TRIPASS XR تري باس

 

who selflessly pass on their values and knowledge to us

Mian Ahmad, MD

Department of Anesthesiology and Perioperative Medicine, Drexel University College of

Medicine, Philadelphia, Pennsylvania

Sheri M. Berg, MD

Instructor, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts

General Hospital, Boston, Massachusetts

Edward A. Bittner, MD, PhD, FCCP, FCCM

Program Director, Critical Care Medicine-Anesthesiology Fellowship, Associate Director,

Surgical Intensive Care Unit, Assistant Professor of Anaesthesia, Harvard Medical

School, Massachusetts General Hospital, Department of Anesthesia, Critical Care, and

Pain Medicine, Boston, Massachusetts

Yuriy S. Bronshteyn, MD

Surgical Critical Care Fellow, Massachusetts General Hospital, Department of Anesthesia,

Critical Care, and Pain Medicine, Boston, Massachusetts

Thomas M. Halaszynski, DMD, MD, MBA

Associate Professor of Anesthesiology, Director of Regional Anesthesia/Acute Pain

Medicine, Department of Anesthesiology, Yale University School of Medicine, Yale

New Haven Hospital, New Haven, Connecticut

Darrin J. Hyatt, MD

Anesthesia Chief Resident, Department of Anesthesia, Critical Care, and Pain Medicine,

Massachusetts General Hospital, Boston, Massachusetts

Daniel W. Johnson, MD

Assistant Professor, Fellowship Director, Critical Care Anesthesiology, Department of

Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska

Rebecca Kalman, MD

Clinical Instructor in Anesthesia, Massachusetts General Hospital, Boston, Massachusetts

Jean Kwo, MD

Anesthesiologist, Department of Anesthesia, Critical Care, and Pain Medicine,

Massachusetts General Hospital, Assistant Professor of Anaesthesia, Harvard Medical

School, Boston, Massachusetts

Jinlei Li, MD

Assistant Professor of Anesthesiology, Yale University School of Medicine, Yale New

Haven Hospital, New Haven, Connecticut

Dipty Mangla, MD

Staff Anesthesiologist, Cumberland Pain Management, Cumberland, Maryland

Ala Nozari, MD

Assistant Professor, Department of Anesthesia, Critical Care, and Pain Medicine,

Massachusetts General Hospital, Boston, Massachusetts

Thoha M. Pham, MD

Associate Clinical Professor, University of California, San Francisco (UCSF), Department

of Anesthesia and Perioperative Care, San Francisco, California

Manish Purohit, MD

Department of Anesthesiology and Perioperative Medicine, Drexel University College of

Medicine, Philadelphia, Pennsylvania

Paul Sikka, MD, PhD

Department of Anesthesia and Perioperative Medicine, Signature Healthcare Brockton

Hospital, Brockton, Massachusetts, Affiliate of Beth Israel Deaconess Medical Center,

Boston, Massachusetts (Former Faculty—Brigham and Women’s Hospital, Harvard

Medical School)

Ashish C. Sinha, MD, PhD, DABA

Vice Chairman, Anesthesiology & Critical Care, Drexel University College of Medicine,

Hahnemann University Hospital, Philadelphia, Pennsylvania

Preet Mohinder Singh, MD

Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India

David L. Stahl, MD

Clinical Fellow, Department of Anesthesia, Critical Care and Pain Medicine,

Massachusetts General Hospital, Boston, Massachusetts

Deppu Ushakumari, MD

Department of Anesthesiology and Perioperative Medicine, Drexel University College of

Medicine, Philadelphia, Pennsylvania

The practice of anesthesiology requires a solid foundation of knowledge. It is with extreme

pleasure that we introduce Lippincott’s Anesthesia Review: 1,001 Questions and Answers.

The book is designed to rapidly review anesthesiology to help residents pass the written

examinations taken during and after residency. The book is broadly divided into 21

chapters to cover almost all relevant topics tested. Each question is followed by four

possible answers, among which one is the best or most likely answer.

