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Kuis Anestesi dan Bedah

Total questions: 35

Worksheet time: 23mins

Name
Class
Date
1.

A 72-year-old man with a heavy smoking history complains of chronic pain in the lower limbs. Clinical examination reveals ischemic ulcers in both legs. He is referred to a pain clinic for management. What is the most effective therapy for this patient?

a)

Lumbar sympathetic chemical block

b)

Superior hypogastric plexus block

c)

Nerve block

d)

Epidural steroid

e)

Regular morphine

2.

One of the complications that often occurs in SC CITO patients is aspiration pneumonia, which requires the anesthesiologist to carefully manage pre-anesthesia with medication. What should be considered in drug selection?

a)

5-HT3 receptor antagonists can trigger extrapyramidal reactions, respiratory depression, and sedation

b)

Mixing non-particulate antacid solution with stomach contents is better than particulate with reversed stomach contents

c)

Omeprazole can trigger hypertensive crises in patients with pheochromocytoma due to tumor catecholamine release

d)

Ranitidine increases lower esophageal sphincter tone

e)

Metoclopramide is sometimes associated with myalgia, angioedema, and constipation

3.

A 32-year-old man was rescued by firefighters in a room containing carbon monoxide. The victim's respiratory rate is 42 breaths per minute. The patient appears weak, complains of nausea, and is disoriented. Based on his symptoms, what is the carboxyhemoglobin level in the victim's blood?

a)

20-40%

b)

10-15%

c)

5-10%

d)

15-20%

e)

> 40%

4.

A 5-year-old obese child undergoes elective herniotomy. General anesthesia is administered with sevoflurane and 50% nitrous oxide using a low-flow technique, with tidal volume set at 7 ml/kg body weight and a frequency of 16 breaths/min. About 45 minutes later, tachycardia and increased blood pressure occur, which do not resolve with fentanyl administration, even followed by ventricular arrhythmia. What is the most appropriate issue regarding this child's condition?

a)

Initial signs of malignant hyperthermia

b)

Hypoxia

c)

Hypercapnia due to ineffective soda lime

d)

Pain from the surgical procedure

e)

Dehydration due to fasting

5.

A 65-year-old woman is admitted to the ICU after undergoing intracranial hematoma evacuation surgery. The patient is unable to breathe adequately, so her breathing is assisted with a ventilator. Two hours after being connected to the ventilator, the following blood gas analysis results are obtained: pH 7.59, PCO2 15 mmHg, PaO2 253 mmHg, TCO2 15.30 mmol/L, HCO3 14.80 mmol/L, BEecf -7.8, SpO2 99%. The patient is given NaCl 0.9% solution at 30 cc/kg body weight to be completed in 24 hours. If the patient's kidney function is still good, how will the kidneys respond to compensate for the above condition?

a)

Excrete bicarbonate ions

b)

Absorb bicarbonate ions

c)

Increased potassium reabsorption

d)

Initially, the kidneys will excrete sodium followed by bicarbonate absorption.

e)

No compensation will be made as compensation will be done by the lungs

6.

What is the pH of a 2.5% thiopental solution?

a)

8

b)

2

c)

>10

d)

4

e)

6

7.

Which class of barbiturates causes the most enzymatic induction?

a)

Thiopental

b)

Secobarbital

c)

Methohexital

d)

Thiamylal

e)

Phenobarbital

8.

What effect does ketamine anesthesia have?

a)

Increased heart rate

b)

Heart rate unchanged

c)

Decreased cardiac output

d)

Cardiac output remains the same

e)

Decreased heart rate

9.

