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Flashcards in Sharkey Final Deck (111):
1

Which statement best describes the hypo pharynx?

a. Adenoids and openings to Eustachian tubes are found here
b. Level C2-3 location
c. Also known as oropharynx
d. Lowermost portion of pharynx, which leads to esophagus and larynx, extending down into trachea

d. Lowermost portion of pharynx, which leads to esophagus and larynx, extending down into trachea

2

Which statement best describes treatment of epiglottitis?

a. Caused by Haemophilus influenza type D bacteria
b. It is appropriate to look into and/or manipulate the oral cavity of the child at home while waiting for EMS to arrive
c. Intubation and extubation are best in controlled environment, where emergent tracheotomy may be prepared for
d. Extubate in the childs room, as long as the parents are present to reassure the child

c. Intubation and extubation are best in controlled environment, where emergent tracheotomy may be prepared for

3

Abducts the vocal cords:

a. Lateral cricoarytenoids
b. Posterior cricoarytenoids
c. Transverse arytenoids
d. None of the above

b. Posterior cricoarytenoids

4

The following drugs are desired for treatment of laryngospasm:

a. 100% oxygen, IV lidocaine, and succinylcholine
b. 100% oxygen, vecuronium, and neostigmine
c. 100% oxygen, succinylcholine, and zofran
d. 100% oxygen, valium, fentanyl, versed, and pancuronium

100% oxygen, IV lidocaine, and succinylcholine

5

Initial treatment of laryngospasm includes:

a. Intubation immediately
b. Ask the patient to cough to clear the airway
c. Head tilt, jaw thrust maneuver with gentle positive airway pressure using 100% oxygen
d. Proceed to recovery room

c. Head tilt, jaw thrust maneuver with gentle positive airway pressure using 100% oxygen

6

The following are factors that may exacerbate bronchospasm:

a. Light depth of anesthesia
b. History of smoking and/or asthma
c. Use of blood products
d. All of the above

d. All of the above

7

When examining your patient preoperatively, you can only see the soft palate and base of uvula. Which Mallampati class is this patient?

a. Class I
b. Class II
c. Class III
d. Class IV

c. Class III

8

When repositioning your patients head, you may expect neck extension or lateral rotation to move the ETT tip:

a. Toward the carina
b. No movement should be expected
c. Away from the carina
d. None of the above

c. Away from the carina

9

The following statement is true regarding LMA:

a. Safe for any patient, any position, any procedure
b. Partially protects the larynx from pharyngeal secretions, but not gastric secretions
c. Remove LMA as soon as the patient starts to spontaneously breathe, even if they are still unable to follow commands
d. Great for morbidly obese and pregnant patients

b. Partially protects the larynx from pharyngeal secretions, but not gastric secretions

10

An important rule during endoscopy is to never advance into a lumen.

a. True b. False

b. False

11

What is the normal resting lower esophageal pressure that prevents reflux of stomach contents?

a. ~100mmHg
b. ~10mmHg
c. ~30mmHg
d. None of the above

c. ~30mmHg

12

In patients with GERD, the normal lower esophageal resting pressure is:

a. Less than normal
b. Higher than normal

Less than normal

13

Drugs that increase the lower esophageal pressure and decrease the risk of gastric aspiration include:

a. Dopamine, thiopental, opioids, propofol
b. Metoclopramide, propofol, antacids, thiopental
c. Edrophonium, neostigmine, metoclopramide, antacids
d. Anticholinergics, neostigmine, prochloperazine, opioids.

c. Edrophonium, neostigmine, metoclopramide, antacids

14

The earliest and most reliable sign of aspiration of gastric contents into the respiratory tract is:

a. Wheezing
b. Coughing
c. Cyanosis
d. Hypoxemia

d. Hypoxemia

15

What is the most common cause of malpractice claims in anesthesia?

a. Death in the OR
b. Tooth damage
c. Sore throat
d. Airway injury

b. Tooth damage

16

Malignant Hyperthermia can be defined as:

a. A life-threatening hypermetabolic syndrome
b. Can occur with or without triggering agents
c. Occurs within skeletal muscle tissue
d. All of the above