The editors acknowledge the work of all who have given their valuable time and effort

to complete this book. These include all authors, proofreaders (including Shilpa Shah,

MD), and the team at Lippincott Williams & Wilkins. We would also like to thank our

families for their support while we prepared this manuscript.

We hope that this review book proves to be a valuable educational resource for

anesthesia residents and young practitioners to help them pass the boards. For any

constructive suggestions, please contact us by email: Anes1001@outlook.com.

The Editors

Contributors

Preface

1. Perioperative Evaluation and Management

PREET SINGH, MANISH PUROHIT, ASHISH SINHA, AND PAUL SIKKA

2. Airway Management

YURIY BRONSHTEYN AND EDWARD BITTNER

3. Anesthesia Machine

PAUL SIKKA

4. Patient Monitoring

DARREN HYATT, ALA NOZARI, AND EDWARD BITTNER

5. Fluid Management and Blood Transfusion

REBECCA KALMAN AND EDWARD BITTNER

6. Anesthetic Pharmacology

MIAN AHMAD AND ASHISH SINHA

7. Spinal and Epidural Anesthesia

THOMAS HALASZYNSKI

8. Peripheral Nerve Blocks

THOMAS HALASZYNSKI

9. Pain Management

THOMAS HALASZYNSKI

10. Orthopedic Anesthesia

THOMAS HALASZYNSKI

11. Cardiovascular Anesthesia

DEPPU USHAKUMARI AND ASHISH SINHA

12. Thoracic Anesthesia

DEPPU USHAKUMARI AND ASHISH SINHA

13. Neuroanesthesia

DIPTY MANGLA AND ASHISH SINHA

14. Gastrointestinal, Liver, and Renal Diseases

THOHA PHAM

15. Endocrine Diseases

JEAN KWO AND EDWARD BITTNER

16. Ophthalmic, Ear, Nose, and Throat Surgery

THOHA PHAM

17. Obstetric Anesthesia

THOHA PHAM

18. Pediatric Anesthesia

DIPTY MANGLA AND ASHISH SINHA

19. Critical Care

DAVID STAHL, DANIEL JOHNSON, AND EDWARD BITTNER

20. Postoperative Anesthesia Care

SHERI BERG AND EDWARD BITTNER

21. Miscellaneous Topics

PAUL SIKKA AND THOMAS HALASZYNSKI

Perioperative Evaluation and Management

Preet Singh, Manish Purohit, Ashish Sinha, and Paul Sikka

1. Preoperative application of scopolamine patch to prevent postoperative nausea and

vomiting should be avoided in

A. Female, 35 years old

B. Smoker, 20 years old

C. Patient with a blood pressure of 160/96 mm Hg

D. Male, 70 years old

2. Which of the following drugs is least likely to be effective for prophylaxis for

postoperative nausea and vomiting?

A. Ondansetron

B. Scopolamine patch

C. Aprepitant

D. Metoclopramide

3. Famotidine, when used for stress ulcer prophylaxis, must be avoided preoperatively

in which of the following patients?

A. Patients with replaced mitral valve on warfarin

B. Patients with idiopathic thrombocytopenic purpura (ITP) for splenectomy

C. Patients with achalasia cardia for esophageal myotomy

D. Patients with a history of coronary stenting on aspirin

4. Which of the following drugs antagonizes substance P in the central nervous system

and is used as premedication to prevent postoperative nausea and vomiting?

A. Palonosetron

B. Aprepitant

C. Metoclopramide

D. Prochlorperazine

5. Which of the following predictors is likely to be associated with lower incidence of

perioperative nausea and vomiting?

A. Female gender

B. Use of fentanyl for pain relief

C. Patients with a history of smoking

D. Patients undergoing laparoscopic surgery

6. All of the following have an antiemetic action, except

A. Promethazine

B. Propofol

C. Etomidate

D. Haloperidol

7. Cefazolin, as a component of perioperative antimicrobial prophylaxis for surgery,

must begin within what time before incision?

A. Simultaneously with incision

B. Within 30 minutes prior to incision

C. Within 60 minutes prior to incision

D. Within 120 minutes prior to incision

8. Vancomycin, as a component of perioperative antimicrobial prophylaxis for surgery,

must begin within what time before incision?

