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WorksheetsFIRST QUARTER JAN-FEB 2020
Total questions: 122
Worksheet time: 1hrs 19mins
In obese patients, which system could be the most vulnerable?
Cardiac
Respiratory
Renal
Central Nervous
Who should document in the patients chart concerning physical assessment:
Nurse
Doctor
Both
None
Lisa is alcoholic, after undergoing surgery, you might expect to see:
Withdrawal
Decreased bleeding
Increased hydration
Desire to quit drinking
Spinal anesthesia used on a patient needs monitoring for:
Hypotension
Hypertension
Glucose Levels
Renal Function
Preoperative application of scopolamine patch to prevent postoperative nausea and vomiting should be avoided in
Female, 35 y/o
Smoker, 20 y/o
Patient with blood pressure of 160/96 mmHg
Male, 70 y/o
Which of the following drug is least likely to be effective for prophylaxis for post operative nausea and vomiting?
Ondansetron
Scopolamine patch
Aprepitant
Metoclopramide
Which of the following predictors is likely to be associated with lower incidence of perioperative nausea and vomiting?
Female gender
Use of fentanyl for pain relief
Patients with a history of smoking
Patients undergoing laparoscopic surgery
These herbs can increase bleeding except:
Danshen
Kava
Feverfew
Garlic
These herbs increase heart rate and blood pressure except
Ginseng
Ephedra
Licorice
Dong quai
Antiemetics should be given:
Before the patient vomits
After the patient vomits
Both
None
CBC is a must in this patient, except:
53 y/o for cataract surgery
1 month old for release of tongue tie
20 y/o w/ G6PD for EGD
50 y/o on ASA for colonoscopy
Which of the following equation is not correct:
Force = mass x acceleration
Pressure = density x acceleration x height
Pressure = force/area
Density = volume/mass
According to Hagen-Poiseuille’s law:
Flow is laminar at low flows in the flow meter
Flow is turbulent at low flows in the flow meter
Flow is dependent on density
Flow is dependent on viscosity
Law that governs at constant pressure, volume and temperature directly proportional to each other:
Boyle’s law
Charles Law
Third gas law
Universal law
Law that governs at constant temperature, pressure and volume are inversely proportional to each other:
Boyle’s law
Charles law
Third gas law
Universal law
In the equation for pressure ---P=rho x g x h, the units for g (SI systems) are:
Kg/m3
m/sec
kg-m/sec
m/sec2
Which of the following syringes would require the least effort when unblocking an intravenous catheter?
2.5 cc syringe
5 cc syringe
10 cc syringe
20 cc syringe
You encountered an old machine in which the oxygen gauge reads 100 Bar. This is also equivalent to?
29.92 inHg
100 Mbar
7600 mmHg
1450 psig
2. What is its absolute pressure?
10000 kPa
10010 kPa
10100 kPa
11000 kPa
CASE: You are about to use 50% Nitrous oxide/50% Oxygen in an obstetric patient at a total flow of 4 liters. Upon looking at the pressure gauge of Nitrous oxide its pressure reading is 750 psig, upon checking you were able to weigh the cylinder at 5.6 kg with a tare weight of 4.5 kg. How much time do you have before running out?
200 mins
240 mins
280 mins
320 mins
CASE: Dr Realina while doing a neurosurgical case noticed this wave form in his patients’ arterial line. What is this wave form and the proper troubleshooting?
It’s a normal arterial line wave form, no need to do anything.
It’s an over-damped wave form- overestimating the SBP, Change tubing.
It’s an underdamped wave form- overestimating the SBP, Change tubing.
It’s an underdamped waveform- underestimating the SBP, Change tubing.
CASE: Dr Cajoles was inducting his patient for cholecystectomy when suddenly he noticed a change in his ECG wave form. What will be his immediate treatment…?
Nothing is wrong, Nagiinaarte lang yang patient at matanda na sya!
Call for help, CBA, Check rhythm, Non shockable wave, epinephrine, atropine.
Call for help, CBA, Check rhythm, Non shockable wave, Defibrillate, epinephrine
Call for help, CBA, Check rhythm, shockable wave, Defibrillate, epinephrine.