A 30-year-old woman with a tibia fracture is scheduled for elective ORIF surgery. During the history taking, physical examination, and laboratory tests, everything is normal. The anesthesiologist plans to perform spinal anesthesia. When the spinal needle is inserted, what is the order of the layers that are traversed?

a)

Skin, subcutaneous tissue, ligamentum flavum, interspinous ligament, supraspinous ligament, epidural space, dura mater, subarachnoid space

b)

Skin, subcutaneous tissue, interspinous ligament, supraspinous ligament, ligamentum flavum, epidural space, dura mater, subarachnoid space

c)

Skin, subcutaneous tissue, ligamentum flavum, supraspinous ligament, interspinous ligament, epidural space, dura mater, subarachnoid space

d)

Skin, subcutaneous tissue, supraspinous ligament, ligamentum flavum, interspinous ligament, epidural space, dura mater, subarachnoid space

e)

Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, subarachnoid space

10.

What should be examined to determine the Mallampati score?

a)

Pillar isthmus faucium

b)

Mouth opening width

c)

Tongue size

d)

Thyromental distance

e)

Mentohyoid distance

11.

Which coagulation factor's synthesis depends on vitamin K?

a)

Factor X

b)

Factor V

c)

Factor III

d)

Factor VIII

e)

Factor I

12.

Elimination and clearance through non-enzymatic degradation (Hofmann elimination):

a)

Vecuronium

b)

Cisatracurium

c)

Doxacurium

d)

Pancuronium

e)

Rocuronium

13.

A 2-year-old child has burns on both legs (partial thickness). To estimate the burn area as a guide for fluid therapy for burns, the total area of both legs is calculated as:

a)

Burn area of both limbs 14%

b)

Burn area of both limbs 36%

c)

Burn area of both limbs 38%

d)

Burn area of both limbs 18%

e)

Burn area of both limbs 28%

14.

A 58-year-old patient appears short of breath and has wheezing. On examination, there is stridor during expiration and inspiration. There is a tumor compressing the trachea. The type of airflow at the obstruction site is:

a)

Stenotic flow

b)

Turbulent flow

c)

Laminar flow

d)

No flow

e)

Undulant flow

15.

During extracorporeal shock wave lithotripsy (ESWL), the shock wave must be synchronized with:

a)

The end of the patient's expiration phase

b)

P wave of the EKG

c)

The peak of the patient's inspiration phase

d)

T wave of the EKG

e)

R wave of the EKG

16.

A 60-year-old man weighing 60 kg with a diagnosis of rectal cancer will undergo hemicolectomy under general anesthesia. Preoperative examination concluded ASA 2. A few months before surgery, the patient routinely consumed butorphanol to manage his pain. Induction is done using propofol, muscle relaxant, and maintenance using sevoflurane at adequate doses. Analgesics during surgery use maximum doses of fentanyl. However, the analgesia in this patient is still insufficient, and based on monitoring, the patient still shows signs of pain. What is the cause of the patient's pain?

a)

Fentanyl dose is still insufficient

b)

Routine use of butorphanol before surgery

c)

Did not receive premedication before surgery

d)

Muscle relaxant dose is still insufficient

e)

Down regulation of µ receptors

17.

The inhalation anesthetic that is the most inert (very little metabolized by the body) is:

a)

Enflurane

b)

Isoflurane

c)

Desflurane

d)

Halothane

e)

Sevoflurane

18.

Which of the following is included in group A, Child classification?

a)

Sufficient nutrition

b)

No encephalopathy

c)

Serum albumin > 2.5

d)

Mortality in this group is only 10%

e)

Bilirubin < 3.0

19.

What is the effect of opioids on Kappa opioid receptors?

a)

Supraspinal analgesia

b)

Euphoria

c)

Physical dependence

d)

Depression of ventilation

e)

Constipation

20.

A 65-year-old woman is referred to anesthesia with a diagnosis of hip fracture (D) planned for Total Hip Replacement. Shortly after the administration of bone cement, blood pressure is 80/40 mmHg, the patient is short of breath with oxygen saturation of 87%, heart rate 124 bpm, and appears anxious. What initial action would you take for this patient?

a)

Provide ventilation and oxygenation with 100% oxygen concentration

b)

Administer heparin 18 IU/kg initial dose

c)

Administer ephedrine 5 mg bolus intravenously

d)

Perform Head up 15-30

e)

Administer Ringer's lactate 10-20 ml/kg in 15 minutes

21.

