Stoelting 3

Front 1

10. A1C averages glucose over the previous _____ to _______ days?

a. 1 to 7
b. 10 to 32
c. 7 to 21
d. 50 to 107

Back 1

10. D (just kidding C)

Front 2

11. Assess the following in diabetic PTS when doing preoperative history.
a. CAD
b. Renal disease
c. Cerebral vascular disease
d. All of the above

Back 2

11. D (Most common cause of mortality is CAD)

Front 3

12. Diabetics are at increased risk for difficult intubation s/t
a. Stiff joint dx
b. Obesity
c. A
d. A&B

Back 3

12. D (have dec joint mobility and primarily NIDDM are obese)

Front 4

13. IDDM may require ________ infusions intraop with _________ containing solutions and titrate accordingly to blood glucose checks (every 1-2hrs). Regular insulin should be given IV/IM/SQ (select one)

Back 4

13. Insulin, glucose, IV b/c SQ will vary with perfusion, edema etc and IV will be more accurate

Front 5

14. Keep blood glucose _____-______ in critically ill pts for improved outcomes
a. 100-150
b. 150-200
c. 80-110
d. 65-90

Back 5

14. 80-110

Front 6

15. Diabetics may require ETT with cuff b/c of increased risk of ________ d/t gastroporesis

Back 6

15. Aspiration

Front 7

select one) GA/regional (epidural & spinal) will preserve glucose tolerance but d/t increased risk for __________ neuropathy, may be contraindicated

Back 7

16. Regional, peripheral

Front 8

17. Periods of ____________ resistant to atropine may occur and _________ resistant to ephedrine d/t autonomic neuropathy. Should have __________ available to treat

Back 8

17. Bradycardia, HOTN, epinephrine

Front 9

18. Diabetics may be at increased risk for HTN leading to diastolic dysfunction along with increased risk for ________ insufficiency which can lead to volume overload and cause ______

Back 9

18. Renal, CHF

Front 10

19. Elderly with impaired thirst mechanisms place them at increased risk for ketoacidosis/HHNK (choose one)

Back 10

19. HHNK, (2/3 are not diabetic, no ketoacidosis occurs, do not require insulin once coma restored)

Front 11

20. HHNK signs and symptoms include all except:
a. Hyperosmolality
b. Hyperglycemia
c. Decreased pH
d. Hypokalemia
e. Hypovolemia
f. Seizures
g. Coma

Back 11

20. C (no decrease in pH, do not become acidotic, treat HHNK with insulin IV and fluids to restore volume with Na solutions)

Front 12

21. Treat hyperdynamic states of hyperthyroidism with beta__________, will also help prevent T4 conversion to T3

Back 12

21. Beta antagonists

Front 13

22. Achieve a HR <______with hyperthyroid pts
a. 70
b. 85
c. 90

Back 13

22. B

Front 14

23. Need pts to be euthyroid prior to surgery, if it is an emergency and this is not possible, placing them on a/an ________ infusion can help treat hyperthyroid effects

Back 14

23. Esmolol

Front 15

24. PTU and methimazole are given first to block thyroid hormone release while iodide preperations are given second to block synthesis of the hormone T/F

Back 15

24. F-(PTU and methimazole are given first but its b/c they first block the synthesis, then giving iodide preparations later will prevent the release of hormone from the gland)

Front 16

25. Avoid anticholinergic drugs in hyperthyroid pts d/t the effects on _____

Back 16

25. HR (will increase HR, will also alter heat regulation)

Front 17

26. Preop, a CT scan may be needed to evaluate airway anatomy d/t risk of upper airway obstruction from which of the following:
a. Goiter
b. Tracheal malacia
c. Hematoma
d. All of the above
e. A&B

Back 17

26. E (hematoma is a postop risk for upper airway obstruction, tracheal malacia is from chronic enlarged gland, will become weak and collapse with negative inspiratory force with spont breathing)

Front 18

27. Avoid any drugs that stimulate the SNS, avoid which of the following (circle all that apply)
a. Propofol
b. Ketamine
c. Rocuronium
d. Succinylcholine
e. Pancuronium

Back 18

27. B & E (sns stim)

Front 19

28. Elevated temperature with hyperthyroid will increase MAC ______% per 1 degree celcius >37 degrees

Back 19

28. 5%

Front 20

29. Increased sensitivity to _________________ d/t muscle weakness. Reversal with anticholinesterase and anticholinergic will increase the risk of an increased _____. Which anticholinergic is safer to use d/t less chronotropic effects?

Back 20

29. NMBD’a, increased HR, use glycopyrolate if need to reverse

Front 21

30. T/F hyperthyroid pts can have exaggerated responses to catecholamines so one should use decreased doses of neosynephrine to treat HOTN

Back 21

30. T (use a direct acting, ephedrine will cause an increased release of catecholamines, HR etc)

Front 22

31. All are true of thyroid storm except:
a. Hyperthermia
b. CHF
c. Dehydration
d. Shock
e. Mimics MH
f. Mimis pheochromocytoma
g. Avoid using Tylenol as antipyretic
h. Decadron can decrease T4 conversion to T3
i. Esmolol should be ready G