CASE: Intraoperatively during an E LTCS Dr Eheng noticed this ECG wave form. What will be his immediate treatment?
Nothing is wrong, Maarte lang etong patient.
Immediately check on the vital signs of the patient and check for ECG artifacts.
Call for help, CBA, Check rhythm, Non-shockable wave, Defibrillate, epinephrine.
Call for help, CBA, Check rhythm, shockable wave, Defibrillate, epinephrine.
CASE: Dr Villasin was vigilantly monitoring her patient undergoing an MRM under GETA when she noticed her SPO2 showing this…. What will be your immediate treatment for this patient?
Wala lang yan, Malamig lang kamay nya! (I will do nothing!)
Call for help, immediately reintubate.
Verify clinically, ABC, equipment and monitors.
Call for help, stop surgeon, CPR, defibrillate, epinephrine.
CASE: Dr Soliven noticed that patient capnography wave form exhibited a curare cleft he immediately administered atracurium and noticed a change in the patients ETCO2 wave form. What will be his immediate treatment?
Wala lang yan! Continue giving atracurium….
Call for help, stop surgery, CBA, Defibrillate, Epinephrine.
Call for help, stop surgery, CBA, sedate, Defibrillate, Epinephrine.
Call for help, stop surgery, CBA, Epinephrine, MDI salbutamol.
CASE: A 58-year-old patient will be undergoing an elective ORIF plating. Dr Salamanca while doing his preop round noticed patient’s ECG. What will be your preoperative orders?
It is best for cardiologist to evaluate pacemaker prior to operation.
Please prepare magnet for intraoperative use.
Needs to be turned off before and turned on after operation.
Needs to be converted to VOO for op tomorrow and returned to original mode post operatively.
CASE: Dr Pancho has just finished giving epiduralanesthesia for a patient undergoing a nephrectomy she notices a change in her patients IABP waveform. What would she do?
Verify BP, ABC, equipment and monitors.
Call for help, CBA, Restore blood volume.
Call for help, CBA, Defibrillate, Epinephrine.
Call for help, start inotropes.
CASE: Dr Soriano while doing an explore laparotomy noticed his patient BP and HR increasing and noticed this ETCO2 wave form. What would be his immediate management?
Continue monitoring and documenting vigilantly.
Verify BP, ABC, equipment and monitors.
Deepen anesthesia and add top up dose of atracurium.
Call for help, stop surgeon, CBA, Defibrillate, epinephrine.
CASE: A 58-year-old female undergoing lap chole, GA/IPPV commenced after intubation, Dr Co noticed this ETCO2 waveform. What would be her management?
Patient ETT is obstructed and kinked… Immediately reintubate.
Malignant Hyperthermia crisis management.
Call for help, stop surgery, CBA, defibrillate, epinephrine.
Verify clinically, Increase FiO2, manually bag patient, equipment, monitors.
CASE: A 6-year-old child for ORIF of radial fracture. GA/IPPV started you then noticed this ETCO2 waveform which increased from 70 mmHg from initial 38 mmHg. Hemodynamics is stable although HR has increased from 100 to 130/ min. What do you do?
This is normal for a pediatric patient.
Call for help, CBA, Defibrillate, epinephrine.
Verify clinically, increase Fio2, increase minute ventilation.
Malignant hyperthermia crisis management.
Which of the following is the most common complication of direct laryngoscopy and tracheal intubation?
Dental trauma
Esophageal intubation
Pulmonary aspiration
Subglottic stenosis
Laryngospasm
Which one of the following is the most appropriate technique to effectively disinfect a fiberoptic endoscopy?
Formaldehyde gas sterilization
Ethylene oxide sterilization
Immersion in quaternary ammonium compound solution for 20 minutes
Immersion in 2% glutaraldehyde solution
Steam sterilization
Pre-oxygenation during induction of anesthesia delays the onset of critical hypoxia during the period of apnea. Which of the following best describes the mechanism involved in pre oxygenation.
