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  • What is the primary definition of the AANA Code of Ethics?

    It outlines expected behaviors for individuals who are part of the CRNA profession.

    ethics aana professionalism

  • In the context of clinical practice, what are Standards of Care?

    A set of rules or minimum requirements for clinical practice that ensures high quality patient care.

    standards clinical nursing

  • How are Standards of Care determined?

    By individual hospital policies

    By patient preference

    By government decree only

    By consensus and approval of recognized authoritative body

    standards clinical

  • When can Standards of Care be modified?

    Only under unusual circumstances, such as extreme emergencies or unavailability of equipment.

    standards practice legal

  • What is the fundamental difference between Standards of Care and Practice Guidelines?

    Comparison of Standards vs Guidelines

    • Standards of Care: Must be adhered to, set of rules/requirements.
    • Practice Guidelines: Should be adhered to, represent recommendations and evidence-based practice.
    practice guidelines standards

  • AANA Standard 1 focuses on Patient Rights, emphasizing the respect for the patient's autonomy, dignity, and privacy.

    aana standards nursing

  • AANA Standard 2 pertains to Pre-anesthesia Patient Assessment and Evaluation, which involves documenting the patient's general health, allergies, medication history, pre existing conditions, anesthesia history, and relevant diagnostic tests.

    aana standards anesthesia

  • What documentation is required under Standard 4 regarding informed consent?

    Obtain and document or verify that the patient or legal representative has given informed consent for planned anesthesia care or related services.

    standards consent

  • What is the frequency for documenting blood pressure, heart rate, and respiration during all anesthetics?

    At least every five minutes.

    monitoring standards

  • According to Standard 6, how should anesthesia equipment be managed prior to each use?

    Verify the function of anesthesia equipment prior to each anesthetic.

    equipment standards

  • For patient ventilation, confirm intubation of the trachea or placement of airway devices by auscultation, chest excursion, and confirmation of expired carbon dioxide.

    ventilation monitoring

  • What safety measures should be taken regarding physiological monitoring device alarms?

    Ensure variable pitch and threshold alarms are turned on and audible.

    monitoring safety

  • What is the primary responsibility of a CRNA when transitioning patient care to another professional?

    Evaluate the patient's status and determine when it is appropriate to transfer responsibility, while communicating essential information for continuity of care.

    transfer standards

  • What is the main goal of operating anesthesia equipment as described in Standard 6?

    To maximize anesthesia output

    To minimize the risk of fire, explosion, electrical shock, and equipment malfunction

    To expedite patient recovery time

    To reduce equipment maintenance costs

    equipment safety

  • What is the ethical principle of Beneficence?

    The obligation to do good.

    ethics

  • Define negligence in the context of professional practice.

    Medical malpractice is a form of professional negligence. Negligence note

    law negligence

  • What are the four required elements of proof for a plaintiff in a negligence case?

    • Duty
    • Breach of Duty
    • Causation
    • Damages
    law negligence

  • The Res ipsa loquitur doctrine translates to the thing speaks for itself, where the burden of proof of causation shifts from the plaintiff to the defendant.

    law

  • When should a patient be informed of a medical risk?

    Only when the risk is low and severity is great

    Only when the severity is minor

    Only when the patient specifically asks for details

    When the risk is statistically high

    consent ethics

  • What are the two types of Advanced Directives?

    • Living Will
    • Medical Durable Power of Attorney
    medical directives

  • What is the function of a Medical Durable Power of Attorney?

    It designates another person to make health care decisions for a patient if they become incompetent or unable to make such decisions themselves.

    medical directives
  • Occlusion Question Image

  • What is the classification for a Level 5 surgical urgency?

    Within 24 hours.

    anesthesia surgery

  • What is an elective surgical procedure?

    A procedure planned and scheduled in advance with no urgency.

    anesthesia surgery

  • What does a patient's physical and history assessment allow for during anesthesia planning?

    • Assignment of ASA status
    • Formulation of patient-related and procedure-related problem list
    • Assessment of risk
    • Choosing patient-specific anesthetic agents and techniques
    anesthesia assessment

  • Which herbal supplement use is noted as often overlooked?

    Herbal supplements, which are used by up to 30% of the US population.

    anesthesia history

  • What are three examples of patient-related anesthetic history complications?

    • Difficult intubation
    • Prolonged emergence
    • Unplanned admission
    anesthesia history

  • What condition might explain a prolonged duration of muscle relaxant effect in a patient?

    Pseudocholinesterase deficiency.

    anesthesia complications

  • For NPO status, it is important to document the last solid food, content and time and the last liquid intake.

    anesthesia npo

  • When assessing airway requirements, what does the airway assessment allow for?

    Planning for masking, intubation, or alternate airway modalities

    Determining the patient's ASA physical status

    Calculating the required dosage of muscle relaxants

    Scheduling the procedure urgency level

    anesthesia airway

  • What is the minimum fasting period required before surgery for clear liquids, such as water, black coffee, or pulp-free fruit juice?

    2 hours

    preoperative fasting

  • How long should a patient fast before surgery after consuming breast milk?

    4 hours

    preoperative fasting

  • What is the required minimum fasting period for nonhuman milk, such as infant formula?

    6 hours

    preoperative fasting

  • What is the required minimum fasting period for a light meal containing toast and clear liquids?

    6 hours

    preoperative fasting

  • What is the minimum fasting period for a regular or heavy meal, including fried or fatty food?

    8 hours

    preoperative fasting

  • In the ASA Physical Status Classification system, what does the addition of an 'E' denote?

    Emergency surgery

    asa surgery

  • According to the ASA Physical Status Classification, how is an 'ASA 1' patient described?

