Boards Hall Questions
The following blood gases would best be explained by which disorder?pH 7.18, Paco2 25 mm Hg, HCO3− 11 mEq/L A. Aspirin overdose B. Nasogastric suction C. Chloride wasting diarrhea D. Hyperaldosteronism
A. Aspirin overdose *The only item listed above that causes a metabolic acidosis is aspirin toxicity. The other items in the question all cause a metabolic alkalosis*
On Monday morning the absorbent granules in your anesthesia machine, which was not used in the last 48 hours, are violet. In addition to rebreathing CO2 when exhausted, this form of absorbent also carries the risk of A. Channeling B. Fire C. Compound A formation D. Carbon monoxide production
A. Channeling *Channeling can occur with any type of CO2 absorber*
According to National Institute for Occupational Safety and Health (NIOSH) regulations, the highest concentration of volatile anesthetic contamination allowed in the OR atmosphere when administered in conjunction with N2O is A. 0.5 ppm B. 2 ppm C. 5 ppm D. 25 ppm
A. 0.5 ppm
In the event of misfilling, what percent sevoflurane would be delivered from an isoflurane vaporizer set at 1%? A. 0.6% B. 0.8% C. 1.0% D. 1.2%
A. 0.6%
In a normal person, what percentage of the cardiac output is dependent on the "atrial kick"? A. 25% B. 35% C. 45% D. 55%
A. 25%
Hypothyroidism and hyperthyroidism could develop in patients receiving which of the following antidysrhythmic drugs? A. Amiodarone B. Verapamil C. Procainamide D. Lidocaine
A. Amiodarone *Amiodarone is a benzofuran derivative with a chemical structure similar to that of thyroxine, which accounts for its ability to cause either hypothyroidism or hyperthyroidism.*
General anesthesia is administered to an otherwise healthy 38-year-old patient undergoing repair of a right inguinal hernia. During mechanical ventilation, the anesthesiologist notices that the scavenging system reservoir bag is distended during inspiration. The most likely cause of this is A. An incompetent pressure-relief valve in the mechanical ventilator B. An incompetent pressure-relief valve in the patient's breathing circuit C. An incompetent inspiratory unidirectional valve in the patient's breathing circuit D. An incompetent expiratory unidirectional valve in the patient's breathing circuit
A. An incompetent pressure-relief valve in the mechanical ventilator
A 65-year-old female patient with sepsis is undergoing an emergency exploratory laparotomy. After induction of anesthesia and tracheal intubation, the patient's blood pressure is noted to be 65 systolic with a heart rate of 120 beats/min. Cardiac output determined by a thermodilution PA catheter is 13 L/min. Of the following vasopressors the LEAST appropriate choice would be A. Dobutamine B. Vasopressin C. Norepinephrine D. Phenylephrine
A. Dobutamine *Because dobutamine is predominantly a β1 agonist, it would be an extremely poor choice for a patient with a high cardiac output in the face of a low SVR*
What rhythm is described: Depressed ST segments, flat T wave, U wave present A. Hypokalemia B. Hyperkalemia C. Hyponatremia D. Hypercalcemia
A. Hypokalemia
Potential complications associated with total parenteral nutrition (TPN) include all of the following EXCEPT A. Ketoacidosis B. Hyperglycemia C. Hypoglycemia D. Hypophosphatemia
A. Ketoacidosis
The fundamental difference between microshock and macroshock is related to A. Location of shock B. Duration C. Voltage D. Lethality
A. Location of shock
Which of the following medications blocks angiotensin at the receptor? A. Losartan (Cozaar) B. Terazosin (Hytrin) C. Lisinopril (Prinivil, Zestril) D. Spironolactone (Aldactone)
A. Losartan *ACEi block conversion of angiotensinogen to Angiotensin I. ARBs block conversion of Angiotensin I to Angiotensin II.* *-prils = ACEi* *-Sartans = ARBs*
Which of the following is NOT found in the low-pressure circuit on an anesthesia machine? A. Oxygen supply failure alarm B. Flowmeters C. Vaporizers D. Vaporizer check valve
A. Oxygen supply failure alarm *The low-pressure circuit starts with and includes the gas flow control valves, flowmeters, vaporizers, and vaporizer check valve and goes to the machine common gas outlet.*
Which of the following statements concerning the distribution of O2 and CO2 in the upright lungs is TRUE? A. Pao2 is greater at the apex than at the base B. Paco2 is greater at the apex than at the base C. Both Pao2 and Paco2 are greater at the apex than at the base D. Both Pao2 and Paco2 are greater at the base than at the apex
A. Pao2 is greater at the apex than at the base
Accidental injection of air into a peripheral vein would be LEAST likely to result in arterial air embolism in a patient with which of the following anatomic cardiac defects? A. Patent ductus arteriosus B. Eisenmenger syndrome C. Tetralogy of Fallot D. Tricuspid atresia
A. Patent ductus arteriosus *The anesthetic management of patients with CHD requires thorough knowledge of the pathophysiology of the defect. In general, congenital heart defects can be categorized into those that result in left-to-right intracardiac shunting and into those that result in right-to-left shunting. The main features in congenital heart defects that result in right-to-left intracardiac shunting are a reduction in pulmonary blood flow and arterial hypoxemia. The more common congenital heart defects that result in right-to-left intracardiac shunting include tetralogy of Fallot, Eisenmenger syndrome, Ebstein malformation of the tricuspid valve, pulmonary atresia with a ventricular septal defect, tricuspid atresia, and patent foramen ovale.*