All of the above

17

The following may occur in a hypermetabolic state:

a. Increased oxygen consumption and increased carbon dioxide production
b. Severe lactic acidosis and hyperthermia
c. Hyperkalemia and possible arrhythmias
d. All of the above

d. All of the above

18

The most sensitive indicator of Malignant Hyperthermia is:

a. Tachycardia
b. Increase in ETCO2 levels, possible 2-3 times greater than normal
c. Fever
d. Masseter spasm

Increase in ETCO2 levels, possible 2-3 times greater than normal

19

Known triggers of Malignant Hyperthermia include:

a. Benzodiazepenes
b. Narcotics
c. Propofol
d. Inhaled agents and Succinylcholine

Inhaled agents and Succinylcholine

20

“Safe” drugs for Malignant Hyperthermia susceptible patients include:

a. Inhaled general anesthetics
b. Succinylcholine
c. Nitrous Oxide, Propofol, Ketamine
d. Ether

Nitrous Oxide, Propofol, Ketamine

21

The immediate and initial dose for Dantrolene IV in a Malignant Hyperthermia crisis is:

a. 1-1.5 mg/kg IV b. 4.0 mg/kg IV
c. 2.5mg/kg IV d. 10 mg/kg IV

c. 2.5mg/kg IV

22

Suggested maximal (total) dose of Dantrolene IV is:

a. 1-1.5 mg/kg IV
b. 4.0 mg/kg IV
c. 2.5 mg/kg IV
d. 10 mg/kg IV (or more if needed)

10 mg/kg IV (or more if needed)

23

Anesthesia Machine preparation for MH susceptible patients includes:

a. Changing out old soda lima or other CO2 absorbent to brand new
b. Remove or disable vaporizers
c. Use of new disposable circuits, bag, and y pieces
d. All of the above

d. All of the above

24

The best indicator of fluid status in an NPO patient is the urine output.

a. True b. False

True

25

Examples of crystalloids include:

a. Hespan b. Lactated Ringers c. Dextran d. Albumin

Lactated Ringers

26

Examples of colloids include:

a. Hespan b. D5W c. 7.5% NaHCO3 d. Plasmalyte

a. Hespan

27

Examples of nonhemolytic transfusion reaction includes:

a. Febrile reaction b. Urticarial reaction c. Anaphylaxis d. All of the above

All of the above

28

Management of suspected blood transfusion reaction includes:
a. Immediately stop blood and manage immediate patient issues
b. Observe, allow blood to infuse at slower rate, document temperature q 15 minutes
c. Documentation of VS, allow blood to infuse at a faster rate

Immediately stop blood and manage immediate patient issues

29

Emergent blood transfusion “emergency release” blood is:

a. B Positive b. O Rh Negative c. AB Negative d. A Positive

O Rh Negative

30

Ideally, it is best to adequately hydrate the patient prior to induction.

a. True b. False

True

31

1. Choose the correct position for the arms and hands of a patient placed in supine position:

a. Arms pronated with the hands tucked under the buttocks
b. Arms at greater than 90 degree angles on armboards
c. Arms at the patients’ sides, secured with a sheet and padding, hands parallel to the legs and trunk, thumbs up position
d. Arms at the patients’ sides, thumbs down position

Arms at the patients’ sides, secured with a sheet and padding, hands parallel to the legs and trunk, thumbs up position

32

2. In elderly patients, the MAC for inhalation agents:

a. Is decreased by 10% per decade of age > 40 yrs
b. Is decreased by 4% per decade of age > 40 yrs
c. Is increased by 4% per decade of age > 40 yrs

