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Truelearn Advanced Exam > ACE Exam 1 > Flashcards

ACE Exam 1 Flashcards

1
Q

MC SE of deep cervical plexus block

A

ipsilateral diaphragm paresis

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2
Q

What nerve block occurs b/w pec major and pec minor?

A

PECS I
-analgesia to upper anterolateral chest wall

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3
Q

What nerve block occurs b/w pec minor and serratus anterior?

A

PECS II
-blocks cutenaous branches of intercostal nerves T2-T6
-analgesia to upper anterolateral chest wall

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4
Q

What area does the serratus anterior plane block block?

A

Cutaneous branches of intercostal nerves
T3-T9
-analgesia to lateral chest wall
-can block long thoracic and thoracodorsal nerves

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5
Q

What does erector spinae plane block cover?

A

Spinal nerve dorsal and ventral rami
-T2-T9 (if blocked at T5)
-anterior, lateral, posterior chest wall covered

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6
Q

What blood product is stored at room temp and why?

A

plts
-cooling causes them to activate and aggregate

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7
Q

If full term infant, at what post conceptual age do you need additional monitoring after GA?

A

< 44 weeks

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8
Q

If preterm infant, at what postconceptual age do you still require monitoring after GA?

A

< 60 weeks

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9
Q

who is more likley to have postop apnea: SGA or LGA?

A

LGA
-SGA protected from apnea

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10
Q

bronchopulm dysplasia and postop apnea

A

does NOT correlate

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11
Q

At what Hct is there an inc risk of postop apnea in neonates?

A

< 30%

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12
Q

Buprenorphine formulations approved for opioid use d/o

A

-sublingual tablets
-sublingual film
-subdermal implant
-extended release solution for injxn
-buccal film

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13
Q

FDA approved buprenorphine formulations for chronic pain

A

-transdermal patch
-buccal film

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14
Q

Buprenorphine mechanism of action

A

-partial mu opioid agonist
-weak kappa antagonist
-delta agonist

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15
Q

Naltrexone

A

mu receptor antagonist
-competitive, displaces opioid drugs

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16
Q

MC complication assoc w/ placement of radial art lines?

A

transient arterial occlusion
(hematoma formation 2nd)

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17
Q

Cerebral perfusion pressure equation

A

MAP - ICP (or CVP whatevers higher)
-if CVP increased w/ PPV -> dec cerebral perfusion
-PPV -> inc intrathoracic pressure -> inc CSF pressure

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18
Q

pt on hospice, COPD, optimized on O2 and resp meds, still has dyspnea, what to do?

A

morphine

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19
Q

How long to desat in an RSI pt breathing room air? healthy otherwise

A

60 seconds

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20
Q

After preoxyengation, healthy patient, how long to desat?

A

7 minutes

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21
Q

Adequately preoxygenated obese pt, how long to desat?

A

1-2 minutes

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22
Q

HIPAA privacy rule

A

identifies personal health info -> estabilishes protection w/ health plans, health care clearing houses, and health care providers

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23
Q

HIPAA Security rule

A

sets the standards for protecting electronic PHI

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24
Q

HIPAA Enforcecment rule

A

establishes the processes by which a breach of HIPAA would be investigated and the sanctions that apply

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25
The Breach Notification Rule HIPAA
Require HIPAA covered entities provide notification after a breach of unsecured PHI (regardless if PHI is electronic, paper, or verbal)
26
Nerves blocked w/ scalp block
-greater occipital -lesser occipital -auriculotemporal -supratrochlear -supraorbital -zygomaticotemporal
27
in peds, what age group is most likely to get LAST?
under 12 months -less protein-binding -> more unbound fraction of local anesthetic
28
At birth where is the conus medullaris?
L3/L4
29
At what age does the conus medullaris go to adult position of L1?
1 year old
30
Where does the dural sac terminate in neonates?
S3 (s1 in adults)
31
What can trigger V fib in a pt w/ Brugada syndrome?
overload of parasympathetic activation (vagal activity) -hypoK, hyperK, hyperCa -CCB, beta blockers, Procainamide
32
What to give Brugada pt w/ worsening ST elevation?
Isoproterenol
33
SE of etomidate
-inc PONV -thrombophlebitis -myoclonus (not if given w/ midaz or Mg) -pain on injxn -hiccups
34
Reversal agent for Apixaban
Andexanet alfa
35
Reversal agent for dabigatran
idarucizumab
36
Reversal agent for rivaroxaban
Andexanet alpha
37
What factors are in PCC?
II, VII, IX, X
38
How long before surgery should the oral form of naltrexone be held?
48-72 hours
39
How long before surgery should the extended release naltrexone be held?
4 weeks
40
Preop Optimization for pheo
-arterial BP should not exceed 165/90 48 hrs before surgery -orthostatic hypoTN no lower than 80/45 w/ standing -no nonpermanent ST-T wave changes on EKG -no more than 1 PVC every 5 minutes
41
proper functioningn of O2 fail-safe valve dept on what?
pressure! if O2 < 25 psig -> won't allow other gases to flow through -> goal to prevent hypoxic mixture to pt
42
Which steroid has the highest glucocorticoid potency?
Dexamethasone -has 0 mineralocorticoid potency
43
Which steroid has the highest mineralocorticoid potency?
Fludrocortisone
44
What is a sinus venosus defect
defect in the atrial septum near SVC or ICV that is assoc w/ anomalous pulmonary venous connection
45
Tetralogy of Fallot
-overriding aorta -pulm stenosis -RVH -VSD
46
hemodynamic changes in response to hyperbaric O2
-inc in SVR -dec in HR, dec in CO, dec in PVR
47
effects of abd insufflation on oxygenation and PVR/SVR
-SVR decreases -> vasodilation -PVR inc due to hypercarbia -> inc hypoxic pulm vasoconstriction -> dec intrapulm shunting -> improved oxygenation
48
What is the best way to relieve catheter-related bladder discomfort
preop gabapentin
49
How long does it take methimazole to work?
6-8 weeks
50
Thyroid storm intraop, best first tx?
IV propranolol -> direct beta blocking activity and prevents conversion of T4 to T3 -PTU can only be given rectally or NGT no IV form exists
51
Meds that don't cross the placenta
He Is Going Nowhere Soon Heparin (incl LMWH!!) Insulin Glyco NDNMB Succ
52
What AC is most likely to cross the placenta?
apixaban rivaroxaban
53
which upper extremity blocks most likely to give Horner syndrome?
-Stellate ganglion block (MC) -interscalene
54
What medication assoc w/ inc risk of uterine rupture w/ TOLAC?
misoprostol
55
MC cardiac tumor
myxoma
56
MC malignant cardiac tumor
angiosarcoma
57
Where is a myxoma MC located?
LA
58
paraneoplastic syndrome w/ squamous cell carcinoma
hyperCa (inc parathryoid hormone related protein)
59
tx of hyperCa paraneoplastic
-fluids and loop diuretics -bisphosphonates
60
What is paraneoplastic cushing syndrome assoc w/?
neuroendocrine lung tumors carcinoid tumors SCLC
61
Paraneoplastic SIADH assoc w/
SCLC
62
herniation of brain tissue through a fracture or defect in skull
transcalvarial herniation
63
herniation of cortex across the flax
subfalcine herniation -usually due to inc ICP -> pushes one side to the other (R to L herniation)_
64
Leading cause of maternal, fetal, and neonatal morbidity and mortality rates
maternal heart dx
65
Worse pregnancy outcomes cardiac dx
pulm HTN -severe LV dyxfxn -EF < 30% -severe MS, severe AS -aortic dilation -unrepair aortic coarctation
66
TXA inhibits action of what?
plasmin/plasminogen
67
Neonatal pain score
CRIES crying req O2 inc vital signs expression (grimace?) sleepless
68
pain scale for 2 months to 7 years
Face, Legs, Activity, Cry and Consolability FLACC
69
Wong-Baker Face Pain Scaled used in what age?
3-18 years
70
What would lead to a falsely elevated Hg A1c?
things that prolong RBC duration (dec turnover) -iron def anemia -B12 and folate def anemia -renal failure -hyper TG -severe hyperbili -chronic alcoholism -leald poisoning -asplenia
71
What would lead to a falsely low Hg A1c?
things that shorten PRBC lifespan? -acute and chronic blood loss -splenomegaly -hemolytic anemia, sickle cell anemia -pregnancy
72
pericardial effusion
73
damage to the long thoracic n causes?
n to serratus anterior -winging of the scapula
74
after open thoracotomy pt has severe ipsilateral shoulder pain, what causes it?
phrenic n referred pain
75
def of postop delirium
w/i 24-72 hours postop
76
def of postop cognitive dysfxn
