Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
1. Choose the true statements Can cause methemoglobinemia - adequate anesthesia is ob-
about EMLA cream. (select 2) tained in 60 minutes
a. It is made up of 2.5% lido-
caine and 2.5% procaine Eutectic mixture of LA (EMLA cream) is a mixture of 2.5% lido-
b. Can cause methemoglo- caine and 2.5% prilocaine (not procaine).
binemia
Adequate anesthesia is obtained in 60 minutes.
c. adequate anesthesia is ob-
tained in 60 minutes
Because it contains prilocaine, it can cause methemoglobine-
d. Risk of toxicity is similar in
mia.
small children and adults.
Systemic absorption of the LA mixture is dependent on total
dose and applied surface area. When compared to the adult,
toxicity is more likely in infants and small children.
2. All of the following are anes- an LMA is an acceptable airway device
thetic considerations for the
patient with a tonsillar bleed nearly all post-tonsillectomy hemorrhages occurs w/n the first
EXCEPT: 24 hours of surgery.
a. the patient requires a RSI
By the patient presents to the OR, he may have swallowed a
b. hemorrhage most com-
significant amount of blood. This can cause nausea and vom-
monly occurs w/n 24 hours of
iting. Tachycardia and hypotension suggest hypovolemia. These
surgery
patients should receive volume resuscitation induction.
c. the patient should be vol-
ume resuscitated before in-
Unknown quantity of blood in the stomach, a RSI is the preferred
duction
method of airway management. An LMA is contraindicated.
d. LMA is an acceptable air-
way device.
3. A patient has remained in superficial peroneal - sural
this position for several
hours following induction of We move our bodies to prevent compression injury. patient
anesthesia. Which nerves are under GA is unable to change position, and is at risk for nerve
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
at the HIGHEST risk of injury? compression.
(select 2).
a. superficial peroneal patient's legs remain crossed for a prolonged period of time
b. sural risk of sural n. compression in the leg on top and a superficial
c. popliteal peroneal n compression in leg on bottom.
d. perineal
4. Match the context sensitive Fentanyl - A
half-time of each opioid with Alfentanil - B
the corresponding letter on Sufentanil - C
the graph. Remifentanil - D
a. Fentanyl
b. Alfentanil
c. Sufentanil
d. Remifentanil
5. When properly placed, the upper esophageal sphincter
distal tip of an LMA sits at
the: Distal tip of an LMA will sit at the cricopharyngeus muscle (at the
a. upper esophageal sphinc- upper esophageal sphincter)
ter
b. pyriform sinus
c. inferior pharyngeal con-
strictor muscle
d. base of the tongue
6.
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
Which option MOST accu- water soluble drugs require a larger dose
rately describes neonatal
pharmacokinetics? neonates respond much differently to medications than older
a. drug clearance is in- children and adults. Warrants a special secton of pharmacology
creased review for the neonate.
b. water soluble drugs re-
Number of factors that affect the pharmacokinetics and phar-
quire a larger dose
macodynamics of anesthetics in neonates:
c. fat to body weight ratio is
- immature organ systems - liver, renal, neurologic
higher in neonate than pedi-
- larger volume of distribution
atric patients
- decreased protein binding
d. protein bound drugs re-
- decreased fat content
quire a larger dose
immature organ systems:
- decreased emtabolism secondary to immature hepatic and
renal function will increase blood levels of normal doses by
decreasing clearance.
Volume of distribution:
- administered dose divided by resulting plasma concentration.
neonates have a much larger water content than older children
and adults. larger doses of water soluble medications will be
needed b/c of the dilutional effect of increased extracellular
water.
Protein binding: (small consequence anesthetic drugs)
- secondary to immature liver, neonates have lower protein
volume. Albumin 70-80% of adults 1st year of life. increased free
drug levels cause exaggerated response from protein bound
drugs. albumin = acidic drugs, alpha-1 acid glycoprotein - basic
drugs.
7.
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
Male patient, what is the Rotate the DLT 90 degrees in the direction of the bronchus to be
next step after the tip of the intubated.
DLT passes through the vocal
cords? - Remove the stylet to avoid mucosal damage
- Rotate the DLT 90 degrees in the direction of the bronchus to
be intubated
- advance the tube to 29cm = males 27 cm = female at teeth.
- Fill the tracheal cuff with 5-10 ml of air and the bronchial cuff
with 1-2 ml of air
- auscultation is not the most reliable method of determining
correct placement. Confirm placement w/FOI
8. Name the area of EKG that PR interval - "a-wave" - atrial contraction
coincides with the "a" wave of
the CVP waveform. BIG NCE question! P wave represents atrial depolarization - PR
is the actual atrial contraction of the "a-wave"
9. Which indices suggest a prer- Urine sodium < 20 mEq/L - FENA < 1%
enal cause of oliguria? (select
2). Decreased renal blood flow causes prerenal oliguria. Kidney
a. FENA < 1% function is normal, you should expect to see concentrated urine
b. Bun; Cr ratio < 20 (increased osmolality) and a low FENA. Suggests the body is
c. Urine sodium < 20 mEq/L holding on to Sodium and water in an effort to preserve in-
d. urine osmolarity < 400 travascular volume.
mOsm/kg
Hypovolemia, hypotension, and decreased CO are common
causes of prerenal failure.
