QoD 18.1

Question 1 of 15

1

A 5 kg 3-month-old full term boy presents for right inguinal hernia repair. A caudal block is performed with 1 ml/kg 0.25% bupivacaine during sevoflurane anesthesia via an endotracheal tube. The infant's vital signs prior to injection reveal a HR of 133 bpm, SBP 83 mmHg, upright T-waves in lead II. Which of the following is the MOST appropriate test dose of epinephrine?

Select one of the following:

25 mcg
10 mcg
2.5 mcg
1 mcg

Explanation

Question 2 of 15

1

A 3-month-old full term boy presents for right inguinal hernia repair. He experiences an intravascular injection during the administration of a caudal the test dose. Atropine was administered 5 minutes prior to the test dose. What is the EARLIEST clinical marker of this intravascular injection of epinephrine?

Select one of the following:

ST segment elevation greater than 25%
SBP increase greater than 25 mmHg
HR increase greater than 20 bpm
HR increase greater than 10 bpm

Explanation

Question 3 of 15

1

A 28-year-old G1P0 woman with a history of multiple sclerosis presents to the labor and delivery unit after rupture of membranes. She is currently suffering from lower extremity sensory changes and requires an urgent cesarean section. Which of the following is the BEST option for her anesthetic?

Select one of the following:

Combined spinal epidural anesthesia
Epidural anesthesia
General anesthesia
Spinal anesthesia

Explanation

Question 4 of 15

1

Prostaglandin E1 is MOST appropriate for which of the following congenital cardiac lesions?

Select one of the following:

Truncus arteriosus
Pulmonary hypertension
Patent ductus arteriosus
Interrupted aortic arch

Explanation

Question 5 of 15

1

You are called to the NICU to perform an anesthetic on a 3.5 kg neonate with congenital diaphragmatic hernia. The patient is intubated with conventional mechanical ventilation. The most recent arterial blood gas reveals a pH 7.38, PaCO2 45 mmHg, PaO2 89 mmHg, HCO3 29 mEq/L, SaO2 of 97% on an FiO2 of 0.6. Peak airway pressures are 32 cmH2O with 5 cmH2O PEEP. Expiratory tidal volume is 45 ml. Which of the following is the MOST appropriate ventilatory management for this patient?

Select one of the following:

Increase PEEP to 7 cmH2O
Increase FiO2 to 90%
Decrease FiO2 to 50%
Decrease peak airway pressure to 25 cmH2O

Explanation

Question 6 of 15

1

A 67-year-old, 96-kg man underwent ultrasound-guided supraclavicular blockade for a 2-hour right wrist surgery. Forty ml of 0.5% bupivacaine was injected under ultrasound guidance. In the recovery room the patient reports that his breathing does not feel "normal" and you notice that his pupil diameter is unequal with the right pupil being smaller. Vital signs include HR 65 bpm, BP 117/68 mmHg, SpO2 98% on room air. Which of the following is the BEST course of action?

Select one of the following:

Reassure the patient
Perform an emergent needle decompression of the right lung
Obtain an upright Chest X-Ray
Initiate an intralipid infusion

Explanation

Question 7 of 15

1

According to the 2010 American Society of Regional Anesthesia (ASRA) guidelines, epidural catheter placement in obstetric patients should be delayed for at least how long after administration of a therapeutic dose of low-molecular weight heparin?

Select one of the following:

48 hours
24 hours
12 hours
6 hours

Explanation

Question 8 of 15

1

A 68-year-old man undergoes right colectomy for colorectal cancer. He had been taking clopidogrel, which was held for one week prior to surgery. Intraoperatively he is transfused one unit of PRBCs and one unit of platelets. On post-operative day 3, his hemoglobin drops from 10 to 8.2 mg/dL. He is hemodynamically stable and only complains of mild back pain. He is transfused 1 unit of PRBCs and follow-up Hgb is 8.4 mg/dL. What is the MOST likely cause for his anemia?

Select one of the following:

Dilution of blood by maintenance IV fluids
Inadequate surgical hemostasis exacerbated by preoperative clopidogrel
Carcinoma-induced coagulopathy
Immune-mediated reaction

Explanation

Question 9 of 15

1

Two days after resection of a brain tumor through a right frontal craniotomy, a 70-year-old man has persistent postoperative delirium with waxing-waning mental status. His sodium is 136 mEq/L and glucose is 123 mg/dL. A head CT reveals some residual pneumocephalus but no hemorrhage. Which of the following is the MOST appropriate next step in his care?

Select one of the following:

High flow oxygen (FiO2 1.0)
Continuous EEG monitoring
Transcranial Doppler
Brain MRI

Explanation

Question 10 of 15

1

A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?

