Anesthesia and Perioperative medicine Practice Questions

Question 1

A 4-year-old boy is brought to the emergency department by his mother after cutting his buttock on a piece of broken glass. There is a 5-cm curvilinear laceration over the patient's right buttock. His vital signs are unremarkable. The decision to repair the laceration is made. Which of the following will offer the longest anesthesia for the laceration repair?

Accepted Answer

Bupivacaine with epinephrine

Answer

Lidocaine

Answer

Lidocaine mixed with bupivacaine

Answer

Lidocaine with epinephrine

Answer

Bupivacaine

Question 2

A 37-year-old woman undergoes diagnostic laparoscopy under general anesthesia for evaluation of chronic pelvic pain. Postoperatively, the patient requires prolonged intubation. Neostigmine is administered. Results of acceleromyography during train-of-four ulnar nerve stimulation are shown. Which of the following drugs is most likely to have been used intraoperatively in this patient?

Accepted Answer

Succinylcholine

Answer

Tizanidine

Answer

Clonazepam

Answer

Ropivacaine

Answer

Rocuronium

Question 3

A 52-year-old obese man is brought to the emergency department 30 minutes after he was involved in a high-speed motor vehicle collision. He was the unrestrained driver. On arrival, he is lethargic. His pulse is 112/min, respirations are 10/min and irregular, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. The pupils are equal and react sluggishly to light. He withdraws his extremities to pain. There are multiple bruises over his face, chest, and abdomen. Breath sounds are decreased over the left lung base. Two large bore peripheral venous catheters are inserted and 0.9% saline infusion is begun. Rapid sequence intubation is initiated and endotracheal intubation is attempted without success. Bag and mask ventilation is continued. Pulse oximetry shows an oxygen saturation of 84%. The patient has no advance directive and family members have not arrived. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

Cricothyrotomy

Answer

Nasotracheal intubation

Answer

Video laryngoscopy

Answer

Comfort measures only

Answer

Tracheostomy

Question 4

A 36-year-old male with fluctuating levels of consciousness is brought to the emergency department by ambulance due to a fire in his home. He currently opens his eyes to voice, localizes painful stimuli, responds when asked questions, but is disoriented and cannot obey commands. The patient’s temperature is 99°F (37.2°C), blood pressure is 86/52 mmHg, pulse is 88/min, and respirations are 14/min with an oxygen saturation of 97% O2 on room air. Physical exam shows evidence of soot around the patient’s nose and mouth, but no burns, airway obstruction, nor accessory muscle use. A blood lactate is 14 mmol/L. The patient is started on intravenous fluids.

What is the next best step in management?

Accepted Answer

100% oxygen, hydroxycobalamin, and sodium thiosulfate

Answer

Methylene blue

Answer

Hyperbaric oxygen

Answer

Sodium thiosulfate and sodium nitrite

Answer

Intravenous epinephrine

Question 5

A 30-year-old man with history of intravenous drug use and methamphetamine-associated chronic thromboembolic pulmonary hypertension (CTEPH) is brought to the emergency department by his girlfriend for worsening abdominal pain and fevers. The patient said the pain was initially around his umbilicus, but he is now experiencing intense tenderness near his groin. He was initially prescribed rivaroxaban, but due to insurance issues, he was switched to warfarin for management of CTEPH two weeks ago. His temperature is 102°F (38.9°C), blood pressure is 95/60 mmHg, pulse is 95/min, respirations are 22/min. He states that his blood pressure usually runs low. His physical exam is notable for an unremarkable cardiac exam, bibasilar crackles, and RLQ tenderness with rebound tenderness when the LLQ is palpated. Laboratory results are shown below:

Hemoglobin: 11 g/dL
Hematocrit: 35 %
Leukocyte count: 16,000/mm^3 with normal differential
Platelet count: 190,000/mm^3

Serum:
Na+: 137 mEq/L
Cl-: 100 mEq/L
K+: 3.7 mEq/L
HCO3-: 23 mEq/L
BUN: 40 mg/dL
Glucose: 110 mg/dL
Creatinine: 0.8 mg/dL
Ca2+: 9.1 mg/dL
AST: 34 U/L
ALT: 45 U/L

International normalized ratio (INR): 6.2
Prothrombin time (PT): 40 seconds
Partial thromboplastin time: 70 seconds

Blood type: O
Rhesus: Positive
Antibody screen: Negative

A clinical diagnosis is made and supported by the surgical consult team in lieu of imaging. The next operating room for an add-on procedure will not be available for another 5 hours. Appropriate medical therapy is initiated. What is the best next step for surgical optimization?

