Anesthesia Machines Quiz! MCQ Trivia

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Anesthesia Machines Quiz! MCQ Trivia - Quiz

Anaesthesia machines quiz MCQ trivia! These machines are also called the anaesthesia workstations and borrow from the foundations made by Henry Boyle. These machines have the ability to induce sleep where a patient or animal will not feel any pain as they undergo surgical procedures. How good are you when it comes to using these machines on patients and solving some of the issues they have? This quiz will help you find out!


Questions and Answers
  • 1. 

    According to the ASA 2008 Recommendations, which of the following machine checks should be completed before each case?

    • A.

      Test scavenging system function

    • B.

      Verify that there are no leaks in the gas supply lines between the flowmeters and the common gas outlet

    • C.

      Verify that patient suction is adequate to clear the airway

    • D.

      Calibrate the oxygen monitor and check the low oxygen alarm

    Correct Answer
    C. Verify that patient suction is adequate to clear the airway
    Explanation
    Of the 15 standard machine checks, the ASA 2008 guidelines advise for all 15 at the start of the day and then only 8 before each case. Here is the list of tests to be completed before each procedure:

    1. Verify that patient suction is adequate to clear the airway
    2. Verify the availability of required monitors including alarms
    3. Verify that vaporizers are adequately filled and if applicable that the filler ports are tightly closed
    4. Verify that the CO2 absorbent is not exhausted
    5. Perform breathing system pressure/leak testing
    6. Verify that gas flows properly through the breathing circuit during both inspiration and expiration
    7. Document completion of checkout procedures
    8. Confirm ventilator settings and evaluate readiness to deliver anesthesia care

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  • 2. 

    The device on anesthesia machines that most reliably detects delivery of hypoxic gas mixtures is which of the following?

    • A.

      Fail-safe valve

    • B.

      O2 analyzer

    • C.

      Gas rotamers

    • D.

      Disconnection alarm

    • E.

      Diameter index safety system

    Correct Answer
    B. O2 analyzer
    Explanation
    The worst thing an anesthesia machine can do is deliver a hypoxic gas mixture to the patient, so there are multiple checks to prevent this from happening--including the rotamers, disconnection alarm, and of course the O2 analyzer. The O2 analyzer is on the inspiratory limb of the breathing circuit immediately before the gas goes to the patient, which makes it the last line of defense against a hypoxic mixture.

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  • 3. 

    An incompetent pressure relief valve will result in which of the following?

    • A.

      Hypoxia

    • B.

      Barotrauma

    • C.

      Hypoventilation

    • D.

      Hyperventilation

    • E.

      A low-circuit pressure signal

    Correct Answer
    C. Hypoventilation
    Explanation
    The pressure-relief valve (also known as the pop-off valve or the APL -- Adjustable Pressure Limiting valve) is designed to release gas when the system pressure exceeds a certain threshold. When this valve fails, pressure builds within the system as new gas enters each time the machine gives the patient breath. This new gas will fill the areas of lowest pressure first, so some of the tidal volumes is diverted from the patient into the reservoir bag as it requires lower force to expand than the patient’s lungs.

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  • 4. 

    The most frequent cause of mechanical failure to deliver adequate FiO2 is which of the following?

    • A.

      Attachment of the wrong compression gas cylinder to the O2 yoke

    • B.

      Crossing the pipelines during daily set-up

    • C.

      Malfunctioning rotamer

    • D.

      Fresh gas line disconnection from the machine to the hospital supply

    • E.

      Disconnection of the O2 supply system from the patient

    Correct Answer
    E. Disconnection of the O2 supply system from the patient
    Explanation
    Failure to oxygenate patients is a leading cause of morbidity in the OR. All of the answer choices can lead to hypoxic gas mixtures being delivered to the patient, but there are many systems in place such as the Diameter Index Safety System to prevent incorrect attachment of gas lines (choices A and B). The most common cause by far is an accidental disconnection between the anesthetic machine and the patient.

