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Truelearn Advanced Exam > ACE exam 3 > Flashcards

ACE exam 3 Flashcards

1
Q

cervical radiculopathy plus Horners syndrome, next step?

A

CXR r/o Pancoast tumor

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2
Q

HLA B27 dx?

A

ankylosing sponylitis or IBD

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3
Q

Muscles need goes through for an erector spinae block

A

trapezius, rhomboid, erector spinae

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4
Q

ocular perfusion pressure

A

MAP - IOP

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5
Q

Desmopressin inc release of what factor?

A

VIII

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6
Q

concern for anesthesia w/ Renal cell carcinoma?

A

invasion into IVC, renal v, RA

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7
Q

what PFT is indicative of severity in cystic fibrosis?

A

FEV1

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8
Q

What time of day should cystic fibrosis case be done?

A

Later in the day -> let chest PT clear out accumulation of ON thick secretions

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9
Q

LMA v ETT for cystic fibrosis?

A

If can LMA to avoid instrumentation of airway
-if ETT use bigest possible for suctioning

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10
Q

which muscle relaxant is likely to cause serotonin syndrome w/ other 5HT meds?

A

Cyclobenzaprine
-b/c acts similarly to TCAs -> so serotinin receptor binding

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11
Q

MOA of baclofen

A

GABA B agonist

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12
Q

What eyedrops interfere w/ succinylcholine?

A

echothiophate and isoflurophate
-inhibit serum cholinesterase

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13
Q

Normal dibucaine number

A

80

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14
Q

MCC of ESRD leading to kidney transplant in the US

A

diabetes

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15
Q

Pain in first and second stage of labor

A

first: T10- L1
second: S2-S4

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16
Q

recent stent, but needs urgent repair, what briging therapy appropriate when clopidogrel needs to be stopped 5 days preop?

A

Cangrelor
CAN GrelOr

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17
Q

Pulmonary alveolar proteinosis homeostasis d/o of?

A

Surfactant -> buildup of lipoprotein rich substance in alveoli

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18
Q

What is in vaping liquid that can lead to bronchiolitis obliterans?

A

Diacetyl -> it’ll kill you
DIE

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19
Q

ANti-glomerular basement membrane antibodies

A

Goodpastures
effect BM in lung and kidneys

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20
Q

In CO2 absorber, w/ soda lime and KOH, how do the concentrations change?

A

KOH doesn’t change -> it’s a catalyst
-soda lime dec and gets consumed

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21
Q

First drug to start in peds HF?

A

ACE inh
(BB second)

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22
Q

fever: TRALI or TACO?

A

TRALI

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23
Q

Spinal cord stimulators and surgery

A

-preop: turn down to lowest setting and then turn off
-intraop: bipolar cautery, if monopolar pad far from SC stimulator leads
-postop: interrogation

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24
Q

Clevidipine metabolism

A

esters blood and tissue

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25
Q

SIADH labs

A

Serum osm < 275
Serum Na < 135
U Na > 30
Urine osm > 1–

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26
Q

Occupational Health says what is the maximum acceptable workplace exposure to halogenated volatile anesthetics?

A

2 ppm

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27
Q

Antiplt medication that reversibly inhibits plt aggregation?

A

Eptifibatide
It’s fibbing b/c its reversible
Ticagrelor
Vorapaxar
Cangrelor (it can go b/c reversible)

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28
Q

Irreversible plt medication

A

ASA
Clopidogrel
Prasugrel
-praying but nada b/c irreversible

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29
Q

N/V neuraxial v IV?

A

same risk!

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30
Q

What are the only reasons to quench an MRI?

A

-metallic object on magnet
-fire
-earthquake

**if pt needs CPR no need to quench, just remove them

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31
Q

succinylcholine recovery time and pregnancy

A

unchanged!

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32
Q

RF for sudden cardiac death in HOCM

A

-LV apical aneursym
-dec LV function (<50%)
-extensive gadolinium enhancement on cardiac magnetic resonance imaging

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33
Q

youngest age a double lumen tube can be used

A

8

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34
Q

most effective drug in smoking cessation

A

Varenicline

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35
Q

TEG value assoc w/ thrombin generation

A

R time

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36
Q

What does K time represent on TEG?

A

rate of fibrin cross-link formations and interaction b/w fibrin and plts

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37
Q

Goal MAP for SCI

A

> 85 for 7 days after injury

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38
Q

incomplete spinal cord injury, best next step?

