1.
What are the two fundamental purposes of all anesthesia breathing systems? (click two answers)
Correct Answer(s)
A. Delivery of O2 & anesthetic gases.
D. Elimination of CO2
Explanation
The two fundamental purposes of all anesthesia breathing systems are to deliver oxygen and anesthetic gases to the patient and to eliminate carbon dioxide from the patient's exhaled breath.
2.
All of the following will reduce Resistance in Laminar flow except...
Correct Answer
B. Increasing Viscosity
Explanation
Increasing viscosity will not reduce resistance in laminar flow. Resistance in laminar flow is primarily determined by the length and diameter of the tubing. Increasing flow rate, increasing diameter of tubing, decreasing length of tubing, and eliminating unnecessary valves will all help to reduce resistance in laminar flow. However, increasing viscosity will have the opposite effect, as higher viscosity fluids will create more resistance to flow.
3.
In Laminar flow resistance is ______________ to flow rate.
Correct Answer
C. Indirectly Proportional
Explanation
In laminar flow, the resistance is inversely proportional to the flow rate. This means that as the flow rate increases, the resistance decreases, and vice versa. In laminar flow, the fluid moves in smooth, parallel layers with minimal disruption, resulting in low resistance to flow. As the flow rate increases, the fluid moves faster and encounters less resistance, leading to an indirect relationship between resistance and flow rate.
4.
What will doubling the radius of a tube do to resistance and flow?
Correct Answer
D. Decrease resistance 16 times, increase flow 16 times
Explanation
Doubling the radius of a tube will lead to a decrease in resistance by 16 times and an increase in flow by 16 times. This is because resistance is inversely proportional to the fourth power of the radius according to Poiseuille's law. Therefore, doubling the radius will result in a decrease in resistance by a factor of 2^4 = 16. Additionally, flow is directly proportional to the fourth power of the radius, so doubling the radius will increase the flow by a factor of 2^4 = 16.
5.
Which will flow faster: a 16 gauge IV or a central line? (Using poiseuilles law)
Correct Answer
A. The #16 IV because of larger radius and shorter length, decreasing resistance.
Explanation
The correct answer is that the #16 IV will flow faster because of its larger radius and shorter length, which decreases resistance. According to Poiseuille's law, the flow rate of a fluid is directly proportional to the fourth power of the radius and inversely proportional to the length. Therefore, a larger radius and shorter length will result in a faster flow rate.
6.
If you half the radius of your breathing circuit what will this do resistance and flow?
Correct Answer
B. Increase resistance by 16, decrease flow by 16.
Explanation
If you halve the radius of your breathing circuit, it will increase the resistance by 16 and decrease the flow by 16. This is because the resistance in a circuit is inversely proportional to the fourth power of the radius. So, by halving the radius, the resistance increases by a factor of 2^4 = 16. Similarly, the flow is directly proportional to the fourth power of the radius. Therefore, by halving the radius, the flow decreases by a factor of 2^4 = 16.
7.
Which of the following is not a means of classifying breathing circuits?
Correct Answer
C. Number of vaporizers
Explanation
The number of vaporizers is not a means of classifying breathing circuits. Breathing circuits can be classified based on the presence of a reservoir bag, which allows for the delivery of oxygen and removal of carbon dioxide. They can also be classified based on the neutralization of CO2, which ensures the removal of carbon dioxide from the patient's exhaled breath. Additionally, the amount of rebreathing, which refers to the amount of exhaled gas that is returned to the patient, is another means of classifying breathing circuits. However, the number of vaporizers does not play a role in classifying breathing circuits.
8.
A nasal cannula is an example of which kind of breathing system?
Correct Answer
D. Open
Explanation
A nasal cannula is an example of an open breathing system because it delivers supplemental oxygen to the patient through two small prongs that are inserted into the nostrils. In an open system, the patient breathes in a mixture of both ambient air and the supplemental oxygen provided by the nasal cannula. This allows for a continuous flow of oxygen without completely sealing off the patient's airway.
9.
Which of the following is true regarding open circuits?
