Anesthesia and Perioperative Care Quiz

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Questions and Answers

Which of the following is NOT a component of the pre-anesthetic airway exam?

  • Mallampati classification
  • Body mass index (BMI) (correct)
  • Thyromental distance
  • Presence of any airway pathology

Which of the following is a strategy to prevent bronchospasm perioperatively in a patient with COPD/asthma?

  • Administering a bronchodilator preoperatively (correct)
  • Administering a beta-blocker preoperatively
  • Avoid using general anesthesia
  • Using a non-rebreathing mask for oxygen delivery

Which of the following is a common comorbidity in obese patients?

  • Hypothyroidism
  • Osteoporosis
  • Sleep Apnea (correct)
  • Hypertension (correct)
  • All of the above (correct)

What does the ASA classification system assess?

<p>Both A and D (E)</p> Signup and view all the answers

Which of the following is NOT a goal of pre-operative assessment?

<p>Determining the patient's level of anesthesia expertise (B)</p> Signup and view all the answers

In the context of pre-operative optimization, how can investigations be helpful?

<p>Identifying and addressing potential pre-operative concerns (A)</p> Signup and view all the answers

Which of the following is an example of a pharmacogenetic disease?

<p>Pseudocholinesterase deficiency (D)</p> Signup and view all the answers

Which of the following situations would increase the risk of post-operative nausea and vomiting (PONV)?

<p>A non-smoking female patient undergoing a long procedure (B), An older patient undergoing a procedure involving volatile anesthetics (C), A patient with a history of motion sickness undergoing a short procedure (D)</p> Signup and view all the answers

What is the maximum possible score on the Simplified Apfel score for PONV?

<p>4 (A)</p> Signup and view all the answers

Which of the following is NOT a common drug used for PONV prophylaxis?

<p>Morphine (D)</p> Signup and view all the answers

Which of the following is NOT a preventative strategy for PONV?

<p>Administering high doses of opioids to manage post-operative pain (A)</p> Signup and view all the answers

Which of the following is NOT a sign of early malignant hyperthermia?

<p>Low body temperature (A)</p> Signup and view all the answers

Which of the following is a trigger for malignant hyperthermia?

<p>Succinylcholine (C)</p> Signup and view all the answers

In the PACU handover, what information should be included regarding anesthesia?

<p>Type of anesthetic used, whether a neuromuscular blocking agent (NMBA) was reversed, and details about intubation (B)</p> Signup and view all the answers

What is the most serious complication of malignant hyperthermia?

<p>Cardiac arrest (A)</p> Signup and view all the answers

What is the primary cause of prolonged respiratory paralysis in a patient with pseudocholinesterase deficiency?

<p>Delayed breakdown of succinylcholine (C)</p> Signup and view all the answers

Which of the following is NOT a typical sign or symptom of pseudocholinesterase deficiency?

<p>Hypotension (A)</p> Signup and view all the answers

Which of these drugs is MOST likely to trigger the symptoms of pseudocholinesterase deficiency?

<p>Succinylcholine (B)</p> Signup and view all the answers

What is the recommended management strategy for a patient with confirmed pseudocholinesterase deficiency?

<p>Continue mechanical ventilation until the paralysis resolves (B)</p> Signup and view all the answers

Which of the following is a primary risk factor associated with pseudocholinesterase deficiency?

<p>Family history of unexplained prolonged paralysis during anesthesia (B)</p> Signup and view all the answers

In the management of pseudocholinesterase deficiency, what is the primary goal of continued mechanical ventilation?

<p>To allow time for the breakdown of succinylcholine (C)</p> Signup and view all the answers

Which of the following statements regarding pseudocholinesterase deficiency is TRUE?

<p>It is a rare genetic condition with a significant impact on anesthesia (B)</p> Signup and view all the answers

What is the most important step in the prevention of complications related to pseudocholinesterase deficiency?

<p>Thorough pre-operative assessment of the patient's medical history (C)</p> Signup and view all the answers

What does the acronym 'CICO' stand for in the context of this content?

<p>Can't Intubate, Can't Oxygenate (A)</p> Signup and view all the answers

According to the content, when should 'CICO Rescue' be initiated?

<p>When all three upper airway lifelines have been attempted without success (D)</p> Signup and view all the answers

What does 'spiral movement inward' signify on the tool mentioned in the content?

<p>The need to consider alternative airway management strategies (A)</p> Signup and view all the answers

Which of these is NOT included in the five categories of optimization mentioned for each lifeline?

<p>Surgical intervention (C)</p> Signup and view all the answers

What is the significance of the 'Green Zone' on the tool?

<p>Represents a successful airway management outcome (A)</p> Signup and view all the answers

The order of using the three lifelines:

<p>Can be modified based on the patient's specific situation. (D)</p> Signup and view all the answers

What indicates the need to initiate CICO Rescue?

<p>Unsuccessful attempt with all three lifelines. (C)</p> Signup and view all the answers

What is the significance of the central 'Green Zone' on the tool?

