Flashcards in c3. BASIC PRInciples B (76-150) Deck (75):
76. The area of the autonomic nervous system concerned with baroreceptors is the:
a. right atrium and right ventricle
b. carotid sinus and aortic arch
c. left atrium and left ventricle
d. left ventricle and abdoinal aorta
-b. carotid sinus and aortic arch
receptors for pressure measurement in the body are located in the aortic arch and carotid sinuses with appropriate feedback mechanisms to cause changes when necessary
77. After burns, the plasma to interstitial fluid shift occurs:
a. in 1 to 2 hours
b. during the first 24 hours
c. during the first 48 hours
d. during the first 72 hours
-c. during the first 48 hours
After 48 hours, capillary integrity returns to normal and colloid solutions will remain intravascular.
78. Among the list of calcium salts, which one ionizes the most?
a. calcium chloride
b. calcium gluconate
c. calcium oxalate
d. calcium hydroxide
- a. calcium chloride
It has long been believed that calcium chloride ionizes to a greater extent (3 x) than calcium gluconate; however recent studies refute this??
79. The facial nerve performs all of the following except:
a. supplies the muscles of facial expression
b. conveys secretotor fibers to the lacrimal and salivary glands
c. transmits taste fibers from the anterior two thirds of the tongue
d. transmits taste fibers from the posterior one third of the tongue
-d. transmits taste fibers from the posterior one third of the tongue
the lingual and laryngeal branches of the glossopharyngeal nerve provide sensation from the posterior one third of the tongue and oral pharynx
80. The initial dose of dantrolene for treating MH is:
a. 1.5 mg/kg
b. 2.5 mg/kg
c. 10 mg/kg
d. 20 mg/kg
-b. 2.5 mg/kg
The usual starting dose in the treatment of MH is 2.5 mg/kg, repeated as necessary up to 10 mg/kg.
81. Identify the vital sign most detrimental in the patient with coronary artery disease:
a. MAP decreases to 50 mmHg
b. MAP increases to 120 mmHg
c. heart rate increases
d. preload increases
-c. heart rate increases
Tachycardia results in the greatest increase in the work of the heart, therefore the greatest potential for mismatch between supply and demand. *Also it causes a decreased filling time further decreasing supply to coronary vessels (tachycardia shortens diastole)
82. coronary perfusion pressure is increased as a result of:
a. increased diastolic pressure
b. increased left ventricular diastolic pressure
c. systolic hypertension
-a. increased diastolic pressure
Because coronary perfusion occurs during diastole, increases in diastolic pressure result in an increase in coronary perfusion.
83. which bellows is safer when there is a disconnect?
c. both are equally safe
d. depends on the site of disconnect
ascending bellows that are found in most modern anesthesia equipment is safer because a disconnect is more easily observed when the bellows do not ascend on cycling (with spont. bellows ascend on exhalation)
84. What is the maximum amount of hetastarch that should be given to a patient?
a. 10 mg/kg
b. 20 mg/kg
c. 10 ml/kg
d. 20 ml/kg
-d. 20 ml/kg/day
Hetastarch has a long plasma life of 1.5 days and does not affect coagulation when used in recommended doses, which should be limited to no more than 20 ml/kg/day
85. Which statement is incorrect regarding the aged patient?
a. the elimination half-life of pancuronium is similar to that of a 30 year old
b. the induction dose for thiopental is decreased
c. the minimal alveolar concentration of halothane is decreased
d. the hand to brain circulation time is greater than 15 seconds
Elimination half life of virtually all drugs is prolonged with increasing age. This includes the muscle relaxants, which last longer in elderly patients.
