Pharmacology Of Anesthesia Quiz: Exam!
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- 1.Which of the following is not at an increased risk for Malignant Hyperthermia?
- A.
Patient with Muscular Dystrophy
- B.
Patient who is immunosuppressed
- C.
Patient who had a heat stroke last year while playing outdoors
- D.
Patients whose mother has MH.
- 2.The non-barbituate agents have short duration of action mainly due to…
- A.
Redistribution
- B.
Metabolism
- C.
Low lipid solubility
- D.
Low potency
- 3.What is an appropriate intubating dose of Atracurium?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 4.What would be an appropriate starting dose of dantrolene to give to a 2 yr old child weighing 14 kg?
- A.
14 mg
- B.
140 mg
- C.
35 mg
- D.
280 mg
- 5.Which of the non-barbituate agents is unique due to the fact it has no stereoisomers?
- A.
Etomidate
- B.
Propofol
- C.
Ketamine
- D.
Thiopental
- 6.You are the SRNA for a 12 yr old male who is 5’0” and weighs 45 kg. What would be an appropriate intubating dose of vecuronium?
- A.
45 mg
- B.
4.5 mg
- C.
54 mg
- D.
9 mg
- E.
22.5 mg
- 7.It is perfectly safe to use regional anesthetics on malignant hyperthermia susceptible patients.
- A.
True
- B.
False
- 8.What is the purpose of giving lidocaine prior to administration of propofol?
- A.
To make the propofol slightly more acidic
- B.
To prevent allergic reaction to egg lecithin
- C.
To prevent burning upon injection
- D.
To decrease ability of bacteria to grow in propofol
- 9.What is the maximum dose of Dantrolene which can be given to a 10 yr old child weighing 30 kg?
- A.
75 mg
- B.
300 mg
- C.
600 mg
- D.
30 mg
- 10.You are the SRNA for a 58 yr old female having open heart surgery. She is 5’4” and 70 kg. What would be an appropriate intubating dose of pancuronium?
- A.
7 mg
- B.
105 mg
- C.
84 mg
- D.
14 mg
- E.
35 mg
- 11.Which of the following patients should NOT receive propofol? PICK TWO
- A.
72 yr old male, allergy to egg whites
- B.
89 yr old male, severe CV shock, EF 10%
- C.
45 yr old male, allergy to sulfites
- D.
8 yr old male with history of asthma
- 12.What test could be done on a patient suspected to have MH?
- A.
DNA Hyperthermia test
- B.
Succinylcholine challenge test
- C.
There are no tests available.
- D.
Caffeine Halothane Test
- 13.You are caring for a 60 yr old male going in for removal of abdominal mass. He is 6’0” and 90 kg, what would be an appropriate intubating dose of succinylcholine?
- A.
135 mg
- B.
9 mg
- C.
81 mg
- D.
18 mg
- E.
45 mg
- 14.You were a very good SRNA this morning and drew up all your drugs, including the propofol, at 6:15 am. At the last minute your first case of the day was cancelled and you did not get another case until 1:30 pm. Can you still use your propofol on this patient?
- A.
No, too much time has passed
- B.
Yes, but only if you remembered to refrigerate the propofol.
- C.
Yes, propofol is good for 12 hours after opening.
- 15.Dantrolene should be continued for ____ Hours post MH episode.
- A.
24
- B.
12
- C.
48
- D.
6
- 16.Which of the following agents has the highest degree of protein binding?
- A.
Etomidate
- B.
Propofol
- C.
Ketamine
- D.
All have similar protein binding
- 17.You are the SRNA for a 75 yr old female going in for a bowel resection. She is 5’2” and 50 kg. What would be an appropriate intubating dose of Rocuronium?
- A.
75 mg
- B.
5 mg
- C.
30 mg
- D.
10 mg
- E.
90 mg
- 18.What is the name of the receptor that is responsible for MH?
- A.
Ranitidine
- B.
Ryanodine
- C.
Cyanide
- D.
Muscarinic
- 19.Propofol is metabolized extensively in the liver, as well as in the lungs and other sites. How will hepatic disease affect the half life of Propofol?
- A.
Effects can be prolonged
- B.
