ASATT REVIEW

Which of the following is not a primary site of drug metabolism? A. Liver B. Kidney C. Plasma D. Heart E. Lung

Liver Drugs are primarily metabolized by the liver. However, the kidneys, lungs, and plasma are also sites of metabolism.

Dysfunction of what organ systems will increase the elimination half-life of many anesthetic drugs? A. Liver B. Heart C. Kidney

Liver Heart Kidney Many drugs are metabolized in the liver, while many others are excreted unchanged by the kidneys. Any condition that reduces blood flow to the liver or kidneys can reduce the amount of drug that is cleared, which will cause an increase in the half-life of the drug.

Which of the following is TRUE about how blood flows through the heart? A. RA to RV to LV to Aorta B. RV to RA to Pulmonary artery to LV to LA to aorta C. RA to RV to Pulmonary Artery to LA to LV to Aorta D. RA to LA to Pulmonary artery to RV to LV

RA to RV to Pulmonary Artery to LA to LV to Aorta

Which of the following veins return blood DIRECTLY into the RA? A. SVC and IVC B. Pulmonary veins C. Femoral vein D. Subclavian vein E. Interjugular vein

SVC and IVC The SVC collects blood from the upper extremity through the subclavian vein and from the head and neck from the interjugular vein. The SVC then drains directly into the superior RA. The blood from the lower extermities drains into the femoral vein and eventually into the IVC. The IVC drains directly into the inferior portion of the RA.

The anesthesia technician... A. Should replenish depleted supplies on between cases. B. Is responsible for disposal of medications between cases. C. Should perform a complete machine checkout between cases. D. Should verify that the ventilator is working between cases. E. All of the above.

Should replenish depleted supplies on between cases. Turnover between cases is brief and efficient. A complete anesthesia machine checkout is performed every 24 hours. This includes verification that the ventilator is working. Between cases, verification that there is no leak in the new circuit is an adequate safety test (even if the automatic ventilator does not work, the anesthesia provider can ventilate the patient safely by hand). The anesthesia provider is responsible for disposal of partially used medications.

Which role on the perioperative team does not require a medical or nursing degree? A. Anesthesia Provider B. Surgical attending C. Surgical first assist D. Circulating nurse E. CRNA

Surgical First Assist The surgical first assist role can be performed by a person with a variety of backgrounds: some are surgical residents; some are specially certified surgical technologists, specially certified surgical technologist, specially certified RN's, NP's, or PA's. Anesthesia providers are either physicians or nurses (CRNA). Surgical attending is another term for surgeon and is a physician.

Which of the following statements is FALSE regarding the cardiac cycle? A. As blood flows from the atria into the ventricles, the ventricular pressure rises. B. After the atria contracts, the ventricles reach their EDV. C. When the LV contracts, the pressure rises in the ventricles until it overcomes the aortic pressure and it begins ejecting blood into the aorta. D. Systole is define as when the ventricles begin to relax.

Systole is define as when the ventricles begin to relax. Systole is defined as when the ventricles are contracting. Diastole is when the ventricles are relaxing. Blood flows from the atria into the ventricle. As the volume increases in the ventricle, the pressure rises. Just before systole begins the atria contract to add more blood into the ventricles. The volume in the ventricles just before they contract is the EDV and determines the end-diastolic pressure.

Which of the following is TRUE regarding the myocardial conduction system? A. The system is composed of specialized nerve cells that conduct impulses. B. The conduction system conducts blood from the LA into the LV. C. The conduction system conducts electrical impulse from the autonomic nervous system to different portions of the heart. D. The conduction system is made up of specialized myocardial muscle cells.

The conduction system is made up of specialized myocardial muscle cells. These are responsible for pacing the heart and conducting electrical impulses to synchronize and coordinate the contraction of the atria and ventricles.

The cardiac action potential represents the changes in membrane potential in myocardial muscle cells from the flow of ions across the membrane. True or False

True The myocardial cells maintain a resting membrane potential like a minibattery. When the membrane is depolarized from an electrical signal, ion channels open, allowing the flow of ions across the membrane further depolarizing the membrane. Eventually, the membrane is repolarized by changing which ion channels are open, allowing the flow of ions.

Certification for both the technologist and technician exams is granted on a: A. Four-year basis B. Rotation of every other year C. Two-year basis D. Yearly basis

Two-year basis

The ASATT was established in this year: A. 1986 B. 1989 C. 1996 D. 2001

1989 ASATT was established in New Orleans, LA, in 1989

ASATT issued its very first written certification exam for the technician in____________. A. 1889 B. 1993 C. 1996 D. 2001 E. 2010

1996

Which of the following is NOT a determinant of myocardial oxygen supply? A. Hemoglobin level B. Afterload C. Blood oxygen saturation D. Coronary blood flow E. Diastole time

Afterload Afterload is a determinant of myocardial oxygen demand (the harder the heart works, the more oxygen it uses). Oxygen is supplied to the blood by binding to hemoglobin in the blood. Low hemoglobin levels can result in insufficient oxygen for the heart. In normal humans, hemoglobin is 97% - 100% saturated with blood. If insufficient oxygen is loaded onto hemoglobin in the lungs, the heart may not get enough oxygen. Finally, coronary blood flow during diastole is what brings the oxygen in the blood to the myocardial cells. High systolic pressures compress the coronary arterioles and prevent blood from flowing to the heart muscle during systole.

Which of the following statements are TRUE regarding the ECG? A. The ECG machine amplifies and measures tiny currents generated by the depolarization of myocardial cells. B. A "lead" is formed by two or more electrodes. * Currents flowing toward a lead are displayed as positive deflections on the ECG. C. The spatial orientation of the leads can help monitor electrical currents generated by different portions of the heart. D. All of the above are true.

All of the above are true. The ECG measures the tiny electrical currents produced by depolorizing myocardial cells. A lead is formed by at least two electrodes (more than one electrode can be combined to form a reference electrode). The electrical forces traveling toward a lead are displayed as upward deflections on the ECG; therefore, the spatial orientation of the leads is important. The leads are positioned so that each lead displays the electrical forces coming from a different region of the heart.

Which of the following statements are TRUE regarding the coronary circulation? A. The RCA, the LAD coronary artery, and the LCX are the major "Truck" arteries that supply large areas of the heart. B. The right and left coronary arteries originate from the aorta. C. The heart protects itself with cross-connections between arteries (collateral circulation). The majority of myocardial blood flow occurs during diastole. D. All of the above are true.

All of the above are true. The right and left coronary arteries originate from the proximal aorta. The LCA branches into the LAD and circumflex arteries. These are all major arteries, and an obstruction in one of these arteries will damage a very large portion of the heart, possibly resulting in death. The heart protects itself from obstructions in its blood supply by connections between arteries (the collateral circulation). The majority of blood flow through the myocardial arterioles and capillaries occurs during diastole, when the ventricular pressure is lower.

5. Beta-blockers can be used to treat A) Tachycardia B) Low blood pressure C) Bronchospasm D) Acute heart failure E) All of the above

Answer: A Beta-blockers can block beta1, beta2, or both types of receptors. Blockade of these receptors will slow the heart rate and would be useful in the treatment of tachycardia. Because beta blockade decreases contractility and slows heart rate, beta-blockers can decrease blood pressure and would not be used to treat low blood pressure or severe acute heart failure.

1. Which of the following areas of the cortex is most likely to be involved with language production? A) Left frontal lobe B) Left temporal lobe C) Right frontal lobe D) Right temporal lobe E) None of the above

Answer: A Broca area is in the left frontal lobe, anterior to the primary motor cortex, and is involved with the efficient production of language and speech. Wernicke area, a region of cortex in the posterior temporal lobe, is important in the understanding of language and is associated with auditory cortex. The right hemisphere plays a role in language, but it is mainly involved with the emotional content rather than the semantic processing of language.

2. Epinephrine may be used in anesthesia for all of the following effects EXCEPT: A) Constrict bronchial smooth muscle B) Constrict blood vessels C) Increase heart rate D) Increase myocardial contractility E) Prolong the action of local anesthetics F) Treat cardiac arrest

Answer: A Epinephrine is a powerful alpha- and beta-receptor agonist. The beta2 receptors on smooth muscle cause relaxation. Epinephrine relaxes bronchial smooth muscle and can be used to treat bronchoconstriction. The beta receptors on the heart cause increased contractility and heart rate. The alpha receptors in vascular smooth muscle cause contraction (vasoconstriction); thus, epinephrine increases blood pressure. When injected in peripheral tissues, epinephrine causes local vasoconstriction and can prolong the action of local anesthetics by decreasing their uptake back into the circulation. Epinephrine is the first drug for use in the ACLS algorithm after CPR and defibrillation, regardless of the suspected cause of cardiac arrest.

3. Which of the following medication has been shown to be absorbed systemically after pulmonary administration? A) Epinephrine B) Norepinephrine C) Dopamine D) Vasopressin E) Phenylephrine

Answer: A Lidocaine, epinephrine, and atropine have all been shown to be absorbed into the systemic circulation from pulmonary administration. Unfortunately, there is a wide variability in absorption and subsequent blood levels

2. True or false, all peripheral nerves are myelinated. A) False B) True

Answer: A Some, but not all, peripheral nerves are myelinated. Myelinated peripheral nerves are wrapped in concentric layers of myelin around the epineurium.

2. You are asked to see an anxious patient whom you suspect may have respiratory alkalosis. Which of the following studies best assesses the patient's acid-base status? A) Arterial blood gas (ABG) B) Pulse oximetry (pulse ox) C) Lactic acid level D) Central venous pressure (CVP) E) Electrocardiogram (EKG

Answer: A The ABG sample is passed through an analyzer machine, providing us with the arterial pH, pCO2, and pO2. This is the most informative study for the patient's acid-base status. Pulse oximetry only measures oxygen saturation (SaO2). Decreased SaO2 will result in decreased tissue oxygenation and increased lactic acid levels. It is not as informative as ABG. Lactic acid levels increase when tissues are not supplied with adequate oxygen but do not give a good picture of global acid-base status. CVP is a measurement of body blood volume. It is decreased in hemorrhage, but it does not directly inform us about acid-base status. EKG findings are nonspecific and not very informative about acid-base status

10. Which of the following factors DO NOT affect the force of contraction of the heart? A) The AV node B) Preload C) Contractility D) Drugs E) Afterload

Answer: A The AV node is a portion of the myocardial conduction system that regulates the speed of conduction from the atria to the ventricles. Preload, afterload, and contractility are the major determinants of the force of myocardial contraction and can be explained by using Frank-Starling curves. Drugs can both positively and negatively affect contractility as well as affect preload and afterload

2. Which of the following veins return blood DIRECTLY into the RA? A) SVC and IVC B) Pulmonary veins C) Femoral vein D) Subclavian vein E) Internal jugular vein

Answer: A The SVC collects blood from the upper extremity through the subclavian vein and from the head and neck from the internal jugular vein. The SVC then drains directly into the superior RA. The blood from the lower extremities drains into the femoral vein and eventually into the IVC. The IVC drains directly into the inferior portion of the RA.

3. The pulmonary artery catheter balloon should be DOWN when A) Withdrawing the balloon from the RV into the RA B) Advancing the balloon from the RV into the PA C) Advancing the balloon from the SVC into the RV D) Wedging the balloon to read the PAWP

Answer: A The balloon should always be down whenever the catheter is being withdrawn. The balloon should be up when advancing the catheter to permit it to "float" forward in the circulation, and it must be up in order to "wedge" into a distal branch of the PA.

1. Which of the following is the MAIN function of the respiratory system? A) Gas exchange B) Gas humidification C) Acid-base balance D) Immunologic defense E) Production of surfactant

Answer: A The main function of the respiratory system is gas exchange, which provides oxygen to the blood for delivery to cells and removes carbon dioxide that is generated by cell metabolism.

7. Which sense does not require processing in the brainstem or thalamus? A) Smell B) Hearing C) Vision D) Vestibular (balance) E) Taste

Answer: A The sense of smell is processed via the central olfactory pathway. It is the simplest of all the sensory pathways as it does not involve processing within the brainstem or thalamus. Specialized chemical sensors on the surface of the nasal cavity respond to interactions with specific chemical compounds in the inhaled air. These sensory neurons project to the olfactory bulb, which has neurons with axon that project directly to the primary olfactory cortex within the temporal lobe. All other pathways are processed first by either the thalamus or the brainstem before moving to their relative locations in the cerebral hemispheres.

9. Which of the following statements are TRUE about the cardiac cycle? A) Valves within the heart prevent the flow of blood backward. B) EF is defined as the amount of blood ejected from the heart during diastole. C) CO is equal to the EF times the HR. D) Diastole is when the heart is contracting. E) None of the above.

Answer: A The valves within the heart are very important as they prevent blood from flowing backward into the atria during ventricular contraction and backward into the ventricles from the pulmonary artery and aorta. The EF is the fraction of the end-diastolic ventricular blood that is ejected during systole. In normal resting patients, around 50% of the blood in the heart at end diastole is ejected during systole. CO is equal to the SV (the amount of blood ejected with each heartbeat during systole) times the HR.

6. The cardiac action potential represents the changes in membrane potential in myocardial muscle cells from the flow of ions across the membrane. A) True B) False

Answer: A True. The myocardial cells maintain a resting membrane potential like a battery. When the membrane is depolarized from an electrical signal, ion channels open, allowing the flow of ions across the membrane further depolarizing the membrane. Eventually, the membrane is repolarized by changing which ion channels are open, allowing the flow of ions.

3. A patient experiencing respiratory acidosis may present with which of the following symptoms? (Select all that apply.) A) Anxiety B) Muscle cramps C) Tingling sensations D) Seizures E) Delirium

Answer: A, D, and E Patients with respiratory acidosis may appear anxious or delirious or even have myoclonic convulsions or seizures in extreme cases. Muscle cramps and tingling sensations present in patients with respiratory alkalosis. Seizures may present in either acidosis or alkalosis.

1. The primary neurotransmitter released by the preganglionic fibers of the sympathetic nervous system and the preganglionic and postganglionic fibers of the parasympathetic nervous system is: A) Epinephrine B) Acetylcholine C) Norepinephrine D) Dopamine E) None of the above

Answer: B Acetylcholine is the primary neurotransmitter for the preganglionic fibers of the sympathetic nervous system and the preganglionic and postganglionic fibers of the parasympathetic nervous system. Norepinephrine is released by most of the postganglionic fibers of the sympathetic nervous system. Both norepinephrine and epinephrine are released from the adrenal medulla after direct stimulation from preganglionic fibers.

12. Which of the following is NOT a determinant of myocardial oxygen supply? A) Hemoglobin level B) Afterload C) Blood oxygen saturation D) Coronary blood flow E) Diastolic time

Answer: B Afterload is a determinant of myocardial oxygen demand (the harder the heart works, the more oxygen it uses). Oxygen is supplied to the blood by binding to hemoglobin in the blood. Low hemoglobin levels can result in insufficient oxygen for the heart. In normal humans, hemoglobin is 97%-100% saturated with blood. If insufficient oxygen is loaded onto hemoglobin in the lungs, the heart may not get enough oxygen. Finally, coronary blood flow during diastole is what brings the oxygen in the blood to the myocardial cells. High systolic pressures compress the coronary arterioles and prevent blood from flowing to the heart muscle during systole

5. When air accumulates in the pleural space, it is referred to as: A) Empyema B) Pneumothorax C) Hemothorax D) Hemopneumothorax E) Pleural effusion

Answer: B Air in the pleural space is referred to as a pneumothorax. When blood accumulates, it is a hemothorax. Pus in the pleural space is an empyema. Other fluid in the pleural space is an effusion

6. Signs of local anesthetic toxicity include all of the following EXCEPT: A) Tinnitus B) Burning smell C) Perioral numbness D) Respiratory arrest E) Metallic taste

Answer: B Ear ringing (tinnitus), perioral numbness, metallic taste, seizures, cardiac arrhythmia, coma, and respiratory arrest are all classically described signs of local anesthetic toxicity. A burning smell is a sign of a focal (starting in an isolated area of the brain) temporal lobe seizure rather than a generalized (whole-brain) seizure as would be expected due to local anesthetic systemic toxicity.

1. Infusing pure HCl will have what effect on H+ and pH? A) Increase H+; increase pH B) Increase H+; decrease pH C) Decrease H+; decrease pH D) Decrease H+; increase pH E) Unchanged H+; unchanged pH

Answer: B HCl is an acid. It will donate its H+ so that the concentration of H+ will increase. An increase in H+ translates to a decrease in pH. If a base were infused instead, there would be a decrease in H+, which translates into an increase in pH (option D).

5. Which of the following local anesthetics is associated with the highest risk of cardiotoxicity? A) Lidocaine B) Bupivacaine C) Chloroprocaine D) Ropivacaine E) Mepivacaine

Answer: B In general, the cardiotoxicity of local anesthetics is proportional to their potency, with bupivacaine being more potent and more cardiotoxic than lidocaine or chloroprocaine, ropivacaine, or mepivacaine. Chloroprocaine's cardiotoxicity is also limited by its very short (seconds to minutes) plasma half-life. Recall that chloroprocaine is an ester; it is very rapidly degraded by plasma esterases.

8. Which of the following conditions results in increased resistance to gas flow? A) High blood pressure B) COPD C) Obesity D) Kidney failure E) Thyroid disease

Answer: B Medical conditions, such as asthma and COPD, reduce the cross-sectional area in the bronchi and bronchioles, thus increasing the resistance to gas flow. This becomes important to the anesthesia provider as the patients may require longer inspiratory and expiratory times in order to achieve the same amount of gas flow and complete exhalation of inspired gases.

3. How does an action potential travel along a myelinated axon? A) The action potential jumps from one myelinated area of the axon to the next. B) The action potential jumps from one nonmyelinated area of the axon to the next. C) There are no gaps in a myelinated axon: the action potential jumps from the beginning of the axon to the terminal. D) Myelin helps the nerve impulse cross the synapse from one myelinated nerve to the next.

Answer: B Myelin is an insulator and cannot conduct nerve impulses. Therefore, in myelinated axons, the action potential jumps between nonmyelinated areas of the axon; these gaps, or nodes, between myelin segments have a concentration of voltage-gated sodium channels. The process of conduction jumping from one node to the next is known as saltatory conduction.

3. Which of the following correctly describes the path of the electrochemical signal through a single neuron as it is received, then processed, then relayed down the length of the neuron? A) Cell body → dendrite → axon B) Dendrite → cell body → axon C) Cell body → axon → dendrite D) Axon → cell body → dendri

Answer: B Neurons receive most of their input signals through receptors on their dendrites. These signals cause changes in the cell's electrical gradient, first within the dendrites themselves and then in the cell body. If the cell is depolarized past threshold, it will then send an action potential down the length of its axon.

5. Oxygen is required to exchange CO2 at the lungs in order to prevent CO2 buildup from causing respiratory acidosis. For which other reason is adequate oxygenation required for prevention of pH imbalance? A) Adequate oxygen is needed to sequester H+ ions. B) Adequate oxygen prevents anaerobic glycolysis. C) Oxygen, O2, becomes an anion in the body to balance Cl−. D) High concentration of oxygen is required to activate filtration cells in the kidneys. E) Oxygen, O2, becomes an anion in the body to balance Na+.

Answer: B O2 is essential for aerobic metabolism. Without adequate oxygen, cells produce energy via anaerobic glycolysis, which requires the reduction of pyruvate to lactic acid, and prolonged glycolysis causes the accumulation of lactic acid, which results in acidosis.

2. Which of the following pulmonary vasodilators can be delivered via an inhaled route? A) Nitroglycerin B) Prostacyclin C) Milrinone D) Nifedipine E) Nicardipine

Answer: B Only nitric oxide, prostacyclin, and endothelin receptor blockers affect the pulmonary circulation more than the systemic circulation. One method of increasing the specificity of the effect on the pulmonary circulation is to administer the drug as an inhalant. Prostacyclin and nitric oxide have been administered in this manner.

1. Select the TRUE statement regarding pulse oximetry. A) SpO2 is a direct measurement of the oxygen content in arterial blood. B) The pulse oximeter continuously reports peripheral capillary blood oxygen saturation, heart rate, and heart rhythm regularity. C) Environmental light in the operating room never interferes with the pulse oximeter because the pulse oximeter only detects light in the infrared region. D) All of the above statements are true.

Answer: B SpO2 is related to SaO2, but neither are direct measurements of the oxygen content of arterial blood. Environmental light in the operating room can interfere with pulse oximeters, as infrared light is also present, especially if infrared-guided stereotactic instrumentation is being used

7. The ECG is useful for monitoring which of the following? A) The pressure in the central venous circulation B) Arrhythmias C) The PCWP D) Cardiac output E) None of the above

Answer: B The ECG is useful for monitoring the rhythm of the heart, the function of the myocardial conduction system, and myocardial ischemia (insufficient oxygen delivery to myocardial cells). The central venous pressure and the PCWP are measured with catheters placed in the central circulation and pulmonary artery, respectively. CO can be measured with a PAC or echocardiography.

4. Select the TRUE statement. A) ASA guidelines mandate use of a pulse oximeter, noninvasive blood pressure, and central venous pressure monitoring during delivery of anesthesia. B) The standard EKG lead setup in the operating room can demonstrate good function of the SA node of the heart. C) Standard IV tubing can be connected to a pressure transducer and central venous catheter to measure central venous pressure. D) Automated oscillometric blood pressure cuffs measure the systolic and diastolic blood pressure.

Answer: B When the SA node is driving the rhythm of the heart, the EKG will display a "P" wave before the QRS. This is usually most clearly seen in lead II of the EKG, which is customarily set up as one of the default leads on the OR monitor. Operating room monitors are ASA guidelines that do not require monitoring of central venous pressure during delivery of anesthesia. Most automated oscillometric blood pressure cuffs measure MAP directly and report a calculated SBP and DBP. Specialized tubing with correct compliance characteristics is needed for use with all types of pressure transducer systems regardless of the absolute pressure of the physiologic system being monitored

1. Which of the following is TRUE about how blood flows through the heart? A) RA to RV to LV to LA to aorta B) RV to RA to pulmonary artery to LV to LA to aorta C) RA to RV to pulmonary artery to LA to LV to aorta D) RA to LA to pulmonary artery to RV to LV E) None of the above

Answer: C Blood flows from the RA into the RV where it is ejected into the pulmonary artery and lungs. Oxygenated blood returns from the lungs into the LA and then into the LV where it is ejected into the aorta.

5. Which of the following statements regarding central venous pressure monitoring is TRUE? A) The "a wave" is generated during contraction of the ventricles. B) CVP monitoring is necessary for calculation of CO by thermodilution. C) CVP monitors are properly placed with the tip at the junction between the superior vena cava and the right atrium. D) CVP reflects fluid status and is the best guide for fluid therapy.

Answer: C CVP lines are most appropriately placed at the cavoatrial junction. CVP monitoring is one of many pieces of data, but not the only one, integrated into the understanding of a patient's fluid status. CVP measurement is not necessary for measurement of cardiac output, though it is necessary for calculation of SVR. The "a" wave is generated by contraction of the atrium

1. Which of the following medications causes bronchoconstriction? A) Albuterol B) Epinephrine C) Neostigmine D) Diphenhydramine E) Theophylline

Answer: C Medications that cause direct bronchial smooth muscle relaxation are referred to as bronchodilators and include beta-adrenergic receptor agonists (e.g., albuterol, terbutaline, epinephrine), methylxanthines (e.g., theophylline), and histamine receptor antagonists (e.g., diphenhydramine). Neostigmine causes stimulation of the parasympathetic nervous system and thus causes bronchoconstriction

7. Which of the following places the patient at risk for aspiration? A) High blood pressure B) COPD C) Obesity D) Kidney failure E) Thyroid disease

Answer: C Patient factors that slow gastric emptying (e.g., diabetes, obesity) or in whom the muscular valve between the stomach and esophagus is dysfunctional (e.g., gastroesophageal reflux) are at increased risk for aspiration during anesthesia.

6. Which monitor provides direct information on cardiac output? A) Pulse oximeter B) EKG C) PA catheter D) Invasive arterial pressure E) None of the above

Answer: C The PA catheter permits use of the thermodilution method of measurement of cardiac output. This directly measures flow, by measuring the temperature of cool liquid as it passes the thermistor. Invasive arterial blood pressure provides indirect information on cardiac output with integration of the area under the waveform curve, but this is derived, indirect information that is poorly validated. The pulse oximeter, likewise, provides indirect evidence on tissue perfusion that suggests adequacy or inadequacy of cardiac output. The EKG suggests only a cardiac rhythm that would permit perfusion.

6. At the end of normal expiration, the volume of gas remaining in the lungs is referred to as: a) Total lung capacity B) Inspiratory capacity C) Functional residual capacity D) Forced vital capacity E Closing capacity

Answer: C The functional residual capacity (FRC) is the volume of gas in the lungs at the end of a normal exhalation. Functional residual capacity, serving as a reserve source of oxygen and a patient's ability to tolerate periods of apnea, is a very important concept to anesthesia providers.

6. In which part of the cerebral hemispheres are visual stimuli interpreted? A) Frontal lobe B) Parietal lobe C) Occipital lobe D) Hippocampus E) Temporal lobe

Answer: C The occipital lobe is primarily associated with the processing of visual information and forming an interpretation of the visual world. The temporal lobe is the primary site of auditory perception. The hippocampus is a structure inside the temporal lobe and is responsible for storage and retrieval of memories. The parietal lobe deals with language and spatial relationships. The frontal lobe carries out executive functions, including long-term planning, conscious motor movement, and behavioral control.

2. A transtracheal nerve block is performed by piercing which structure? A) Thyroid cartilage B) Cricoid cartilage C) Cricothyroid membrane D) Arytenoid cartilage E) Thyrohyoid membrane

Answer: C The recurrent laryngeal nerve (subglottic area) may be anesthetized by application of topical anesthetics usually through the fiberoptic scope or via transtracheal block performed by injection of local anesthetic through the cricothyroid membrane directly into the trachea.

4. Which of the following inhaled anesthetics has been associated with lung irritation, coughing and breath holding? A) Sevoflurane B) Nitrous oxide C) Isoflurane D) Desflurane E) None of the above

Answer: D Although it produces dilation of bronchial smooth muscle, desflurane is notable among the volatile anesthetics in that it is irritating to the airways and can cause breath holding and coughing.

11. Which of the following are potentially lethal cardiac arrhythmias? A) Ventricular fibrillation B) Ventricular tachycardia C) Sinus bradycardia D) A and B E) A and C

Answer: D Both ventricular fibrillation and ventricular tachycardia may not produce any forward blood flow. Unless the ventricular tachycardia is slow, the patient will die.

1. Drugs that increase the force of myocardial contraction are called A) Local anesthetics B) Beta-blockers C) Antiarrhythmic agents D) Positive inotropic agents E) None of the above

Answer: D Drugs that increase the force of myocardial contraction are called positive inotropic agents and include catecholamines, PDE inhibitors, and myofilament calcium sensitizers. Stimulation of beta receptors increase inotropy, increase heart rate, and cause bronchodilation. Blockade of these receptors can decrease inotropy (beta-blockers are negative inotropes). Local anesthetics are used to block nerve conduction, but they can have antiarrhythmic properties (suppress abnormal heart rhythms).

2. What is the true mean arterial blood pressure if the pressure transducer for arterial blood pressure monitoring is zeroed at the level of the patient's right atrium when laying supine, then raised 10 cm? A) 10 mm Hg less than the reported mean arterial blood pressure B) 10 mm Hg more than the reported mean arterial blood pressure C) 7.4 mm Hg less than the reported mean arterial blood pressure D) 7.4 mm Hg more than the reported mean arterial blood pressure E) Additional information is needed to answer this question

Answer: D Every 1 cm of height of a column of saline is equivalent to 0.74 mm Hg. A pressure transducer zeroed 10 cm above the patient's right atrium will underestimate the patient's blood pressure by 7.4 mm Hg.

4. Which of the following would be the most likely to cause alkalosis? A) Aspirin overdose B) Excessive metabolism of fats C) Hypoxia D) Excessive vomiting E) Excess sodium chloride administration

Answer: D Excessive vomiting would remove stomach acid (HCl) from the body, resulting in a loss of acid and making the body more alkaline. All other answers would cause acidosis. Aspirin is an acid and would cause the pH to decrease. Hypoxia would result in loss oxygen being available to exchange for CO2 at the lungs, resulting in increased CO2 retention and decreased pH. Fat metabolism produces acids as a by-product. Increases in blood chloride concentration cause the kidneys to excrete HCO3 −, causing acidosis.

4. Which of the following statements are TRUE about nerve action potentials? A) A nerve membrane is only polarized when conducting an action potential. B) Depolarization cannot be conducted from one stretch of nerve membrane to another. C) Phosphorus ions flowing into the cell cause depolarization. D) Potassium ions flowing out of the cell cause repolarization.

Answer: D Nerves transmit signals from one area of the body to another through action potentials. At rest, the nerve is polarized. During an action potential, sodium channels open and sodium first rushes into the nerve to depolarize it. Potassium channels then open and potassium rushes out of the cell to repolarize the nerve back to its resting state. An action potential occurs in one place in the nerve, and this then triggers depolarization and an action potential on the neighboring segment, propagating the signal along the nerve in a domino-like fashion.

9. Which patient position allows for an improvement in respiratory mechanics? A) Prone B) Lateral decubitus C) Supine D) Reverse Trendelenburg E) Trendelenburg

Answer: D Patient position may affect lung mechanics and ventilation-perfusion matching. In the standing or reverse Trendelenburg position, the abdominal contents fall away from the diaphragm due to gravity. The other positions allow for abdominal contents to be displaced cephalad and possibly impair respiratory mechanics.

8. Which brain structure is responsible for procedural memory? A) Basal ganglia B) Thalamus C) Hippocampus D) Cerebellum E) Hypothalamus

Answer: D Procedural memory is the memory of how to do things, also sometimes called muscle memory. It is important in motor- or procedure-oriented skills like washing dishes, riding a bicycle, or playing a musical instrument and is primarily the task of the cerebellum. The hippocampus is responsible for episodic memory or storage and retrieval of locations, events, and past experiences. The basal ganglia are responsible for coordination of sophisticated motor movements, the thalamus for integration of sensory information, and the hypothalamus for endocrine and autonomic regulation.

8. Which of the following statements is FALSE regarding the cardiac cycle? A) As blood flows from the atria into the ventricles, the ventricular pressure rises. B) After the atria contract, the ventricles reach their EDV. C) When the LV contracts, the pressure rises in the ventricle until it overcomes the aortic pressure and it begins ejecting blood into the aorta. D) Systole is defined as when the ventricles begin to relax. E) None of the above.

Answer: D Systole is defined as when the ventricles are contracting. Diastole is when the ventricles are relaxing. Blood flows from the atria into the ventricle. As the volume increases in the ventricle, the pressure rises. Just before systole begins, the atria contract to add more blood into the ventricles. The volume in the ventricles just before they contract is the EDV and determines the end-diastolic pressure.

4. Which of the following answer choices correctly matches the region of the spinal column with the number of vertebrae in that region? A) Cervical, 12 B) Coccygeal, 5 C) Lumbar, 7 D) Thoracic, 12 E) Sacral,

Answer: D The cervical region of the vertebral column spans the length of the neck and has seven segments. The thoracic region spans the upper part of the back and is divided into 12 segments. The lumbar region spans the lower back and is divided into five segments. The sacral region of the vertebral column extends into the pelvis and is composed of five bones fused to form a single structure. A single coccygeal bone (referred to as the tailbone) is found at the end of the spinal column. Found within the vertebral column is the spinal cord itself.

