Otterbein/Grant CRNA Basics Midterm Review Pre-OP And Airway

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Alainad3

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Quizzes Created: 20 | Total Attempts: 5,878

Questions: 57 | Attempts: 276 | Updated: Mar 18, 2023

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Questions and Answers

1.

You are performing anesthesia on a 10 month old. They last breastfed at 0400. Which is the earliest time could you safely induce the child?
- A.
  
  0500
- B.
  
  0700
- C.
  
  0800
- D.
  
  1000
Correct Answer
C. 0800

Explanation
The correct answer is 0800. Anesthesia is generally recommended to be performed on a fasting patient to reduce the risk of aspiration. For infants, it is recommended to fast for at least 4 hours for breast milk. Since the child last breastfed at 0400, the earliest safe time to induce the child would be 0800, which allows for a 4-hour fasting period.

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2.

You are performing general anesthesia on a healthy 28 y.o. smoker for a scheduled procedure. What is their ASA classification?
- A.
  
  ASA 1
- B.
  
  ASA 2
- C.
  
  ASA 3
- D.
  
  ASA 1E
Correct Answer
B. ASA 2

Explanation
Based on the given information, the patient is a healthy 28-year-old smoker. ASA classification is a system used to assess the overall health of a patient before anesthesia. ASA 1 represents a healthy patient with no systemic diseases, ASA 2 represents a patient with mild systemic disease, ASA 3 represents a patient with severe systemic disease, and ASA 1E represents a patient who is brain-dead but whose organs are being used for transplantation. Since the patient is a smoker, they have a mild systemic disease, which corresponds to ASA 2 classification.

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3.

Which of the following are indicators of a potential difficult intubation?
- A.
  
  Mallampati 1
- B.
  
  Mallampati 3
- C.
  
  Thyromental distance of 4 cm
- D.
  
  A history of TMJ with an interincisor distance of 2.5 cm
- E.
  
  A history of snoring/sleep apnea
Correct Answer(s)
B. Mallampati 3
C. Thyromental distance of 4 cm
D. A history of TMJ with an interincisor distance of 2.5 cm

Explanation
Mallampati 3, Thyromental distance of 4 cm, and a history of TMJ with an interincisor distance of 2.5 cm are all indicators of a potential difficult intubation. Mallampati 3 refers to a classification system that assesses the visibility of the oropharyngeal structures, with a higher number indicating a more difficult intubation. A thyromental distance of 4 cm suggests limited space for intubation, making it more challenging. A history of TMJ with an interincisor distance of 2.5 cm indicates limited mouth opening, which can also contribute to difficulty in intubation. These factors combined suggest a potential difficult intubation.

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4.

All of the following are necessary for a fire to occur in the OR EXCEPT:
- A.
  
  A source of ingition
- B.
  
  A flammable agent
- C.
  
  A gas that supports combustion
- D.
  
  The use of high FGF
Correct Answer
D. The use of high FGF

Explanation
A fire in the operating room (OR) requires three elements known as the fire triangle: a source of ignition, a flammable agent, and a gas that supports combustion. The use of high FGF (fresh gas flow) refers to the amount of gas delivered to the patient during anesthesia, which can contribute to the flammability of the atmosphere in the OR. Therefore, the use of high FGF is necessary for a fire to occur in the OR, making it the exception among the given options.

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5.

Which type of heat loss has the greatest effect on a patient's temperature in the OR?
- A.
  
  Convection
- B.
  
  Radiation
- C.
  
  Conduction
- D.
  
  Evaporation
Correct Answer
B. Radiation

Explanation
Radiation is the type of heat loss that has the greatest effect on a patient's temperature in the operating room. Radiation occurs when heat is transferred through electromagnetic waves, such as infrared radiation. In the OR, patients may lose heat to the surrounding environment through radiation, as the body's heat is emitted as infrared radiation. This can be exacerbated by factors such as cool room temperatures and exposed surfaces. Convection, conduction, and evaporation also contribute to heat loss in the OR, but radiation is the most significant factor.

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6.

This process involves the conduction of heat via air currents around the body and accounts for the 2nd largest source of heat loss in the OR.
- A.
  
  Radiation
- B.
  
  Conduction
- C.
  
  Convection
- D.
  
  Evaporation
Correct Answer
C. Convection

Explanation
Convection is the correct answer because it involves the transfer of heat through the movement of air currents around the body. In the operating room, where there may be various equipment and people moving, air currents can carry away heat from the body, resulting in heat loss. This process is considered the second largest source of heat loss in the operating room, making convection the most appropriate answer.

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7.

