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Truelearn Advanced Exam > ACE Exam 2022 > Flashcards

ACE Exam 2022 Flashcards

1
Q

When doing TOF on foot, what n are you assessing?

A

posterior tibial
***ONLY motor n in foot, the remainder are sensory

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2
Q

TOF at foot v hand

A

foot takes longer to onset and recovers faster

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3
Q

STOP BANG, BMI to inc risk of OSA

A

> 35

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4
Q

STOP BANG, neck circumfrence to inc risk of OSA?

A

40 cm (16 incchs)

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5
Q

STOP BANG, age to inc risk of OSA?

A

> 50

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6
Q

abrupt dec in SpO2, what dye given?

A

Methylene Blue -> absorbs at the same wavelength as deoxy Hg

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7
Q

Indigo carmine SpO2

A

little/no change

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8
Q

Indocynanine Green SpO2

A

slight dec 5-8%

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9
Q

Drugs that cross placenta easily

A

-lipophilic
-not protein bound
-nonionized
-small
-higher proportin of unionized drug in maternal plasma

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10
Q

RF for post herpetic neuralgia

A

-limited physical activity due to severe prodromal symptoms
-inc pain severity during infxn
-comorbid dx states incl resp dx and DM

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11
Q

What meds take the longest to infuse in?

A

Vancomycin
Fluoroquinolones: Ciprofloxacin

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12
Q

b/l blockages of superior laryngeal nerves cause

A

numbness above VC

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13
Q

what Local anesthetic causese the most pain on injection?

A

Etidocaine
-most lipid soluble
-Bupivacaine is also highly lipid soluble so 2nd most painful

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14
Q

Least painful local anesthetic on injxn?

A

Chloroprocaine least lipid soluble
-lidocaine 2nd least

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15
Q

What vasopressor may cause serotonin syndrome?

A

Methylene Blue
-MAO inh

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16
Q

SE of hydroxocobalamin used as vasopressor

A

chromaturia
-red colored urine

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17
Q

What herbal meds theoretically impact coagulation?

A

Garlic
Ginkgo
Ginseng

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18
Q

How long before surgery does garlic need to be d/c for neuraxial?

A

As long as no other anticoagulant drugs are being taken, does not need to be d/c

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19
Q

MC reason for pediatric liver transplant

A

biliary atresia

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20
Q

MC genetic cause of childhood liver dx

A

alpha 1 antitrypsin def

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21
Q

In noncardiac surgery, most common reason for periop stroke?

A

HypoTN (def as > 30% dec in baseline blood pressure)

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22
Q

Colloid osmotic pressure in preeclampsia

A

DECREASED
-plasma albumin is reduced due to loss of albumin in the protein and leaking of plasma protein through capillaries

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23
Q

CI to intraaortic balloon pump

A

-AR
-aortic dissection
-severe PVD
-pts w/ mulitple organ failure w/ no hope of reovery
-aortic stent or grafts
-septic shock
-pt refusal

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24
Q

How to know if pt is adequately alpha blocked for pheo surgery?

A

After 7-14 days of alpha blockade
-BP < 160/90
-some degree of postural hypoTN
-no ventricular arrythmias or ST or T changes for 2 weeks prior to surgery

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25
Q

What intraop infusions would be beneficial during a pheo removal?

A

-remifentanil
-esmolol
-Mg sulfate
-precedex

**Mg especially b/c dec catechlamine release, dec sensativity of alpha rec to catecholamines, antiarrythmic, direct vasodilation

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26
Q

What is important before ligation of adrenal vein in pheo removal?

A

volume explansion!! pt is going to get hypoTN after removal b/c of loss of catecholamines and already alpha blockedinsulin and pheo

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27
Q

What is important before ligation of adrenal vein in pheo removal?

A

volume explansion!! pt is going to get hypoTN after removal b/c of loss of catecholamines and already alpha blocked

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28
Q

insulin and pheo

A

-dec in catecholamines after pheo removal -> dec gluconeogenesis and inc in insulin release -> pts end up hypoglycemic

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29
Q

In trauma what causes the least movement of cervical spine?

A

intubation
-jaw thrust, head tilt and oral airway insertion inc cervical movement

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30
Q

Normal FHR

A

110-160

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31
Q

FHR for uterine rupture

A

likely late decelerations or persistent fetal bradycardia

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32
Q

Postop visual loss due to direct pressures

A

central retianl artery occlusion

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33
Q

postop vision loss not related to direct pressure

A

ischemic optic neuropathy

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34
Q

RF for ischemic optic neuropathy

A

-male sex, older, obesity
-intraop: hypoTN, large volume replacement w/ crystalloid, long duration of operation, Wilson frame, excessive blood loss

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35
Q

How long after catheter removal can heparin be restarted? ppx dose

A

1 hour

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36
Q

how long after heparin stopped can catehter be put in? ppx dose

A

4-6 hours

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37
Q

Why hypoTN after aoritc clamp off?

