Anesthesia QOD-1

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smp7791
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102455
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Anesthesia QOD-1
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2011-09-18 20:42:00
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anesthesia
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Anesthesia question of the day from website
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  1. The highest rate of systemic absorption of local anesthetic is seen with:

    A) epidural injection
    B) caudal injection
    C) brachial plexus injection
    D) intercostal injection
    D) Intercostal injection

    The rate of systemic absorption of local anesthetic is proportionate to the vascularity of the site of injection: intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > subcutaneous
    (this multiple choice question has been scrambled)
  2. Absolute contraindications to electroconvulsive therapy (ECT) include:

    A) CHF
    B) Pregnancy
    C) MI 5 months prior to therapy
    D) Increased ICP
    D) Increased ICP

    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.
    (this multiple choice question has been scrambled)
  3. The therapeutic range of lithium in the plasma is between:

    A) 1.8 to 2.0 mEq/L
    B) 1.2 to 1.5 mEq/L
    C) 0.2 and 0.4 mEq/L
    D) 0.8 to 1.0 mEq/L
    D) 0.8 and 1.0 mEq/L
    (this multiple choice question has been scrambled)
  4. In the fetus, the percentage of cardiac output directed to the placenta is approximately:

    A) 10%
    B) 25%
    C) 50%
    D) 100%
    C) 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.
    (this multiple choice question has been scrambled)
  5. The elimination half-life of intravenously administered oxytocin in the parturient is approximately:

    A) 10 to 15 minutes
    B) 30 to 120 seconds
    C) 3 to 5 minutes
    D) 20 to 30 minutes
    C) 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.
    (this multiple choice question has been scrambled)
  6. A fresh E-cylinder of oxygen:

    A) Contains about 90% liquid oxygen and 10% oxygen as a gas
    B) Has a lower pressure than the pipeline oxygen supply
    C) Contains more liters of gas than an E-cylinder of nitrous oxide
    D) Contains about 660 liters of oxygen
    D) contains about 660 liters of oxygen

    A fresh E-cylinder of oxygen contains about 660 liters of oxygen and is pressurized to 2000 psi.
    (this multiple choice question has been scrambled)
  7. In the United States, the most common cause of cirrhosis is:

    A) hemochromatosis
    B) alcohol consumption
    C) chronic hepatitis
    D) steatohepatitis
    B) alcohol consumption

    Cirrhosis caused by chronic alcohol consumption, also called Laenec's cirrhosis, is the most common form of cirrhosis in the United States.
    (this multiple choice question has been scrambled)
  8. Clinically significant histamine release has been associated with the use of:

    A) atracurium
    B) cisatracurium
    C) vecuronium
    D) rocuronium
    A) atracurium

    Atracurium has been associated with histamine release from mast cells and can result in bronchospasm, skin flushing and hypotension.
    (this multiple choice question has been scrambled)
  9. The therapeutic range of magnesium in the plasma in order to provide tocolysis and prevent eclamptic seizures is between:

    A) 6 to 8 mg/dL
    B) 2 to 4 mg/dL
    C) 18 to 20 mg/dL
    D) 12 to 14 mg/dL
    A) 6 to 8 mg/dL
    (this multiple choice question has been scrambled)
  10. The purpose of the ductus venosus in fetal circulation is to:

    A) allow umbilical vein blood to bypass the liver
    B) bypass the pulmonary circulation
    C) allow umbilical artery blood to bypass the liver
    D) divert portal vein blood to the placenta
    A) allow umbilical vein blood to bypass the liver

    Up to 50% of the umbilical vein blood can pass directly into the inferior vena cava, bypassing the liver, through the ductus venosus. The remainder mixes with blood from the portal vein and passes through the liver prior to returning to the heart.
    (this multiple choice question has been scrambled)
  11. Highly specific preoperative screening tests have a:

    A) low sensitivity
    B) low incidence of false-negative results
    C) low incidence of false-positive results
    D) result that is specific for one pathologic process
    C) 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.
    (this multiple choice question has been scrambled)
  12. Serotonin has vasodilatory properties in the:

    A) hepatic vasculature
    B) renal vasculature
    C) skeletal muscle vasculature
    D) pulmonary vasculature
    C) skeletal muscle vasculature