Back 22

31. G (avoid ASA, use Tylenol for fever ASA can alter binding of T4 and T3 and increase the free plasma levels of these)

Front 23

32. Risk for laryngeal nerve injury with thyroidectomy, match the following:
a. Recurrent laryngeal nerve 1. motor to all but cricothyroid
b. Superior laryngeal nerve 2. Motor to cricothyroid
3. sensory below VC
4. sensory above VC
5. risk airway obstruction with bilat.dmg
6. hoarseness with dmg
7. risk inhalation of material in pharynx

Back 23

32. A=1,3,5; B=2,4,6,7

Front 24

33. increased risk postop for ___________ d/t chronic goiter compression and signs of airway obstruction but normal vocal cord function

Back 24

33. Tracheal malacia

Front 25

34. high risk for removal of ___________ gland with total thryroidectomy and this increases risk of hypo___________ leading to inspiratory stridor within 24-72 hrs postop d/t ___________

Back 25

34. Parathyroid gland, hypocalcemia, laryngospasm (VC sensitive to low Ca+ levels)

Front 26

35. all are signs and symptoms of hypothyroid except:
a. lethargy
b. hyponatremia
c. bradycardia
d. cold intolerance
e. decreased CO
f. peripheral vasodilation
g. atrophied adrenal cortex

Back 26

35. F- peripheral vasoconstriction occurs, (can cause dec CO and slower circulation time)

Front 27

. T/F hypothyroid pts will have exaggerated response to muscle relaxants

Back 27

36. T (d/t muscle weakness, should also use drugs that inherently support CV system)

Front 28

37. which drugs are not recommended in hypothyroid pts during maintenance:
a. N2O
b. ketamine
c. opioids
d. benzos
e. volatile anesthetics

Back 28

37. E (d/t increased myocardial sensitivity to myocardial depressant effects of VA)

Front 29

38. two important things to monitor for during anesthesia in hypothyroid pts:
a. increased HR and BP
b. hypothermia, CHF
c. hyperthermia, dysrythmias

Back 29

38. B

Front 30

39. important to ask pts if they have taken steroids for longer than 1 month for the past ___-___ months
a. 2-3
b.12-24
c. 6-12

Back 30

39. C ( if taking for asthma, COPD or a chronic condition, pt will just require a physiologic dose not a higher dose, if taking b/c of true adrenal insufficiency, dose needs to be increased tp prevent CV collapse with surgical stress)

Front 31

40. Hallmark of pheochromocytoma is paraoxysmal/sustained HTN, all are part of the triad of symptoms except
a. tachycardia/palpitations
b H/A
c.diaphoresis
d. hyperthermia

Back 31

40. D

Front 32

41. T/F clonidine can be used to treat HTN in pheo pts

Back 32

41. F (clonidine alpha agonist will decrease catecholamine release from SNS fibers but will not prevent pheo tumor from releasing the excess amounts of catecholamines)

Front 33

42. all of the following should be done in pheo pts except:
a. normalize BP with alpha and beta blockers
b. restore IVF volume
c. increase Hct

Back 33

42. C ( want to decrease HCt b/c usually a high Hct exists with low IVF volume state d/t chornic constriction in pheo pts)

Front 34

43. T/F treat HTN with beta blockade prior to alpha blockade

Back 34

43. F (if beta before alpha, will have unopposed alpha and have abrupt inc in SVR, will not be able to maintain CO)

Front 35

44. primary periods of HD instability in pheop pts include intubation, manipulation of tumor intraop and after ligation of tumor’s venoud drng T/F

Back 35

44. T, intubation and manipulation can cause elevated catecholamine release, exaggerated HTN, tachy, but once ligated, can have abrupt decreased in BP, sudden drop in circulating catecholamine levels

Front 36

. all are true for anesthesia on pheo pts except:
a. avoid VA b/c can sensitize myocardium to catecholamines
b. avoid ketamine
c. rocuronium, vecuronium and cisatrecurium all will avoid vagolytic affects and histamine release and are all safe to use

Back 36

45. A ( VA sevo,, des and iso will not sensitize the heart)

Front 37

46. On intubation in a pt with pheo, all are true except:
a. estabilish 1.3 MAC with VA to minimize SNS
b. lidocaine 1-2mg/kg
c. phentolamine 1-5mg ready for persistent HTN
d. all of the above

Back 37

46. D

Front 38

47. pts are likely to become hyper or hypoglycemic prior to tumor removal and then hyper or hypoglycemic after removal?

Back 38

47. Hyper prior to removal d/t induced suppression of insulin release with alpha stimulation, hypoglycemic after removal b/c less alpha induced suppression of insulin)

Front 39

48. all are excepted techniques for anesthesia in pheo pts except:
a. N2O and opioids
b. N2O and VA
c. SNP can be used if sustained HTN despite 1.5-2MAC
d. treat reflex tachycardia from SNP with esmolol infusion
e. lidocaine for dysrythmias
f. decreasing VA and increasing IVF after ligation of tumor

Back 39

48. A (N2O and opioid technique will not block SNS and HTN as well with increased catecholamine levels)

Front 40

49. which is not true regarding issues associated with regional anesthesia in pheo pts:
a. can block SNS w/o sensitizing heart to catecholamines
b. postsynaptic alpha receptor will not respond to circulation catecholamines
c. HOTN after ligation cannot be offset by an increased SNS response d/t epidural or spinal
d. should only be performed if pt is supine

Back 40

49. B (postsynaptic alpha receptors can still respond to circulation catecholamines so this will not be blocked with epidural or spinal)

