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ANESTHESIA BOARD QUESTIONS 2023-
2024 EXAM REVIEW UPDATE
The Bourbon pressure gauge can be used to calculate the cylinder volume for (Select 2 ). A- Nitrogen B- Helium C- Nitrous oxide D- Carbon Dioxide - ANS-A- Nitrogen B= Helium Both exist as a liquid. The Bourbon pressure gauge can be used to calculate the cylinder volume for (Select 2 ). A- Nitrogen B- Helium C- Nitrous oxide D- Carbon Dioxide - ANS-A- Nitrogen B= Helium Both exist as a liquid. Changes found in banked blood include: (Select 2) A- increased levels of 2,3-DPG B - a left shift of the hemoglobin dissociation curve C- decreased levels of potassium D- formation of microaggregates E- alkalosis secondary to the presence of citrate F- increased intracellular ATP stores G- thrombocytosis - ANS-B,D Changes occurring in banked blood include: Depletion of 2,3-DPG Depletion of intracellular ATP Oxidative damage Increased adhesion to vascular endothelium Altered cell morphology Accumulation of microaggregates Hyperkalemia (as high as 17.2 mEq/L) Absence of platelets (after 2 days of storage) Hemolysis
Accumulation of proinflammatory products Changes found in banked blood include: (Select 2) A- increased levels of 2,3-DPG B - a left shift of the hemoglobin dissociation curve C- decreased levels of potassium D- formation of microaggregates E- alkalosis secondary to the presence of citrate F- increased intracellular ATP stores G- thrombocytosis - ANS-B,D Changes occurring in banked blood include: Depletion of 2,3-DPG Depletion of intracellular ATP Oxidative damage Increased adhesion to vascular endothelium Altered cell morphology Accumulation of microaggregates Hyperkalemia (as high as 17.2 mEq/L) Absence of platelets (after 2 days of storage) Hemolysis Accumulation of proinflammatory products Does "light" anesthesia promote wheezing? - ANS-Yes, if patint has a reactive airway. Does "light" anesthesia promote wheezing? - ANS-Yes, if patint has a reactive airway. The largest fraction of carbon dioxide in the blood is in the form of : A - carbamino compounds B- Bicarbonate C- Dissolved gas D- Carboxyhemoglobin - ANS-B The largest fraction of carbon dioxide in the blood is in the form of : A - carbamino compounds B- Bicarbonate C- Dissolved gas D- Carboxyhemoglobin - ANS-B Pulmonary changes associated with Duchenne's muscular dystrophy include: A-a restrictive ventilatory defect B-an obstructive ventilatory defect C-decreased pulmonary artery pressures D- increased residual volume - ANS-A- restrictive ventilatory defect
A-nitrous oxide administration B-succinylcholine administration C-opioid administration D-hyperventilation E- laryngoscopy F- hypoxemia G-sevoflurane administration - ANS-B, E, F succinylcholine, laryngoscopy, hypoxemia. Succinylcholine increases intraocular pressure by 5 - 10 mm Hg for 5 - 10 minutes after administration. This increase is primarily the result of prolonged contracture of the extraocular muscles from the depolarizing effects of succinylcholine. Nitrous oxide, volatile anesthetic 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. 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 - ANS-B, E, F succinylcholine, laryngoscopy, hypoxemia. Succinylcholine increases intraocular pressure by 5 - 10 mm Hg for 5 - 10 minutes after administration. This increase is primarily the result of prolonged contracture of the extraocular muscles from the depolarizing effects of succinylcholine. Nitrous oxide, volatile anesthetic 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. 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 from points C to D D-the slope of a line from points A to D - 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. 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 from points C to D D-the slope of a line from points A to D - 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. Current anesthesia apparatus checkout recommendations suggest which of the following prior to every case? A-Check oxygen cylinder supply B-Check the carbon dioxide absorber C-Performance of a machine low-pressure leak test D-Calibration of the oxygen monitor - ANS-B- Check the carbon dioxide absorber Verification of the adequacy of the carbon dioxide absorber is suggested prior to every case. If the same anesthesia machine is being used by the same provider, E-cylinder pressure checks, machine low-pressure leak testing and calibration of the oxygen sensor need not be repeated