Treatment is focused on restoring intravascular volume and
Study online at https://quizlet.com/_8g9rdc
1. Choose the true statements Can cause methemoglobinemia - adequate anesthesia is ob-
about EMLA cream. (select 2) tained in 60 minutes
a. It is made up of 2.5% lido-
caine and 2.5% procaine Eutectic mixture of LA (EMLA cream) is a mixture of 2.5% lido-
b. Can cause methemoglo- caine and 2.5% prilocaine (not procaine).
binemia
Adequate anesthesia is obtained in 60 minutes.
c. adequate anesthesia is ob-
tained in 60 minutes
Because it contains prilocaine, it can cause methemoglobine-
d. Risk of toxicity is similar in
mia.
small children and adults.
Systemic absorption of the LA mixture is dependent on total
dose and applied surface area. When compared to the adult,
toxicity is more likely in infants and small children.
2. All of the following are anes- an LMA is an acceptable airway device
thetic considerations for the
patient with a tonsillar bleed nearly all post-tonsillectomy hemorrhages occurs w/n the first
EXCEPT: 24 hours of surgery.
a. the patient requires a RSI
By the patient presents to the OR, he may have swallowed a
b. hemorrhage most com-
significant amount of blood. This can cause nausea and vom-
monly occurs w/n 24 hours of
iting. Tachycardia and hypotension suggest hypovolemia. These
surgery
patients should receive volume resuscitation induction.
c. the patient should be vol-
ume resuscitated before in-
Unknown quantity of blood in the stomach, a RSI is the preferred
duction
method of airway management. An LMA is contraindicated.
d. LMA is an acceptable air-
way device.
3. A patient has remained in superficial peroneal - sural
this position for several
hours following induction of We move our bodies to prevent compression injury. patient
anesthesia. Which nerves are under GA is unable to change position, and is at risk for nerve
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
at the HIGHEST risk of injury? compression.
(select 2).
a. superficial peroneal patient's legs remain crossed for a prolonged period of time
b. sural risk of sural n. compression in the leg on top and a superficial
c. popliteal peroneal n compression in leg on bottom.
d. perineal
4. Match the context sensitive Fentanyl - A
half-time of each opioid with Alfentanil - B
the corresponding letter on Sufentanil - C
the graph. Remifentanil - D
a. Fentanyl
b. Alfentanil
c. Sufentanil
d. Remifentanil
5. When properly placed, the upper esophageal sphincter
distal tip of an LMA sits at
the: Distal tip of an LMA will sit at the cricopharyngeus muscle (at the
a. upper esophageal sphinc- upper esophageal sphincter)
ter
b. pyriform sinus
c. inferior pharyngeal con-
strictor muscle
d. base of the tongue
6.
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
Which option MOST accu- water soluble drugs require a larger dose
rately describes neonatal
pharmacokinetics? neonates respond much differently to medications than older
a. drug clearance is in- children and adults. Warrants a special secton of pharmacology
creased review for the neonate.
b. water soluble drugs re-
Number of factors that affect the pharmacokinetics and phar-
quire a larger dose
macodynamics of anesthetics in neonates:
c. fat to body weight ratio is
- immature organ systems - liver, renal, neurologic
higher in neonate than pedi-
- larger volume of distribution
atric patients
- decreased protein binding
d. protein bound drugs re-
- decreased fat content
quire a larger dose
immature organ systems:
- decreased emtabolism secondary to immature hepatic and
renal function will increase blood levels of normal doses by
decreasing clearance.
Volume of distribution:
- administered dose divided by resulting plasma concentration.
neonates have a much larger water content than older children
and adults. larger doses of water soluble medications will be
needed b/c of the dilutional effect of increased extracellular
water.
Protein binding: (small consequence anesthetic drugs)
- secondary to immature liver, neonates have lower protein
volume. Albumin 70-80% of adults 1st year of life. increased free
drug levels cause exaggerated response from protein bound
drugs. albumin = acidic drugs, alpha-1 acid glycoprotein - basic
drugs.
7.
, Simulation Test 2
Study online at https://quizlet.com/_8g9rdc
Male patient, what is the Rotate the DLT 90 degrees in the direction of the bronchus to be
next step after the tip of the intubated.
DLT passes through the vocal
cords? - Remove the stylet to avoid mucosal damage
- Rotate the DLT 90 degrees in the direction of the bronchus to
be intubated
- advance the tube to 29cm = males 27 cm = female at teeth.
- Fill the tracheal cuff with 5-10 ml of air and the bronchial cuff
with 1-2 ml of air
- auscultation is not the most reliable method of determining
correct placement. Confirm placement w/FOI
8. Name the area of EKG that PR interval - "a-wave" - atrial contraction
coincides with the "a" wave of
the CVP waveform. BIG NCE question! P wave represents atrial depolarization - PR
is the actual atrial contraction of the "a-wave"
9. Which indices suggest a prer- Urine sodium < 20 mEq/L - FENA < 1%
enal cause of oliguria? (select
2). Decreased renal blood flow causes prerenal oliguria. Kidney
a. FENA < 1% function is normal, you should expect to see concentrated urine
b. Bun; Cr ratio < 20 (increased osmolality) and a low FENA. Suggests the body is
c. Urine sodium < 20 mEq/L holding on to Sodium and water in an effort to preserve in-
d. urine osmolarity < 400 travascular volume.
mOsm/kg
Hypovolemia, hypotension, and decreased CO are common
causes of prerenal failure.
Treatment is focused on restoring intravascular volume and
