Hall Anesthesia Review EXAM LATEST 850 QUESTIONS
AND 100% Verified ANSWERS JUST RELEASED
Which of the following local anesthetics is associated with methemoglobinemia
A. Lidocaine
B. Bupivacaine
C. Prilocaine
D. Levobupivacaine
E. Chloroprocaine - answer>>Answer: C. Prilocaine
Which local anesthetic has the most rapid metabolism in maternal and fetal blood?
A. Lidocaine
B. Bupivacaine
C. Prilocaine
D. Levobupivacaine
E. Chloroprocaine - answer>>Answer: E. Chloroprocaine
Following clipping of an anterior communicating artery aneurysm, a 59-year-old man is admitted to the
intensive care unit (ICU). Serum sodium is 115 mEq/L, 24 hour urine sodium collection 350 mmol
(normal range 40 to 117 mmol/24 h) and central venous pressure (CVP) is 1 cm H2O. The most likely
cause of these findings is:
A. Tubular necrosis
B. Diabetes insipidus
C. Cerebral salt wasting syndrome
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
E. Primary hyperaldosteronism - answer>>Answer: C. Cerebral salt wasting syndrome
*Triad of cerebral salt-wasting syndrome:
-hyponatremia
-volume contraction
,-urine sodium concentrations inappropriately high for the given level of serum sodium.
*It is mainly seen in patients with subarachnoid hemorrhage (SAH).
*A possible etiology may be release of brain natriuretic peptide, leading to excess urinary sodium
excretion.
*It is treated with volume replacement, utilizing normal to hypertonic intravenous sodium chloride
solution, but avoiding overly rapid serum sodium correction as this may result in central pontine
myelinolysis.
*Cerebral salt wasting syndrome (usually hypovolemic) is difficult to differentiate from SIADH (usually
normovolemic or mildly hypervolemic) because patients with SAH can have high antidiuretic hormone
(ADH) levels secondary to trauma, pain etc
*differentiated by high urine sodium, as seen in this patient
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above
A. 5 mm Hg
B. 15 mm Hg
C. 25 mm Hg
D. 40 mm Hg
E. None of the above - answer>>Answer: B. 15 mm Hg
*Normal ICP is less than 15 mm Hg.
*As measured in the supine position, intracranial hypertension is defined as a sustained increase in ICP
above 15 to 20 mm Hg
Calculate cerebral perfusion pressure from the following data: Blood pressure (BP) 100/70, heart rate
(HR) 65 beats/min, central venous pressure (CVP) 20 mm Hg, ICP 15 mm Hg
A. 60 mm Hg
B. 65 mm Hg
C. 70 mm Hg
,D. 75 mm Hg
E. Cannot be determined - answer>>Answer: A. 60 mm Hg
*CPP = MAP - ICP or CVP... whichever greater
MAP = (SBP + 2 DBP)/3 = (100 + 2(70))/3 = 80
CVP 20 > ICP 15
CPP = 80 - 20 = 60
The afferent input for somatosensory evoked potentials (SSEPs) is carried through which spinal cord
tract?
A. Spinocerebellar
B. Spinothalamic
C. Dorsal columns
D. Corticospinal
E. Vestibulospinal - answer>>Answer: C. Dorsal columns
*sensory = afferent = dorsal = ascending
*motor = efferent = ventral = descending
By what percentage does cerebral blood flow (CBF) change for each mm Hg increase in PaCO2?
A. 1%
B. 2%
C. 7%
D. 10%
E. 25% - answer>>Answer: B. 2%
, Which of the following intravenous anesthetics is contraindicated in patients with intracranial
hypertension?
A. Propofol
B. Fentanyl
C. Thiopental
D. Midazolam
E. Ketamine - answer>>Answer: E. Ketamine
*Incr ICP
The term luxury perfusion refers to a situation that occurs in the brain when
A. Blood flow has resumed after a period of ischemia
B. Blood flow is directed from a normal region of the brain to an ischemic region
C. Vasoparalysis exists
D. The Robin Hood phenomenon exists
E. A zone of ischemic penumbra exists - answer>>Answer: C. Vasoparalysis exists
*During acute focal cerebral ischemia, regional vasoparalysis results in impaired coupling between CBF
and metabolism
*autoregulation and the reactivity of the cerebrovasculature to carbon dioxide is also impaired
*must rely on MAP for perfusion during anesthetic management (other compensatory mechanisms are
inhibited)
*Blood flow directed from a normal region of the brain to an ischemic region is known as the "Robin
Hood phenomenon" (B and D)
A 62-year-old patient is scheduled to undergo resection of a frontal lobe intracranial tumor under
general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic
deficits. Within what range should PaCO2 be maintained?
