2020 ITE

Question 1

magnesium toxicity: higher risk in what pts and what is treatment

Answer 1

renal insufficient pts bc this is how it is cleared

tx: calcium gluconate

Question 2

modern recommendation of fluid managment throughout anesthestic now

Answer 2

20-40 ml/kg isotonic crystalloid with further fluid to titrate hemodynamic goals

Question 3

what is maintenance fluid post surgery goals now

Answer 3

2-1-0.5 rule now

Question 4

what is the white arrow pointing to in this axillary nerve block

Answer 4

musculocutaneous nerve

Question 5

axillary nerve block labeled

Answer 5

see front

Question 6

The axillary brachial plexus block does not cover the ___upper arm so if there is any cause of discomfort in this region (e.g. a tourniquet) additional coverage with blockade of the _____nerve may be performed.

Answer 6

medial, intercostalbrachial nerve

Question 7

maternal risk pre-eclampsia

fetal risk pre-eclampsia

Answer 7

Maternal risks include stroke, placental abruption, disseminated intravascular coagulation, renal failure, pulmonary edema, and death. The risks to the fetus include intrauterine growth restriction, preterm delivery, stillbirth, and even potential risks that last a lifetime.

Question 8

what is pseudo-vascularization of maternal spiral arteries and what happens in pre-eclampsia

Answer 8

cytotrophoblasts invade implantation site and then form their own endothelium vessels. Makes maternal spiral arteries transform into bigger low resistance levels, better for blood flow. In pre-eclampsia process is incomplete

Question 9

risks that predispose pre-eclampsia

Answer 9

advanced maternal age, African-American race, a family history of preeclampsia in the maternal or paternal sides, obesity, multiparty, chronic hypertension, and renal disease

Question 10

drugs that do not cross the placenta are tHINGS

Answer 10

heparin, insulin, non depolarizing NMB, glycopyrolate, succinylcholine

Question 11

anesthetic drugs that do cross the placenta

BBANNII LEON

Answer 11

atropine, beta-adrenergic receptor antagonists, nitroglycerin, nitroprusside, benzodiazepines, induction agents (propofol, ketamine, etomidate, thiopental), inhalational anesthetics, local anesthetics, opioids, ephedrine, and neostigmine (to a small degree).

BBANNII LEON

Question 12

Upon ascent to a high altitude, PaO2 and PaCO2 will significantly ___due to decreased atmospheric pressure and the resultant changes in respiratory drive. The initial hypoxia will trigger peripheral chemoreceptors to promote ____ which leads to ____ An adaptive mechanism to offset this is the gradual reduction in plasma bicarbonate (primarily from ___) which is preceded by a decrease in CSF bicarbonate. After 2-3 days of disequilibrium, the stimulation of peripheral chemoreceptors by hypoxia goes unopposed once enough bicarbonate ions have passed into the blood stream from CSF and the pH of the CSF is restored to sea level values.

Answer 12

drop

ventilation –> respiratory alkalosis

increased secretion

Question 13

Acute mountain sickness or high altitude sickness is a result of continuous exposure to ___. The most common symptoms include headache, nausea, vomiting, insomnia, ataxia, peripheral edema, and dyspnea. ____ is a recommended pharmacologic AMS prophylactic measure as it augments the ______ promoting urinary bicarbonate loss. Treatment of AMS and its symptoms is primarily by altitude descent but can also include supplemental oxygen administration, dexamethasone administration (though symptoms often return once discontinued), and acetazolamide (especially for AMS-related insomnia).

Answer 13

hypoxia

acetazolamide

augments hypoxic ventilatory response

Question 14

treatment of acute mountain sickness

Answer 14

Treatment includes descent, supplemental oxygen, and dexamethasone.

Question 15

are laryngeal reflexes preserved with ketamine use

Answer 15

yes

Question 16

MOA of txa and amicar

Answer 16

binds to plasmin and prevents plasmin from binding lysine residues on fibrin

Question 17

MOA of protamine

Answer 17

large positvely charged molecule that prevents the binding of heparin to antithrombin 3

Question 18

Normal TEG times

R time

alpha angle

MA

LY30

Answer 18

R time 6 minutes

alpha angle 60 degrees

MA 60 mm

LY30 6%

Question 19

Heparin induced thrombocytopenia (HIT) is an antibody mediated process in which the patient develops antibodies against

Answer 19

platelet factor 4

Question 20

The 5 Ts of HIT

Answer 20

timing, thrombocytopenia, type of heparin, thrombosis, and type of patient (surgical > medical).

timing 4-10 days following heparin

unfractionated heparin

dvt, pe

Question 21

best anesthetic for retained placenta uterine relaxation in following situations

1) awake, not actively bleeding, using epidural for analgesia
2) patient who is actively bleeding

Answer 21

1) nitroglycerine
2) general anestehsia, dont use epidural, could cause more vasodilation

Question 22

which reflexes are lost after induction with GAnesthesia

Answer 22

corneal reflex, gag reflex, vestibulo-oculo reflex

Question 23

is the puppillary light reflex still intact with GA

Answer 23

yes

Question 24

transpulmonary pressures are highest in pts with what respiratory disease

Answer 24

restrictive lung disease

Question 25

lumbar nerve roots exit below which numbered pedicle

Answer 25

the same

Question 26

cervical nerve roots exit __ their superior numbered pedicle

Answer 26

below

Question 27

during general anesthesia atelectasis develops more often in what lung region and why

Answer 27

lower, near diaphragm, especially when using muscle relaxants bc loss of muscle tone in diaphragm and chest wall impairs pts ability to fully inhale resulting in collapse of diaphrgamatic areas of lungs

Question 28

can you diagnose atelectasis with cxr or ct scan

Answer 28

ct scan only

Question 29

does COPD pts have higher risk of atelectasis with GA

what about asthma?

Answer 29

no, often have less, same with asthma

Question 30

recruitment manuever to fix atelectasis: initailly a peak airway pressure of ___ is needed for initial opening and ___ for complete reversal. usually hold for __ to ___ seconds

Answer 30

30, 40, 6-7 seconds

Question 31

what type of surgery increases risk for atelectasis

Answer 31

thoracic

Question 32

pt has elevated bilirubin and normal liver enzymes, what is ddx

Answer 32

preexisting abnormality of bilirubin metabolism or a result of hemoglobin breakdown which can occur from hemolytic states or hematoma reabsorption

CN, gilbert, rotor, DJ.

resoroption of hematoma

blood cells destoryed

Question 33

hemolytic anemia can occur after transfusions how

Answer 33

if have multiple transfusions some of the red cells will undergo hemolysis

Question 34

billirubin elevated and mild transaminitis would be from

what if marked elevation in ast/alt

Answer 34

intrahepatic cholestasis or extrahepatic biliary obstruction

marked elevation: severe hypotension, viral hepatitis, drugs

Question 35

pt with acute preop viral hepatitis, how to proceed with surgery

Answer 35

do not proceed unless it is an emergency since the risk of morbidity and mortality is significanly elevated in these pts

Question 36

gold standard for dx of IPF, what other things help with diagnosis, what is the way the gold standard must be done and wqhy

Answer 36

lung biopsy, must be done via VATS or thoracatomy bc need large enough tissues sample. bronchosopy cannot provide this.

high res CT will show bilateral patchy bibasilar peripheral opacities

Question 37

patients with idopathic pulmonary fibrosis often have ___ which would change choice of anesthesia induction

Answer 37

GERD, could be fatal if they aspirate

Question 38

doppler ultrasound can be used to determine both ___ and ___ of floq

Answer 38

direction and speed

Question 39

doppler US: When the red blood cells move towards the transducer, the reflected signal will have ____frequency compared to the transmitted signal. By convention, blood moving away is represented in ___and blood moving towards the transducer is represented in ___.

Answer 39

higher

blue

red

Question 40

most common litigation during MAC due to what problem

Answer 40

respiratory event

Question 41

complex regional pain syndrome type I cause

type II cause

sx of both

Answer 41

caused by a trivial injury, sprain, crush injury, or burn.

II: traumatic injury to a MAJOR NERVE trunk such as significant orthopedic trauma, gunshot injuries, or knife wounds.

burning pain and allodynia (pain to non-noxious stimuli). Both syndromes are also characterized by autonomic dysfunction, which presents with localized temperature changes, cyanosis, and/or edema. If the disease progresses without treatment, the skin can become glossy, smooth, and hairless.

Question 42

diagnosis of complex regional pain syndrome type I and treatment, complications in males

Answer 42

clinical signs and symptoms, in conjunction with a diagnostic sympathetic blockade.

tx: serial sympathetic blocks, spinal cord stimulation

if bilateral lumbar blocks can cause ejaculation problems

Question 43

Diarrhea is associated with a __ ___ block (__-_), which supplies innervation to all the intraabdominal organs, including most of the bowel.

Answer 43

celiac plexus, T5-T12

Question 44

for upper extremity complex regional pain syndrome ___ blocks may be performed which can lead to what

Answer 44

stellate ganglion plexus, lead to horners syndrome

Question 45

what NMDA antagonist can be used to treat CRPS

Answer 45

memantadine

Question 46

where is the celiac plexus located and blockade is more sympathtetic or parasymp block

complications

Answer 46

retroperitoneal at T12 to L1, more symp block, leads to diarrhea

diarrhea, dysesthesia, interscapular back pain, backache, reactive pleurisy, and hiccups, postural hypotension, ptx, retroperitoneal hemmorhage

Question 47

MOA HCTZ

Answer 47

blocks sodium and chloride channels in DCT

Question 48

does PTU or methimazole prevent conversion of T4 to T3 peripherally

Answer 48

PTU

Question 49

in secondary adrenal insufficiency is mineralocorticoid production maintianed and what is treatment

Answer 49

yes it is so can treat with a glucocorticoid dexamethasone

Question 50

what treatment would be needed for primary adrenal insufficiency

Answer 50

a mineralocorticoid like methylprednisolone

Question 51

The spinal cord receives its blood supply from __anterior spinal artery providing about ___ of the blood supply. The spinal cord also receives blood supply from ___posterior spinal artery providing about ___ of the blood supply combined

Answer 51

one, 75%

2, 25%

Question 52

The posterior spinal artery receives most of its blood flow from the _____arteries in the cervical segment of the spinal cord. The anterior spinal artery receives most of its blood flow from __ ___ arteries in the thoracic segment of the spinal cord.

