Exam Corrections Flashcards by Alyssa Rivera

Patients with what pathology often have stridor and respiratory distress.

Acute bilateral recurrent laryngeal nerve

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When compared with endotracheal tubes with high pressure (low volume) cuffs; low pressure (high volume) cuffs:

Have a decreased risk of ischemic tracheal mucosa damage

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Which of the following is a cause of decreased preload in a patient receiving anesthesia?

reverse Trendelenburg position

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A 65 y/o patient with moderate aortic stenosis develops a sudden increase in HR during an Appy under GA. The ventricular rate is 140 bpm and irregulary regular. Arterial BP is 70/45, and there is a 2mm St-segment depression in lead V5 of the ECG. Which of the following would be the most appropriate treatment for myocardial ischemia in this patient?

Electrical cardioversion

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Microatelectasis 48 hours after abdominal surgery is most consistently manifested by?

decreased PaO2

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A 70-kg, 77-year-old man Is undergoing left nephrectomy with nitrous oxide, oxygen, fentanyl, and midazolam anesthesia. He has a 90 pack-year history of cigarette smoking and has chronic obstructive pulmonary disease. One hour after incision, expiratory wheezing occurs and peak Inspiratory pressure increases from 35 to 65 cmH20; end-tidal PCO2 is unchanged, but SpO2 decreases from 97% to 80%. The most likely cause is?

pneumothorax

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A 30-year-old man who is undergoing laparotomy and resection of a large kidney tumor has a decrease in SpO2 from 100% to 92% and an increase in peak airway pressure from 20 to 35 cm H2O. Plateau pressure is unchanged at 18 cm H2O. Which of the following is the most likely cause?

Obstruction of the endotracheal tube

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A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of Isoflurane 1% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is?

atelectisis

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A patient is undergoing thoracotomy in the lateral position. Five minutes after initiation of one-lung ventilation using a double-lumen tube and 100% oxygen, SpO2 decreases from 100% to 45%. Which of the following is the most appropriate initial step in management?

Resuming two-lung ventilation

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A 65-kg 70-year-old man in the PACU is breathing spontaneously at 20/min through an endotracheal tube connected to a T-piece with a fresh gas flow of 5 L/min. He has a tidal volume of 350 mL and an FiO2 of 0.5. SpO2 decreases from 98% to 84% over one hour, then improves to 92% with an FiO2 of 1.0. Which of the following is the most likely cause of the hypoxemia?

Decreased functional residual capacity

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A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood gas analysis shows PaO2 80 mmHg, PaCO2 84 mmHg, and pH 7.16. Which of the following statements concerning this patient is true?

Hypercarbia is contributing to the decreased level of consciousness

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If minute ventilation remains constant, which of the following changes in PetCO2 and PaCO2 will result from a decrease in cardiac output?

PetCO2 Decreased

PaCO2 Increased

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A 120-kg 56-year-old man undergoing gastrectomy during anesthesia with fentanyl and isoflurane has a PetCO2 of 35 mmHg and a PaCO2 of 50 mmHg. His FEV,/FVC ratio is 80% of predicted. Heart rate is 120 bpm and arterial blood pressure is 80/40 mmHg. Which of the following is the most likely cause of the difference in PaCO2 and PetCO2?

Decreased cardiac output

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During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?

PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter

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A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has slowly decreased to 89%. Arterial blood gases with an FiO2 of 1.0 are: PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?

Endobronchial intubation

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A 90-kg, 59-year-old man with chronic obstructive pulmonary disease is undergoing laparotomy. Mechanical ventilation is being carried out with a fresh gas flow of 2 L/min at a rate of 16/min and tidal volume of 900 ml; I:E ratio is 1:2.5. PaCO2 remains greater than 50 mmHg. Preoperative PaCO2, was normal. Which of the following is the most appropriate next step?

