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A person given this position at a medical facility is charged with ensuring that all the anesthetic machines are in top condition and are working as they should. Not only is the person expected to know about the different technology used but also know the techniques used in different patients. Do take up the quiz provided and see if you have adequate knowledge to fill this position.
Questions and Answers
1.
A patient receives Drug X, which increases contractility while maintaining the same preload and afterload. What would be the expected result to this drug?
A.
Decreased SV
B.
Increased SV
C.
Unchanged SV
D.
Decreased HR
Correct Answer
B. Increased SV
Explanation When a patient receives Drug X, which increases contractility while maintaining the same preload and afterload, the expected result would be an increased stroke volume (SV). Contractility refers to the force of contraction of the heart muscle, and an increase in contractility leads to a stronger contraction, which in turn increases the amount of blood pumped out of the heart with each beat. Since preload and afterload remain the same, the increased contractility will result in a higher SV.
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2.
Resistance represents:
A.
A way of measuring the HR
B.
The oxygen-carrying capacity
C.
Venous blood clots
D.
The opposition to fluid flow
Correct Answer
D. The opposition to fluid flow
Explanation Resistance represents the opposition to fluid flow. In the context of fluid dynamics, resistance refers to the force that hinders the movement of a fluid through a particular pathway. It is determined by factors such as the diameter of the pathway, the viscosity of the fluid, and the length of the pathway. Higher resistance means that it is more difficult for the fluid to flow through the pathway, while lower resistance indicates easier fluid flow. Resistance is commonly encountered in various systems, such as blood vessels, pipes, and electrical circuits.
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3.
A gremlin enters the OR during surgery and moves the art-line transducer (pressure sensor) to the floor, which places it well below the height of the patient. Which of the following is correct about the indicated arterial line blood pressure?
A.
The arterial line blood pressure will read higher than the patient's actual blood pressure
B.
The arterial line blood pressure will read lower than the patient's actual blood pressure
C.
The arterial line blood pressure will be accurate
D.
The arterial line MAP will be accurate, but not the systolic or diastolic pressures
Correct Answer
A. The arterial line blood pressure will read higher than the patient's actual blood pressure
Explanation When the art-line transducer is moved to the floor, it is well below the height of the patient. This means that the hydrostatic pressure exerted by the column of blood in the transducer will be higher than the patient's actual blood pressure. As a result, the arterial line blood pressure reading will be higher than the patient's actual blood pressure.
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4.
An ICU patient is coming to the OR for an urgent procedure. This patient has the hepatorenal syndrome, meaning that both the liver and kidneys are failing. Which medication would most likely have its metabolism affected (and hence last longer than expected) in this patient?
A.
Cisatracurium
B.
Esmolol
C.
Vecuronium
D.
Succinylcholine
Correct Answer
C. Vecuronium
Explanation The hepatorenal syndrome is a condition where both the liver and kidneys are failing. In this patient, the metabolism of drugs is likely to be affected due to the compromised liver function. Vecuronium is a medication that is primarily metabolized by the liver, so its metabolism would be impaired in this patient. As a result, vecuronium would last longer than expected in the patient's system.
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5.
Lactated Ringer's, although compatible with PRBC administration under certain circumstances, is often avoided when transfusing PRBC's because:
A.
The lactate in LR builds up because of the PRBC's
B.
It results in hyperkalemia
C.
The calcium in the LR can antagonize the citrate anticoagulant in the PRBC's and potentially result in clotting
D.
The red blood cells in the PRBC's shrink because LR is hypertonic
Correct Answer
C. The calcium in the LR can antagonize the citrate anticoagulant in the PRBC's and potentially result in clotting
Explanation The correct answer explains that the reason Lactated Ringer's (LR) is often avoided when transfusing PRBC's (packed red blood cells) is because the calcium in LR can counteract the citrate anticoagulant present in the PRBC's. This interaction between calcium and citrate can potentially lead to clotting, which is an undesirable outcome during a blood transfusion.
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6.
Per ASA guidelines, patients on mechanical ventilation require all of the following EXCEPT:
A.
Audible breathing circuit disconnect alarm
B.
Spontaneous breathing attempt alarm
C.
Inspired oxygen concentration monitor
D.
Qualified volume of air movement with each breath (tidal volume)
Correct Answer
B. Spontaneous breathing attempt alarm
Explanation Patients on mechanical ventilation do not require a spontaneous breathing attempt alarm because they are not expected to initiate their own breaths. Mechanical ventilation provides breaths for the patient, so there is no need for an alarm to alert for spontaneous breathing attempts. The other options are necessary for patient safety and monitoring during mechanical ventilation.