Is decreased by 4% per decade of age > 40 yrs

33

3. In elderly patients, the onset of action for inhalational agents will be less rapid if CO is depressed

a. True b. False

False

34

4. Alpha 1 acid glycoprotein binds acidic drugs

a. True b. False

. False

35

Albumin binds acidic drugs
a. True b. False

a. True

36

6. Triggers to the oculocardiac reflex are:
a. Traction on extraocular muscles b. ocular manipulation c. both a and b

both a and b

37

Dysrhythmias may persist for as long as the oculocardiac reflex is stimulated

a. True b. False

True

38

8. An inhalation induction is slower in geriatrics due to prolonged circulation time.

a. True b. False

False

39

9. The decrease in chronotropic response to catecholamines seen in the geriatric population is attributed to their decreased sensitivity of beta receptors.

a. True b. False

True

40

Which one of the following remains relatively unchanged in geriatric patients?

a. cardiac reserve b. resting stroke volume c. responsiveness to ANS stimulation

resting stroke volume

41

The most common peripheral nerve injury occurs in the:

a. brachial plexus b. radial nerve c. peroneal nerve d. ulnar nerve

ulnar nerve

42

Which nerve is particularly at risk for damage when patients are in lithotomy position?

a. nerves of the brachial plexus b. radial nerve c. peroneal nerve d. ulnar nerve

peroneal nerve

43

Axillary rolls should be placed cephalad to the axilla.

a. True b. False

False

44

Air embolism may occur anytime patients are placed in sitting, prone, and reverse

Trendelenberg positions, and any time the operative site with an open venous system is lower
than the heart.
a. True b. False

False

45

The most common physiologic consequence of positioning is:

a. postural hypotension b. nerve injury c. tissue damage d. hypertension

postural hypotension

46

In geriatric patients, prolonged circulation time

a. delays the onset of IV drugs and inhalational agents
b. speeds the onset of inhalational agents and delays the onset of IV drugs
c. delays the onset of inhalational agens and speeds the onset of IV drugs
d. has no effect on the onset of IV drugs and delays the onset of inhalational drugs

speeds the onset of inhalational agents and delays the onset of IV drugs

47

You are providing anesthesia for an elderly patient for insertion of a permanent pacemaker. The preoperative diagnosis is Sick Sinus Syndrome and is a prevalent condition in the elderly population due to:
a. the increase in number of SA node cells that occurs with the normal aging process
b. the decreased density/fibrosis of the SA node cells that occurs with normal aging process
c. the decrease in number of SA node cells that occurs with the normal aging process
d. the increased density/fibrosis of the SA node cells that occurs with the normal aging process

the decrease in number of SA node cells that occurs with the normal aging process

48

What is the most sensitive indicator of renal function in the elderly?

a. BUN b. urine output c. sodium clearance d. creatinine clearance

creatinine clearance

49

Metabolization of anectine may be prolonged in elderly men due to:

a. decreased plasma cholinesterase levels
b. increased plasma cholinesterase levels

decreased plasma cholinesterase levels

50

In elderly patients, increased elimination half-time reflects:

a. increased renal clearance, increased hepatic clearance, decreased volume of distribution
b. increased renal clearance, increased hepatic clearance, increased volume of distribution
c. decreased renal clearance, increased hepatic clearance, increased volume of distribution
d. decreased renal clearance, decreased hepatic clearance, increased volume of distribution

decreased renal clearance, decreased hepatic clearance, increased volume of distribution

51

For water-soluble drugs, the Vd (volume of distribution) is:

a. increased b. decreased

b. decreased

52

Which one of these drugs does not prolong the duration of muscle relaxants?

a. Lithium b. Antibiotics
c. Antidysrhythmics d. Tricyclic antidepressants

Tricyclic antidepressants

53

Identify whether each of the following normally increases or decreases in geriatric patients:

Biotransformation rate

b. decreases

54

Identify whether each of the following normally increases or decreases in geriatric patients

Elimination half time

a. increases

55

Identify whether each of the following normally increases or decreases in geriatric patients

Lung elasticity

b. decreases

56

Identify whether each of the following normally increases or decreases in geriatric patients

Albumin production

b. decreases

57

Identify whether each of the following normally increases or decreases in geriatric patients