Correct Answer
B. No Neutralization of CO2
Explanation
Open circuits do not have a mechanism to neutralize or remove carbon dioxide (CO2) from the breathing system. In an open circuit, exhaled gases are not recycled or rebreathed, and there is no reservoir bag to collect and store exhaled gases. Therefore, CO2 is not effectively removed from the system, leading to the statement that there is no neutralization of CO2 in open circuits.
10.
What is the difference between an open and a semi-open system?
Correct Answer
C. Presence of gas reservoir bag.
Explanation
An open system does not have a gas reservoir bag, while a semi-open system does. The presence of a gas reservoir bag allows for the storage and collection of excess gases, which can be used during inhalation. This helps to ensure a continuous supply of gases and maintain a steady flow of oxygen to the patient. In contrast, an open system does not have this storage capacity and relies solely on the immediate supply of gases.
11.
How much FGF do you need in a semi-open system?
Correct Answer
D. 2-3 times minute ventilation
Explanation
In a semi-open system, it is necessary to have a higher amount of FGF (Fresh Gas Flow) compared to the patient's minute ventilation. This is because the FGF helps to encourage rebreathing of exhaled gases, which can be beneficial in certain situations. Therefore, having 2-3 times the minute ventilation as the FGF ensures an adequate amount of FGF is supplied to the patient, allowing for effective rebreathing and maintaining the desired levels of anesthesia.
12.
You are using a semi-open breathing circuit for your pt today. Your pt is breathing 500 tidal volume at 12 breaths per minute. What is the minimum amount of fresh gas flow needed to maintain a semi-open curcuit and compensate for dead space?
Correct Answer
A. 12 L / min
Explanation
In a semi-open breathing circuit, fresh gas flow is required to compensate for dead space and maintain the circuit. Dead space refers to the volume of gas that does not participate in gas exchange with the patient. In this case, the patient is breathing at a tidal volume of 500 ml and a rate of 12 breaths per minute. To ensure an adequate supply of fresh gas, the minimum amount needed would be the total volume of gas being delivered to the patient per minute, which is calculated by multiplying the tidal volume (500 ml) by the respiratory rate (12 breaths per minute), resulting in 6000 ml/min or 6 L/min. However, since the question asks for the minimum amount needed, the answer would be 12 L/min, which is the highest option provided and ensures an ample supply of fresh gas to compensate for dead space.
13.
When using a semi-open circuit, what happens if your FGF drops below minute ventilation?
Correct Answer
B. The system then turns into a semi-closed circuit.
Explanation
When using a semi-open circuit, if the fresh gas flow (FGF) drops below minute ventilation, the system then turns into a semi-closed circuit. In a semi-open circuit, the FGF is set to be slightly lower than the patient's minute ventilation. This allows for a small amount of rebreathing of exhaled gases. However, if the FGF drops below the minute ventilation, it means that the patient is rebreathing a significant amount of exhaled gases. To prevent this, the system automatically switches to a semi-closed circuit, where the FGF is higher than the minute ventilation to ensure adequate ventilation and minimize the risk of rebreathing.
14.
What is the primary determinant of whether a system if closed, semi closed, or semi open within our breathing circuits?
Correct Answer
C. Amount of Fresh Gas Flow
Explanation
The primary determinant of whether a system is closed, semi-closed, or semi-open within our breathing circuits is the amount of fresh gas flow. The amount of fresh gas flow refers to the rate at which new gas is supplied to the system. In a closed system, the fresh gas flow is minimal or nonexistent, as the patient's exhaled gases are recirculated. In a semi-closed system, a small amount of fresh gas is added to the circuit to compensate for the patient's metabolic needs. In a semi-open system, a higher amount of fresh gas flow is used to flush out the exhaled gases and maintain a desired concentration of oxygen.
15.
Which of the following is NOT a characteristic of a semi-closed circuit?