Answer 52

vertebral

anterior radicular

Question 53

TCA MOA pain modulation

Answer 53

serotonin reuptake inhibition

NMDA antagonist

noradrenergic effect

opoidergic effect

adenosine uptake inhibition

blockade sodium and calcium channels

Question 54

which drug during delivery is the most appropriate drug for shoulder dystocia and dose

Answer 54

nitroglycerin

0.4 mg sublingual. If IV dosing is needed, then 50-200 mcg IV is typical

Question 56

Estimated Blood Volume

Adult Female

Adult Male

kid 1-12

infant (1-3 months)

full term

preterm

Answer 56

female: 60-65
male: 65-70

1-12: 70-75

infant 70-80

full term: 80-90

premature: 90-105

Question 57

Bradycardia following spinal anesthetic injection is more common in patients with what?

Answer 57

high baseline vagal tone, anesthetic levels above T5, and is associated with decreased cardiac preload (i.e. reverse Bainbridge reflex).

Question 58

Intrathecal blockade results in a ____that is often at least ___spinal levels higher than the sensory level that develops. The higher the level of ____the more likely hemodynamic imbalances will result.

Answer 58

symphatectomy, 2 levels, symphatectomy

Question 59

Factors affecting the height of an intrathecal block include:

Answer 59

patient position, baricity of anesthetic, and the dose of local anesthetic

Question 60

what is the brainbridge reflex

Answer 60

increased preload causes stretch of the myocardium, which increases intrinsic activity of the heart (Bainbridge reflex). When preload falls, the intrinsic depolarization of the SA node slows resulting in another cause of bradycardia following spinal anesthesia.

Question 61

In the majority of patients the thoracic duct drains into the venous system at or near the junction of the ___ internal jugular (IJ) vein and the __subclavian vein (SCV), and therefore can potentially be injured when placing a central line on the ___in either the IJ of the SCV.

Answer 61

left, left, left

Question 62

which central lines have the lowest rate of infection

Answer 62

subclavian

Question 63

equation for standard Error

Answer 63

SE = SDeviatgion / square root (N)

Question 64

does airway closure happen first in dependent or non dependent areas of the lung

Answer 64

dependent

Question 65

in emphysema which part of the airway collapses first and does it close earlier than normal lung

Answer 65

distal part, alveoulus, it is damaged and thin

closes earlier in empysema

Question 66

4 things that increase chance of PONV in peds

Answer 66

including patient age (> 3 years old), duration of surgery (> 30 minutes), type of procedure (strabismus repair and adenotonsillectomy increase risk of PONV), as well as patient and family history of PONV

Question 67

CBF and CMRO2 with sevoflurane at 1.0 MAC

how about 1.5-2.0 MAC

Answer 67

1.0 decreases CMRO2 with minimal effect on CBF

at 1.5-2.0 MAC decreases CMRO2 and increases CBF (cerebral dilation)

Question 68

laryngospasm is mediated by what nerve (afferent branch)

Answer 68

internal branch of SLN

Question 69

mnemonic to differentiate the SLN branches is “SIME”

Answer 69

sensory internal

motor external

Question 70

Major independent preoperative risk factors for postoperative AKI following noncardiac surgery in patients with previously normal renal function include:

Answer 70

BMI >32

60 and older

chronic liver disease

emergency surgery

PVD

high risk surgery

COPD with chronic bronchodilator use

Question 71

what supplements can alter platelet function

Answer 71

Garlic, ginger, gingko, and vitamin E

GGGE

Question 72

While many different drugs potentiate NDNBDs, fewer drugs decrease their activity and/or duration of action. These include

Answer 72

these include anticonvulsants (e.g. carbamazepine and phenytoin), calcium, and corticosteroids.

Question 73

important drugs that can desensitize AChRs (make them less able to stimulate muslce) include

Answer 73

volatile anesthetics, local anesthetics, calcium channel blockers, certain classes of antibiotics (e.g. aminoglycosides, clindamycin, polymyxin, and tetracyclines), and alcohol.

magnesium can block it

Question 75

in ICU pts what is the most common complication of enteral nutrition

Answer 75

high residual volumes

Question 76

Fresh gas flow (FGF) must be greater than or equal to what? in the Mapleson D semi-open breathing system to prevent rebreathing during controlled ventilation.

Answer 76

to 1-2 times minute ventilation

Question 77

side effects of phenytoin

Answer 77

gingival hyperplasia, dermatitis, and resistance to nondepolarizing muscle relaxants with chronic use

Question 78

what is lusitropy

Answer 78

myocardial relaxation

Question 79

treatment for botulism

Answer 79

equine serum antitoxin

Question 80

mechanism of botulinism

Answer 80

prevents release of ach from nerve end terminals

Question 81

for those with foodborne botulinism exposure what should be performed

Answer 81

serum analysis for toxin by mice bioassay

Question 82

treatment of botulinism by age

Answer 82

Two types of antitoxin therapies are available – equine serum in patients older than one year old and human-derived immune globulin for infants less than one year of age.

Question 83

theorized mechanism behind botox use

Answer 83

decrease in release of substance P and calcitonin gene-related peptide (CGRP) in sensory nerves. In addition, glutamate, an excitatory neurotransmitter, is also inhibited.

Question 84

mortalitiy from transfusion of blood products, top 3 causes in order

Answer 84

1) transfusion related acute lung injury
2) hemolytic transfusion reactions (non ABO > ABO)
3) infection and transfusion related sepsis

Question 85

trigger point injection indication

2 types of it

Answer 85

painful limited ROM

active: spontaneous pain
latent: pain with palpation

Question 86

why should PEEP be avoided in pts with an ostium primum defect

Answer 86

, PEEP should be avoided since it can worsen the increased pulmonary vascular resistance (PVR) and mean airway pressures.

Question 89

what lab value will be prolonged in DIC

Answer 89

PT

Question 90

triad most likely seen in DIC lab wise

Answer 90

increased PT/aPTT with decreased platelets and fibrinogen levels

Question 91

what drug should be avoided in asthmatic patients for uterine atony

Answer 91

carboprost

Question 92

in ARDS tidal volume and plateua pressure

Answer 92

6 ml/kg

under 30

Question 93

ideal body weight equation for males and females

Answer 93

Males: 50 + 2.3 * (height in inches - 60)
Females: 45.5 + 2.3 * (height in inches - 60)

Question 94

oxygen dissociation curve what makes it go right vs left

Answer 94

Question 95

afferent and efferent limbs of laryngospasm

Answer 95

afferent is interanal branch SLN

efferent is RLN

Question 96

where do potassium sparing diuretics work

Answer 96

distal collecting ducts of nephron

Question 97

best lab value for liver function

Answer 97

PT-INR

Question 98

fetal scalp monitoring pH:

A measurement > ___ is generally considered acceptable and an indication that the parturient may continue labor. A pH
___ is abnormal and, should a second sample confirm the finding, delivery should be accelerated and conversion to a cesarean section may be considered.

Answer 98

> 7.25

< 7.2

Question 99

ABG in 3rd trimester female will show

Answer 99

respiratory alkalosis (from increased minute ventilation) with copensatory metabolic acidosis

Question 102

during an awake craniotemy for epilepsy pt gets seizure what is most appropriate next step

Answer 102

propofol or application of iced saline to the cortex

Question 103

CAM-ICU initial questions for delerium

if both yes then what other 2 questions

how to interpret

Answer 103

1) is there an acute change in mental status or fluctuating course
2) is the patient inattentive or easily distracted

if both yes

3) is there an altered level of consciousness or RASS other than 0
4) does the patient experience disorganized thinking

if either 3 or 4 are positive then delerium present

Question 104

possible complications of transcutanesous pacemakers

Answer 104

patient discomfort, muscle injury, rhabdomyolysis, and hyperkalemia

Question 105

transcutaneous pacing

original rate should be set at ___ or ___ bpm above intrinsic rate

Answer 105

80 bpm

30 bpm above

Question 106

transcutaneous pacing: pacing current is usually set at ___ mA and should be increased by ____ mA at a time until what

Answer 106

Pacing current is usually set at 70mA and should be increased 5-10mA at a time until a definite QRS complex and T wave is demonstrated following the pacer spike, which is usually obtained around 100mA.

Question 107

2 common antidotes for extravasation of IV are what

Answer 107

phentolamine and hyaluronidase

Question 108

extravasation of vasopressors can be managed how

Answer 108

with limb elevation, warm compresses, irrigating with saline (Gault technique), injection of phentolamine, and/or a stellate ganglion block (for upper limbs).

Question 110

onset of a block is related to the ___ because why

Answer 110

pH

a pH closer to the PKA of the LA will increase number of unionized drug which is what penetrates nerve membrane

Question 111

epinerphrine pH and block speed, what can you use to help speed it up

Answer 111

ampules with epi lower pH so slow onset of block

use bicarb

Question 112

what is the alveolar gas equaiton

Answer 112

PAO2 = FiO2(PB – PH2O) – PCO2 / RQ

Question 113

does scopalamine cross the BBB

Answer 113

yes

Question 114

common metabolic changes seen with TPN administration

Answer 114

hypercarbia

hyperglycemia

hypophosphatemia

hypokalemia

hypomagnesemia

hyperinsulinemia

Question 115

cardiac action potential ions

Answer 115

Question 116

pH 7.2-7.3, PaCO2 50-55 mm Hg, PaO2 18-25 mm Hg, bicarbonate 22-25 mEq/L, base excess -2.7 to -4.7 mEq/L. is normal numbers for umbillical vein or artery?

Answer 116

artery

Question 117

The American College of Obstetricians and Gynecologists (ACOG) states that umbilical arterial blood pH <__ and a base deficit ≥___ mEq/L at delivery are one part of the definition of an acute intrapartum hypoxic event sufficient to cause cerebral palsy.

Answer 117

7.0

12

Question 118

diagnosis of ALS is made how

Answer 118

(electromyography [EMG] and electroneurography) and by neurologic examination, which demonstrates early spastic weakness of the upper and lower extremities, typical subcutaneous muscle fasciculation, and bulbar involvement affecting pharyngeal function, speech, and the facial muscles.

