Test 9 Possibles: Anesthesia and Pain Management

2. A tranquilizer and/or sedative combined with an opioid or a alpha2-agonist called: a. Cyclohexamine b. A barbiturate c. A neuroleptanalgesia d. An anticholinergic

A neuroleptanalgesia *** 2. (Answer:c). Neuroleptanalgesic(a)is a combination of a tranquilizer and/or sedative with anopioid (analgesia). Anticholinergics (d) are parasympatholyticdrugs that exert their effects by blocking the actions of the parasym pathetic neurotransmitter acetylcholine at the muscarinic receptors. Cyclohexamine (a) is a specific classification of anesthetic called dissociative drugs that interrupt neural transmission that induce unconscious and conscious brain functions. Barbiturates (b) are based on the chemical substitutions on the barbituric acid molecule and the duration of action.

384. Which substance in blood can alter the rate and amount of absorption of barbiturates? (21) a. Growth hormone b. Humoral factor c. Calcium d. Protein

Protein *** 384. d Rationale : Level of plasma protein (d) can alter the rate and amount of absorption of the barbiturates. Barbiturates will bind to protein; therefore, for example, the amount of barbiturate free in the circulation and not bound to protein will increase if the patient is hypoproteinemic. The other substances-humoral factor, growth hormone, and calcium (a, b, and c)-have little to no effect on the absorption of barbiturates. (21)

14. The maximum halogenated anesthesia agent dose per day (ppm) according to the Occupational Safety and Health Administration (OSHA) is: a. 1 ppm b. 2 ppm c. 3 ppm d. 4 ppm

b. 2 ppm *** 14. (Answer: b). Halogenated anesthetic agents (i.e., isoflurane, enflurane) should not exceed 2 parts per million (ppm) dose per day (b). It is acceptable to exceed 1 ppm (a), as long as 2 ppm is not exceeded, which is recommended by Occupational Health and Safety Administration (OHSA). Finally, 3 ppm and 4 ppm (c and d) would exceed OSHA's recommended daily exposure.

1. The veterinary technician can play an important role in pain management by: a. Monitoring urine and fecal output b. Changing the medication when it is ineffective c. Communicating directly with the clinician about particular concerns d. Directing the veterinary assistant to give medications

c. Communicating directly with the clinician about particular concerns *** 1. (Answer: c). The veterinary technician can play an important role in pain management by communicating directly with the clinician about particular concerns (c). Monitoring urine and fecal output (a), although important, unless having direct bearing on a particular case, would not be the best answer to contributing to pain management. Changing the medication when it is ineffective (b) is important but cannot be done by a technician without input from the attending clinician. Directing the veterinary assistant to give medications (d) is not the most helpful choice because it would be important to see the animal receives the medication directly, not by passing the duty off to another.

359. Which is the most commonly used tranquilizer in veterinary medicine, for both large and small animals: and as both a tranquilizer and a sedative? (21) a. Acepromazine b. Hydromorphone c. Lorazepam d.Diazepam

Acepromazine *** 359. a Rationale : Acepromazine (a) is most commonly used in veterinary medicine and approved for use in both small and large animals and is used as both a tranquilizer and a sedative. The mechanism of action involves the blockade of DZ-dopamine receptors in the brain. Benzodiazepines such as diazepam and lorazepam (c and d) enhance the activity of CNS inhibitory neurotransmitters to reduce neural activity for use as a tranquilizer, anti convulsant, or muscle relaxer. Hydromorphone (b) and acepromazine together will produce neuroleptic analgesia. (21)

460. Which preanesthetic agent blocks acetylcholine at the muscarinic receptors? (21) a. Atropine b. Physostigmine c. Acepromazine d. Chlorpromazine

Atropine *** 460. a Rationale :Anticholinergics,such as atropine(a)and glycopyrrolate,are parasympatholytic drugs that exert their effects by blocking the actions of the parasympathetic neurotransmitter acetylcholine at the muscarinic receptors. Atropine overdose can be reversed with physostigmine (b). Acepromazine and chlorpromazine (c and d) are phenothiazines;their mechanism of action involves the blockade ofD2-dopamine receptors in the brain. (21)

414. Which of the following preanesthetic drugs will cross the blood-brain barrier and placental barrier in pregnant patients and cause more than minimal fetal effect? (21) a. Atropine b. Etomidate c. Guaifenesin d. Glycopyrrolate

Atropine ***414. a Rationale : Atropine (a) will cross the blood-brain barrier and placental barrier in pregnant patients. Glycopyrrolate (d) will not cross either barrier. Although both etomidate and guaifenesin (b and c) will cross the placental barrier, the fetal effects of each are minimal. (21)

21. Which animal should never receive acetaminophen? (22) a. Dogs b. Cats c. Cattle d. Chinchillas

Cats *** 21. b Rationale: Cats (b) should never receive acetaminophen. Other mammals (a, c, and d) can be given this and other nonsteroidal antiinflammatory drugs. (22)

52. Which of the following is an appropriate role for the veterinary technician in pain management? (22) a. Analyze urinary and fecal output b. Change pain medication when ineffective c. Direct veterinary assistant to administer a medication d. Communicate directly with the clinician about the patient's responses