Front 41

50. pts with obesity increased risk for all except:
a. HTN
b. cardiomegaly
c. increased blood volume and CO
d. pulmonary HTN
e. chronic hypoxemia
f. decreased pulmonary blood volume

Back 41

50. F (pts will obesity have inc 3000m of blood vessels per 1kg, so there is increased blood volumd which causes inc CO, pulm HTN, inc pulm blood volume, cardiomegaly)

Front 42

51. Which is not true in regards to obese pts:
a. increased aspiration risk
b. desaturate faster with induction
c. decreased FRC
d. slower alveolar rate of rise in agent concentration

Back 42

51. D (the alveolar rate of rise in gas concentration is not slower b/c these pts have less FRC, it would be faster if anything)

Front 43

52. Use ideal or actual body wt with drug calculations?

Back 43

52. Ideal- obese pts have higher plasma blood volume but a decreased in blood flow to adipose tissue so if using actual body wt, it may lead to increased plasma concentration and accumulation will occur with further repeated doses)

Front 44

1) True or False. Like Desflurane, Sevoflurane, Isoflurane, and Halothane decrease the patient’s Mean arterial Pressure (MAP) by reducing the SVR.

Back 44

1) FALSE: Des/sevo/& sevo all reduce MAP by decreasing SVR but Halothane lowers the Mean arterial Pressure (MAP) by decreasing the Cardiac Output (CO). (Page 88)

Front 45

2) Is it safe to give inhaled anesthetics (IA) to patients with congenital long QT syndrome? If so, how are these IA administered safely?

Back 45

2)Sevoflurane, other IAs, and propofol can produce prolonged QT intervals in patients with congenital long QT syndrome (LQTS). Sevo should be avoided in these patients with known LQTS, but these patients can be safely anesthetized with sevo and other IA’s if treated concurrently with B-Blocking agents. (Page 91)

Front 46

3) Inhaled anesthetics _______ the frequency of breathing and ________ tidal volume as the anesthetic concentration increases.

Back 46

3) Inhaled anesthetics INCREASE the frequency of breathing and DECREASE tidal volume as the anesthetic concentration increases. Although minute volume is relatively preserved, the decreased TV due to increased deadspace ventilation will cause a progressive increase in PaCO2 as the concentration of the IA increases. (page 92)

Front 47

4)How can the anesthetist attenuate the increased HR and Blood pressure responses caused by stepwise increases in the desflurane concentration?

Back 47

4) These responses can be attenuated with the administration of opioids, clonidine, or esmolol. (page 90)

Front 48

5)Why is the induction of inhalational anesthesia rapid in patients in shock?

Back 48

5) Induction of IA is faster in patients in shock due to the low CO present in this population. A high CO results in a more rapid uptake (less time to fill the bucket) and greater uptake in the blood, leading to a slowed induction. In shock, the CO is reduced and there is less uptake of the IA in the blood and results in a faster induction.

Front 49

6) explain how Nitrous Oxide transfers to closed gas spaces.

Back 49

6) The blood-gas partition coefficient of N2O is 0.46 and is 34 x greater than Nitrogen (0.014). This difference in solubility allows N2O to leave the blood and enter a air/gas filled cavity faster than nitrogen can escape. As a result the pressure inside the cavity becomes increased and causes the cavity to expand. (page 87)

Front 50

1) What are the objectives during the maintenance phase of general anesthesia?

Back 50

1) The four main objectives during the maintenance of general anesthesia are amnesia, analgesia, skeletal muscle relaxation, and control of the SNS responses evoked by noxious stimulation. (page 181)

Front 51

) What are the advantages of Spinal anesthesia over an epidural anesthetic?

Back 51

2) Spinals take less time to perform, produces more rapid onset of better-quality sensory and motor anesthesia and is associated with less pain during surgery. (page 181)

Front 52

3) What conditions may lead to an increased risk associated with spinal or epidural anesthesia?

Back 52

3) Hypovolemia, Increased ICP, Coagulopathy (Thrombocytopenia), Sepsis, Infection at the cutaneous puncture site, and a pre-existing neurological disease (Multiple Sclerosis). (page 182)

Front 53

4) What is the only absolute contraindication to regional anesthesia?

Back 53

4) Patient refusal. (page 182)

Front 54

5) What is a disadvantage of peripheral nerve blocks as an anesthetic technique?

Back 54

) A disadvantage of Peripheral nerve blocks is the unpredictable attainment of adequate sensory and motor anesthesia as needed for a particular procedure. (page 182)

Front 55

1. True or False: Age is a factor considered in selection of patients for outpatient surgery. (p.540)

Back 55

1. False. Age is usually not a factor; many pediatric procedures are amenable to being performed on an outpatient basis. Advanced age is not a reason alone to avoid outpatient surgery.