Question 119

what is the only treatment for ALS and MOA

Answer 119

Riluzole, glutamate release inhibitor

Question 120

what can increase the B1 adrenoreceptor densityon a cardiac myocyte

Answer 120

hypertyroidism

beta blockers

myocardial ischemia

Question 122

why are beta blockers good for MI at cell level

Answer 122

Myocardial ischemia causes a rapid upregulation of β adrenoceptors despite a large surge of plasma norepinephrine (this should normally cause downregulation; see below). Norepinephrine release and β adrenoceptor upregulation cause adrenergic overstimulation of an ischemic myocardium, which can lead to further myocardial ischemia and damage. This is 1 reason why the administration of β-blockers, which inhibit the catecholamine component of this vicious cycle, is beneficial for patients with coronary artery disease and myocardial infarction.

Question 123

aging, congestive heart failure, and chronic use of β agonists cause ____ of b receptor density on cardiac myocytes

Answer 123

downregulation

Question 124

initial resuscitation in pediatric patients with severe dehydration begins with ____mL/kg of what solution

Answer 124

20 mL/kg bolus of an isotonic salt solution, usually 0.9% sodium chloride (B), Ringer’s lactate, or Plasmalyte

Question 125

where does weakness occur with steroid myopathy

Answer 125

the proximal muscles in the upper and lower limb and to the neck flexors

Question 126

where is vasopressin made in body and stored

Answer 126

hypothalamic supraoptic and paraventricular nuclei that is stored in the posterior lobe of the pituitary

Question 127

radiation exposure equation, how much less exposure from distance

Answer 127

(1/radius^2)

Question 128

what reflexes are permissible when diagnosing brain death

Answer 128

spinally mediated reflexes

Question 129

TAP block, what what nerves blocked

Answer 129

anterior rami T7-L1

Question 130

A motor response with a current ___ increases the likelihood of intraneural injection.

Answer 130

< 0.2mA

Question 131

Appropriate perineural placement occurs with a response between __ and ___ mA. If stimulation is elicited using a current below ___ mA, intraneural injection is possible and the needle should be repositioned (e.g. pulled back slightly)

Answer 131

0.2 to 0.5 mA

below 0.2 mA

Question 132

the lab test that best determines imminent AKI is what

Answer 132

creatinine clearance

Question 133

creatinine clearance equation

Answer 133

CCr = (Urine creatinine * Urine volume) / Plasma creatinine

Question 134

high dose phenyleprhine and splanchnic circulation

Answer 134

causes arterial and venous constriction which leads to decreased perfusion

Question 135

autonomic hyperreflexia occurs in pts with spinal cord injuries above ___ outflow distribution within the ___ which usually occurs in lesions above ___

Answer 135

splanchnic

SNS

T5

Question 136

splanchnic nerves responisible for PNS or SNS innervation

Answer 136

SNS

Question 137

greater splanchnic nerve supplies SNS innervation to __

lesser to ___

least to ___

Answer 137

greater T5-9

lesser is T10-11

least is T12

Question 138

how does Autonomic hypereflexia occur

Answer 138

SCI, so when cutaneous or visceral stimulation occurs below the level of the SCInjury spinal cord reflexes from above triger SNS activity along splanchnic outflow tract but bc of SCI inhibtory centers from above the SCI cannot inhibit below SCI so intense vasoconstirction below SCI and cutaneous vasodilation above SCI

Question 139

signs and sx of autonomic hyperreflexia:

BP

HR

heart

head

skin color and temp

nasal and UE sx

Answer 139

hypertension, reflex bradycardia, cardiac arrhythmias, myocardial infarction, headaches, retinal hemorrhages, pallor, and coolness of the lower extremities, sweating of the upper extremities, and nasal congestion

Question 140

tx of autonomic hyperreflexia

caution giving what

Answer 140

cessation of the triggering event and immediate delivery of fast-acting vasodilators such as sodium nitroprusside, nitroglycerin, or nicardipine.

caution giving BBlockers

Question 141

recommendation of high dose glucocorticoids in TBI

Answer 141

dont use them

Question 142

gold standard for dx of malignant hyperthermia

Answer 142

halothane caffeine contracture test

Question 143

methemoglobin and iron

Answer 143

Fe2+ gets oxidized to Fe3+ and doesn’t bind oxygen

Question 144

SaO2 ABG with methemoglobinemia

Answer 144

will be falsely elevated bc abg thinks all hgb is normal

Question 145

examples of things that can cause methemoglobinemia

LAs

abx

and others

Answer 145

Examples include some local anesthetics (notably benzocaine and prilocaine), certain antibiotics (e.g. dapsone, sulfonamides, and trimethoprim), metoclopramide, nitrates, and nitrites.

Question 146

what intervention most improves pulmonary function following major open upper abdominal surgery

Answer 146

mid thoracic epidural

Question 147

GFR of newborns

Answer 147

low at birth and greatly increases in first few days of life bc at brith BP increases and renal vascular resistance decreases

Question 148

after the first 24 hours of life a newborns urine output should be what

Answer 148

1-2 ml/kg/hr

Question 149

peak inspiratory pressure vs plateua presure

PIP is what resistance and examples

PP is what resistance and examples

Answer 149

PIP varies with flow resistance from vent tubing to segmental bronchi

Airway compression
Bronchospasm
Foreign body
Kinked endotracheal tube
Mucus plug
Secretions

PP: decreased elastance of lung or compliance

Abdominal insufflation
Ascites
Intrinsic lung disease
Obesity
Pulmonary edema
Tension pneumothorax
Trendelenburg position?

Question 150

what is an alternative therapy to postdural puncture headache

Answer 150

sphenopalatine ganglion block

Question 151

in pregnancy

FRC

TV

RR

resp acidosis or alkalosis

Answer 151

FRC decreases

TV increases

RR increases from progesteroone

resp alkalosis

Question 152

in pregnant pts what drug to increase BP, usually avoid what

Answer 152

phenylephrine, avoid ephedrine (some reports of acidosis)

Question 153

MOA phenytoin

Answer 153

to shorten phase 0 of the cardiac action potential by binding to voltage gated sodium channels to terminate ventricular arrhythmias

Question 154

first line choice for tonsilectomy pain in peds and dose in 24 hr period

Answer 154

acetaminophen

no more than 75 mg/kg PO/IV at ideal body weight in a 24 hour period

Question 155

____ is a noncardiogenic pulmonary edema that shows up after transfusions and bilateral patchynes on CXR and occurs most often after administration of what

Answer 155

TRALI

FFP and platelets

Question 156

transfusion associated circulatory overload occurs from what and what are early sx

can lead to what

Answer 156

rapid administration of more blood products than the pts CV status can handle

htn and elevated CVP

can evetnaully lead to CV collapse

Question 157

is cardiomegaly more likely to be seen in TACO or TRALI

Answer 157

TACO

Question 158

airway of infant compared to adult

larynx position

tongue size

angle of vocal cords

shape of epiglottis

Answer 158

larynx is more cephalad

tongue size is relatvely larger

angled vocal cords

omega shaped epiglotis

Question 159

infant larynx is positioned at __ to __ as compared to the adult which is positioned where

Answer 159

C3-4 infant

C5-6 adult

Question 160

preop anxioxlysis for peds pts dose

how long to work and how long can last

Answer 160

oral midazolam 0.5 to 0.75 mg/kg

10 minutes to work, can last for up to 60 minutes

Question 161

Preoperative pharmacologic anxiolysis is not usually necessary until the development of separation anxiety, which normally occurs after ___ months of age.

Answer 161

6 months

Question 162

lithium potentiates or inhibits? the effects of nondepolarizing neuromuscular blocking drugs (NDNBDs) and how

Answer 162

potentiates

by activating potassium channels in prejunctional neurons which interferes with transmission of an action potential to the nerve terminal.

Question 163

normal pulmonary artery occlusion pressure

Answer 163

4-12

Question 164

normal CVP range

Answer 164

4-12

Question 165

normal pulmonary artery diastolic pressure range

systolic pulm pressure

Answer 165

4-12

15-30

Question 166

normal RA pressure

Answer 166

2 to 7

Question 167

glucocorticoid/mineralcorticoid potency

hydrocortisone

Answer 167

G: 1

M: 1

Question 168

chronic corticosteroid use and the following levels

hgb

potassium

sodium

BG

urinary uric acid

urinary calcium

alkalosis vs acidosis

Answer 168

all increased except for potassium

alkalosis

Question 169

cortisol effect on kidney electrolytes

Answer 169

increase sodium retention and potassium excretion but no effect on hydrogen

Question 170

glucocorticoid/mineralcorticoid potency

cortisone

Answer 170

G 0.8

M: 0.8

Question 171

glucocorticoid/mineralcorticoid potency

prednisolone

Answer 171

G 8

M 0.8

Question 172

glucocorticoid/mineralcorticoid potency

prednisone

Answer 172

G 4

M 0.8

Question 173

glucocorticoid/mineralcorticoid potency

methylprednisolone

Answer 173

G 5

M 0

Question 174

glucocorticoid/mineralcorticoid potency

dexamethasone

Answer 174

G 25

M 0

think dexters lab is smart as a 25 year old

Question 175

glucocorticoid/mineralcorticoid potency

fludrocortisone

Answer 175

G 10

M 125

Question 176

is glycine excitatory or inhibitory

Answer 176

inhibitory

Gly = I for inhibitory

Question 177

which of these stimuli are activators vs inhibtors of nociceptors:

prostaglandins, glycine, neuropeptides (e.g. substance P, calcitonin gene-related peptide), glutamate, bradykinin, H+, ATP, and proinflammatory cytokines (e.g., TNF-α, Interleukin-1β).

Answer 177

all stimulators except glycine

Question 178

advantage of double burst stimulation vs TOF

explain how it works

Answer 178

better tactile assessment

Most commonly, three 0.2 msec bursts at a 50 Hz frequency are applied followed 750 msec later by an identical burst. The muscle responses are of greater magnitude than those elicited by TOF allowing more accurate visual and tactile assessmen

Question 179

alcohol and AIP

Answer 179

can increase ALA so cause exacerbation

Question 180

what should be avoided in AIP pts when doing anesthesia or cases

what about hydration and temp

Answer 180

Barbiturates, benzodiazepines, nifedipine, glucocorticoids, and alcohol should be avoided.

keep hydrated and keep normothermic

Question 181

massive air embolus would have an increased in end tidal what

Answer 181

nitrogen

Question 182

who gets basal opioid on PCA

Answer 182

pts who are not opioid naiiave

Question 183

what is closing capacity

Answer 183

is the volume remaining in the lungs during expiration when small airways begin to close

Question 184

most common side effect of fospropofol

Answer 184

parasthesias

Question 185

onset of action fospropofol vs propofol

Answer 185

fospropofol takes 4 minutes or so, slower onset

Question 186

what lab value is the strongest predictor of perioperative outcomes of pts on TPN

Answer 186

albumin

Question 187

TPN metabolic abnormalities: Metabolic abnormalities include ___with initiation and ____with discontinuation. sugars

Answer 187

hyperglycemia with initiation

hypoglycemia with DC

Question 188

what happens to the closing capacity with age

Answer 188

it increases and exceeds FRC by age 60

Question 189

pudendal nerve block is done during what stage of labor

Answer 189

second

Question 190

first stage of labor includes the __ and __ phase and nerve pain from where

Answer 190

active, latent

T10-L2

Question 191

______events make up the largest proportion of claims in the American Society of Anesthesiologists (ASA) Closed Claims Project database (70% in the 1990s).