Automatic implantable cardioverter-defibrillators (AICD's) need to be deactivated when the surgeon plans on using a Bovie.
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
A Bovie is a device used in surgery that emits electrical current to cut or coagulate tissue. The electrical current from a Bovie can interfere with the function of an automatic implantable cardioverter-defibrillator (AICD), which is a device implanted in the chest to monitor and regulate the heart's rhythm. Therefore, it is necessary to deactivate the AICD when a surgeon plans on using a Bovie to prevent any potential interference or harm to the patient.

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8.

ANSI/ASHRAE/ASHE standard 170 reduced the required humidity percentage in the operating room to _____ ?

Correct Answer
20
20%

Explanation
The correct answer is 20% because ANSI/ASHRAE/ASHE standard 170 reduced the required humidity percentage in the operating room to 20%. This means that the operating room must maintain a humidity level of 20% in order to comply with the standard.

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4
9.

Which of the following is NOT a complication of hypothermia?
- A.
  
  Increased surgical wound infection rates.
- B.
  
  Increased risk of clotting.
- C.
  
  Increased metabolic demand upon re-warming
- D.
  
  Increased length of hospital stay.
Correct Answer
B. Increased risk of clotting.

Explanation
Hypothermia is a condition characterized by abnormally low body temperature. It can lead to various complications, but increased risk of clotting is not one of them. Hypothermia actually has the opposite effect, as it can cause blood vessels to constrict, reducing blood flow and making it more difficult for blood to clot. Some common complications of hypothermia include increased surgical wound infection rates, increased metabolic demand upon re-warming, and increased length of hospital stay.

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10.

The maximum amount of electrical leakage in the OR is how many mA?

Correct Answer
10

Explanation
The maximum amount of electrical leakage in the operating room (OR) is 10 mA. This means that any electrical equipment or devices in the OR should not exceed this limit to ensure the safety of patients and medical staff. Maintaining a low electrical leakage is crucial to prevent electrical shocks or accidents during surgical procedures.

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4
11.

Garlic, gingko, and ginseng are 3 herbal medications associated with increased clot formation.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Increased bleeding.

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12.

In order for a smoker to decrease carboxyhemoglobin levels they should refrain from smoking for how many hours?

Correct Answer
48

Explanation
To decrease carboxyhemoglobin levels, a smoker should refrain from smoking for 48 hours. Carboxyhemoglobin is formed when carbon monoxide binds to hemoglobin in the blood, reducing its ability to carry oxygen. By abstaining from smoking for 48 hours, the smoker allows their body to eliminate the carbon monoxide and restore normal oxygen-carrying capacity in the blood.

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4
13.

What is the greatest risk factor for post-operative pulmonary complications?
- A.
  
  Obesity
- B.
  
  Surgical incision location.
- C.
  
  A history of smoking.
- D.
  
  A history of asthma.
Correct Answer
B. Surgical incision location.

Explanation
The greatest risk factor for post-operative pulmonary complications is surgical incision location. This is because the location of the incision can affect the respiratory system, leading to complications such as pneumonia or atelectasis. Obesity, a history of smoking, and a history of asthma are also risk factors for post-operative pulmonary complications, but they are not considered to be the greatest risk factor in comparison to surgical incision location.

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14.

Which of the following is NOT an indicator for a pre-operative chest x-ray?
- A.
  
  History of tuberculosis
- B.
  
  Congenital heart disease
- C.
  
  A history of well-controlled asthma
- D.
  
  Presence of malignancy in the thoracic cavity
Correct Answer
C. A history of well-controlled asthma

Explanation
A pre-operative chest x-ray is typically done to evaluate the condition of the lungs and thoracic cavity before surgery. It helps to identify any abnormalities or conditions that may affect the safety or success of the procedure. In this case, a history of well-controlled asthma is not an indicator for a pre-operative chest x-ray. Asthma is a chronic respiratory condition, but if it is well-controlled and not causing any acute symptoms or complications, it does not necessarily require a chest x-ray before surgery.

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15.

A patient undergoing major surgery must have a CBC, BMP, EKG, room air O2 saturations, and a toxicology & screen performed. Their history and physical and lab draws must be completed within how much time related to the date of surgery?

Correct Answer
1 month
4 weeks

Explanation
The patient undergoing major surgery must have their history and physical and lab draws completed within 1 month or 4 weeks prior to the date of surgery. This ensures that the necessary tests and evaluations are up to date and accurate before the surgery takes place.

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4
16.

This cardiovascular condition poses the greatest risk for patients undergoing anesthesia and is associated with a 14-fold increase risk of perioperative sudden death.
- A.
  
  Ischemic heart disease
- B.
  
  Left ventricular dysfunction
- C.
  
  Severe aortic stenosis
- D.
  