A. 15 and 20 mm Hg
AND 100% Verified ANSWERS JUST RELEASED
Which of the following local anesthetics is associated with methemoglobinemia
A. Lidocaine
B. Bupivacaine
C. Prilocaine
D. Levobupivacaine
E. Chloroprocaine - answer>>Answer: C. Prilocaine
Which local anesthetic has the most rapid metabolism in maternal and fetal blood?
A. Lidocaine
B. Bupivacaine
C. Prilocaine
D. Levobupivacaine
E. Chloroprocaine - answer>>Answer: E. Chloroprocaine
Following clipping of an anterior communicating artery aneurysm, a 59-year-old man is admitted to the
intensive care unit (ICU). Serum sodium is 115 mEq/L, 24 hour urine sodium collection 350 mmol
(normal range 40 to 117 mmol/24 h) and central venous pressure (CVP) is 1 cm H2O. The most likely
cause of these findings is:
A. Tubular necrosis
B. Diabetes insipidus
C. Cerebral salt wasting syndrome
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
E. Primary hyperaldosteronism - answer>>Answer: C. Cerebral salt wasting syndrome
*Triad of cerebral salt-wasting syndrome:
-hyponatremia
-volume contraction
,-urine sodium concentrations inappropriately high for the given level of serum sodium.
*It is mainly seen in patients with subarachnoid hemorrhage (SAH).
*A possible etiology may be release of brain natriuretic peptide, leading to excess urinary sodium
excretion.
*It is treated with volume replacement, utilizing normal to hypertonic intravenous sodium chloride
solution, but avoiding overly rapid serum sodium correction as this may result in central pontine
myelinolysis.
*Cerebral salt wasting syndrome (usually hypovolemic) is difficult to differentiate from SIADH (usually
normovolemic or mildly hypervolemic) because patients with SAH can have high antidiuretic hormone
(ADH) levels secondary to trauma, pain etc
*differentiated by high urine sodium, as seen in this patient
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above
A. 5 mm Hg
B. 15 mm Hg
C. 25 mm Hg
D. 40 mm Hg
E. None of the above - answer>>Answer: B. 15 mm Hg
*Normal ICP is less than 15 mm Hg.
*As measured in the supine position, intracranial hypertension is defined as a sustained increase in ICP
above 15 to 20 mm Hg
Calculate cerebral perfusion pressure from the following data: Blood pressure (BP) 100/70, heart rate
(HR) 65 beats/min, central venous pressure (CVP) 20 mm Hg, ICP 15 mm Hg
A. 60 mm Hg
B. 65 mm Hg
C. 70 mm Hg
,D. 75 mm Hg
E. Cannot be determined - answer>>Answer: A. 60 mm Hg
*CPP = MAP - ICP or CVP... whichever greater
MAP = (SBP + 2 DBP)/3 = (100 + 2(70))/3 = 80
CVP 20 > ICP 15
CPP = 80 - 20 = 60
The afferent input for somatosensory evoked potentials (SSEPs) is carried through which spinal cord
tract?
A. Spinocerebellar
B. Spinothalamic
C. Dorsal columns
D. Corticospinal
E. Vestibulospinal - answer>>Answer: C. Dorsal columns
*sensory = afferent = dorsal = ascending
*motor = efferent = ventral = descending
By what percentage does cerebral blood flow (CBF) change for each mm Hg increase in PaCO2?
A. 1%
B. 2%
C. 7%
D. 10%
E. 25% - answer>>Answer: B. 2%
, Which of the following intravenous anesthetics is contraindicated in patients with intracranial
hypertension?
A. Propofol
B. Fentanyl
C. Thiopental
D. Midazolam
E. Ketamine - answer>>Answer: E. Ketamine
*Incr ICP
The term luxury perfusion refers to a situation that occurs in the brain when
A. Blood flow has resumed after a period of ischemia
B. Blood flow is directed from a normal region of the brain to an ischemic region
C. Vasoparalysis exists
D. The Robin Hood phenomenon exists
E. A zone of ischemic penumbra exists - answer>>Answer: C. Vasoparalysis exists
*During acute focal cerebral ischemia, regional vasoparalysis results in impaired coupling between CBF
and metabolism
*autoregulation and the reactivity of the cerebrovasculature to carbon dioxide is also impaired
*must rely on MAP for perfusion during anesthetic management (other compensatory mechanisms are
inhibited)
*Blood flow directed from a normal region of the brain to an ischemic region is known as the "Robin
Hood phenomenon" (B and D)
A 62-year-old patient is scheduled to undergo resection of a frontal lobe intracranial tumor under
general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic
deficits. Within what range should PaCO2 be maintained?
A. 15 and 20 mm Hg