It replaces nitrogen in the FRC with oxygen
It increases the concentration of inspired oxygen
It increases the amount of dissolved oxygen in blood
It increases the peripheral oxygen saturation
It decreases the shunt fraction
CASE: An obese 80 year old male presents for a cystoscopy. He is previously fit and well GA is induced and the airway is secured with an LMA. He is breathing 28% oxygen spontaneously 10 minutes later his oxygen saturation decreases from 99-96%. Which of the following statements best describes the reason for this.
Increase sensitivity to hypoxia and hypercarbia in the elderly
Increase RV in the elderly
Absorption atelectasis
Reduce FRC due to supine position and general anesthesia
The loss of auto-PEEP due to the presence of LMA
As part of the awake fiberoptic intubation, you have injected 2 ml of 2% lidocaine just below the cornu of the hyoid bone, through the thyro-hyoid ligament. Which of the following intrinsic muscles of the larynx is likely to be paralyzed?
Transverse arytenoids
Posterior cricoarytenoid
Cricothyroid
Thyroarytenoid
Aryepiglottics
In CICO scenario, the patient should be oxygenated via cricothyroidotmy. In an adult, what is the largest size of tracheostomy tube that can be inserted to the cricothyroid membrane?
8.0
7.0
6.0
5.0
4.0
11 year old obese girl has undergone a tonsillectomy. Later that evening she is found pale and hypotensive. She is diagnosed with post tonsillectomy bleeding, she is very anxious. The preferred method of induction would be?
Inhalational induction with sevoflurane with the head down tilt
RSI with thiopental and succinylcholine
RSI with thiopental and rocuronium
RSI with propofol and rocuronium
Inhalational induction with desflurane with head down tilt
CASE: You encountered a difficult laryngoscopy in a patient scheduled for emergency laparotomy. The laryngoscopic view was grade 3, you manage to intubate the trachea by railroading the tracheal tube over a gum elastic bougie.which of the following is the most reliable method of confirming the correct placement of the tracheal tube?
Feeling clicks whilst advancing the bougie
Distal holdup of Bougie
Presence of CO2 in the initial few breaths
Presence of bilateral chest movement
Endoscopic confirmation using a fiber optic scope
CASE: A 40 year old male patient underwent neck dissection and excision of tumor on the floor of the mouth. 2 weeks later he complains of loss of taste sensation. Which of the following nerves is most to be likely to be injured during this surgery?
Inferior alveolar nerve
Lingual nerve
Glossopharyngeal nerve
Buccal nerve
Hypoglossal Nerve
CASE: A 53 year old female is anesthetized for anemergency laparotomy. She is obese with BMI of 39. After induction of anesthesia/A central venous catheter is placed via right subclavian vein, following 2 failed attempts by the right Int.Jugular vein. About 30 mins after starting the procedure ,the airway pressure and HR increases and the oxygen saturation decreases to 88% .The most likely cause.
A displaced ET tube
Severe bronchospasm
Kinking of the ET tube
Anaphylaxis
Tension pneumothorax
CASE: Following a vaginal hysterectomy in the lithotomy position under general anesthesia, a patient has numbness of the lateral aspect of the left calf and medial half of the dorsum of the left foot. On physical examination she has foot drop and the toes cannot be extended. Which nerve is most likely to be involved?
Common peroneal nerve
Deep peroneal nerve
Posterior tibial nerve
Saphenous nerve
Sciatic nerve
All of the following statements concerning radial nerve injury are true except?
Compression at the mid humerus level by sheets used to tuck the arm may cause damage to the nerve
Radial nerve injury results in wrist drop and weakness of thumb abduction
The most common site of injury is the olecranon groove
A patient with a radial nerve injury cannot extend the distal phalanx of the thumb
A patient with radial nerve injury has decreased sensation in the web space between the thumb and index finger
More acute flexion of the hips to greater than 90 degrees during lithotomy position may cause injury to what nerve?
Sciatic nerve
Common fibular nerve
Tibial nerve
Lateral cutaneous femoral nerve
None of the above
Lateral displacement of the head during a steep head down tilt may injure what nerve/s?
Axillary nerve
Brachial plexus
Long thoracic nerve
Radial nerve
None of the above
Lumbar backache may be prevented by which of the following practice/s?