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  • 5. 

    Which of the following explains the monitor reading seen here?

    • A.

      Incompetent inspiratory valve

    • B.

      Incompetent expiratory valve

    • C.

      Incompetent pop off valve

    • D.

      Breathing circuit air leak

    • E.

      Exhausted CO2 absorbent

    • F.

      More than one of the above

    • G.

      More than two of the above

    • H.

      None of the above

    Correct Answer
    F. More than one of the above
    Explanation
    The capnograph portion of the monitor shows that this patient’s CO2 is above 0 mmHg even after expiration. The easiest way this can happen is when the CO2 absorbent is exhausted because exhaled CO2 will be able to return to the inspiratory limb of the breathing circuit. This can be corrected by replacing the soda-lime or increasing the gas flow. CO2 is also elevated when there is an incompetent expiratory valve. The expiratory valve is supposed to prevent expired air from passing back to the patient, so if it is broken, the patient’s own previously exhaled CO2 will cause the reading seen on the monitor here.

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  • 6. 

    Which of the following medical gases is matched incorrectly with the standard color of its holding canister?

    • A.

      Air : Yellow

    • B.

      Oxygen : Green

    • C.

      Carbon Dioxide : Orange

    • D.

      Nitrous Oxide : Blue

    • E.

      Nitrogen : Black

    Correct Answer
    C. Carbon Dioxide : Orange
    Explanation
     

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  • 7. 

    Which of the following values (in PSI) corresponds with the pressure inside a standard Oxygen canister at 100%, 50%, and 25% volume respectively?

    • A.

      4000, 4000, 4000

    • B.

      4000, 2000, 1000

    • C.

      2200, 2200, 2200

    • D.

      2200, 1100, 550

    Correct Answer
    D. 2200, 1100, 550
    Explanation
    Oxygen is stored as a gas under high pressure within the cylinder, so as the gas is released, the pressure within the container decreases proportionally. This is an example of Boyle's Law.

    Medical Gas Supply, Ch 1, available at: 
    http://elsevierhealth.com/media/us/samplechapters/9780443100871/9780443100871.pdf

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  • 8. 

    Which of the following values (in PSI) corresponds with the pressure inside a standard nitrous oxide canister at 100%, 50%, and 25% volume respectively?

    • A.

      2200, 2200, 2200

    • B.

      2200, 1100, 550

    • C.

      745, 745, 745

    • D.

      745, 373, 187

    Correct Answer
    C. 745, 745, 745
    Explanation
    Because nitrous oxide is stored as a liquid, the pressure within the canister is the same until all of the gas is used. Like any liquid, N2O exists in equilibrium between liquid and gas within the container. Whenever any of the gas is released to the patient, the momentary drop in pressure from the container gas on the liquid allows more of the liquid N2O molecules to escape into the gaseous state. This is why the pressure gauge is not the way to check how much gas is left as it should always be 745 PSI. N2O volume remaining is checked by weight-- a full canister weighs 8kg, and an empty one weighs 6kg.
     

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  • 9. 

    As the surgeon is closing from a laparotomy for small bowel obstruction, the hospital central oxygen line stops working, and the size E oxygen cylinder comes on automatically.  The pressure gauge says 550 psi.  If the patient requires 4L by nasal cannula, how long will the canister last?

    • A.

      36 minutes

    • B.

      42 minutes

    • C.

      58 minutes

    • D.

      67 minutes

    • E.

      > 75 minutes

    Correct Answer
    B. 42 minutes
    Explanation
    A full-size E oxygen cylinder contains 680L O2 at 2200 psi, and as it is stored as a gas, the pressure decreases proportionally as the volume is released. The pressure here is 550, which is 25% of the original, so the volume must also be 25% of the starting value. 680 / 4 = 170 L still in the canister. 170 / 4L per minute = 42.5 minutes.

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  • 10. 

