Apex Exams Missed Questions And Rationale

Question 1

Torsades des pointes is Most likely to occur following administration of what narcotic

Answer 1

Methadone- only narcotic known to prolong the QT interval

Question 2

Hepatic function tests and their baisis of abnormality

Answer 2

Synthetic function- PT, INR, Albumin
Hepatocellular injury- AST, ALT, GST
Cholelithiasis- alkaline phosphate, GGTP(more specific)

Question 3

Complications of celiac plexus block

Answer 3

Used for blocking abdominal organs in cancer patients or those going under for abdominal surgery who cannot receive spinal

Complications- hypotension (most common), bowel puncture, retroperitoneal bleeding, diarrhea, and paralysis.

Question 4

Functional group of Amine, Alcohol, Ether, Ester

Answer 4

Amine- NR3
Alcohol-ROH
Ether-ROR’
Ester-RCOOR

Question 5

Law of laplace

Answer 5

Tension= pressure x radius
Abdominal aneurysm more likely to rupture during hypertension

Question 6

Poiseuills law

Answer 6

Flow is directly proportional to the radius to the fourth power and the pressure difference along the tube. Flow is inversely proportional to viscosity and the length of the tube.
Describes laminar flow through a tube

Question 7

Bernoullis principle

Answer 7

Describes flow through a constriction. At the site of the constriction the fluids velocity increases, creating a pressure drop at the constriction.

Question 8

How long to postpone elective surgery for a pt who just had a drug eluting stent or bare mental stent placed

Answer 8

Drug eluting- 6 months
Bare metal stent-30 days

Question 9

Mannitol dosing

Answer 9

Inhibits water transportation at the loop of Henle

0.25-1 g/kg.

Question 10

Dorsal respiratory center, central respiratory center, amnesties center, and pneumotaxic centers. Where are the found and what do they do

Answer 10

All are a part of the reticular activating system in the pond or medulla.
Dorsal- found in medulla, inspiration pacemaker
Ventral- found in medulla, causes active exhalation
Apneustic- found in pons and stimulates DRC triggering inhalation
Pneumotaxic- found in pons and inhibits DRC triggers the end of inhalation

Question 11

Cerebral blood flow is directly proportional to PaCO2 by how much

Answer 11

For every 1mmHG change in PaCO2 from 40mmHG, CBF changes in the same direction by 1-2ml/100g/min

Question 12

Drugs that interfere with SSEP monitoring

Answer 12

SSEP monitors integrity of dorsal (sensory) but not ventral (motor) region of spinal cord.

Drugs - volatile anesthetic, nitrous oxide, propofol, barbiturates, midazolam, and diazepam.

Drugs that do not- ketamine, precedex, etomidate, opioids, and droperidol.

Question 13

Near infrared spectroscopy measures cerebral-

Answer 13

Venous oxygen saturation, only measures venous o2 in prefrontal cortex and is not a suitable monitor for global ischemia

Question 14

Drugs that can precipitate carcinoid crisis in patient with carcinoid tumors

Answer 14

Succs, atracurium, thiopental, epinephrine, norepinephrine, isoproterenol.

Presents as intense flushing, diarrhea, abdominal pain, tachy, hypertension, or hypotension.

Zofran, and octreitide are useful in management of these pts. No volatile anesthetics affect this.

Question 15

Afferent and efferent limbs of oculocardiac reflex and comprised of-

Answer 15

Afferent- long and short ciliary nerves, ciliary ganglion, ophthalmic division of trigeminal nerve, gasserian ganglion.

Efferent- vagus nerve and SA node.

Treatment of reflex includes removing stimulus, 100% O2, and anticholinergic (atropine or glyco)

Question 16

Most common cause of perioperative allergic reactions

Answer 16

Muscle relaxants (50-60%)
Latex (15%)
Antibiotics (10-15%)

Less common (less than 2-3%) protamine, hypnotics, colloids, opioids, contrast, blood, local anesthesia.

Question 17

Causes of early, late, and variable fetal heart rate decelerations

Answer 17

Early- uterine contractions compress head

Late- decrease uteroplacental perfusion, maternal hypotension, hypovolemia, acidosis, preeclampsia.