Answer 191

non respiratory

Question 192

top 3 factors leading to death and permanent brain damage in anesthesia are

Answer 192

1) Cardiovascular events (pulmonary embolism, stroke, myocardial infarction, arrhythmia, undiagnosed conditions)
2) Respiratory events (inadequate ventilation, esophageal intubation, difficult airway)
3) Equipment issues (failure or misuse)

Question 193

First-order neurons secrete ____ and __in the dorsal horn as a chemical mediator of pain signaling.

Answer 193

substance P

adenosine

Question 194

contraindication to retrograde intubation

Answer 194

Coagulopathy.

Inability to identify landmarks (obesity, thyroid goiter, distorted anatomy).

Laryngeal disease (such as laryngeal stenosis directly at the puncture site. Retrograde intubation has successfully been used in epiglottitis, laryngeal trauma, laryngeal cancer).

Local infection (such as pre-tracheal abscess).

Question 195

Decelerations and accelerations lasting from __ to ___minutes are prolonged. When they last for more than ___ minutes they lead to a change in the baseline FHR.

Answer 195

2-10 minutes

10 minutes

Question 196

normal baseline fetal heart rate is what

Answer 196

110-160 bpm

Question 197

causes of FHR tachycardia

Answer 197

fetal hypoxia, maternal fever, chorioamnionitis, anticholinergics, beta-agonists, fetal anemia, or tachyarrhythmias.

Question 198

causes of FHR bradycardia

Answer 198

congenital heart block, beta-antagonists, hypoglycemia, hypothermia, or fetal hypoxia

Question 199

FHR late decelerations due to what

Answer 199

uterine contractions

Question 200

variable decelerations are due to what

Answer 200

umbillical cord compression

Question 201

of the following which is a curved blade:

mccoy

wisconsin

wis-hipple

Answer 201

McCoy

Question 202

Efficacy of epidural steroid injections (ESIs) for lumbar radiculopathy is inversely correlated with what?

Answer 202

duration of symptoms.

Question 203

preop testing in pts with myotonic dystrophy. what does not need to be done

Answer 203

• ECG and echo
• if ECG abnormal need cards consult
• Pacemaker placement may be considered even if only first degree heart block is present
• If second or third degree heart block is present, pacemaker implantation is warranted
• CXR if pt has acute pulmonary sx

no PFTs

Question 204

what will not help distinguish thyroid storm from MH on the monitors

Answer 204

tachycardia

Question 205

how can MH and thyroid storm be differentiated

Answer 205

presence of muscle rigidity (present with MH, not a sign of TS), rate of EtCO2 rise (MH >> TS), the temperature increase (MH usually greater and faster than TS), and the degree of hypertension (TS > MH).

Question 206

Fresh gas flow must be equal to at least which of the following parameters to prevent rebreathing during spontaneous ventilation while using a Mapleson A circuit?

Answer 206

minute ventilation

Question 207

how to tx thyroid strom

Answer 207

PTU followed by iodide tx

Question 208

a fetal biophysical profile consists of what

what is the scoring and what is normal and abnormal

Answer 208

of a non-stress test and observation of fetal breathing, fetal movement, fetal tone, and amniotic fluid volume

each component gets 2 or 0,

normal is 8

6 is equivocal

4 or less suggests fetal hypoxia

Question 209

The non-stress test component of the BPP is classified as reactive when what occurs

what would has nonreactive

Answer 209

at least 2 fetal heart rate accelerations of 15 beats/minute for 15 seconds within a 20-40 minute time period are observed.

suboptimal oxygenation

Question 211

how long is the half life of plasma albumin

Answer 211

around 3 weeks

Question 213

2 groups of laryngeal muscles and what do they do

Answer 213

extrinsic move muscles of larynx as a whole

intrinsic muscles move the various laryngeal cartilages in relation to one another in order to alter the size and shape of the rima glottidis and to change the length and tension of the vocal cords.

Question 214

thyroaretenoid muscles are responsible for what

Answer 214

vocal cord relaxation

Question 215

which muscles are responsible for vocal cord adduction

Answer 215

lateral cricroarytenoids

transverse and obliquie aretynoids

Question 216

which muscle lowers pitch voice and raises

Answer 216

The cricothyroid increases voice pitch (i.e. high pitch) and the thyroarytenoid decreases voice pitch (i.e. low pitch). Saying these terms with a high and low pitch, respectively, is one way to help recall their function.

Question 217

mean median and mode for left, normal, right skew data

Answer 217

Question 218

To identify the seizure foci during a craniotomy several medications have demonstrated the ability to “activate” the seizure area. Medications to detect this area include:

Answer 218

etomidate, sufentanil, alfentanil

Question 219

A patient under moderate sedation should have a purposeful response to either

Answer 219

tactile or repeated verbal stimulation

Question 220

purposeful response to repeated stimulation would be what level of sedation

Answer 220

deep

Question 221

cryoprecipitate contains about how much per unit

what does it contain high amounts of

Answer 221

200mg/unit

high amounts of factor VIII, XIII, fibrinogen, vWF

Question 222

70 kg pt gets 10 units of cryo, how much will it raise his fibrinogen

Answer 222

70mg/dl

Question 223

what is MAC-BAR

Answer 223

MAC at which adrenergic response to noxious stimuli is blunted. Usually at least 50% higher than standard MAC

1.7-2.0

Question 224

MAC for loss of awareness and recall

ASA guidelines recommend maintaining a MAC of at least ___ to prevent recall and awareness

Answer 224

MAC of 0.4-0.5

0.7

Question 225

what is MAC-awake and is it higher at induction or emergence

Answer 225

MAC value at which voluntary reflexes and perceptive awareness are lost

higher at induction

Question 226

awareness under anesthesia most likely during which casesq

Answer 226

cardiac, OB, trauma

Question 227

Severe aortic stenosis is defined as a valve area less than __ cm2 and a transvalvular pressure gradient higher than ___ mmHg.

Answer 227

0.8cm2

50 mmHG

Question 228

HR goal in aortic stenosis

what about afterload

Answer 228

normal to slower to allow for more LV filling time

afterload: want to maintain it distal to stenotic lesion in order to maintain coronary perfusion, decrease can lead to MI

Question 229

HR goal in Aortic regurge

Answer 229

keep above 80 bpm

Question 230

PPV equation

Answer 230

( (PPmax - PPmin)/(PPmax + PPmin)/2 )

Question 231

other lung changes that occur with aging

RV

ICapacity

FRC

TLC

Answer 231

higher residual volume (RV) (A), lower inspiratory capacity (IC), higher FRC (C), and a decrease in total lung capacity (TLC

Question 232

propofol infusion syndrome usually occurs at infusion doses of what

Answer 232

>4mg/kg/hr

Question 233

manifestations of propofol infusion syndrome (PRIS)

Answer 233

metabolic acidosis, rhabdomyolysis, congestive heart failure, and bradycardia

Question 234

other expected electrolyte change in ESRD besides hyperkalemia

Answer 234

hypocalcemia

Question 235

Elective repair of an aoritc aneurysm is indicated if the size is > ___ or the rate of growth is > ___ per year

Answer 235

5.5 cm

>1.0 cm per year

Question 236

when placing aortic stent for aneurysm what 3 techqniues used to prevent them from moving to the wrong place while opening it up

Answer 236

1) induced-hypotension (SBP 70-80)
2) transient cardiac asystole (adenosine)
3) rapid ventricular pacing (>180 bpm will cease left ventricular ejection, done with transvenous pacing)

Question 237

____ should be administered to someone following blood or bodily fluid exposure to HBV. ___should also be offered.

Answer 237

Hepatitis B virus (HBV) hyperimmune globulin

HBV vaccine should also be offered

Question 238

what causes hypophosphatemia in TPN administration

Answer 238

glucose loading

causes big release of insulin which causes cells to take up lots of glucose and phosphate

Question 239

cardiac AP why does hypocalcemia prolong QT

Answer 239

becasue less calcium in sarcoplasmic reticulum which is needed to activate the outward K+ channels during repoloarization phase 3

Question 240

which has more opioid consumption: nurses giving opoid boluses or PCA

Answer 240

PCA

Question 241

Pregnant women with cord injury above ___may have an increased risk of preterm labor. Since these women do not experience labor pain, weekly cervical evaluation during the third trimester is typically performed. Vaginal delivery is preferred and assist-devices may be needed given a decreased ability to push during labor.

Answer 241

T11

Question 243

which local anesthetic has the least amount of placental transfer when given via epidural route

Answer 243

chloroprocaine

Question 244

The induction agents propofol and thiopental, as well as the opioids fentanyl and remifentanil should be dosed based on what weight

Answer 244

Lean Body weight

Question 245

what is lean body weight

Answer 245

total weight minus adipose tissue

Question 246

succinylcholine should be dosed based off what weight and why

Answer 246

total body weight

-Obese patients have an increase in both extracellular fluid and their amount of pseudocholinesterase, both of which affect the duration of action of succinylcholine.