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7.
EKG electrodes work by using a combination of:
A.
Silver chloride and conducting gel
B.
Copper rings for decreased electrical resistance
C.
Calcium chloride solution
D.
Petroleum jelly layer for improved conductance with skin
Correct Answer
A. Silver chloride and conducting gel
Explanation EKG electrodes work by using a combination of silver chloride and conducting gel. Silver chloride is used as the electrode material because it is a good conductor of electricity and is also biocompatible, meaning it is safe to use on the skin. Conducting gel is applied to the electrode to ensure good contact with the skin and to reduce any impedance or resistance to the flow of electrical signals. Together, silver chloride and conducting gel help to accurately detect and transmit the electrical activity of the heart during an EKG procedure.
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8.
Which of the following is the most favorable airway exam for intubation and ventilation?
A.
Oral excursion 1 fingerbreadth (1 FB), Mallampati 1, Thyromental distance 1 FB, Full neck range of motion
B.
Oral excursion 4 FB, Mallampati 1, Thyromental distance 4 FB, Full neck range of motion
C.
Oral excursion 4 FB, Mallampati 4, Thyromental distance 2 FB, Full neck range of motion
D.
Oral excursion 2 FB, Mallampati 3, Thyromental distance 3 FB, Limited neck range of motion
Correct Answer
B. Oral excursion 4 FB, Mallampati 1, Thyromental distance 4 FB, Full neck range of motion
Explanation The most favorable airway exam for intubation and ventilation is determined by several factors. In this case, the answer choice of Oral excursion 4 FB, Mallampati 1, Thyromental distance 4 FB, Full neck range of motion indicates that the patient has a good oral excursion, a Mallampati score of 1 (indicating a clear view of the uvula and tonsillar pillars), a good thyromental distance (indicating adequate space for intubation), and a full range of motion in the neck. These factors suggest that intubation and ventilation will be easier and more successful in this patient compared to the other answer choices.
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9.
Which of the following ventilation strategies would be most likely to reduce the ICP?
A.
Increase PEEP to 15 cm H2O
B.
Keep ETCO2 50-60 mm Hg
C.
Keep FiO2 > 0.60 (60%)
D.
Keep ETCO2 20-30 mm Hg
Correct Answer
D. Keep ETCO2 20-30 mm Hg
Explanation Keeping the ETCO2 (end-tidal carbon dioxide) levels between 20-30 mm Hg would be most likely to reduce the intracranial pressure (ICP). High levels of carbon dioxide can cause cerebral vasodilation, leading to increased blood flow and increased ICP. By maintaining ETCO2 levels within the normal range, it helps to prevent excessive cerebral vasodilation and thus reduce ICP.
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10.
Which of the following actions would be undertaken first in an airway fire?
A.
Irrigate the airway with saline
B.
Send someone to get the fire extinguisher
C.
Remove the ET tube
D.
Mask ventilate with air
Correct Answer
C. Remove the ET tube
Explanation In an airway fire, the first priority should be to remove the ET tube. This is because the ET tube can act as a conduit for the fire to spread into the lungs, causing further damage and potentially leading to respiratory distress. By removing the ET tube, the source of the fire is eliminated, reducing the risk of further harm to the patient. Once the ET tube is removed, other actions such as irrigating the airway, getting the fire extinguisher, and mask ventilating with air can be taken to address the situation.
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11.
A 26 yo male patient is stabbed in the chest several times and comes to the OR for emergency surgery. An ultrasound in the ER shows cardiac tamponade. The hemodynamic objective for this anesthetic would be:
A.
Keep the HR low
B.
Keep the HR high
C.
Maintain a very low BP
D.
Minimize IV fluids
Correct Answer
B. Keep the HR high
Explanation In the case of cardiac tamponade, where there is an accumulation of fluid or blood in the pericardial sac, maintaining a high heart rate is essential. This is because a high heart rate helps to compensate for the decreased cardiac output caused by the compression of the heart by the accumulated fluid. By keeping the heart rate high, the anesthetic aims to ensure an adequate amount of blood is being pumped out of the heart to maintain organ perfusion and prevent further deterioration of the patient's condition.
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12.
A patient has the heart rhythm shown. What is the appropriate treatment?
A.
Beta-blockers
B.
Magnesium
C.
Calcium-channel blockers
D.