Front 56

2. Infants with apnea in the PACU after outpatient surgery should (p. 540):
a. Be monitored for 2 additional hours before being discharged
b. Receive an albuterol nebulizer treatment and then if O2 sat > 95%, okay for discharge
c. Be admitted to the hospital
d. Receive stat chest xray

Back 56

2. C. Any infant with apnea in PACU or infant with anemia should be admitted to the hospital, regardless of age

Front 57

3. Which surgery is not suitable for outpatient surgery? (p. 540)
a. Cranium and thorax surgery
b. Patients with infection
c. Emergency surgery patients
d. All of the above are not suitable for outpatient surgery

Back 57

3. D.

Front 58

4. Which is an appropriate NPO guideline? (p. 541)
a. Clear fluids (water, black coffee, clear tea, pulp-free juice, carbonated beverage) up to 2 hours prior to induction
b. Breast milk up to 3 hours prior to induction
c. Light meal up to 4 hours prior to induction
d. Formula up to 4 hours prior to induction

Back 58

4. A. Clear fluids are appropriate up to 2 hours prior to induction, breast milk up to 4 hours prior to induction, formula up to 6 hours prior to induction, and light meal up to 6 hours prior to induction (unless history of gastroparesis).

Front 59

5. When is it appropriate to pre-medicate with anticholinergics in outpatient surgery? (p. 543)

Back 59

5. Routine use of anticholinergic drugs is not indicated for outpatients, due to the possibility of mydriasis and dry mouth. Only give routinely for surgeries where antisialagogue effect may be useful (surgeries involving oropharynx).

Front 60

6. What is the number one drug used for induction of anesthesia in outpatient surgery? (p. 544)

Back 60

6. Propofol (associated with rapid recovery and less nausea and vomiting)

Front 61

1. Which of the following metal are considered unsafe for MRI? (p. 554)
a. Nickel and Cobalt
b. Aluminum and Titanium
c. Copper and Silver
d. All of the above are unsafe for MRI

Back 61

1. A. Nickel and Cobalt are dangerous because they are magnetic, other metals (aluminum, titanium, copper, and silver) do not pose a missile danger and are used to make MRI compatible IV poles and anesthesia machines.

Front 62

2. What is the best drug choice for Radiation Therapy? (p. 555)
a. Fast onset, long acting drugs
b. Fast onset induction drugs plus muscle relaxants
c. Fast onset, short-acting drugs

Back 62

2. C. Radiation therapy requires patient immobility so that radiation can be precisely targeted, but fast-onset, short acting drugs should be used to permit rapid emergence

Front 63

3. What anesthetic drug is best suited for the electrically induced seizures associated with electroconvulsive therapy? (p. 556)

Back 63

3. Propofol 1 mg/kg IV or Etomidate (0.3 mg/kg IV). Etomidate may be chosen over propofol due to its association with longer electrically induced seizures and minimal cardiovascular and respiratory depression.

Front 64

4. What considerations are taken in regards to muscle relaxation for ECT? (p. 557)
a. Long acting muscle relaxants, such as pancuronium are used to prevent adverse effects of seizures such as seizure-induced bone injury.
b. Succinylcholine is the drug of choice due to its short duration of action.
c. A second blood pressure cuff is usually placed on the lower part of the leg or forearm to prevent spread of the neuromuscular blocking drug to allow monitoring of motor activity during the seizure
d. Both A and C
e. Both B and C

Back 64

4. E.

Front 65

5. Anesthetic mangagement in patients undergoing cardiac catheterization should include: (p. 558)
a. General anesthesia with muscle relaxation
b. Avoidance of positive-pressure ventilation
c. Maintenance of low- normal SBP
d. Measures to increase pulmonary vascular resistance

Back 65

5. A primary element in the anesthesia plan is avoidance of positive-pressure ventilation because it will increase pulmonary vascular resistance, decrease left ventricular filling, and decrease arterial pressure.

Front 66

6. The best anesthetic drug choice for cardioversion is: (p. 559)
a. Propofol
b. Etomidate
c. Benzodiazepines
d. High dose opioids

Back 66

6. Short acting drugs such as propofol are best for cardioversion. Etomidate is avoided due to its incidence of myoclonus and benzodiazepines are avoided due to their profound central nervous system depression and longer duration of action.

Front 67

7. A major side effect to be aware of with lithotripsy includes (p. 559):
a. Decreased CVP
b. Hypertension
c. Risk for sudden death if patient with an external pacemaker undergoes lithotripsy
d. Hematuria and hematoma formation

Back 67

7. D. Patients undergoing lithotripsy often have higher CVP, hypotension, increased work of breathing, cardiac dysrhythmias, hematuria, and risk for bleeding, hematoma formation, emboli, pulmonary contusions, pancreatitis, and flank pain.

Front 68

List the layers that a needle to pass in order to obtain a SAB (dorsal to ventral): (pg. 243, figure 17-3)
a. Spinous process, supraspinous ligament, ligamentum flavum, epidural space, dura mater, pia mater, arachnoid mater
b. Supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater, pia mater
c. Supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, epidural space, arachnoid mater, pia mater
d. Spinous process, supraspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater, pia mater

Back 68

1. B (fyi: pia mater surrounds the spinal cord, so it technically will not be present where we will be placing spinals)

Front 69

2. What is the most important landmark used to identify specific spinal interspaces? (pg. 243, under surface landmarks)
a. The bony knob at the lower end of the neck which indicates C7 spinous process
b. The lower limits of the scapulae which identifies T7-8 interspace, a line is drawn across
c. The terminal portion of the 12th rib which intersects the L2 vertebral body
d. A line draw between the iliac crests which usually traverses the body of the L4 vertebra

Back 69

2. D

Front 70

3. True or False: The dura mater serves as the major pharmacologic barrier preventing movement of drugs from the epidural to the subarachnoid space. (pg 246, first column)

