Anesthesia and Analgesia

Question 1

1) Which anesthetic is cardiotoxic?
a) Marcaine(Bupivicane)
b) 2-Chloroprocaine

Answer 1

A

Question 2

2) Which anesthetic has the shortest half-life?
a) 2-Chloroprocaine
b) Lidocaine
c) Bupivicane

Answer 2

A
2-Chlorprocaine has the shortest half-life of the local anesthetics at approximately 30 minutes. Lidocaine has the shortest onset of action (<2 minutes) and the next shortest half-life. Bupivicaine & ropivicaine have the longest & similar half-lifes (hours).

Question 3

3) What is the most likely risk from regional anesthesia?
a) Allergic reaction to local anesthetic
b) Toxicity from local anesthetic
c) Epidural bleeding
d) Brain herniation

Answer 3

) B-Local anesthetic toxicity. I think this is the right answer. The most common adverse effect is hypotension, which affects 20-30% of patients but does not have any actual long-term sequelae. Spinal headache occurs in 1-3% of subjects. True allergic reaction to local anesthetics is extraordinarily rare. I did not find incidences of epidural bleeding or brain herniation but are “rare.” Local anesthetic toxicity occurs in 0.1% of subjects but local anesthetic toxicity if the most common cause of death resulting from regional anesthesia during a cesarean delivery & convulsions due to local anesthetic toxicity were the most common damaging events during regional anesthesia in obstetric patients.

Question 4

4) What is the cause of a post regional headache?
a) Increased intracranial pressure
b) Traction on pain sensitive structures
c) Vasoconstriction
d) Herniation

Answer 4

B. Traction on pain sensitive structures. Spinal headache complicates 1-3% of epidurals but 70% of epidurals complicated by wet tap. Leakage of CSF leads to hypotension, displacement of spine downward, and pulling/stretching of pain-sensitive fibers. Treatment is with oral analgesics, caffeine, & blood patch.

Question 5

5) What drug would you see opiate withdrawal?
a) Stadol
b) Toradol
c) Valium
d) Morphine

Answer 5

A. Stadol. Stadol (butorphanol) and nalbuphine (Nubain) are both opioid agonist-antagonists. Administration of this drug to a chronic drug user can result in opioid withdrawal symptoms.

Question 6

6) A patient has mitral stenosis, what do you give to block intubation reflex hypertension?
a) Valium
b) Nitroprusside
c) nitroglycerine
d) labetalol

Answer 6

B. Nitroprusside. In patients where hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation. Choices include labetalol, nitroglycerine, and nitroprusside. Nitroprusside has the advantage of allowign minute-to-minute control.

Question 7

7) A patient has a lesion at T10, all the following are suggestive of autonomic dysreflexia except?
a) Hypotension
b) Facial flushing
c) Bradycardia

Answer 7

A- usually HYPERtension
Autonomic dysreflexia occurs for lesions at or below the level of T7 and is characterized by hypertension, flushing, bradycardia, pilomotor erection, sweating. When an impulse is conducted to the spinal cord a reflex response is triggered – in cases of spinal cord lesion at or above that point, the reflex cannot be modulated by higher centers. This results in uncontrolled adrenergic discharge with norepinephrine release from peripheral sympathetic nerve endings.

Question 8

8) Why are pregnant patients more susceptible of hypoxia during intubation?

Answer 8

Decreased functional reserve.

Question 9

9) Most common cause of death from epidural toxicity?

Answer 9

Local anesthetic toxicity. Even though this only occurs in 0.1% of subjects it is the most common cause of death resulting from regional anesthesia.

Question 10

10) Longest lasting local anesthetic for an epidural?
a) bupivacaine
b) lidocaine
c) chloroprocaine

Answer 10

A. Bupivicaine. Bupivicaine lasts 2-4 hours.

Question 11

11) Shortest half life in the neonate?
a) bupivacaine
b) lidocaine
c) chloroprocaine

Answer 11

C

Question 12

13) What are side effects of halothane- most severe

Answer 12

The most severe adverse effect of all the volatile anesthetics is fulminant hepatic necrosis caused by halothane

Question 13

17) What is the treatment of malignant hyperthermia?

