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Principles 2 > Final exam review > Flashcards

Final exam review Flashcards

1
Q

true or false: Elderly patients display a lower dose requirement for barbiturates, opioid agonistis, and benzodiazepines.

A

True

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2
Q

what condition is NOT usually associated with increased perioperative complications and death in the elderly is

A

asthma

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3
Q

Comparing pulmonary function in the elderly to that of a 20 year old, which statement is correct?

A

Total lung capacity unchanged or slight decrease of 10%.

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4
Q

Pharmacokinetic qualities of the elderly include:

A

decreased hepatic function

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5
Q

The work of breathing in the elderly patient is associated with

A

30% more effort at age 60

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6
Q

Physiologically, which statement is FALSE concerning the aged patient?

A

The baroreceptor reflex is unchanged with age

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7
Q

Respiratory changes associated with aging include all of the following EXCEPT

A

decreased closing capacity

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8
Q

Which statement is correct with regard to cardiac output in the elderly

A

decreases 1% per year beyond age 30

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9
Q

True or False: Diminished cardiac reserve in many elderly patients may be manifested as exaggerated drops in blood pressure during induction of general anesthesia

A

true

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10
Q

true or false: Many elderly patients experience varying degrees of an acute confusional state, delirium, or cognitive dysfunction postoperatively.

A

true

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11
Q

The brain achieves its maximal weight at age

A

30

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12
Q

Comparing pulmonary function in the aged to that in a 20 yo, the correct statement is

A

total lung capacity is reduced by 10%

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13
Q

Which statement is NOT correct regarding the aged patient

A

The elimination half-life of pancuronium is similar to that of a 30 year old.

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14
Q

The elimination half-life of midazolam in the geriatric patient is

A

twice that of the young adult male

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15
Q

<p>

| The narcotic analgesic of choice for intraoperative use in the geriatric patient is:</p>

A

<p>

| fentanyl</p>

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16
Q

<p>
True or False: In the absence of disease, resting systolic cardiac function appears to be preserved even in octogenarians.</p>

A

<p>

| true</p>

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17
Q

Initial requirements for nondepolarizing muscle relaxants in the geriatric patient are

A

the same as the younger adult

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18
Q

Which formula below is used to calculate the Ideal Body Weight of a female

A

height (cm) - 105

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19
Q

Obesity is defined as BMI greater than or equal to

A

30 kg/m2

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20
Q

What is the incidence of obesity among adults in the U. S.

A

30%

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21
Q

When assessing your obese patient prior to surgery, all of the following are extremely important EXCEPT:

A

Family history of cancer

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22
Q

True or false: The safest position to induce ansethesia in the obese patient is supine (completely flat).

A

False

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23
Q

Pickwician Syndrome is associated with all of the following EXCEPT

A

decreased O2 consumption

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24
Q

true or false: Laryngeal mask airways are absolutely contraindicated in obese patients.

A

false

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25
Q

Esmolol was initially thought to hold promise for attenuating the hypertension and tachycardia of laryngoscopy in preeclampsia patients

A

???

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26
Q

Cardiac Output increases ________% by the third trimester of pregnancy, due mainly to an increase in stroke volume and to a lesser extent an increase in resting heart rate.

A

40

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27
Q

Which of the following statements are true regarding the anesthesia management of the OB patient?

A

General anesthetic considerations require a basic understanding of the physiologic changes in the parturient.

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28
Q

With regard to the systemic decline in blood pressure related to aortocaval compression, supine hypotension syndrome results in?

A

A significant decline of venous return to the heart for which the cardiovascular system cannot compensate.

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29
Q

Which statement is true regarding natural physiologic compensation as it relates to aortocaval compression?

A

Compensation occurs as venous return is routed to the SVC via the paravertebral venous plexuses and azygos vein.

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30
Q

Which statement is true regarding uncompensated or untreated hypotension in the parturient at term?

A

Usually decreases in systolic BP of <100mmHg is considered problematic and requires intervention.

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31
Q

One of the most effective means for treatment of supine hypotension syndrome is placing the patient in the lateral decubitis position; right uterine displacement via left hip elevation.

A

False

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32
Q

When considering a laboring epidural for the parturient, these patients can develop profound decreases in systolic BP as a result of the sympathectomy related to regional anesthesia.

A

true

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33
Q

Parturients experience all of the following pulmonary physiological changes except?

A

Respiratory rate increases by 30%

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34
Q

When considering the physiological changes in the pulmonary system as it relates to inhalation anesthetics, which statement is true?

