Core Concepts Anesthesia Review: Questions & A+
Solutions
Factors decreasing physiologic dead space include:
1. the supine position
2. anticholinergic agents
3. increasing age
4. emphysema Right Ans - 1. the supine position
Dead space is comprised of gases in non-respiratory airways (anatomic dead
space) as well as in alveoli that are not perfused (alveolar dead space). The
sum of the two is known as physiologic dead space. Certain factors affect dead
space. The supine position is known to decrease dead space, whereas
anticholinergics, β2-sympathomimetics, advancing age and COPD all increase
dead space.
pg. 599
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
pg. 363
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New
York: McGraw Hill, 2012.
As compared with plasma osmolality, hypertonic crystalloid solutions include:
1. D5W
2. LR
3. D5 0.25NS
4. D5 0.45NS Right Ans - 4. D5 0.45NS
Normal plasma osmolality ranges between 280 - 290 mOsm/L. D5W is
hypotonic in relation to plasma, with a tonicity of 253 mOsm/L. Both Ringer's
lactate and D5 0.25NS are isotonic solutions, with tonicities of 273 and 355
mOSm /L respectively. D5 0.45NS is hypertonic with a tonicity of 406 - 432
mOsm/L.
pg. 392
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
,Pancreatic somatostatin producing cells in the islets of langerhans are:
A. Alpha cells
B. Beta cells
C. Gamma cells
D. Delta cells Right Ans - D. Delta cells
Islets of langerhans are comprised of 4 cells types: alpha cells producing
glucagon, beta cells producing insulin, delta cells producing somatostatin and
PP cells producing pancreatic polypeptide
Pg. 789 Nagelhout
Congenital heart diseases a/w right-to-left shunt include: (select 3)
a. tricuspid atresia
b. hypoplastic left heart syndrome
c. aortopulonary window
d. patent ductus arteriosus
e. tetralogy of Fallot
f. subvalvular aortic stenosis
g. ventricular septal defects
i. atrial septal defects Right Ans - a. tricuspid atresia
b. hypoplastic left heart syndrome
e. tetralogy of Fallot
Right-to-left shunting (cyanotic) heart disease is a/w : TOF, pulmonary
atresia, tricuspid atresia, transposition of the great vessels, trunks arterioles,
single ventricle, double-oulte ventricle, total anomalous pulmonary venous
return and hypoplastic left heart.
With tricuspid atresia, blood can flow out of the right atrium only via patent
foramen ovale (PFO). A PDA or VSD is necessary for the blood to flow from the
LV to the pulmonary circulation
Nagelhout pg. 1181
Carbonic anhydrase inhibitors are used in the treatment of:
,a. acute glaucoma
b. rental tubular acidosis
c. diarrhea induced acidosis
d. acidosis resulting from hypoventilation Right Ans - a. acute glaucoma
Carbonic anhydrase inhibitors decrease the ability of the kidneys to reabsorb
bicarbonate, resulting a hyperchloremic acidosis. As a result, carbonic
anhydrase inhibitors would be avoided in patients with acidosis, especially a
normal-anionic-gap acidosis. Because bicarbonate is filtered by the ciliary
process in the formation of aqueous humor, carbonic anhydrase inhibitors
reduce the formation of aqueous humor and can be used to decrease
intraocular pressure.
pg. 1211
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New
York: McGraw Hill, 2012.
Prior to pneumonectomy, split lung function testing is indicated in the patient
with:
a. an FEV1 of 2.2 L
b. a PaCO2 of 49 mm Hg on room air
c. a PaO2 of 54 mm Hg on room air
d. a maximum VO2 of 21 mL/kg/min Right Ans - b. a PaCO2 of 49 mm Hg
on room air
Split lung function testing is indicated in patients requiring pneumonectomy,
but not meeting the recommended laboratory criteria. Current
recommendations for patients requiring pneumonectomy are:
PaCO2 < 45 mm Hg
FEV1 > 2 L
Predicted postop FEV1 > 800 mL
Maximum VO2 > 15 mL/kg/min
FEV1/FVC > 50% of predicted
pp. 663-665
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
, Renal blood flow: (select 2)
a. is largely determined by renal oxygen consumption
b. accounts for 20 - 25% of the cardiac output
c. is distributed mostly to juxtamedullary nephrons
d. can be directed away from cortical nephrons by sympathetic stimulation
e. is not autoregulated Right Ans - b. accounts for 20 - 25% of the cardiac
output
d. can be directed away from cortical nephrons by sympathetic stimulation
The kidneys are the only organ for which oxygen consumption is determined
by blood flow; the reverse is true in other organs. The kidneys receive 20 -
25% of the cardiac output with only 10 - 15% going to the juxtamedullary
nephrons and 80% going to cortical nephrons. However, blood flow can be
redirected to juxtamedullary nephrons by increased levels of catecholamines
and angiotensin II. Autoregulation of RBF occurs between mean arterial
pressures of 80 - 180 mm Hg.
pp. 639-641
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's Clinical
Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical
Publishing Division, 2013.
The perception of an ordinarily non-noxious stimulus as pain is referred to as:
a. allodynia
b. anesthesia dolorosa
c. dysesthesia
d. hyperalgesia Right Ans - a. allodynia
Allodynia is the perception of non-noxious stimuli as pain. Dysesthesia is an
unpleasant sensation without a stimulus. Hyperesthesia is an increased
response to a mild stimulus. Anesthesia dolorosa is pain in an area that lacks
sensation.
pp. 1649-1650
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R.
Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.
Solutions
Factors decreasing physiologic dead space include:
1. the supine position
2. anticholinergic agents
3. increasing age
4. emphysema Right Ans - 1. the supine position
Dead space is comprised of gases in non-respiratory airways (anatomic dead
space) as well as in alveoli that are not perfused (alveolar dead space). The
sum of the two is known as physiologic dead space. Certain factors affect dead
space. The supine position is known to decrease dead space, whereas
anticholinergics, β2-sympathomimetics, advancing age and COPD all increase
dead space.
pg. 599
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
pg. 363
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New
York: McGraw Hill, 2012.
As compared with plasma osmolality, hypertonic crystalloid solutions include:
1. D5W
2. LR
3. D5 0.25NS
4. D5 0.45NS Right Ans - 4. D5 0.45NS
Normal plasma osmolality ranges between 280 - 290 mOsm/L. D5W is
hypotonic in relation to plasma, with a tonicity of 253 mOsm/L. Both Ringer's
lactate and D5 0.25NS are isotonic solutions, with tonicities of 273 and 355
mOSm /L respectively. D5 0.45NS is hypertonic with a tonicity of 406 - 432
mOsm/L.
pg. 392
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
,Pancreatic somatostatin producing cells in the islets of langerhans are:
A. Alpha cells
B. Beta cells
C. Gamma cells
D. Delta cells Right Ans - D. Delta cells
Islets of langerhans are comprised of 4 cells types: alpha cells producing
glucagon, beta cells producing insulin, delta cells producing somatostatin and
PP cells producing pancreatic polypeptide
Pg. 789 Nagelhout
Congenital heart diseases a/w right-to-left shunt include: (select 3)
a. tricuspid atresia
b. hypoplastic left heart syndrome
c. aortopulonary window
d. patent ductus arteriosus
e. tetralogy of Fallot
f. subvalvular aortic stenosis
g. ventricular septal defects
i. atrial septal defects Right Ans - a. tricuspid atresia
b. hypoplastic left heart syndrome
e. tetralogy of Fallot
Right-to-left shunting (cyanotic) heart disease is a/w : TOF, pulmonary
atresia, tricuspid atresia, transposition of the great vessels, trunks arterioles,
single ventricle, double-oulte ventricle, total anomalous pulmonary venous
return and hypoplastic left heart.
With tricuspid atresia, blood can flow out of the right atrium only via patent
foramen ovale (PFO). A PDA or VSD is necessary for the blood to flow from the
LV to the pulmonary circulation
Nagelhout pg. 1181
Carbonic anhydrase inhibitors are used in the treatment of:
,a. acute glaucoma
b. rental tubular acidosis
c. diarrhea induced acidosis
d. acidosis resulting from hypoventilation Right Ans - a. acute glaucoma
Carbonic anhydrase inhibitors decrease the ability of the kidneys to reabsorb
bicarbonate, resulting a hyperchloremic acidosis. As a result, carbonic
anhydrase inhibitors would be avoided in patients with acidosis, especially a
normal-anionic-gap acidosis. Because bicarbonate is filtered by the ciliary
process in the formation of aqueous humor, carbonic anhydrase inhibitors
reduce the formation of aqueous humor and can be used to decrease
intraocular pressure.
pg. 1211
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New
York: McGraw Hill, 2012.
Prior to pneumonectomy, split lung function testing is indicated in the patient
with:
a. an FEV1 of 2.2 L
b. a PaCO2 of 49 mm Hg on room air
c. a PaO2 of 54 mm Hg on room air
d. a maximum VO2 of 21 mL/kg/min Right Ans - b. a PaCO2 of 49 mm Hg
on room air
Split lung function testing is indicated in patients requiring pneumonectomy,
but not meeting the recommended laboratory criteria. Current
recommendations for patients requiring pneumonectomy are:
PaCO2 < 45 mm Hg
FEV1 > 2 L
Predicted postop FEV1 > 800 mL
Maximum VO2 > 15 mL/kg/min
FEV1/FVC > 50% of predicted
pp. 663-665
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
, Renal blood flow: (select 2)
a. is largely determined by renal oxygen consumption
b. accounts for 20 - 25% of the cardiac output
c. is distributed mostly to juxtamedullary nephrons
d. can be directed away from cortical nephrons by sympathetic stimulation
e. is not autoregulated Right Ans - b. accounts for 20 - 25% of the cardiac
output
d. can be directed away from cortical nephrons by sympathetic stimulation
The kidneys are the only organ for which oxygen consumption is determined
by blood flow; the reverse is true in other organs. The kidneys receive 20 -
25% of the cardiac output with only 10 - 15% going to the juxtamedullary
nephrons and 80% going to cortical nephrons. However, blood flow can be
redirected to juxtamedullary nephrons by increased levels of catecholamines
and angiotensin II. Autoregulation of RBF occurs between mean arterial
pressures of 80 - 180 mm Hg.
pp. 639-641
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's Clinical
Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical
Publishing Division, 2013.
The perception of an ordinarily non-noxious stimulus as pain is referred to as:
a. allodynia
b. anesthesia dolorosa
c. dysesthesia
d. hyperalgesia Right Ans - a. allodynia
Allodynia is the perception of non-noxious stimuli as pain. Dysesthesia is an
unpleasant sensation without a stimulus. Hyperesthesia is an increased
response to a mild stimulus. Anesthesia dolorosa is pain in an area that lacks
sensation.
pp. 1649-1650
Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, and Ortega, R.
Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2013.