A

Mediator induced vasodilation
-fluid shifts from central to peirpheral compartments

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38
Q

What other congenital defect is found in peds w/ aortic coarctation?

A

bicuspid aortic valve (MC 80%))
PDA (50%)

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39
Q

What n block to use in circumcision w/ tethered spinanl cord?

A

pudendal

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40
Q

PPV in dec mycoardial contractility, effect on LV afterload?

A

decreased

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41
Q

At what MAC are pts going to get amnesia?

A

0.5-0.7 age adjusted MAC

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42
Q

MCC of death in hospitalized pts w/ SAH?

A

rebleeding

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43
Q

Which opioid metabolism does renal failure most affect?

A

Morphine -> M6G has resp depression
Meperidine -> CNS excitation sz

44
Q

Sub-Tenon optho block

A

essentially peribulbar block w/ catheter at end of syringe instead of needle

45
Q

What causes gastroschisis?

A

occlusion of omphalomesenteric artery

46
Q

Goal Hg for ESRD pts on EPO?

A

10

47
Q

ACLS pregnant woman

A

-manul L uterine displacement, don’t tilt the table
-if no ROSC in 5 minutes, hysterotomy
-no change to J for shocking
-compressions at normal lower sternum site

48
Q

What muscle relaxant is most likely to cause inc in catecholamine release?

A

succinylcholine

49
Q

If in OR and airway fire, what type of event?

A

sentinel event
-means that there is a catastrophic pt safety issue that requires evaulation ASAP

50
Q

Six Sigma

A

set of QI tools and techniques

51
Q

What n likely to be paralyzed w/ deep cervical plexus block?

A

phrenic

52
Q

why does epi hel pw/ pain control when intrathecal?

A

alpha 2 agonist

53
Q

What level of CO2 promotes upper airway dilating muscle activity?

A

hypercarbia ~45

54
Q

What def makes people more susceptible to LAST?

A

Carnitine

55
Q

Iodinated contrast v gadolinium contrast, which has higher radiopacity?

A

iodinated

56
Q

RF for postop urinary retention

A

male
age
BPH
anesethesia lol (spinal, epidural, and GA)
-anticholinergics
-excessive IVF
-anorectal surgery
-lower limb arthroplasty
-long duration of surgery

57
Q

Which genetic defect gets harder to intubate w/ age?

A

Pierre RObin

58
Q

Hurler Syndrome, what is it? symp?

A

lysosomal storage d/o
-airway obstruction, cervical spine instability, cardiac dysnfxn, restrictive lung dx, cognitive dyzfxn, dec vision and hearing
f**atlanto axial instabolity

59
Q

ESRD autonomic dysregulation

A

inc sympathetic, dec paraympathetic NS
-delayed gastric emptying
-inc resting HR
-dec HR variability
-dec exercise tolerance
-orthostatic hypoTN

60
Q

What n to block for cleft lip?

A

Infraorbital

61
Q

target for lumbar sympathetic block

A

L3 anterolateral aspect of vertebral body

62
Q

where is the celiac plexus located?

A

T12/L1

63
Q

MC complications in donors for livingn liver transplant

A

infxn
bile leak
pleural effusion

64
Q

What test is most useful for assessing pts post thoracotomy outcome?

A

maximal O2 consumption
-risk of M&M is low if VO@ > 20

65
Q

Assessment of M&M in lung resection surgery

A

***maximum O2 consumption is most useful!
-VO2 < 15-20 higher risk, or 6 minute walk test < 400 m
-FEV1 < 40% higher risk
-DLCO < 40% higher risk

66
Q

Best way to assess max O2 consumption

A

6 minute walk test -> how far can a pt walk in that time?-normal 400-600
-> if less than 400 time to do formal testing
-if COPD divide 6MWT by 30 to get VO2

67
Q

In ambulatory surgery center w/ no volatile anesthetics, which must they have? succ? dantrolene or both?

A

just succ

68
Q

In ambulatory surgery center w/ volatile anesthetics, which must they have? succ? dantrolene or both?

A

both

69
Q

What herbal medical can cause serotonin syndrome w/ MAOi?

A

Ephedra
-sounds like esmerelda -> she dances and inc serotonin in herself and those around her

70
Q

why cancel elective cases w/ positive COVID 19?