    Healthy patients

    Declared brain-dead patient

    Severe disease process

    Moribund patient

    asa classification

  • Which ASA classification level describes a patient who is moribund and not expected to survive 24 hours with or without an operation?

    ASA 6

    ASA 5

    ASA 3

    ASA 4

    asa classification

  • An emergency surgery is defined as existing when delay in treatment would lead to a significant increase in the threat to life or body part.

    surgery definitions

  • What is the clinical significance of an inability to achieve 4 METs?

    It is associated with increased perioperative risk.

    cardiology surgery risk

  • What is the formal definition of 1 MET?

    It is defined as the energy used when resting or sitting still, equal to \(3.5 \text{ mL O}_2 / \text{kg} / \text{min}\).

    cardiology metabolism

  • Which six independent risk factors are included in the Revised Cardiac Risk Index (RCRI)?

    The RCRI uses the following six independent predictors: - Ischemic heart disease - Congestive heart failure - Cerebrovascular disease - Diabetes mellitus treated with insulin - Serum creatinine \(> 2 \text{ mg/dL}\) - High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular)

    cardiology risk surgery

  • What is the Revised Cardiac Risk Index (RCRI) primarily used for?

    To assess metabolic equivalents

    To measure long-term mortality

    To assign perioperative cardiac risk

    To diagnose coronary artery disease

    cardiology risk surgery

  • Chronic hypertension affects autoregulation curves by causing a shift to the right and a narrowing of the plateau.

    cardiology hypertension

  • What are the common symptoms of unstable cardiac disease that require further evaluation?

    • Dyspnea
    • Chest pain
    • Syncope
    • CHF
    • Decreased or poor exercise tolerance
    cardiology symptoms

  • What activities require an energy expenditure of 4 METs according to the estimation table?

    Table 23-8 showing estimated energy requirements

    • Climbing a flight of stairs or walking up a hill
    • Walking on level ground at 4 mph or 6.4 km/h
    • Running a short distance
    • Performing heavy work around the house (e.g., scrubbing floors or lifting heavy furniture)
    • Participating in moderate recreational activities (e.g., golf, bowling, dancing, doubles tennis, throwing a baseball or football)
    cardiology exercise

  • What are the common symptoms of aortic stenosis (AS) or its disease progression?

    • Angina
    • Heart failure
    • Syncope
    cardiology aortic_stenosis

  • What is the recommended interval for interrogating a patient's pacemaker?

    Every 12 months

    cardiology pacemaker

  • What is the recommended interval for interrogating a patient's ICD?

    Every 6 months

    cardiology icd

  • For patients with coronary artery stents, the delay for elective surgery should be 30 days for bare metal stents (BMS) and 365 days for drug-eluting stents (DES).

    cardiology surgery

  • What happens when a magnet is placed over an implanted cardioverter-defibrillator (ICD)?

    It inhibits arrhythmia detection.

    cardiology icd

  • How many risk factors for CAD indicate an intermediate risk level for pre-operative testing?

    0-1

    2

    3

    4

    cardiology risk_stratification

  • What does a systolic murmur in the right second intercostal space indicate?

    Aortic stenosis

    cardiology aortic_stenosis

  • According to AHA/ACC guidelines, preoperative echocardiography is required for moderate to severe valvular stenosis or regurgitation if no studies have been performed within 1 year or if there is worsening clinical status.

    cardiology echocardiography

  • What are the components of the STOP-Bang screening tool for obstructive sleep apnea?

    • Snoring
    • Tiredness
    • Observed apnea
    • High blood pressure
    • Body mass index \(>35\) \(kg/m^2\)
    • Age \(>50\) years
    • Neck circumference \(>40\) cm
    • Male gender
    pulmonary apnea screening

  • What is considered a high-risk score on the STOP-Bang screening tool?

    4+

    2+

    0-3

    5+

    pulmonary apnea screening

  • What happens to the body 24-48 hours after smoking cessation?

    Short-term physiological effects of smoking cessation - Decrease in nicotine levels - Decrease in CV (cardiovascular) effects - Decrease in carbon monoxide levels

    smoking cessation pulmonary

  • What improvements occur 6-8 weeks after smoking cessation?

    Short-term physiological effects of smoking cessation - Improvement in ciliary function - Decrease in mucus production

    smoking cessation pulmonary

  • Long-term benefits of smoking cessation include an addition of 6 to 8 years life expectancy and a reduced risk of lung cancer and heart disease.

    smoking cessation health

  • What are three common GI and hepatic conditions assessed in a preoperative history?

    • GERD
    • Gastroparesis
    • Bowel obstruction
    gi hepatic assessment

  • What conditions are commonly noted in a renal assessment?

    • Renal insufficiency
    • Nephrotic syndrome
    • Congenital malformations or absence
    • Chronic renal disease
    • ESRD
    renal assessment

  • What are three blood-related conditions relevant to a hematologic assessment?

    • Anemia
    • Thrombocytopenia
    • Sickle Cell Disease
    hematology assessment

  • What is the normal measurement for the interincisor gap (IIG) during a preoperative airway exam?

    Normal = 3 finger breadths or 5 cm

    airway preoperative

  • What is the normal thyromental distance (TMD) measurement?

    Normal = 3 finger breadths or 6.5 cm

    airway preoperative

  • For the airway exam, c-spine extension is necessary to align the axes and visualize the vocal cords.

    airway preoperative

  • During an airway exam, the presence of ridges from the patient's teeth on the tongue is a sign that the tongue does not have much room.

    airway preoperative

  • What does the upper lip bite test signify during an airway exam?

    Difficult intubation

    Macroglossia

    Reduced neck extension

    Good mobility

    airway preoperative

  • Why is macroglossia problematic during intubation?