The diameter index safety system refers to the interface between A. Pipeline source and anesthesia machine B. Gas cylinders and anesthesia machine C. Vaporizers and refilling connectors attached to bottles of volatile anesthetics D. Both pipeline and gas cylinders interface with anesthesia machine
A. Pipeline source and anesthesia machine
The dial of an isoflurane-specific, variable bypass, temperature-compensated, flowover, out-of-circuit vaporizer (i.e., modern vaporizer) is set on 2%, and the infrared spectrometer measures 2% isoflurane vapor from the common gas outlet. The flowmeter is set at a rate of 700 mL/min during this measurement. The output measurements are repeated with the flowmeter set at 100 mL/min and 15 L/min (vapor dial still set on 2%). How will these two measurements compare with the first measurement taken? A.Output will be less than 2% in both cases B. Output will be greater than 2% in both cases C. Output will be 2% at 100 mL/min O2 flow and less than 2% at 15 L/min flow D. Output will be less than 2% at 100 mL/min and 2% at 15 L/min
A.Output will be less than 2% in both cases *The output of the vaporizer will be lower at flow rates less than 250 mL/min because there is insufficient pressure to advance the molecules of the volatile agent upward. At extremely high carrier gas flow rates (> 15 L/min), there is insufficient mixing in the vaporizing chamber.*
Select the FALSE statement. A. If a Magill forceps is used for a nasotracheal intubation, the right nares is preferable for insertion of the nasotracheal tube B. Extension of the neck can convert an endotracheal intubation to an endobronchial intubation C. Bucking signifies the return of the coughing reflex D. Postintubation pharyngitis is more likely to occur in female patients
B. Extension of the neck can convert an endotracheal intubation to an endobronchial intubation *· Flexion of the neck can shift the carina upward, which may convert a midtracheal tube placement into a bronchial intubation. Extension of the neck can cause cephalad displacement of the tube into the pharynx.*
A 62-year-old patient scheduled for elective repair of an abdominal aortic aneurysm develops a wide complex regular tachycardia (heart rate 150 beats/min) during induction of anesthesia. Blood pressure is 110/78 mm Hg. Which of the following drugs would be MOST useful in the management of this dysrhythmia? A. Esmolol, 35 mg IV B. Amiodarone, 150 mg IV over 10 minutes C. Adenosine, 6 mg rapidly over 3 seconds D. Verapamil, 5 to 10 mg IV
B. Amiodarone, 150 mg IV over 10 minutes *The patient described in this question has a wide complex tachycardia of undetermined origin. As this patient appears to be hemodynamically stable and has an uncertain rhythm, amiodarone 150 mg IV over 10 minutes, repeated as needed to a maximum dose of 2.2 g IV over 24 hours*
A 45-year-old patient recovering in the ICU after a motor vehicle accident is continuously being assessed with transcutaneous O2 and CO2 monitoring. Compared with conventional arterial blood gas values, those for transcutaneous oxygen (Ptco2) and transcutaneous carbon dioxide (Ptcco2) would likely be A. Higher (both) B. Ptco2 lower, Ptcco2 higher C. Ptco2 higher, Ptcco2 lower D. Lower (both)
B. PtcO2 lower, PtcCO2 higher *In order to get reliable transcutaneous readings, the skin must be warmed to facilitate gas diffusion. This, however, allows for some metabolism of oxygen and production of carbon dioxide by the skin. The net result is a lower Ptco2 level and a higher Ptcco2 level.*
Which of the following drugs or interventions will cause the LEAST increase in heart rate in the transplanted denervated heart? A. Glucagon B. Atropine C. Isoproterenol D. Norepinephrine
B. Atropine *Drugs that exert their effect by blocking the parasympathetic branches of the autonomic nervous system (e.g., atropine) will have no effect. Direct-acting drugs such as glucagon, isoproterenol, epinephrine, and norepinephrine will still be effective. Isoproterenol is commonly used for increasing heart rate in cardiac transplant recipients. Epinephrine and norepinephrine may have exaggerated β-mimetic effects on the heart rate because the increase in blood pressure will not lead to a reflex slowing of the heart rate via the baroreceptor reflexes (i.e., efferent vagus nerve). Drugs with both direct and indirect effects, such as ephedrine, evoke a less intense response.*
Which of the following valves prevents transfilling between compressed-gas cylinders? A. Fail-safe valve B. Check valve C. Pressure-sensor shut off valve D. Adjustable pressure-limiting valve
B. Check Valve *Check valves permit only unidirectional flow of gases. These valves prevent retrograde flow of gases from the anesthesia machine or the transfer of gas from a compressed-gas cylinder at high pressure into a container at a lower pressure.*
ECG monitors utilize high- and low-frequency filters to reduce noise (artifact). Which of the following are reduced with low-frequency filtering? A. Muscle fasciculation B. Respirations C. Tremor D. Electromagnetic interference from other devices
B. Respirations
During the pre-anesthesia checkout (PAC) of the anesthesia delivery system, the mounted oxygen E cylinder is shown to have a pressure of 1200 psi. Before proceeding with the next case, the most appropriate action would be: A. Leave cylinder valve open and proceed with case B. Close cylinder valve and proceed with case C. Replace the cylinder, open valve to check pressure, then close and proceed with case D. Replace the cylinder, open valve to check pressure, and proceed with case
