Anesthesia QOD-2

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smp7791
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Anesthesia QOD-2
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2011-09-19 07:45:39
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Anesthesia QOD questions from website
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  1. Regarding the effects of CO2 pneumoperitoneum during laparoscopic surgery:

    A) absorption of CO2 is greater during intraperitoneal vs. extraperitoneal insufflation
    B) ETCO2 levels may not correlate with PaCO2 levels in ASA III patients
    C) increased ETCO2 causes bronchodilation and a reduction in peak airway pressures
    D) splanchnic blood flow is decreased during mechanical pneumoperitoneum
    B) 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.
    (this multiple choice question has been scrambled)
  2. Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they:

    A) interfere with the use of the cautery
    B) can precipitate severe hyponatremia
    C) can cause hyperglycemia in diabetic patients
    D) are associated with elevated ammonia levels postoperatively
    A) 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.
    (this multiple choice question has been scrambled)
  3. The inhaled anesthetic agent with the highest vapor pressure is:

    A) Sevoflurane
    B) Isoflurane
    C) Desflurane
    D) Nitrous oxide
    D) nitrous oxide

    Nitrous oxide has the highest vapor pressure of the listed inhaled agents, with a vapor pressure of 38770 mmHg (745 psi). The vapor pressures of the other agents, in mmHg, are: desflurane - 669, isoflurane - 238 and sevoflurane - 157. Vapor pressures vary with ambient temperature.
    (this multiple choice question has been scrambled)
  4. The speed in an inhalation induction is slowed by right-to-left shunting. The change in the rate of induction is LEAST pronounced when using:

    A) Nitrous oxide
    B) Sevoflurane
    C) Isoflurane
    D) Desflurane
    C) Isoflurane

    With right-to-left shunting there is slowing of an inhalation induction. This effect is less pronounced with agents with high blood/gas solubilities.
    (this multiple choice question has been scrambled)
  5. MAC-BAR is the:

    A) partial pressure of an anesthetic at which autonomic blockage occurs
    B) partial pressure of an anesthetic required to abolish movement in 50% of patients
    C) partial pressure of an anesthetic at which subjects will open their eyes
    D) partial pressure of an anesthetic at which amnesia occurs
    A) partial pressure of an anesthetic at which autonomic blockade occurs

    MAC-BAR is the minimum alveolar concentration that blocks autonomic reflexes. MAC-BAR is considerably greater than MAC, particularly in the absence of opioids.
    (this multiple choice question has been scrambled)
  6. In a 5-year-old, the appropriate length of an endotracheal tube from distal tip to incisors is:

    A) 14 cm
    B) 16 cm
    C) 13 cm
    D) 15 cm
    B) 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
    (this multiple choice question has been scrambled)
  7. 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:

    A) Volatile-agent-based general anesthesia
    B) Opioid-based general anesthesia
    C) Spinal anesthesia
    D) Epidural anesthesia
    B) 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.
    (this multiple choice question has been scrambled)
  8. Difficulty with mask ventilation is most reliably predicted by:

    A) A history of snoring
    B) The lack of teeth
    C) The presence of a beard
    D) A body mass index greater than 26
    C) The presence of a beard

    Difficulty with mask ventilation is associated with the following (in decreasing order of probability of difficulty): presence of a beard, BMI > 26, lack of teeth, age > 55 and a history of snoring.
    (this multiple choice question has been scrambled)
  9. The area of myocardium most vulnerable to ischemia is the:

    A) Right ventricular epicardium
    B) Left ventricular epicardium
    C) Right ventricular subendocardium
    D) Left ventricular subendocardium
    D) 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.
    (this multiple choice question has been scrambled)
  10. The formation of active metabolites has NOT been associated with the use of:

    A) Vecuronium
    B) Pancuronium
    C) Rocuronium
    D) Succinylcholine
    C) Rocuronium