Answer 13

Dantrolene

Question 14

What is malignant hyperthermia and symptoms

Answer 14

Malignant hyperthermia (MH) is a rare but potentially life-threatening condition that can be triggered by certain medications used during general anesthesia. Rapid rise in body temperature: One of the hallmark features of MH is a rapid increase in body temperature, often exceeding 38.8°C (101.8°F).
Muscle rigidity: Muscles become rigid, particularly in the jaw and upper body, which can lead to difficulty breathing or inadequate ventilation.
Rapid heart rate: Tachycardia, or a fast heart rate, is a common symptom of MH.
Increased breathing rate: Patients may experience rapid breathing or hyperventilation.
High blood pressure: Hypertension or an elevated blood pressure can occur during an MH episode.
Sweating: Profuse sweating is often observed in individuals experiencing MH.
Dark-colored urine: The urine may become dark or brown due to muscle breakdown and the release of myoglobin, a muscle protein, into the bloodstream.
Altered mental status: Some individuals may experience confusion, agitation, or even loss of consciousness during an MH crisis.

Question 15

19) Local anesthetic epidural anesthesia is LEAST associated with
a) hypotension
b) FHR abnormalities
c) pruritis
d) spinal headache

Answer 15

C Pruritus. Hypotension & FHR abnormalities occur in ~25% of epidurals. Pruritus is caused by narcotics and also systemic

Question 16

21) What is the best medication to alleviate hypertension in a preeclamptic patient at time of general anesthesia induction?
a) Hydralazine
b) Magnesium sulfate
c) Nitroglyceride

Answer 16

C

Question 17

27) Which drug do you use when intubating a patient to decrease reflex hypertension?

Answer 17

Nitroprusside, nitroglycerin.

Question 18

Spinal anesthesia resulting in sympathetic blockade is worst for: ***
a) mitral insuff
b) coarctation
c) PHTN
d) IHSS hypertrophic obstructive cardiomyopathy

Answer 18

D.
Do not want drop in preload. Must keep preload up in RV in order to have enough blood to perfuse the elevated pulmonary vascular bed

Question 19

27. Which is least likely to deliver vaginally (term, 6cm dilated, 0 station)?
    a. brow
    b. mentum anterior
    c. footling breech
    d. occiput posterior
    e. occiput transverse

Answer 19

Brown (Mentum (chin) anterior OK. Posterior not okay

Question 20

What is least important for determining sample size?
a. desired alpha
b. desired beta
c. desired chi squared result
d. prevalence in controls
e. desired prevalence in treatment group

Answer 20

C

Question 21

Which is least important for power analysis?
a. sample size
b. standard deviation
c. variance
d. coefficient of variance
e. desired chi-squared result

Answer 21

D

Question 22

How does iodine Rx hyperthyroidism?

Answer 22

Decrease thyroxine release

Question 23

How does iodine Rx hyperthyroidism?

Answer 23

Decrease thyroxine release

Question 24

59. What is most associated with fetal risk?
    a) antimicrosomal antibodies
    b) thyroglobulin binding antibodies
    c) thyroid receptor stimulating antibodies

Answer 24

C
TSI can cause fetal Graves, even after mom has been treated for the disease

Question 25

Second most common cause of fetal CAH
a. 11-hydroxylase deficiency
b. 21-hydroxylase deficiency
c. 17-hydroxylase deficiency
d. 3-hydroxysteroid dehydrogenase deficiency

Answer 25

The second most common is 11-hydroxylase deficiency. This results in androgen excess and hypertension. Treatment of pregnant patients is the same as in 21-hydroxlyase deficiency (C p.1098).

Question 26

What is this karyotype due to
e. 47,XXY

Answer 26

e. 47,XXY this is due to digynic triploidy- diploid ovum by haploid sperm or diploid sperm with haploid ovum

Question 27

How to H2o cross the placenta

Answer 27

Bulk flow

Question 28

Findings of a mature newborn

Answer 28

Mature newborn has parchment/leather skin, very little lanugo, crease over whole sole, full areola of 5-10 mm, a stiff ear, deep rugae/majora covers clitoris and minora

Question 29

Effects of MPA (depo)

Answer 29

MPA decrease triglycerides, decreases LDL, decreases HDL, and decreases bone mineral density.

