MODERATE SEDATION COURSE 2021

This quiz consists of 10 questions. Each question, you are required to provide 3 responses with an answer True [T] or False [F]. In total, you are required to provide 30 responses.

To pass this quiz, you will need to answer correctly to 25 out of the 30 responses. Please note that you have only up to 3 attempts to pass the quiz.

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1. Please assess the following scenarios: During insertion of OGD, the patient is coughing continuously and secretions are seen in the mouth. The Sp02 showed a dropped from baseline 99% to 90%.

a. Procedure can continue as usual after increasing oxygen flow rate True False

b. An increase in the dose of opioids can be given to reduce tracheal irritation True False

c. Patient’s vital signs and conscious level should be re-assessed True False

2. Regarding drug use in sedation

a. Due to the synergistic effect of sedatives and narcotics used in combination, individual drug doses should be reduced True False

b. The initial dose of Propofol alone sedation for a 65 year old patient (ASA I, 60kg) undergoing OGD is 80-100mg over 1 min True False

c. The initial dose of naloxone to reverse respiratory depression in opioid over-sedation is 0.02-0.2mg and can be repeat every 2-3min True False

3. Regarding drug use in sedation

a. The standard initial dose for a healthy 50 year old patient weighing 53kg is as follows: midazolam 2mg and fentanyl 37.5 mcg True False

b. Patients who received topical lignocaine spray can be allowed to eat immediately after completion of gastroscopy if they did not receive sedation True False

c. Respiratory depression is a major side effect of midazolam True False

4. In assessing your patients for risk of sedation

a. Uvula is well-visualised with a Mallampati score of III True False

b. A focused examination revealing rhonchi in the lungs during assessment should prompt further work up/treatment before elective scope True False

c. A patient with uncontrolled hypertension is classified as ASA 2 True False

5. The following statements are consistent with moderate sedation

a. Patient's oxygen saturation usually drops to 95% True False

b. Patient respiratory rate would be 4-6 breaths per minute True False

c. Patient cannot be expected to give a proper consent True False

6. Please assess the following scenario: During insertion of the endoscope, the patient is noted to have noisy breathing and Sp02 revealed a dropped from baseline 99% to 93%.

a. Procedure can continue but examination should be hastened True False

b. Sedation should be deepened to provide more comfort to the patient True False

c. Laryngospasm is a potential complication True False

7. Regarding the right selection of patients for moderate sedation in gastroscopy. The following patients are considered suitable for endoscopist-directed sedation:

a. A 65 year male with well controlled diabetes mellitus and a Mallampati score of II True False

b. A 35 year old male BMI 40, with a history of snoring and a Mallampati score III True False

c. A 70 year old female admitted for giddiness and hypotension after several bouts of hematemesis True False

8. Regarding drug use in sedation

a. When used as combination in a healthy 40 year old female, the initial dose of midazolam is 4mg and fentanyl 75 mcg given over 1-2 min True False

b. In patients struggling during endoscopy, drug top-up with midazolam 1mg should be given every 30 seconds until the patient is well sedated True False

c. The usual starting dose for flumazenil to reverse sedation is 0.5 mg True False

9. Regarding procedure room assessment

a. ‘Time out’ can be performed for an anxious patient after a small ‘calming’ dose of midazolam is given True False

b. IV access should be maintained throughout the entire procedure True False

c. Supplemental oxygen is recommended for all receiving moderate sedation unless there are specific contraindications True False

10. Regarding drug use in sedation

a. When used in a healthy 60 year old female with BMI 18, an initial dose of midazolam 4mg and fentanyl 75 mcg given over 2 min is safe True False

b. In patients struggling during endoscopy, further top up with midazolam 1mg can be given every 1 minute until the patient is calm True False

c. If the patient is not achieving adequate sedation despite standard doses, the IV cannula should be checked for possible extravasation True False

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