5. An endogenous peptide is discovered to act on receptors within the CNS and cause pain relief as well as euphoria and sedation. Which of the following CNS drugs acts on the same receptor as this molecule? A) Isoflurane B) Succinylcholine C) Lithium D) Morphine E) Scopolamine

Answer: D The endogenous opioids are peptides that act on opioid receptors within the CNS with analgesic effects. Opioid agonists, such as morphine, bind to and activate the brain's opioid receptors and are used for analgesia. The inhaled anesthetics (such as isoflurane) directly interact with cell membranes within the CNS to cause analgesia and sedation. Succinylcholine is a neuromuscular blocking agent that interferes with cholinergic signaling between motor nerve terminals and muscles. Lithium can be used as a mood stabilizer to treat bipolar and other mood disorders. Scopolamine is a drug that is used to combat motion sickness through its anticholinergic effects at the CT

3. Which of the following is NOT a part of the lower airway? A) Trachea B) Bronchi C) Alveoli D) Vocal cords E) Bronchioles

Answer: D The lower airway begins at the level of the trachea, just below the glottic opening (vocal cords) and includes the trachea, bronchi, bronchioles, respiratory bronchioles, and alveoli

4. Which of the following is TRUE regarding the myocardial conduction system? A) The system is composed of specialized nerve cells that conduct impulses. B) The conduction system conducts blood from the LA into the LV. C) The conduction system conducts electrical impulse from the autonomic nervous system to different portions of the heart. D) The conduction system is made up of specialized myocardial muscle cells. E) None of the above.

Answer: D The myocardial conduction system is made up of specialized myocardial muscle cells that are responsible for pacing the heart and conducting electrical impulses to synchronize and coordinate the contraction of the atria and ventricles.

4. Which of the following participates in gas exchange with blood? A) Trachea B) Bronchi C) Bronchioles D) Alveoli E) Type II pneumocytes

Answer: D The trachea, bronchi, and bronchioles are conducting airways and do not participate in gas exchange between the airway and blood. Type II pneumocytes produce surfactant.

1. There are __ pairs of spinal nerves. A) 12 B) 13 C) 21 D) 31 E) 43

Answer: D There are 31 pairs of spinal nerves

5. Which of the following statements are TRUE regarding the coronary circulation? A) The RCA, the LAD coronary artery, and the LCX are the major "trunk" arteries that supply large areas of the heart. B) The right and left coronary arteries originate from the aorta. C) The heart protects itself with cross-connections between arteries (collateral circulation). D) The majority of myocardial blood flow occurs during diastole. E) All of the above are true.

Answer: E All of the above statements are true. The right and left coronary arteries originate from the proximal aorta. The LCA branches into the LAD and circumflex arteries. These are all major arteries, and an obstruction in one of these arteries will damage a very large portion of the heart, possibly resulting in death. The heart protects itself from obstructions in its blood supply by connections between arteries (the collateral circulation). The majority of blood flow through the myocardial arterioles and capillaries occurs during diastole, when the ventricular pressure is lower.

5. Which of the following neuromuscular blocker is most likely to cause rapid muscle contractions referred to as fasciculations? A) Atracurium B) Mivacurium C) Rocuronium D) Vecuronium E) Succinylcholine

Answer: E Succinylcholine is the prototypical depolarizing muscle relaxant, which acts by binding to the acetylcholine receptors of the neuromuscular junction and causing rapid contractions of the muscles called fasciculations. All the others listed are nondepolarizing neuromuscular blockers that do not cause fasciculations

6. Which of the following organs does not play a role in balancing acids and bases in the human body? A) Lungs B) Kidneys C) Central nervous system of the brain D) Stomach E) Gallbladder

Answer: E The lungs balance acid by increasing or decreasing respiration rate, changing the amount of CO2 retained, which affects acid-base chemistry. The kidneys excrete and reabsorb H+ and HCO3 −. Chemoreceptors in the central nervous system sense changes in pCO2 and instruct the lungs to adjust for acid-base chemistry accordingly. The stomach can expel excess acid by vomiting. The gallbladder, however, is involved in metabolism and digestion; while these processes may alter acid-base chemistry, the gallbladder does actively participate in balancing acids and bases.

3. Which of the following statements are TRUE about the ventricles? A) The ventricles have thicker walls than the atria. B) The LV has much thicker walls than the RV. C) The right and left ventricles are separated by the interventricular septum. D) The ventricles receive blood from the atria. E) All of the above are true.

Answer: E The ventricles receive blood from the atria after which they pump the blood into a major artery. This pumping action requires a larger pressure, and thus, the ventricles have thicker, more muscular walls than the thin-walled atria. The LV must pump blood into the aorta at very high pressures and is much more muscular than the RV, which pumps blood into the lower-pressure pulmonary circulation.

2. Blocking which of the following neurotransmitter receptors in the CTZ will have an antiemetic effect? A) Serotonin B) Acetylcholine C) Dopamine D) A and C only E) A, B, and C

Answer: E There are a number of drug classes that antagonize emesis, mainly by inhibiting the neurotransmitters and receptors within the CTZ. Dopamine receptor blockers are used as antipsychotics and have antiemetic effects by blocking D2 receptors within the CTZ. Scopolamine is a drug that is used to combat motion sickness through its anticholinergic effects at the CTZ. Additionally, selective serotonin antagonists (e.g., ondansetron) are often given to inhibit the nausea that occurs as a side effect of anesthesia and chemotherapeutic treatments.

4. Vasopressors A) Cause vasoconstriction B) Include phenylephrine, ephedrine, and vasopressin C) Cause vasodilation D) Include nitroprusside, nitroglycerin, and nicardipine E) A and B

Answer: E Vasopressors cause vasoconstriction and include phenylephrine, ephedrine, and vasopressin. Vasodilators include nitroprusside, nitroglycerin, and nicardipine.

The ECG is useful for monitoring which of the following? A. The pressure in the central venous circulation B. Arrhythmias C. The PCWP D. Cardiac output

Arrhythmias The ECG is useful for monitoring the rhythm of the heart, the function of the myocardial conduction system, and myocardial ischemia (insufficient oxygen delivery to myocardial cells). The central venous pressure and the PCWP are measured with catheters placed in the central circulation and pulmonary artery, respectively. CO can be measured with a PAC or echocardiography.

Place in the correct order A. Assessment, induction, maintenance, emergence, recovery, discharge. B. Induction, emergence, assessment, discharge. C. Assessment, discharge, emergence, maintenance, recovery. D. Induction, assessment, maintenance, recovery, emergence, discharge. E. Maintenance, induction, assessment, emergence, discharge, recovery.

Assessment, induction, maintenance, emergence, recovery, discharge. A full assessment happens in the preoperative area. Induction is the beginning of anesthesia, which transitions into the maintenance phase during which surgery occurs. After surgery is complete, the patient is allowed to emerge from anesthesia. The patient goes to PACU for recovery, when recovery is complete, they are discharged.

You have just arrived in a new hospital where you will be working as an anesthesia technician. You should begin to learn your way around. Which of the following locations are you unlikely to visit frequently in the course of your work? A. ICU B. Emergency Room C. MRI D. Labor & Delivery E. General surgery postoperative ward

General surgery postoperative ward Anesthesia procedures are performed in all these places, including frequent emergency intubations, resuscitation, and transfers to the OR in the ICU and the emergency room. Your patients will go to the general surgery postoperative ward after you care for them in the PACU, and will occasionally require emergency intubation, but it will be the least frequent place where anesthesia care is provided.

A certified anesthesia technician must show proof of the number of CEHs in a 2-year period: A. 30 B. 20 C. 120 D. 125 E. 10

20 CEHs for every two years for re-certification. Anesthesia Technologist has to have 30 CEHs.

Which of the following can cause adverse drug reactions? A. overdose B. Metabolites C. Allergy

All of the above Adverse reactions can be dose related, and the more narrow the therapeutic window, the more likely that adverse reactions due to overdose will occur. Breakdown of drugs can form toxic metabolites, which may lead to adverse effects. Allergic reactions are a form of adverse reaction to a drug, the most severe being anaphylaxis.

The Item/test writing committee is composed of: A. Anesthesiologists B. CRNAs C. Corporate representatives D. Anesthesia technicians & technologist

Anesthesiologists CRNAs Corporate representatives Anesthesia technicians & technologist along with a representative from the test writing development company

Which of the following statements about drug interactions is TRUE? A. Drugs that act on the same receptors and cause the same response are antagonists. B. When two drugs mixed together form a precipitate, a pharmacokinetic reaction has occurred. C. Anesthesiologists commonly utilize drug interactions to their advantage in standard general anesthetics. D. Herbal supplements are natural and do not interact with drugs administered by anesthesiologists.

Anesthesiologists commonly utilize drug interactions to their advantage in standard general anesthetics.

4. Match the drug to its unique property 1. Versed A) reversible with naloxone 2. Fentanyl B) dissociative and analgesic 3. Ketamine C) often causes hypotension 4. Propofol D) risks paradoxical reaction in the elderly

Answer: 1/D, 2/A, 3/B, 4/C Benzodiazepines, like midazolam (commonly referred to by its trade name, Versed, though it is almost always sold as a generic now), can cause paradoxical agitation in the elderly. Fentanyl, like all opioids, is rapidly reversed by naloxone. Ketamine is uniquely "dissociative" and produces a trancelike state in which patients appear awake but may be unresponsive or apparently nonsensical and have profound analgesia. Propofol, in addition to its depression of the level of consciousness, is a vasodilator and can produce hypotension.

3. Use of dobutamine can increase oxygen demand of the heart. A) True B) False

Answer: A

1. The indications for tracheal intubation include all of the following EXCEPT A) A full stomach B) External compression from a mass or bleeding C) Inadequate spontaneous ventilation D) A surgical procedure requiring paralysis and general anesthesia

Answer: A A patient with a full stomach can protect his or her airway unless he or she has impaired reflexes from a neurologic condition, sedation, intoxication, or anesthesia. (Most people have a "full stomach" most of the time; only when the airway is unprotected is this a risk for aspiration.) An external compression may rapidly occlude an airway and requires protection from obstruction with urgent intubation. Inadequate patient ventilation necessitates intubation so that positive pressure can be delivered to improve gas exchange. While an airway can be managed with mask ventilation or a supraglottic airway, a prolonged surgical procedure should be managed with an endotracheal tube.

1. How does an AED differ from a manual external defibrillator? A) User is provided guidance about whether the cardiac rhythm should be treated with defibrillation. B) External pacing is automatically started without any user input. C) Shock is applied without any user input. D) All of the above.

Answer: A AEDs have a computer that can analyze the cardiac rhythm to determine if it is VT or VF. If the computer determines that it is one of these two rhythms, it will give the user a prompt that a shock is advised. Most modern manual defibrillators come equipped with an AED mode as well.

4. Which maneuver increases the risk of brachial plexopathy in a prone-positioned patient? A) Abduction of the shoulder for greater than 90 degrees B) Flexion of the elbow for greater than 90 degrees C) Neutral position of the head D) Placement of the arms at the sides

Answer: A Abduction of the shoulder greater than 90 degrees places the distal nerves of the plexus on the extensor side of the shoulder joint and potentially stretches the plexus. While flexion of the elbow for greater than 90 degrees may increase the risk of ulnar neuropathy, it does not appear to increase stretch on the brachial plexus.

2. Which of the following is NOT a common cause of cardiac arrest in perioperative settings? A) Malignant hyperthermia B) Massive hemorrhage C) Anaphylaxis D) Failed or difficult airway E) Arrhythmia

Answer: A Although all of the above are potential causes of cardiac arrest in the perioperative setting, malignant hyperthermia is very uncommon and occurs on the order of 1:10,000 to 1:100,000 patients having surgery (see Chapter 60, Malignant Hyperthermia). The anesthesia technician is much more likely to encounter a myocardial infarction or failed airway in the perioperative setting than malignant hyperthermia.

4. Which of the following is FALSE regarding the anesthesia machine and MH? A) It is necessary to switch out the anesthesia machine immediately during an MH crisis. B) Preparing modern anesthesia machines for an MHS patient are machine specific. C) Anesthesia machine preparation requires flushing with oxygen at 10 L/min for between 20 and 50 minutes. D) New activated charcoal filters attached to the inspiratory and expiratory ports of the anesthesia machine can achieve rapid reductions in halogenated agents. E) All of the above.

Answer: A Although the halogenated agent should be immediately turned off and high fresh gas flows initiated, MHAUS does not recommend switching out the anesthesia machine as a first priority during an MH crisis. Modern anesthesia machines require a variable time of flushing with 100% oxygen at 10 L/min to achieve acceptably low concentrations of halogenated agents. Most can be prepared within 20-50 minutes. New activated charcoal filters may be used to prepare the anesthesia machine or be used during an MH crisis to reduce the patient's exposure to halogenated agents.

6. The radiation safety principle protecting the anesthesia provider in the room that the anesthesia technician can best assist with is A) Distance B) Time C) Shielding

Answer: A Anesthesia providers can rarely control the amount of time they spend in a room where radiation is being used. Appropriate PPE can be provided either by the AT or by the site, and radiography sites are expert in shielding. However, distance is critical (because of the inverse square law) in protecting the anesthesia provider in the room. The AT, in siting the anesthesia machine and monitors, assisting with the length of circuits, IV tubing, and cables, and in providing the anesthesia provider access to IV access ports and the anesthesia machine in a location as distant as reasonable from the radiation source, is uniquely able to assist with this aspect of provider safety.

1. What is an antigen? A) A unique cellular marker on cell surfaces B) A molecule made up from amino acids C) A part of the cell's nucleus D) The oxygen-carrying part of a red cell

Answer: A Antigens are markers that are used by the body to identify different cells.

7. The leading cause of patient harm is medication errors. A) True B) False

Answer: A Approximately 20% of medical errors are caused by medication errors, making it the single leading cause of harm to patients.

1. Which type of pathogen is most often implicated in health care-associated infections? A) Bacteria B) Fungi C) Virus D) Prion

Answer: A Bacteria are the most likely cause of HAI.

6. A blood gas machine would most likely analyze which of the following parameters? A) HCT, NA+, PO2, lactate B) HCT, NA+, PO2, INR C) HCT, NA+, PO2, ACT D) HCT, NA+, PO2, platelets

Answer: A Blood gas machines regularly test for hemoglobin/hematocrit, electrolytes, and gas values. Different specialized machines would be required to test INR, ACT, and other blood components or coagulation parameters.

8. In LAST, when should cardiopulmonary bypass be undertaken? A) After resuscitation efforts with standard treatment have failed B) After the patient has suffered multiple seizures C) After lipid emulsion therapy has proven unsuccessful D) As soon as the patient starts presenting symptoms of LAST E) None of the above

Answer: A Cardiopulmonary bypass is a bridging therapy that gives time for the local anesthetic to clear. Efforts for cardiopulmonary bypass should be initiated immediately if the patient is unresponsive to resuscitation attempts with standard treatment. Facilitating CPB can be lengthy, therefore early deployment is important.

3. Cleaning is important as a first step because A) It removes physical debris and bioburden before any other part of the decontamination process B) Cleaning of disposable items before discarding reduces the waste stream C) Cleaning destroys microorganisms D) Cleaning is unnecessary if an item will be undergoing sterilization

Answer: A Cleaning is the physical process that removes organic or inorganic debris (bioburden), such as retained salts and organic soil, from inanimate or animate objects. It is the first step in the decontamination process. Soil can damage sterilizer equipment. Residues may interfere with the device function even after sterilization. Reducing the waste stream is important but is accomplished through proper sorting of waste and reusables rather than cleaning of waste items before disposal. Initial destruction of microorganisms is decontamination.

3. Sevoflurane reacts with CO2 absorbent to create what dangerous chemical? A) Compound A B) Compound C C) Carbon monoxide (CO) D) Sodium hydroxide E) None of the above

Answer: A Compound A is created by the interaction of sevoflurane with a strong base present in the absorber material and has been shown to be toxic to the kidneys in animals. Carbon monoxide is produced by the interaction of isoflurane and desflurane and CO2 absorbents.

4. Using a blood pressure cuff that is too small for the patient can result in false high readings. A) True B) False

Answer: A Conversely, a blood pressure cuff that is too large for the patient can result in false low readings.

3. Which of the following would be least likely to cause an overdose of anesthetic agent? A) Damaged O-ring on the vaporizer-mounting bracket B) Filled vaporizer that has been tipped over C) Vaporizer usage in an especially hot environment D) Failed interlock system E) All of the above.

Answer: A Damaged O-rings typically cause a leak with some of the gas containing anesthetic escaping (not added to the fresh gas). This will result in lower than expected vaporizer output. Vaporizers that have been tipped over can introduce the agent into the bypass circuit, causing the bypass gas to pick up the agent, resulting in a higher than expected vaporizer output. As temperature increases, the vapor pressure of liquids increases, which could increase the amount of agent added to the fresh gas. Most modern vaporizers compensate for temperature variations within a set range. A failed interlock system may allow multiple vaporizers to contribute agents to the fresh gas flow, potentially resulting in an overdose.

5. Laryngospasm may be avoided or treated by all of the following EXCEPT A) Deep extubation B) Applying positive pressure ventilation via mask C) Administration of a paralytic drug D) Adequate suctioning of secretions in the pharynx E) None of the above

Answer: A Deep extubation can reduce coughing but does not prevent laryngospasm. Positive pressure maintained through a face mask can often break a laryngospasm. Paralytic drugs will break laryngospasm by relaxing the vocal cords. Adequate suctioning of the pharynx removes blood or saliva that stimulates the larynx to spasm.

3. Which of these is not a monitor of a patient's ventilation? A) Pulse oximetry B) Visualization of chest excursions C) Capnography D) Auscultation of breath sounds

Answer: A EtCO2 monitoring (capnography) provides the most complete assessment of the adequacy of ventilation by capnography (measurements of exhaled CO2). Still, EtCO2 monitoring for transport may not be available on every monitor, and in these situations, the provider must have unobstructed and continuous visualization of chest wall movements or continuously auscultate breath sounds. Pulse oximetry is used regardless of whether EtCO2 monitoring is available. However, pulse oximetry monitors oxygenation, not ventilation: a drop in oxygenation can be a late development after a patient has stopped breathing for several minutes.

2. An AT performing his or her hospital duties may be sued. A) True B) False

Answer: A Even though the hospital and other providers are named in a lawsuit, ATs may be sued individually for their actions and held liable for negligence or battery.

2. Which of the following is an absolute contraindication for cell salvage use. A) Fecal contamination B) Cancerous tumor C) Obstetrics D) Hepatitis infection

Answer: A Frankly infected sites should be avoided because of the possibility of bacteria returning to cell saver machine and then being reinfused into the bloodstream, potentially causing disseminated infection.

2. Which of the following is not an important step in prevention of perioperative neuropathy? A) Avoiding hyperextension of the knee B) Ensuring that operating room equipment is positioned securely C) Ensuring that the shoulder is not abducted greater than 90 degrees D) Supination of the elbow E) Ensuring that the head is in a midline, neutral position

Answer: A Hyperextension of the knee can cause joint injury but is not associated with neuropathy. Improperly positioned operating room equipment can easily press against an extremity and cause nerve compression. Shoulder abduction can stretch the brachial plexus. Any time the head is not maintained in a neutral position, it can stretch cervical nerves. Elbow supination is the process of turning the hand and forearm upward; this positioning will rotate the upper arm and ulnar nerve off the table, which lessens the risk of compression-related injury.

3. Which of the following effects is elicited by stimulation of the α1 receptors? A) Hypertension B) Hypotension C) Increased heart rate D) Dilation of bronchioles E) None of the above

Answer: A Hypertension and relaxation of bladder and bowel are effects caused by stimulation of the α1 receptor. Hypotension and dilation of the bronchioles is caused by stimulation of the β2 receptors. Increased heart rate is an effect of stimulating the β1 receptors

7. Correctly match the action with the possible consequence for interventional neuroradiology procedures. A) Glues and occlusive particles injected into the wrong vessel → stroke B) Hypertension → stroke C) Hypotension → aneurysm rupture D) A + B E) B + C F) A+ B + C

Answer: A If glues and occlusive particles are injected into the wrong vessel during an INR procedure, it may lead to stroke. Hypertension can result in the rupture of an aneurysm and hypotension can lead to cerebral ischemia. The main complication of neuroradiologic procedures is cerebral hemorrhage and stroke; acute hemorrhage may require rapid conversion to open craniotomy, and so the location carrying out this procedure should be located close to an operating room.

4. What is a reason for only one gas reading being low? A) Suspect that the monitor is not properly calibrated. B) There is a crack on the sample line. C) The sample line is leaking. D) The water trap or filter is leaking. E) The exhaust port is calibrated.

Answer: A If the sample line is leaking or cracked, you would expect all gas readings to be low. Likewise, if the water trap or filter is leaking, all or most of the gas readings will be low. If the exhaust port is blocked, all or most gas readings will be high. If the monitor is not properly calibrated, it can cause any number of problems to present: if only one gas reading may be low, all gas readings may be low, readings may be higher than expected, or there may be no readings.

5. What should you, the anesthesia technician, do if you discover a controlled substance during a room turnover and the anesthesia provider is unavailable? A) Immediately alert the operating room pharmacist. B) Wait for the anesthesia provider. C) Obtain a witness and return the controlled substance yourself, properly documenting the process. D) Try to return the substance to the anesthesia team that was in the room before you. E) Waste the substance per hospital policy.

Answer: A If you discover any controlled substance in either unopened vials or syringes during room turnover, you should immediately alert the anesthesia provider. However, if the anesthesia provider is not available, you should immediately alert the operating room pharmacist. Controlled substances must usually be returned by the anesthesia provider under supervision of a witness (nurse, anesthesia provider, pharmacist). Do not attempt to return the substance without instruction to do so. Do not wait before alerting someone, as you may forget about the presence of the controlled substance. Do not waste the substance and do not try to return the substance to the anesthesia team that used the room prior to you.

2. In French sizes, the larger the number is, the larger the diameter is. A) True B) False

Answer: A In French sizes, the larger the number, the larger the catheter. This is in contrast to the Stubbs wire gauge system in which the larger the gauge, the smaller the catheter.

7. Which of the following is true about emergency cricothyrotomy? A) Bleeding can be minimized by staying in the midline. B) It requires a special kit, such as the Melker® emergency cricothyrotomy kit. C) A full chlorhexidine prep with scrub for 30 seconds should be performed to prevent infection. D) Uncuffed tubes are preferred as they slip in more easily.

Answer: A In emergency cricothyrotomy, time is of the essence. A full prep may be sacrificed for the time saved. A formal kit is useful, but not required. Any type of tube may be place into the trachea (a cuffed tube may be preferable as it protects the lungs from bleeding from the cricothyrotomy site and makes it easier to ventilate). Most blood vessels do not cross the midline, so bleeding may be minimized by staying in the midline.

6. Which would be the most common cause of perioperative peroneal neuropathy in a patient in a lithotomy position? A) Compression of the nerve by a leg holder as the nerve wraps around just below the knee B) Hyperextension of the knee and ankle simultaneously C) Prolonged dorsiflexion of the foot in a leg holder D) Excessive hip flexion when the lower extremity is placed in a leg holder

Answer: A Leg holders should be padded to avoid direct pressure on the upper lateral leg when the peroneal nerve wraps around the fibular head, which is the bony prominence located on the outside of the lower leg just below the knee. Peroneal neuropathies typically result in significant motor dysfunction, resulting in foot drop and difficulty with walking or running.

4. During cardiac arrest due to local anesthesia toxicity or unintended intravascular injection of local anesthetics, the treatment of choice is: A) Lipid infusion B) Vasopressin C) Amiodarone D) Epinephrine E) Defibrillation alone

Answer: A Lipid emulsions have been demonstrated to reduce the amount of local anesthetic interfering with cardiac cells and are a common emergency drug found on regional block carts.

9. Which of the following is NOT a symptom of local anesthetic toxicity? A) Headache B) Tinnitus C) Seizure D) Agitation E) Cardiac arrhythmias

Answer: A Local anesthetic systemic toxicity typically presents first with neurologic symptoms, which includes agitation, tinnitus (ringing in the ears), metallic taste, and abrupt psychological changes, and is followed by seizures and cardiac symptoms. Headaches are not a symptom of LAST.

8. Medication pumps are one of the most widely used technologies in the health care environment. A) True B) False

Answer: A Medication pumps are a normal part of the anesthesia care routine and one of the most widely used medical technologies in health care; they are commonly used in the OR, OB, and PACU.

4. Medication pumps are configured generically to fit the average needs of the patient in any area of the hospital. A) True B) False

Answer: A Most pumps are configured with pharmacy-recommended dosages and concentrations based on generic populations.

9. How is the shelf life of stored blood extended? A) The addition of nutrient supplements B) Repeated freezing and thawing C) Inverted storage freezers D) Constant centrifugation

Answer: A Nutrients help keep red cells alive while they are outside of the body. Blood cells cannot be frozen, though storing them between 1°C and 6°C slows their aging and metabolic processes. FFP is frozen once; when it has been thawed, it must be used or discarded and cannot be refrozen.

6. Which of the following statements is true? A) A patient can go home with a continuous infusion of local anesthetic via a peripheral nerve catheter that she will remove herself, as long as she has a 24-hour contact person. B) A patient who declines a block can give consent for a block after surgery if he is in intractable pain in the PACU. C) Patients do not require EKG monitoring during block placement. D) Bleeding disorders or anticoagulant medications are absolute contraindications to peripheral nerve blocks.

Answer: A Patients can and do go home with peripheral nerve catheters infusing local anesthetic via elastomeric pumps, but should have rapid access to an anesthesia provider for questions and troubleshooting. This is now an important part of many fast-track outpatient recovery protocols. Obtaining informed consent for a patient is optimally performed prior to surgery, anesthesia, sedation, and acute pain, all of which can impair patient judgment (see Chapter 65, Legal and Regulatory Issues), and most regional anesthesia services would agree that it is optimal to discuss risks and benefits of blocks prior to surgery. Block placement requires ASA standard monitors. Bleeding abnormalities are relative contraindications and must be weighed carefully against the bleeding risk, compressibility of site, vulnerability of nerve (an ankle block is different from the neuraxis), and potential benefit.

5. Which of the following should not be given through a rapid infuser? A) Platelets B) FFP C) Red blood cells D) Cell saver blood E) Normal saline

Answer: A Platelets are vulnerable to shear forces and should be given at room temperature and via gravity, not warmed or under pressure. Other blood components, and crystalloid, can be given through the rapid infuser.

4. Why is it important that pressure bags be placed with the drip chambers in the upright position? A) Air might otherwise entrain into the arterial tubing or embolize in the patient. B) The pressure bag will not function if it is not in the upright patient, so the provider will be unable to assess the patient's circulation. C) The pressure bag will not function as well if it is not in the upright position, causing increased risk of postoperative wound infection and myocardial ischemia. D) The pressure bag will depressurize if it is not in the upright position, causing inaccurate readings.

Answer: A Pressure bags should always be hung on an IV line pole or other post connected to the bed, with the drip chamber in the upright position. When the bag is upright, air cannot enter the arterial tubing (which exits at the bottom). Air in the arterial tubing can cause inaccurate readings or, worse, can embolize in the patient, causing ischemia in the hand or even stroke. The pressure bag may give abnormal readings if it is not upright (since air bubbles may enter the tubing), but it will not stop functioning if it is in an improper position.

7. Prior to the delivery of a defibrillating shock with a manual defibrillator, the device must first be A) Charged B) Synced C) Paced D) Analyzed E) None of the above

Answer: A Prior to delivery of a shock, the device must be charged. Most devices will have a default energy level that may have to be adjusted depending upon the clinical situation. Although analysis should be performed prior to shock delivery, the best answer is charging the device.

3. Salvaged blood has a higher viability than allogenic (transfused) blood. A) True B) False

Answer: A Salvaged RBCs have as much as 88% greater viability than allogenic RBCs and also have higher levels of other cellular health markers.

4. In the event of a fire in the OR, it is important to turn off the flow of oxygen, regardless of the oxygen saturation of the patient. A) True B) False

Answer: A Shutting off the oxygen supply (removing the oxidizer part of the triangle) is important regardless of whether the fire is an airway fire, a surgical fire, an OR fire, or a facility fire. The continued flow of oxygen will sustain and even spread a fire, rapidly endangering not only the patient but also everyone in the room. In a surgical or OR fire, the patient can be ventilated with air while the fire is extinguished.

2. Wearing gloves when picking up a urine-soiled sheet is required under which type of precaution? A) Standard B) Contact C) Airborne D) Droplet

Answer: A Standard precautions require that handling of soiled materials should always be performed with gloves. Standard precautions are practiced in all patients: other precautions may be added to standard precautions in the presence of certain infections.

6. An intubating dose of succinylcholine can be reversed by: A) Succinylcholine is not reversed B) Neostigmine alone C) Neostigmine and glycopyrrolate D) Sugammadex

Answer: A Succinylcholine is a depolarizing neuromuscular blocker. Its paralysis is noncompetitive, brief, and temporarily irreversible. Nondepolarizing neuromuscular blockers are competitive inhibitors and are reversed by increasing the concentration of acetylcholine at the neuromuscular junction; this is done with an acetylcholinesterase inhibitor, neostigmine. Glycopyrrolate prevents neostigmine (and its associated acetylcholine) from having muscarinic toxicity at autonomic nerve terminals, particularly the heart. Sugammadex chelates some nondepolarizing neuromuscular blockers, particularly rocuronium.

3. Which of the following best describes the "cannot ventilate, cannot intubate" situation? A) It is a true emergency and will rapidly lead to death without intervention within a few minutes. B) It is a situation that is urgent and needs some sort of intervention over the next 15-20 minutes. C) It is a stable situation that can be treated as time allows. D) None of the above.

Answer: A The "cannot ventilate, cannot intubate" scenario is a true emergency that must be resolved in a few minutes to avoid serious patient harm. If the patient is able to be ventilated by mask, supraglottic airway, or jet ventilation, then the situation is less urgent and may be resolved over a longer period of time.

2. Why is it important to be able to identify the 5 gauss (G) line? A) Once inside the 5 G line, ferrous metallic objects can become projectiles. B) All non-MRI compatible electronic equipment should be placed within this boundary. C) The 5 G line demarcates the outer boundary of zone 4. D) It represents the highest level of the magnetic field and is located closest to the MRI magnet.

Answer: A The 5 G line represents the point in which any ferrous metallic object can become a projectile. Electronic devices that are not MRI approved that are placed within the 5 G line will malfunction. Though in general the 5 G line is encountered within the MRI scan room (zone 4), it can protrude outside of this room into the MRI control room (zone 3). As one moves away from the bore of the MRI scanner, the strength of the magnetic field will diminish—the 5 G line being located at some distance away from it, dependent upon the strength of the MRI magnet. For this reason, all MRI-approved electronic devices that must be located within the 5 G line should be placed as close to it as possible.