A

surgical decompression

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39
Q

HFrEF tx

A

Angiotensin receptor-neprilysin inhibitors

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40
Q

ASA III v IV

A

III: poorly controlled dx
IV: severe dx that is a constant threat to life

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41
Q

Drugs where metabolism is dept on hepatic blood flow

A

high hepatic extraction ratio!
-propofol, sufent, morphine, lidocaine

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42
Q

Drugs where metabolism is indpt of hepatic blood flow

A

wafarin
phenytoin
alfentanil

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43
Q

minimum wait time to redose roc after giving sugammadex

A

5 minutes
-but will take 4 minutes to onset, and duration of action is only about 15 minutes

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44
Q

if signifcant difference b/w upper extremity BP, where should one put an a line?

A

the limb w/ the higher BP -> more accurate to what the brain is seeing

45
Q

When is aprepitant supposed to be given?

A

1 hour before induction of anesthesia

46
Q

Difference of Oliceridine from other opioids?

A

It is selective for mu opiod receptors -> minimizing other SE compared to other opioids

47
Q

myocardial injury after noncardiac surgery

A

-inc trops w/o symp or EKG changes -> inc 30 day mortality risk

48
Q

Andexanet alfa is a reversal agent for?

A

Apixaban and rivaroxaban

49
Q

Metochlopramide and pheo

A

avoid!

50
Q

What type of stents have highers risk of thrombosis more than 1 year after implantation?

A

1st generation drug eluting stents

51
Q

which stents are most likely to restenose?

A

bare metal stents

52
Q

What neurmonitoring should be done w/ TAA?

A

MEPs b/c concern for ischemic in anterior spinal cord -> MEPs monitor

53
Q

When giving hydroxycobalamin for BP control, what lab value is likely to be inaccurate?

A

Hg

54
Q

criteria for ON admission after T&A

A

severe OSA (apnea-hypopnea index > 10)
-sleep disturabnce
-age < 3
-craniofacial abnormalities
-living 1 hour away or unstable housing
-postop problems (fever, PONV, no oral intake)
-coagulpathy
-extreme obesity (> 98th %ile)

55
Q

What monitor is reliable w/ LVAD?

A

EKG
-pulse ox and NIBP cuff req pulsatile flow

56
Q

after catheter PDA closure, peds pt gets SOB, difficulty feeding due to choking and coughing, why?

A

RLN injury 2/2 nerve running near where PDA closure was

57
Q

How long after spinal drain placement can IV heparin be given?

A

1 hour

58
Q

sign of human trafficking

A

-pt doesn’t speak english and person with them doesn’t want them to use a translator

59
Q

How to do uterine relaxation during EXIT procedure?

A

volatile anesthesitc

60
Q

Meralgia paresthetica

A

injury to LFCN (L2-3)

61
Q

Which chemotherapy agent prolongs NMB?

A

cyclophosphamide

62
Q

Pt is a poor CYP2C19 metabolizer, what antiplt to avoid?

A

Clopidogrel

63
Q

Anesthesia concerns for pt w/ Epidermolysis bullosa

A

-sensitive skin on face, can have perioral scarring, enlarged epiglottis
-IV induction, inh too much contact w/ mask and face
-intranasal intubation (resp mucosa, so less scarring of nasal passages)
-avoid LMAs -> friction in perioral area
-clip on pulse ox
-protective layer b/w pt and BP cuff
-may have a difficult airway

64
Q

Nicardipine CBF

A

-inc CBF while dec systemic pressure
-inc SV and coronary blood flow

65
Q

roc onsent and off set in age > 80

A

slower onset
and slower off set (longer acting)

66
Q

What can cause torsades when given w/ methadone?

A

Metochlopramide and Ondansetron

67
Q

What factors affect block height?

A

-age (less CSF)
-baricity
-pregnancy (higher level)

68
Q

Hemochromatosis

A

dx of iron metabolism -> body is overloaded in iron
-affects liver, pancreas, and heart
-assoc w/ diabetes

69
Q

Diff b/w addiction and pseudoaddiction

A

-in pseudoaddiction -> behavior extinguished once adequate pain control is achieved
-true addicts continue drug seeking even once pain has been relieved

70
Q

Nocebo effect

A

adverse outcomes triggered by pt expectations that the treatment will be harmful

71
Q

SAH and hypoNa why?

A

Cerebral Salt Wasting

72
Q

w/ ruptured aneurysm, postop?

A

Follow troponins -> may indicate cardiac issues that aren’t presenting

73
Q

what dx is assoc w trigeminal neuralgia?

A

MS

74
Q

what arrythmia is common w/ Fontan physiology?

A

intra-atrial reentrant tachycardia
-basically redo anatomy so only 1 functioning ventricle

75
Q

what other use has bupropion/naltrexone been approved for?

A

chronic weight management

76
Q

a line dx?

A

AR

77
Q

a lline dx?

A

HOCM

78
Q

gabapentin preop inc risk of what postop?

A

dizziness
visual changes

79
Q

Difference b/w subcutaneous ICD and typical AICD?

A

-just subq, no venous access -> so more susceptible to electromagnetic interference
-has only pacing possibilities for 30 sec after shock, no longer PM
-used in pts who can’t get vascular acces or prothrombic

SAME: same response to magnets

80
Q

Frailty components

A

-unintentional weight loss
-weakness
-exhaustion
-slowness
-low activity

–> useful for predicting poor outcomes postop -> postop delirium higher in frail pt, risk of D/c to not home 5x increase

81
Q

Factor V Leiden

A

hypercoag
-makes factor V resistant to degradation by protein C

82
Q

Time to d/c ER naltrexone prior to surgery?

A

4 weeks

83
Q

Recommendation for anesthesia for c/s when women want to breastfeed

A

neuraxial

84
Q

TURP w/ shoulder pain during procedure and abd distention

A

bladder perforation

85
Q

What prevents the wrong gas cylinder from being connected to the anesthesia machine?

A

pin index safety system

86
Q

What is the diameter index safety system used for?

A

hose-to-wall and hose-to-machine connections for different medical gases

87
Q

RF for warfarin induced skin necrosis

A

protein C def
protein S def
antiphospholipid antibodies

88
Q

Indications for intraop cell salvage

A

-EBL will be > 1L
2. blood loss confined: cardiac, vascular
3. diff obtaining homologous blood

89
Q

Changes in blood banked blood compared to cell salvaged blood

A

-2,3 DPG dec
-pH dec
-K inc
-dec resistance to osmotic stress
-microaggregate formation

90
Q

urgent intracranial surgery needed for pregnant week 28 woman, modification to anesthesia needed?

A

RSI

91
Q

most effective neuroprotectic strategy during aortic arch reconstruction w/ temporary interruption of cerebral blood flow?

A

deep systemic hypothermia

92
Q

what can you do to increase cerebral rSO2?

A

inc MAP
**position has NO impact

93
Q

NSAIDs (ketorolac) have a ceiling effect for?

A

Analgesia

94
Q

NSAIDs (ketorolac) have no ceiling effect for

A

GI bleeding, AKI

95
Q

What color goggles for Argon lasers?

A

Orange
-like ARG -> pirate -> scurvy -> need oranges

96
Q

What goggles for Nd:YAG laser?

A

GREEN

97
Q

Rgoggles for CO2 lasers/

A

Clear

98
Q

potassium titanyl phosphate lasers, what color goggles?

A

RED
-PQR -> Red goggles for Potassium

99
Q

if pt has anterior mediastinal mass and onc is saying 911 OR, next step?

A

delay case get echo and CT scan first!
-need to assess options and see extent of compression before anesthesia

100
Q

Coag factors dec in pregnancy

A

XI XIII

101
Q

Coag factors unchanged in pregnancy

A

II, V

102
Q

anticoag unchanged in pregnancy

A

protein C
-CEE? i’m unchanged

103
Q

Anticoag factors dec in pregnancy

A

ATIII, protein S
So sad i’m decreased S

104
Q

RF for chronic opioid use postop in opioid naive pt

A

age > 50
-male sex
-chronic benzo use or antidepressant use
-hx of substance use
-lower socioeconomic status
-type of surgery: TKA, open chole, total hip, mastectomy

105
Q

How are roc and cistatracurium dosed?

A

ideal body weight

106
Q

RF for postop cognitive dysfxn

A

vascular dx

107
Q

What are vagal nerve stimulators used for?

A

refractory epilepsy and major depression

108
Q

Anesthesias concerns w/ vagal n stimulators

A

-can affect VC -> inc risk of aspiration
-inc risk of central OSA
-same concerns as PM w/ cautery

109
Q

What valvular pathology is better tolerated in pregnancy?

A

AR -> b/c SVR is low and HR is high in pregnancy
-stenotic lesions are difficult b/c dec in SVR limits coronary BF and fast HR limites LV filling

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