Avoid placing paddings under the lumbar spine
Patients should be placed in positions that are comfortable when they are awake
Maintaining hyperlordosis
Place both arms at patient’s sides at all times
All of the above
All of the following may cause a compartment syndrome except?
Systemic hypotension with loss of perfusion pressure
Vascular obstruction by pelvic retractors
External compression of the leg wrappings that are too tight
Compression stockings
Prolonged lithotomy position
Improper locations of the elevated transverse rest in the flank during lateral flexed kidney positions may cause?
Fracture of the iliac crest
Lumbar strain
Restricted ventilation of the dependent lung
Compartment syndrome
All of the above
All of the following statements concerning upper extremity injuries are true EXCEPT?
The long thoracic nerve arises from nerve roots c5 to c7
Winging of the scapula is commonly associated with injury of the long thoracic nerve
The long thoracic nerve is routinely in stretched injuries of the brachial plexus
Hyperabduction of the arm may push the humerus into the axillary neurovascular bundle
A dampened pulse oximetry tracing may be a sign of neurovascular compression
CASE: A 57 year old woman is scheduled for exploratory laparotomy because of a large pelvic mass. Before induction, she suddenly develops hypotension, and tachycardia. What is the appropriate next step?
Increase the Fio2 to 100 percent
Put the patientina in a Trendelenburg position
Rapidly infuse 1L of intravenous saline
Place a wedge underneath the patient’s right hip
Administer 100 ug of phenylephrine
Changes during lithotomy position include?
Increase preload
Increase lung compliance
Increase tidal volume
Decrease intracranial pressure
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: Tachycardia is a compensatory mechanism which is best described by this reflex
Baroreceptor reflex
Bainbridge reflex
Hering Bruer reflex
Bezold Jarish reflex
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: The elevated HR of this patient has an inverse effect on
Preload
Afterload
Contractility
Vasoactivity
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: The elevated HR of this patient has a direct effect on
Preload
Afterload
Contractility
Vasoactivity
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: Answer for number 3 is best explained by this phenomenon/principle
Anrep
Treppe
Frank starling
Reynolds
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: Upon induction of GA, patient’s BP further decreased to palpatory level, the decrease in BP is secondary to the effect of anesthesia on which modulator of hemodynamics
Chronotropy
Inotropy
Vasoactivity
Dromotropy
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: After induction, patient’s ECG demonstrated T wave inversion on leads II, III, and avf, which part of the myocardium is more likely affected
Lateral
Anterior
Septal
Inferior
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: Which coronary artery is more likely affected
RCA
LAD
Marginal
Diagonal
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: Patient also demonstrated persistent PVCs and arrrythmias, which branch of the coronary artery is more likely affected
RCA
LAD
Diagonal
Marginal
CASE: A patient admitted as a case of complete intestinal obstruction, patient was admitted 4 days prior scheduled emergency OR. Upon referral to your service, patient presented with hemodynamic instability (BP 70/30; HR 150; RR 30; Temp 40 C)
Q: If this is a case of sepsis, what would be your initial management for this patient?
Fluid resuscitation
Inotropic support
Transcutaneous pacer
Cardiac massage
If you are to start pharmacologic intervention, what would be the initial DOC for this patient
Epinephrine
Dobutamine
Noradrenaline
Dopamine
At the PACU, patient was referred to you due to anuria of several hours, patient’s skin is mottled with barely appreciable plethysmographic tracing; what would be your next DOC in managing this patient
Epinephrine
Dobutamine
Noradrenaline
Dopamine
Which among the following statements concerning the sympathetic nervous system is TRUE?
There are 22 paired sympathetic ganglia.
All preganglionic fibers are unmyelinated fibers.
Pre ganglionic fibers only synapse with postganglionic fibers in ganglia at the level of exit.
Pre ganglionic fibers may also synapse in a ganglion that can traverse the adrenal gland.
Which of the following statements concerning postganglionic fibers of the sympathetic nervous system is TRUE?
The postganglionic nerve cell bodies are located in the paired lateral ganglia.
The celiac and inferior mesenteric ganglia are located along the spinal cord are considered part of a sympathetic paired ganglion.
