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Anesthesia Question of the Day 2

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Quiz on Anesthesia Question of the Day 2, created by thomasina413 on 10/08/2014.
thomasina413
Quiz by thomasina413, updated more than 1 year ago
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Created by thomasina413 over 9 years ago
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Resource summary

Question 1

Question
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?
Answer
  • Inflate tracheal cuff, ventilate tracheal lumen, bilateral lung breath sounds
  • Inflate bronchial cuff, inflate tracheal cuff, ventilate tracheal lumen, right lung breath sounds
  • 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:
Answer
  • 13 - 15
  • 9 - 12
  • 6 - 9
  • less than 6
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