Communicate directly with the clinician about the patient's responses ***52. d Rationale: The veterinary technician can play an important role in pain management by communicating directly with the clinician about particular concerns (d). Monitoring urine and fecal output (a), is one aspect of monitoring pain level. Changing the medication when it is ineffective (b) cannot be done by a technician without authorization from the attending clinician. Directing the veterinary assistant to give medications (c) is normally part of pain management. (22)

450. Which pain therapy treatment uses very cold temperatures as its modality? (22) a. Extracorporealshock wave therapy b. Therapeutic ultrasound c. Thermotherapy d. Cryotherapy

Cryotherapy *** 450. d Rationale : Cryotherapy (d) can be applied via ice bath, ice massage, ice pack, vapocoolant gel, or circulating ice compression units. Extracorporeal shock wave therapy uses sound waves, not cold; it is a high-energy focused sound wave therapy. Thermotherapy (c) is the application of heat and can be applied by hot packs, infrared light, hydrotherapy, and therapeutic ultrasound (b). (22)

106. Which can cause hypoxemia when using N20 in general anesthesia? (21) a. Pulse oximetry b. Decreased inspired 02 concentration c. Hyperventilation while inspiring 21 % 0 2 d. Hyperventilation with venous admixture

Decreased inspired 02 concentration *** 106. b Rationale: Decreased inspired oxygen concentration (b) can cause hypoxemia when using nitrous oxide in general anesthesia. Pulse oximetry (a) is a way to monitor for this reaction, not a cause. Hyperventilation(c and d) is not a cause, but the opposite, hypoventilation, can be a cause.(21)

430. What is the greatest disadvantage of using constant or continuous rate infusion (CRI) of analgesic drugs? (22) a. More breakthrough pain b. Less stable plane of analgesia c. Difficulty in dosage calculations d. Less control over administration (e.g., dose changes)

Difficulty in dosage calculations *** 430. c Rationale: The greatest disadvantage of using constant or continuous rate infusion (CRI) of analgesic drugs is calculating CRI dosages (c). Thus, rather than calculating drug dosages for each CRI, a "cheat sheet" or computer program is recommended. CRI offers a more stable planes of analgesia (b), with less incidence of breakthrough pain (a). It also offers greater control over drug administration (easy to change the dose)(d); it is less expensive and easy to use; and a lower drug dosage can be delivered at any given time, resulting in a lower incidence of dose-related side effects. (22 )

362. Which behavior most likely indicates that a chicken is in pain? (22) a. Grunting, with restlessness and pacing b. Gasping, standing on one foot, easy to handle c. High-pitched, urgent squealing sounds; agitated d. Hissing sounds; hunched and immobile, but aggressive when handled

Gasping, standing on one foot, easy to handle *** 362. b Rationale: A chicken in pain makes gasping sound, stands on one foot,,,hunches or huddles; the chicken in pain is lethargic and allows handling(b). Grunting with restlessness and pacing is characteristic of a horse in pain. Urgent squeals with agitation (c) is characteristic of a guinea pig in pain; and hissing with hunched posture, a_nd immobility and aggression when handled (d) are characteristic of a reptile in pain. (22)

345. Which patient situation is considered a category III risk for anesthesia complications, according to the ASA scale? (21) a. Ovariohysterectomy b. Ruptured cruciate ligament c. Advanced multiple organ failure d. Heart murmur and moderate dehydration

Heart murmur and moderate dehydration ***345. d Rationale: A patient with a heart murmur and moderate dehydration (d) is an example of a category III risk (moderate risk) for anesthesia complications, according to the American Society of Anesthesiologists' scale. A patient undergoing ovariohysterectomy(a) or castration is considered a category I (minimal risk) provided the patient is healthy. Category II (slight risk) examples include a patient with a ruptured cruciate ligament (b), a neonate, or a geriatric patient. A patient with advanced multiple organ failure (c) is a category IV (high risk) patient. (21)

442. Which of the following involves the transcutaneous delivery of medications via direct current using electrostatic repulsion? (22) a.Laser therapy b. Iontophoresis c. NMES d. TENS

Iontophoresis ***442. b Rationale : Iontophoresis (b) is the transcutaneous delivery of medications via direct current using electrostatic repulsion. Laser therapy (a) stands for light amplification by stimulated emission of radiation, and thus uses radiation, not electrostatic repulsion. Neuromuscular electrical stimulation (NMES) (c) uses electrical current stimulation to work on motor nerves and muscle fibers for muscle reeducation. Transcutaneous electrical nerve stimulation (TENSHd) works by applying a high-frequency current to the skin for electrical stimulation of nerves for relief of pain. (22)

393. A sight hound undergoes surgery and anesthesia is induced at a normal rate and at an abnormally high dosage at the beginning of the procedure using thiopental, yet the patient experiences a prolonged recovery. What has most likely caused this? (21) a. Low body fat b. Injection of air c. Too rapid administration d. Subsequent doses given for maintenance of anesthesia

Low body fat *** 393. a Rationale: Anesthetists are encouraged to avoid using thiopental in sighthounds; low body fat and. therefore must increase the dosage in order to induce anesthesia. This results in a prolonged recovery. (a) will result in a prolonged recovery. The other effects are all true of thiopental as well, but with causes other than low body fat; injecting air (b) may cause premature precipitation, but there is less evidence of this than of low body fat. Transient apnea may occur if given rapidly (c), but there is no indication of either apnea or rapid induction. There will be a cumulative effect with repeated administration (d); however, this patient received only one initial induction dosage. (21)