Question 247

decompensated HF graph. what happens with diuretic, diuretic + inotropy

Answer 247

Question 248

normal contractility curve, vs exercise, vs HF

Answer 248

Question 249

which electrolyte changes lead to PRolonged PR interval

Answer 249

hyPeR calcemia, magnesemia, kalemia

Question 250

does magnesium sulfate therapy potentiate NDNMB or depolarizing NBM

Answer 250

both

Question 251

___ describes the precision of the population mean

Answer 251

standard error of mean

Question 252

effect of supine position on closing capacity

Answer 252

no effect

Question 253

Airway exchange catheters have advantages over gum elastic bougies when performing endotracheal tube exchange. These include

Answer 253

jet ventilation and ETCO2 monitoring

Question 254

which fentanil has fastest onset of action and why

Answer 254

alfentanil

high unionized fraction due to low pKa

Question 255

For opioid medications, _____ _____correlates with duration of action. with ___ solubility leading to longer DOA

Answer 255

lipid solubility

lower

Question 256

what EKG finding axis wise would lean you more towards hyperkalemia vs STEMI and what else about QRS

Answer 256

right axis deviation

negative lead I with a positive AVF

wide QRS

Question 257

what week of pregnancy does amniocentesis pose a higher risk

Answer 257

when done before 15 weeks

Question 258

The lumbar sympathetic ganglia are located along the ____surface of the ____to ___lumbar vertebral bodies, ____to the _____muscle.

Answer 258

anterolateral

2nd to 4th

anteromedial to the psoas muscle

Question 259

severity of TBI based off glasgow coma scale

mild

moderate

severe

Answer 259

mild 13-15

moderate 9-12

severe 3-8

Question 260

beckers muscular dystrophy

genetic problem

other manifestations

Answer 260

decreased quantity of dystrophin

macroglossia, color blindness, epilepsy

cardiac involvement

Question 261

The parasympathetic component of the facial, glossopharyngeal, and vagus nerves lie in (VII, IX, X)

oculomotor nerve lies where (III)

Answer 261

the medulla oblongata

midbrain

Question 262

does CPAP increase or decrease surfactant depletion

Answer 262

decrease

Question 263

CPAP ___inspiratory and expiratory time, and also ___tidal volume. Respiratory rate typically ____and minute ventilation typically ____.

Answer 263

increases, increases

decreases

increases

Question 264

What is the most appropriate endotracheal tube type to prevent airway fire during laser procedures?

Answer 264

stainless steal endotracheal tube

Question 265

can mannitol cause cerebral vasodilation and how

Answer 265

yes

if given too fast

Question 266

What is the most appropriate endotracheal tube type to prevent airway fire during laser procedures?

Answer 266

stainless steal ETT

Question 267

deleterious effect of neonatal hypothermia, explain

Answer 267

metabolic acidosis

neonates use nonshivering thermoregulation to control body temperature. A decline in temperature below 36.0 degrees Centigrade is likely to trigger this response. If left uncorrected, maladaptive physiological responses such as metabolic acidosis are likely to occur and could prove lethal for a neonate.

Question 268

if a patient is on selegeline what is the intrapop pain control choice and why

Answer 268

fentanyl

meperidine can interact with MAOI and so can morphine and diluaudid

Question 269

patient on TCA what is a preop test to do

what anesthetic drugs should be used with caution with these pts and why

Answer 269

EKG

ketamine, halothane, pancoronium —> HTN and tachycardia

Question 270

pt is on MAOI effect on

MAC

succinylcholine

ephedrine use

Answer 270

increase MAC requirement

incresae succ requirement

careful with ephedrine can lead to HTN

Question 271

which of the following opoids does not have any activity at the NMDA receptor:

tramadol

propoxyphene

oxymorphone

what other drugs from this dumbass truelearn question have action there

Answer 271

oxymorphone does not

magnesium, dextromethorphan, NO, PCP

Question 272

treatment for inhalational anthrax

Answer 272

ciprofloxacin or doxycycline

Question 273

exposure ppx to anthrax

Answer 273

cipro or doxycycline

Question 274

anthrax incubation period and original presenting sx

Answer 274

1-7 days

non specific flu like sx

Question 275

benefit of using an isolation transformer with line isolation monitor (LIM) over a ground fault current interrupter (GFCI)?

benefit of GFCI

Answer 275

A GFCI is cheaper and easier to install but it shuts off power in the event of a fault whereas an LIM does not.

Question 276

what kind of pain is this describing: a dull, aching, and poorly localized pain.

inflammatory, somatic, neurogenic, myofascial

Answer 276

inflammatory

Question 277

___ pain is caused by tissue injury and is sharp and well localized.

Answer 277

somatic

Question 278

What is the maximum dose of lidocaine that can be used in a tumescent solution?

-in heatlhy pt

Answer 278

55 mg/kg

healthy pt

Question 279

____is the process at the beginning of a malpractice suit where documents are exchanged and depositions are made

Answer 279

discovery

Question 280

coagulation changes in pregnancy

protein S

protein C

fibrinolysis

d dimer

thrombin-antithrombin complexes

platelet number

Answer 280

protein S concentration decreases

activated protein C resistance

fibrinolysis is impaired

increase in D-dimer

increase thrombin antithrombin complex

thrombocytopenia

Question 281

differnece between central sleep apnea and OSA

Answer 281

only 20-25% of patients with central sleep apnea snore

Question 282

A central sleep apnea event is defined as an apneic period (≥_____seconds) without an identifiable respiratory effort and a diagnosis requires ≥___ episodes per hour of sleep.

Answer 282

10 seconds

10 episodes

Question 283

Common volatile anesthetics are thought to manipulate what channels and but not what

Answer 283

GABA, background potassium channels, sodium channels (inhibitory)

not NMDA

Question 285

decreased CO would affect alveolar dead space how

Answer 285

increase it

Question 286

is atelectasis a shunt or increased dead space and why

what about mainstem intubation

Answer 286

shunt. alveoli still receive blood just not vented

mainstem = shunt, same thing, getting blood but not verntilation

Question 287

what muscle relaxant should be avoided in pts with hyperthyroidism and why

Answer 287

pancuronium, can stimulate sympathetic nervous syteem

Question 288

workers’ compensation insurers, workers’ compensation administrative agencies, or employers (except to the extent that they may otherwise be covered entities) are 3 things not covered by what

Answer 288

HIPPA

Question 289

how long does neonatal myasthenia gravis last

Answer 289

usually 2-4 weeks as maternal Abs that were transfered across the placenta are metabolized

-caused by transfer of maternal antibodies

Question 290

When performing a caudal epidural, which of the following structures should a needle traverse just prior to the epidural space?

Answer 290

sacrococcygeal ligament

Question 291

advantage of using fructosamine vs hemoglobin A1c, time interval and pt population

what is used to test it

Answer 291

shorter timer interval so good for pts who have reduced red cell lifespans (e.g. hemolytic anemia, sickle-cell disease). (1-2 weeks)

proteins that use nonenzymatic glycation

Question 292

with aortic cross clamping what happens to the CVP

Answer 292

it does not decrease bc catecholamines are released and cause venoconstriction distal to the clamp

Question 293

increase or decrease with aortic cross clamping

body oxygen extraction

arterial blood pressure

catecholamine levels

pulmonary artery wedge pressure

Answer 293

decreased oxygen extraction

increased arterial blood pressure

increased catecholamine levels

increased pulmonary artery wedge pressure

Question 294

advantages of using a bronchial blocker vs double lumen tube

Answer 294

• for selective lobar collapse
• patients that have had prior oral or neck surgery with challenging airways may better tolerate a bronchial blocker since these patients may not anatomically accommodate larger DLTs.
• Patients with tracheostomies
• pts under 12
• post op ventilation, using bronchial blocker will not have to exchange at end of procedure

Question 295

does post pyloric feeding tube decrease the risk of aspiration?

Answer 295

no

Question 296

____, ____, and ____have all been shown to reduce pulmonary hypertension in children.

Answer 296

Inhaled nitric oxide, epoprostenol, and sildenafil

Question 297

infant with meningomyelocele may need what procedure performed

Answer 297

VP shunt bc may have arnold chiari malformation

Question 299

a ____is the official beginning of a lawsuit, and it is to notify the defendant that an action has been instituted against him or her, and that he or she is required to answer to it at a time and place named.

Answer 299

summons

Question 300

___ is evidence given by a witness under oath about the case. It is part of a deposition, which is part of discovery.

Answer 300

testimony

Question 301

____ are statements made under oath about the case, usually for clarification of the written record or to explain the reasoning or thought process behind a decision. They are part of the discovery process.

Answer 301

depositions

Question 302

ST segment depression can be normal in what leads

Answer 302

V1 and AVR

Question 303

early onset vent associated pneumonia is caused mainly by what organisms and what is the timeframe

Answer 303

48-72 hours

MSSA, Haemophilus influenzae, and Streptococcus pneumoniae (pneumococcus), as well as Proteus, Klebsiella, and Enterobacter species

Question 304

late onset VAP is associated with what organisms

Answer 304

MRSA and pseudomonas

Question 305

is epinephrine metabolized in the lung at all

Answer 305

no

Question 306

Up until what postconceptual age is it prudent to monitor neonates overnight following a general anesthetic

Answer 306

60 weeks

Question 307

MCC periop anaphylaxis is it NMB or antibiotics

Answer 307

NMBs

Question 308

_____ syndrome, or hemifacial microsomia, affects the eye, ear, and mandible unilaterally. Micrognathia leads to difficult intubation.

Answer 308

Goldenhar

Question 309

factors that increase likelihood of postop ventilator in MG pts

Answer 309

Duration of disease ≥72 months (≥6 years)

History of a chronic respiratory disease (e.g., asthma and chronic obstructive pulmonary disease)

Pyridostigmine dose of >750 mg/day

Vital capacity < 2.9 L

Question 310

what is more common following carotid endarterectomy: hypertension or hypotension and what is tx. when is peak of this

Answer 310

hypertension

BB or vasodilators

peak 2-3 hrs postop

Question 311

post op delerium risk factors include high risk surgeries such as ___ ___ and ___

Answer 311

cardiac, thoracic, and odly ortho

Question 312

what is an early sign of diabtetic autonomic neuropathy

Answer 312

decreased pulse rate variability with breathing

Question 313

suspected inheritance pattern of malignant hyperthermia

Answer 313

autosomal dominant inheritance with variable penetrance

Question 314

in a patient with ESLD what lab value can determine the cause of a coagulation disorder. how to tell this from DIC

Answer 314

factor VIII

in DIC VIII will be low and in ESLD bleeding it will be normal or elevated

Question 315

This patient needs to undergo urgent non-elective surgery and has significant risk factors for aspiration at induction and extubation with his history of uncontrolled diabetes, esophageal reflux, obesity, and recent food intake. With an hour prior to going to the operating room and a possible operative time of up to six hours, ____ is the best choice for preoperative antihistamine for aspiration prophylaxis. why this as opposed to others

Answer 315

ranitidine

onset within 1 hour and lasts 9 hours

Question 316

which antihistmaine class is good for aspiration ppx in urgent non elective cases

Answer 316

first generation

cemitidijne and ranitidine

Question 317

Acute kidney injury (AKI) is generally defined as a rapid decline in renal function. A commonly used specific definition based on serum creatinine includes any one of the following:

3 of them

Answer 317

increased serum creatinine by 0.3 mg/dL within 48 hours of insult, increased serum creatinine to above 1.5 times baseline within 7 days, or urine output of less than 0.5 mL/kg/hr for over 6 hours.

