Quiz
QoD 18.1
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Questions in this quiz (15)
1A 5 kg 3-month-old full term boy presents for right inguinal hernia repair. A caudal block is performed with 1 ml/kg 0.25% bupivacaine during sevoflurane anesthesia via an endotracheal tube. The infant's vital signs prior to injection reveal a HR of 133 bpm, SBP 83 mmHg, upright T-waves in lead II. Which of the following is the MOST appropriate test dose of epinephrine?
- A25 mcg
- B10 mcg
- C2.5 mcg
- D1 mcg
2A 3-month-old full term boy presents for right inguinal hernia repair. He experiences an intravascular injection during the administration of a caudal the test dose. Atropine was administered 5 minutes prior to the test dose. What is the EARLIEST clinical marker of this intravascular injection of epinephrine?
- AST segment elevation greater than 25%
- BSBP increase greater than 25 mmHg
- CHR increase greater than 20 bpm
- DHR increase greater than 10 bpm
3A 28-year-old G1P0 woman with a history of multiple sclerosis presents to the labor and delivery unit after rupture of membranes. She is currently suffering from lower extremity sensory changes and requires an urgent cesarean section. Which of the following is the BEST option for her anesthetic?
- ACombined spinal epidural anesthesia
- BEpidural anesthesia
- CGeneral anesthesia
- DSpinal anesthesia
4Prostaglandin E1 is MOST appropriate for which of the following congenital cardiac lesions?
- ATruncus arteriosus
- BPulmonary hypertension
- CPatent ductus arteriosus
- DInterrupted aortic arch
5You are called to the NICU to perform an anesthetic on a 3.5 kg neonate with congenital diaphragmatic hernia. The patient is intubated with conventional mechanical ventilation. The most recent arterial blood gas reveals a pH 7.38, PaCO2 45 mmHg, PaO2 89 mmHg, HCO3 29 mEq/L, SaO2 of 97% on an FiO2 of 0.6. Peak airway pressures are 32 cmH2O with 5 cmH2O PEEP. Expiratory tidal volume is 45 ml. Which of the following is the MOST appropriate ventilatory management for this patient?
- AIncrease PEEP to 7 cmH2O
- BIncrease FiO2 to 90%
- CDecrease FiO2 to 50%
- DDecrease peak airway pressure to 25 cmH2O
6A 67-year-old, 96-kg man underwent ultrasound-guided supraclavicular blockade for a 2-hour right wrist surgery. Forty ml of 0.5% bupivacaine was injected under ultrasound guidance. In the recovery room the patient reports that his breathing does not feel "normal" and you notice that his pupil diameter is unequal with the right pupil being smaller. Vital signs include HR 65 bpm, BP 117/68 mmHg, SpO2 98% on room air. Which of the following is the BEST course of action?
- AReassure the patient
- BPerform an emergent needle decompression of the right lung
- CObtain an upright Chest X-Ray
- DInitiate an intralipid infusion
7According to the 2010 American Society of Regional Anesthesia (ASRA) guidelines, epidural catheter placement in obstetric patients should be delayed for at least how long after administration of a therapeutic dose of low-molecular weight heparin?
- A48 hours
- B24 hours
- C12 hours
- D6 hours
8A 68-year-old man undergoes right colectomy for colorectal cancer. He had been taking clopidogrel, which was held for one week prior to surgery. Intraoperatively he is transfused one unit of PRBCs and one unit of platelets. On post-operative day 3, his hemoglobin drops from 10 to 8.2 mg/dL. He is hemodynamically stable and only complains of mild back pain. He is transfused 1 unit of PRBCs and follow-up Hgb is 8.4 mg/dL. What is the MOST likely cause for his anemia?
- ADilution of blood by maintenance IV fluids
- BInadequate surgical hemostasis exacerbated by preoperative clopidogrel
- CCarcinoma-induced coagulopathy
- DImmune-mediated reaction
9Two days after resection of a brain tumor through a right frontal craniotomy, a 70-year-old man has persistent postoperative delirium with waxing-waning mental status. His sodium is 136 mEq/L and glucose is 123 mg/dL. A head CT reveals some residual pneumocephalus but no hemorrhage. Which of the following is the MOST appropriate next step in his care?
- AHigh flow oxygen (FiO2 1.0)
- BContinuous EEG monitoring
- CTranscranial Doppler
- DBrain MRI
10A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?
- ADesflurane plus nitrous oxide
- BPentobarbital load followed by continuous infusion
- CIsoflurane titrated to burst suppression
- DPropofol TIVA with vasopressors to maintain CPP
11In the obstetric patient, which of the following is the MOST common side effect of 100 mcg of epidural fentanyl?
- AUterine atony
- BRespiratory depression
- CPruritus
- DDifficulty "pushing" if administered too close to delivery
12An otherwise healthy 45-year-old woman is seen at an ambulatory surgical center for release of Dupuytren's contracture. A brachial plexus block is performed using the axillary approach. Assuming that no other nerve blocks are performed, and that the axillary block successfully achieves a complete motor and sensory block in its intended distribution, which of the following motor responses in the blocked extremity would MOST likely still be present?
- A1st-5th digit adduction
- BForearm supination
- CExtension of the MCP joints
- DWrist flexion
13A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?
- ADesflurane plus nitrous oxide
- BPentobarbital load followed by continuous infusion
- CIsoflurane titrated to burst suppression
- DPropofol TIVA with vasopressors to maintain CPP
14A 26-year-old woman presents for laparoscopic cholecystectomy. She has a family history of sudden death and was found to have hypertrophic cardiomyopathy (HCM). Which of the following is a MOST correct regarding hypertrophic cardiomyopathy?
- AThe gradient across the aortic valve will be likely to be higher than the gradient across left ventricular outflow tract
- BReverse Trendelenburg position during laparoscopy can worsen the systolic anterior motion of the mitral valve leaflet
- CBeta blockers will worsen stroke volume in HCM
- DDecreased systemic vascular resistance following induction can be beneficial since it increases cardiac output
15A 60-year-old man is emergently brought to the OR for right a hemicraniectomy. The patient had a right middle cerebral artery stroke two days ago and now has clinical uncal herniation syndrome (coma with blown right pupil). What are the anesthetic considerations for this procedure?
- AControl cerebral edema; avoid hypotension leading to further hypoperfusion injury; avoid cerebral vasodilatation with halogenated anesthetics
- BMinimizing delay; maintain hypovolemia to avoid increased cerebral edema; cerebral vasodilatation from propofol
- CControl cerebral edema; head down position to optimize cerebral perfusion; cerebral vasodilatation from inhalational agents
- DAvoid hypertension to minimize cerebral edema; hyperventilation to reduce cerebral blood volume
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- Mike Ru
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