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ACE 2011 Flashcards

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1
Q

What type of tocolytic agent is associated with hypoglycemia in neonate

A

Beta agonists like terbutaline

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2
Q

Combined ventricular output in a normal fetus through foramen ovale, ductus arteriosus, and pulmonary artery

A

Foramen ovale: 33%
Ductus arteriosus: 45%
Pulmonary artery: 11%

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3
Q

Gold standard for diagnosis of heart failure

A

Echocardiogram

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4
Q

Nerve that becomes the medial and lateral plantar nerves

A

Posterior tibial nerve

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5
Q

Nerve that innervates web space between first and second toes

A

Deep peroneal nerve

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6
Q

Nerve that innervates the dorsum aspect of foot

A

Superficial peroneal nerve

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7
Q

Nerve that innervates the lateral aspect of foot

A

Sural nerve

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8
Q

Absolute criteria for obsolescence of an anesthesia machine

A
  • Absence of minimum oxygen ratio device to deliver N2O
  • Absence of oxygen fail safe device
  • Absence of oxygen supply pressure failure alarm
  • Absence of vaporizer interlock device
  • Absence of PISS
  • Absence of DISS
  • Presence of connectors in scavenging system that are same diameter as breathing system
  • ## Presence of vaporizer with clockwise rotation of dial that increases concentration
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9
Q

Preop fasting guidelines for breast milk

A

4 hrs

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10
Q

Preop fasting guidelines for infant formula

A

6 hrs

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11
Q

Blood tests to identify pathophysiology of anaphylaxis

A

Plasma histamine and tryptase concentrations

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12
Q

Blood sample to detect tryptase elevation should be obtained when after severe anaphylaxis

A

30 min to 2 hrs after

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13
Q

Dermatomal range for adequate anesthesia for c section

A

T4-S4

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14
Q

How does epidural analgesia for labor affect maternal core temperature?

A

Increases it, usually by less than 1 degree C

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15
Q

Ideal positioning of a central venous catheter to aspirate venous air embolism can be determined by what kind of EKG wave?

A

Biphasic P wave indicating central venous catheter is in the right atrium

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16
Q

Treatment for Symptomatic hypercalcemia

A

1) IV infusion of normal saline
2) loop diuretic
3) bisphosphonates
4) IV calcitonin for life threatening hypercalcemia

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17
Q

What is the association of SLE with platelet count?

A

Thrombocytopenia

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18
Q

Most common cardiac problem associated with SLE

A

Pericarditis. SLE also associated with HTN, coronary atherosclerosis, valvular disease, tamponade

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19
Q

How do systolic pressure recordings change the more distal it is measured?

A

The more distal the pressure is measured, the greater the systolic pressure will be recorded because branch points along the way increase the amplification

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20
Q

What condition in a patient makes hemabate a contraindication?

A

Pulmonary hypertension because hemabate (prostaglandin) increases pulmonary artery pressures

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21
Q

Plasma local anesthetic concentrations from most to least in terms of site of injection

A

Intercostal > caudal epidural > lumbar epidural > brachial plexus > peripheral nerve > subcutaneous tissue

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22
Q

EMLA (eutectic mixture of local anesthetics) contains which 2 local anesthetics

A

Lidocaine and prilocaine

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23
Q

Prilocaine is metabolized to what?

A

O-toluidine, which may produce methemoglobinemia

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24
Q

Phrenic nerve blockade occurs in how many patients receiving supraclavicular brachial plexus block?

A

30-50%

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25
Q

Normal P50 for adult is

A

27 mmHg

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26
Q

Types of shock

A

Hypovolemic
Cardiogenic
Distributive (sepsis, neuro, anaphylaxis)
Obstructive (tamponade, PE, tension ptx)

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27
Q

Median nerve’s anatomical relationship to ulnar nerve in the axilla

A

Median nerve is superior to ulnar nerve

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28
Q

What nerve innervates the dorsal webspace between thumb and forefinger

A

Radial n

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29
Q

Perineum, pelvic floor, anal skin are innervated by what nerves?

A

Pudendal nerves

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30
Q

What should the ETT leak be?

A

Between 20-25 cm H2O

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31
Q

Single most important patient attribute affecting risk of developing postdural puncture headache.

A

Age, highest incidence in late teens to twenties, incidence decreases with increasing age

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32
Q

Type of pain associated with pancreatitis, cancer, trauma

A

Nociceptive pain

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33
Q

Type of pain resulting from damage or dysfunction of normal pain pathways

A

Neuropathic pain

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34
Q

Classes of drugs generally used to treat neuropathic pain

A

TCAs, anticonvulsants, NMDA antagonists

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35
Q

Initial intervention when HR less than 60 in a neonate

A

Chest compressions, consider intubation

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36
Q

Intervention if chest compressions do not raise HR above 60 in a neonate resuscitation

A

Epinephrine

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37
Q

Avg hemoglobin in a healthy term neonate

A

16.8 g/dL

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38
Q

Nadir for hemoglobin after birth for newborn is at how many weeks?