2. Which of the following statements is true regarding the ACT analyzer? A) The ACT measures the time to clot formation in seconds. B) The ACT analyzer should be cooled to 32°C prior to running the sample. C) Dilution of the blood sample has minimal effect on the results of the ACT. D) All ACT analyzers are standardized, so values from one manufacturer can be compared to values from another manufacturer. E) None of the above.

Answer: A The ACT is measured in seconds. The ACT analyzer should be warmed up prior to use. Failure to do so can produce faulty values. Similar to blood gas analysis, dilution of the sample can cause erroneous values. Two different ACT manufacturers have different methodologies to measure the ACT and the values cannot be compared.

4. Which federal agency regulates operating room devices and equipment? A) Food and Drug Administration (FDA) B) American Society of Anesthesia Technicians and Technologists C) Centers for Medicare and Medicaid Services (CMS) D) National Organization for Competency Assurance (NOCA)

Answer: A The FDA regulates all medical devices and equipment. ASATT is a member of NOCA and provides the only nationally recognized certification exam for anesthesia technicians and technologists. CMS provides federal funding for hospitals.

1. Which of the following is the CORRECT order of events for muscle contractions? A) The motor cortex of the brain sends a message→action potential sent down the axon→ACh attaches to the nicotinic ACh receptors on the motor end plate. B) ACh from the axon terminal goes to the synaptic cleft→action potential sent down the axon→muscle contraction. C) ACh attaches to the nicotinic ACh receptors on the motor end plate→action potential sent down the axon→muscle contraction. D) The motor cortex of the brain sends a message→ACh attaches to the nicotinic ACh receptors on the motor end plate→action potential reaches the presynaptic terminal. E) None of the above.

Answer: A The correct order of events is as follows: the motor cortex of the brain sends a message→action potential sent down the axon→action potential reaches the presynaptic terminal→ACh attaches to the nicotinic ACh receptors on the motor end plate→muscle contraction.

5. Which of the following statements is true? A) Colloid solutions contain large molecular weight proteins or sugars. B) Lactated Ringer solution contains calcium, but not potassium. C) CVP is the most reliable measure of fluid status. D) Urine output is the most reliable measure of fluid status. E) All of the above are true.

Answer: A The large molecular weight proteins and sugars in colloid solutions cause them to stay in the intravascular space longer than crystalloids. Both CVP and urine output are commonly used to assess the volume status of a patient. However, no single measure of volume status can be considered "most reliable." CVP is used to monitor volume status, but trends in the CVP must be integrated with other measures. Likewise, dehydrated patients do not make as much urine as they would normally, and urine output usually reflects volume status, but it too can be affected by other conditions, like diuretics and renal insufficiency. Lactated Ringer solution contains sodium, potassium, chloride, calcium, and lactate.

6. You have a patient with Parkinson disease who is presenting with a high fever, rigidity, and unusual shifts in consciousness. Given this information, what is likely to be the patient's treatment? A) Dantrolene, dopamine agonist, supportive care, and close observation B) Dantrolene, metoclopramide, supportive care, and close observation C) Dantrolene, discontinuation of dopamine agonist, supportive care, and close observation D) Dantrolene, discontinuation of metoclopramide, supportive care, and close observation E) None of the above

Answer: A The patient likely has neurologic malignant syndrome, a rare condition that is marked by hyperthermia, rigidity, autonomic instability, and altered consciousness. This disorder can be caused by drugs that interfere with normal dopamine release, such as antipsychotics (e.g., metoclopramide), and by abruptly stopping dopamine agonist use. Given that our patient has Parkinson disease, and that dopamine agonists are used in treatment of Parkinson's, it is likely that our patient has abruptly stopped the course of dopamine agonists, which has induced neuroleptic malignant syndrome.

6. What is the difference between a gas analyzer and a gas monitor? A) A gas analyzer measures gas concentration; a gas monitor also has adjustable alarm settings. B) A gas analyzer is capable of measuring multiple different gases, including anesthetic agents; a gas monitor measures only oxygen in the circuit. C) A gas analyzer uses a variety of different analysis technologies; a gas monitor is always a galvanic cell. D) A gas analyzer is a broad term for all the different capabilities of gas analysis; a gas monitor is the specific term for ASA standard capnography and oxygen monitoring.

Answer: A The primary difference between devices labeled "analyzer" or "monitor" is that a monitor includes adjustable alarm settings. In other words, an analyzer will measure whatever substances it is designed for, but a monitor will take that data and signal an alert if and when it falls outside a preset range. Gas monitors can measure a single gas or multiple gases depending on the design and technology used.

5. The recommended type of fire extinguisher for use in an OR is A) CO2 B) Pressurized water C) Halon. D) Dry powder E) None of the above

Answer: A The recommended fire extinguisher for an OR is the CO2 extinguisher. CO2 extinguishers can be used for fires involving organic solids (e.g., paper, wood), flammable or combustible liquids (e.g., oil and grease fires), combustible metals, and cooking fat and oil.

6. What is the goal of holding a start of work shift huddle for the anesthesia workroom staff? A) Discuss any issues that are anticipated during the upcoming shift and make required daily assignments B) Distribute refreshments such as coffee to the anesthesia technical team from a centralized location C) Contribute to the publication of standard operating procedures for the full staff of the workroom. D) Receive a lecture from an anesthesia provider on a topic related to anesthesia. E) All of the above.

Answer: A The start of work shift huddle is a mostly informal meeting to discuss anticipated work issues for the upcoming shift. It is also a time to assign daily tasks, such as who will function as the lead technician/technologist for the day and what locations each technician/technologist is primarily responsible for. Other things can be done around the time of the huddle, such as sharing group bought coffee or receiving an inservice from an anesthesia provider, but the main goal of the huddle is to discuss anticipated issues and assign tasks for the shift.

3. What differentiates a smart pump from any other IV pump? A) Drug libraries that include dosage-limiting parameters and alerts B) Connection to a central database and EMR C) Medication sensors to prevent errors D) Clinician overrides to bypass safety systems E) All of the above

Answer: A There is not a pump on the market that can sense the medication being run through it. The other options can be nice features of an advanced smart pump, but the bare minimum a pump needs to be considered a smart pump is drug libraries and dosing parameters with limits.

1. A 90-kg male is scheduled for an inguinal hernia repair at 7 a.m. He has not had any food or water since dinner the night before (7 p.m.). What is his water deficit? A) 1,560 mL B) 850 mL C) 1,750 mL D) 550 mL E) 2,750 mL

Answer: A Using the 4:2:1 rule, this patient would have a deficit of 40 mL/h for the first 10 kg, 20 mL/h for the next 10 kg, and 70 mL/h for the next 70 kg. This would total to 130 mL/h multiplied by 12 hours, which equals 1,560 mL.

5. Your workroom has run out of sevoflurane for the day. You notice that each room has a full bottle backup available to refill its vaporizer if needed. If the providers deliver an average of 2.1% sevoflurane and fresh gas flows of 2 L/min, do you have enough agent to make it through the day? A) Yes B) No

Answer: A Using the equation 3 × Fresh gas flow (L/min) × volume% = milliliters of liquid used per hour, you will use 12.6 mL of sevoflurane per hour. Assuming all of the sevoflurane bottles hold the standard 250 mL, you have enough sevoflurane on hand to last just over 19 hours. Unless your vaporizers were empty to start the day or your facility runs cases 24 hours a day nonstop, you have enough to last the day. You should, however, notify your providers that you are low on agent and order more ASAP.

3. Microshock occurs A) In the electrically susceptible patient B) In small amounts over time C) In the use of microscopes D) In microbiology E) When a transformer has failed

Answer: A Very small amounts of current below the threshold of perception are generally not harmful to patients; however, when a patient has a direct conductive connection to the heart (e.g., saline-filled vascular catheter or a pacing wire), the current may be sufficient to induce an arrhythmia. When this happens, the patient has received a microshock.

4. What is the function of PEEP? A) It can improve patient oxygenation by preventing alveolar collapse. B) It prevents backward flow of ventilator gases through the vaporizer. C) It pushes breathing circuit gases through the CO2 absorber. D) High PEEP allows more comfortable breathing for lightly anesthetized patients. E) It accelerates the flow of gases at the beginning of the next inspiratory cycle.

Answer: A With PEEP, the breathing circuit is pressurized with a small amount of positive pressure (usually 5-10 cm H2O, controlled by the PEEP setting) during exhalation, to prevent alveoli from collapsing. This can improve oxygenation in some patients.

6. Rank in order the risk of HIV transmission in the following scenarios: A) Needlestick from a large-bore needle used on an HIV-positive patient B) Medium volume of HIV-positive patient's nonbloody saliva in a health care personnel's eye C) Small amount of an HIV-status unknown patient's blood splashing into a health care personnel's eye

Answer: A, C, B Needlestick exposure has a greater risk of transmission than mucosal exposure. Nonbloody saliva is unlikely to lead to HIV transmission.

6. An LIM stops the flow of electricity when a fault is detected. A) True B) False

Answer: B A GFCI stops the flow of electricity when a fault is detected. The advantage of an LIM is that it will sound an alarm when a fault has been detected but will not stop the flow of electricity to critical equipment.

6. A severe asthmatic patient is emerging from anesthesia. The anesthesia provider will likely use a medication to reduce the potential of severe airway constriction and spasm during extubation. Which adrenergic receptor do you anticipate this medication will likely stimulate? A) β1 B) β2 C) α1 D) α2

Answer: B A beta two (β2) agonist medication is most appropriate in this situation. Stimulating the beta two (β2) adrenergic receptor will cause the airway and bronchioles to dilate and thus reducing the potential for airway complications during emergence.

3. Anesthesia technologist recertification is required every: A) 1 year B) 2 years C) 3 years D) 4 years E) 5 years

Answer: B A certified anesthesia technologist must recertify every 2 years after completing and submitting a required number of CEHs. Failure to recertify could lead to suspension or termination of employment.

2. All anesthesia machines have a check valve in the low-pressure system. A) True B) False

Answer: B A check valve in the low-pressure system will negate a positive pressure leak test. A negative pressure leak test will be necessary to perform an adequate anesthesia machine checkout. Anesthesia technicians should consult the manufacturer's operator manual for the presence of a low-pressure system check valve and the proper procedure for testing for leaks in this system.

5. An e-cylinder of oxygen has a pressure reading of 1,200 psi prior to transport. How long will this oxygen supply last with O2 flows of 8 L/min? A) 42 minutes B) 52 minutes C) 57 minutes D) 62 minutes E) 67 minutes\

Answer: B A full cylinder holds 1,900 psi = 660 L. To find the number of liters of oxygen in 1,200 psi, set up the equation 660 L/1,900 psi = x/1,200 psi and solve for x (multiply 1,200 by 0.35 = 420 L of O2). Divide 420 by 8 (liter flow of O2 during transport) = 52 minutes remaining of oxygen.

7. Neurologic manifestations are always seen before cardiac symptoms develop in LAST. A) True B) False

Answer: B A small portion of patients present with isolated cardiovascular signs.

7. Communication about an adverse event between an AT and each of the following individuals is considered privileged, EXCEPT: A) Attorney B) Other colleagues involved in the event C) Spouse D) Risk manager

Answer: B After an adverse event, you should report the incident to your risk manager. Such reporting is confidential and cannot be discovered during the course of a lawsuit. Communication about the adverse event with your attorney or spouse is also protected by the law. However, talking to your colleagues, even if they were also involved in the event, is not privileged and can be discoverable during a lawsuit.

4. Which of the following is true regarding the anesthetic care of pediatric patients? A) All anesthetic care of pediatric patients involves general anesthesia. B) All anesthetic care of children must use approved monitoring practices throughout the hospital. C) All pediatric anesthesia providers are required to have completed a pediatric anesthesiology fellowship. D) The continuum of mild, moderate, and deep sedation does not exist for children. E) All of the above.

Answer: B All anesthesia services provided to pediatric and adult patients, including sedation, regional, and general anesthesia, must follow federal guidelines regarding their provider credentialing and monitoring practice.

6. Which of the following is a critical element of basic life support (BLS)? A) IV access B) Chest compressions that are hard, fast, and effective C) Intubation D) Epinephrine E) Intermittent pulse checks

Answer: B All of the above can be important to resuscitation. An essential component to BLS, however, is maintenance of circulation with effective chest compressions that are hard, fast, effective, and not interrupted. The others are maintaining an open airway, providing ventilation, and early defibrillation. Inserting an advanced airway and IV access and administering epinephrine, all important, are part of ACLS. Basic life support provides oxygen to the brain while these things are happening. Intermittent pulse checks are done between compressions but should not interrupt compressions for greater than 10 seconds.

2. An elevation in the baseline of a CO2 monitor can be due to any of the following except A) A faulty expiration valve on the ventilator B) Cardiac arrest C) Exhausted CO2 absorbent D) Insufficient expiratory time E) Inadequate fresh gas flow

Answer: B All of the above can cause an elevation in the CO2 baseline with the exception of cardiac arrest, which results in a fall in ETCO2.

1. As an anesthesia technician in an obstetric unit, you should expect all of the following except: A) Access to the OR at any hour of day or night. B) Decision-to-incision interval less than 15 minutes. C) Adequate anesthesia coverage and technical support 24/7. D) Anesthesia providers may not always be in-house at night. E) None of the above.

Answer: B Although in certain life-threatening situations delivery of the neonate within 10-15 minutes improves outcomes, the standards set by the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, and the Joint Commission dictate that the decision to incision interval be less than 30 minutes, not less than 15 minutes. Obstetric units should always provide adequate anesthesia coverage and technical support, and you should always expect to have access to the OR, regardless of time of day. However, in rural areas and/or at small hospitals, there may not be an anesthesia provider in-house at night.

4. Which of the following is NOT a means to assess ongoing blood loss intraoperatively? A) Monitoring suction canisters B) Periodically weighing the patient C) Counting soiled laparotomy pads D) Checking the hematocrit level E) All of the above

Answer: B Although serial weights are an important measure of fluid status from day to day in the medical patient who has too much fluid in their tissues, it is impractical to weigh the patient during surgery. In addition, changes in patient weight would be affected by fluid losses as well as blood losses (e.g., evaporative losses). Monitoring suction canisters and blood-soaked laparotomy pads is important to follow blood loss during surgery. Serial hematocrits are also useful to monitor blood loss.

6. A Jehovah's Witness patient is experiencing postpartum hemorrhage and has agreed to the use of cell salvage. The provider is concerned about the potential for inducing amniotic fluid embolism, which of the following best describes what you should be watching for? A) Tachypnea (rapid breathing), hypoxia, and bradycardia B) Tachypnea (rapid breathing), hypoxia, and tachycardia C) Bradypnea (abnormally slow breathing), hypoxia, and bradycardia D) Bradypnea (abnormally slow breathing), hypoxia, and tachycardia E) None of the above

Answer: B Amniotic fluid embolism (AFE) is marked by rapid-onset dyspnea (shortness of breath), hypoxia, and cardiovascular collapse. Its signs include rapid breathing, tachycardia (rapid pulse), and a decrease in blood pressure. AFE has a mortality rate as high as 60% in developed countries and occurs at a rate of 1 in 13,000 in the United States. If cell salvage is used in cases of postpartum hemorrhage (such as when allogenic blood is not available or is refused by the patient), a leukocyte depletion filter is highly recommended.

7. True or False? If an anesthesia machine passed its automated checkout, any problem (e.g., very high pressures without ventilation after intubation or very low compliance and a large gas leak) cannot be a problem in the checked out anesthesia machine. A) True B) False

Answer: B An automated checkout does not rule out either a malfunction in an item not included in the machine checkout or a failure of the checkout process. A malfunction in the interaction between the human and the machine is also a possibility: some difficulty with machine setup or configuration. A "passed" automated checkout also does not rule out the possibility of a malfunction that begins after the checkout is completed.

8. True or False: Anesthesia technologists do not need to be familiar with the intricacies of the anesthesia machine because anesthesia providers are responsible for diagnosing and managing equipment malfunctions and failures. A) True B) False

Answer: B Anesthesia providers are responsible for diagnosing and managing equipment malfunctions and failures, in collaboration with the anesthesia technologist. In a circumstance where the anesthesia machine is failing to provide adequate ventilation, adequate anesthesia gas, or adequate monitoring, the anesthesia provider first needs a substantial amount of attention just to re-establish these patient care tasks of the anesthesia machine (monitor, ventilate, anesthetize) before attempting a diagnosis or repair of the machine. This is where the advanced skills of the AT at diagnosis and repair of the machine are invaluable.

5. The radiation safety principle most responsible for protecting the anesthesia technician or technologist is A) Distance B) Time C) Shielding

Answer: B Anesthesia technicians are rarely in active procedure rooms for more than a few minutes, resulting in negligible cumulative radiation exposure. Hospital standards and badging programs establish safety for staff who remain all day in the procedure room: the AT's exposure is a small fraction of this. It is still advisable to be aware of the distance from the radiation source, and to wear appropriate PPE, but it is the minimal in-room time that should make the AT have minimal personal worries about radiation safety.

5. Which of the following is true: A) Gram-positive bacteria have a thin peptidoglycan wall and an outer membrane. B) Some antibiotics are more effective against either gram-positive or gram-negative bacteria. C) Gram-positive bacteria are the only cause of bloodstream infections. D) Gram-positive bacteria are common causes of surgical site infections.

Answer: B Antibiotics can be more selective against either gram-positive or gram-negative organisms depending on the antibiotic. For example, vancomycin is more effective against gram-positive organisms. Multiple bacteria and even nonbacterial pathogens can lead to bloodstream and surgical site infections. Gram-negative bacteria have a thin peptidoglycan wall and an outer membrane.

5. An intraoperative death has occurred; the anesthesia provider expresses concern that a faulty monitor may have contributed. What is the appropriate next step? A) Troubleshoot the monitor to find and fix the problem. B) Sequester and quarantine the monitor, pending referral to hospital risk management. C) Call biomedical engineering to assess whether the next case in the room can safely be performed with that monitor. D) Report the device failure to the FDA and return the monitor to the manufacturer.

Answer: B Any faulty equipment that may have contributed to patient harm must be immediately sequestered and quarantined pending an investigation by risk management.

1. A 65-year-old man with a history of diabetes, hypertension, and peripheral vascular disease presents to the emergency room after a car accident with chest pain and ST-segment elevations suggestive of a large anterior wall MI. While in the emergency room, he develops persistent hypotension with blood pressure reading 70/30 despite an infusion of epinephrine. He is taken to the catheterization lab for further management. Which of the following is an absolute contraindication to the placement of an IABP for cardiac support? A) Cardiac contusion from the car accident B) Aortic dissection from the impact of the seat belt C) History of peripheral vascular disease requiring interventions for revascularization D) Rupture of the papillary muscle during a large anterior wall MI E) All of the above

Answer: B Aortic dissection is a contraindication to placement of an IABP since the balloon may be placed in the false lumen and cause an extension of the aortic dissection. Both (A) cardiac contusion and (D) rupture of papillary muscle causing mitral insufficiency resulting in cardiogenic shock are indications for an IABP. (C) Peripheral vascular disease is a relative contraindication for the placement of an IABP.

1. When providing moderate sedation for a patient, the anesthesia provider is A) Not permitted to use propofol B) Expecting the patient to be able to maintain his or her own airway C) Not required to record vital signs as often as for other anesthetics D) Not required to perform a physical exam prior to the case E) None of the above

Answer: B As defined by the ASA, moderately sedated patients should be able to maintain their own airway without assistance. Patients who require adjuncts or support to maintain their airway are by definition deeply sedated. All sedation cases require appropriate preprocedure evaluation including a physical exam. A sedation case does not obviate the need for ASA standard monitoring and frequent recording of vital signs. An anesthesia provider is not limited in drug selection for sedation cases.

1. An LIM will protect against microshock. A) True B) False

Answer: B As the term implies, microshock is caused by very low levels of current, which are nonetheless dangerous because they come into direct contact with the heart (e.g., via a pacemaker lead). An LIM is designed to detect current leakage associated with isolated power supplies, at much higher current levels than are seen with microshock. The detection of a leakage current by an LIM indicates either faulty grounding or a large-magnitude current leakage, but does not protect you from a microshock.

5. Blood flow to the pregnant uterus around the time of delivery is A) 500 mL B) 1,000 mL/min C) Reduced by left uterine displacement D) Directly monitored by fetal cardiotocography

Answer: B Blood flow to the pregnant uterus is as high as 1,000 mL/min at term; thus, obstetric hemorrhage can be very rapid. (Flow is measured as a volume per unit time, e.g., mL/min.) Typical blood loss at vaginal delivery is 500 mL. Uterine blood flow is increased by left uterine displacement, which moves the uterus off the inferior vena cava and aorta and permits increased perfusion to the lower half of the body, including the uterus. Cardiotocography monitors fetal heart rate and uterine contractions; fetal heart rate patterns are associated with changes in fetal and/or placental, but not necessarily uterine, perfusion. Uterine contractions are also not reflective of uterine blood flow.

5. A 30-year-old woman with a history of myocarditis and end-stage cardiomyopathy had a HeartMate II placed while awaiting transplantation. Prior to leaving the hospital, you notice that the PI has decreased. What is the appropriate intervention for this patient? A) Increasing the pump speed B) Giving the patient a fluid bolus C) Turning down the pump flow D) Anticoagulation E) Surgical intervention to assess device

Answer: B Higher PI values indicate that the pump is providing less support to the LV. When there is a drop in the PI, the patient's blood volume should be assessed and likely the patient will need a fluid bolus to improve cardiac output.

3. Which of the following correctly matches the type of monitoring with the procedure it is most likely to be used for? A) Somatosensory evoked potential monitoring—removal of tumors involving the optic pathway B) Brainstem auditory evoked potential monitoring—removal of acoustic neuromas, posterior fossa craniotomies, and tumors near the cochlear nerve C) Motor evoked potential monitoring—carotid surgery D) Electromyography—in operations where cerebral blood flow may be interrupted E) Camino catheter monitoring—patients requiring CSF drainage

Answer: B Brainstem auditory evoked potential monitoring is often used for removal of tumors at the brainstem, such as those near the cochlear nerve or the cerebellum. Somatosensory evoked potential monitoring is often used in operations where cerebral blood flow may be interrupted or in most major spinal surgeries where there is a concern for damage to the spinal cord. Likewise, motor evoked potential is commonly used for spinal surgery. Electromyography is often used for operations of the peripheral nervous system and musculature, such as operations of the ear, neck, and brainstem; it does not monitor perfusion of the central nervous system. Camino catheters monitor intracranial pressure but cannot drain CSF.

1. What is the primary function of the anesthetic breathing circuit? A) Ventilate the patient. B) Deliver oxygen and anesthesia gases to the patient. C) Protect anesthesia staff from exposure to anesthetic gases. D) Remove all CO2 from the gas mixture by conducting gas to a CO2 absorber. E) All of the above.

Answer: B Breathing circuits are devices that provide the ability to deliver a defined gas or vapor to the patient. The other functions described are not performed by the breathing circuit or not performed by all designs of circuits. Ventilation of the patient is an active mechanical process performed by a mechanical ventilator (often part of the anesthesia machine) a dedicated ventilator, or a human being (either a spontaneously breathing patient, or the anesthesia provider squeezing a ventilation bag). Two additional functions of a breathing circuit are described, which are not performed perfectly by all designs of breathing circuits. The breathing circuit prevents release of anesthetic gas into the environment only in a closed (circle) system. The breathing circuit's design must also permit the patient access to gas relatively free of CO2. A circle system performs this by carrying rebreathed gas to a CO2 absorber; open and semiopen circuits by supplying a fresh gas flow adequate to clear most expired gases into the environment, utilizing one-way valves, or both.

2. Why is compatibility testing important? A) To avoid losing blood units at the blood bank B) To avoid adverse reactions, even death, from transfusion C) To screen for HIV-1 D) To prolong unit shelf life

Answer: B Compatibility testing ensures that patients will not receive incompatible transfusions, for this could cause death.

5. You are in an OOR location and the patient has been given radiopaque materials to enhance the images when the patient starts to complain of feeling sick. Which of these symptoms would be most concerning? A) Nausea and vomiting B) Tachycardia C) Flushing D) Sweating

Answer: B Contrast reactions are relatively common: symptoms include nausea and vomiting, urticaria, hoarseness, dyspnea, facial edema, wheezing, tachycardia, and hypotension. Tachycardia (especially in combination with hypotension, facial edema, or wheezing) may be a sign of an anaphylactic reaction. Facial edema is concerning as it can be a sign of edema of the airway as well. Wheezing and dyspnea are signs of bronchospasm but can also be signs of threatened upper airway closure.

5. Dantrolene is A) Always dosed at 2.5 mg/kg B) Drawn up only in sterile water C) Discontinued when patients leave the operating room D) Available in two formulations, one of which works better E) Required for hospital operating rooms; office-based and out-of-OR anesthesia locations should always know where the nearest dantrolene is available in case a patient needs to be transferred

Answer: B Dantrolene must be drawn up only in sterile water and not saline, lactated Ringer's, or glucose-containing fluids. Its starting dose is 2.5 mg/kg, but it may be repeated with additional doses of 2.5 mg/kg up to a total of 10 mg/kg. It is not discontinued when patients leave the operating room, but continued at 1 mg/kg every 4-6 hours in the intensive care unit postoperatively. It continues to be available in two formulations; both work well, but one dissolves much faster than the other, thus using personnel resources more efficiently in a crisis. Dantrolene must be available in every anesthetizing location; office-based anesthesia locations and out-of-OR anesthesia locations in the hospital must stock dantrolene for immediate on-site administration. Preparation for MH crisis includes planning for MH expertise and ICU transfer after a patient is stabilized.

6. The Doppler effect can be utilized in US scanning to delineate which of the following structures. A) Peripheral nerves B) Blood vessels C) Bone D) Muscle E) Air-filled spaces

Answer: B Doppler (or color) imaging uses a physical phenomenon known as the Doppler shift to measure movement. This phenomenon can be used to measure flow through blood vessels. The Doppler effect is displayed on the US screen as color, and the color scale can be used to show how fast blood (or any other substance) is moving toward or away from the US transducer. Therefore, structures such as blood vessels, which contain fluid with flow will display color allowing for delineation from nonblood vessel structures, which will not display color. Tilting the US transducer (discussed later) toward or away from the direction of flow may improve the color signal.

4. In which of the following situations should an endobronchial blocker be selected in lieu of a double-lumen endotracheal tube? A) Differential ventilation of both lungs is needed. B) Isolation of small lung segments is needed. C) Only one lung needs ventilation. D) There are significant changes to the anatomy of the left main bronchus.

Answer: B Double-lumen endotracheal tubes are often used when differential ventilation of both lungs is needed, when only one lung needs ventilation, and when there are significant changes to the anatomy of the left main bronchus (in which case, a right DLT may be used). Isolation of smaller lung segments is the only scenario in which an endobronchial blocker placement is most appropriate, as double-lumen endotracheal tubes are unable to reliably isolate individual lung segments.

4. Which of the following statements are FALSE? A) New TEE probes can cost up to $40,000. B) A TEE probe should always be inserted into the patient with the tip in the locked position. C) Ultrasound gel should be available for TEE probe placement. D) An anesthesia technician can help the anesthesiologist with TEE probe placement by holding the handle of the TEE probe up while the anesthesiologist places the TEE probe into the patient. E) The TEE machine should be plugged into a grounded and protected outlet.

Answer: B One should NEVER manipulate a TEE probe in the patient while the tip is in the locked position. All other lettered options are correct.

4. During a massive hemorrhage, if a fluid warmer is not working properly, replacing it is not a high priority, since warming fluid does not have a proven benefit. A) True B) False

Answer: B During resuscitation efforts, it is very important to maintain the patient's body temperature at 36°C-37°C. Blood products are stored either on ice (red blood cell, FFP) or at room temperature (platelets), both of which are very cold relative to body temperature. Warming fluid cannot significantly warm a patient, but the rapid infusion of cold fluids can drop the body temperature rapidly and significantly, which will impair the blood's ability to clot and can lead to metabolic disturbances, electrolyte and acid-base derangements, and even cardiac arrest. If a fluid warmer is not warming properly, it needs to be replaced immediately. Methods for actively warming the patient include the use of forced air heating blankets and increasing the temperature of the OR.

4. A laser beam of energy can be all of the following EXCEPT A) Invisible B) Multicolored C) A single color D) Derived from an active medium (solid, liquid, or gas) E) Travel through a substance without affecting the substance at all

Answer: B Each laser type emits a specific wavelength producing one color (only if the wavelength falls in the visible spectrum). A laser can also be in the invisible portion of the light spectrum. Lasers can be produced from a variety of active mediums (solids, liquids, or gases) and can travel through some substances without affecting them. If the substance absorbs the light energy, heat can be produced, which can affect the substance.

3. Screening and preparation of patients and staff for entry into the MRI scanner is done in which zone of the MRI suite? A) Zone 1 B) Zone 2 C) Zone 3 D) Zone 4

Answer: B Entry into zone 1 is unrestricted. Entry into zone 3 and zone 4 should only occur after one is screened by an MRI technologist to identify any contraindications for exposure to a strong magnetic field and removal of all non-MRI approved objects and devices.

4. A patient with poor cardiac function presents for surgery and requires a general anesthetic. The anesthesia provider prepares several medications. Which of the following is an anesthesia induction agent that is commonly used in this scenario? A) Atropine B) Etomidate C) Norepinephrine D) Propofol E) None of the above

Answer: B Etomidate is the only hypnotic/sedative that does not result in significant decrease in sympathetic outflow, and as a result, it is often chosen to induce anesthesia in patients with poor cardiac function. Propofol is an anesthesia induction agent that produces sympathetic attenuation, a drop in venous and arterial vascular tone, and a drop in cardiac contractility; it would not be a common choice for a patient with very poor cardiac function, though certainly a possibility if combined with a sympathetic stimulant. The other drugs are not anesthesia induction agents. Atropine is a muscarinic antagonist and norepinephrine is a sympathetic agonist.

2. Fentanyl falls under the category of A) Schedule I B) Schedule II C) Schedule III D) Schedule IV E) Schedule V

Answer: B Fentanyl is designated a schedule II drug, which is defined as a controlled substance with a high potential for abuse with an accepted medical use. Other drugs in this schedule include hydromorphone, morphine, and cocaine. Schedule I drugs do not have an accepted medical use.

4. Inhaled anesthetics often cannot be used at all with which type of neuromonitoring? A) Somatosensory evoked potentials B) Motor evoked potentials C) Brainstem auditory evoked potentials D) Processed EEG E) Electromyography

Answer: B For cases in which neurophysiologic monitoring is used, anesthesia providers will often choose to reduce the amount of inhaled anesthetic gas used, supplementing this with intravenous anesthesia. This is because inhaled anesthetic gases depress signal amplitude and prolong latency. Motor evoked potentials (MEPs) are particularly susceptible to the effects of inhaled anesthetics and may require total intravenous anesthesia.

8. Grounded equipment cannot cause electrical shock. A) True B) False

Answer: B Grounded equipment reduces the risk of receiving an electrical shock should there be a short in the equipment. In grounded equipment, the bulk of the fault current will be conducted through the ground line and only a small portion will flow through the person.