  Dilated cardiomyopathy
Correct Answer
C. Severe aortic stenosis

Explanation
Severe aortic stenosis poses the greatest risk for patients undergoing anesthesia and is associated with a 14-fold increase risk of perioperative sudden death. Aortic stenosis is a condition where the aortic valve becomes narrowed, leading to restricted blood flow from the heart to the rest of the body. Severe aortic stenosis can cause significant strain on the heart and can lead to complications during anesthesia, such as decreased cardiac output and sudden cardiac events. Therefore, patients with severe aortic stenosis require careful monitoring and management during anesthesia to minimize the risk of adverse events.

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17.

The highest period of risk for reinfarction following an acute MI is during the emergent CABG performed the day of the original MI.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Patients are most likely to reinfarct in the 30 days following the acute event, typically occurs post-operatively.

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18.

You are going to be performing anesthesia on a patient with Type 1 diabetes mellitus. During their pre-op assessment two weeks prior to surgery, the patient asks you what they should do with their insulin regimen on the day of surgery. You advise them:
- A.
  
  Do not take any insulin due to your NPO status.
- B.
  
  Double their typical insulin dose due to the stress of surgery increasing glucose levels.
- C.
  
  Take 1/3-1/2 of their intermediate to long acting insulin dose the morning of surgery.
- D.
  
  Tell them to google it.
Correct Answer
C. Take 1/3-1/2 of their intermediate to long acting insulin dose the morning of surgery.

Explanation
Patients with Type 1 diabetes mellitus should take 1/3-1/2 of their intermediate to long acting insulin dose on the morning of surgery. This is because they will be NPO (nothing by mouth) and not eating on the day of surgery, which can lead to hypoglycemia if they take their full dose of insulin. Taking a reduced dose helps to prevent hypoglycemia while still providing some insulin coverage to maintain blood glucose levels.

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19.

Which of the following are contraindications for peri-operative beta-blockers?
- A.
  
  CHF
- B.
  
  2nd degree heart block
- C.
  
  History of acute MI
- D.
  
  A resting heart rate of 54.
- E.
  
  A blood pressure of 110/60.
- F.
  
  Acute bronchospasm.
Correct Answer(s)
A. CHF
B. 2nd degree heart block
D. A resting heart rate of 54.
F. Acute bronchospasm.

Explanation
The contraindications for peri-operative beta-blockers include CHF (congestive heart failure) because beta-blockers can worsen heart failure symptoms, 2nd degree heart block because beta-blockers can further slow down the heart's conduction, a resting heart rate of 54 because beta-blockers can further decrease the heart rate, and acute bronchospasm because beta-blockers can cause bronchoconstriction and worsen respiratory symptoms. A blood pressure of 110/60 is not a contraindication for peri-operative beta-blockers.

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20.

During your patient's pre-operative assessment for an elective procedure you note that their blood pressure is 210/100 mmHg. True or false: The procedure should still occur since you feel comfortable controlling their blood pressure intraoperatively with nipride
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Elective surgeries are typically cancelled for BP greater than or equal to 180/110 mmHg.

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21.

Which of the following will NOT reduce the risk of aspiration during intubation?
- A.
  
  RSI
- B.
  
  Prolonging the pre-op NPO period.
- C.
  
  Metoclopramide - gastrokinetic
- D.
  
  Ranitidine - H2 receptpor agonist
Correct Answer
B. Prolonging the pre-op NPO period.

Explanation
Prolonging the pre-op NPO (nothing by mouth) period will not reduce the risk of aspiration during intubation. Aspiration occurs when stomach contents, including gastric acid and bacteria, enter the lungs. RSI (rapid sequence intubation) is a technique used to secure the airway quickly and minimize the risk of aspiration. Metoclopramide is a gastrokinetic agent that increases gastric emptying and reduces the risk of aspiration. Ranitidine is an H2 receptor antagonist that decreases gastric acid production and also helps reduce the risk of aspiration. Therefore, prolonging the pre-op NPO period does not have any direct effect on reducing the risk of aspiration during intubation.

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22.

You are happily performing general anesthesia on your intubated patient when a series of unfortunate events occurs and their ETT spontaneously combusts into flames. After you scream like a little girl, what should be your next action?
- A.
  
  Immediately remove the airway and discontinue O2.
- B.
  
  Accept the fate of your imminent death/disfigurement.
- C.
  
  Provide total IV anesthetic.
- D.
  
  Increase the tidal volumes on your ventilator due to your patient's newly decreased compliance.
Correct Answer
A. Immediately remove the airway and discontinue O2.

Explanation
The correct answer is to immediately remove the airway and discontinue O2. This action is necessary to prevent further injury to the patient and to extinguish the flames. Continuing to administer oxygen would only fuel the fire and increase the risk of harm. Removing the airway allows for the patient to breathe without the burning tube obstructing their airway.

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23.