Adenosine
Correct Answer
B. Magnesium
Explanation The appropriate treatment for the patient's heart rhythm is magnesium. Magnesium is commonly used to treat various cardiac arrhythmias, including torsades de pointes, which is characterized by a prolonged QT interval on the ECG. Magnesium helps stabilize the electrical activity of the heart and can effectively terminate or prevent these abnormal rhythms. Beta-blockers and calcium-channel blockers are also used in the treatment of certain arrhythmias, but they may not be the most appropriate choice in this particular case. Adenosine is typically used to treat supraventricular tachycardias, which is not indicated by the given ECG.
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13.
Which of the following would be expected to increase contractility?
A.
Increased PEEP
B.
Administration of Calcium
C.
Adenosine
D.
Amiodarone
Correct Answer
B. Administration of Calcium
Explanation Administration of calcium would be expected to increase contractility because calcium is an essential ion involved in the process of muscle contraction. When calcium ions enter the cardiac muscle cells, they bind to troponin, causing a conformational change in the troponin-tropomyosin complex. This allows the myosin heads to bind to actin, leading to the sliding of the filaments and muscle contraction. Therefore, by increasing the availability of calcium, the force of contraction of the cardiac muscle would be enhanced, resulting in increased contractility.
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14.
A normal ICP is typically:
A.
5-15 mm Hg
B.
20-40 mm Hg
C.
50-70 mm Hg
D.
100-140 mm Hg
Correct Answer
A. 5-15 mm Hg
Explanation A normal ICP (intracranial pressure) is typically between 5-15 mm Hg. This means that the pressure inside the skull, specifically in the brain, is within a normal range. If the pressure exceeds this range, it can indicate various medical conditions or injuries such as a brain tumor, bleeding in the brain, or hydrocephalus. Monitoring and maintaining normal ICP levels are crucial for the proper functioning of the brain and overall neurological health.
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15.
A patient in the PACU becomes unresponsive and is found to be pulseless. The EKG shows sinus tachycardia with an HR of 115. Which of the following should be done first?
A.
CPR
B.
Synchronized cardioversion
C.
Administration of IV magnesium sulfate
D.
Administration of adenosine 6mg IV
Correct Answer
A. CPR
Explanation In this scenario, the patient is unresponsive and pulseless, indicating cardiac arrest. The priority in this situation is to initiate CPR immediately. CPR helps maintain blood flow to vital organs until advanced cardiac life support measures can be initiated. The other options, such as synchronized cardioversion, administration of IV magnesium sulfate, and administration of adenosine, may be appropriate interventions in specific cardiac rhythm disturbances, but they are not the first-line treatment for a pulseless patient.
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16.
Shortly after induction of GA with propofol, a patient is found to be difficult to mask ventilate and the clinician is unable to intubate the patient with direct laryngoscopy. The patient was well-pre oxygenated and the SpO2 is 98%. The next step should be:
A.
Attempt to place an LMA
B.
Use a retrograde intubation
C.
Continue to attempt direct laryngoscopy until a total of 5 have been attempted
D.
Avoid any muscle relaxation
Correct Answer
A. Attempt to place an LMA
Explanation The next step should be to attempt to place an LMA. This is because the patient is difficult to mask ventilate and unable to be intubated with direct laryngoscopy. Placing an LMA can provide a patent airway and ensure adequate ventilation in the patient.
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17.
An 82-year-old female patient has a past medical history that includes aortic stenosis. Her anesthetic strategy includes which of the following:
A.
Low HR
B.
High HR
C.
Only use Ketamine
D.
Maintain a very low BP
Correct Answer
A. Low HR
Explanation The correct answer is "Low HR" because in a patient with aortic stenosis, the narrowing of the aortic valve restricts blood flow from the heart to the rest of the body. A low heart rate helps to maintain adequate blood flow by allowing more time for the blood to pass through the narrowed valve. This can be achieved through the use of medications that slow down the heart rate or by avoiding medications that increase heart rate.
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18.
EKG lead II uses which electrodes?
A.
Left Arm (LA) and Right Arm (RA)
B.
Left Arm (LA) and Left Leg (LL)
C.
Right Arm (RA) and Left Leg (LL)
D.
Left Arm (LA) and Right Leg (RL)
Correct Answer
C. Right Arm (RA) and Left Leg (LL)
Explanation EKG lead II uses the Right Arm (RA) and Left Leg (LL) electrodes. These electrodes are placed on specific locations of the body to measure the electrical activity of the heart. The RA electrode is placed on the right arm, while the LL electrode is placed on the left leg. This configuration allows for the recording of electrical signals in a specific direction, providing valuable information about the heart's functioning and any potential abnormalities.
