1
APEX MOCK EXAM 1 QUESTIONS & ANSWERS
100% CORRECT!!
Match each West zone of the lung with its corresponding pressures:
Zone 1
Zone 2
Zone 3
Zone 4 - (answers)Zone 1: P alveolar> P arterial> P venous> P interstitial (dead space)
Zone 2: P arterial> P alveolar> P venous> P interstitial (matched V/Q)
Zone 3: P arterial> P venous> P Alveolar> P interstitial (shunt)
Zone 4: P arterial> P interstitial> P venous> P alveolar (increase pressure in the interstitium-
pulm edema)
Which interventions are MOST appropriate in the "cant ventilate can't intubate" scenario? Select
2
Percutaneous transtracheal jet ventilation
Tracheostomy
Surgical cricothyrotomy
Retrograde intubation - (answers)Percutaneous transtracheal jet ventilation
Surgical cricothyrotomy
Surgical cricothyrotomy and transtracheal jet ventilation can reestablish ventilation very quickly,
and are appropriate options in the cant Ventilate can't intubate scenario.
Retrograde intubation is best used one ventilation as possible. It takes 5 to 7 minutes to complete
in the hands of an experience practitioner. This is often performed for the patient with a
suspected or known difficult airway in a controlled setting before the induction of Anesthesia. It
is also useful in the patient with an unstable cervical spine.
At what point during laparoscopic cholecystectomy is a gas embolism most likely to occur?
, 2
A. Initial abdominal insufflation.
B. During the cholangiogram
C. The risk is the same throughout the procedure.
D. Dissection of gallbladder from the liver bed. - (answers)A. Initial abdominal insufflation.
There is a risk of air embolism if a trocar is inadvertently placed into a blood vessel, or any time
when intravascular pressure falls below intraabdominal pressure.
Gas embolism creates an airlock in the right heart, and thus obstructs forward flow.
Signs and symptoms include : decreased EtCO2, increased EtN, increased PAP, pulmonary
edema, decreased blood pressure, hypoxia, dysrhythmias, cyanosis, and a mill wheel murmur.
TEE is the most sensitive indicator of gas embolism.
The risk of gas embolism is greatest during initial insufflation of the abdomen, especially those
with previous abdominal surgery .
Which finding places a child at the GREATEST risk for laryngospasm?
A. Upper respiratory infection.
B. Upper airway surgery.
C. Exposure to secondhand tobacco smoke.
D. Gastro esophageal reflux. - (answers)A. Upper respiratory infection.
Noxious stimulation of the internal branch of the superior, laryngeal, nerve and precipitate
laryngospasm. This complication can lead to complete airway obstruction negative pressure
pulmonary edema, aspiration of gastric contents, cardiac arrest, and death.
The risk of laryngospasm is greatest in the child with an upper respiratory infection 9.6/100
The Distractors were the other risk factors for laryngospasm:
-Preoperative risk factors include exposure to secondhand smoke and GERD.
-Intra-operative risk factors include upper airway surgery, mechanical irritant (secretions),
airway manipulation during light planes of anesthesia, and the excitement phase during an
inhalation induction.
, 3
Which lung volume increases as a function of aging? - (answers)Aging is associated with the
loss of lung elastic recoil. Said another way, There is an increased lung compliance. Lung elastic
recoil is integral to the maintenance of airway diameter. Loss of this property causes a small
airways to collapse prematurely. This causes gas trapping, and gas trapping increases
RESIDUAL VOLUME.
A Morbidly obese patient is undergoing removal of an infected hip hardware under general
anesthesia. Midway through the procedure you observe the following vital signs. What is the
MOST likely diagnosis?
Increased HR
hypotension
Increased CVP
Drop in ETCO2
Drop in O2 sats
PIP increased
A. PE
B. Exsanguination.
C. Myocardial infarction
D. Congestive heart failure. - (answers)A. PE
pulmonary embolism creates a mechanical obstruction in the pulmonary circulation. If the
embolism is of sufficient size, it significantly increases dead space ventilation and pulmonary
vascular resistance. A Precipitous fall in EtCO2 and tachycardia are usually the first signs of PE.
Dead space ventilation, contributes to arterial hypoxemia. Cardiac filling pressures may increase
as a result of increased PVR. Hypotension may occur & bronchospasm may increase peak
inspiratory pressure.
, 4
Immediate treatment consists of 100% FiO2 and hemodynamic support with fluids and
inotropes. If symptoms do not resolve, pulmonary embolectomy or thrombolysis in the non-
surgical patient should be considered.
MI, CHF and exsanguination can cause some, but not all, of the physiological changes in the
question so these weren't the best options.
All of the following are contraindications to retrograde tracheal intubation, EXCEPT:
A. Neck flexion deformity.
B. Cervical spine injury.
C. Goiter.
D. Coagulopathy. - (answers)B. Cervical spine injury
Retrograde intubation involves puncturing the cricothyroid membrane in passing a wire through
the vocal cords and out of the mouth. Next, an endotracheal tube is loaded over the wire and
advanced into the trachea. Most of the reported cases of retrograde intubation described its use in
patients with cervical spine injuries.
Neck flexion deformity can make this procedure challenging, if not impossible.
a goiter may prevent you from accurately identifying the cricothyroid membrane. Coagulopathy
increases the risk of bleeding into the airway following needle puncture.
In the patient with chronic bronchitis which preoperative interventions MOST reliably reduce the
incidence of post operative, pulmonary complications?
A. Smoking cessation for 8 weeks.
B. Prophylactic doxycycline.
C. Instruction in postop pulmonary toilet techniques.
D. Adequate hydration. - (answers)A. Smoking cessation for 8 weeks
APEX MOCK EXAM 1 QUESTIONS & ANSWERS
100% CORRECT!!
