induction agents of choice for the hypovolemic trauma patient—___ and ___

Answer 209

Ketamine and etomidate

Question 210

Trauma patients are always at risk for ___; always assume a ___

Answer 210

Aspiration; always assume a full stomach

Question 211

___ = circulatory failure leading to inadequate organ perfusion and oxygen delivery

Answer 211

Shock

Question 212

Consider a ___ injury in any trauma patient with an altered level of consciousness

Answer 212

Brain injury

Question 213

Cushing’s Triad—nervous system’s response to increased ___; ___tension, ___cardia, irregular ___

Answer 213

Nervous system’s response to increased ICP; hypertension, bradycardia, irregular respirations

Question 214

Cushing’s triad is early signs of brain injury—T/F?

Answer 214

False—LATE signs that are preceded by brain herniation

Question 215

Brain injuries—no sedatives or analgesics should be given if neuro exam is to be conducted—T/F?

Answer 215

True

Question 216

Anticholinergic meds cause pupillary ___ (i.e.: robinol, spiriva, atrovent)

Answer 216

Dilation

Question 217

Beck’s Triad = signs of pericardial ___, which is d/t an excessive accumulation of fluid within the ___; ___ distention, ___tension, ___ heart tones

Answer 217

Signs of pericardial effusion, which is d/t an excessive accumulation of fluid within the pericardial sac; neck vein distention, hypotension, muffled heart tones

Question 218

Pulsus paradoxus = ___ mm Hg ___ (increase/decrease) in BP during spontaneous ventilation

Answer 218

10 mm Hg decrease in BP during spontaneous ventilation

Question 219

Abdominal traumas usually need an ___

Answer 219

Exploratory laparotomy

Question 220

Abdominal trauma—___tension occurs when abdomen is opened

Answer 220

Hypotension—air and/or fluid that was sitting in the abdomen leaks out of body (path of least resistance), so pressure drops

Question 221

Abdominal traumas require ___ IV and ___…___ is key!

Answer 221

Large bore IV and blood…fluid resuscitation is key!

Question 222

Remember, massive transfusions are associated with ___kalemia

Answer 222

Hyperkalemia

Question 223

Pelvic fractures can lead to ___volemic shock

Answer 223

Hypovolemic shock

Question 224

___ can occur with fractures

Answer 224

Fat embolism

Question 225

Fat embolism—labs—elevation of serum ___; ___ in urine; thrombo___

Answer 225

Elevation of serum lipase; fat in urine; thrombocytopenia

Question 226

Extremity reattachment—in general, keep patients ___ and avoid ___ on emergence to help reperfusion

Answer 226

Keep patients warm and avoid shivering on emergence to help reperfusion

Question 227

LeFort ___ fractures are associated with increased risk with intubation—ETT may go through the fracture and right into the brain, instead of through the trachea

Answer 227

III

Question 228

Intracranial hypertension is controlled by ___ restrictions, ___, ___capnia (PaCO2 goal ___-___ mm Hg)

Answer 228

Fluid restrictions, diuretics (mannitol), hypocapnia (PaCO2 goal 26-30 mm Hg)

Question 229

Hypertension/tachycardia during intubation can be treated with ___ and/or ___

Answer 229

Lidocaine and/or fentanyl

Question 230

Avoid ___ in patients with increased ICP because it increases ICP

Answer 230

Ketamine

Question 231

Spinal cord injuries—injury to C___-C___ can cause apnea

Answer 231

C3-C5 (C3,C4,C5 phrenic nerve, keeps the diaphragm alive)

Question 232

Spinal cord injuries—T___-T___ = cardiac accelerators

Answer 232

T1-T4

Question 233

With a high spinal cord injury, you may see spinal shock—loss of ___ (sympathetic/parasympathetic) tone—___tension, ___ to the touch, ___cardia, ___reflexia, and ___ atony

Answer 233

Spinal shock = loss of sympathetic tone—hypotension, warm to the touch, bradycardia, areflexia, and GI atony

Question 234

Autonomic hyperreflexia usually doesn’t occur in the first ___ hours after spinal cord injury

Answer 234

48 hours

Question 235

Autonomic hyperreflexia is a reaction of the ___ (somatic/autonomic) nervous system in response to ___ (over/under) stimulation; this reaction may include ___tension (can be extreme), change in ___ rate, ___ color changes, and excessive ___

Answer 235

Autonomic hyperreflexia is a reaction of the autonomic nervous system in response to overstimulation; this reaction may include hypertension (can be extreme), change in heart rate, skin color changes (paleness, redness, blue-grey skin color), and excessive sweating

Question 236

What type of pneumothorax is this?—air in the parietal and visceral pleura; lung collapse causes V/Q mismatch and hypoxia

Answer 236

Simple pneumothorax

Question 237

Treatment of simple pneumothorax—chest tube ___ or ___ intercostal space

Answer 237

4th or 5th

Question 238

What type of pneumothorax is this?—air in pleural space is trapped and increases with inspiration but cannot escape with expiration; will see tracheal deviation

