Anesthesia Equipment

Questions

DIRECTIONS (Questions 35-75): Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

35. An anesthesiologist is administering isoflurane via a variable bypass vaporizer in Denver (altitude 1,609 m). The fresh gas flow rates are 1 L/min oxygen and 2 L/min nitrous oxide. When the vaporizer is set to deliver 2% isoflurane, the concentration of isoflurane present at the common gas outlet is approximately

(A) 1.1%

(B) 1.6%

(D) 2.7%

(E) 3.4%

36. A patient is being monitored with a bispectral index (BIS) monitor. When the value for BIS is 60, it means that the patient

(A) has about a 60% probability of being awake

(B) has a very small (less than 1%) probability of having recall of intraoperative events

(D) if not pharmacologically paralyzed, will not move in response to surgical incision

(E) is less likely to be awake than if the BIS value were 50

37. An open waste-gas scavenging system

(A) must have a negative pressure relief valve

(B) must have a positive pressure relief valve

(D) does not need a reservoir

(E) cannot be simultaneously connected to the APL and ventilator relief valves

38. Which one of the following statements is TRUE regarding blood pressure cuffs?

(A) The bladder length should be 50% of the limb circumference.

(B) The bladder width should be 40% of the limb circumference.

(D) A cuff designed for an arm cannot be used on a small thigh.

(E) A cuff whose bladder is too narrow for the limb will give an erroneously low blood pressure.

DIRECTIONS: Use the following figure to answer Questions 39-40:

39. The system depicted in the figure is the

(A) Georgia valve

(B) Jackson–Rees system

(D) Bain circuit

(E) Mapleson A system

40. A disadvantage of the circuit in the figure is the

(A) inability to use spontaneous ventilation with the system

(B) requirement for low flow

(D) presence of overflow valve farther from the patient

(E) kinking of inner delivery tube

41. A resident notices an increasing discrepancy between the PaCO₂ and the end-tidal carbon dioxide. Factors that increase this difference include ALL of the following EXCEPT

(A) mismatch of ventilation and perfusion

(B) wheezing

(D) high cardiac output

42. An anesthesia technician is transporting several Aladin isoflurane vaporizer cassettes on a cart. After one of the cassettes accidentally tips over onto its side

(A) the wick will become saturated

(B) the cassette must be returned to the factory

(D) the cassette should be flushed with oxygen at 10 L/min for 10 min

(E) the cassette may be put into use immediately

43. Which one of the following situations regarding intraoperative monitoring is mandated by the American Society of Anesthesiologists’ Standards for Basic Intraoperative Monitoring?

(A) A patient having an inguinal herniorrhaphy under local anesthesia with monitored anesthesia care must have a resident or attending anesthesiologist or nurse anesthetist present in the operating room at all times during the surgical procedure.

(B) A patient who underwent a thoracotomy and wedge resection yesterday and who is receiving a continuous epidural infusion of 0.1% bupivacaine must have his heart rate taken and recorded every five minutes.

(D) A patient having intraoperative radiation therapy under general anesthesia must have a resident or attending anesthesiologist or nurse anesthetist present in the operating room at all times during the procedure.

(E) A woman in labor with an indwelling epidural catheter and receiving a continuous epidural infusion of local anesthetic must have her blood pressure taken and recorded every five minutes.

44. An anesthesia circuit is connected to a circle system and the combined volume of both is 6 L. The fresh gas flow is 3 L/min. After isoflurane 2% is turned on, how long will it take the concentration in the circuit to reach 1.96% isoflurane (i.e., 98.1% of the concentration set on the vaporizer?)

(A) 0.5 min

(B) 1 min

(D) 4 min

(E) 8 min

45. A negative-pressure leak test

(A) is accomplished by having the clinician apply mouth suction to the tubing connected to the common gas outlet

(B) reliably finds leaks in the carbon dioxide absorber

(D) must be performed with the anesthesia machine’s master switch turned on

(E) may detect internal vaporizer leaks

46. All anesthesia machines approved for current use have check valves located at the

(A) common gas outlet

(B) expiratory connection on the circle system

(D) waste gas scavenging outlet

47. A 56-year-old woman with breast cancer metastatic to the spine needs an MRI to evaluate the metastases. Because she cannot lie flat comfortably, general anesthesia is planned. Anesthesia equipment that is UNSAFE to use in a room containing a functioning magnetic resonance imaging machine includes

(A) laryngeal mask airway

(B) fiberoptic oximeter probe

(D) Macintosh laryngoscope with plastic handle

(E) end-tidal carbon dioxide sampling tubing

48. The major component, by weight, in currently used carbon dioxide absorbents is

(A) barium hydroxide

(B) calcium hydroxide

(D) potassium hydroxide

(E) sodium hydroxide

49. The formation of carbon monoxide in a carbon dioxide absorber is facilitated by the presence of ALL of the following compounds EXCEPT

(A) desflurane

(B) potassium hydroxide

(D) water

50. A patient is being ventilated with a traditional anesthesia machine ventilator using the following set parameters:

Tidal volume = 500 mL

Ventilatory rate = 10/min

I:E ratio = 1:3

Oxygen flow = 1 L/min

Nitrous oxide flow = 2 L/min

The resulting minute ventilation is approximately

(A) 5 L/min

(B) 5.25 L/min

(D) 5.75 L/min

(E) 6 L/min

51. The tubing that connects the APL (adjustable pressure limiting, or pop-off) valve to the waste gas scavenging system is the same diameter as the tubing or the connector that is connected to the

(A) circle system

(B) common gas outlet

(D) reservoir bag

(E) ventilator pressure relief valve

52. The anesthesia machine checkout instructions published by the American Society of Anesthesiologists in 2008 include ALL of the following steps EXCEPT