Decrease the half life
- C.
Contraindicated in liver disease
- 20.What is an appropriate intubating dose of Nimbex for a 50 yr old 5’11” male weighing 110 kg?
- A.
165 mg
- B.
11 mg
- C.
100 mg
- D.
22 mg
- E.
55 mg
- 21.Hyperthermia is an early sign of MH.
- A.
True
- B.
False
- 22.You are caring for a 82 yr old woman who is about to be induced for surgery. You plan to use propofol for your induction and would plan that….
- A.
You would reduce your dose by 25-50%
- B.
With no prior medical history you could use the standard dosage of propofol
- C.
You would increase your dose by 25-50%
- 23.How much can your temperature increase every 5 minutes in MH? (pick best answer)
- A.
1 degree C
- B.
1-2 degrees C
- C.
0.5-1 degree C
- D.
0.1 degree C
- 24.What would be an appropriate intubating dose of Atracurium for a 5’1” 48 yr old female weight 60 kg?
- A.
90 mg
- B.
6 mg
- C.
70 mg
- D.
12 mg
- E.
30 mg
- 25.What is an appropriate induction dose of propofol for a 50 yr old male who is 5’10” and weighs 80 kg?
- A.
80 mg
- B.
160 mg
- C.
16 mg
- D.
400 mg
- 26.What class of medications is contraindicated in MH?
- A.
Calcium Channel blockers
- B.
Beta Blockers
- C.
Calcium gluconate
- D.
NSAIDS
- 27.You are the SRNA for a patient with a known pseudocholinesterase deficiency who needs a rapid sequence induction due to past medical history of GERD which is poorly controlled. The patient weighs 80 kg. What medication would you choose for this induction?
- A.
Rocuronium 90 mg
- B.
Succinylcholine 120 mg
- C.
Mivacurium 20 mg
- D.
Rapid sequence can not be done on this patient without prolonged effect of muscle relaxant.
- 28.What be an appropriate induction dose of propofol for a 75 yr old female who is 5’4” and weighs 75 kg? (Be careful here…)
- A.
150 mg
- B.
225 mg
- C.
75 mg
- D.
15 mg
- 29.You suspect your patient has MH, what do you expect to see on their ABG?
- A.
CO2 42, BE +3, Ph 7.34
- B.
CO2 62, BE 0, Ph 7.60
- C.
CO2 65, BE -10, Ph 7.43
- D.
CO2 32, BE -9, Ph 7.18
- E.
CO2 61, BE -11, Ph 7.20
- 30.What is the recommended dose of propofol for maintenance of anesthesia?
- A.
1.5-2.5 mg/kg
- B.
3-5 mg/kg
- C.
25-100 mcg/kg/min
- D.
100-300 mcg/kg/min
- 31.Pre-treatment with a non-depolarizer may help to lessen all side effects from succinylcholine except:
- A.
Arrythmias
- B.
Hyperkalemia
- C.
Myalgia
- D.
Elevated Intraocular Pressure
- 32.The MH gene is passed via:
- A.
Autosomal dominant gene
- B.
Autosomal recessive gene
- 33.What is an appropriate dose of propofol sedation during a MAC case?
- A.
25-100 mcg/kg/min
- B.
1.5-2.5 mg/kg
- C.
100-300 mcg/kg/min
- D.
3-5 mg/kg
- 34.Regaining 4/4 twitches after administration of a non-depolarizing muscle relaxant means that you no longer need to administer a reversal agent.
- A.
True
- B.
False
- 35.In a patient with MH, what would you expect their serum myoglobin to be?
- A.
> 100 mg
- B.
> 170 mcg
- C.
> 180 mg
- D.
>2200 mcg
- 36.At what percentage of blockade by non-depolarizing muscle relaxants would you achieve surgical relaxation?
- A.
99%
- B.
75%
- C.
90%
- D.
60%
- 37.You have a patient in the PACU who has been receiving morphine and is now itching from the pain medications. What might you give to help relieve the itching?
- A.
Ketamine 0.2 mg/kg
- B.
Propofol 10 mg
- C.
Etomidate 0.1 mg/kg
- D.