Answer 238

Tension pneumothorax

Question 239

Treatment of tension pneumothorax—14 gauge needle at ___ intercostal space, mid-___ line; then place chest tube

Answer 239

14 gauge needle at second intercostal space, mid-clavicular line

Question 240

Acute respiratory distress syndrome (ARDS)—___ (acute/delayed) lung response to trauma

Answer 240

Delayed

Question 241

ARDS mortality = ___%

Answer 241

50%

Question 242

When caring for the trauma patient, priority should be ___ and ___ efforts first and foremost…then you can turn on gas/give other drugs

Answer 242

Airway and resuscitative efforts

Question 243

Geriatric = patients over the age of ___

Answer 243

65

Question 244

Geriatric CV changes—___ (increase/decrease) in elasticity of arteries; ___ (increased/decreased) afterload; ___ (increased/decreased) systolic pressures; left ventricular ___trophy; adrenergic [sympathetic] activity ___ (increases/decreases); ___ (increased/decreased) heart rate both rest and max; ___ (increased/decreased) baroreceptor response

Answer 244

Decrease in elasticity of arteries; increased afterload; increased systolic pressures; left ventricular hypertrophy; adrenergic activity decreases; decreased heart rate both rest and max; decreased baroreceptor response

Question 245

Heart rate declines ___ beat per minute per year over the age of 50

Answer 245

1 beat per minute per year over the age of 50

Question 246

Conduction system fibrosis and loss of SA node cells ___ (increases/decreases) chances of arrhythmias

Answer 246

Increases

Question 247

Atrial enlargement in geriatric patients puts them at risk for ___ and most commonly, atrial ___

Answer 247

SVT and most commonly, atrial fibrillation

Question 248

Geriatrics—left ventricular wall ___ (thins/thickens) by decreasing the cavity; as a result, SV and CO ___ (increase/decrease)

Answer 248

Left ventricular wall thickens by decreasing the cavity; as a result, SV and CO decrease

Question 249

What type of hypertrophy is this?—ventricular dilation while maintaining normal sarcomere lengths—the heart can expand to receive a greater volume of blood; the wall thickness normally increases in proportion to the increase in chamber radius

Answer 249

Eccentric hypertrophy

Question 250

What type of hypertrophy is this?—in the case of chronic pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing arteries), the chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres

Answer 250

Concentric hypertrophy

Question 251

Geriatrics—decrease in CV system causes ___ (spikes/drops) in BP during induction; autonomic responses that maintain homeostasis progressively ___ (improve/decline)

Answer 251

Drops in BP during induction; progressively decline

Question 252

Geriatrics—circulation time will ___ (slow/speed up) IV drugs but ___ (slows/speeds) induction with inhalation agents

Answer 252

Slow IV drugs but speeds induction with inhalation agents

Question 253

Two CV responses that are altered d/t blunted beta-receptor response—decreased maximal ___ rate and decreased peak ___ fraction

Answer 253

Decreased maximal heart rate and decreased peak ejection fraction

Question 254

The elderly patient is more dependent on an increase in end-___ (systolic/diastolic) volume than an increase in ___ to produce an increase in CO; this makes the geriatric patient more prone to ___ heart failure when large volumes of IV fluids are administered in the presence of anesthetic-induced myocardial depression and hypotension

Answer 254

Increase in end-diastolic volume than an increase in heart rate to produce an increase in CO; this makes the geriatric patient more prone to congestive heart failure when large volumes of IV fluids are administered in the presence of anesthetic-induced myocardial depression and hypotension

Question 255

Geriatric respiratory changes—___ (increase/decrease) in elasticity of lungs; ___ (increase/decrease) in alveolar surface area; ___ (increased/decreased) residual volume; ventilation/perfusion ___ (match/mismatch); ___ (increased/decreased) chest wall rigidity; ___ (increased/decreased) cough; blunted response to ___capnia and ___ia; ___ (increased/decreased) max breathing capacity; ___ (increased/decreased) closing capacity and closing volume

Answer 255

Decrease in elasticity of lungs; decrease in alveolar surface area; increased residual volume; ventilation/perfusion mismatch; increased chest wall rigidity; decreased cough; blunted response to hypercapnia and hypoxia; decreased max breathing capacity; increased closing capacity and closing volume

Question 256

Geriatrics—will see an ___ (over/under) distention of alveoli; ___ of small airways

Answer 256

Over distention of alveoli; collapse of small airways

Question 257

Edentulous patients are difficult to ___

Answer 257

Mask ventilate—cheeks suck in so the mask does not fit as well

Question 258

Geriatric patients are at ___ (increased/decreased) risk of aspiration d/t ___ (increase/decrease) in airway reflexes

Answer 258

Increased risk of aspiration d/t decrease in airway reflexes

Question 259

Geriatrics respiratory—FRC ___ (increases/decreases) slightly; vital capacity significantly ___ (increases/decreases); residual volume ___ (increases/decreases) with age; total lung capacity ___ (increases/decreases) with age; elderly have signs of both ___ and ___ disease; dead space ___ (increases/decreases)

