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138 Cards in this Set
- Front
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The effects of barbiturates on ischemic areas of the brain include: |
Redirection of blood flow to the ischemic areas.
Barbiturates cause cerebral vasoconstriction in normal areas. These agents tend to redistribute blood flow to ischemic areas in what is sometimes referred to as a reverse steal phenomenon or Robin Hood effect. Ischemic areas remain maximally dilated and unaffected by the barbiturate. |
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Venous irritation associated with the injection of diazepam and lorazepam is secondary to:
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the presence of propylene glycol as a solvent |
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In patients with a history of hypertrophic cardiomyopathy, intraoperative management should include:
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In patients with outflow obstruction, myocardial depression and maintenance of preload and afterload are desireable.
pg. 475 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Correct statements regarding cerebral metabolism include:
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The adult brain consumes about 20% of the total body oxygen (50 ml/min). Neuronal cells normally utilize glucose as their energy source, but can also utilize ketone bodies and lactate. Hyperglycemia has been shown to worsen global and focal hypoxic brain injury.
pg. 615 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3)
hypotension secondary to cement monomer absorption hypoxemia secondary to air embolization hypoxemia secondary to fat embolization hypocarbia decreased pulmonary artery pressure increased end-tidal carbon dioxide |
During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, hypoxemia secondary to fat embolization
During hip replacement surgery, hypotension associated with the use of acrylic bone cement has been attributed to absorption of methyl methacrylate monomer, embolization of air and bone marrow, lysis of red cells and marrow and conversion of methyl methacrylate to methacrylic acid. Hypoxemia is common. Embolic events cause an increase in dead space with a reduction in ETCO2 with an increase in PaCO2. pg. 1125 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Maternal mortality associated with amniotic fluid embolization is:
10 - 15% 20 - 25% 40 - 45% greater than 50% |
Maternal mortality associated with amniotic fluid embolization is: greater than 50%
Amniotic fluid embolism is rare with a occurrence of about 1:20,000. However, it carries a very high mortality; some studies quoting as much as 86%. Mortality within the first hour after onset is about 50%. pg. 912 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Absolute contraindications to electroconvulsive therapy (ECT) include:
congestive heart failure pregnancy myocardial infarction 5 months prior to therapy increased intracranial pressure |
Absolute contraindications to electroconvulsive therapy (ECT) include: increased intracranial pressure
Absolute contraindications to ECT include recent MI (usually < 3 months), recent stroke (< 1 month), intracranial mass, or increased ICP from any cause. Relative contraindications include angina, CHF, significant pulmonary disease, bone fractures, osteoporosis, pregnancy, glaucoma and retinal detachment. pg. 660 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In the fetus, the percentage of cardiac output directed to the placenta is approximately:
10% 25% 50% 100% |
In the fetus, the percentage of cardiac output directed to the placenta is approximately: 50%
In the fetus, the lungs receive little blood flow. The placenta receives nearly one-half of the fetal cardiac output and is responsible for respiratory gas exchange. pg. 884 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The elimination half-life of intravenously administered oxytocin in the parturient is approximately:
30 to 120 seconds 3 to 5 minutes 10 to 15 minutes 20 to 30 minutes |
The elimination half-life of intravenously administered oxytocin in the parturient is approximately: 3 to 5 minutes
Both endogenous and intravenously administered oxytocin have short elimination half-lives of about 3 to 5 minutes. As a result, oxytocin must be administered as a continuous infusion for the induction of labor. |
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Clinically significant histamine release has been associated with the use of:
vecuronium rocuronium cisatracurium atracurium |
Clinically significant histamine release has been associated with the use of: atracurium
Atracurium has been associated with histamine release from mast cells and can result in bronchospasm, skin flushing and hypotension. |
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The therapeutic range of magnesium in the plasma in order to provide tocolysis and prevent eclamptic seizures is between:
2 to 4 mg/dL 6 to 8 mg/dL 12 to 14 mg/dL 18 to 20 mg/dL |
The therapeutic range of magnesium in the plasma in order to provide tocolysis and prevent eclamptic seizures is between: 6 to 8 mg/dL
pg. 884 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Highly specific preoperative screening tests have a:
low incidence of false-positives results low incidence of false-negative results result that is specific for one pathologic process low sensitivity |
Highly specific preoperative screening tests have a: low incidence of false-positives results
The usefulness of a screening test depends on its sensitivity and specificity. Sensitive tests have a low rate of false-negative results, whereas specific tests have a low rate of false-positive results. pg. 10 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Drugs that inhibit coagulation through direct inhibition of thrombin include:
heparin warfarin bivalirudin aprotonin |
Drugs that inhibit coagulation through direct inhibition of thrombin include: bivalirudin
Bivalirudin, hirudin, lepirudin and argatroban are anticoagulants that directly inhibit thrombin. These agents are most commonly used for cardiopulmonary bypass when heparin is contraindicated. No specific reversal agent is available and termination of effect occurs as a result of renal elimination of the drug. pg. 236 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. Heparin is a biological substance, usually made from pig intestines. It works by activating antithrombin III, which blocks thrombin from clotting blood. Heparin can be used in vivo (by injection), and also in vitro to prevent blood or plasma clotting in or on medical devices. Dosage for heparin reversal is 1mg protamine sulfate i.v. for every 100 IU of active heparin. In patients who are allergic to fish, it can cause significant histamine release resulting in hypotension and br |
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Enoxaparin:
causes less platelet inhibition than heparin is easily reversed with protamine has a half-life that is 35% less than that of heparin effects are monitored using the INR |
causes less platelet inhibition than heparin
Symptoms of overdose include hemorrhage. Protamine sulfate has been used to reverse effects (protamine 1 mg neutralizes enoxaparin 1 mg). Monitor aPTT 2-4 hours after first infusion; consider readministration of protamine (50% of original dose). Note: anti-Xa activity is never completely neutralized (maximum of 60% to 75%). Avoid overdose of protamine. Low molecular weight heparins (LMWH), such as enoxaparin, have greater activity against factor Xa than thrombin. As a result, the INR is not a reliable monitoring tool. The LMWHs cause less platelet inhibition and are associated with a lesser incidence of heparin induced thrombocytopenia. pg. 400 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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Termination of the effects of succinylcholine at the neuromuscular junction occurs as a result of:
succinylcholine hydrolysis by acetylcholinesterase diffusion of succinylcholine away from the receptors succinylchoine hydrolysis by hepatic esterases the competition of succinylcholine with acetylcholine |
Termination of the effects of succinylcholine at the neuromuscular junction occurs as a result of: diffusion of succinylcholine away from the receptors
Because depolarizing muscle relaxants are not metabolized by acetylcholinesterase, they diffuse away from the neuromuscular junction and are hydrolyzed in the plasma by pseudocholinesterase. |
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A occurrence malpractice insurance policy:
offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed offers coverage if the policy is in place at the time the claim is filed is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy is the most common form of malpractice insurance in place today |
A occurrence malpractice insurance policy: offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed
An occurrence policy offers coverage of an incident resulting in a claim, whenever that claim might be filed. The much more common claims-made policy covers claims that are filed only while the insurance is in force. Umbrella coverage is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy. pp. 40 - 41 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Ventilatory parameters that are increased during pregnancy include:
tidal volume airway resistance PaCO2 bicarbonate |
Ventilatory parameters that are increased during pregnancy include: tidal volume
Respiratory/ventilatory effects of pregnancy include increased oxygen consumption, decreased airway resistance, decreased FRC, increased tidal volume and rate, increased PaO2, decreased PaCO2 and decreased serum bicarbonate. pp. 875 - 876 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Droperidol:
has antiarrhytmic activity causes shortening of the QT interval causes peripheral vasoconstriction is effective for blood pressure control in patients with pheochromocytoma |
Droperidol: has antiarrhythmic activity
Droperidol has mild alpha-blocking activity and causes vasodilation and has antiarrhythmic properties with prolongation of the QT interval. As a result of the prolongation of the QT interval, droperidol has been associated with torsades de pointes and should not be given to patients with QT intervals measuring more than 440 ms. Patients with pheochromocytoma should not receive droperidol because it can induce catecholamine release. |
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Type I pneumocytes:
prevent the passage of albumin into the alveolus are more numerous than Type II pneumocytes produce surfactant are capable of rapid cell division |
Type I pneumocytes: prevent the passage of albumin into the alveolus
Type I pneumocytes are flat and form a tight junction with one another. This prevents the passage of oncotic molecules, such as albumin, into the alveolus. Type II pneumocytes are smaller, but more numerous, and produce surfactant. Unlike Type I pneumocytes, Type II pneumocytes are capable of cell division and can produce Type I pneumocytes when needed. pg. 540 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. Type I pneumocytes (squamous alveolar cells) are responsible for gas exchange in the alveoli and cover a majority of the alveolar surface area (>95%). While type I pneumocytes account for most of the surface area, they are approximately half as numerous as type II cells, due to differences in size. Type I pneumocytes are large, thin cells stretched across a large surface area, while type II pneumocytes are smaller cells. Type I pneu |
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List causes and effects of surfactant deficiency.