Propofol 50 mg
- 38.What is the most important clinical s/s that would lead you to suspect MH?
- A.
Increased temperature
- B.
Increased ETCO2
- C.
Hypoxia
- D.
Muscle rigidity
- E.
Increased HR
- 39.Which of the following muscle relaxants would you choose to give to a patient having cardiac surgery in order to counteract the bradycardia caused by narcotics?
- A.
Succinylcholine
- B.
Rocuronium
- C.
Mivacurium
- D.
Pancuronium
- 40.How is Etomidate metabolized?
- A.
By pseudocholinesterase
- B.
By the kidneys
- C.
By hepatic microsomal enzymes
- D.
Via exhalation through the lungs
- 41.What are the common side effects of Dantrolene?
- A.
Muscle weakness including difficulty swallowing or choking
- B.
Pulmonary edema
- C.
Anaphylaxis
- D.
Rhabdomyolysis
- E.
All of the above
- 42.Which of the following muscle relaxants allows you to skip use of a reversal agent?
- A.
Mivacurium
- B.
Vecuronium
- C.
Pancuronium
- D.
Rocuronium
- 43.For which patient would it be inappropriate to use Etomidate? PICK TWO
- A.
20 yr old asthmatic
- B.
60 yr old SZ disorder
- C.
30 yr old having eye globe surgery
- D.
40 yr old who requires long term infusion.
- 44.Which of the following muscle relaxing agents would be BEST to give to a patient in multi-system organ failure?
- A.
Succinylcholine
- B.
Mivacurium
- C.
Vecuronium
- D.
Rocuronium
- 45.What is the half life of Dantrolene?
- A.
1 hour
- B.
6 hours
- C.
30 minutes
- D.
2 hours
- 46.What would be an appropriate induction dose of etomidate for a 58 yr old female who is 5’6” and weighs 90 kg?
- A.
18 mg
- B.
180 mg
- C.
45 mg
- D.
90 mg
- 47.Which of the following agents is eliminated via Hoffman Elimination?
- A.
Mivacurium
- B.
Pancuronium
- C.
Atracurium
- D.
Rocuronium
- 48.Which drugs are potentiated by dantrolene?
- A.
Neuromuscular blockers like vecuronium
- B.
NSAIDS like ketoralac
- C.
Steroids like prednisone
- D.
Beta blockers like esmolol
- 49.What is the half life of etomidate?
- A.
2-5 hours
- B.
30-90 minutes
- C.
5-10 hours
- D.
10-20 minutes
- 50.Which of the following has the longest duration of effect?
- A.
Nimbex
- B.
Vecuronium
- C.
Succinylcholine
- D.
Pancuronium
- 51.The majority of incidences of MH occur in patients under 15.
- A.
True
- B.
False
- 52.Which of the following non-barbituate agents do we use as a racemic mixture?
- A.
Etomidate
- B.
Propofol
- C.
Ketamine
- D.
Thiopental
- 53.If you give your pt an intubating dose of succynocholine and they have a MH reaction, what type of muscle rigidity can you see prior to actually intubating the patient?
- A.
Masseter
- B.
Chest wall
- C.
Diaphragm
- D.
Bicep
- 54.which of the following has the shortest duration of action?
- A.
Vecuronium
- B.
Rocuronium
- C.
Pancuronium
- D.
Succinylcholine
- 55.Which of the non-barbituate agents has the lowest amount of protein binding & works on NMDA receptors?
- A.
Propofol
- B.
Ketamine
- C.
Etomidate
- D.
Thiopental
- 56.MH affects which types of muscles? (Check all that apply)
- A.
Smooth
- B.
Cardiac
- C.
Skeletal
- 57.Which agents is known for its HIGH degree of individual variability?
- A.
Rocuronium
- B.
Nimbex
- C.
Vecuronium
- D.
Succinylcholine
- 58.Which isomer of ketamine is known to cause delirium and combatance on emergence?
- A.
Both isomers can cause this.
- B.
Neither isomer can cause this
- C.
S isomer
- D.
R isomer
- 59.You have diagnosed your patient with MH and have found their serum K+ to be 6.8. How can you treat this? (More than one answer)
- A.