All ganglia of the sympathetic chain are located closer to the spinal cord than the organs they innervate.
Postganglionic myelinated fibers proceed from paired ganglia to the respective organs.
Which of the following statements concerning the sympathetic nervous system is TRUE?
The first four to five thoracic spinal segments generate fibers that converge to form three special paired ganglia.
The middle cervical ganglion also is known as the stealth ganglion.
The stellar ganglion provides sympathetic innervation only to the head and neck.
One preganglionic fiber influences one postganglionic neuron.
Which of the following statements regarding the parasympathetic nervous system is TRUE?
The sacral fibers originate from the white matter of the second, third and fourth sacral nerves.
Preganglionic fibers are myelinated fibers analogous to those in the sympathetic nervous system and terminate in the ganglia next to the spinal cord.
The ratio of preganglionic to postganglionic fibers in the PNS is the same as in the SNS.
Postganglionic neurons are located in or near the organ to be innervated.
All of the following are functions of the autonomic innervation of the heart EXCEPT:
The ANS changes the heart rate (chronotropism).
The ANS changes the strength of contraction (inotropism).
The ANS modulates coronary blood flow.
There is parasympathetic innervation of the ventricles of the heart.
Which of the following statements regarding ANS and peripheral circulation is true?
The SNS and PNS are equally distributed along the peripheral circulation.
Distribution is equal among tissues.
SNS stimulation of the coronary depends on the predominant receptor activity.
Local auto regulatory factors do not influence coronary vascular tone.
All of the following statements about neurotransmission in the ANS are true EXCEPT:
Terminations of postganglionic fibers are anatomically and physiologically similar in both SNS and PNS.
In the PNS, the postganglionic receptors secrete acetylcholine.
Norepinephrine is the only neurotransmitter of the SNS at the postganglionic site.
The preganglionic neurotransmitter is ACh in both SNS and PNS.
Which of the following statements regarding PNS is TRUE?
ACh is formed by acetylation of choline by the enzyme acetylcholinesterase.
ACh is stored in presynaptic vesicles and is released in small amounts called quanta.
After it is released, ACh is taken up by the presynaptic membrane for release again.
In addition to acetylcholiesterase, pseudocholinesterase also plays a significant role in the termination of ACh.
All of the following statements regarding the SNS are true EXCEPT:
In the adrenal medulla, the preganglionnic neurotransmitter is ACh.
Chromatic cells in the adrenal medulla are responsible for release of Epinephrine and NE.
The massive release of NE and Epinephrine in the “fight or flight” response and lasts approximately 10 times as long as local direct stimulation.
Equal amounts of Epinephrine and NE are released during stimulation of the adrenal medulla.
Which of the following statements about catecholamines is TRUE?
The only brain catecholamine is dopamine.
Catecholamines have only a direct effect on adrenergic receptors.
Endogenous catecholamines are dopamine, epinephrine and NE.
Circulating catecholamines are responsible for stimulating receptors in the central nervous system during the “fight or flight” response.
All of the following statements regarding the autonomic receptors are true EXCEPT:
ACh is the neurotransmitter in the PNS, at preganglionic receptors of the SNS, and at the neuromuscular junction.
Muscarinic receptors in the myocardium are stimulated by ACh and inhibit the release of NE.
The two subdivisions of cholinergic receptors are muscarinic and nicotinic.
Muscarinic stimulation causes tachycardia, inotropism, bronchodilation and mitosis.
Which of the following statements are true
At rest inspiration requires work while expiration is passive
During ventilation, The thorax moves Anteroposterior direction(upper thorax) and lateral or transverse direction (lower thorax)
Sternal angle is located at T3
A and B
All of the above
During non-strenuous breathing the diaphragm performs most of the work however as the work of breathing increases which of the following muscle will help elevate the sternum to optimize the dimension of thoracic cavity.
Cervical strap muscle
Abdominal muscle
Paravertebral muscle of the shoulder
Sternocleidomastoid
Intercostal muscle
Which of the following functional airway division acts as conduit of air and limited gas diffusion and exchange.
Conductive
Transitional
Respiratory
All of the above
The following statements are true of Absolute shunt.