Correct Answer
D. Allows for Total rebreathing of gases
Explanation
A semi-closed circuit is a breathing system used in anesthesia where exhaled gases are partially rebreathed. It typically contains unidirectional valves to ensure the flow of gases in one direction. It always provides for the neutralization of CO2 to prevent its buildup. It also usually has a reservoir bag to store excess gases. However, it does not allow for total rebreathing of gases, as some fresh gases are always added to maintain an adequate oxygen concentration.
16.
You are using a semi-closed system, and want to determine how much FGF to use. Your pt is breathing 600 Tv at 10 breaths per minute. How much FGF would be appropriate to maintain your semi-closed circuit?
Correct Answer
A. 4 L / min
Explanation
FGF needs to be less than minute ventilation (not equal, not more). 150 ml/min is too little and would lead to total rebreathing.
17.
Which of the following is NOT true regarding a closed circuit?
Correct Answer
B. Only to be used during controlled ventilations with open pop-off valve
Explanation
A closed circuit in the context of ventilation refers to a breathing system where exhaled gases are recirculated back to the patient. It allows for total rebreathing of gases, meaning that a portion of the exhaled gases, including carbon dioxide (CO2), is reintroduced into the patient's lungs. This helps to conserve heat and moisture in the respiratory system. A closed circuit always contains unidirectional valves to control the flow of gases. However, it is not true that a closed circuit should only be used during controlled ventilations with an open pop-off valve. The pop-off valve is used to release excess pressure from the system, and its use is not limited to controlled ventilations.
18.
Which non-rebreathing circuit contains a Fresh gas hose inside the expiratory limb?
Correct Answer
C. Mapleson D (Bain)
Explanation
Mapleson D (Bain) is the correct answer because it is the only non-rebreathing circuit that contains a fresh gas hose inside the expiratory limb. In this circuit, the fresh gas enters the system through the fresh gas hose and is mixed with the patient's exhaled gases in the expiratory limb, before being delivered to the patient again. This design allows for efficient removal of carbon dioxide and delivery of fresh gas to the patient, making it suitable for controlled ventilation during anesthesia.
19.
Which type of non-rebreathing circuit is used almost exclusively in children?
Correct Answer
D. Mapleson F (Jackson-Rees)
Explanation
Mapleson F (Jackson-Rees) is the type of non-rebreathing circuit that is used almost exclusively in children. This circuit is specifically designed for pediatric patients and is preferred due to its ability to deliver a precise concentration of oxygen and anesthetic gases. It consists of a reservoir bag, a unidirectional valve, and a fresh gas inlet. The Mapleson F circuit allows for efficient removal of exhaled gases and minimizes the risk of rebreathing, making it suitable for pediatric patients who have a higher risk of complications from rebreathing.
20.
What two things do all non-rebreathing circuits lack? (two answers)
Correct Answer(s)
A. Unidirectional valves
B. Soda Lime CO2 absorption
Explanation
Non-rebreathing circuits are used in anesthesia to deliver oxygen to the patient while removing exhaled carbon dioxide. These circuits lack unidirectional valves, which ensure that the flow of gases is in one direction only, preventing the rebreathing of exhaled gases. Additionally, non-rebreathing circuits lack soda lime CO2 absorption, which is a substance used to remove carbon dioxide from the exhaled gases. By not having these two components, non-rebreathing circuits ensure that the patient receives a fresh supply of oxygen while eliminating carbon dioxide effectively.
21.
What could you do to decrease amount of CO2 (rebreathing) in a NRB circuit?
Correct Answer
C. Long Expiratory Pause
Explanation
long expiratory pause allows for exhaled gas to be more thoroughly flushed out by high FGF since inspiration will draw on gases present in expiratory limb. PPT slide 18
22.
Which type of circuit is most efficient during Spontaneous Ventilation?
Correct Answer
D. Mapleson A
Explanation
Mapleson A circuit is the most efficient during spontaneous ventilation because it allows for the patient to inhale fresh gas directly from the anesthesia machine, while exhaling into a reservoir bag. This circuit is commonly used for short procedures and in patients with normal lung compliance. The T-Piece circuit is not as efficient because it lacks a reservoir bag, which can lead to rebreathing of exhaled gases. Mapleson D and F circuits are also less efficient as they require higher fresh gas flow rates to prevent rebreathing.