BUN

a. increases

58

Identify whether each of the following normally increases or decreases in geriatric patients

Gastric pH

a. increases

59

You are preparing to provide anesthesia for a patient for an exploratory laparotomy for probable acute appendicitis. During the preop assessment, the patient informs you that 3 weeks ago, he had a repair of retinal detachment, and a gas bubble consisting of SF6 was placed in his right eye. For this procedure, how long should nitrous oxide be avoided as part of the anesthesia plan?

a. 10 days after SF6 bubble injection
b. 10 weeks after SF6 bubble injection
c. 5 days after SF6 bubble injection
d. 5 weeks after SF6 bubble injection

10 days after SF6 bubble injection

60

Characteristics of jet ventilation include:

a. Uses about 50psi
b. May blow smoke and debris down the trachea
c. Requires total IV anesthesia
d. All of the above

d. All of the above

61

Which laser effects are more localized and superficial?

a. CO2 b. YAG

a. CO2

62

If the eyes of the patient are closed during a laser procedure, there is no need to provide further protection with gauze.

A. True b. False

False

63

It is unnecessary for anesthesia providers for wear laser protection for their eyes during gynecological laser cases, since you are more than 4 feet from the site of use.

a. True b. False

b. False

64

The most appropriate ETT for laser procedures is:

a. Metallic tape wrapped ETT
b. Double cuffed ETT
c. Silicone ETT
d. Standard ETT

Double cuffed ETT

65

Inspired oxygen concentrations for laser procedures should be as high as possible.

a. True b. False

b. False

66

Anesthesia for a postop tonsillectomy hemorrhage includes:

a. Normal induction, and fluids at keep open rate
b. Awake induction, fluids wide open, and oral gastric tube placed
c. Full stomach precautions and fluid resuscitation prior to surgery
d. Preop sedation to suction the gastric contents our prior to induction

Full stomach precautions and fluid resuscitation prior to surgery

67

Common side effects of intranasal cocaine include:

a. Bradycardia and hypotension
b. Tachycardia and hypertension

Tachycardia and hypertension

68

Patients with epistaxis are considered to have full stomachs, so RSI is indicated.

a. True b. False

True

69

Intraoperative hypothermia and vasoconstriction increase perfusion of the microvasculature of the free flap in head and neck procedures.

a. True b. False

False

70

You are providing anesthesia for a permanent tracheotomy to be placed in a patient that has been on the ventilator in the ICU for an extended period of time. After a smooth induction, the prep and draping are complete. The surgeon makes the incision into the skin, and dissects down to the trachea. Prior to the incision directly into the trachea, it is important for the anesthesia provider to:

a. Ventilate with 21% oxygen
b. Deflate the cuff on the ETT
c. Turn off the inhalational agent
d. All of the above

Deflate the cuff on the ETT

71

1. After inhalational anesthesia, speed of emergence is directly proportionate to:

a. Redistribution b. Blood solubility of agent used c. Alveolar ventilation

Alveolar ventilation

72

2. Postoperatively, you are called to return to PACU to evaluate the patient that you gave report on about 30 minutes prior. The patient’s HR and temperature are within normal limits, but, you observe that the patient has an oxygen saturation ranging from 88-90%, and respirations are of a slow rate with large TV. Choose the likely cause of the respiratory status.

a. Residual muscle paralysis b. Opioid induced respiratory depression c. MI

Opioid induced respiratory depression

73

What drug would be the appropriate treatment for the patient with opioid induced respiratory depression?

a. Flumazenil b. Narcan c. Racemic Epinephrine d. Neostigmine + Robinul

Narcan

74

4. The most common cause of hypotension in PACU is:

a. hyperglycemia b. hypovolemia c. hypoglycemia d. uncontrolled pain

hypovolemia

75

The standard drug for reversal of Benzodiazepines is:

a. Fentanyl b. Versed c. Flumazenil d. Narcan

Flumazenil

76

The standard dose for IV Narcan in adults is:

a. O.4mg b. 400mcg c. 4mg d. 0.4-1.0mgIV

0.4-1.0mgIV

77

7. Complications of Narcan administration include:

a. Pulmonary edema b. sudden death c. uncontrolled pain d. all of the above

all of the above

78

Which drug is shown to be most effective for control of shivering in the PACU?