A

inc risk in pt periop complications

71
Q

Dose of methadone for 35 hr coverage?

A

20 mg

72
Q

Dose of methadone for 3-4 hr coverage?

A

10 mg

73
Q

When should chemoppx for DVT start postop after brain surgery?

A

Ideal within 72 hours!
-24 hours better than 96

74
Q

Paraneoplastic syndrome w/ squamous cell carcinoma

A

hyperCa (PTHrP)

75
Q

Paraneoplastic syndrome w/ adenocarcinoma

A

Cushings
growth hormone

76
Q

caffeine and ECT

A

inc sz duration

77
Q

What factor def can cause abnormal bleeding despite normal PT, PTT, and functional thrombin and fibrinogen time?

A

factor XIII

78
Q

blood supply?

A

R coronary artery

79
Q

how to tell a tension HA from a migraine?

A

tension: b/l, mild to moderate
migraine: photophobia, phonophobia, rhinorrhea, lacrimation, conjunctival injxn, miosis, ptosis

80
Q

why clevidipine so short acting?

A

metabolized by blood and tissue esterases

81
Q

clveidipine arterial or v vasodilator?

A

selective arterial vasodilator
-already has a v so just arterial vasodilating

82
Q

After how many weeks can intraop FHR monitoring be done?

A

22 weeks

83
Q

Porphyrias cause?

A

congenital errors in the synthetic chain that leads to production of Hg -> def in this cause accumulations of intermediates

84
Q

Why do pts w/ acute porphyrias get attacks intraop?

A

because they lose blood -> body wants to make more -> triggers inc in enzymes to make more Hg, but they have issues w/ that
-stressors that trigger: dehydration, infxn, fasting

85
Q

where in brachial plexus is interscalene block done?

A

roots C5-C7

86
Q

Where is supraclav done in brachial plexus?

A

Trunks

87
Q

Infraclav, where done in brachial plexus?

A

Cords

88
Q

Unsafe avoid in porphyria

A

All barbiturates
CCB
Amiodarone
Phenytoin
Spironolactone
Valproic Acid
Ketamine

89
Q

Safe in porphyria

A

all volatiles
atropine
fentanyl
midaz
meperidine
neostigmine
nitrous oxide
propfol
succ
vecuronium

90
Q

pt w/ low SVR and high PVR, what pressor to use?

A

Vasopressin

91
Q

cardiac concerns w/ scleroderma

A

pulm HTN
-sclerosis of coronary arteries
-issues w/ electrical conduction

92
Q

TEF repair, and sudden desat and dec in EtCO2 next step?

A

advance ETT

93
Q

RF PONV peds

A

-age > 3
-strabismus surgery
-family hx PONV
-surgery > 30 minutes

94
Q

pts allergic to hemostatic agents, more likely to be allergic to?

A

red meat
-Mg
-heparin
-gabapentin
-tylenol

95
Q

faster onset: rectal midaz, intranasal clonidine, PO precedez?

A

rectal midaz

96
Q

best regional block for coverage for a median sternotomy?

A

erector spinae

97
Q

What is multisystem inflammatory syndrome in peds?

A

kids 0-19 fever > 3 days
-rash, hypoTN, myocardial dysfxn, coagulopathy, acute GI problems
-inc ESR, CRP
-no other microbial cause

98
Q

what opioid is assoc w/ serotonin syndrome?

A

Fentanyl!

99
Q

SVR and pneumoperitoneum

A

increased!

100
Q

Sickle cell dx and moyamoya and stroke, best steps?

A

-so no hyperventilation b/c moyamoya has profoundly small vessels distally -> vasoconstrictiona nd ischemic stroke
-mannitol CI
-dec HbS through transfusion!

101
Q

blood product most assoc w/ infxn?

A

plts room temp storage

102
Q

Where does greater occipital n originate?

A

C2 medial branch of dorsal ramus
-on back of head, like dorsal more posterior

103
Q

severe hyperK next steps?

A

EKG to confirm actually severe -> Ca

104
Q

PPV of what is considered fluid responsive?

A

13%

105
Q

WHen is PPV to assess fluid responsiveness unrelieable?

A

-arrythmias (must be NSR)
-RV failure
-low lung compliance
-low TV
-sponatenous respirations
-inc intraabd pressure
-open chest

106
Q

Naloxegol MOA

A

selective mu opioid antagonist

107
Q

inc in inspiratory flow rate on I:E ratio?

A

decrease
-less time in inh b/c flowing faster to get to the TV

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