{"ad_unit_id":"App_Resource_Sidebar_Upper","resource":{"id":1133364,"author_id":143609,"title":"Anesthesia Question of the Day 2","created_at":"2014-08-10T11:54:18Z","updated_at":"2017-01-09T00:31:29Z","sample":false,"description":"","alerts_enabled":true,"cached_tag_list":"","deleted_at":null,"hidden":false,"average_rating":"5.0","demote":false,"private":false,"copyable":true,"score":80,"artificial_base_score":0,"recalculate_score":true,"profane":false,"hide_summary":false,"tag_list":[],"admin_tag_list":[],"study_aid_type":"Quiz","show_path":"/quizzes/1133364","folder_id":266436,"public_author":{"id":143609,"profile":{"name":"thomasina413","about":null,"avatar_service":"google","locale":"en","google_author_link":"https://plus.google.com/114791503718757675637","user_type_id":null,"escaped_name":"thomasina413","full_name":"thomasina413","badge_classes":""}}},"width":300,"height":250,"rtype":"Quiz","rmode":"canonical","sizes":"[[[0, 0], [[300, 250]]]]","custom":[{"key":"env","value":"production"},{"key":"rtype","value":"Quiz"},{"key":"rmode","value":"canonical"},{"key":"uauth","value":"f"},{"key":"uadmin","value":"f"},{"key":"ulang","value":"en_us"},{"key":"ucurrency","value":"usd"}]}
{"ad_unit_id":"App_Resource_Sidebar_Lower","resource":{"id":1133364,"author_id":143609,"title":"Anesthesia Question of the Day 2","created_at":"2014-08-10T11:54:18Z","updated_at":"2017-01-09T00:31:29Z","sample":false,"description":"","alerts_enabled":true,"cached_tag_list":"","deleted_at":null,"hidden":false,"average_rating":"5.0","demote":false,"private":false,"copyable":true,"score":80,"artificial_base_score":0,"recalculate_score":true,"profane":false,"hide_summary":false,"tag_list":[],"admin_tag_list":[],"study_aid_type":"Quiz","show_path":"/quizzes/1133364","folder_id":266436,"public_author":{"id":143609,"profile":{"name":"thomasina413","about":null,"avatar_service":"google","locale":"en","google_author_link":"https://plus.google.com/114791503718757675637","user_type_id":null,"escaped_name":"thomasina413","full_name":"thomasina413","badge_classes":""}}},"width":300,"height":250,"rtype":"Quiz","rmode":"canonical","sizes":"[[[0, 0], [[300, 250]]]]","custom":[{"key":"env","value":"production"},{"key":"rtype","value":"Quiz"},{"key":"rmode","value":"canonical"},{"key":"uauth","value":"f"},{"key":"uadmin","value":"f"},{"key":"ulang","value":"en_us"},{"key":"ucurrency","value":"usd"}]}
A 73-year-old woman taking warfarin for chronic atrial fibrillation is brought to the operating room for evacuation of a spontaneous left temporal intracerebral hematoma with uncal herniation syndrome. Her INR is 3.8. Her platelet count and hematocrit are normal. What is the recommended medical therapy for reversing her coagulopathy?
Answer
Cryoprecipitate
4-Factor prothrombin complex concentrate (PCC)
Fresh frozen plasma
Vitamin K
Question 2
Question
The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:
Answer
with decreasing age
by keeping the patient supine for more than 12 hours following puncture
with the use of fluid, instead of air, for loss of resistance
by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges
Question 3
Question
All of the following statements are true about hypoxic pulmonary vasoconstriction (HPV) EXCEPT:
Answer
HPV is a local response of bronchiolar artery smooth muscle in underventilated areas of the lung
HPV is responsible for most lung perfusion redistribution during one-lung ventilation
HPV occurs in areas of the lung with low alveolar oxygen pressure
HPV allows the lung to maintain optimal ventilation/perfusion matching
Question 4
Question
Factors decreasing physiologic dead space include:
Answer
the supine position
anticholinergic agents
increasing age
emphysema
Question 5
Question
A 64-year-old, 73 kilogram male with a 50 pack-year smoking history is scheduled to undergo a lobectomy for a right upper lobe mass. You have placed a left-sided double lumen endotracheal tube, and you would like to confirm proper placement. Which of the following findings would suggest that your double-lumen endotracheal tube has entered the right main bronchus by accident?