Increasing exhalation time

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A 35-kg child requires mechanical ventilation with pure oxygen at a tidal volume of 350 ml and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is:

inadequate expiratory time

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You are called to a witnessed cardiac arrest where cardiopulmonary resuscitation is being performed. After successful intubation, arterial blood gas values are PaO2 70 mmHg, PaCO2 63 mmHg, and pH 7.15 at an FiO2 of 1.0. The most appropriate management at this time is to?

hyperventilate the patient

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A 55-year-old man is undergoing craniotomy in the sitting position. Mean arterial pressure is 75 mmHg; arterial blood gas values are PaCO2 41 mmHg and pH 7.37. End-tidal CO2 is 7 mmHg. Which of the following is the most likely cause of the increased PaCO2 to PetCO2 gradient?

Partial disconnect of the capnograph sample tubing

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A patients presents with blood gases: pH = 7.32, PaCO2 = 31, HCO3 = 17. What is this patient’s diagnosis?

Compensated metabolic acidosis

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For intraoperative management of a patient with acute respiratory distress syndrome, which of the following actions may be conterproductive?

Increase tidal volumes delivered

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Results of a pulmonary function test reveal a decrease in the FEV1/FVC ratio and lung volume measurements indicating increased residual volume, increased FRC, and increased total lung capacity. Based solely on this PFT, which of the following conditions may be a probable diagnosis?

Chronic obstructive pulmonary disease

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During a your preoperative evaluation for a total knee arthroplasty for a 75 kg 65 year old retired coal miner he tells you that years of exposure coal dust may have caused some damage to his lungs. His primary care physician is aware of this and has recently ordered a pulmonary function test. The results are as follows:
FVC – 58% of predicted value
FEV1 – 51% of predicted value
FEV1/FVC – 88%
PFT results were not markedly different following the administration of nebulized albuterol. What is the proper assessment of these results?

pulmonary fibrosis

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Smoking should be discontinued for at least how long before an operation to decrease secretions and to reduce pulmonary complications

8 weeks

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Asthmatic bronchoconstriction can be triggered by histamine releasing drugs. Which of the following drugs is NOT associated with histamine release?

Ketamine

The optimal heart rate for a patient with mitral regurgitation should be:

81-100

On xray, the cardiac silohouette should be no greater than ____% of the internal width of the chest

Mitral regurgitation is considered “severe” when the regurgitated fraction is greater than?

55%

Mitral stenosis is generally classified as “severe” once the cross sectional area of the valve falls below which of the following?

1.0 cm2

Which of the following represents the most likely explanation for the “plateau phase” that occurs during phase 2 of the cardiac action potential

Opening of slow Ca2+ channels

A patient who is hypovolemic will exhibit which changes in central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP)?

Decreased CVP, Decreased PAWP

What is the primary determinant of systemic vascular resistant?

arteriolar tone

In a patient with a known superior vena cava syndrome (obstruction of blood flow through the superior vena cava)

IV lines should not be used in the upper extremity

A patient who is hypovolemic will exhibit which changes in central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP)?

Decreased CVP, Decreased PAWP

For a patient with aortic insufficiency undergoing a CABG procedure, the pulmonary capillary wedge pressure (PCWP) will most likely ________________ the left ventricular end-diastolic pressure LVEDP).

underestimate

Which of the following best describes the anesthetic goals for patients with aortic regurgitation?

Maintain an elevated heart rate but prevent increases in SVR

Which anesthetic agent would be the best choice for induction of a patient with cardiac tamponade?

Ketamine

In which one of the following valvular defects will you see an abnormally large V wave on PCWP tracing?

Mitral regurge

While monitoring the patient intraoperativly you notice what looks like PAC’s (Premature Atrial Contractions) on the EKG. You look to the pulse Oximeter to confirm your suspicion. What should you see?

Variable distance between peaks

In a patient with cardiac tamponade, which of the following represents the expected cardiac output and central venous pressure?

decreased cardiac output, increased central venous pressure

Lead II is good for monitoring for _________ wall ischemia and V5 is good for monitoring for ________ wall ischemia of the heart during surgery.

inferior, lateral

Aortic stenosis is generally considered critical once the valve area falls below _____

0.7 cm2

During a routine mediastinoscopy, the surgical team notifies you that they have uncontrollable bleeding from the SVC. You currently have two 16 ga antecubital IVs in the arms and the patient is typed and crossed for 2 units of RBCs. Your first action should be

Place additional IV’s in the feet

Anesthetic management of a patient with IHSS include which of the following?

