CA2-ITE Flashcards

1
Q

Acupuncture can be reversed by _______

A

Naloxone (who knew?)

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2
Q

What are three ventilatory goals in Congenital Diaphragmatic Hernia?

A
  1. SpO2 90-95%
  2. Permissive hypercapnea (up to 65 mmHg)
  3. Low volumes with PIP < 25 cm H20

“Gentle ventilation”

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3
Q

Which position change causes the largest decrease in FRC?

A

60 degrees upright to supine. Or supine to Trendelenburg greater than -30 degrees.

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4
Q

Name two difference between BLS and PALS

A
  1. In an unwitnessed collapse on an adult one can leave to activate emergency response, in a child 2 mins CPR should be inititated
  2. With two providers a ration of 15:2 is used in children
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5
Q

What three physiologic conditions are associated with persistent fetal circulation?

A
  1. Acidosis
  2. Hypothermia
  3. Hypoxemia
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6
Q

Why is pregnancy a hyper coagulable state?

A

Increase in factors with decrease in factor S and resistance to factor C

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7
Q

Inhaled agents and EEG. What’s the relationship?

A

Inhaled agents can cause burst suppression at > 2 MAC doses

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8
Q

What is Propofol’s effect on ICP?

A

Decreases by decreasing CMO2

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9
Q

What is the drug of choice for any (of the three) Protamine reactions?

A

Epinephrine

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10
Q

Early decelerations:
Late decelerations:
Variable decelerations:

A

Early: Head compression
Late: Fetal hypoxia
Variable: Cord compression

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11
Q

What is concern for Midazolam infusion in patient with renal failure?

A

Accumulation of metabolite

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12
Q

What reflects the least amount of Beam rays during US?

A

Blood (liquid)

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13
Q

What is different about coronary perfusion between left and right coronaries?

A

Right is also perfused during systole

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14
Q

Define context-senstiive half-time

A

Time required for drug concentration to decrease by one half

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15
Q

CSF lavage is a reasonable treatment option for what?

A

High spinal in setting of inadvertent intrathecal catheter placement

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16
Q

Large quantities of blood product can lead to what acid base status? 2/2 what?

A

Metabolic alkalosis 2/2 Sodium Citrate

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17
Q

What two opioids have the lowest risk of Opioid Induced Neurotoxicity?

A

Fentanyl and Methadone

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18
Q

What is the Bohr Effect?

A

The shift in the oxygen dissociation curve caused by changes in pH, temperature, environment

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19
Q

What is the Haldane effect?

A

Describes hemoglobin’s increased affinity for CO2 when deoxygenated

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20
Q

What is the Heparin dose and goal ACT for SPB?

A

300-400 units/kg

About 480 seconds

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21
Q

What lab test best measures actual Heparin concentration for CPB?

A

HiTT (High Dose Thrombin Time)

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22
Q

What is the initial compensatory mechanism to maintain O2 delivery in the setting of anemia?

A

Rightward shift in the oxygen-hemoglobin dissociation curve

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23
Q

Patient with recent history of postpartum hemorrhage now with inability to breastfeed. Likely (board answer) diagnosis?

A

Postpartum pituitary necrosis

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24
Q

What is most common cause of death in women with preeclampsia?

A

Stroke

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25
Q

What finding can differentiate TRALI from other types of transfusion reactions?

A

Leukopenia

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26
Q

Which nerve block carries the highest risk of pneumothorax?

A

Supraclavicular

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27
Q

Key features of trisomy 21

A
Single palmar crease
Upslanting palpebral fissures
Endocardial cushion defects
Atlantoaxial instability
OSA
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28
Q

Key Features Trisomy 18

A

VSD
Rocker Bottom feet
Clenched hand with overriding digits

-Edwards syndrome

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29
Q

Key features trisomy 13

A

Holoprocencephaly
Cleft lip
Absent ribs
Polydactyly

_Patau syndrome

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30
Q

Key features trisomy 8

A

Long face
Wide nose
Thick lower lip
Cleft palate

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31
Q

What is the most common congenital heart defect recognized at birth?

A

VSD

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32
Q

Separation anxiety begins at what age?

A

6-8 months

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33
Q

Anesthesia specifics for CP:

  • Roc dosing
  • Succs
  • MAC
  • Coagulation
A
  • Roc requirements are normal to increased
  • Succs in not contraindicated
  • MAC is decreased
  • Coagulation factors abnormal
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34
Q

Open ureteral reimplantation, postop analgesia, what is mechanism of postop pain and preferred analgesia postop?

A

Bladder spasm

Caudal catheter

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35
Q

In kids what are 4 independent risk factors for PONV?

A
  1. Age > 3
  2. History is fam or patient
  3. Surgery > 30 min
  4. Strabismus surgery
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36
Q

What is preferred initial agent in treatment of cardiogenic shock?

