Anesthesia Questions Of The Day With Accurate
Answers
In patients receiving Vecuronium, the greatest augmentation of
neuromuscular blockade is seen the use of?
A. Isoflurane
B. Sevoflurane
C. Desfurane
D. Nitrous Oxide Right Ans - C. Desflurane
Volatile agents decrease the non depolarizer dosage requirement. The degree
of augmentation of blockade depend on the inhalation agent Desflurane
>Sevoflurane> Isoflurane>Nitrous Oxide
Page 213 Morgan & Mikhail's Clinical Anesthesiology
The addition of bicarbonate to a local anesthetic solution:
A. Delays the onset of blockade
B. Increases the concentration of the nonionic form of the local anesthetic
C. Causes a fall in eth pH of the solution
D. Should only be done when using bupivacaine Right Ans - B. Increases the
concentration of the nonionic form of the local anesthetic
The onset of neural blockade depends on eth penetration of the nerve cell
membrane by the nonionic form of the anesthetic. Increasing the pH of the
anesthetic solution increases the concentration of the nonionic form and
thereby hastens the onset of the block. Bicarbonate is usually not added to
bupivacaine, since it can cause precipitation if the pH is raised above 6.8
Page 963 Morgan & Mikhail's Clinical Anesthesiology
During hip replacement surgery, cardiopulmonary changes associated with
acrylic bone cement includes:
A-hypotension secondary to cement monomer absorption
B- Hypoxemia secondary to air embolization
C-Hypoxemia secondary to fat embolization
D-Hypocarbia
E-Decreased pulmonary artery pressure
F-Increased end-tidal carbon dioxide Right Ans - A-Hypotension secondary
to cement monomer absorption
B-Hypoxemia secondary to air embolization
,C-Hypoxemia secondary to fat embolization
During hip replacement surgery, hypotension with the use acrylic bone
cement has been attributed to absorption of methyl methacrylate monomer,
embolization of air and bone marrow and conversion of Methyl methacrylate
to methacrylic acid. Hypoxemia is common. Embolic event cause an increase
in dead space with a reduction in ETCO2 with an increase in PaCO2.
Page 1454 Barash, Clinical Anesthesia.
Maternal mortality associated with amniotic fluid embolization is:
A- 10-15%
B- 20-25%
C- 40-45%
D- Greater than 50% Right Ans - Answer: D- Greater than 50%
Amniotic fluid embolism is a very rare occurrence of about 1:20,000.
However, it carries a very high mortality; some studies quoting as much as
86%. Mortality within the first hour after onset is about 50%.
Page 867 Morgan & Mikhail's Clinical Anesthesiology
Pulmonary changes associated with Duchenne's muscular dystrophy include:
A. A restrictive ventilator defect
B. An obstructive ventilator defect
C. Decreased pulmonary artery pressure
D. Increased residual volume Right Ans - Answer: A restrictive ventilator
defect
Pulmonary changes associated with Duchenne's muscular dystrophy include:
a restrictive ventilator defect.
The combination of marked kyphoscoliosis and degeneration of the
respiratory muscles produces a severe restrictive ventilator defect in patients
with Duchenne's muscular dystrophy. Pulmonary hypertension is also
commonly seen. (Page 753 Morgan & Mikhail's Clinical Anesthesiology, 2013).
Muscular Dystrophy
Core Notes by Core Concepts Anesthesia Review, LLC
1. Duchenne muscular dystrophy (DMD) is the most common type of muscular
dystrophy.
,2. It is an X-linked disorder seen in males, appearing in childhood with
progressive muscle wasting. Death usually occurs during adolescence.
3. Cardiac muscle is also affected and death usually results from cardiac
and/or ventilator failure.
4. ECG changes appear as decreased R-wave amplitude and the appearance of
Q waves.
5. Changes in the architecture of the thorax result in progressive and severe
restrictive lung disease.
6. Severe hyperkalemia and rhabdomyolysis have resulted from the
administration of succinylcholine. The use of succinylcholine is
contraindicated in these patients.
7. Although once felt to be associated with MH, recent data suggest that this
may not be true and deaths were likely the result of hyperkalemia.
DMD is the most common childhood muscular dystrophy. It is an X-linked
recessive disorder appearing in between the ages of 3 - 5, with progressive
weakness. It is sometimes referred to as pseudohypertrophic muscular
dystrophy and is usually fatal by late adolescence as a result of ventilatory
and/or cardiac failure. In addition, these young males suffer from
contractures, marked scoliosis, restrictive lung disease, and
cardiomyopathies; 50% of sufferers have a dilated cardiomyopathy by the age
of 15.