B. Close cylinder valve and proceed with case *In general, the oxygen cylinder is used only when there is a failure of the pipeline oxygen supply. If there is no pipeline supply, then the oxygen cylinder must supply oxygen for the entire anesthetic. Although the ASA's 2008 checkout guidelines do not specify an exact pressure, manufacturer's manuals often recommend an oxygen cylinder pressure of > 1000 psi.*
Which of the following systems prevents attachment of gas-administering equipment to the wrong type of gas line? A. Pin index safety system B. Diameter index safety system c. Fail-safe system D. Proportion-limiting control system
B. Diameter index safety system
Inhalation of CO2 increases by A. 0.5 L/min/mm Hg increase in Paco2 B. 1 to 1.5 L/min/mm Hg increase in Paco2 C. 2 to 2.5 L/min/mm Hg increase in Paco2 D. Greater than 3 L/min/mm Hg increase in Paco2
B. 1 to 1.5 L/min/mm Hg increase in Paco2 *inhalation of CO2 increases minute ventilation by approximately 1 to 1.5 L/min/mm Hg increase in Paco2.*
Calculate the body mass index (BMI) of a man 200 cm (6 feet 6 inches) tall who weighs 100 kg (220 lb). A. 20 B. 25 C. 30 D. 35
B. 25
O2 requirement for a 70-kg adult is A. 150 mL/min B. 250 mL/min C. 350 mL/min D. 450 mL/min
B. 250 mL/min *The O2 requirement for an adult is 3 to 4 mL/kg/min*
The O2 pressure-sensor shutoff valve requires what O2 pressure to remain open and allow N2O to flow into the N2O rotameter? A. 10 psi B. 30 psi C. 50 psi D. 100 psi
B. 30 psi
Gas from an N2O compressed-gas cylinder enters the anesthesia machine through a pressure regulator that reduces the pressure to A. 60 psi B. 45 psi C. 30 psi D. 15 psi
B. 45 psi
How long does the antiplatelet effect of Clopidogrel last? A. 3 days B. 7 days C. 21 days D. Life of platelet
B. 7 days
During a normal VT (500-mL) breath, the transpulmonary pressure increases from 0 to 5 cm H2O. The product of transpulmonary pressure and Vt is 2500 cm H2O-mL. This expression of the pressure-volume relationship during breathing determines what parameter of respiratory mechanics? A. Lung compliance B. Airway resistance C. Pulmonary elastance D. Work of breathing
B. Airway resistance
If the oxygen cylinder were being used as the source of oxygen at a remote anesthetizing location and the oxygen flush valve on an anesthesia machine were pressed and held down, as during an emergency situation, each of the items below would be bypassed during 100% oxygen delivery EXCEPT A. O2 flowmeter B. First-stage regulator C. Vaporizer check valve D. Vaporizers
B. First-stage regulator *The high-pressure circuit is from the oxygen cylinder to the oxygen pressure regulator (first-stage regulator), which takes the oxygen pressure from a high of 2200 psi to 45 psi. The intermediate-pressure circuit consists of the pipeline pressure of about 50 to 55 psi and goes to the second-stage regulator, which then lowers the pressure to 14 to 26 psi (depending on the machine). The low-pressure circuit then consists of the flow tubes, vaporizer manifold, vaporizers, and vaporizer check valve to the common gas outlet.*
The dose of adenosine necessary to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm should be initially reduced A. In patients receiving theophylline for chronic asthma B. In patients with a history of arterial thrombotic disease taking dipyridamole C. In patients with a history of chronic renal failure D. In chronic alcoholics
B. In patients with a history of arterial thrombotic disease taking dipyridamole *Administration of the usual dose of adenosine to a patient receiving dipyridamole may result in asystole. If adenosine is used in patients receiving dipyridamole, or the patient has a central line, the initial dose is 3 mg. Methylxanthines, such as caffeine, theophylline, and amrinone, are competitive antagonists of this drug, and doses may need to be adjusted accordingly*
Which of the following combinations would result in delivery of a lower-than-expected concentration of volatile anesthetic to the patient? A. Sevoflurane vaporizer filled with desflurane B. Isoflurane vaporizer filled with sevoflurane C. Sevoflurane vaporizer filled with isoflurane D. All of the above would result in less than the dialed concentration
B. Isoflurane vaporizer filled with sevoflurane *Putting a volatile anesthetic with a higher saturated vapor pressure into a vaporizer made for an agent with a lower vapor pressure would lead to a higher-than-expected concentration of anesthetic delivered, whereas putting a drug with a lower saturated vapor pressure into a vaporizer made for a higher vapor pressure would lead to a lower-than-expected concentration of drug delivered.* *Vapor pressure of volatile agents: o Sevoflurane: 157 o Enflurane: 172 o Isoflurane: 238 o Halothane: 243 o Desflurane: 669*
A patient presents for knee arthroscopy and tells his anesthesiologist that he has a VDD pacemaker. Select the true statement regarding this pacemaker. A. It senses and paces only the ventricle B. It paces only the ventricle C. Its response to a sensed event is always inhibition D. It is not useful in a patient with atrioventricular (AV) nodal block
B. It paces only the ventricle
Which of the following supraglottic airway devices features a built-in bite block, a channel for nasogastric suctioning, and a cuff modified to extend to the posterior surface of the mask? A. LMA Fastrach B. LMA Supreme C. Air-Q D. I-Gel
B. LMA Supreme
An admixture of room air in the waste gas disposal system during an appendectomy in a paralyzed, mechanically ventilated patient under general volatile anesthesia can best be explained by which mechanism of entry? A. Positive-pressure relief valve B. Negative-pressure relief valve C. Soda lime canister D. Ventilator bellows