after an initial check. Current anesthesia apparatus checkout recommendations suggest which of the following prior to every case? A-Check oxygen cylinder supply B-Check the carbon dioxide absorber C-Performance of a machine low-pressure leak test D-Calibration of the oxygen monitor - ANS-B- Check the carbon dioxide absorber Verification of the adequacy of the carbon dioxide absorber is suggested prior to every case. If the same anesthesia machine is being used by the same provider, E-cylinder pressure checks, machine low-pressure leak testing and calibration of the oxygen sensor need not be repeated after an initial check. A patient with diabetic ketoacidosis is scheduled for an emergent laparotomy. Which of the following best explains the decrease in serum potassium concentration that occurs in this patient following administration of insulin? A-Dilutional hypokalemia follows free water retention from decreased osmotic diuresis B-Extracellular potassium is actively transported with glucose into cells C-Insulin enhances renal excretion of potassium
B. Atrial fibrillation with ventricular rate of 105 C. Mild tricuspid regurgitation D. New-onset heart failure - ANS-C. Mild tricuspid regurgitation All of the following patients should have a cardiology consult prior to non-cardiac surgery except: A. Unstable angina B. Atrial fibrillation with ventricular rate of 105 C. Mild tricuspid regurgitation D. New-onset heart failure - ANS-C. Mild tricuspid regurgitation Pick 2 of the following which do NOT cause SPÓ artifact.
- fetal Hgb
- bilirubin
- Hgb < 7
- carboxyhemoglobin
- methemoglobin - ANS-2) bilirubin
- Hgb < 7 Pick 2 of the following which do NOT cause SPÓ artifact.
- fetal Hgb
- bilirubin
- Hgb < 7
- carboxyhemoglobin
- methemoglobin - ANS-2) bilirubin
- Hgb < 7 According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of: A- 13 - 15 B- 9 - 12 C- 6 - 9 D- less than 6 - ANS-B- 9 - 12
According to the Modified Glasgow Coma scale, mild head injury is associated with a score of 13 - 15, moderate head injury is associated with a score of 9 - 12, and severe head injury is associated with a score of less than 8. According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of: A- 13 - 15 B- 9 - 12 C- 6 - 9 D- less than 6 - ANS-B- 9 - 12 According to the Modified Glasgow Coma scale, mild head injury is associated with a score of 13 - 15, moderate head injury is associated with a score of 9 - 12, and severe head injury is associated with a score of less than 8. 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 the pH of the solution D-should only be done when using bupivacaine - ANS-B-increases the concentration of the nonionic form of the local anesthetic The onset of neural blockade depends on the 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. 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 the pH of the solution D-should only be done when using bupivacaine - ANS-B-increases the concentration of the nonionic form of the local anesthetic The onset of neural blockade depends on the 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. Factors increasing the affinity of hemoglobin for oxygen include: (Select 2)
C- B
D- B + tidal volume - ANS-B- A + tidal volume Inspiratory capacity is the sum of the inspiratory reserve volume (A) and the tidal volume. B represents the expiratory reserve volume, C represents the FRC, D represents the residual volume, E represents the vital capacity and F represents the total lung volume. Laminar flow in the airway occurs in the: (Select 2) A- trachea B- main stem bronchi C- terminal bronchiole D- 3rd generation bronchus E- respiratory bronchiole - ANS-E, C - terminal bronchiole, respiratory bronchiole Flow in the larger airways is mostly turbulent. Laminar flow normally occurs only distal to small bronchioles (< 1mm). The Reynolds number is used to predict the type of airway flow; a low Reynolds number (< 1000) is associated with laminar flow, whereas a high value (> 1500) is associated with turbulent flow. Laminar flow in the airway occurs in the: (Select 2) A- trachea B- main stem bronchi C- terminal bronchiole D- 3rd generation bronchus E- respiratory bronchiole - ANS-E, C - terminal bronchiole, respiratory bronchiole Flow in the larger airways is mostly turbulent. Laminar flow normally occurs only distal to small bronchioles (< 1mm). The Reynolds number is used to predict the type of airway flow; a low Reynolds number (< 1000) is associated with laminar flow, whereas a high value (> 1500) is associated with turbulent flow. Sickle hemoglobin: (Select 2) A-has a lower P50 than hemoglobin A B-releases oxygen less readily than hemoglobin A C-is present in about 30% of African Americans D-readily polymerizes and precipitates in the red cell E-results from a single amino acid substitution on the α-chain F- has decreased solubility as compared to hemoglobin A - ANS-(D, F) readily polymerizes and precipitates in the red cell, has decreased solubility as compared to hemoglobin A
