ACE 2011 Flashcards
1
Q
What type of tocolytic agent is associated with hypoglycemia in neonate
A
Beta agonists like terbutaline
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%
3
Q
Gold standard for diagnosis of heart failure
A
Echocardiogram
4
Q
Nerve that becomes the medial and lateral plantar nerves
A
Posterior tibial nerve
5
Q
Nerve that innervates web space between first and second toes
A
Deep peroneal nerve
6
Q
Nerve that innervates the dorsum aspect of foot
A
Superficial peroneal nerve
7
Q
Nerve that innervates the lateral aspect of foot
A
Sural nerve
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
9
Q
Preop fasting guidelines for breast milk
A
4 hrs
10
Q
Preop fasting guidelines for infant formula
A
6 hrs
11
Q
Blood tests to identify pathophysiology of anaphylaxis
A
Plasma histamine and tryptase concentrations
12
Q
Blood sample to detect tryptase elevation should be obtained when after severe anaphylaxis
A
30 min to 2 hrs after
13
Q
Dermatomal range for adequate anesthesia for c section
A
T4-S4
14
Q
How does epidural analgesia for labor affect maternal core temperature?
A
Increases it, usually by less than 1 degree C
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
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
17
Q
What is the association of SLE with platelet count?
A
Thrombocytopenia
18
Q
Most common cardiac problem associated with SLE
A
Pericarditis. SLE also associated with HTN, coronary atherosclerosis, valvular disease, tamponade
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
20
Q
What condition in a patient makes hemabate a contraindication?
A
Pulmonary hypertension because hemabate (prostaglandin) increases pulmonary artery pressures
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
22
Q
EMLA (eutectic mixture of local anesthetics) contains which 2 local anesthetics
A
Lidocaine and prilocaine
23
Q
Prilocaine is metabolized to what?
A
O-toluidine, which may produce methemoglobinemia
24
Q
Phrenic nerve blockade occurs in how many patients receiving supraclavicular brachial plexus block?
A
30-50%
25
Normal P50 for adult is
27 mmHg
26
Types of shock
Hypovolemic
Cardiogenic
Distributive (sepsis, neuro, anaphylaxis)
Obstructive (tamponade, PE, tension ptx)
27
Median nerve's anatomical relationship to ulnar nerve in the axilla
Median nerve is superior to ulnar nerve
28
What nerve innervates the dorsal webspace between thumb and forefinger
Radial n
29
Perineum, pelvic floor, anal skin are innervated by what nerves?
Pudendal nerves
30
What should the ETT leak be?
Between 20-25 cm H2O
31
Single most important patient attribute affecting risk of developing postdural puncture headache.
Age, highest incidence in late teens to twenties, incidence decreases with increasing age
32
Type of pain associated with pancreatitis, cancer, trauma
Nociceptive pain
33
Type of pain resulting from damage or dysfunction of normal pain pathways
Neuropathic pain
34
Classes of drugs generally used to treat neuropathic pain
TCAs, anticonvulsants, NMDA antagonists
35
Initial intervention when HR less than 60 in a neonate
Chest compressions, consider intubation
36
Intervention if chest compressions do not raise HR above 60 in a neonate resuscitation
Epinephrine
37
Avg hemoglobin in a healthy term neonate
16.8 g/dL
38
Nadir for hemoglobin after birth for newborn is at how many weeks?
8-12 weeks, hgb 8-9 g/dL, rbc lifespan is 80-100 days in full term neonate
39
Which volatile agent is preferred in patients with liver disease and why?
Isoflurane, vasodilates hepatic circulation to maintain hepatic blood flow. Sevo and des also maintain hepatic blood flow
40
Which volatile agent decreases hepatic blood flow
Halothane
41
Primary blood supply to thoracolumbar portion of spinal cord
Artery of Adamkiewicz, branching off the aorta in the T9-12 region
42
Best initial management strategy in an unstable patient with Stanford type A aortic dissection with a echo showing large pericardial tamponade?