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19.
A 54 yo Male with vocal cord lesions is having a suspension micro laryngoscopy with laser treatment of the vocal cord lesions. Which of the following ET tubes might be used for this procedure?
A.
Double-lumen
B.
Bronchial blocker
C.
A NIMS tube with electrodes for monitoring the vocal cords
D.
A metal-reinforced laser tube
Correct Answer
D. A metal-reinforced laser tube
Explanation A metal-reinforced laser tube might be used for this procedure because it provides protection against the heat generated by the laser during treatment. The metal reinforcement prevents the tube from melting or catching fire, ensuring the safety of the patient's airway.
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20.
A 74 yo male with hypertension is undergoing a knee replacement under GA. At some point intraoperatively, the BP and O2 saturation both unexpectedly drop significantly. Which of the following is a likely cause?
A.
History of alcoholism
B.
Bone cement implantation syndrome/fat embolism
C.
The use of femoral and sciatic nerve blocks
D.
Long-term use of convective warmers intraoperatively
Correct Answer
B. Bone cement implantation syndrome/fat embolism
Explanation Bone cement implantation syndrome (BCIS) is a possible cause for the significant drop in blood pressure and oxygen saturation during knee replacement surgery. BCIS occurs when the bone cement used in joint replacement surgery leaks into the bloodstream and causes a systemic inflammatory response. This can lead to cardiovascular collapse, hypoxemia, and other complications. Given the patient's age, hypertension, and the invasive nature of knee replacement surgery, BCIS is a likely cause for the unexpected drop in vital signs. The other options, such as history of alcoholism, nerve blocks, and convective warmers, are less likely to cause such a significant and sudden decline in vital signs.
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21.
A patient is undergoing a TURP procedure for an enlarged prostate and at some point intraoperatively the clinician feels that he may have TURP syndrome. This would be due to which of the following causes?
A.
Carbon dioxide embolism
B.
Fat Embolism
C.
Hypernatremia from excessive sodium load
D.
Extensive absorption of the irrigation fluid
Correct Answer
D. Extensive absorption of the irrigation fluid
Explanation During a TURP procedure, irrigation fluid is used to maintain visibility and flush out debris. If there is extensive absorption of the irrigation fluid, it can lead to a condition called TURP syndrome. This occurs when the absorbed fluid, which contains electrolytes, is rapidly absorbed into the bloodstream, causing an imbalance in the body's electrolyte levels. Symptoms of TURP syndrome can include hyponatremia, which is a low sodium level, as well as fluid overload, confusion, seizures, and even cardiac arrest. Therefore, the extensive absorption of the irrigation fluid can cause TURP syndrome in this scenario.
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22.
What is bone cement implantation syndrome?
A.
Bone cement inappropriately sticking to RBC's, resulting in low SpO2
B.
A poorly defined syndrome of hypoxemia, hypotension, and/or altered mental status in patients with cementation
C.
Excessive adherence of bone to a newly placed joint hardware
D.
Thrombocytopenia (low platelet count) caused by methyl methacrylate
Correct Answer
B. A poorly defined syndrome of hypoxemia, hypotension, and/or altered mental status in patients with cementation
Explanation Bone cement implantation syndrome is a poorly defined syndrome that occurs in patients undergoing cementation during surgery. It is characterized by symptoms such as hypoxemia (low oxygen levels), hypotension (low blood pressure), and altered mental status. The exact cause of this syndrome is not fully understood, but it is believed to be a result of the interaction between the bone cement and the patient's body. This syndrome can be potentially life-threatening and requires immediate medical attention.
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23.
Posterior fossa sciatic nerve blocks and ankle blocks would be most useful for which kinds of surgeries?
A.
Hip fracture surgeries
B.
Knee surgeries
C.
Surgeries involving the distal femur
D.
Foot surgeries
Correct Answer
D. Foot surgeries
Explanation Posterior fossa sciatic nerve blocks and ankle blocks would be most useful for foot surgeries. These blocks provide anesthesia to the foot and ankle region, making them ideal for procedures involving the foot. Hip fracture surgeries, knee surgeries, and surgeries involving the distal femur would not require anesthesia specifically in the foot area, so these blocks would not be as useful for those types of surgeries.
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24.
Interpret the following ABG:
pH 7.24 / pCO2 60 / PO2 96 / HCO3 23
A.
Metabolic alkalosis
B.
Metabolic acidosis
C.
Respiratory alkalosis
D.