weeks to months after surgery
77
delirium < 24 hrs postop
emergence delirium
78
rewarming and postop cog dysfxn
slow rewarming is preferred
79
What suppresses the neuronal and basal components to dec CMRO2?
hypothermia -barbs and sleep only dec neuronal
80
post drowning conscious, but hypoxia, next step?
CPAP and PEEP -> expands lung volume and improves oxygenation
81
shunt fraction and improvement w/ FiO2 100%
-at higher shunt fractions, 100% FiO2 makes less of a difference on PAO2
82
What dx has ketamine infusions shown a significant long-term improvement in pain?
CRPS
83
influences likelihood to develop phantom pain
pain before amputation
84
what happens after successful mitral valve repair w/ a clip device?
commonly a tx for MR -improved cardiac output -inc pressure gradient through mitral valve
85
NORA self-inflating hand resuscitator bag should be available and capable of giving what % O2?
90%
86
What level of brachial plexus does infraclavicular block cover?
Cords
87
Which cord is most likely to be spared w/ infraclavicular block?
Posterior --> radial
88
Celecoxib likely to cause a severe rxn in pts who have an allergy to what abx?
Sulfonamides
89
If pt needs PCC, but has HIT, what PCC can they NOT get?
K centra -> has heparin in it!
90
What is Profilnine?
NINE -> factor IX complex -nonactivated factors II, IX, X, does not contain heparin -most useful in hemophilia B (IX def)
91
FEIBA
Factor Eight inhibitor bypassing activity -factors II, VII, IX, X, shortes PTT w/ factor VIII inh -no heparin, used in hemophilia A and B
92
according to joint commission, who is most likely to be responsible for hospitals sedation policies?
director of anesthesia services
93
What factor correlates w/ extent of atelectasis?
BMI!
94
Concerns for pt w/ Williams Syndrome
Elfan syndrome w/ Intellectual disability -Cardiac! needs preop eval -DM -GERD -hyperCa (hyperPTH)
95
Metabolic Syndrome dx criteria
Central Obesity and 2 of following -inc TG > 150 -reduced HDL < 40 men, < 50 women -inc BP >130/85 -inc fasting glucose >100 or DM2 **b/c adipose tissue releases proinflammatory cytokines -> insulin resistance
96
abnormal ion channel for paramytonia congenita?
Sodium channel
97
What is paramytonic congenita
Na channel dysfxn -exacerbated by the cold!! -NOT predisposed to MH
98
what channelopathy is assoc w/ myotonia congenita?
Cl
99
Calculation of RR using ECG measures does so how?
Measuring changes in the axis of the heart (changes based on insp and exh)
100
pt w/ hx of esophagectomy, higher risk of?
aspiration PNA
101
timeframe for TRALI
1-6 hours
102
Diagnostic criteria for hepatopulm syndrome
-PaO2 < 70 while breathing room air (or A-a gradient > 15) -evidence of intrapulm vascular dilation
103
Why is remimazolam so short acting?
b/c of it's ester side group -> broken down by TISSUE esterases (not blood esterases like remi and esmolol)
104
Contraindications to celiac plexus block
-infxn -uncorrectable coagulopathies -bowel obstruction **be careful in pts w/ orthostatic hypoTN
105
Kava SE
used for anxiolysis to inc GABA -SE: inc in gamma-glutamyl transpeptidase levels -> hepatoxicity -can suppress plt aggregation and COX inhibitor
106
When to stop kava preop
24 hours
107
Most common complication after heart surgery?
A fib
108
Common dx associated w autism spectrum d/o
epilepsy
109
Which ECMO supports only lungs?
VV ECMO
110
Which ECMO supports lungs and heart?
VA ECMO
111
Why does opioid induced hyperalgesia occur?
-spinal sensitization to glutamate and substance P -NMDA rec involved
112
treatment or ppx of opioid induced hyperalgesia
ketamine low dose buprenorphine COX 2 inh Methadone alpha 2 agonists regional anesthesia
113
What lyte abnormality is likely to precipitate torsades in long QT syndrome?
HypoK hypoCa hypoMg
114
Predictive factor for cardiac events in pts w/ long QT?
QTc > 500
115
Pt who had anaphylactic rxn has inc serum levels of?
Tryptase (careful baseline elevated in hematologic cancers, CKD, mastocytosis)
116
CVC tip should be where on CXR to be in the correct stop?
carina below inferior clavicle 3rdd frib T4-5 interspace take off of R mainstem bronchus
117
treatment of carcinoid syndrome symp
octreotide somatostatin
118
Which inhaled anesthetic is doing the most damage to the ozone layer?
nitrous oxide
119
What inh anesthetic has more global warming potential?
Des
120
Which substance use d/o can claim disability under americans w/ disabilities act?
CURRENTLY abusing alcohol -for illegal drugs, you have to not be using and in a rehab program
121
if mother addicted to opioids and baby has resp depression tx?
intubate! no naloxone
122
Peds resp to pneumoperitoneum
-inc in SVR (dec preload, dec cardiac output -> inc in SVR compensation) -reflex bradycardia (vgal activation) -dec FRC and complicance -dec UOP
123
pleural effusion
124
New weakness in peroneus brevis muscle, what n injured?
Superficial peroneal n
125
Lithium and effects on muscle relaxants?
potentiates both depolarizing and nondepolarizing muscle relaxants

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