    The tongue has to be displaced, and the larger the tongue, the more difficult it is to gain control of it.

    airway preoperative

  • The preoperative physical exam includes assessing vital signs, height/weight/BMI, general appearance, and breath sounds.

    preoperative exam

  • What structures are visible in a Mallampati Class 1 airway? Mallampati scoring system

    Full view of the soft palate, uvula, and tonsillar pillars.

    airway mallampati

  • Which Mallampati class is characterized by the soft palate and upper portion of the uvula being visible?

    Class 2.

    airway mallampati

  • What is the visibility expectation for a Mallampati Class 3 airway?

    Just the soft palate is visible; the uvula is not.

    airway mallampati

  • What structure is visible in a Mallampati Class 4 airway?

    Only the hard palate.

    airway mallampati

  • Predictors of difficult intubation include an interincisor distance of less than 3 cm.

    intubation airway

  • A patient with a 'thick neck' is a predictor of difficult intubation if the circumference is greater than 17 in in males or 16 in in females.

    intubation airway

  • Which of the following is considered a predictor of difficult mask ventilation?

    Long neck

    Young age

    Obesity

    High range of motion of C-spine

    ventilation airway

  • Besides obesity and male gender, what is another anatomical predictor of difficult mask ventilation related to the face?

    Beard.

    ventilation airway

  • According to the 2012 ASA Practice Advisory, how should pre-op tests be ordered for asymptomatic patients?

    They should only be ordered after considering information obtained from the medical record, H&P, and the type or invasiveness of the planned procedure and anesthesia.

    preoperative guidelines

  • What are the clinical indications for ordering a preoperative CBC?

    • Extremes of age
    • Liver or kidney disease
    • Anticoagulant use
    • Bleeding/hematologic disorder
    • Malignancy
    • Type and invasiveness of procedure
    preoperative cbc

  • What factors should the decision to order T&S (Type and Screen) or T&C (Type and Crossmatch) be based on?

    • Patient condition
    • Baseline Hct
    • Expected blood loss
    blood surgery

  • For preoperative blood conservation, strategies should be considered to minimize the use of allogeneic blood.

    blood surgery

  • How long prior to the date of surgery (DOS) should NSAIDs be held?

    2-7 days prior to DOS.

    medications surgery

  • How long prior to the date of surgery (DOS) should Coumadin be held?

    5 days prior to DOS.

    medications surgery

  • Which of the following medications should be continued before surgery?

    GLP-1 Agonists

    Statins

    Diuretics

    NSAIDs

    medications surgery

  • What is the recommended pre-operative hold time for St. John's Wort?

    At least 5 days prior to the date of surgery.

    medications surgery

  • What is the recommended pre-operative hold time for Enbrel?

    2 weeks prior to surgery.

    medications surgery

  • How should high-risk antiplatelet therapy be managed before surgery?

    Hold clopidogrel and continue ASA.

    medications surgery

  • What is the upper limit for glucose control in Type 1 diabetic patients undergoing surgery?

    Less than 200 mg/dL

    diabetes surgery

  • When should antibiotics be administered in relation to the incision?

    Within 1 hour prior to incision

    antibiotics surgery

  • What is the recommended antibiotic strategy if a procedure is prolonged beyond two half-lives?

    Redose the antibiotic

    antibiotics surgery

  • What dosage adjustment is required for morbidly obese patients receiving antibiotic prophylaxis?

    Twice the dose of normal weight patients

    antibiotics obesity

  • Which antibiotics should be used for surgical prophylaxis in patients with a penicillin allergy?

    Vancomycin or clindamycin

    antibiotics allergy

  • What criteria define Mendelson's syndrome?

    Volume > 25 mL and pH < 2.5

    aspiration pulmonary

  • What is the most significant ranked risk factor for pulmonary aspiration?

    Obesity

    Emergency surgery

    GERD

    Opioid use

    aspiration risk

  • Routine pharmacologic prophylaxis for aspiration is not recommended in otherwise healthy patients with no risk factors undergoing elective procedures.

    aspiration prevention

  • What is the primary clinical benefit of administering Sodium Citrate prior to anesthesia?

    It minimizes the risk of lung injury by increasing the pH of gastric fluid.

    pharmacology anesthesia

  • Why should Metoclopramide be avoided in patients with a suspected bowel obstruction?

    Because it increases gastric motility, which could precipitate complications like bowel perforation.

    pharmacology metoclopramide

  • Which type of antacid is contraindicated for use due to the risk of serious pulmonary sequelae if aspirated?

    Nonparticulate antacids (e.g., Sodium Citrate)

    Histamine-2 receptor antagonists

    Proton pump inhibitors

    Particulate antacids (e.g., Tums, Rolaids)

    pharmacology anesthesia

  • How do Histamine-2 receptor antagonists affect gastric secretions?

    They decrease gastric volume and acidity by blocking the ability of histamine to induce secretion of gastric fluid with a high \(H^+\) concentration.

    pharmacology gastroenterology

  • Among H2 receptor antagonists, Famotidine has the longest duration of action, typically lasting 10-12 hours.

    pharmacology medication

  • What is the primary mechanism of action for Proton Pump Inhibitors (PPIs)?

    They suppress gastric acid secretion by binding to the proton pump of the parietal cells.

    pharmacology medication

  • List three primary goals of administering pre-operative medication.

    • Decrease risk of aspiration
    • Relief of anxiety
    • Sedation
    anesthesia pre-op

  • Cautionary notice regarding pre-op sedation risks for specific patient populations.