6. Which of the following is a "high-risk" medication? A) Rocuronium B) Heparin C) Propofol D) Epinephrine E) Bupivacaine F) None of the above

Answer: B High-risk medications have designated special handling instructions to ensure safety. Several, particularly in the OR, are "high risk" because they are commonly given and come in multiple concentrations, and the risk of overdose (or, in the case of heparin and cardiopulmonary bypass, underdose) can be fatal. These include insulin, heparin, potassium, and opioids. The other medications on this list are certainly associated with significant risks but are not classified as "high-risk" medications by the pharmacy and throughout the hospital. Rocuronium is given in a consistent fashion, setting, and concentration, and only under the supervision of an anesthesiologist. Propofol, too, is given in the context of strict general anesthesia or sedation protocols. Bupivacaine is high risk in the intrathecal space (where all drugs are "high risk" and treated with this protocol) and in settings where its doses are high enough that patients are at risk for LAST (see Chapter 63, Local Anesthetic Toxicity). Epinephrine is given in resuscitation situations that are "high risk" but also as a component of low-risk subcutaneous local anesthetic solutions.

4. High-risk medications can be treated just like any other medication in the OR setting. A) True B) False

Answer: B High-risk medications have designated special handling instructions to ensure safety. These can range from a "high alert" or "high-risk" sticker attached to having two providers verify the drug and concentration before administration.

2. Which of the following is not a contraindication for arterial line placement? A) Arteriovenous fistula in the same extremity B) History of axillary lymph node dissection on the same side C) Infection or severe scarring at the site D) Coagulopathy or administration of tissue plasminogen activator E) Substantial trauma in the same extremity

Answer: B History of ipsilateral (the same side) axillary lymph node dissection is not contraindication to the placement of arterial line. Severe coagulopathy is a relative contraindication, especially for femoral artery or axillary artery due to difficulty in hemostasis. Infection and trauma in the same extremity are also contraindications, and the site/extremities should be inspected carefully prior to placement.

3. Which of these is not a major cause of transfusion-related death? A) Septic transfusions. B) Transfusion-related hyperkalemia. C) Transfusion-related lung injuries. D) Hemolytic transfusion reactions. E) All of these are major causes of transfusion-related death.

Answer: B Hyperkalemia can be a common complication during massive transfusion; however, it is not considered a major cause of transfusion-related death. The three most common causes of transfusion-related death are septic transfusions, transfusion-related lung injuries, and hemolytic transfusion reactions.

5. For which of the following methods is crystalloid or colloid solutions given in large volumes? A) Cell salvage B) ANH C) PABD D) Allogenic transfusion E) None of the above

Answer: B In acute normovolemic hemodilution (ANH), blood is withdrawn in a controlled fashion immediately before surgery so that it can be administered to the patient after surgery. Crystalloid or colloid solutions are given in volumes of one to three times the amount of blood removed to make the patient's blood volume normal: this is essential to ensure normal cardiac output.

3. Which of the following is not a health care-associated infection (HAI)? A) Catheter-associated urinary tract infection (CAUTI) B) Influenza C) Central line-associated bloodstream infection (CLABSI) D) Surgical site infection (SSI) E) Ventilator-associated pneumonia

Answer: B Influenza is not normally considered an HAI. All the others are, by definition, health care-associated infections.

1. Which of the following poses the greatest hazard to both patients and staff in the MRI suite? A) Ionizing radiation B) A strong magnetic field C) Nonferromagnetic materials which can become projectiles D) Loud noise levels

Answer: B Ionizing radiation is not employed in MRI scanning. The strong magnetic field required in MRI can cause ferromagnetic objects to become projectile and be drawn into the bore of the MRI scanner, resulting in injury. Nonferromagnetic materials such as plastic and aluminum are compatible with MRI safety. Loud noises are a hazard to hearing but are not as potentially hazardous to patients with the simple use of earplugs. The strong magnetic field is a significant risk as it can cause ferromagnetic devices to become projectiles and can cause electronic equipment to malfunction. The magnetic field does not cause direct patient injury.

3. It is unnecessary to have 20% lipid emulsion on hand in a procedural area if only epidurals are performed there. A) True B) False

Answer: B It is likely to encounter LAST in situations where large doses of local anesthetics are given, for example, while performing epidural blocks or regional blocks.

5. Which of the following statements are TRUE with regard to central venous access? A) The internal jugular, subclavian, and femoral veins can be used for peripheral venous access. B) It is necessary to gown when inserting a CVC. C) Manometry is used to verify the CVC is not in the lung. D) A cordis introducer CVC should be used if you do not expect large amounts of blood loss. E) All of the above are TRUE.

Answer: B It is necessary to use a sterile gown and gloves and use a mask when inserting a CVC to reduce the incidence of bloodstream infections. The internal jugular, subclavian, and femoral veins are used for central venous access. Once a CVC has been inserted, measuring the pressure in the line can help determine that the line was placed in a vein (low pressure) and not inadvertently in an artery (high pressure). A cordis introducer has a very large infusion channel (if nothing else is put into it, e.g., hands-free catheter or PAC) and can be used for high-flow infusions.

1. You are present during induction of a trauma patient. You witness the following drugs given. Which of the following agents induces a state of general anesthesia? A) Fentanyl B) Ketamine C) Succinylcholine D) Vecuronium

Answer: B Ketamine induces unconsciousness and is an intravenous general anesthetic, though it works by a different mechanism than the other intravenous general anesthetics: ketamine is an NMDA antagonist, whereas propofol, the barbiturates, and the benzodiazepines are GABA agonists. Fentanyl is an opioid. Opioids block pain and depress patients' responsiveness but do not cause amnesia or loss of consciousness. Succinylcholine and vecuronium are neuromuscular blockers and have no effect on the central nervous system or the level of consciousness.

3. If administering a citrated blood product, it is best to use lactated Ringer solution as a carrier. A) True B) False

Answer: B Lactated Ringer solution contains calcium, which can combine with the anticoagulant citrate used in blood products. This may cause the blood products to form clots.

2. During massive hemorrhage, peripheral IVs are of little or no use. A) True B) False

Answer: B Large-bore peripheral IVs (14G, 16G) and RICs can be used to infuse blood products at very high rates. In fact, they will flow at rates much higher than many central lines, with the exception of the Cordis introducer. Remember that the flow rate is increased by a large inner diameter but slowed by the greater length of the catheter. Most central lines have lumens that are both narrower and much longer than peripheral IVs. Peripheral lines can also be placed much more quickly than central lines, so if the hemorrhage was unanticipated, the speed with which peripheral lines can be placed is vitally important.

5. Benefits of laser over other surgical techniques include all EXCEPT A) Decreased pain B) Expense C) Decreased swelling D) Decreased bleeding E) Ability to target difficult-to-reach regions of the body

Answer: B Lasers used in surgical procedures offer several unique advantages over traditional surgical methods. A laser is capable of targeting a specific layer of tissue and can often target difficult-to-reach regions of the body. Since a laser beam does not diverge as it travels over a distance, it can treat a precise target while often sparing the surrounding tissue of edema and pain. Lasers are also associated with decreased amounts of bleeding due to their ability to clot off small blood vessels. Unfortunately, lasers can be quite costly to use.

1. Which of the following pieces of personal protective equipment is optional in a dose-intensive radiation environment? A) Thyroid shield B) Protective eyewear C) Two-piece lead skirt and vest D) None of the above

Answer: B Long-term exposure to ionizing radiation can cause cataract; however, the cumulative (over years) amount of radiation required to cause harm to the eye is much higher than the amount which can potentially cause harm to the thyroid; cataract-protective eyewear is optional. A two-piece lead is required in a dose-intensive environment because it also protects the back of the body if the wearer turns around with the back to the source of radiation.

1. What is an advantage of mainstream monitors? A) Bulky analyzing equipment does not need to be directly attached to whatever tubing is delivering gas to the patient. B) They are quick to respond to changes in gas concentration. C) They are more efficient and portable than sidestream monitors. D) They are less likely than sidestream monitors to suffer from interference. E) They are capable of analyzing anesthetic gases, in addition to oxygen and carbon dioxide.

Answer: B Mainstream monitors must be directly in-line with gas flows and must be placed close to the patient, making them more susceptible to interference from condensation and secretions from the patient. Mainstream monitors are only capable of analyzing oxygen and carbon dioxide and are not more efficient and portable than sidestream monitors. However, since mainstream monitors must be placed close to the gas source, they are quick to respond to changes in gas concentration.

6. All vaporizers will alert you to a low agent fill level. A) True B) False

Answer: B Many modern vaporizers such as the Aladdin cassettes found in GE machines can alert you to low agent level because they are electronically controlled. Similarly, the Tec 6 desflurane vaporizer has an alert because it is powered. The majority of sevoflurane and isoflurane vaporizers in use do not have power for alarms and only have a sight glass to visually gauge fill level.

3. Nonchanneled rigid video laryngoscopes require the endotracheal tube be passed into the airway separately from the rigid video laryngoscope. Which device must always accompany the rigid video laryngoscope? A) Miller blade B) Stylet C) Bougie D) LMA E) All the above

Answer: B Nonchanneled scopes require the endotracheal tube be loaded onto a reusable proprietary stylet and advanced independently into the mouth and airway. A standard disposable stylet may suffice if the device-specific stylet is unavailable.

5. Which of the following statement is TRUE when monitoring neuromuscular blockade on a twitch monitor? A) Nondepolarizing agents are monitored by placing the twitch monitor on the facial nerve only, while depolarizing agents are monitored by placing the twitch monitor on the ulnar nerve only. B) Nondepolarizing agents demonstrate a response called "fade" where the twitch response decreases with repetitive nerve stimulation. C) Depolarizing agents always cause "fade." D) Neuromuscular blockade caused by nondepolarizing agents cannot be monitored with a nerve stimulator. E) None of the above.

Answer: B Nondepolarizing agents cause the muscle response (twitch) to a stimulus applied to a nerve innervating the muscle to "fade." The twitch strength will decrease with repetitive stimuli. This is a major method of monitoring the intensity of neuromuscular blockade caused by nondepolarizing agents. The nerve stimulator may be placed over a variety of nerves including the ulnar and facial nerves. Depolarizing agents, in most cases, do not cause "fade."

1. What is a problem that is unique to monitoring with a pulse oximeter? A) Readings may be affected by excessive movement. B) Low readings are a late sign of ventilation problems. C) Readings may be affected by high-perfusion states (high cardiac output or vasodilation). D) Readings may be affected by patient shivering. E) They may not be readily available on all transport monitors.

Answer: B Pulse oximeters continuously measure the percentage of hemoglobin saturated with oxygen (SpO2) in the patient's blood and are found on all transport monitors. Although pulse oximetry readings are affected by excessive movement and shivering, this is not a problem that is unique to the pulse oximeter: these also affect ECG lead and NIBP cuffs. Pulse oximetry readings are also affected by low (not high)-perfusion states.

5. Because of concerns about a loss of power, essential equipment in the OR should be plugged into A) White sockets B) Red sockets C) Either socket, because it doesn't matter D) Neither, it should be run off battery power E) Surge protectors

Answer: B Red sockets are designed to have backup power in case of a loss of power. All essential equipments should be plugged into a red socket. White sockets are not designed to have backup power. Surge protectors protect the equipment from fluctuations in the power supply but do not have a backup power supply.

7. It is inappropriate to reprocess which of these items? A) Electrophysiology catheters B) Intravenous tubing C) Single-use pulse oximetry probes D) Sequential compression sleeves E) Orthopedic equipment

Answer: B Reprocessed items include single-use pulse oximetry probes, sequential compression sleeves, laparoscopic and orthopedic equipment, and electrophysiology catheters. These items are cleaned, sterilized, and quality tested by FDA-approved, third-party reprocessors and are purchased back by hospitals at a reduced cost.

3. Which of the following is likely to be a complication from a peroneal sciatic block? A) Intrathecal injection B) Seizure C) Pneumothorax D) Hemidiaphragm paralysis E) All of the above are potential complications

Answer: B Seizure is a presenting sign of LAST, which can occur with intravascular injection of local anesthetic medications. Any peripheral nerve block can contain enough local anesthetic to cause CNS or cardiovascular toxicity. The sciatic nerve is located in the posterior part of the leg; the peroneal approach to it is just above the knee. Nerve blocks in the neck or upper arm can puncture the lung cavity, resulting in a pneumothorax. Nerve blocks in the neck can also block the phrenic nerve, resulting in paralysis of part of the diaphragm. Intrathecal injection is injection into the spinal fluid, not accessible from the peroneal space.

2. Which of the following is the process that kills all bacterial life forms including spores? A) Disinfection B) Sterilization C) Decontamination D) Sanitation E) All of the above

Answer: B Sterilization is the only process capable of destroying all microbial spores. Autoclaving, using a hot air oven, or using a chemical sterilant can accomplish sterilization.

1. Which of the following agents is SAFE to use in an MH patient? A) Succinylcholine B) Nitrous oxide C) Sevoflurane D) Halothane E) Desflurane

Answer: B Succinylcholine and all of the potent inhaled anesthetics can trigger MH. Nitrous oxide is safe to use.

6. Testing for MH is recommended before anesthesia for all patients who might be MH susceptible: A) True. B) False.

Answer: B Testing with a muscle biopsy requires travel and a minor surgical procedure, and not all those who have a positive result are MHS. Genetic testing only detects 30% of those who are MHS, since not all genes are known. When an MH patient tests positive for a known gene, it is recommended other family members can be tested. Safe nontriggering techniques (regional or TIVA) are available when there is a high clinical suspicion that a patient may be MHS.

5. Which of the following is true about the Combitube®? A) It is reusable. B) It may be used for emergency ventilation. C) It may be used to intubate through. D) It will only work if placed in the trachea.

Answer: B The Combitube is a good choice for emergency ventilation because it has two lumens and may work whether it is placed into the esophagus or the trachea. It is single-use only and does not make a good conduit for intubation.

1. Which of the following statements regarding accreditation is false? A) The Joint Commission accredits most health care organizations to ensure the provision of safe care and compliance with performance measures. B) Site visits occur every 3 years and are scheduled with the Joint Commission. C) Anesthesia technicians must show proficiency in credentialed tasks and policies during site visits. D) Federal funding from the Centers for Medicare and Medicaid Services is contingent on JC accreditation. E) The Joint Commission is a nonprofit organization.

Answer: B The Joint Commission is a nonprofit organization that accredits most health care organizations to ensure the provision of safe care and compliance with performance measures. Although site visits do occur every 3 years, they are not scheduled with the Joint Commission; instead, assessors visit unannounced to assess the organization's compliance with health care standard. Anesthesia technicians must be able to show proficiency in a number of tasks, including policies on drug handling and operating equipment. A prerequisite for receiving federal funding from CMS is accreditation; if the Joint Commission fails to accredit the institution, it will no longer be eligible for this federal funding. This can close a hospital.

3. A 72-year-old woman with a history of a three-vessel coronary artery bypass graft had trouble weaning from cardiopulmonary bypass and an IABP was placed. You are called to set the trigger for the balloon inflation and deflation based on the EKG. Which is the proper trigger setting based on the EKG? A) Balloon inflation on the R wave, balloon deflation on the middle of the T wave B) Balloon deflation on the R wave, balloon inflation on the middle of the T wave C) Balloon inflation on the R wave, balloon deflation on the P wave D) Balloon deflation on the R wave, balloon inflation on the P wave

Answer: B The R wave corresponds to ventricular systole, and the balloon should deflate to allow the heart to eject blood into the aorta. The T wave corresponds to ventricular relaxation and diastole. The balloon inflates during this period to increase the diastolic blood pressure in the proximal aorta, thus improving coronary blood flow.

5. If a pump sounds an alarm, the technologist should check all of the following EXCEPT A) The data screen for message alerts B) Whether the medication is appropriate for this patient C) Air in the tubing D) Whether a roll valve or clamp on the IV tubing has not been opened E) Whether the tubing is properly installed

Answer: B The anesthesia technologist may check any of the possible reasons for alarm other than if the medication is appropriate for the patient. The anesthesia provider is responsible for making sure that is the case. The machine is incapable of determining if the correct medication is being administered and would not alarm for that reason. If the anesthesia technologist has any reason to suspect that the wrong medication is being infused, the technologist should bring it to the anesthesia provider's attention immediately.

6. When adhesive gel pads are placed in the standard anterolateral position, the anterior pad should be placed A) Directly over the heart B) To the right of the sternum below the clavicle C) On the right chest, lateral to and below the nipple D) Directly over the sternum E) On the anterior abdomen

Answer: B The anterior pad should be placed just to the right of the sternum and below the clavicle. Multiple positions of the pads are acceptable including anterolateral and anteroposterior.

7. Which statement is true in regard to performing the cardiac output measurement? A) Connect thermodilution kit to distal (yellow) port, making sure to deair the fluid bag. B) To calculate body surface area (BSA), thus cardiac index (CI), the weight and the height of the patient are needed along with a computation constant specific for the catheter in use. C) One measurement of cardiac output is appropriate if the value is similar to the previous measurement. D) Cardiac output measurement can be performed during cardiopulmonary bypass. E) The cardiac output measurement with the use of PAC by the change of temperature of injectate is called the "Fick principle."

Answer: B The cardiac output measurement using PAC from the change in temperature of injectate is called "thermodilution technique." Cardiac index (CI) is calculated from cardiac output (CO) and BSA (CI = CO/BSA). BSA is calculated by a complex formula using weight and height. A thermodilution kit should be connected to the proximal (blue) port. Cardiac output values can change from multiple factors. It also can vary from beat to beat in the setting of arrhythmias. The average value should be obtained from at least three consecutive measurements or more in the presence of arrhythmias. The Fick method is an alternative method which you will sometimes hear being discussed. This can use mixed venous oxygen saturation to calculate an approximated cardiac output.

7. "Total intravenous anesthesia" refers to which of the following? A) Administering an intravenous agent followed by an inhalational agent for maintenance of anesthesia B) Administering a continuous infusion of an intravenous agent titrated to the appropriate depth of anesthesia C) Administering smaller amounts of a number of different anesthetic drugs in order to reduce the unwanted side effects associated with each one D) Performing induction of anesthesia using a volatile anesthetic or nitrous oxide via mask and then placing an intravenous line E) None of the above

Answer: B The correct answer is B. Option A describes a routine general anesthetic in an adult. Option C describes the concept of a balanced anesthetic. Option D describes an inhalational induction (commonly used in the pediatric population).

5. Which of the following is true regarding setting up or using a transducer for an arterial line? A) Bubbles in the line can cause a venous embolus. B) The drip chamber should always be in the upright position. C) Damping of the signal will cause an overestimation of blood pressure. D) When flushing the line into the patient, hold the pressurized flush open for at least 6 seconds. E) The femoral artery should never be used for an arterial line.

Answer: B The drip chamber of the pressurized flush should be kept in the upright position to prevent air from entering the line to the patient. Bubbles in the line could cause an embolus in the artery and not the vein. In addition, bubbles in the line could dampen the signal (flatten the waveform), leading to an underestimation of the blood pressure. When flushing the line with pressurized fluid, the flush should not be applied for more than 3 seconds to prevent flush from reaching the central arterial circulation. The femoral artery is commonly accessed for arterial pressures.

5. Which device is not used for lung isolation in anesthesia? A) Double-lumen endotracheal tubes B) Endotracheal adapters C) Endobronchial tubes D) Bronchial blockers

Answer: B The endotracheal adapter is the only device listed unable to be used for lung isolation.

3. Which of the following modalities can only be used to provide pacing of the atria of the heart and cannot be used to pace the ventricle directly? A) Transcutaneous. B) Transesophageal. C) PA catheter. D) Epicardial. E) All of the above can pace either chamber.

Answer: B The esophageal lead sits directly behind the left atrium and cannot directly pace the ventricle. It can only pace the atrium and relies on intact AV conduction to successfully pace the heart. Transcutaneous leads conduct current to the ventricle, which is both the largest part of the heart, and the closest to the chest wall, by passing a large amount of current through the skin. The PA catheter permits separate wires to be passed into both ventricle and atrium. Epicardial wires are sewn directly onto the surface of the ventricle.

4. At what temperature would you most likely expect to see a patient experience temperature-related ventricular fibrillation? A) 18°C B) 28°C C) 32°C D) 37°C E) 41°C

Answer: B Ventricular fibrillation is known to occur with hypothermia and occurs when the patient's temperature is less than 28°C.

2. Which sedative hypnotic medication is commonly used for the induction of anesthesia in unstable patients due to its ability to maintain blood pressure and cardiac output? A) Propofol B) Ketamine C) Dexmedetomidine D) Midazolam E) Fentanyl

Answer: B The hemodynamic effects of ketamine make it a favorable medication for many unstable patients. Blood pressure and cardiac output are usually maintained. Respiratory drive and airway reflexes are preserved as well. Propofol commonly reduces blood pressure and cardiac output. Dexmedetomidine is a sedative hypnotic but not an induction agent and is not typically given in bolus doses. Midazolam can be given for the induction of anesthesia and can maintain blood pressure and cardiac output, but it is inadequate to do these things as a sole induction agent even in an unstable patient. Fentanyl does not produce amnesia and is not a sedative-hypnotic agent.

1. Thermoregulation is maintained centrally in the brain by which of the following structures? A) Amygdala B) Hypothalamus C) Pineal gland D) Right frontal cortex

Answer: B The hypothalamus is responsible for controlling the body's regulation of its temperature.

1. Which of the following roles in the anesthesia workroom is primarily responsible for making decisions regarding what equipment is necessary for the conduct of anesthesia at a surgical site? A) Workroom manager B) Medical director C) Anesthesia technologist D) Supply ordering specialist E) Biomedical engineer

Answer: B The medical director of the anesthesia workroom is primarily responsible for making decisions regarding what equipment is necessary for the conduct of anesthesia at a site. The workroom manager and anesthesia technicians often offer opinions on what they think may be needed with the medical director, but the medical director has primary responsibility for making the decisions regarding what equipment is necessary.

4. The presenting symptoms of LAST can vary from one patient to another. However, identify the most typical progression of symptoms, as described in this text. A) CNS excitement → CNS depression → seizures → hyperdynamic cardiac manifestations → cardiac depression B) CNS excitement → seizures → CNS depression → hyperdynamic cardiac manifestations → cardiac depression C) Seizures → CNS excitement → CNS depression → hyperdynamic cardiac manifestations → cardiac depression D) Seizures → cardiac depression → hyperdynamic cardiac manifestations → CNS excitement → CNS depression E) CNS excitement → seizures → CNS depression → cardiac depression → hyperdynamic cardiac manifestations

Answer: B The most stereotypical progression of symptom presentation is CNS excitement (e.g., agitation, tinnitus, metallic taste, and abrupt psychological changes), followed by seizures, CNS depression (e.g., coma or respiratory arrest), hyperdynamic cardiac manifestations (e.g., hypertension, tachycardia, and ventricular arrhythmias), and cardiac depression (e.g., hypotension, bradycardia, conduction block, and asystole). However, it is important to realize that not every patient will show every symptom, and symptoms may progress differently from one patient to another. You should be prepared for cardiac and neurologic symptoms appearing concurrently and for other abnormal presentation of symptoms.

4. Which of the following is true? A) If you spend twice the time in a radiation location, you get 4 times the exposure. B) If the distance from the radiation source is doubled, radiation exposure drops by a factor of 4. C) A and B D) Neither A nor B

Answer: B The relationship between time and radiation exposure is linear: the longer you stay, the more you are exposed, in a linear, 1:1 fashion. If you stay twice as long, you get twice the exposure.The relationship between distance and radiation exposure is the inverse square law: as you move away from the source of radiation, your exposure drops not linearly with the distance, but with the square of the distance, so that if you double the distance, you cut your exposure by a factor of 4. That is to say, it drops very quickly.

6. The safety and reliability of oxygen and anesthetic gas delivery are principal concerns and of critical importance to safe medical practice. Which machine improvement is not a required safety component of the anesthesia machine? A) Agent-specific vaporizers. B) Electronic checkout. C) Oxygen analyzers. D) Oxygen failure safety valves. E) All of the above are essential for safe anesthesia machine operation.

Answer: B There are many key safety developments that have been integrated into the modern anesthetic machine and importantly include the components noted above in addition to circuit pressure monitors, pin indexing systems. Neither human nor electronic checkout is a perfect safety solution. Most current machines in service function rely on human checkout, and all providers and technicians should know how to checkout a machine manually and to troubleshoot machine problems.

7. You are setting up for a facial surgery in which the anesthesiologist has requested a wire-reinforced endotracheal tube. Which of the following is not also important in your setup? A) I don't need to check to see if there is laser equipment present in the room; this tube is laser safe. B) I don't need to put out warm saline to soften this tube: although it is wire, it is not stiff. C) I don't need to put a stylet out: this tube's wire will give its curve "memory" and allow shaping to help it reach the larynx. D) I don't need to put out a bite block: this tube is reinforced and cannot kink.

Answer: B This tube is wire reinforced throughout, and the coils of the wire keep the lumen open. Neither its plastic nor wire gives it stiffness, and it is "floppy" along its length. It bends like a "slinky" and does not hold the standard shaped curve that a PVC tube does. It requires a stylet for placement. Although it will not kink under normal conditions, it can develop a permanent pinch under intense occlusive pressure, like biting, and requires a bite block. It is not laser or MRI safe.

2. When using US to visualize deeper structures, which of the following adjustments are most likely to improve image quality? A) Decreasing depth, increasing frequency, decreasing focus depth. B) Increasing depth, decreasing frequency, increasing focus depth. C) Increasing gain, increasing frequency, decreasing focus depth. D) Decreasing gain, decreasing frequency, decreasing focus depth.

Answer: B To image deeper structures, there must be sufficient depth to the image to include the structure(s) of interest. Lower frequency US waves travel better through tissues, and though they have by definition lower resolution than higher frequency US waves, they can reach deeper structures better as they are less subject to tissue attenuation. Increasing the focus depth so that the US beams are focused at the depth of the structure(s) of interest will improve the quality of the image at that depth. Increasing or decreasing gain settings may or may not improve the ability of see deeper structures, depending on the specific sonographic properties of the particular structure.

8. When performing POC testing, you do not have to follow universal precautions and perform two patient identifiers because the test is not being performed in the lab. A) True B) False

Answer: B When drawing blood or working with patient fluids, you should always following universal precautions. Checking two patient identifiers ensures that you are performing the correct test on the correct patient.

2. All of the following are essential in setting up an IABP EXCEPT A) EKG leads B) Heparin for anticoagulation C) Arterial blood pressure monitoring D) A gas reservoir E) Electric console

Answer: B While some institutions routinely anticoagulate their patients to prevent clot formation on the balloon, many institutions believe that this increases the bleeding risk in the postsurgical setting.

7. Anesthesia machines have progressed in sophistication and complexity and routinely include a number of important components to manage gas delivery. Which of these is no longer used in gas delivery in all anesthesia machines? A) APL (adjustable pressure limiting) valve B) Bobbin flowmeters C) Ventilators D) Scavenging systems E) Chemical CO2 absorption

Answer: B While there are a number of anesthetic machines available and in use today worldwide, they principally share many similar fundamental components and functionalities, including anesthetic vaporizers, ventilators, scavenging systems, and CO2 absorption. Manual bobbin gas flowmeters for air, oxygen, and nitrous oxide, however, have been replaced by electronic flowmeters in most anesthesia machines currently being manufactured and sold. It is critical that one has a solid basic understanding of the principals of the workings of the anesthetic machine and its fundamental components.

1. Which of the following ventilator modes requires patients to initiate a respiratory cycle? A) Volume control B) Pressure support C) Pressure control D) PEEP mode E) None of the above

Answer: B With pressure support ventilation, the ventilator senses a drop in circuit pressure initiated by a patient's breath and then delivers a set pressure to augment the patient's breath. This mode is often used to synchronize the ventilator with the patient's respiratory efforts. Volume control delivers a fixed volume breath at a given rate regardless of patient effort. Pressure control delivers a fixed pressure breath at a given rate regardless of patient effort. PEEP is not really a ventilator "mode" but rather a setting for the ventilator to maintain a small amount of fixed pressure during expiration.

2. Nasal cannulas and face masks can deliver equal amounts of FiO2. A) True B) False

Answer: B. False. Nasal cannulas are able to reach FiO2 in the range of 0.30-0.40. The FiO2 becomes less reliable at the high and low ends of the range. The FiO2 is limited by the significant mixing with room air that occurs from an open source of O2. Standard face masks can deliver FiO2 of 0.30-0.50. Compared to nasal cannulas, standard face masks have less mixing with room air and rebreathing.

1. True or False: Nasal cannulas are only useful for patients who breathe through their nose. A) True B) False

Answer: B. False. Nasal cannulas are useful even in patients who breathe through their mouths. The air inhaled through the mouth may create a vacuum in the nasopharynx that enhances flow of oxygen through the nasal cannula into the airway. The mixing of oxygen from the nasal cannula and room air increases the FiO2 of the inspired gas.

2. When setting up a channeled rigid video laryngoscope, which adjunct/device should always be readily available? A) Miller blade B) Stylet C) Bougie D) LMA E) All of the above

Answer: C A gum elastic bougie may be requested by the anesthesia practitioner to assist with placement of the endotracheal tube if the blade is too short to reach and direct the tube into the trachea. The bougie can be placed through the endotracheal tube and be manipulated to access the trachea.

6. An arm board falls off during surgery but is quickly replaced before the patient suffers any harm. Which term best describes this patient safety event? A) Adverse event B) Close call C) Near miss D) Sentinel event

Answer: C A near miss is an unintended event that does not result in patient harm.

3. A code is called in the OR in a patient who is semiconscious and gasping for breath. Your most important role is to A) Go to the OR hallway and get the code cart. B) Prepare to begin chest compressions. C) Assist the anesthesia provider as requested in assembling equipment for mask ventilation and intubation. D) Assemble additional vascular access equipment which you anticipate will be needed.

Answer: C A patient who is gasping for breath is not yet in cardiac arrest: this is a prearrest situation. All OR team members should be prepared to assist with BLS skills like chest compressions or bringing the code cart, and the OR will soon fill with additional people. Only you, however, as the AT, are familiar with the intubation equipment and able to assist the anesthesia provider, who is preparing to intubate prior to arrest and asking for help. This is not the time to leave to assemble additional equipment for the advanced stages of resuscitation, though it may well be needed soon.

4. What type of training is required to operate an AED? A) ACLS certification B) BLS certification C) None D) Should only be operated by a physician E) Should only be operated by cardiologists

Answer: C AEDs are designed to be operated by individuals without any (or minimal) training. A series of audio prompts and visual instructions will be given once the device is powered up.

7. An electrical shock occurs when A) Electrical shock does not occur in the OR environment. B) Equipment is not kept in good working condition. C) Electric current flows through the body. D) A piece of equipment has a ground fault.

Answer: C Although a piece of equipment that has been poorly maintained or that has a ground fault surely increases the risk for electrical shock, electrical shock only occurs when current flows through the body.

2. RACE stands for A) Remove, Alarm, Contain, Extinguish B) Recover, Alarm, Cover, Evacuate C) Rescue, Alarm, Contain, Evacuate D) Respond, Alarm, Contain, Extinguish

Answer: C Anesthesia technicians will be called upon in the event of a fire emergency in the OR. The RACE acronym describes, in order, the key steps to take during a fire emergency.

3. Compared to defibrillation using adhesive gel pads, defibrillation using internal cardiac paddles requires A) No change in energy output setting B) Increase in energy output setting C) Decrease in energy output setting D) A specific defibrillator for internal defibrillation E) None of the above

Answer: C Because internal paddles are applied directly to the heart, the energy setting is much lower than that used by external paddles or pads.