The disease i
A 46-year old male is scheduled for an emergent laparotomy for small bowel
obstruction. His history is complicated by the acute onset of hepatitis B four
days earlier and he presents with significant scleral jaundice. The
perioperative mortality in this patient is approximately:
A. 2%
B. 5%
C. 10%
D. 25% Right Ans - Answer:
C. 10%
Patient with acute hepatitis should have elective surgery postponed until the
acute hepatitis has resolved. Studies indicate increased perioperative
morbidity (12%) and mortality (10% with laparotomy) during acute hepatitis.
Pp. 1315-1316 Barash, Clinical Anesthesia.
, An increase in intraocular pressure has been associated with: (select 3)
A. Nitrous oxide administration
B. Succinylcholine administration
C. Opioid administration
D. Hyperventilation
E. Laryngoscopy
F. Hypoxemia
G. Sevoflurane administration Right Ans - Answer:
B. Succinylcholine administration
E. Laryngoscopy
F. Hypoxemia
An increase in IOP (intraocular pressure) has been associated with:
succinylcholine administration, hypoxemia, and laryngoscopy
Succinylcholine increased intraocular pressure by 5-10 mmHg for 5 to 5
minutes after administration. This increase is primarily the result of
prolonged contracture of the extrocular muscles from the depolarizing effects
of succinylcholine. Nitrous oxide, volatile anesthetics agents and opioids have
been associated with a reduction in intraocular pressure. Hypoxemia,
Hypercarbia, hypertension, hypervolemia, laryngoscopy and intubation have
all been shown to increase IOP.
Pp 760-761 Morgan $ Mikhail's Clinical Anesthesiology
In the pressure-volume loop below, cardiac work is best represented by:
A. The area of the curve
B. The slope of the line from points C to D
C. The distance of the line form points C to D
D. The slope of a line from points A to D Right Ans - A. The area of the curve
Cardiac work is the product of pressure and volume and is linearly related to
myocardial oxygen consumption. Cardiac work is best represented by the area
of the curve of a pressure-volume loop.
Pg. 250 Barash, PG, Cullen, Clinical Anesthesia
Dextran 40 has been shown to improve microcirculation by:
A- Reducing blood density
B- Increasing blood density
C- Decreasing blood viscosity
Answers
In patients receiving Vecuronium, the greatest augmentation of
neuromuscular blockade is seen the use of?
A. Isoflurane
B. Sevoflurane
C. Desfurane
D. Nitrous Oxide Right Ans - C. Desflurane
Volatile agents decrease the non depolarizer dosage requirement. The degree
of augmentation of blockade depend on the inhalation agent Desflurane
>Sevoflurane> Isoflurane>Nitrous Oxide
Page 213 Morgan & Mikhail's Clinical Anesthesiology
The addition of bicarbonate to a local anesthetic solution:
A. Delays the onset of blockade
B. Increases the concentration of the nonionic form of the local anesthetic
C. Causes a fall in eth pH of the solution
D. Should only be done when using bupivacaine Right Ans - B. Increases the
concentration of the nonionic form of the local anesthetic
The onset of neural blockade depends on eth penetration of the nerve cell
membrane by the nonionic form of the anesthetic. Increasing the pH of the
anesthetic solution increases the concentration of the nonionic form and
thereby hastens the onset of the block. Bicarbonate is usually not added to
bupivacaine, since it can cause precipitation if the pH is raised above 6.8
Page 963 Morgan & Mikhail's Clinical Anesthesiology
During hip replacement surgery, cardiopulmonary changes associated with
acrylic bone cement includes:
A-hypotension secondary to cement monomer absorption
B- Hypoxemia secondary to air embolization
C-Hypoxemia secondary to fat embolization
D-Hypocarbia
E-Decreased pulmonary artery pressure
F-Increased end-tidal carbon dioxide Right Ans - A-Hypotension secondary
to cement monomer absorption
B-Hypoxemia secondary to air embolization
,C-Hypoxemia secondary to fat embolization
During hip replacement surgery, hypotension with the use acrylic bone
cement has been attributed to absorption of methyl methacrylate monomer,
embolization of air and bone marrow and conversion of Methyl methacrylate
to methacrylic acid. Hypoxemia is common. Embolic event cause an increase
in dead space with a reduction in ETCO2 with an increase in PaCO2.
Page 1454 Barash, Clinical Anesthesia.