The temperature of an OR in a pediatric hospital is typically less than that of an adult hospital.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Pediatric OR's are typically kept at 75F (24C) while adults are 68-72F.

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24.

This nerve provides sensation to the posterior 1/3 of the tongue, the roof of the pharynx, tonsils, and the undersurface of the soft palate. It also provides the afferent signal of the gag reflex.
- A.
  
  Lingual nerve
- B.
  
  Superior laryngeal nerve
- C.
  
  Vagus nerve
- D.
  
  Glossopharyngeal nerve
Correct Answer
D. GlossopHaryngeal nerve

Explanation
The glossopharyngeal nerve is responsible for providing sensation to the posterior 1/3 of the tongue, the roof of the pharynx, tonsils, and the undersurface of the soft palate. It also plays a role in the afferent signal of the gag reflex. This nerve is therefore the correct answer because it is the one that provides sensation to these specific areas and is involved in the gag reflex.

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25.

Which of the following is NOT a paired cartilage in the larynx?
- A.
  
  Arytenoid
- B.
  
  Corniculate
- C.
  
  Cricoid
- D.
  
  Cuneiform
Correct Answer
C. Cricoid

Explanation
The cricoid cartilage is the only option in the list that is not paired. The arytenoid cartilages, corniculate cartilages, and cuneiform cartilages are all paired structures in the larynx. The cricoid cartilage, on the other hand, is a single, unpaired cartilage that forms a ring-shaped structure in the lower part of the larynx. It connects the thyroid cartilage above and the trachea below, providing support and maintaining the shape of the larynx.

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26.

This nerve provides motor control to the cricothyroid muscle.
- A.
  
  Recurrent laryngeal nerve
- B.
  
  Glossopharyngeal nerve
- C.
  
  External branch of superior laryngeal nerve
- D.
  
  Internal branch of superior laryngeal nerve
Correct Answer
C. External branch of superior laryngeal nerve

Explanation
The external branch of the superior laryngeal nerve is responsible for providing motor control to the cricothyroid muscle. This muscle is important for vocalization as it tenses the vocal cords, allowing for changes in pitch and voice production. The recurrent laryngeal nerve is responsible for innervating the intrinsic muscles of the larynx, while the glossopharyngeal nerve is involved in taste sensation and swallowing. The internal branch of the superior laryngeal nerve is responsible for providing sensory innervation to the larynx.

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27.

This nerve provides sensory innervation BELOW the vocal cords as well as motor control to all intrinsic muscles of the larynx EXCEPT the cricothyroid muscle.
- A.
  
  Spinal accessory nerve
- B.
  
  Superior laryngeal nerve - internal branch.
- C.
  
  Recurrent laryngeal nerve
- D.
  
  Superior laryngeal nerve - external branch.
Correct Answer
C. Recurrent laryngeal nerve

Explanation
The recurrent laryngeal nerve is the correct answer because it provides sensory innervation below the vocal cords and motor control to all intrinsic muscles of the larynx except the cricothyroid muscle. The other options do not fit this description. The spinal accessory nerve is not involved in innervating the larynx, and the superior laryngeal nerve, both internal and external branches, do not provide motor control to the intrinsic muscles of the larynx.

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28.

Which of the following intrinsic muscle of the larynx adducts the vocal cords?
- A.
  
  Posterior cricoarytenoid
- B.
  
  Lateral cricoarytenoid
- C.
  
  Thyroarytenoid
- D.
  
  Arytenoids
Correct Answer
B. Lateral cricoarytenoid

Explanation
The lateral cricoarytenoid is the intrinsic muscle of the larynx that adducts the vocal cords. Adduction refers to the movement of bringing the vocal cords together, which is necessary for phonation or producing sound. The posterior cricoarytenoid muscle is responsible for abduction, or moving the vocal cords apart, while the thyroarytenoid and arytenoid muscles have different functions in controlling tension and position of the vocal cords.

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29.

You extubate your patient and note that they are in acute respiratory distress with loud stridor. What nerve damage do you suspect occured?
- A.
  
  Bilateral superior laryngeal nerve
- B.
  
  Unilateral vagus nerve
- C.
  
  Unilateral recurrent laryngeal nerve
- D.
  
  Bilateral recurrent laryngeal nerve
Correct Answer
D. Bilateral recurrent laryngeal nerve

Explanation
When a patient experiences acute respiratory distress with loud stridor after extubation, it suggests damage to the bilateral recurrent laryngeal nerve. The recurrent laryngeal nerve innervates the muscles responsible for vocal cord movement, and its damage can lead to vocal cord paralysis. Bilateral damage to this nerve can cause both vocal cords to be paralyzed and lead to severe respiratory distress and stridor.

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30.

The LMA has increased OR safety by easily provided protected airways to patients.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
The LMA does not provide a protected airway.

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31.

