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Quiz on Anesthesia Question of the Day 2, created by thomasina413 on 10/08/2014.

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Anesthesia Question of the Day 2

Question 1 of 48

1

A 73-year-old woman taking warfarin for chronic atrial fibrillation is brought to the operating room for evacuation of a spontaneous left temporal intracerebral hematoma with uncal herniation syndrome. Her INR is 3.8. Her platelet count and hematocrit are normal. What is the recommended medical therapy for reversing her coagulopathy?

Select one of the following:

  • Cryoprecipitate

  • 4-Factor prothrombin complex concentrate (PCC)

  • Fresh frozen plasma

  • Vitamin K

Explanation

Question 2 of 48

1

The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:

Select one of the following:

  • with decreasing age

  • by keeping the patient supine for more than 12 hours following puncture

  • with the use of fluid, instead of air, for loss of resistance

  • by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges

Explanation

Question 3 of 48

1

All of the following statements are true about hypoxic pulmonary vasoconstriction (HPV) EXCEPT:

Select one of the following:

  • HPV is a local response of bronchiolar artery smooth muscle in underventilated areas of the lung

  • HPV is responsible for most lung perfusion redistribution during one-lung ventilation

  • HPV occurs in areas of the lung with low alveolar oxygen pressure

  • HPV allows the lung to maintain optimal ventilation/perfusion matching

Explanation

Question 4 of 48

1

Factors decreasing physiologic dead space include:

Select one of the following:

  • the supine position

  • anticholinergic agents

  • increasing age

  • emphysema

Explanation

Question 5 of 48

1

A 64-year-old, 73 kilogram male with a 50 pack-year smoking history is scheduled to undergo a lobectomy for a right upper lobe mass. You have placed a left-sided double lumen endotracheal tube, and you would like to confirm proper placement. Which of the following findings would suggest that your double-lumen endotracheal tube has entered the right main bronchus by accident?

Select one of the following:

  • Inflate tracheal cuff, ventilate tracheal lumen, bilateral lung breath sounds

  • Inflate bronchial cuff, inflate tracheal cuff, ventilate tracheal lumen, right lung breath sounds

  • Inflate bronchial cuff, ventilate bronchial lumen, left lung breath sounds

  • Inflate bronchial cuff, ventilate bronchial lumen, right lung breath sounds

Explanation

Question 6 of 48

1

The development of transient neurologic symptoms (TNS) after spinal anesthesia is MOST associated with which of the following local anesthetics?

Select one of the following:

  • Bupivacaine

  • Lidocaine

  • Prilocaine

  • Tetracaine

Explanation

Question 7 of 48

1

Selective adrenergic stimulation of the β2-receptor results in:

Select one of the following:

  • increased heart rate

  • increased insulin secretion

  • detrusor muscle contraction

  • pupillary constriction

Explanation

Question 8 of 48

1

A patient with a severe traumatic brain injury is emergently brought to the operating room for evacuation of a parenchymal hematoma causing uncal herniation. The neurosurgeon requests that you limit systolic blood pressure to < 160 mmHg but keep cerebral perfusion pressure > 60mmHg. Currently, blood pressure is 190/100 mmHg and ICP is 25 mmHg. What antihypertensive agent will avoid a further increase in intracranial pressure?

Select one of the following:

  • Hydralazine

  • Minoxidil

  • Nitroglycerin

  • Nicardipine

Explanation

Question 9 of 48

1

Hormones released by the neurohypophysis include: (Select 2)

Select one or more of the following:

  • thryotropin

  • growth hormone

  • arginine vasopressin

  • adrenocorticotropic hormone

  • follicle stimulating hormone

  • oxytocin

  • prolactin

  • luteinizing hormone

Explanation

Question 10 of 48

1

A 50-year-old woman presents for lumbar spine surgery. Vital signs include blood pressure 210/130 mmHg. She appears comfortable but somewhat anxious. The anesthesiologist is concerned that this is a hypertensive emergency. What is the MOST appropriate next step in her management?