A

8-12 weeks, hgb 8-9 g/dL, rbc lifespan is 80-100 days in full term neonate

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39
Q

Which volatile agent is preferred in patients with liver disease and why?

A

Isoflurane, vasodilates hepatic circulation to maintain hepatic blood flow. Sevo and des also maintain hepatic blood flow

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40
Q

Which volatile agent decreases hepatic blood flow

A

Halothane

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41
Q

Primary blood supply to thoracolumbar portion of spinal cord

A

Artery of Adamkiewicz, branching off the aorta in the T9-12 region

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42
Q

Best initial management strategy in an unstable patient with Stanford type A aortic dissection with a echo showing large pericardial tamponade?

A

Immediate surgical repair. Pericardiocentesis is contraindicated because it can produce a pressure gradient between dissection and pericardial space which results in increased blood flow into pericardial space and extension of aortic dissection

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43
Q

Laboring patient starts experiencing respiratory distress, cardiovascular collapse, coagulopathy, pulmonary hypertension and RV failure

A

Amniotic fluid embolism

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44
Q

Fetal acidemia is defined as

A

pH < 7.2

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45
Q

Metabolic or respiratory acidemia is associated with increased risk of neonatal complications

A

Metabolic

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46
Q

Unilateral painless visual loss 2 days following cardiac surgery resulting in optic disc swelling seen on funduscopic examination and abnormal afferent papillary reflexes

A

Anterior ischemic optic neuropathy

47
Q

Bilateral painless visual loss immediately following spine surgery with normal funduscopic exam and abnormal afferent papillary reflexes

A

Posterior ischemic optic neuropathy

48
Q

Painless visual loss with normal funduscopic exam and normal afferent papillary reflexes

A

Cortical blindness

49
Q

Type of congenital heart lesion that slows rate of inhalational induction

A

Right to left shunt: tricuspid atresia, tetralogy of Fallot, transposition of great arteries, truncus arteriosus

50
Q

closing capacity equals FRC in supine position at what age?

A

44

51
Q

closing capacity equals FRC in upright position at what age?

A

66

52
Q

Antibodies to what causes Lambert Eaton syndrome?

A

Calcium channels of motor and autonomic nerves

53
Q

How does Lambert Eaton syndrome affect activity of muscle relaxants?

A

Increased sensitivity to both depolarizing and non depolarizing muscle relaxants

54
Q

First line treatment for Lambert Eaton syndrome

A

Potassium channel blocker 3,4-diaminopyridine (3,4-DAP), to be continued throughout perioperative period

55
Q

Preferred neuraxial anesthesia for parturient with hypertrophic cardiomyopathy

A

Epidural anesthesia. Goal is to avoid sudden decrease in SVR seen with spinal anesthesia

56
Q

Prader Willi Syndrome Association recommendations for postop monitoring:

A
  • Recovery overnight in monitored unit
  • Continuous pulse ox for 24 hrs postop
  • Reduced opioid administration
  • Conservative advancement of diet
  • 1:1 monitoring to prevent postop foraging and wound picking
57
Q

Cutaneous innervation of medial leg below knee is provided by

A

Saphenous nerve which is superficial extension of femoral nerve

58
Q

Innervation of posterior lateral aspect of foot and ankle is provided by

A

Sural nerve

59
Q

Sural nerve is a major branch of what nerve?

A

Common peroneal nerve

60
Q

TEG parameter that reflects coagulation factor activity

A

R time, time from beginning of test until beginning of clot formation

61
Q

TEG parameter that reflects clot kinetics

A

K time, time from start of clot formation to the point at which the curve reaches a 20 mm amplitude

62
Q

TEG parameter that reflects acceleration and kinetics of fibrin formation as well as the process of fibrin cross-linking

A

Alpha angle

63
Q

TEG parameter that reflects clot strength and platelet function

A

MA, maximum amplitude. Dependent on platelet concentration, function, and platelet-fibrin interaction

64
Q

TEG parameter that reflects fibrinolysis activity

A

LY30, difference in amplitude between MA and A30 (amplitude 30 minutes after MA)

65
Q

Relative risk of developing TNS (transient neurologic symptoms) with spinal lidocaine versus other local anesthetics

A

7 times greater

66
Q

TNS (transient neurologic symptoms) usually dissipate within how many hours?

A

72 hrs

67
Q

Does dose or concentration of lidocaine affect rate of TNS (transient neurologic symptoms)?

A

No.

68
Q

Rate of TNS (transient neurologic symptoms) is highest in what type of surgery?

A

Outpatient gynecologic procedures performed in LITHOTOMY position, risk rate of 30-36%. Supine position is 4-8%.

69
Q

Most successful therapy for TNS (transient neurologic symptoms)

A

NSAIDs

70
Q

Local anesthetic onset time is usually affected by what property?