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Pulmonary surfactant can result from the destructionof type 2 pneumatocytes or from the destruction or inactivation of surfactant.
Genetic deficiencies have been described. Surfactant lines the alveolus to provide a host defense barrier and reduces alveolar surface tension preventing collapse (adhesive atelectasis). Deficiency produces diffuse loss of lung volume, shunt, and the influw of intersititial fluid resulting in impaired gas exchange. ARDS, hyaline membrane disease, pneumonia, interstitial lung diseases, alveolar proteinosis, obstructive lung disease, smoke inhalation, CABG, uremia and prolonged shallow breathing are conditions which frequently produce generalized surfactant deficiency. Pulmonary embolism and radiation pneumonitis have a similar effect localized to the affect segment of lung. |
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The phrenic nerves arise from the:
nucleus ambiguous C1 - C2 nerve roots C3 - C5 nerve roots C6 - T2 nerve roots |
The phrenic nerves arise from the: C3 - C5 nerve roots
The phrenic nerves arise from the C3 - C5 nerve roots. Unilateral phrenic nerve palsy only modestly reduces most indices of pulmonary function (about 25%). Bilateral phrenic nerve palsies produce more severe impairment, but accessory muscles may maintain adequate ventilation. Cervical cord injuries above C5 are incompatible with spontaneous ventilation. pg. 542 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Large differences between end-tidal carbon dioxide tension and arterial carbon dioxide tension can be caused by:
pulmonary embolism intrapulmonary shunting atrial septal defect with left to right shunting all of the above |
Large differences between end-tidal carbon dioxide tension and arterial carbon dioxide tension can be caused by: pulmonary embolism
Large differences in end-tidal CO2 and PaCO2 are caused by increases in dead space, but little change is seen with increases in shunting. Intra-pulmonary and intra-cardiac shunting do not increase dead space. Conversely, pulmonary embolism produces an increase in ventilated, non-perfused lung (deadspace) and a decrease in CO2 elimination. pp. 699 - 700 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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Cessation of smoking 12 -24 hours prior to surgery has been shown to: (Select 2)
decrease carboxyhemoglobin levels improvement in pulmonary macrophage function decrease the P50 decrease the postoperative morbidity and mortality improve mucous clearance |
Cessation of smoking 12 - 24 hours prior to surgery has been shown to: decrease carboxyhemoglobin levels, improve mucous clearance
Benefits from discontinuation of smoking for 12-24 hours prior to surgery include a decrease in carboxyhemoglobin levels, an increase the P50, improved mucous clearance and a decrease in plasma nicotine levels. Acute cessation of tobacco use has not been shown to improve postop morbidity or mortality. pp. 171 - 172 Hines, RL, and Marschall, KE. Stoelting's Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2008. pg. 579 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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During your preoperative evaluation of an 86-year-old 50 kg female for placement of a pericardial window, you discover a "Do Not Resuscitate" (DNR) order. Prior to surgery you should:
inform the patient that she is not a candidate for surgery clarify the DNR order with the patient and family ignore the DNR order since it does not apply to patients having surgery report the case to your malpractice carrier |
During your preoperative evaluation of an 86-year-old 50 kg female for placement of a pericardial window, you discover a "Do Not Resuscitate" (DNR) order. Prior to surgery you should: clarify the DNR order with the patient and family
DNR orders regarding surgical candidates must be clarified with the patient and family prior to surgery. In addition, DNR orders must comply with hospital policies as well as federal and state laws. pg. 1022 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Factors associated with acute lung injury following thoracic surgery include:
right pneumonectomy rigorous fluid restriction use of small tidal volumes with increased rate all of the above |
Factors associated with acute lung injury following thoracic surgery include: right pneumonectomy
Factors associated with primary ALI are: excessive intravascular volume, high ventilation pressures, right pneumonectomy and preoperative alcohol abuse. pg. 601 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The primary mechanism of intraoperative heat loss resulting in hypothermia is:
convection radiation conduction evaporation |
The primary mechanism of intraoperative heat loss resulting in hypothermia is: radiation
Radiation accounts for approximately 40% of intraoperative heat loss. Convection is the next most significant mechanism of loss accounting for 32%. pg. 384 Starr, M. Anesthesiology Boards: A Survival Guide. Philadelphia: Churchill Livingstone, 2000. |
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Sinus arrhythmia:
is mediated through sympathetic innervation of the AV node causes an increase in heart rate with inspiration is indicative of SA node ischemia is the primary cause of premature atrial contractions |
Sinus arrhythmia: causes an increase in heart rate with inspiration
Sinus arrhythmia is a cyclic variation in heart rate that corresponds to ventilation, increasing with inspiration and decreasing with expiration. Sinus arrhythmia is a normal cardiac rhythm and is due to cyclic changes in vagal tone. pg. 420 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The incidence of venous air embolism during sitting craniotomies is approximately:
5 - 10% 10 - 15% 20 - 40% greater than 50% |
The incidence of venous air embolism during sitting craniotomies is approximately: 20 - 40%
The incidence of venous air embolism is highest during sitting crainotomies, with an incidence of 20 - 40%. Venous air embolization can occur during any procedure when the wound is above the level of the heart. pg. 638 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The duration of action of atracurium may be prolonged by:
hyperthermia respiratory alkalosis metabolic acidosis all of the above |
The duration of action of atracurium may be prolonged by: metabolic acidosis
Because of its unique metabolism, the Hoffman elimination, the duration of action of atracurium may be prolonged by hypothermia or acidosis. pg. 221 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in:
the first 2 hours 4 to 6 hours 7 to 9 hours 12 to 14 hours |
A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in: 12 - 14 hours Tumescent liposuction is commonly done with large volumes of tumescent solution consisting of normal saline with 1:1,000,000 epinephrine and 0.025 - 0.1% lidocaine. Peak serum levels of lidocaine occur 12 - 14 hours after injection and decline over the next 6 - 14 hours. pg. 1350 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Opioids currently NOT approved for epidural or intrathecal use include:
fentanyl sufentanil morphine remifentanil |
Opioids currently NOT approved for epidural or intrathecal use include: remifentanil
Remifentanil is prepared in a solution of glycine, a known inhibitory neurotransmitter. Currently remifentanil is not approved for epidural or intrathecal use. pg. 114 - 115 Stoelting, RK. Pharmacology and Physiology in Anesthetic Practice. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Safety features that prevent filling of the vaporizer with an incorrect agent include:
the pin index safety system agent-specific keyed filling ports the diameter index safety system counter-threading of the bottle attachment |
Safety features that prevent filling of the vaporizer with an incorrect agent include: agent-specific keyed filling ports
Modern vaporizers offer agent-specific keyed filling ports to prevent filling with an incorrect agent. The pin-index safety system is found on e-cylinders to prevent incorrect tank placement. pg. 66 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A person acting as an amicus curiae:
is not a party to the litigation gives expert testimony for the defense gives expert testimony for the plaintiff cannot file a written brief |
A person acting as an amicus curiae: is not a party to the litigation
Amicus curiae is a phrase that literally means 'friend of the court' -- someone who is not a party to the litigation, but who believes that the court's decision may affect its interest. An expert, not associated with either the defendant or plaintiff may, at the court's discretion, file a brief or give testimony to assist the court in decision making. "Amicus curiae." URL: http://en.wikipedia.org/wiki/Amicus_curiae |
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The first nurse anesthetist to be appointed to a university medical school faculty was:
Alice Maude Hunt Agatha Hodgen Helen Lamb Alice Magaw |
The first nurse anesthetist to be appointed to a university medical school faculty was: Alice Maude Hunt
In 1922, Alice Maude Hunt became an instructor in anesthesia at the Yale University School of Medicine and was later promoted to assistant professor. Hunt also pioneered the use of nitrous oxide and oxygen as an anesthetic modality. pg. 4 Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005. |
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Re-order the list of inhaled agents below from highest vapor pressure to lowest (Highest vapor pressure agent at top of list):
* Isoflurane * Sevoflurane * Nitrous Oxide * Desflurane |
Re-order the list of inhaled agents below from highest vapor pressure to lowest (Highest vapor pressure agent at top of list):
Vapor Pressure of Agents At 20o C, the highest vapor pressure of the inhaled agents is possessed by nitrous oxide (38,700 mm Hg), followed by desflurane (669 mm Hg), isoflurane (238 mm Hg) and sevoflurane (157 mm Hg). pg. 415 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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Pulmonary effects of α1-adrenergic stimulation include:
inhibition of hypoxic pulmonary vasoconstriction bronchodilation major changes in pulmonary vascular tone decreased bronchial secretions |
Pulmonary effects of α1-adrenergic stimulation include: decreased bronchial secretions
The tracheobronchial tree receives sympathetic innervation form the T1 - T4 nerve roots. β2 stimulation causes bronchodilation and decreased secretions. α1 stimulation causes decreased bronchial secretions and possible bronchoconstriction. Both α- and β-adrenergic receptors are present in the pulmonary vasculature, but seem to have little effect on pulmonary vascular tone. pg. 542 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Nervous system changes seen in the pregnant patient at term include: (Select 2)
increased minimum alveolar concentration increased sensitivity to local anesthetics decreased cerebrospinal fluid volume decreased cephalad spread of spinal anesthetics decreased epidural space pressure increased potential volume of the epidural space |
Nervous system changes seen in the pregnant patient at term include: increased sensitivity to local anesthetics, decreased cerebrospinal fluid volume
Nervous system effects of pregnancy include a decreased MAC, an increased sensitivity to local anesthetics, an increase in epidural blood volume, increased pressure of the epidural space and a decrease in spinal CSF volume. There is an increase in the cephalad spread of both spinal and epidural anesthetics. pg. 875 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Clinical signs of tension pneumothorax include:
contralateral absence of breath sounds ipsilateral hyporesonance to percussion neck vein distention all of the above |