<p>It reminds clinicians that CICO Rescue can also restore oxygen delivery. (D)</p> Signup and view all the answers

What are the potential complications of mechanical ventilation?

<p>Hemodynamic instability, baro/volutrauma, increased work of breathing (B)</p> Signup and view all the answers

Which of the following are risk factors for myocardial ischemia/infarction during surgery?

<p>CAD/CHF and associated risk factors, vascular surgeries (C)</p> Signup and view all the answers

What are the potential signs and symptoms of myocardial ischemia/infarction during surgery?

<p>ST elevation/depression, unexplained ↑ HR or ↓ BP, arrhythmias (B)</p> Signup and view all the answers

Which of the following are potential differential diagnoses (DDx) for myocardial ischemia/infarction during surgery?

<p>Cardiac tamponade, arrhythmia, pulmonary embolism (PE) (B)</p> Signup and view all the answers

Which of the following is the most appropriate management principle for myocardial ischemia/infarction during surgery?

<p>Maximizing myocardial oxygenation and decreasing demand. (D)</p> Signup and view all the answers

What is the most important step to take when managing a patient with myocardial ischemia/infarction during an elective surgery in an ASA 2 patient?

<p>Consult with cardiology and the surgical team to determine the best management plan. (A)</p> Signup and view all the answers

Which of the following statements best describes the management principles for a patient with myocardial ischemia/infarction during a trauma surgery in an ASA 5E patient?

<p>Optimize myocardial and hemodynamic stability while minimizing surgical insult/time. (C)</p> Signup and view all the answers

What is the most important factor to consider when managing a patient with myocardial ischemia/infarction during surgery?

<p>The patient's medical history. (D)</p> Signup and view all the answers

Which of the following is NOT a physiological change associated with diabetes mellitus in the perioperative period?

<p>Increased gastric motility (C)</p> Signup and view all the answers

Which of the following anesthetic considerations is MOST important for a patient with COPD undergoing surgery?

<p>Ensuring adequate preoxygenation and positive pressure ventilation (D)</p> Signup and view all the answers

Which of the following is a recommended pre-operative management strategy for a diabetic patient undergoing surgery?

<p>Administering an insulin infusion to achieve more aggressive glycemic control before surgery (A)</p> Signup and view all the answers

What factors can contribute to post-operative nausea and vomiting (PONV) in the patient? (Select all that apply)

<p>Stimulation of the chemoreceptor trigger zone (CTZ) by opioids (B), Pre-operative anxiety and stress (C), Stimulation of the chemoreceptor trigger zone (CTZ) by serotonin (5HT3) agonists (D)</p> Signup and view all the answers

Which of the following medications is MOST LIKELY to have delayed clearance in an obese patient?

<p>Desflurane (A)</p> Signup and view all the answers

In managing the postoperative care of a patient with COPD, which of the following is a crucial element?

<p>Regular suctioning and physiotherapy to prevent sputum plugging and aspiration (B)</p> Signup and view all the answers

Which of the following is a recommended practice for managing a patient with diabetes mellitus undergoing a surgery?

<p>Measuring glucose frequently and adjusting insulin doses as needed during the perioperative period (B)</p> Signup and view all the answers

Which of the following is a significant concern for a patient with COPD undergoing general anesthesia?

<p>Increased risk of developing postoperative respiratory failure (C)</p> Signup and view all the answers

Flashcards

Malignant Hyperthermia

A hypermetabolic state triggered by certain anesthetics, leading to rapid rise in body temperature and muscle rigidity.

Pseudocholinesterase Deficiency

A genetic disorder affecting the enzyme that breaks down certain anesthetics, prolonging their effects.

Obesity Comorbidities

Three conditions frequently associated with obesity, such as hypertension, diabetes, and sleep apnea.

OSA Post-Operative Impact

Obstructive Sleep Apnea can complicate post-operative recovery, increasing risks like respiratory failure.

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Airway Exam Components

Elements include assessing jaw movement, teeth alignment, and neck mobility to predict intubation difficulty.

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Mallampati Classification

A system to assess airway by visualizing oropharyngeal structures; higher classes indicate increased difficulty in intubation.

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ASA Classification

A measure of a patient's physical status before anesthesia, ranging from I (healthy) to VI (moribund).

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Pre-Operative Optimization

Actions taken to improve a patient's health and address risk factors before surgery for safer outcomes.

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CPAP/BiPAP Management

Continue CPAP/BiPAP if used at home during surgery management.

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Autonomic Dysfunction in Diabetes

Changes like orthostatic hypotension and hypothermia seen in diabetes.

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Diabetes Pre-operative Management

Take comprehensive history, measure glucose, insulin infusion as needed.

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COPD Physiological Changes

Obstructive lung disease leading to reduced gas transfer and hypoventilation.

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Post-operative Monitoring for Diabetes

Measure glucose frequently to monitor for complications in diabetes patients.

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Complications of Diabetes

Issues like silent myocardial infarction and poor wound healing.

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Chemoreceptor Trigger Zone

Area in the brainstem stimulated, causing nausea from various receptors.

