CSFA Surgical Pharmacology and Anesthesia Questions and Answers — Questions and Answers
Question 1: Which intravenous anesthetic agent is known for its sympathomimetic properties, causing bronchodilation and an increase in heart rate and blood pressure, making it a favorable choice for hemodynamically unstable or asthmatic patients?
- Ketamine (Correct answer)
- Propofol
- Etomidate
- Midazolam
Correct answer: Ketamine
Ketamine is a dissociative anesthetic that stimulates the sympathetic nervous system, leading to increased heart rate, blood pressure, and cardiac output. It also possesses potent bronchodilatory effects, which is beneficial for patients with reactive airway disease. Propofol and etomidate can cause hypotension, while midazolam is primarily a sedative.
Question 2: A 55-year-old patient is scheduled for a coronary artery bypass grafting (CABG) procedure at 8:00 AM. According to Surgical Care Improvement Project (SCIP) guidelines, when is the most appropriate time to administer the prophylactic intravenous antibiotic, such as cefazolin?
- In the post-anesthesia care unit (PACU)
- Within 60 minutes prior to the surgical incision (Correct answer)
- On-call to the operating room
- After the skin incision is made
Correct answer: Within 60 minutes prior to the surgical incision
To be effective in preventing surgical site infections (SSIs), prophylactic antibiotics must reach therapeutic concentrations in the tissue by the time the incision is made. The SCIP guidelines recommend administration within 60 minutes before the incision. For certain antibiotics with longer infusion times, like vancomycin, the window is extended to 120 minutes prior to incision.
Question 3: During a shoulder arthroscopy performed in the beach chair position, the patient's blood pressure drops significantly. The CSFA and surgical team should be most concerned about which specific position-related complication?
- Venous thromboembolism
- Brachial plexus injury
- Cerebral hypoperfusion (Correct answer)
- Sciatic nerve damage
Correct answer: Cerebral hypoperfusion
In the upright beach chair position, a hydrostatic gradient exists between the heart (where a blood pressure cuff is typically placed) and the brain. A normal blood pressure reading at the arm may correspond to a dangerously low perfusion pressure in the brain, leading to cerebral hypoperfusion and potential ischemic injury.
Question 4: At the conclusion of a procedure, the anesthesiologist needs to reverse the effects of rocuronium. Which of the following drugs works by encapsulating the neuromuscular blocking agent, rendering it inactive?
- Neostigmine
- Atropine
- Flumazenil
- Sugammadex (Correct answer)
Correct answer: Sugammadex
Sugammadex is a selective relaxant binding agent that directly encapsulates aminosteroid neuromuscular blockers like rocuronium and vecuronium in a 1:1 ratio, forming a complex that is then cleared by the kidneys. This mechanism allows for rapid and complete reversal at any depth of blockade. Neostigmine is a cholinesterase inhibitor, and flumazenil reverses benzodiazepines.
Question 5: A surgeon requests a local anesthetic with epinephrine for a procedure on a patient's finger. The addition of epinephrine is traditionally contraindicated in such 'end-arterial' areas primarily due to the risk of what complication?
- Profound vasoconstriction leading to tissue ischemia and necrosis (Correct answer)
- Systemic hypertension from epinephrine absorption
- Increased risk of local anesthetic systemic toxicity (LAST)
- Severe vasodilation causing excessive bleeding
Correct answer: Profound vasoconstriction leading to tissue ischemia and necrosis
Epinephrine is a potent vasoconstrictor. In areas with end-arterial circulation like fingers, toes, and the nose, this vasoconstriction can compromise the limited blood supply, potentially leading to tissue ischemia and necrosis. While this long-held belief has been challenged by recent studies showing it can be used safely in certain contexts, it remains a key principle and potential exam topic.
Question 6: A patient requires a rapid sequence intubation (RSI). The anesthesiologist plans to use succinylcholine. The CSFA should be aware that an absolute contraindication for this depolarizing neuromuscular blocker is a personal or family history of what condition?
- Asthma
- Hypertension
- Malignant Hyperthermia (Correct answer)
- Diabetes Mellitus
Correct answer: Malignant Hyperthermia
Succinylcholine is a known and potent trigger for malignant hyperthermia (MH), a rare but life-threatening inherited hypermetabolic disorder of skeletal muscle. Its use is strictly contraindicated in any patient with a personal or family history of MH.
CSFA Surgical Pharmacology and Anesthesia Questions and Answers
Which intravenous anesthetic agent is known for its sympathomimetic properties, causing bronchodilation and an increase in heart rate and blood pressure, making it a favorable choice for hemodynamically unstable or asthmatic patients?