Back 70

3. False, the arachnoid mater serves as the major pharmacologic barrier, the dura mater provides structural support.

Front 71

4. Factors that influence the selection of the interspace to be used for spinal anesthesia should include: (pg. 252, under selection of interspace)
a. The likelihood of a “failed spinal” increases as interspaces that are more caudal are used, with up to a 7% incidence occurring when the L4-5 interspace is selected
b. Caudal limitation of the spinal cord in an adult usually lies between L1 and L2, therefore, spinal anesthesia is not usually performed above the L2-3 interspace
c. The use of conceptual line across the iliac crests to ID the body of L4 often results in selection of an interspace that is one or more levels higher than believed
d. All of the above influence the selection

Back 71

4. D

Front 72

5. The distribution of local anesthetic solution in CSF is influences principally by: (pg. 254, under level and duration)
a. The baricity of the solution, the contour of the spinal canal, and the position of the patient within the first few minutes after injection of local into the SAB space.
b. The baricity of the solution, the drug selected, and the position of the patient within the first few minutes after injection of local into the SAB space.
c. The baricity of the solution, the contour of the spinal canal, and the presence or absence of a vasoconstrictor in the local anesthetic solution.
d. The drug selected, the contour of the spinal canal, and the position of the patient within the first few minutes after injection of local into the SAB space.

Back 72

5. A, the drug selected and presence or absence of a vasoconstrictor affect the duration of spinal anesthesia

Front 73

6. True or False: The degree of hypotension often parallels the sensory level of spinal anesthesia. (pg. 259 under hypotension)

Back 73

6. True

Front 74

7. After receiving a spinal, your patient c/o their pinkies being numb, you are worried about_______? (pg. 259-260)
a. Unopposed parasympathetic nervous system activity because anesthesia above T5 inhibits sympathetic nervous system innervations to the GI tract, this results in contracted intestines and relaxed sphincters.
b. Risk for bradycardia and possibly asystole because the cardioaccelerator fibers are blocked also
c. I’m not worred, this is the response I want
d. A and B

Back 74

7. D, Dermatome level associated with the little finger is C8

Front 75

8. 12-48 hours after a wet tap with an epidural placement, your patient develops a PDPH. You initially instruct the patient to treat it with bed rest, fluids, analgesics, and caffeine but all are ineffective. You perform a blood patch with 15-20 mL of the patients’ blood, where is the blood preferably injected? (pg. 261, 2nd column, 1st paragraph)
a. And the same site the epidural was placed
b. I wouldn’t use this treatment
c. Slightly below the site of the epidural
d. Slightly above the site of the epidural

Back 75

8. C, because there is a preferential cephalad spread

Front 76

9. What is the usual depth of the epidural space? (pg. 263, 2nd column, 1st para)
a. 4-6 cm
b. 4-6 mm
c. 6-8 cm
d. 6-8 mm

Back 76

9. A

Front 77

10. The principle factors affecting the spread of epidural anesthesia are… (pg. 266, under level of anesthesia)
a. Dose and baricity of local anesthetic used
b. Dose and site of injection
c. Site of injection and position
d. Baricity of local anesthetic used and position

Back 77

10. B

Front 78

11. Addition of what to the local anesthetic promotes more rapid onset of epidural anesthesia? (pg. 267, 1st column, 2nd para)
a. Epinephrine
b. Opioids
c. Sodium bicarbonate
d. 8.5% Dextrose

Back 78

11. C

Front 79

1. Important considerations prior to administering a peripheral nerve block include:
a. Recognition of a skin infection
b. Presence of normal coagulation
c. Presence of pre-existing neuropathy
d. All of the above

Back 79

2. B

Front 80

2. Peripheral nerve anesthesia:
a. Obliterates the need for general anesthesia or sedation
b. Promotes pain control in and out of the OR
c. Is contraindicated in patients with HIV infection
d. Is only useful for orthopedic and genitourinary procedures

Back 80

2. B

Front 81

3. The choice of LA used for the block depends on:
a. The speed of onset, duration of block, and degree of conduction block needed
b. Speed of onset, duration of block and cost
c. Cost, duration, and allergies of patient
d. Comorbities, speed of onset and cost

Back 81

3. A

Front 82

4. Methods used to locate peripheral nerves and guide injection of LA include all except:
a. Paresthesias
b. Nerve stimulation
c. Ultrasound
d. Vital signs

Back 82

4. D

Front 83

5. A motor response evoked with currents of approximately ___________ indicate sufficient proximity of the block needle to the nerve for success of the block.
a. 0.2mA
b. 0.5mA
c. 0.1mA
d. None of the above

Back 83

5. B

Front 84

6. Nerve stimulation based approaches may fail to produce plexus anesthesia if:
a. The nerves of the plexus are not at a great enough distance from each other
b. Shorter pulse widths are used for stimulation of the nerves
c. The nerves are not in close proximity to each other
d. All of the above

Back 84

6. C

Front 85

7. Ultrasound techniques:
a. Allow indirect visualization of peripheral nerves and needle placement
b. Have little effect on block success
c. Increase the risk of complications to nerve blocks
d. Minimize local anesthetic volume requirements

Back 85

8. E

Front 86

8. When paresthesias occur during block
a. Patient may complain of shock-like sensation
b. May indicate increased likelihood of nerve injury
c. Indicates appropriate placement of the block
d. A & C
e. A & B

