APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
Permissive hypercapnia is BEST suited for the patient with? - ANSWER ARDS - also benefits from low
tidal volume, minimizing plateau pressure (<30), PEEP
Choose the BEST oxygen source for transtracheal jet ventilation through a large bore IV catheter placed
through the cricothyroid membrane? - ANSWER Oxygen tank with pressure regulator
oxygen flush valve on the anesthesia workstation
*technique requires high oxygen source (50 psi) - attached to ventilator, o2 tank with regulator, o2 flush
valve on anesthesia machine
Which drug classes are indicated for acid aspiration prophylaxis - ANSWER Gastrointestinal stimulants
(metoclopramide)
Proton pump inhibitors (omeprazole)
H2 antagonist (famotidine)
antacids (sodium citrate)
Antiemetics (ondansetron)
During a Nissen fundoplication, crepitus is observed around the patient's neck and face. Identify the
MOST important anesthetic considerations for this complication? - ANSWER Consider post-op
mechanical ventilation
Auscultate the chest
*CO2 accumulation - reduce abdominal pressure or stop pneumoperitoneum if possible
100% oxygen, discontinue N20
Assess for pneumo by auscultation
,APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
increase Mv to blow of CO2
Consider post op ventilation if necessary
Postop pulmonary complications are BEST prevented by the maintenance of: - ANSWER FRC
*sum of expiratory reserve volume and RV
a reduction in FRC = closing volume that can enter tidal breathing which promotes atelectasis
*upper abdominal surgery carries the highest risk of post op complications (pulmonary) - 45-50%
reduction in FRC
Compared to the healthy lung, which volume undergoes the greatest increase in the patient with
emphysema? - ANSWER Residual volume
*In the patient with emphysema, gas trapping d/t premature airway closure increases residual volume.
This also explains why the FRC is increased in this patient population
What is the maximum volume of air that can be injected into an LMA that is appropriate for 15kg? -
ANSWER Size 2 LMA - 10ml
Match each postop hypoxemia with it's BEST example - ANSWER Hypoventilation - excessive opioid
administration - r/t respiratory depression
Diffusion limitation - excessive fluid admin - pulmonary edema
Shunt - excessive oxygen administration - (typically 100%) can cause shunt as a function of absorption
atelectasis
, APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
For the patient on ACE inhibitor therapy, which drugs are indicated in the setting of vasoplegic
syndrome unresponsive to first-line interventions? - ANSWER Vasopressin
Methylene blue
*When first line treatments fail (reducing anesthetic depth, a fluid challenge, phenylephrine, ephedrine,
epi), second line-therpay, such as vasopressin, terlipressin, or methylene blue should be considered
Which compartment of the sympathetic nervous system forms the white rami? - ANSWER Preganglionic
neuron
*preganglionic fibers exit the spinal cord via the ventral nerve roots. These fibers enter the sympathetic
chain (T1-L2) by way of the white rami. They are called white rami, because they are myelinated
Place the precursor of epinephrine synthesis in the correct order - ANSWER Tyrosine
DOPA
Dopamine
Norepinephrine
Expected consequences of an interscalene block include all of the following EXCEPT: - ANSWER pupilary
dilation
*Stellate ganglion block is often an unintended consequence of brachial plexus block which manifests as
HORNER's syndrome on the ipsilateral side
Miosis (pupil constriction)
Ptosis (upper eyelid drooping)
Anhydrosis (inability to sweat)
Enophthalmos (eyeball appears sunken into orbit)
solutions Graded A+
APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
Permissive hypercapnia is BEST suited for the patient with? - ANSWER ARDS - also benefits from low
tidal volume, minimizing plateau pressure (<30), PEEP
Choose the BEST oxygen source for transtracheal jet ventilation through a large bore IV catheter placed
through the cricothyroid membrane? - ANSWER Oxygen tank with pressure regulator
oxygen flush valve on the anesthesia workstation
*technique requires high oxygen source (50 psi) - attached to ventilator, o2 tank with regulator, o2 flush
valve on anesthesia machine
Which drug classes are indicated for acid aspiration prophylaxis - ANSWER Gastrointestinal stimulants
(metoclopramide)
Proton pump inhibitors (omeprazole)
H2 antagonist (famotidine)
antacids (sodium citrate)
Antiemetics (ondansetron)
During a Nissen fundoplication, crepitus is observed around the patient's neck and face. Identify the
MOST important anesthetic considerations for this complication? - ANSWER Consider post-op
mechanical ventilation
Auscultate the chest
*CO2 accumulation - reduce abdominal pressure or stop pneumoperitoneum if possible
100% oxygen, discontinue N20
Assess for pneumo by auscultation
,APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
increase Mv to blow of CO2
Consider post op ventilation if necessary
Postop pulmonary complications are BEST prevented by the maintenance of: - ANSWER FRC
*sum of expiratory reserve volume and RV
a reduction in FRC = closing volume that can enter tidal breathing which promotes atelectasis
*upper abdominal surgery carries the highest risk of post op complications (pulmonary) - 45-50%
reduction in FRC
Compared to the healthy lung, which volume undergoes the greatest increase in the patient with
emphysema? - ANSWER Residual volume
*In the patient with emphysema, gas trapping d/t premature airway closure increases residual volume.
This also explains why the FRC is increased in this patient population
What is the maximum volume of air that can be injected into an LMA that is appropriate for 15kg? -
ANSWER Size 2 LMA - 10ml
Match each postop hypoxemia with it's BEST example - ANSWER Hypoventilation - excessive opioid
administration - r/t respiratory depression
Diffusion limitation - excessive fluid admin - pulmonary edema
Shunt - excessive oxygen administration - (typically 100%) can cause shunt as a function of absorption
atelectasis
, APEX - MOCK Exam 6 Review 73 complete
solutions Graded A+
For the patient on ACE inhibitor therapy, which drugs are indicated in the setting of vasoplegic
syndrome unresponsive to first-line interventions? - ANSWER Vasopressin
Methylene blue
*When first line treatments fail (reducing anesthetic depth, a fluid challenge, phenylephrine, ephedrine,
epi), second line-therpay, such as vasopressin, terlipressin, or methylene blue should be considered
Which compartment of the sympathetic nervous system forms the white rami? - ANSWER Preganglionic
neuron
*preganglionic fibers exit the spinal cord via the ventral nerve roots. These fibers enter the sympathetic
chain (T1-L2) by way of the white rami. They are called white rami, because they are myelinated
Place the precursor of epinephrine synthesis in the correct order - ANSWER Tyrosine
DOPA
Dopamine
Norepinephrine
Expected consequences of an interscalene block include all of the following EXCEPT: - ANSWER pupilary
dilation
*Stellate ganglion block is often an unintended consequence of brachial plexus block which manifests as
HORNER's syndrome on the ipsilateral side
Miosis (pupil constriction)
Ptosis (upper eyelid drooping)
Anhydrosis (inability to sweat)
Enophthalmos (eyeball appears sunken into orbit)
