General Anesthesia Dr. Hong Someth (part2)
51. Which one of the following statement is NOT the disadvantages of IV sedation?
σ½ Venipuncture is necessary
σ½ Venipuncture complications may occur
σ¾ No monitoring is required
σ½ Recovery not complete – escort needed
52. How much Midazolam is needed for slow IV titration?
σ¾ 1mg to 2.5mg over 30 seconds
σ½ 2mg - 4mg over 1 minute
σ½ 3mg - 5mg over 2 minutes
σ½ 5mg - 10mg over 5 minutes
53. Which one of the following statements is NOT the actions and effects of Benzodiazepines?
σ½ Anxiolytic
σ½ Hypnotic
σ¾ Antiemetic
σ½ Anticonvulsant and muscle relaxant
54. What Benodiazepines do when using low-doses?
σ¾ Calm and relaxed behaviour
σ½ Sleepiness
σ½ Respiratory depression
σ½ Loss of airway reflexes
55. What Benodiazepines do when using high-doses?
σ½ Amnesia
σ½ Ataxia
σ½ Loss of consciousness
σ¾ All of the above
56. Which one of the following is NOT the contraindications of Benzodiazepines?
σ½ Pregnancy
σ½ Severe hepatic impairment
σ¾ Patient with gag reflex
σ½ Severe respiratory impairment
57. Which one of the following statement is NOT the disinhibitory effects of Benzodiazepimes?
σ½ . Excitement
σ¾ Sadness
σ½ Hyperactivity and agitation
σ½ Hostility
58. What are the things to be avoided when using Triazolam?
σ½ Pineapple juice and antibiotics
σ½ Orange juice and steroids
σ½ Melon juice and Tricyclic antidepressant drug
σ¾ Grape juice, alcohol and Barbiturates
59. Which one of the following is Benzodiapine antagonist or the reversal drug?
σ½ Temazepam
σ½ Naloxone
σ¾ Flumazenil
σ½ Fluconazole
60. Which one of the following is NOT the vital signs?
σ¾ Blood sugar or glucose level
σ½ Heart rate (pulse) & rhythm
σ½ Blood pressure
σ½ Respiratory rate
61. Which one of the following statement is NOT the advantages of oral sedation?
σ½ Good acceptance by patients
σ½ Ease of administration and relatively safe
σ½ Low incidence and severity of adverse reactions
σ¾ Need needles, syringes or monitoring equipment
62. Which one of the following statement is NOT the suitable siutation for IV sedation?
σ½ Severe apprehensive patients
σ¾ No suitable escort and inadequate equipment & facilities
σ½ Presence of prominent veins
σ½ Pretty long and difficult procedures
63. How much of IV Midazolam do you have to dilute with water for injection if the concentration in the bottle says "5mg/ml"?
σ¾ 1ml of Midazolam dilute with 4ml saline or water in a 5ml syringe; 2ml of Midazolam dilute with 8ml of water in a 10ml syringe
σ½ 5ml of Midazolam dilute with 5ml saline or water in a 10ml syringe
σ½ 3ml of Midazolam dilute with 2ml of water in a 5ml syringe
σ½ 8ml of Midazolam dilute with 2ml of saline in 10m syringe
64. What is the initial dose of Flumazenil?
σ½ 0.02mg
σ½ 0..0mg
σ¾ 0.2mg (2ml over 15 seconds)
σ½ 0.5mg
65. What is the maximum dose of Flumaenil?
σ¾ 1mg
σ½ 2mg
σ½ 3mg
σ½ 5mg
66. What do we use to monitor oxygen saturation and pulse?
σ½ ECG
σ½ Capnograph device
σ¾ Pulse oximeter
σ½ Blood pressure monitoring device
67. What is the normal oxygen saturation at sea level?
σ½ 80%
σ½ 85%
σ½ 90%
σ¾ 95%
68. When do we stop monitoring the sedated patients?
σ½ When the patients start talking normally
σ¾ When vital signs are be stable as to compared to baseline pre-procedure readings
σ½ When oxygen saturation is over 100%
σ½ When the patients breath normally
69. What oxygen saturation levels that may cause severe hypoxia?
σ½ Between 96% - 100%
σ½ Between 86% - 90%
σ¾ Less than 81%
σ½ Less than 71%
70. What level of oxygen saturation when the patient becomes cyanosis?
σ¾ SpO2 <80%
σ½ SpO2 <85%
σ½ SpO2 <90%
σ½ SpO2 <94%
71. Which one of the following statement is NOT the criteria for discharge of sedated patients?
σ½ The patients are able to understand and follow directions
σ½ The patients are appropriately talk
σ¾ The patients are able to drink water
σ½ The patients can understand discharge instructions
72. 58. What is not necessary to record in the IV sedation sheet?
σ½ Sedative dose
σ½ Pulse
σ½ Oxygen saturation level
σ¾ Temperature
73. What is the incorrect instruction after dental treatment under conscious sedation?
σ½ Patients may go home within 20 minutes or less without further monitoring
σ½ Patients must be monitored until the discharge criteria are met; discharged with a responsible adult; and must be given written clear instructions
σ¾ Patients may drive home
σ½ Patients are not allowed to take codeine as an analgesic
74. Which one of the following statement is NOT the reason for failure of sedation?
σ¾ Cooperative patient
σ½ Wrong site (unable to find vein, unable to titrate)
σ½ Unpredicted drug response
σ½ Equipment failure (monitoring failure)
