ACE

Question 1

Most common complication of OB paracervical block

Answer 1

-fetal bradycardia

Question 2

U/S PNX

Answer 2

lung point

Question 3

Intra-aortic ballon pump

Answer 3

• he primary purpose of IABP therapy is to improve myocardial perfusion during diastole by improving coronary blood flow. It also reduces left ventricular afterload, thus decreasing left ventricular work.
• The most accurate way to correctly time IABP counterpulsation is to initiate inflation immediately as the dicrotic notch is detected. Deflation of the IABP balloon should take place just before the systolic upstroke
• helium in balloon

Question 4

Peds, % blood loss before hypotension

Answer 4

40%

Question 5

Shortest half life of benzos (versed, lorazepam, diazepam, alprazolam)

Answer 5

versed

Question 6

Methylphenidate perioperative concerns

Answer 6

increased cardiovascular instability, altered anesthesia requirements, and lowering of the seizure threshold. Methylphenidate use is associated with an increased minimum alveolar concentration (MAC) and thus a decreased sensitivity to volatile anesthetics. Time to emergence from general anesthesia is not increased in patients taking methylphenidate

Question 7

Carcinoid heart disease

Answer 7

Carcinoid heart disease typically produces tricuspid regurgitation and mixed pulmonic stenosis and regurgitation, resulting in right heart failure.

Question 8

OI associations

Answer 8

-platelet dysfunction, easy trauma, pectus excavatum, heat intolerance, increases thyroid hormone

Question 9

Dementia drugs interactions

Answer 9

-Anticholinesterase medications are also frequently used in the treatment of dementia (eg, donepezil). These medications may prolong paralysis from succinylcholine and impact nondepolarizing muscle relaxants by decreasing or reversing their effects

Question 10

Most predictve on unsuccessful mask

Answer 10

-neck radiation changes

Question 11

Fractional flow reserve

Answer 11

< .8 likely to improve with PCI or stent

Question 12

Pregnancy s/p renal transplant

Answer 12

However, some complications of pregnancy are higher in transplant recipients, such as preeclampsia (27.0% vs 3.8%) and gestational diabetes (8% vs 3.9%). Also higher are the rates of cesarean delivery (56.9% vs 31.9%) and preterm delivery (45.6% vs 12.5%

Question 13

presedex context sensitive halflife for 40 yo

Answer 13

50 minutes

Question 14

post ROSC hypothermia

Answer 14

32°C to 34°C and 34°C to 36°C

Question 15

MH susceptibility

Answer 15

There is a wide range of disorders associated with mutations in the RYR1 gene (eg, central core disease, King–Denborough syndrome, periodic paralysis, and idiopathic hyperCKemia).

Question 16

Stellate ganglion block

Answer 16

• In 80% of patients, the stellate ganglion is formed by the inferior cervical and the first thoracic ganglion. The anterior approach is most commonly used for SGB
• Left-sided SGB has been noted to be more effective at managing ventricular arrhythmias. If left SGB fails, a right SGB can be added, but this should be restricted to intubated patients, as bilateral phrenic nerve paralysis is possible
• LA injected anterior to longus colli muscle

Question 17

TIPS procedure

Answer 17

shunt between hepatic vein and portal vein

Question 18

Aortic coarctation

Answer 18

headache, epistaxis, lower extremity claudication, and hypertension. Upper extremity systolic hypertension (with normal diastolic pressure) and lower extremity hypotension are also common. These individuals exhibit extensive collateral circulation

Question 19

cancer drugs that interact with pseudochilinesterase

Answer 19

nitrogen mustards

eg, mechlorethamine, cyclophosphamide, melphalan, and chlorambucil

Question 20

treatment for heparin resistance

Answer 20

administration of recombinant human antithrombin, additional heparin, or fresh frozen plasma (FFP)

Question 21

thorasic scoliosis PFTs

Answer 21

• follow restrictive pattern

- decrease in FVC

Question 22

PONV acupuncture

Answer 22

Pericardium-6

- 4 cm proximal to the distal wrist crease, between the palmaris longus and flexor carpi radialis tendons

Question 23

Parkinsons and PONV

Answer 23

Haloperidol, metoclopramide, and promethazine are all dopamine antagonists and have proved efficacious in treating PONV. However, dopamine antagonists may exacerbate symptoms in patients with Parkinson disease and should therefore be avoided in such patients.

Question 24

cerebral edema in tumor

Answer 24

• Vasogenic cerebral edema occurs when tight endothelial junctions of the blood–brain barrier are compromised, such as with tumor growth
• Intravenous steroids, such as dexamethasone, selectively target vasogenic cerebral edema by stabilizing the blood–brain barrier

Question 25

Most appropriate way to report drug dosage

Answer 25

mean drug dose +/- SEM

Question 26

elective procedure s/p stroke

Answer 26

wait 6 weeks

Question 27

Serotonin syndrome

Answer 27

``` Signs and symptoms of altered mental status include: Agitation Disorientation Anxiety Visual hallucinations ``` ``` Signs of neuromuscular overactivity include: Myoclonus Tremor Hyperreflexia Muscle rigidity Positive akathisia Nystagmus Trismus ``` ``` Signs of autonomic instability include: Hypertension Tachycardia Hyperthermia Mydriasis ```

Question 28

button battery

Answer 28

honey 10ml q 10 minutes

Question 29

Epsilon waves on EKG

Answer 29

Epsilon waves on 12-lead electrocardiogram are considered characteristic of rrhythmogenic right ventricular cardiomyopathy (ARVC) -The disorder is often familial and typically autosomal dominant with variable expressivity

Question 30

Vd in old people

Answer 30

The volumes of distribution for drugs change with age, depending on whether they are fat soluble or water soluble. The volume of distribution of fat-soluble drugs is increased in the elderly, leading to a longer elimination half-life compared to younger patients. For water-soluble drugs, the volume of distribution is decreased in the elderly, leading to higher plasma concentrations compared to younger patients.

Question 31

gabapentin MOA

Answer 31

Gabapentin and pregabalin are best described as calcium-channel antagonists

Question 32

caudal block landmarks

Answer 32

PSIS for equilateral traingle with the sacral hiatus

Question 33

cirhotic cardiomyopathy

Answer 33

CCM is characterized by diastolic dysfunction, impaired contractile response to β-adrenergic stimulation, prolonged QT interval (>440 ms), and other evidence of autonomic dysfunction such as a decreased ability to increase heart rate in response to exercise.

Question 34

most common side effect of precedex infusion

Answer 34

hypotension

Question 35

interferes with hormononal birth control

Answer 35

suggamadex, rifampin, aprepitant

Question 36

heparin resistant associations

Answer 36

Thrombocytosis (platelet count above 300,000 to 450,000 per microliter) Release of platelet factor 4, often due to subclinical thrombotic processes Sepsis Preoperative heparin infusion Hypereosinophilia Consumptive coagulopathy

Question 37

Horners syndrome

Answer 37

Ptosis Miosis (Figure 2) Bloodshot conjunctiva (due to vasodilation) Pseudoenopthalmos (the eye appears sunken, but has not actually changed position in the orbit) Nasal congestion Anhidrosis

Question 38

drugs that interfere with DBS placemetnq

Answer 38

beta blockers

Question 39

methylergonovine avoided in

Answer 39

CAD, HTN

Question 40

prostagladin avoided in

Answer 40

asthmatics

Question 41

superior hypogastric nerve block

Answer 41

uterus and lower pelvic tissue

Question 42

Celiac plexus

Answer 42

The celiac plexus is the largest autonomic plexus located in the retroperitoneum. It is composed of the left and right celiac ganglia, the superior mesenteric ganglia, and the aorticorenal ganglia, with fibers from presynaptic sympathetic nerves carried by the greater, lesser, and least splanchnic nerves.

Question 43

tumescent liposuction

Answer 43

The safe dose of lidocaine using the tumescent technique (with epinephrine) has been reported to be 35 mg/kg, with some advocating as high as 55 mg/kg -The dilute epinephrine dose causes a constriction of the blood vessels, leading to a peak lidocaine dose occurring 12 to 14 hours after the procedure.

Question 44

Xenon anesthesia

Answer 44

does not trigger MH, doesnt destroy ozone, , no hepatic damage. Increase in PONV and cost

Question 45

Tramadol

Answer 45

Tramadol is a weak μ-opioid receptor agonist and a serotonin and norepinephrine reuptake inhibitor. Due to the latter effects, tramadol has additional risks not associated with other opioids, including serotonin syndrome and seizures.