    Serotonin is a vasoconstrictor in most vascular beds, but has vasodilatory properties in the vasculature of the heart and skeletal muscle
    (this multiple choice question has been scrambled)
  13. Drugs that bind to the proton pump of gastric parietal cell and inhibit hydrogen ion secretion include:

    A) ranitidine
    B) famotidine
    C) cimetadine
    D) omeprazole
    D) omeprazole

    Omeprazole (Prilosec) inhibits the proton pump of the parietal cells of the gastric mucosa, decreases hydrogen ion secretion and increase pH. Cimetidine, ranitidine and famotidine also increase gastric pH, however their mechanism is through blockade of the H2 receptor
    (this multiple choice question has been scrambled)
  14. Drugs that inhibit coagulation through direct inhibition of thrombin include:

    A) aprotonin
    B) bivalirudin
    C) heparin
    D) warfarin
    B) 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.
    (this multiple choice question has been scrambled)
  15. Enoxaparin:

    A) effects are monitored using the INR
    B) is easily reversed with protamine
    C) has a half-life that is 35% less than that of heparin
    D) causes less platelet inhibition than heparin
    D) causes less platelet inhibition than heparin

    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.
    (this multiple choice question has been scrambled)
  16. An occurrence malpractice insurance policy:

    A) is the most common form of malpractice insurance in place today
    B) offers coverage if the policy is in place at the time the claim is filed
    C) is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy
    D) offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed
    D) 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.
    (this multiple choice question has been scrambled)
  17. Clinical signs of cardiac tamponade include:

    A) a 12mmHg decline in blood pressure with exhalation
    B) muffled heart sounds
    C) collapsed neck veins
    d) all of the above
    B) muffled heart sounds

    Cardiac tamponade is indicated by the presence of neck vein distention, hypotension, muffled heart sounds (Beck's triad) and a greater than 10 mmHg decline in blood pressure during spontaneous inspiration (pulsus paradoxus).
    (this multiple choice question has been scrambled)
  18. Ventilatory parameters that are increased during pregnancy include:

    A) tidal volume
    B) PaCO2
    C) airway resistance
    D) bicarbonate
    A) 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.
    (this multiple choice question has been scrambled)
  19. Droperidol:

    a) has antiarrhythmic activity
    b) causes shortening of the QT interval c) causes peripheral vasoconstriction
    d) is effective for blood pressure control in patients with pheochromocytoma
    a) has antiarrhythmic activity

    Droperidol has mild alpha-blocking activity and causes vasodilation and has anti-arrhythmic 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.
  20. Type I pneumocytes:

    A) are capable of rapid cell division
    B) prevent the passage of albumin into the alveolus
    C) produce surfactant
    D) are more numerous than Type II pneumocytes
    B) 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.
    (this multiple choice question has been scrambled)
  21. The phrenic nerves arise from the:

    A) C1 – C2 nerve roots
    B) C6 – T2 nerve roots
    C) C3 – C5 nerve roots
    D) nucleus ambiguous
    C) 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.
    (this multiple choice question has been scrambled)
  22. The primary mechanism of intraoperative heat loss resulting in hypothermia is:

    A) conduction
    B) evaporation
    C) convection
    D) radiation
    D) radiation

    Radiation accounts for approximately 40% of intraoperative heat loss. Convection is the next most significant mechanism of loss accounting for 32%.
    (this multiple choice question has been scrambled)
  23. Sinus arrhythmia:

    A) causes an increase in heart rate with inspiration
    B) is indicative of SA node ischemia
    C) is the primary cause of premature atrial contractions
    D) is mediated through sympathetic innervation of the AV node
    A) 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
    (this multiple choice question has been scrambled)
  24. The block associated with the highest blood level of local anesthetic per volume injected is the:

    A) epidural block
    B) intercostals block
    C) caudal block
    D) spinal block
    B) intercostal block

    Blood concentration of local anesthetic is dependent on the total volume and concentration injected. However, the intercostal block results in the highest blood levels of local anesthetic per volume injected of any block in the body.
    (this multiple choice question has been scrambled)
  25. In addition to providing analgesia, tramadol has been shown to:

    A) cause comparable respiratory depression to morphine
    B) inhibit cholinesterase
    C) significantly delay gastric emptying
    D) inhibit the reuptake of serotonin and norepinephrine
    D) inhibit the reuptake of serotonin and norepinephrine