B. Negative-pressure relief valve *The negative-pressure relief valve is used in active systems and will entrap room air if the pressure in the system is less than −0.5 cm H2O.*
A 59-year-old pacemaker-dependent patient comes to surgery with the pacemaker programmed in the DDD mode. Extracorporeal shock wave lithotripsy (ESWL) is scheduled for fragmentation of several 3- to 5-mm kidney stones. What preparation is needed before undertaking ESWL in this setting to avoid inappropriate firing of the lithotripter? A. Program pacemaker to DVI B. Program pacemaker to VVI C. Program pacemaker to DOO D. Proceed with the case
B. Program Pacemaker to VVI
During normal laminar airflow, resistance is dependent on which characteristic of oxygen? A. Density B. Viscosity C. Molecular weight D. Temperature
B. Viscosity *Laminar flow is usually inaudible and is dependent on gas viscosity. Turbulent flow tends to be faster, is audible, and is dependent on gas density. Gas density can be decreased by using a mixture of helium with oxygen.*
After induction and intubation with confirmation of tracheal placement, the O2 saturation begins to fall. The O2 analyzer shows 4% inspired oxygen. The oxygen line pressure is 65 psi. The O2 tank on the back of the anesthesia machine has a pressure of 2100 psi and is turned on. The oxygen saturation continues to fall. The next step should be to A. Exchange the tank B. Replace pulse oximeter probe C. Disconnect O2 line from hospital source D. Extubate and start mask ventilation
C. Disconnect O2 line from hospital source
Eye protection for OR staff is needed when laser surgery is performed. Clear wraparound goggles or glasses are adequate with which kind of laser? A. Argon laser B. Nd:YAG (neodymium:yttrium-aluminum-garnet) laser C. CO2 laser D. None of the above
C. CO2 laser
Afterload reduction is beneficial during anesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT A. Aortic insufficiency B. Patent ductus arteriosus C. Tetralogy of Fallot D. CHF
C. Tetralogy of Fallot
A 32-year-old man is found unconscious by the fire department in a room where he has inhaled 0.1% carbon monoxide for a prolonged period. His respiratory rate is 42 breaths/min, but he is not cyanotic. Carbon monoxide has increased this patient's minute ventilation by which of the following mechanisms? A. Shifting the O2 hemoglobin dissociation curve to the left B. Increasing CO2 production C. Causing lactic acidosis D. Decreasing Pao2
C. Causing lactic acidosis *there would not be an increase in minute ventilation until tissue hypoxia was sufficient to produce lactic acidosis*
What is the minimal time after angioplasty and placement of a drug-eluting stent (DES) that dual antiplatelet therapy (DAPT) should be continued before considering stopping it for elective surgery? A. 3 months B. 6 months C. 1 year D. 18 months
C. 1 year
Oxygen consumption (Vo2) is measured in a 70-kg subject on a treadmill at 2500 mL per minute. This corresponds to: A. 1 metabolic equivalent (MET) B. 5 METs C. 10 METs D. 15 METs
C. 10 METs *One MET is equal to the amount of energy expended during 1 minute at rest, which is roughly 3.5 mL of oxygen per kilogram of body weight per minute (3.5 mL/kg/min). For a 70-kg (150 lb) person, one MET would equal 250 mL O2 per minute, so 2500 mL would correspond to 10 METs*
The minimum macroshock current required to elicit ventricular fibrillation is A. 1 mA B. 10 mA C. 100 mA D. 500 mA
C. 100 mA
Uptake of sevoflurane from the lungs during the first minute of general anesthesia is 50 mL. How much sevoflurane would be taken up from the lungs between the 16th and 36th minutes? A. 25 mL B. 50 mL C. 100 mL D. 500 mL
C. 100 mL *The amount of volatile anesthetic taken up by the patient in the first minute is equal to the amount taken up between the squares of any two consecutive minutes (square root of time equation). Thus, if 50 mL is taken up in the first minute, 50 mL will be taken up between the first (1 squared) and fourth (2 squared) minutes. Similarly, between the fourth and ninth minutes (2 squared and 3 squared), another 50 mL will be absorbed. In this example, we are looking for the uptake between the 16th (4 squared) and 36th (6 squared) minutes, which would be 2 consecutive minutes squared, or 2 × 50 mL = 100 mL.* *I dont get it*
A 56-year-old patient is brought to the operating room (OR) for elective replacement of a stenotic aortic valve. An awake 20-gauge arterial catheter is placed into the right radial artery and is then connected to a transducer located at the same level as the patient's left ventricle. The entire system is zeroed at the transducer. Several seconds later, the patient raises both arms into the air until his right wrist is 20 cm above his heart. As he is doing this the BP on the monitor reads 120/80 mm Hg. What would this patient's true BP be at this time? A. 140/100 mm Hg B. 135/95 mm Hg C. 120/80 mm Hg D. 105/65 mm Hg
C. 120/80 mm Hg
The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of A. 4 psi B. 8 psi C. 16 psi D. 32 psi
C. 16 psi *O2 and N2O enter the anesthesia machine at pressures as high as 2200 psi and 750 psi (N2O). First-stage pressure regulators reduce these pressures to approximately 45 psi. Before entering the rotameters, second-stage O2 pressure regulators further reduce the pressure to approximately 14 to 16 psi.*
How long does the antiplatelet effect of Ticlopidine last? A. 3 days B. 7 days C. 21 days D. Life of platelet
C. 21 days
The pressure gauge on a size "E" compressed-gas cylinder containing O2 reads 1600 psi. How long could O2 be delivered from this cylinder at a rate of 2 L/min? A. 90 minutes B. 140 minutes C. 250 minutes D. 320 minutes