1. Which of the following would correctly identify a leak in an oxygen flow tube? A) Positive-pressure leak check B) Oxygen analyzer C) Negative-pressure leak test D) All of the above E) None of the above

Answer: C Because most machines have a check valve between the patient circuit and the common gas inlet, a positive-pressure leak test will not identify a leak upstream. If a small leak was present, the oxygen analyzer would be unable to identify that 1 L of 100% oxygen instead of 5 L of oxygen was flowing through the circuit. Only a negative-pressure leak test will identify this.

3. Which of the following is not a patient safety measure for US-guided procedures? A) Use of probe covers or other barriers, as well as cleaning the transducer between procedures to prevent cross-contamination. B) Continued contact with the manufacturer for inspection, calibration, software updating, and maintenance of US equipment. C) Use of color Doppler with every US exam to identify vessels before guided placement of in-plane needles. D) Archiving of images for possible future review as part of a teaching file of continuing quality improvement. E) All of the above are necessary for patient safety.

Answer: C Color Doppler is not the only method for identification of blood vessels and is not always reliable. Recall that Doppler signal is directional and is not seen at all if flow is directly underneath the probe and not flowing either toward or away from the probe. Color is not used in all US exams or needle placements. Prevention of cross-contamination between patients will help reduce the risk of infection complications. Ensuring proper function of US equipment will help to reduce the risk of error due to malfunctioning equipment and prevent risks of electrical shocks or other injuries; ongoing contact with manufacturer recommendations regarding maintenance and updates is essential for this. Storage of images for periodic review can be helpful to determine potential causes of ineffective procedures or complications.

4. What are the primary causes of noncompatible transfusions? A) Bacterial contamination B) Excessively clumped platelets C) Clerical errors D) Expired crossmatch test tubes

Answer: C Compatibility testing is very sophisticated, but clerical errors can cause an incompatible transfusion.

8. Which is the correct intracardiac path of the PAC during its placement? SVC, superior vena cava; IVC, inferior vena cava; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; PA, pulmonary artery. A) RV → RA → SVC → PA B) RA → LA → LV → PA C) SVC → RA → RV → PA D) IVC → RV → RA → PA E) LA → RA → RV → PA

Answer: C Correct intracardiac path of the PAC during its placement is: SVC (or IVC) → RA → RV → PA Change in the pressure waveform correlates with the position of the tip of the PAC.

5. Cross-matching is the process by which the paperwork for the donor unit and the recipient are matched and is subject to clerical error. When is cross-matching required? A) Whenever a patient receives a transfusion B) Whenever the patient receives blood from a donor (as opposed to blood they had previously donated) C) When the patient receives red blood cells D) When the patient receives plasma E) Only in nonemergency situations

Answer: C Cross-matching is only required when the patient receives red blood cells. In emergency situations, there is an abridged crossmatch that tests only for the most severe errors, such as ABO and Rh-D compatibility.

2. The most common legal claim against anesthesiologists related to airway management comes from which of the following? A) Anoxic brain injury from failed airway management B) Lip lacerations from laryngoscopy C) Dental injury during laryngoscopy D) Vocal cord dysfunction and speech problems from intubation E) None of the above

Answer: C Dental injury is not the most common or severe complication, but the injury requires expensive dental work to correct the problems and results in a high incidence of legal claims. Fortunately, anoxic brain injury is a rare and catastrophic event. It results in the largest claims and settlements. Lip lacerations are very common, but the injuries tend to heal without added intervention, so claims are rarely associated with these injuries. Vocal cord dysfunction may occur from traumatic intubation but is more likely from prolonged intubation and pressure of the tube cuff on the laryngeal nerve (e.g., intensive care unit patients intubated for several days). This dysfunction most often resolves with time and does not usually require intervention.

5. Which of the following inhalation anesthesia agents is considered to be the only inhalation agent that will produce an increase in the sympathetic outflow, causing tachycardia, when it is suddenly increased to high levels? A) Isoflurane B) Sevoflurane C) Desflurane D) Halothane E) None of the above

Answer: C Desflurane is the only agent that will produce an increase in the sympathetic outflow, causing tachycardia. Thus, it is not usually used as an induction agent.

6. You have a pulse oximetry probe that needs to be cleaned after use. What Spaulding decontamination category is this device in, and what level of cleaning is required? A) Noncritical, high-level disinfection B) Semicritical, high-level disinfection C) Noncritical, low-level disinfection D) Semicritical, low-level disinfection E) Semicritical, sterilization

Answer: C Devices that do not ordinarily touch the patient or touch only intact skin, such as a pulse oximetry probe, are noncritical objects that require low-level disinfection. Semicritical devices require high-level disinfection and are devices that come into contact with intact mucous membranes and do not ordinarily penetrate sterile tissue. The third category in the Spaulding classification system is critical devices, which are devices that enter normally sterile tissue or through which blood flows and which require sterilization.

2. If a patient were to have a stroke on the right side of the motor cortex, which area of the body would be affected and what would be the resulting symptoms? A) Right side of the body, lower motor neuron signs B) Right side of the body, upper motor neuron signs C) Left side of the body, upper motor neuron signs D) Left side of the body, lower motor neuron signs E) None of the above

Answer: C Due to crossover of nerve fibers, the motor cortex of the brain affects the opposite (contralateral) side of the body. Therefore, a stroke in the right motor cortex will affect the left side of the body. Upper motor neurons are in the brain. Lower motor neurons are in the nerves that leave the spinal cord.

7. A patient is undergoing laparoscopic abdominal surgery with deep paralysis. Which of these ventilator modes should be selected, and why? A) Patient Regulated Volume Control—the patient may continue to make respiratory efforts and would otherwise "fight" against the ventilator. B) Pressure Support—the patient may continue to make respiratory efforts and would otherwise "fight" against the ventilator. C) Patient Regulated Volume Control—the patient's diaphragm is unable to contract, leaving the patient unable to assist with ventilation. D) Pressure Support—the patient's diaphragm is unable to contract, leaving the patient unable to assist with ventilation. E) None of the above correctly explain what would be chosen and why.

Answer: C During deep paralysis, the patient is completely paralyzed, making them unable to contract their diaphragm and assist in ventilation efforts. Therefore, it is absolutely vital that a ventilation mode with timed ventilation is selected.

5. All of the following occur in the preoperative period EXCEPT A) Performing the preanesthesia assessment B) Obtaining laboratory data C) Preoxygenating the patient D) Assessing the nil per os—nothing-by-mouth (NPO) status E) Explaining the risks, benefits, and alternatives of anesthesia

Answer: C During the preoperative period, a thorough assessment of the patient is performed. Preoxygenating the patient is a step in anesthesia induction and typically occurs in the intraoperative period.

2. What are the five rights of medication safety? A) Right medication, right dose, right time, right patient, right provider B) Right medication, right time, right concentration, right patient, right dose C) Right medication, right dose, right time, right route, right patient D) Right medication, right time, right patient, right dose, right program

Answer: C Ensuring that all of these factors are correct is crucial to preventing critical and potentially deadly medication errors.

4. Initial treatment for bronchospasm associated with anaphylaxis includes A) Vasopressin IV B) Dexamethasone IV C) Epinephrine IV D) Antihistamines E) None of the above

Answer: C Epinephrine is a mixed α- and β-agonist and affects β 2-receptors in the bronchial tree to cause bronchodilation. Vasopressin is a direct-acting vasoconstrictor used to treat hypotension. Dexamethasone is a steroid with anti-inflammatory properties but a slow onset of action. Antihistamines compete with histamine at histamine receptors and will eventually decrease the adverse effects of histamine.

6. Which of the following statements are false in regard to zeroing a transducer? A) The transducer should be opened to air to perform zeroing. B) It is necessary to press a button on the monitor to initiate zeroing. C) Zeroing is not necessary the first time you set up and use a pressure transducer. D) The monitor should read "0" when the transducer is open to air. E) All of the above are false.

Answer: C Every time you set up a transducer, it must be zeroed. In addition, when the transducer cable is disconnected, the transducer may have to be rezeroed. To perform a zero, the transducer is opened to air, and the monitor button for that particular line is pressed until the monitor reads "0."

1. All of the following can cause an erroneous value on a blood gas analyzer except A) Excess anticoagulant in the sample tube B) Inadequate removal of flush solution during blood draw C) Excessive blood drawn into the sample tube D) Delay of more than 10 minutes before running blood gas sample E) None of the above

Answer: C Excess blood in the sample tube will not cause any problems. Flush solution can dilute the actual sample. A delay of more than 10 minutes can allow continued metabolism in the red blood cells and alter values.

6. What is FFP used for? A) Raising hematocrit B) Expanding blood volume C) Replacing clotting factors D) Raising concentration of fibrinogen E) To treat factor IX deficiency

Answer: C FFP contains plasma factors like factors V and VIII, which are needed for effective blood clotting. FFP replaces coagulation factors lost with bleeding and is used as a reversal agent for anticoagulation drugs like warfarin, in the treatment of immunodeficiencies, in antithrombin III deficiencies, in massive blood transfusion, and in other coagulation system deficiencies; however, it should never be used as a primary volume expander. Other blood products include packed red blood cells (which increase the hematocrit levels), platelets (helps the body form blood clots), cryoprecipitate (contains high concentrations of clotting factor VIII and fibrinogen and is used to treat clotting factor deficiencies like hemophilia A), and prothrombin complex (contains vitamin K-dependent coagulation factors II, VIII, IX, and X and antithrombotic protein C and protein S and is used to reverse the effect of vitamin K antagonist warfarin, to treat factor IX deficiency, hemophilia B, and other bleeding disorders).

4. Which of the following statements is true? A) Femoral nerve blocks provide complete pain relief for knee surgery. B) Axillary nerve blocks can be used for shoulder surgery. C) Femoral blocks can be used for pain relief for hip surgery. D) Lumbar plexus blocks are commonly used for foot and ankle surgery.

Answer: C Femoral blocks provide significant, but not complete, pain relief in hip surgery and can be used as part of a postoperative pain relief plan. The femoral nerve is more commonly used for pain relief in knee surgery but does not provide complete coverage of the knee: the posterior aspect of the knee is innervated by the sciatic nerve. The axillary nerve block does not cover the shoulder. The lumbar plexus block is technically challenging and typically would be replaced by a more distal block, such as a combined sciatic/saphenous, for a foot and ankle surgery.

1. Anaphylaxis can typically present with the following symptoms: A) Hypertension and bronchospasm B) Hypotension and fever C) Hypotension and bronchospasm D) Bronchospasm and muscle rigidity E) None of the above

Answer: C Fever and muscle rigidity are typically not features of anaphylaxis. The release of inflammatory mediators leads to capillary leak, with resultant vasodilation and hypotension; there is also smooth muscle spasm with resultant bronchospasm.

4. Which one of the following has been demonstrated as an acceptable treatment for destination therapy in patients who are not suitable for heart transplantation? A) IABP B) Thoratec VAD C) HeartMate II D) None of the above E) All of the above

Answer: C HeartMate II is a continuous flow LVAD that is small and durable, appropriate for patients for bridge to transplant, bridge to recovery, or destination. Both the IABP and the Thoratec VAD can be used as a bridge to transplantation, but these are not indicated for longer term destination therapy.

3. Which of these physiologic effects is not a potential result of hypothermia in an anesthetized patient? A) Ventricular fibrillation B) Increased systemic vascular resistance C) Hypoglycemia D) Delayed emergence E) Excessive urine production

Answer: C Hypothermic patients are typically at risk for hyperglycemia. Hypothermic patients are actually at greater risk of bleeding than are normothermic patients, due to poor platelet and clotting factor function. Hypothermia can cause EKG conduction abnormalities including Osborne J waves, prolonged intervals, and, in extreme hypothermia, ventricular fibrillation. Hypothermia impairs nervous system function, delaying emergence from anesthesia. It also impairs renal function, specifically urine concentrating ability, so that patients cannot appropriately regulate their fluid balance and produce too much urine.

1. The following is an example of a critical item, according to the Spaulding classification system: A) Laryngoscope blade B) Pulse oximeter C) IV catheter D) Nasopharyngeal airway E) None of the above

Answer: C IV catheter: A critical item includes a device that enters normally sterile tissue or the vascular system or through which blood flows. Such devices should be sterilized, which is defined as the destruction of all microbial life.

5. According to the ASA Practice Advisory on the perioperative management of patients with CIEDs, which of the following statement is FALSE? A) In the pacing-dependent patient with an ICD, a magnet will not make the pacemaker asynchronous: if EMI is likely, the pacemaker must be reprogrammed. B) When intraoperative EMI is likely, an ICD's high-voltage therapy should be temporarily suspended. C) A magnet should always be applied to a pacemaker or ICD during surgery. D) Backup pacing and defibrillation equipment should be immediately available. E) All ICDs are also pacemakers.

Answer: C If intraoperative EMI is likely, the CIED of a pacing-dependent patient should be programmed to an asynchronous pacing mode, and the high-voltage therapy of an ICD should be suspended. In both instances, backup equipment for defibrillation and pacing should be readily available. Although blind magnet placement is not advised (especially over an ICD), a magnet can sometimes be used in lieu of reprogramming to mitigate the effects of intraoperative EMI. All ICDs have pacemaker functions: even if the patient never requires a pacemaker under normal circumstances, it is possible they could require pacing after a shock.

4. When there is a question about the validity of a test result, the best rule of thumb is A) Assume the values are true because today's POCT machines are highly accurate. B) Recalibrate the POCT machine in question. C) Draw two samples, reanalyze one on the POCT, and send one to the central lab for comparison. D) Check to make sure the calibration reagents are not out of date. E) None of the above.

Answer: C If there is any doubt about the accuracy of a POCT device result, the best course of action is to perform another sample and to compare the result to a result obtained from the central lab.

6. Which of the following would be indicated for the patient who has not been able to be ventilated by mask or by LMA or intubated and saturation is falling quickly? A) Retrograde wire intubation B) Blind nasal intubation C) Cricothyrotomy D) Fiberoptic intubation

Answer: C If ventilation by mask and LMA and intubation have all failed, this is a true emergency and a reason for invasive airway such as cricothyrotomy. It would not be appropriate to spend additional time on noninvasive techniques.

5. You need to monitor the concentration of oxygen being delivered to the patient. Which type of monitor would not work for this purpose? A) Electrochemical B) Paramagnetic C) Infrared D) Sidestream

Answer: C If you need to analyze the concentration of oxygen being delivered to the patient, you should not choose an infrared sensor; infrared sensors are only capable of analyzing multiple gases with a structure of more than one element. Infrared sensors are not capable of analyzing nonpolar, elemental gases like oxygen.

3. Why is fresh gas decoupling important? A) It prevents wall oxygen from mixing with the anesthesia gases. B) It allows patients to breathe spontaneously while the ventilator is active. C) It allows delivered tidal volumes to be independent of gas flow rate through the machine. D) It allows fresh volatile anesthetics to be separated from those exhaled from the patient. E) It allows ventilators to deliver positive pressure during both expiration and inspiration.

Answer: C In many older ventilators, the fresh gas flow continues to flow into the circuit while the ventilator is delivering a breath. This means that the fresh gas flow during inspiration will be added to the flow from the ventilator. At high fresh gas flows, this can significantly increase a delivered tidal volume if the ventilator is set to volume control. Fresh gas decoupling excludes fresh gas from flowing into the circuit during an inspiration from the ventilator.

1. The three elements that are necessary for a fire to occur are A) Fuel, flame, oxygen B) Oxygen, fuel, paper C) Fuel, ignition source, oxidizer D) Electrocautery, sparks, oxidizer E) None of the above

Answer: C In order for a fire to occur, the three elements, or fire triangle, that need to be present are a fuel source, an ignition source, and an oxidizer, which can include oxygen or nitrous oxide.

7. Which of the following statements are TRUE with regard to peripheral venous access? A) A tourniquet should never be used. B) A transducer should be set up. C) Ultrasound can be used to identify the vein. D) The FV can be used. E) All of the above are TRUE.

Answer: C In rare circumstances, a peripheral vein can be difficult to see or palpate. In these cases, ultrasound can be utilized to identify a vein. A tourniquet is almost always used to enlarge the vein so that it can be more easily palpated and cannulated. A transducer is used to monitor CVP and is not used for peripheral venous lines. The FV is part of the central circulation and is not considered a peripheral vein.

2. Which of the following would be suggested by the ASA practice guidelines for management of the difficult airway to establish ventilation if mask ventilation and intubation attempts have failed? A) Retrograde wire intubation B) Flexible fiberoptic intubation C) Laryngeal mask airway D) Blind nasal intubation

Answer: C In the situation where mask ventilation and intubation attempts have failed, the next step is LMA placement. If this fails or is unfeasible, emergency ventilation techniques such as Combitube or jet ventilation may be pursued. If the saturation is dropping very quickly, it may also be appropriate to move directly to an invasive airway. It is not suggested to spend additional time on alternative noninvasive techniques.

8. Which of the following would not be performed in the cardiac catheterization lab? A) Insertion of percutaneous VAD B) Closure of septal defects C) Catheter ablation D) Heart valve repair E) Heart valve replacement

Answer: C Insertion of percutaneous VAD, closure of septal defects, and heart valve repair/replacement are regularly performed in the cardiac catheterization lab. Catheter ablation is typically performed in the electrophysiology lab.

10. Manual analysis of the patient's rhythm by the medical team can occur A) During chest compressions B) Only when in a "synchronous" mode C) Only when the patient is not being moved D) Only when using an AED

Answer: C It is important to only analyze the patient rhythm after ensuring the proper leads/pads are connected to the patient and that interference is not occurring while the patient is being moved such as during chest compressions. Otherwise this may lead to health care providers inaccurately thinking the patient is in asystole during a disconnection or in VF/VT during excessive interference.

3. Risks associated with jet ventilation include A) Eye injury B) Burns C) Aspiration of gastric contents D) Infection E) Pain

Answer: C Jet ventilation is a nonintubating technique used for laser airway surgery when the surgeon wants a completely unobstructed view of the airway. Due to the high-pressure oxygen used to ventilate the patient, a risk of the procedure includes aspiration of gastric contents since the stomach may be inadvertently distended with air.

4. Which of the following is true about emergency jet ventilation? A) It is important to start the pressure low so that no trauma is caused to the lungs. B) A blender should be used to decrease the amount of oxygen to prevent lung damage. C) It should be performed through a large catheter placed in the cricothyroid membrane. D) It cannot be performed without a specific jet ventilator.

Answer: C Jet ventilation should be performed through a large catheter placed in the cricothyroid membrane. Wall pressure oxygen should be used initially. It may be administered with a jet ventilator (ideally) or by using equipment at hand. Oxygen toxicity from 100% oxygen will not manifest until several hours exposure.

4. Which item is NOT an indication of exhausted CO2 absorbent? A) Change in color of granules B) Increase in temperature of absorber C) Moisture in circuit D) Increased inspired CO2 E) None of the above

Answer: C Moisture is not an indicator of exhausted absorbent and is a natural by-product of the chemical reaction of most absorbents. All other indicators are regularly used to judge exhaustion.

1. Medications NOT commonly used in drug pumps include A) Vasopressors B) Heparin C) Antiemetics D) Muscle relaxants E) All of the above

Answer: C Most drugs with a short duration of action or whose action the provider would like to have come on and off rapidly are ideal to be given via infusion. Antiemetics are typically long-acting drugs (since preventing nausea is always a long term goal), and thus, they are not typically given via IV infusion.

3. Which involves the highest staff radiation exposure? A) MRI B) CT C) Neuroangiography D) Radiation therapy

Answer: C Neuroangiography, which is high-dose fluoroscopy (video shot with x-ray), and in which the anesthesia provider remains in the room with the patient, involves the highest staff radiation doses. MRI does not use ionizing radiation at all. CT uses high doses of radiation, but the patient is in a completely shielded room, and staff are not exposed. Radiation therapy involves the highest radiation doses but is also in a shielded room.

5. Which of the following is an opioid medication with a long half-life, appropriate for use at the end of a surgical procedure or in the recovery unit for postoperative pain? A) Sufentanil B) Remifentanil C) Morphine D) Alfentanil E) Fentanyl

Answer: C Opioids with a slower onset and longer half-life, such as morphine and hydromorphone, are commonly given toward the end of a procedure or in the recovery unit when a longer duration of action is desired.

3. Procedures carried out outside of the operating room include all of the below except A) Percutaneous insertion of a left ventricular assist device B) Insertion of an automatic cardiac defibrillator C) Removal of a pacemaker lead D) Insertion of a carotid artery stent E) Repair of a stenosed mitral valve

Answer: C Pacemaker leads are removed in the operating room because of the high risk of injury to the heart. All the others are performed in the out-of-OR setting.

7. A patient has received a "high spinal" and "sympathectomy" during the administration of spinal anesthesia when a high dose and concentration local anesthetic was inadvertently injected. The patient quickly becomes unconscious and vital signs reveal severe hypotension and bradycardia. The anesthesia provider provides bag-mask ventilation and then prepares for emergent intubation of the unresponsive patient. You expect this patient to have the following symptoms as a result of the noxious stimulation from emergency intubation: A) Severe hypertension due to unopposed sympathetic response. B) Severe tachycardia due to a surge in catecholamine release from the adrenal glands. C) Both hypertension and tachycardia as commonly occur during every intubation. D) No change in vital signs.

Answer: C Patients often experience a surge in sympathetic response during intubation yielding high blood pressure and possibly tachycardia. However, in this patient, the sympathetic response is obliterated and the parasympathetic response is unopposed and the patient will likely continue to suffer from severe hypotension and bradycardia. Very occasionally patients have bradycardia during laryngoscopy due to stimulation of cranial nerves IX and X; these parasympathetic nerves are unopposed in this patient, and it is actually possible the patient could have further bradycardia.

2. Polarographic and galvanic cells are two types of electrochemical cells used for oxygen analysis. Which of the following statements is true regarding the differences between polarographic and galvanic cells? A) Galvanic cells are sold as either reusable or disposable. B) Polarographic cells should be disposed of similarly to automotive batteries. C) Polarographic sensors are highly accurate but can be slow to respond to rapid changes in gas composition. D) Polarographic analyzers are thought to be more reliable than galvanic analyzers. E) None of the above (statements A-D are all false).

Answer: C Polarographic sensors are highly accurate but can be slow to respond to rapid changes in gas composition. Galvanic analyzers, however, are thought to be more reliable than polarographic analyzers. Polarographic cells are sold as either reusable or disposable, which will dictate how they should be disposed; galvanic cells should always be disposed of in a way that is similar to the disposal of automotive batteries.

4. The purpose of preoxygenation is A) To remove nitrogen from the lungs B) To improve baseline oxygen saturation C) To create a reservoir of oxygen in the lungs for consumption during apnea D) To demonstrate adequate mask seal and return of end-tidal CO2 E) All of the above

Answer: C Preoxygenation serves to prolong the time period to oxygen desaturation during apnea by lung volume with oxygen. Nitrogen in the lungs is removed during preoxygenation, but nitrogen itself is not inherently harmful; replacing the nitrogen with oxygen is the critical safety step. Baseline oxygen saturation may be improved with preoxygenation, but even the patient who has perfect baseline oxygen saturation does not have "extra" oxygen in the blood, compared to the large reserve of oxygen gas that the lungs can be filled with, and will benefit from a prolonged desaturation time during apnea after preoxygenation. While it is important to demonstrate a mask seal and competence of the end-tidal CO2 system, this is not the purpose of preoxygenation.

1. In which of the following situations is processed EEG monitoring most likely to be requested by an anesthesia provider? A) Monitoring a patient for carotid surgery B) Managing moderate sedation in the GI suite C) Monitoring a patient under total intravenous anesthesia for rigid bronchoscopy with muscle relaxation D) Monitoring a patient with elevated ICP for aneurysm clipping in the neuro IR suite

Answer: C Processed EEG monitors are useful as one of many components of monitoring for intraoperative awareness. Patients undergoing total intravenous anesthesia in whom monitoring of anesthesia gas is not possible, particularly if they must be paralyzed, are at particular risk; those patients may benefit most from a processed EEG monitor. Moderate sedation patients are not usually monitored with EEG. Carotid surgery patients often have standard EEG monitoring. Patients with elevated ICP require ICP and MAP monitoring to assist with CPP but do not usually require EEG monitoring unless requiring monitoring of sedation regimens to reduce CMRO2.

2. Radiation safety in the workplace involves three key principles: A) Personal protection, shielding, and dose reduction B) Structural shielding, lead, and eyewear C) Distance, time, and shielding D) Distance, shielding, and personal protection

Answer: C Radiation safety in the workplace involves three distinct principles: distance, time, and shielding. Increasing the distance from the radiation source; minimizing the time of exposure to the radiation: and placing an absorbent shield, either structural (part of the building) or personal protective equipment, between the radiation source and the person.

1. Which of the following statements about filling an isoflurane vaporizer with sevoflurane are TRUE? A) Agent monitors cannot detect different anesthetic agents. B) The output of the vaporizer would be unchanged. C) The output of the vaporizer would change. D) The vaporizer would not output any vapor. E) None of the above.

Answer: C Sevoflurane has a much lower vapor pressure than isoflurane. Each vaporizer is calibrated for the specific vapor pressure of the agent intended for the vaporizer. If the vaporizer is filled with an agent of a different vapor pressure, the output will differ from what is set on the dial. Agent monitors are specifically designed to detect the amount of agent in the circuit and are the best way to determine if there is a discrepancy between the dial setting and the vaporizer output.

4. The dispersive pad for an electrosurgery device A) Should be placed over the hairiest possible part of the body B) Should be placed over a patient's total hip replacement C) Should be placed over a well-muscled area such as the thigh D) Should be placed over a bony prominence E) Is not necessary most of the time

Answer: C The dispersive pad is an important piece of equipment to allow return of electrical currents from an electrosurgery unit. Good contact of the dispersive pad and a large surface area lower the current density and impedance to return of the current. Poor contact with the skin (e.g., dry gel, hairy body, incomplete contact from poor or repeated application) can all increase the impedance and reduce the area through which the current returns, thus increasing the current density. Patients may suffer burns if the current density is high enough. Bony prominences or metal objects in the patient can also concentrate the current, causing heating or burning.

2. Which of these would NOT be an initial step when an unusual NIBP reading is obtained during transport? A) The NIBP should be immediately recycled to get a new reading. B) The patient should be checked for the presence of a radial or carotid pulse. C) Vasopressor infusions and IV infusion rates should immediately be increased. D) The pulse oximeter should be checked for a pulsatile waveform.

Answer: C Since the NIBP may give unusual readings due to excessive movement, shivering, or compression of any part of the system, the NIBP should be immediately recycled when the monitor displays an unusual reading. It may take a minute to receive a new reading, so during this time, the patient should be assessed for adequate circulation and other monitors should be checked for possible hypotension: ECG (may show arrhythmia), pulse oximeter (often fails to work if systolic BP is <60 mm Hg), and CO2 waveform (will fall with decrease in cardiac output). Vasopressor infusions and IV infusions should be checked rather than reflexively increased. It is very easy to make an error either in monitoring or in vasopressor and IV infusion rates and changes should be made carefully during transport after confirmation.

1. The most common perioperative neuropathy involves which peripheral nerve? A) Median B) Sciatic C) Ulnar D) Obturator

Answer: C Studies have shown that a new perioperative ulnar neuropathy typically develops more than 24 hours after surgery. This finding, along with the discovery that 90% of patients with a symptomatic ulnar neuropathy in one arm have nerve conduction problems in the opposite, nonsymptomatic arm, suggests that patients may have abnormal but asymptomatic nerves before surgery, and a variety of factors during the perioperative period cause one or both ulnar nerves to become symptomatic.

4. With regard to probe manipulation during US-guided procedures, the mnemonic "PART" stands for A) Polarity, activity, response, timing. B) Power, arc, resonance, tension. C) Pressure, alignment, rotation, tilting. D) Positioning, access, reference, time. E) Procedure, access, rotation, traction.

Answer: C The "PART" mnemonic stands for pressure, alignment, rotation, and tilting. These are four attributes of the position of the US probe, which the operator can use to optimize ultrasound view of underlying structures. The other choices are random words starting with the same letters.

5. According to the ASA Guidelines on Monitoring, which of the following patient scenarios require temperature monitoring intraoperatively? A) Electroconvulsive therapy B) Ear tube placement under mask anesthesia C) A minimally invasive robotic prostatectomy D) A CT scan of the head with contrast

Answer: C The ASA standards for basic monitoring state that those undergoing general anesthesia must be monitored for temperature in cases greater than 30 minutes. A robotic prostatectomy will surely take longer than 30 minutes, so that the patient requires temperature monitoring. All the other cases listed are less than 30 minutes.

5. Which statement is true regarding the INR? A) It is measured by a TEG. B) It evaluates the body's ability to form clot as a whole dynamic process. C) It measures the adequacy of anticoagulation for patients taking warfarin. D) The blood sample must be drawn from an artery. E) None of the above.

Answer: C The INR is a measurement of a portion of the clotting cascade that is affected by warfarin. Thus, the INR is a common test for evaluating warfarin anticoagulation. The INR does not test the entire clotting process (e.g., another limb of the clotting cascade or platelet function). Blood samples for INR testing can be drawn from an artery or a vein.

3. The Pin Index Safety System is designed for which purpose? A) To prevent the gas hose from one gas to be connected to another B) To prevent the backflow of gas from one cylinder to another C) To prevent the placement of gas tanks onto the wrong yoke D) To allow the quick-release connection of gas hoses to the machine E) To allow any gas tank to be connected to any yoke on the machine

Answer: C The Pin Index Safety System ensures that each gas tank can only be attached to the specific gas yoke for which it was designed. The Diameter Index Safety System prevents one gas hose from being connected to another. They can only be attached to the specific gas line they are made for. The back-check valves prevent the flow of gas from one tank or gas line into another tank.

3. A three-lead EKG harness commonly consists of A) RA (white), LA (black), V (brown) B) RA (white), RL (green), LL (red) C) RA (white), LA (black), LL (red) D) RA (white), RL (green), V (brown) E) None of the above

Answer: C The RA, LA, and LL make up the common three-lead harness. The RL and V leads are added to make up the common five-lead harness.

4. Which of the following statements are FALSE regarding nondepolarizing agents? A) Examples of nondepolarizing agents include rocuronium, vecuronium, and cisatracurium. B) Nondepolarizing NMJ blockers are also called competitive blockers and are most commonly used in the operating room. C) Nondepolarizing agents are shorter acting and have a faster onset than depolarizing agents. D) Nondepolarizing agents can be reversed with anticholinesterases. E) All of the above are TRUE.

Answer: C The agent with the fastest onset and shortest duration of action is succinylcholine, which is a depolarizing agent. All of the other statements are true regarding nondepolarizing neuromuscular blockers. These agents are competitive antagonists for the ACh receptor on the motor end plate. To reverse the effects of these agents, the administration of an anticholinesterase will prevent the breakdown of ACh and allow it to outcompete the nondepolarizing agent for the ACh receptor.