Respiratory acidosis
Correct Answer
D. Respiratory acidosis
Explanation The given ABG values show a pH of 7.24, pCO2 of 60, PO2 of 96, and HCO3 of 23. A pH below the normal range indicates acidosis. In respiratory acidosis, the primary abnormality is an elevated pCO2, which is seen in this case. The elevated pCO2 suggests that there is an excess of carbon dioxide in the blood, indicating a respiratory problem. The other values (PO2 and HCO3) are within the normal range, ruling out metabolic acidosis or alkalosis. Therefore, the correct answer is respiratory acidosis.
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25.
An epidural test dose is used to determine which of the following?
A.
That the epidural is in the lumbar region
B.
The epidural isn't one-sided
C.
The epidural catheter is not intravascular or intrathecal
D.
That the epidural will function for surgical anesthesia
Correct Answer
C. The epidural catheter is not intravascular or intrathecal
Explanation The correct answer is that the epidural catheter is not intravascular or intrathecal. An epidural test dose is administered to ensure that the catheter is correctly placed in the epidural space and not in a blood vessel or the spinal canal. This is important to prevent complications such as intravascular injection of medication or unintentional spinal anesthesia. By confirming that the catheter is in the epidural space, healthcare providers can safely administer medications for pain relief or anesthesia during surgery.
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26.
A patient comes to the ER and has an EKG that shows "prominent U waves". Which of the following would be the most likely result of their plasma potassium level?
A.
1.8 mEq/L
B.
3.6 mEq/L
C.
5.2 mEq/L
D.
7.9 mEq/L
Correct Answer
A. 1.8 mEq/L
Explanation A plasma potassium level of 1.8 mEq/L would be the most likely result for a patient with prominent U waves on an EKG. Prominent U waves are often seen in hypokalemia, which is a condition characterized by low levels of potassium in the blood. Potassium plays a crucial role in maintaining the electrical activity of the heart, and low levels can lead to abnormal heart rhythms and changes in the EKG. Therefore, a low plasma potassium level of 1.8 mEq/L is the most likely explanation for the prominent U waves observed in this patient.
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27.
Which of the following represent ASA Standard Monitors?
Correct Answer
C. 2nd Degree AV Block, Mobitz type I (Wenkebach)
Explanation The correct answer is 2nd Degree AV Block, Mobitz type I (Wenkebach). This is because the EKG rhythm shown exhibits a progressive prolongation of the PR interval until a P wave is not conducted, followed by a dropped QRS complex. This pattern is characteristic of Mobitz type I, also known as Wenkebach, which is a form of second-degree atrioventricular block. In this type of AV block, there is a delay in the conduction of electrical impulses from the atria to the ventricles, leading to intermittent dropped beats.
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29.
In the shown lung volume tracing, letter "A" corresponds to which volume/capacity?
A.
Functional Residual Capacity (FRC)
B.
Reserve Volume (RV)
C.
Vital Capacity (RV)
D.
Tidal Volume (TV)
Correct Answer
D. Tidal Volume (TV)
Explanation In the given lung volume tracing, letter "A" corresponds to Tidal Volume (TV). Tidal Volume is the volume of air that is inhaled or exhaled during normal breathing. It represents the amount of air that moves in and out of the lungs with each breath.
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30.
A 28 yo female patient is involved in a car accident and brought emergently to the OR. She receives emergency release blood. What is the most appropriate blood type for transfusion of PRBC's in this context?
A.
O +
B.
O -
C.
AB +
D.
AB -
Correct Answer
B. O -
Explanation In emergency situations where the patient's blood type is unknown, O- blood type is considered the universal donor. This means that O- blood can be safely transfused to patients of any blood type without causing a severe immune reaction. O- blood lacks both A and B antigens on the red blood cells, making it compatible with all blood types. Therefore, O- is the most appropriate blood type for transfusion of PRBCs in this context.
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31.
The most common causes of death from administration of blood products in the US are:
A.
Citrate intoxication resulting in hypocalcemia and death
B.
Zika Virus
C.
Administration of Rh-negative blood to an Rh-positive patient
D.
Transfusion Related Acute Lung Injury (TRALI) and Tranfusion Related Cardiac Overload (TACO)
Correct Answer
D. Transfusion Related Acute Lung Injury (TRALI) and Tranfusion Related Cardiac Overload (TACO)
Explanation Transfusion Related Acute Lung Injury (TRALI) and Transfusion Related Cardiac Overload (TACO) are the most common causes of death from administration of blood products in the US. TRALI is a rare but potentially fatal complication characterized by acute respiratory distress syndrome (ARDS) following transfusion. It is caused by an immune response to donor antibodies present in the blood product. TACO, on the other hand, occurs due to fluid overload from the transfusion, leading to cardiac dysfunction and pulmonary edema. Both conditions can be life-threatening and require prompt recognition and management.