    Extreme caution should be used with pre-op sedation in patients with intracranial pathology, severe pulmonary disease, or hypovolemia.

    safety anesthesia

  • What is the primary action of Dexmedetomidine as an alpha-2 agonist?

    It produces sedation and attenuates the sympathetic nervous system response to stimulation.

    pharmacology anesthesia

  • What is a characteristic side effect of opioid administration regarding gastrointestinal function?

    Delayed gastric emptying.

    pharmacology analgesics

  • Which anticholinergic medication listed is known to be more potent than Atropine for antisialagogue effects?

    Glycopyrrolate.

    pharmacology anticholinergics

  • Which drug is categorized as a Quaternary Amine anticholinergic that does not easily cross the blood-brain barrier?

    Glycopyrrolate

    Atropine

    Midazolam

    Scopolamine

    pharmacology anticholinergics

  • According to the table comparing anticholinergics, which agent has the strongest sedative and amnesic effects?

    Scopolamine

    pharmacology anticholinergics

  • The most common benzodiazepine used in anesthetic practice is Midazolam, which is valued for its rapid onset and recovery.

    pharmacology benzodiazepines

  • Why is the routine use of anticholinergics considered uncommon?

    Due to side effects such as CNS toxicity, tachycardia, pupil dilation, relaxation of the lower esophageal sphincter, inhibition of sweating, and thickened secretions.

    pharmacology anticholinergics

  • What are the five main risk factors for PONV in adults? Radial chart of PONV risk factors

    • Female sex
    • Risk surgery
    • Volatile anesthesia
    • History of PONV or Motion Sickness
    • Non-smoking
    ponv anesthesia

  • Which of the following is a recommended strategy to mitigate PONV?

    Routine use of nitrous oxide

    Avoidance of hydration

    Increased use of volatile anesthetics

    Use of regional anesthesia

    ponv anesthesia

  • For patients with 1-2 risk factors for PONV, give 2 agents; for patients with > 2 risk factors, give 3-4 agents.

    ponv stratification

  • What is the recommended newer stress-dose steroid treatment for the first day of surgery?

    100 mg hydrocortisone IV followed by 50 mg IV q8 hours.

    steroids surgery

  • Potential adverse effects of stress-dose steroid treatment include: - Hypertension - Hyperglycemia - Increased risk of infection - Delayed wound healing - Electrolyte disturbance/Fluid retention

    steroids side-effects

  • What is the typical prophylactic combination used against allergic reactions?

    H1 (Benadryl) + H2 (Zantac/Pepcid) + Steroid (hydrocortisone)

    allergies prophylaxis

  • Pretreatment with a combination of H1 and H2 antagonists is more effective than H1 antagonists alone.

    allergies prophylaxis

  • What are the five major goals of general anesthesia?

    • Amnesia
    • Analgesia
    • Loss of consciousness
    • Muscle relaxation/immobility
    • Suppression of the ANS
    anesthesia goals

  • During which stage of Guedel's anesthesia is 'Excitement' observed?

    Stage 3

    Stage 2

    Stage 4

    Stage 1

    anesthesia stages

  • What are the pupil characteristics in Guedel's Stage 4 anesthesia?

    Dilated and unreactive

    anesthesia stages

  • In Guedel's classification, Stage 1 is also known as the Induction Period or Analgesia.

    anesthesia stages

  • What is the primary characteristic of Guedel's Stage 4 anesthesia?

    Anesthetic Crisis (breathing stops to death)

    anesthesia stages

  • What occurs during Plane 4 of Guedel's Stage 3 (Surgical Anesthesia)?

    Complete intercostal paralysis to diaphragmatic paralysis, apnea, and loss of respiratory effort.

    anesthesia stages

  • In Guedel's Stage 3, Plane 3, what happens to the light reflex?

    It is abolished.

    anesthesia stages

  • What are the physiological signs associated with Guedel's Stage 2 (Excitement)?

    Table of Guedel's stages - Irregular respiration - Breath holding - Pupillary dilation

    anesthesia stages

  • What mnemonic is used for pre-induction anesthesia tasks?

    MS. MAIDS

    anesthesia mnemonic

  • What does each letter in the 'MS. MAIDS' mnemonic stand for in the context of pre-induction anesthesia tasks?

    • M: Machine
    • S: Suction
    • M: Monitors
    • A: Airway
    • I: IV access
    • D: Drugs
    • S: Special
    anesthesia mnemonic

  • The components of the MS. MAIDS mnemonic are: - Machine - Suction - Monitors - Airway - IV access - Drugs - Special

    anesthesia mnemonic

  • What is the primary goal of administering pre-induction medications?

    Blunt hemodynamic (HD) response to direct laryngoscopy (DL).

    anesthesia medication

  • What are two ways to achieve preoxygenation for anesthesia induction?

    • Tidal breathing for 3 minutes via oxygen facemask
    • 4 vital capacity (VC) breaths over 30 seconds
    • 8 vital capacity (VC) breaths over 60 seconds
    anesthesia preoxygenation

  • How is loss of consciousness (LOC) assessed during pre-induction?

    By checking the lash reflex, then taping the eyes.

    anesthesia assessment

  • List four methods to verify endotracheal tube (ETT) placement.

    • Visualization of ETT through vocal cords (VC)
    • Fogging
    • Equal bilateral (BL) chest rise
    • Bilateral breath sounds (BBS)
    • Positive end-tidal CO2 ((+) ETCO2)
    • No breath sounds over the stomach
    anesthesia intubation

  • What is a standard component of pre-induction documentation?

    Discharge summary

    Informed consent obtained

    Post-operative pain scale

    Patient insurance verification

    anesthesia documentation

  • What is the primary goal of Rapid Sequence Induction (RSI)?