The most convincing and safe indicator for the recovery of the effects of non-depolarizing muscle relaxants on neuromuscular function is:

a)

TOF ratio examination greater than 0.9

b)

Able to grip the examiner's hand tightly

c)

Minimal inspiratory pressure strength

d)

Vital capacity 15 ml/kg body weight, correct 10 ml/kg

e)

Able to lift the head for at least 5 seconds

22.

Theoretically, anesthesia alters thermoregulation and tends to lower the patient's core temperature. Intraoperative hypothermia should be prevented as much as possible because it has many effects, including:

a)

Increased vascular resistance

b)

Preventing the spread of existing infections

c)

Decreased O2 binding with Hb

d)

Decreased protein catabolism post-surgery

e)

Shifting the Hb-CO2 dissociation curve to the right

23.

A 48-year-old man weighing 50 kg is scheduled for 'release contracture' surgery on the neck due to burns from a year ago. The patient cannot extend due to the contracture but can still be given assisted breathing. Intubation is planned using fiber optic laryngoscopy (FOL). What should we understand about intubation using FOL?

a)

The complication of entering the endotracheal tube at the glottis is the small angle of the cricothyroid cartilage and epiglottis

b)

For local anesthesia of the upper airway, lidocaine 4% is usually given at a dose of 9 mg/kg body weight

c)

Sedation with dexmedetomidine has the advantage of maintaining respiration

d)

The patient needs to be awake and can cooperate with the doctor for successful intubation

e)

If the endotracheal tube can enter the trachea, immediately remove the FOL and connect the endotracheal tube to the anesthesia machine

24.

A 41-year-old woman underwent resection of a 10 mm hypophyseal tumor. The patient complains of amenorrhea and decreased vision. What potential problem may occur if transsphenoid approach surgery is performed?

a)

Increased hypophyseal function

b)

This approach is safe from cranial nerve disturbances

c)

Risk of bleeding if it involves the maxillary sinus

d)

If Diabetes Insipidus occurs, it usually persists

e)

Potential for venous air embolism

25.

What is the most common cause of non-surgical bleeding?

a)

Von Willebrand Disease

b)

Dilutional Anemia

c)

Dilutional Thrombocytopenia

d)

Citrate Toxicity

e)

Hypothermia

26.

What is the function of Vitamin K in the blood coagulation process?

a)

Plays a role in the synthesis of factors III, VI, IX, and X.

b)

Plays a role in the synthesis of factors II, VII, IX, and X.

c)

Plays a role in the synthesis of factors I, IV, IX, and X.

d)

Plays a role in the synthesis of factors VII, VIII, IX, and X.

e)

Plays a role in the synthesis of factors II, III, IV, and V.

27.

What should be considered in the perioperative management of this patient?

a)

Intramuscular injections and arterial punctures can be safely performed.

b)

Perform tracheal intubation atraumatically.

c)

Succinylcholine can be given as it does not cause muscle inflammation and joint hematoma.

d)

Perform therapeutic hypothermia.

e)

Factor VIII concentrate does not need to be given.

28.

What signs and symptoms should be looked for to identify the possibility of Heparin-Induced Thrombocytopenia (HIT) in this patient?

a)

Decrease in platelet count compared to baseline

b)

Onset of thrombocytopenia

c)

Presence of thrombosis

d)

Other possible causes of thrombocytopenia

e)

All of the above

29.

A 10-year-old child underwent outpatient tonsillectomy. The patient was obese and had OSA. After surgery, the patient was observed in the recovery room and experienced hypoventilation and hypoxemia (SpO2 88%). What are the discharge criteria for this patient based on ASA recommendations?

a)

Patient is monitored in the recovery room for 3 hours before discharge.

b)

Monitoring in the recovery room for 7 hours after the hypoxemia episode.

c)

Patient is hospitalized and monitored for 24 hours.

d)

Patient can be discharged after saturation has reached baseline.

e)

The presence of postoperative hypoxemic episodes is a contraindication for patient discharge (ambulatory).