80. What is meant by"the fourth vital sign"? (22) a. Pain levels b. Body position c. Appetite levels d. Activity/restlessness

Pain levels *** 80. a Rationale: Pain (a) has become the "fourth vital sign," ranking in equal importance with temperature, pulse, and respiration. Physiological signs of pain include increased heart rate, increased blood pressure (BP), increased respiratory rate, and vocalization. Behavioral signs include restlessness (d), decreased appetite (c), not sleeping, resentment of being handled, and assuming an abnormal position (b). (22)

481. Which best describes the type of pain treated in myofascial trigger point therapy? (22) a. Pain of soft tissue origin characterized by a hardened muscle band that is intensely painful on palpation b. Point of concentrated debris within the tendon sheath in response to tendinopathy c. Pain from OA with hip and elbow dysplasia and supraspinatus tendinopathy d. Areas of strain lesion in the iliopsoas muscle

Pain of soft tissue origin characterized by a hardened muscle band that is intensely painful on palpation *** 481. a Rationale: Myofascial trigger point (MTrP) refers to a pain phenomenon of soft tissue origin that is characterized by two specific attributes: (1) a hardened muscle band (motor dysfunction) with (2)intense pain on palpation (sensory dysfunction) (a). Extracorporeal shock wave therapy (ESWT) has been applied to painful osteo arthritic (OA) lesions in veterinary practice, including hip and elbow dysplasia and supraspinatus tendinopathy (c). Therapeutic ultrasound works by heating areas of muscle spasm to create relaxation, treating tendinopathies with nonthermal effects to break up the debris within the tendon sheath (b), and stimulating the insertion of the iliopsoas muscle to encourage healing of a strain lesion (d). (22)

467. Which opioid is a mixed agonist-antagonist, in that it can block one type of receptor and stimulate another type of receptor? (21) a. Fentanyl b. Naloxone c. Pentazocine d. Meperidine

Pentazocine ***467. c Rationale : Pentazocine (c) is a mixed agonist-antagonist, in that it can block one type of receptor and stimulate another type of receptor. Meperidine and fentanyl (a and d) are both pure (mu) agonists, meaning that they stimulate all opioid receptors. Naloxone (b) is a pure antagonist, meaning it will reverse the effects of pure and mixed agonists with very little clinical effect of its own. (21)

493. Which best describes the transduction phase of nociception? (22) a. Phase of the physical, subjective experience of pain b. Process by which afferent nerve endings translate the noxious stimulus into nociceptive impulses c. Process of enhancement or regulation of perception with input from both ascending and descending pathways .. d. Process by which impulses are sent to the dorsal horn of the spinal cord, and then along the sensory tracts to the brain

Process by which afferent nerve endings translate the noxious stimulus into nociceptive impulses *** 493. b Rationale: Transduction is the process by which afferent nerve endings translate the noxious stimulus into nociceptive impulses (b). Nerve fibers that respond maximally to noxious stimulation are referred to as nociceptors. Transmission is the process by which impulses are sent to the dorsal horn of the spinal cord and then along the sensory tracts to the brain(d). Next, modulation provides enhancement or regulation of perception with input from both ascending and descending pathways (c), and perception occurs when the individual has the subjective experience of pain (a).(22)

1. Preanesthetic drugs are commonly used for all of the following advantages except: a. Analgesia b. Sedation c. Respiratory stimulant d. Safe handling

Respiratory stimulant *** 1. (Answer: c). Preanesthetic drugs are not used to stimulate respiratory rate (c). Instead, they provide mild sedation (b) and analgesia (a) for preoperative, intraoperative, and postoperative phases and reduce anxiety (d), calming the patient.

347. Which route of preanesthetic administration tends to produce longer lasting effects? (21) a. IM b. IV c. SC d. PO

SC ***347. c Rationale: Pre Anesthetics Given subcutaneously(SC) (c) usually take 20 minutes to reach peak effect but can last longer than intramuscularly(IM) and intravenously (IV) administered drugs(a and b). Oral administration, or PO (d), is not recommended for preanesthetic agents. (21)

444. In which patient groups are the butyrophenones most commonly used for preanesthesia?(21) a. Dogs and cats b. Swine and exotic animals c. Goats, camelids, and sheep d. Rabbits, ferrets, and chinchillas

Swine and exotic animals *** 444. b Rationale : The most common use of butyrophenones in veterinary medicine is in swine and exotic animals (b). Frequently, alpha-2 agonists such as dexmedetomidine are used in dogs and cats (a), along with a variety of other agents. Others, such as the phenothiazines, are used in a wider variety of animals, including the categories listed (c and d).(21)

471. Which pain and relaxation therapy option can be used both to coupage the lungs or to cause muscles to fire and contract for strengthening?(22) a. Iontophoresis b. Tapotement c. NMES d. TENS

Tapotement *** 471. b Rationale: Tapotement massage can be used to coupage the lungs or cause muscles to fire and contract for strengthening (b). Iontophoresis is the transcutaneous delivery of medications via direct current using electrostatic repulsion (a). Neuromuscular electrical stimulation (NMES) (c) uses electrical current stimulation to work on motor nerves and muscle fibers for muscle reeducation. Transcutaneous electrical nerve stimulation (TENS) (d) works by applying a high-frequency current to the skin for electrical stimulation of nerves for relief of pain. (22)