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32.
Which of the following medications can be reversed by sugammadex?
A.
Rocuronium
B.
Cisatracurium
C.
Vecuronium
D.
Succinylcholine
Correct Answer(s)
A. Rocuronium C. Vecuronium
Explanation Sugammadex is a medication used to reverse the effects of certain muscle relaxants, called neuromuscular blocking agents, used during surgery. It specifically targets a class of muscle relaxants called steroidal non-depolarizing neuromuscular blockers, which includes Rocuronium and Vecuronium. Cisatracurium and Succinylcholine are not in this class and therefore cannot be reversed by sugammadex.
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33.
All of the following can increase the MAC of a volatile anesthetic EXCEPT:
A.
Natural redhead patient
B.
Young age
C.
Recent use of a stimulant, such as cocaine
D.
Female patient
Correct Answer
D. Female patient
Explanation The MAC (minimum alveolar concentration) of a volatile anesthetic refers to the concentration required to prevent movement in 50% of patients in response to a surgical stimulus. In general, females tend to have a slightly lower MAC compared to males, meaning they require a lower concentration of the anesthetic to achieve the desired effect. Therefore, the presence of a female patient would not increase the MAC of a volatile anesthetic.
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34.
For the laminar flow of a fluid through a tube, which of the following would not be expected to increase the flow?
A.
Increased diameter of the tube
B.
Increased length of the tube
C.
Decreased viscosity of the fluid
D.
Increased pressure applied
Correct Answer
B. Increased length of the tube
Explanation Increasing the length of the tube would not be expected to increase the flow for laminar flow of a fluid. In laminar flow, the fluid moves in parallel layers with minimal mixing between them. Increasing the length of the tube would increase the resistance to flow, as there would be more surface area for the fluid to come into contact with. This would result in a decrease in flow rate.
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35.
The MAC of a volatile anesthetic is defined as:
A.
The point at which toxicity develops
B.
The minimum concentration the vaporizer can be set to
C.
The alveolar concentration where 95% of patients don't move to surgical stimulation
D.
The alveolar concentration where 50% of patients don't move to surgical stimulation
Correct Answer
D. The alveolar concentration where 50% of patients don't move to surgical stimulation
Explanation The MAC of a volatile anesthetic is the alveolar concentration where 50% of patients don't move to surgical stimulation. This means that at this concentration, half of the patients are effectively anesthetized and do not respond to surgical stimulation. It is a measure of the potency of the anesthetic and is used to determine the appropriate dosage for patients undergoing surgery.
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36.
Which IV fluid is considered physiologically hypotonic?
A.
Plasma-Lyte
B.
Lactated Ringer's
C.
Normal Saline (0.9% sodium chloride)
D.
3% sodium chloride
Correct Answer
B. Lactated Ringer's
Explanation Lactated Ringer's is considered physiologically hypotonic because it has a lower concentration of sodium and chloride ions compared to the body's extracellular fluid. This allows for the movement of water from the intracellular space to the extracellular space, helping to hydrate cells and restore fluid balance. Additionally, Lactated Ringer's contains lactate, which can be metabolized by the liver to produce bicarbonate ions, helping to buffer acidosis.
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37.
What is the design that modern vaporizers use?
A.
Copper Kettle
B.
Electromagnetic Induction
C.
Variable bypass
D.
Wet wick
Correct Answer
C. Variable bypass
Explanation Modern vaporizers use a design called variable bypass. This design allows the user to adjust the amount of air that flows through the vaporizer, which in turn affects the temperature and vapor production. By controlling the bypass, users can customize their vaping experience to their preferences. This design is preferred by many because it offers flexibility and control over the vaporizer's performance.
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38.
A patient is to undergo a thyroidectomy due to thyroid cancer. The surgeon requests a special type of endotracheal tube for nerve monitoring during the procedure. Which nerve is monitored due to concerns about injury during thyroid surgeries?
A.
Lateral pharyngeal nerve
B.
Glossopharyngeal nerve
C.
Long thoracic nerve
D.
Recurrent laryngeal nerve
Correct Answer
D. Recurrent laryngeal nerve
Explanation During a thyroidectomy, the recurrent laryngeal nerve is monitored due to concerns about injury. This nerve innervates the muscles that control the vocal cords, and any damage to it can lead to vocal cord paralysis. Monitoring the recurrent laryngeal nerve helps the surgeon to avoid injury and preserve vocal cord function during the procedure.