Answer 259

FRC increases slightly; vital capacity significantly decreases; residual volume increases with age; total lung capacity decreases with age; elderly have signs of both restrictive and obstructive disease; dead space increases

Question 260

Vital capacity in geriatric patients significantly ___ (increases/decreases) with age—___ ml per year starting at age 20

Answer 260

Significantly decreases with age—25 ml per year starting at age 20

Question 261

Vd/Vt ratio ___ (increases/decreases) with age

Answer 261

Increases with age

Dead space increases, tidal volume decreases

Vd/Vt will increase with age because dead space increases with age

Question 262

Geriatrics GI—gastric pH ___ (increases/decreases); gastric emptying ___ (speeds up/slows); some elderly patients have ___ (smaller/larger) stomach volumes than younger patients

Answer 262

Gastric pH increases; gastric emptying slows; some elderly patients have smaller stomach volumes than younger patients

Question 263

Geriatrics temperature—heat production ___ (increases/decreases); heat loss ___ (increases/decreases); ___ (increased/decreased) metabolic rate; ___ (sufficient/deficient) thermostat control

Answer 263

Heat production decreases; heat loss increases; decreased metabolic rate; deficient thermostat control

Question 264

Geriatric renal changes—___ (increased/decreased) renal blood flow; ___ (increased/decreased) GFR; ___ (increased/decreased) renal mass; impaired ___ (what electrolyte?) handling; ___ (increased/decreased) concentration/dilution; ___ (increased/decreased) drug excretion; ___ (increased/decreased) renin-aldosterone response; impaired ___ (what electrolyte?) excretion

Answer 264

Decreased renal blood flow; decreased GFR; decreased renal mass; impaired sodium handling; decreased concentration/dilution; decreased drug excretion; decreased renin-aldosterone response; impaired potassium excretion

Question 265

Renal cortex in geriatric patients is replaced with fat and fibrotic tissue—T/F?

Answer 265

True

Question 266

Serum creatinine is ___ r/t decrease in muscle mass and decreased production of creatinine

Answer 266

The same

Question 267

Geriatrics—BUN gradually ___ (increases/decreases) 0.2% mg/dL per year

Answer 267

Decreases

Question 268

Geriatrics are predisposed to ___ as well as fluid ___ r/t sodium, dilution, and concentration management changes

Answer 268

Dehydration as well as fluid overload r/t sodium, dilution, and concentration management changes

Question 269

Geriatrics—inability to reabsorb glucose ___ (increases/decreases)

Answer 269

Decreases

So more glucose is reabsorbed

Question 270

Geriatrics—decreased blood flow to the kidney increases the risk of acute renal ___

Answer 270

Failure

Question 271

The most specific test of renal failure is ___ (___ hours) to assess ___

Answer 271

Serum creatinine clearance (25 hours) to assess GFR

Question 272

Geriatrics nervous system—cerebral blood flow and brain mass ___ (increase/decrease); neurotransmitters and their receptors ___ (increase/decrease)

Answer 272

Decrease; decrease

Question 273

Physical activity has proven to preserve cognitive function—T/F?

Answer 273

True

Question 274

Geriatrics have ___ (increased/decreased) thresholds to touch, temperature, and pain; ___ (increased/decreased) thresholds to proprioception, hearing, and vision

Answer 274

Increased thresholds…so they are slower to respond to tactile, temperature, and painful stimulation

Increased thresholds to proprioception, hearing, and vision

Question 275

Geriatrics—dosages for local and general anesthetics are ___ (increased/decreased)

Answer 275

Decreased

Question 276

Geriatrics—epidural tends to have a more ___ (cephalad/caudal) spread

Answer 276

Cephalad

Question 277

Geriatric patients need more time to recover cognitively from general anesthetics—T/F?

Answer 277

True

Question 278

Pharmacokinetics-relationship between drug dose and ___ concentrations

Answer 278

Plasma

Question 279

Pharmacodynamic-relationship between plasma concentrations and ___ effect

Answer 279

Clinical

Question 280

Geriatrics—___ (increase/decrease) in muscle mass and ___ (increase/decrease) in body fat

Answer 280

Decrease in muscle mass and increase in body fat

Question 281

Geriatrics—___ (increased/decreased) total body water can lead to ___ (lower/higher) plasma concentrations of water-soluble drugs

Answer 281

Decreased total body water can lead to higher plasma concentrations of water-soluble drugs

Question 282

Geriatrics—___ (increased/decreased) volume of distribution; this can ___ (increase/decrease) plasma concentrations of fat-soluble drugs

Answer 282

Increased volume of distribution; this can decrease plasma concentrations of fat-soluble drugs

Question 283

Geriatrics—many drugs have ___ (shortened/prolonged) effects d/t renal and hepatic function ___ (improving/declining)

Answer 283

Many drugs have prolonged effects d/t renal and hepatic function declining

Question 284

Geriatrics—MAC for inhalation agents decreases by ___% per decade after age ___

Answer 284

Decreases by 4% per decade after age 40

Question 285

Onset of inhalation agents is more ___ (slow/rapid) if cardiac output is decreased

Answer 285

Rapid

Question 286

Geriatrics—lower doses of barbiturates, opioid agonists, and benzos can be given—T/F?

Answer 286

True

Question 287

Lower doses of muscle relaxants should be given to geriatric patients—T/F?

Answer 287

False—no change in muscle relaxant effects in geriatrics…just be cautious in renal patients d/t prolonged excretion

Question 288

Most plasma proteins are unchanged in geriatric patients; albumin levels are slightly ___ (increased/decreased); alpha-1 glycoprotein (AAG) ___ (increases/decreases)—this protein binds with local anesthetics and opioids

Answer 288

Albumin levels are slightly decreased; alpha-1 glycoprotein (AAG) increases—this protein binds with local anesthetics and opioids

Question 289

___ is aka Hutchinson-Gilford syndrome; premature aging

Answer 289

Progeria

Question 290

Anesthesia considerations for progeria—patients will have ___ heart disease, ___ tension, cerebrovascular disease, ___arthritis, and diabetes mellitus; mandibular ___plasia; ___gnathia; ___ (narrow/wide) glottic opening—have to use ETT 1-2 sizes ___ (smaller/larger)

Answer 290

Patients will have ischemic heart disease, hypertension, cerebrovascular disease, osteoarthritis, and diabetes mellitus; mandibular hypoplasia; micrognathia; narrow glottic opening—have to use ETT 1-2 sizes smaller

Question 291

Who is responsible for proper patient position on OR table?

Answer 291

Anesthesia

Question 292

Bone cement hardens by an ___ (endothermic/exothermic) reaction

Answer 292

Exothermic reaction

Question 293

Bone cement—residual MMA monomer produces vaso___, ___ (increase/decrease) in SVR

Answer 293

Vasodilation, decrease in SVR

Question 294

Bone cement—tissue thromboplastin release may cause platelet ___, micro___ (to the lungs), and CV ___ (stability/instability)

Answer 294

Platelet aggregation, microthrombus (to the lungs) and CV instability

Question 295

Bone cement implantation syndrome—___ia (from increased pulmonary shunt); ___tension; dysrhythmias—heart ___ and sinus ___; pulmonary ___tension—___ (increased/decreased) PVR; ___ (increased/decreased) cardiac output; embolization occurs most frequently during prosthetic ___

Answer 295

Hypoxia (from increased pulmonary shunt); hypertension; dysrhythmias—heart block and sinus arrest; pulmonary hypertension—increased PVR; decreased cardiac output; embolization occurs most frequently during prosthetic insertion

Question 296

Strategies to minimize effects of MMA—___ (increase/decrease) inspired O2 prior to use of MMA; maintain ___volemia; administer vaso___ as needed; surgical methods—___ distal femur, ___ (low/high) pressure lavage of femoral shaft

Answer 296

Increase inspired O2 prior to use of MMA; maintain ESU volemia; administer vasopressors as needed; surgical methods—venting distal femur, high pressure lavage of femoral shaft

Question 297

Pneumatic tourniquets are used on upper/lower extremities to create a bloodless field—T/F?

Answer 297

True

Question 298

Tourniquet problems—hemodynamic and metabolic ___; pain; arterial ___ and pulmonary ___; muscle and nerve ___; limb ___ (warming/cooling)

Answer 298

Hemodynamic and metabolic changes; pain; arterial thromboembolism and pulmonary embolism; muscle and nerve injury; limb cooling

Question 299

Hemodynamic changes with pneumatic tourniquets—exsanguination of a limb shifts blood volume into ___ (central/peripheral) circulation; prolonged cuff time 45-60 min is associated with ___tension, ___cardia, and ___ (sympathetic/parasympathetic) stimulation [sweating]; cuff deflation ___ (increases/decreases) CVP, MAP, and pain; HR ___ (increases/decreases), core temp ___ (increases/decreases)

Answer 299

Exsanguination of a limb shifts blood volume into central circulation; prolonged cuff time 45-60 min is associated with hypertension, tachycardia, and sympathetic stimulation [sweating]; cuff deflation decreases CVP, MAP, and pain; HR increases, core temp decreases

Question 300

Tourniquet pain—occurs when cuff pressure is ___ tor/mm Hg above systolic pressure; severe aching and burning after several minutes; involves ___ (myelinated/unmyelinated), ___ (slow/fast) conduction ___ (A/B/C) fibers; ___ (more/less) common in regional anesthesia vs. general

Answer 300

Occurs when cuff pressure is 100 torr/mm Hg above systolic pressure; severe aching and burning after several minutes; involves unmyelinated, slow conduction C fibers; less common in regional anesthesia vs. general

Question 301

Tourniquet pain requires supplemental analgesia—T/F?

Answer 301

True

Question 302

Metabolic changes caused by tourniquets—metabolic waste products accumulate in tissue; cuff deflation causes a rapid wash out of the metabolic waste products—PaCO2, ETCO2, serum lactate and potassium ___ (increase/decrease); PaO2 and pH ___ (increase/decrease)

Answer 302

PaCO2, ETCO2, serum lactate and potassium increase; PaO2 and pH decrease

Question 303

Metabolic changes caused by tourniquets—see ___ (increase/decrease) in minute volume in spontaneously breathing patients and possibly dysrhythmias

Answer 303

See increase in minute volume in spontaneously breathing patients

Question 304

Metabolic changes caused by tourniquets—___ injuries can occur from free radical formation

Answer 304

Reperfusion injuries

Question 305

Tourniquet ischemia, especially in a ___ (upper/lower) extremity, leads to deep venous ___

Answer 305

Especially in a lower extremity, leads to deep venous thrombosis

Question 306

Pulmonary emboli have been reported with leg exsanguination, tourniquet inflation and deflation—T/F?

Answer 306

True

Question 307

Tourniquets are contraindicated in ___ arteries

Answer 307

Calcified arteries

Question 308

Prolonged tourniquet inflation is > ___ hours; can cause transient muscular injury, permanent nerve injury, and rhabdomyolysis

Answer 308

> 2 hours

Question 309

It is important for the CRNA to monitor ___ time and inform the surgeon

Answer 309

Tourniquet time

Question 310

Some degree of fat embolism occurs in all long bone fractures—T/F?

Answer 310

True

Question 311

Fat embolism syndrome (FES) is ___ (more/less) frequent and ___ (more/less) fatal than fat embolism

Answer 311

Less frequent and more fatal (10-20% fatality) than fat embolism

Question 312

Fat embolism syndrome onset is within ___ hours of long bone or pelvic fracture

Answer 312

72 hours

Question 313

Symptoms of fat embolism syndrome—triad of ___nea, ___, and ___

Answer 313

Dyspnea, confusion, and petechiae

Question 314

FES is also seen with ___, ___suction, and IV ___

Answer 314

CPR, liposuction, and IV lipids

Question 315

Pathogenesis of FES—___ globules are released by disrupted fat cells in fractured bone and they enter the ___ through ___ in medullary vessels; ___ (increased/decreased) fatty acid levels are toxic to the capillary-alveolar membrane and release vasoactive ___ and ___

Answer 315

Fat globules are released by disrupted fat cells in fractured bone and they enter the circulation through tears in medullary vessels; increased fatty acid levels are toxic to the capillary-alveolar membrane and release vasoactive amines and prostaglandins

Question 316

FES can result in ___ syndrome, ___ capillary damage, ___

Answer 316

ARDS, cerebral capillary damage, edema

Question 317

FES diagnosis—petechiae of ___, ___ extremities, ___, and ___

Answer 317

Chest, upper extremities, axillae, and conjunctiva

Question 318

FES diagnosis—fat globules in ___, ___, ___

Answer 318

Fat globules in retina, urine, sputum

Question 319

FES diagnosis—coagulation abnormalities—___penia, ___ (shortened/prolonged) clotting time sometimes seen

Answer 319

Thrombocytopenia, prolonged clotting time sometimes seen

Question 320

FES—progressive ___ involvement—clinically, can go from mild ___ and a clear ___ to ___

Answer 320

Progressive pulmonary involvement—clinically, can go from mild hypoxia and a clear CXR to ARDS

Question 321

FES under GETA—will see a/an ___ (increase/decrease) in ETCO2 and SPO2 and ___ (increase/decrease) in PAP

Answer 321

Will see a decrease in ETCO2 and SPO2 and increase in PAP

Question 322

Treatment for FES is ___

Answer 322

Supportive

Question 323

DVT and PE are major sources of mortality and morbidity post ___ and ___ extremity surgery

Answer 323

Pelvic and lower extremity surgery

Question 324

Risk factors for DVT and PE—age > ___ years; ___ity; ___ use; procedures > ___ min; ___ extremity fracture; immobilization > ___ days

Answer 324

Age > 60 years; obesity; tourniquet use; procedures > 30 min; lower extremity fracture; immobilization > 4 days

Question 325

Highest risk procedures for DVT/PE = ___ and ___ replacements

Answer 325

Knee and hip replacements

Question 326

DVT and PE pathogenesis—___ stasis and ___coagulability from inflammation

Answer 326

Venous stasis and hypercoagulability from inflammation

Question 327

DVT and PE—prophylactic anti___ and pneumatic ___ compression significantly reduces incidence

Answer 327

Prophylactic anticoagulation and pneumatic leg compression significantly reduces incidence