It comprise about 10% of Cardiac output
It is made by the anatomic connections between bronchial and pulmonary venous circulation
All of the above
Neither A or B
Dorsal Respiratory groupMedullary center Contains the most basic ventilatory control, what part serves as the pacemaker of respiration as well as the inspiratory center.
Dorsal Respiratory group
Ventral respiratory group
Pons
None of the above
The following statements are true in the role of Pons in respiration
Process information that originates from the medulla
Site of apneustic center
Site of pneumotaxic respiratory center
All of the above
What is the role Midbrain in the control of respiration
Increases rate and amplitude of ventilation by Stimulating Reticular Activating System
Serves as pacemaker of respiration
Inspiratory center
Expiratory center
Ventilatory control responds to changes in lack of oxygen, changes in PCO2,pH and acid base disturbances. In a decrease Pa02 of 60-65 mm hg which of the following peripheral receptors are activated
Carotid bodies
Aortic bodies
A and B
Neither A or B
The following statements are true of carotid bodies
Located at the bifurcation of the common carotid artery, predominantly ventilatory effects
Reaches the central respiratory center via glossopharyngeal nerve
Reaches the medullary center via vagus nerve
A and B
The following will depress ventilation
Cold anesthetic local anesthetic applied at medullary surface
Inhaled anesthetics
Opioid
B and C
All of the above
A 58-year-old man develops acute kidney injury (AKI) after undergoing open repair of an abdominal aortic aneurysm. His creatinine increases from 0.5 to 1.0 and his urine output has been 20 to 25 cc/hour for the last 12 hours. According to the RIFLE criteria, his AKI is categorized as:
Risk
Injury
Failure
Loss
A 60-year-old woman with nephrolithiasis develops urosepsis after undergoing ureteroscopy and stone removal. Broad spectrum antibiotics, fluids, and vasopressor support are administered. Blood gas analysis early in the resuscitation reveals a metabolic acidosis with pH 7.23. As she clinically improves, the strong ion difference will be expected to:
Increase
Decrease
Remain unchanged
Exceed 50 mEq/cc
Which of the following is the most characteristic ECG finding in a patient with hypercalcemia?
QT prolongation
PR shortening
U wave
Osborn wave
A 76-year-old man with CKD is scheduled to undergo an abdominal CT scan with PO and IV contrast. Pretreatment with which of the following is most effective for decreasing the development of contrast-induced nephropathy?
Normal saline
Mannitol
N-acetylcysteine
Fenoldapam
What factor that maintain metabolic alkalosis has a proposed mechanism of increasing Na-dependent proton secretion in cortical collecting tubule and Na-independent proton secretion in cortical collecting tubule and medullary collecting tubule?
Passive backflux of HCO3-
Aldosterone
Decrease GFR
Hypochloremia
What are the principal determinants of neurologic injury following osmotic demyelination syndrome?
Magnitude and chronicity of hyponatremia and the rate of correction
Acute hyponatremia less than 24 hours onset and liver disease
Poor nutritional status and hyponatremia secondary to alcoholism
Chronic hypokalemia and acute hyponatremia
A 40-year-old female developed symptomatic hypocalcemia associated with severe vitamin D deficiency following treatment for Grave’s disease with methimazole. The hypocalcemia was mainly caused by vitamin D deficiency due to unbalanced diets and inadequate exposure to sunlight in addition to the resolution of hyperthyroidism. What is the hallmark of hypocalcemia?
Dysrhythmias and ECG changes
Hypotension and heart failure
Increased neuronal membrane irritability and tetany
Seizures and weakness
A 6-year-old girl with a history of cerebral palsy and severe developmental delay was admitted because of failure to thrive with a weight of 11.5 kg. on admission, phosphorus level was 3.8 mg/dL (3.7-5.4). After initiation of nasogastric feeds, her phosphorus level dropped to 3.1 mg/dL, likely secondary to refeeding syndrome. The next 4 days, the following test reveals the following: phosphorus level rose to 7.9 mg/dL; 1,25-hydroxyvitamin D was 157 pg/mL (24-86). What are the basic mechanisms that can cause hyperphosphatemia in this case?