    The 3-OH metabolites of both vecuronium and pancuronium possess about 50% of the neuromuscular blocking activity of parent compound. Succinylcholine is metabolized to choline, succinic acid and succinylmonocholine. Succinylmonocholine also has some neuromuscular blocking activity. A small amount of rocuronium is metabolized to the 17-OH compound, which lacks activity. Most rocuronium is excreted by the kidneys and liver as intact drug.
    (this multiple choice question has been scrambled)
  11. The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately:

    A) 0.9%
    B) 0.09%
    C) 0.03%
    D) 0.3%
    A) 0.09%

    Percutaneous exposure (needle stick) carries a risk of HIV-seroconversion of approximately 0.3% or about 1:300. Mucous membrane exposure carries a risk of approximately 0.09% or about 1:1100.
    (this multiple choice question has been scrambled)
  12. Actuation of the oxygen flush valve delivers 100% oxygen at a rate of:

    A) 20 – 30 L/min
    B) 10 – 20 L/min
    C) 35 – 75 L/min
    D) 80 – 100 L/min
    C) 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
    (this multiple choice question has been scrambled)
  13. A decrease in cholinesterase activity has been associated with:

    A) Obesity
    B) Alcoholism
    C) Throtoxicosis
    D) Burns
    D) 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.
    (this multiple choice question has been scrambled)
  14. The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:

    A) by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges
    B) with the use of fluid, instead of air, for loss of resistance
    C) with decreasing age
    D) by keeping the patient supine for more than 12 hours following puncture
    B) with the use of fluid, instead of air, for loss of resistance

    The use of fluid instead of air has been associated with a significant reduction in the incidence of postdural puncture headache (PDPH). Other factors associated with a reduced incidence of PDPH are: increasing age, insertion of the bevel aligned parallel to the long axis of the meninges and the use of smaller needles. There is no evidence that keeping the patient supine reduces the incidence of PDPH.
    (this multiple choice question has been scrambled)
  15. Factors decreasing physiologic dead space include:

    A) emphysema
    B) anticholinergic agents
    C) increasing age
    D) the supine position
    D) the supine position

    Dead space is comprised of gases in non-respiratory airways (anatomic dead space) as well as in alveoli that are not perfused (alveolar dead space). The sum of the two is known as physiologic dead space. Certain factors affect dead space. The supine position is known to decrease dead space, whereas anticholinergics, β2-sypmathomimetics, advancing age and COPD all increase dead space.
    (this multiple choice question has been scrambled)
  16. As compared with plasma osmolality, hypertonic crystalloid solutions include:

    A) D5 0.45NS
    B) Ringer’s lactate
    C) D5 0.25NS
    D) D5W
    A) 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.
    (this multiple choice question has been scrambled)
  17. Selective adrenergic stimulation of the β2-receptor results in:

    A) Detrusor muscle contraction
    B) Pupilary constriction
    C) Increased heart rate
    D) Increased insulin secretion
    D) 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.
    (this multiple choice question has been scrambled)
  18. Allergic reactions are most commonly seen with the use of:

    A) Neuromuscular blockers
    B) Local anesthetics
    C) Barbiturates
    D) Propofol
    A) Neuromuscular blockers

    Muscle relaxants are responsible for more than 60% of drug-induced allergic reactions during the perioperative period. It is estimated that 50% of patients who experience allergic reactions to a muscle relaxant will also exhibit sensitivity to other muscle relaxants. The cross-sensitivity among this class of drugs is secondary to their structure similarities; specifically the presence of one or more antigenic quaternary ammonium groups.
    (this multiple choice question has been scrambled)
  19. The most consistent clinical manifestation of aspiration pneumonitis is:

    A) Arterial hypoxemia
    B) Tachypnea
    C) Bronchospasm
    D) Pulmonary vasoconstriction
    A) 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.
    (this multiple choice question has been scrambled)
  20. A full-term, 4.2 kg neonate is scheduled for a thoracotomy for resection of congenital lobar emphysema. The infant's starting hematocrit is 48%. Estimated allowable blood loss to maintain a hematocrit at or above 38% is:(Enter numerical answer below).