400. Which is true of a Bier block? (22) a. It can anesthetize the entire proximal aspect of a limb b. The LA agent used should be injected above the catheter c. The LA used with this procedure can only be lidocaine, without epinephrine d. A tourniquet on the affected limb occludes both the vein and arterial flow

The LA used with this procedure can only be lidocaine, without epinephrine ***400. c Rationale: The local anesthetic used with a Bier block can only be lidocaine, without epinephrine (c), and this is injected intravenously below the catheter, not above (b). A Bier block can anesthetize the entire distal aspect of a lim b, not the proximal aspect (a). A tourniquet on the affected limb should not include both the vein and arterial flow (d); instead, a tourniquet is only placed tight enough to occlude venous but not arterial blood flow.(22)

421. A cat is being administered an epidural. When the needle is advanced, the cat's hind leg twitches. What does this indicate? (22) a. The needle has missed the cauda equina b. The needle has bypassed the epidural space c. The needle has entered the subarachnoid space d. The needle does not have to be redirected; the drug may be injected

The needle does not have to be redirected; the drug may be injected **** 421. d Rationale: The drug may be injected without redirecting the needle (d) because the epidural space has indeed been entered, not bypassed (b), indicating the needle has not missed the cauda equina (a). In the presence of this reaction, we know that the subarachnoid space has not been entered (c). (22)

464. Which therapy is controlled by means of a piezoelectric effect on a crystal housed in a transducer head? (22) a. Laser b. Petrissage c. Iontophoresis d. Therapeutic ultrasound

Therapeutic ultrasound *** 464. d Rationale: Therapeutic ultrasound(d) converts electricity to sound waves by means of piezoelectric effect on the crystal housed in the transducer head. Laser therapy (a) stands for light amplification by stimulated emission of radiation, and thus uses radiation,not a piezoelectric effect. Petrissage.(b) is a group of massage techniques that increase circulation, stimulate the nervous system, mechanically relax muscles, and reduce muscle stiffness. Iontophoresis (c) is the transcutaneous delivery of medication s via direct current using electrostatic repulsion.(22)

3. Which of the following is a classification of a drug that calms an anxious patient but will not necessarily reduce awareness? , a. Anticholinergic b. Tranquilizer c. Sedative d. Isoflurane

Tranquilizer

487. Which is a measure of the volatility of an anesthetic liquid? (21) a. Atmospheric pressure b. Vapor pressure c. Boiling point d. Solubility

Vapor pressure *** 487. b Rationale: Vapor pressure (b) is the measure of the volatility of the anesthetic liquid. The liquid form requires a carrier gas, correct temperature, and correct vaporizing chamber to be able to convert the liquid form into a vapor phase so that it can be safely administered through a breathing system. Boiling point (c) of a volatile

3. During hospitalization, how often should pain assessment be performed? a. Every 4 to 6 hours b. Every 30 minutes to 1 hour c. Every 12 to 24 hours d. Every 8 hours

a. Every 4 to 6 hours *** 3. (Answer: a). During hospitalization, a pain assessment should be conducted every 4 to 6 hours (a). Doing this every 30 to 60 minutes (b)is not necessary unless this is the immediate postoperative period, which is not specified in this question. Assessing pain less frequently, such as every 8 to 24 hours, is not enough for a hospitalized patient (cord).

11. Which of the following is an NMDA antagonist medication? a. Ketamine b. Lidocaine c. Meperidine d. Dexmedetomidine

a. Ketamine *** 11. (Answer: a). Ketamine (a) is an NMDA antagonist medication. Lidocaine (b) is a sodium channel blocker; me pericline (c) is an opioid; and dexmedetomidine(d) is an alpha-2 adrenoreceptor agonist.

16. Massage is an example of what rehabilitation technique? a. Manual therapy b. Effleurage techniques c. Physical modalities d. Therapeutic exercise

a. Manual therapy *** 16. (Answer: a). The three basic approaches to pain management in human physical therapy are manual techniques, electrophysical agents, or physical modalities (c), and interventions that change movement patterns thought to promote pain. Examples of manual therapies (a) include massage, as well as joint mobilizations, stretches, therapeutic exercises, and soft tissue mobilization. Physical modalities (c) are a different category. Effleurage (b) is a type of massage technique, and therapeutic exercise (d) is another type of manual therapy.

10. Which of the following drugs can be used as a sedative, induction agent, and maintenance anesthetic? a. Propofol b. Diazepam c. Ketamine d. Thiopental

a. Propofol *** 10. (Answer: a). Propofol (a) is a short-acting hypnotic and alkylphenol derivative. It is rapid acting with smooth, excitement-free inductions, rapid smooth recovery as a result of the redistribution, and rapid metabolism (redistribution to vessel-rich areas such as the brain rather than muscle or fat). Diazepam (b) is a member of the benzodiazepine family, which act as muscle relaxants and anticonvulsants, and are classified as tranquilizers (mild calming effect). They are additives or synergistics that are used with other drugs. Ketamine (c) is a cyclohexylamine with selective analgesic properties, used in conjunction with benzodiazepines for induction, but not used alone. Thiopental (d) is commonly used as an induction agent, but it is not used for maintenance anesthesia because of the protein binding and lipid solubility effects.