Sickle hemoglobin (HbS) has a lower affinity for oxygen and an elevated P50 (31 mm Hg) as compared to hemoglobin A (27 mm Hg). HbS also has decreased solubility and readily polymerizes and precipitates in the red cell producing the sickled appearance of the cell. HbS results from the substitution of valine for glutamic acid on the β-chain. Sickle hemoglobin: (Select 2) A-has a lower P50 than hemoglobin A B-releases oxygen less readily than hemoglobin A C-is present in about 30% of African Americans D-readily polymerizes and precipitates in the red cell E-results from a single amino acid substitution on the α-chain F- has decreased solubility as compared to hemoglobin A - ANS-(D, F) readily polymerizes and precipitates in the red cell, has decreased solubility as compared to hemoglobin A Sickle hemoglobin (HbS) has a lower affinity for oxygen and an elevated P50 (31 mm Hg) as compared to hemoglobin A (27 mm Hg). HbS also has decreased solubility and readily polymerizes and precipitates in the red cell producing the sickled appearance of the cell. HbS results from the substitution of valine for glutamic acid on the β-chain. A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: A- phenoxybenzamine B- doxazosin C- propranolol D-terazosin - ANS-A-phenoxybenzamine Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1- antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients with pheochromocytoma, α-blockade and intravascular volume replacement must precede β-blockade, so as to prevent the possibility of unopposed α-stimulation. A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: A- phenoxybenzamine B- doxazosin C- propranolol D-terazosin - ANS-A-phenoxybenzamine Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1- antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients
Examples of Type IV hypersensitivity reactions include: A-contact dermatitis B-hemolytic transfusion reactions C-anaphylaxis D-angioedema - ANS-A-contact dermatitis Type IV hypersensitivity reactions are delayed and cell-mediated. Examples of Type IV reactions include contact dermatitis, tuberculin-type hypersensitivity and chronic hypersensitivity pneumonitis. Examples of Type IV hypersensitivity reactions include: A-contact dermatitis B-hemolytic transfusion reactions C-anaphylaxis D-angioedema - ANS-A-contact dermatitis Type IV hypersensitivity reactions are delayed and cell-mediated. Examples of Type IV reactions include contact dermatitis, tuberculin-type hypersensitivity and chronic hypersensitivity pneumonitis. The maximum recommended occupational whole-body exposure to radiation is: A-1 rem/year B-5 rem/year C-10 rem/year D-20 rem/year - ANS-B-5 rem/year The intraoperative use of imaging equipment exposes anesthesia providers to ionizing radiation. The maximum recommended whole-body exposure to radiation is 5 rem/year. The maximum recommended occupational whole-body exposure to radiation is: A-1 rem/year B-5 rem/year C-10 rem/year D- 2 0 rem/year - ANS-B-5 rem/year The intraoperative use of imaging equipment exposes anesthesia providers to ionizing radiation. The maximum recommended whole-body exposure to radiation is 5 rem/year. Basal metabolic oxygen consumption in a 20-kg patient is approximately: - ANS- 95 ml/min
Basal metabolic oxygen consumption can be estimated using the following formula: VÓ = 10 KG ^3/ Basal metabolic oxygen consumption in a 20-kg patient is approximately: - ANS- 95 ml/min Basal metabolic oxygen consumption can be estimated using the following formula: VÓ = 10 KG ^3/ ___________________ states that the rate of change of the amount of a drug at any given time is proportional to the concentration present at that time. a. Zero order kinetics b. first order kinetics c. elimination half life d. nonlinear kinetics - ANS-b. first order kinetics Drug elimination occurs at different rates. Zero-order kinetics yields a constant amount of drug elimination over a specific amount of time. First-order kinetics