Question 328

DVT and PE—highest incidence still in those over ___ years of age

Answer 328

70

Question 329

DVT and PE—the role of neuraxial anesthesia—note reduction in events via: sympathectomy-induced ___ (increases/decreases) in venous blood flow; anti-___ effects of local anesthesia; ___ (increased/decreased) platelet activity; ___ (increased/decreased) rise in factor VIII and von Willebrand factor; ___ (more/less) fall in antithrombin III; ___ (more/less) stress hormone release

Answer 329

Sympathectomy-induced increases in venous blood flow; anti-inflammatory effects of local anesthesia; decreased platelet activity; decreased rise in factor VIII and von Willebrand factor; less fall in antithrombin III; less stress hormone release

Question 330

Neuraxial anesthesia and prophylactic anticoagulation—risk of spinal or epidural ___ formation following neuraxial anesthesia with the use of mini dose heparin or LMWH

Answer 330

Hematoma

Question 331

Neuraxial anesthesia and prophylactic anticoagulation—placement/removal of epidural needle or catheter should not be performed within ___-___ hours of a SQ dose of heparin or within ___-___ hours of LMWH administration

Answer 331

6-8 hours of a SQ dose of heparin or within 12-24 hours of LMWH administration

Question 332

Neuraxial anesthesia and prophylactic anticoagulation—___ (epidural/spinal) anesthesia is associated with lower risk

Answer 332

Spinal anesthesia is associated with lower risk

Question 333

An epidural needle/catheter can be placed or removed in a fully anticoagulated patient—T/F?

Answer 333

False—cannot be placed or removed in a fully anticoagulated patient

Question 334

Neuraxial anesthesia and prophylactic anticoagulation—antiplatelet drugs ___ (increase/decrease) the risk of spinal hematoma

Answer 334

Increase the risk of spinal hematoma

Question 335

Neuraxial anesthesia and prophylactic anticoagulation—hallmarks of hematoma are ___ pain and ___ extremity weakness

Answer 335

Back pain and lower extremity weakness

Question 336

Joint manipulation under anesthesia (MUA)—scars and adhesions that limit ROM of a joint may require anesthesia for manipulation to occur; procedures = ___ or ___ manipulation; ___ of dislocation

Answer 336

Procedures = shoulder or knee manipulation; reduction of dislocation

Question 337

Anesthetic management of joint manipulation—IV agents with ___ (short/long) duration; ___ is preferred to ___—___ ventilation/___/___

Answer 337

IV agents with short duration (i.e.: propofol); general is preferred to regional—mask ventilation/LMA/GETA

Question 338

Anesthetic management of joint manipulation—profound ___ allows surgeon to distinguish anatomical limitations from patient ___

Answer 338

Profound relaxation allows surgeon to distinguish anatomical limitations from patient guarding (can use succinylcholine or rocuronium)

Question 339

Management of closed reduction—usually ___, but may become ___

Answer 339

Brief, but may become lengthy

Considerations: percutaneous pins; x-ray/fluoro; casting/splinting

Question 340

Selection of anesthesia for closed reduction—regional can be used for patients with multiple ___ problems, patients with ___ stomach; general may need ___ induction; if injury is remote, ___ ventilation or ___ may be okay for a general anesthetic

Answer 340

Regional can be used for patients with multiple medical problems, patients with full stomach; general may need rapid sequence induction; if injury is remote, mask ventilation or LMA may be okay for a general anesthetic

Question 341

Hip fractures usually involve what specific patient population?

Answer 341

Geriatrics

Question 342

Hip fracture mortality rates—___% during initial hospitalization and ___% in the first year

Answer 342

10% during initial hospitalization and 25% in the first year

Question 343

Immediate surgery is required for hip fractures—T/F?

Answer 343

False—immediate surgery is usually NOT required, but should be done within 48 hours of injury

Question 344

Reasons to delay hip repair—___pathy, uncompensated ___ failure

Answer 344

Coagulopathy, uncompensated heart failure

Question 345

Predictors of perioperative mortality for hip fracture repair—age > ___ years; history of ___; pre-op alteration in ___ status; post-op ___ infection; post-op ___ infection

Answer 345

Age > 85 years; history of cancer; pre-op alteration in neuro status; post-op chest infection; post-op wound infection

Question 346

Regional vs. general for hip fracture repair—advantages of regional—___baric (hypo/hyper) technique can be utilized to keep patient off fracture; ___ (increased/decreased) blood loss; ___ (increased/decreased) incidence of DVT/PE; ___ (slower/faster) return to baseline neuro status

Answer 346

Hypobaric technique can be utilized to keep patient off fracture; decreased blood loss; decreased incidence of DVT/PE; faster return to baseline neuro status

Question 347

Will lose the benefit of regional anesthesia for hip fracture repair if the patient is ___ or patient becomes ___

Answer 347

Oversedated or patient becomes hypoxic

Question 348

Hip surgery—regional vs. general—after ___ months, there is no difference in mortality for regional vs. general