    To minimize aspiration risk.

    rsi anesthesia

  • What is the clinical endpoint for preoxygenation in RSI?

    \(ETO_2 > 90\%\)

    rsi preoxygenation

  • When should cricoid pressure be applied and released during RSI?

    • Applied: Just prior to induction
    • Released: After placement of the endotracheal tube (ETT) is confirmed
    rsi airway

  • The Cormack-Lehane Grade 1 view indicates a complete or nearly complete view of the glottic opening.

    laryngoscopy cormack-lehane

  • Which of the following is a contraindication to the use of succinylcholine (SCh) for RSI?

    Full stomach

    Pregnancy

    Malignant hyperthermia (MH) susceptibility

    GERD

    rsi contraindications

  • Based on the Cormack-Lehane scale, what is visible in a Grade 3 view?

    Epiglottis only.

    laryngoscopy cormack-lehane

  • What is the definition of fasciculations seen with succinylcholine induction?

    SCh-induced involuntary muscle contractions.

    rsi pharmacology

  • Using the provided Cormack-Lehane grading scale illustration, which grade displays only the soft palate?

    Cormack-Lehane Grading Scale Grade 4

    laryngoscopy cormack-lehane

  • What are some clinical indications for using Total Intravenous Anesthesia (TIVA)?

    • Procedures requiring neuro monitoring
    • Severe Postoperative Nausea and Vomiting (PONV)
    • Airway procedures where agents cannot be reliably delivered
    • Malignant Hyperthermia (MH) susceptible patients
    anesthesia tiva

  • What categories of drugs are commonly used in Balanced Anesthesia?

    • INH agents
    • IV anesthetics (propofol, ketamine, precedex)
    • Narcotics (short-acting and long-acting)
    • Benzodiazepines
    • NMBDs
    • Vasoactives (beta blockers, pressors)
    anesthesia pharmacology

  • What are the minimum recording intervals for vital signs (BP, HR, RR) during maintenance of anesthesia?

    Every 5 minutes

    monitoring anesthesia

  • What specific patient safety documentation must occur every 30 minutes regarding body position?

    Documentation of the assessment of position changes.

    monitoring safety

  • Intraoperative documentation of critical events (such as cardiac arrest, anaphylactic reaction, difficult airway, or EKG changes) usually requires a separate note in the patient's chart.

    documentation anesthesia

  • Which of the following monitoring parameters is required to be documented at a minimum interval of every 15 minutes?

    BP, HR, RR

    Rate, Vt, PIP, PEEP

    O2, N2O, or air

    SaO2, FiO2, ETCO2

    monitoring anesthesia

  • Regarding the surgical time-out, what items are included in the verification checklist?

    Surgical time-out checklist - Patient identified - Procedure confirmed - Consent / H&P - Site marking visible - Diagnostics / images available - Allergies verified - Antibiotics verified - Beta blocker verified - Implants verified - Blood verified - DVT prophylaxis verified

    safety surgery

  • What clinical signs are associated with 'Light Anesthesia' when Neuromuscular Blocking Drugs (NMBD) are present?

    • Tachycardia
    • Hypertension
    • Sweating
    • \(BIS > 60\)
    anesthesia depth

  • What are the cardiovascular effects of excessive 'deep anesthesia'?

    • Bradycardia
    • Hypotension
    anesthesia depth

  • Which of the following is considered a patient group less suited for deep extubation?

    Obese patients

    Patients with no history of aspiration

    Patients with low BMI

    Patients with high tidal volume

    anesthesia extubation

  • The requirements for awake extubation include: - Breathing frequency < 30 breaths/min - Maximum inspiratory pressure < -20 cm \(H_2O\) - Vital capacity > 15 mL/kg - Tidal volume > 6 mL/kg

    anesthesia extubation

  • According to the comparative table, what is a primary 'Con' of awake extubation?

    Increased coughing risk. Awake vs Deep Extubation

    anesthesia extubation

  • What does a deep extubation attempt to avoid?

    Coughing and bucking.

    anesthesia extubation

  • For deep extubation, the ETT is removed prior to wake up and prior to return of upper airway reflexes.

    anesthesia extubation

  • List the three items that must be verbally confirmed by the surgeon, anesthesia professional, and nurse before skin incision.

    • Patient
    • Site
    • Procedure
    safety surgery

  • What is the Aldrete score required to meet discharge criteria?

    9-10

    anesthesia post-op

  • According to the Aldrete Scoring system, what oxygen saturation value indicates a score of 2?

    \(SpO_2 > 92\%\) on RA

    anesthesia monitoring

  • What blood pressure criteria is needed for a score of 2 in the circulation category of the Aldrete score?

    BP within \(20\text{ mmHg}\) of preanesthetic value (min SBP = \(90\text{ mmHg}\))

    anesthesia monitoring

  • For the consciousness category of the Aldrete score, a patient who is fully awake receives a score of 2, while a patient who is arousable to voice receives a score of 1.

    anesthesia monitoring

  • What is the score for a patient who is apneic in the respiration category of the Aldrete scoring system?

    0

    3

    2

    1

    anesthesia monitoring

  • When is the anesthesia end time documented?

    When care is transferred to PACU/ICU

    anesthesia documentation

  • In the context of follow-up post-op notes, how often should inpatients be seen after discharge from PACU?

    At least once within 48 hours

    anesthesia post-op

  • What elements should be included in a PACU handoff?

    • Patient name and age
    • Allergies and medications
    • Medical history
    • Procedure
    • Anesthetic technique and medications given
    • Labs
    • Fluids given and output
    • Immediate post-op concerns and recommendations
    anesthesia handoff

  • What is the leading cause of anesthesia-related malpractice claims?