Increase inorganic phosphate and vitamin D intake
Renal excretion and decreased movement of inorganic phosphate out of cells
Rapid cell lysis from chemotherapy
Sepsis and rhabdomyolysis
What is the mechanism of action of magnesium in patient with pheochromocytoma?
Stabilizes axonal membrane
Competitively inhibits the entry of calcium in the presynaptic terminals
Altering cellular potassium and sodium concentrations
Blocks the release of catecholamines
Administration of large volumes of normal saline can lead to:
A metabolic alkalosis
A hyperchloremic-induced nongap metabolic acidosis
An anion gap lactic acidosis
An anion gap lactic alkalosis
Which of the following is NOT a vitamin K-dependent factor?
II
V
VII
IX
X
Which is NOT considered as a non-infectious risk associated with transfusion?
Hypothermia
Dilutional coagulopathy
Increase in 2,3-DPG
Hyperkalemia
Microaggregate delivery
Delayed hemolytic transfusion reactions:
Present 3-10 days after an apparently compatible transfusion
Can be confirmed by an indirect Coombs’ test
Does not require previous exposure
Generally result in hemolysis and have the same symptoms as an immediate transfusion reaction
Usually require extensive hemodynamic support
Which of the following condition does NOT represent a situation that is likely associated with a decrease in the tolerance for anemia?
A tachycardic and hypotensive 70-year-old healthy male undergoing exploratory laparotomy.
A 70-year old female undergoing open cholecystectomy with a history of TIAs and starting hemoglobin of 8 g/dL
A 40-year old male with ST elevations during laparoscopic cholecystectomy
A healthy 40-year old female having vaginal hysterectomy with urine output 0.2 cc/kg/hr over the last 12 hours
A 60-year old male having exploratory laparotomy with mixed venous saturation of 65%
Which is NOT a recommended indication for platelet transfusion?
Patient having intraocular surgery; platelet count 75,000 per microliter
Asymptomatic patient; platelet count 25,000 per microliter
Patient scheduled for resection of abdominal aortic aneurysm; platelet count 40,000 per microliter
Patient scheduled for resection of intracranial meningioma; platelet count 80,000 per microliter
All of the above
All of the following are indications for transfusion of fresh frozen plasma EXCEPT:
Dilutional coagulopathy
A deficiency of coagulation factors
Hypovolemia with a normal hemoglobin
Bleeding due to a warfarin overdose
None of the above
Which of the following would be the BEST choice of blood for transfusion for a 25-year-old patient with serious hemorrhage secondary to trauma until a type specific blood is available?
Type O Rh-positive
Type A Rh-negative
Type B Rh-negative
Type AB Rh-negative
None of the above
All of the following statements about aspirin are true, EXCEPT:
It inhibits cyclo-oxygenase
It prevents synthesis of thromboxane
It interferes with platelet activation
Its effect is readily reversible
None of the above
As a result of trauma, a 60-year-old patient is undergoing an emergent leg amputation in the hospital. An indication for transfusion of whole blood is:
A hemoglobin level of <5 g/dL
A blood pressure of <70/50 mmHg for 10 minutes
Ongoing blood loss exceeding 8,000 mL
None of the above
All of the above
An otherwise healthy 25-year-old female is admitted with a clinical and radiographic sign of appendicitis. Workup yields the following data: BP 115/85 mmHg, HR 110, T 39C, WBC 12,000, Hgb 7.5 g/dL, Urinalysis normal. The most appropriate next step is:
Proceed urgently to perform an appendectomy
Administer erythropoietin and then proceed to surgery
Transfuse 2 units PRBCs and then proceed to surgery
Delay surgery for 24 hours to determine the cause of the anemia
Request for a cardiopulmonary evaluation
Wound healing phase consisting of neovascularization and synthesis of collagen and connective tissue proteins and epithelialization.
