APEX: MOCK EXAM 4 questions and complete answers

APEX: MOCK EXAM 4 questions and complete jm jm jm jm jm jm




answers
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Which pharmacologic concepts BEST describe the effect of Naloxone at the mu receptor?
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Select 2
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Efficacy jm


Reversibility jm


Potentiation jm


Affinity Reversibility
Affinity

Competitive antagonist (can be reversed by adding more agonist)
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Identify the factors that are MOST likely to increase the gradient between PaCO2 and
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EtCO2. Select 3
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Tracheostomy
Increasing length of tubing in circle system
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Face mask jm jm


Amniotic fluid embolism jm jm jm


Hypervolemia jm


Ipratropium Face mask jm jm


Amniotic fluid embolism jm jm jm


Ipratropium jm




Physiologic dead space = anatomic dead space + alveolar dead space
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Anatomic Vd is increased by anything that increases the volume of the airway conduit
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Alveolar Vd is increased by anything that reduces pulmonary blood flow.
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# of ways this
jm jm jm jm Q could have been asked:
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What increases jm jm dead space? jm


What increases jm jm zone 1 in the lung?
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What increases jm jm the PaCO2-EtCO2 gradient?
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What increases jm jm ventilation in excess of perfusion? jm jm jm jm




Physiologic dead space is increased by: jm jm jm jm jm


Decreased pulm blood flow jm jm jm


Decreased CO jm


PE
COPD
old age jm jm


Face mask jm

,APEX: MOCK EXAM 4 questions and complete
jm jm jm jm jm jm




answers
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Positive pressure ventilation
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HME
Neck extension jm jm


Anticholinergics cause bronchodilation (Ipratropium) jm jm jm jm




Because Vd begins at the y-piece in the circle system, it is not affected by increasing
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length of tubing in the circle system
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What is the largest ETT that can be passed through a size 3 LMA classic?
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A. 6.0
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B. 6.5
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C. 7.0
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D. 7.5 A. 6.0
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LMA 1->3.5ETT jm


LMA 1.5->4.0 ETTjm jm


LMA 2->4.5 ETT jm jm


LMA 2.5-> 5.0 ETT
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LMA 3-> 6.0 ETT jm jm jm


LMA 4-> 6.0 ETT jm jm jm


LMA 5-> 7.0 ETT jm jm jm


LMA 6-> 7.0 ETT jm jm jm


What is the antidote for central anticholinergic syndrome?
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A. Pyridostigmine
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B. Glycopyrrolate
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C. Physostigmine
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D. Atropine C. Physostigmine
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Central anticholinergic syndrome caused by anticholinergics capable of crossing BBB
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(atropine & scopolamine-NOT glyco)
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Signs of toxicity: restlessness, combativeness, confusion, & delerium
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The elderly & pts w/ uncontrolled pain are at increased risk of developing central
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anticholinergic syndrome
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Neostigmine, pyridostigmine, & physostigmine are cholinesterase inhibitors (increase Ach in
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the synaptic cleft), but only physostigmine diffuses across BBB.
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Select the statement that BEST describes the age related autonomic nervous system changes
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in the elderly
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,APEX: MOCK EXAM 4 questions and complete jm jm jm jm jm jm




answers
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A. jm The response to beta stimulation decreases
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B. jm Parasympathetic tone increases jm jm jm


C. jm Baroreceptor sensitivity is unchanged jm jm jm jm


D. jm Sympathetic tone decreases A. The response to beta stimulation decreases
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Key age related ANS changes in elderly include:
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SNS tone increases (increased NE in plasma), however the response to beta stimulation is
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reduced
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PNS tone decreases
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Baroreceptor sensitivity decreases jm jm


CV changes that accompany a normal pregnancy include an increased:
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Select 3 jm


SVR
SV
plasma volume jm jm


DBP
HR
SBP SV
plasma volume jm jm


HR

Several weeks after conception, SVR decreases with a compensatory rise in CO & RAAS
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activity (sodium retention—> increased plasma volume)
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A reduction in SVR causes the DBP to decline. SBP is unchanged
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Key cardiovascular changes during pregnancy:
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CO: (Inc 40%)
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-SV (Inc 30%)
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-HR (Inc 15%)
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Peripheral circulation: jm


-SBP- no change jm jm jm


-DBP- (Dec 15%) jm jm


-SVR- (Dec 15%) jm jm




Intravascular fluid volume: (Inc 35%) jm jm jm jm

, APEX: MOCK EXAM 4 questions and complete jm jm jm jm jm jm




answers
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-plasma volume (Inc 45%) jm jm jm


-erythrocyte volume (Inc 20%) jm jm jm


A 4 y/o pt who weighs 15kg experiences cardiac arrest. What is energy setting for the first
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defibrillation attempt?
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1st shock: 2 J/kg
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2nd shock: 4 J/kg
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Subsequent shocks: 4-10 J/kg jm jm jm


Choose the BEST methods to restore CO in heart transplant recipient. Select 2
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Atropine jm


Ephedrine jm


Isoproterenol jm


500ml 0.9% NACL bolus Isoproterenol
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500ml 0.9% NACL bolus jm jm jm jm




CO is the product of SV & HR
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The transplanted heart is severed from autonomic influence, so HR is determined by
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intrinsic rate of phase 4 depolarization of the SA node (100-120bpm)
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Since the HR is fixed, CO becomes dependent on preload. CO adjusts according to the
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position on the Starling curve—increasing preload augments CO until a point is reached
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where the ventricular myocytes become overstretched & cardiac output fails
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Anesthetic considerations include maintaining adequate preload to optimize the Frank-
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Starling mechanism. Isoproterenol and dilute epinephrine should be available to augment
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HR
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Indirect acting vasopressin's, such as ephedrine, partially rely on endogenous catecholamine
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stores in the post-synaptic sympathetic neuron & are therefore less effective
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Atropine reduces vagal tone by acting as a competitive antagonist of the cardiac M2
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receptor. In the absence of vagal input, atropine has no effect
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Choose the statements that represent an accurate understanding of the flowmeters on the
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anesthesia machine. Select 2
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They are the beginning of the low pressure system
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The annular space is the distance b/t the needle valve & the float
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The plumb bob float is read in the middle of the float
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