86. the volume of distribution of drugs in the elderly is:
a. increased for water soluble drugs
b. decreased for lipid soluble drugs
c. increased for lipid soluble drugs
d. constant for both water and lipid soluble drugs
geriatric patients have a less well developed blood brain barrier in cell membranes. Therefore, drugs that are lipid soluble distribute more freeely resulting in a higher distribution volume
87. Diffusion hypoxia is a phenomenon associated with rapid movement of which anesthetic agent from the circulation into the lungs producing a significant dilution of oxygen:
d. nitrous oxide
-d. nitrous oxide
diffusion hypoxia occurs owing to the insolubility of nitrous oxide and the high concentrations administered
88. The nonionized form of a local anesthetic is:
a. water soluble
b. lipid soluble
c. unable to cross the placental barrier
d. electrically charged
-b. lipid soluble
nonionized forms of all drugs will be lipid soluble because no charge is present to repel the molecule from lipid membranes.
89. The rapidity and extent of diffusion of a local anesthetic to its site of action depends primarily on:
a. pka of the drug
b. concentration of drug injected
c. lipid solubility
d. all of the above
-d. all of the above
Local anesthetics must diffuse throught the lipid nerve membrane to reach their site of action. All of the listed factors will either increase lipid solubility or concentration in the nerve.
90. It is important to monitor the right radial pulse during mediastinoscopy to detect:
a. right carotid artery compression
b. inominate artery compression
c. right brachial artery compression
d. ascending aorta compression
-b. inominate artery
Monitoring the right radial pulse will signal compression by the scope on the inominate (brachiocephalic) artery and allow for repositioning to ensure adequate circulation. Blood pressure should be monitorid in the left arm because of this potential compression.
91. Autonomic hyperreflexia is rarely seen in cases of cord transection below:
Overactivity of the sympathetic nervous system is common with transection at T5 or above and is unusual with injuries below the T10 level.
92. Sympathetic preganglionic cardiac accelerator nerve outflow is from which ganglia?
Sympathetic innervation to the heart is mediated via sympathetic fibers arising from the cord at the level T1 through T5 (with T3, T4 & T5 having the greatest input).
93. The superior laryngeal nerve provides _____ innervation to the larynx.
c. sensory and motor
-c. sensory and motor
The suerior laryngeal branch of the vagus divides into an external (motor) nerve and internal (sensory) laryngeal nerve that provides sensory supply to the larynx between the eipglottis and the vocal cords.
94. Structurally, the larynx is composed of _____ (number) of cartilages.
The larynx is composed of 9 cartilages (3 single and 6 paired):
95. Indirect acting sympathomimetic drugs exert their effect by:
a. stimulating beta receptors
b. stimulating alpha receptors
c. causing catecholamine release
d. blocking catecholamine release
-c. causing catecholamine release
Many sympathomimetic drugs act by causing endogenous release of catecholamines, which results in an adrenergic effect.
96. Cardiac output in the parturient is greater at which point in pregnancy?
a. 10-12 weeks gestation
b. immediately postpartum
c. 20 weeks gestation
d. immediately after conception
-b. immediately postpartum
Cardiac output reaches a maximum immediately after delivery where it can be increased as much as 60% of normal. It returns to normal within 2 weeks of delivery.
97. The vasopressor of choice for the parturient after SAB administration is:
Ephedrine preserves uterine blood flow to a greater extent than either pure alpha-receptor vasopressors (phenylephrine) or epinephrine. (old school thought process; phenylephrine is used more and more).
98. An absolute contraindication to the adminiistration of heparin for cardiopulmonary bypass is:
a. carotid disease
b. recent CVI
c. increased antithrombin III activity
d. previous streptokinase therapy
-c. increased antithrombin III activity
Heparin antithrombin III and serine proteases combine to produce the anticoagulant effect. Elevated antithrombin III would affect coagulation and heparin should be avoided.
99. Elderly patients may become hypertensive and not exhibit any compensetory changes in heart rate because of:
a. diminished activity of carotid sinus reflex responses
b. reduced sympathetic afferent traffic to the medulla
c. decreased responsiveness of nervous system mediated compensatory mechanisms
d. increased parasympathetic efferent traffic to the sinus node.
-c. decreased responsiveness of nervous system mediated compensatory mechanisms
With age there is a decreased responsiveness to the usual compensatory mechanisms. This occurs in the central nervous systems cardiovascular control centers which send the inputs by means of the autonomic nervous system and alpha, beta and muscarenic receptors.
