Pt2 61-130 Anesthesia general/Prof. Hong Someth
61. Which one of the following statement is NOT the advantages of oral sedation?
Good acceptance by patients
Ease of administration and relatively safe
Low incidence and severity of adverse reactions
Need needles, syringes or monitoring equipment
62. Which one of the following statement is NOT the suitable siutation for IV sedation?
Severe apprehensive patients
No suitable escort and inadequate equipment & facilities
Presence of prominent veins
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"?
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
5ml of Midazolam dilute with 5ml saline or water in a 10ml syringe
3ml of Midazolam dilute with 2ml of water in a 5ml syringe
8ml of Midazolam dilute with 2ml of saline in 10m syringe
64. What is the initial dose of Flumazenil?
0.02mg
0..0mg
0.2mg (2ml over 15 seconds)
0.5mg
65. What is the maximum dose of Flumaenil?
1mg
2mg
3mg
5mg
66. What do we use to monitor oxygen saturation and pulse?
ECG
Capnograph device
Pulse oximeter
Blood pressure monitoring device
67. What is the normal oxygen saturation at sea level?
80%
85%
90%
95%
68. When do we stop monitoring the sedated patients?
When the patients start talking normally
When vital signs are be stable as to compared to baseline pre-procedure readings
When oxygen saturation is over 100%
When the patients breath normally
69. What oxygen saturation levels that may cause severe hypoxia?
Between 96% - 100%
Between 86% - 90%
Less than 81%
Less than 71%
70. What level of oxygen saturation when the patient becomes cyanosis?
SpO2 <80%
SpO2 <85%
SpO2 <90%
SpO2 <94%
71. Which one of the following statement is NOT the criteria for discharge of sedated patients?
The patients are able to understand and follow directions
The patients are appropriately talk
The patients are able to drink water
The patients can understand discharge instructions
72. 58. What is not necessary to record in the IV sedation sheet?
Sedative dose
Pulse
Oxygen saturation level
Temperature
73. What is the incorrect instruction after dental treatment under conscious sedation?
Patients may go home within 20 minutes or less without further monitoring
Patients must be monitored until the discharge criteria are met; discharged with a responsible adult; and must be given written clear instructions
Patients may drive home
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?
Cooperative patient
Wrong site (unable to find vein, unable to titrate)
Unpredicted drug response
Equipment failure (monitoring failure)
75. What is is the most common side-effect of the administration of benzodiazepine drugs?
Sleepiness
Dry mouth
Confusion
Reduction in normal peripheral oxygen sedation (SpO2 < 95%)