C. 250 min *1600/2100 psi = 0.77 psi* *0.77 psi x 650 L = 500 L* *500 L / 2 L/min = 250 min*
The P50 of sickle cell hemoglobin is A. 19 mm Hg B. 26 mm Hg C. 31 mm Hg D. 35 mm Hg
C. 31 mm Hg
The normal vital capacity for a 70-kg man is A. 1 L B. 2 L C. 5 L D. 7 L
C. 5 L *In a normal healthy adult, the vital capacity is 60 to 70 mL/kg.*
By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30°C? A. 10% B. 25% C. 50% D. 75%
C. 50% *For each degree Celsius that body temperature is lowered, tissue metabolic rate declines approximately 5% to 8%. A core temperature of 28° to 30°C would correspond roughly to a 50% reduction in metabolic rate*
How long would a vaporizer (filled with 150 mL volatile) deliver 2% isoflurane if total flow is set at 4.0 L/min? A. 2 hours B. 4 hours C. 6 hours D. 8 hours
C. 6 hours *Two percent of 4 L/min will be 80 mL of isoflurane per minute. Given that 1 mL of isoflurane liquid yields 195 mL of anesthetic vapor and by applying the calculation (195 mL vapor/1 mL liquid isoflurane) × (150 mL isoflurane liquid) = 29,250 mL isoflurane vapor, it follows that (29,250 mL ÷ 80 mL/min = 365 minutes). 365 minutes is around 6 hours*
During the first minute of apnea, the Paco2 will rise A. 2 mm Hg/min B. 4 mm Hg/min C. 6 mm Hg/min D. 8 mm Hg/min
C. 6 mm Hg/min *During apnea, the Paco2 will increase approximately 6 mm Hg during the first minute and then 3 to 4 mm Hg each minute thereafter*
Normal resting coronary artery blood flow is A. 10 mL/100 g/min B. 40 mL/100 g/min C. 75 mL/100 g/min D. 120 mL/100 g/min
C. 75 mL/100 g/min Resting coronary artery blood flow is approximately 225 to 250 mL/min or about 75 mL/100 g/min, or approximately 4% to 5% of the cardiac output.
Normal resting myocardial O2 consumption is A. 2.0 mL/100 g/min B. 3.5 mL/100 g/min C. 8 mL/100 g/min D. 15 mL/100 g/min
C. 8 mL/100 g/min
A 63-year-old patient with a DDD-R pacemaker is scheduled for right hemicolectomy. The indication for pacemaker implantation was sick sinus syndrome, and the pacemaker has been reprogrammed to the asynchronous (DOO) mode at a rate of 70 for surgery. After induction, the patient's native heart rate rises to 85 beats/min with blood pressure 130/90 mm Hg. Which of the following actions would be MOST appropriate? A. Turn off pacemaker for duration of case B. Administer lidocaine C. Administer esmolol D. Observe
C. Administer esmolol *With the VOO or DOO modes, the possibility of an R-on-T phenomenon exists if the native heart rate exceeds the programmed rate or when there are frequent premature ventricular contractions (PVCs) or premature atrial contractions (PACs). Administration of esmolol would slow the heart rate down below 70, so that the pacemaker could again lead*
Currently, the commonly used vaporizers (e.g., GE-Datex-Ohmeda Tec 4, Tec 5, Tec 7; Dräger Vapor 19.n and 2000 series) are described as having all of the following features EXCEPT? A. Agent specificity B. Variable bypass C. Bubble through D. Temperature compensated
C. Bubble through
Which of the following would result in the greatest decrease in the arterial hemoglobin saturation (Spo2) value measured by the dual-wavelength pulse oximeter? A. Intravenous injection of indigo carmine B. Intravenous injection of indocyanine green C. Intravenous injection of methylene blue D. Elevation of bilirubin
C. Intravenous injection of methylene blue *Dyes will present inaccurate measurements of the pulse oximeter. These dyes include methylene blue and indigo carmine. Methylene blue has the greatest effect on Sao2 measurements because the extinction coefficient is so similar to that of oxyhemoglobin*
A 22-year-old patient who sustained a closed head injury is brought to the operating room (OR) from the ICU for placement of a dural bolt. Hemoglobin has been stable at 15 g/dL. Blood gas analysis immediately before induction reveals a Pao2 of 120 mm Hg and an arterial saturation of 100%. After induction, the Pao2 rises to 150 mm Hg and the saturation remains the same. How has the oxygen content of this patient's blood changed? A. It has increased by 10% B. It has increased by 5% C. It has increased by less than 1% D. Cannot be determined without Paco2
C. It has increased by less than 1% O2 content = 1.39 × [Hgb] × SaO2 + (0.003 × PaO2)
A 78-year-old patient is anesthetized for resection of a liver tumor. After induction and tracheal intubation, a 20-gauge arterial line is placed and connected to a transducer that is located 20 cm below the level of the heart. The system is zeroed at the stopcock located at the wrist while the patient's arm is stretched out on an arm board. How will the arterial line pressure compare with the true blood pressure (BP)? A. It will be 20 mm Hg higher B. It will be 15 mm Hg higher C. It will be the same D. It will be 15 mm Hg lower
C. It will be the same *n this question, the system was zeroed at the stopcock, which was located at the patient's wrist (approximate level of the ventricle). The BP expressed by the arterial line will therefore be accurate, provided the stopcock remains at the wrist and the transducer is not moved once zeroed.*
Raising the frequency of an ultrasound transducer used for line placement or regional anesthesia (e.g., from 3 MHz to 10 MHz) will result in A. Higher penetration of tissue with lower resolution B. Higher penetration of tissue with higher resolution C. Lower penetration of tissue with higher resolution D. Higher resolution with no change in tissue penetration
C. Lower penetration of tissue with higher resolution
