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29 Cards in this Set
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A 5-day-old male is scheduled for a pyloromyotomy. The patient has experienced two episodes of apnea since birth. Anesthetic management shown to reduce the incidence of postoperative apnea includes:
the use of ketamine as the sole anesthetic agent the intravenous administration of caffeine use of desflurane as the sole anesthetic agent the avoidance of nitrous oxide |
5-day-old male is scheduled for a pyloromyotomy. The patient has experienced two episodes of apnea since birth. Anesthetic management shown to reduce the incidence of postoperative apnea includes: the intravenous administration of caffeine
Both caffeine and theophylline have been shown to reduce the incidence of postoperatitive apnea in infants at increased risk. Caffeine is favored because of its wider therapeutic margin. The recommended loading dose is 10 mg/kg caffeine base. pg. 1193 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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A 82-year-old female is scheduled for a total hip replacement under spinal anesthesia. She has been receiving enoxaparin for deep vein thrombosis prophylaxis. Current recommendations regarding the dosing of enoxaparin state that the drug be:
continued without interruption as scheduled held for 4 - 6 hours prior to the spinal anesthetic held for 10 - 12 hours prior to the spinal anesthetic held for not less than 24 hours prior to the spinal anesthetic |
Your response is incorrect.
A 82-year-old female is scheduled for a total hip replacement under spinal anesthesia. She has been receiving enoxaparin for deep vein thrombosis prophylaxis. Current recommendations regarding the dosing of enoxaparin state that the drug be: held for 10 - 12 hours prior to the spinal anesthetic Patients receiving fractionated low-molecular weight heparin are to be considered at increased risk of spinal hematoma. Patients receiving these drugs should have the drug held for 10 - 12 hours preoperatively according to the Consensus Statement from the American Society for Regional Anesthesia and Pain Medicine. pg. 713 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. 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 |
Your response is correct.
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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Mortality after liposuction procedures most commonly is the result of:
pulmonary embolism bowel perforation fat embolization reactions to anesthetic agents |
Mortality after liposuction procedures most commonly is the result of: pulmonary embolism
The mortality rate from liposuction procedures is approximately 0.02%. The most common cause of mortality is pulmonary embolism accounting for 23.1% of the deaths. pg. 1351 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. |
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Heart rate:
is the sole determinant of cardiac output in the elderly is normally determined by the intrinsic rate of the AV node after puberty, decreases with increasing age is increased by stimulation of the M2 cholinergic receptors |
Heart rate: after puberty, decreases with increasing age
Cardiac output is the product of stoke volume and heart rate. Heart rate is an intrinsic function of the SA node and decreases with increasing age. Enhanced vagal activity slows the heart via stimulation of the M2 cholinergic receptors. pp. 420 - 421 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 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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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 |
Your response is correct.
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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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 is associated with radial nerve injury. |
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Regarding the effects of CO2 pneumoperitoneum during laparoscopic surgery:
absorption of CO2 is greater during intraperitoneal vs. extraperitoneal insufflation splanchnic blood flow is decreased during mechanical pneumoperitoneum ETCO2 levels may not correlate with PaCO2 levels in ASA III patients increased ETCO2 causes bronchodilation and a reduction in peak airway pressures |
Regarding the effects of CO2 pneumoperitoneum during laparoscopic surgery: ETCO2 levels may not correlate with PaCO2 levels in ASA III patients
ASA III patients have been shown to require greater minute ventilation to eliminate absorbed CO2. Additionally, PaCO2 levels may not correlate well with ETCO2 levels in ASA III patients. Pelvic insufflation (extraperitoneal) is associated with higher CO2 absorption than intraperitoneal insufflation. Peak airway pressures are consistently increased by pneumoperitoneum. |
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Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they:
interfere with the use of the cautery can precipitate severe hyponatremia can cause hyperglycemia in diabetic patients are associated with elevated ammonia levels postoperatively |
Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they: interfere with the use of the cautery
Electrolyte containing solutions conduct electricity and interfere with cautery use during the resection of the prostate. Electrolyte solutions are commonly used in the postop period. Sorbitol solutions have been associated with hyperglycemia, especially in diabetic patients. Glycine solutions have been associated with elevated ammonia levels and transient postoperative visual syndrome. Sorbitol, glycine and distilled water have all been associated with TURP syndrome. |
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n a 5-year-old, the appropriate length of an endotracheal tube from distal tip to incisors is:
13 cm 14 cm 15 cm 16 cm |
In a 5-year-old, the appropriate length of an endotracheal tube from distal tip to incisors is: 16 cm