    A healthy 25 yo M is in sitting position for an open craniotomy under general anesthesia when his ETCO2 and HR suddenly drop significantly. Rank the following from most sensitive to least in diagnosing this patient's most likely problem: 1. Increased HR 2. Decreased CVP 3. Transesophageal Echo 4. Pre-cordial doppler 5. Decreased ET-CO2

    • A.

      3, 4, 2, 1, 5

    • B.

      4, 3, 5, 2, 1

    • C.

      4, 3, 5, 2, 1

    • D.

      3, 4, 5, 2, 1

    Correct Answer
    D. 3, 4, 5, 2, 1
    Explanation
    As he is in a sitting position and having a craniotomy, this patient is already at high risk for a venous air embolism (VAE), and his drop in HR and ETCO2 is consistent with this diagnosis.  While a large amount of air is required most often (5ml/kg in some studies), there are case reports of VAE with as little as 20ml air.  The amount of air required is thought to be a function of the procedure, the speed of air injection, and the position of the patient.

    Transesophageal echo is most sensitive in detecting VAE followed by pre-cordial doppler.  Both of these methods detect VAE before there are any physiologic changes.  Decreased ET-CO2 and PAP can detect VAE when symptoms are still modest.  Decreased CVP and CO are able to detect larger emboli.  SIgns of catastrophic VAE are EKG changes (either bradyarrhythmia or ventricular fibrillation), cardiovascular collapse, and "Millwheel" murmur.

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  • 11. 

    A 26 yo F with no PMHx is getting a rhinoplasty.  As the surgeon is using the bovie, flames start shooting out of the ET tube.  Which of the following is the best next step?

    • A.

      Disconnect the ET tube

    • B.

      Extubate the patient

    • C.

      Cover the area with water

    • D.

      Use the fire extinguisher

    Correct Answer
    A. Disconnect the ET tube
    Explanation
    OR fires can only happen when the triad of ignition source, fuel, and oxidizer all come together. In this case, the source is the bovie, the fuel is the patient's skin, and the oxidizer is the O2 she is breathing.  Stopping the fire is as simple as removing one part of the triad, so disconnecting the ET tube here will take away the fire's oxygen supply and it should go out immediately.  The patient should then be extubated and the airway inspected by bronchoscopy.
     

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  • 12. 

    What is the end product of the reaction of soda-lime with CO2?

    • A.

      CaCO3 + H2O

    • B.

      NaHCO3 + H2O

    • C.

      NaCO3 + H2O

    • D.

      None of the above

    Correct Answer
    A. CaCO3 + H2O
    Explanation
    Think of soda-lime as a base that combines with CO2 to produce CaCO3 and water with some heat. It is made of: 75% Ca(OH)2, 20% water, 3% NaOH, and 1% KOH. The mechanism of the reaction is:

    1) CO2 + H2O → CO2 (aq) (CO2 dissolves in water - slow and rate-determining)
    2) CO2 (aq) + NaOH → NaHCO3 (bicarbonate formation at high pH)
    3) NaHCO3 + Ca(OH)2 → CaCO3 + H2O + NaOH

    The NaOH and KOH are catalysts as they cancel in the final equation.  Now it makes sense that the soda lime is spent when too much water is in the canister. 

     

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  • 13. 

    A patient in Denver is going to have an exploratory laparotomy with sevoflurane.  When compared to a patient at sea level with the same setting on the vaporizer, what are the changes in the percentage of sevoflurane delivered as well as the sevoflurane partial pressure in the gas mixture?

    • A.

      Percent sevoflurane delivered will increase, partial pressure of sevoflurane will also increase

    • B.

      Percent sevoflurane delivered will increase, parial pressure of sevoflurane will remain the same

    • C.

      Percent sevoflurane delivered will remain the same, partial pressure of sevoflurane will also remain the same

    • D.

      Percent sevoflurane delivered will decrease, and partial pressure of sevoflurane will also decrease

    • E.