IV Kayexalate
- B.
Hyperventilation
- C.
IV Insulin/ D50
- D.
Calcium chloride or gluconate
- 60.For a patient who is borderline tachycardic it is recommended to administer neostigmine without glycopyrolate.
- A.
True
- B.
False
- 61.What would be a proper IV induction dose for ketamine on a patient who is 5’9” and 80 kg?
- A.
120 mg
- B.
40 mg
- C.
240 mg
- D.
200 mg
- 62.You can safely administer glycopyrolate without a cholinesterase inhibitor.
- A.
True
- B.
False
- 63.http://www.youtube.com/watch?v=c1JzCDqt3BM
- A.
Love it
- B.
Now I have that song stuck in my head....
- C.
All of the above.
- 64.What would be a proper dose of ketamine to give to a patient who is having pain and weighs 50 kg?
- A.
100 mg
- B.
25 mg
- C.
150 mg
- D.
50 mg
- 65.When can your reversal agents be administered?
- A.
When you have 0/4 twitches
- B.
When you have at least 1 /4 twitches
- C.
You must have 4/4 twitches prior to administration
- D.
After your anesthetic agent has been turned off.
- 66.The chemical structure of this drug is 2,6-diisopropylphenol.
- A.
Etomidate
- B.
Ketamine
- C.
Propofol
- 67.Which of the non-barbituate agents has analgesic properties?
- A.
Ketamine
- B.
Etomidate
- C.
Propofol
- D.
Thiopental
- 68.Which of the following is true regarding systemic effects of cholinesterase inhibitors? (more than one answer)
- A.
Decrease heart rate
- B.
Cause bronchodilation
- C.
Increase peristalsis
- D.
Pupillary Dilation
- 69.A patient with a sulfite allergy should not be given the generic propofol because of the metabisulfite preservative in it, but it is ok to give Diprovan.
- A.
True
- B.
False
- 70.The mixing of Lidocaine w/ Propofol may result in coalescence of oil droplets which may pose risk of pulmonary embolism.
- A.
True
- B.
False
- 71.How do we prevent the muscarinic effects of cholinesterase inhibitors?
- A.
By delivering small doses calculated on patient weight
- B.
By pre-medication with an opioid
- C.
Through inactivation of acetylcholinesterase
- D.
By concurrently administering an anticholinergic drug
- 72.This non-barb hypnotic is good for patients with a history of PONV.
- A.
Etomidate
- B.
Propofol
- C.
Ketamine
- 73.Which of the following non-barbituate agents would be the BEST choice for a trauma patient?
- A.
Thiopental
- B.
Etomidate
- C.
Propofol
- D.
Ketamine
- 74.What is the recommended dose of neostigmine?
- A.
0.08 mg/kg
- B.
1 mg/kg
- C.
0.014 mg/kg
- D.
0.2 mg/kg
- 75.This non-barb has a high incidence of emergence delirium, 12%.
- A.
Etomidate
- B.
Propofol
- C.
Ketamine
- 76.Which non-barb induction agent has analgesic and bronchodilator effects?
- A.
Ketamine
- B.
Propofol
- C.
Etomidate
- 77.What would be an appropriate dose of reversal agent for a 23 yr old female weighing 50 kg?
- A.
Edrophonium 25 mg
- B.
Neo 4 mg, glyco 0.8 mg
- C.
Glyco 4 mg, Neo 0.8 mg
- D.
Physotigmine 0.5 mg, Atropine 0.5 mg
- 78.Propofol can lead to significant bradycardia that is resistant to atropine. Which of the following drugs would you give?
- A.
Dopamine
- B.
Esmolol
- C.
Isoproterenol
- 79.Which of the following will increase your ICP?
- A.
Propofol
- B.
Etomidate
- C.
Ketamine
- D.
All of the above
- 80.This non-barb has a chemical structure of carboxylated imidazole-containing compound that (like versed) is water solule at acidic pH and lipid soluble at physiologic pH.
- A.
Etomidate
- B.
Ketamine
- C.
Propofol
- 81.Which non-barb can supress adrenal cortical function?
- A.
Etomidate
- B.
Ketamine
- C.
