Miscellaneous Topics

Miscellaneous Topics

Paul Sikka and Thomas Halaszynski

1. A 90-year-old male is presented to the operating room for surgical repair of a right femoral neck fracture. His medical history is significant for chronic obstructive pulmonary disease (60 pack year smoking history) and is prescribed 4 L/min of continuous home oxygen. A note from his pulmonologist states that this patient is a high-risk candidate for general anesthesia and will prove to be difficult to wean from mechanical ventilation. To properly assess the respiratory risk for this patient, which of the following will provide the least beneficial value?

A. Stat pulmonary function tests

B. Baseline chest radiograph

C. Thorough history and physical examination

D. Baseline arterial blood gas

2. A 65-year-old female, status post coronary artery bypass grafting (CABG) 2 weeks ago, is scheduled for a fem-fem bypass. The patient has been recovering well since her routine two-vessel cardiac bypass surgery, but continues to experience intermittent claudication symptoms of the left lower extremity. The surgeon informs you that the patient was scheduled for the vascular bypass surgery several weeks ago, but could not undergo the surgery due to her poor cardiac function. Now that cardiac pathology has been resolved, he would like to proceed with the vascular procedure as soon as possible. Your recommendations to the vascular surgeon would be

A. Provided she is without cardiac symptoms, the vascular surgery can now be performed

B. The vascular procedure should be delayed for another 2 weeks

C. The surgeon needs to obtain cardiology clearance prior to the procedure

D. The vascular surgery should be delayed for at least 6 months following the CABG procedure

3. A 76-year-old female comes to the preadmission clinic for anesthetic evaluation prior to a right total hip replacement (THR) scheduled in 2 weeks. Her medical history is significant for coronary artery disease (status post stent placement 6 months ago) and baseline unstable angina one to two times per month. The patient indicates that her symptoms are relieved by sublingual nitroglycerin. A recent echocardiogram (30 days prior) showed an ejection fraction of 30% along with evidence of inferior-wall-motion abnormality. Examination of the most current EKG shows diffuse T-wave inversions with a heart rate of 60 to 65 bpm (on metoprolol) and a blood pressure of 125/60 mm Hg. In addition, the patient has severe chronic obstructive pulmonary disease, is dependent upon 2 L/min home O₂, and has obstructive sleep apnea (on bi-level positive-airway pressure at night). In order to maximize the preoperative condition of this patient, you will order all of the following diagnostic tests/examinations/consultations, except

A. Repeat the cardiac catheterization and confirm whether or not the patient requires coronary artery bypass grafting (CABG) surgery prior to THR

B. Communicate with cardiologist to confirm patient is medically optimized

C. Would not introduce any more coronary interventions unless new symptoms are present

D. Maintain hemodynamic stability during THR surgery

4. A 74-year-old patient undergoes a lumbar sympathetic blockade to improve blood flow after sustaining a frostbite injury to the left lower extremity. Clinical findings that would suggest a successful block include

A. Inability to dorsiflex the foot

B. Piloerection on the legs

C. Numbness from the knee to the toes

D. Temperature increase in the legs

5. The nerve that needs to be blocked to obliterate the gag reflex when applying pressure to the posterior portion of the tongue during an awake fiberoptic intubation is the

A. Recurrent laryngeal nerve

B. Glossopharyngeal nerve

C. Superior laryngeal nerve

D. Inferior laryngeal nerve

6. A 74-year-old patient undergoes a stellate ganglion block secondary to extreme hot flashes and night awakenings secondary to a long history of breast cancer. Potential complications include all of the following, except

A. Recurrent laryngeal nerve paralysis

B. Subarachnoid block

C. Pneumothorax

D. All of the above

7. Incorrect statement regarding metabolic equivalent (MET) is

A. 1 MET = consumption of 3.5 mL O₂/min/kg of body weight

B. 5 MET = climbing one to two flights of stairs, dancing, or bicycling

C. 4 MET = equivalent to gardening

D. 2 MET = equivalent to getting dressed

8. A 35-year-old G2P1 at 30 weeks gestational age is coming to the OR within the next hour for open reduction internal fixation of an ankle fracture. The patient’s blood type is O⁺ and has hematocrit of 32. All of the following should be arranged, except

A. Prepare for a perioperative obstetrical (OB) consultation

B. Type screen and crossmatch for blood

C. Intraoperative RhoGam injection prior to surgery start

D. Prepare for perioperative fetal monitoring

9. An E-cylinder of oxygen with a pressure of 1,000 psig and being used at a rate of 2 L/min will run out in

A. 2 hours

B. 3 hours

C. 4 hours

D. 6 hours

10. A 49-year-old patient is undergoing a craniotomy for tumor resection. Intraoperatively, the patient received drugs including thiopental, vecuronium, isoflurane, and fentanyl. The patient is brought to the postanesthesia care unit with a HR of 58/min, BP of 196/96 mm Hg, and oxygen saturation of 98%. A few moments later the patient has two episodes of vomiting. You would then