75. What is is the most common side-effect of the administration of benzodiazepine drugs?
σ½ Sleepiness
σ½ Dry mouth
σ½ Confusion
σ¾ Reduction in normal peripheral oxygen sedation (SpO2 < 95%)
76. How much oxygen saturation the pulse oximeter alarm should be programmed to sound?
σ½ Less than 80%
σ½ Less than 85%
σ¾ Less than 90%
σ½ Less than 95%
77. Which one of the following statement is NOT the management of oxygen desaturation?
σ½ Ask the patient to take a few deep breaths
σ½ Pinch the earlobe
σ½ Give oxygen by facemask at 6-8L/min
σ¾ Inject hydrocortisone
78. What is the most common sedation risk?
σ½ Paradoxical reaction
σ½ Anaphylactic reaction
σ¾ Respiratory depression
σ½ Confusion
79. What type of patients are at risk for sedation?
σ½ Obesity
σ½ Hypertensive patients
σ½ Elderly patients
σ¾ Obesity and Elderly patients
80. How much low flow oxygen by nasal prongs for non-acute respiratory depression?
σ½ 1 - 2 L/min
σ¾ 2 - 4 L/min
σ½ 4 - 6 L/min
σ½ 8 - 10 L/min
81. How much oxygen flow used in anaphylaxis?
σ½ 2 - 4 L/min
σ½ 4 - 6 L/min
σ½ 5 - 7 L/min
σ¾ 8-10 + litres/minute
82. In CPR, how many chest compressions per minute and how many breaths?
σ½ 15 compressions per minute, one breath
σ½ 20 compressions per minute, 3 breaths
σ¾ 30 compressions, 2 breaths
σ½ 40 compressions, 4 breaths
83. What is the half-life of Flumaenil?
σ½ 30 minutes
σ¾ <1 hour
σ½ ˃1 hour
σ½ 2 hours
84. What is the maximum dose of Flumaenil?
σ½ 2 ml
σ½ 4 ml
σ½ 6 ml
σ¾ 10 ml
85. When do need to put the patients on their side in the recovery position?
σ¾ When they are breathing but unconscious
σ½ When they are not breathing and unconscious
σ½ When their pulse and blood pressure are dropped
σ½ When they have normal breathing and conscious
86. When should you consider the use of bag mask ventilation or oropharyngeal airways?
σ½ When there's a gag reflex
σ½ When the patient has got airway obstruction
σ¾ When there's a respiratory depression
σ½ When the patient is unconscious
87. Which one of the following is NOT the abnormal sounds in airway obstruction?
σ½ Snoring
σ¾ Hiccup
σ½ Gurgling
σ½ Wheezing
88. When a patient has got snoring, what happens to him/her?
σ½ He/she is sleepy
σ½ His/her throat is obstructed by a foreign body
σ½ He/she has got laryngospasm
σ¾ He/she has got hypopharyngeal obstruction by the tongue
89. How to manage a patient with snoring?
σ¾ Repeat head-tilt, chin lift
σ½ Use bronchodilator medication
σ½ Clear airway with a suction tip
σ½ Wake the patient up with Flumazenil injection
90. When a patient has got wheezing, what happens to him/her?
σ½ He/she has got asthmatic attack
σ½ His/her throat is obstructed by a foreign body
σ¾ He/she has got bronchospasm
σ½ He/she has got hypopharyngeal obstruction by the tongue
91. How to manage a patient with wheezing?
σ½ Inject 1:1000 adrenalin
σ¾ Use bronchodilator medication
σ½ Clear airway with a suction tip
σ½ Repeat head-tilt, chin lift
92. What may happen when a patient is over-sedated?
σ¾ Reduction in normal peripheral oxygen sedation (SpO2 < 95%) and respiratory depression is usually mild and transient
σ½ Increased heart rate
σ½ Raised blood pressure (hypertension)
σ½ Nausea and vomiting
93. How do you manage the patient when oxygen saturation drops below 90%?
σ½ Ask the patient to take a few deep breaths, pinching the earlobe
σ½ If the SpO2 is still low give the Oxygen by facemask at 6-8L/min
σ½ Give IV reversal drug, Flumazenil if not better
σ¾ All of the above
94. Who are the patients at risk with sedation?
σ½ Chronic respiratory diseases
σ½ History of sleep apnea syndrome
σ½ Extreme age and obesity
σ¾ All of the above
95. What type of patient that has got restricted airway?
σ½ Obese patients
σ½ Down's Syndrome
σ½ Heavy smokers
σ¾ Obese patients and Heavy smokers
96. 82. How do you manage paradoxical reactions?
σ½ Inject adrenalin
σ¾ Inject Flumazenil
σ½ Use Naloxone
σ½ Use hydrocortine
97. Which one of the following is NOT the predisposing factors for paradoxical reactions?
σ½ Young and advanced age
σ½ Alcoholism and drug abuse
σ¾ Patients who are allergic to local anesthetic
σ½ Psychiatric disorders
98. How to manage haematoma formation at the IV injection site?
σ½ Remove the IV cuff to decrease the venous blood pressure
σ½ Remove the needle and apply firm pressure for 5 minutes
σ½ If the site is painful apply ice in the first few hours
σ¾ All of the above
99. Which one of the following is NOT the management of air embolism during IV sedation?
σ¾ Withdraw air from the vein by using large needle and syringe
σ½ Remove air bubbles from the IV tubing before connecting the IV
σ½ Remove air bubbles from the syringe before injecting
σ½ Periodically check the infusion bag to prevent it employing
100. How much small bubbles of air in the vein can a patient tolerate after IV sedation?
σ½ 0.2ml of air / kg weight
σ½ 0.5ml of air / kg weight
σ¾ Up to 1ml of air /kg weight
σ½ Over 2ml of air / kg weight
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