Propofol
- 82.Which of the following patients should NOT receive Ketamine? PICK TWO
- A.
22 yr old trauma patient, serious MVA with multiple fractures and large amount of blood loss
- B.
34 yr old asthmatic
- C.
Patient with past history of Malignant Hyperthermia
- D.
19 yr old male, cocaine abuser, diagnosed with pulmonary HTN.
- E.
67 yr old male, head trauma
- 83.When caring for children you should ALWAYS give the anticholinergic and the cholinesterase inhibitor together in one syringe.
- A.
True
- B.
False
- 84.This non-barb will increase salivation, inclusion of a antisialagogue is recommended.
- A.
Etomidate
- B.
Ketamine
- C.
Propofol
- 85.What would be the most appropriate reversal agent for a child weighing 20 kg?
- A.
Neo 1.6 mg, atropine 0.2 mg
- B.
Pyridostigmine 2 mg, no cholinergic agent
- C.
Do not use agents which require reversal on pediatric patients.
- D.
Edrophonium 20 mg, Atropine 0.28 mg
- 86.What drug could you give to decrease the incidence of emergence delirum in patients receiving ketamine?
- A.
Propofol
- B.
Thiopental
- C.
Versed
- D.
All of the above
- 87.Ketamine is a NMDA agonist or antagonist?
- A.
Agonist
- B.
Antagonist
- C.
Neither, works on GABA receptors
- 88.Why is gylcopyrolate the anticholinergic agent of choice for neostigmine?
- A.
Onset of action is very similar to neo
- B.
Only cholinergic which can be safely mixed with neo
- C.
Only cholinergic which will counteract bradycardia caused by neo
- D.
Because of it’s ability to cross blood brain barrier.
- 89.Acetylcholine is rapidly metabolized by acetylcholinesterase to…. (Two answers)
- A.
Acetic Acid
- B.
Choline
- C.
Succinylmonocholine
- D.
Cholinesterase
- 90.This non-barb is know to inhibit PLT aggregation.
- A.
Etomidate
- B.
Ketamine
- C.
Propofol
- 91.Which of the following will have the most rapid onset?
- A.
Neostigmine
- B.
Edrophonium
- C.
Pyrdiostigmine
- D.
All have same onset time.
- 92.All muscle relaxants are quaternary ammonium compounds that mimic the effects of…
- A.
Pseudocholinesterase
- B.
Acetylcholine
- C.
Monocholine
- D.
Muscarinic receptors
- 93.Which of the following is commonly used in the treatment of myasthenia gravis?
- A.
Edrophonium
- B.
Physostigmine
- C.
Pyridostigmine
- D.
Glycopyrolate
- 94.Which of the following is a depolarizing muscle relaxant?
- A.
Rocuronium
- B.
Mivacurium
- C.
Succinylcholine
- D.
Vecuronium
- 95.Which of the following could you give to counteract delirium cause by benzodiazepines and CNS effects of anticholinergic drugs?
- A.
Neostigmine
- B.
Edrophonium
- C.
Pyridostigmine
- D.
Physostigmine
- 96.What is the mechanism of action of succinylcholine?
- A.
Works at spinal nerve roots to cause paralysis and NMJ
- B.
Bind to alpha subunit receptors but do not activate them, merely tie up the receptors to block acetylcholine.
- C.
By potentiating the inhibitory effects of GABA
- D.
Through binding to and activating alpha subunit receptors to cause sustained depolarization.
- 97.Which of the following is true regarding systemic effects of Anticholinergics? (More than one answer)
- A.
Cause Bradycardia
- B.
Inhibits secretions
- C.
Decreases bladder tone
- D.
Causes bronchospasm
- 98.Which of the following patients could you use succinylcholine on?
- A.
A burn patient admitted 3 hours ago.
- B.
A spinal cord injury patient in the ICU admitted 1 week ago
- C.
Dialysis patient who is mildly hyperkalemic
- D.
Patient with past history of Muscular Dystrophy
- E.
None of the above
- 99.What is the mechanism of action of the cholinesterase inhibitors?
- A.
Attenuate the peripheral muscarinic effects of NMBA's.
- B.
