Anesthesia

Question 1

Max dose of epinephrine non-cardiac / cardiac

Answer 1

.2mg / 0.04mg

Question 2

Sulfa allergy has greater incidence to which class of local anesthetic

Answer 2

Esters

Question 3

Max dose 2% lidocaine

Answer 3

4.4mg/kg or 300mg

Question 4

Max dose 4% articaine

Answer 4

1.3mg/kg or 90mg

Question 5

How many mg of 1% anesthetic in 1.7ml

Answer 5

17mg

Question 6

How many mg of epi in 1:100,000 1.7ml

Answer 6

0.02mg

Question 7

Which vasocontrictor additive in LA has alpha agonism resulting in increased MAP and reflex braycardia (good for tachycardic patients)

Answer 7

Levonordefrin

Question 8

Which vasocontrictor additive in LA has beta agonism and is better for hypertensive patients

Answer 8

Epinephrine

Question 9

NPO time for breast milk

Answer 9

4hrs

Question 10

Role and mechanism of Train of Four

Answer 10

• Depolarizing –> uniform decrease in twitch amplitude in TOF - Non depolarizing –> sum of twitches based on % of receptors occupied. 1 twitch 95%, 2 twitches 85%, 3 twitches 80%, 4 twitches 75% makes sense because minimum 25% available receptors for NMJ function

Question 11

Role and mechanism of Tetanic nerve stimulator

Answer 11

Depolarizing –> no fade in muscle response with tetany (if there is fade then there has been prolonged exposure to succinylcholine or phase 2 blockade) - Non depolarizing –> fade with tetany

Question 12

Why is Sp02 falsely elevated in CO poisoning and heavy smokers?

Answer 12

CO poisoning and heavy smokers have increased carboxyhemoglobin which falsely elevates SpO2

Question 13

Which leads most sensitive to ST elevation

Answer 13

Lead II Lead V5

Question 14

Which volatile agent has airway irritation

Answer 14

Desflurane

Question 15

Which volatile agent has slow onset

Answer 15

Isoflurane

Question 16

While volatile agent may be contraindicated in renal patient?

Answer 16

Sevoflurane (compound A)

Question 17

What hemodynamic effects do all volatile agents have

Answer 17

hypotension tachycardia decreased contractility decreased systemic vascular resistance

Question 18

What ventilation effects do volatile agents have? (Exception-Isoflurane)

Answer 18

Tachypnea Hypercapnea Decreased Tv Decreased minute ventilation

Question 19

Mechanism of Miosis with opioid

Answer 19

CN III parasympathetic agonist

Question 20

Site of propofol metabolism

Answer 20

liver

Question 21

All IV sedation agents decrease cerebral blood flow and ICP except

Answer 21

Ketamine

Question 22

Mechanism of neostigmine

Answer 22

Build up of ACh within NMJ. It is an acetyl cholinesterase inhibitor

Question 23

Dose of neostigmine

Answer 23

0.03-0.07 mg/kg

Question 24

Contraindications of Succinylcholine

Answer 24

Recent burn/crush injury NMJ disease Narrow angle glaucoma Malignant hyperthermia Skeletal muscle myopathies

Question 25

Which two neuromuscular blocking agents are best for renal or hepatic failure patients

Answer 25

Atracurium Cisatracurium (Hoffman Elimination)

Question 26

s/s cocaine intoxication

Answer 26

HTN, Tachy, hallucinations, convulsions, HA, Angina, CVA

Question 27

Tx cocaine intoxication

Answer 27

B-blockers Nitrates CCB

Question 28

Cocaine half-life

Answer 28

30-90 mins

Question 29

Main difference between cocaine detox and EtOH detox

Answer 29

EtOH detox also has HTN/Tachycardia

Question 30

Age/gender most common for thyroid storm

Answer 30

Women 20-40 yrs

Question 31

Most common cause underlying condition in thyroid storm

Answer 31

recently diagnosed/undiagnosed Grave's disease with trauma/surgical stress

Question 32

s/s thyroid storm

Answer 32

HTN, Tachy, MI, dysrhythmias, Hyperthermia

Question 33

Main difference in s/s between thyroid storm and MH

Answer 33

MH also has acidosis

Question 34

Emergent tx of thyroid storm

Answer 34

Propranolol

Question 35

What medications can be given 6-8 weeks prior to elective surgery in patient with recently diagnosed Grave's Disease

Answer 35

Propylthiouracil Prevents conversion of T4 to T3, inhibits thyroid hormone stimulation

Question 36

How many mins reserve O2 does obese person have?

Answer 36

2mins

Question 37

What common maneuver worsens air trapping in bronchospasm?

Answer 37

PEEP It can cause lung hyperinflation.

Question 38

Pathophysiology of MH

Answer 38

Calcium dump from sarcoplasmic reticulum in skeletal muscle

Question 39

Early signs of MH

Answer 39

Hypercarbia Tachy Tetany

Question 40

Late signs of MH

Answer 40

Hyperkalemia with ECG changes Rhabdo Hyperthermia

Question 41

Most common causes of death in MH

Answer 41

Hypercoagulation 2/2 hyperthermia Hyperkalemia

Question 42

Loading dose of dantrolene for MH

Answer 42

2.5mg/kg

Question 43

s/s myasthenic crisis vs cholinergic crisis

Answer 43

SAME signs/symptoms Weakness, bronchospasm, diaphoresis, cyanosis

Question 44

Myasthenic crisis vs cholinergic crisis

Answer 44

Myasthenic crisis = insufficient medication Cholinergic crisis = excess medication

Question 45

Most common myasthenia gravis medication and its duration of effect

Answer 45

Pyridostigmine = Anti-Acetylcholinesterase 3-6 hour duration

Question 46

Which volatile agents are potent bronchodilators

Answer 46

Isoflurane Enflurane

Question 47

Which paralytics cause histamine release and are contraindicated in asthmatic

Answer 47

Atracurium Mivacurium

Question 48

Classification of cerebral palsy

Answer 48

Spastic (motor cortex, 75% of CP patients) Dyskinetic (basal ganglia) Ataxic (cerebellum)

Question 49

Periop management of CP

Answer 49

Volatile induction (IV access hard with contractures) Aspiration precautions (decreased tone + hypersalivation) Avoid Succinylcholine Increase MAC and non-depolorizing dose Lowered seizure threshold Chronic hypovolemia with pre-renal kidney injury/failure

Question 50

What LA agents can cause methemoglobinemia at high doses?

Answer 50

Prilocaine