76. How much oxygen saturation the pulse oximeter alarm should be programmed to sound?
Less than 80%
Less than 85%
Less than 90%
Less than 95%
77. Which one of the following statement is NOT the management of oxygen desaturation?
Ask the patient to take a few deep breaths
Pinch the earlobe
Give oxygen by facemask at 6-8L/min
Inject hydrocortisone
78. What is the most common sedation risk?
Paradoxical reaction
Anaphylactic reaction
Respiratory depression
Confusion
79. What type of patients are at risk for sedation?
Obesity
Hypertensive patients
Elderly patients
Obesity and Elderly patients
80. How much low flow oxygen by nasal prongs for non-acute respiratory depression?
1 - 2 L/min
2 - 4 L/min
4 - 6 L/min
8 - 10 L/min
81. How much oxygen flow used in anaphylaxis?
2 - 4 L/min
4 - 6 L/min
5 - 7 L/min
8-10 + litres/minute
82. In CPR, how many chest compressions per minute and how many breaths?
15 compressions per minute, one breath
20 compressions per minute, 3 breaths
30 compressions, 2 breaths
40 compressions, 4 breaths
83. What is the half-life of Flumaenil?
30 minutes
<1 hour
˃1 hour
2 hours
84. What is the maximum dose of Flumaenil?
2 ml
4 ml
6 ml
10 ml
85. When do need to put the patients on their side in the recovery position?
When they are breathing but unconscious
When they are not breathing and unconscious
When their pulse and blood pressure are dropped
When they have normal breathing and conscious
86. When should you consider the use of bag mask ventilation or oropharyngeal airways?
When there's a gag reflex
When the patient has got airway obstruction
When there's a respiratory depression
When the patient is unconscious
87. Which one of the following is NOT the abnormal sounds in airway obstruction?
Snoring
Hiccup
Gurgling
Wheezing
88. When a patient has got snoring, what happens to him/her?
He/she is sleepy
His/her throat is obstructed by a foreign body
He/she has got laryngospasm
He/she has got hypopharyngeal obstruction by the tongue
89. How to manage a patient with snoring?
Repeat head-tilt, chin lift
Use bronchodilator medication
Clear airway with a suction tip
Wake the patient up with Flumazenil injection
90. When a patient has got wheezing, what happens to him/her?
He/she has got asthmatic attack
His/her throat is obstructed by a foreign body
He/she has got bronchospasm
He/she has got hypopharyngeal obstruction by the tongue
91. How to manage a patient with wheezing?
Inject 1:1000 adrenalin
Use bronchodilator medication
Clear airway with a suction tip
Repeat head-tilt, chin lift
92. What may happen when a patient is over-sedated?
Reduction in normal peripheral oxygen sedation (SpO2 < 95%) and respiratory depression is usually mild and transient
Increased heart rate
Raised blood pressure (hypertension)
Nausea and vomiting
93. How do you manage the patient when oxygen saturation drops below 90%?
Ask the patient to take a few deep breaths, pinching the earlobe
If the SpO2 is still low give the Oxygen by facemask at 6-8L/min
Give IV reversal drug, Flumazenil if not better
All of the above
94. Who are the patients at risk with sedation?
Chronic respiratory diseases
History of sleep apnea syndrome
Extreme age and obesity
All of the above
95. What type of patient that has got restricted airway?
Obese patients
Down's Syndrome
Heavy smokers
Obese patients and Heavy smokers
96. 82. How do you manage paradoxical reactions?
Inject adrenalin
Inject Flumazenil
Use Naloxone
Use hydrocortine
97. Which one of the following is NOT the predisposing factors for paradoxical reactions?
Young and advanced age
Alcoholism and drug abuse
Patients who are allergic to local anesthetic
Psychiatric disorders
98. How to manage haematoma formation at the IV injection site?
Remove the IV cuff to decrease the venous blood pressure
Remove the needle and apply firm pressure for 5 minutes
If the site is painful apply ice in the first few hours
All of the above
99. Which one of the following is NOT the management of air embolism during IV sedation?
Withdraw air from the vein by using large needle and syringe
Remove air bubbles from the IV tubing before connecting the IV
Remove air bubbles from the syringe before injecting
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?
0.2ml of air / kg weight
0.5ml of air / kg weight
Up to 1ml of air /kg weight
Over 2ml of air / kg weight
101. Which one of the following is NOT the symptoms of accidental intra-arterial injection?
A bright-red flash of blood in the cannula
A dark red blood clots under the skin
Pulsatile movement of blood in the IV line
Intense pain or burning at the site of injection
102. How to prevent intra-arterial cannulation during IV sedation?
Always palpate a vessel before applying the IV cuff
Check the colour of blood in the cannula and look for a pulse of blood in the IV tubing
Ask the patient if there is pain or coldness going down the arm when you first inject a saline test
All of the above
103. How to prevent extravascular drug administration during IV sedation?
Always test the IV by injecting first some saline or water for injection
Inject a few drops of Diazepam into the vein first
If a saline drip is being used, hold the IV bag below the patients' heart
Always test the IV by injecting first some saline or water for injection and . If a saline drip is being used, hold the IV bag below the patients' heart
104. Which one of the following is NOT the required equipment for IV sedation?
Pulse Oximeter
Thermometer
Blood pressure monitor
Bag-valve-mask and oxygen cylinder
105. What are the required drugs for IV sedation?
Midazolam and Flumazenil
Adrenalin 1:1000
Other essential emergency drugs
All of the above
106. Which one of the following is NOT the prerequisites for sedation?
Blood tests
Knowledge of the agents to be used
Consent
Adequate equipment & materials
107. What are the guiding principles for sedation of children?
Supervision by medical personnel
Cooperative children
Trained & skilled in both airway management and cardiopulmonary resuscitation
Supervision by medical personnel and Trained & skilled in both airway management and cardiopulmonary resuscitation
108. What advanced knowledge for primary practitioner in conscious sedation?
Capable of providing bag mask ventilation and, ultimately, endotracheal intubation
Understand pharmacology of sedating medications
Maintain advanced pediatric airway skills
All of the above
109. Which one of the following is NOT the basic knowledge for supported personnel?
Be trained in, and capable of providing basic life support
Know how to do tracheotomy
Assist in any supportive or resuscitation measures
Know how to use resuscitation equipment & supplies in the event of an emergency
110. What happens when insulin is injected to a hypoglycaemic patient?
The patient will recover from hypoglycaemia
Blood glucose level will rise up
The patient might die
The patient's blood pressure will go down
111. What does S O A P M E stand for?
Supply, Order, Accident, Pain, Management, Emergency
Suction, Oxygen, Airway, Pharmacy, Monitors, Equipment
Safe, Old, Analgesics, Prescription, Malignancy, Effectiveness
Sedationists of Oral Association for Pediatric Malformation and Epilepsy
112. What is Naxolone used for?
For reversing Benzodiazepines
For pain control
For reversing opioids, eg. Morphine
For anti-inflammatory
113. You have been asked to administer conscious sedation to a healthy, 25 year old female patient in the dental school clinic. She has dental phobia and requires a simple dental extraction. The most appropriate statements in this context include:?