100. What are the cardiovascular effects of positive end-expiratory pressure (peep)?
a. decreased cardiac output
b. stabilized pulmonary blood flow
c. augment venous return
d. increased lymphatic flow
-a. decreased cardiac output
The decrease in cardiac output produced by PEEP is due to interference with venous return and a leftward displacement of the heart that restricts filling of the left ventricle.
101. Correct application of Sellick's maneuvre includes:
a. gentle pressure applied over the cricothyroid membrane
b. using the index finger to apply pressure over the thyroid
c. maintaining cricoid pressure during positive pressure ventilation
d. pinching the cricoid cartilage between the thumb and index finger
-c. maintaining cricoid pressure during positive pressure ventilation
Moderate positive pressure ventilation does not increase air entry into the stomach as long as the airway remains patent.
102. Which of the following drugs would be contraindicated in the patient with parkinson's disease?
-a. droperidol (inapsine)
Droperidol has an ANTI-DOPAMINE effect; therefore it is contraindicated in patients with parkinson's disease because extrapyrimidal side effects can occur.
103. What are the cardiovascular effects of cocaine?
b. reduced vascular resistance
c. cardiac dysrhythmias
d. decreased cardiac output
-c. cardiac dysrhythmias
because of the reuptake of catecholamines, cocaine may produce multiple cardiac dysrhythmias
104. The most important mechanism for the termination of action of norepinephrine is:
a. uptake into the preganglionic nerve terminals
b. reuptake into postganglionic nerve endings
c. metabolism by catechol-o-methyl transferase (comt)
d. competition of increasing acethycholine
-b. reuptake into postganglionic nerve endings
like other neurotransmitters, the main effect of norepinephrine is terminated by active reuptake and transport into the nerve terminal.
105. what are the effects of cocaine on the centran nervous system:
a. increased seizure threshold
b. central hypothermic activity
c. stimulation then depression
d. strong antiemetic effects
-c. stimulation then depression
with chronic therapy, catecholamine levels decrease and the initial stimulation is then followed by a central nervous system depression and fatigue. (??decreased seizure threshold and hyperthermic activity??)
106. Clonidine is a:
a. adrenergic neuron blocker
b. central alpha 2 receptor agonist
c. direct acting arteriolar vasodilator
d. direct acting vasodilator
-b. central alpha 2 receptor agonist
by stimulating central alpha 2 receptors, produces a vasodepressor and sedative effect
107. which physiological derangement will result in slower metabolism of ester local anesthetics
a. acute renal failure
b. atypical plasma cholinesterase
d. diabetes insipidis
-b. atypical plasma cholinesterase
ester local anesthetic metabolism is catalyzed by cholinesterase, therefore patients with atypical genotypes will have prolonged metabolism.
108. Duchene muscular dystrophy has been implicated with what drug in a life threatening side effects?
several recent reports of sudden cardiac arrest after administration of succinylcholine to patients with undiagnosed Duchenne muscular dystrophy has led to warning in children younger than 12 yrs old.
109. A normal (average) dibucaine number is:
Dibucaine inhibits normal cholinesterase. The dibucaine number reflects the amount of inhibition that in the average person equals approximately 80%.
110. Rebound hypertension after cessation of sodium nitroprusside drip results from:
b. renin release
c. central nervous system stimulation
d. catecholamine release
-b. renin release
After nitroprusside drip is discontinued, there is a rebound release of renin, which results in a period of rebound hypertension.
111. The oxygen pressure from piped in systems leading to anesthesia machines should be in the range of:
a. 40 psi
b. 50 psi
c. 60 psi
d. 70 psi
-b. 50 psi
Hospital piping systems provide gas to the machine at approximately 50 psi, which is the normal working pressure of most machines
112. Pressure sensor shut off valves will be activated when the pressure of oxygen falls below:
a. 15 psi
b. 25 psi
c. 35 psi
d. 40 psi
-b. 25 psi
The pressure sensor shut off valve decreases the supply of nitrous oxide if the oxygen supply pressure falls below approximately 25 psi
113. The statement that the amount of gas dissolving in a liquid is proportional to the partial pressure of the gas defines:
a. charles' law
b. boyle's law
c. graham's law
d. henry's law
-d. henry's law
Henry's law states that the concentration of any gas in solution is proportional to the partial pressure of that gas (at a constant temp).