A

Increases in minute ventilation and decreases in FRC result in higher concentrations of inhaled anesthetics

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35
Q

Which of the following key points regarding physiologic changes in the parturient are true?

A

The greatest demand on the heart is immediately after delivery, when cardiac output increases 180%.

B.
Minute ventilation increases 45%, and this change is mostly due to the large increase in tidal volume.

C.
Plasma volume is increased to a greated extent than red blood cell volume, resulting in a dilutional anemia

D.
Blood volume is markedly increased and prepares the parturient for the blood loss associated with delivery.

E.
Cardiac Output increases are mostly due to the increase in stroke volume but are also due to an increase in heart rate.

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36
Q

Overall considerations with the anesthetic management of patients as it relates to pulmonary changes include all except:

A

Use of nasal airways is a standard of practice

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37
Q

Which of the following factors contribute to a decrease in dose requirement of local anesthetics by 30% to 50%?

A

All of the above are correct as they all contribute to decreased local anesthetic dose requirements.

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38
Q

Labor pain associated with the first stage of labor

A

Is visceral in origin caused by uterine contractions and dilation of the cervix (T10 - L1)

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39
Q

Which of the following is an expected EBL for a c-section

A

750- 1000 mL

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40
Q

true or false: Late decelerations are normal during labor and usually not associated with fetal distress.

A

false

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41
Q

true or false: Early decelerations are abnormal during labor and are indicative of fetal distress.

A

false

42
Q

Normal Fetal heart rate ranges are between:

A

120- 160 beats/min

43
Q

What percent of babies are born in cephalic presentation in either occiput transverse or occiput anterior position?

A

90%

44
Q

You are called to the preop area to evaluate a patient for an elective c-section. Your assessment results include: 30YOF, Healthy, no PMHx, no PSHx, Prenatal Vit. throughout pregnancy, 62 inches in height, 141 lbs., G1P0000, Good physical condition, Airway: MPI, TM>3fb, MO >3fb, FROM. No GERD during pregnancy. VSS, no fetal distress. C-section planned due to patient’s small pelvic girth and estimated large fetus weight/size. Which anesthetic course would you consider most appropriate considering all patient factors are normal for this patient?

A

Preop meds: zantac 50 mg, reglan 10mg, nonparticulate antacid; SAB using bupivicaine; convert to general anesthesia if SAB unsuccessful, as described in B.

45
Q

What percent of OB patients annually require a nonobstetric surgical procedure?

A

2%

46
Q

From the list below, which are the most commonly performed surgical procedures on OB patients?

a. Neurosurgical procedures
b. Trauma related procedures
c. Appendectomy
d. Cholecystectomy
e. Ovarian cysectomy

A

b, c, d, e

47
Q

true or false: It is safe for the OB patient to undergo extracorporeal shock-wave lithotripsy.

A

false

48
Q

The OB Patient undergoing appendectomy has an 18% incidence of postoperative pulmonary edema or ARDS; risk factors include all of the following except:

A

Preoperative temperature > 99.0°F

49
Q

Which statement is true regarding cervical cerclage

A

Cervical cerclage is a procedure for an incompetent cervix resulting in the weakness of the cervical os related to trauma, congenital abnormalities or multiple pregnancies.

50
Q

Thalidomide babies were born with limb abnormalities. All of the following statements are true except?

A

Thought to be a safe treatment for severe nausea in 1960, Thalidomide was initially over-the-counter to pregnant mothers in the US.

51
Q

Teratogenicity as it relates to specific drug exposure can be dependent on a number of factors which include all except:

A

Distinguishing drug exposure versus naturally occurring incidence of congenital anomalies has no bearing on teratogenicity.

52
Q

Which drug listed below is not a known teratogen

A

lasix

53
Q

The anesthetic management objectives of the OB patient can be summarized into four main components which should be maintained during the course of surgery:

A

Maternal oxygenation, CO, oxygen delivery, uterine blood flow

54
Q

Virtually all anesthetic agents given to the mother are rapidly shared with the unborn child. The exception to this statements is:

A

Paralytic agents which are quaternary ammonium salts have difficulty crossing the placenta.

55
Q

All of the following statements are true except?

A

Postpone elective surgery until after delivery, immediately following delivery all the risks are resolved.

56
Q

true or false: Loss of beat-to-beat variability is normal after anesthesia.

A

true

57
Q

Decelerations related to anesthesia may indicate a need for:

A

look it up

58
Q

Choose the incorrect statement with regard to positioning the OB patient for nonobstetric surgery?