Direct current (DC) cardioversion is not useful and, therefore, NOT indicated in an unstable patient with which of the following? A. Supraventricular tachycardia in a patient with Wolff-Parkinson-White syndrome B. Atrial flutter C. Multifocal atrial tachycardia (MAT) D. New-onset atrial fibrillation
C. Multifocal atrial tachycardia (MAT) *MAT is an ectopic atrial rhythm often seen in patients with chronic obstructive pulmonary disease (COPD). Ectopic atrial tachydysrhythmias are not amenable to cardioversion because they lack the re-entrant mechanism, which is necessary for successful termination with electrical counter shock*
Of the following medical lasers, which laser light penetrates tissues the most? A. Argon laser B. Helium-neon laser (He-Ne) C. Nd:YAG laser D. CO2 laser
C. Nd:YAG laser
A 31-year-old female with primary pulmonary hypertension is scheduled for a mastectomy. Pharmacologic agents that might be useful in reducing pulmonary vascular resistance (PVR) include each of the following EXCEPT A. Prostaglandin I2 (epoprostenol) B. Oxygen C. Nitrous oxide D. Milrinone
C. Nitrous oxide
The MOST important pathophysiologic difference between pericardial effusion and cardiac tamponade is A. Type of fluid (e.g., transudate, exudate, blood) B. Quantity of fluid C. Pressure D. Inflammation
C. Pressure
A 135-kg man is ventilated at a rate of 14 breaths/min with a VT of 600 mL and positive end-expiratory pressure (PEEP) of 5 cm H2O during a laparoscopic banding procedure. Peak airway pressure is 50 cm H2O, and the patient is fully relaxed with a nondepolarizing neuromuscular blocking agent. How can peak airway pressure be reduced without a loss of alveolar ventilation? A. Increase the inspiratory flow rate B. Take off PEEP C. Reduce the I:E ratio (e.g., change from 1:3 to 1:2) D. Decrease VT to 300 and increase rate to 28
C. Reduce the I:E ratio (e.g., change from 1:3 to 1:2) *Increasing the inspiratory flow rate would cause the airway pressures to go up faster and would produce higher peak airway pressures. Removing PEEP would lower peak pressure at the expense of alveolar ventilation. Changing the I:E ratio from 1:3 to 1:2 will permit 8% (25% inspiratory time to 33% inspiratory time) more time for the VT to be administered and will result in lower airway pressures.*
Arrange the percutaneous insertion sites from nearest to farthest for placement of a PA catheter. A. Left internal jugular, right internal jugular, antecubital, femoral B. Right internal jugular, left internal jugular, antecubital, femoral C. Right internal jugular, left internal jugular, femoral, antecubital D. Left internal jugular, right internal jugular, femoral, antecubital
C. Right internal jugular, left internal jugular, femoral, antecubital
Which of the following anatomic sites is associated with the LEAST incidence of central line infection? A. Internal jugular vein B. External jugular vein C. Subclavian vein D. Femoral vein
C. Subclavian vein *risk factors are likely highest for femoral lines*
The main advantage of milrinone is that it lacks which side effect, compared with amrinone, for long-term use? A. Tachycardia B. Hypothyroidism C. Thrombocytopenia D. Hyperglycemia
C. Thrombocytopenia
A sevoflurane vaporizer will deliver an accurate concentration of an unknown volatile anesthetic if the latter shares which property with sevoflurane? A. Molecular weight B. Oil/gas partition coefficient C. Vapor pressure D. Blood/gas partition coefficient
C. Vapor Pressure
Useful therapy for hypercyanotic "tet spells" in patients with tetralogy of Fallot might include any of the following EXCEPT A. Esmolol B. Morphine C. Phenylephrine D. Isoproterenol
D. Isoproterenol *Spasm of the infundibular cardiac muscle or decreases in SVR will exacerbate the right-to-left intracardiac shunt. Phenylephrine, an α-adrenergic receptor agonist, is the drug of choice for treatment of hypercyanotic attacks, because it increases SVR, which reduces the intracardiac right-to-left shunt. Esmolol is also effective because it reduces spasm of the infundibular cardiac muscle. Isoproterenol, with its β-mimetic effects, reduces afterload and therefore increases right-to-left shunting, and may exacerbate infundibular spasm.*
How long does the antiplatelet effect of ASA last? A. 3 days B. 7 days C. 21 days D. Life of platelet
D. Life of platelet
A 75-year-old patient in the intensive care unit (ICU) is extubated after recovering from acute respiratory distress syndrome (ARDS). He has a history of previous myocardial infarction, congestive heart failure, and pneumonia. He has an A-line, pulmonary artery (PA) catheter and is receiving oxygen by nasal cannula. Which of the following techniques is LEAST accurate for assessing an intravascular fluid challenge? A. Central venous pressure (CVP) B. PA occlusion pressure C. Transesophageal echocardiography (TEE) D. Measurement of pulse pressure variation (PPV)
D. Measurement of pulse pressure variation (PPV) *Patient must be intubated & mechanically ventilated to measure PPV*
An acute increase in Paco2 of 10 mm Hg will result in a decrease in pH of A. 0.01 pH unit B. 0.02 pH unit C. 0.04 pH unit D. 0.08 pH unit
D. 0.08 pH unit
The maximum Fio2 that can be delivered by a nasal cannula is A. 0.30 B. 0.35 C. 0.40 D. 0.45
D. 0.45
Calculate the cardiac output from the following data: patient weight 70 kg, hemoglobin concentration 10 mg/dL, arterial blood gases on 100% O2: Pao2 450 mm Hg, Paco2 32 mm Hg, pH 7.46, Sao2 99%. Mixed venous blood gases are: Pvo2 30 mm Hg, Paco2 45 mm Hg, pH 7.32, Svo2 60%. A. 1.5 L/min B. 2.5 L/min C. 3.5 L/min D. 4.5 L/min
