Lippincott's Anesthesia Review: 1001 Questions and Answers

218 Pages·2015·6.21 MB·English

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Lippincott’s
ANESTHESIA
REVIEW:
1,001
QUESTIONS AND ANSWERS
Lippincott’s
ANESTHESIA
REVIEW:
1,001
QUESTIONS AND ANSWERS
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)
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
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
Thoha M. Pham, MD
Associate Clinical Professor, University
of California, San Francisco (UCSF),
Department of Anesthesia and
Perioperative Care, San Francisco, California
Ashish C. Sinha, MD, PhD, DABA
Vice Chairman, Anesthesiology &
Critical Care, Drexel University College
of Medicine, Hahnemann University
Hospital, Philadelphia, Pennsylvania
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9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Sikka, Paul, author.
Lippincott’s anesthesia review : 1001 questions and answers / Paul Sikka, Edward Bittner, Thomas Halaszynski, Thoha Pham, Ashish Sinha.
p. ; cm.
Anesthesia review
E-ISBN: 978-1-4698-3101-5
I. Bittner, Edward A., 1967- author. II. Halaszynski, Thomas, author. III. Pham, Thoha, author. IV. Sinha, Ashish, author. V. Title. VI. Title: Anesthesia review.
[DNLM: 1. Anesthesia--Examination Questions. 2. Anesthetics—Examination Questions. WO 218.2]
RD82.3
617.9'6076—dc23
2014019574
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currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age,
weight, gender, current or prior medical conditions, medication history, laboratory data, and other factors unique to the patient. The publisher does not provide medical
advice or guidance, and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work, including all
medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate
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“Dedicated to our Parents and Teachers”
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: [email protected].
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?