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
43
Laboring patient starts experiencing respiratory distress, cardiovascular collapse, coagulopathy, pulmonary hypertension and RV failure
Amniotic fluid embolism
44
Fetal acidemia is defined as
pH < 7.2
45
Metabolic or respiratory acidemia is associated with increased risk of neonatal complications
Metabolic
46
Unilateral painless visual loss 2 days following cardiac surgery resulting in optic disc swelling seen on funduscopic examination and abnormal afferent papillary reflexes
Anterior ischemic optic neuropathy
47
Bilateral painless visual loss immediately following spine surgery with normal funduscopic exam and abnormal afferent papillary reflexes
Posterior ischemic optic neuropathy
48
Painless visual loss with normal funduscopic exam and normal afferent papillary reflexes
Cortical blindness
49
Type of congenital heart lesion that slows rate of inhalational induction
Right to left shunt: tricuspid atresia, tetralogy of Fallot, transposition of great arteries, truncus arteriosus
50
closing capacity equals FRC in supine position at what age?
44
51
closing capacity equals FRC in upright position at what age?
66
52
Antibodies to what causes Lambert Eaton syndrome?
Calcium channels of motor and autonomic nerves
53
How does Lambert Eaton syndrome affect activity of muscle relaxants?
Increased sensitivity to both depolarizing and non depolarizing muscle relaxants
54
First line treatment for Lambert Eaton syndrome
Potassium channel blocker 3,4-diaminopyridine (3,4-DAP), to be continued throughout perioperative period
55
Preferred neuraxial anesthesia for parturient with hypertrophic cardiomyopathy
Epidural anesthesia. Goal is to avoid sudden decrease in SVR seen with spinal anesthesia
56
Prader Willi Syndrome Association recommendations for postop monitoring:
- 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
Cutaneous innervation of medial leg below knee is provided by
Saphenous nerve which is superficial extension of femoral nerve
58
Innervation of posterior lateral aspect of foot and ankle is provided by
Sural nerve
59
Sural nerve is a major branch of what nerve?
Common peroneal nerve
60
TEG parameter that reflects coagulation factor activity
R time, time from beginning of test until beginning of clot formation
61
TEG parameter that reflects clot kinetics
K time, time from start of clot formation to the point at which the curve reaches a 20 mm amplitude
62
TEG parameter that reflects acceleration and kinetics of fibrin formation as well as the process of fibrin cross-linking
Alpha angle
63
TEG parameter that reflects clot strength and platelet function
MA, maximum amplitude. Dependent on platelet concentration, function, and platelet-fibrin interaction
64
TEG parameter that reflects fibrinolysis activity
LY30, difference in amplitude between MA and A30 (amplitude 30 minutes after MA)
65
Relative risk of developing TNS (transient neurologic symptoms) with spinal lidocaine versus other local anesthetics
7 times greater
66
TNS (transient neurologic symptoms) usually dissipate within how many hours?
72 hrs
67
Does dose or concentration of lidocaine affect rate of TNS (transient neurologic symptoms)?
No.
68
Rate of TNS (transient neurologic symptoms) is highest in what type of surgery?
Outpatient gynecologic procedures performed in LITHOTOMY position, risk rate of 30-36%. Supine position is 4-8%.
69
Most successful therapy for TNS (transient neurologic symptoms)
NSAIDs
70
Local anesthetic onset time is usually affected by what property?
pKa, low pKa equals rapid onset time
71
What accounts for the rapid onset of chloroprocaine?
High concentration and dose. pKa of chloroprocaine is 9.1
72
Local anesthetic potency is usually affected by what property?
Lipid solubility
73
Local anesthetic duration is usually affected by what property?