D. 4.5 L/min *Fick Equation* *Q = [VO2 / (CaO2 - CvO2)] x 10* VO2 = (4ml x kg) = 4 ml x 70 kg = *280 ml/min* CaO2 = (1.36 x hgb x SaO2) x (0.003 x PaO2) = (1.36 x 10 x 100) x (0.003 x 450) = *13.5* CvO2 = (1.36 x hgb x SvO2) x (0.003 x PvO2) = (1.36 x 10 x 100) x (0.003 x 30) = *8.16* *Q = [280 / (13.5 - 8.16)] x 10 = 4.6 L/min*
What percent desflurane is present in the vaporizing chamber of a desflurane vaporizer (pressurized to 1500 mm Hg and heated to 23°C)? A. Nearly 100% B. 85% C. 65% D. 45%
D. 45%
The pressure and volume per minute delivered from the central hospital oxygen supply are A. 2100 psi and 650 L/min B. 1600 psi and 100 L/min C. 75 psi and 100 L/min D. 50 psi and 50 L/min
D. 50 psi and 50 L/min
A mechanically ventilated patient is transported from the OR to the ICU using a portable ventilator that consumes 2 L/min of oxygen to run the mechanically controlled valves and drive the ventilator. The transport cart is equipped with an "E" cylinder with a gauge pressure of 2000 psi. The patient receives a tidal volume (VT) of 500 mL at a rate of 10 breaths/min. If the ventilator requires 200 psi to operate, how long could the patient be mechanically ventilated? A. 20 minutes B. 40 minutes C. 60 minutes D. 80 minutes
D. 80 minutes Tank Time Formula *The minute ventilation is 5 L (0.5 L per breath at 10 breaths/min) and 2 L/min to drive the ventilator for a total O2 consumption of 7 L/min. A full oxygen "E" cylinder contains 625 L. Ninety percent of the volume of the cylinder (≈ 560 L) can be delivered before the ventilator can no longer be driven. At a rate of 7 L/min, this supply would last about 80 minutes*
Which of the following arrangements of rotameters on the anesthesia machine manifold is safest with left-to-right gas flow? A. O2, CO2, N2O, air B. CO2, O2, N2O, air C. Air, CO2, O2, N2O D. Air, CO2, N2O, O2
D. Air, CO2, N2O, O2 *The last gas added to a gas mixture should always be O2. This arrangement is the safest because it ensures that leaks proximal to the O2 inflow cannot result in the delivery of a hypoxic gas mixture to the patient.*
The reason CO2 measured by capnometer is less than the arterial Paco2 value measured simultaneously is A. Use of ion-specific electrode for blood gas determination B. Alveolar capillary gradient C. One-way values D. Alveolar dead space
D. Alveolar dead space *The difference between the end-tidal CO2 (Etco2) and the arterial CO2 (Paco2) is typically 5 to 10 mm Hg and is due to alveolar dead space ventilation.*
While on cardiopulmonary bypass during elective coronary artery revascularization, the patient is noted to have bulging sclerae. Mean arterial pressure (MAP) is 50 mm Hg, temperature is 28°C, and there is no ECG activity. The MOST appropriate action to take at this time is to A. Administer mannitol, 50 g IV B. Decrease the cardiac index C. Check the position of the aortic cannula D. Check the position of the venous return cannula
D. Check the position of the venous return cannula *Incorrect positioning of the aortic perfusion and venous return cannula is a possible complication associated with cardiopulmonary bypass. Improper positioning of the aortic cannula would tend to result in unilateral facial blanching, whereas facial edema (e.g., bulging sclerae) reflects venous congestion and may be caused by improper positioning of the venous return cannula.*
The most frequent cause of mechanical failure of the anesthesia delivery system to deliver adequate O2 to the patient is A. Attachment of the wrong compressed-gas cylinder to the O2 yoke B. Improperly assembled O2 rotameter C. Fresh-gas line disconnection from the anesthesia machine to the in-line hosing D. Disconnection of the O2 supply system from the patient
D. Disconnection of the O2 supply system from the patient
Maximizing which of the following lung parameters is the most important factor in prevention of postoperative pulmonary complications? A. Tidal volume (Vt) B. Inspiratory reserve volume C. Vital capacity D. Functional residual capacity (FRC)
D. Functional residual capacity (FRC) *It is essential to maximize FRC in the postoperative period to ensure that it will be greater than closing volume. Closing volume is that lung volume at which small-airway closure begins to occur. Maximizing FRC, therefore, reduces atelectasis and lessens the incidence of arterial hypoxemia and pneumonia. Maneuvers aimed at increasing FRC include early ambulation, incentive spirometry, deep breathing, and intermittent positive-pressure breathing*
The primary determinants of myocardial O2 consumption, from most to least important, are A. Preload > afterload > heart rate B. Heart rate > preload > afterload C. Afterload > preload > heart rate D. Heart rate > afterload > preload
D. Heart rate > afterload > preload
Select the TRUE statement regarding cardiopulmonary resuscitation (CPR) and defibrillation by a health care provider in patients experiencing sudden cardiac arrest. A. Defibrillation times one should always precede CPR B. CPR should always be carried out for 2 minutes before defibrillation C. Two minutes of chest compressions alone (no ventilation) should be carried out before first shock D. If arrest less than 1 minute (witnessed), deliver one biphasic shock, then five cycles of CPR
D. If arrest less than 1 minute (witnessed), deliver one biphasic shock, then five cycles of CPR *All adult shocks should be 360 J. With out-of-hospital cardiac arrest (unwitnessed), five cycles of CPR (about 2 minutes) should be performed before checking the ECG and attempting defibrillation*