a. Dilaudid b. Fentanyl c. Demerol d. Zofran

Demerol

79

What is the most common cause of hypotension in the PACU?

a. Hypovolemia b. Acidosis c. Hypertension
d. Hypervolemia

Hypovolemia

80

Postoperative hypertension may be expected in patients with a history of hypertension preoperatively. An effective drugs to treat postoperative hypertension is:

a. Ephedrine b. Neosynephrine c. Nicardipine d. IV NS bolus of 250mL

Nicardipine

81

Propofol has an anti-emetic property.

a. True b. False

True

82

12. Treatment of shivering in PACU is forced air warming and IV Demerol 200mg.

a. True b. False

False

83

13. Recovery from most IV anesthetics is dependent primarily on alveolar ventilation.

a. True b. False

False

84

Signs and symptoms of fat embolism during general anesthesia include:

a. Decrease in ETCO2, decrease in SaO2, increase in PA pressures, EKG changes
b. Increased ETCO2, increase in SaO2, increase in PA pressures, EKG changes
c. Decrease in ETCO2, increase in SaO2, decrease in PA pressures, EKG changes

Decrease in ETCO2, decrease in SaO2, increase in PA pressures, EKG changes

85

Treatment of fat embolism includes:

a. Corticosteroids b. 100% oxygen c. Intubation and ventilation with PEEP
d. All of above

All of above

86

Tourniquets are never used in patients with Sickle Cell Disease.

a. True b. False

False

87

When using a tourniquet, pressure distal to the cuff is more damaging to the tissue than the pressure under the cuff.

a. True b. False

False

88

The maximum inflation time for a tourniquet is:

a. 2 hours b. 4 hours c. 1 hour d. There is no maximum inflation time

2 hours

89

Damage to underlying vessels, nerves, and skeletal muscles with tourniquet use is a function of:

a. Both inflation pressure and duration of inflation
b. Inflation pressure only
c. Duration of inflation only
d. None of the above

Both inflation pressure and duration of inflation

90

You are scheduled to give the anesthetic for a Total Knee Replacement for an ASAII patient with no cardiac history. The team places the deflated tourniquet, raises the operative leg, wraps a tightly placed Esmarch bandage beginning at the foot and extending to the thigh, and asks you to inflate the tourniquet. As an anesthesia provider, you expect the exsanguination process to:

a. Cause a shift of blood volume of about 100cc into the central circulation
b. Cause a shift of blood volume of about 300-500cc into the central circulation
c. Cause no change in blood volume into the central circulation

Cause a shift of blood volume of about 300-500cc into the central circulation

91

In a patient with poor cardiac function or LV dysfunction, exsanguination may not be well tolerated due to:

a. The decrease in CVP and BP that occur with exsanguination
b. The changes in systemic vascular resistance that occur with exsanguination
c. The increase in CVP and BP that occur with exsanguination
d. None of the above

The increase in CVP and BP that occur with exsanguination

92

Changes that occur in the tissue, vessels, and nerves during tourniquet inflation are completely reversible for inflations of 1-2 hours.

a. True b. False

True

93

Prolonged tourniquet inflation may cause:

a. Transient muscle dysfunction
b. Rhabdomyolysis
c. Permanent nerve injury
d. All of the above

All of the above

94

Bone Cement Implantation Syndrome (BCIS) is a poorly understood, but important cause of intraoperative mortality/morbidity in patients undergoing Total Hip Replacement (THR), Total Knee Replacement (TKR), and Vertebroplasty procedures. As discussed in class, after mixing the cement, hardening occurs, and this exothermic reaction is accompanied by the release of heat. Different grades of hypoxia may occur, progressing to CV collapse and the need for resuscitation. As expected, this is a potentially dangerous time for anesthesia personnel and the patient. Please answer questions 24 through 30 related to BCIS.