Degree of protein binding
74
Drug classified as an inodilator
Milrinone
75
Mechanism of action of baclofen
GABA B agonist
76
Mechanism of action of benzodiazepines
GABA A agonist
77
Pain in the distribution of a nerve or nerves
Neuralgia
78
Walking uphill or downhill worsens symptoms of lumbar stenosis?
Downhill
79
EKG findings seen in a patient with TCA toxicity
Widened QRS, PR and QT prolongation, RBBB
80
Treatment of choice for cardiac dysrhythmia in setting of TCA toxicity
Sodium bicarbonate. Increased pH makes TCA less available to bind to sodium channels
81
Hereditary form of angioneurotic edema is caused by deficiency of?
C1 esterase deficiency, resulting in increased vascular permeability
82
Recommendations for perioperative management of patients with HAE (hereditary angioneurotic edema) undergoing general endotracheal intubation
Daily anabolic steroid 5-7 days before surgery
FFP on day of surgery
C1 esterase inhibitor Berinert P on morning of surgery
83
Laplace's law, wall tension equation
P*r / 2*h
P=pressure
R=radius
H=wall thickness
84
How does increased ejection fraction affect wall tension
Decrease
85
How does magnesium affect uterine blood flow?
Increase
86
Difference in postop complications between caudal epidural analgesia vs. dorsal nerve penile block
More risk of motor block and lower extremity weakness in caudal block than in DNPB (dorsal nerve penile block)
87
Nerve root that causes radiculopathy to the groin
L2
88
Nerve roots that causes radiculopathy to the lateral thigh, groin, and upper buttock but not extending below the knee
L2-L3
89
First line therapy for mild lumbar radiculopathy
NSAIDs, then epidural steroid injection
90
Neuralgia with presence of sympathetic nervous system dysfunction and known injury (surgery/trauma)
CRPS type II (complex regional pain syndrome)
91
Neuralgia with presence of sympathetic nervous system dysfunction in the absence of known injury
CRPS type I (complex regional pain syndrome)
92
Tremor and incoordination are how common in patients with CRPS?
Tremor 50%
| Incoordination 82%
93
How is SVR (systemic vascular resistance) changed with term parturient
Decreased 20%
94
How is plasma volume changed with term parturient
Increased 45%
95
How is red cell mass changed with term parturient
Increased 20%
96
How does central venous pressure in term parturient compare with nonpregnant?
No change, despite increase in plasma volume, venous capacitance also increases
97
How is cardiac output changed with term parturient
Increased 45%
98
How is stroke volume changed with term parturient
Increased 30%
99
How is heart rate changed with term parturient
Increased 20%
100
How is minute ventilation changed with term parturient
Increased 50%
101
How is tidal volume changed with term parturient
Increased 40%
102
How is respiratory rate changed with term parturient
Increased 15%
103
How is FRC changed with term parturient
Decreased by 20-30%
104
Initial therapy for stable monomorphic ventricular tachycardia (VT)
IV amiodarone
105
Odds ratio definition for an outcome
Ratio of odds of outcome among exposed group to the odds of outcome among unexposed group
106
Statistical test used to compare the association of 2 categorical variables
Chi-square test
107
Primary treatment for neurogenic pulmonary edema following head injury
Reduction of intracranial pressure (ICP) with surgical intervention and osmotic diuretics
108
Cardiac abnormalities associated with carcinoid syndrome
Pulmonic stenosis or tricuspid regurgitation
109
Carcinoid syndrome is associated with what issue during anesthetic emergence?
Delayed awakening because of increased serotonin
110
Only medication approved by FDA for treatment of trigeminal neuralgia
Carbamazepine
111
Interventional treatment of trigeminal neuralgia involves blockade of what ganglion?
Gasserian ganglion, aka trigeminal ganglion
112
Proper placement of retrograde cardioplegia cannula in the coronary sinus shows measured pressure of what?
10-40 mmHg
113
Clinical factors associated with successful TOLAC (trial of labor after cesarean delivery)
Prior vaginal birth, spontaneous labor