yields drug elimination that is proportionate to that drugs concentration- at a higher concentration, a larger amount of drug is eliminated within a specific amount of time. ___________________ states that the rate of change of the amount of a drug at any given time is proportional to the concentration present at that time. a. Zero order kinetics b. first order kinetics c. elimination half life d. nonlinear kinetics - ANS-b. first order kinetics Drug elimination occurs at different rates. Zero-order kinetics yields a constant amount of drug elimination over a specific amount of time. First-order kinetics yields drug elimination that is proportionate to that drugs concentration- at a higher concentration, a larger amount of drug is eliminated within a specific amount of time. Bone marrow depression and peripheral neuropathy have been associated with prolonged exposure to anesthetic concentrations of: A-isoflurane B-desflurane C-sevoflurane D-nitrous oxide - ANS-Bone marrow depression and peripheral neuropathy have been associated with prolonged exposure to anesthetic concentrations of: B-nitrous oxide By irreversibly oxidizing the cobalt atom in vitamin B12, nitrous oxide inhibits vitamin B12 dependent enzymes. These enzymes include methionine synthetase and
d. all of the above. - ANS-d. all of the above Uptake of a drug by a targeted tissue is dependent on several factors, both physical and chemical, including circulation or blood flow, the characteristics of the bbb toward that specific drug, the chemical properties of that drug - such as the degree of ionization, lipid solubility, and protein binding, among others. Determinants of drug tissue uptake include which of the following? a. blood flow b. blood-brain barrier c. ionization d. all of the above. - ANS-d. all of the above Uptake of a drug by a targeted tissue is dependent on several factors, both physical and chemical, including circulation or blood flow, the characteristics of the bbb toward that specific drug, the chemical properties of that drug - such as the degree of ionization, lipid solubility, and protein binding, among others. Disodium edetate or sodium metabisulfite is added to formulations of propofol to: A-enhance drug solubility B-adjust pH C-inhibit bacterial growth D-ncrease drug potency - ANS-C-inhibit bacterial growth Current formulations of propofol contain 0.005% disodium edetate or 0.025% sodium metabisulfite to help retard the rate of microorganism growth. Disodium edetate or sodium metabisulfite is added to formulations of propofol to: A-enhance drug solubility B-adjust pH C-inhibit bacterial growth D-ncrease drug potency - ANS-C-inhibit bacterial growth Current formulations of propofol contain 0.005% disodium edetate or 0.025% sodium metabisulfite to help retard the rate of microorganism growth. Choose 4 pathways of drug metabolism: a- biotransformation b- reduction c- demethylation d- conjugation e- oxidation
f- deamination g- hydrolysis h- phosphorylation - ANS-b,d,e,g [Drug metabolism typically involves alteration to the physical or chemical properties of the drug to make that drug more attractive to the physiological process to facilitate the drug removal. Drug metabolism i accomplished via four methods: oxidation, reduction, hydrolysis, and conjugation; the first methods typically prepare a drug to be further acted upon by the fourth, conjugation. Choose 4 pathways of drug metabolism: a- biotransformation b- reduction c- demethylation d- conjugation e- oxidation f- deamination g- hydrolysis h- phosphorylation - ANS-b,d,e,g [Drug metabolism typically involves alteration to the physical or chemical properties of the drug to make that drug more attractive to the physiological process to facilitate the drug removal. Drug metabolism i accomplished via four methods: oxidation, reduction, hydrolysis, and conjugation; the first methods typically prepare a drug to be further acted upon by the fourth, conjugation. During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of: A- 20 cmH2O B- 50 cmH2O C- 25 psi D- 50 psi - ANS-D- 50 psi After proper location of the catheter is confirmed by aspiration air, jet ventilation may be achieved with intermittent pulses of oxygen at 50 psi. During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of: A- 20 cmH2O B- 50 cmH2O C- 25 psi D- 50 psi - ANS-D- 50 psi