Maternal mortality associated with amniotic fluid embolization is:
A- 10-15%
B- 20-25%
C- 40-45%
D- Greater than 50% Right Ans - Answer: D- Greater than 50%
Amniotic fluid embolism is a very rare occurrence of about 1:20,000.
However, it carries a very high mortality; some studies quoting as much as
86%. Mortality within the first hour after onset is about 50%.
Page 867 Morgan & Mikhail's Clinical Anesthesiology
Pulmonary changes associated with Duchenne's muscular dystrophy include:
A. A restrictive ventilator defect
B. An obstructive ventilator defect
C. Decreased pulmonary artery pressure
D. Increased residual volume Right Ans - Answer: A restrictive ventilator
defect
Pulmonary changes associated with Duchenne's muscular dystrophy include:
a restrictive ventilator defect.
The combination of marked kyphoscoliosis and degeneration of the
respiratory muscles produces a severe restrictive ventilator defect in patients
with Duchenne's muscular dystrophy. Pulmonary hypertension is also
commonly seen. (Page 753 Morgan & Mikhail's Clinical Anesthesiology, 2013).
Muscular Dystrophy
Core Notes by Core Concepts Anesthesia Review, LLC
1. Duchenne muscular dystrophy (DMD) is the most common type of muscular
dystrophy.
,2. It is an X-linked disorder seen in males, appearing in childhood with
progressive muscle wasting. Death usually occurs during adolescence.
3. Cardiac muscle is also affected and death usually results from cardiac
and/or ventilator failure.
4. ECG changes appear as decreased R-wave amplitude and the appearance of
Q waves.
5. Changes in the architecture of the thorax result in progressive and severe
restrictive lung disease.
6. Severe hyperkalemia and rhabdomyolysis have resulted from the
administration of succinylcholine. The use of succinylcholine is
contraindicated in these patients.
7. Although once felt to be associated with MH, recent data suggest that this
may not be true and deaths were likely the result of hyperkalemia.
DMD is the most common childhood muscular dystrophy. It is an X-linked
recessive disorder appearing in between the ages of 3 - 5, with progressive
weakness. It is sometimes referred to as pseudohypertrophic muscular
dystrophy and is usually fatal by late adolescence as a result of ventilatory
and/or cardiac failure. In addition, these young males suffer from
contractures, marked scoliosis, restrictive lung disease, and
cardiomyopathies; 50% of sufferers have a dilated cardiomyopathy by the age
of 15.
The disease i
A 46-year old male is scheduled for an emergent laparotomy for small bowel
obstruction. His history is complicated by the acute onset of hepatitis B four
days earlier and he presents with significant scleral jaundice. The
perioperative mortality in this patient is approximately:
A. 2%
B. 5%
C. 10%
D. 25% Right Ans - Answer:
C. 10%
Patient with acute hepatitis should have elective surgery postponed until the
acute hepatitis has resolved. Studies indicate increased perioperative
morbidity (12%) and mortality (10% with laparotomy) during acute hepatitis.
Pp. 1315-1316 Barash, Clinical Anesthesia.
, An increase in intraocular pressure has been associated with: (select 3)
A. Nitrous oxide administration
B. Succinylcholine administration
C. Opioid administration
D. Hyperventilation
E. Laryngoscopy
F. Hypoxemia
G. Sevoflurane administration Right Ans - Answer:
B. Succinylcholine administration
E. Laryngoscopy
F. Hypoxemia
An increase in IOP (intraocular pressure) has been associated with:
succinylcholine administration, hypoxemia, and laryngoscopy
Succinylcholine increased intraocular pressure by 5-10 mmHg for 5 to 5
minutes after administration. This increase is primarily the result of
prolonged contracture of the extrocular muscles from the depolarizing effects
of succinylcholine. Nitrous oxide, volatile anesthetics agents and opioids have
been associated with a reduction in intraocular pressure. Hypoxemia,
Hypercarbia, hypertension, hypervolemia, laryngoscopy and intubation have
all been shown to increase IOP.
Pp 760-761 Morgan $ Mikhail's Clinical Anesthesiology
In the pressure-volume loop below, cardiac work is best represented by:
A. The area of the curve
B. The slope of the line from points C to D
C. The distance of the line form points C to D
D. The slope of a line from points A to D Right Ans - A. The area of the curve
Cardiac work is the product of pressure and volume and is linearly related to
myocardial oxygen consumption. Cardiac work is best represented by the area
of the curve of a pressure-volume loop.
Pg. 250 Barash, PG, Cullen, Clinical Anesthesia
Dextran 40 has been shown to improve microcirculation by:
A- Reducing blood density
B- Increasing blood density
C- Decreasing blood viscosity