4. A persistent nosebleed requires an intervention that requires intubation. Which of the following methods is likely the clinicians' first choice for placing an endotracheal tube in a patient with blood in the oropharynx? A) Pediatric fiberoptic bronchoscope B) Rigid video laryngoscope C) Laryngoscope and a Yankauer-tipped suction D) Bougie E) None of the above

Answer: C The laryngoscope and a Yankauer-tipped suction will provide the largest view and best suction. The fiberoptic scope's small lens is likely to become occluded by excessive blood in the oropharynx. Also, most fiberoptic scopes have limited suctioning ability, and depending on the rate of bleeding, they may prove usable due to inadequate blood clearance. A rigid video laryngoscope's lens may also occlude. A bougie is an option but is a "blind" technique and may be chosen as a backup plan after attempted visualization.

2. Which of these drugs should NOT be in a local anesthetic toxicity kit? A) Amiodarone B) Intralipid C) Vasopressin D) Epinephrine E) Succinylcholine

Answer: C The local anesthetic toxicity kit should include amiodarone, intralipid, propofol, succinylcholine, ephedrine, and epinephrine. Vasopressin should be avoided in cases of local anesthetic toxicity.

3. After surgery, a patient complains of numbness in the lateral hand and fourth and fifth finger, as well as being unable to firmly close their little finger against their thumb. Why does the motor dysfunction suggest a more significant ulnar nerve injury and a slower recovery time than a neuropathy with only sensory loss? A) The motor fibers are damaged more easily than sensory fibers. B) Sensory fibers heal more quickly than motor fibers. C) A more significant ischemic injury has occurred if the motor fibers deep in the ulnar nerve are affected. D) The motor fibers are more superficial on the ulnar nerve.

Answer: C The motor fibers of the ulnar nerve are typically buried in the core of the nerve and surrounded by the sensory fibers. Thus, an injury that impacts the motor nerve function usually involves the sensory fibers and also suggests that a significant ischemic event has occurred to the nerve.

3. Which of the following correctly describes the American Society of Anesthesia Technologists and Technicians (ASATT) recommendation for number of anesthesia technicians a site should have if liver transplants are being performed? A) One technician per four rooms B) One technician per two rooms C) Two technicians per room D) One technician per two areas E) One technician per four rooms during working hours

Answer: C The number of technicians recommended for a site depends on multiple factors. The case type(s) being done at a site strongly influences what the anesthesia providers will need. In general, it is desirable to have more technicians available when high-acuity cases are performed. It is also desirable to increase the number of technicians when more rooms are running simultaneously so that the needs of the anesthesia providers are adequately covered. Liver transplant anesthesia is an extremely high-acuity anesthesia case that would be very challenging to perform by one person working alone, due to multiple line placements, possible massive transfusion, possible need for TEE machine, cell saver, and POC lab testing. The ASATT recommendation of two technicians/technologists per room for liver transplant reflects the need for immediate knowledgeable assistance for the anesthesia providers.

4. Expiration time for reinfusion of processed, washed cells is? A) 6 hours if refrigerated B) 8 hours at room temperature C) 6 hours at room temperature D) 24 hours at room temperature

Answer: C The packaged cell salvage blood can be given immediately or within 6 hours.

4. Which of the following cannot be obtained by placing a pulmonary artery catheter (PAC)? A) Right atrial pressure (central venous pressure) B) Right ventricular pressure C) Left ventricular pressure D) Pulmonary artery pressure E) Cardiac output

Answer: C The parameters that can be obtained directly by placing a PAC are: Right atrial pressure Right ventricular pressure Pulmonary arterial pressure Pulmonary artery wedge pressure (represents left atrial pressure) Cardiac output With a special catheter, mixed venous oxygen saturation (SVO2) and continuous cardiac output (CCO) can be also obtained. Left ventricular pressure cannot be obtained from PAC.

6. Using the keypad, the following data may NOT be entered into the drug pump. A) Patient's weight B) Volume to be infused C) Patient's gender D) Desired dosage

Answer: C The patient's gender is not needed in order to utilize any drug pumps.

3. What are the two basic ways to block neuromuscular transmission at the neuromuscular junction? A) Presynaptically block receptor release; postsynaptically block ACh nicotinic receptors on the muscle end plate B) Presynaptically block ACh release; postsynaptically block ACh muscarinic receptors on the muscle end plate C) Presynaptically block ACh release; postsynaptically block ACh nicotinic receptors on the muscle end plate D) All of the above E) None of the above

Answer: C The presynaptic neuron releases ACh as the neurotransmitter, which then binds to nicotinic ACh receptors on the motor end plate of the muscle. Muscarinic ACh receptors are present in other parts of the body. Receptors are not released; they are present on cell membranes.

6. Vaporizers should A) Be checked for adequate agent prior to each case B) Have filler ports tightened after filling to prevent leakage C) Never be tipped D) B and C only E) All of the above

Answer: E Not only should the vaporizers be checked for adequate agent prior to each case but, after filling, the filler ports should be tightened. Vaporizers should never be tipped, as tipping may cause the internal wick to become saturated and the delivery concentration could become inaccurate.

3. Which of the following statements regarding tracheal intubation during pregnancy is FALSE? A) The rate of failed intubation is increased. B) Rapid sequence induction with cricoid pressure is usually used. C) The risk of airway complications is higher during emergence and recovery than induction. D) In the event of a failed intubation, the anesthesia provider will attempt to awaken the patient, given that the mother and fetus are not in immediate danger. E) After induction, maintenance of anesthesia is usually with an inhalational agent at one-half minimum alveolar concentration (MAC), with 50% nitrous oxide until delivery of the fetus, and then 70% nitrous oxide.

Answer: C The risk of airway complications is just as high during emergence and recovery as they are during induction. In pregnant women, the rate of failed intubation is increased. In the event of a failed intubation, the anesthesia provider will attempt to awaken the patient, as long as the mother and fetus are not in immediate danger. Rapid sequence induction with cricoid pressure is usually used; after induction, maintenance of anesthesia is usually with an inhalational agent at one-half MAC, with 50% nitrous oxide until delivery of the fetus and 70% nitrous oxide after delivery.

4. Identify the incorrect statement about obstetric emergencies. A) Magnesium is used to stop and prevent eclamptic seizures. B) You should begin preparation for management of massive hemorrhage if blood loss exceeds 700 mL after vaginal delivery or 1,200 mL after cesarean section. C) Pulmonary embolus is described as sudden cardiovascular collapse, cyanosis, mental status changes, or massive hemorrhage. D) Recent research suggests that for cases of amniotic fluid embolus, there may be an anaphylactoid response to amniotic material, rather than a mechanical obstruction of blood vessels. E) In the event of a cardiac arrest, the fetus should be delivered if a perfusing rhythm has not been reestablished after 4 minutes.

Answer: C The symptoms listed in (C) above describe amniotic fluid embolus, which is unique to pregnancy. Pulmonary embolus instead marked by chest pain, shortness of breath, or cardiac arrest.

2. Which of the following would NOT be needed during placement of a routine peripheral nerve block? A) Ultrasound machine with gel B) Sterile prep C) X-ray equipment (e.g., fluoroscopy) D) Basic monitoring equipment E) Peripheral nerve stimulator

Answer: C The vast majority of peripheral nerve blocks are placed using ultrasound, anatomic landmarks, or peripheral nerve stimulators to locate the nerve. X-ray equipment would be necessary under very rare circumstances. The placement of nerve blocks requires a sterile prep and sterile technique to reduce the incidence of infection. Basic monitors should be applied because these patients are often lightly sedated and to monitor for the effects of inadvertent intravascular injection.

4. Which of the following actions is the best course of action if the anesthesia technician is considering whether to bring a piece of equipment bearing the label seen below into the MRI scan room? missing A) It is permissible to bring the item into the MRI scan room as there are no contraindications for using the item in zone 3 or zone 4. B) The item is not MRI compatible; therefore, it should not be brought into the scan room. C) Consult with an MRI technologist to determine if it may be brought into the MRI scan room. D) Apply a magnet to the object to determine if it has ferromagnetic properties.

Answer: C This ASTM standard label is placed on an MR "conditional" item and indicates that the item may pose no hazard only if it is used within a specified MR environment. The MRI technologist must be consulted to determine if these requirements are met prior to bringing the item into zone 3 or zone 4.

5. US image formation at its most fundamental level involves a visual representation of the A) Direct measurement of the natural resonant frequencies of varying tissue compositions averaged over time. B) Indirect measurement of the electromagnetic waves emitted by movement of ions across cellular membranes. C) Generation of sound waves by a piezoelectric element, the reflections of which are measured by the element and processed by a computer. D) Direct measurement of microscopic oscillations of molecules, filtered through a white noise generator. E) Generation of low-intensity ionizing radiation that penetrates tissues of varying density in a characteristic pattern.

Answer: C This US image is a graphical representation of US waves that have been emitted from and received by the US transducer. The waves are generated by a piezoelectric element that vibrates when exposed to an electrical current. Waves are emitted for only a small percentage of the time, and the transducer is in the "receive" mode the majority of the time. The other choices are nonsense except for "E," which describes the physics underlying roentgenograms (also known as X-rays).

1. A patient needs to be intubated after a car accident. She has a suspected cervical (neck) spine injury. Which is the LEAST ideal device to use? A) Fiberoptic bronchoscope B) Rigid video laryngoscope C) Laryngoscope with MAC 3 blade D) Intubating LMA E) None of the above

Answer: C This approach requires visual alignment of the mouth with the vocal cords to obtain a direct view of the glottic opening. The head and neck will need to be manipulated, an unwise move after an injury to the neck. All the other choices do not require extensive neck manipulation and are therefore safer.

2. During a training session at the simulation center, the anesthesia technician is assisting the anesthesia provider with the positioning of a standardized live patient actor for an epidural placement. This is an example of ________fidelity and _______ technology simulation. A) high, high B) low, low C) high, low D) low, high E) This is not an example of simulation because it is being conducted with a real patient actor.

Answer: C This is considered high fidelity because the patient actor replicates a real patient very closely, but low technology because humans aren't considered technology. Human patient actors are frequently used to practice health and physical skills, communication skills, and team training.

2. A patient has a blood pressure of 128/60, a mean arterial pressure of 75 mm Hg, and an intracranial pressure of 22 mm Hg. What is the cerebral perfusion pressure, and how do you think the anesthesia provider will address it? A) CPP is low—provider should try to raise blood pressure and ICP. B) CPP is high—provider should try to lower blood pressure and ICP. C) CPP is low—provider should try to raise blood pressure and lower ICP. D) CPP is high—provider should try to raise blood pressure and lower ICP. E) None of the above options are correct.

Answer: C To calculate CPP, subtract ICP from MAP (75 − 22 = 53). This is low—cerebral perfusion pressures greater than 60 mm Hg are associated with better outcomes. To raise the CPP, the anesthesia provider should take steps to raise the patient's blood pressure and lower their ICP. Notably, it is important to note that this patient's ICP is high (normal values are 5-15), which is also associated with poor outcomes.

6. Identify the true statement: A) Intubated patients should have mechanical ventilators for transport. B) Anesthetized and critically ill patients cannot regulate their own body temperature, leaving them at risk for hyperthermia. C) ETTs, urinary catheters, IV lines, chest tubes, and arterial lines are at risk for being pulled out when moving a patient from one bed to another. D) Transport ventilators typically consume about the same amount of oxygen as manual ventilation. E) Invasive arterial line to continuously monitor a patient's blood pressure is typically used only for critically ill patients.

Answer: C Transferring a patient from the operating room table to the bed is one of the most hazardous moments in transport. It is imperative that ETTs, urinary catheters, IV lines, chest tubes, arterial lines, and any other monitors, lines, or drains are each accounted for and protected before a patient is transferred. Any can be accidentally pulled out, causing significant harm to the patient. With the exception of some patients with severe pulmonary disease, most intubated patients will be manually ventilated during transport. Although it is true that anesthetized and critically ill patients cannot regulate their own body temperature, they are at risk for hypothermia (decreased body temperature) rather than hyperthermia (increased body temperature). Transport ventilators may use oxygen both for ventilation of the patient and as a driving gas for ventilation bellows, resulting in higher oxygen demands than manual ventilation and possibly requiring an additional tank for transport. Arterial lines are commonly used to monitor surgical patients' blood pressure (not just the critically ill).

7. Why are O-negative patients considered universal donors? A) They have a lower hematocrit. B) They lack Rh (D) antigen. C) They lack antigens on their cell surfaces. D) They provide extra factor VII.

Answer: C Type O red blood cells do not carry antigens on their surfaces that the recipient could recognize as foreign. When red cells are transfused, it is the transfused red cell antigens into a patient with an anti-A or anti-B antibody that can cause a hemolytic reaction. Patients who have type A blood, for example, have anti-B antibodies that recognize B antigens as incompatible and cannot receive type B or AB blood cells. Type O blood cells carry no antigens and cannot cause an ABO reaction in any patient.

2. When are regional anesthesia procedures (epidural, caudal, and peripheral nerve blocks) performed in the course of a pediatric anesthetic? A) In the preoperative area with the child sedated. B) In the OR with the child sedated. C) In the OR after induction of general anesthesia. D) In the postanesthesia care unit (PACU) after surgery is completed. E) Regional anesthesia is not indicated for pediatric patients.

Answer: C Unlike adults, most children will not be able to understand or cooperate with regional anesthetic procedures being done awake or lightly sedated. Therefore, most will be performed safely under general anesthesia in the OR.

8. Match the stages of anesthesia on the left with the correct definition on the right: Stage 1 A) Excitation phase Stage 2 B) Cardiovascular and respiratory collapse Stage 3 C) Loss of consciousness Stage 4 D) Surgical anesthesia

Answer: C, A, D, B Stage 1 = C (time from administration of an anesthetic to loss of consciousness); stage 2 = A (commonly observed in the pediatric population); stage 3 = D (depth of anesthesia required for surgery); stage 4 = B (anesthesia crisis/overdose).

5. The five Rs include A) Right drug, right dose, right route, right concentration, and right pathway B) Right drug, right patient, right pathway, right dose, and right away C) Right drug, right dose, right route, right patient, and right time D) Right drug, right patient, right time, right route, and right concentration E) None of the above

Answer: C.

1. When care is being provided for the CIED patient undergoing surgery, the anesthesia technician or technologist should do all of the following EXCEPT: A) Set up the ECG monitor to detect pacing activity ("spikes"). B) Ensure that a magnet is readily available. C) Ensure that temporary pacing and defibrillation equipment is readily available. D) Offer to assist with magnet placement as part of placing monitors on the patient. E) Anticipate that an anesthesia provider might choose not to make any changes in a patient's management as a result of their CIED.

Answer: D "Blind" placement of a magnet over a CIED is not recommended and may have undesired effects. It is important for the anesthesia technician or technologist to ensure that appropriate monitoring and emergency equipment is immediately available. Not all procedures involve EMI risk to a CIED, and many anesthesiologists may proceed without any changes to a CIED in minor procedures, procedures remote from the heart and pacemaker generator, or procedures performed without EMI.

1. You are called into the operating room (OR) and told that the pulse oximeter is broken. You look at the monitor and see that the reading is lower than expected with little, if any, waveform present. Which of the following is unlikely to be causing the problem? A) Cold body part B) Vasospasm C) Reduced cardiac output D) Broken pulse oximeter E) Overinflation of blood pressure cuff proximal to pulse oximeter

Answer: D A broken pulse oximeter, or one which has fallen off, is a frequent problem, but other problems must be ruled out as well. Alarm fatigue is a frequent problem with pulse oximetry. A pulse oximeter which needs to be replaced is an unlikely cause of a poor, nonpulsatile waveform. Poor perfusion to the extremity is the most likely cause of a poor, nonpulsatile waveform. All these could be causes of poor perfusion.

2. A fire in the operating room requires three components: A) Match, plastic, and oxidizer B) Ignition source, plastic, and nitrous oxide C) Fuel, nitrous oxide, and explosives D) Fuel, oxidizer, and ignition source E) Oxidizer, ignition source, and helium

Answer: D A fire requires three essential components: fuel, an oxidizer, and an ignition source. Lasers may act as an ignition source during laser surgery, and safety measures must be taken to minimize the risk of an operating room fire by eliminating fuel sources or oxidizers. These safety measures include the use of nonflammable objects near the treatment site and the attempt to minimize the use of supplemental oxygen during laser surgery of the neck, head, and face.

6. To be an effective anesthesia breathing system, a device must have A) A large reservoir B) Low resistance C) Low dead space D) All of the above E) None of the above

Answer: D A large reservoir, low resistance to airflow, and low dead space are all key design features of an effective anesthesia circuit.

6. What three components are required to create a laser? A) Power source, mirrors, and a fiber B) Active medium, mirrors, and a fiber C) Power source, concentrator, and mirrors D) Power source, active medium, and mirrors

Answer: D A laser is produced by energizing an active medium with a power source. Mirrors then channel and amplify the energy produced into the emitted light.

3. In which scenario would a face tent or shovel mask would be most appropriate? A) In a patient with a significant amount of airway secretions B) In a patient in need of positive pressure ventilation C) In a patient with a known airway obstruction D) In a delirious/confused patient

Answer: D A standard face mask would be more reliable for oxygen delivery. Compared to a face mask, which can cause some level of discomfort around the nose and mouth, a shovel mask would be more likely to be better tolerated by a delirious patient. Of the options listed, a shovel mask would provide supplemental oxygen with minimal discomfort around the face including the nose and mouth.

7. Which of the following tests are not available on POC machines in the OR? A) Blood glucose B) INR C) ACT D) Type and screen E) Thrombelastography (TEG)

Answer: D A type and screen is a specialized lab test to determine the ABO type and Rh factor of the blood. It is performed in the main laboratory and can take as long as 45 minutes to perform.

1. To adjust the brightness of the US image, which of the following controls on the US machine should be adjusted? A) Frequency B) Focus depth C) Depth D) Gain E) Focal zone

Answer: D Adjusting gain affects the brightness of the image. Gain may be adjusted overall or in specific areas of the image (near/far, TGC, or LGC). The other choices can all be adjusted on most US machines and are useful to optimize image quality, but they do not directly affect the brightness of the US image.

8. Which of these regarding transfusion tubing is false? A) Most tubing filters are designed to transfuse 2-4 RBC units before they need changed. B) The tubing in the OR typically has a Y connector with two separate "spikes" so that a unit or fluid can be prepared on one spike while the other is being actively used for transfusion or fluid administration. C) Some pediatrics sets come with buretrol in which the provider can measure out a specific amount of blood product or fluid. D) After multiple RBC units have been transfused, the entire tubing setup should be replaced so as to prevent possible machine malfunctions. E) In-line heated tubing is used to warm the blood products during transfusion.

Answer: D After multiple RBC units have been transfused, only the filters need to be replaced; the tubing setup can remain in place. Most tubing filters are designed to transfuse 2-4 RBC units before they need changed, but since specifications can change by manufacturer, you should know how much RBC units can be transfused before the filters you're using need changed.

3. Which of the following statements are true in regard to the TEG? A) The TEG measures time to clot formation in seconds. B) The main advantage of the TEG compared to ACT is that heparin or citrated blood does not affect the results. C) The TEG does not evaluate the integrity of platelets on the clotting process. D) Excessive agitation of the blood sample can cause premature clot formation. E) All of the above.

Answer: D Agitation of the sample can cause premature clot formation and is a common source of errors with TEG measurements. The TEG results are plotted on a graph and not reported as a time. One of the advantages of the TEG is that it measures platelet function.

5. The most common triggers of anaphylaxis under anesthesia are A) Latex, propofol, and muscle relaxants B) Muscle relaxants, iodine prep, and antibiotics C) Antibiotics, latex, and iodine prep D) Muscle relaxants, antibiotics, and latex E) Antibiotics, latex, and narcotics

Answer: D All of the above substances have been reported to cause anaphylaxis in the perioperative period. However, statistically, muscle relaxants, antibiotics, and latex accounted for the majority of the cases.

3. You know that the cell for an electrochemical sensor must obtain a stable temperature in order for calibration to be accurate. At most, how long should you prepare for the cell to warm up? A) 5 minutes B) 15 minutes C) 30 minutes D) 45 minutes E) 60 minutes

Answer: D Although some monitors may only take a few minutes to warm up, some older models can take up to 45 minutes to obtain a stable temperature. A stable temperature must be reached for calibration to be accurate.

1. The first modern cell salvage machines were made available in what time period? A) 1870s B) 1920s C) 1940s D) 1970s

Answer: D Although the idea of reinfusing surgical blood has been around since the early 1800s, devices were not developed until the 1940s. Even then the machines needed further refinement and the machines we now recognize as "cell saver" machines were not released until the 1970s.

5. Which of the following correctly describes the American Society of Technologists and Technicians (ASATT) recommendation for expected anesthesia technical coverage for the operating rooms at a hospital designated as a level 1 trauma center? A) In house coverage during working hours, on call coverage 6 hours/night B) In house coverage 16 hours per day, on call coverage 8 hours per night C) On call coverage 24/7, 365 days per year D) In house coverage 24/7, 365 days per year E) None of the above

Answer: D Anesthesia technical staffing need depends in part on the acuity of cases being performed. A level 1 trauma center can accept any case at any time of the day and as such can need immediate anesthesia technical help. For this reason, it is recommended to have anesthesia technical coverage in house at all times at a level 1 trauma center.

5. Dead space is best described as A) The volume of gas inspired and expired by the patient B) The endotracheal tube C) The inspiratory limb of the circuit D) Any space where inhalation and exhalation coincide E) All of the above

Answer: D Any space where expired gas is not replaced by fresh gas can be considered dead space. When using a circle system, this can be any part of the circuit distal to the y-connection where the inspiratory and expiratory limbs come together.

1. Nonintubating techniques available for laser surgery of the airway that remove the fire potential of an ETT include all EXCEPT A) Apneic oxygenation B) Spontaneous ventilation C) Venturi jet ventilation D) Laryngeal mask airway (LMA™) E) None of the above

Answer: D Apneic oxygenation, spontaneous ventilation, and Venturi jet ventilation represent available nonintubating techniques for laser surgery of the airway. They minimize the risk of fire during laser surgery of the airway while allowing direct visualization of the airway. Although a laryngeal mask airway can be used as an alternative to endotracheal intubation, it does not allow direct visualization of the airway due to its position in the oropharynx.

4. Which tasks and items are not commonly relocated outside the physical space of the anesthesia workroom when space is limited? A) Ordering of supplies B) Stocking of carts C) Storage of large (TEE machines) and medium size (bronchoscope) equipment D) Storage of disposable equipment (endotracheal tubes, IV catheters) E) Morning huddle of staff to plan day

Answer: D As you have seen throughout this chapter, the term "anesthesia workroom" encompasses both a central physical space housing anesthesia equipment awaiting deployment and a virtual pool of available anesthesia technical resources for deployment; equipment, personnel on hand, and reserves of personnel and planning for the future. This virtual workroom includes the work of inventory, ordering, stocking, turnover, and restocking of rooms; planning disposables and large capital investments in equipment; and hiring, training, and development of personnel. Ideally, the virtual workroom occupies a large, central, physical space, which can accommodate most of its work and personnel. This ideal is seldom achieved, and one of the manager's tasks is to allot the limited space to the tasks at hand.

5. How frequently should a defibrillator and the associated equipment be tested for functionality? A) Monthly B) Weekly C) Daily D) At the change of every shift E) Only after they have been used

Answer: D Because of the lifesaving nature of this equipment, most institutions require that it be checked at every shift change. In addition, a record of the testing results should be kept in a log.

3. What is the typical cost of a standard new TEE machine? A) $20,000 B) $40,000 C) $100,000 D) $200,000 or more E) None of the above

Answer: D Brand new full-size TEE machines can cost upward of $200,000.

7. Rebreathing may be influenced by which of the following factors? A) Dead space B) The arrangement of the circuit assembly C) Fresh gas flow D) All of the above E) None of the above

Answer: D By increasing the size of the dead space, you increase the amount of rebreathed gas. By decreasing the fresh gas flow, the amount of expired gas washed from the circuit decreases and by changing the arrangement of the circuit, you can alter both these factors.

4. Which of the following diseases is not caused by a virus? A) West Nile encephalitis B) Ebola C) HIV/AIDS D) Cellulitis E) The common cold

Answer: D Cellulitis infections are generally bacterial.

1. Which of the following statements concerning administration of anesthesia in an OOR location is not true? A) Monitoring standards for patients being anesthetized in OOR locations are identical to the ASA standards used in the OR. B) Anesthetic equipment left in OOR sites may be missing essential items and should be checked thoroughly before every case. C) OOR technical staff may be less familiar with anesthetic procedures than are main OR personnel. D) Code carts are not required as codes rarely occur. E) Neither wall suction nor wall oxygen is necessary for a room to be an anesthetizing location.

Answer: D Codes are uncommon in OOR locations; however, they may occur and a code cart must be present within the OOR location. All staff must know where the code cart is and be familiar with resuscitation protocols. ASA standards for the administration of anesthesia are the same everywhere regardless of the target level of anesthesia or sedation. Suction and oxygen are both required to provide anesthesia, but both can be supplied portably.

4. Of the following medications, which prevents, but does not treat, postoperative nausea and vomiting (PONV)? A) Ondansetron B) Promethazine C) Scopolamine D) Dexamethasone E) Droperidol

Answer: D Dexamethasone prevents, but cannot treat, PONV. Scopolamine treats and prevents PONV but because of its transdermal route, it is delayed significantly in onset, making it best for placement in the preop area. However, if a patient is in the PACU with intractable vomiting, placement of a scopolamine patch may well be of assistance, even if the onset is delayed. (The patient will still need effective antiemetic therapy on board 2 hours later, especially for a nauseating drive home.) Promethazine and droperidol are both dopaminergic antagonists that can be used for prevention or treatment; a primary difference between the two is that droperidol is currently under an FDA "black box warning" advising that it may be high risk for causing arrhythmias. Ondansetron is a 5-HT3 receptor antagonist. This class of medications blocks a subtype of the serotonin receptor, and can be used to prevent or treat PONV.

1. Which of the following medications is commonly administered for procedural sedation when ventilation is a concern, due to its ability to produce sedation without significant respiratory depression? A) Etomidate B) Propofol C) Fentanyl D) Dexmedetomidine E) Methohexital

Answer: D Dexmedetomidine is a highly selective alpha2 agonist. A key property of this medication is its ability to produce sedation without significant respiratory depression, making it a popular choice for procedures like awake fiberoptic intubation.

2. Dexmedetomidine is used for providing sedation for procedures A) Only in cardiac cases B) When the surgeon or endoscopist wants the patient deeply sedated C) For procedures that are not painful, but amnesia is very important D) Where preservation of respiratory function is important E) Only in the ICU

Answer: D Dexmedetomidine is a unique sedative that produces analgesia and sedation without respiratory or significant cognitive depression and without amnesia. It is well validated in the ICU but is not used exclusively there. Patients properly sedated with dexmedetomidine are sedated but cooperative. It does not cause cardiac dysfunction and can be good for cardiac patients because of its preservation of breathing, but it can cause heart rate slowing and drops in blood pressure.

9. Which of these are true regarding catheter ablation procedures? A) Patients are required to be completely still, so anesthesia providers usually opt for general anesthesia. B) During this procedure, the cardiologist will attempt to use electrical impulses to convert the patient to normal rhythm. C) This procedure is relatively short, lasting about 2-3 hours. D) A catheter is used to damage the part of the conduction pathway responsible for the abnormal rhythm, usually with heat.

Answer: D During catheter ablation, the cardiologist will identify the part of the heart responsible for the abnormal rhythm and will use a catheter to heat and damage this area, thus interrupting the pathway and preventing abnormal rhythm. Patients are typically able to handle this procedure with sedation, although some patients may struggle with the length of the procedure (highly variable but possibly up to 8 hours). The cardiologist may induce arrhythmias to identify the aberrant part of the heart. Cardiac ablation is performed in the electrophysiology lab.

2. A woman in labor has an epidural catheter and is being prepared for a cesarean section delivery, when she begins complaining of ringing in her ears. You should be most concerned that what is occurring? A) Epileptic seizure; ringing in the ears is a symptom of seizures B) High spinal, because the epidural catheter may be intrathecal C) Hypotension, because the block is setting up quickly D) Early signs of local anesthetic systemic toxicity (LAST), because the epidural catheter may be intravascular E) Cardiac arrhythmia due to local anesthetic

Answer: D Early symptoms of local anesthetic toxicity include tingling in the lips and ringing in the ears. LAST may develop into seizures secondary to CNS toxicity, arrhythmias, or cardiac arrest. Signs of high spinal are hypotension, bradycardia, breathing difficulties and/or apnea, and loss of consciousness. Hypotension often causes nausea and/or vomiting.

6. Choose the statement that is FALSE: A) Allergic reactions can occur anytime a patient is exposed to a drug. B) Histamine release can cause vasodilation and hypotension. C) True anaphylaxis involves IgE antibodies. D) Epinephrine acts to destabilize mast cells, affecting their ability to degranulate. E) Vasopressin is useful in treating the hypotension associated with anaphylaxis if the patient is unresponsive to epinephrine.

Answer: D Epinephrine acts to "stabilize" mast cells and prevent further degranulation of mast cells. All of the other statements are true.

6. Nitrous oxide A) Was the first successful demonstrated anesthetic in 1846 B) Is used for maintenance of anesthesia but not induction C) Is chemically related to the other inhalational anesthetics D) Cannot be delivered during patient transport E) All of the above

Answer: D Ether was the first successful demonstrated anesthetic in 1846: nitrous oxide, though attempted earlier, was unsuccessful because it was not potent enough for surgery when used by itself. Nitrous oxide is often used as the initial anesthetic induction gas because it is odorless. The inhalational anesthetics, including nitrous oxide, are chemically very different from one another, and their molecular mechanisms are not well understood. Nitrous oxide must be mixed with oxygen for safe delivery: this mixing in the high-pressure system happens in an anesthesia machine and cannot be done in transport.

3. The expiration of propofol drawn up in the OR is A) 2 hours B) 4 hours C) 6 hours D) 12 hours E) 24 hours

Answer: D Even though the propofol on the market today has added preservatives, it is an emulsion and can support bacterial growth. Once it is opened and drawn up, even using aseptic technique, it must be used within 12 hours. Propofol syringes should be properly labeled, including the time and date the drug was prepared.

7. Which of the scenarios below is LEAST likely to result in EMI? A) A patient is given succinylcholine for muscle relaxation. B) A patient undergoes a radiofrequency ablation procedure to minimize nerve pain. C) A patient who complains of feeling cold. D) A patient undergoing a CT scan to obtain images of their lungs. E) A patient who has been given external defibrillation.

Answer: D Factors that have been recognized to cause EMI during the perioperative period include Bovies, nerve stimulators, evoked potential monitors, fasciculations (e.g., succinylcholine), shivering (e.g., from being cold), external defibrillation, MIR, radiofrequency ablation, extracorporeal shockwave lithotripsy, electroconvulsive therapy, and radiofrequency identification. Ionizing radiation is not commonly a cause of EMI, and CT is a common alternative to MRI if providers are concerned about pacemaker malfunction.

2. The most common cause of improper delivery of oxygen to the patient is A) Improper gas cylinder connected to the machine B) Crack in oxygen flow tube C) Crossing of gas supply from the wall D) Disconnection of circuit from the patient E) Incompetent inspiratory flow valve

Answer: D Failure to properly deliver oxygen to the patient is most commonly caused by a disconnection in the patient circuit. Although improper gas cylinder connected to the machine, crack in oxygen flow tube, and crossing of gas supply from the wall can cause problems with delivery of oxygen, these are much less common causes. An incompetent inspiratory valve can lead to elevated baseline levels of carbon dioxide, but it should not cause poor oxygenation.