6. What is nociception? a. The activity in the peripheral pathway that transmits and processes the information about the stimulus to the brain b. A normal response to tissue damage c. Pain without apparent biological value that has persisted beyond the normal tissue healing time, usually taken to be 3 months d. Any stimuli to the affected area that would normally be innocuous becomes noxious

a. The activity in the peripheral pathway that transmits and processes the information about the stimulus to the brain *** 6. (Answer: a). Nociception is the activity in the peripheral pathway that transmits and processes the information about the stimulus to the brain (a). It is not a normal response to tissue damage (b), which would be the definition for adaptive acute pain. Nociception is not pain without apparent biological value that has gone on for some time (c); this is the definition of chronic maladaptive pain. The definition for allodynia is pain from any stimuli to the affected area that would normally be innocuous that becomes noxious (d).

7. What is the correct sequence of steps in the pain pathway? a. Transduction, transmission, modulation, perception b. Modulation, transduction, perception, transmission c. Transduction, modulation, transmission, perception d. Transmission, transduction, modulation, perception

a. Transduction, transmission, modulation, perception d. Transmission, transduction, modulation, perception *** 7. (Answer: a). The correct sequence is as follows: Transduction, Transmission, Modulation, Perception (a). The others are not in the correct sequence (b, c, and d).

17. Using IPPV, the rate to ventilate a patient under general anesthesia is: a. 4 to 8 breaths per minute b. 8 to 12 breaths per minute c. 12 to 16 breaths per minute d. 16 to 20 breaths per minute

b. 8 to 12 breaths per minute *** 17. (Answer: b). The only acceptable rate for ventilation during IVVP is 8 to 12 breaths per minute (b). All other rates (a, c, and d) are incompatible with safe and ideal ventilation. The inspiration-to-expiration ratio should be 1:2, with a tidal volume of 15 to 20 mL/kg (30 mL/kg for open chest), and an inspiratory pressure of 12 to 20 cm H2O (30 cm H2O with open chest). The Goal of using these parameters is to decrease carbon dioxide levels to slightly below normal, thereby eliminating spontaneous breathing and allowing control of ventilation.

6. Anticholinergics may be given to which of the following patients and included in the preanesthetic protocol? a. A 1 7-year-old poodle with a possible grade IV heart murmur that is scheduled for dentistry b. A 2-year-old St. Bernard that will be having hernia repair surgery c. A 14-year-old cat with tachycardia and a history of ventricular arrhythmias d. A 5-year-old border collie that is scheduled for endoscopy

b. A 2-year-old St. Bernard that will be having hernia repair surgery *** 6. (Answer: b). Only the 2-year-old St. Bernard with the hernia should be put on this drug (b). Anticholinergics are contraindicated in patients undergoing upper GI barium series and endoscopy (d);any patient with tachycardia (c) or ventricular arrhythmias; and-geriatric patients with organ dysfunction (a).

482. Which best describes neuroleptic analgesic agents? (21) a. Drugs that interrupt neural transmission that induces unconscious and conscious brain functions b. Any combination of an analgesic and a tranquilizer to enhance the CNS depressant effects of each drug c. CNS depressant group that produces varying degrees of CNS depression by acting on CNS neurons and gamma-aminobutyric acid (GABAA) receptors d. Parasympatholytic Drugs that exert their effects by blocking the actions of the parasympathetic transmitter acetylcholine at the muscarinic receptors

b. Any combination of an analgesic and a tranquilizer to enhance the CNS depressant effects of each drug *** 482. b Rationale: A neuroleptic analgesia is any combination of an analgesic and a tranquilizer to enhance the central nervous system (CNS) depressant effects of each drug(b). Dissociative anesthetics are drugs that interrupt neural transmission that induce unconscious and conscious brain functions (a).Barbiturates are a CNS depressant group that produces varying degrees of CNS depression by acting on CNS neurons and gamma-aminobutyric acid (GABA.J receptors (c). Anticholinergics Are parasympatholytic drugs that exert their effects by blocking the actions of the parasympathetic neurotransmitter acetylcholine at the muscarinic receptors (d).(21)

17. What is a benefit of cryotherapy? a. Decreased metabolism so patient is less hungry b. Decreased production of pain mediators, leading to analgesia c. Prevention of hyperthermia d. Useful 2 to 3 weeks post injury

b. Decreased production of pain mediators, leading to analgesia *** 17. (Answer: b). The beneficial effects of cryotherapy include vasoconstriction; reduced cellular metabolism, decreased nerve conduction velocity, and decreased production of pain mediators, leading to analgesia (a),as well as reduction of edema and decreased muscle spasm. Connecting decreased metabolism so the patient is less hungry (a)is misleading and taken out of context; instead, cryotherapy reduces cellular metabolism . Cryotherapy does not prevent hyperthermia (c) and is not normally recommended for this condition. Finally, it is not true that it is most useful for 2 to 3 weeks post injury (d);instead, icing should be used for the first 48 hours.

11. The component that is color-coded and fitted with non interchangeable, gas-specific connectors on an anesthesia machine is termed the: a. Check valve b. Diameter-index safety system c. Flowmeter d. Pressure relief valve

b. Diameter-index safety system *** 11. (Answer: b). The diameter-index safety system (DISS) (b) is a set of connectors that are specific to each gas. The flow meter (c) measures and indicates flow of gases into the vaporizer and then to the patient, and the check valve (a) located in the E tank yoke, anesthetic machine pipelines, and regulators, ensures a one-way safe flow of gases from the regulator, tank, and/or pipeline. Finally, the pressure relief valve (d) is also known as the pop-off valve and does just what its name implies. It is located on the circle system's carbon dioxide absorber or Bain system mount.