Clinical signs of tension pneumothorax include: neck vein distention
A tension pneumothorax develops from air entering the pleural space through a one-way valve in the lung or chest wall. Clinical signs include ipsilateral absence of breath sounds, hyperresonance to percussion, contralateral tracheal shift and distended neck veins. pg. 868 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the:
hemorrhoidal veins pulmonary veins hepatic vein azygous vein |
Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the: hemorrhoidal veins
Chronic portal hypertension leads to the development of portal-systemic collateral channels. Four major collateral sites are commonly recognized: gastroesophageal, hemorrhoidal, periumbilical and retroperitoneal. pg. 793 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is:
phenoxybenzamine doxazosin propranolol terazosin |
A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: phenoxybenzamine
Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1-antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients with pheochromocytoma, α-blockade and intravascular volume replacement must precede β-blockade, so as to prevent the possibility of unopposed α-stimulation. pg. 1143 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the:
glomerulus loop of Henle proximal convoluted tubule distal convoluted tubule |
The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the: loop of Henle
The loop of Henle is responsible for formation of hypertonic fluid in the (renal) medullary interstitium via the countercurrent multiplier system. pg. 410 Stoelting, RK, Dierdorf, SF, McCammon, RL. Anesthesia and Co-Existing Disease. New York: Churchill Livingstone, 1988. |
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Sympathetic fibers to the kidney causing vasoconstriction arise from:
the vagus nerves C8 - T3 T4 - L1 L2 - S2 |
Sympathetic fibers to the kidney causing vasoconstriction arise from: T4 - L1
Nerve supply to the kidney is abundant; sympathetic constrictor fibers originate from T4 to L1 spinal segments. There is no sympathetic dilator or parasympathetic innervation. pp. 237-238 Duke, J. Anesthesia Secrets. Orlando: Elsevier, 2000. |
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MAC-BAR is the:
partial pressure of an anesthetic required to abolish movement in 50% of patients partial pressure of an anesthetic at which subjects will open their eyes partial pressure of an anesthetic at which autonomic blockade occurs partial pressure of an anesthetic at which amnesia occurs |
MAC-BAR is the: partial pressure of an anesthetic at which autonomic blockade occurs
MAC-BAR is the minimum alveolar concentration that blocks autonomic reflexes. MAC-BAR is considerably greater than MAC, particularly in the absence of opioids. pp. 29, 35, 93, 99-100 Eger, EI, Weiskopf, RB, and Eisenkraft, JB. The Pharmacology of Inhaled Anesthetics. San Antonio: Dannemiller Memorial Educational Foundation, 2006. |
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Local anesthetic solutions that are isobaric with the cerebrospinal fluid include:
tetracaine 0.5% in 5% dextrose bupivacaine 0.75% in normal saline procaine 10% in sterile water lidocaine 0.5% in sterile water |
Your response is correct.
Local anesthetic solutions that are isobaric with the cerebrospinal fluid include: bupivacaine 0.75% in normal saline Hyperbaric Tetracaine 0.5% in 5% dextrose Bupivacaine 0.75% in 8.25% dextrose Lidocaine 5% in 7.5% dextrose Procaine 10% in sterile water Isobaric Tetracaine 0.5% in normal saline Bupivacaine 0.75% in normal saline Lidocaine 2% in normal saline Hypobaric Tetracaine 0.2% in sterile water Bupivacaine 0.3% in sterile water Lidocaine 0.5% in sterele water pg. 939 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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Difficulty with mask ventilation is most reliably predicted by:
the presence of a beard a body mass index greater than 26 the lack of teeth a history of snoring |
Difficulty with mask ventilation is most reliably predicted by: the presence of a beard
Difficulty with mask ventilation is associated with the following (in decreasing order of probability of difficulty): presence of a beard, BMI > 26, lack of teeth, age > 55 and a history of snoring. pg. 756 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately:
0.03% 0.09% 0.3% 0.9% |
The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately: 0.09%
Percutaneous exposure (needle stick) carries a risk of HIV-seroconversion of approximately 0.3% or about 1:300. Mucous membrane exposure carries a risk of approximately 0.09% or about 1:1100. pg. 71 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:
with decreasing age by keeping the patient supine for more than 12 hours following puncture with the use of fluid, instead of air, for loss of resistance by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges |
The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased: with the use of fluid, instead of air, for loss of resistance
The use of fluid instead of air has been associated with a significant reduction in the incidence of postdural puncture headache (PDPH). Other factors associated with a reduced incidence of PDPH are: increasing age, insertion of the bevel aligned parallel to the long axis of the meninges and the use of smaller needles. There is no evidence that keeping the patient supine reduces the incidence of PDPH. pp. 947 - 948 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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Selective adrenergic stimulation of the β2-receptor results in:
increased heart rate increased insulin secretion detrusor muscle contraction pupilary constriction |
Selective adrenergic stimulation of the β2-receptor results in: increased insulin secretion
β2-receptor stimulation results in: increased insulin secretion, bronchodilation, increased salivary gland secretion, decreased upper GI motility, gluconeogenesis, pupilary dilation and detrusor muscle relaxation. Increased heart rate is a result of β1-receptor stimulation. Pupilary constriction (miosis) is the result of parasympathetic stimulation. pg. 243 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Allergic reactions are most commonly seen with the use of:
propofol barbiturates neuromuscular blockers local anesthetics |
Allergic reactions are most commonly seen with the use of: neuromuscular blockers
Muscle relaxants are responsible for more than 60% of drug-induced allergic reactions during the perioperative period. It is estimated that 50% of patients who experience allergic reactions to a muscle relaxant will also exhibit sensitivity to other muscle relaxants. The cross-sensitivity among this class of drugs is secondary to their structure similarities; specifically the presence of one or more antigenic quaternary ammonium groups. pg. 528 Hines, RL, and Marschall, KE. Stoelting's Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2008. |
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The most consistent clinical manifestation of aspiration pneumonitis is:
bronchospasm arterial hypoxemia pulmonary vasoconstriction tachypnea |
The most consistent clinical manifestation of aspiration pneumonitis is: arterial hypoxemia
Inhaled gastric fluid is rapidly distributed throughout the lungs, leading to destruction of surfactant-producing cells, damage to the pulmonary capillary endothelium and resultant atelectasis and pulmonary edema. Arterial hypoxemia is the most consistent clinical finding associated with aspiration pneumonitis. Tachypnea, bronchospasm and pulmonary vasoconstriction with secondary pulmonary hypertension may also be present. pg. 484 Hines, RL, and Marschall, KE. Stoelting's Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2008. |
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A full-term, 4.2 kg neonate is scheduled for a thoracotomy for resection of congenital lobar emphysema. The infant's starting hematocrit is 48%. Estimated allowable blood loss to maintain a hematocrit at or above 38% is:
50 ml 80 ml 90 ml 105 ml |
A full-term, 4.2 kg neonate is scheduled for a thoracotomy for resection of congenital lobar emphysema. The infant's starting hematocrit is 48%. Estimated allowable blood loss to maintain a hematocrit at or above 38% is: 105 ml
The full-term neonate has approximately 85 ml/kg total blood volume. Therefore: 4.2 kg x 85 ml/kg = 357 ml (blood volume) 357 ml x 48% = 171 ml (current red cell mass) 357 ml x 38% = 136 ml (allowable red cell mass) 171 ml - 136 ml = 35 ml (allowable red cell mass loss) 35 ml x 3 = 105 ml (allowable blood loss) pg. 696 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Hormones secreted by the neurohypophysis include:
ACTH TSH prolactin oxytocin |
Hormones secreted by the neurohypophysis include: oxytocin
The neurohypophysis is another term for the posterior pituitary gland. The hormones of the neurohypophysis, oxytocin and antidiuretic hormone (vasopressin), are synthesized in the hypothalamus and stored in the posterior pituitary. Stimulus for the release of these hormones arises from osmoreceptors in the hypothalamus that sense plasma osmolality. pg. 402 Hines, RL, and Marschall, KE. Stoelting's Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2008. |
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Pancreatic somatostatin producing cells in the Islets of Langerhans are:
alpha cells beta cells gamma cells delta cells |
Pancreatic somatostatin producing cells in the Islets of Langerhans are: delta cells
The Islets of Langerhans are comprised of three cell types: alpha cells producing glucagon, beta cells producing insulin and delta cells producing somatostatin. pg. 136 Stoelting, RK, and Dierdorf, SF. Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2002. |
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Carbonic anhydrase inhibitors are used in the treatment of:
acute glaucoma renal tubular acidosis diarrhea induced acidosis all of the above |
Carbonic anhydrase inhibitors
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Hypoxemia during one-lung anesthesia is most effectively treated by:
PEEP applied to the ventilated lung continuous oxygen insufflation to the collapsed lung changing tidal volume and rate periodic inflation of the collapsed lung |
Hypoxemia during one-lung anesthesia is most effectively treated by: periodic inflation of the collapsed lung
The application of PEEP to the ventilated lung, changes in the ventilatory parameters and oxygen insufflation to the collapsed lung may offer marginal improvement in oxygenation. However, periodic inflation of the collapsed lung with oxygen, early ligation of the ipsilateral pulmonary artery and CPAP to the collapsed lung offer consistently effective improvement in oxygenation. pg. 598 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Sympathetic blockade during acute herpes zoster has been shown to:
increase analgesic requirements reduce the incidence of postherpetic neuralgia increase the need for corticosteroid therapy be an effective treatment for patients who have had postherpetic neuralgia for a number of years |
Sympathetic blockade during acute herpes zoster has been shown to: reduce the incidence of postherpetic neuralgia
Sympathetic blockade within 2 months of the onset of herpes zoster has been shown to significantly reduce analgesic requirements and reduce the incidence of postherpetic neuralgia. Once the neuralgia is established however, blocks are usually ineffective. pg. 407 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Branches of the femoral nerve anesthetized during an ankle block include the:
deep peroneal nerve sural nerve saphenous nerve posterior tibial nerve |
Branches of the femoral nerve anesthetized during an ankle block include the: saphenous nerve