23.
Which type of circuit is most efficient during Controlled ventilation?
Correct Answer
A. Mapleson D
Explanation
Mapleson D circuit is the most efficient type of circuit during controlled ventilation. This circuit is designed to deliver a high fresh gas flow rate to the patient, which ensures efficient removal of carbon dioxide and prevents rebreathing. It is commonly used for controlled ventilation in anesthesia, as it provides good control over the inspired and expired gases. Mapleson D circuit is also lightweight and portable, making it convenient for use in various settings.
24.
Which non-invasive BP measurements are only reliable for measuring systolic BP?
Correct Answer
B. Palpation & Doppler
Explanation
Palpation is a method of measuring blood pressure by feeling the pulse at certain points in the body. It is only reliable for measuring systolic blood pressure because it does not provide an accurate measurement of diastolic blood pressure. Doppler is another non-invasive method that uses ultrasound technology to measure blood flow and is also only reliable for measuring systolic blood pressure. Therefore, the correct answer is Palpation & Doppler.
25.
Identify the above rhythm.
Correct Answer
A. 3rd degree heart block
Explanation
3rd degree heart block is a condition in which there is a complete blockage of electrical signals between the atria and ventricles of the heart. This results in the atria and ventricles beating independently of each other, leading to a slow and irregular heart rhythm. The answer choice "3rd degree heart block" accurately describes the rhythm shown in the given question.
26.
Identify the above rhythm.
Correct Answer
B. Inferior wall MI
Explanation
The correct answer is Inferior wall MI. Inferior wall MI refers to a myocardial infarction (heart attack) that occurs in the inferior wall of the heart, which is the lower part of the heart. This can be identified on an ECG (electrocardiogram) by specific changes in the ST segment and T wave in the inferior leads (II, III, and aVF). It is important to recognize this rhythm as it can indicate damage to the heart muscle and the need for prompt medical intervention.
27.
Identify above rhythm.
Correct Answer
C. Old Inferior MI
Explanation
Q waves leads 2 & 3
28.
Identify the above rhythm.
Correct Answer
D. Atrial Bigeminy
Explanation
Atrial bigeminy is the correct answer because the rhythm shown in the above question is characterized by a regular pattern of a premature atrial contraction (PAC) followed by a normal sinus beat. This pattern repeats consistently throughout the rhythm strip, indicating a consistent occurrence of PACs in a 1:1 ratio with normal sinus beats. This is indicative of atrial bigeminy, where every other beat is a PAC.
29.
What is this capnography indicative of?
Correct Answer
C. Re-breathing of CO2
Explanation
Capnography suggests re-breathing of CO2, where exhaled air is re-inhaled. Elevated levels of carbon dioxide in the exhaled breath are indicative of inefficient ventilation. Monitoring capnography helps identify respiratory issues, guiding interventions to maintain proper ventilation and prevent complications like hypoventilation or hyperventilation.
30.
The above capnogram is indicative of what?
Correct Answer
B. COPD or Bronchospasm
Explanation
The given capnogram shows a characteristic waveform pattern that is commonly seen in patients with COPD or bronchospasm. These conditions are characterized by airway obstruction and reduced airflow, leading to an increased end-tidal carbon dioxide (ETCO2) level and a prolonged expiratory phase on the capnogram. This is consistent with the waveform shown in the given capnogram.
31.
The following capnogram represents what?
Correct Answer
C. Hyperventilation
Explanation
The given capnogram represents hyperventilation. Hyperventilation is characterized by an increased rate and depth of breathing, leading to a decrease in the level of carbon dioxide (CO2) in the blood. This is reflected in the capnogram as a lower than normal end-tidal CO2 (ETCO2) level. In hyperventilation, the respiratory rate is usually increased, resulting in a rapid and deep breath pattern. The decreased CO2 levels can lead to symptoms such as dizziness, lightheadedness, and tingling in the extremities.
32.
The above capnogram is indicative of what?
