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Test sobre Anesthesia Question of the Day 2, creado por thomasina413 el 10/08/2014.

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Anesthesia Question of the Day 2

Anesthesia Question of the Day 2

Pregunta 1 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Cryoprecipitate

  • 4-Factor prothrombin complex concentrate (PCC)

  • Fresh frozen plasma

  • Vitamin K

Explicación

Pregunta 2 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 3 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 4 de 48

1

Factors decreasing physiologic dead space include:

Selecciona una de las siguientes respuestas posibles:

  • the supine position

  • anticholinergic agents

  • increasing age

  • emphysema

Explicación

Pregunta 5 de 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?

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 6 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • Bupivacaine

  • Lidocaine

  • Prilocaine

  • Tetracaine

Explicación

Pregunta 7 de 48

1

Selective adrenergic stimulation of the β2-receptor results in:

Selecciona una de las siguientes respuestas posibles:

  • increased heart rate

  • increased insulin secretion

  • detrusor muscle contraction

  • pupillary constriction

Explicación

Pregunta 8 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Hydralazine

  • Minoxidil

  • Nitroglycerin

  • Nicardipine

Explicación

Pregunta 9 de 48

1

Hormones released by the neurohypophysis include: (Select 2)

Selecciona una o más de las siguientes respuestas posibles:

  • thryotropin

  • growth hormone

  • arginine vasopressin

  • adrenocorticotropic hormone

  • follicle stimulating hormone

  • oxytocin

  • prolactin

  • luteinizing hormone

Explicación

Pregunta 10 de 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?

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 11 de 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:

Selecciona una de las siguientes respuestas posibles:

  • 0.25%

  • 0.5%

  • 1%

  • 2%

Explicación

Pregunta 12 de 48

1

Pancreatic somatostatin producing cells in the Islets of Langerhans are:

Selecciona una de las siguientes respuestas posibles:

  • alpha cells

  • beta cells

  • gamma cells

  • delta cells

Explicación

Pregunta 13 de 48

1

Pancreatic somatostatin producing cells in the Islets of Langerhans are:

Selecciona una de las siguientes respuestas posibles:

  • alpha cells

  • beta cells

  • gamma cells

  • delta cells

Explicación

Pregunta 14 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 5 μA

  • 10 μA

  • 1 mA

  • 5 mA

Explicación

Pregunta 15 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • Axillary block

  • Bier block

  • Epidural block

  • Supraclavicular block

Explicación

Pregunta 16 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • Decreased systemic diastolic pressure

  • Increased systemic vascular resistance

  • Increased left ventricular diastolic pressure

  • Tachycardia

Explicación

Pregunta 17 de 48

1

Causes of normal-anion-gap acidosis include:

Selecciona una de las siguientes respuestas posibles:

  • renal failure

  • starvation

  • diarrhea

  • lactic acidosis

Explicación

Pregunta 18 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Decreased systemic vascular resistance

  • Decreased pulmonary vascular resistance

  • Increased systemic vascular resistance

  • Increased pulmonary vascular resistance

Explicación

Pregunta 19 de 48

1

The area of myocardium most vulnerable to ischemia is the:

Selecciona una de las siguientes respuestas posibles:

  • left ventricular epicardium

  • right ventricular epicardium

  • left ventricular subendocardium

  • right ventricular subendocardium

Explicación

Pregunta 20 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • PEEP applied to the ventilated lung

  • continuous oxygen insufflation to the collapsed lung

  • changing tidal volume and rate

  • periodic inflation of the collapsed lung

Explicación

Pregunta 21 de 48

1

Which of the following antibiotics is nephrotoxic?

Selecciona una de las siguientes respuestas posibles:

  • Quinolones

  • Rifampin

  • Vancomycin

  • All of the above

Explicación

Pregunta 22 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 23 de 48

1

Sympathetic blockade during acute herpes zoster has been shown to:

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 24 de 48

1

Sympathetic blockade during acute herpes zoster has been shown to:

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 25 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • deep peroneal nerve

  • sural nerve

  • saphenous nerve

  • posterior tibial nerve

Explicación

Pregunta 26 de 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?