Question 318

specific patient comorbidities that are risk factors for AKI during surgery

Answer 318

preexisting chronic kidney disease, obesity, metabolic syndrome, diabetes mellitus, cardiovascular and hepatobiliary disease, chronic obstructive pulmonary disease, male gender, young or old age, smoking, steroid use, cancer, bleeding disorders, sepsis, and ventilator dependence.

Question 319

variables measured in thermodilution on x and y axis

Answer 319

temperature is y

x is time

Question 320

principle of thermodilution analagy

and how it works for real

Answer 320

Imagine you have a bucket with an unknown volume of water. If you measure the temperature of the bucket before and after adding 10 mL of iced water, you should be able to calculate the volume in the bucket (the greater the volume, the smaller the change in temperature).

if the flow that dilutes the injectate is high, the change in temperature effected will be small and if the flow is going fast, the dip in temperature will be momentary and quickly gone. Thus, high cardiac output will cause a small, narrow peak and low cardiac output will cause a tall, wide peak

Question 321

what will cause an overestimation of CO with thermodilution technique

Answer 321

injectate volume is lower or injectate temperature is warmer than it should.

Question 322

Only __% of anesthesiology residents with a history of opioid abuse successfully reentered anesthesiology training programs.

Answer 322

34

Question 323

factors that increase SvO2

Answer 323

• Decreased oxygen extraction (cyanide poisoning, methemoglobin)
• Increased CO (left to right shunt, inotropes)
• Blood transfusion
• Increased oxyhemoglobin saturation

Question 324

nfants have a higher initial uptake of volatile anesthetic than adults due to their

Answer 324

minute ventilation to FRC ratio

Question 325

Local anesthetic administration through an epidural catheter can ____ intracranial pressure

Answer 325

increase

Question 326

loop diuretic effect on calcium

Answer 326

hyper

Question 327

is D-Dimer elevated or decreased in DIC

Answer 327

elevated

Question 328

the most effective way to reduce myalgia with sux use is what

Answer 328

pre-op NSAIDs

Question 329

is pleural effusion more likely to occur in hyperthryoidism or hypothyroidism

Answer 329

hypothyroidism

Question 330

anemia and thrombocytopenia in hyper or hypothyroidism

Answer 330

hyperthyroidism

Question 331

___ is the most common etiology of hypotension following initiation of cardiopulmonary bypass

Answer 331

The acute hemodilution of the patient’s blood with the large volume of crystalloid solution

Question 332

anesthetic agents that may induce seizures include . High concentrations of ___may induce seizures

Answer 332

ketamine, etomidate, methohexital, and lidocaine

sevoflurane

Question 333

status epilepticus dosing for lorazapam IV, midazolam IM, diazapam rectal

Answer 333

lorazapam IV = 4 mg or 0.1 mg /kg in peds

midaz = 10 mg IM or 0.2mg/kg peds

diazapam = 10mg or 0.5 mg/kg

Question 334

gastric distension with PPV under what is unlikely to occur in adults

in children

Answer 334

15-cm h2o

under 15 in kids

Question 335

best way to avoid post-op hoarseness from direct injury to the ___ nerve during cervical spine surgery

Answer 335

ETT cuff readjustment after surgical exposure of the neurovascular bundle

RLN

Question 336

Maintenance of a mean arterial pressure above mmHg is one of the major recommendations in spinal cord injuries, allowing adequate perfusion of the injured cord.

Answer 336

85

Question 337

____is the best method by which cardiac output (CO) may be augmented in this patient with moderate aortic stenosis (AS), new-onset atrial fibrillation (AF), and normal left ventricle (LV) ejection fraction.

Answer 337

maintenance of NSR

Question 338

acute lung injury associated with pneumonectomy diagnosis criteria (3)

Answer 338

requires a PaO2/FiO2 < 200, pulmonary capillary wedge pressure < 18 mm Hg, and bilateral infiltrates on chest radiograph.

Question 339

Studies have shown risk factors associated with post pneumonectomy pulmonary edema (PPE) to be:

Answer 339

pre op alcohol use

right sided pneumonectomy

periop fluid overload (>3-4L 1st 24 hrs)

high intraop airway pressures

high UOP post op period

Question 340

In the second stage of labor, maternal oxygen consumption increases by ___

Answer 340

75%

Question 341

MCC of pregnancy related maternal mortality in US

Answer 341

cardiovascular conditions

Question 342

patient needs surgery but has to get cardiac cath and stent placed

if surgery can wait a few weeks what is periop plan and what type of stent

if surgery is completely elective then what

Answer 342

BMS, DAPT for one month then aspirin through periop period

completely elective then DES for 6 months and postpone surgery till after

Question 343

In patients undergoing PCI for stable ischemic heart disease, dual antiplatelet therapy should be given for at least ____ after BMS and at least ___ after DES (but it is reasonable to discontinue after ___ in patients at high risk of severe bleeding, e.g. major intracranial surgery).

In patients undergoing PCI for acute coronary syndrome, the recommendation is to continue dual antiplatelet therapy for at least ____, irrespective of the type of stent, (but it is reasonable to discontinue after___ in patients at high risk of severe bleeding, e.g. major intracranial surgery).

Answer 343

1 month

6 months

3 months

12 months

6 months

Question 344

which area of the spinal cord is sent electrical impulses from a spinal cord stimulator

Answer 344

dorsal columns

Question 345

what is the leading cause of periop mortality in obese

Answer 345

DVT not airway obstruction

Question 346

is hypothermia or hyperthermia a precipitating factor for hypokalemic periodic paralysis

Answer 346

hypothermia

Question 347

which drugs during periop period that pts take may inhibit hypoxic pulmonary vasoconstriction

Answer 347

Phosphodiesterase inhibitors,

ACE/ARBs inhibitors

steroids

nitric oxide

nitro-vasodilators

endothelin receptor antagonists (e.g., bosentan)

prostacyclin and its analogs

Question 348

how does norepi and phenylephrine effect hypoxic pulmonary vasoconstriction

Answer 348

increases it

Question 349

____ _____muscular dystrophy is associated with proximal weakness in the shoulder and pelvic girdles and multiple gene defects causing an array of clinical pictures. Cardiomyopathy and atrioventricular conduction defects may lead to the short life-span seen in some of these patients.

Answer 349

limb girdle

Question 350

succinylcholine administration, safe in which of these patients

MGravis

lambart eaton

myotonic dystrophy

muscular dystrophy

MS

spinal cord transection 2 months ago

renal failure with normal K

Answer 350

MG

renal failure

lambert eaton

Question 351

what is most likely to be the ignition source of an airway fire

Answer 351

laser

Question 352

respiratory depression from mg tox. Is it an early or late finding

Answer 352

late

Question 353

what is diastasis in the cardiac cycle and when does it occur

Answer 353

slow filling

occurs during ventricular diastole

Question 354

during laproscopic surgery what physiological mechanism causes increase in MAP and SVR

Answer 354

vasopressin release

Carbon dioxide absorption produces an overall sympathetic response. In addition, the renin-angiotensin system is activated with resultant vasopressin release.

Question 355

does foreign body aspiration increase dead space or cause shunt

Answer 355

causes shunting

Question 356

Which of the following would be the most reasonable anesthetic plan for a 36-year-old G1P0 with sickle cell disease at 39 weeks who presents with rupture of membranes in acute chest crisis?

Answer 356

epidural

Question 357

In the setting of massive transfusion, if the platelet count is less than __ to ___, a bleeding problem is likely and possibly a combination of dilutional coagulopathy and DIC. The indication for platelet transfusion in the setting of massive transfusion is less than __ and in patients with ongoing bleeding; platelet transfusion is indicated if less than __

Answer 357

50-75k

75k

50k

Question 358

what is the largest risk factor when considering passage of mencomium

Answer 358

gestational age

longer >42 is higher risk

Question 359

nerve regeneration with cryoanalgesia occurs after how long

Answer 359

1-3 months

Question 360

Which of the following methods is the quickest and most reliable to diagnose proper placement of the central line thin-walled needle or catheter prior to vessel dilation?

Answer 360

column manometry

Question 361

should calcium channel blockers be continued in periop period

diuretics

A2 agonists?

ace/arb

Answer 361

CCB yes

diuretics no

a2 agonsits: yes

ace/arb: no answer at this time based off studies

Question 362

does metformin have to be discontinued day before surgery

Answer 362

no

Question 363

MAOI and other antipsychotics: how might you change anesthetic plan and what tests

Answer 363

ECG for QT prolongation

avoid meperidine

avoid ephedrine

can lead to hypertension

Question 364

Elective surgery should be delayed when possible until former preterm infants are ___weeks gestation.

preventative measures?

Answer 364

44 weeks

preop caffeine or theophyline

neuraxial anesthesia

Question 365

what are the few special circumstances where bicarb should be used in cardiac arrest CPR and how much and guide for therapy

Answer 365

known hyperkalemia and known tricyclic antidepressant overdose. For these situations, a dose of 1 mEq/kg is used and therapy should be guided by bicarbonate concentration or calculated base deficit from blood gas measurement

Question 366

__is the most common risk of TPN and ___is the next most common risk,

Answer 366

infection

thrombophlebitis

Question 367

another name for myasthenic syndrome

Answer 367

lambert eaton

Question 368

___ reactions are drug reactions that cause uncontrolled histamine release by a mechanism not involving IgE.

how to differentiate btwn this and anaphylaxis

Answer 368

anaphylatoid reacitons

cannot differentiate

Question 369

A patient has been receiving LMWH, how long after the last dose of LMWH can I perform a neuraxial procedure?
For patients that were receiving therapeutic doses of LMWH, wait ___hours after the last dose.
For patients that were receiving prophylactic doses of LMWH, wait ___hours after the last dose.