Question 30

Genetics and presentation of Osler-Weber-Randu

Answer 30

What autosomal dominant disorder has telangectasia, epistaxis, and AV malformations? ***
A. Osler-Weber-Randu, AD, known for epistaxis and GI bleed

Question 31

148. A patient is sent to you at 22 weeks with a diagnosis of absent radii bilaterally, polyhydramnios, hydronephrosis, and severe growth restriction fetal ultrasound. What is the most likely diagnosis? ***
     Remember MOST LIKELY

a. Thrombocytopenia absent radius syndrome
b. Carbamazepine exposure
c. VACTERL association
d. Holt-Oram syndrome

Answer 31

The answer is C.
Radius problems on ultrasound lead a whole host of possible diagnoses. High on the list should be thrombocytopenia absent radius syndrome and Fanconi’s anemia. TAR (AR)-the thumbs are present: cardiac defects (15-33%) and micrognathia (3-30%), renal anl/hydronephrosis (23%) (S p.291). Carbamazepine is not associated with radial abnormalities, although valproic acid has been (C p.284). Holt-Oram syndrome is a good possibility, but again cardiac defects are usually a hallmark of the disease including septal defects, transposition of the great arteries, or Tetralogy of Fallot. The most likely diagnosis is VACTERL complex, which usually consists of vertebral anomalies, anal atresia, esophageal atresia, renal abnormalities, and radial ray problems (S p.333). Hydronephrosis is often seen with the disease.

Question 32

What medication that one is taking that folic acid does not help? (for NTDs) anti seizure medication

Answer 32

A. Dilantin- phenytoin (NTDS) it interferes with folic acid metabolism

Question 33

What nerve is affected if the mother’s legs are hyperflexed during delivery?
A. Femoral
B. Obturator
C. Peroneal

Answer 33

Femoral – prob secondary to prolonged lithotomy. Weakness of quads, sparing ADDuction. Sensory loss of ant/medial thigh.

Question 34

A patient was diagnosed with an IUFD, after delivery there appeared to be no gross anomalies, placenta appeared normal, and the fetus was macerated and weighed 2500 grams. What would most likely give you the diagnosis?
A. Autopsy
B. Karyotype
C. Kleihauer-Betke test 1.5% of loss
D. TORCH – infection = 15% of IUFD

Answer 34

Autopsy recommended in all cases (useful in 20-50%), but this case macerated. Karyotype recommended, but only 2% aneuploidy if no dysmorphic features. KB less diagnostic if done after delivery. Parvo is common (in 7-15% of IUFD by PCR). TORCH titers not recommended

Utdol.com: The frequency of abnormal karyotype in macerated stillbirths, nonmacerated stillbirths, and neonatal deaths was approximately 12, 4, and 6 percent, respectively.

Question 35

What is avascular?
A. Chorion leave
B. Chorion frondosum
C. Desidua capsularis
D. Desidua basalis
E. Desidual

Answer 35

A.
Answers.com: The greater part of the chorion is in contact with the decidua capsularis, and over this portion the villi, with their contained vessels, undergo atrophy, so that by the fourth month scarcely a trace of them is left, and hence this part of the chorion becomes smooth, and is named the chorion læve; as it takes no share in the formation of the placenta, it is also named the non-placental part of the chorion.
On the other hand, the villi on that part of the chorion which is in contact with the decidua placentalis increase greatly in size and complexity, and hence this part is named the chorion frondosum.

Question 36

What is used to measure intraobserver variability?

Answer 36

Kappa score

Question 37

Preload and afterload fixed, what increases CO?
- alpha
- beta
- hydralazine
- lassie

Answer 37

Preload and afterload fixed, what increases CO? ***
A. alpha adrenergic – vasoconstricts, increase afterload
B. beta adrenergic – increase heart rate & contractility
C. Hydralazine – vasodilates, decreases afterload (but fixed)
D. Lasix – decrease preload