Henry=dissolved amount is equal to partial pressure at constant temp
114. (MAP-CVP) X 80/CO measures:
a. pulmonary vascular resistance
b. MAP and CVP pre heart beat
d. systemic refraction of cardiac output
total SVR is calculated from hemodynamic variables derived with a pulmonary artery catheter. the normal systemic vascular resistance is 1200 to 1500 dynes/sec/cm-5
115. One of the greatest advantages to a non breathing system for children is:
a. loss of heat and humidity
b. low flow rates
c minimal resistance
d. maximal dead space
-c. minimal resistance
nonbreathng systems are used for children primarily because they offer little resistance to breathing and will not as easily cause fatigue in a child's respiration.
116. clamping of the abdominal aorta during aneurysm surgery is followed by:
a. loss of blood pressure in the right arm
b. immediate drop in systolic blood pressure
c. no change
d. immediate rise in systolic blood pressure
-d. immediate rise in systolic bp
clamping of the aorta causes an acute increase in left ventricular afterload which can result in ischemia, failure, and severe hypertension. Use of vasodilators can attenuate (solve) this problem
117. the principal catalyst for carbon dioxide absorption in soda lime and baralyme is:
a. magnesium hydroxide
b. postasium hydroxide
c. sodium hydroxide
d. calcium hydroxide
-c. sodium hydroxide
is a catalyst for carbon dioxide absorption in soda lime, although both substances contain more calcium hydroxide than sodium hydroxide
118. current F-29 standards mandate the use of ventilator bellows that:
a. descend on inspiration
b. ascend on inspiration
c. descend on expiration
d. ascend on expiration
-d. ascend on expiration
ventilators whose bellows ascend expiration have been deemed the safest regarding disconnects and are now in use on all anesthesia equipment
119. Which ventilator mode allows spontaneous respiratory effort while administering a pre set tidal volume at a specific interval.
a. assisted- controlled ventilation
b. synchronized intermittent mandatory ventilation
c. controlled ventilation
d. mandatory minute ventilation
-b. synchronized intermittent mandatory ventilation
SIMV allows the patient to initiate a breath but ensures that he or she receives an adequate tidal volume
120. Diaphoresis under general anesthesia may indicate:
b. deep anesthesia
high carbon dioxide levels result in tachycardia, restlessness and diaphoresis. Fortunately with improved monitorind, this has become less of a propblem
121. Which of the following nondeporalizing muscle relaxants has the most rapid onset.
in equivalent doses, rocuronium exhibits the fastest onset for intubating conditions among the nondepolarizing muscle relaxants
122. During a pneumonectomy, the main bronchus is clamped. What is the most important physiologic finding?
a. decreased tidal volume
b. increased CO2
c. decreased PAo2
d. increased peak inspiratory pressure
-d. increased pip
Airway resistance increases greatly when the bronchus in the diseased lung is clamped. Adjustments in respiration to ensure adequate oxygenation and CO2 removal are necessary.
123. Which of the following lab values would not be expected in a patient with chronic renal disease?
a. BUN of 52
b. creatnine of 1.2
c. ph: 7.41
d. hemogolbin: 9.2
-c. ph: 7.41
patients with chronic renal failure do not excrete non volatile acids; which results in high anion gap metabolic acidosis
124. an agent is removed faster from the central compartment if:
a. half life is short with small volume of distribution
b. half life is short with large volume of distribution
c. half life is long with small volume of distribution
d. half life is long with large volume of distribution
-a. short half life with small vD
a small volume of distribution means the drug is primarily the blood stream and, with a short half life, this would make it easily removed from the body
125. The concentration of which of the following differs greatest in the trachea from ambient air?
b. carbon dioxide
one of the main functions of the airway is to increase the humidity of gases as they are breathed; therefore the water vapor increases as gases are drawn into the lungs
126. In banked blood there is an excess of all of the following except:
b. hydrogen ions
c. 2,3- diphosphoglycerate
d. plasma potassium
ammonia increases in the blood in intact humans when there is liver damage and is released as urea when synthesized. In banked blood, ammonia levels stay constant and are not affected during transfusion...note...however 2,3-dpg levels in banked blood ARE LOW!!