Increase preload

A 46 year old male is scheduled for laparoscopic Nissen repair of a hiatal hernia. The patient has a history of idiopathic hypertrophic subaortic stenosis, DM I, and prostate CA. After induction with 12mg etomidate, the BP drops from 115/72 to 86/42. What is the most appropriate choice to treat the hypotension?

Phenylephrine

In a 12 lead ECG, lateral wall ischemia is detected with all of the following leads EXCEPT

aVF

Which of the following ECG leads is most useful in detecting inferior wall myocardial ischemia?

Soon after initiating general anesthesia, a patient develops 1.5mm ST segment elevation in lead II and the patient develops complete heart block. Which coronary artery is most likely affected?

Right coronary

In the preceeding patient, what would be the most appropriate treatment for PVCs?

1 mg/kg of lidocaine

Electrical cardioversion

You are taking care of patient with known aortic stenosis with valve area of 0.7 cm2 about to undergo a total knee replacement. Which of the following would be most appropriate in the management of this patient?

maintenance of normal sinus rhythm

Coronary perfusion pressure is increased as a result of

Increased diastolic blood pressure

Calculate cardiac output from the following data: Pt weight = 70kg; Hb = 10mg/dL ABG’s: PaO2 on 100% FiO2 = 450mmHg; PaCO2 = 32mmHg; pH = 7.46; SaO2 = 99% Mixed venous blood gases: PvO2 = 30mmHg; PvCO2 = 45mmHg; pH = 7.32; SvO2 = 60%

4.5L/min

Kussmaul’s sign is

Increased CVP with inspiration resulting in distention of jugular veins

A drug that increases the HR is a

Chronotrope

Which of the following is NOT a contraindication to performing a TEE?

Cracked tooth

Coronary blood flow is usually predominantly controlled by:

O2 demand

PVR =

80 x [(PAP-PCWP)/(CO)]

Coronary Perfusion Pressure is equal to _________?

Arterial Diastolic Pressure – LVEDP

Mitral stenosis is a delayed complication of:

rheumatic fever

Cardiac Output is reduced by how much in patients who exhibit atrial fibrillation?

20%

During thorasic aneurysm resection, which of the following represents the common recommended mean arterial blood pressure above the clamp?

100 mmHg

Which of the following is NOT an application of intraoperative transesophageal echocardiography?

Coronary blood flow

Which of the following does NOT determine stroke volume?

heart rate

Which of the following best describes the anesthetic goals for patients with aortic stenosis?

HR- Slow SVR- Maintain

Sympathetic innervation to the heart originates from which spinal cord levels?

T1-5

Normal Cardiac Index range is _______ L/min/m^2?

2.5-4

The average coronary blood flow of an adult at rest is ____ mL/min?

250

Coronary Sinus oxygen saturation is approximately?

30%

The most accurate clinical measurement of ventricular systolic function is:

ejection fraction

The formula for calculating SVR is:

80 x (MAP-CVP)/CO

Which of the following laws explains the relationship between cardiac output and left ventricular end-diastolic volume?

Starling’s law

What is the primary determinant of systemic vascular resistant?

arteriolar tone

Ventricular preload is

End diastolic volume

A drug that increases the conduction speed in the heart is a(n)

Dromotrope

Which of the following is most important for minimizing changes in blood pressure caused by acute events, such as a change in posture?

carotid baroreceptors

Which of the following is the most likely consequence of CO2 insufflation during laparoscopy?

decreased preload

An electrical impulse passes through the AV node and into the ventricles during which ECG phase?

PR interval

Which of the following is NOT considered to be a wall motion abnormality?