13. An example of topical analgesia is: a. Buprenorphine b. EMLA cream c. Bupivacaine · d. Fentanyl

b. EMLA cream *** 13. (Answer: b), (a) Buprenorphine e, this is either injectable or t ransmucosal . (b) EMLA cream correct answer. (c) Bupivacaine, this is injectable. (d)Fentanyl, this is either injectable or a transdermal patch.

14. An intratesticular block: a. Can only be used in large animal patients b. Is an excellent block for canine and feline orchiectomy c. Requires the use of a vaporizer d. Has never been performed in veterinary patients

b. Is an excellent block for canine and feline orchiectomy *** 14. (Answer: b). (a) Only used in large animal patients: this is not true.(b)Is An excellent block for canine and feline orchiectomy (correct answer). (c) Requires the use of a vaporizer: not true,can be performed on injectable anesthesia. (d) Never been performed in veterinary patients: not true, utilized routinely.

20. What are three chronic pain diseases? a. Lymphoma, diabetes, gastric dilatation- volvulus b. Osteoarthritis, intervertebral disc disease, cancer c. Respiratory infection, cardiac disease, blocked cat d. Broken leg, bronchitis, hypertension

b. Osteoarthritis, intervertebral disc disease, cancer *** 20. (Answer: b). (a) Lymphoma, diabetes, GOV (GOV is acute and this negates this answer). (b) Osteoarthritis, IVOD, cancer(correct answer). (c) Respiratory infection, cardiac disease, blocked cat (all 3 are not chronic diseases). (d) Broken leg, bronchitis, hypertension (all 3 are not chronic diseases).

2. Name three signs of pain in a cat. a. Sleeping continually, overeating, attention-seeking behavior b. Resentment at being handled, aggression, abnormal posture c. Hyperactivity, pupillary enlargement, tail swishing d. Hypotension, hypocapnia, bradycardia

b. Resentment at being handled, aggression, abnormal posture ***2. (Answer: b). Three behavioral signs of pain in a cat include resentment at being handled, reclusive, and abnormal posture (b). Sleeping continually, overeating, and attention-seeking behavior (a) are not thought41>f as indicating pain.Combined, hyperactivity,pupillary enlargement, and tail swishing (c) would not necessarily result in di cate pain. Finally, hypotension, hypocapnia, hypopnea, and bradycardia (d) are not behavioral signs for pain.

4. When trying to distinguish pain from dysphoria a. Put the patient-on comfortable blankets b. Speaking in low tones and interaction with the animal makes the patient feel better but behaviors resume when interaction stops c. Moving the animal to a different ward makes it better d. Automatically reverse the analgesic medication

b. Speaking in low tones and interaction with the animal makes the patient feel better but behaviors resume when interaction stops *** 4. (Answer: b). To distinguish pain from dysphoria, try speaking in low tones and interacting with the animal; if this makes the patient feel better but behaviors resume when interaction stops, this will show that the patient has pain and is not dysphoric (b). Putting the patient on comfortable blankets will not relieve an animal with dysphoria (a). Similarly, neither will moving the animal to a different ward (c). Finally, automatically reversing the analgesic medication is not appropriate (d).

8. During which stage of anesthesia delirium or excitement and loss of consciousness occur? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

b. Stage 2 *** 8. (Answer:b). Delirium or excitement occurs in stage 2 (b). Effects of each stage are as follows: Stage 1: induction stage, stage of analgesia, and altered consciousness Stage2 : stage of delirium or excitement, loss of consciousness Stage 3: stage of surgical anesthesia Stage 4: stage of medullary paralysis (apnea and cardiac arrest)

3. Which of the following is a classification of a drug that calms an anxious patient but will not necessarily reduce awareness? a. Anticholinergic b. Tranquilizer c. Sedative d. Isoflurane

b. Tranquilizer *** 3. (Answer: b). Tranquilizers (b) can calm anxieties without altering consciousness. Anticholinergics (a) are parasympatholyticdrugs used to prevent or treat bradycardia. A sedative (c) is a tempting choice, but it reduces excitement or irritability by causing decreased activity. Finally, isoflurane (d) is an inhalant anesthetic agent used to produce unconsciousness and general anesthesia.

15. The importance of a will significantly affect a patient's physiological signs (heart rate and blood pressure) and pathological effects (tissue healing). a. antitussive b. algesia c. agonist d. antisialagogue

b. algesia *** 15. (Answer:b). In thislist, onlythe analgesic (c) has the ability to significantly affect both vital physiological signs and pathological effects. Antisialogogue Drugs (d) prevent salivation. Antitussive (a) agents suppress the cough reflex. Agonists (c} have an affinity for a specific receptor before they produce an effect.

20. Respiratory acidosis is an acid-base disturbance where the blood gas analysis reveals: a. ↓ CO2, ↑ pH b. ↑ CO2, ↓ pH c. ↓ CO2, ↓ pH d. ↑ CO2, ↑ pH

b. ↑ CO2, ↓ pH *** 20. (Answer: b). Respiratory acidosis is an acid-base disturbance in which the blood gas analysis reveals carbon dioxide production is greater than carbon dioxide excretion (b). The increased carbon dioxide causes a gain in acids and decrease in pH. By contrast, respiratory alkalosis is defined as carbon dioxide excretion greater than carbon dioxide production (d), which causes excess loss ofH' ions (c) and gain in bases(a).