79-year-old patient returns to the operating room with cardiac tamponade after three-vessel coronary artery grafting. In addition to gentle positive-pressure ventilation, which of the following permutations in hemodynamics would be MOST beneficial in this scenario? A. Increased preload, slow heart rate, increased afterload B. Normal preload, slow heart rate, decreased afterload C. Normal preload, fast heart rate, decreased afterload D. Increased preload, fast heart rate, increased afterload
D. Increased preload, fast heart rate, increased afterload *Patients with cardiac tamponade have a fixed ejection fraction that is very dependent on high filling pressures, and the cardiac output is very much dependent on the heart rate. A high SVR helps to maintain blood pressure in the face of the decreased cardiac output*
Intraoperative awareness under general anesthesia can be eliminated by closely monitoring A. Electroencephalogram B. BP/heart rate C. Bispectral index (BIS) D. None of the above
D. None of the above
The effects of clopidogrel (Plavix) can be reversed with A. Fresh frozen plasma B. Factor VIII concentrate C. Aprotinin D. None of the above
D. None of the above *Clopidogrel exerts its antithrombotic action by noncompetitively and irreversibly inhibiting adenosine diphosphate (ADP) receptor named P2Y12. The P2Y12 receptor is permanently affected, so the duration of action of clopidogrel is for the life of the platelets. No drug reverses these effects, and only platelet transfusion can reverse the effects of clopidogrel*
A 71-year-old man is undergoing revascularization of three coronary vessels on cardiopulmonary bypass at 28°C. After the last graft is sewn into the aorta, the arterial pressure measured from a left radial artery is 47 mm Hg and the PA pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is 52 mm Hg and PA pressure is 31 mm Hg. The MOST likely explanation for this is A. Malposition of the aortic cannula B. Malposition of the venous cannula C. Faulty ventricular venting D. PA catheter migration
D. PA catheter migration
A 22-year-old man with HOCM is undergoing an elective cholecystectomy under general anesthesia. Immediately after induction with propofol, 2.5 mg/kg IV, the arterial blood pressure decreases from 140/82 to 70/40 mm Hg. What would be the most appropriate drug for treatment of hypotension in this patient? A. Ephedrine B. Epinephrine C. Isoproterenol D. Phenylephrine
D. Phenylephrine *All of the drugs listed in this question except phenylephrine will increase the inotropic state of the myocardium, which can increase left ventricular outflow obstruction and decrease cardiac output. Phenylephrine, because it is a pure α-adrenergic receptor agonist, has minimal direct effects on myocardial contractility*
A patient with known Wolff-Parkinson-White (WPW) syndrome develops a wide complex tachycardia during a hernia operation under general anesthesia. Vital signs are stable, and pharmacologic treatment is desired. Which of the following drugs is MOST likely to be successful in controlling heart rate in this patient? A. Verapamil B. Esmolol C. Adenosine D. Procainamide
D. Procainamide *AV nodal reentrant tachycardia (AVNRT) is the most common tachydysrhythmia associated with WPW syndrome and comprises 95% of arrhythmias associated with this syndrome. Wide complex tachycardias are not amenable to treatment with β-blockers, calcium channel blockers, adenosine, or digoxin, and can, in fact, be made worse with these drugs. Intravenous procainamide, a class Ia antidysrhythmic agent, is the only useful pharmacologic agent among the drugs listed in the question. If pharmacologic therapy fails, electrical cardioversion is indicated to control rate*
Cardiac tamponade is associated with A. Pulsus alternans B. Pulsus tardus C. Pulsus parvus D. Pulsus paradoxus
D. Pulsus paradoxus *Pulsus paradoxus describes an inspiratory fall in systolic arterial blood pressure of greater than 10 mm Hg, often seen in cardiac tamponade.*
An oximetric pulmonary artery (PA) catheter is placed in a 69-year-old man who is undergoing surgical repair of an abdominal aortic aneurysm under general anesthesia. Before the aortic cross-clamp is placed, the mixed venous O2 saturation decreases from 75% to 60%. Each of the following could account for the decrease in mixed venous O2 saturation EXCEPT A. Hypovolemia B. Bleeding C. Congestive heart failure (CHF) D. Sepsis
D. Sepsis *During sepsis with adequate volume resuscitation, the cardiac output is increased and maldistribution of perfusion (distributive shock) results in an elevated mixed venous O2 saturation.*
The line isolation monitor A. Prevents microshock B. Prevents macroshock C. Provides electric isolation in the OR D. Sounds an alarm when grounding occurs in the OR
D. Sounds an alarm when grounding occurs in the OR
Anastomosis of the right atrium to the PA (Fontan procedure) is a useful surgical treatment for each of the following congenital cardiac defects EXCEPT A. Tricuspid atresia B. Hypoplastic left heart syndrome C. Pulmonary valve stenosis D. Truncus arteriosus
D. Truncus arteriosus *The Fontan procedure is an anastomosis of the right atrial appendage to the PA. This procedure is most frequently performed to treat congenital cardiac defects, which decrease PA blood flow (e.g., pulmonary atresia and stenosis, and tricuspid atresia). The Fontan procedure is also used to increase pulmonary blood flow when it is necessary to surgically convert the right ventricle to a systemic ventricle (e.g., hypoplastic left heart syndrome). Truncus arteriosus occurs when a single arterial trunk, which overrides both ventricles (which are connected via a ventricular septal defect), gives rise to both the aorta and PA. Surgical treatment of this defect includes banding of the right and left pulmonary arteries and enclosure of the associated ventricular septal defect*