Select one of the following:

  • Apply nitroglycerin paste to the chest wall and proceed to surgery

  • Cancel surgery and send the patient to the emergency room

  • Proceed with surgery without further consideration

  • Question the patient regarding history of hypertension and antihypertensive therapies

Explanation

Question 11 of 48

1

At 10,000 feet elevation (atmospheric pressure is 520 mm Hg), oxygen 100 mL/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 260 mmHg. This mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is:

Select one of the following:

  • 0.25%

  • 0.5%

  • 1%

  • 2%

Explanation

Question 12 of 48

1

Pancreatic somatostatin producing cells in the Islets of Langerhans are:

Select one of the following:

  • alpha cells

  • beta cells

  • gamma cells

  • delta cells

Explanation

Question 13 of 48

1

Pancreatic somatostatin producing cells in the Islets of Langerhans are:

Select one of the following:

  • alpha cells

  • beta cells

  • gamma cells

  • delta cells

Explanation

Question 14 of 48

1

The recommended maximum leakage current allowed in operating room equipment is:

Select one of the following:

  • 5 μA

  • 10 μA

  • 1 mA

  • 5 mA

Explanation

Question 15 of 48

1

In a coagulopathic patient, the risk of bleeding after a paravertebral blockade is MOST similar to which other form of regional anesthesia?

Select one of the following:

  • Axillary block

  • Bier block

  • Epidural block

  • Supraclavicular block

Explanation

Question 16 of 48

1

Which of the following changes would MOST likely result in increased coronary artery perfusion in a patient with aortic stenosis?

Select one of the following:

  • Decreased systemic diastolic pressure

  • Increased systemic vascular resistance

  • Increased left ventricular diastolic pressure

  • Tachycardia

Explanation

Question 17 of 48

1

Causes of normal-anion-gap acidosis include:

Select one of the following:

  • renal failure

  • starvation

  • diarrhea

  • lactic acidosis

Explanation

Question 18 of 48

1

A 62-year-old man has had CABG surgery and develops atrial fibrillation in the ICU afterward. He is administered an amiodarone loading dose with a planned maintenance dose to follow. Which of the following hemodynamic effects is MOST likely to occur during the acute bolus phase?

Select one of the following:

  • Decreased systemic vascular resistance

  • Decreased pulmonary vascular resistance

  • Increased systemic vascular resistance

  • Increased pulmonary vascular resistance

Explanation

Question 19 of 48

1

The area of myocardium most vulnerable to ischemia is the:

Select one of the following:

  • left ventricular epicardium

  • right ventricular epicardium

  • left ventricular subendocardium

  • right ventricular subendocardium

Explanation

Question 20 of 48

1

Hypoxemia during one-lung anesthesia is most effectively treated by:

Select one of the following:

  • PEEP applied to the ventilated lung

  • continuous oxygen insufflation to the collapsed lung

  • changing tidal volume and rate

  • periodic inflation of the collapsed lung

Explanation

Question 21 of 48

1

Which of the following antibiotics is nephrotoxic?

Select one of the following:

  • Quinolones

  • Rifampin

  • Vancomycin

  • All of the above

Explanation

Question 22 of 48

1

Which of the following statements regarding open surgical versus percutaneous tracheostomies is MOST likely true?

Select one of the following:

  • Open tracheostomies are associated with fewer major complications

  • Open tracheostomies are associated with fewer infectious complications

  • Percutaneous tracheostomies are associated with fewer major complications

  • There is no difference in the incidence of major complications

Explanation

Question 23 of 48

1

Sympathetic blockade during acute herpes zoster has been shown to:

Select one of the following:

  • increase analgesic requirements

  • reduce the incidence of postherpetic neuralgia

  • increase the need for corticosteroid therapy

  • be an effective treatment for patients who have had postherpetic neuralgia for a number of years

Explanation

Question 24 of 48

1

Sympathetic blockade during acute herpes zoster has been shown to:

Select one of the following:

  • increase analgesic requirements

  • reduce the incidence of postherpetic neuralgia

  • increase the need for corticosteroid therapy

  • be an effective treatment for patients who have had postherpetic neuralgia for a number of years