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39.
A patient is having laparoscopic surgery. The abdomen is insufflated to a certain pressure. At what insufflation pressure does the preload generally start to decrease?
A.
5 mm Hg
B.
10 mm Hg
C.
15 mm Hg
D.
25 mm Hg
Correct Answer
C. 15 mm Hg
Explanation During laparoscopic surgery, the abdomen is insufflated with gas to create space for the surgeon to operate. Insufflation pressure refers to the pressure of the gas inside the abdomen. As the insufflation pressure increases, it can compress the blood vessels, leading to a decrease in preload, which is the amount of blood returning to the heart. Therefore, at an insufflation pressure of 15 mm Hg, the preload generally starts to decrease.
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40.
A patient is in the recovery room after having a laparoscopic cholecystectomy. Suddenly he develops a narrow-complex tachyarrhythmia with an HR of 180. BP is 60/40. What is the appropriate treatment?
A.
Esmolol
B.
Diltiazem
C.
Magnesium
D.
Synchronized cardioversion
Correct Answer
D. Synchronized cardioversion
Explanation In this scenario, the patient is experiencing a narrow-complex tachyarrhythmia with a high heart rate and low blood pressure. Synchronized cardioversion is the appropriate treatment because it involves delivering a synchronized electrical shock to the patient's heart in order to restore normal sinus rhythm. Esmolol and Diltiazem are medications used to control heart rate, but they may not be effective in this acute situation. Magnesium is typically used for certain types of arrhythmias, such as torsades de pointes, which is not the case here. Therefore, synchronized cardioversion is the most appropriate intervention to quickly restore the patient's normal heart rhythm and stabilize their blood pressure.
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41.
The nitrous oxide tank can't have both liquid and gas phases present if:
A.
The pressure is too high
B.
The temperature in the tank is greater than the critical temperature
C.
The temperature in the tank is less than the critical temperature
D.
The tank is stationary
Correct Answer
B. The temperature in the tank is greater than the critical temperature
Explanation If the temperature in the tank is greater than the critical temperature, the nitrous oxide will exist only in the gas phase and not in the liquid phase. Above the critical temperature, the substance cannot be liquefied regardless of the pressure. Therefore, if the temperature is higher than the critical temperature, there can't be both liquid and gas phases present in the nitrous oxide tank.
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42.
All of the following are risk factors for carbon monoxide formation in the anesthesia breathing system EXCEPT:
A.
The use of desflurane (vs sevoflurane)
B.
Moist absorbent
C.
Non-use of the absorber for 2 or more days
D.
Low fresh gas flowrates
Correct Answer
B. Moist absorbent
Explanation Moist absorbent is not a risk factor for carbon monoxide formation in the anesthesia breathing system. The other options listed are all risk factors. The use of desflurane instead of sevoflurane can increase the production of carbon monoxide. Non-use of the absorber for 2 or more days can result in the accumulation of carbon monoxide. Low fresh gas flowrates can cause rebreathing of exhaled gases, including carbon monoxide. However, moist absorbent does not directly contribute to carbon monoxide formation.
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43.
A patient comes to the OR from the ICU. He is on a heparin infusion. Which of the following tests would be most appropriate to determine the degree of anticoagulation from the heparin?
A.
PT (INR)
B.
PTT
C.
Bleeding time
D.
Blood smear
Correct Answer
B. PTT
Explanation The most appropriate test to determine the degree of anticoagulation from heparin is the PTT (Partial Thromboplastin Time) test. This test measures the time it takes for blood to clot and is specifically used to monitor the effectiveness of heparin therapy. Heparin works by inhibiting the clotting factors in the blood, and the PTT test can assess the level of anticoagulation by measuring the time it takes for the blood to clot in the presence of heparin.
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44.
A patient has high acute blood loss in the OR and receives 7 PRBC's. What electrolyte abnormalities might be expected as a result of the multiple PRBC transfusions?
A.
High potassium and high calcium
B.
High potassium and low calcium
C.
Low potassium and high calcium
D.
Low potassium and low calcium
Correct Answer
B. High potassium and low calcium
Explanation Multiple PRBC transfusions can lead to high potassium levels (hyperkalemia) due to the release of potassium from the red blood cells. This is because stored blood has high levels of potassium. On the other hand, transfusions can also result in low calcium levels (hypocalcemia) due to the citrate anticoagulant present in the blood products. Citrate binds to calcium, leading to a decrease in ionized calcium levels. Therefore, high potassium and low calcium can be expected as electrolyte abnormalities following multiple PRBC transfusions.