The saphenous nerve is the only branch of the femoral nerve innervating the foot. The four remaining nerves innervating the foot, the deep peroneal nerve, the posterior tibial nerve, the sural nerve and the superficial peroneal nerve, are all branches of the sciatic nerve. pg. 352 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is:
echinacea valerian ginko ephedra |
An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is: valerian
Both valerian and kava have been shown to have a GABA-mediated hypnotic effect and by this mechanism decrease MAC. pg. 9 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A decrease in pseudocholinesterase activity has been associated with the use of: (Select 3)
pancuronium esmolol droperidol vecuronium metoclopramide magnesium sulfate dantrolene rocuronium |
A decrease in pseudocholinesterase activity has been associated with the use of: pancuronium, esmolol, metoclopramide
The following drugs have been associated with a decrease in pseudocholinesterase activity: echothiophate, pyridostigmine, neostigmine, phenelzine, cyclophosphamide, metoclopramide, esmolol, pancuronium and oral contraceptives. Although both dantrolene and magnesium may alter the effects of neuromuscular blockers, neither causes inhibition of pseudocholinesterase. pg. 212 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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During the delivery of an anesthetic in the radiology department, full E-cylinders of nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is being delivered and the case has been proceeding for 60 minutes, the expected pressure in the nitrous oxide E-cylinder is:
372 psi 745 psi 1500 psi 2000 psi |
During the delivery of an anesthetic in the radiology department, full E-cylinders of nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is being delivered and the case has been proceeding for 60 minutes, the expected pressure in the nitrous oxide E-cylinder is: 745 psi
Nitrous oxide has a critical temperature of 37oC. This allow nitrous oxide to exist as a liquid at room temperature. Full E-cylinders of nitrous oxide contain approximately 1590 L at a pressure of 745 psi. A sixty minute delivery of 3 L/min would result in a 180 L consumption, and this would be inadequate to consume all the liquid nitrous oxide in the tank. As a result, there would be no change in tank pressure. pg. 20 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Characteristics of the dystrophic phase of complex regional pain syndrome type I include:
cold, sweaty skin severe osteoporosis with ankylosis of the joints localized severe throbbing pain inciting event that occurred 1 - 3 months earlier |
Characteristics of the dystrophic phase of complex regional pain syndrome type I include: cold, sweaty skin
Complex regional pain syndrome type I, previously known as reflex sympathetic dystrophy, is characterized by 3 phases: acute, dystrophic and atrophic. The dystrophic phase usually occurs 3 - 6 months after an inciting incident and is characterized by cold sweaty skin, some degree of muscle wasting with osteoporosis and pain that is described as diffuse and throbbing. pg. 406 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome |
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An action potential characterized by a spike followed by a plateau phase is seen in:
peripheral sensory nerve cells peripheral motor nerve cells striated skeletal muscle cells cardiac muscle cells |
An action potential characterized by a spike followed by a plateau phase is seen in: cardiac muscle cells
In contrast to the action potentials of nerve and skeletal muscle cells, the action potential of the cardiac myocyte is characterized by a sharp spike followed by a plateau phase (2), which results from the opening of slower calcium channels. pg. 415 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Autonomic hyperreflexia:
is common with cord lesions below T6 can precipitate pulmonary edema is not effectively prevented by regional anesthesia can be prevented by adequate intraoperative sedation |
Autonomic hyperreflexia: can precipitate pulmonary edema
Autonomic hyperreflexia should be suspected in patients with lesions above T6. Regional anesthesia and deep general anesthesia are effective in preventing autonomic hyperreflexia. Surgical stimulation in these patients without adequate anesthesia can result in pulmonary edema, myocardial ischemia and cerebral hemorrhage. pg. 655 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. The most common cause of autonomic hyperreflexia is spinal cord injury. This is generally in patients with a spinal cord injury above the T6 level, but can occur in patients with a transection as low as T10 level. When a painful stimulus occurs, nerve impulses are sent to the brain via the spinal cord. However, in spinal cord transection, these impulses are unable to travel past the injury. This results in a spinal cord reflex to the sympathetic nervous system in response to pa |
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During placement of a lumbar epidural using a midline approach, the needle passes through the: (Select 3)
interspinous ligament anterior longitudinal ligament intervertebral disk supraspinous ligament ligamentum flavum facet joint |
During placement of a lumbar epidural using a midline approach, the needle passes through the: supraspinous ligament, intraspinous ligament, ligamentum flavum
Passing anteriorly from the skin to the epidural space are the following structures: skin, subcutaneous tissue, supraspinous ligament, intraspinous ligament, ligamentum flavum. pp. 292 - 293 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Interpleural analgesia can be accomplished by placing local anesthetic:
along the cephalad border of the T6 rib immediately deep to the parietal pleura immediately deep to the visceral pleura superficial to the internal intercostal muscle |
Interpleural analgesia can be accomplished by placing local anesthetic: immediately deep to the parietal pleura
Interpleural analgesia is accomplished by placing an catheter between the parietal and visceral pleura. A loss-of-resistance technique is most commonly used at the T6 to T8 intercostal spaces. Pneumothorax is a significant complication if the needle or catheter penetrates the visceral pleura. pg. 410 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In the CVP trace below, the v wave is caused by:
atrial contraction ventricular contraction atrial filling opening of the tricuspid valve |
In the CVP trace below, the v wave is caused by: atrial filling
In the normal CVP tracing, the a wave is due to atrial systole. The c wave coincides with ventricular contraction. The v wave is the result of atrial filling prior to the opening of the tricuspid valve. The x descent is thought to be due to the pulling down of the atrium by ventricular contraction. The y descent corresponds to the opening of the tricuspid valve. pg. 420 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by:
free acetate anion choline acetyltransferase acetyl cholinesterase pseudocholinesterase |
The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by: choline acetyltransferase
The synthesis of acetylcholine occurs in the cholinergic nerve terminal. Acetyl Co-A and choline combine to form acetylcholine. This reaction is catalyzed by the enzyme choline acetyltransferase. pp. 227 - 228 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The primary causative factor in the development of persistent pulmonary hypertension (PPH) in the neonate is:
cystic fibrosis pregnancy-induced hypertension hypoxemia right-to-left shunting through a patent ductus arteriosus |
The primary causative factor in the development of persistent pulmonary hypertension (PPH) in the neonate is: hypoxemia
Hypoxia or acidosis during the early neonatal period may predispose the infant to return to fetal circulation. This serious condition, previously known as persistent fetal circulation (PFC), is currently known as persistent pulmonary hypertension (PPH). Hypoxemia and/or acidosis promotes an increase in pulmonary vascular resistance which ultimately causes right to left shunting through the ductus arteriosus, foramen ovale, or both. Shunting causes continued hypoxemia, leading to a continued increase in pulmonary vascular resistance, and a vicious cycle ensues. Primary causes of hypoxemia in the neonate include pneumonia and meconium aspiration. pg. 887 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Prior to pneumonectomy, split lung function testing is indicated in the patient with:
an FEV1 of 2.2 L a PaCO2 of 49 mm Hg on room air a PaO2 of 54 mm Hg on room air a maximum VO2 of 17 mL/kg/min |
Prior to pneumonectomy, split lung function testing is indicated in the patient with: a PaCO2 of 49 mm Hg on room air
Split lung function testing is indicated in patients requiring pneumonectomy, but not meeting the recommended laboratory criteria. Current recommendations for patients requiring pneumonectomy are: * PaCO2 < 45 mmHg * FEV1 > 2 L * Predicted postop FEV1 > 800 mL * Maximum VO2 > 10 mL/kg/min * FEV1/FVC > 50% of predicted pg. 595 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Mechanisms of renal compensation during acidosis include:
decreased reabsorption of filtered bicarbonate decreased excretion of hydrogen ions increased production of ammonia increased elimination of carbon dioxide |
Mechanisms of renal compensation during acidosis include: increased production of ammonia
The renal response to acidemia is: * increased reabsorption of bicarbonate anion * increased excretion of hydrogen ion in the form of titratable acids * increased production of ammonia Although increased carbon dioxide elimination is a compensatory mechanism in acidemia, it is accomplished by increased alveolar ventilation. pg. 713 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Postintubation croup:
is secondary to inflammation at the level of the cricoid is less common when cuffed endotracheal tubes are used occurs most frequently in infants less than 4 months of age is most often seen immediately upon extubation |
Postintubation croup: is secondary to inflammation at the level of the cricoid
Postintubation croup usually occurs at the level of the cricoid, since this is the narrowest part of the pediatric airway. Croup is less common with endotracheal tubes that are uncuffed and small enough to allow a gas leak at 10 - 25 cm H2O. Postintubation croup is associated with early childhood (1 - 4 years). Unlike laryngospasm, postintubation croup is seen some time after extubation, usually within 3 hours. pg. 939 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Closing capacity is defined as:
closing volume + expiratory reserve volume functional residual capacity - residual volume closing volume + residual volume residual volume + expiratory reserve volume |
Closing capacity is defined as: closing volume + residual volume
Closing capacity is the lung volume at which airways begin to close and is defined as the closing volume + residual volume. pp. 546 - 547 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. The closing capacity (CC) is the volume in the lungs at which its smallest airways, the alveoli collapse. The alveoli lack supporting cartilage and so depend on other factors to keep them open. The closing capacity is usually less than the residual volume (RV), the amount of gas that normally remains in the lungs during respiration. This means that there is normally enough air within the lungs to keep these airways open throughout both inhalation and exhalation. As the lungs age, there is a gradual increase in the closing capacity. This also occurs with certain disease processes, such as asthma, chronic obstructive pulmonary disease, and pulmonary edema. Any |
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What is the effect of aminoglycosides on nondepolarizing neuromuscular blockers?
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They inhibit ACh release, and post synaptic ACh response at the neuromuscular junction.
IV Calcium gluconate or neostigmine may be used to over come aminoglucosides effects at the neuromuscular junction. |
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Dantrolene: (Select 2)
depends on an extracellular mechanism to achieve muscle relaxation inhibits calcium ion release from the sarcoplasmic reticulum can also be used in the treatment of thyroid storm therapy should not be repeated after an MH episode has terminated has a half-life of approximately 12 hours |
Dantrolene: inhibits calcium ion release from the sarcoplasmic reticulum, can be used in the treatment of thyroid storm
Dantrolene binds with the Ryr1 receptor and inhibits calcium ion release from the sarcoplasmic reticulum. Dantrolene's effects are intracellular and may result in muscle weakness and ventilatory insufficiency. The half-life of dantrolene is approximately 6 hours. Dantrolene has also been used to treat neuroleptic malignant syndrome and thyroid storm. pg. 947 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Renal effects of nitrous oxide include:
decreased renal blood flow secondary to decreased cardiac output decreased renal blood flow secondary to increased renal vascular resistance increased renal blood flow secondary to sympathetic stimulation increased glomerular filtration with increased reabsorption |
Renal effects of nitrous oxide include: decreased renal blood flow secondary to increased renal vascular resistance
Nitrous oxide appears to decrease renal blood flow by increasing renal vascular resistance. This results in decreased glomerular filtration and decreased urine output. pg. 164 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The elimination half-life of a drug:
is inversely proportional to the clearance is inversely proportional to the volume of distribution is directly proportional to clearance is shortest in drugs that are rapidly redistributed |
The elimination half-life of a drug: is inversely proportional to the clearance
The elimination half-life of a drug is proportional to the volume of distribution and inversely proportional to the rate of clearance. pg. 182 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Effects of lidocaine include:
increased intracranial pressure increased refractory period of cardiac muscle decreased fibrinolysis lytic degeneration, edema and necrosis of skeletal muscle |
Effects of lidocaine include: lytic degeneration, edema and necrosis of skeletal muscle
Intravenous lidocaine decreases cerebral blood flow unless seizure activity develops. Lidocaine decreases the refractory period of cardiac muscle and decreases platelet aggregation while enhancing fibrinolysis. Local anesthetics have been shown to cause lytic degeneration and necrosis of muscle fibers when directly injected into the muscle (trigger point injections). pp. 270, 271, 274 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Correct statements concerning the use of antidepressants in pain management include:
analgesic effects require a higher dose than that needed for antidepression analgesic effects appear to be secondary to the blockade of serotonin and norepinephrine reuptake antidepressants are not effective in neuropathic pain newer SSRIs are more effective analgesics than the older tricyclic antidepressants |
Correct statements concerning the use of antidepressants in pain management include: analgesic effects appear to be secondary to the blockade of serotonin and norepinephrine reuptake
Antidepressants demonstrate an analgesic effect at doses lower that those needed for antidepressant effect. Both actions appear secondary to the block of the reuptake of serotonin and norepinephrine. Older tricyclic antidepressants seem more effective analgesics than the newer SSRIs. Antidepressants are most useful in patients with neuropathic pain. pg. 389 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The dibucaine number:
is normally less than 60% is a quantitative assessment of pseudocholinesterase activity is inversely proportional to pseudocholinesterase function reflects inhibition of pseudocholinesterase by dibucaine |
The dibucaine number: reflects inhibition of pseudocholinesterase by dibucaine
Dibucaine, a local anesthetic, inhibits normal pseudocholinesterase. Homozygous patients with abnormal pseudocholinesterase characteristically have a dibucaine number of about 20%, heterozygous patients have numbers of 40 - 60% and normal patients usually have a dibucaine number of 80%. The dibucaine number is proportional to pseudocholinesterase function, but is independent of the amount of the enzyme. pg. 212 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The body mass index (BMI) associated with extreme obesity is:
> 30 > 35 > 40 > 45 |
The body mass index (BMI) associated with extreme obesity is: > 40
Overweight and obesity are classified using the BMI. Overweight is defined as a BMI > 24, obesity as a BMI > 30 and extreme obesity as a BMI > 40. BMI is calculated with the following formula: BMI = Weight (kg) / Height (meters)2 pg. 813 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Release of aldosterone by the adrenal cortex is stimulated by: (select 3)
angiotensin I angiotensin II hypokalemia pituitary ACTH congestive heart failure hypervolemia |
Release of aldosterone by the adrenal cortex is stimulated by: angiotensin II, pituitary ACTH, congestive heart failure
Aldosterone release is stimulated by the renin-angiotensin system, but specifically by angiotensin II. Other causes of aldosterone release include hyperkalemia, ACTH release, hypovolemia, hypotension, CHF and the stress response. pg. 811 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 36-year-old female is scheduled for an elective cholecystectomy. Her past medical history is significant for depression treated with phenelzine (Nardil). Her anesthetic plan should include: (Select 2)
discontinuation of phenelzine for at least 2 weeks prior to surgery the avoidance of indirect acting vasopressors the avoidance of propofol the avoidance of meperidine the avoidance of nitrous oxide the avoidance of volatile anesthetic agents |
A 36-year-old female is scheduled for an elective cholecystectomy. Her past medical history is significant for depression treated with phenelzine (Nardil). Her anesthetic plan should include: the avoidance of meperidine, the avoidance of indirect acting vasopressors
Phenelzine is a monamine oxidase (MAO) inhibitor. The practice of discontinuing MAO inhibitors prior to surgery is no longer recommended. The use of meperidine in patients receiving MAO inhibitors has been associated with hypertensive crisis and should be avoided. Additionally, indirect acting vasopressors have also been associated with hypertensive crisis and direct acting vasopressors should be used to treat hypotension. pg. 657 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Neuroleptic malignant syndrome:
can be precipitated with the use of metoclopramide carries a mortality of over 80% can be treated with physostigmine administration can be diagnosed with muscle biopsy |
Neuroleptic malignant syndrome: can be precipitated with the use of metoclopramide
Neuroleptic malignant syndrome is a rare complication of antipsychotic therapy. Meperidine and metoclopramide can also precipitate the disorder which appears to be secondary to dopamine blockade in the basal ganglia. The disease has many characteristics in common with MH including increased temperature, metabolic derangement and hyperthermia. The mortality is 20 - 30%. Treatment with dantrolene and dopamine agonist, bromocripitine, appears effective. pg. 658 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The most common complication of thoracic paravertebral nerve block is:
hypotension subarachnoid injection pneumothorax intravascular injection |
The most common complication of thoracic paravertebral nerve block is: pneumothorax
Pneumothorax is the most common complication of paravertebral block and a chest radiograph is needed upon completion of the block. Other complications include subarachnoid injection, epidural injection, intravascular injection, and hypotension. pg. 381 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The number of dichotomous divisions of the tracheobronchial tree from the trachea to the alveolar sacs is approximately:
9 15 23 31 |
The number of dichotomous divisions of the tracheobronchial tree from the trachea to the alveolar sacs is approximately: 23
Dichotomous division, each branch dividing into two smaller branches, of the tracheobronchial tree is estimated to involve 23 divisions. pg. 539 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Anesthetic management of the patient with the pressure-volume loop shown below (yellow) should include:
maintenance of a heart rate of < 50 spinal or epidural anesthesia if possible vasodilator therapy treatment of hypotension with phenylephrine |
Anesthetic management of the patient with the pressure-volume loop shown below (yellow) should include: treatment of hypotension with phenylephrine
This pressure-volume loop is indicative of aortic stenosis. Patients with severe aortic stenosis have a fixed stroke volume and cardiac output is rate dependent. Both tachycardia and bradycardia are poorly tolerated. Vasodilation from regional anesthesia or volatile agent may precipitate severe hypotension. Treatment of hypotension should be prompt and accomplished with small doses of an alpha-stimulant such as phenylephrine. pg. 474 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The largest fraction of carbon dioxide in the blood is in the form of:
carbamino compounds bicarbonate dissolved gas carboxyhemoglobin |
The largest fraction of carbon dioxide in the blood is in the form of: bicarbonate
Nearly 90% of carbon dioxide in the blood is in the form of bicarbonate. pg. 565 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 42-year-old man is undergoing a thoracoscopy. During the procedure an 8-minute period of apneic oxygenation is required. If the patient's PaCO2 is 40 mmHg, the expected PaCO2 at the end of the apneic period would be:
(Enter numerical answer in box below. Click 'Next' when completed.) mmHg |
A 42-year-old man is undergoing a thoracoscopy. During the procedure an 8-minute period of apneic oxygenation is required. If the patient's PaCO2 is 40 mmHg, the expected PaCO2 at the end of the apneic period would be: 67 to 74 mmHg
The apneic oxygenation technique affords adequate oxygen delivery, but progressive respiratory acidosis limits the use of this technique to 10 - 20 minutes in most patients. Arterial PaCO2 rises 6 mmHg in the first minute followed by a rise of 3 - 4 mmHg during each subsequent minute. In this patient this will produce a 27 - 34 mmHg increase, resulting in a PaCO2 of 67 to 74 mmHg. pg. 599 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Stimulation of the parasympathetic nervous system results in:
far vision accommodation increased inotropy increased insulin secretion contraction of the urinary sphincter |
Stimulation of the parasympathetic nervous system results in: increased insulin secretion
Insulin secretion is increased by stimulation of the parasympathetic nervous system through the vagus nerves. pg. 229 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The formation clinically significant amounts of carbon monoxide has been associated with:
the use of a non-rebreathing circuit the use of fresh carbon dioxide absorber the use of desflurane expiratory valve incompetence |
The formation clinically significant amounts of carbon monoxide has been associated with: the use of desflurane
The formation of CO depends on the use of a volatile agent containing a difluoromethoxy moiety (desflurane, isoflurane, enflurane). This moiety can react with desiccated base (baralime or sodalime) to form CO. Fresh absorber has sufficient water to prevent the reaction. Clinically, CO intoxication occurs after a weekend when the flow of dry oxygen in the machine has desiccated the absorber and desflurane is being used. Anesthesiology. 89(4):929-941, October 1998. Baxter, Pamela J. PhD; Garton, Kyle BS; Kharasch, Evan D. MD, PhD |
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In the flow-volume loops below, restrictive lung disease is best represented by
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In the flow-volume loops below, restrictive lung disease is best represented by: D
Restrictive disease is best represented by flow-volume loop D, which demonstrates reductions in TV, TLC and FRC. pp. 24 - 25 Starr, M. Anesthesiology Boards: A Survival Guide. Philadelphia: Churchill Livingstone, 2000. |
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The essential component of cardioplegia solutions is:
mannitol magnesium potassium corticosteroid |
The essential component of cardioplegia solutions is: potassium
High concentrations of potassium (10 - 40 mEq/L) are used in cardioplegia solutions. These solutions result in an increase in extracellular potassium and reduce transmembrane potential. This progressively interferes with the normal sodium currents of depolarization and eventually the sodium channels are completely inactivated. pg. 495 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Forms of mechanical ventilation that produce tidal volumes at or below anatomic dead space include: (Select 2)
high-frequency oscillation inverse I:E ratio ventilation airway pressure release ventilation differential lung ventilation high-frequency positive-pressure ventilation pressure support ventilation |
Forms of mechanical ventilation that produce tidal volumes at or below anatomic dead space include: high-frequency oscillation, high-frequency positive-pressure ventilation
High-frequency oscillation (HFO) creates a to-and-fro gas movement in the airway at rates of 180 - 3000 times/min. High frequency positive-pressure ventilation is delivered at a rate of 60 - 120 breaths/min. Tidal volume is at or below anatomic dead space. High-frequency ventilation techniques may be useful in cases of bronchopleural and tracheoesophageal fistulas. pp. 1034 - 1035 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In the absence of hypoxia or severe anemia, the best determinant of the adequacy of cardiac output is:
cardiac output cardiac index mixed venous oxygen tension arterial oxygen content |
In the absence of hypoxia or severe anemia, the best determinant of the adequacy of cardiac output is: mixed venous oxygen tension
Both cardiac output and cardiac index have a wide range and may not reflect the adequacy of cardiac output against metabolic requirements. During periods of increased oxygen consumption, mixed venous oxygen tension is the best indicator of the adequacy of cardiac output. pg. 420 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Pulmonary changes associated with Duchenne's muscular dystrophy include:
a restrictive ventilatory defect an obstructive ventilatory defect decreased pulmonary artery pressures increased residual volume |
Pulmonary changes associated with Duchenne's muscular dystrophy include: a restrictive ventilatory defect
The combination of marked kyphoscoliosis and degeneration of the respiratory muscles produces a severe restrictive ventilatory defect in patients with Duchenne's muscular dystrophy. Pulmonary hypertension is also commonly seen. pg. 820 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Pulmonary changes associated with Duchenne's muscular dystrophy include:
a restrictive ventilatory defect an obstructive ventilatory defect decreased pulmonary artery pressures increased residual volume |
Pulmonary changes associated with Duchenne's muscular dystrophy include: a restrictive ventilatory defect
The combination of marked kyphoscoliosis and degeneration of the respiratory muscles produces a severe restrictive ventilatory defect in patients with Duchenne's muscular dystrophy. Pulmonary hypertension is also commonly seen. pg. 820 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 46-year-old male is scheduled for an emergent laparotomy for small bowel obstruction. His history is complicated by the acute onset of hepatitis B four days earlier and he presents with significant scleral jaundice. The perioperative mortality in this patient is approximately:
2% 5% 10% 25% |
A 46-year-old male is scheduled for an emergent laparotomy for small bowel obstruction. His history is complicated by the acute onset of hepatitis B four days earlier and he presents with significant scleral jaundice. The perioperative mortality in this patient is approximately: 10%
Patients with acute hepatitis should have elective surgery postponed until the acute hepatitis has resolved. Studies indicate increased perioperative morbidity (12%) and mortality (10% with laparotomy) during acute hepatitis. pg. 791 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In the pressure-volume loop below, cardiac work is best represented by:
the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D |
In the pressure-volume loop below, cardiac work is best represented by: the area of the curve
Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop. pp. 873 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Current anesthesia apparatus checkout recommendations suggest which of the following prior to every case?
Check oxygen cylinder supply Check the carbon dioxide absorber Performance of a machine low-pressure leak test Calibration of the oxygen monitor |
Current anesthesia apparatus checkout recommendations suggest which of the following prior to every case? Check the carbon dioxide absorber
Verification of the adequacy of the carbon dioxide absorber is suggested prior to every case. If the same anesthesia machine is being used by the same provider, E-cylinder pressure checks, machine low-pressure leak testing and calibration of the oxygen sensor need not be repeated after an initial check. pp. 88 - 89 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of:
13 - 15 9 - 12 6 - 9 less than 6 |
According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of: 9 - 12
According to the Modified Glasgow Coma scale, mild head injury is associated with a score of 13 - 15, moderate head injury is associated with a score of 9 - 12, and severe head injury is associated with a score of less than 8. pg. 782 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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The addition of bicarbonate to a local anesthetic solution:
delays the onset of blockade increases the concentration of the nonionic form of the local anesthetic causes a fall in the pH of the solution should only be done when using bupivacaine |
The addition of bicarbonate to a local anesthetic solution: increases the concentration of the nonionic form of the local anesthetic
The onset of neural blockade depends on the penetration of the nerve cell membrane by the nonionic form of the anesthetic. Increasing the pH of the anesthetic solution increases the concentration of the nonionic form and thereby hastens the onset of the block. Bicarbonate is usually not added to bupivacaine, since it can cause precipitation if the pH is raised above 6.8. pg. 314 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Factors increasing the affinity of hemoglobin for oxygen include: (Select 2)
increased carbon dioxide levels increased 2,3-DPG levels increased pH the presence of fetal hemoglobin increased body temperature the presence of hemoglobin-S |
Factors increasing the affinity of hemoglobin for oxygen include: increased pH, presence of fetal hemoglobin
Factors that increase the affinity of hemoglobin for oxygen would cause a leftward shift of the hemoglobin dissociation curve and a decrease in the P50. These factors include alkalosis, decreased CO2 levels, and decreased 2,3-DPG levels. Hemoglobin-S, found in patients with sickle cell disease, has a decreased affinity for oxygen. Fetal hemoglobin, however, has an increased affinity for oxygen to help in oxygen transfer from the mother to the fetus. pp. 562, 704, 880 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In the figure below, inspiratory capacity is best represented by:
A A + tidal volume B B + tidal volume |
In the figure below, inspiratory capacity is best represented by: A + tidal volume
Inspiratory capacity is the sum of the inspiratory reserve volume (A) and the tidal volume. B represents the expiratory reserve volume, C represents the FRC, D represents the residual volume, E represents the vital capacity and F represents the total lung volume. pg. 546 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Laminar flow in the airway occurs in the: (Select 2)
trachea main stem bronchi terminal bronchiole 3rd generation bronchus respiratory bronchiole |
Laminar flow in the airway occurs mostly in the: terminal bronchiole, respiratory bronchiole
Flow in the larger airways is mostly turbulent. Laminar flow normally occurs only distal to small bronchioles (< 1mm). The Reynolds number is used to predict the type of airway flow; a low Reynolds number (< 1000) is associated with laminar flow, whereas a high value (> 1500) is associated with turbulent flow. pg. 548 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Sickle hemoglobin: (Select 2)
has a lower P50 than hemoglobin A releases oxygen less readily than hemoglobin A is present in about 30% of African Americans readily polymerizes and precipitates in the red cell results from a single amino acid substitution on the α-chain has decreased solubility as compared to hemoglobin A |
Sickle hemoglobin: readily polymerizes and precipitates in the red cell, has decreased solubility as compared to hemoglobin A
Sickle hemoglobin (HbS) has a lower affinity for oxygen and an elevated P50 (31 mmHg) as compared to hemoglobin A (27 mmHg). HbS also has decreased solubility and readily polymerizes and precipitates in the red cell producing the sickled appearance of the cell. HbS results from the substitution of valine for glutamic acid on the β-chain. pg. 704 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is:
phenoxybenzamine doxazosin propranolol terazosin |
A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: phenoxybenzamine
Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1-antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients with pheochromocytoma, α-blockade and intravascular volume replacement must precede β-blockade, so as to prevent the possibility of unopposed α-stimulation. pg. 1143 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Average blood loss during a vaginal delivery is:
100 - 200 ml 400 - 500 ml 700 - 800 ml 1000 - 1500 ml |
Average blood loss during a vaginal delivery is: 400 - 500 ml
At term, blood volume has increased by 1000 - 1500 ml in most women allowing them to easily tolerate the blood loss associated with delivery. Average blood loss during vaginal delivery is 400 - 500 ml, compared with 800 - 1000 ml for cesarean section. pg. 876 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Absolute contraindications to the use of epidural anesthesia in the parturient include: (Select 2)
inability of the patient to cooperate herniated lumbar disc multiple sclerosis patient refusal history of previous cesarean section aortic regurgitation |
Absolute contraindications to the use of epidural anesthesia in the parturient include: inability of the patient to cooperate, patient refusal
Absolute contraindications to epidural anesthesia/analgesia in the parturient include infection over the injection site, coagulopathy, thrombocytopenia, marked hypovolemia, true local anesthetic allergy, patient refusal and inability of the patient to cooperate. Preexisting neurological disease and back disorders are relative contraindications. Patients with aortic regurgitation usually benefit from the reduction in afterload seen after neuraxial anesthesia. pp. 896, 477 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Basal metabolic oxygen consumption in a 20 kg patient is approximately:
50 ml/min 95 ml/min 150 ml/min 250 ml/min |
Basal metabolic oxygen consumption in a 20 kg patient is approximately: 95 ml/min
Basal metabolic oxygen consumption can be estimated using the following formula: pg. 175 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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An increase in the plasma concentration and a prolongation of the elimination half-life of etomidate is seen with the concomitant administration of:
midazolam rocuronium fentanyl succinylcholine |
An increase in the plasma concentration and a prolongation of the elimination half-life of etomidate is seen with the concomitant administration of: fentanyl
Fentanyl has been shown to increase the plasma level of etomidate as well as prolong the elimination half-life of the drug. pg. 200 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Disodium edetate or sodium metabisulfite is added to formulations of propofol to:
enhance drug solubility adjust pH inhibit bacterial growth increase drug potency |
Disodium edetate or sodium metabisulfite is added to formulations of propofol to: inhibit bacterial growth
Current formulations of propofol contain 0.005% disodium edetate or 0.025% sodium metabisulfite to help retard the rate of microorganism growth. pg. 201 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of:
20 cmH2O 50 cmH2O 25 psi 50 psi |
During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of: 50 psi
After proper location of the catheter is confirmed by aspiration air, jet ventilation may be achieved with intermittent pulses of oxygen at 50 psi. pg. 983 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Sensory innervation of the trachea and larynx below the vocal cords is supplied by the:
internal laryngeal nerve external laryngeal nerve recurrent laryngeal nerve glossopharyngeal nerve |
Sensory innervation of the trachea and larynx below the vocal cords is supplied by the: recurrent laryngeal nerve
The vagus nerve provides sensation to the airway below the epiglottis. The superior laryngeal branch of the vagus divides into an external (motor) and internal (sensory) laryngeal nerve that provide sensory supply to the larynx between the epiglottis and the vocal cords. Another branch of the vagus, the recurrent laryngeal nerve, innervates the larynx below the vocal cords and trachea. pg. 92 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 24-year-old female is scheduled for resection of a cerebral aneurysm. She has no other significant past medical history. Acceptable levels of hypotension would include a mean arterial pressure of:
20 - 30 mmHg 35 - 45 mmHg 50 - 60 mmHg 90 - 100 mmHg |
A 24-year-old female is scheduled for resection of a cerebral aneurysm. She has no other significant past medical history. Acceptable levels of hypotension would include a mean arterial pressure of: 50 - 60 mmHg
Healthy young individuals tolerate mean arterial pressures as low as 50 - 60 mmHg without complications. Chronically hypertensive patients have altered autoregulation of cerebral blood flow and may tolerate a mean arterial pressure of no more than 20 - 30% below baseline. pg. 262 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Correct statements concerning the use of benzodiazepines in the elderly include:
volume of distribution is increased reduced pharmacodynamic sensitivity is observed the elimination half-life of diazepam, but not midazolam, is increased all of the above |
volume of distribution is increased
Aging increases the volume of distribution for all benzodiazepines, effectively prolonging their elimination half-lives. Enhanced pharmacodynamic sensitivity is also observed. The elimination half-lives of both diazepam and midazolam are increased. pg. 956 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The cardiovascular effects of pancuronium are caused by: (Select 3)
vagal blockade stimulation of cardiac muscarinic receptors ganglionic stimulation decreased catacholamine reuptake direct myocardial stimulation blockade of cardiac slow calcium channels central thalamic stimulation |
The cardiovascular effects of pancuronium are caused by: vagal blockade, ganglionic stimulation, decreased catecholamine reuptake
The cardiovascular effects of pancuronium are caused by the combination of vagal blockade and sympathetic stimulation. The latter is due to a combination of ganglionic stimulation, catecholamine release and decreased catecholamine reuptake. pp. 222 - 223 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Anesthetic implications of multiple sclerosis include:
exacerbation induced by spinal anesthesia exacerbation induced by epidural anesthesia exacerbation of symptoms secondary to hypothermia all of the above |
Anesthetic implications of multiple sclerosis include: exacerbation induced by spinal anesthesia
Spinal anesthesia has been reported to cause exacerbation of the disease. Epidural and other regional techniques appear to have no adverse effect, especially in obstetrics. Demyelinated nerve fibers are extremely sensitive to hyperthermia, but conduction is usually improved by mild hypothermia. pg. 653 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Ulnar nerve injury:
results in wrist drop and loss of sensation in the web space between the thumb and index finger occurs more frequently in males manifests itself in the immediate postoperative period is most commonly seen in the patient with a BMI of less than 38 |
Ulnar nerve injury: occurs more frequently in males
Three attributes which are highly associated with development of postoperative ulnar nerve injury are: 1) male sex - various reports suggest that 70-90% of patients with postoperative ulnar neuropathy are men 2) high body mass index - BMI > or = 38 3) prolonged postoperative bed rest. Many patients with postoperative ulnar neuropathy have a high frequency of contralateral ulnar nerve dysfunction, suggestive of a pre-existing abnormality. Patients may not develop symptoms of ulnar neuropathy until more than 48 hours postoperatively. Wrist drop and loss of sensation of the web space between the thumb and index finger are associated with radial nerve injury. pp. 650 - 651 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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The potency of local anesthetics increases as the:
lipid solubility increases pKA increases protein binding increases molecular weight decreases |
The potency of local anesthetics increases as the: lipid solubility increases
Local anesthetic potency correlates directly with lipid solubility. In general, lipid solubility increases with an increase in the total number of carbon atoms in the molecule and by adding a halogen to the aromatic ring. pg. 265 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Topically applied ophthalmic medications are absorbed:
as quickly as intravenous administration more quickly than subcutaneous administration only minutely, with insignificant clinical effect directly into the central nervous system through the optic nerve foramen |
Topically applied ophthalmic medications are absorbed: more quickly than subcutaneous administration
Topically applied ophthalmic medications are absorbed at a rate intermediate between intravenous and subcutaneous injection. Children and the elderly are at particular risk for the toxic effects of topically applied medications. pg. 829 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Correct location of the catheter tip of a central venous line is in the:
superior vena cava right atrium right ventricle pulmonary artery |
Correct location of the catheter tip of a central venous line is in the: superior vena cava
The CVP catheter tip should not be allowed to migrate into the heart chamber to avoid arrhythmias and perforation. pg. 132 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Physiologic effects of electroconvulsive therapy (ECT) include an:
initial sympathetic response with sustained tachycardia initial sympathetic discharge followed by a sustained parasympathetic response initial parasympathetic discharge followed by a sustained sympathetic response initial parasympathetic response with sustained bradycardia |
Physiologic effects of electroconvulsive therapy (ECT) include an: initial parasympathetic discharge followed by a sustained sympathetic response
An initial parasympathetic discharge followed by a sustained sympathetic response is immediately seen after the induction of a seizure. Marked bradycardia with increased secretions can occur, which is then followed by hypertension and tachycardia. Patients scheduled for ECT are routinely given anticholinergic medication preoperatively. pg. 659 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The postretrobulbar block apnea syndrome:
is likely secondary to intravascular injection most commonly occurs during or immediately after injection is associated with unconsciousness carries a high morbidity and mortality |
The postretrobulbar block apnea syndrome: is associated with unconsciousness
The postretrobulbar block apnea syndrome is probably due to injection of local anesthetic into the optic nerve sheath, with spread into the CSF. The CNS is exposed to high concentrations of local anesthetic leading to apprehension and unconsciousness. Apnea occurs within 20 minutes and resolves within an hour. Treatment is supportive. pg. 832 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant for third degree heart block treated with a permanent pacemaker. Problems with electrocautery use in this patient can be minimized by:
placing the grounding pad near the pacemaker using infrequent bursts of longer duration the use of a bipolar cautery all of the above |
A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant for third degree heart block treated with a permanent pacemaker. Problems with electrocautery use in this patient can be minimized by: the use of a bipolar cautery
Electrical interference from the electrocautery can be interpreted by the pacemaker as myocardial activity and suppress pacemaker activity. These problems can be minimized by limiting use to short bursts, placing the grounding pad as far from the pacemaker as possible and using a bipolar cautery. pg. 488 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from:
T5 - T8 T9 - T12 L1 - L2 L4 - S1 |
The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from:T9 - T12
A major complication of thoracic aortic surgery is paraplegia, occurring in 6% of cases, and is secondary to spinal cord ischemia. The arteria radicularis magna supplies blood to the anterior spinal artery. The arteria radicularis magna has a variable origin from aorta, arising between T5 - T8 in 15%, between T9 - T12 in 60% and between L1 - L2 in 25% of individuals. pg. 530 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The most common acid-base abnormality in the critically ill patient is:
metabolic acidosis respiratory acidosis metabolic alkalosis respiratory alkalosis |
oligohydramnios
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The perception of an ordinarily non-noxious stimulus as pain is referred to as:
allodynia anesthesia dolorosa dysethesia hyperalgesia |
The perception of an ordinarily non-noxious stimulus as pain is referred to as: allodynia
Allodynia is the perception of non-noxious stimuli as pain. Dysesthesia is an unpleasant sensation without a stimulus. Hyperesthesia is an increased response to a mild stimulus. Anesthesia dolorosa is pain in an area that lacks sensation. pg. 361 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Cholinesterase inhibitors that freely cross the blood-brain barrier include: physostigmine
Physostigmine is a teritary amine and has a carbamate group, but no quaternary ammonium. Therefore, it is lipid soluble and is the only clinically available cholinesterase inhibitor that freely passes the blood-brain barrier. pg. 235 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
Cholinesterase inhibitors that freely cross the blood-brain barrier include:
neostigmine pyridostigmine physostigmine edrophonium |
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During fetal monitoring, Type III decelerations are thought to be related to:
head compression umbilical cord compression uteroplacental insufficiency placental abruption |
During fetal monitoring, Type III decelerations are thought to be related to: umbilical cord compression
Type III, or variable, decelerations are the most common type of decelerations. They are thought to be related to umbilical cord compression and intermittent decreases in umbilical blood flow. pg. 915 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Airway obstruction caused by the tongue falling posteriorly against the wall of the pharynx is secondary to relaxation of the:
genioglossus muscle longitudinal muscle of the tongue palatoglossus muscle styloglossus muscle |
Airway obstruction caused by the tongue falling posteriorly against the wall of the pharynx is secondary to relaxation of the: genioglossus muscle
The genioglossus muscle allows the tongue to be protruded and kept away from the posterior pharynx. It is innervated by the hypoglossal nerve. The palatoglossus muscle elevates the tongue and depresses the soft palate. The styloglossus muscle elevates and retracts the tongue. The superior longitudinal muscle of the tongue is an intrinsic muscle of the tongue that elevates the tip. |
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Reactants that are regenerated during the absorption of carbon dioxide by soda lime include:
carbonic acid sodium hydroxide calcium hydroxide calcium carbonate |
Reactants that are regenerated during the absorption of carbon dioxide by soda lime include: sodium hydroxide
Both water and sodium hydroxide are initially required during the absorption of carbon dioxide by soda lime, but then are regenerated. pg. 38 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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In patients receiving vecuronium, the greatest augmentation of neuromuscular blockade is seen with the use of:
isoflurane sevoflurane desflurane nitrous oxide |
In patients receiving vecuronium, the greatest augmentation of neuromuscular blockade is seen with the use of: desflurane
Volatile agents decrease the nondepolarizer dosage requirements. The degree of the augmentation of blockade depends on the inhalational agent, with desflurane > sevoflurane > isoflurane > nitrous oxide. pg. 218 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006 |
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The formation of active metabolites has NOT been associated with the use of:
vecuronium rocuronium pancuronium succinylcholine |
The formation of active metabolites has NOT been associated with the use of: rocuronium
The 3-OH metabolites of both vecuronium and pancuronium possess about 50% of the neuromuscular blocking activity of parent compound. Succinylcholine is metabolized to choline, succinic acid and succinylmonocholine. Succinylmonocholine also has some neuromuscular blocking activity. A small amount of rocuronium is metabolized to the 17-OH compound, which lacks activity. Most rocuronium is excreted by the kidneys and liver as intact drug. pg. 512 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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The maximum leakage current allowed in operating room equipment is:
5 μA 10 μA 1 mA 5 mA |
The maximum leakage current allowed in operating room equipment is: 10 μA
10 μA has been established as the maximum allowable leakage current. This amount of current is below the threshold of perception (1mA) as well as below the threshold for risk of microshock. pg. 23 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by:
free acetate anion choline acetyltransferase acetyl cholinesterase pseudocholinesterase |
The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by: choline acetyltransferase
The synthesis of acetylcholine occurs in the cholinergic nerve terminal. Acetyl Co-A and choline combine to form acetylcholine. This reaction is catalyzed by the enzyme choline acetyltransferase. pp. 227 - 228 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Deleterious effects of hypothermia include: (Select 2)
impaired renal function right shift of the hemoglobin-oxygen saturation curve irreversible platelet dysfunction increased incidence of wound infection increased postoperative protein anabolism |
Deleterious effects of hypothermia include: impaired renal function, increased incidence of wound infection
Deleterious effects of hypothermia include: * increased PVR * left shift of the hemoglobin-oxygen saturation curve * reversible platelet dysfunction * postoperative protein catabolism * altered mental status * impaired renal function * decreased drug metabolism * poor wound healing * increased incidence of infection |
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Postintubation croup:
is secondary to inflammation at the level of the cricoid is less common when cuffed endotracheal tubes are used occurs most frequently in infants less than 4 months of age is most often seen immediately upon extubation |
Postintubation croup: is secondary to inflammation at the level of the cricoid
Postintubation croup usually occurs at the level of the cricoid, since this is the narrowest part of the pediatric airway. Croup is less common with endotracheal tubes that are uncuffed and small enough to allow a gas leak at 10 - 25 cm H2O. Postintubation croup is associated with early childhood (1 - 4 years). Unlike laryngospasm, postintubation croup is seen some time after extubation, usually within 3 hours. pg. 939 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |
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Closing capacity is defined as:
closing volume + expiratory reserve volume functional residual capacity - residual volume closing volume + residual volume residual volume + expiratory reserve volume |
Closing capacity is defined as: closing volume + residual volume
Closing capacity is the lung volume at which airways begin to close and is defined as the closing volume + residual volume. pp. 546 - 547 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. |