Answer 348

2

Question 349

Blood loss from hip fracture is related to the ___ of the fracture

Answer 349

Location

Question 350

Hip capsule ___ (restricts/enhances) blood supply by acting as a ___

Answer 350

Restricts blood supply by acting as a tourniquet

Question 351

Level of blood loss from hip fracture in order of ___ (least/greatest) amount of blood loss to ___ (least/greatest): subtrochanteric; intertrochanteric; base of femoral neck; transcervical; subcapital

Answer 351

In order of greatest amount of blood loss to least

Subtrochanteric hip fracture = greatest amount of blood loss
Subcapital hip fracture = least amount of blood loss

Question 352

Hip fracture—general anesthesia—bigger fracture should consider ___ line and large bore IV for ___ and ___ monitoring

Answer 352

Arterial line and large bore IV for transfusion and hemodynamic monitoring

Question 353

GA for hip fracture—use ___ (short/long) acting drugs; use ___ (lower/higher) solubility agents; minimize postop ___ impairment—minimize use of ___ in older patients; maintain ___; maintain ___; maintain ___capnea

Answer 353

Use short acting drugs; use lower solubility agents; minimize postop cognitive impairment—minimize use of versed in older patients; maintain oxygenation; maintain hemoglobin; maintain normocapnea

Question 354

Arthroscopy is a procedure done to examine the interior of a ___ with an ___; goal is to obtain a definitive ___

Answer 354

Interior of a joint with an endoscope; goal is to obtain a definitive diagnosis

Question 355

Benefits of arthroscopy: less blood ___; less post-op ___; less ___ time

Answer 355

Less blood loss; less post-op pain; less rehabilitation time

Question 356

General, neuraxial (spinal/epidural), or regional are acceptable anesthetic options for arthroscopy—T/F?

Answer 356

True

Question 357

Airway management for knee/wrist arthroscopy—generally will use ___

Answer 357

LMA

Question 358

Airway management for shoulder arthroscopy—___ or ___

Answer 358

LMA or ETT

Question 359

Airway management for elbow arthroscopy—depends on patient ___

Answer 359

Position

Question 360

Pain control for arthroscopy—intraarticular injection of ___ and ___ provide adequate pain relief for early mobility; can also give ___ (if OK with surgeon) and/or IV ___

Answer 360

Bupivacaine and duramorph provide adequate pain relief for early mobility; can also give ketorolac (if OK with surgeon) and/or IV Tylenol

Question 361

Total hip arthroplasty/replacement (THA/THR)—arthroplasty = surgical replacement of all ___ components to achieve the return of natural ___ and ___ of the joint

Answer 361

Surgical replacement of all joint components to achieve the return of natural motion and function of the joint

Question 362

Goals of arthroplasty = ___ relief; deformity ___; stability of joint ___

Answer 362

Pain relief; deformity correction; stability of joint motion

Question 363

THA indications = ___arthritis; ___ arthritis; vascular ___

Answer 363

Osteoarthritis; rheumatoid arthritis; vascular necrosis

Question 364

THA intraoperative management—patient position = ___

Answer 364

Lateral decubitus

Question 365

THA—embolic event occurs most frequently during insertion of the ___ component

Answer 365

Insertion of the femoral component

Question 366

THA intraoperative management—+/- use of ___; prophylaxis of ___/___; blood loss—___-___ ml, up to ___ ml for revisions; ___ loss; perioperative ___; postoperative ___ control

Answer 366

+/- use of MMA; prophylaxis of DVT/PE; blood loss—400-1500 ml, up to 2000 ml for revisions; heat loss; perioperative infection; postoperative pain control

Question 367

Total knee arthroplasty (TKA)—___ position, ___ (shorter/longer) duration than hip

Answer 367

Supine position, shorter duration than hip

Question 368

TKA—___ (more/less) intraoperative blood loss than THA—___-___ ml—due to ___ (most blood loss occurs postop in first ___ hours)

Answer 368

Less intraoperative blood loss than THA—100-200 ml—due to tourniquet (most blood loss occurs postop in first 24 hours)

Question 369

TKA—___ (more/less) bone cement syndrome than THA, but release of emboli with tourniquet deflation may increase ___tension; check ___ after tourniquet goes down

Answer 369

Less bone cement syndrome than THA, but release of emboli with tourniquet deflation may increase hypotension; check BP after tourniquet goes down

Question 370

TKA has the highest rate of ___ out of all ortho procedures

Answer 370

DVT

Question 371

Partial knee replacements (unicondylar) are ___ (more/less) invasive but not always ___ in duration

Answer 371

Less invasive but not always shorter in duration

Question 372

TKA—early ___ and ___ relief are key!

Answer 372

Early mobilization and pain relief are key!