Select one of the following:

Desflurane plus nitrous oxide
Pentobarbital load followed by continuous infusion
Isoflurane titrated to burst suppression
Propofol TIVA with vasopressors to maintain CPP

Explanation

Question 11 of 15

1

In the obstetric patient, which of the following is the MOST common side effect of 100 mcg of epidural fentanyl?

Select one of the following:

Uterine atony
Respiratory depression
Pruritus
Difficulty "pushing" if administered too close to delivery

Explanation

Question 12 of 15

1

An otherwise healthy 45-year-old woman is seen at an ambulatory surgical center for release of Dupuytren's contracture. A brachial plexus block is performed using the axillary approach. Assuming that no other nerve blocks are performed, and that the axillary block successfully achieves a complete motor and sensory block in its intended distribution, which of the following motor responses in the blocked extremity would MOST likely still be present?

Select one of the following:

1st-5th digit adduction
Forearm supination
Extension of the MCP joints
Wrist flexion

Explanation

Question 13 of 15

1

A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?

Select one of the following:

Desflurane plus nitrous oxide
Pentobarbital load followed by continuous infusion
Isoflurane titrated to burst suppression
Propofol TIVA with vasopressors to maintain CPP

Explanation

Question 14 of 15

1

A 26-year-old woman presents for laparoscopic cholecystectomy. She has a family history of sudden death and was found to have hypertrophic cardiomyopathy (HCM). Which of the following is a MOST correct regarding hypertrophic cardiomyopathy?

Select one of the following:

The gradient across the aortic valve will be likely to be higher than the gradient across left ventricular outflow tract
Reverse Trendelenburg position during laparoscopy can worsen the systolic anterior motion of the mitral valve leaflet
Beta blockers will worsen stroke volume in HCM
Decreased systemic vascular resistance following induction can be beneficial since it increases cardiac output

Explanation

Question 15 of 15

1

A 60-year-old man is emergently brought to the OR for right a hemicraniectomy. The patient had a right middle cerebral artery stroke two days ago and now has clinical uncal herniation syndrome (coma with blown right pupil). What are the anesthetic considerations for this procedure?

Select one of the following:

Control cerebral edema; avoid hypotension leading to further hypoperfusion injury; avoid cerebral vasodilatation with halogenated anesthetics
Minimizing delay; maintain hypovolemia to avoid increased cerebral edema; cerebral vasodilatation from propofol
Control cerebral edema; head down position to optimize cerebral perfusion; cerebral vasodilatation from inhalational agents
Avoid hypertension to minimize cerebral edema; hyperventilation to reduce cerebral blood volume

	Created by Mike Ru over 6 years ago

MCQ

Question 1 of 15

Select one of the following:

Explanation

Question 2 of 15

Select one of the following:

Explanation

Question 3 of 15

A 28-year-old G1P0 woman with a history of multiple sclerosis presents to the labor and delivery unit after rupture of membranes. She is currently suffering from lower extremity sensory changes and requires an urgent cesarean section. Which of the following is the BEST option for her anesthetic?

Select one of the following:

Explanation

Question 4 of 15

Prostaglandin E1 is MOST appropriate for which of the following congenital cardiac lesions?

Select one of the following:

Explanation

Question 5 of 15

Select one of the following:

Explanation

Question 6 of 15

Select one of the following:

Explanation

Question 7 of 15

According to the 2010 American Society of Regional Anesthesia (ASRA) guidelines, epidural catheter placement in obstetric patients should be delayed for at least how long after administration of a therapeutic dose of low-molecular weight heparin?

Select one of the following:

Explanation

Question 8 of 15

Select one of the following:

Explanation

Question 9 of 15

Select one of the following:

Explanation

Question 10 of 15

A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?

Select one of the following:

Explanation

Question 11 of 15

In the obstetric patient, which of the following is the MOST common side effect of 100 mcg of epidural fentanyl?

Select one of the following:

Explanation

Question 12 of 15

Select one of the following:

Explanation

Question 13 of 15

A patient with an acute subdural hematoma is brought to the operating room for emergent clot evacuation. He is intubated and has a large, non-reactive right pupil suggestive of an uncal herniation syndrome. Which of the following anesthetic approaches is MOST appropriate?

Select one of the following:

Explanation

Question 14 of 15

A 26-year-old woman presents for laparoscopic cholecystectomy. She has a family history of sudden death and was found to have hypertrophic cardiomyopathy (HCM). Which of the following is a MOST correct regarding hypertrophic cardiomyopathy?

Select one of the following:

Explanation

Question 15 of 15

A 60-year-old man is emergently brought to the OR for right a hemicraniectomy. The patient had a right middle cerebral artery stroke two days ago and now has clinical uncal herniation syndrome (coma with blown right pupil). What are the anesthetic considerations for this procedure?

Select one of the following:

Explanation