Joel O Johnson MD PhD Coeditor in Chief 2 Disclosure Coeditor in Chief for Anesthesiology Continuing Education Objectives Understand the goals of the ACE product in furthering education Appreciate the types of questions included in ACE ID: 1007297
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1. Anesthesiology Continuing Education (ACE)Joel O. Johnson, MD, PhDCo-editor in Chief
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3. DisclosureCo-editor in Chief for Anesthesiology Continuing Education
4. ObjectivesUnderstand the goals of the ACE product in furthering educationAppreciate the types of questions included in ACEGauge the benefit that the ACE product will have on your individual learning goals
5. Question writingEach item is researched and written by an expert anesthesiologistThe item is reviewed and edited by the co-editors-in-chiefEach question and it’s content is discussed by the ACE Editorial Board at quarterly meetings100 questions are chosen for publication semi-annually, after a final review for content and educational value
6. Content“Walking Around Knowledge”Concise explanationsIllustrations, Figures and TablesReferences including one textbook and at least one published paper
7. PublicationElectronic, web-basedBooklet
8. Audience Response and ParticipationPlease take out your mobile device/laptop.Go to www.pollev.com/The polling questions will appear in your browser.8
9. CardiacA patient scheduled for surgery has a preoperative electrocardiogram (ECG)
10. Which of the following rhythms is MOST likely to develop in this patient?Second-degree atrioventricular blockSupraventricular tachycardiaPulseless electrical activityVentricular fibrillation
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12. Delta waves in an ECG are associated with the presence of a myocardial accessory conducting pathway. Wolff–Parkinson–White (WPW) pattern on an ECG consists of a delta wave and a short P-R interval due to an accessory pathway in the conducting system of the heart. Some patients with a WPW pattern on ECG may develop WPW syndrome, which includes the presence of dysrhythmias, most commonly tachydysrhythmias such as supraventricular tachycardia (SVT).Neither second-degree atrioventricular block nor pulseless electrical activity is commonly associated with WPW syndrome. Although ventricular fibrillation has been reported in patients with WPW syndrome, it is not the most common dysrhythmia in this patient population.
13. Anesthesia MachineWhich of the following properties of desflurane MOST likely necessitates the unique construction of the agent-specific desflurane vaporizer?Low blood–gas solubilityHigh boiling pointLow molecular weightHigh vapor pressure.
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15. AgentVaporPressure(°C)BoilingPoint(°C)MACBlood:Gas Partition CoefficientDesflurane66422.86.00.43Isoflurane23848.51.281.4Halothane24350.20.752.3Enflurane17556.51.581.9Sevoflurane15758.52.050.68
16. Variable Bypass vaporizer
17. Desflurane vaporizer
18. Effects of Aging (Geriatrics) Which of the following is MOST likely to be decreased as a consequence of aging? Total lung capacityResidual volumeVital capacityClosing capacity
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21. Closing capacity increases with age
22. PharmacologyWhich of the following statements about egg allergies is MOST likely true? Propofol contains the allergen egg white ovalbumin.Parenteral nutrition with fat emulsion containing egg lecithin is contraindicated in egg allergic patients.Egg allergy is more common in the adult population than in the pediatric population.Previous anaphylaxis to eggs is considered a contraindication to propofol.
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24. It is likely that rare reports of allergic reactions to propofol are due to interactions with the propofol molecule itself, involving the phenol ring or isopropyl side chains. In particular, prior exposure to cosmetic and dermatological products containing isopropyl side chains may have cross-sensitized the patient, particularly in atopic individuals. Explanation
25. Morbid obesityWhich of the following drugs is BEST dosed on total body weight in a morbidly obese patient? SuccinylcholineRocuroniumVecuroniumCisatracurium
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28. Mask ventilationWhich of the following is MOST predictive of difficult mask ventilation? Lack of teethBody mass index greater than 26 kg/m2Presence of a beardHistory of snoring
29. Table 1. Identification of risk factors for difficult mask ventilation with multivariate analysis (n = 1,502). Used with permission, from Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology. 2000;92(5):1229-1236.
