ACE 2010 Flashcards
Only nerve required to be anesthetized in order to perform awake tracheostomy
Recurrent laryngeal nerve
3 main nerves that innervate the airway
Trigeminal, glossopharyngeal, vagus nerves
Occupational exposure to ionizing radiation mostly occurs from what type of X-rays?
Scattered x-rays
Lesion of which nerve root causes pain in index finger and thumb
C6
Lesion of which nerve root causes pain in shoulder and proximal arm with deltoid weakness and loss of biceps reflex
C5
Circle system test checks the machine between what 2 points?
Common gas outlet and Y piece
How is SVR and cardiac output affected by liver cirrhosis?
Decreased SVR, increased CO
Side effect of narcotics that is increased in patients who were chronically on narcotics preoperatively
Respiratory depression
Most reliable method to diagnose facet joint pain
Diagnostic nerve block
Celiac plexus block results in blockade of which types of nerves?
Sympathetic efferents and visceral sensory afferents
Median nerve’s relation to axillary artery
Superior to axillary a.
Ulnar nerve’s relation to axillary artery
Inferior to axillary a.
Radial nerve’s relation to axillary artery
Posterior to axillary a.
Musculocutaneous nerve’s relation to axillary artery
Superiolateral to axillary a.
FFP may be administered up to how many hrs after thawing?
24 hrs
ASA task force recommendation for monitoring after single injection of neuraxial fentanyl
2 hrs
ASA task force recommendation for monitoring after single injection of neuraxial morphine
24 hrs
ASA task force recommendation for monitoring after single injection of neuraxial extended release morphine
48 hrs, monitoring after 1st 24 hrs should be every 4 hrs
Aprepitant is a drug used to treat what?
PONV
Aprepitant is administered via what route?
PO
Mechanism of action of aprepitant
Blocking action of substance P in the CNS
Reaction to protamine administration can result in what symptoms?
Allergic reaction, pulmonary hypertension, RV failure, hypotension
Step to take if on initiation of CPB, patient is hypotensive and there is high pressure in outflow to aorta with flow of 1L/min
Separate from CPB
Absolute indications for one lung ventilation
- Isolation of healthy lung to prevent contamination with infection or hemorrhage.
- Control of ventilation for a bronchopleural fistula, bullae.
- VATS
- Unilateral lung lavage
Anesthetic drugs that should be avoided in patients with porphyria
Etomidate, thiopental, methohexital, nifedipine
Most common adverse reaction to protamine
Hypotension
Level of 2,3-DPG in banked blood after 96 hrs of storage
Essentially zero
Percent of normal level of 2,3-DPG 7 hrs after blood transfusion.
50%
How many hrs after blood transfusion will levels of 2,3-DPG return to normal?
48 hrs
Factor that is the most predictive of hypoxemia during one lung ventilation
Right side thoractomy because left lung has 2 lobes and right lung has 3 lobes
How does magnesium affect local anesthetic and neuromuscular blocker administration
Potentiate them
What is metoclopramide’s effect on lower esophageal sphincter?
Increase tone of lower esophageal sphincter
Absolute contraindication to ECT
- Pheochromocytoma
- Intracranial hypertension
Pectus excavatum is associated with what congenital heart disease.
Mitral valve prolapse.
Treatment for methemoglobinemia
Methylene blue
Treatment for cyanide toxicity
Sodium thiosulfate which converts cyanide to thiocyanate.
Amyl and sodium nitrite which induce methemoglobin which binds to cyanide.
Hydroxycobalamin binds to cyanide to form cyanocobalamin (vit b12) which is cleared by kidneys
Capsaicin in use for treatment of postherpetic neuralgia
Poorly tolerated
Acute fatty liver of pregnancy often coexists with what pregnancy related diseases
Preeclampsia, HELLP syndrome
Sickling of RBCs in a pt with sickle cell disease can be precipitated by what conditions?
Hypoxemia, hypothermia, acidosis, dehydration, vascular stasis, infection
How does rapid administration of mannitol affect ICP?
Increase ICP because intravascular volume is expanded
Full E-cylinder of nitrous oxide contains how many liters?
1600L
Pressure of full E-cylinder nitrous oxide tank
750 psi
How much nitrous oxide is left in E-cylinder tank when pressure starts dropping?
25% or approx 400L
Severe hemophilia A is associated with factor VIII activity that is what percent of normal?
Less than 1% of normal
FDA has approved use of what coagulation factor for treatment of bleeding and prophylaxis in hemophilia A patients with antibody inhibitors to factor VIII
Recombinant factor VIIa
Half life of argatroban
45 min
Mechanism of action of argatroban
Synthetic direct thrombin inhibitor
Early goal directed therapy for sepsis
CVP 8-12 mmHg
MAP 65-90 mmHg
SvO2 >= 70%
Hct >= 30% (if SvO2 < 70%)
Aldrete score required for hospital discharge
> 8
GI procedure most frequently associated with cardiopulmonary complications
ERCP
Pain in nondependent shoulder occurs in how many patients undergoing thoracotomy
85%
Axilla and inner arm pain is caused by injury to what nerve?
Intercostobrachial nerve, which arises from T2
MCC of sudden cardiac death in young competitive athletes
Hypertrophic cardiomyopathy
Prevalence of HCM in general adult population
0.2% (1/500)
Myasthenia gravis affect on nondepolarizing neuromuscular blocking agent
Increased sensitivity to nondepolarizing nmbs due to decrease in functional acetylcholine receptors
Myasthenia gravis affect on succinylcholine
Resistance to succinylcholine
Percent of deaths from amniotic fluid embolism that occur within 5 hrs of initial presentation
2/3
Specific lab test for diagnosis of amniotic fluid embolism
None!