    ________ mL
    70 - 110 mL

    The full-term neonate has approximately 85 ml/kg total blood volume. Therefore:

    • - 4.2 kg x 85 ml/kg = 357 ml (blood volume)
    • - 357 ml x 48% = 171 ml (current red cell mass)
    • - 357 ml x 38% = 136 ml (allowable red cell mass)
    • - 171 ml - 136 ml = 35 ml (allowable red cell mass loss)
    • - 35 ml x 3 = 105 ml (allowable blood loss)
  21. Hormones secreted by the neurohypophysis include:

    A) Prolactin
    B) ACTH
    C) Oxytocin
    D) TSH
    C) Oxytocin

    The neurohypophysis is another term for the posterior pituitary gland. The hormones of the neurohypophysis, oxytocin and antidiuretic hormone (vasopressin), are synthesized in the hypothalamus and stored in the posterior pituitary. Stimulus for the release of these hormones arises from osmoreceptors in the hypothalamus that sense plasma osmolality.
    (this multiple choice question has been scrambled)
  22. Pancreatic somatostatin producing cells in the Islets of Langerhans are:

    A) Gamma cells
    B) Beta cells
    C) Delta cells
    D) Alpha cells
    C) Delta cells

    The Islets of Langerhans are comprised of four cell types: alpha cells producing glucagon, beta cells producing insulin, delta cells producing somatostatin and PP cells producing pancreatic polypeptide.
    (this multiple choice question has been scrambled)
  23. Congenital heart diseases associate with right-to-left shunting include:

    A) Tricuspid atresia
    B) Coarctation of the aorta
    C) Atrial septal defect
    D) Ventricular septal defect
    A) Tricuspid atresia

    Right-to-left shunting (cyanotic) heart disease is associated with: Tetrology of Fallot, pulmonary atresia, triscupid atresia, transposition of the great vessels, truncus arteriosus, single ventricle, double-outlet ventricle, total anomalous pulmonary venous return and hypoplastic left heart. With tricuspid atresia, blood can flow out of the right atrium only via a patent foramen ovale (PFO). A PDA or VSD is necessary for the blood to flow from the left ventricle to the pulmonary circulation.
    (this multiple choice question has been scrambled)
  24. The maximum leakage current allowed in operating room equipment is:

    A) 5 mA
    B) 1 mA
    C) 5 µA
    D) 10 µA
    D) 10 μA

    10 μA has been established as the maximum allowable leakage current. This amount of current is below the threshold of perception (1mA) as well as below the threshold for risk of microshock.
    (this multiple choice question has been scrambled)
  25. Causes of normal-anion-gap acidosis include:

    A) Diarrhea
    B) Starvations
    C) Renal failure
    D) Lactic acidosis
    A) Diarrhea

    Normal-anion-gap acidosis is also called hyperchloremic acidosis and results from the selective loss of bicarbonate anion or the introduction of large amounts of chloride anion. Common causes include: diarrhea, hypoaldosteronism, renal tubular acidosis and increased intake of chloride containing acids sometimes found in hyperalimentation.
    (this multiple choice question has been scrambled)
  26. Carbonic anhydrase inhibitors are used in the treatment of:

    A) Renal tubular acidosis
    B) Diarrhea induced acidosis
    C) Acute glaucoma
    d) All of the above
    C) 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.
    (this multiple choice question has been scrambled)
  27. Hypoxemia during one-lung anesthesia is most effectively treated by:

    A) Continuous oxygen insufflation to the collapsed lung
    B) Periodic inflation of the collapsed lung
    C) PEEP applied to the ventilated lung
    D) Changing tidal volume and rate
    B) Periodic inflation of the collapsed lung

    The application of PEEP to the ventilated lung, changes in the ventilatory parameters and oxygen insufflation to the collapsed lung may offer marginal improvement in oxygenation. However, periodic inflation of the collapsed lung with oxygen, early ligation of the ipsilateral pulmonary artery and CPAP to the collapsed lung offer consistently effective improvement in oxygenation.
    (this multiple choice question has been scrambled)
  28. Sympathetic blockade during acute herpes zoster has been shown to:

    A) Reduce the incidence of postherpetic neuralgia
    B) Be an effective treatment for patients who have had postherpetic neuralgia for a number of years
    C) Increase analgesic requirements
    D) Increase the need for corticosteroid therapy
    A) Reduce the incidence of postherpetic neuralgia

    Sympathetic blockade within 2 months of the onset of herpes zoster has been shown to significantly reduce analgesic requirements and reduce the incidence of postherpetic neuralgia. Once the neuralgia is established however, blocks are usually ineffective.
    (this multiple choice question has been scrambled)
  29. Branches of the femoral nerve anesthetized during an ankle block include the:

    A) Saphenouse nerve
    B) Sural nerve
    C) Posterior tibial nerve
    D) Deep peroneal nerve
    A) 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.
    (this multiple choice question has been scrambled)
  30. Pulmonary complications from advanced hepatic disease with cirrhosis include:

    A) Respiratory acidosis
    B) Increased functional residual capacity
    C) Increased intrapulmonary shunting
    D) An obstructive ventilatory defect
    C) Increased intrapulmonary shunting

    Pulmonary manifestations associated with cirrhosis include: increased intrapulmonary shunting, decreased FRC, pleural effusions, restrictive ventilatory defect and respiratory alkalosis.
    (this multiple choice question has been scrambled)
  31. An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is

    A) Echinacea
    B) Valerian
    C) ephedra
    D) Ginko
    B) Valerian

    Both valerian and kava have been shown to have a GABA-mediated hypnotic effect and by this mechanism decrease MAC.
    (this multiple choice question has been scrambled)
  32. A decrease in pseudocholinesterase activity has been associated with the use of: (Select 3)

    a) Pancuronium
    b) Esmolol
    c) Droperidol
    d) Vecuronium
    e) Metoclopramide
    f) Magnesium sulfate
    g) Dantrolene
    h) Rocuronium
    • a) Pancuronium
    • b) Esmolol
    • e) 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.
  33. During the delivery of an anesthetic in the radiology department, full E-cylinders of nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is being delivered and the case has been proceeding for 60 minutes, the expected pressure in the nitrous oxide E-cylinder is:

    A) 745 psi
    B) 2000 psi
    C) 372 psi
    D) 1500 psi
    A) 745 psi

    Nitrous oxide has a critical temperature of 37C. This allow nitrous oxide to exist as a liquid at room temperature. Full E-cylinders of nitrous oxide contain approximately 1590 L at a pressure of 745 psi. A sixty minute delivery of 3 L/min would result in a 180 L consumption, and this would be inadequate to consume all the liquid nitrous oxide in the tank. As a result, there would be no change in tank pressure.
    (this multiple choice question has been scrambled)
  34. The formation of metanephrine is the result of:

    A) Monamine oxidase metabolism of norepinephrine
    B) Catechol-O-methyltransferase metabolism of norepinephrine
    C) Catechol-O-methyltransferase metabolism of epinephrine
    D) Monamine oxidase metabolism of epinephrine
    C) 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).
    (this multiple choice question has been scrambled)
  35. Characteristics of the dystrophic phase of complex regional pain syndrome type I include:

    A) Localized severe throbbing pain
    B) Cold, sweaty skin
    C) Severe osteoporosis with ankylosis of the joints
    D) Inciting event that occurred 1-3 months earlier
    B) Cold, sweaty skin

    Complex regional pain syndrome type I, previously known as reflex sympathetic dystrophy, is characterized by 3 phases: acute, dystrophic and atrophic. The dystrophic phase usually occurs 3 - 6 months after an inciting incident and is characterized by cold sweaty skin, some degree of muscle wasting with osteoporosis and pain that is described as diffuse and throbbing.
    (this multiple choice question has been scrambled)
  36. An action potential characterized by a spike followed by a plateau phase is seen in:

    A) Peripheral sensory nerve cells
    B) Peripheral motor nerve cells
    C) Cardiac muscle cells
    D) Striated skeletal muscle cells
    C) 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.
    (this multiple choice question has been scrambled)
  37. During mediastinoscopy the risk of air embolization is greatest:

    A) immediately after closure of the incision
    B) during spontaneous ventilation
    C) in the postoperative period
    D) when the patient is supine
    B) during spontaneous ventilation

    Air embolization is seen with mediastinoscopy as a result of the 30o elevation of the head. This risk is increased if the patient is spontaneously ventilating, secondary to the negative intrathoracic pressures generated during inhalation
    (this multiple choice question has been scrambled)
  38. Autonomic hyperreflexia:

    A) is not effectively prevented by regional anesthesia
    B) can be prevented by adequate intraoperative sedation
    C) can precipitate pulmonary edema
    D) is common with cord lesions below T6
    C) can precipitate pulmonary edema

    Autonomic hyperreflexia should be suspected in patients with lesions above T6. Regional anesthesia and deep general anesthesia are effective in preventing autonomic hyperreflexia. Surgical stimulation in these patients without adequate anesthesia can result in pulmonary edema, myocardial ischemia and cerebral hemorrhage.
    (this multiple choice question has been scrambled)
  39. During placement of a lumbar epidural using a midline approach, the needle passes through the: (Select 3)

    a) Interspinous ligament
    b) Anterior longitudinal ligament
    c) Intervertebral disk
    d) Supraspinous ligament
    e) Ligamentum flavum
    f) Facet joint
    • d) Supraspinous ligament
    • a) Intraspinous ligament
    • e) Ligamentum flavum

    Passing anteriorly from the skin to the epidural space are the following structures: skin, subcutaneous tissue, supraspinous ligament, intraspinous ligament, ligamentum flavum.
  40. Interpleural analgesia can be accomplished by placing local anesthetic:

    A) along the cephalad border of the T6 rib
    B) immediately deep to the visceral pleura
    C) superficial to the internal intercostal muscle
    D) immediately deep to the parietal pleura
    D) immediately deep to the parietal pleura

    Interpleural analgesia is accomplished by placing an catheter between the parietal and visceral pleura. A loss-of-resistance technique is most commonly used at the T6 to T8 intercostal spaces. Pneumothorax is a significant complication if the needle or catheter penetrates the visceral pleura.
    (this multiple choice question has been scrambled)
  41. The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by:

    A) Free acetate anion
    B) Acetyl cholinesterase
    C) Pseudocholinesterase
    D) Choline acetyltransferase
    D) Choline acetyltransferase

    The synthesis of acetylcholine occurs in the cholinergic nerve terminal. Acetyl Co-A and choline combine to form acetylcholine. This reaction is catalyzed by the enzyme choline acetyltransferase.
    (this multiple choice question has been scrambled)
  42. The primary causative factor in the development of persistent pulmonary hypertension (PPH) in the neonate is:

    A) Hypoxemia
    B) Pregnancy-induces hypertension
    C) Cystic fibrosis
    D) Right-to-left shunting through a patent ductus arteriosus
    A) Hypoxemia

    Hypoxia or acidosis during the early neonatal period may predispose the infant to return to fetal circulation. This serious condition, previously known as persistent fetal circulation (PFC), is currently known as persistent pulmonary hypertension (PPH). Hypoxemia and/or acidosis promotes an increase in pulmonary vascular resistance which ultimately causes right to left shunting through the ductus arteriosus, foramen ovale, or both. Shunting causes continued hypoxemia, leading to a continued increase in pulmonary vascular resistance, and a vicious cycle ensues. Primary causes of hypoxemia in the neonate include pneumonia and meconium aspiration.
    (this multiple choice question has been scrambled)
  43. Electrocardiographic changes seen with hypokalemia include:

    A) Peaked T Waves
    B) Shortened PR interval with P wave inversion
    C) Increasingly prominent U waves
    D) Decreased QRS amplitude
    C) Increasingly prominent U waves