A. Simultaneously with incision

B. Within 30 minutes prior to incision

C. Within 60 minutes prior to incision

D. Within 120 minutes prior to incision

9. A 65-year-old male with a history of hypertension and diabetes presents to

emergency department with altered sensation with a likely subdural hematoma. To

assess his cardiorespiratory status, he is asked about his level of physical activity. If

he is capable of performing at least which of the following activities independently,

he is less likely to have significant cardiopulmonary ailment during surgery?

A. Walk to washroom on level floor

B. Play the accordion

C. Walk one block

D. Climb a flight of stairs

10. In preoperative assessment of patients, physical activity is graded in terms of

metabolic equivalents (METs). The value that corresponds to oxygen consumption

of 1 MET in an adult is

A. 2 mL/kg/min

B. 7 mL/kg/min

C. 3.5 mL/kg/min

D. 5.5 mL/kg/min

11. As per American Society of Regional Anesthesia (ASRA) guidelines, intravenous

infusion of unfractionated heparin should be stopped how long prior to a planned

epidural?

A. 1 to 1.5 hours

B. 2 to 4 hours

C. at least 12 hours

D. at least 24 hours

12. For emergent surgery, anticoagulation produced by warfarin can be reversed by

using

A. Fresh-frozen plasma (FFP)

B. Injectable vitamin K

C. Prothrombin complex concentrate

D. Factor VIII concentrate

13. Neuraxial block is not contraindicated for patients on which of the following drugs?

A. Warfarin

B. Low-molecular-weight heparin

C. Aspirin

D. Clopidogrel

14. All of the following are risk factors for obstructive sleep apnea, except

A. Obesity

B. Short neck

C. Enlarged tonsils

D. Female gender

15. A 70-year-old male, who is diabetic for the last 20 years, is scheduled for an

elective surgery. Which of the following is not a sign of autonomic diabetic

neuropathy?

A. History of recurrent diarrhea

B. History of postural hypotension

C. History of recurrent constipation

D. History of urinary retention

16. Which of the following perioperative factors in patients undergoing dialysis prior to

surgery predicts the possibility of hypotension (due to increased volume removed)?

A. Change in serum sodium

B. Change in body weight

C. Change in serum potassium

D. Change in pH after dialysis

17. A patient with a history of severe asthma is scheduled for an appendectomy. Which

of the following induction agents will cause the least respiratory depression?

A. Ketamine

B. Propofol

C. Etomidate

D. Thiopental

18. Which of the following drugs can significantly prolong the QT interval on the ECG?

A. Dexamethasone

B. Droperidol

C. Aprepitant

D. Glycopyrrolate

19. Which of the following tests is used to confirm coagulation after stopping lowmolecular-weight heparin (LMWH)?

A. PT

B. aPTT

C. ACT

D. None of the above

20. Effect of combined administration of midazolam and fentanyl is

A. Additive

B. Synergistic

C. Competitively antagonistic

D. Noncompetitively antagonistic

21. Preoperative anesthetic evaluation is likely to bring down the incidence of all the

following, except

A. Case cancellations

B. Patient morbidity

C. Preoperative anxiety

D. Direct procedural costs

22. For elective procedures, an anesthesia provider must obtain informed and preferably

written consent

A. Just prior to transferring the patient to the operating room for surgery

B. During preoperative anesthetic evaluation

C. At the same time that a surgeon obtains consent for the surgical procedure

D. Just prior to induction of anesthesia in the operating room

23. An optimal preoperative evaluation is designed

A. To screen for and properly manage comorbid conditions

B. To assess the risk of anesthesia and surgery and lower it

C. To identify patients who may require special anesthetic techniques or

postoperative care

D. All the above

24. ASA classification for risk stratification is validated for predicting preoperative

morbidity associated with the following, except

A. General or regional anesthesia

B. Conscious sedation

C. Monitored anesthesia care

D. Surgical procedure

25. A healthy pregnant patient in labor has which of the following ASA classifications?

A. I

B. II

C. III

D. IV