127. If an awake patient is placed in the lateral position, there will be:
a. decreased perfusion to the down lung
b. decreased ventilation to the down lung
c. increased? ventilation to the top lung
d. increased perfusion to the top lung
-b. decreased ventilation to the down lung
Spontaneous ventilation may partially compensate for the compression on the dependent hemithorax; however, there is still a slight decrease in the ventilatory capacity in the down lung.
128. The following finding are symptomatic in pyloric stenosis except:
a. metabolic acidosis
-a. metabolic acidosis
Persistent vomiting in a patient with pyloric stenosis depletes sodium, potassium, chloride and hydrogen ions causing metabolic alkalosis
129. Which of the following represents the best criterion for extubation after effective reversal of nondepolarizing muscle relaxation.
a. return of reflexes
b. sustained tetanus
c. tidal volume of 5 ml/kg
d. head lift sustained for 5 seconds
-d. head lift sustained for 5 seconds
although all of the answers are important, sustaining headlift for 5 secnds appears to correlate with muscle strength to a greater degree than the other parameters.
130. The occupational safety and health administration defines acceptable limits of pollutants in the OR as:
a. halothane 25 parts per million (ppm)
b. halothane 50 ppm
c. nitrous oxide 2 ppm
d. nitrous oxide 25 ppm
-d. NO2 25 ppm
Recomendations for nitrous oxide are based on studies by Bruce and colleagues, who noted after exposure to 25 ppm of nitrous oxide that no impairment of psychomotor tests was present
131. Which of the following is of concern when anesthetizing an acromegalic patient?
b. laryngeal edema
c. probable hiatal and diaphragmatic hernia
d. altered airway structure and landmarks
-d. altered airway structure and landmarks
distortion of the facial anatomy and uper airway, including enlarged tongue and epiglottis and thickened vocal cords is common with this disorder.
132. The department of transportation mandates that gas cylinders be checked at what interval?
a. each refill
d. every 5 years
-d. every 5 years
to ensure the safety of medical cylinders, inspection must be completed every 5 years. This has become a standard in the US
133. Which level of humidity is recommended to prevent explosion hazard in the operative suite?
a. 50-60% relative humidity
b. 50-60% absolute humidity
c. greater than 60% absolute humidity
d. 100% relative humidity
-a. 50-60% relative humidity
static dischared, which are a source of ignition are much less likely if the relative humidity is at least 50%
134. after extubation after parathyroidectomy, your patient experiences mild stridor and significant hoarseness. You suspect:
a. hematoma formation
b. superior laryngeal nerve injury
c. laryngeal bruising
d. recurrent laryngeal nerve injury
-d. recurrent laryngeal nerve injury
a diagnosis of stridor hoarseness (unilateral=aphonia) is an indication of recurrent laryngeal nerve damage
135. current research suggests that the pathologic process underlying the clinical syndrome of malignant hyperthermia may be:
a. interference with sodium-potassium/ATPase pump
b. sympathetic nervous system hypersensitivity
c. impaired intracellular control of calcium
d. blockade of intracellular sodium/calcium pump
-c. impaired intracellular control of calcium
malignant hyperthermia results from an increase in myoplasmic calcium. The ryanodine receptor may be involved because control of calcium by this receptor is prominant in muscle cells.
136. Which of the following factors is most important when planning anesthesia for the patient undergoing portacaval shunt?
a. distended ascitic abdomen
b. decreased levelof consciousness
c. decreased cerebral blood flow
-a. distended ascitic abdomen
a grossly distended abdomen makes the patient at very high risk for aspiration and desaturation in the airway is difficult, as well as for hypotension from decreased venous return.