Back 86

8. E

Front 87

9. Anesthesia produced by a cervical plexus block:
a. Includes the area from the temporal area to the mandible
b. Includes the area from the mandible to the clavicle
c. Includes the area from the clavicle to the lower sternal border

Back 87

9. B

Front 88

10. Brachial plexus:
a. Arises from the posterior rami of C5-C8 or T1
b. Forms three trunks that pass under the first rib and over the clavicle to enter the axilla
c. Supplies all of the motor but little of the sensory innervation to the upper extremity
d. Can be anesthetized by four different methods of block

Back 88

10. D

Front 89

11. Pneumothorax is the most serious complication of which method of brachial plexus block and the least risk with which:
a. Interscalene, infraclavicular
b. Supraclavicular, axillary
c. Infraclavicular, interscalene
d. Axillary, supraclavicular

Back 89

11. B

Front 90

12. Femoral nerve blocks:
a. Are indicated for deep surgical procedures when neuraxial anesthesia is contraindicated
b. Provides anesthesia to the anterior thigh and medial knee and leg
c. Elicits quadriceps contraction with nerve stimulator
d. Carries little risk of vascular injection

Back 90

12. C

Front 91

13. The saphenous nerve block:
a. Is one of two branches of the femoral nerve that provides innervations below the knee
b. Provides anesthesia to the lateral part of leg
c. Is often used with a popliteal block for ankle anesthesia
d. Is easy to locate, making it a simple block to perform without ultrasound

Back 91

13. C

Front 92

14. The nerve that provides sensory innervation to the lateral thigh and provides anesthesia for superficial procedures or to supplement other lower extremity blocks above the knee is:
a. Obturator
b. Sciatic
c. Popliteal
d. Lateral Femoral Cutaneous

Back 92

14. D

Front 93

15. Contraction of the adductor muscles of the thigh with a nerve stimulator indicates proximity to the:
a. Obturator nerve
b. Lateral Femoral Cutaneous
c. Femoral nerve
d. Sciatic nerve

Back 93

15. A

Front 94

16. For adequate sciatic nerve block:
a. A LA volume of 15-20ml is sufficient
b. Evoked movement is of the adductor muscles
c. Nearly complete foot and lower leg anesthesia is expected
d. Provides extensive anesthesia regardless of a femoral block

Back 94

16. D

Front 95

17. The major nerve of the sole of the foot is the ____________and the ______________innervates the medial aspect of the foot.
a. Sural, tibial
b. Tibial, saphenous
c. Sural, saphenous
d. Deep peroneal, sural

Back 95

17. B

Front 96

18. The superficial peroneal nerve innervates the _______________ and the deep peroneal innervates the ____________.
a. Webbing between the first and second toes, dorsum of the foot
b. Lateral side of foot, medial side of foot
c. Sole of foot, dorsum of foot
d. Dorsum of foot, webbing of first and second toes

Back 96

18. D

Front 97

19. Contraindications for a Bier block include all but:
a. Sickle cell disease
b. Vascular disease
c. Tourniquet use
d. Infection

Back 97

19. C

Front 98

20. The duration of a bier block depends on:
a. The local anesthetic used
b. The duration of tourniquet inflation
c. The type of procedure
d. The metabolism of the patient

Back 98

20. B

Front 99

21. Local anesthetic levels peak ____________minutes after tourniquet deflation and risks can be reduced by:
a. 5-8min, rapid deflation
b. 2-5min , rapid deflation
c. 5-8min, slow deflation
d. 2-5min, slow deflation

Back 99

21. D

Front 100

Beyond midgestation, women are at increased risk for aspiration because of:
a. decreased competence of the lower esophageal sphincter.
b. delayed gastric emptying with onset of labor or administration of opioids.
c. both a and b.
d. none of the above.

Back 100

1. c

Front 101

2. T or F: By the 3rd trimester CO inc’es by 40-50%, which is augmented by a 25-30% inc in SV and a 15-25% inc in HR. However, the greatest inc occurs immediately after delivery when the CO is inc’ed by 80%. CO will then return to prepregnant values by 2 weeks postpartum.

Back 101

2. T

Front 102

3. Which of the following is true about the pulmonary system changes associated with pregnancy?
a. There is capillary engorgement causing swelling of the upper airway, which will hinder your view during direct laryngoscopy; however, the vocal cords and arytenoids do not become edematous.
b. MV inc’es about 50% during the 1st trimester primarily by an inc in VT d/t inc’ed progesterone levels; this MV is maintained throughout pregnancy.
c. At term, there is a 20% dec in FRC d/t caphalad displacement of the diaphragm; this can result in the FRC being less that closing capacity of small airways and leads to atelectasis.
d. a and b only.
e. b and c only.
f. a, b, and c are correct.

Back 102

3. e (vocal cords and arytenoids do become edematous)

Front 103

4. T or F: Uterine blood flow inc’es to about 900mL/min (which is 10% of the CO) at term. 80% of the uterine blood flow perfuses the intervillous space (placenta) and 20% perfuses the myometrium.