Match each West zone of the lung with its corresponding pressures:
Zone 1
Zone 2
Zone 3
Zone 4 - (answers)Zone 1: P alveolar> P arterial> P venous> P interstitial (dead space)
Zone 2: P arterial> P alveolar> P venous> P interstitial (matched V/Q)
Zone 3: P arterial> P venous> P Alveolar> P interstitial (shunt)
Zone 4: P arterial> P interstitial> P venous> P alveolar (increase pressure in the interstitium-
pulm edema)
Which interventions are MOST appropriate in the "cant ventilate can't intubate" scenario? Select
2
Percutaneous transtracheal jet ventilation
Tracheostomy
Surgical cricothyrotomy
Retrograde intubation - (answers)Percutaneous transtracheal jet ventilation
Surgical cricothyrotomy
Surgical cricothyrotomy and transtracheal jet ventilation can reestablish ventilation very quickly,
and are appropriate options in the cant Ventilate can't intubate scenario.
Retrograde intubation is best used one ventilation as possible. It takes 5 to 7 minutes to complete
in the hands of an experience practitioner. This is often performed for the patient with a
suspected or known difficult airway in a controlled setting before the induction of Anesthesia. It
is also useful in the patient with an unstable cervical spine.
At what point during laparoscopic cholecystectomy is a gas embolism most likely to occur?
, 2
A. Initial abdominal insufflation.
B. During the cholangiogram
C. The risk is the same throughout the procedure.
D. Dissection of gallbladder from the liver bed. - (answers)A. Initial abdominal insufflation.
There is a risk of air embolism if a trocar is inadvertently placed into a blood vessel, or any time
when intravascular pressure falls below intraabdominal pressure.
Gas embolism creates an airlock in the right heart, and thus obstructs forward flow.
Signs and symptoms include : decreased EtCO2, increased EtN, increased PAP, pulmonary
edema, decreased blood pressure, hypoxia, dysrhythmias, cyanosis, and a mill wheel murmur.
TEE is the most sensitive indicator of gas embolism.
The risk of gas embolism is greatest during initial insufflation of the abdomen, especially those
with previous abdominal surgery .
Which finding places a child at the GREATEST risk for laryngospasm?
A. Upper respiratory infection.
B. Upper airway surgery.
C. Exposure to secondhand tobacco smoke.
D. Gastro esophageal reflux. - (answers)A. Upper respiratory infection.
Noxious stimulation of the internal branch of the superior, laryngeal, nerve and precipitate
laryngospasm. This complication can lead to complete airway obstruction negative pressure
pulmonary edema, aspiration of gastric contents, cardiac arrest, and death.
The risk of laryngospasm is greatest in the child with an upper respiratory infection 9.6/100
The Distractors were the other risk factors for laryngospasm:
-Preoperative risk factors include exposure to secondhand smoke and GERD.
-Intra-operative risk factors include upper airway surgery, mechanical irritant (secretions),
airway manipulation during light planes of anesthesia, and the excitement phase during an
inhalation induction.
, 3
Which lung volume increases as a function of aging? - (answers)Aging is associated with the
loss of lung elastic recoil. Said another way, There is an increased lung compliance. Lung elastic
recoil is integral to the maintenance of airway diameter. Loss of this property causes a small
airways to collapse prematurely. This causes gas trapping, and gas trapping increases
RESIDUAL VOLUME.
A Morbidly obese patient is undergoing removal of an infected hip hardware under general
anesthesia. Midway through the procedure you observe the following vital signs. What is the
MOST likely diagnosis?
Increased HR
hypotension
Increased CVP
Drop in ETCO2
Drop in O2 sats
PIP increased
A. PE
B. Exsanguination.
C. Myocardial infarction
D. Congestive heart failure. - (answers)A. PE
pulmonary embolism creates a mechanical obstruction in the pulmonary circulation. If the
embolism is of sufficient size, it significantly increases dead space ventilation and pulmonary
vascular resistance. A Precipitous fall in EtCO2 and tachycardia are usually the first signs of PE.
Dead space ventilation, contributes to arterial hypoxemia. Cardiac filling pressures may increase
as a result of increased PVR. Hypotension may occur & bronchospasm may increase peak
inspiratory pressure.
, 4
Immediate treatment consists of 100% FiO2 and hemodynamic support with fluids and
inotropes. If symptoms do not resolve, pulmonary embolectomy or thrombolysis in the non-
surgical patient should be considered.
MI, CHF and exsanguination can cause some, but not all, of the physiological changes in the
question so these weren't the best options.
All of the following are contraindications to retrograde tracheal intubation, EXCEPT:
A. Neck flexion deformity.
B. Cervical spine injury.
C. Goiter.
D. Coagulopathy. - (answers)B. Cervical spine injury
Retrograde intubation involves puncturing the cricothyroid membrane in passing a wire through
the vocal cords and out of the mouth. Next, an endotracheal tube is loaded over the wire and
advanced into the trachea. Most of the reported cases of retrograde intubation described its use in
patients with cervical spine injuries.
Neck flexion deformity can make this procedure challenging, if not impossible.
a goiter may prevent you from accurately identifying the cricothyroid membrane. Coagulopathy
increases the risk of bleeding into the airway following needle puncture.
In the patient with chronic bronchitis which preoperative interventions MOST reliably reduce the
incidence of post operative, pulmonary complications?
A. Smoking cessation for 8 weeks.
B. Prophylactic doxycycline.
C. Instruction in postop pulmonary toilet techniques.
D. Adequate hydration. - (answers)A. Smoking cessation for 8 weeks