Explanation

Question 25 of 48

1

Branches of the femoral nerve anesthetized during an ankle block include the:

Select one of the following:

  • deep peroneal nerve

  • sural nerve

  • saphenous nerve

  • posterior tibial nerve

Explanation

Question 26 of 48

1

A 35-year-old woman complains of chest pain on her seventh postpartum day. EKG reveals STEMI in anterior leads and a regional wall motion abnormality is appreciated on TTE. An angiogram reveals LCA dissection and the diagnosis of acute MI secondary to spontaneous coronary artery dissection (SCAD) is made. What is the incidence of SCAD in pregnant patients with MI?

Select one of the following:

  • 27%

  • 17%

  • 7%

  • 0.7%

Explanation

Question 27 of 48

1

Pulmonary complications from advanced hepatic disease with cirrhosis include:

Select one of the following:

  • an obstructive ventilatory defect

  • respiratory acidosis

  • increased intrapulmonary shunting

  • increased functional residual capacity

Explanation

Question 28 of 48

1

A patient with a large mediastinal tumor presents for excision of the mass. CT scan shows a mass of 14 x 10 cm causing about 40% tracheal compression and moderate compression of the superior vena cava (SVC) and other mediastinal structures. The heart is displaced laterally and an apical impulse is felt just medial to the anterior axillary line. The patient is asymptomatic with no signs of SVC syndrome. Which of the following is the MOST common mechanism of hemodynamic collapse under general anesthesia in this patient?

Select one of the following:

  • Increased afterload

  • Decreased preload

  • Ventilation-perfusion mismatch

  • Rhythm abnormalities

Explanation

Question 29 of 48

1

An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is:

Select one of the following:

  • echinacea

  • valerian

  • ginkgo

  • ephedra

Explanation

Question 30 of 48

1

A 23-year-old primiparous woman in spontaneous labor is monitored with continuous fetal heart monitors. The cardiotocograph shows a baseline fetal heart rate of 110/min with moderate variability. There are no accelerations over a period of 20 minutes and no early decelerations. This tracing falls under which of the following categories?

Select one of the following:

  • Category I

  • Category II

  • Category III

  • Category IV

Explanation

Question 31 of 48

1

The formation of metanephrine is the result of:

Select one of the following:

  • catechol-O-methyltransferase metabolism of epinephrine

  • catechol-O-methyltransferase metabolism of norepinephrine

  • monamine oxidase metabolism of epinephrine

  • monamine oxidase metabolism of norepinephrine

Explanation

Question 32 of 48

1

A 35-year-old man who had right ankle ORIF under general anesthesia after sciatic-saphenous nerve blockade develops right foot drop postoperatively. Which nerve is most likely injured?

Select one of the following:

  • Peroneal nerve

  • Tibial nerve

  • Saphenous nerve

  • Sural nerve

Explanation

Question 33 of 48

1

Which of the following is MOST true regarding a pediatric patient with a URI and the risk of anesthesia?

Select one of the following:

  • Airway reactivity has been demonstrated to occur in the lab, but has not been definitively shown to occur

  • Increased incidence of adverse airway events have been demonstrated in children to last for 2-4 weeks after the URI

  • The best approach is to cancel all children with a URI presenting for elective surgery

  • There are no known affects of a URI on the lower airways

Explanation

Question 34 of 48

1

Characteristics of human immunodeficiency virus neuropathy include: (Select 2)

Select one or more of the following:

  • distal polyneuropathy

  • rapid sudden onset

  • proximal muscle weakness

  • allodynia

  • upper extremities most commonly involved

  • proximal to distal progression of symptoms

Explanation

Question 35 of 48

1

An action potential characterized by a spike followed by a plateau phase is seen in:

Select one of the following:

  • peripheral sensory nerve cells

  • peripheral motor nerve cells

  • striated skeletal muscle cells

  • cardiac muscle cells

Explanation

Question 36 of 48

1

Patient risk factors associated with the development of perioperative peripheral nerve injuries include all of the following EXCEPT:

Select one of the following:

  • Diabetes mellitus

  • Hypertension

  • Female sex

  • Tobacco abuse

Explanation

Question 37 of 48

1

Autonomic hyperreflexia:

Select one of the following:

  • is common with cord lesions below T8

  • can precipitate pulmonary edema

  • is not effectively prevented by regional anesthesia

  • can be prevented with adequate intraoperative sedation

Explanation

Question 38 of 48

1

Mannitol may be administered during surgical clipping of an aneurysm to decrease brain water and thus brain bulk. The peak effect of mannitol occurs approximately:

Select one of the following:

  • 5 – 10 minutes after the infusion begins

  • 15 – 20 minutes after the infusion begins

  • 30 – 45 minutes after the infusion begins

  • About 1 hour after the infusion begins

Explanation

Question 39 of 48

1

Renal effects of nitrous oxide include:

Select one of the following:

  • decreased renal blood flow secondary to decreased cardiac output

  • decreased renal blood flow secondary to increased renal vascular resistance

  • increased renal blood flow secondary to sympathetic stimulation

  • increased glomerular filtration with increased reabsorption

Explanation

Question 40 of 48

1

What are the primary anatomic landmarks for a fascia iliaca block?

Select one of the following:

  • Anterior superior iliac spine and pubic tubercle

  • Anterior superior iliac spine and greater trochanter of femur

  • Iliac crest and pubic tubercle

  • Posterior superior iliac spine and greater trochanter of femur

Explanation

Question 41 of 48

1

The dibucaine number:

Select one of the following:

  • is normally less than 60%

  • is a quantitative assessment of pseudocholinesterase activity

  • is inversely proportional to pseudocholinesterase function

  • reflects inhibition of pseudocholinesterase by dibucaine

Explanation

Question 42 of 48

1

A 45-year-old morbidly obese man with a medical history of hypertrophic cardiomyopathy presents for ear surgery. He has an ejection fraction of 65% on transthoracic echocardiography. After induction of general anesthesia, his blood pressure is 78/40 mmHg with a regular heart rate of 80 bpm. Which of the following is the MOST appropriate initial intervention?

Select one of the following:

  • Ephedrine 20 mg IV

  • Epinephrine 30 mcg IV

  • Esmolol 50 mg IV

  • Phenylephrine 100 mcg IV

Explanation

Question 43 of 48

1

Chronic aortic regurgitation results in all the following EXCEPT:

Select one of the following:

  • Decreased aortic diastolic pressure

  • Increased stroke volume

  • Decreased LV end diastolic pressure

  • Increased LV mass

Explanation

Question 44 of 48

1

Release of aldosterone by the adrenal cortex is stimulated by: (select 3)

Select one or more of the following:

  • angiotensin I

  • angiotensin II

  • hypokalemia

  • pituitary ACTH

  • congestive heart failure

  • hypervolemia

Explanation

Question 45 of 48

1

The most common complication of thoracic paravertebral nerve block is:

Select one of the following:

  • hypotension

  • subarachnoid injection

  • pneumothorax

  • intravascular injection

Explanation

Question 46 of 48

1

A 55-year-old woman with an infected automatic cardioverter-defibrillator (AICD) lead presents for removal. During the course of the procedure she develops acute profound, refractory hypotension that progresses to cardiovascular collapse and pulseless electrical activity. Which of the following is the MOST appropriate intervention at this time?

Select one of the following:

  • Administration of epinephrine to increase blood pressure

  • Needle thoracostomy to treat pneumothorax

  • Thoracotomy to evacuate pericardial effusion

  • Transcutaneous pacing to increase heart rate

Explanation

Question 47 of 48

1

Which of the following drugs is NOT a cell cycle inhibitor?

Select one of the following:

  • Azathioprine

  • Mycophenolate mofetil

  • Ortho Kung T3 (OKT3)

  • Sirolimus

Explanation

Question 48 of 48

1

According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of:

Select one of the following:

  • 13 - 15

  • 9 - 12

  • 6 - 9

  • less than 6

Explanation

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