The patient must be able to understand and respond purposefully to verbal commands, throughout the period of sedation
The end point is maintenance of a purposeful response after repeated or painful stimulation
Sedation with IV Midazolam is unlikely to be associated with over-sedation if titrated slowly
Sedative drugs are administered as a single bolus
114. A 75 years old man of ASA (American Society of Anesthesiologists) III status is scheduled for surgical removal of retained roots in the maxilla under IV sedation. The most appropriate statements regarding this procedure include:?
After an initial dose of midazolam, an additional dose is recommended if analgesia is inadequate
Administration of a specific analgesic agent is likely to be needed for pain
If midazolam and fentanyl are administered, then fentanyl should be given after the peak effect of midazolam is observed
Midazolam dose for elderly patient with ASA III should be reduced
115. Which one of the following statement is NOT TRUE in relation to the use oral sedation?
Patient commonly complain of post operative headache
An acceptable level of anxiolytic action is obtained when the drug is given one hour preoperatively
There is a profound amnesic action and no side affects
Oral Midazolam is considered as minimal sedation
116. Which one of the following statement is TRUE about Midazolam?
It has interaction with orange juice
Midazolam injectable solution can be mixed with sweet drinks or Paracetamol syrup
Normally, we titrate Midazolam in 5mg (5ml) increments every 5 minute while we talk to the patient
The half-life of Midazolam is 10 to 20 hours
117. Which one of the following statement is NOT TRUE about monitoring during sedation?
Pulse oximeter measures oxygen saturation in arterial blood using infrared light
Oxygen saturation (SpO2) is the amount of oxygen carried by hemoglobin, compared with the total oxygen-carrying capacity of hemoglobin; expressed as percentage
Pulse oximeter with the alarm set is better than the finger-clip without the alarm
Record pulse and oxygen saturation every 35 minutes
118. Dental extraction may be most appropriately performed under conscious sedation in the following patients:?
A patient with known allergy to local anaesthetic
A cooperative patient for extraction of four impacted wisdom teeth
A severely mentally handicapped adult
A 3-yr-old child for extraction of a single tooth
119. During a minor procedure under sedation and analgesia, the patient is breathing slowly with some snoring, is not easily aroused, and does not respond to verbal commands. At which level of sedation is this patient?
Twilight sedation
Moderate sedation
Deep sedation
Irreversible sedation
120. Which of the following defines moderate sedation?
A medically controlled state of depressed consciousness from which the patient does not respond to verbal or tactile stimuli
CNS depression produced by sedatives that allow patients to tolerate unpleasant procedures while maintaining the ability to respond to verbal or tactile stimuli
The administration of morphine to treat post-operative pain
The administration of a sedative/hypnotic agent to facilitate sleep
121. Patients being evaluated for procedure-related sedation need: ?
A history and physical
An ASA physical status assignment
A consent
all of the above
122. All of the following are monitoring requirements for the sedated patient EXCEPT?
Blood pressure
Capillary refill
Pulse oximetry
respiratory rate
123. What parameter must be monitored continuously during sedation?
State of consciousness (breathing)
Pulse oximetry
Blood pressure
Cardiac output
124. The first and most important action when a patient starts to vomit during a procedure is to?
Apply restraints
Give supplemental O2
Give a reversal agent
Reposition to lateral decubitus
125. The first response for an obstructed airway is to: ?
Suction the patient
Tntubate the patient
Insert an oral airway
Perform a chin lift/neck extension
126. Guidelines for patients at discharge after sedation should include: ?
Written release of the hospital from responsibility
Discussion of all potential adverse effects of moderate sedation
Discussion of the effects of sedation and a warning about operating a motor vehicle
A mandatory follow-up visit with the physician who performed the procedure
127. Which of the following statements about the use of benzodiazepines for moderate sedation is true?
Adjustment in dosing is needed when giving an opioid
Should always be reversed by flumazenil
Should always be reversed by naloxone
Should always be given by the oral route
128. Infants and small children are particularly susceptible to complications during sedation. The unique anatomy of which body system contributes to this susceptibility:?
Neurological
Gastrointestinal
Respiratory
Renal
129. A Post-Anesthesia Recovery Score is: ?
An objective measure used to determine a patient's suitability for discharge
The same as an ASA Physical Status Classification
A neurological assessment of LOC
A physician test of how well a patient will tolerate narcotics
130. When can the patients be discharged to home after procedure-related sedation?
After they can walk
After they can drink water
After all the vital signs have returned to normal
All of the above
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