Hyperkinesis

The dicrotic notch on an arterial pressure waveform corresponds with:

Closure of the aortic valve

The precordial leads in a 12 lead ECG

Examine the horizontal plane of the heart

In the ECG, the Q-T interval is prolonged by:

Decreased K+

Coronary perfusion pressure is determined by the difference between what?

diastolic blood pressure minus central venous pressure

Tracheal cuff pressure is affected by which one of the following?

A. Inflation volume of the cuff b. The cuff diameter in relation to the trachea c. Use of nitrous oxide * d. All of the above

Laryngospasms are cause by stimulation of ?

Sensory branch of Vagus nerve

Bronchospasm will typically cause an increase in all the following EXCEPT:

EtCO2

Which of these structure ARE NOT part of the larynx?

Maxillary

The blood supply of the larynx is derived from branches of what artery

Thyroid

Which of the following muscles is NOT NORMALLY involved in forced inspiration?

Rectus abdominis

Which of the following findings would be unexpected for a patient with COPD?

Pulmonary Edema

For a normal patient in an upright position, which zone of the lung does not exist?

Zone 1

During one lung ventilation, a patients SpO2 start to drop. What is the last step to raise SpO2?

Extubate the patient and reintubate with single lumen tube

Resorption atelectasis can be a result from everything except?

Air in lungs

The CaO2 equations is:

(Hgb x 1.34) SaO2 + 0.003 (PaO2)

Work of breathing is most efficient with slow & deep breaths in patients with:

COPD

These nerve roots are known as the phrenic nerves and innervate the diaphragm

C3-C5

An increase in blood hydrogen ion concentration reducing O2 binding to hemoglobin is known as

The Bohr effect

Which is the proper equation to determine O2 consumption?

VO2= 10 (wt in kg)3/4

Which of the following is correct?

FRC= ERV+ RV

Induction of anesthesia reduces FRC by an average?

15%

Which of the following is not usually a symptom of pulmonary embolism?

Hypertension

Which of the following is the cause of lower lung syndrome?

Excessive fluid administration

The most powerful stimulus for pulmonary vasoconstriction is:

Hypoxia

What percentage of metabolic oxygen consumption equals carbon dioxide production?

80%

Which of the following changes is most likely to occur in the patient whose pulmonary pathology is schematically illustrated?

Decreased PaO2

Principal pulmonary muscle which normally accounts for 75% of the change in chest volume?

Diaphragm

Anticholinergic drugs, such as atropine, block the release of acetylcholine to the?

Muscarinic receptors of the parasympathetic system

Carbon dioxide retention first occurs when the ratio of forced expiratory volume in 1 second to vital capacity (FEV1/VC) decreases below

35%

Static lung compliance is decreased by each of the following EXCEPT

pulmonary emphysema

After the bronchial and tracheal cuffs of a right endobronchial tube are inflated, ventilation through the tracheal lumen is not possible. This finding is most consistent with

positioning of both cuffs in the trachea

Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia?

It occurs within the first 10 minutes of anesthesia

Which of the following results in decreased mixed venous oxygen saturation?

Cardiogenic shock

Which of the following is the most likely cause of the increased incidence of right ventricular failure in patients with morbid obesity?

Chronic hypoxia

Which of the following is the greatest disadvantage of pressure-cycled ventilation?

Variable tidal volumes

Which of the following statements concerning functional residual capacity is true?

It decreases in pregnancy

Which of the following statements concerning pressure support ventilation is true?

It augments gas inflow in response to spontaneous inspiration

Which of the following statements regarding carbon monoxide poisoning is true?

Breathing 100% oxygen at 1 atmosphere reduces the carboxyhemoglobin half-life

Peak airway pressure increases from 25 to 45 cmH2O when beginning right endobronchial ventilation with a right double-lumen tube. The most likely explanation for this increase is

failure to decrease tidal volume

The average coronary blood flow of an adult at rest is (mL/min)?

250

Which of the following is NOT considered to be a wall motion abnormality?

Hyperkinesis

Exam Corrections Flashcards

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