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45.
A patient is emergently brought from the ICU to the OR for sepsis and dead bowel. The patient is hypotensive and on a norepinephrine infusion. The ABG is: pH 7.02 / PCO2 36 / PO2 108 / HCO3 12. Which medication might be considered to help with the BP in this context?
A.
Vasopressin
B.
Phenylephrine
C.
Dobutamine
D.
Intralipid
Correct Answer
A. Vasopressin
Explanation Vasopressin might be considered to help with the blood pressure in this context because it is a potent vasoconstrictor that can increase systemic vascular resistance and improve blood pressure. The patient is hypotensive and in sepsis, which can cause vasodilation and decreased vascular tone. Vasopressin can help restore vascular tone and increase blood pressure.
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46.
The appropriate initial dose of dantrolene is:
A.
0.25 mg/kg
B.
1 mg/kg
C.
2.5 mg/kg
D.
10 mg/kg
Correct Answer
C. 2.5 mg/kg
Explanation The appropriate initial dose of dantrolene is 2.5 mg/kg. This dosage is determined based on the patient's weight, with the recommended dose being 2.5 mg for every kilogram of body weight. This dosage ensures that the patient receives an appropriate amount of the medication based on their individual characteristics.
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47.
A patient with a known pseudocholinesterase deficiency comes to the OR for elective surgery. Which medication's effects would be expected to be significantly prolonged in this patient?
A.
Cisatracurium
B.
Remifentanil
C.
Midazolam
D.
Succinylcholine
Correct Answer
D. Succinylcholine
Explanation Succinylcholine is a depolarizing neuromuscular blocking agent that is rapidly hydrolyzed by pseudocholinesterase. In patients with pseudocholinesterase deficiency, the metabolism of succinylcholine is significantly impaired, leading to prolonged effects of the medication. Therefore, the effects of succinylcholine would be expected to be significantly prolonged in this patient.
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48.
A patient is on warfarin and requires emergent abdominal surgery. There is considerable bleeding during the procedure. What would be an appropriate way to counteract this patient's anticoagulation?
A.
FFP
B.
Vitamin C
C.
Protamine
D.
Hypothermia
Correct Answer
A. FFP
Explanation FFP stands for Fresh Frozen Plasma, which is a blood product that contains various clotting factors. In this scenario, the patient is on warfarin, which is an anticoagulant medication that inhibits blood clotting. Since there is considerable bleeding during the surgery, administering FFP would be an appropriate way to counteract the patient's anticoagulation. FFP provides the necessary clotting factors that can help stop the bleeding and promote hemostasis.
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49.
A patient receives a nerve block with ropivacaine and IV lidocaine and subsequently starts having a seizure. What is the most likely cause of the seizure?
A.
Local Anesthetic Systemic Toxicity (LAST)
B.
Increased PaO2
C.
Carbon monoxide poisoning
D.
Propofol infusion syndrome
Correct Answer
A. Local Anesthetic Systemic Toxicity (LAST)
Explanation The most likely cause of the seizure in this scenario is Local Anesthetic Systemic Toxicity (LAST). LAST occurs when local anesthetic drugs, such as ropivacaine and lidocaine, are absorbed into the systemic circulation in excessive amounts. This can lead to central nervous system toxicity, causing seizures as one of the symptoms. Increased PaO2 and carbon monoxide poisoning are not directly related to the administration of local anesthetics, and propofol infusion syndrome is a rare complication of prolonged propofol infusion, not associated with nerve blocks or lidocaine administration.
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50.
Malignant hyperthermia is:
A.
The consequence of giving anesthesia to a patient when they have a fever
B.
A sudden release of epinephrine and norepinephrine from the adrenal glands
C.
Hyperthyroidism (high thyroid hormone production)
D.
A disorder of calcium regulation in cells (specifically muscle cells)
Correct Answer
D. A disorder of calcium regulation in cells (specifically muscle cells)
Explanation Malignant hyperthermia is a disorder of calcium regulation in cells, specifically muscle cells. This condition is triggered by certain medications used during anesthesia, causing an abnormal release of calcium in muscle cells. This leads to a rapid increase in body temperature, muscle rigidity, and potentially life-threatening complications. It is not caused by giving anesthesia to a patient with a fever, a sudden release of epinephrine and norepinephrine, or hyperthyroidism.
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