Variable- umbilical cord compression- causes baroreceptor mediated decrease in FHR. Urgent assessment of fetus

Question 18

findings for primary hyperparathyroidism

Answer 18

Hypersecretion of PTH leads to increased Ca2. Symptoms at 12mg/dl
HTN, short QT, hypotonia, kidney stones, polyuria, dehydration, bone pains, NV, abd pain, pancreatitis, cognitive dysfunction.

Question 19

List types of cutting, pencil point, and bevel tip spinal needles

Answer 19

Cutting- quinke, pitkin- increase risk of PDPH

Pencil- sprotte, pecan, Whitaker, lower risk of PDPH

Bevel- Greene lower risk of PDPH

Question 20

Calcium channel blocker that reduces mortality in pt with cerebral vasospasm

Answer 20

Nimodipine- only calcium channel blocker to improve outcomes.

Question 21

BmI calculation

Answer 21

Weight in Kg / height in meters squared= BMI

Question 22

What contusions are associated with gastroschisis/ omphalocele

Answer 22

Gastroschisis- prematurity. Usually occurs to right of unbillicus, not covered by hernia sac.

Omphalocele- midline defect covered by hernia sac, associated with beckwith-Weidmann, congenital heart disease, trisomy 21, etc.

Question 23

Neuromuscular test and % receptors still occupied
TOF 4\4, Tidal volume 5ml/kg, bite on tounge blade more than 5 seconds, double burst without fade

Answer 23

TOF 4/4- 70%
Tidal volume 5ml/kg- 80%
Bite on tounge blade - 50%
Double burst- 60%

Question 24

Losartan increases what

Answer 24

Increases lithium reabsorbtion , increases maternal and fetal mortality, increases serum potassium.

Oral angiotensin 2 receptor antagonist. Combats hypertension, but does not affect Angiotensin converting enzyme. Can cause post-induction hypotension, will respond to vasopressin or methylene blue

Question 25

Glucagon effects

Answer 25

Antagonizes affects of insulin- raises blood sugar by gluconeogenesis in liver, produced by alpha cells in pancreas (insulin produced by beta cells), increase myocardial contractility by increasing cAMP inside cardiac myocite. Useful in beta-blocker overdose, chf, low CO in MI or CPB pts.

Nausea and vomiting is side effect.

Question 26

Cvp monitoring in pneumonectomy pt

Answer 26

CVP line should be placed on operative side (risk of pneumothorax), IJ over EJ line, CVP in not a necessity for routine cases, increased filling pressure predispose lung to injury.

Question 27

Location of ST abnormality and the monitors

Answer 27

Right coronary artery monitored by lead 2, 3, and aVF. Supplies RA, RV, Sa+AV nodes, and inferior aspect of LV

Left coronary divides to left anterior descending LAD and circumflex artery Cx

LAD- V3-V5, anterolaterak region of LV

Circumflex- 1 and AVL. Lateral aspect of LV

Question 28

Max time of spinal hematoma before surgical decompression

Answer 28

8 hours

Question 29

Anes. Consideration for pt with pheochromocytoma

Answer 29

Catecholamine secreting tumor (NE) presents as excessive SNS activation (headache, diaphoresis, and tachycardia)

Must alpha block before beta block

Phenoxybenzamine before labetolol
Nitroprusside decreases SVR and decreases BP safely, have dextrose available once tumor is removed- leaded to hypoglycemia.

Question 30

Recommend bladder width of blood pressure cuff

Answer 30

40% circumstance of extremity
Cuff to small with give high reading
Cuff to big will give low reading

Question 31

Cardioversion of a fib, flutter, av node re-entry, or tachycardia secondary to preexcitation syndrome

Answer 31

First shock at 50-100 joules then increase incrementally to 360
Need to use synchronized shock to the R wave

Question 32

Equation for MAP

Answer 32

MAP=(SBP X 1/3) + (DBP X 2/3)

Systolic accounts for 1/3 of cardiac cycle and diastolic accounts for 2/3 of cardiac cycle

Question 33

Conditions that warrant antibiotic prophylaxis for infective endocarditis when undergoing tooth extraction

Answer 33

Previous infective endocarditis, prosthetic heart valve/repair, heart transplant with valvuplasty, unrepaird cyanotic congenital heart defect, dental procedure with gingival manipulation, and resp procedure with perforation to mucosal lining.