CMSRN Anesthetist 3 — Questions and Answers
Question 1: A patient is receiving epidural analgesia post-operatively and develops sudden onset weakness in both legs with loss of bowel and bladder function. What is the MOST likely complication?
- Epidural hematoma compressing the spinal cord (Correct answer)
- Expected dermatomal numbness from epidural
- Opioid-induced urinary retention
- Spinal headache
Correct answer: Epidural hematoma compressing the spinal cord
New neurological deficits (bilateral leg weakness, bowel/bladder dysfunction) after epidural placement are signs of epidural hematoma requiring emergency intervention.
Question 2: When monitoring a patient under general anesthesia, what does a sustained increase in end-tidal CO2 (EtCO2) MOST likely indicate?
- Hyperventilation by the ventilator
- Hypovolemia
- Inadequate ventilation or increased CO2 production (Correct answer)
- Pulmonary embolism
Correct answer: Inadequate ventilation or increased CO2 production
A sustained rise in EtCO2 indicates either hypoventilation (insufficient minute ventilation) or increased metabolic CO2 production such as in malignant hyperthermia.
Question 3: A patient receiving ketamine anesthesia is most likely to experience which unique emergence phenomenon?
- Respiratory depression and apnea
- Dissociative reactions and vivid hallucinations (Correct answer)
- Prolonged neuromuscular blockade
- Severe bradycardia
Correct answer: Dissociative reactions and vivid hallucinations
Ketamine is a dissociative anesthetic that commonly causes emergence reactions including hallucinations, vivid dreams, and disorientation upon recovery.
Question 4: Which anesthetic agent is the drug of choice for patients with a history of malignant hyperthermia susceptibility?
- Halothane
- Sevoflurane
- Propofol-based total intravenous anesthesia (TIVA) (Correct answer)
- Desflurane
Correct answer: Propofol-based total intravenous anesthesia (TIVA)
Propofol-based TIVA avoids all volatile halogenated anesthetics and succinylcholine, which are the known triggers for malignant hyperthermia.
Question 5: A nurse notices that dantrolene is requested urgently in the OR. This medication is the specific treatment for which anesthesia emergency?
- Local anesthetic systemic toxicity
- Malignant hyperthermia (Correct answer)
- Anaphylaxis
- Laryngospasm
Correct answer: Malignant hyperthermia
Dantrolene sodium is the specific antidote for malignant hyperthermia, working by inhibiting calcium release from the sarcoplasmic reticulum in muscle cells.
Question 6: After extubation in the PACU, a patient develops high-pitched inspiratory stridor and increasing respiratory distress. The MOST likely cause is:
- Laryngospasm (Correct answer)
- Bronchospasm
- Pulmonary edema
- Tension pneumothorax
Correct answer: Laryngospasm
High-pitched inspiratory stridor immediately after extubation is classic for laryngospasm, a forceful involuntary closure of the vocal cords.
Question 7: Which preoperative medication is routinely administered to reduce the risk of pulmonary aspiration of gastric contents in patients with a full stomach?
- Diazepam
- Sodium citrate (non-particulate antacid) (Correct answer)
- Atropine
- Midazolam
Correct answer: Sodium citrate (non-particulate antacid)
Sodium citrate neutralizes gastric acid, reducing the risk of aspiration pneumonitis (Mendelson's syndrome) if aspiration occurs during rapid sequence induction.
CMSRN Anesthetist 3
A patient is receiving epidural analgesia post-operatively and develops sudden onset weakness in both legs with loss of bowel and bladder function.
What is the MOST likely complication?