Hemostasis
Inflammation
Proliferation
Remodelling
What Is the current best recommendations for volume management:
Replacement of blood loss
Replacement of other ongoing fluid losses
Replacing fluid losses based on standard recommendations for the type of surgery
All of the above
Modifiable or potentially modifiable risks for wound infections should be assessed and corrected when possible prior to surgery except:
Anemia
Steroid use
Hypoglycemia
Hypercholesterolemia
The most crucial component of infection prevention is frequent and effective hand hygiene. The ideal hand hygiene agent must meet the following criteria except:
Is simple to use
Has few side effects
Kills a broad spectrum of microbes
Has antimicrobial activity that persists for at least 5 hours after application
The World Health Organization has developed a campaign highlighting the “5 Moments” of hand hygiene, handwashing is done to protect the patient against harmful germs, including the patient’s own germs, entering his/her body is true:
After patient contact
Before an aseptic task
After body fluid exposure risk
After contact with patients surroundings
Factors commonly present in the perioperative period which may cause inappropriate diuresis in the face of mild hypovolemia are, except
Hyperglycemia
Dye administration
Adrenal insufficiency
Thermoregulatory vasodilatation
The most frequent and clinically the most important impediment to wound oxygenation and wound healing is:
Hypothermia
Poor pain control
Peripheral vasoconstriction
Timing of antibiotic administration
Common barriers to hand hygiene includes the following:
Inaccessibility
Health care worker acceptance
Skin irritation and fear of skin irritation
All of the above
The major complications of hypovolemia, aside from hemodynamic instability are the following except:
Impaired wound healing
Increased wound breakdown
Increased collagen formation
Decreased oxygenation of surgical wounds
Wound oxygen delivery depends on the following:
Arterial PO2
Vascular anatomy
Degree of vasoconstriction
All of the above
The most important (but often overlooked) item in the preuse checkout of the anesthesia workstation:
Presence of a Jackson-Rees circuit or any Mapleson circuit
Functioning suction machine, tubing and Yankauer-type suction
Functioning self- inflating resuscitation bag (SRIB) and a full auxiliary tank of oxygen
Presence of an E-cylinder as backup to pipeline gas supply
Considered the most common principal monitor alerting the anesthesiologist to an equipment problem
Pulse oximeter alarm
Low-pressure circuit alarm
Oxygen supply failure alarm
High-pressure circuit alarm
The most common cause of malfunction based on the 1997 Review of the Closed Claims database:
Vaporizers
Anesthesia machine
Ventilators
Breathing circuit
True statements about the fail-save valve (“oxygen failure cutoff valve”), EXCEPT:
Serves as interface between the oxygen and nitrous supply sources
Located upstream from the nitrous oxide supply source
Shuts off/proportionally decreases the supply of nitrous oxide (and other gases) if the oxygen supply pressure decreases
Pressure sensitive and not flow sensitive
Calculate the approximate remaining time (in minutes) in the cylinder supply source given the following: oxygen pressure reads at 1, 200 psig and oxygen flow rate of 3 LPM:
180 minutes
60 minutes
75 minutes
120 minutes
True statement about the oxygen flush valve:
Actuation delivers 100% oxygen at a flow of 20 to 30 LPM
Use is very accurate to evaluate the low-pressure circuit
Allows direct communication between the intermediate and low-pressure circuits
Cannot be used for jet ventilation
True statements about Desflurane, EXCEPT:
Has a MAC of 6 to 7%
Has a boiling point of 37oC
Vapor pressure is 3-4 times greater than that of other inhaled anesthetics
Variable bypass vaporizers are unsuitable for controlled vaporization of desflurane
Mapleson system best used for spontaneously breathing patients:
Magill attachment
Ayre’s T-piece
Modified Ayre’s T-piece
Mapleson B
Which of the following is a FALSE statement regarding CO2 absorbents:
Efficiency is inversely proportional to hardness
Calcium hydroxide lime lacks strong bases which eliminates undesirable production of carbon monoxide, compound A and eliminate the possibility of a fire in the breathing circuit
Ideal size of granules is between 10 and 15 mesh since this is the size at which absorptive surface area and resistance to flow are optimized
Lower temperatures increase Compound A production
Eliminates cylinder interchanging and the possibility of accidentally placing the incorrect gas on a yoke designed to accommodate another gas:
Hanger-Yoke assembly
Pin Index Safety System (PISS)
Diameter Index Safety System (DISS)
One-Way Check Valve