You are performing general anesthesia on an obese patient with DM, and a history of GERD. This is a procedure does not require neuromuscular blockade. Which airway would you anticipate using?
- A.
  
  Proseal LMA
- B.
  
  Fastrach LMA
- C.
  
  ETT
- D.
  
  IGel LMA
Correct Answer
C. ETT

Explanation
High risk of aspiration.

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32.

Congratulations! You have successfully intubated your first adult patient. How much air do you anticipate injecting into the cuff?
- A.
  
  4 mL
- B.
  
  10 mL
- C.
  
  Until you can palpate the cuff in the sternal notch.
- D.
  
  6 mL
Correct Answer
D. 6 mL

Explanation
The correct answer is 6 mL. When intubating a patient, it is important to inflate the cuff of the endotracheal tube to ensure a proper seal. The recommended amount of air to inject into the cuff is usually around 6 mL. This amount is typically sufficient to create a seal without overinflating the cuff, which can lead to complications such as tracheal damage or pressure necrosis. It is important to check the cuff pressure regularly and adjust the volume as needed to maintain an appropriate seal.

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33.

Which of the following is the most reliable indicator of successful ETT placement?
- A.
  
  Continuous etCO2 monitoring of 40 for >3-5 breaths.
- B.
  
  O2 saturation
- C.
  
  Tube condensation
- D.
  
  Initial color change on CO2 detector.
Correct Answer
A. Continuous etCO2 monitoring of 40 for >3-5 breaths.

Explanation
Continuous etCO2 monitoring of 40 for >3-5 breaths is the most reliable indicator of successful ETT placement because it confirms proper ventilation and end-tidal carbon dioxide levels. This indicates that the endotracheal tube is correctly positioned in the trachea, allowing for effective exchange of gases. O2 saturation and tube condensation can provide some information about ETT placement, but they are not as accurate or reliable as continuous etCO2 monitoring. The initial color change on a CO2 detector may indicate ETT placement, but it does not provide ongoing confirmation of proper ventilation.

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34.

Which of the follow is true about cricoid pressure, also known as the Sellick maneuver?
- A.
  
  Pressure should be applied prior to loss of consciousness.
- B.
  
  Pressure should be applied with about 100 Newtons.
- C.
  
  Pressure should be applied backwards, upwards, and to the right.
- D.
  
  The use of cricoid pressure prevents aspiration during active regurgitation.
Correct Answer(s)
A. Pressure should be applied prior to loss of consciousness.
C. Pressure should be applied backwards, upwards, and to the right.

Explanation
Cricoid pressure is applied with 20-40 Newtons, it is used to prevent the aspiration of passive reflux.

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35.

Which of the following NOT a contraindication to nasal intubation?
- A.
  
  A 50 year old man with a basilar skull fracture.
- B.
  
  A 29 year old patient with active profuse epistaxis.
- C.
  
  A 78 year old man currently taking Coumadin with an INR of 4.2
- D.
  
  A 20 year old patient undergoing jaw surgery.
Correct Answer
D. A 20 year old patient undergoing jaw surgery.

Explanation
A contraindication to nasal intubation means a condition or factor that would make nasal intubation unsafe or not recommended. In this case, the correct answer is "A 20 year old patient undergoing jaw surgery." This is because undergoing jaw surgery does not pose a risk or contraindication to nasal intubation. The other options, such as a basilar skull fracture, active profuse epistaxis, and taking Coumadin with a high INR, all have potential complications or risks that would make nasal intubation unsafe or contraindicated.

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36.

Which of the following is not indicative of a patient being able to tolerate extubation?
- A.
  
  Ability to lift head for 8 seconds.
- B.
  
  3/4 strong twitches.
- C.
  
  Vital capacity > 10mL/kg
- D.
  
  Respiratory rate of 16.
Correct Answer
B. 3/4 strong twitches.

Explanation
4/4 twitched w/no fade.

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37.

Which of the following is not an indicator of difficult airway?
- A.
  
  Large tongue
- B.
  
  High-arched narrow palate
- C.
  
  Wide palate
- D.
  
  Large teeth
Correct Answer
C. Wide palate

Explanation
A wide palate is not an indicator of a difficult airway because it allows for more space and easier passage of air. On the other hand, a large tongue, high-arched narrow palate, and large teeth can all contribute to a difficult airway by obstructing the air passage or making it harder to insert an airway device.

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38.

A short thyromental distance:
- A.
  
  Is less than 6 Cm or 3 ordinary fingerbreadths.
- B.
  
  Is ideal for intubation.
- C.
  
  Indicates that the anterior larynx is at a more acute angle and that their is less space for the tongue to be compressed during laryngoscopy.
- D.
  