A. Give ondansetron

B. Give metoclopramide

C. Give fentanyl

D. Call the neurosurgeon

11. Parkinsonism is associated with

A. Loss of dopaminergic neurons alone

B. Loss of cholinergic neurons alone

C. Loss of cholinergic and increase in dopaminergic activity

D. Loss of dopaminergic and increase in cholinergic activity

12. A 36-year-old patient with multiple sclerosis (MS) is to undergo an exploratory laparotomy. The best anesthesia technique to prevent a flare-up of symptoms would be

A. General anesthesia with endotracheal intubation using a nondepolarizing muscle relaxant

B. General anesthesia with endotracheal intubation using a depolarizing muscle relaxant

C. Spinal anesthesia

D. Combined spinal–epidural anesthesia

13. The primary aim of using succinylcholine for anesthesia for electroconvulsive therapy (ECT) is to

A. Prevent loss of airway

B. Control excessive seizure activity

C. Control cardiovascular sympathetic discharge

D. Prevent musculoskeletal injuries

14. Cardiovascular response following an electroconvulsive therapy (ECT) is characterized by

A. An initial parasympathetic discharge followed by a sympathetic discharge

B. An initial sympathetic discharge followed by a parasympathetic discharge

C. Sympathetic discharge alone

D. Parasympathetic discharge alone

15. Nondepolarizing muscle relaxants block which of the following receptors?

A. Adrenergic

B. Calcium

C. Muscarinic

D. Nicotinic

16. Ipratropium acts to relieve bronchospasm via which of the following receptors?

A. Nicotinic

B. Muscarinic

C. α-Receptors

D. β-Receptors

17. All statements regarding neostigmine are true, except

A. It inhibits acetylcholinesterase

B. It inhibits pseudocholinesterase

C. It shortens the duration of action of succinylcholine

D. It can cause neuromuscular blockade

18. When using neostigmine to reverse neuromuscular blockade in the presence of severe renal disease, you would use the following dose when compared to a normal patient

A. Same

B. Higher

C. Lower

D. Titrated

19. Fastest acting neuromuscular reversal agent is

A. Edrophonium

B. Neostigmine

C. Pyridostigmine

D. Physostigmine

20. Highest plasma concentration of a local anesthetic will occur if infiltrated via which of the following routes?

A. Tracheal

B. Caudal

C. Intercostal

D. Brachial plexus

21. A 27-year-old 38 weeks pregnant female presents with painless vaginal bleeding. The best step in the management of this patient is

A. Direct examination with a vaginal speculum and then take the patient to OR for cesarean section

B. Cesarean section

C. Bed rest and observation

D. Epidural after bleeding stops

22. The most frequent cause of delayed emergence in the postanesthesia care unit is

A. Residual anesthetic agents

B. Hypoventilation

C. Hypotension

D. Hypothermia

23. Emergence from inhalational anesthetics is primarily dependent on

A. Type of agent used

B. Cardiac output

C. Ventilation

D. Adjunct anesthetic drugs

24. Emergence from intravenous anesthetics is primarily dependent on

A. Redistribution

B. Elimination half-life

C. Type of agent used

D. Hepatic or renal disease

25. A 35-year-old patient is brought to the postanesthesia care unit (PACU) after undergoing an appendectomy. His anesthetics included propofol 140 mg, isoflurane 2.0 MAC, vecuronium 6 mg, and morphine 6 mg. In the PACU, the patient is shivering. The most likely cause of his shivering is

A. Use of isoflurane

B. Presence of infection and dehydration

C. Use of unwarmed fluids

D. Use of morphine

26. Best method to prevent shivering is

A. Use warmed fluids

B. Warming lights

C. Meperidine

D. Forced-air-warming device

27. A 56-year-old patient, with a tracheostomy, is undergoing a radical neck dissection under general anesthesia. The induction is uneventful and you proceed to replace the tracheostomy tube with an endotracheal tube for the procedure. The patient’s peak airway inspiratory pressures increase suddenly. The most likely diagnosis is

A. Bronchospasm

B. Pneumothorax

C. Malposition of the endotracheal tube (ETT)

D. Patient attempting to breath

28. Laryngospasm (LS) is due to stimulation of the

A. Superior laryngeal nerve

B. Internal laryngeal nerve

C. Recurrent laryngeal nerve

D. External laryngeal nerve

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