A

pKa, low pKa equals rapid onset time

71
Q

What accounts for the rapid onset of chloroprocaine?

A

High concentration and dose. pKa of chloroprocaine is 9.1

72
Q

Local anesthetic potency is usually affected by what property?

A

Lipid solubility

73
Q

Local anesthetic duration is usually affected by what property?

A

Degree of protein binding

74
Q

Drug classified as an inodilator

A

Milrinone

75
Q

Mechanism of action of baclofen

A

GABA B agonist

76
Q

Mechanism of action of benzodiazepines

A

GABA A agonist

77
Q

Pain in the distribution of a nerve or nerves

A

Neuralgia

78
Q

Walking uphill or downhill worsens symptoms of lumbar stenosis?

A

Downhill

79
Q

EKG findings seen in a patient with TCA toxicity

A

Widened QRS, PR and QT prolongation, RBBB

80
Q

Treatment of choice for cardiac dysrhythmia in setting of TCA toxicity

A

Sodium bicarbonate. Increased pH makes TCA less available to bind to sodium channels

81
Q

Hereditary form of angioneurotic edema is caused by deficiency of?

A

C1 esterase deficiency, resulting in increased vascular permeability

82
Q

Recommendations for perioperative management of patients with HAE (hereditary angioneurotic edema) undergoing general endotracheal intubation

A

Daily anabolic steroid 5-7 days before surgery
FFP on day of surgery
C1 esterase inhibitor Berinert P on morning of surgery

83
Q

Laplace’s law, wall tension equation

A

Pr / 2h
P=pressure
R=radius
H=wall thickness

84
Q

How does increased ejection fraction affect wall tension

A

Decrease

85
Q

How does magnesium affect uterine blood flow?

A

Increase

86
Q

Difference in postop complications between caudal epidural analgesia vs. dorsal nerve penile block

A

More risk of motor block and lower extremity weakness in caudal block than in DNPB (dorsal nerve penile block)

87
Q

Nerve root that causes radiculopathy to the groin

A

L2

88
Q

Nerve roots that causes radiculopathy to the lateral thigh, groin, and upper buttock but not extending below the knee

A

L2-L3

89
Q

First line therapy for mild lumbar radiculopathy

A

NSAIDs, then epidural steroid injection

90
Q

Neuralgia with presence of sympathetic nervous system dysfunction and known injury (surgery/trauma)

A

CRPS type II (complex regional pain syndrome)

91
Q

Neuralgia with presence of sympathetic nervous system dysfunction in the absence of known injury

A

CRPS type I (complex regional pain syndrome)

92
Q

Tremor and incoordination are how common in patients with CRPS?

A

Tremor 50%

Incoordination 82%

93
Q

How is SVR (systemic vascular resistance) changed with term parturient

A

Decreased 20%

94
Q

How is plasma volume changed with term parturient

A

Increased 45%

95
Q

How is red cell mass changed with term parturient

A

Increased 20%

96
Q

How does central venous pressure in term parturient compare with nonpregnant?

A

No change, despite increase in plasma volume, venous capacitance also increases

97
Q

How is cardiac output changed with term parturient

A

Increased 45%

98
Q

How is stroke volume changed with term parturient

A

Increased 30%

99
Q

How is heart rate changed with term parturient

A

Increased 20%

100
Q

How is minute ventilation changed with term parturient

A

Increased 50%

101
Q

How is tidal volume changed with term parturient

A

Increased 40%

102
Q

How is respiratory rate changed with term parturient

A

Increased 15%

103
Q

How is FRC changed with term parturient

A

Decreased by 20-30%

104
Q

Initial therapy for stable monomorphic ventricular tachycardia (VT)

A

IV amiodarone

105
Q

Odds ratio definition for an outcome

A

Ratio of odds of outcome among exposed group to the odds of outcome among unexposed group

106
Q

Statistical test used to compare the association of 2 categorical variables

A

Chi-square test

107
Q

Primary treatment for neurogenic pulmonary edema following head injury

A

Reduction of intracranial pressure (ICP) with surgical intervention and osmotic diuretics

108
Q

Cardiac abnormalities associated with carcinoid syndrome

A

Pulmonic stenosis or tricuspid regurgitation

109
Q

Carcinoid syndrome is associated with what issue during anesthetic emergence?

A

Delayed awakening because of increased serotonin

110
Q

Only medication approved by FDA for treatment of trigeminal neuralgia

A

Carbamazepine

111
Q

Interventional treatment of trigeminal neuralgia involves blockade of what ganglion?

A

Gasserian ganglion, aka trigeminal ganglion

112
Q

Proper placement of retrograde cardioplegia cannula in the coronary sinus shows measured pressure of what?

A

10-40 mmHg

113
Q

Clinical factors associated with successful TOLAC (trial of labor after cesarean delivery)

A

Prior vaginal birth, spontaneous labor

*ACE's (27 decks)

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