Question 373

Upper extremity surgery (shoulders)—performed ___ or ___

Answer 373

Opened or arthroscopically

Question 374

Shoulder surgery position is ___ or ___

Answer 374

Sitting (beach chair) or lateral decubitus

Question 375

Shoulder surgery—important to maintain ___, especially in beach chair position

Answer 375

Maintain MAP

Question 376

Shoulder surgery—consider ___ block of ___ plexus

Answer 376

Interscalene block of brachial plexus

Question 377

Anesthesia considerations for upper extremity arthroplasty—surgical ___; no tourniquet = potential for large ___ loss; potential for pneumo___; potential injury to ___ veins; potential inadvertent ___; potential for ___-spine injury; potential for ___ adverse event; ___ or ___ embolism; effects of ___

Answer 377

Surgical position; no tourniquet = potential for large blood loss; potential for pneumothorax; potential injury to subclavian veins; potential inadvertent extubation; potential for C-spine injury; potential for vaccine adverse event; fat or bone embolism; effects of MMA

Question 378

Anesthesia considerations for forearm/hand surgery—___ anesthesia (i.e.: ___ block, ___ block); ___ anesthesia is the best option for lengthy procedures (can use ___ or ___)

Answer 378

Regional anesthesia (i.e.: Bier block, axillary block); general anesthesia is the best option for lengthy procedures (can use LMA or ETT)

Question 379

Anesthesia considerations for foot and ankle surgery—excellent candidates for ___ anesthesia; another common choice = ___ anesthesia with ___ + ___ injection for postop pain control

Answer 379

Excellent candidates for regional anesthesia (nerve blocks with IV sedation); another common choice = general anesthesia with LMA + local injection for postop pain control

Question 380

Anesthesia considerations for amputations—___ trauma and ___ pain

Answer 380

Psychological trauma and phantom limb pain

Question 381

Anesthesia considerations for re-implantations—pay careful attention to ___; maintain body ___; regulation of ___; maintenance of ___ flow—optimal Hct ___-___%; keep patient ___; avoid vaso___; ___ or ___ infusion intraop

Answer 381

Pay careful attention to positioning; maintain body temperature; regulation of fluids; maintenance of blood flow—optimal Hct 28-80%; keep patient warm; avoid vasoconstrictors; dextran or heparin infusion intraop

Dextran/heparin infusion is used to improve microcirculation after reimplantation* Heparin is usually preferred because dextran has been associated with post-op renal failure

Question 382

Peripheral nerve blocks for ortho procedures—what should you do when you get a regression of block, i.e.: movement, tingling?

Answer 382

Medicate the patient for pain! Do NOT wait for onset of pain, otherwise you will be far behind

Question 383

Upper extremity blocks—inter___ block; ___clavicular block; ___clavicular block; ___ block

Answer 383

Interscalene block; supraclavicular block; infraclavicular block; axillary block

Question 384

Interscalene block targets brachial plexus ___

Answer 384

Trunks—upper arm and shoulder

Question 385

Interscalene block should be avoided in patient with compromised ___ status

Answer 385

Respiratory

Question 386

Risks with interscalene block—pneumo___ can occur hours later; ___, ___, or ___ injection; 100% ___ nerve block on ipsilateral (same) side; ___ syndrome; ___ness from RLN injection; decreased ___ sensation

Answer 386

Pneumothorax can occur hours later; epidural, spinal, or arterial injection; 100% phrenic nerve block on ipsilateral (same) side; Horner’s syndrome; hoarseness; decreased chest wall sensation

Question 387

Supraclavicular block targets brachial plexus ___

Answer 387

Divisions—upper and lower arm

Question 388

Supraclavicular block risks—pneumo___ and ___ palsy; 50% ___ nerve block

Answer 388

Pneumothorax and vocal cord palsy; 50% phrenic nerve block

Question 389

Infraclavicular block—targets brachial plexus ___

Answer 389

Cords

Question 390

Infraclavicular block is useful for surgery of the ___ and ___ hand

Answer 390

Elbow and distal hand

Question 391

Infraclavicular block risks—___ in 1% of patients

Answer 391

Pneumothorax

Question 392

Axillary block blocks the ___, ___, and ___ nerves

Answer 392

Medial, ulnar, and radial nerves

Question 393

Axillary block misses the ___ nerve and ___ nerve

Answer 393

Axillary nerve and musculocutaneous nerve

Question 394

Risks of axillary block = ___ and ___ injection

Answer 394

Hematoma and vascular injection

Question 395

Lower extremity blocks—___, ___, and ___

Answer 395

Femoral, sciatic, and popliteal/sciatic nerve block

Question 396

Femoral nerve block causes loss of ___ function, making these patients ___ risks

Answer 396

Loss of quad function, making these patients fall risks

Question 397

Femoral nerve block—patients should have indwelling catheters in place for < ___ hours to avoid infection

Answer 397

< 48 hours

Question 398

Patients who receive single shot femoral nerve block are not at risk for falls—T/F?

Answer 398

False—still at risk for falls

Question 399

This nerve block blocks the hip, thigh, knee, lower leg, and foot

Answer 399

Sciatic nerve block

Question 400

This nerve block is useful for foot and ankle surgery; it spares the hamstring and knee, allowing flexion, which makes ambulation easier

Answer 400

Popliteal/sciatic nerve block