Bone Cement Implantation Syndrome (BCIS) is a poorly understood, but important cause of intraoperative mortality/morbidity in patients undergoing Total Hip Replacement (THR), Total Knee Replacement (TKR), and Vertebroplasty procedures. As discussed in class, after mixing the cement, hardening occurs, and this exothermic reaction is accompanied by the release of heat. Different grades of hypoxia may occur, progressing to CV collapse and the need for resuscitation. As expected, this is a potentially dangerous time for anesthesia personnel and the patient. Please answer questions 24 through 30 related to BCIS.

95

24. Clinical manifestations of BCIS include:

a. Hypoxia, hypotension, dysrhythmias, decreased cardiac output, pulmonary hypertension
b. Hypertension, increased cardiac output, pulmonary hypertension
c. None of the Above

Hypoxia, hypotension, dysrhythmias, decreased cardiac output, pulmonary hypertension

96

25. When is the most dangerous time for emboli to occur?

a. Induction of anesthesia
b. Initial positioning of the patient
c. Insertion of a femoral prosthesis with THA
d. Insertion of the acetabular prosthesis with THA

Insertion of a femoral prosthesis with THA

97

Expansion and hardening of the Methyl Methacrylate (MMA) cement against the prosthetic components results in:

a. Intramedullary hypertension >100mmHg
b. Intramedullary hypertension >500mmHg
c. Intramedullary hypotension and increased urine output
d. Intramedullary hypotension and clotting effects

Intramedullary hypertension >500mmHg

98

Anesthesia strategies to minimize effects of BCIS include:

a. Maintaining normovolemia and increasing FIO2 shortly before cementing
b. Allowing purposeful hypovolemia and increasing FIO2 shortly before cementing
c. Keeping the blood pressure low shortly before cementing

Maintaining normovolemia and increasing FIO2 shortly before cementing

99

Insertion of cement may cause:

a. Sudden hypertension b. Sudden hypotension

Sudden hypotension

100

Hypertension may appear 30-60 seconds after cement insertion, or up to 10 minutes after prosthesis insertion.

a. True b. False

False

101

A possible complication of cement insertion is sudden cardiac death.

a. True b. False

True

102

31. The Cytochrome P-450 pathways mature at the end of the neonatal period.

a. True b. False

True

103

32. Nonshivering thermogenesis is the primary method of heat production in infants.

a. True b. False

True

104

33. MAC values of inhalational agents for pediatrics are highest in:

a. Neonates c. Infants
b. Small children d. Premies

Infants

105

When infants have been given muscle relaxants, lifting both legs generally indicates that the patient still cannot generate adequate negative inspiratory force, and have not yet recovered from the effects of the muscle relaxants.

a. True b. False

False

106

35. In Pediatric patients, it is important to remember that hypoxia often leads to bradycardia, followed often by cardiac arrest.

a. True b. False

True

107

The recommended dose for nebulized racemic epinephrine is:

a. 0.25mL-0.5mL of a 2.25% solution in 10mL of NS
b. 0.25mL-0.5mL of a 2.25% solution in 25mL of NS
c. 0.25mL-0.5mL of a 2.25% solution in 2.5mL of NS

0.25mL-0.5mL of a 2.25% solution in 2.5mL of NS

108

What is the definitive treatment of Sux induced hyperkalemia?

a. Allow time for self correction without medical treatment
b. IV Calcium
c. IV Neostigmine
d. IV non depolarizing muscle relaxants

IV Calcium

109

Preemies are at highest risk for morbidity/mortality.

a. True b. False

False

110

The hallmark of intravascular fluid depletion in neonates and infants is:

a. Hypotension with tachycardia
b. Hypertension with tachycardia
c. Hypotension without tachycardia
d. Hypertension without tachycardia

Hypotension without tachycardia

111

Many toddlers react to the stress of surgery with an increase in serum glucose.

a. True b. False

False