Correct Answer
D. Rebreathing of CO2
Explanation
The above capnogram is indicative of rebreathing of CO2. A capnogram is a graphical representation of carbon dioxide levels in exhaled breath. In a normal capnogram, there should be a sharp rise in CO2 levels during expiration, followed by a rapid decline as the CO2 is exhaled. However, in the case of rebreathing of CO2, there is a gradual rise and plateau in CO2 levels during expiration, indicating that the patient is inhaling some of the exhaled CO2. This can occur when there is a problem with the ventilation system or when the patient is using a breathing circuit that is not properly functioning.
33.
The above capnogram is indicative of what?
Correct Answer
A. Curare Cleft
Explanation
The capnogram shown in the question indicates a curare cleft. A curare cleft is a specific pattern seen on a capnogram when there is a partial blockage in the airway due to the use of neuromuscular blocking agents (such as curare) during anesthesia. This pattern is characterized by a sudden decrease in the end-tidal carbon dioxide (ETCO2) level followed by a gradual increase. It is important to recognize this pattern as it can help identify the use of these medications and ensure appropriate management during anesthesia.
34.
The above capnogram represents what?
Correct Answer
B. Air leak caused by incompetent valve
Explanation
The given capnogram represents an air leak caused by an incompetent valve. This can be inferred from the irregular and fluctuating shape of the capnogram waveform, which indicates the presence of an abnormality in the respiratory system. In this case, the incompetent valve is causing a leak, leading to the irregularities in the capnogram. This interpretation is supported by the absence of any other characteristic patterns or abnormalities associated with hypoventilation, lung transplant, or a normal capnogram.
35.
The above capnogram represents what?
Correct Answer
C. Normal Capnogram
Explanation
The above capnogram represents a normal capnogram. A capnogram is a graphical representation of the concentration of carbon dioxide (CO2) in exhaled breath over time. In a normal capnogram, there is an initial rise in CO2 concentration as the patient exhales dead space air, followed by a sharp increase as alveolar air is exhaled, and then a gradual decrease as fresh air is inhaled. This pattern indicates effective ventilation and normal lung function.
36.
The above capnogram represents what?
Correct Answer
C. Cardiogenic oscillations in low frequency ventilation
Explanation
The capnogram shown in the question represents cardiogenic oscillations in low frequency ventilation. This means that the oscillations seen in the capnogram are caused by the heart's pumping action during low frequency ventilation. This can be observed when the ventilation rate is slow and the heart's pulsations are transmitted to the capnogram waveform.
37.
The above capnogram is indicative of what?
Correct Answer
D. CPR
Explanation
The given capnogram shows a flat line, indicating no carbon dioxide being exhaled. This is indicative of a lack of ventilation, which is commonly seen during CPR (Cardiopulmonary Resuscitation) when the heart has stopped beating and artificial respiration is being performed. Therefore, the correct answer is CPR.
38.
Identify the above rhythm.
Correct Answer
A. A fib with Left Bundle branch
Explanation
The correct answer is A fib with Left Bundle branch. This rhythm is characterized by irregular and rapid atrial fibrillation (A fib) with the presence of a Left Bundle Branch Block (LBBB) pattern. A fib is a chaotic and irregular rhythm originating from multiple ectopic foci in the atria, while LBBB is a conduction abnormality in the ventricles. The combination of these two findings suggests a potential cardiac pathology involving both the atria and ventricles.
39.
Identify the above rhythm.
Correct Answer
B. Wide Complex Tachycardia
Explanation
Look for the P waves along V1, they are there.
40.
Identify the above ECG rhythm.
Correct Answer
C. Acute Anterior/ Lateral MI
Explanation
The correct answer is Acute Anterior/ Lateral MI. This is indicated by the presence of ST segment elevation in the anterior and lateral leads of the ECG. Acute MI refers to a blockage in the blood flow to the heart muscle, leading to tissue damage. The specific location of the MI can be determined by analyzing the affected leads on the ECG. In this case, the anterior and lateral leads show ST segment elevation, indicating an acute MI in these areas.
41.
Identify the above ECG rhythm.
Correct Answer
D. NSR
Explanation
The correct answer is NSR, which stands for Normal Sinus Rhythm. This means that the electrical activity in the heart is normal and originates from the sinus node, which is the natural pacemaker of the heart. In NSR, the heart rate is regular, and the P waves, QRS complexes, and T waves are all within normal limits. This is considered the normal rhythm for a healthy individual.
42.
Identify the above rhythm.
Correct Answer
A. Digitalis Toxicity
Explanation
Dig toxicity has a characteristic downsloping ST depression
43.
Identify the above ECG rhythm.
Correct Answer
B. Hyperkalemia
Explanation
The correct answer is Hyperkalemia. Hyperkalemia refers to elevated levels of potassium in the blood, which can affect the electrical conduction system of the heart. This can lead to various changes in the ECG rhythm, including peaked T waves, widened QRS complexes, and eventually progressing to a sine wave pattern. Identifying these characteristic changes in the ECG can help diagnose hyperkalemia.
44.
Identify the above ECG rhythm. Examine V5 lead for clues.
Correct Answer
C. Hypokalemia
Explanation
The correct answer is "Hypokalemia". Hypokalemia refers to low levels of potassium in the blood. ECG changes associated with hypokalemia include flattened or inverted T waves, U waves, and ST segment depression. By examining the V5 lead, one can look for these specific ECG changes to help identify the rhythm as hypokalemia.
45.
Identify the above ECG rhythm.
Correct Answer
D. Wolff-Parkinson-White Syndrome
Explanation
Characteristic Slurred upstroke to QRS indicating pre-excitation (delta wave).
46.
Identify the above rhythm.
Correct Answer
A. Paced Rhythm
Explanation
A paced rhythm refers to a heart rhythm that is artificially controlled by a pacemaker. This means that the heart's natural electrical system is not functioning properly, so an external device is used to regulate the heart rate and rhythm. In a paced rhythm, the pacemaker sends electrical signals to the heart muscle, causing it to contract and pump blood. This is often done when the heart is beating too slowly or irregularly.
47.
Identify the above rhythm.
Correct Answer
B. Junctional Rhythm
Explanation
The given rhythm is identified as a junctional rhythm. This can be determined by analyzing the ECG waveform and observing the absence of P waves, as well as the presence of regular QRS complexes that are preceded by inverted or absent P waves. In a junctional rhythm, the electrical impulses originate from the atrioventricular (AV) junction instead of the sinoatrial (SA) node. This can occur when the SA node is not functioning properly or when there is an interruption in the conduction pathway between the SA node and the atria.
48.
Identify the above ECG.
Correct Answer
C. Right Atrial HypertropHy
Explanation
The given ECG shows signs of Right Atrial Hypertrophy. This can be identified by the presence of P wave changes, specifically an increased amplitude of the P wave in leads II, III, and aVF. Right atrial hypertrophy can occur due to various conditions such as pulmonary hypertension or chronic lung disease. It is important to identify this condition as it can indicate underlying cardiac or pulmonary pathology.
49.
Identify the above ECG rhythm.
Correct Answer
B. Acute Anterior Wall MI
Explanation
The correct answer is Acute Anterior Wall MI. This can be identified by the presence of ST-segment elevation in leads V1-V6, indicating myocardial injury in the anterior region of the heart. This pattern is characteristic of an acute myocardial infarction affecting the front wall of the heart. The other options (Old MI, Acute Inferior Wall MI, Right Bundle Branch Block) do not exhibit the same ST-segment elevation pattern seen in an acute anterior wall MI.
50.
Identify the above rhythm.
Correct Answer
C. Acute Inferior wall MI
Explanation
The given rhythm is identified as an Acute Inferior wall MI. This can be determined by analyzing the EKG waveform and observing specific changes that are characteristic of an inferior wall myocardial infarction. These changes typically include ST-segment elevation in leads II, III, and aVF, as well as reciprocal ST-segment depression in leads I and aVL. Additionally, the presence of Q waves in leads II, III, and aVF may also indicate an acute inferior MI.