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COPD Post-operative Care

Provide respiratory support and monitor closely to prevent complications.

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Complications of Ventilation

Hemodynamic instability, baro/volutrauma, and ↑ work of breathing during mechanical ventilation.

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Differential Diagnosis (DDx) for Ventilation Issues

Conditions like bronchospasm, pulmonary edema, pneumothorax, or secretions causing respiratory problems.

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Myocardial Ischemia/Infarction

Decreased blood flow to the heart due to CAD or oxygen-demand mismatch leading to ischemia.

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Signs/Symptoms of Myocardial Ischemia

ST elevation or depression, altered heart rate, arrhythmias, new Q waves, new LBBB.

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Complications of Myocardial Ischemia

Cardiogenic shock and cardiac arrest can occur as complications of ischemia or infarction.

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Risk Factors for Myocardial Ischemia

Includes CAD, CHF, surgeries, and significant bleeding which can predispose to ischemia.

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Prevention Strategies for Myocardial Ischemia

Identify at-risk patients, optimize pre-op conditions, and monitor with ECG.

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Management of Myocardial Ischemia/Infarction

Varies by urgency, type of surgery, patient condition; focus on oxygenation and demand reduction.

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Triggers of Pseudocholinesterase Deficiency

Succinylcholine and mivacurium are anesthetics that can trigger symptoms in affected individuals.

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Management of Malignant Hyperthermia

Involves stopping succinylcholine, administering dantrolene, and supportive care.

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Signs of Pseudocholinesterase Deficiency

Prolonged respiratory paralysis and apnea following anesthesia.

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Risk Factors for Malignant Hyperthermia

Family history of MH and symptoms like unexplained fever or muscle weakness.

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Complications of Pseudocholinesterase Deficiency

Includes prolonged mechanical ventilation and potential respiratory failure if extubated early.

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Prevention of Malignant Hyperthermia

Identify at-risk patients and take precautions like removing triggering agents.

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CICO Situation

A scenario where intubation and oxygenation fail, requiring emergency access.

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CICO Rescue

Emergency front-of-neck access initiated in a CICO situation.

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Upper Airway Lifelines

Three methods used to manage airway during emergencies: intubation, ventilation, and supplemental oxygen.

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Green Zone

Area indicating successful alveolar oxygen delivery and opportunity for strategies and resource gathering.

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Spiral Movement Inward

The process of progressing to the next lifeline after unsuccessful attempts to oxygenate.

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Best Effort

Maximum attempts made using airway management techniques before moving to the next option.

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Circumferential Strategy

The approach to manage airways in any order based on clinical judgment.

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Alveolar Oxygen Delivery

Successful transfer of oxygen to the alveoli for effective breathing.

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PONV Risk Factors

Factors increasing the likelihood of post-operative nausea and vomiting (PONV).

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Simplified Apfel Score

A scoring system from 0 to 4 predicting PONV incidence based on risk factors.

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PONV Prophylaxis Drugs

Medications commonly used to prevent post-operative nausea and vomiting.

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Signs of Malignant Hyperthermia

Symptoms indicating the onset of malignant hyperthermia, such as increased ETCO2 and heart rate.

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PONV Preventative Strategies

Approaches to minimize the occurrence of postoperative nausea and vomiting.

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PACU Handover Checklist

Essential information to communicate during post-anesthesia care unit transition.

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Consequences of Malignant Hyperthermia

Severe complications such as hyperthermia, arrhythmias, and potential death.

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Study Notes

Anesthesia: A Clerkship Pocket Guide

  • This is a practical resource for anesthesia clerkship learners
  • It's physically accessible in the OR and hospital
  • The resource covers McMaster core anesthesia clerkship learning objectives and Essential Clinical Encounter (ECE) topics
  • It provides a comprehensive scope of knowledge for integration with other specialties
  • It aims to improve understanding of anesthesia pharmacology
  • The resource is grounded in the McMaster core anesthesia clerkship learning objectives and Essential Clinical Encounters (ECEs)
  • It's meant to be used alongside clerkship rotations, not as a substitute for hands-on experience
  • The resource does not cover the full depth of knowledge required for each topic, providing references instead
  • Variations in practice between different hospitals and physicians are acknowledged
  • Users are encouraged to discuss these variations to promote learning opportunities
  • The resource was supported by WRC Research at the Michael G. DeGroote School of Medicine Waterloo Regional Campus, McMaster University.

Contributors

  • The document includes a list of authors, editors, and reviewers with their affiliations.
  • This section details individuals involved in the creation of the document (e.g., editors and reviewers) indicating their affiliations. (Examples are listed with names, titles, and institutional affiliations.)

Table of Contents

  • Section titles represent the topics covered in the pocket guide (e.g., Pre-operative assessment, Airway management, etc.)
  • Page numbers are provided for each section to easily navigate between topics.
  • The structured organization helps readers quickly locate the desired information about each topic.

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Anesthesia: A Clerkship Pocket Guide (2020-2021) PDF

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