30.

Nyeri yang terjadi pada daerah yang kurang sensasi adalah ?

a)

Allodynia

b)

Hyperalgesia

c)

Hyperpatia

d)

Anesthesia dolorosa

e)

Paresthesia

31.

Pasien wanita umur 56 tahun, berat badan 75 Kg, menjalani operasi laparoskopi cholesistektomi. Operasi berlangsung selama 2 jam, perdarahan durante operasi: minimal, total balance cairan selama operasi +200 cc. Monitoring urine output selama pemulihan pasca operasi, menghasilkan urine sebanyak 30 cc selama 2 jam pemantauan di Recovery Room. Pasien tidak ada riwayat gangguan ginjal sebelum operasi Apakah mekanisme yang menyebabkan terjadinya oligouria pasca operasi laparoskopi?

a)

Meningkatnya Cardiac Output karena peningkatan venous return

b)

Penurunan kadar renin plasma

c)

Penurunan kadar ADH

d)

Kompresi parenkim renal

e)

Kompresi arteri renalis

32.

Seorang perempuan, 31 tahun dengan diagnosa G3P1A0 hamil 6 minggu datang ke IGD RS karena mengeluh nyeri perut kanan bawah. Setelah dilakukan USG, pasien didiagnosa appendicis. Dokter bedah merencanakan melakukan appendektomi untuk pasien ini. Pasien merasa khawatir dengan risiko kecacatan yang mungkin dialami bayinya. Kapan waktu paling kritis fetus terpengaruh teratogenitas?

a)

Usia 1-2 minggu

b)

Usia 1-8 minggu

c)

Usia 3-8 minggu

d)

Usia 3-12 minggu

e)

Usia 1-12 minggu

33.

Seorang wanita berusia 20 tahun, dikonsulkan kepada anda untuk menjalani operasi tumor jaringan lunak di payudara. Pasien belum pernah oeprasi sebelumnya dan tidak memiliki Riwayat penyakit penyerta lain. Pada pemeriksaan fisik tidak didapatkan kelainan. pemeriksaan penunjang wajib anda lakukan preoperasi adalah

a)

Hemoglobin, tes fungsi ginjal dan elektrolit

b)

Hemoglobin dan chest x-ray

c)

Chest x-ray dan gula darah sewaktu

d)

Tidak ada

e)

Hemoglobin dan elektrokardiogram

34.

Salah satu sirkuit pernapasan yang digunakan untuk penghantaran gas anestesi kepada pasien adalah circle system. Pernyataan yang benar mengenai sirkuit pernapasan ini adalah?

a)

Tidak mudah terjadi rebreathing CO2

b)

Kemampuan control kedalaman anestesi kurang baik

c)

Sirkuit napas yang tidak kompleks

d)

Dapat menjaga panas dan kelembaban udara

e)

kemampuas gas scavenging kurang baik

35.

Seorang wanita berusia 36 tahun menjalani operasi laparatomi kistektomi dengan anestesi umum intubasi dan epidural kontinu. Pemasangan kateter epidural dilakukan sebelum ekstubasi. Terjadi 3 kali wet tap, namun kateter epidural berhasil terpasang. Setelah pasien sadar, di ruang pemulihan dilakukan injeksi bupivacaine 0,25% via kateter epidural. 20 menit kamudian terjadi henti napas, desaturase, bradikardia, hipotensi dan kedua pupil midriasis. Dilakukan intubasi dan pemberian vasopressor. Setelah 2 jam kondisi pasien membaik, diameter pupil mengecil dan Kembali bernapas spontan. Kemungkinan etiologi komplikasi tersebut adalah?

a)

Syok neurogenik

b)

False root epidural

c)

Total spinal anesthesia (high spinal yang sampai ke nervus cranialis)

d)

Syok anafilaktik

e)

High spinal anesthesia (sampai cervical)