5. Which joint maneuver increases the risk of an obturator neuropathy in a patient who is placed in a lithotomy position? A) Hip flexion greater than 90 degrees B) Trendelenburg position C) Lumbar hyperextension D) Hip abduction for greater than 30 degrees

Answer: D Hip abduction results in significant strain on the obturator nerve as it crosses the pelvic rim and passes through the obturator foramen. With hip abduction, the superior and lateral rim of the foramen serves as a fulcrum, compressing the nerve. Abduction beyond a patient's normal range of motion (e.g., typically >30 degrees) may also stretch the nerve. Hip flexion greater than 90 degrees increases the risk of a neuropathy not in the obturator but in the lateral femoral cutaneous (and, less commonly, femoral) nerves, which can be compressed as they pass through the inguinal canal. Trendelenburg position places patients at risk for slipping on the operating room table, for upper extremity neuropathies if cervical stretch occurs or arms slip, and for airway edema if this is for a prolonged period, but not specifically for obturator neuropathy. Lumbar hyperextension stresses the lumbar spine and can cause spinal cord ischemia.

6. Which of the following statements is true? A) The anesthesia provider cannot stay in the scan room because it will damage their hearing. B) Standard IV tubing can be used in the MRI suite as long as it is checked for patency before the scan is started. C) A standard anesthesia cart can be used in zone 2 of the MRI suite. D) Standard anesthesia monitors can be used in zone 2 of the MRI suite.

Answer: D IV tubing must be checked to ensure that no loops are present which can heat up due to magnetic fields and that tubing is not in direct contact with patient skin. ASA standards permit the anesthesia provider to leave the MRI scan room provided that visual contact with the patient is maintained along with all other standard monitors. However, the anesthesia provider may choose to remain in the scan room with hearing protection. Zone 2 of the MRI suite is not an area where RF interference with pumps or monitors is likely or where ferromagnetic projectiles pose a hazard. However, the anesthesia cart is mobile as are its components, and use of ferromagnetic materials in this area is high risk and not considered best practice. Monitors that do not travel into zone 4 with the patient can be used outside the 5 G line.

5. The following steps should all be performed if a problem with the central gas supply is suspected in a room, EXCEPT A) Open the oxygen cylinder on the back of the machine. B) Alert the OR front desk. C) Disconnect the wall supply from the machine. D) Ventilate the patient with a separate circuit. E) All should be performed.

Answer: D If a central pipeline crossover is suspected, the oxygen tank should be opened and the pipeline supply disconnected. If the pipeline supply is not disconnected, gas from the tank won't be used. If oxygen levels are restored by this change, it is critical to alert the appropriate hospital staff to avoid further serious adverse events. There is no need to change to a separate circuit once a proper oxygen source is connected to the machine.

6. During volume control ventilation, the mechanical ventilator reads a high inspiratory pressure that is above the predetermined P-max, causing the ventilator to stop delivering positive pressure and sound an alarm. Which of the following should be done? A) The ventilator should be set to deliver a lower fixed tidal volume. B) The ventilator should be switched to a PRVC mode. C) PEEP should be turned on; if it is already on, the respiratory rate should be lowered. D) The provider should momentarily pause mechanical ventilation. E) The provider should switch to manual ventilation while the anesthesia technician troubleshoots the ventilator.

Answer: D If the inspiratory pressure is above the predetermined P-max during volume control ventilation, the provider should switch to manual ventilation of the patient while the anesthesia technician troubleshoots the ventilator. In this situation, the compliance of the circuit has markedly changed, indicating a dramatic change in patient condition, tube malposition, partial or complete tube occlusion, or ventilator failure. Although the anesthesia provider may momentarily pause the mechanical ventilator for nonparalyzed patients who are coughing or straining, doing so to address the very high inspiratory pressure would not be appropriate.

3. You are called into a room where the anesthesia staff complains that the airway pressure continues to rise in a relaxed patient with regular breath sounds. Which of the following problems with the machine could be causing this? A) A kink in the scavenging transfer means B) A faulty positive-pressure release valve in the scavenging system C) An incompetent pressure relief valve in the ventilator D) A and B E) All of the above

Answer: D If the scavenging transfer means is kinked, excess gas cannot be vented from the circle system to the scavenging system and barotraumas can occur from elevated airway pressures. This can also occur if flows are high in the system and the positive-pressure release valve does not function properly to vent the excess gas. An incompetent pressure relief valve in the ventilator will allow gas that is compressed by the ventilator to escape into the scavenging systems and would cause lower airway pressures and a leak in the circuit.

1. Which organization(s) was involved in developing the 1993 Anesthesia Apparatus Checkout Recommendations? A) FDA B) American Medical Association (AMA) C) ASA D) A and C E) All of the above

Answer: D In 1993, a joint effort between the American Society of Anesthesiologists (ASA) and the U.S. Food and Drug Administration (FDA) resulted in the 1993 FDA Anesthesia Apparatus Checkout Recommendations. The ASA is the principal body making safety recommendations in anesthesia, and the FDA is responsible for medical device regulation in the United States.

3. The most conservative approach to a difficult intubation is A) Direct laryngoscopy B) Rigid video laryngoscopy C) Awake flexible fiberoptic intubation D) Awake tracheostomy E) None of the above

Answer: D In experienced surgical hands, this procedure rarely fails and rarely results in hypoxia. As it results in a permanent scar, it is reserved for the most difficult airways, but is the most conservative approach. Direct laryngoscopy is the most common intubation procedure performed but carries a failure rate of about 6% in the predicted difficult intubation. Rigid video laryngoscopy likely has a higher success rate in the predicted difficult intubation, but failures still occur at a rate of 1%-3%. Awake flexible fiberoptic intubation is a conservative airway management approach but requires a skilled anesthesiologist, a cooperative patient, and good airway topicalization. However, a patient may still suffer hypoxia, aspiration, or laryngospasm during the performance of this technique.

2. In which of these situations is it okay to continue placement of the probe? A) Moderate resistance to probe insertion despite maneuvers. B) On checking the knobs, the tip of the probe does not move. C) The probe insertion pins do not match up with the TEE machine insertion ports. D) The provider has to pull the jaw forward to allow the probe to pass into the esophagus. E) A patient has limited mouth opening and history of neck radiation.

Answer: D In option A, when the probe is difficult to insert despite helpful maneuvers, do not force probe insertion. Option B is an example of a broken probe and should not be inserted into the patient. In option C, the probe type and machine likely do not match one another or require an adapter. Option E is incorrect because TEE is relatively contraindicated in patients with limited mouth opening and neck radiation. Option D is correct; pulling the jaw forward gently can safely open space in the hypopharynx for the probe to pass.

2. You are paged to the operating room to assist in a case. The anesthesiologist tells you that they are "putting monitors on." What is likely to be the NEXT event? A) The start of surgery B) Administration of intravenous induction agents C) Informed consent for anesthesia D) Placement of the breathing circuit and mask for preoxygenation E) Placement of vascular access

Answer: D Informed consent for anesthesia is typically obtained before patients are transported to the operating room, as is (in adult or cooperative patients) vascular access. Monitors are placed once the patient is positioned on the operating room bed. After this, the patient is preoxygenated to create a reservoir of several liters of oxygen in the lungs prior to induction of anesthesia.

3. Piped gas pressure should be A) 20-25 psig B) 30-35 psig C) 40-45 psig D) 50-55 psig E) Greater than 55 psig

Answer: D It is important to check for adequate pipeline supply pressure for all gases connected to the anesthesia machine. Although failure of pipeline pressure is rare, it can affect the delivery of gases to the patient and function of the ventilator.

10. During cardiac arrest due to local anesthetic toxicity, the anesthesia technician should do the following, EXCEPT: A) Call for help B) Be prepared to begin high-quality chest compressions C) Bring lipid infusion D) Bring rapid transfusion device(s)

Answer: D LAST is not associated with the need for rapid transfusion unless there is a concurrent source of blood loss.

5. Which of the following is NOT an advantage of mechanical ventilation? A) It allows precise control of tidal volumes. B) It allows precise control of minute ventilation. C) It allows the anesthesia provider to perform other tasks without manually ventilating. D) It prevents patients from trying to initiate spontaneous breathing. E) It allows fine adjustment of inspiratory and expiratory pressures.

Answer: D Mechanical ventilation can allow the anesthesia provider to control tidal volumes, respiratory rate, minute ventilation (rate × tidal volume), inspiratory pressure, and expiratory pressure. It also does not require the anesthesia provider to squeeze the bag for each breath and can free her or him up to perform other tasks. However, just because a patient is anesthetized or on a mechanical ventilator does not mean that the patient cannot attempt to breathe on his or her own: respiratory efforts are not blocked by some anesthetics. Patients can also "overbreathe" the ventilator as they attempt to take breaths during mechanical ventilation, which might prompt the anesthesia provider to change the mode to pressure support ventilation to augment the patient's breathing efforts.

3. Which of the following sedative-hypnotic medications decreases the threshold for seizure activity and is therefore commonly used for sedation in electroconvulsive therapy (ECT)? A) Midazolam B) Valium C) Dexmedetomidine D) Methohexital E) Thiopental

Answer: D Methohexital is one of the few sedative-hypnotic medications that decreases the threshold for seizure activity; therefore, it is commonly used to produce hypnosis for ECT.

2. The majority of modern vaporizers have the following characteristics EXCEPT A) Agent specific B) Variable bypass C) Temperature compensated D) In-circuit E) Flow over

Answer: D Modern vaporizers are placed such that the agent is introduced into the system prior to the common gas outlet. Very old vaporizers injected agent directly into the breathing circuit (in-circuit design). All of the answers describe features of modern vaporizes.

2. On a monophasic manual external defibrillator, the optimal dose for defibrillation of an adult patient is A) Device specific B) 120 J C) 200 J D) 360 J E) None of the above

Answer: D Monophasic defibrillators should be set to 360 J for defibrillation. Biphasic defibrillators should be set to the manufacturer's suggested energy level, which is usually between 120 and 200 J.

2. Which of the following is an indicator of an MH crisis? A) Jaw muscle relaxation B) Low end-tidal CO2 levels C) Bradycardia D) Cola-colored urine E) Symptoms that begin 2 days after surgery

Answer: D Muscle breakdown in an MH crisis releases the muscle protein myoglobin into the bloodstream where it is filtered by the kidneys. This can turn the urine a brownish color. Jaw muscle rigidity, tachycardia, and high end-tidal CO2 levels are signs of MH. Although MH can present in the recovery room, it is rare. Most late cases of MH present within an hour of surgery.

9. Protected health information (PHI) includes all of the following, EXCEPT: A) Medical record number B) Phone number C) Photograph D) Religion

Answer: D PHI is any information that may lead to identification of the individual. Therefore, broad demographic information such as race or religion are not, by themselves, PHI, since we would not be able to identify an individual by this information alone.

7. Which is the primary reason to pad peripheral nerves when positioning patients? A) The pad improves blood flow. B) The pad limits stretch of the nerve. C) The pad decreases stretch on the nerve. D) The pad distributes point pressure.

Answer: D Padding typically is used to distribute and disperse point pressure from hard surfaces. This dispersion of pressure reduces the risk of compressive injury to peripheral nerves. There are no studies that indicate any specific type of padding (e.g., gel, form, or other padding materials) to be any better than the others. The key is to distribute point pressure broadly or avoid pressure on a peripheral nerve entirely.

2. Which of the following is TRUE regarding piston-driven ventilators? A) Pressurized gas drives movement of the piston. B) They are unable to work in pressure support mode. C) They require wall outlet electricity to be functional at all times. D) They require a servo-controlled valve that prevents the circuit pressure from exiting to the scavenging system during inspiration. E) None of the above.

Answer: D Piston control ventilators use a motorized drive to move the piston and deliver the breath. Bellows control ventilators, not piston control, use pressurized gas to collapse the bellows and deliver a breath. Piston control ventilators require electricity to drive the piston, but this can come from either a wall outlet or the internal battery. All anesthesia machine ventilators must have a mechanism to prevent a positive-pressure breath from escaping into the scavenging system instead of being delivered to the patient. Piston control ventilators have a servo-controlled valve that is triggered at the same time the piston is triggered, and which shuts off flow to the scavenging system.

7. Which lethal pathogen cannot be disinfected with standard methods? A) Fungi, because they exist in multiple forms B) Viruses, because they can be airborne C) Gram-positive bacteria, because they have a thick cell wall D) Prions, because they are not cells and do not contain DNA

Answer: D Prions are unique transmissible infectious agents composed only of protein. They cause incurable, fatal neurologic diseases. Because they are neither cellular nor made of DNA, prions do not respond to standard disinfection or even sterilization techniques. Contaminated instruments and blood products can lead to infections. Even the possibility of prion disease requires specialized handling of all instruments and everything in the environment of the patient.

1. Which of the following statements is FALSE regarding spinal anesthesia? A) For placement, the patient is placed in the sitting or lateral position. B) The needle is placed at the level of the lumbar spine. C) The patient should have basic monitors placed prior to the injection of local anesthetic. D) The spine should be as straight as possible to facilitate needle placement. E) A "high spinal" may result in severe hypotension or apnea.

Answer: D Proper positioning of the patient is important to facilitate needle placement. The space between the spinous processes can be very small. Having the patients arch their back can open the space and make proper placement of the needle easier. All of the other statements are true. Spinal needles are usually placed in the lower lumbar spine because the spinal cord usually ends above this level. If the needle is placed in the lower lumbar region, the risk of injuring the spinal cord is reduced. Because of the potential for hypotension even with properly placed blocks, and the risk of apnea and major cardiovascular changes with a high spinal, all patients should be monitored during block placement.

3. The American Society of Anesthesiologists recommends that propofol A) Should only be used for deep sedation B) Should only be used for induction and maintenance of general anesthesia C) Should only be used with a controlled infusion D) Should only be used by an anesthesia provider

Answer: D Propofol is used both for sedation and for induction and maintenance of general anesthesia. It can be given by bolus or infusion; it is usually titrated by infusion for sedation, but this is not a requirement. The ASA does recommend that it be given by an anesthesia provider given the high risk of hypotension and apnea associated with the drug.

9. Research has shown that for every minute defibrillation is delayed, survival decreases by A) 1% B) 2%-3% C) 4%-6% D) 7%-10%

Answer: D Research has shown that survival is decreased by 7%-10% for every minute defibrillation is delayed.

5. Which of the following often requires intravenous anesthesia and neuromonitoring? A) Surgery for children under 4 years old B) Ventriculoperitoneal (VP) shunt for hydrocephalus C) Pediatric cardiac surgery D) Scoliosis surgery E) Surgery for congenital diaphragmatic hernia

Answer: D Scoliosis surgery, because of the risk of traction or other damage to the nerves of the spinal cord or nerve roots, often involves neurologic monitoring, which inhaled anesthetics can interfere with, so intravenous anesthetics are also used. Hydrocephalus surgery, although it is intracranial, does not involve a serious risk of brain damage. Pediatric cardiac surgery and CDH surgery are serious cardiovascular challenges but do not usually involve neurologic monitoring. There is a question about neurotoxicity in children under four undergoing repeated anesthetics, but neither TIVA nor neuromonitoring is particularly involved with this controversy.

6. Which of these is not true for interventional radiologic procedures? A) The Seldinger technique is used as a way to access a blood vessel without initial use of a large needle. B) The patient may be on a moving x-ray table surrounded by moving imaging equipment, so it is important to be aware of all tubing and monitors during this time. C) Monitors can produce artifacts that interfere with the procedure and must be properly placed. D) Because these are often minimally invasive procedures, the anesthesia provider will usually prefer minimal anesthesia and sedation. E) All of these are true.

Answer: D Since it is vital that the patients remain completely still during these procedures, anesthesia and interventional radiology providers may prefer general anesthesia. The Seldinger technique involves dilating a vessel that has been accessed with a smaller needle and is widely used throughout medicine. Since monitors can produce artifacts that interfere with the procedure, and since the patient is often on a moving x-ray table surrounded by moving imaging equipment, it is vital to be aware of the location and placement of all anesthesia equipment.

2. Which of the following could be considered an open breathing system? A) Tarzan's reed "snorkel" B) A dual limb circle circuit system C) Bain circuit D) Open drop anesthesia mask E) All of the above

Answer: D Tarzan's snorkel and the Bain circuit are examples of semiopen systems in that they use a tube to deliver gases to the patient. A circle system can be semiclosed or closed depending on the amount of rebreathing of exhaled gases. The only fully open system here is the open drop mask where the patient is breathing directly to and from the atmosphere.

2. The proper response to an LIM alarm is to A) Shut off power to the OR B) Silence the alarm and address the problem with engineering at the end of the day C) Notify the power company that there is a grounding problem D) Unplug equipment one piece at a time, starting with the last item plugged in E) None of the above

Answer: D The LIM alarms when it has detected a current leakage in an isolated power supply above its alarm threshold. The most common reason is one or more devices connected to the power supply have a ground fault. To determine which device has the fault, disconnect each device from the power supply, one at a time, until the alarm stops.

9. The Mallampati score helps estimate the patient's A) Overall health status B) Risk of aspiration C) Risk of anesthesia D) Risk of intubation difficulty E) None of the above

Answer: D The Mallampati score is an assessment of the airway that is used to detect the probability of a difficult intubation. Visualizing fewer structures (e.g., tongue, uvula, and tonsils) gives a higher score and is one of several indicators of the likelihood of a difficult intubation.

5. Which of the following statements is correct? A) The anesthesia gas machine which is used in the out-of-OR environment should also be appropriate for use in the MRI scan room. B) Standard portable infusion pumps can be used in zone 4 of the MRI suite as long as they are outside the 5 G line. C) Standard patient monitoring systems may be used in the MRI scan room as long as they are firmly fixed to the MRI-compatible anesthesia machine and as close to the 5 G line as possible. D) The anesthesia cart used in an MRI suite must be constructed from MRI-compatible materials and must contain only MRI-approved supplies and anesthesia equipment.

Answer: D The anesthesia machine, all infusion pumps (including syringe pumps), and patient monitors used during MRI must be shielded from RF pulses and designed to function when exposed to strong magnetic fields. They have an MRI-specific design. The level of approved magnetic field strength, if one exists, should be identified for each piece of equipment; it should be placed as close to the 5 G line as possible to avoid exceeding the approved threshold. The anesthesia cart should be MRI compatible, designated for use only in an MRI environment, and stocked only with MRI-compatible anesthesia supplies and resuscitation equipment.

5. How often should the breathing system pressure and leak testing be performed? A) Once per day B) Prior to the start of each case C) Anytime the circuit is changed D) A and B

Answer: D The breathing system pressure and leak testing should be performed before the start of each case. If a day has multiple cases, some of which are MAC cases and the circuit is not changed, the anesthesia provider is still responsible for checking that there is a working source of positive pressure before each case. Similarly, if an operating room in an obstetric or trauma suite remains set up for a few days, unused but awaiting a possible emergency general anesthetic at any moment, breathing system pressure and leak testing is done once per day.

4. After identifying a patient has a CIED, it is important for the clinical care team to determine: A) Proper CIED function B) The device manufacturer C) Date of the last CIED interrogation D) A, B, and C E) A and C

Answer: D The device manufacturer, date of last CIED interrogation, and proper CIED function should always be established prior to elective surgery. Consulting a CIED expert may be required. Device manufacturer information is required in order to understand how the device will respond to a magnet and to obtain the manufacturer-specific reprogramming machine.

9. Which of the following is NOT TRUE regarding intraosseous access? A) Intraosseous access site can be used for blood samples for the laboratory tests and cross match. B) Contraindications include fractured bones, bones with osteomyelitis, proximal bone fracture, previous sternotomy, and some rare disorders of bone development. C) All of the IV mediation and blood products can be administered through the intraosseous access, and the onset of action and peak drug level are comparable to those of IV administration. D) The intraosseous needle can be maintained more than 24 hours without increasing the risk of complications. E) All of the above are TRUE statement.

Answer: D The intraosseous needle should be removed as soon as peripheral or central vascular access is obtained, or within 24 hours, to minimized the risk of complications.

8. Which of the following is NOT an element necessary to prove medical negligence? A) Duty B) Breach of Duty C) Proximate Cause D) Standard of Care

Answer: D The legal elements of medical negligence are (1) duty, (2) breach of duty, (3) actual and proximate cause, and (4) damages. The commonly expressed concept of the "standard of care" falls under the legal concept of "breach of duty," that is, that the provider had a duty to care for the patient, but breached that duty by providing care that falls below the standard of what a reasonable practitioner in the community would have provided in a similar situation.

1. The rate of fluid flow in a catheter INCREASES with A) The fourth power of the increased radius of the catheter lumen B) Higher pressure applied to the fluid line (e.g., a pressurized IV bag) C) Increasing length of the catheter D) A and B E) All of the above

Answer: D The radius of the catheter is a critical determinant of fluid flow rates and is related to the fourth power of the radius. Increasing the catheter length would decrease the fluid flow rates.

10. What is the rhesus blood group? A) The markers of the Kell blood group system B) What makes AB patients universal recipients C) The determinant of cryoprecipitate effectiveness D) Blood group with D antigens in cell membranes

Answer: D The rhesus blood group is identified by the D antigen.

5. You have assisted in the performance of a nerve block in the operating room. If the patient were to develop symptoms of LAST, when would you expect them to present? A) Immediately B) Within 5 minutes C) Within 30 minutes D) Any of the above E) None of the above

Answer: D The symptoms of LAST can range from immediately to half an hour later. It depends on the rate in which the bloodstream acquires the local anesthetic.

5. Which of the following statements are true regarding a test dose of local anesthetic for an epidural catheter? A) The test dose will detect a pneumothorax. B) If the test dose produces anesthesia, the catheter is in the epidural space. C) If the catheter is in a blood vessel, the patient will have CNS symptoms like tinnitus. D) The test dose is used to detect intrathecal and intravascular injection. E) Once the test dose is negative, the catheter is definitely not intravascular.

Answer: D The test dose is used to detect intrathecal and intravascular injection. It will not detect pneumothorax, which would be a rare but not impossible complication of epidural placement. The epidural test dose usually contains a small amount of local anesthetic mixed with epinephrine. If the epidural catheter is inadvertently placed in the subarachnoid space, the local anesthetic will cause a spinal within 5 minutes; an immediate anesthetic level indicates intrathecal placement. Because the test dose is a small amount of local anesthetic, it should not cause a high spinal. If the catheter is placed inadvertently into a blood vessel, the epinephrine may cause tachycardia, but there is a significant false-negative rate. Similarly, there is a significant false-negative rate for CNS symptoms, especially in sedated patients. Thus, a negative test dose definitively rules out an intrathecal but not an intravascular catheter.

4. There are many parts to a scavenging system. Which part listed below is part of an active gas disposal system but not part of a passive system? A) Ventilator relief valve B) Rigid transfer tubing C) Adjustable Pressure-Limiting valve (APL) D) Vacuum system E) Positive pressure relief valve

Answer: D The vacuum system is required for the active scavenging system and provides suction to draw the gases out of the building. The ventilator relief and APL valves allow the excess gas to flow from the breathing circuit to the scavenging interface. The rigid transfer tubing is part of all scavenging systems. The positive pressure relief valve is part of a closed systems design in both active and passive systems.

2. At the end of a long operation, a new anesthetist calls you into the operating room. The anesthetist tells you that he is trying to switch volatile anesthetic agents from isoflurane to desflurane but is unable to turn the dial on the desflurane vaporizer to turn it on. He currently has the isoflurane vaporizer on. Both vaporizers are noted to be full of medication. The anesthetist wants to know if he needs a new vaporizer. What should you tell the anesthetist? A) Yes, the anesthetist needs a new vaporizer. You should be able to turn on both vaporizers at the same time to switch medications. B) Yes, the anesthetist needs a new vaporizer. There must be a leak in the vaporizer as the anesthesia machine has a safety mechanism that prevents the vaporizer from turning on if there is a leak. C) No, the vaporizer does not need to be replaced. You explain that there is a safety feature on the anesthesia machine that will not let him switch volatile anesthetics during an operation. D) No, the vaporizer does not need to be replaced. You explain that there is a safety feature on the anesthesia machine that will not let more than one vaporizer open at a time. E) No, the vaporizer does not need to be replaced. You tell the anesthetist that if he wants to switch medications, he should just add some desflurane to the sevoflurane vaporizer rather than use a different vaporizer.

Answer: D The vaporizers are properly functioning. When there is more than one vaporizer present on the anesthesia machine, there is a mechanical link called an Interlink that prevents more than one vaporizer from being opened at a time. This prevents the patient from receiving a simultaneous administration of two volatile anesthetics from the anesthesia machine.

3. During an anesthesia crisis resource management simulation training, the anesthesia technician states, "Somebody get me a code cart." This is an example of ... A) Error anticipation B) Closed loop communication C) Directed communication D) Indirect communication E) Resource allocation

Answer: D This is an example of indirect communication, which is when the statement, question, concern, or order is not directed to a specific person. Error anticipation is when an error is identified or anticipated before it occurs; closed loop communication refers to team members acknowledging a request and reporting back when the task is accomplished; directed communication refers to addressing questions, concerns, or orders to a specific person; and resource allocation refers to organizing the resources available, whether it's equipment or personnel.

6. When a patient with a CIED is undergoing a procedure involving monopolar electrosurgery, the dispersive electrode ("Bovie pad") should: A) Not be used. B) Be placed directly over the pulse generator. C) Be placed so the current return path is directed through the pulse generator and leads. D) Be placed so the current return path is directed away from the pulse generator and leads. E) Always be on the lower extremities.

Answer: D To minimize EMI effects, the dispersive electrode should be placed so that the current return path is diverted away from the pulse generator and leads.

8. Of the devices listed below, which device is designed to deliver a more predictable FiO2? A) Nasal cannula B) Face mask C) Shovel mask D) Venturi mask

Answer: D Venturi masks are capable of delivering a more reliable FiO2 determined by the adapter utilized and the flow delivered from the oxygen source.

8. Complications that can occur from improper use of a defibrillator include A) Fire B) Electrical shock of responding medical personnel in contact with the patient C) Skin burns to the patient D) All of the above

Answer: D Vigilance is required to minimize the risk of complications associated with defibrillator use such as inadvertent spread of electrical current that can cause injury to responding medical personnel or ignition of a fire, as well as to prevent injury to the patient such as skin burns.

10. There are many factors that may determine whether a child should be awakened in the OOR location or the PACU following general anesthesia. However, which of the following is not one of the factors mentioned in this text as something that should usually be considered? A) Child's baseline condition B) Anesthetic technique used C) Distance to PACU D) Parent request to be present when child emerges E) Procedural factors

Answer: D When deciding whether to wake the child in the OOR location or the PACU, you should consider the child's baseline condition, the anesthetic technique used, procedural factors, and distance to the PACU. Parents are often present at the induction of anesthesia at the discretion of the anesthesia provider (see Chapter 48, Pediatric Anesthesia) and typically rejoin children after emergence is complete.

1. Which of the following may be helpful in making mask ventilation easier? A) Nasal airway B) Oral airway C) Two-handed mask ventilation D) All of the above

Answer: D When difficulty is encountered with mask ventilation, techniques to improve the ease of mask ventilation include nasal airways, oral airways, or two-handed mask techniques.

5. The most reliable site for monitoring core temperature is A) Esophageal B) Skin C) Oral D) PA E) Nasopharyngeal

Answer: D When measuring core temperature, the most reliable site is via the PA catheter.

3. Place in order the sequence in which drugs are administered for a general inhalational anesthetic in an adult patient. A) Neuromuscular blocker B) Intravenous induction agent C) Inhalational agent D) Sedative/anxiolytic E) Reversal agent

Answer: D, B, A, C, E First = D. Sedative/anxiolytic; Second = B. Intravenous induction agent; Third = A. Neuromuscular blocker; Fourth = C. Inhalational agent; Fifth = E. Reversal agent. A sedative/anxiolytic can be administered before the patient is brought to the operating room suite to help alleviate the stress response associated with surgery. After application of ASA standard monitors and preoxygenation, an intravenous induction agent is administered for loss of consciousness. After loss of consciousness occurs, a neuromuscular blocker may be administered. Inhalational agents are used for maintenance. Reversal agents are given if the presence of a neuromuscular blocker requires them.

1. Which of the following are strategies that the anesthesia technician must employ to properly prepare for a LAST event? A) Prepare emergency airway equipment (i.e., oxygen source, bag-valve-mask ventilation system, oral airways, laryngoscopes, and endotracheal tubes) in a readily available location. B) Be aware of crash cart location. C) Be prepared to assist with cardiac resuscitation. D) Regularly check and restock medications used in LAST management (i.e., lipid emulsion and ACLS drugs). E) All of the above.

Answer: E

4. Which infusion set should be used to maintain strict control over the volume of fluid or medication delivered? A) Buretrol® B) Microdrip C) Infusion pump tubing with an infusion pump D) Y-type blood administration tubing E) A, B, and C

Answer: E A Buretrol® is a 150-mL chamber that can be used to control medication or volume delivery, particularly in pediatric patients. A microdrip set has smaller drops (approximately 60 drops per milliliter) and can be used to deliver lower infusion rates. An infusion pump can be set to control infusion amounts and rates. A Y-type blood administration set would be used to deliver higher volumes of fluid or blood.

2. Acetylcholine exerts its effect on which of the following receptors? A) Cholinergic B) Muscarinic C) Nicotinic D) Adrenergic E) A, B, and C

Answer: E Acetylcholine exerts its effect on cholinergic receptors of which there are two types: nicotinic and muscarinic. Nicotinic receptors are almost always excitatory. Muscarinic receptors exhibit both excitatory and inhibitory effects.

1. Reducing medication errors in the OR depends on A) Pharmacy B) Nursing C) Anesthesiologists D) Anesthesia technicians E) All of the above

Answer: E All OR personnel are at least peripherally involved with medication administration. Even if not directly administering a medication, an anesthesia technician can be called upon to retrieve medications, set up infusions, or assist with medication delivery.

6. Which of the following should be available to place a CVC? A) Ultrasound machine B) CVC kit C) Infusion setup D) IV fluids E) All of the above

Answer: E All of the above should be available for CVC insertion. Ultrasound is extremely common to identify the relevant anatomy and guide needle insertion into the vein.

2. Which of the following is a factor in determining how much physical space is needed for an anesthesia workroom? A) Number of anesthetizing locations at a site B) Planned location for restocking anesthesia carts C) Number of computers for ordering equipment D) Number of equipment manuals present E) All of the above

Answer: E All of the listed choices influence the decision regarding how much space is needed for an anesthesia workroom. The higher the number of anesthetizing locations, the bigger the workroom needs to be in order to have enough room for the equipment needs of the practice. Location of anesthesia cart restocking affects the size needed for a workroom; if the carts are restocked in the workroom, it needs to be bigger than if the carts are not stocked in the workroom. The amount of office equipment that is planned to be in the workroom affects how much space is needed for the workroom.

2. Temporary pacing can be achieved by which of the following modalities? A) Transcutaneous B) Transesophageal C) Transvenous D) Via a PAC E) All of the above

Answer: E All of the listed modalities may be used to provide temporary pacing support.