A

Dobutamine

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37
Q

Brainstem ischemia is best monitored with what?

A

Brainstem auditory evoked potentials

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38
Q

What is the effect of isoflurane on the baroreceptor reflex?

A

Blunts the response

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39
Q

Why should hyperventilation be avoided in pregnancy?

A

Hypocarbia increases uterine vascular tone and decreases uterine perfussion

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40
Q

Radiation is related to distance how?

A

Inversely proportional to the square of the radius

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41
Q

What can decreased preload do to heart rate via what reflex?

A

“reverse” Bainbridge reflex. Reduced myocardial stretching results in decreased firing of SA node and bradycardia

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42
Q

Primary hyperparathyroidism does what to acid/base?

A

Non-ion gap metabolic acidosis

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43
Q

Wait how long after heparin for palacement of epidural?

A

4-6 hours

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44
Q

In decompensated heart failure what is the effect of diuretic?

A

Movement downward along the same frank-starling curve. This decreased the filling pressure and stretch on the myocardium

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45
Q

What are EKG findings of hypokalemia?

A

St-segment and T-wave depression

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46
Q

Dermatomes of lower extremity:

L1:
L2:
L3:
L4:
L5:
A
L1: Inguinal ligament
L2: Lateral thigh
L3: Medial (lower) thigh
L4: Medial lower leg and medial first toe
L5: Lower Lateral and lateral second toe
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47
Q

Describe the schematic of renin/angiotensin

A

Decrease in renal perfusion->renin secreted-> converts angiotensin (from liver) to angiotensin 1-> ACE (from lungs) converts to Angiotensin II -> Angiotensin II :

  1. Increases sympathetic anctivity
  2. Stimulates release of aldosterone
  3. Arteriole vasoconstriction
  4. Secretion of ADH which reabsorbs H20

Aldosterone: re-absorption of sodium, chloride, and H20. Potassium excreted

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48
Q

What is the equation for respiratory system compliance?

A

1/CRS= 1/CL + 1/CCW

CL= Compliance of lung
CW= Compliance of Chest Wall
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49
Q

Typical intracardiac pressures:

RA, RV, LA, LV

A

RA: 1-10
RV: 15-30/0-8
LA: 8-10
LV: 140/4-12

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50
Q

Transtracheal injection with anesthetize what nerve?

A

Recurrent laryngeal

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51
Q

What fracture is associated with radial nerve palsy?

A

Humerus shaft

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52
Q

In ESRD other than hyperkalemia what other electrolyte abnormality is common?

A

Hypocalcemia

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53
Q

According to AHA what is definition of hypertension and hypotension?

A

Hypertension = 130/80

Hypotension is 90 mmHg or MAP 65

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54
Q

What is current preoperative recommendations regarding Metformin?

A

Continue untill Day of Surgery

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55
Q

In antiphospholipid syndrome what is elevated? What is not elevated?

A

PTT is elevated

PT is not elevated

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56
Q

What is minimum amount of wait time after MI in the case of no intervention?

A

60 days

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57
Q

Patient with symptomatic idiopathic intracranial hypertension presents in labor. What is best anesthetic?

A

Intrathecal catheter. This was medication can be administered with quick relief of pain (ICP increases with pain) and ability to remove CSF.

An epidural can increase the pressure and lead to ocular nerve injury

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58
Q

A simple facemask with flows of 5-10 L/min O2 delivers approximately what FiO2?

A

35-50%

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59
Q

An increase in albumin and phosphates will cause what acid/base abnormality? Why?

A

Metabolic acidosis. Albumin and phosphates are weak acids

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60
Q

Chronic phenytoin and gabapentin do what to NDNMB?

A

Resistance to blockade

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61
Q

What is dosing for intralipid in the setting of LAST?

A

20% lipid emulsion with bolus of 1.5ml/kg or 2-3 mins followed by infusion at .25 ml/kg/min

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62
Q

Which Mapleson circuit is most efficient user of fresh gas flow during spontaneous ventilation?

A

Mapleson A

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63
Q

How does Pregnancy affect speed of inhalation induction? Why?

A

Speeds it up 2/2 increased MV, decreased FRC, decreased MAC

64
Q

Peritoneal dialysis may be preferred in what patient population?

A

Patients that cannot tolerate large hemodynamic shifts

65
Q

Placing a magnet will change pacemaker to what mode?

A

To an asynchronous mode. So DDD to DOO, VVI to VOO, AAI to AOO, etc.

66
Q

What are three asynchronous pacemaker modes?

A

AOO, VOO, DOO

67
Q

What will ABG in patient with CO poisoning show?

Acid/Base, SpO2, SaO2

A

Metabolic acidosis
Normal PaO2
Falsely elevated SpO2 and calculated SaO2

68
Q

Medial calf receives sensory innervation from what nerve?