Answer 369

24

12

Question 370

I performed a neuraxial procedure where I did not leave a catheter, how soon after the procedure can I start/restart LMWH administration?
Wait ___ hours after needle insertion before administering therapeutic doses of LMWH after non-high-bleeding risk surgery, wait ___ hours after high-bleeding risk surgery.
Wait ___hours after needle insertion before administering prophylactic doses of LMWH.

Answer 370

24

48-72

12

Question 371

I performed a neuraxial procedure where I left a catheter, can I start/restart LMWH while the catheter is in place?

Answer 371

You may administer once daily prophylactic doses of LMWH while a neuraxial catheter is in place starting 12 hours after needle insertion.

Question 372

In this patient undergoing a time-sensitive orthopedic procedure which is defined by the 2014 ACC/AHA guidelines as being a procedure which can be delayed 1-6 weeks; postponing the procedure until the____ allows for the best chance of avoiding preterm labor and delivery.

Answer 372

second trimester

Question 373

The ACh receptor is a ligand-gated channel that opens when ACh binds to the ___ subunits.

Answer 373

α

Question 374

Avoidance of ______ and ____ during repair of an arteriovenous malformation is important because these solutions could exacerbate cerebral edema and worsen neurologic outcome.

Answer 374

hypotonic and glucose-containing solutions

Question 375

does the following help or make spinal stenosis worse

squatting

walking up a hill

Answer 375

both make it better

Question 376

methods to help prevent peripheral nerve injury include ___ The presence of a high opening injection pressure (> __PSI) is a sensitive sign of intrafascicular needle tip placement.

Answer 376

injection pressure monitoring

20 PSI

Question 377

what percentage of blood flow is supplied to the uterus from the ovarian arteries

Answer 377

15%

Question 378

propofol induction based off what weight and why

Answer 378

lean or ideal body weight

insolubility in fat

Question 379

what weight should sux be dosed based off of

Answer 379

total body weight

Question 380

Wide complex QRS is defined as >___seconds’ duration in children.

Answer 380

0.09 seconds

Question 381

which specific surgeries should ASA be held

(4)

Answer 381

intracranial neurosurgical procedures, middle ear surgery, posterior eye surgery, intramedullary spine surgery, and, possibly, prostate surgery

Question 382

What is the mean (average) sodium concentration in standard 5% albumin in the United States

Answer 382

145

Question 383

dantrolene dose for MH

Answer 383

2.5 mg/kg and up to 10mg/kg if sx persists

Question 384

contraindications for nasal intubation

Answer 384

severe coagulopathy, high-dose systemic anticoagulation, known nasal or paranasal pathologies, infection of the paranasal sinuses, basilar skull fracture, and traumatic brain injury with liquor leakage (cerebrospinal fluid [CSF] leakage

Question 385

In scoliosis a Cobb angle >___ is indication for surgical intervention due to the severity and eventual worsening of pulmonary complications.

Answer 385

40 degrees

Question 386

why is epidural dosing in the elderly reduced

Answer 386

because of increased dura permeability

Question 387

is CSF increased or decreased in the elderly

Answer 387

decreased

Question 388

airway injury algorhythm

Answer 388

Question 389

does sodium or chloride delivery changes at the JG lead to changes in afferent and efferent arteriole

Answer 389

chloride

Question 391

modified hunt hess scale for SAH

grade 0

grade 1

grade 2

grade 3

grade 4

grade 5

Answer 391

0 = unruptured aneursym

1 = asymptomatic or mild HA

2 = moderate/severe HA and or CN palsy

3 = mild focal defecit and or confusion/lethargy

4 = hemiparesis and/or stupor

5 = coma or decerebrate posture

Question 392

which epidural needle has the most risk for puncturing dura and causing HA

sprotte, whitacre, quincke

Answer 392

quincke

Question 393

After a dural puncture with an epidural needle, the risk for PDPH is approximately __%, whereas after puncture with a spinal needle, the risk is between about __ and __.

Answer 393

50%

1-10%

Question 394

timeframe of presentation of pdph after epidural

Answer 394

6-72 hours

Question 395

The risk of awareness is sufficiently low if the exhaled minimum alveolar concentration is >___

Answer 395

0.7

Question 396

oxygen content of blood equation

Answer 396

CaO2 = [(SaO2 * Hgb * O2 carrying capacity of Hgb) + (O2 solubility * PaO2)]

SaO2 is the fraction of Hgb that is saturated with oxygen, O2 carrying capacity of Hgb is 1.34 mL of oxygen per gram of Hgb, Hgb is grams of Hgb per 100 mL of blood, PaO2 is the oxygen tension, and the solubility of oxygen in plasma is 0.003 mL of oxygen per 100 mL plasma for each mmHg PaO2.

Question 397

besides supportive care what can you use to treat negative pressure pulmonary edema

Answer 397

PEEP and diuretics

Question 398

equation for SVR

Answer 398

SVR = 80 x (MAP - CVP) / CO

Question 399

absolute indications for 1 lung ventilation

Answer 399

Protective isolation of each lung to prevent contamination of the healthy lung: infection

massive hemorrhage

Control of distribution of ventilation to only 1 lung: bronchopleural fistula, bronchopleural cutaneous fistula, unilateral cyst or bullae, major bronchial disruption, or trauma

Unilateral lung lavage (e.g., pulmonary alveolar proteinosis)

Question 400

VATS relative indications for 1 lung ventilation

Answer 400

Surgical exposure (high priority): thoracic aortic aneurysm, pneumonectomy, lung volume reduction, minimally invasive cardiac surgery, upper lobectomy

Surgical exposure (low priority): esophageal surgery, middle and lower lobectomy, mediastinal mass resection, thymectomy, bilateral sympathectomy

Question 402

SVR and HR goal for the following valvular lesions

AS

AR

MS

MR

Answer 402

AS: slow HR and increased SVR (want sinus rhythm)

AR: relative tachycardia and decreased SVR

MS: lower heart rate SVR doesnt matter

MR: faster HR and decreased SVR

Question 403

examples of distributive shock

Answer 403

adrenal crisis, anaphylaxis, myxedema coma, sepsis, spinal cord trauma, toxic shock.

Question 404

amplitude and frequency of EEG under GA

Answer 404

low frequency and high amplitude

Question 405

The most common cause of noncommunicating hydrocephalus in the pediatric population are ___, while the most common cause of communicating hydrocephalus in pediatric patients is

Answer 405

posteior fossa tumors

history of intraventricular hemorrhage.

Question 406

for transplant, which organ benefits most from continuous hypothermic perfusion?

Answer 406

kidney

Question 407

cold ischemic times for following organ transplants

Heart:
Lungs:
Liver:
Pancreas:
Intestines:
Kidneys:

Answer 407

heart: 4 hours

lungs 4-6 hrs

livre 6-10 hrs

pancreas 12-18 hrs

intestines 6-12 hrs

kidneys: 24 hours, can be up to 72 if placed on perfusion pump following recovery

Question 408

most common indication for retrograde cardioplegia is what

Answer 408

aortic valve insufficiency

Question 409

inheritance of malignant hyperthermia

Answer 409

autosomal dominant

Question 410

There is a ___ to ___ decrease in CMR per each degree Celsius decrease in temperature

Answer 410

6 to 7%

Question 411

In deep hypothermic cardiac arrest (DHCA), nasopharyngeal temperature targets are typically < ___ ºC

Answer 411

25

Question 412

STOP-BANG score of __ or more shows 88% sensitivity of pts having severe OSA

Answer 412

4

Question 413

STOP BANG questions

Answer 413

S = Snore – do you snore loud?
T = Tired – do you feel tired no matter how many hours of sleep you get?
O = Observed – have others observed you stop breathing during sleep?
P = Pressure – are you being treated for high blood pressure?
B = BMI – is your body mass index \> 35 kg/m2
A = Age – are you older than 50?
N = Neck circumference – is the neck circumference \> 40 cm?
G = Gender – is the patient a male?

Question 414

hydroxyethyl starch sodium content

Answer 414

154 meq

Question 415

brain waves that are in awake resting states

ones that are in awake concentrating states

Answer 415

awake resting = alpha

awake concentrating = beta

Question 416

order of brain waves in which frequency decreases and amplitude increases

Answer 416

BAT Drink

beta, alpha, theta, delta

Question 417

what is the major efferent pathway of the hippocampus

Answer 417

fornix

Question 419

During cardiopulmonary bypass (CPB), optimal hemodynamic goals include a pump blood flow of around ___ to ___L/min/m^2, an arterial blood pressure of around __ to ___ mmHg, and an oxygen saturation in the venous cannula of greater than __%. Mean arterial pressure (MAP) below _

__mmHg should generally be avoided.

Answer 419

1.6 to 3

50 to 90

65%

50

Question 420

The ___ nerve innervates the pharynx and can be anesthetized by injecting local anesthetic where

Answer 420

glossopharyngeal

base of the anterior tonsillar pillar

Question 421

The subgluteal approach to sciatic nerve block uses the __ ___ and ___ ____ as bony landmarks for orientation.

Answer 421

greater trochanter and ischial tuberosity

Question 422

The effects of adrenergic agents and vasoconstrictors is ___during pregnancy

Answer 422

blunted

Question 423

what is the MOST LIKELY source of air embolism from a conventional cardiopulmonary bypass machine?

Answer 423

occlusion of the gas outlet port from the oxygenator

The occlusion of the gas outlet port on the oxygenator can result in a buildup of pressure within the gas compartment of the oxygenator and can consequently force air into the blood compartment resulting in air embolus.

Question 424

infraclavicular nerve bloock traverses which 2 muscles to reach the brachial plexus

Answer 424

pec major

pec minor

Question 425

The infraclavicular block can be used for arm and hand surgery. It takes place at the level of the cords and provides blockade to the arm below the level of the __

advantage over axillary nerve block?

Answer 425

shoulder

will cover musculocutaneous nerve

Question 426

are MAC requirements increased or decreased in pregnant pts

Answer 426

decreased

Question 427

is NO safe in labor analgesia

Answer 427

yes

Question 428

Despite initial research targeted towards lipid-centered mechanisms of anesthesia, there is generally widespread acceptance of the notion that anesthetics exert their clinical effect through interactions with

Answer 428

critical signaling proteins

anesthetic agents will tend to incorporate into binding sites on these critical proteins that provide both a hydrophilic and lipophilic binding.