Back 103

4. F (should be 700mL/min)

Front 104

5. The fetal-to-maternal ratio of lidocaine is ________ during fetal academia (fetal pH of 6.9-7.18) as compared to the normal fetus (fetal pH of 7.3-7.35).
a. increased
b. decreased
c. unchanged

Back 104

5. a (ion trapping of lidocaine, a weakly basic drug)

Front 105

6. After administration of regional analgesia, fetal bradycardia can occur from uterine hyperactivity causing dec’ed uteroplacental perfusion. This is most likely d/t a dec in maternal catecholamines and can be ameliorated by _________, which provides uterine relaxation.
a. Ephedrine
b. Nitroglycerine
c. Vecuronium
D. Lidocaine

Back 105

6. b

Front 106

7. When using an epidural, visceral pain (1st stage of labor) is usually relieved by ____mL of 0.125-0.25% bupivacaine or ropivacaine. These are used b/c of their motor-sparing block and long DOA.
a. 2-5mL
b. 4-8mL
c. 6-10mL
D. 10-12mL

Back 106

7. c

Front 107

8. A ________ of LA in an epidural will inc the density of motor blockade while a ________ of LA will achieve greater dermatomal spread of analgesia.
a. larger volume; higher concentration
b. higher concentration; larger volume
c. smaller volume; higher concentration
d. concentration and volume will not make a difference

Back 107

8. b

Front 108

9. If the occiput does not undergo internal rotation to the occiput anterior position, the ________ position can result in prolonged/painful labor with back pain.
a. occiput anterior
b. right occiput transverse
c. left occiput transverse
d. persistent occiput posterior

Back 108

9. d (d/t pressure on the posterior sacral nerves by the fetal occiput)

Front 109

10. All of the following provide uterine relaxation except:
a. Nitroglycerin (50-150mcg IV)
b. Volatile anesthetics
c. Methergine (0.2mg IM)
d. Magnesium (4-8gm bolus and 1-4gm/H infusion)

Back 109

10. c

Front 110

11. What is the therapeutic range for magnesium?
a. 2-4 mEq/L
b. 4-6 mEq/L
c. 6-8 mEq/L
d. 8-10 mEq/L

Back 110

11. b

Front 111

12. All of the following will increase uterine tone except:
a. Pitocin (10-15 units in a 500mL bag, titrated to effect)
b. PG F2 (0.25mg IM)
c. Magnesium (4-8gm bolus and 1-4gm/H infusion)
d. Methergine (0.2mg IM)

Back 111

12. c

Front 112

13. Match the following terms with their description:
___ Preeclampsia a. abnormally low implantation of the
placenta in the uterus; cardinal sign is painless
vaginal bleeding

___ HELLP Syndrome b. manifests after 20 wks gestation w/ HTN, proteinurea, edema, and HA

___ Eclampsia c. implantation of the placenta beyond the endometrium, onto the myometrium

___ Placenta Previa d. severe form of preeclampsia w/ hemolysis, inc’ed liver enzymes, & dec’ed plt

___ Abruptio Placentae e. separation of a normally implanted placenta after 20 wks gestation

___ Placenta Accreta f. implantation of the placenta beyond the endometrium, w/ penetrationthrough the full thickness of the myometrium

___ Placenta Increta g. preeclampsia with seizures

___ Placenta Precreta h. implantation of the placenta beyond the endometrium, onto the myometrium

Back 112

13. b, d, g, a, e, h, c, f

Front 113

14. When is the critical period of organogenesis?
a. between gestation day 15 and 56
b. between gestation day 15 and 42
c. between gestation day 21 and 42
d. between gestation day 28 and 56

Back 113

14. a

Front 114

Quick Review:
• Autonomic Nervous system is divided into the sympathetic and parasympathetic nervous systems.
• It is under involuntary control
• Innervates smooth muscle, cardiac muscle, and exocrine glands
• In the Autonomic NS 2 neurons are required to connect the CNS and effector organs

Back 114

Quick Review:
• Autonomic Nervous system is divided into the sympathetic and parasympathetic nervous systems.
• It is under involuntary control
• Innervates smooth muscle, cardiac muscle, and exocrine glands
• In the Autonomic NS 2 neurons are required to connect the CNS and effector organs

Front 115

1. The pre-ganglionic fibers of both the Parasympathetic and Sympathetic nervous systems release this neurotransmitter?

Back 115

(1) Acetylcholine

Front 116

2. Match the agonist drug to the appropriate receptor is stimulates:
Beta 1 Demedetomidine
Beta 2 Neosynephrine
Alpha 1 Albuterol
Alpha 2 Dobutamine

Back 116

(2) Beta 1= dobutamine, Beta 2 = Albuterol, Alpha 1 =Neosynephrine, Alpha 2 = dexmedetomidine

Front 117

3. This neurotransmitter is released by postganglionic receptors in the sympathetic nervous system?

Back 117

(3) Norepinephrine

Front 118

4. This is the drug of choice for treatment of life threatening allergic reactions?

Back 118

(4) Epinephrine

Front 119

5. Choice of a direct acting sympathomimetic drug called ________________ is best when cardiac output is adequate, while choice of an indirect acting sympathomimetic drug such as ____________ is an appropriate when an increase myocardial contractility is desired.

Back 119

(5) Phenylephrine,

Front 120

6. In patient’s taking tricyclic antidepressants and MAOI’s, there is an increased availability of endogenous norepinephrine in the bloodstream. Therefore, administration of and indirect acting sympathomimetic such as _____________ can lead to exaggerated response in their systemic blood pressure.