    Electrocardiographic changes seen with hypokalemia include:
    · T wave flattening/inversion
    · ST segment depression
    · increased P wave amplitude
    · prolongation of the P-R interval
    · increasingly prominent U waves
    (this multiple choice question has been scrambled)
  44. Deleterious effects of hypothermia include: (Select 2)

    a) Impaired renal function
    b) Right shift of the hemoglobin-oxygen saturation curve
    c) Irreversible platelet dysfunction
    d) Increased incidence of wound infection
    e) Increased postoperative protein anabolism
    • a) Impaired renal function
    • d) Increased incidence of wound infection

    • Deleterious effects of hypothermia include:
    • · increased PVR
    • · left shift of the hemoglobin-oxygen saturation curve
    • · reversible platelet dysfunction
    • · postoperative protein catabolism
    • · altered mental status
    • · impaired renal function
    • · decreased drug metabolism
    • · poor wound healing
    • · increased incidence of infection
  45. Prior to pneumonectomy, split lung function testing is indicated in the patient with:

    A) An FEV1 of 2.2L
    B) A PaO2 of 54 mmHg on room air
    C) A PaCO2 of 49 mmHg on room air
    D) A maximum VO2 of 17 mL/kg/min
    C) A PaCO2 of 49 mm Hg on room air

    Split lung function testing is indicated in patients requiring pneumonectomy, but not meeting the recommended laboratory criteria. Current recommendations for patients requiring pneumonectomy are:
    · PaCO2 < 45 mmHg
    · FEV1 > 2 L
    · Predicted postop FEV1 > 800 mL
    · Maximum VO2 > 10 mL/kg/min
    · FEV1/FVC > 50% of predicted
    (this multiple choice question has been scrambled)
  46. Mechanisms of renal compensation during acidosis include:

    A) Increased elimination of carbon dioxide
    B) Decreased excretion of hydrogen ions
    C) Increased production of ammonia
    D) Decreased reabsorption of filtered bicarbonate
    C) Increased production of ammonia

    The renal response to acidemia is:
    · increased reabsorption of bicarbonate anion
    · increased excretion of hydrogen ion in the form of titratable acids
    · increased production of ammonia

    Although increased carbon dioxide elimination is a compensatory mechanism in acidemia, it is accomplished by increased alveolar ventilation.
    (this multiple choice question has been scrambled)
  47. Postintubation croup:

    A) is secondary to inflammation at the level of the cricoid
    B) is most often seen immediately upon extubation
    C) occurs most frequently in infants less than 4 months of age
    D) is less common when cuffed endotracheal tubes are used
    A) 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.
    (this multiple choice question has been scrambled)
  48. Closing capacity is defined as:

    A) Closing volume + expiratory reserve volume
    B) Functional residual capacity – residual volume
    C) Residual volume + expiratory reserve volume
    D) Closing volume + residual volume
    D) Closing volume + residual volume

    Closing capacity is the lung volume at which airways begin to close and is defined as the closing volume + residual volume.
    (this multiple choice question has been scrambled)
  49. Dantrolene: (Select 2)

    a) Depends on an extracellular mechanism to achieve muscle relaxation
    b) Inhibits calcium ion release from the sarcoplasmic reticulum
    c) Can also be used in the treatment of thyroid storm
    d) Therapy should not be repeated after an MH episode has terminated
    e) Has a half-life of approximately 12 hours
    • b) Inhibits calcium ion release from the sarcoplasmic reticulum
    • c) Can be used in the treatment of thyroid storm

    Dantrolene binds with the Ryr1 receptor and inhibits calcium ion release from the sarcoplasmic reticulum. Dantrolene's effects are intracellular and may result in muscle weakness and ventilatory insufficiency. The half-life of dantrolene is approximately 6 hours. Dantrolene has also been used to treat neuroleptic malignant syndrome and thyroid storm.
  50. The elimination half-life of a drug:

    A) Is directly proportional to clearance
    B) Is inversely proportional to the volume of distribution
    C) Is inversely proportional to the clearance
    D) Is shortest in drugs that are rapidly redistributed
    C) Is inversely proportional to the clearance

    The elimination half-life of a drug is proportional to the volume of distribution and inversely proportional to the rate of clearance.
    (this multiple choice question has been scrambled)

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