Inhibition of the hydrolysis of acetylcholine resulting in greater availability at its sites of action
- C.
Through binding to and activating alpha subunit receptors to cause sustained depolarization.
- D.
Selective inhibition of GABA
- 100.Which of the following drugs is metabolized by pseudocholinesterase?
- A.
Atracurium
- B.
Mivacurium
- C.
Rocuronium
- D.
Vecuronium
- 101.What is recommended dose of Edrophonium?
- A.
0.1-0.4 mg/kg
- B.
0.08 mg/Kg
- C.
0.5-1.0 mg/Kg
- D.
0.01-0.03 mg/Kg
- 102.What is the MOA of Etomidate?
- A.
GABAa agonist
- B.
Non-competitive binding to the phencyclidine recognition site on the NMDA receptor & acts on opioid receptors
- C.
Through binding to and activating alpha subunit receptors to cause sustained depolarization.
- D.
Inhibition on GABAa receptors
- 103.What is the recommended dose of Pyridostigmine?
- A.
0.1-0.4 mg/kg
- B.
.08 mg/kg
- C.
0.5-1 mg/kg
- D.
0.01-0.03 mg/kg
- 104.Whta is MOA of Ketamine?
- A.
Selective modulation of GABA receptors
- B.
Non-competitive antagonist binding to the phencyclidine recognition site on the NMDA receptor & acts on opioid receptors
- C.
Through binding to and activating alpha subunit receptors to cause sustained depolarization.
- D.
Inhibition of acetycholinesterase
- 105.What is the recommended dose of physostigmine?
- A.
0.1-0.4 mg/kg
- B.
0.08 mg/kg
- C.
0.5-1.0 mg/Kg
- D.
0.01-0.03 mg/Kg
- 106.Succinylcholine is rapidly metabolized to succinylmonocholine which is known to cause:
- A.
Hyperkalemia
- B.
Increase ICP
- C.
Bradycardia
- D.
Malignant hyperthermia
- 107.How much glycopyrolate should you give to a patient receiving 3 mg of neostigmine?
- A.
0.6 mg
- B.
0.32 mg
- C.
0.021 mg
- D.
3 mg
- 108.What is the mechanism of action of non-depolarizing muscle relaxants?
- A.
Works at spinal nerve roots to cause paralysis and NMJ
- B.
Bind to alpha subunit receptors but do not activate them, merely tie up the receptors to block acetylcholine.
- C.
By potentiating the inhibitory effects of GABA
- D.
Through binding to and activating alpha subunit receptors to cause sustained depolarization.
- 109.How much atropine would you give to a patient receiving 40mg Edrophoinium?
- A.
0.28 mg
- B.
0.56 mg
- C.
0.8 mg
- D.
4 mg
- 110.You are caring for Mr. Wren today who has a past medical history of DM, HTN and renal failure. You are asked to choose an appropriate muscle relaxing agents for him. Which do you choose as the BEST agent for Mr. Wren?
- A.
Vecuronium
- B.
Succinylcholine
- C.
Rocuronium
- D.
Pancuronium
- 111.What is the incidence of Malignant hyperthermia in adults?
- A.
1: 50,000
- B.
1: 100,000
- C.
1: 15,000
- D.
1: 250,000
- 112.You are the SRNA for Ms. Cartaya today who has a past medical history of seizures, which are controlled through dilantin. How will this effect your muscle relaxants?
- A.
I should not give any muscle relaxants.
- B.
Will not affect my medication at all
- C.
Will prolong the effect of the medication. So will need less.
- D.
Will shorten the effect of the medication. So will need more.
- 113.What is the incidence of Malignant Hyperthermia in children?
- A.
1: 50,000
- B.
1: 100,000
- C.
1: 15,000
- D.
1: 250,000
- 114.What is an appropriate intubating dose of Succinylcholine?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 115.Malignant Hyperthermia is a severe reaction which results in ryanodine receptor activation leading to…
- A.
Intracellular Hyperkalemia
- B.
Intracellular Hypernatremia
- C.
Intracellular Hypercalcemia
- D.