    Death (30%)

    anesthesia malpractice

  • Name three causes of severe hypoxemia in the context of anesthesia. Table summarizing common causes of severe hypoxemia and cerebral ischemia during anesthesia.

    • Inadequate ventilation
    • Severe lung disease
    • Delivery of inappropriately low \(FiO_2\)
    hypoxemia anesthesia

  • What are three common causes of reduced cardiac output leading to cerebral ischemia under anesthesia? Table summarizing common causes of severe hypoxemia and cerebral ischemia during anesthesia.

    • Cardiac failure
    • Cardiac arrest
    • Severe bradycardia
    ischemia anesthesia

  • The psychological consequences of anesthesia awareness can include sleep disturbances, work & social impairment, and PTSD.

    anesthesia psychology

  • List four risk factors associated with anesthesia awareness.

    • Cardiac surgery
    • OB/GYN surgery
    • Trauma
    • Difficult airway
    anesthesia risks

  • What are three pharmacological or monitoring strategies used to mitigate the risk of anesthesia awareness?

    • Benzodiazepines
    • Scopolamine
    • Ketamine
    anesthesia mitigation

  • What is the most common reported eye injury related to anesthesia?

    Corneal abrasion.

    anesthesia complications

  • What are three causes of corneal abrasion during anesthesia?

    • Drying of eyes
    • Decreased tear production from general anesthesia
    • Chemical injury from prep solutions
    anesthesia corneal injury

  • Which surgical positions or procedures are risk factors for ischemic optic neuropathy?

    • Prone position
    • Trendelenburg position
    • Spine surgery
    anesthesia neuropathy

  • What are the causes of central retinal artery occlusion?

    • Direct pressure to the globe (from a face mask)
    • Increased intraocular pressure (IOP)
    • Increased central venous pressure (CVP)
    • Poor venous drainage
    • Nitrous oxide (\(N_2O\)) use with a gas bubble
    anesthesia retinal occlusion

  • Mendelson's syndrome is a type of chemical pneumonitis caused by the aspiration of gastric contents with a pH of less than 2.5 and a volume of 0.3 ml/kg or greater.

    anesthesia mendelson aspiration

  • What are the prevention strategies for Mendelson's syndrome?

    • Strict adherence to NPO guidelines
    • Pharmacological agents (Non-particulate Antacids, H2 antagonists, PPIs, Gastrokinetics)
    • Regional anesthesia vs general endotracheal anesthesia (GETA)
    • Rapid sequence induction (RSI) with cricoid pressure
    • Awake intubation for difficult airways
    • Awake extubation with airway reflexes intact
    anesthesia prevention mendelson

  • What is the primary genetic defect associated with malignant hyperthermia?

    A defect in the genes coding for ryanodine receptors (RYR1).

    pathophysiology genetics

  • What classes of agents are known to trigger malignant hyperthermia?

    • Inhaled anesthetics (halothane, sevo, des, iso)
    • Depolarizing muscle relaxants (succinylcholine)
    anesthesia pharmacology

  • What are the earliest clinical signs of malignant hyperthermia?

    • Rise in \(ETCO_2\)
    • Tachycardia
    • Tachypnea
    clinical symptoms

  • Malignant hyperthermia is inherited in an autosomal dominant pattern, meaning that one defective gene is needed for the disease to manifest.

    genetics inheritance

  • What is a major consequence of sustained hypermetabolism in malignant hyperthermia related to muscle cell breakdown?

    Decrease in core temperature

    Decreased \(ETCO_2\) levels

    Release of myoglobin, \(K^+\), and CK

    Improved muscle oxygenation

    pathophysiology complications

  • What physiological event occurs when triggering agents react with RYR1 receptors, initiating a hypermetabolic state?

    Uncontrolled \(Ca^{2+}\) release from the sarcoplasmic reticulum into the myoplasm.

    pathophysiology mechanism

  • What condition occurs if the body temperature reaches or exceeds \(41^{\circ} C\) during a malignant hyperthermia crisis?

    Death usually due to DIC (disseminated intravascular coagulation).

    pathophysiology complications

  • What are two specific musculoskeletal complications resulting from rhabdomyolysis in malignant hyperthermia?

    • Muscular weakness
    • Compartment syndrome
    complications musculoskeletal

  • What is the mechanism of action of dantrolene?

    It is a specific RYR1 receptor antagonist that prevents \(Ca^{2+}\) release from the SR and RYR1/DHP receptor coupling.

    pharmacology dantrolene

  • What is the initial recommended dose of dantrolene for the treatment of malignant hyperthermia?

    \(2.5\text{ mg/kg}\)

    pharmacology dantrolene

  • Which of the following is true regarding the new formulation of dantrolene (Ryanodex) compared to the original (Dantrium)?

    It is 150 times more concentrated.

    It takes 860 seconds to mix.

    It requires 60 ml of sterile water.

    It is less expensive than the original formulation.

    pharmacology dantrolene

  • Delays in treatment are associated with high rates of complications and death in MH-related cases.

    mh safety

  • What are the three main categories of causes for Neuroleptic Malignant Syndrome?

    • Antipsychotic (neuroleptic) drugs
    • Abrupt withdrawal of dopaminergic agonists in patients with Parkinson's
    • Dopamine antagonists
    neurology nms

  • How do NMS and MH compare regarding inheritance and onset time?

    NMS is not inherited and takes 24-72 hours or several weeks to develop. MH is inherited and has early onset within minutes.

    nms mh comparison

  • Which drug is used as a dopaminergic agonist for the treatment of Neuroleptic Malignant Syndrome?

    Bromocriptine

    neurology nms treatment

  • Which of the following is a symptom of Neuroleptic Malignant Syndrome?