(A) assessment of the competency of the unidirectional valves in the breathing circuit

(B) calibration of the oxygen analyzer

(D) determination that the vaporizers can deliver agent

(E) determination of the internal pressure of the attached oxygen cylinder

53. The typical automatic noninvasive blood pressure measuring device most accurately determines

(A) cessation of Korotkoff sounds

(B) diastolic blood pressure

(D) systolic blood pressure

54. The device used to reduce the pressure of a gas from a compressed gas cylinder to a usable, nearly constant pressure is

(A) a gauge

(B) a flowmeter

(D) a regulator

(E) a check valve

55. The position best tolerated by the surgical patient is the

(A) lithotomy position

(B) prone position

(D) Trendelenburg position

(E) Fowler position

56. If a nitrous oxide tank is contaminated with water vapor, ice will form on the cylinder valve as a result of the

(A) latent heat of vaporization

(B) specific heat

(D) low pressure of the nitrous oxide

(E) ambient temperature

57. The indicator in carbon dioxide absorbent is

(A) methylene blue

(B) ethyl violet

(D) phenolphthalein

(E) cresol purple

DIRECTIONS: Use the following figure to answer Question 58:

58. The oxygen flowmeter should be at position

(A) A

(B) B

(D) D

(E) position is not critical

59. An anesthesiologist is using an anesthesia machine equipped with an oxygen proportioning system, as well as an extra flowmeter that is supplied by a helium tank. A hypoxic gas mixture may be administered to the patient in any of the following situations EXCEPT

(A) the gas supplied by the wall oxygen outlet is not oxygen

(B) there is a leak in the oxygen flowmeter

(D) the nitrous oxide flowmeter is adjusted to an excessively high flow rate

60. A resident is teaching a medical student to intubate for the first time. She hands her a laryngoscope handle with a Macintosh blade and tells her that in order to use the Macintosh blade properly, the

(A) tip is advanced into the vallecula

(B) epiglottis is lifted directly

(D) patient should be told to say, “Ah.”

(E) blade enters the mouth on the left side

61. A nitrous oxide tank contains gas at a pressure of 750 psi. When the last drop of liquid nitrous oxide evaporates

(A) the pressure will fall rapidly

(B) the rate of pressure fall is dependent on the rate of flow

(D) the pressure will be zero

(E) the pressure will remain at 750 psi until the tank is empty

62. A patient with a prior history of awareness under anesthesia is to be monitored with a BIS monitor. This monitor most reliably indicates the depth of anesthesia when the patient is anesthetized with

(A) oxygen plus high-dose fentanyl

(B) ketamine

(D) xenon

(E) propofol

63. When the oxygen flush valve is pressed

(A) oxygen at the pressure of the compressed oxygen cylinders is applied to the breathing system

(B) the oxygen flow rate is accurately displayed by the oxygen rotameter

(D) barotrauma may result if the APL valve is open and connected to an open scavenging system

(E) the ventilator should not be in the inspiratory phase of positive pressure ventilation

64. The diameter index safety system (DISS)

(A) prevents attachment of gas-administering equipment to the wrong type of gas

(B) prevents incorrect yoke-tank connections

(D) is found on the wall end, but not the machine end, of gas hoses connected to anesthesia machines

(E) is prohibited on the outlet connections of portable gas tanks

65. In the supine position, all of the following areas should be padded EXCEPT

(A) occiput

(B) elbows

(D) heels

(E) popliteal fossae

66. The TRUE statement regarding ECG lead placement is

(A) lead I displays the ECG signal recorded from the left arm and right arm.

(B) lead II displays the ECG signal recorded from the left arm and right leg.

(D) lead V1 displays the ECG signal recorded from a unipolar electrode placed in the 2^nd intercostal space at the right midaxillary line.

(E) lead V6 displays the ECG signal recorded from a unipolar electrode placed in the 4^th intercostal space at the anterior axillary line.

67. The laryngeal mask airway

(A) protects against aspiration as well as an endotracheal tube

(B) can be used to prevent airway obstruction during monitored anesthesia care

(D) requires a flexible fiberoptic laryngoscope for proper placement

(E) is more easily placed when an assistant applies cricoid pressure

68. Viewing the waveform of the capnograph may detect all of the following scenarios EXCEPT

(A) disconnection of wall oxygen supply

(B) exhaustion of carbon dioxide absorbent

(D) wheezing

(E) esophageal intubation

69. All of the following are true of the lithotomy position EXCEPT

(A) the back is supine

(B) the knees are flexed

(D) the legs are internally rotated

(E) there are few hemodynamic disadvantages to the position

70. The isolated power supply system used in operating rooms requires that

(A) the metal portions of the operating table be connected to earth ground

(B) the patient be insulated from the metal portions of the operating table

(C) the anesthesia machine and anesthesia monitors be connected to different electrical circuits than electrocautery devices

(D) conductive flooring be used in the operating room

(E) a transformer be connected between electrical equipment in the operating room and the electric power supplied by the utility company

71. A fiberoptic bronchoscope is useful for airway management of the patient with a difficult airway, and the suction channel of the scope may facilitate intubation by facilitating all of the following actions EXCEPT

(A) administer oxygen

(B) ventilate the patient during bronchoscopy

(D) spray local anesthetic

(E) aspirate tracheal secretions

72. Pulse oximeters

(A) are based on the Bernoulli principle

(B) can differentiate carboxyhemoglobin from oxyhemoglobin

(D) use a single wavelength of red light

73. Gases and vapors that may be measured by infrared spectrometry include ALL of the following EXCEPT

(A) halothane

(B) isoflurane

(D) nitrogen