30. IntubationIn the properly executed ramped or head-elevated laryngoscopy position (HELP), which of the following is MOST likely true? The cervical spine is in an extended position with respect to the thoracic spine. The head is in a flexed position with respect to the cervical spine.The external auditory meatus is in the same plane as the sternal notch.The oral axis is perpendicular to the pharyngeal axis.
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32. Sniffing position
33. HELP (head elevated)
34. Intraoperative ComplicationsThe reported risk of perioperative venous gas embolism (VGE) is HIGHEST during which of the following procedures? Cesarean deliveryCentral line placementStereotactic brain biopsyLaparoscopy
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36. ProcedureReported RiskHysteroscopy85%‒98%Cesarean delivery30%‒97%Craniofacial procedures66%‒83%Sitting craniotomy10%‒80%Uterine myomectomy40%‒70%Hepatic resection/surgery44%‒68%Total hip arthroplasty57%Operative hysteroscopy10%‒50%Stereotactic brain biopsy8%‒14%Deep brain stimulator implant4.5%Laparoscopy<0.6%Central line placement0.2%‒1%
37. Rare (case reports) of VGEProcedureMechanismIntestinal endoscopyAir/CO2 under pressureVitrectomyEntrainment through the central retinal veinSpine surgery Venous entrainment when the operative site is ≥ 5 cm above the level of the right ventricleShoulder arthroscopyEntrainment of residual air in saline irrigation bagsInfusionsGravity driven or pressurized venous entry of airTransurethral resection of the prostateContrast injector in imaging studiesIntravenous infusion bagsEndoscopic retrograde cholangiopancreatography Forced air via the endoscope after a Kasai procedure
38. RiskThe HIGHEST risk of seroconversion from a needlestick injury is from a patient infected with which of the following? RabiesHuman immunodeficiency virus (HIV)Hepatitis CHepatitis B
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42. PediatricsPostextubation croup in pediatric patients is MOST likely to be associated with:an audible leak at a peak inspiratory pressure of 20 cm H2O.supine position.patient age of 5 or 6 years.a recent history of croup
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45. SummaryThe benefits associated with the Anesthesiology Continuing Education product are:Refreshes the participants knowledgeIntroduces new concepts that are built on existing knowledgeProvides continuing education that translates into useful clinical information
46. A 40-year-old patient in the postanesthesia care unit after laparoscopic cholecystectomy develops new-onset atrial fibrillation (AF). Vital signs include a heart rate of 135 beats/min and noninvasive blood pressure of 140/66. The patient is awake and oriented. What is the recommended initial next step? Heart rate controlEchocardiogramElectrical cardioversionAnticoagulation
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48. Which of the following is MOST likely to be associated with an increased risk of postoperative nausea and vomiting (PONV)? Age greater than 75 yearsHistory of smoking cigarettesMale sexLonger duration of anesthesia
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50. A 52-year-old woman with mitral valve stenosis presents for a cholecystectomy. Her preoperative electrocardiogram reveals normal sinus rhythm at 90 beats/min. Which of the following represents the BEST perioperative management strategy? β-Receptor blockade Infective endocarditis prophylaxis Anticoagulation Nitroglycerin
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52. Exposure to which of the following is MOST likely to deactivate the color indicator in soda lime absorbent? Fluorescent lightsCompound AWaterHeat
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54. Each of the following medications is capable of causing burst suppression on the electroencephalogram (EEG) EXCEPT midazolam. pentobarbital. sevoflurane. sufentanil.
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56. If an E-cylinder is providing 4 L/min flow of oxygen and the cylinder pressure gauge reads 600 psig, the cylinder will MOST likely become empty in 90 minutes. 60 minutes. 45 minutes. 15 minutes.
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58. Which of the following estimates of the total blood volume for a 1.8-kg premature neonate is MOST accurate? 125 mL 150 mL 175 mL 240 mL
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60. Questions?