  Is an indicator of a difficult airway.
Correct Answer(s)
A. Is less than 6 Cm or 3 ordinary fingerbreadths.
C. Indicates that the anterior larynx is at a more acute angle and that their is less space for the tongue to be compressed during laryngoscopy.
D. Is an indicator of a difficult airway.

Explanation
A short thyromental distance refers to a distance that is less than 6 cm or 3 ordinary fingerbreadths. This measurement is considered ideal for intubation because it indicates that the anterior larynx is at a more acute angle and there is less space for the tongue to be compressed during laryngoscopy. Additionally, a short thyromental distance is also an indicator of a difficult airway, suggesting that intubation may be more challenging in such cases.

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39.

Which of the following are indications for awake intubation?
- A.
  
  History of difficult intubation
- B.
  
  Neck mass
- C.
  
  High aspiration risk
- D.
  
  Cervical collar in place.
- E.
  
  All of the above.
Correct Answer
E. All of the above.

Explanation
All of the given options are indications for awake intubation. History of difficult intubation suggests that the patient may have anatomical or physiological factors that make intubation challenging under general anesthesia. A neck mass can obstruct the airway and make intubation difficult, requiring awake intubation. High aspiration risk indicates that the patient is at a higher risk of regurgitation and aspiration during intubation, making awake intubation a safer option. Lastly, a cervical collar in place suggests that the patient may have a cervical spine injury, which requires caution during intubation and may necessitate awake intubation.

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40.

You have attempted to intubate your patient for the 3rd time and were unsuccessful. You resume bag/mask ventilation and discover you are no longer getting chest rise and your patient begins desaturating. What is your next intervention?
- A.
  
  Place a surgical airway.
- B.
  
  Attempt ventilation with an LMA or combitube that you keep in your backstand because you are so prepared.
- C.
  
  Administer more sedation/paralytic and reattempt intubation.
- D.
  
  Start freaking out, man.
Correct Answer
B. Attempt ventilation with an LMA or combitube that you keep in your backstand because you are so prepared.

Explanation
In this scenario, the correct next intervention would be to attempt ventilation with an LMA or combitube that is kept in the backstand. This is because the initial attempts at intubation were unsuccessful and the patient is now experiencing desaturation. Using an LMA or combitube can provide a temporary airway and ensure adequate ventilation while further interventions are planned. Administering more sedation/paralytic and reattempting intubation may not be effective in this situation and placing a surgical airway would be a more invasive and last resort option.

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41.

You are unable to intubate your patient after multiple attempts. You are now unable to ventilate your patient. You attempt ventilation with an LMA but are unsuccessful. At this point you realize you are having the worst day of your life because you accidentally administered Pancuronium with a duration of action >180 minutes. What do you do now?
- A.
  
  Call your attorney.
- B.
  
  Pursue an emergency surgical airway.
- C.
  
  Patiently wait for the pancuronium to wear off so the patient can breath spontaneously.
- D.
  
  Administer more sedation.
Correct Answer
B. Pursue an emergency surgical airway.

Explanation
Pursuing an emergency surgical airway is the correct answer because the patient is unable to be intubated or ventilated, and the administration of Pancuronium, a paralytic agent with a long duration of action, further complicates the situation. An emergency surgical airway, such as a cricothyroidotomy or tracheostomy, may be necessary to establish a patent airway and ensure the patient's oxygenation and ventilation. Calling an attorney, administering more sedation, or waiting for the Pancuronium to wear off are not appropriate actions in this critical scenario.

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42.

Which of the following is the proper sequence of RSI?
- A.
  
  BVM, apply cricoid pressure, attempt intubation, administer drugs.
- B.
  
  Preoxygenate w/o PPV, administer drugs, apply cricoid pressure, successful intubation.
- C.
  
  Option 3
- D.
  
  Option 4
Correct Answer
B. Preoxygenate w/o PPV, administer drugs, apply cricoid pressure, successful intubation.

Explanation
The proper sequence of Rapid Sequence Intubation (RSI) is to first preoxygenate the patient without positive pressure ventilation, then administer drugs, apply cricoid pressure, and finally achieve successful intubation. This sequence ensures that the patient is adequately oxygenated before the administration of drugs, which can cause respiratory depression. Cricoid pressure is applied to prevent aspiration during intubation. Successful intubation is the final step in securing the patient's airway.

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43.

Fiberoptic intubations are contraindicated in which scenarios?
- A.
  
  Epiglottitis
- B.
  
  Cervical halo in place
- C.
  
  High risk of aspiration
- D.
  
  Mass present on neck
Correct Answer
A. Epiglottitis

Explanation
Fiberoptic intubations are contraindicated in cases of epiglottitis. This is because epiglottitis is an inflammation of the epiglottis, which can cause swelling and obstruction of the airway. Performing a fiberoptic intubation in such cases can worsen the condition and lead to further airway obstruction. Therefore, it is important to avoid fiberoptic intubations in patients with epiglottitis and consider alternative methods for securing the airway.