Between 2 and 12 years of age, the following formula is commonly used to calculate ETT length: Length from tip to incisors = 11 + age in years pg. 481 Yao, FS. Yao and Artusio's Anesthesiology. Philadelphia: Lippincott Williams & Wilkins, 2003. |
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An 82-year-old female arrives to the OR for open reduction of a left intratrochanteric fracture. Significant past medical history includes hypertension, moderate aortic stenosis and dementia. The most appropriate anesthetic technique for this patient is:
opioid-based general anesthesia spinal anesthesia volatile-agent-based general anesthesia epidural anesthesia |
An 82-year-old female arrives to the OR for open reduction of a left intratrochanteric fracture. Significant past medical history includes hypertension, moderate aortic stenosis and dementia. The most appropriate anesthetic technique for this patient is: opioid-based general anesthesia
In patients with mild to moderate aortic stenosis, a primarily opioid-based technique results in minimal cardiac depression, less tachycardia and suppression of the sympathetic response to surgical stimulation. These are all desired effects as HTN and tachycardia may precipitate ischemia in these patients. Spinal or epidural anesthesia as well as a volatile-agent-based anesthesia can cause a fall in afterload with resulting severe hypotension. |
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The area of myocardium most vulnerable to ischemia is the:
left ventricular epicardium right ventricular epicardium left ventricular subendocardium right ventricular subendocardium |
The area of myocardium most vulnerable to ischemia is the: left ventricular subendocardium
The subendocardium of the left ventricle is most vulnerable to ischemia since this is an area of greater systolic shortening. In addition, left ventricular subendocardium perfusion is almost entirely restricted to diastole, in contrast to the subendocardium of the right ventricle that receives most of its perfusion during systole. |
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Actuation of the oxygen flush valve delivers 100% oxygen at a rate of:
10 - 20 L/min 20 - 30 L/min 35 - 75 L/min 80 - 100 L/min |
Actuation of the oxygen flush valve delivers 100% oxygen at a rate of: 35 - 75 L/min
The oxygen flush valve delivers 100% oxygen at a rate of 35 - 75 L/min with a pressure of 40 - 60 psi. pg. 660 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009. |
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A decrease in cholinesterase activity has been associated with:
obesity thyrotoxicosis alcoholism burns |
A decrease in cholinesterase activity has been associated with: burns
Burns, liver disease, 3rd trimester of pregnancy, carcinoma, and collagen diseases as well as certain drug therapy have been associated with a decrease in cholinesterase activity. Increased cholinesterase activity has been associated with obesity, alcoholism, thyrotoxicosis, nephrosis, psoriasis and ECT therapy. |
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As compared with plasma osmolality, hypertonic crystalloid solutions include:
D5W Ringer's lactate D5 0.25NS D5 0.45 NS |
As compared with plasma osmolality, hypertonic crystalloid solutions include: D5 0.45NS
Normal plasma osmolality ranges between 280 - 290 mOsm/L. D5W is hypotonic in relation to plasma, with a tonicity of 253 mOsm/L. Both Ringer's lactate and D5 0.25NS are isotonic solutions, with tonicities of 273 and 355 mOSm /L respectively. D5 0.45NS is hypertonic with a tonicity of 432 mOsm/L |
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elective 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. |
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he most consistent clinical manifestation of aspiration pneumonitis is:
bronchospasm arterial hypoxemia pulmonary vasoconstriction tachypnea |
he 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 |
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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 are used in the treatment of: acute glaucoma
Carbonic anhydrase inhibitors decrease the ability of the kidneys to reabsorb bicarbonate, resulting a hyperchloremic acidosis. As a result, carbonic anhydrase inhibitors would be avoided in patients with acidosis, especially a normal-anionic-gap acidosis. Because bicarbonate is filtered by the ciliary process in the formation of aqueous humor, carbonic anhydrase inhibitors reduce the formation of aqueous humor and can be used to decrease intraocular pressure. |
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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. |
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n 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. |
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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. |
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The formation of metanephrine is the result of:
catechol-O-methyltransferase metabolism of epinephrine catechol-O-methyltransferase metabolism of norepinephrine monamine oxidase metabolism of epinephrine monamine oxidase metabolism of norepinephrine |
The formation of metanephrine is the result of: catechol-O-methyltransferase metabolism of epinephrine
Catechol-O-methyltransferase (COMT) metabolizes epinephrine to metanephrine and norepinephrine to normetanephrine. Subsequently, monamine oxidase (MAO) further metabolizes metanephrine and normetanephrine to vanillymandelic acid (VMA). |
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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 |
Your response is correct.
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. |
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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. |
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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. |
