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QUESTIONS AND ANSWERS

Questions and answers

Raffán-Sanabria, Fernandoa,b,c

Author Information
Colombian Journal of Anesthesiology (Revista Colombiana de Anestesiología): January-March 2020 - Volume 48 - Issue 1 - p 57-58
doi: 10.1097/CJ9.0000000000000150

1. Which of the following characteristics is compatible with a moderate neuromuscular blockade using the train of 4 (TOF)?1

  • (A) TOF count = 0 and post-tetanic count ≥ 1.
  • (B) TOF count = 1 to 3.
  • (C) TOF count = 1 and post-tetanic count = 1.
  • (D) TOF count = 2 and post-tetanic count > 2.

2. In applying enhanced recovery protocols after surgery in duodenum-pancreatectomy surgery, a statistically significant improvement of the following has been evidenced when compared with standard management, except2:

  • (A) In blood loss.
  • (B) During the hospital stay.
  • (C) In the number of transfusions of blood components.
  • (D) In the frequency of death to 30 days.

3. In live births, cardiac congenital anomalies are a serious public health problem, as they constitute the most common congenital defect. Which of the following congenital cardiopathies cannot be detected with the pulse-oximetry screening test during the first 48 hours of life, as it does not cause hypoxemia in the neonatal period?3

  • (A) Aortic stenosis, non-ductus dependent.
  • (B) Hypoplastic left heart syndrome.
  • (C) Pulmonary atresia.
  • (D) Serious Tetralogy of Fallot.

4. The pulse-oximetry test for neonatal screening of congenital heart disease within the first 48 hours of life is considered positive in all of the following, except3:

  • (A) If the pulse-oximetry is less than 90%.
  • (B) If the pulse-oximetry is less than 95% in the right hand (preductal) and in the foot (post-ductal).
  • (C) If there is a difference of more than 3% between the preductal and post-ductal measurements.
  • (D) If the pulse-oximetry is less than 95% in the left hand and left foot.

5. Regarding Ebstein's anomaly, it's true that4:

  • (A) Mitral stenosis is common.
  • (B) Tricuspid insufficiency is common, and associated heart defects include persistence of permeable oval foramen and interauricular or interventricular communications.
  • (C) Anesthetic management during non-cardiac surgery is primarily aimed at minimizing pulmonary vascular resistance and decreasing systemic vascular resistance.
  • (D) An elevated pressure of the right ventricle converted into an atrium generates protrusion of the septum into the exit tract of the left ventricle, which in turn improves the dynamic obstruction and ultimately causes an increase in cardiac output.

6. The lingual amygdala (LA) is a normal anatomical structure composed of lymphoid tissue that is part of the Waldeyer's ring in the oral cavity. With reference to this structure, which of the following statements is false?5

  • (A) Hypertrophy of LA has an unknown prevalence, but has been described as a frequent cause for unpredictable difficult airway.
  • (B) It is located at the base of the tongue, between the caliciform papillae and the epiglottis.
  • (C) Unlike the palatine amygdala, it does not have a capsule, so an unopposed growth may produce a posterior displacement of the epiglottis, which may in turn make intubation and manual ventilation difficult.
  • (D) In patients with a history of adeno-tonsillectomy, this is definitely considered one of the factors not related to LA hypertrophy.

7. In the perioperative management of patients with sickle cell anemia, which of the following actions is considered the gold standard?6:

  • (A) Avoid hypoxemia.
  • (B) Transfuse blood components.
  • (C) Use a thermal blanket.
  • (D) Apply locoregional anesthesia.

8. Regarding the patient with sickle cell disease, it is false that6:

  • (A) The number of hospitalizations and the number of crises in the previous year are independent predictors of vasoocclusive crisis.
  • (B) Theoretically, locoregional anesthesia causes venous stasis in the blocked area and compensatory vasoconstriction in the rest, because its use is contraindicated.
  • (C) Regarding the use of tourniquets, the available evidence suggests that, when strictly necessary, they can be used without complications for most patients, since the risk, although it exists, is very rare.
  • (D) Acute chest syndrome usually develops around the third day after surgery. Incentive spirometry—conducted in a pre and postoperative manner—decreases the incidence of this syndrome.

9. In the research on the use of dipyrone for postoperative pain management published in the Cochrane Database Syst Rev, according to Edwards et al., which of the following drugs has the lowest Number Needed to Treat to decrease pain by at least 50% of intensity?7

  • (A) Oxycodone.
  • (B) Acetaminophen.
  • (C) Celecoxib.
  • (D) Dipyrone.

10. In Wellen syndrome associated with critical left anterior descending artery stenosis, changes in the t-wave occur predominantly in shunts8:

  • (A) V1–V2.
  • (B) V2–V3.
  • (C) V3–V5.
  • (D) AVF—V5–V6.

Answers

  • 1. B.
  • 2. D.
  • 3. A.
  • 4. D.
  • 5. B.
  • 6. D.
  • 7. A.
  • 8. B.
  • 9. D.
  • 10. B.

References

1. Moltó L, Fernández-Candil JL, López-Argüello E, et al. Is 1 mg/kg of sugammadex sufficient to reverse moderate neuromuscular block? A randomized clinical trial. Colombian Journal of Anesthesiology 2019;47:211–218.
2. Aristizábal Linares JP, Estrada Quiroz JJ, Hoyos Gómez C, et al. Analysis of complications after Whipple's procedure within eras protocols. Colombian Journal of Anesthesiology 2019;47:219–225.
3. Enríquez LE, Prada M, Basto-Duarte MC, et al. The scenario for children with heart disease in Colombia. Colombian Journal of Anesthesiology 2019;47:236–242.
4. Khanna S, Bustamante S. Ebstein anomaly and left ventricular outflow tract obstruction. Colombian Journal of Anesthesiology 2019;47:243–244.
5. Marcotegui-Barber I, Bilbao-Ares A, Azcona-Salvatierra A, et al. Lingual tonsillar hypertrophy, an unknown enemy. A case report. Colombian Journal of Anesthesiology 2019;47:245–248.
6. Morales C, Ascuntar J, Londoño JM, et al. Perioperative sickle cell anemia considerations for total hip arthroplasty: case report. Colombian Journal of Anesthesiology 2019;47:249–252.
7. Moreno DA, Echeverry MA. Current controversies on the clinical use of dipyrone: safe alternative? Colombian Journal of Anesthesiology 2019;47:261–263.
8. Welsh S, Morris N. A brief addition to the article titled “Wellens síndrome: left anterior descending coronary t-wave syndrome”. Colombian Journal of Anesthesiology 2019;47:260.

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