Question 429

stages of heart failure

stage A

stage B

stage C

stage D

Answer 429

Stage A: High Risk for Heart Failure

-no signs or sx but risk factors: hypertension, diabetes, or coronary artery disease

Stage B: Asymptomatic Heart Failure

• history of a previous myocardial infarction, either systolic or diastolic LV dysfunction, or some finding of valvular heart disease
• still asx but can compensate

Stage C: Symptomatic Heart Failure

-sx begin to develop

Stage D: Refractory End-Stage Heart Failure

Question 430

NYHA heart failure classification

class I

class II

class III

class IV

Answer 430

Class I: Ordinary physical activity is not limited by heart failure symptoms

Class II: Ordinary physical activity is somewhat limited by heart failure symptoms

Class III: Exercise is limited by dyspnea during modest exertion

Class IV: Dyspnea at rest or with minimal exertion.

Question 431

During an ultrasound-guided interscalene block, the probe should be moved ___ and ____ after identifying the ___ ___, and the plexus is found between the anterior and middle scalene muscles.

Answer 431

laterally and posteriorly

carotid artery

Question 432

Interscalene blocks are commonly used for procedures of the shoulder and upper arm by targeting the __of the brachial plexus. However, the___ nerve (or inferior trunk) is frequently spared

Answer 432

roots

ulnar

Question 433

in pts with ventricular assist devices and cardiac arrest when should you start compressions based off MAP and EtCO2

Answer 433

MAP < 50

EtCO2 < 20

Question 434

the arteria radicularis magna, or artery of Adamkiewicz, almost always lies on the __side of the aorta and is usuallly found between T_ and T_

Answer 434

left

9-12

Question 435

A normal fetal oxygen saturation, when measured by reflectance pulse oximetry, is between

Answer 435

35-65%

Question 436

a urine anion gap is calculated how? and what is a normal value

Answer 436

Na + K+ - Cl

0-5

Question 437

steroid use in adults for airway edema how long does it take to work

Answer 437

usually 12 hours

Question 438

While there are several morphologies that may be present on the electroencephalogram during convulsions and seizures, the most likely is

Answer 438

spike and slow wave pattern

Question 439

rocuronium should be dosed based off what weight?

what about succinylcholine?

Answer 439

roc = IBW

succinylcholine = TBW

think the rock is the ideal person to base yourself off of

succinylcholine is opposite

Question 441

Following release from the sarcoplasmic reticulum, what does calcium bind to within myofibrils during the initiation of a muscle contraction? when this binds this what happens

Answer 441

troponin C

This causes tropomyosin to change conformation, exposing actin-binding sites to allow for the actin and myosin interaction that creates sarcomere shortening and muscle contraction.

Question 442

hepatic arterial buffer response

Answer 442

when portal blood flow decreases = increase in adenosine = increase in hepatic artery dilation/blood flow

when portal blood flwo increases = increased washout of adenosine = decreased hepatic artery dilation/blood flow

Question 443

cushings reflex is mediated by parasympt or sympathteic activation via what

Answer 443

sympathetic activation via medullary vasomotor center. increases symp tone and get reflex brady

Question 444

colloid solutions are typically avoided for patients who have suffered

Answer 444

an acute TBI

Question 445

most common sx in pts with primary hyperparathyroidism that are symptomatic

Answer 445

nephrolithiasis

Question 446

Acetazolamide causes an increase in what and decrease in what

Answer 446

H+ and Cl- but a decrease in K+, Na+, and HCO3-.

Question 447

The response of the ___ nerve and ___ muslce to stimulation is a better reflection of the blockade of the laryngeal muscles than the stimulation of other monitoring sites

Answer 447

facial nerve

corrugator supercilii

Question 448

Indications for immediate surgery in a patient with suspected necrotizing enterocolitis (NEC) include what

Answer 448

perforation of the intestine, development of an abdominal mass with intestinal obstruction or intestinal stricture, and clinical deterioration despite maximal medical treatment.

Question 449

major risk factors for the development of necrotizing enterocolitis include

Answer 449

low birth weight, prematurity, formula feeding, and intestinal dysbiosis.

Question 450

____ lithotripsy is contraindicated in pregnancy, ___laser lithotripsy does not present the same risks.

Answer 450

extracorporeal shock wave lithotripsy (ESWL)

intracorporeal

Question 451

For a femoral nerve block, contraction of the ___muscle (not the ___muscle) indicates correct needle placement. A ___muscle contraction indicates that only the anterior branch of the femoral nerve will be blocked, and not the main trunk (posterior branch). The needle should be directed which direction

Answer 451

quadriceps, not sartorious

sartorious

lateral and advanced deeper.

Question 452

barbituates are eliminated how

Answer 452

hepatic metabolism, biliary conjugation, followed by renal excretion of the more water-soluble metabolites.

Question 453

Medications that induce CYP-3A4 include

Answer 453

carbamazepine, phenytoin, phenobarbital, St. John’s wort, dexamethasone, topiramate, and oxcarbazepine

Question 454

best type of anesthesia for upper extremity AV fistula creation and evaluation of patency

Answer 454

regional brachial plexus block

Question 455

shunt or dead space

pulmonary embolism

pulmonary edema

empysema

chronic bronchitis

hepatopulmonary syndrome

Answer 455

PE: dead space

pulmonary edema: shunt

empysema: dead space

CB: shunt

HPS: shunt

Question 456

Administration of SC UFH should be delayed __ ___ after needle placement. Providers should wait at least ____after the last dose of SC UFH prior to neuraxial catheter removal and should wait ____ after catheter removal prior to restarting SC UFH.

Answer 456

1

4-6 hours

1

Question 457

4 physiologic parameters that must be monitored during anesthetic

Answer 457

oxygenation

ventilation

temperature

circulation

Question 458

____is a synthetic prostaglandin E1 uterotonic. Unlike ____, it does not carry the risk of bronchoconstriction.

misoprostol and carboprost are two options

Answer 458

misoprostol

carboprost

Question 459

___is a synthetic prostaglandin F2-alpha. It should be carefully administered to patients with a history of reactive airway disease as it can trigger bronchoconstriction but is safe in patients with mild, asymptomatic cases. Other adverse effects include nausea, vomiting, and diarrhea.

___ is a synthetic prostaglandin E1 uterotonic. it commonly causes diarrhea. However, this prostaglandin does not cause bronchoconstriction.

Answer 459

carboprost

mE1eeses (misses the bronchoconstriction)

Question 460

Patients experiencing prolonged hypoxia will have a dominance of low-frequency waves, the lowest of which is ___waves that can be seen in the states of deep coma and encephalopathy.

Answer 460

delta

Question 461

best block for pelvic pain

Answer 461

superior hypogastric block

Question 462

block for coccydeal and perineal pain and anus rectum and vagina

Answer 462

ganglion impar block

Question 463

respiratory effect on following electrolytes

potassium

phosphate

calcium

Answer 463

leads to hypo of all

hydrogen ions shift from intracellular to extracellular to compensate and K, phos, and Ca shift intracellularly

Question 464

Risk factors for umbilical cord prolapse include

position

cord length

weight

how many pregnancies

twins or nah

articical or spontaneous rupture of membranes?

Answer 464

fetal malpresentation, excessive cord length, low birth weight, multiparity, multiple gestations, and artificial rupture of membranes.

Question 465

___ reversibly complexes with the active sites of plasmin and other serum proteases resulting in competitive inhibition of its action and decreased fibrinolysis.

antifibrinolytic

Answer 465

aprotinin

Question 466

osteogenesis imperfecta inheritance

Answer 466

AD

Question 467

Oxytocin is made in the ___nucleus of the hypothalamus, then travels through ____ ___ where it is released into the posterior pituitary.

Answer 467

paraventricular

neuroendocrine cells

Question 468

drugs known to trigger AIP in anesthesia

Answer 468

barbiturates, etomidate, benzos, ropivacaine, phenytoin, sulfonamide antibiotics, lead, ethanol, amphetamines, and ergot derivatives.

Question 469

Answer 469

redo

Question 470

Effects on anesthesia

echinacea

ephedra

garlic

ginger

ginkgo

ginseng

kava

saw palmetto

st johns wort

valerian root

Answer 470

Question 471

Brain glucose metabolism in the brain is approximately____ Cerebral oxygen consumption (CMRO2) is normally __ or ___

The brain is normally dependent on glucose stores for energy, around 90% of which is processed through ___respiration to generate ATP. In the absence of oxygen-rich blood flow, the brain will deplete its ATP stores within __ to ___ minutes. During starvation, the brain begins to utilize more what?.

Answer 471

5 mg/100 g/

3 to 3.8 ml/ 100g/min or 50mL/min

aerobic

3 to 8 minutes

ketone bodies

Question 472

MAC at different ages

A simpler approach for a patient at any given decade would be to multiply MAC at age 40 times 6%, then subtract that number for each decade greater than 40.

calculate for 80 year old for desflurane

Answer 472

MAC for 40 year old is 6.6%

6. 6 x .06 = 0.4
7. 4 x 4 = 1.6

MAC for 80 year old is 6.6 - 1.6 = 5

Question 473

what kind of induction is often used for lung transplant

Answer 473

RSI

Question 474

what comorbidity increases risk for contrast allergy

Answer 474

asthma and atopy

Question 475

predicted body weight in females and males equations

Answer 475

PBW (kg) Men: 50 + 0.9 * (Height [cm] - 152.4)
PBW (kg) Women: 45.5 + 0.9 * (Height [cm] - 152.4)

Question 476

accidental needle stick, what is likelihood of getting the following

HIV

HCV

HBV

Answer 476

HIV transmission rate: about 0.3%
HCV transmission rate: about 0.5%
HBV transmission rate: about 30%

Question 477

____is superior to ___blockers (e.g. ____, ___) in preventing ventilator-associated pneumonia, while ____ (__) have been shown to increase the risk of ventilator-associated pneumonia.

Answer 477

sucralfate

H2 blockers, cimitidine, ranitidine

PPIs, pantoprazole

Question 478

TENS involves the use of electrical pulses at varying frequencies to stimulate large diameter ___cutaneous mechanoreceptors to inhibit signaling of A-delta and C pain fibers.

how can analgesic effects of TENS be reversed

Answer 478

A-beta

reversed by naloxone

Question 479

The ____ test is used to compare multiple groups of categorical data.

Answer 479

chi square

Question 480

the ____ test is used to evaluate 3 or more groups of parametric data. Parametric data are normally distributed data.

Answer 480

ANOVA

Question 481

A ___ test is used to evaluate 2 paired groups of parametric (normally distributed) data.

Answer 481

paired t test