Inflate bronchial cuff, ventilate bronchial lumen, left lung breath sounds
Inflate bronchial cuff, ventilate bronchial lumen, right lung breath sounds
Question 6
Question
The development of transient neurologic symptoms (TNS) after spinal anesthesia is MOST associated with which of the following local anesthetics?
Answer
Bupivacaine
Lidocaine
Prilocaine
Tetracaine
Question 7
Question
Selective adrenergic stimulation of the β2-receptor results in:
Answer
increased heart rate
increased insulin secretion
detrusor muscle contraction
pupillary constriction
Question 8
Question
A patient with a severe traumatic brain injury is emergently brought to the operating room for evacuation of a parenchymal hematoma causing uncal herniation. The neurosurgeon requests that you limit systolic blood pressure to < 160 mmHg but keep cerebral perfusion pressure > 60mmHg. Currently, blood pressure is 190/100 mmHg and ICP is 25 mmHg. What antihypertensive agent will avoid a further increase in intracranial pressure?
Answer
Hydralazine
Minoxidil
Nitroglycerin
Nicardipine
Question 9
Question
Hormones released by the neurohypophysis include: (Select 2)
Answer
thryotropin
growth hormone
arginine vasopressin
adrenocorticotropic hormone
follicle stimulating hormone
oxytocin
prolactin
luteinizing hormone
Question 10
Question
A 50-year-old woman presents for lumbar spine surgery. Vital signs include blood pressure 210/130 mmHg. She appears comfortable but somewhat anxious. The anesthesiologist is concerned that this is a hypertensive emergency. What is the MOST appropriate next step in her management?
Answer
Apply nitroglycerin paste to the chest wall and proceed to surgery
Cancel surgery and send the patient to the emergency room
Proceed with surgery without further consideration
Question the patient regarding history of hypertension and antihypertensive therapies
Question 11
Question
At 10,000 feet elevation (atmospheric pressure is 520 mm Hg), oxygen 100 mL/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 260 mmHg. This mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is:
Answer
0.25%
0.5%
1%
2%
Question 12
Question
Pancreatic somatostatin producing cells in the Islets of Langerhans are:
Answer
alpha cells
beta cells
gamma cells
delta cells
Question 13
Question
Pancreatic somatostatin producing cells in the Islets of Langerhans are:
Answer
alpha cells
beta cells
gamma cells
delta cells
Question 14
Question
The recommended maximum leakage current allowed in operating room equipment is:
Answer
5 μA
10 μA
1 mA
5 mA
Question 15
Question
In a coagulopathic patient, the risk of bleeding after a paravertebral blockade is MOST similar to which other form of regional anesthesia?
Answer
Axillary block
Bier block
Epidural block
Supraclavicular block
Question 16
Question
Which of the following changes would MOST likely result in increased coronary artery perfusion in a patient with aortic stenosis?
Answer
Decreased systemic diastolic pressure
Increased systemic vascular resistance
Increased left ventricular diastolic pressure
Tachycardia
Question 17
Question
Causes of normal-anion-gap acidosis include:
Answer
renal failure
starvation
diarrhea
lactic acidosis
Question 18
Question
A 62-year-old man has had CABG surgery and develops atrial fibrillation in the ICU afterward. He is administered an amiodarone loading dose with a planned maintenance dose to follow. Which of the following hemodynamic effects is MOST likely to occur during the acute bolus phase?