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44.

A right-sided double lumen tube is the most commonly used.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
Left is most common

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45.

Benzocaine spray, also known as Hurricane Spray, is a 20% solution. It can cause methemoglobinemia with toxicity. The toxic dose of benzocaine spray is how many mL's?

Correct Answer
0.5

Explanation
Benzocaine spray is a 20% solution that can cause methemoglobinemia with toxicity. The question asks for the toxic dose of benzocaine spray in mL. The correct answer is 0.5, indicating that 0.5 mL of benzocaine spray is considered a toxic dose.

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4
46.

Convulsions, respiratory arrest and circulatory collapse have been associated with small doses (20 mg) of which topical anesthetic?
- A.
  
  Lidocaine
- B.
  
  Benzocaine
- C.
  
  Tetracaine
- D.
  
  Cocaine
Correct Answer
C. Tetracaine

Explanation
Tetracaine is a topical anesthetic that has been associated with adverse effects such as convulsions, respiratory arrest, and circulatory collapse, even with small doses of 20 mg. Lidocaine, benzocaine, and cocaine are also topical anesthetics, but they are not specifically mentioned as causing these severe reactions in small doses. Therefore, tetracaine is the most likely correct answer based on the information given.

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47.

This topical anesthetic causes local anesthesia and vasoconstriction. It should be used with extreme caution in patients with known coronary artery disease, HTN, pseudocholinesterase deficiency, preeclampsia, and hyperthyroidism. The maximum dose is 200 mg or 1 mg/kg.
- A.
  
  Lidocaine
- B.
  
  Benzocaine
- C.
  
  Tetracaine
- D.
  
  Cocaine
Correct Answer
D. Cocaine

Explanation
Cocaine is the correct answer because it is a topical anesthetic that causes local anesthesia and vasoconstriction. However, it should be used with extreme caution in patients with known coronary artery disease, hypertension (HTN), pseudocholinesterase deficiency, preeclampsia, and hyperthyroidism. The maximum dose of cocaine is 200 mg or 1 mg/kg.

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48.

This nerve block is difficult to perform, it requires an angled needle being inserted into the greater palatine foramen of the upper posterior palate. The resulting block affects the greater and lesser palatine nerves that provide sensation to nasal turbinates and posterior 2/3 of the septum.
- A.
  
  Transtracheal
- B.
  
  Spenopalatine
- C.
  
  Glossopharyngeal
- D.
  
  Superior laryngeal
Correct Answer
B. Spenopalatine

Explanation
The correct answer is Spenopalatine because the given explanation states that the nerve block requires an angled needle to be inserted into the greater palatine foramen of the upper posterior palate. This block affects the greater and lesser palatine nerves, which provide sensation to nasal turbinates and the posterior 2/3 of the septum. Therefore, the spenopalatine nerve block is the most suitable option for this scenario.

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49.

This block is placed at the posterior of the lower palate at the gutter of the floor of the mouth. It affects the lingual branch of the glossopharyngeal nerve that innervates the base of the tongue, the epiglottis, and part of the posterior pharynx.
- A.
  
  Sphenopalatine
- B.
  
  Transtracheal
- C.
  
  Glossopharyngeal
- D.
  
  Superior laryngeal nerve
Correct Answer
C. GlossopHaryngeal

Explanation
The correct answer is "Glossopharyngeal" because the given description states that the block is placed at the posterior of the lower palate at the gutter of the floor of the mouth, affecting the lingual branch of the glossopharyngeal nerve. The glossopharyngeal nerve innervates the base of the tongue, the epiglottis, and part of the posterior pharynx.

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50.

The recurrent laryngeal nerve block is performed above the thyroid cartilage and below the hyoid bone bilaterally, blocking the vocal cords and up to the base of the tongue.
- A.
  
  True
- B.
  
  False
Correct Answer
B. False

Explanation
This describes the superior laryngeal nerve block

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Quiz Review Timeline +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

Current Version
Mar 18, 2023

Quiz Edited by
ProProfs Editorial Team
Mar 07, 2015

Quiz Created by
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Otterbein/Grant CRNA Basics Midterm Review Pre-OP And Airway

You are performing anesthesia on a 10 month old. They last breastfed at 0400. Which is the earliest time could you safely induce the child?

You are performing general anesthesia on a healthy 28 y.o. smoker for a scheduled procedure. What is their ASA classification?

Which of the following are indicators of a potential difficult intubation?

All of the following are necessary for a fire to occur in the OR EXCEPT:

Which type of heat loss has the greatest effect on a patient's temperature in the OR?