      None of the abobe

    Correct Answer
    B. Percent sevoflurane delivered will increase, parial pressure of sevoflurane will remain the same
    Explanation
    Studies of volatile agents at increased altitudes show that while a higher percentage of gas is delivered, the partial pressure remains roughly the same.

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  • 14. 

    The presence of a bubble in the tubing between the transducer and catheter of an arterial line is which of the following: 

    • A.

      Not significant

    • B.

      Leads to an artificially high reading

    • C.

      Leads to a damping of the tracing

    • D.

      Has the greatest effect on the mean blood pressure

    • E.

      Has a greater effect on the mean blood pressure

    Correct Answer
    C. Leads to a damping of the tracing
    Explanation
    An arterial line works by using a fluid column to transfer subtle differences in pressure from the patient's circulation to a transducer. Bubbles--even small bubbles-- can interrupt the transferring of these waves and result in a damping of the tracing. Both systolic and diastolic will be effected.

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  • 15. 

    Which of the following will increase the damping of an arterial line?

    • A.

      Air bubbles between the catheter and transducer

    • B.

      A kink in the tubing between the catheter and the transducer

    • C.

      A blood clot within the catheter

    • D.

      Using soft tubing

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    An arterial line works by transferring the patient's pulse pressure through a fluid column against a transducer, which converts the force it feels into a blood pressure tracing.  If the patient's pulse pressure is removed, there is a short time during which the system will still register pressure.  This concept is called "damping," and the mathematical model for how long the signal lingers is called the "damping coefficient."

    Anything that extinguishes the vibration of the pulse pressure within the tubing will increase the damping coefficient.  This includes air bubbles, blood clots, kinks in the line, soft tubing, and an extended line.

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  • 16. 

    A radial arterial line is zeroed with the transducer level to a position 12 cm posterior to the patient's sternal border.  While positioning the patient, the arm with the arterial line is elevated, and the catheter rests 10cm above the transducer.  The blood pressure currently is measured as 130 / 72.  Which of the following is the actual blood pressure?

    • A.

      118 / 60

    • B.

      130 / 72

    • C.

      142 / 84

    • D.

      142 / 72

    • E.

      130 / 84

    Correct Answer
    A. 118 / 60
    Explanation
    An arterial line works by transferring pressure from the catheter through a fluid-filled tube and against a transducer that can convert the force into a tracing.  When the catheter is elevated as in this case, a fluid column forms that push on the transducer and create a higher value than is actually present in the patient.

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  • 17. 

    Which of the following breathing systems is most efficient for a patient with spontaneous ventilation?

    • A.

      Mapleson A

    • B.

      Mapleson B

    • C.

      Mapleson C

    • D.

      Mapleson D

    • E.

      Mapleson E

    • F.

      Bain Circuit

    Correct Answer
    A. Mapleson A
    Explanation
    A Mapleson A circuit has a pressure valve near the patient, which means that when the patient exhales, alveolar gas leaves the system.  As a result, only a minimum of fresh gas flow is required.

    Kaul TK, Mittal G. Mapleson's breathing systems. Indian J Anesthesia, 2013 [cited 2014 Feb 17];57:507-15. Available from: http://www.ijaweb.org/text.asp?2013/57/5/507/120148

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  • 18. 

    Which of the following breathing systems is most efficient for a patient with controlled ventilation?

    • A.

      Mapleson A

    • B.

      Mapleson B

    • C.

      Mapleson C

    • D.

      Mapleson D

    • E.

      Mapleson E

    • F.

      Bain Modification

    Correct Answer
    D. Mapleson D
    Explanation
    The Mapleson D circuit places the fresh gas flow next to the patient and a pressure valve near the ventilator.  This means that excess pressure generated by the ventilator will be released by the valve and the patient will receive the gas flow.



    Kaul TK, Mittal G. Mapleson's breathing systems. Indian J Anesthesia, 2013 [cited 2014 Feb 17];57:507-15. Available from: http://www.ijaweb.org/text.asp?2013/57/5/507/120148

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