15. What is NOT a benefit of a constant rate infusion? a. A more stable plane of analgesia with less incidence of breakthrough pain b. Greater control over drug administration c. A lower drug dosage delivered at any given time, resulting in a lower incidence of dose related side effects d. Allows the technician to leave the room and come back several hours later

c. A lower drug dosage delivered at any given time, resulting in a lower incidence of dose related side effects *** 15. (Answer: c). All of these are benefits of CRI except choice (c). Although it is helpful that a variety of drugs can be used in the CRI, drug choice should be based not only on what is best for the patient (e.g., analgesic potency and safety) but also on what is best for the hospital (e.g., comfort level with and availability of drugs). The other advantages are true-CSI does enable lower doses and fewer side effects (a),a more stable plane of analgesia (c), and greater control over drug administration (b).

5. What guidelines have elevated pain to the Fourth Vital Sign? a. American College of Veterinary Anesthesiologists' Pain Management Guidelines b. The International Veterinary Academy of Pain Management's Guidelines c. AAHA/AAFP Pain Management Guidelines for Dogs and Cats d. The AVMA Pain Management Guidelines

c. AAHA/AAFP Pain Management Guidelines for Dogs and Cats *** 5. (Answer: c). AAHA/AAFP Pain Management Guidelines for Dogs and Cats (c) has elevated pain to be the fourth vital sign. The other organizations are not listed in the chapter (a, b, and d).

12. Gabapentin is a(n): a. Benzodiazepine b. Sodium channel blocker c. Antiepileptic d. Nutraceutical

c. Antiepileptic *** 12. (Answer: c). Gabapentin is an antiepileptic. Sodium channel blockers (a) include drugs such as lidocaine or bupivacaine); benzodiazepines(b) include drugs such as midazolam and diazepam. Finally, nutraceuticals(d)include drugs such as glucosamine and chondroitin.

7. Which of the following drug(s) may cause histamine release when administered intravenously? a. Morphine b. Meperidine c. Both of the above d. Neither of the above

c. Both of the above *** 7. (Answer: c). Morphine and meperidine (a and b) have been reported to cause histamine release when administered intravenously.

5. All of the following drugs are pure mu agonists except: a. Morphine b. Meperidine c. Butorphanol d. Hydromorphone

c. Butorphanol *** 5. (Answer: c). Pure mu agonists include morphine (a), meperidine (b), hydromorphone (d), and fentanyl, which stimulate all opioid receptors. By contrast, butorphanol (c) is an agonist-antagonist opioid.

18. A(n) monitor is a device that measures end-tidal CO^2 a. Doppler b. ECG c. Capnograph d. Pulse oximeter

c. Capnograph *** 18. (Answer: c). Capnography (c) is a graphic measurement of instantaneous carbon dioxide level of respiratory gases and displayed as a waveform on a monitor . Electrocardiography (b) measures the quality, rhythm, and rate of the heart. A Doppler (a) unit is a noninvasive blood pressure monitor that also allows an audible heart rate sound and is especially useful for systolic pressure readings. Pulse Oximetry (d)measures the percent saturation of oxygen.

9. An example of an opioid agonist is: a. Butorphanol b. Naloxone c. Morphine d. Buprenorphine

c. Morphine *** 9. (Answer:c). In this particular list, only morphine (a)is an opioid agonist. Naloxone (b) is an antagonist; and both butorphanol and buprenorphine (a and d) are partial agonists.

16. Which class of drugs acts peripherally by reducing the prostaglandin production in the area of tissue damage? a. Barbiturates b. Local anesthetics c. Nonsteroidal antiinflammatories d. a2-Agonists

c. Nonsteroidal antiinflammatories *** 16. (Answer: c). NSAIDs. [cl Barbiturates, local anesthetics and Alpha2 agonists do not work peripherally by reducing prostaglandins production on areas of damaged tissue. Barbiturates (a) causeCNS depression by acting on CNS neurons and GABA receptors. Local anesthetics (b) block sensory and motor nerves and nerve transmission and Alpha2-agonists (d) stimulate alpha-adrenoreceptors causing CNS depression and decreased catecholamine release.

18. What is a myofascial trigger point? a. Apoint in the muscle where you elicit a reflex b. A microlesion in the muscle c. Painful areas of sustained muscle contraction that cannot easily self-release because of anoxia d. A technique where needles are used to pierce the skin at certain points to bring about a physiological change to treat or prevent disease

c. Painful areas of sustained muscle contraction that cannot easily self-release because of anoxia *** 18. (Answer: c). A myofascial trigger point is a pain phenomenon of soft-tissue origin characterized by a hardened muscle band that is intensely painful on palpation (c). Tocallit a microlesion (b) is misleading and inaccurate, and it is not a natural reflex (a). It is not a treatment strategy (d); the one described in choice (d) is actually a description of acupuncture.