Answer
Decreased systemic vascular resistance
Decreased pulmonary vascular resistance
Increased systemic vascular resistance
Increased pulmonary vascular resistance
Question 19
Question
The area of myocardium most vulnerable to ischemia is the:
Answer
left ventricular epicardium
right ventricular epicardium
left ventricular subendocardium
right ventricular subendocardium
Question 20
Question
Hypoxemia during one-lung anesthesia is most effectively treated by:
Answer
PEEP applied to the ventilated lung
continuous oxygen insufflation to the collapsed lung
changing tidal volume and rate
periodic inflation of the collapsed lung
Question 21
Question
Which of the following antibiotics is nephrotoxic?
Answer
Quinolones
Rifampin
Vancomycin
All of the above
Question 22
Question
Which of the following statements regarding open surgical versus percutaneous tracheostomies is MOST likely true?
Answer
Open tracheostomies are associated with fewer major complications
Open tracheostomies are associated with fewer infectious complications
Percutaneous tracheostomies are associated with fewer major complications
There is no difference in the incidence of major complications
Question 23
Question
Sympathetic blockade during acute herpes zoster has been shown to:
Answer
increase analgesic requirements
reduce the incidence of postherpetic neuralgia
increase the need for corticosteroid therapy
be an effective treatment for patients who have had postherpetic neuralgia for a number of years
Question 24
Question
Sympathetic blockade during acute herpes zoster has been shown to:
Answer
increase analgesic requirements
reduce the incidence of postherpetic neuralgia
increase the need for corticosteroid therapy
be an effective treatment for patients who have had postherpetic neuralgia for a number of years
Question 25
Question
Branches of the femoral nerve anesthetized during an ankle block include the:
Answer
deep peroneal nerve
sural nerve
saphenous nerve
posterior tibial nerve
Question 26
Question
A 35-year-old woman complains of chest pain on her seventh postpartum day. EKG reveals STEMI in anterior leads and a regional wall motion abnormality is appreciated on TTE. An angiogram reveals LCA dissection and the diagnosis of acute MI secondary to spontaneous coronary artery dissection (SCAD) is made. What is the incidence of SCAD in pregnant patients with MI?
Answer
27%
17%
7%
0.7%
Question 27
Question
Pulmonary complications from advanced hepatic disease with cirrhosis include:
Answer
an obstructive ventilatory defect
respiratory acidosis
increased intrapulmonary shunting
increased functional residual capacity
Question 28
Question
A patient with a large mediastinal tumor presents for excision of the mass. CT scan shows a mass of 14 x 10 cm causing about 40% tracheal compression and moderate compression of the superior vena cava (SVC) and other mediastinal structures. The heart is displaced laterally and an apical impulse is felt just medial to the anterior axillary line. The patient is asymptomatic with no signs of SVC syndrome. Which of the following is the MOST common mechanism of hemodynamic collapse under general anesthesia in this patient?
Answer
Increased afterload
Decreased preload
Ventilation-perfusion mismatch
Rhythm abnormalities
Question 29
Question
An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is:
Answer
echinacea
valerian
ginkgo
ephedra
Question 30
Question
A 23-year-old primiparous woman in spontaneous labor is monitored with continuous fetal heart monitors. The cardiotocograph shows a baseline fetal heart rate of 110/min with moderate variability. There are no accelerations over a period of 20 minutes and no early decelerations. This tracing falls under which of the following categories?
Answer
Category I
Category II
Category III
Category IV
Question 31
Question
The formation of metanephrine is the result of:
Answer
catechol-O-methyltransferase metabolism of epinephrine
catechol-O-methyltransferase metabolism of norepinephrine
monamine oxidase metabolism of epinephrine
monamine oxidase metabolism of norepinephrine
Question 32
Question
A 35-year-old man who had right ankle ORIF under general anesthesia after sciatic-saphenous nerve blockade develops right foot drop postoperatively. Which nerve is most likely injured?
Answer
Peroneal nerve
Tibial nerve
Saphenous nerve
Sural nerve
Question 33
Question
Which of the following is MOST true regarding a pediatric patient with a URI and the risk of anesthesia?