    Bradycardia

    Muscle rigidity

    Hypothermia

    Increased dopamine activity

    neurology nms

  • What three myopathic disorders are associated with susceptibility to malignant hyperthermia?

    • King Denborough Syndrome
    • Central Core Disease
    • Multi-Minicore Disease
    medicine anesthesia

  • What percentage of patients with masseter muscle rigidity (MMR) test positive for malignant hyperthermia susceptibility (MHS)?

    50%

    medicine anesthesia

  • In the management of masseter muscle rigidity (MMR) during emergent surgery, prophylactic dantrolene is not recommended.

    medicine anesthesia

  • What is the Gold Standard test for malignant hyperthermia susceptibility?

    Caffeine-Halothane Contracture Test (CHCT)

    medicine diagnosis

  • What are the sensitivity and specificity of the Caffeine-Halothane Contracture Test (CHCT)?

    • Sensitivity: 100%
    • Specificity: 78-94%
    medicine diagnosis

  • Which of these is a known disadvantage of genetic testing for malignant hyperthermia susceptibility?

    It is always less accurate than the CHCT.

    A negative test does not rule out susceptibility.

    It is more expensive than the CHCT.

    It requires a muscle biopsy.

    medicine genetics

  • What is the initial dose and repetition protocol for Dantrolene in the management of an MH crisis?

    Administer 2.5 mg/kg, repeating until symptoms are reversed up to 10 mg/kg.

    emergency pharmacology mh

  • Which class of drugs is contraindicated in the management of MH-related dysrhythmias after the administration of Dantrolene?

    Calcium Channel Blockers.

    emergency pharmacology mh

  • What are the measures to prevent myoglobinuria-induced renal failure in the context of an MH crisis?

    • Initiate diuresis
    • Maintain urine output > 1 mL/kg/hr
    • Administer Lasix
    • Alkalinize urine
    • Administration of mannitol (as part of Dantrolene protocol)
    emergency mh renal

  • The earliest clinical sign of Malignant Hyperthermia (MH) is increased ETCO2.

    monitoring mh

  • What is the recommended cleaning procedure for an anesthesia machine before a case involving an MH-susceptible patient?

    • Ideally schedule as the first case of the day
    • Remove vaporizers and succinylcholine from the room
    • Change CO2 absorbent and disposable components
    • Place charcoal filters on inspiratory and expiratory limbs of the circuit
    • Flush system at flows of 10L/min for at least 20 minutes
    pre-op mh anesthesia

  • Which medications may be used to treat dysrhythmias during an MH crisis?

    Procainamide and lidocaine

    Verapamil

    Diltiazem

    Amlodipine

    emergency pharmacology

  • What is the primary risk associated with arm abduction exceeding 90 degrees in a surgical patient? Patient positioning diagram

    Brachial plexus injury caused by the humeral head pushing into the axilla.

    anesthesia positioning safety

  • During the supine position, arm abduction must be limited to less than 90 degrees to prevent brachial plexus injury.

    anesthesia positioning

  • Which compensatory mechanism is attenuated by neuraxial anesthesia?

    Sympathectomy

    anesthesia physiology

  • How does neck flexion affect the ETT position?

    It increases the risk of endobronchial intubation.

    anesthesia intubation

  • What sex is specifically associated with an increased risk of ulnar neuropathy during surgery?

    Male

    anesthesia risk

  • What is the effect of increased intrathoracic pressure on venous return (VR)?

    Decreased venous return ($ o ext{VR}$)

    anesthesia physiology

  • Which position is identified as the most common surgical position?

    Prone

    Lithotomy

    Lateral decubitus

    Supine

    anesthesia positioning

  • What is the recommended intervention to mitigate back pain caused by the loss of normal lumbar lordotic curvature in the supine position?

    Use a pillow under the knees.

    anesthesia positioning

  • What is the primary cardiovascular effect of the Trendelenburg position?

    Increased venous return and central venous pressure, leading to increased cardiac output.

    cardiology trendelenburg

  • What happens to functional residual capacity (FRC) in the Trendelenburg position?

    FRC decreases due to abdominal contents being displaced toward the diaphragm.

    respiratory trendelenburg

  • What are the common potential complications associated with the Trendelenburg position?

    • Increased airway pressure
    • V/Q mismatch
    • Edema of face, eyes, and airway
    • Aspiration
    • Sliding
    • Brachial plexus injury from shoulder braces
    • Visual disturbances
    • Masking signs of hypovolemia
    complications trendelenburg

  • How does the Reverse Trendelenburg position affect cardiovascular parameters?

    It decreases venous return, preload, cardiac output, and arterial blood pressure.

    cardiology reverse-trendelenburg

  • The Reverse Trendelenburg position improves exposure for abdominal procedures and typically causes a decrease in cerebral perfusion.

    surgery reverse-trendelenburg

  • What is the effect of the lithotomy position on pulmonary function?

    • Cephalad shift of diaphragm
    • Decreased lung compliance
    • Decreased FRC
    • Decreased tidal volume (Vt)
    • High peak airway pressures
    • V/Q mismatching
    respiratory lithotomy

  • What characterizes the 'Standard' lithotomy position?

    Hips flexed at 90 degrees, knees bent with lower legs parallel to floor

    Hips flexed at 30-45 degrees

    Hips flexed at 90 degrees or more with greater knee extension

    Hips flexed at 180 degrees

    positioning lithotomy

  • What is the effect of obesity on the pulmonary complications of the lithotomy position?

    Obesity and Trendelenburg exacerbate these effects.

    respiratory lithotomy obesity

  • Which nerve is the most commonly injured in the lithotomy position?