Accepted Answer

Prothrombin complex concentrate

Answer

Fresh frozen plasma

Answer

Protamine

Answer

Do nothing

Answer

Phytonadione

Question 6

A 63-year-old man is brought to the emergency department, 30 minutes after being involved in a high-speed motor vehicle collision. He is obtunded on arrival. He is intubated and mechanical ventilation is begun. The ventilator is set at a FiO2 of 60%, tidal volume of 440 mL, and positive end-expiratory pressure of 4 cm H2O. On the third day of intubation, his temperature is 37.3°C (99.1°F), pulse is 91/min, and blood pressure is 103/60 mm Hg. There are decreased breath sounds over the left lung base. Cardiac examination shows no abnormalities. The abdomen is soft and not distended. Arterial blood gas analysis shows:
pH 7.49
pCO2 29 mm Hg
pO2 73 mm Hg
HCO3- 20 mEq/L
O2 saturation 89%
Monitoring shows a sudden increase in the plateau airway pressure. An x-ray of the chest shows deepening of the costophrenic angle on the left side. Which of the following is the most appropriate next step in management?

Accepted Answer

Insertion of a chest tube

Answer

CT scan of the chest

Answer

Administer levofloxacin

Answer

Close observation

Answer

Increase the PEEP

Question 7

A group of researchers is studying various inhaled substances to determine their anesthetic properties. In particular, they are trying to identify an anesthetic with fast onset and quick recovery for use in emergencies. They determine the following data:
Inhalational anesthetic  Blood-gas partition coefficient
A 0.15
B 0.92
C 5.42
Which of the following statements is accurate with regard to these inhaled anesthetic substances?

Accepted Answer

Agent A has the fastest onset of action

Answer

Agent C has the fastest onset of action

Answer

Agent B is the most potent

Answer

Agent B has the fastest onset of action

Answer

Agent A is the most potent

Question 8

A previously healthy 44-year-old man is brought by his coworkers to the emergency department 45 minutes after he became light-headed and collapsed while working in the boiler room of a factory. He did not lose consciousness. His coworkers report that 30 minutes prior to collapsing, he told them he was nauseous and had a headache. The patient appears sweaty and lethargic. He is not oriented to time, place, or person. The patient’s vital signs are as follows: temperature 41°C (105.8°F); heart rate 133/min; respiratory rate 22/min; and blood pressure 90/52 mm Hg. Examination shows equal and reactive pupils. Deep tendon reflexes are 2+ bilaterally. His neck is supple. A 0.9% saline infusion is administered. A urinary catheter is inserted and dark brown urine is collected. The patient’s laboratory test results are as follows:
Laboratory test
Blood
Hemoglobin 15 g/dL
Leukocyte count 18,000/mm3
Platelet count 51,000/mm3
Serum
Na+ 149 mEq/L
K+ 5.0 mEq/L
Cl- 98 mEq/L
Urea nitrogen 42 mg/dL
Glucose 88 mg/dL
Creatinine 1.8 mg/dL
Aspartate aminotransferase (AST, GOT) 210
Alanine aminotransferase (ALT, GPT) 250
Creatine kinase 86,000 U/mL
Which of the following is the most appropriate next step in patient management?

Accepted Answer

Ice water immersion

Answer

Dantrolene

Answer

Acetaminophen therapy

Answer

Hemodialysis

Answer

Evaporative cooling

Question 9

A 23-year-old man is brought to the emergency department by ambulance following a motor vehicle accident. He was pinned between 2 cars for several hours. The patient has a history of asthma. He uses an albuterol inhaler intermittently. The patient was not the driver, and admits to having a few beers at a party prior to the accident. His vitals in the ambulance are stable. Upon presentation to the emergency department, the patient is immediately brought to the operating room for evaluation and surgical intervention. It is determined that the patient’s right leg has a Gustilo IIIC injury in the mid-shaft of the tibia with a severely comminuted fracture. The patient’s left leg suffered a similar injury but with damage to the peroneal nerve. The anesthesiologist begins to induce anesthesia. Which of the following agents would be contraindicated in this patient?

Accepted Answer

Succinylcholine

Answer

Halothane

Answer

Propofol

Answer

Etomidate

Answer

Neostigmine

Question 10

An obese 52-year-old man is brought to the emergency department because of increasing shortness of breath for the past 8 hours. Two months ago, he noticed a mass on the right side of his neck and was diagnosed with laryngeal cancer. He has smoked two packs of cigarettes daily for 27 years. He drinks two pints of rum daily. He appears ill. He is oriented to person, place, and time. His temperature is 37°C (98.6°F), pulse is 111/min, respirations are 34/min, and blood pressure is 140/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. Examination shows a 9-cm, tender, firm subglottic mass on the right side of the neck. Cervical lymphadenopathy is present. His breathing is labored and he has audible inspiratory stridor but is able to answer questions. The lungs are clear to auscultation. Arterial blood gas analysis on room air shows:
pH 7.36
PCO2 45 mm Hg
PO2 74 mm Hg
HCO3- 25 mEq/L
He has no advanced directive. Which of the following is the most appropriate next step in management?

Accepted Answer

Cricothyroidotomy

Answer

Comfort care measures

Answer

Tracheostomy

Answer

Intramuscular epinephrine

Answer

Tracheal stenting

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