This process involves the conduction of heat via air currents around the body and accounts for the 2nd largest source of heat loss in the OR.

Automatic implantable cardioverter-defibrillators (AICD's) need to be deactivated when the surgeon plans on using a Bovie.

ANSI/ASHRAE/ASHE standard 170 reduced the required humidity percentage in the operating room to _____ ?

Which of the following is NOT a complication of hypothermia?

The maximum amount of electrical leakage in the OR is how many mA?

Garlic, gingko, and ginseng are 3 herbal medications associated with increased clot formation.

In order for a smoker to decrease carboxyhemoglobin levels they should refrain from smoking for how many hours?

What is the greatest risk factor for post-operative pulmonary complications?

Which of the following is NOT an indicator for a pre-operative chest x-ray?

A patient undergoing major surgery must have a CBC, BMP, EKG, room air O2 saturations, and a toxicology & screen performed. Their history and physical and lab draws must be completed within how much time related to the date of surgery?

This cardiovascular condition poses the greatest risk for patients undergoing anesthesia and is associated with a 14-fold increase risk of perioperative sudden death.

The highest period of risk for reinfarction following an acute MI is during the emergent CABG performed the day of the original MI.

You are going to be performing anesthesia on a patient with Type 1 diabetes mellitus. During their pre-op assessment two weeks prior to surgery, the patient asks you what they should do with their insulin regimen on the day of surgery. You advise them:

Which of the following are contraindications for peri-operative beta-blockers?

During your patient's pre-operative assessment for an elective procedure you note that their blood pressure is 210/100 mmHg. True or false: The procedure should still occur since you feel comfortable controlling their blood pressure intraoperatively with nipride

Which of the following will NOT reduce the risk of aspiration during intubation?

You are happily performing general anesthesia on your intubated patient when a series of unfortunate events occurs and their ETT spontaneously combusts into flames. After you scream like a little girl, what should be your next action?

The temperature of an OR in a pediatric hospital is typically less than that of an adult hospital.

This nerve provides sensation to the posterior 1/3 of the tongue, the roof of the pharynx, tonsils, and the undersurface of the soft palate. It also provides the afferent signal of the gag reflex.

Which of the following is NOT a paired cartilage in the larynx?

This nerve provides motor control to the cricothyroid muscle.

This nerve provides sensory innervation BELOW the vocal cords as well as motor control to all intrinsic muscles of the larynx EXCEPT the cricothyroid muscle.

Which of the following intrinsic muscle of the larynx adducts the vocal cords?

You extubate your patient and note that they are in acute respiratory distress with loud stridor. What nerve damage do you suspect occured?

The LMA has increased OR safety by easily provided protected airways to patients.

You are performing general anesthesia on an obese patient with DM, and a history of GERD. This is a procedure does not require neuromuscular blockade. Which airway would you anticipate using?

Congratulations! You have successfully intubated your first adult patient. How much air do you anticipate injecting into the cuff?

Which of the following is the most reliable indicator of successful ETT placement?

Which of the follow is true about cricoid pressure, also known as the Sellick maneuver?

Which of the following NOT a contraindication to nasal intubation?

Which of the following is not indicative of a patient being able to tolerate extubation?

Which of the following is not an indicator of difficult airway?

A short thyromental distance:

Which of the following are indications for awake intubation?

You have attempted to intubate your patient for the 3rd time and were unsuccessful. You resume bag/mask ventilation and discover you are no longer getting chest rise and your patient begins desaturating. What is your next intervention?

Which of the following is the proper sequence of RSI?

Fiberoptic intubations are contraindicated in which scenarios?

A right-sided double lumen tube is the most commonly used.

Benzocaine spray, also known as Hurricane Spray, is a 20% solution. It can cause methemoglobinemia with toxicity. The toxic dose of benzocaine spray is how many mL's?

Convulsions, respiratory arrest and circulatory collapse have been associated with small doses (20 mg) of which topical anesthetic?

This topical anesthetic causes local anesthesia and vasoconstriction. It should be used with extreme caution in patients with known coronary artery disease, HTN, pseudocholinesterase deficiency, preeclampsia, and hyperthyroidism. The maximum dose is 200 mg or 1 mg/kg.

This nerve block is difficult to perform, it requires an angled needle being inserted into the greater palatine foramen of the upper posterior palate. The resulting block affects the greater and lesser palatine nerves that provide sensation to nasal turbinates and posterior 2/3 of the septum.

This block is placed at the posterior of the lower palate at the gutter of the floor of the mouth. It affects the lingual branch of the glossopharyngeal nerve that innervates the base of the tongue, the epiglottis, and part of the posterior pharynx.

The recurrent laryngeal nerve block is performed above the thyroid cartilage and below the hyoid bone bilaterally, blocking the vocal cords and up to the base of the tongue.