Intracellular Hyperglycemia
- 116.What is an appropriate intubating dose of Pancuronium?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 117.What is an appropriate intubating dose of Vecuronium?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 118.You are the SRNA for Mr. Joe, a 20 yr old male having repair of a torn ACL tendon. You paralyzed the patient using succinylcholine to intubate, and currently have your Sevo going at 2%. Right as the makes his incision into the patients knee you notice your HR has jumped and the patient is tachycardic. His BP has also jumped up considerably. What does this mean?
- A.
He may be too light on anesthesia, give some fentanyl and go up on your sevo.
- B.
This may be the beginning stages of Malignant hyperthermia. Call for Help.
- C.
He is not paralyzed enough, give some vec.
- D.
Do nothing, the tachycardia will go away once the incision portion is over.
- 119.What is an appropriate intubating dose of Rocuronium?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 120.You are the SRNA for Mrs. Nannit who is currently having a fem pop done. You have used vecuronium to paralyze the patient and she is receiving Desflurane for sedation. Her heart rate is currently NSR 60, blood pressure is stable, but your ETCO2 is climbing. What should you do?
- A.
Send an ABG immediately to evaluate for malignant hyperthermia, call for help.
- B.
Increase the patient respiratory rate, she is hypoventilating.
- C.
Give some fentanyl and increase your des.
- D.
Wait and watch the patient for further signs of MH.
- 121.You are the SRNA for a 16 yr old boy coming in for appendectomy. After administering succinylcholine to the pt you can not open the patients mouth the intubate him. What should you do next?
- A.
Wait for sux to wear off, and give a different paralytic agent
- B.
Plan to mask the case. Place face mask on pt and turn on the sevo.
- C.
Immediately notify MD and send an ABG and labs to assess for MH. Cancel case.
- D.
Trach the patient immediately.
- 122.What is an appropriate intubating dose of Nimbex?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 123.You are the SRNA for a patient currently undergoing biopsy and removal and liver mass. You paralyzed the patient with vecuronium and are using Sevoflurance for sedation. You notice your patient suddenly becomes tachycardic and the ETCO2 goes way up. You attempt to increase your RR to decrease ETCO2 but it does not work. At the same time you notice the patients muscles are becoming rigid. What is the FIRST thing you should do now?
- A.
Give a beta blocker to decrease HR and increase O2 to 100%
- B.
Start mixing dantrolene and apply a hypothermic blanket
- C.
Call for Help, tell surgeon to stop procedure.
- D.
Turn off your sevoflurane and draw an ABG.
- 124.What is an appropriate intubating dose of Atracurium?
- A.
1-1.5 mg/kg
- B.
.08-0.1 mg/kg
- C.
0.6-1.2 mg/kg
- D.
0.15-0.2 mg/kg
- E.
0.4-0.5 mg/kg
- 125.Which of the following lab values would not help to confirm diagnosis of Malignant hyperthermia?
- A.
Serum K 6.5
- B.
Ph 7.10
- C.
Base excess –10
- D.
PCO2 50
- 126.It is perfectly safe to use regional anesthetics on malignant hyperthermia susceptible patients.
- A.
True
- B.
False
- 127.What is the maximum dose of Dantrolene which can be given to a 10 yr old child weighing 30 kg?
- A.
75 mg
- B.
300 mg
- C.
600 mg
- D.
30 mg
- 128.Dantrolene should be continued for ____ Hours post MH episode.
- A.
24
- B.
12
- C.
48
- D.
6
- 129.You are the SRNA for a patient with a known pseudocholinesterase deficiency who needs a rapid sequence induction due to past medical history of GERD which is poorly controlled. The patient weighs 80 kg. What medication would you choose for this induction?
- A.
Rocuronium 90 mg
- B.
Succinylcholine 120 mg
- C.
Mivacurium 20 mg
- D.
Rapid sequence can not be done on this patient without prolonged effect of muscle relaxant.
- 130.Pre-treatment with a non-depolarizer may help to lessen all side effects from succinylcholine except:
- A.
Arrythmias
- B.
Hyperkalemia
- C.
Myalgia
- D.
Elevated Intraocular Pressure
- 131.Hyperthermia is an early sign of MH.
- A.
True
- B.
False
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