A

Right uterine displacement, left hip elevation is the best position to avoid aortocaval compression.

59
Q

Risk Factors for Aspiration in Pregnancy include all except:

A

Increased gastric emptying in labor

60
Q

During induction and maintenance of the OB patient during nonobstetric surgery, all of the statements below are important except:

A

Avoid all opioid use.

61
Q

Which of the following agents is contraindicated for epidural analgesia in the obstetric patient?

A

0.75% bupivacaine

62
Q

Bupivacaine is:

A

highly protein bound, limiting transplacental transfer

63
Q

Antepartum Hemorrhage occurs in approximately _____% of pregnancies and includes:

A

4%, placenta previa, placental abruption and uterine rupture

64
Q

All of the following statements about placenta previa are true except?

A

Prior preterm labor is a common element

65
Q

A G3P2002, presents with painless vaginal bleeding. She has a history of uterine trauma from a MVA 2 years ago at which time she underwent surgery to repair her uterus. She is currently at the end of her 2nd trimester. You would be correct to be suspicious for which of the following conditions

A

Placenta previa

66
Q

You are overhead paged to the OB Triage Desk to evaluate a 44 year old, G3P2002 parturient at 34 weeks gestation, 63 inches in height, 75 kilograms in weight. She admits having continued to smoke and drink during the pregnancy. Her medical history includes: mild HTN and GERDS. Past hospitalizations include the birth of her other two children and several hospital admissions for physical abuse from her domestic partner. She admits having had a little cocaine just yesterday. The patient presented to the clinic after several episodes of bright red painful bleeding. At this time the patient has stopped complaining of pain. She appears somewhat dazed and inappropriately responsive to all the attention.
Which of the following would be the most likely diagnosis? Does this situation require immediate action.

A

Placenta abruption. Yes, this requires immediate attention.

67
Q

Your patient presents with placental abruption. You enter the patient’s room, note the following vital signs: HR 128, RR 28, SATS 94% on FM 8L, BP 89/42; FHRs is 90 beats/min. What would be the most logical next best step.

A

Obtain consent and prepare the OR for c-section under general anesthesia.

68
Q

Given the diagnosis of placental abrutption, the FHR of 90 beats/min, would you say.

A

The FHR is an indication that there is fetal distress, most likely associated with a loss of maternal-fetal gas exchange

69
Q

Your patient is to proceed to the OR for c-section as she is actively bleeding. Her platelet count is low, regional is not an option. 1000mL of LR has been administered and her current VS are unimproved, FHR is now 85 beats/min. Which of the following is the most appropriate sequence of action once in the OR?

A

Place monitors, support BP with a sympathomimetic, place 2nd large bore IV while OR team prep and drape; induce GA with ketamine (if no contraindications) or Etomidate (if stable), intubate facilitated by succinylcholine, give the okay to start. Prepare for aggressive volume resuscitation with crystalloids and colloids. Confirm PRBCs readily available.

70
Q

Your patient has a c-section without complications, baby and placenta are delivered. EBL is approximately 3000cc, the surgeon states he is having difficulty achieving hemostasis. You continue to have difficulty with SBPs in the 80s. Which of the following would be the most appropriate action at this time?

A

Call for assistance, start oxytocin, give PRBC and crystalloids, consider FFP and platelets, recheck H/H, coags.Prepare for Cesarean Hysterectomy

71
Q

true or false: Placental abruption is the most common cause of DIC in pregnancy, coagulopathies occur in 10% of all cases and predisposes the fetus to hypoxia; 15-25% of perinatal deaths are associated with abruption.

A

true

72
Q

Primary postpartum hemorrhange is defined as blood loss of:

A

> 300 mL after delivery and/or a 10% decrease in HCT from admission to postpartum period, or need to administer PRBCs, occurs during first 24 hours after delivery

73
Q

The preterm infant is defined as:

A

look it up

74
Q

Which of the following is not considered a tocolytic in current use?

A

nimesulide

75
Q

All of the statements below with regard to anesthetics and how the risks change with gestational age are true except:

A

After 26 weeks there is less risk to developmental abnormalities.

76
Q

true or false: Neonates delivered from pregnant women in hemorrhagic shock are likely to be acidotic and hypervolemic.

A

false

77
Q

Which of the following are serious risks under general anesthesia in the parturient?