1. Which of the following is not an example of simulation training in health care? A) Using an orange to practice intramuscular injections B) Visualizing the steps involved in a paramedian epidural catheter placement before actually performing the procedure C) Using a tibia model for practicing intraosseous catheter D) Using virtual reality to perform the anesthesia gas machine checklist E) All of these are examples of simulation training in health care

Answer: E All of these are examples of simulation training in health care. Anything that involves practice before a procedure or task is performed on a real patient can be considered simulation training. This may include mental or physical rehearsal for a difficult procedure before performing the actual task, using a specialized task trainer model and using a screen-based computer model or a high-fidelity virtual reality environment such as a medical simulation center.

4. Which of the following monitors is NOT an ASA standard monitor in all patients? A) Pulse oximeter. B) Blood pressure. C) Capnogram. D) Electrocardiogram. E) All of the above are ASA standard monitors.

Answer: E All these are ASA standard monitors.

4. From which of the following patients should used anesthesia equipment be considered contaminated, regardless of whether or not there is visible evidence of contamination? A) Patients with hepatitis C B) Patients with prion disease C) Patients with TB D) Patients with isolation orders for transmission-based precautions E) All patients regardless of infectious disease states

Answer: E All used anesthesia equipment in the operating room should be considered contaminated whether or not there is visible evidence of contamination and regardless of patient condition.

5. When cardiac arrest is due to hypovolemia or hemorrhage, which of the following is least likely to be used by the anesthesia provider? A) Fluids B) Blood products C) Forced-air warmer D) Rapid transfusion device(s) E) Defibrillator

Answer: E Arrhythmia requiring defibrillation is not often caused by hypovolemia—the cardiac arrest of hypovolemia or massive hemorrhage happens initially because the heart is beating or functioning normally but it has little or nothing to pump out: it is sometimes called "pulseless electrical activity" and a defibrillator will not help as the heart rhythm is normal. Fluids and blood via a rapid infusion device and large IV access are the treatment of choice. These, however, can cool the patient too much, so that a forced-air warmer is needed.

5. A nasal RAE endotracheal tube may be requested for head and neck surgery. To aid placement, which of the following might be useful? A) Magill forceps B) Laryngoscope C) Fiberoptic bronchoscope D) Yankauer-tipped suction E) All of the above

Answer: E Because the endotracheal tube needs to travel through the nostril into the back of the throat, a stylet cannot be used to direct the tube through the glottic opening. The tip of the tube may need to be directed into the trachea by use of Magill forceps. Standard intubation equipment (suction, laryngoscope with different blades) is also needed. If the mouth opening is limited, the tube will need to be directed by use of a fiberoptic flexible scope.

6. Which of these is not a treatment that would be used for a patient with LAST? A) Benzodiazepines B) Cardiopulmonary bypass C) Bag-mask ventilation D) Propofol E) Calcium channel blockers

Answer: E Calcium channel blockers should be avoided when treating LAST. In the event of LAST, the patient may receive oxygen supplementation, bag-mask ventilation, and/or endotracheal intubation, depending on the clinical situation. Benzodiazepines are used to control seizures, and in the event of persistent seizures, a small dose of short-acting neuromuscular blocker, such as succinylcholine, should be used. Propofol is NOT used as a substitute for intralipid, and it is contraindicated for intubation in the hemodynamically unstable patient. It is kept in the LAST kit for two reasons: it may be used to terminate seizures if midazolam fails or to facilitate intubation in a stable and semiconscious patient. Succinylcholine is also used in the seizing semiconscious patient to facilitate intubation. Cardiopulmonary bypass is a bridging therapy that gives the local anesthetic time to clear. An essential treatment not listed here is lipid emulsion therapy.

8. What are some common components of CO2 absorbents? A) Calcium hydroxide B) Potassium hydroxide C) Silica D) Barium hydroxide E) All of the above

Answer: E Calcium hydroxide, potassium hydroxide, and silica are components of most modern CO2 absorbents. Barium hydroxide is the key component in Baralyme.

3. Compared to adults, which statement regarding children's body temperature under general anesthesia is true? A) Surface area to weight ratio is less than adults. B) Temperature decreases more quickly than adults. C) Pediatric ORs should be warmed and intraoperative warming devices routinely used. D) A and C only. E) B and C only.

Answer: E Compared to adults, infants have a much greater surface area to weight ratio (i.e., the area of their skin is large, but their weight is small) and are at increased risk to develop intraoperative hypothermia. Special attention needs to be given to keep operating rooms warm and use of active warming devices for pediatric patients.

3. The first step in the treatment of anaphylaxis is A) Place two large-bore IVs and give 2 L of IV fluids quickly. B) Administer IV steroids, such as dexamethasone. C) Give epinephrine bolus for low blood pressure. D) Give IV antihistamines. E) Stop the administration of suspected triggering drug, give 100% oxygen, and manage the airway.

Answer: E Discontinuing the suspected triggering agent and ensuring an open airway and oxygenation come first. Supporting the circulation with volume administration and epinephrine comes next. Use of antihistamines and steroids is considered to be secondary treatment.

1. Which of the following should be available for a catheter-guided heart procedure? A) Ultrasound gel B) Bite block C) Network connection or available media (DVD, USB drive, external hard drive) D) A 3D TEE probe E) All of the above

Answer: E For a catheter-based heart procedure, a 3D machine and 3D probe are recommended if available. The rest of the options are part of the preinsertion checklist.

7. Anesthesia technicians and technologists should A) Make sure they are not in the room when x-ray is going on B) Be enrolled in their hospital radiation badge dosimetry programs C) Wear a one-piece lead apron at all times in the angio suite D) Ensure that patients have radiation protective eyewear available E) None of the above.

Answer: E If patient care requires that the AT be in the room while x-ray is being used, then it is safe, just as it is for the other staff: by the minimal time that the AT is exposed, maintaining an appropriate distance where possible, and using PPE (lead garment with thyroid shield.) ATs do not usually need to enroll in badge dosimetry programs, as their exposure in procedure areas is minimal. It is not necessary to wear PPE in the angio suite unless there is a case going on; if there is a case going on, it may be advisable in this area to wear 2-piece (skirt and vest) lead rather than an apron, as this is a dose-intensive application and the AT may wish to be able to turn his/her back to the radiation source. Protective eyewear for patients is required for laser procedures, and not for radiation procedures.

6. During a difficult intubation, which of the following will be useful? A) Multiple laryngoscopic blades B) Intubating LMAs C) Rigid video laryngoscope D) Fiberoptic bronchoscope E) All the above

Answer: E If presented in an organized manner, the more options the better.

3. As an anesthesia technician, you may be asked to assist with various types of fire, which may include A) Airway fires B) OR fires C) Surgical fires D) Facility fire E) All of the above

Answer: E In a hospital setting, all of these types of fires are possible.

8. Which of the following is NOT an appropriate location of intraosseous access? A) Distal radius. B) Proximal humerus. C) Sternum. D) Iliac crest. E) All of the above are appropriate location for IO access.

Answer: E Intraosseous access can be obtained in the proximal tibia, the distal tibia, the proximal humerus, the femur, the distal radium, the iliac crest, or sternum.

9. An anesthesiologist asked you to obtain mixed venous blood for the calibration of SVO2 value (in vivo calibration). From which of the following lines should you obtain the blood sample? A) Arterial line B) Peripheral IV C) Side port of introducer placed in the internal jugular vein D) Proximal (blue) port of the PAC E) Distal (yellow) port of the PAC

Answer: E Mixed venous blood is the mixture of the venous blood from SVC, IVC, and coronary sinus, which can be aspirated from the distal (yellow) port of the catheter. The oxygen saturation of mixed venous blood is slightly lower than that of central venous blood in the absence of intracardiac shunt. It is used to calibrate SVO2 during the in vivo calibration.

1. You are scheduled to work at your hospital's ambulatory surgery center on Monday morning. As you start setting up equipment for the first case, you notice that the anesthesia machine is on and the oxygen is flowing at 10 L/min. You note that the operating room had not been in use since the previous Thursday when the surgery center was last open. What should you do? A) Turn off the oxygen. Finish setting out equipment for this room and then continue setting up the rest of the rooms for the day. B) Turn off the machine and the oxygen. Finish setting out equipment for this room and then continue setting up the rest of the rooms for the day. C) Do not touch the machine. Finish setting out equipment for this room and then continue setting up the rest of the rooms for the day. D) If the CO2 canister has not changed colors, do not replace it. Finish setting out equipment for this room and then continue setting up the rest of the rooms for the day. E) Turn off oxygen. Replace the CO2 canister. Finish setting out equipment for this room and then continue setting up the rest of the rooms for the day.

Answer: E Prolonged fresh gas flows can lead to desiccation or dehydration of the carbon dioxide absorbent. If desiccation is suspected, the absorbent should be changed. Desiccation can sometimes but not always lead to a change in the color of the absorbent. The hazards associated with the use of desiccated absorbent include carbon monoxide formation, compound A formation with sevoflurane, and fire within the canister.

2. Patients may lose heat via conduction, convection, evaporation, and radiation, yet some of these heat loss mechanisms are of greater concern than others. Which two mechanisms of heat loss account for approximately 90% of body heat loss in the operating room? A) Evaporation and conduction B) Convection and conduction C) Radiation and conduction D) Evaporation and convection E) Radiation and convection

Answer: E Radiation and convection account for about 90% of body heat loss. In regard to radiation, all surfaces with a temperature greater than absolute zero radiate heat, and heat transfer is proportional to the 4th power of the absolute temperature difference between the two surfaces. Likewise, for convection, heat loss is proportional to the square root of air speed. Conduction and evaporation are less of a concern since a foam pad between the patient and operating room table minimizes heat lost due to conduction, and sweating (which increases skin evaporative heat loss) is rare under anesthesia.

2. Which of the following physical exam findings suggests dehydration? A) Excessive sweating B) Clammy, moist hands C) Heart rate of 65 beats/min D) Blood pressure of 135/85 mm Hg E) Heart rate of 125 beats/min

Answer: E Tachycardia (fast heart rate) is a sign of dehydration as well as low blood pressure. In addition, patients who are dehydrated do not produce sweat.

3. Which of the following supplies are not required during an MH crisis? A) 36 vials of older-formulation of dantrolene or 3 vials of nanocrystalline dantrolene and bacteriostatic-free sterile water B) Extra personnel C) Arterial line setup D) Vascular access setup (peripheral and/or central) E) None of the above (all of the supplies may be needed)

Answer: E The administration of dantrolene is the only effective treatment for MH. Thirty-six vials need to be readily available to treat the initial crisis. The patient should be continually monitored in an intensive care setting, because MH has been documented to recrudesce up to 36 hours after the initial treatment. Dantrolene is packaged in a lyophilized form that requires reconstitution with bacteriostatic-free sterile water.

4. Who is qualified to perform portions of the anesthesia machine check? A) Anesthesia care provider B) Anesthesia technician C) Biomedical technician D) A and B E) All of the above

Answer: E The anesthesia provider is responsible for the anesthesia machine check and ensuring the adequacy of its function. However, the provider can delegate this task, or parts of this task, to an anesthesia technician or biomedical engineering technician at the provider's discretion: the provider, however, is ultimately responsible for the machine and the patient being cared for with that machine.

1. Which of these surgical cases is NOT high risk for developing massive hemorrhage? A) Cases in the chest B) Vascular cases involving large blood vessels C) Procedures involving the liver D) Patients taking anticoagulants E) All of the above

Answer: E The chest is a "high real estate" area. The working space tends to be very crowded, and the surgeons are working right next to the largest vessels in the body. An injury to the inferior/superior vena cava, or worse, the aorta, can lead to massive blood loss within seconds. With large vascular cases, there is always the possibility of significant blood loss because the surgeons are intentionally violating the largest vessels in the body. The liver is a very vascular organ; it has a large blood supply, and it also contains a large amount of blood within it. A cut surface of liver will bleed profusely, and stopping the bleeding can be difficult because there is not a single bleeding site but rather the entire cut surface will bleed. Patients undergoing liver surgery also very likely have some degree of liver dysfunction. This often results in a coagulopathy, which compounds the extent of bleeding.

5. You are called into a room by an anesthetist who complains about smelling volatile anesthetic in the middle of an operation while a patient is intubated and under a general anesthetic. What should you do? A) Wait until the operation is done before looking for a leak. B) Look for a hole in patient circuit or disconnect between the patient and circuit. C) Ensure that the carbon dioxide absorbent canister is properly connected. D) Ensure that the scavenging system is functioning properly. E) B, C and D.

Answer: E The leak of a volatile anesthetic in the middle of the operation is a risk to the patient and all providers in the room. If a significant leak is present, the anesthesia machine should have an audible alarm and an error message displayed on the machine's screen. There are many sources of a small leak including a hole in the circuit, a hole in the cuff of the endotracheal tube, or a problem with the scavenging system. Each of these should be investigated as appropriate during the operation and double-checked before any subsequent operation.

2. Concerning MRI scanners, which of the following is true? A) In the case of an emergency during anesthesia for a patient undergoing MRI, the magnetic field should be shut down to allow the anesthesia team rapid access to the patient. B) All staff must wear dosimeters to keep track of their exposure to harmful magnetic radiation. C) Modern anesthetic equipment is designed to be safely used in an MRI scanner. D) Most MRI scans are of brief duration, and patients rarely require sedation. E) Patients with any implantable device must be assessed by an MRI technologist for safety before entering the MRI scanner.

Answer: E The magnetic field can interfere with devices like pacemakers and can cause them to malfunction; it can also cause older ferromagnetic implantable devices like aneurysm clips, or newer devices like epidural catheters, to move or heat up. The MRI magnetic field remains on at all times, and patients need to be removed from the scanner if an emergency occurs; immediate shutdown is not possible, and rapid shutdown ("quench") can cause its own emergency (see Chapter 52, MRI Safety). Dosimeters are used to monitor radiation exposure; the MRI scanner does not produce radiation. Only specially designed anesthetic equipment is compatible with the magnetic field. Most MRI scan sequences last at least 45 minutes and often longer.

4. Concerning sedation, which of the following is correct? A) Sedation describes a number of clearly defined and discrete states between the fully awake state and full unconsciousness. B) Airway obstruction is not a concern with moderate sedation. C) Drugs used to provide sedation are different from the ones used to induce anesthesia. D) Pediatric patients always require GA in OOR sites. E) Respiratory depression is a side effect of the majority of agents used for sedation.

Answer: E The majority of sedative agents produce respiratory depression. Sedation is described as a continuum between the awake state and GA. Patients may move variably in and out of different levels of sedation depending on the type of stimulation and the drugs administered. The airway may be compromised at any level of sedation. Many of the drugs used for sedation are also used as part of an anesthetic. Pediatric patients may be successfully managed with sedation or with general anesthesia in OOR sites.

4. You are called into a room because of problems with the end-tidal carbon dioxide tracing not going back to a baseline of "0." Which of the following could cause this? A) Incompetent expiratory valve B) Incompetent inspiratory valve C) Exhausted soda lime granules D) A and C E) All of the above

Answer: E The most common cause for elevated end-tidal carbon dioxide levels is exhausted absorbent, but improperly functioning inspiratory and expiratory valves can also cause this. Expired gas escapes down the inspiratory limb, and the patient is ventilated with this gas again. Inspired gas can also push a small amount of expired air back down the expiratory limb if the valve is incompetent. If this were to occur, the tracing would never reach "0" because small amounts of expired air would pass by the sampling port during inspiration.

3. A rapid infuser system is NOT equipped with A) Filter B) Heat exchanger C) Roller pump D) Reservoir E) Centrifuge

Answer: E The rapid infuser system is equipped with filters, line pressure monitors, air detectors, and a warming device with temperature monitors. In addition, the Belmont® system has a reservoir and a computer system to regulate flow rate. The centrifuge is one of the features of an autotransfusion system (Cell Saver®).

3. Which of the following is (are) potential complication(s) associated with arterial line placement? A) Infection B) Bleeding/hematoma C) Thrombosis/limb ischemia D) Nerve injury E) All of the above

Answer: E The risk of thrombosis/limb ischemia is associated with the size of the catheter and the artery. Brachial artery should be best avoided due to the higher risk of limb ischemia. The majority of blood stream infection associated with arterial line is acquired extraluminally from the skin, and chlorhexidine for cutaneous antisepsis is shown to be beneficial for its prevention. Radial nerve injury associated with radial arterial line is rare and mostly transient. When paresthesia is encountered during or after the placement, the catheter should be removed immediately.

5. Which of the following neuromonitors was developed specifically to assess a patient's level of consciousness and risk for awareness under anesthesia? A) Somatosensory evoked potential B) Motor evoked potential C) Brainstem auditory evoked potential D) Electromyography E) Processed EEG monitoring

Answer: E There is no specific monitor that can determine whether a patient is unconscious. Instead, adequacy of anesthesia is based on a combination of knowledge of drug doses, monitoring of inhaled concentrations of anesthetics, monitoring of physiologic variables such as spontaneous respirations, heart rate, and blood pressure. Processed EEG monitoring was developed to assess the level of consciousness under anesthesia but is not a perfect measure, as it is subject to artifact as well as pharmacologic and physiologic influences. Its information must be integrated with the anesthesia provider's judgment. Evoked potentials and electromyography all measure disruptions in nerve transmission: each is used depending on which nerve transmission is near the site of surgery (sensory pathways, motor pathways, brainstem and auditory pathways, or peripheral nerves).

4. Team members who all share a mental model of evolving clinical circumstances share: A) Situational awareness B) Closed loop communication C) Directed communication D) Indirect communication E) Transparent thinking

Answer: E Transparent thinking is when team members share a mental model of an evolving clinical situation. Situational awareness is when an individual has an understanding of the etiology of the unfolding crisis; closed loop communication refers to team members acknowledging a request and reporting back when the task is accomplished; directed communication refers to addressing questions, concerns, or orders to a specific person; and indirect communication is when a statement, question, concern, or order is not directed to a specific person.

2. During an anaphylactic reaction, tryptase is released by A) Basophils B) Capillary endothelium cells C) Mast cells D) Lung alveolar cells E) A and C

Answer: E Tryptase is a specific marker for mast cell and basophil degranulation. Elevated tryptase levels after an event can be diagnostic of an anaphylactic reaction.

1. What should an anesthesia tech do during a cardiac arrest? A) Know his or her scope of practice as defined by accrediting agencies, AHA certification, and local institutional policy. B) Try to think about what the cause of the arrest might be. C) Anticipate equipment needs. D) Be prepared to participate as a member of the team during resuscitation. E) All of the above. F) A, C, and D only.

Answer: E Understanding the cause of the cardiac arrest will help the AT anticipate what equipment and help might be needed. An airway event will need different therapy and equipment than a massive hemorrhage, and while making a diagnosis is not within the scope of practice of the AT, situational awareness, observation of events described in this chapter (e.g., cardiac arrest in a patient who has just had a regional block), and attention to the statements of the team leader should prompt the AT to think about what might be happening, so that he or she can prioritize actions appropriately (e.g., asking "should I get the lipid infusion" and calling for another AT to help prepare equipment for intubation).

1. Concerning younger pediatric patients and IV's, which of the following statements are true? A) Air bubbles must be removed from IV tubing and stopcocks. B) Microdrip tubing is preferred to macrodrip tubing. C) Buretrols are used for only older children. D) All of the above. E) A and B only.

Answer: E Younger children, especially those younger than 2 years, may have a patent foramen ovale (PFO). This anatomic abnormality can allow air bubbles in the blood stream to pass directly from the right atrium into the left atrium and into the systemic circulation. This can lead to systemic ischemic complications, such as a stroke. The fluid requirements of children differ significantly from adults, and anesthesia providers must closely monitor the amount of IV fluids that are administered to pediatric patients. Microdrip IV tubing and buretrols allow more precise volumes of IV fluids to be administered than does a standard adult set (macrodrip tubing).

1. Which artery is not appropriate for placement of an arterial line? A) Radial artery. B) Femoral artery. C) Dorsalis pedis artery. D) Axillary artery. E) Temporal artery. F) All of the above are appropriate.

Answer: F Most commonly used artery for the placement of arterial line is, by far, radial artery due to the ease of access. Other superficial arteries are also used when radial arteries are not accessible. Brachial arteries are not a preferable option due to higher risk of limb ischemia from thrombosis. Dorsalis pedis, femoral, and axillary arteries are the second options. Temporal arteries can be used in neonates.

Family Members... A. Must stay in the surgical waiting area during surgery so that the surgical team can reach them. B. Cannot come into the OR, because it is a sterile environment. C. Can expect to be welcome in the preoperative area, but to separate at some point as the patient goes to the OR. D. Are required to sign the patient out of the hospital.

Can expect to be welcome in the preoperative area, but to separate at some point as the patient goes to the OR. Family members are present when the patient arrives but in general do not come to the OR. They can, under special circumstances, such as with pediatric patients. Family members must be available for contact by the surgical team, but this can be in the waiting room or bu phone or pager. Ambulatory patients must be accompanied by another person when they leave the hospital (i.e., they cannot leave alone immediately after anesthesia) but they do not have to be accompanied by a family member.

The first recorded use of anesthesia support personnel occurred in _____________. A. England B. Australia C. Louisiana D. China E. California

England The first recorded use of anesthesia support personnel occurred in England in late 1930s

Prior to surgery, the patient should... A. Have nothing to eat for at least 6 hours. B. See a cardiologist if he or she has a heart problem. C. Have laboratory testing and an EKG if having major surgery. D. Have a complete history, physical, and review of systems, and any testing that is indicated. E. Be evaluated and cleared by a medical doctor or anesthesiologist before surgery is scheduled.

Have a complete history, physical, and review of systems, and any testing that is indicated. The ASA does not recommend any testing without a specific indication: "major surgery" is not, by itself an indication for a EKG though it may be a reasonable indication for a baseline evaluation of electrolytes, kidney function, and blood counts. A heart problem may be fairly minor and easily managed by the anesthesiologist or primary care doctor, or the patient may recently have seen the cardiologist; not all heart problems or all surgeries require a visit to a cardiologist. Very few patients are so ill that they need assessment before surgery is scheduled. The ASA in general recommends that patients have nothing to eat or drink for 8 hours before surgery, and many anesthesia providers still recommend that patients be instructed "nothing after midnight" to avoid confusion.

Receptors site are ______________ and cell membranes are ________________? A. Hydrophilic and Hydrophobic B. Hydrophilic and Hydrophilic C. Hydrophobic and Lipophilic D. Lipophilic and Lipophilic

Hydrophilic; Hydrophobic Cell membranes are made of lipid and are hydrophobic (repels charged molecules or water). They are also lipophilic (accommodate fat-soluble molecules, those that are not charged). Receptors can attach to ionized molecules and send a message through the cell membrane to effect change within the cell.

6. What are some differences between regular LMAs and intubating LMAs?

Intubating LMAs are different than standard LMAs in that they are designed to optimize intubation in patients in which an LMA would be important to provide ventilation in the process of securing the airway with an endotracheal tube.

Which of the following combinations will produce the safest drug profile? *Large LD50, large ED50 *Small LD50, small ED 50 *Large LD50, small ED50 *Small LD50, large ED50

Large LD50, small ED50 A higher therapeutic index indicates a safer profile. by definition, TI= ld50/ed50. Therefore, a high LD50 and low ED50 would lead to the lowest degree of safety.

The certification exam is administered in accordance with standards developed by: A. ASA B. AANA C. APSF D. NOCA E. JCAHO

NOCA National Organization for Competency Assurance

Aspirin is a __________________ of platelet clotting function. A. Competitive agonist B. Competitive antagonist C. Noncompetitive agonist D. Noncompetitive antagonist

Noncompetitive antagonist It attaches to platelets irreversibly; in other words, aspirin cannot be removed from its receptor on the platelet with another competitor ligand. Competitive antagonist compete for binding to the receptor with other molecules. The concentration of the molecules and the Kd of the molecules determine which competitor binds more receptors.

Which of the following statements about agonists is FALSE? A. Partial agonist act at the same site as full agonist B. Partial agonist can be as efficacious as full agonist if large amounts are used C. Partial agonist may also have antagonistic properties D. Partial agonist's efficacy is unrelated to their potency E. None of the above

Partial agonist can be as efficacious as full agonist if large amounts are used By definition, a partial agonist is a Ligand that operates as receptor and produces an effect that is sub-maximal hen compared to the affect of a full agonist. This cannot be overcome by increasing the amount of partial agonist administered. In the presence of a full agonist, a partial agonist may compete for the receptor binding site and must act as an antagonist. A partial agonist's efficacy is not the same as a full agonist: amount of drug required to achieve efficacy (i.e., potency) is related and may be large or small.

Drugs that increase the force of myocardial contraction are called A. Local anesthetics B. Beta-blockers C. Antiarrhythmic agent D. Positive inotropic agents

Postive inotropic agents

What process is responsible for the offset of effects of a bolus of propofol? A. First -pass effect B. Redistribution C. P-450 enzyme reduction D.Increased renal blood flow E. None of the above

Redistribution The bolus of propofol is mixed and distributed rapidly to the central compartment and the vessel rich group. Subsequently, the plasma level falls as the propofol is redistributed to muscles and the vessel-poor group.

What process is responsible for the offset of effects of a bolus of propofol? A. First pass effect B. Redistribution C. P450 enzyme reduction *D. Increased renal blood flow

Redistribution The bolus of propofol is mixed and distributed rapidly to the central compartment and to the vessel-rich group. Subsequently, the plasma level falls as the propofol is redistributed to muscles and the vessel poor group.

How would drug onset and duration of action be affected in a patient with heart failure (low cardiac output)? A. Speed drug onset B. Increase metabolism of the drug C. Shorten the duration of action D. Slow the onset

Slow onset A patient with reduced cardiac output, as in heart failure, will circulate the blood more slowly to the target organs, resulting in a delay in onset of action. The duration of action is usually, but not always, prolonged due to reduced blood flow to the liver (reduced metabolism) and kidneys (reduced elimination).

Which of the following factors DO NOT affect the force of contraction of the heart? A. The AV node B. Preload C. Contractility D. Drugs E. Afterload

The AV Node The AV node is a portion of the myocardial conduction system that regulates the speed of conduction from the atria to the ventricles. Preload, afterload, and contractility are major determinants of the force of myocardial contraction and can be explained by using Frank-Starling curves. Drugs can both positively and negatively affect contractility as well as affect preload and afterload.

What is the definition of ED 50? A. The ratio of effective dose to lethal dose in 50% of the population. B. The ratio of IV to oral medication that produces equivalent effect in 50% of the population. C. The dose that causes mortality in 50% of the population. D. The dose that produces the desired effect in 50% of the population. E. the dose that produces adverse effect in 50% of the population.

The dose that produces the desired effect in 50% of the population

What is pharmacodynamics? A. The effect of the drug on the body B. Drugs acting on a cell C. Drugs acting on a molecular level D. Drugs effect on an organ system

The effect of the drug on the body drugs acting on a cell Drugs acting on a molecular level Drugs effect on a organ system

Half-life is defined as: A. Halfway to the expiration date for a drug B. The time it takes the body to eliminate 50% of a drug C. The dose of a a drug that is effective in 50% of patients D. One-half the volume of distribution E. None of the above

The time it takes the body to eliminate 50% of a drug Drugs are gradually eliminated from the body. Some are eliminated at a constant rate(x amount of drugs per hour) in a process known a zero-order kinetics. With the vast majority of drugs, a first- order kinetic process is observed in which the amount of drug eliminated is dependent upon the concentration of the drug-a fixed percentage of the drug, not a fixed amount is eliminated each hour. The half- life is the amount of time is takes for 50% of the drug to be eliminated.

Which of the following statements are TRUE about cardiac cycle? A. Valves within the heart prevent the flow of blood backward. B. EF is defined as the amount of blood ejected from the heart during diastole. C. CO is equal to the EF times the HR. D. Diastole is when the heart is contracting.

Valves within the heart prevent the flow of blood backward. The vavles in the heart are very important as they prevent blood from flowing backward into the atria during ventricular contraction and backward into the ventricles from the pulmonary artery and aorta. The EF is the fraction of the end-diastolic ventricular blood that is ejected during systole. In normal resting patients, around 50% of the blood in the heart at the end-diastole is ejected during systole. CO is equal to the SV (the amount of blood ejected with each heartbeat during systole) times the HR.

Which of the following are potentially lethal cardiac arrhythmias? A. Ventricular Fibrillation B. Ventricular Tachycardia C. Sinus Bradycardia

Ventricular Fibrillation Ventricular Tachycardia Both may not produce any forward blood flow. Unless the ventricular tachycardia is slow, the patient will die.

3. Which of the following fluids and blood products are needed to resuscitate a patient with massive blood loss? A) PRBCs B) FFP C) Platelets D) Crystalloids (normal saline, lactated Ringer solution) E) All of the above

nswer: E Red blood cells carry oxygen, which is the single most important function of the blood. If blood lost were replaced only with crystalloid and other blood products, there would be a very low concentration of red blood cells (hematocrit), and the blood's ability to carry oxygen would be severely impaired. Both FFP and platelets are needed during resuscitation because clotting factors (contained in FFP) and platelets are both consumed and lost during massive bleeding. Without replacing them, the blood will not be able to form a strong clot to prevent continued bleeding. While crystalloids are the fluid of choice for replacing minor blood loss, once the amount of bleeding is high enough (this amount is different for every patient, but roughly half a blood volume for a healthy adult), blood products become the priority.

Half-life is defined as: A. The half way to the expiration date for the drug B. The time required for the amount of drug in the body to decrease by 50% C. The dose of drug that is effective in 50% of patients D. One half the volume of distribution

the time required for the amount of drug in the body to decrease by 50% Drugs are gradually eliminated from the body. Some are eliminated at a constant rate (xxx amount of drug per hour --- zero-order kinetics). With the vast majority of drugs, the amount of drug eliminated is dependent upon the concentration of the drug --- a fixed percentage of the drug, not a fixed amount, is eliminated each hour --- first-ordered kinetics. The half-life is the amount of time it takes for 50% of the drug to be eliminated.

. What is the volume percent of sevoflurane if the partial pressure is 19 mm Hg and atmospheric pressure is 633 mm Hg? A) 0.3% B) 12% C) 3% D) 1.2%

using the equation (partial pressure of gas/total ambient pressure × 100), we can determine that the percentage of sevoflurane being delivered is 3. (19/633) X 100

Which of the following statements is false? A. Oral administration of drugs may be subject to the first pass effect. B. IV administration is the route with the fastest onset of drug effects. C. Inhaled drugs cannot be absorbed into the bloodstream. D. Certain drugs may only be administered by certain routes. E. Appropriate drug dose may differ depending upon the route of administration.

Inhaled drugs cannot be absorbed into the bloodstream. Many drugs including inhaled anesthetics, nitric oxide, and lidocaine are all taken up into the bloodstream after inhaled administration. Orally administered drugs are absorbed by the gut and taken up in the bloodstream. From there, the blood passes through the portal circulation in the liver before mixing with systemic circulation. As the blood passes through the liver, it has the opportunity to metabolize the drug. Drugs given intravenously have the fastest onset because drugs are delivered to their target organs by the bloodstream, so the rate of onset is largely determined by how long it takes for a drug to get to the bloodstream. A critical safety concern is making sure the right drug in the right dose is given by the right route. Some drugs are toxic if given by one route but not another. Other drugs have 100-fold different doses depending upon the route of administration.