19. A 35-kg canine patient is about to be induced. The anesthesia machine has been prepared by a student technician. After attaching a 2-L reservoir bag and the universal F-circuit, she then completed a leak test and declared the system ready to be used. She also prepared an induction tray and placed on the tray three endotracheal tubes sizes 10, 11, and 12 mm. What is wrong with her plan? a. She should have used a 2.5-L bag and smaller endotracheal tubes for a 35-kg patient. b. A 35-kg dog would require a 3-L reservoir bag and a 9-mm endotracheal tube. c. The patient requires a 3-L bag and a rebreathing circuit. d. There is nothing wrong with her plan. The protocol is acceptable.

c. The patient requires a 3-L bag and a rebreathing circuit. *** 19. (Answer: c). A 35-kg dog requires at the minimum a 3-L reservoir bag and 10-mm or larger endotracheal tube, eliminating choices (a) and (d). This could make it tempting to select choice (b). However, the universal F circuit cannot be used with an endotracheal tube bigger than 9.5 mm because the inner tube is not big enough to accom modate the larger endotracheal tube size.This may result in hypoventilation. The Correct choice, then, is (c).

9. Tissue necrosis will occur if administered perivascularly. a. Dexmedetomidine b. Pentobarbital c. Thiopental d. Methohexital

c. Thiopental *** 9. (Answer: c). Thiopental (c) is the only extremely alkaline solution. If tissue sloughing accidentally occurs, dilute the perivascular thiopental by injecting small amounts of normal saline around the site.The Other drugs are not associated with tissue necrosis. For example, dexmedetomine's (a) side effects include cardiovascular effects; pentobarbital's description (b) specifically notes that it can be administered IM for sedation without tissue reaction. Finally, methohexital (d) is associated with profound respiratory depression.

13. What can be done to reduce waste anesthetic gas exposure in the environment? a. Use a scavenging system to capture waste gas b. Leak-test machine prior to each use c. Annual preventative maintenance d. All of the above

d. All of the above *** 13. (Answer: d). All three methods (d) are effective measures for reducing waste anesthetic gas exposure in the environment. For example , directly attaching a scavenger hose (a) to an active scavenging system will ensure there are no waste gas anesthetics going directly into the room or atmosphere. Leak-testing an anesthetic machine (b) will identify any significant leaks,which could lead to waste gas exposure. Finally, annual preventive maintenance (c) will ensure that the anesthetic machine is functioning properly per the guidelines and recommendations set by the manufacturer. Preventive maintenance will also ensure the safety of the patient and personnel.

4. Atipamezole is a reversal agent specific to: a. Ketamine b. Butorphanol c. Acepromazine d. Dexmedetomidine

d. Dexmedetomidine *** 4. (Answer: d). Atipamezole is an alpha-2 antagonist that is specific to dexmedetomidine(d),which is its opposite, an alpha-2 agonist. Ketamine (a) is a dissociative anesthetic drug; butorphanol (b) can reverse the effects of morphine. Finally, acepromazine (c) is a tranquilizer that can be used in combination with ketamine to reduce seizures in dogs.

10. Prostaglandins play an important role in: a. Production of endorphins b.Mammalian cardiovascular physiology c. Production of leukotrienes d. Mammalian renal physiology

d. Mammalian renal physiology *** 10. (Answer:d). Prostaglandins Play an important role in mammalian renal physiology (d), where they play a role in autoregulation of vascular tone, glomerular filtration rate (GFR), renin production, and sodium and water bal-. ance. The other choices do not involve prostaglandins- production of endorphins (a), production of leukotrienes (c),or mammalian cardiovascular physiology (b).

19. What is NOT a type of visceral pain? a. Pancreatitis b. Gastroenteritis c. Bowel ischemia d. Osteosarcoma

d. Osteosarcoma *** 19. (Answer: d). Visceral pain is associated with internal viscera, such as that found in organs such as the pancreas, stomach, and bowel (a, b, and c), and not within bone(d). Other causes of visceral pain besides pancreatitis, gastroenteritis, and bowel ischemia include increased wall tension from distention of the GI tract, biliary system, or urinary bladder and capsular distention of solid organs.

12. An anesthesia machine flush valve does not: a. Provide a method of ventilation in emergency cases b. Deliver 100% oxygen c. Aid in filling the reservoir bag d. Relieve pressure within the breathing systems

d. Relieve pressure within the breathing systems *** 12. (Answer:d). The oxygen flush valve can actually create increased pressure within the breathing system when connected to the patient, not relieve pressure (d). In an oxygen flush valve, oxygen bypasses the vaporize. (a), delivering 100% oxygen to the breathing system (b). Besides flushing the system with pure oxygen, it also can fill the reservoir bag and system (c)to check for leaks.

8. What is "wind-up"? a. An increase in the excitability of spinal neurons, mediated in part by the activation of NMDA receptors in dorsal horn neurons b. Occurs when tissue inflammation leads to the release of a complex array of chemical mediators, resulting in reduced nociceptive thresholds c. Brief trauma or noxious stimulus-physiological pain d. The perceived increase in pain intensity over time when a given painful stimulus is delivered repeatedly above a critical rate

d. The perceived increase in pain intensity over time when a given painful stimulus is delivered repeatedly above a critical rate *** 8. (Answer: d). "Wind-up" is an increase in the excitability of spinal neurons over time when a painful stimulus is delivered repeatedly above a critical rate (d). This process is mediated in part by the activation of NMDA receptors in dorsal horn neurons (a), but the two are not the same thing. Wind-up is not a response to tissue inflammation (b); nor is it used to refer to any type of physiological pain(c).