    Common peroneal nerve

    anesthesia complications lithotomy

  • Where should an axillary roll be placed in a patient in the lateral decubitus position?

    Just caudal to the axilla, not in the axilla itself.

    positioning lateral-decubitus

  • What is the primary purpose of placing an axillary roll in the lateral decubitus position?

    To prevent compression injury to the dependent brachial plexus and dependent axillary vascular structures.

    positioning lateral-decubitus

  • In the lateral decubitus position, which lung is favored by perfusion?

    The dependent lung.

    physiology lateral-decubitus

  • In the lateral decubitus position, which lung is favored by ventilation in an anesthetized patient?

    The non-dependent lung.

    physiology lateral-decubitus

  • Induction of anesthesia causes decreased FRC.

    physiology anesthesia

  • Lateral decubitus position complications include: - impaired venous return - brachial plexus injury - pressure injuries - neck pain

    complications lateral-decubitus

  • Which nerve injury can be caused by the shoulder rolling forward onto the dependent arm in the lateral decubitus position?

    Femoral nerve

    Obturator nerve

    Suprascapular nerve

    Common peroneal nerve

    complications lateral-decubitus

  • What happens to venous return when the inferior vena cava is compressed in the prone position?

    It becomes impaired.

    prone physiology

  • What effect does the prone position have on pulmonary compliance in obese patients?

    It is improved, particularly when the abdomen is hanging freely.

    prone respiratory

  • List three potential ocular complications of the prone position.

    • Ischemic optic neuropathy
    • Central retinal artery occlusion
    • Conjunctival edema
    prone complications

  • When the head is rotated to the side for more than 3 hours in the prone position, there is a risk of cervical neuropathy.

    prone complications

  • When a patient is in the sitting position, where should arterial blood pressure be measured?

    At the level of the tragus.

    sitting monitoring

  • What happens to lung volumes and functional residual capacity (FRC) in the sitting position?

    They increase.

    sitting respiratory

  • What is a potential risk of excessive neck flexion in the sitting position?

    Edema of the face, tongue, and neck due to impaired venous drainage.

    sitting complications

  • What serious complication can occur in the sitting position due to stretching of the spinal cord?

    Mid-cervical tetraplegia.

    sitting complications

  • Which of the following is an effect of the sitting position on cerebral blood flow?

    No change

    Increased

    Decreased

    Unpredictable

    sitting physiology

  • What is the consequence of stretching a nerve to 5% greater than its normal resting length?

    It leads to ischemia due to the kinking of the arterioles and venules.

    neurology injury

  • Which peripheral nerve is the most frequently injured?

    Ulnar nerve

    neurology ulnar

  • What forearm position helps avoid external compression of the ulnar nerve in the cubital tunnel?

    Forearm supination

    neurology ulnar

  • What motor manifestation is characteristic of an ulnar nerve injury?

    Loss of abduction, extension, or opposition of 4th and 5th fingers (claw hand).

    neurology ulnar

  • Radial nerve injury results in loss of dorsiflexion, a condition known as wrist drop.

    neurology radial

  • What clinical deformity is associated with a median nerve injury when a patient attempts to make a fist?

    Hand of benediction or ape hand.

    neurology median

  • According to the mnemonic 'DR CUMA', which nerve injury is associated with 'Claw Hand'?

    Radial nerve

    Femoral nerve

    Ulnar nerve

    Median nerve

    neurology mnemonic

  • What are two clinical manifestations of an Ulnar nerve injury?

    • Claw Hand
    neurology injury

  • What physical actions increase the risk of brachial plexus stretching injuries?

    • Arm abduction > 90°
    • Excessive lateral rotation of the head
    brachial injury

  • Common peroneal injury is the most frequently damaged nerve in the lower extremity.

    peroneal injury

  • What is a common mechanism for peroneal nerve compression damage?

    When the lateral aspect of the leg leans against a stirrup bar or candy canes, typically in the lithotomy position.

    peroneal injury

  • What is the primary manifestation of an obturator nerve injury?

    Inability to ADDUCT the leg.

    obturator injury

  • What is the cause of pudendal nerve injury during surgery?

    Pressure from the perineal post of an orthopedic fracture table.

    pudendal injury

  • What site is most susceptible to external pressure for a saphenous nerve injury?

    The medial aspect of the leg.

    saphenous injury

  • Which of the following is a manifestation of radial nerve injury?

    Foot drop

    Claw Hand

    Inability to flex forearm

    Wrist drop

    neurology radial

  • What preventative measures should be taken to avoid venous air embolism during surgery?

    Maintain adequate venous pressure and ligate 'open' veins.

    surgery complications

  • Which surgical positions are associated with the risk of alopecia?

    • Supine
    • Lithotomy
    • Trendelenburg
    surgery complications

  • How can corneal abrasion be prevented during surgery?

    Taping or lubricating the eye.

    surgery complications

  • What is the recommended prevention for brachial plexus nerve palsy during surgery?

    Avoid stretching or direct compression at the neck, shoulder, or axilla.

    surgery nerve complications

  • What surgical positions increase the risk of common peroneal nerve palsy?

    • Lithotomy
    • Lateral decubitus
    surgery nerve complications

  • What prevention strategy is recommended for radial nerve palsy during surgery?

    Avoid compression of the lateral humerus.

    surgery nerve complications

  • What prevention strategy is recommended for ulnar nerve palsy during surgery?

    Avoid sustained pressure on the ulnar groove.

    surgery nerve complications

  • What is the recommended prevention for retinal ischemia during surgery?

    Avoid pressure on the globe.

    surgery complications

  • What is the recommended prevention for skin necrosis during surgery?

    Avoid sustained pressure over bony prominences.

    surgery complications