Back 120

(6) Ephedrine

Front 121

7. __________________ is a direct acting sympathomimetic drug that increases venous constriction more than arterial constriction, and acutely increases preload and afterload. Clinically, this drug causes increased blood pressure, reflex bradycardia and an associated decrease in cardiac output shortly after administration.

Back 121

(7) Phenylephrine

Front 122

8. Prolonged _____________ after the induction of anesthesia is a side effect commonly associated with patients taking ACE inhibitors during the perioperative period.
a. Hypertension
b. Hypotension

Back 122

(8) hypotension, B

Front 123

9. Small pre-operative doses of ____________, an alpha-2 agonist with sedative and analgesic properties used in the treatment of hypertension, can decrease the MAC of inhaled and injected anesthetics.

Back 123

(9) Clonidine

Front 124

10. Pre-operative administration of _____________ is useful for patients at risk of myocardial ischemia and patients with known CAD because these drugs cause decreased heart rate, blood pressure and myocardial oxygen demand.

Back 124

(10) Beta Blockers

Front 125

11. ______________ has a tertiary amine structure and therefore is the only anticholinesterase drug that crosses the blood brain barrier. It is useful for the treatment of central anticholinergic syndrome aka “emergence delirium” which can be seen in the PACU.

Back 125

(11) Physostigmine

Front 126

1. Local anesthetics work by blocking the transmission of the action potential by bonding to ____________ channels in their inactivated state. Therefore, LAs block conduction of neural transmission by decreasing rate of depolarization in response to a stimulus, preventing achievement of the action potential.

Back 126

1. Sodium

Front 127

2. True or False: Thinner, myelinated nerve fibers are more easily blocked than thicker, unmyelinated nerve fibers

Back 127

2. True

Front 128

3. Please list the sequence of Neural Blockade from first to last.

Back 128

3. B, C, A-d, A-g, A-b, A-a

Front 129

4. Bicarbonate is added to some preparations of local anesthetics to ___________ the speed of onset by increasing the amount of drug that exists in the non-ionized form.

Back 129

4. increase

Front 130

5. Lipid solubility directly affects the ____________ of Local anesthetics. Therefore, those LA’s with greater lipid solubility more easily penetrate the tissue and have faster uptake in the nerve membrane

Back 130

5. potency

Front 131

6. Duration of action of the Local anesthetic directly correlates with the amount of drug that is _________________.

Back 131

6. protein bound

Front 132

7. True of False: Local anesthetics diffuse along a concentration gradient to block nerve fibers on the outer surface (mantle) before more centrally located (core) fibers.

Back 132

7. True

Front 133

8. Addition of _____________ to local anesthetics produces local vasoconstriction which limits systemic absorption and prolongs the duration of action of the local anesthetic.

Back 133

8. Epinephrine

Front 134

9. _______________ results from excessive plasma concentration of local anesthetics which most often results from an accidental intravascular injection during a nerve block.

Back 134

9. LA toxicity

Front 135

10. True or False: Local anesthetic toxicity occurs most often when performing an Intercostal block, followed by epidural and caudal blocks.

Back 135

10. True

Front 136

11. Oxygen is applied before starting a regional block because arterial hypoxemia and acidosis develop rapidly if toxicity occurs. List the signs and symptoms of LA toxicity.

Back 136

11. circumoral numbness, tinnitus, metallic taste, slurred speech, seizures, muscle twitching, respiratory arrest, coma, CV collapse

Front 137

1. T/F Aging in healthy individuals affects the peripheral vasculature through decreases in wall thickness and the diameter and vascular stiffness of the aorta and large arteries.

Back 137

1. F, Increases in wall thickness and diameter and vascular thickness

Front 138

Lung compliance in elderly is increased and a decrease in chest wall compliance.

Back 138

T

Front 139

3. T/F FRC in elderly is decreased and total lung capacity decreases minimally.

Back 139

F, increased FRC

Front 140

By the age of 80, kidneys lose approx. 50% of their functional glomeruli, with similar decreases in renal BF.

Back 140

T

Front 141

. T/F Elderly individuals frequently take multiple medications that might interfere with the binding of drugs to protein active sites

Back 141

T

Front 142

6. T/F Circulating blood vol. generally decreases with aging and results in a lower than expected initial plasma drug concentration for the same amount of drug administered.

Back 142

6. F, Circulating BV increases with age

Front 143

T/F Pre-op ECG in the elderly is a good indicator in predicting postoperative cardiac complications

Back 143

F, not a good indicator

Front 144

T/F Bradycardia is one of the most important hemodynamic abnormalities that has been shown to be associated with ischemia.

Back 144

8. F, tachycardia

Front 145

. T/F A midsystolic ejection murmur is often present in elderly patients secondary to thickening of the aortic cusps or calcification.

Back 145

T

Front 146

T/F In case of emergent surgery, FFP or Vit. K can be given to reverse Warfarin’s effects.

Back 146

T

Front 147

T/F The MAC for various inhaled anesthetic s is reduced by approx. 6% per year after the age of 40.

Back 147

T

Front 148

T/F Treatment of resultant hypotension after spinal or epidural typically consists of the administration of crystalloid solutions or vasopressors such as phenylephrine.

Back 148

T

Front 149

T/F Disorders associated with systolic dysfunction include systemic HTN, CAD, cardiomyopathies, DM, chronic renal disease, aortic stenosis, and A fib.

Back 149

F, Diastolic dysfunction