137. Drug interations with phenytoin and warfarin include:
a. enhanced biotransformation of warfarin and reduced bleeding time
b. increased sedation and prolonged anticoagulation activity
c. reduced biotransformation of warfarin and increased bleeding time
d. increased renal excretion of phenytoin with a reduced seizure threshold
-b. increased sedation and prolonged anticoagulation activity
Increased action of both phenytoin and warfarin would be expected because the interaction involves the high protein binding and displacement of the drugs, increasing free concentration.
138. Drug interactions with clonidine and propanolol would cause:
both clonidine and propanolol produce a vaso-depressor response, so when they are given together the possiblilty of hypotension is greatly increased.
139. Identify the mechanism most likely to explain the drug interactions seen with cimetidine and many classes of drugs.
a. alteration of gastric acidity and enhanced drug absorption
b. competitive inhibition in the distal tubule with altered excretion
c. great reduction in hepatic blood flow and drug clearance
d. inhibition of the microsomal cytochrome p450 system in the liver
-d. inhibition of microsomal cytochrome p450 system in the liver
cimetidine is famous for its ability to inhibit drug metabolizing enzymes in the liver, resulting in the decreased metabolism of other drugs relying on the liver for biotransformation.
140. what is the effect of verapamil on blood coagulation?
a. prolonged prothrombin time
b. shortened partial thromboplastin time
c. inhibition of factors II and VII
d. increased bleeding time
-d. increased bleeding time
High doses of calcium channel blockers have been reported to increase bleeding by reducing calcium coagulant ability
141. In shock, what unique feature of dopamine makes it a drug of choice?
a. renal tissue blood flow can be increased
b. myocardial contractility is usually decreased
c. myocardial oxygen consumption is decreased
d. peripheral vascular resistance is decreased
-a. renal tissue blood flow can be increased
dopamine stimulates dopamine receptors in renal arteries resulting in vasodilation, increased blood flow, and increased GFR
142. The treatment for extrapyramidal effects associated with droperidol is:
extrapyramidal side effects usually require no treatment; however, if they are extreme, anticholinergic therapy with diphenhydramine may help relieve these symptoms.
143. Treatment of cyanide toxicity includes all of the following except:
a. amyl nitrate
b. sodium nitrate
c. sodium thiosulfate
d. sodium thiocyanate
-d. sodium thiocyanate
sodium thiocyanate is the end product of metabolism of cyanide by thiosulfate. Thiocyanate is then excreted in the kidney as a nontoxic byproduct.
144. The cascade of events occuring with cyanide toxicity are due to:
a. the development of metabolic acidosis
b. a loss of buffering capacity
c. decreased ability of molecular oxygen
d. inablility of the tissues to utilize oxygen
-d. inability of the tissuess to utilize oxygen
cyanide poisoning represents histotoxic hypoxia, which is the inabilty of the cell to utilize oxygen.
145. Which of the following drugs has been shown to directly antagonize benzodiazepine induced sedation?
Aminophylline has been shown to decrease sedation from benzodiazepines possibly by means of an effect on adenosine receptors
146. The relative affinity of an anesthetic and how it partitions itself in the body is implied in which of the following?
a. concentration effect
b. second gas effect
c. blood solubility
d. pressure gradient
-c. blood solubility (bgsc)
blood gas solubility partition coefficient is a measure of how an anesthetic compartmentalizes itself in the body
147. Flexation of the intubated neonate's head:
a. may cause endobronchial intubation
b. may cause inadvertent extubation
c. may cause laryngospasm
d. may expose the glottic opening
-a. may cause endobronchial intubation
flexion of a child's head may advence the tube more deeply into the chest, resulting in endobronchial intubation
148. Which of the following class of drugs lowers intraocular pressure?
a. alpha agonist
b. alpha blockers
c. beta agonist
d. beta blockers
-d. beta blockers
Beta-receptor blocking drugs are comonly given to people with glaucoma. These agents appear to decrease synthesis of aqueous humor, thus reducing pressure in the eye.
149. Which of the following is not a pathophysiologic change in toxemia of pregnancy?
a. decrease GFR
hypertension is the hallmark characteristic of theis pregnancy induced syndrome also known as preeclampsia