A

look it up

78
Q

Uterine rupture can be caused by

A

look it up

79
Q

Absolute contraindications of regional anesthesia in the parturient include (choose all that apply)

A

Significant fetal distress, Skin infection at the placement site, Patient refusal, Coagulopathy

80
Q

True or false: “Despite decreases in cholinesterase activity, clinically relevant prolongation of the duration of action of drugs that depend on cholinesterase for elimination, such as succinylcholine, is uncommon in women with genotypically normal cholinesterase enzymes”

A

true

81
Q

Performing a Subarachnoid block in Right Lateral Decubitis position can be advantageous to achieving optimal anesthesia because
Answer

A

It ensures that all nerves are bathed in hyperbaric local anesthetic solution when the parturient is placed in Left Uterine Displacement prior to cesarean section

82
Q

Undesirable side effects of intrathecal morphine include which of the following?(Choose all that apply)

A

Nausea and/or vomiting, Urinary retention, Pruritis

83
Q

As a general rule of thumb when placing a lumbar epidural in a parturient for labor, you should not place more than ____cm of catheter into the epidural space.

A

5

84
Q

You have placed your epidural and give a test dose of 3cc of 1.5% lidocaine with 1:200,000 epinephrine. Less than one minute later, the parturient states “Wow, my pain is gone! You are a miracle worker!” There is a strong likelihood that

A

The catheter is in the subarachnoid space

85
Q

Indications for General Anesthesia for Cesarean Section include (Choose all that apply):

A

Acute fetal distress without epidural catheter present, Significant coagulopathy, Maternal hemmorhage

86
Q

Dermatomal spread of local anesthetic injected epidurally is dependent of _____________more than any other factor.

A

volume

87
Q

Glucosuria and Proteinuria in the absence of disease in the third trimester can be attributed to:

A

increased glomerular fitration rate with decreased absortion

88
Q

You have just come in to relieve a colleague at the completion of a cesarean section, but you are unable to see the suction cannister to estimate blood loss. On a quick scanning exam of the situation you note that your patient is tachycardic (HR 114), with a narrowing pulse pressure (current B/P 94/74), moderate tachypnea (28 breaths per minute), and urine output of 30cc/hr. You can assume that:

A

Your patient has experienced moderate bleeding (20-25% of blood volume or about 1200-1500mL). You open the IV, send a stat H&H and check for availability of blood products. Notify the attending of your concerns.

89
Q

A key point regarding physiologic changes in pregnancy is that Platelets, factor VII, and fibrinogen levels are normally

A

increased

90
Q

true or false: All pregnant women are at an increased risk of aspiration due to the physiologic changes in their gastrointestinal system

A

true

91
Q

In regards to physiologic changes in pregnancy, which of the following statements are true? (Choose all that apply)

A

Pregnant women have an increased sensitivity to local anesthetic agents, Blood volume is increased to prepare the parturient for blood loss associated with delivery

92
Q

Pain in the first stage of labor is caused by:

A

cervical dilation and uterine muscle ischemia

93
Q

true or false: Given a reasonable maternal oxygen saturation, fetal oxygenation is limited primarily by uteroplacental blood flow, not maternal oxygenation.

A

true

94
Q

Before performing a regional anesthetic, it is important to ask

A

look it up

95
Q

The fetal bradycardia is:

A

usually well tolerated if it lasts <2 minutes

96
Q

The dermatomes that cover the perineum are

A

S2, S3, S4

97
Q

Which of the following statements are true …

A

Butorphanol (Stadol (R)) has fallen out of favor in labor analgesia (as a parenteral agent) due to a 75% incidence of transient sinusoidal fetal heart pattern (although benign) associated with it’s use.

B.
The mean age of women having children for the first time has increased from 20.7 in 1970 to 25.2 in 2004.

C.
Increased ICP, patient refusal, and frank coagulopathy are absolute contraindications to labor epidural analgesia.

D.
Ketamine is useful in partial or spotty blocks during Cesarean Section. Doses of 10-20mg IV produce profound analgesia without an impact on maternal respirations or fetal obtundation.

F.
Always administer 30mL of a non particulate antacid by mouth before initiating labor epidural analgesia for c-section

98
Q

true or false: You must ensure that your normal saline is preservative free if using it for a loss of resistance epidural placement technique.

A

true

99
Q

Criteria for diagnosis of severe preeclampsia include all of the following except:

A

Glucosuria of 5g per 100mL of urine on 24 hour urine collection

100
Q

Select all of the predisposing factors for Preeclampsia (choose all that apply)

A

Primagravida, Renal disease, Insulin dependent diabetes, Obesity, Chronic preexisting Hypertension

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