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SEE EXAM
ANESTHESIA QOD
QUESTIONS AND
ANSWERS
An action potential characterized by a spike followed by a plateau phase is seen in:

A. peripheral sensory nerve cells
B. peripheral motor nerve cells
C. striated skeletal muscle cells
D. cardiac muscle cells
cardiac muscle cells

In contrast to the action potentials of nerve and skeletal muscle cells, the action
potential of the cardiac myocyte is characterized by a sharp spike followed by a plateau
phase (2), which results from the opening of slower calcium channels.

pg. 345
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's Clinical
Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing
Division, 2013.
Autonomic hyperreflexia:

A. is common with cord lesions below T8
B. can precipitate pulmonary edema
C. is not effectively prevented by regional anesthesia
D. can be prevented with adequate intraoperative sedation
Autonomic hyperreflexia:

,can precipitate pulmonary edema

Autonomic hyperreflexia should be suspected in patients with lesions above T5-8.
Regional anesthesia and deep general anesthesia are effective in preventing autonomic
hyperreflexia. Surgical stimulation in these patients without adequate anesthesia can
result in pulmonary edema, myocardial ischemia and cerebral hemorrhage.

pg. 927
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
During mediastinoscopy the risk of air embolization is greatest:

A. when the patient is supine
B. during spontaneous ventilation
C. immediately after closure of the incision
D. in the postoperative period
during spontaneous ventilation

Air embolization is seen with mediastinoscopy as a result of the 30o elevation of the
head. This risk is increased if the patient is spontaneously ventilating, secondary to the
negative intrathoracic pressures generated during inhalation.

pp. 988-989
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York:
McGraw Hill, 2012.
The formation of metanephrine is the result of:
catechol-O-methyltransferase metabolism of epinephrine

Catechol-O-methyltransferase (COMT) metabolizes epinephrine to metanephrine and
norepinephrine to normetanephrine. Subsequently, monamine oxidase (MAO) further
metabolizes metanephrine and normetanephrine to vanillymandelic acid (VMA).

pg. 868
Nagelhout, JJ, and Plaus, KL. Nurse Anesthesia. St. Louis: Elsevier, 2014.
During the delivery of an anesthetic in the radiology department, full E-cylinders of
nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is
being delivered and the case has been proceeding for 60 minutes, the expected
pressure in the nitrous oxide E-cylinder is:
745 - 750 PSIg

Nitrous oxide has a critical temperature of 37oC. This allow nitrous oxide to exist as a

,liquid at room temperature. Full E-cylinders of nitrous oxide contain approximately 1590
L at a pressure of 745 psig. A sixty minute delivery of 3 L/min would result in a 180 L
consumption, and this would be inadequate to consume all the liquid nitrous oxide in the
tank. As a result, there would be no change in tank pressure.

pg. 622
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York:
McGraw Hill, 2012.
A decrease in pseudocholinesterase activity has been associated with the use of:
(Select 3)

pancuronium
esmolol
droperidol
vecuronium
metoclopramide
magnesium sulfate
dantrolene
rocuronium
A decrease in pseudocholinesterase activity has been associated with the use of:

pancuronium, esmolol, metoclopramide

The following drugs have been associated with a decrease in pseudocholinesterase
activity: echothiophate, pyridostigmine, neostigmine, phenelzine, cyclophosphamide,
metoclopramide, esmolol, pancuronium and oral contraceptives. Although both
dantrolene and magnesium may alter the effects of neuromuscular blockers, neither
causes inhibition of pseudocholinesterase.

pg. 207
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's Clinical
Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing
Division, 2013.
A decrease in pseudocholinesterase activity has been associated with the use of:
(Select 3)

A. pancuronium
B. esmolol
C. droperidol
D. vecuronium
E. metoclopramide

, F. magnesium sulfate
G. dantrolene
H. rocuronium
response is incorrect.
A decrease in pseudocholinesterase activity has been associated with the use of:

pancuronium, esmolol, metoclopramide

The following drugs have been associated with a decrease in pseudocholinesterase
activity: echothiophate, pyridostigmine, neostigmine, phenelzine, cyclophosphamide,
metoclopramide, esmolol, pancuronium and oral contraceptives. Although both
dantrolene and magnesium may alter the effects of neuromuscular blockers, neither
causes inhibition of pseudocholinesterase.

pg. 207
Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's Clinical
Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing
Division, 2013.
During the delivery of an anesthetic in the radiology department, full E-cylinders of
nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is
being delivered and the case has been proceeding for 60 minutes, the expected
pressure in the nitrous oxide E-cylinder is:
745 - 750 psig

Nitrous oxide has a critical temperature of 37C. This allow nitrous oxide to exist as a
liquid at room temperature. Full E-cylinders of nitrous oxide contain approximately 1590
L at a pressure of 745 psig. A sixty minute delivery of 3 L/min would result in a 180 L
consumption, and this would be inadequate to consume all the liquid nitrous oxide in the
tank. As a result, there would be no change in tank pressure.

pg. 622
Longnecker, DE, Brown, DL, Newman MF and Zapol, WM. Anesthesiology. New York:
McGraw Hill, 2012.
The formation of metanephrine is the result of:
catechol-O-methyltransferase metabolism of epinephrine

Catechol-O-methyltransferase (COMT) metabolizes epinephrine to metanephrine and
norepinephrine to normetanephrine. Subsequently, monamine oxidase (MAO) further
metabolizes metanephrine and normetanephrine to vanillymandelic acid (VMA).

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