D- glossopharyngeal nerve - ANS-C- recurrent laryngeal nerve The vagus nerve provides sensation to the airway below the epiglottis. The superior laryngeal branch of the vagus divides into an external (motor) and internal (sensory) laryngeal nerve that provide sensory supply to the larynx between the epiglottis and the vocal cords. Another branch of the vagus, the recurrent laryngeal nerve, innervates the larynx below the vocal cords and trachea. Sensory innervation of the trachea and larynx below the vocal cords is supplied by the: A- internal laryngeal nerve B- external laryngeal nerve C-recurrent laryngeal nerve D- glossopharyngeal nerve - ANS-C- recurrent laryngeal nerve The vagus nerve provides sensation to the airway below the epiglottis. The superior laryngeal branch of the vagus divides into an external (motor) and internal (sensory) laryngeal nerve that provide sensory supply to the larynx between the epiglottis and the vocal cords. Another branch of the vagus, the recurrent laryngeal nerve, innervates the larynx below the vocal cords and trachea. Correct statements concerning the use of benzodiazepines in the elderly include: A-volume of distribution is increased B-reduced pharmacodynamic sensitivity is observed C-the elimination half-life of diazepam, but not midazolam, is increased D-all of the above - ANS-A-volume of distribution is increased Aging increases the volume of distribution for all benzodiazepines, effectively prolonging their elimination half-lives. Enhanced pharmacodynamic sensitivity is also observed. The elimination half-lives of both diazepam and midazolam are increased. Correct statements concerning the use of benzodiazepines in the elderly include: A-volume of distribution is increased B-reduced pharmacodynamic sensitivity is observed C-the elimination half-life of diazepam, but not midazolam, is increased D-all of the above - ANS-A-volume of distribution is increased Aging increases the volume of distribution for all benzodiazepines, effectively prolonging their elimination half-lives. Enhanced pharmacodynamic sensitivity is also observed. The elimination half-lives of both diazepam and midazolam are increased. When do pharmacokinetic interactions occur? a- When one drug alters the absorption/distribution/metabolism/ excretion of another.
b- Before a drug is administered or absorbed systematically. c- When one drug alters the sensitivity of a target receptor or tissue to the effects of a second drug. d- none of the above. - ANS-A-When one drug alters the absorption/distribution/metabolism/ excretion of another. [Pharmacokinetic interactions occur when more than one drug is administered and the interactions are dictated by the effects of one drug on the absorption, distribution, metabolism, and elimination of another drug. ] When do pharmacokinetic interactions occur? a- When one drug alters the absorption/distribution/metabolism/ excretion of another. b- Before a drug is administered or absorbed systematically. c- When one drug alters the sensitivity of a target receptor or tissue to the effects of a second drug. d- none of the above. - ANS-A-When one drug alters the absorption/distribution/metabolism/ excretion of another. [Pharmacokinetic interactions occur when more than one drug is administered and the interactions are dictated by the effects of one drug on the absorption, distribution, metabolism, and elimination of another drug. ] Concerning preoperative informed consent: A-it should disclose only life-threatening complications B-charges of assault and battery are possible if it is not obtained C-oral consent is insufficient D-it is not necessary if the procedure is done in an office setting - ANS-B-charges of assault and battery are possible if it is not obtained Any procedure performed without the patient's consent can constitute assault and battery. Oral consent may be sufficient, but written consent is advisable for medicolegal purposes. It is generally accepted that not all risks need to be detailed, but risks that are realistic and have resulted in complications in similar patients should be disclosed. Concerning preoperative informed consent: A-it should disclose only life-threatening complications B-charges of assault and battery are possible if it is not obtained C-oral consent is insufficient D-it is not necessary if the procedure is done in an office setting - ANS-B-charges of assault and battery are possible if it is not obtained Any procedure performed without the patient's consent can constitute assault and battery. Oral consent may be sufficient, but written consent is advisable for medicolegal
