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GKA CPC Study Guide 2024 Questions With Complete Solutions!!
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GKA CPC Study Guide 2024 Questions With Complete Solutions!!
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Name: Score:160 Multiple choice questions
Term 1 of 160
Metoclopramide (Reglan) should be avoided in patients with which medical condition?
Hypertension
Hypothyroidism
Diabetes
Parkinson's disease
Term 2 of 160
Sensation to the airway below the epiglottis is provided by which cranial nerve?
Glossopharyngeal
Vagus
Facial
Trigeminal
,Term 3 of 160
Please use the following information to answer the next 7 questions.
A 22-year old man who is 5 ft 10 in tall and weighs 80 kg presents to the emergency room 6 hours
after tonsillectomy secondary to chronic tonsillitis. Following otolaryngology evaluation,
emergent control of post-tonsillectomy bleeding is deemed necessary. The patient comes to the
operating room sitting up, swallowing frequently, and spitting bright red blood intermittently into
a large basin. Other past medical history is unremarkable. The patient has an 18-gauge IV line in
his left arm. Blood pressure is 90/50 mm Hg, pulse is 115/min, respiratory rate is 24/min, and SpO2
is 95%.
Considerations in the management of this airway include:
(Select 2.)
rapid-sequence induction.
inhalation induction.
availability of surgical airway.
mask ventilation prior to laryngoscopy.
rapid suctioning of the airway.
tracheal intubation.
early application of PEEP.
Justification
If vomiting or aspiration occurs during induction, immediate treatment includes tilting of the
patient's head downward or to the side, rapid suctioning of the mouth and pharynx, and
intubation. There is little benefit in performing tracheal or bronchial suctioning in most
cases, and bronchoscopy should be reserved for those patients suspected of having
aspirated solid material. Arterial blood gas analysis should be performed for determination
of the extent of hypoxemia. Early application of PEEP is recommended for improving
pulmonary function and combating atelectasis.
ephedrine, 5 mg.
Justification
,Administering phenylephrine to a bradycardic patient results in further bradycardia.
Dopamine takes longer to elicit an effect and is usually given via infusion rather than bolus.
Ephedrine has mixed alpha- and beta- adrenergic effects. Epinephrine has a pure alpha-
adrenergic effect; it would be less than ideal at this dose for this patient with coronary
artery disease.
rapid-sequence induction.
availability of surgical airway.
Justification
These patients are considered to have a full stomach due to the blood that they have
swallowed. Therefore, a rapid-sequence intubation with cricoid pressure is recommended.
An oral examination may reveal swelling, bleeding, and encroachment of the tonsils on
airway structures, which can potentially cause difficulty with mask ventilation and/or direct
laryngoscopy. This difficulty may require the availability of a surgical airway.
Urine pregnancy
Justification
Urine pregnancy tests should be considered in all females of reproductive age to minimize
the risks of anesthetic agents to the fetus
, Term 4 of 160
In malignant hyperthermia, what medications should be administered to the patient?
(Select 2.)
Sodium bicarbonate
Succinylcholine (Anectine)
Verapamil (Calan, Verelan)
Dantrolene (Dantrium)
meperidine (Demerol).
Justification
Monoamine oxidase inhibitors (MAOIs) and the tricyclic antidepressants are a source of
potentially serious anesthetic interactions in patients who take them chronically to treat
psychotic depression. The blockade of monoamine oxidase produces an accumulation of
norepinephrine, epinephrine, dopamine, and 5-hydroxytryptamine (5-HT) in adrenergically
active tissues, including the brain. All phenylpiperidine opioids (meperidine, methadone,
tramadol) are weak serotonin reuptake inhibitors and can lead to excessive serotonergic
stimulation of 5-HT. Meperidine has been reported to produce hypertensive crisis,
convulsions, and coma when given to patients currently taking MAOIs.
Sodium bicarbonate
Dantrolene (Dantrium)
Justification
Malignant hyperthermia (MH) is an uncommon, life-threatening, hypermetabolic disorder
of skeletal muscle, triggered in susceptible individuals by inhalation anesthetic agents and
succinylcholine. The ryanodine receptor (RYR1) is the major calcium release channel of the
sarcoplasmic reticulum, and the RYR1 is the site of the MH defect. Dantrolene is the drug of
choice in treating an MH crisis as it works by reducing calcium efflux from the sarcoplasmic
reticulum, counteracting the abnormal intracellular calcium levels accompanying MH.
Verapamil (a calcium channel blocker) is contraindicated with dantrolene. Sodium
bicarbonate is used to treat respiratory acidosis. Succinylcholine is a triggering agent of
MH.
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