Answer
Airway reactivity has been demonstrated to occur in the lab, but has not been definitively shown to occur
Increased incidence of adverse airway events have been demonstrated in children to last for 2-4 weeks after the URI
The best approach is to cancel all children with a URI presenting for elective surgery
There are no known affects of a URI on the lower airways
Question 34
Question
Characteristics of human immunodeficiency virus neuropathy include: (Select 2)
Answer
distal polyneuropathy
rapid sudden onset
proximal muscle weakness
allodynia
upper extremities most commonly involved
proximal to distal progression of symptoms
Question 35
Question
An action potential characterized by a spike followed by a plateau phase is seen in:
Answer
peripheral sensory nerve cells
peripheral motor nerve cells
striated skeletal muscle cells
cardiac muscle cells
Question 36
Question
Patient risk factors associated with the development of perioperative peripheral nerve injuries include all of the following EXCEPT:
Answer
Diabetes mellitus
Hypertension
Female sex
Tobacco abuse
Question 37
Question
Autonomic hyperreflexia:
Answer
is common with cord lesions below T8
can precipitate pulmonary edema
is not effectively prevented by regional anesthesia
can be prevented with adequate intraoperative sedation
Question 38
Question
Mannitol may be administered during surgical clipping of an aneurysm to decrease brain water and thus brain bulk. The peak effect of mannitol occurs approximately:
Answer
5 – 10 minutes after the infusion begins
15 – 20 minutes after the infusion begins
30 – 45 minutes after the infusion begins
About 1 hour after the infusion begins
Question 39
Question
Renal effects of nitrous oxide include:
Answer
decreased renal blood flow secondary to decreased cardiac output
decreased renal blood flow secondary to increased renal vascular resistance
increased renal blood flow secondary to sympathetic stimulation
increased glomerular filtration with increased reabsorption
Question 40
Question
What are the primary anatomic landmarks for a fascia iliaca block?
Answer
Anterior superior iliac spine and pubic tubercle
Anterior superior iliac spine and greater trochanter of femur
Iliac crest and pubic tubercle
Posterior superior iliac spine and greater trochanter of femur
Question 41
Question
The dibucaine number:
Answer
is normally less than 60%
is a quantitative assessment of pseudocholinesterase activity
is inversely proportional to pseudocholinesterase function
reflects inhibition of pseudocholinesterase by dibucaine
Question 42
Question
A 45-year-old morbidly obese man with a medical history of hypertrophic cardiomyopathy presents for ear surgery. He has an ejection fraction of 65% on transthoracic echocardiography. After induction of general anesthesia, his blood pressure is 78/40 mmHg with a regular heart rate of 80 bpm. Which of the following is the MOST appropriate initial intervention?
Answer
Ephedrine 20 mg IV
Epinephrine 30 mcg IV
Esmolol 50 mg IV
Phenylephrine 100 mcg IV
Question 43
Question
Chronic aortic regurgitation results in all the following EXCEPT:
Answer
Decreased aortic diastolic pressure
Increased stroke volume
Decreased LV end diastolic pressure
Increased LV mass
Question 44
Question
Release of aldosterone by the adrenal cortex is stimulated by: (select 3)
Answer
angiotensin I
angiotensin II
hypokalemia
pituitary ACTH
congestive heart failure
hypervolemia
Question 45
Question
The most common complication of thoracic paravertebral nerve block is:
Answer
hypotension
subarachnoid injection
pneumothorax
intravascular injection
Question 46
Question
A 55-year-old woman with an infected automatic cardioverter-defibrillator (AICD) lead presents for removal. During the course of the procedure she develops acute profound, refractory hypotension that progresses to cardiovascular collapse and pulseless electrical activity. Which of the following is the MOST appropriate intervention at this time?
Answer
Administration of epinephrine to increase blood pressure
Needle thoracostomy to treat pneumothorax
Thoracotomy to evacuate pericardial effusion
Transcutaneous pacing to increase heart rate
Question 47
Question
Which of the following drugs is NOT a cell cycle inhibitor?
Answer
Azathioprine
Mycophenolate mofetil
Ortho Kung T3 (OKT3)
Sirolimus
Question 48
Question
According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of: