Exam 6

What is an appropriate volume of local anesthetic for a caudal anesthetic in an adult patient undergoing a procedure that requires anesthesia to the T10 dermatome? A. 5-8 mL B. 12-15 mL C. 20-30 mL D. 35-40 mL

You answered B. The correct answer is C. A 3 mL test dose is administered first. For sacral procedures, 12-15 mL is sufficient. 20-30 mL is usually required for anesthesia up to a T10 dermatome.

When using a circle anesthesia circuit, the fresh gas flow rate A. determines how much of the exhaled gas returns to the patient B. should be at least the same as the patient's minute ventilation C. should be no lower than 2 liters per minute D. is inversely proportional to the patient's minute ventilation

You answered B. The correct answer is A. In a circle anesthesia circuit, the fresh gas flow rate determines the amount of gas that returns to the patient and is rebreathed.

The low peak pressure alarm is activated when A. the flow rate is below 2 liters per minute B. the APL valve is open C. the anesthesia machine is turned on D. the ventilator is on

The correct answer is D. The low peak pressure alarm is activated when the ventilator is turned on. It is designed to help detect disconnects in the anesthesia circuit. In order to prevent the alarm from triggering, the airway pressure must exceed a preset minimum within a set amount of time (usually about 15 seconds).

A patients arterial blood gas results reveal the following data: pH 7.51, PCO2 38, HCO3 30, PO2 92. How would you interpret this information? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

The correct answer is D. The pH is above 7.4 which indicates that this is an alkalosis. The bicarbonate level is elevated indicating that the disturbance is metabolic in origin.

All of the following are potential systemic manifestations of rheumatoid arthritis except: A. Aortic regurgitation B. Pleural effusion C. Coronary arteritis D. Catecholamine excess

The correct answer is D. Unlike osteoarthritis, rheumatoid arthritis is associated with numerous systemic abnormalities including pericardial thickening and effusion, myocarditis, coronary arteritis, conduction defects, vasculitis, aortic regurgitation, pleural effusion, interstitial pulmonary fibrosis, anemia, and thrombocytopenia. The use of immunosuppressive treatment drugs leads to atrophy of the skin. Platelet dysfunction can occur secondary to the use of aspirin and adrenal insufficiency (resulting in catecholamine depletion, not excess) results from chronic corticosteroid therapy.

Match the inhalation agent with the number of fluoride atoms it contains Isoflurane Desflurane Sevoflurane

The correct match is: Isoflurane to 5 Desflurane to 6 Sevoflurane to 7.

Match the pacemaker codes below with the characteristics for pacing, sensing, and response that each code represents in that order Ventricular, none, none AV, AV, Triggered Ventricular, Ventricular, Inhibited

The correct match is: ventricular, none, none to VOO AV, AV, triggered and inhibited to DDD ventricular, ventricular, inhibited to VVI.

How is a patient positioned for splenectomy? A. Supine B. Lithotomy C. Lateral decubitus D. Prone

The correct answer is C. The patient is positioned in lateral decubitus position for a splenectomy.

Where in the anesthesia circuit would you find a Wright respirometer? A. Upstream from the flowmeters B. In the expiratory limb C. In the inspiratory limb D. Upstream from the CO2 absorber

The correct answer is B. A Wright respirometer is located in the expiratory limb and contains vanes that cause it to rotate when exhaled gas passes across it. The rotations are measured electronically, mechanically, or through photoelectrics to indicate the exhaled tidal volume.

Chronic or recurrent excessive mucus secretion for at least three months a year for two consecutive years is the defining characteristic of A. emphysema B. asthma C. chronic bronchitis D. COPD

The correct answer is C. Chronic or recurrent excessive mucus secretion for at least three months a year for two consecutive years is the defining characteristic of chronic bronchitis.

Which of the following drugs would not be safe for use in the anesthetic management of a patient with acute porphyria? A. Nitrous oxide B. Neostigmine C. Morphine D. Ketorolac

The correct answer is D. Nitrous oxide, neostigmine, morphine, fentanyl, succinylcholine, pancuronium, and propofol are considered safe for use in patients with porphyria. Ketorolac, thiopental, thiamylal, etomidate, pentazocine, methohexital, and nifedipine should all be avoided.

All of the following are associated with cigarette smoking except: A. Emphysema B. Elevated carboxyhemoglobin C. Decreased mucociliary function D. Sarcoidosis

The correct answer is D. Sarcoidosis is a disorder of the immune system. Smoking leads to an increase in carboxyhemoglobin in the blood, dysfunction of the mucociliary escalator, and an increase in elastase activity in the alveoli that leads to emphysema.

The half-life of thyroxine (T4) in the circulation is: A. 24-30 hours B. 48-72 hours C. 4-5 days D. 6-7 days

The correct answer is D. The half-life of thyroxine (T4) in the circulation is about 7 days and (T3) is 24-30 hours.

What is the blood oxygen content in a patient with a hemoglobin of 14.5 g/dL, an oxygen saturation of 97%, and a PaO2 of 102 mmHg? (Calculate answer in mL/dL and to two decimal places)

The correct answer is 19.15. Using the formula: (1.34 X Hgb X O2 Sat/100) + (0.003 X PaO2), the answer is (18.8471 + 0.306) or (19.15 mL)/dL

What is the body mass index (BMI) of a patient who is five foot six inches and weighs 220 pounds? (Calculate to one decimal place)

The correct answer is 35.6. The BMI is calculated by dividing the weight in kilograms by the height in meters squared. In this case, the weight must first be converted from pounds to kilograms by dividing by 2.2. Thus, a 220 pound patient weighs 100 kilograms. Then, you must converted the height into meters. This is best done by taking the height in inches and multiplying it by 0.0254 which equals 1.6764 meters. Then, perform the calculation. (100 kg)/(1.6764) (1.6764) = 35.583 or 35.6

What is the hourly intravenous fluid maintenance rate in mL/hour for a 12 kilogram infant? (Calculate answer to a whole number with no decimals)

The correct answer is 44. The hourly intravenous fluid maintenance rate for patients of all ages is calculated as 4 mL/kg for the first ten kilograms, 2 ml/kg for the second ten kilograms, and 1 mL/kg for each kilogram thereafter. In this instance, the patient weighs 12 kilograms, so we have 40 mL/hour for the first ten kilograms of weight. We then add 2 mL/kg for each kilogram in the second ten kilograms of weight. Since there are only two kilograms left, we only need to add 4mL to the 40 mL we have already calculated, leaving an answer of 44 mL/hour.

A gas occupies 50 mL at a temperature of 325 Kelvin. What volume does it occupy at a temperature of 55 Kelvin? (Calculate to two decimals)

The correct answer is 8.46. This problem is calculated using Charles' law which is represented as (V1/T1) = (V2/T2). Using this formula, we get (50/325) = (V2/55) where V2 = 8.46 mL.

The glomerular filtration rate (GFR) decreases by approximately ____ ml/min/year after age 40. A. 1 B. 2 C. 3 D. 4

The correct answer is A. After age 40, GFR lowers approximately 1 mL/min/year after age 40.

Ideally the time-out procedure should be performed A. before the induction of anesthesia while the patient is awake B. immediately after induction of anesthesia C. immediately prior to incision D. Immediately after incision

The correct answer is A. Both the WHO's Surgical Safety Checklist and the Joint Commission's Universal Protocol utilize the time-out. The time-out serves as a safety check and communication tool between the surgical, nursing, and anesthesia teams, and it is the final assessment that ascertains that the correct procedure will be done on the correct patient at the correct site. It is advised that it be performed before induction of anesthesia so that the patient can participate in the verification process.

Which of the following regarding the use of dantrolene is true? A. It inhibits the efflux of calcium from the sarcoplasmic reticulum B. The dose in patients with malignant hyperthermia is 5 mg/kg every 5 minutes to a total dose of 15 mg/kg C. It is packaged as a powder that must be mixed with sterile saline before administration D. Dantrolene is extremely water-soluble

The correct answer is A. Dantrolene works directly on the ryanodine type 1 receptor to inhibit the efflux of calcium from the sarcoplasmic reticulum. It is packaged as a lyophilized (freeze dried) powder that must be mixed with 60 cc of sterile water prior to injection. It may be administered in doses of 2.5 mg/kg every 5 minutes to a total dose of 10 mg/kg.

Which of the following parameters increases with pregnancy? A. PaO2 B. PaCO2 C. HCO3 D. Total lung capacity

The correct answer is A. During pregnancy, oxygen consumption increases, but the increase in minute ventilation results in an elevation in PaO2 by about 10%. The PaCO2 decreases to between 28-32 mmHg. The HCO3 level decreases about 15% as well. The total lung capacity reduces slightly during pregnancy.

Which of the following statements regarding eutectic mixture of local anesthetic (EMLA) cream is true? A. The depth of analgesia is usually 3-5 mm B. It requires a contact time of 15-30 minutes under an occlusive dressing C. It has a typical duration of 3-4 hours D. It is contraindicated in pregnancy

The correct answer is A. EMLA cream consists of a 1:1 mixture of 2.5 percent lidocaine and 2.5 percent prilocaine in an oil-in-water emulsion. It requires a contact time of at least one hour under an occlusive dressing, reaches a depth of analgesia of about 3-5 mm, and has a duration of about 1-2 hours.

Which of the following has the greatest effect on the block height of a spinal anesthetic? A. Intra-abdominal pressure B. Patient age C. Patient height D. The body mass index of the patient

The correct answer is A. Factors such as patient height, age, BMI, and length of the vertebral column don't affect the spread of a spinal anesthetic. Pregnancy, obesity, and increased intra-abdominal pressure increase the height of sensory block, however. It is believed that these conditions increase the block height because of a lower lumbar CSF volume.

Which electrolyte disorder would be most likely to worsen cerebral edema following a craniotomy? A. Hyponatremia B. Hypermagnesemia C. Hypokalemia D. Hypercalcemia

The correct answer is A. Hyponatremia causes the extracellular fluid to become hypotonic. As this occurs, water begins moving into the brain cells causing cerebral edema and intracranial hypertension.

In the central venous pressure tracing, the v wave corresponds with A. venous return pressure B. atrial contraction C. ventricular contraction D. opening of the AV valves

The correct answer is A. In the CVP tracing, the v wave corresponds to the pressure buildup from venous return prior to the opening of the AV valves. The a wave corresponds with atrial contraction. Ventricular contraction results in a bulging of the AV valve into the right atrium causing the C wave.

Which of the following statements regarding the use of muscle relaxants in patients with Huntington's disease is true? A. They are sensitive to both succinylcholine and nondepolarizing muscle relaxants B. Succinylcholine is contraindicated, but the response to nondepolarizing muscle relaxants is normal C. The response to succinylcholine is normal, but they are sensitive to nondepolarizing muscle relaxants D. The response to both depolarizing and nondepolarizing muscle relaxants is normal

The correct answer is A. Patients with Huntington's Chorea have extreme sensitivity to nondepolarizing muscle relaxants, therefore they should be titrated very carefully. Also, because of a decrease in plasma cholinesterase, they exhibit an increased sensitivity to succinylcholine.

Which of the following is not associated with septic shock? A. Low cardiac output B. Low systemic vascular resistance C. Tissue hypoperfusion D. Disseminated intravascular coagulation

The correct answer is A. Septic shock is typically characterized by a high cardiac output, low systemic vascular resistance, and tissue hypoperfusion. Endotoxins from the bacteria can affect the coagulation pathway, resulting in DIC. DIC is one of the reasons that the mortality rate for septic shock is as high as 85 percent.

Select all of the sites where arginine vasopressin exerts its effects (select two) A. renal collecting ducts B. skeletal muscle tissue C. loop of Henle D. vascular smooth muscle

The correct answer is AD. Arginine vasopressin exerts its primary effects on the renal-collecting ducts in the nephron where it encourages passive water reabsorption. It also acts upon vascular smooth muscle and cardiac myocytes. It also causes dramatic vasoconstriction and has an inotropic effect. The endogenous form of vasopressin is released from the posterior pituitary gland.

Which of the following factors would exert the greatest effect on the duration of action of local anesthetics? A. Serum alpha-1 acid glycoprotein levels B. Serum albumin levels C. pH as determined by arterial blood gas D. Serum alpha-1 antitrypsin levels

The correct answer is A. The duration of action of local anesthetics is dependent upon their binding to alpha-1 acid glycoprotein. Increased binding prolongs the duration of action. Patient pH plays a significant role in the onset of action (acidosis slows the onset of local anesthetics) but doesn't have as significant an effect on duration. As local anesthetics do not bind to albumin significantly, it does not affect their duration of action. A homozygous deficiency of the protease inhibitor alpha-1 antitrypsin is associated with early development of emphysema and is not related to local anesthetic duration.

What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream? A. stratum corneum B. stratum basale C. stratum granulosum D. stratum spinosum

The correct answer is A. The epidermis is the outer layer of skin. It contains 5 layers. From bottom to top the layers are named: stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum. The stratum corneum is the rate-limiting layer of skin for the absorption of transcutaneous drugs.

What is the leading cause of death in patients with diabetes mellitus? A. Cardiovascular disease B. Diabetic ketoacidosis C. Hyperosmolar hyperglycemic nonketotic coma D. Emphysema

The correct answer is A. The incidence of cardiovascular disease is significantly higher in patients with diabetes mellitus. It is also the leading cause of death in these patients.

Click the Exhibit button at the top of the screen. In the diagram of the circle of Willis shown in the exhibit, identify the structure indicated by the letter A. A. Middle Cerebral Artery B. Anterior Cerebral Artery C. Posterior Cerebral Artery D. Posterior Communicating Artery

The correct answer is A. The internal carotid arteries and vertebral branches of the subclavian artery provide the blood supply to the brain through a redundant flow mechanism called the circle of Willis. The circular flow helps ensure circulation to both sides of the brain even if the blood supply on one side is impeded. The structure indicated by letter A is the middle cerebral artery.

Which of the following statements regarding the oxyhemoglobin dissociation curve is correct? A. The curve shifts to the right in acidosis B. The curve shifts to the right in alkalosis C. The curve shifts to the left with hyperpyrexia D. The oxyhemoglobin curve shifts to the left as 2,3 DPG increases

The correct answer is A. The oxyhemoglobin dissociation curve shifts to the right in acidosis to allow for a greater unloading of oxygen from the hemoglobin in the tissue bed. Other factors that shift the oxyhemoglobin dissociation curve to the right include: increased 2,3 DPG (also known as 2,3 BPG), fever, elevated CO2, and low carbon monoxide levels.

When administering local anesthetics via epidural to a pregnant patient, you know that segmental spread is most dependent upon: A. The dose of the local anesthetic solution B. The height of the patient C. The baricity of the local anesthetic solution D. The patient's position during and immediately after injection

The correct answer is A. The segmental spread of an epidural is reliant primarily upon the dose of local anesthetic solution used and the site of injection. The size of the epidural space increases down the spinal cord as the cord itself occupies less space. This is in contrast to spinal anesthesia, which relies more on the dose in milligrams of the local anesthetic, the baricity of the solution, and the patient's position to determine the spread of the anesthetic.

You are caring for a patient undergoing a posterior cervical laminectomy in the sitting position. You suspect a venous air embolism has occurred. What action should be instituted first? A. Have the surgeon flood the surgical field with saline B. Place an arterial line C. Administer a vasopressor D. Turn off the volatile anesthetic agent

The correct answer is A. The surgeon must first be notified in order for the surgical field to be flooded and packed until the site of entry can be detected. The patient should be given 100% O2 (turn off nitrous oxide if it is on). Vasopressors should be administered, the patient should be placed supine and any air possible should be aspirated from the CVP line. Use of a precordial doppler and placement of a central venous line are prudent measures prior to beginning the procedure.

The ventral decubitus position is the same as the A. prone position B. lateral jackknife position C. supine position D. lithotomy position

The correct answer is A. The ventral decubitus position is another term for the prone position.

Which of the following conditions would be detected by capnography? (select two) A. Circuit disconnection B. Anesthesia circuit leak C. Circuit hypoxia D. Vaporizer overdose

The correct answer is AB. Capnography is capable of detecting or aiding in the detection of errors in gas delivery, circuit disconnection, circuit leaks, endotracheal cuff leaks, poor mask or LMA fit, hypoventilation, malignant hyperthermia, airway obstruction, and air embolism. Vaporizer overdose or malfunction is detected by the agent analyzer. Circuit hypoxia is detected by the oxygen analyzer.

The initial treatment for a chemical burn is irrigation of the affected area with (select two) A. water B. saline C. 7.5% sodium bicarbonate solution D. betadine

The correct answer is AB. Chemical burns are caused by disruption of the cellular components of the skin by the chemical irritant. The initial treatment is irrigation with water or saline irrigation because the chemical will continue to damage tissue until it is removed.

Elective surgery should be cancelled in patients with chronic bronchitis if they exhibit (select two) A. A room air PaCO2 of 52 mmHg B. A room air PaO2 of 91 mmHg C. Severe wheezing D. Clubbing of the fingernails

The correct answer is AC. Elective surgery should be postponed in these patients if they exhibit severe dyspnea, wheezing, pulmonary congestion, or a PaCO2 greater than 50 mmHg.

What are the major groups tissues are divided into when discussing the transfer of volatile anesthetics to the tissues? (select four) A. Muscle B. Vascular C. Fat D. Skin E. Cartilage F. Vessel-poor G. Vessel-rich H. Renal

The correct answer is ACFG. The four groups are the vessel-rich group, muscle, fat, and the vessel-poor group.

When performing a wrist block, you inject 3 mL of local anesthetic at the level of the styloid process on the volar aspect of the arm between the palmaris longus and flexor carpi radialis tendons. What nerve are you anesthetizing when you do this? A. Ulnar B. Median C. Radial D. Musculocutaneous

The correct answer is B. A median nerve block at the wrist is performed by injecting 2-5 mL of local anesthetic in the carpal tunnel using a short, B-bevel needle between the long palmar muscle and the radial flexor muscle proximal to the proximal crease of the wrist. An additional 2-3 mLs are injected as the needle is withdrawn from the carpal tunnel.

Which of the following is considered the gold standard in evaluating cardiac function and volume status? A. Thermodilution pulmonary artery catheter B. Esophageal doppler monitoring C. Pulse contour analysis D. Arterial blood pressure

The correct answer is B. Although a thermodilution PAC and pulse contour analysis are beneficial in assessing cardiac function and volume status, the esophageal doppler ultrasound is considered the gold standard for measurement.

Which of the following statements regarding mitral valve stenosis is false? A. It is associated with a decreased left ventricular volume B. It is associated with a decreased left atrial pressure and increased right atrial pressure C. It can cause right ventricular failure D. It can result in pulmonary edema

The correct answer is B. As flow through the mitral valve opening into the left ventricle is decreased (thus decreasing the left ventricular volume), left atrial pressure increases, resulting in left atrial hypertrophy and distention. The increased pressure is transmitted into the pulmonary vasculature as the volume of pulmonary blood increases. This increased pulmonary vascular pressure represents an increase in right ventricular afterload and will cause right ventricular hypertrophy and failure. As pulmonary venous pressure increases above about 25 mmHg, fluid can leak into the pulmonary interstitial space resulting in a decrease in pulmonary compliance and increased work of breathing. If the change in pulmonary venous pressure occurs over a long period of time, an increase in pulmonary lymph flow can partially compensate for the fluid accumulation.

Cerebrospinal fluid normally flows from the lateral ventricles to the third ventricle via the: A. Aqueduct of Sylvius B. Foramen of Monroe C. Foramen of Lushke D. Foramen of Magendie

The correct answer is B. CSF flows from the lateral ventricles into the third ventricle via the foramen of Monroe, through the aqueduct of Sylvius into the fourth ventricle, and into the cerebromedullary cistern via the foramina of Lushke and Magendie.

An anaphylactic reaction to latex is mediated by which antibody? A. IgA B. IgE C. IgG D. IgM

The correct answer is B. Classic anaphylactic reactions such as food and latex allergies are mediated by IgE antibodies. Anaphylactoid reactions differ in that they do not involve IgE antibodies, but are instead mediated by mast cell and basophil activation.

Which form of a drug is responsible for reaching the site of action? A. Ionized B. Non-ionized C. Acidic D. Basic

The correct answer is B. In solution, the non-ionized form of a drug is considered to confer pharmacologic activity, because it is in the non-ionized form that the drug is able to pass through lipid-soluble biologic membranes to reach its point of action.

Injection of 3 mL of 2% lidocaine bilaterally 1 centimeter below each greater cornu of the hyoid A. is called a transtracheal block B. anesthetizes the airway below the epiglottitis C. blocks the lingual and pharyngeal branches of the glossopharyngeal nerve D. anesthetizes the airway above the epiglottis

The correct answer is B. Injection of 3 mL of 2% lidocaine bilaterally 1 cm below each greater cornu of the hyoid is a superior laryngeal nerve block which anesthetizes the airway below the epiglottis as well as a portion of the epiglottis itself. A transtracheal block is performed by injecting 3-5 mL of 2% lidocaine through a needle penetrating the cricothyroid membrane into the trachea. The lingual and pharyngeal branches of the glossopharyngeal nerve are blocked by infiltrating local anesthetic into the base of the palatoglossal arch.

Which of the following statements regarding the Bain circuit is true? A. It requires a fresh gas flow equal to three times the minute ventilation B. It utilizes a countercurrent exchange to warm the fresh gas C. It is a modification of the Mapleson A circuit D. The exhalation tubing should provide a volume larger than the tidal volume to prevent rebreathing

The correct answer is B. The Bain circuit is a modification of the Mapleson D circuit utilizing a coaxial system in which the fresh gas hose lies within the corrugated tubing through which exhaled gas flows. The exhaled gas passes in the opposite direction of the fresh gas, establishing a countercurrent, which helps warm the inspired gas. It requires a fresh gas flow of 1-2 times that of the minute ventilation to prevent rebreathing. The exhalation tubing should provide a volume larger than the tidal volume to prevent rebreathing when using an Ayres T-piece, not a Bain circuit.

Which of the following is true regarding epidural steroid injections? A. Methylpredisolone is a non-particulate agent B. The injection should be given at least 2-3 weeks before attempting another one C. Interlaminar injections are more efficacious than transforaminal injections D. Betamethasone is preferred for cervical epidural injections

The correct answer is B. The injection should be given at least 2-3 weeks to allow time for the corticosteroid to exert its effects. Dexamethasone is the preferred agent for cervical epidural injections. Transforaminal injections have been shown to be more efficacious than interlaminar injections. Methylprednisolone contains the largest particles among all steroids used for epidural injections.

Which of the following topical anesthetic agents can result in methemoglobinemia if administered in large doses? A. Viscous lidocaine B. Benzocaine C. Cocaine D. Tetracaine

The correct answer is B. The protective enzyme systems normally present in red blood cells maintain methemoglobin levels at less than one percent of the total hemoglobin in healthy people. Exposure to exogenous oxidizing drugs and their metabolites (such as benzocaine, dapsone and nitrates) may accelerate the rate of formation of methemoglobin up to a thousand-fold, overwhelming the protective enzyme systems and acutely increasing methemoglobin levels.

Which Mallampati score involves the visualization of only the uvula, fauces, and soft palate? A. I B. II C. III D. IV

The correct answer is B. The uvula, fauces, and soft palate can be visualized in a Class II airway. In a class I airway, the entire oropharynx including the tonsillar pillars can be seen.

Click the Exhibit button at the top of the screen. Identify the cardiac rhythm depicted in the exhibit A. Atrial fibrillation B. Atrial flutter C. Second-degree block type I D. Normal sinus rhythm

The correct answer is B. This rhythm originates in the atria, but because of a malfunction that is probably occurring in the atrial conduction system, the atria are depolarizing very rapidly. The AV Node cannot keep up with the atrial rate of 260, so it is conducting the impulses that it is able, which in this circumstance is every fourth impulse. Sometimes, in atrial flutter, you will see a QRS for every 2,3,4 or even five flutter waves. Usually, the ventricular rhythm is regular, but on some occasions you will see variable conduction, which means that the AV node will alternate the number of flutter waves it takes to produce a QRS with each beat. The rhythm is still identifiable by the characteristic flutter waves.

Thymectomy is a procedure often used to treat A. Muscular dystrophy B. Myasthenia gravis C. Polymyalgia rheumatica D. Rhabdomyolysis

The correct answer is B. Thymectomies are commonly performed to treat myasthenia gravis patients. This autoimmune disorder appears to regress when the breeding ground for the immune cells responsible for nicotinic destruction is resected.

What is the most common postoperative complication in the patient undergoing transsphenoidal hypophysectomy for a pituitary tumor? A. Transient blindness B. Diabetes insipidus C. Hypertension from catecholamines released during surgical manipulation of the tumor D. Laryngeal nerve damage

The correct answer is B. Diabetes insipidus is the most common complication that arises from this surgery (it develops in up to 40% of all patients), but it is typically only temporary. The anterior pituitary secretes adrenocorticotropic hormone (ACTH), thyroid stimulating hormone, growth hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary releases antidiuretic hormone and oxytocin. The most common type of functional pituitary tumor produces hyperprolactinemia. The release of prolactin by the tumor can cause amenorrhea, galactorrhea, or both, in women. In men, it can result in galactorrhea or infertility. Complications related to this procedure may arise from the need for mucosal injection of epinephrine to prevent bleeding, the accumulation of blood in the pharynx and stomach, risk of injury to the cavernous sinus or internal carotid artery, damage to cranial nerves III, IV, V1, and VI that travel near the pituitary gland, and hypofunction of the pituitary gland.

The anesthetist performing a supraclavicular block knows that A. if blood is aspirated, the needle should be redirected anteriorly and medially B. the brachial plexus is positioned posterior to the subclavian artery C. the patient should be positioned supine with the head turned toward the side being blocked D. the brachial plexus is positioned anterior to the subclavian artery

The correct answer is B. Just posterior to the subclavian artery between the clavicle and the first rib, the brachial plexus is tightly compacted. Because of this, a block performed here will achieve adequate anesthesia of the entire arm and hand. The patient is positioned supine with the head turned to the opposite side. A skin wheal is raised over the nerve. A 22-gauge, 1.5 inch needle enters the wheal posterior to the pulse and is directed caudally until a paresthesia or muscle contraction (if using a nerve stimulator) is elicited. If blood is aspirated, redirect the needle posteriorly and laterally. If the first rib is encountered, walk the needle in an anterior to posterior manner.

Which of the following are signs of hyperparathyroidism? (select four) A. Decreased serum ionized calcium B. Polyuria C. Ventricular arrhythmias D. Increased glomerular filtration rate E. Hyperchloremic alkalosis F. Hyperphosphatemia G. Bone demineralization H. Muscle weakness

The correct answer is BCGH. Patients with hyperparathyroidism will exhibit signs and symptoms related to an underlying hypercalcemia (elevated serum ionized calcium level). These signs and symptoms include renal stones, polyuria, hypertension, ventricular arrhythmias, muscle weakness, and osteoporosis. Surgical excision is the standard treatment for the condition.

Which of the following pathologies are closely associated with kyphoscoliosis? (select two) A. Central sleep apnea B. Pulmonary hypertension C. Increased vital capacity D. Restrictive lung disease

The correct answer is BD. Kyphoscoliosis is a pathology of the spine characterized by anterior curvature (kyphosis) and lateral curvature (scoliosis) that results in compression of the lung tissue, and decreased vital capacity. The most common causes of death in patients with kyphoscoliosis are restrictive lung disease and pulmonary hypertension. A poor cough often contributes to an increased risk for pulmonary infections.

What are the ECG changes often seen with hypothyroidism? (select three) A. Peak T waves B. Flattened T waves C. Peak P waves D. Low-voltage P waves E. Sinus bradycardia F. Sinus tachycardia G. ST depression H. ST elevation

The correct answer is BDE. The ECG may exhibit flattened or inverted T waves, low-voltage P waves and QRS complexes, and sinus bradycardia. They are also more prone to the development of ventricular dysrhythmias

What is the most common cause of suboptimal preoxygenation prior to induction of anesthesia? A. Inadequate oxygen flow rate B. Asthma C. Inadequate mask seal D. Pulmonary hypertension

The correct answer is C. A loose-fitting mask (inadequate mask seal) is the most common cause of suboptimal preoxygenation.

According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source? A. 21% B. 30% C. 40% D. 100%

The correct answer is C. According to ASTM standards, a self-inflating manual resuscitator should be able to deliver a minimum FiO2 of 40% when connected to an oxygen source.

All preganglionic sympathetic and parasympathetic neurons secrete A. epinephrine B. norepinephrine C. acetylcholine D. dopamine

The correct answer is C. All sympathetic and parasympathetic preganglionic neurons are cholinergic and secrete acetylcholine.

Cardiac catheterization data reveals that a patient has a pulmonary artery occlusion pressure of 18 mmHg, and central venous pressure of 14 mmHg, an end diastolic volume of 130ml, and end systolic volume of 30 mL, and a heart rate of 100. The patients cardiac output is A. 5 L/min B. 7.5 L/min C. 10 L/min D. 13 L/min

The correct answer is C. Cardiac output is calculated as the stroke volume X heart rate. Stroke volume is calculated as the end diastolic volume minus the end systolic volume. In this instance, cardiac output is calculated as (130-30) X 100 or 10 liters/minute.

You are preparing to induce a patient with uncorrected hydrocephalus for placement of a ventriculoperitoneal shunt. Which of the following agents would be least appropriate for this patient? A. Spironolactone B. Isoflurane C. Desflurane D. Acetazolamide

The correct answer is C. Desflurane can increase cerebrospinal fluid production and could potentially increase cerebrospinal fluid pressure prior to placement of the shunt. Acetazolamide, isoflurane, sevoflurane, furosemide, corticosteroids, spironolactone, and vasoconstrictors all decrease CSF production.

When administered for induction, etomidate may cause a slight decrease in blood pressure. If it occurs, this is most likely due to a decrease in A. heart rate B. stroke volume C. systemic vascular resistance D. myocardial contractility

The correct answer is C. Etomidate administration causes minimal changes in hemodynamic status. It is considered the induction drug of choice in patients with cardiovascular disease, as well as any other patients in whom maintenance of a normal BP is imperative. Slight decreases in BP following administration of etomidate are due to a minor decrease in SVR.

Which of the following statements regarding aortic stenosis is true? A. Aortic stenosis is associated with an increase in left ventricular compliance B. Myocardial oxygen demand is not altered in aortic stenosis C. Aortic stenosis is associated with diastolic dysfunction D. Aortic stenosis does not alter arterial flow to the myocardium

The correct answer is C. In aortic stenosis, left ventricular compliance decreases as the left ventricle hypertrophies, resulting in diastolic dysfunction. The myocardial demand is increased due to ventricular hypertrophy and the supply is decreased as the extraordinary compression of intramyocardial vessels during systole restricts arterial flow to the myocardium.

Which pathology would explain the administration of indomethacin to a premature infant? A. Osteodystrophy B. Renal impairment C. Patent ductus arteriosus D. Aortic regurgitation

The correct answer is C. Indomethacin, a potent prostaglandin inhibitor is administered to stimulate closure of a patent ductus arteriosus.

Which of the following is true regarding cerebrovascular accident or stroke? A. Most strokes are hemorrhagic in nature B. Ischemic strokes are four times more lethal than hemorrhagic strokes C. The incidence of stroke is the same in men and women over the age of 75 D. Dextrose is commonly administered to protect neural function in an ischemic stroke

The correct answer is C. Most CVAs are ischemic in nature. Only about 10 percent are hemorrhagic. Hemorrhagic strokes are four times more lethal than ischemic strokes. The risk for a stroke is higher in men until age 75 when the risk for men and women is the same. Hyperglycemia is associated with poor outcomes in patients with ischemic stroke.

A patient with von Willebrand disease is experiencing continued bleeding at the site of his surgical incision despite treatment with DDAVP. The next treatment you would recommend for this patient is: A. Fresh frozen plasma B. Platelets C. Cryoprecipitate D. Concentrated factor VIII

The correct answer is C. Patients with von Willebrand disease should be given desmopressin which increases factor VIII-vWF complex and improves coagulation. If desmopressin doesn't produce a sufficient response, cryoprecipitate should be considered.

What structure is most at risk for damage from a tracheotomy? A. superior laryngeal nerve B. facial nerve C. recurrent laryngeal nerve D. vagus nerve

The correct answer is C. Potential complications from a tracheotomy include damage to the recurrent laryngeal nerve and damage to the blood vessels in the neck.

The most common cause of respiratory distress syndrome in the premature infant is A. tobacco abuse by the mother B. intracranial hemorrhage C. insufficient surfactant production D. bronchopulmonary dysplasia

The correct answer is C. Respiratory distress syndrome in premature infants is most commonly caused by a lack of surfactant production. Surfactant is not produced until about 28 weeks of gestation and doesn't reach normal production until 35 weeks of gestation.

Steep reverse Trendelenburg position for surgery on the head is associated with A. an increase in cardiac output B. an increase in preload C. a risk for air embolus D. an increase in mean thoracic pressure

The correct answer is C. Steep reverse trendelenburg position elevates the head, which displaces the abdominal contents toward the pelvis resulting in a decreased mean thoracic pressure. It also results in venous pooling in the lower extremities which decreases preload and cardiac output. The elevation of the surgical site above the level of the heart increases the risk for air embolus

To more accurately facilitate calculation of the cerebral perfusion pressure during a craniotomy for tumor removal, the arterial pressure transducer should be level with the patient's A. atria B. sternal angle C. ear D. shoulder

The correct answer is C. The arterial transducer should be level with the patient's ear to more accurately facilitate calculation of the cerebral perfusion pressure. Otherwise, it should be placed even with the atria.

Which of the following organs is most responsible for the initial rapid uptake of local anesthetics following intravenous injection? A. Liver B. Kidneys C. Lungs D. Muscle

The correct answer is C. The initial rapid uptake of local anesthetics is due to uptake by the highly perfused organs (brain, heart, liver, kidneys, and lungs). The lungs in particular extract large amounts of local anesthetics and reduce the plasma concentration of the local anesthetic quickly. Muscle and gut tissue exhibit moderate perfusion and contribute to the slower redistribution of local anesthetics.

You are about to perform an intravenous induction in a patient with chronic renal failure. Which agent would be least likely to exhibit a prolonged duration of action? A. Ketamine B. Dexmedetomidine C. Propofol D. Fentanyl

The correct answer is C. The metabolites of ketamine undergo renal excretion and could accumulate in renal failure. Dexmedetomidine is cleared by the liver primarily, but patients with chronic renal failure still exhibit prolonged sedation. The slow elimination half-life of fentanyl is prominent in renal failure patients and it may exhibit a prolonged duration of action. Propofol is relatively unchanged in renal failure and these patients may actually require a slightly higher dosage because of a hyperdynamic circulation.

Which of the following hemodynamic patterns is consistent with a diagnosis of sepsis? A. High pulmonary capillary wedge pressure, high cardiac output, low systemic vascular resistance B. Low pulmonary capillary wedge pressure, Low cardiac output, high systemic vascular resistance C. Low pulmonary capillary wedge pressure, high cardiac output, low systemic vascular resistance D. High pulmonary capillary wedge pressure, high cardiac output, high systemic vascular resistance

The correct answer is C. The patient with sepsis typically presents with a low pulmonary capillary wedge pressure, a high cardiac output, and a low systemic vascular resistance.

Neuromuscular blocking agents work by acting on A. presynaptic nicotinic cholinergic receptors B. presynaptic muscarinic cholinergic receptors C. postsynaptic nicotinic cholinergic receptors D. postsynaptic muscarinic cholinergic receptors

The correct answer is C. The primary site of action for neuromuscular blocking agents is the postsynaptic nicotinic cholinergic receptor on the muscle endplate.

A 41 year-old female is five foot nine inches tall and weighs 220 pounds. You would classify this patient as A. Ideal body weight B. Overweight C. Obesity Class I D. Obesity Class II

The correct answer is C. To answer this question, you must first determine the patients body mass index (BMI) which is the weight in kilograms divided by the height in meters squared. To obtain the weight in kilograms, divide the weight in pounds by 2.2. The answer is 100 kilograms. Next, multiply the height in inches (69) by 0.0254 to convert it to meters. Take this result (1.75m) and square it to arrive at 3.0 meters squared. Divide the weight in kilograms (100) by 3.0 meters squared to arrive at a BMI of 33.3. The scale for BMI is as follows: A BMI < 18.5 = Underweight, 18.5-24.9 = Normal, 25-29.9 = Overweight, 30-34.9 = Obesity Class I, 35-39.9 = Obesity Class II, > 40 = Obesity Class III (morbid obesity)

Which of the following laboratory results is associated with damage to the renal tubules? A. Orthostatic proteinuria B. Decreased hematocrit C. Increased urinary sodium excretion D. Glucosuria

The correct answer is C. Urinary sodium > 40 mEq/L is associated with damage to the renal tubules. Orthostatic proteinuria occurs in 5- 10% of the population and is not associated with renal damage. Glucosuria is associated with increased serum glucose levels. Decreased hematocrit is associated with anemia and increased intravascular fluid volume.

How are cortical somatosensory evoked potentials affected by the administration of volatile anesthetics? A. Latency and amplitude both increase B. Latency and amplitude both decrease C. Latency increases and amplitude decreases D. Latency decreases and amplitude increases

The correct answer is C. Volatile anesthetics produce an increase in the latency and decrease in the amplitude of the cortical component of somatosensory evoked potentials. The decrease in amplitude is more pronounced than the increase in latency.

When inducing general anesthesia for a patient with chronic hypertension, you should strive to maintain the mean arterial blood pressure within what percent of normal? A. 10 B. 15 C. 20 D. 30

The correct answer is C. When inducing general anesthesia for a patient with chronic hypertension, you should strive to maintain the mean arterial blood pressure within 20 percent of normal.

Which of the following are produced by the administration of ketamine? (select two) A. An increase in bronchiolar smooth muscle tone B. An isoelectric EEG C. An increase in cerebral oxygen consumption D. An increase in intracranial pressure

The correct answer is CD. Ketamine produces dose-dependent changes in the EEG. Light anesthesia with ketamine is associated with an increase in EEG frequency. An isoelectric EEG does not occur with ketamine. In contrast with other intravenous anesthetics, ketamine increases intracranial pressure, cerebral blood flow, and cerebral oxygen consumption. Ketamine produces bronchodilation, not an increase in bronchiolar smooth muscle tone.

A patient undergoing hysteroscopy is placed in lithotomy position with medially-placed strap supports. In the recovery area, the patient complains of numbness and tingling along the medial aspect of the calves. You suspect there could be damage to the A. sciatic nerve B. obturator nerve C. common peroneal nerve D. saphenous nerve

The correct answer is D. Although lithotomy position can result in damage to any of these nerves, this patient's presentation is most consistent with damage to the saphenous nerve, which innervates the medial calf. This is most likely to occur with medially placed strap supports. Extreme flexion at the thigh can result in injury to the sciatic, obturator, and femoral nerves while injury to the common peroneal nerve can occur if the lateral thigh is allowed to rest on strap supports.

You are about to perform anesthesia for an opthalmic procedure in which the surgeon wishes for the patient to be awake, but able to tolerate the placement of a lid speculum. Blockade of which nerve would prevent the patient from squinting during the procedure? A. Glossopharyngeal nerve B. Optic nerve C. Trigeminal nerve D. Facial nerve

The correct answer is D. Blockade of the facial nerve will prevent the patient from being able to squint the eyelids and allow placement of a lid speculum.

All of the following are associated with increased serum potassium levels except: A. Nonsteroidal anti-inflammatory drugs B. Beta blockers C. ACE inhibitors D. Bumetanide

The correct answer is D. Bumetanide is a loop diuretic associated with decreased serum potassium levels. Drugs such as triamterene, spironolactone, NSAIDs, ACE inhibitors, and beta blockers are associated with increased potassium levels.

All of the following symptoms are associated with interstitial nephritis except: A. Proteinuria B. Decreased ability to concentrate urine C. Hypertension D. Intractable renal failure

The correct answer is D. Interstitial nephritis is a disorder most commonly associated with allergic reactions to drugs such as sulfonamides, allopurinol, phenytoin, and diuretics. It is also less commonly associated with diseases such as lupus erythematosus and sarcoidosis. Patients display a decreased ability to concentrate urine, proteinuria, and systemic hypertension. Renal failure from interstitial nephritis typically resolves once the offending agent or cause has been removed.

Disclosure of an unanticipated anesthetic outcome to a patient and their family is A. discouraged because of the potential for litigation B. disruptive to the patient's ability to make decisions about their care C. not required regardless of situation D. required by JCAHO

The correct answer is D. Joint Commission (JCAHO) has added language to their policies that require practitioners to disclose unanticipated outcomes to patients and their families. The AANA code of ethics also requires CRNAs to advocate for the patient's welfare, which may include disclosure of critical events.

Which of the following positioning techniques indicates the anesthetist's understanding of appropriate methods of protecting the ulnar nerve from position-related injury? A. Both arms are abducted less than 90 degrees B. Both hands are positioned prone C. Both hands are positioned supine D. Both arms are tucked at the sides

Which of the following positioning techniques indicates the anesthetist's understanding of appropriate methods of protecting the ulnar nerve from position-related injury? A. Both arms are abducted less than 90 degrees B. Both hands are positioned prone C. Both hands are positioned supine D. Both arms are tucked at the sides

A patient presents for emergency surgery with an open-globe eye injury. Which of the following would present the greatest risk for further ocular damage? A. Rapid sequence intubation using propofol and succinylcholine B. Intubating a patient without sufficient muscle relaxation C. Administering lidocaine prior to intubation D. Retrobulbar block

You answered A. The correct answer is B. Although studies are conflicting about the risk, succinylcholine can increase intraocular pressure about 8-10 mm Hg and potentially increase the risk for expulsion of the globe contents. However, intubation during light anesthesia can cause a large increase in the IOP. The risk of further eye damage must be balanced with the risk of aspiration. Regional anesthesia may be a consideration for this patient if the increase in intraocular pressure during injection would not be too great. Another alternative would be to use rocuronium 0.9-1.2 mg/kg to produce adequate intubating conditions and reversing with sugammadex as needed.

Which substance enhances the sensitivity of nerve endings to painful stimuli but does not directly excite them? A. histamine B. substance P C. serotonin D. bradykinin

You answered A. The correct answer is B. Histamine, bradykinin, potassium, serotonin, acetylcholine, acids, and proteolytic enzymes are direct chemical stimulators. Substance P and prostaglandins don't directly stimulate the nerve endings, but they increase their sensitivity to other painful stimuli.

During the preoperative evaluation of a morbidly obese patient undergoing a surgery with a potentially long duration, your facility has a protocol suggesting you order a preoperative creatine kinase. You know that this is done in this patient to aid in the diagnosis and management of A. cardiac ischemia B. rhabdomyolysis C. myasthenia gravis D. postoperative respiratory failure

You answered A. The correct answer is B. Pre- and postoperative creatine kinase levels can help in diagnosing and managing rhabdomyolysis which occurs in 1-2 percent of morbidly obese patients undergoing surgery. Rhabdomyolysis occurs due to compression of deep tissues and can lead to acute renal failure.

In adults, the dura extends from the foramen magnum to: A. L1 B. L3 C. S2 D. S5

You answered A. The correct answer is C. In adults, the dura space extends from the foramen magnum to S2. The spinal cord itself extends to L1 in adults and L3 in children.

What conditions have the highest associated risk for silent myocardial infarction? (select two) A. Diabetes mellitus B. Peripheral vascular disease C. Hypertension D. Cigarette smoking

You answered AD. The correct answer is AC. Silent myocardial infarctions are most common in patients with diabetes and hypertension.

Which of the following statements regarding superficial parotidectomy is false? A. The parotid gland is left intact and only the tumor is removed B. The facial nerve will be intentionally removed in most cases C. The patient should be positioned with the head turned towards the opposite side D. Surgical paralysis is not necessary for this procedure

You answered B. The correct answer is A. A superficial parotidectomy removes all of the parotid tissue superficial to the facial nerve. A parotid tumor enucleation removes only the tumor. Because the facial nerve has branches that invest the parotid gland and nerve monitoring is employed to protect the nerve, muscle relaxation is contraindicated in this procedure.

Which of the following statements regarding the use of an automatic implantable cardioverter defibrillator (AICD) is false? A. Unipolar cautery will not cause an AICD to fire B. All AICD functions are deactivated by placing a doughnut magnet over it C. Some AICDs also function as a pacemaker D. AICDs are capable of normal function if the patient is anesthetized

You answered B. The correct answer is A. Unipolar cautery may produce electrical interference that may be interpreted as a ventricular dysrhythmia by an AICD. This could potentially trigger a defibrillation pulse. It is best to consult with someone who has experience with the specific device prior to surgery or place a magnet over the device to temporarily disable it.

Which statement regarding the use of a cell phone in the operating room is false? A. It is a possible source of bacterial contamination B. It can produce electromagnetic inference C. It is a source of distraction D. The FDA prohibits the use of mobile devices in the OR

You answered B. The correct answer is D. Ninety percent of healthcare worker's cell phones test positive for bacteria, making cell phones a potential source of bacterial contamination. They can produce electromagnetic interference that can alter equipment if in close proximity. It is a potentially hazardous source of distraction. The FDA does not prohibit the use of cell phones in the OR, but they have issued guidelines regarding the regulation of medical software for mobile devices.

Which of the following symptoms are not commonly associated with carcinoid syndrome? A. Left-sided heart failure B. Right-sided heart failure C. Hypotension D. Bronchospasm

You answered C. The correct answer is A. Because of the release of various hormones such as serotonin, histamine, bradykinin, and kallikrein, patients with carcinoid syndrome may experience cutaneous flushing, hypotension, a decrease in cardiac output, bronchospasm, and right-sided heart failure. The left heart, however, is typically spared. This is believed to be due to the inactivation of the vasoactive substances by the pulmonary endothelium.

Patients with carcinoid tumors do not always experience symptoms related to the release of hormones from the tumor. Why is this? A. Over time, patients may develop resistance to the effects of the hormones B. Hepatic first-pass metabolism eliminates the hormones from the circulatory system C. The effects of the hormones are compensated for by the renin-angiotensin system D. Hormones are metabolized by tissue and plasma esterases

You answered C. The correct answer is B. Usually, hepatic first-pass metabolism eliminates the hormones from the circulatory system before they can exert any deleterious effects.

All of the following are true regarding the anesthetic management of the patient undergoing a vertebroplasty except A. general anesthesia is acceptable for this procedure B. IV sedation is acceptable for this procedure C. the patient will need to be placed in a prone position D. the procedure requires the use of portable computer tomography

You answered C. The correct answer is D. General anesthesia and IV sedation are both acceptable techniques when performing a vertebroplasty. The patient is placed in the prone position and the back is prepped and draped. A fluoroscope is mandatory for the procedure so that the surgeon or radiologist can guide the trocars and monitor the cement injection. The vertebral body is entered via a posterior approach through the pedicle.

Which of the following is not true regarding Alport syndrome (hereditary nephritis)? A. It occurs most commonly in males B. It is often accompanied by hearing loss C. ACE inhibitors are contraindicated in these patients D. The preferred treatment is renal transplantation

You answered D. The correct answer is C. Hereditary nephritis is a genetic disorder most commonly seen in males and is associated with hearing and ocular abnormalities. The disease ultimately results in systemic hypertension and renal failure. Drug treatment has not proved successful in this class of patients.

Which of the following is not a contributing factor to the development of retinopathy of prematurity? A. Hyperoxia B. Low birth weight C. Administration of anesthesia D. Postnatal hypotension

You answered D. The correct answer is C. Retinopathy of prematurity has been shown to be related to supplemental oxygen therapy, low birth weight, postnatal hypotension, the use of surfactant or inotropes, and mechanical ventilation.