    Tramadol is a synthetic opioid that also blocks neuronal reuptake of norepinephrine and serotonin. Tramadol is associated with significantly less respiratory depression and delay in gastric emptying as compared to other narcotics.
    (this multiple choice question has been scrambled)
  26. Compensatory mechanisms generally present in patients with congestive heart failure include:

    a) decreased sympathetic tone
    b) decreased plasma renin levels
    c) decreased plasma aldosterone levels d) ventricular hypertrophy
    d) ventricular hypertrophy

    Major compensatory mechanisms present in patients with CHF include increased preload, increased sympathetic tone, activation of the renin-angiotensin-aldosterone system, release of ADH and ventricular hypertrophy.
  27. The incidence of venous air embolism during sitting craniotomies is approximately:

    A) 5 – 10%
    B) 10 – 15%
    C) 20 – 40%
    D) Greater than 50%
    C) 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.
    (this multiple choice question has been scrambled)
  28. The duration of action of atracurium may be prolonged by:

    A) respiratory alkalosis
    B) hyperthermia
    C) metabolic acidosis
    d) all of the above
    C) metabolic acidosis

    Because of its unique metabolism, the Hoffman elimination, the duration of action of atracurium may be prolonged by hypothermia or acidosis.
    (this multiple choice question has been scrambled)
  29. 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:

    A) The first 2 hours
    B) 4 to 6 hours
    C) 7 to 9 hours
    D) 12 to 14 hours
    D) 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.
    (this multiple choice question has been scrambled)
  30. Opioids currently NOT approved for epidural or intrathecal use include:

    A) Sufentanil
    B) Remifentanil
    C) Fentanyl
    D) Morphine
    B) Remifentanil

    Remifentanil is prepared in a solution of glycine, a known inhibitory neurotransmitter. Currently remifentanil is not approved for epidural or intrathecal use.
    (this multiple choice question has been scrambled)
  31. 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:

    A) the intravenous administration of caffeine
    B) use of desflurane as the sole anesthetic agent
    C) the use of ketamine as the sole anesthetic agent
    D) the avoidance of nitrous oxide
    A) the intravenous administration of caffeine

    Both caffeine and theophylline have been shown to reduce the incidence of postoperative 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.
    (this multiple choice question has been scrambled)
  32. Safety features that prevent filling of the vaporizer with an incorrect agent include:

    A) the pin index safety system
    B) agent-specific keyed filling ports
    C) the diameter index safety system
    D) counter-threading of the bottle attachment
    B) 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.
    (this multiple choice question has been scrambled)
  33. A person acting as an amicus curiae:

    A) gives expert testimony for the defense
    B) gives expert testimony for the plaintiff
    C) cannot file a written brief
    D) is not a party to the litigation
    D) 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.
    (this multiple choice question has been scrambled)
  34. The first nurse anesthetist to be appointed to a university medical school faculty was:

    A) Helen Lamb
    B) Alice Magaw
    C) Agatha Hodgen
    D) Alice Maude Hunt
    D) 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.
    (this multiple choice question has been scrambled)
  35. Re-order the list of inhaled agents below from highest vapor pressure to lowest (Highest vapor pressure agent at top of list):

    a) isoflurane
    b) sevoflurane
    c) nitrous oxide
    d) desflurane
    • a) Nitrous oxide
    • b) Desflurane
    • c) Isoflurane
    • d) Sevoflurane

    At 20C, 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).
  36. Reduction of heart rate seen with the administration of opiates is mediated through the:

    A) mu-2 receptors
    B) delta receptors
    C) mu-1 receptors
    D) kappa receptors
    A) mu-2 receptors

    The cardiovascular effects of narcotics appear to be mediated through the mu-2 receptors. In addition, these receptors seem, at least in part, to be responsible for the ventilatory depression associated with narcotic admnistration.
    (this multiple choice question has been scrambled)
  37. Mortality after liposuction procedures most commonly is the result of:

    A) fat embolization
    B) pulmonary embolism
    C) bowel perforation
    D) reactions to anesthetic agents
    B) 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.
    (this multiple choice question has been scrambled)
  38. Heart rate:

    A) is the sole determinant of cardiac output in the elderly
    B) is normally determined by the intrinsic rate of the AV node
    C) is increased by stimulation of the M2 cholinergic receptors
    D) after puberty, decreased with increasing age
    D) 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.
    (this multiple choice question has been scrambled)
  39. Pulmonary effects of α1-adrenergic stimulation include:

    A) major changes in pulmonary vascular tone
    B) bronchodilation
    C) decreased bronchial secretions
    D) inhibition of hypoxic pulmonary vasoconstriction
    C) 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.
    (this multiple choice question has been scrambled)
  40. Nervous system changes seen in the pregnant patient at term include: (Select 2)

    a) increased minimum alveolar concentration
    b) increased sensitivity to local anesthetics
    c) decreased cerebrospinal fluid volume d) decreased cephalad spread of spinal anesthetics
    e) decreased epidural space pressure
    f) increased potential volume of epidural space
    • b) increased sensitivity to local anesthetics
    • c) 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
  41. Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the:

    A) azygous vein
    B) hemorrhoidal veins
    C) hepatic vein
    D) pulmonary veins
    B) 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.
    (this multiple choice question has been scrambled)
  42. After its formation in 1933, the American Association of Nurse Anesthetists set as its first priority the establishment of:

    A) specifications for delivery of anesthetic vapors
    B) equality of pay between physicians and nurses
    C) standards for educating nurse anesthetists
    D) state organizations
    C) standards for educating nurse anesthetists

    The AANA also recognized the need to certify nurse anesthetists at that time.
    (this multiple choice question has been scrambled)
  43. A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is:

    A) phenoxybenzamine
    B) propranolol
    C) terazosin
    D) doxazosin
    A) 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.
    (this multiple choice question has been scrambled)
  44. The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the:

    A) glomerulus
    B) proximal convoluted tubule
    C) distal convoluted tubule
    D) Loop of Henle
    D) Loop of Henle

    The Loop of Henle is responsible for formation of hypertonic fluid in the (renal) medullary interstitium via the countercurrent multiplier system.
    (this multiple choice question has been scrambled)
  45. Ulnar nerve injury:

    A) manifests itself in the immediate postoperative period
    B) occurs more frequently in males
    C) results in wrist drop and loss of sensation in the web space between the thumb and index finger
    D) is most commonly seen in the patient with a BMI of less than 38
    B) 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
    (this multiple choice question has been scrambled)
  46. Sympathetic fibers to the kidney causing vasoconstriction arise from:

    A) the vagus nerves
    B) T4 – L1
    C) C8 – T3
    D) L2 – S2
    B) 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.
    (this multiple choice question has been scrambled)
  47. The most common acid-base abnormality in the critically ill patient is:

    A) respiratory alkalosis
    B) metabolic acidosis
    C) metabolic alkalosis
    D) respiratory acidosis
    C) metabolic alkalosis

    Metabolic alkalosis is the commonest acid-base abnormality in critically ill patients. Common causes metabolic alkalosis are nasogastric suctioning, diuretic administration and hypovolemia.
    (this multiple choice question has been scrambled)
  48. The most frequent manifestation of sickle cell disease is:

    A) splenic sequestration
    B) pain
    C) right upper quadrant syndrome
    D) aplastic crisis
    B) pain

    The most frequent manifestation of sickle cell disease is pain. The pain is thought to be secondary to tissue ischemia and usually affects the back, chest, extremities and abdomen.
    (this multiple choice question has been scrambled)
  49. The line isolation monitor:

    A) provides a source of ungrounded electrical power
    B) reduces the risk of microshock
    C) monitors the integrity of the isolated power system
    d) all of the above
    C) monitors the integrity of the isolated power system

    The line isolation monitor continuously monitors the integrity of the isolated power system. The line isolation transformer provides ground isolation. Microshock hazards occur with the delivery of 100 microamps or less of current directly to the endocardium. These small amounts of current are well below the sensing range of the ground isolation monitor.
    (this multiple choice question has been scrambled)
  50. Parasympathetic preganglionic fibers are found in:

    A) cranial nerve V
    B) cranial nerve IV
    C) sacral nerves 2, 3, and 4
    D) thoracic nerves 8, 9, and 10
    C) sacral nerves 2, 3 and 4

    Parasympathetic preganglionic fibers are found in cranial nerves III, VII, IX and X as well as sacral nerves 2, 3 and 4
    (this multiple choice question has been scrambled)

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