Selecciona una de las siguientes respuestas posibles:

  • 27%

  • 17%

  • 7%

  • 0.7%

Explicación

Pregunta 27 de 48

1

Pulmonary complications from advanced hepatic disease with cirrhosis include:

Selecciona una de las siguientes respuestas posibles:

  • an obstructive ventilatory defect

  • respiratory acidosis

  • increased intrapulmonary shunting

  • increased functional residual capacity

Explicación

Pregunta 28 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Increased afterload

  • Decreased preload

  • Ventilation-perfusion mismatch

  • Rhythm abnormalities

Explicación

Pregunta 29 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • echinacea

  • valerian

  • ginkgo

  • ephedra

Explicación

Pregunta 30 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Category I

  • Category II

  • Category III

  • Category IV

Explicación

Pregunta 31 de 48

1

The formation of metanephrine is the result of:

Selecciona una de las siguientes respuestas posibles:

  • catechol-O-methyltransferase metabolism of epinephrine

  • catechol-O-methyltransferase metabolism of norepinephrine

  • monamine oxidase metabolism of epinephrine

  • monamine oxidase metabolism of norepinephrine

Explicación

Pregunta 32 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Peroneal nerve

  • Tibial nerve

  • Saphenous nerve

  • Sural nerve

Explicación

Pregunta 33 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 34 de 48

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • distal polyneuropathy

  • rapid sudden onset

  • proximal muscle weakness

  • allodynia

  • upper extremities most commonly involved

  • proximal to distal progression of symptoms

Explicación

Pregunta 35 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • peripheral sensory nerve cells

  • peripheral motor nerve cells

  • striated skeletal muscle cells

  • cardiac muscle cells

Explicación

Pregunta 36 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • Diabetes mellitus

  • Hypertension

  • Female sex

  • Tobacco abuse

Explicación

Pregunta 37 de 48

1

Autonomic hyperreflexia:

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 38 de 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:

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 39 de 48

1

Renal effects of nitrous oxide include:

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 40 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 41 de 48

1

The dibucaine number:

Selecciona una de las siguientes respuestas posibles:

  • is normally less than 60%

  • is a quantitative assessment of pseudocholinesterase activity

  • is inversely proportional to pseudocholinesterase function

  • reflects inhibition of pseudocholinesterase by dibucaine

Explicación

Pregunta 42 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Ephedrine 20 mg IV

  • Epinephrine 30 mcg IV

  • Esmolol 50 mg IV

  • Phenylephrine 100 mcg IV

Explicación

Pregunta 43 de 48

1

Chronic aortic regurgitation results in all the following EXCEPT:

Selecciona una de las siguientes respuestas posibles:

  • Decreased aortic diastolic pressure

  • Increased stroke volume

  • Decreased LV end diastolic pressure

  • Increased LV mass

Explicación

Pregunta 44 de 48

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • angiotensin I

  • angiotensin II

  • hypokalemia

  • pituitary ACTH

  • congestive heart failure

  • hypervolemia

Explicación

Pregunta 45 de 48

1

The most common complication of thoracic paravertebral nerve block is:

Selecciona una de las siguientes respuestas posibles:

  • hypotension

  • subarachnoid injection

  • pneumothorax

  • intravascular injection

Explicación

Pregunta 46 de 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?

Selecciona una de las siguientes respuestas posibles:

  • Administration of epinephrine to increase blood pressure

  • Needle thoracostomy to treat pneumothorax

  • Thoracotomy to evacuate pericardial effusion

  • Transcutaneous pacing to increase heart rate

Explicación

Pregunta 47 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • Azathioprine

  • Mycophenolate mofetil

  • Ortho Kung T3 (OKT3)

  • Sirolimus

Explicación

Pregunta 48 de 48

1

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

Selecciona una de las siguientes respuestas posibles:

  • 13 - 15

  • 9 - 12

  • 6 - 9

  • less than 6

Explicación

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