A

Femoral nerve via the saphenous

69
Q

Neonate with abdominal wall defect, hypoglycemia, large tongue. Diagnosis?

A

Beckwith-Wiedemann syndrome

70
Q

Once daily dosing of prophylactic LMWH, how long to wait for placement of epidural?

A

12 hrs

71
Q

What is the effect of anemia on coagulation cascade and clot formation?

A

Longer to initiate coagulation cascade, but stronger clot

72
Q

What distinguishes OSA from CSA?

A

Snoring

73
Q

Who needs stress dose steroids and what’s the dose?

A

Patient on > 10mg/day Prednisone or those taking > 10mg/day but stopped < 3 months ago.

Dose is 25mg hydrocortisone

74
Q

What lung parameter increases with administration of labor epidural?

A

Vital Capacity

75
Q

Cardiogenic shock is defined by a PCWP above what value? CI below what?

A

18, 2.2

76
Q

How to remember carotid sinus vs carotid body?

A

“Sinus pressure.” “Body chemistry”

77
Q

What is current recommendation for intraoperative fluid management in infants and children?

A

20-40 ml/kg throughout the case

78
Q

What is the relationship of sux with histamine release and bronchospasm?

A

It does cause a histamine release, however it does not cause bronchospasm and is safe in asthmatics

79
Q

What are two risk factors/characteristics of aspirate that cause aspiration pneumonitis?

A

Volume > 0.4 mL/kg

pH < 2.5

80
Q

What is the difference between a paired and unpaired T-test?

A

A paired T-test is for a single group, unpaired is for two.

81
Q

Spinal for lateral wall bladder tumor. What additional nerve must be blocked to prevent kicking?

A

Obturator nuerve

82
Q

What is different about living liver donation in adult to kid compared to adult to adult?

A

In adult to child the left liver can be donated

83
Q

How do benzos affect the CO2 ventilatory respone curve?

A

Decreases the slope of the curve

84
Q

Which side effect of neostigmine is not reversed by an anticholinesterase?

A

Paradoxical muscle weakness

85
Q

Why is the NPO guideline for breast milk 4 hours but clear liquids is 2 hours?

A

Studies have shown that breast milk leads to larger gastric volumes

86
Q

What is the primary process performed by the body to compensate for heart failure?

A

Diuresis and increased sympathetic activity

87
Q

What happens to sputum production after cessation of smoking?

A

Increases

88
Q

What is pneumonic for Mapleson A vs Mapleson D?

A

Mapleson A is better for SpontAneous ventilation, Mapleson D is better for controlleD

89
Q

What is the alveolar gas equation?

A

PAO2 = FiO2* (Patm-PH20) - PaCO2/RER

Patm = 760
PH20 = 47
RER = 0.8
90
Q

Infants who drink cow’s milk prior to 12 months of age are at increased risk of what?

A

Iron deficiency anemia

91
Q

Patient with COPD as administered excessive O2 with resultant hypercarbia. Why?

A

V/Q mismatch

92
Q

What is the effect of barbituates on neuro physiology?

A

Decrease CBF, ICP, and CMRO2

93
Q

On average how long does a Type and Screen take?

A

30-45 minutes

94
Q

What number predicts turbulent flow and how is it calculated?

A

Reynold number = velocity * density * diameter / viscosity

When Reynolds number is high (>4000) turbulent flow occurs

95
Q

In desflurane vaporizer if atmospheric pressure decreases by half what must be done to dial setting to achieve one MAC?

A

Must increase percentage.

96
Q

What is the most common cause of respiratory failure in the pregnant patient?

A

ARDS

97
Q

What coagulation factors decrease in pregnancy?

A

XI, XIII

98
Q

What surgery is a risk factor for anterior ischemic optic neuropathy?

Posterior ischemic optic neuropathy?

A

Anterior: Cardiac

Posterior: Spine surgery

99
Q

What does Nitrous Oxide do to CMO2, CBF, ICP?

A

Increases all three

100
Q

What is a risk factors for bradycardia in sux administration?

A

Repeat dosing

101
Q

What disease carries highest seroconversion risk 2/2 needle stick?

A

Hep B e antigen

102
Q

What is the effect of epidural on uterine blood flow?

A

Increased if hypotension is avoided

103
Q

Aminocaproic acid binds what?

A

Plasminogen

104
Q

Describe P50 of hemoglobin affinity for O2 with age

A

Affinity is highest (lowest P50) in newborns. It is lowest (highest P50) at one year of age. It reaches adult levels at age 10.

So on the curve from left to right: newborn -> adult -> infant

105
Q

What foods are generally associated with a latex allergy?

A

Fruit (and some nuts). Avocado

106
Q

Which NMBD has an active metabolite that is nearly as potent as the original?

A

Vecuronium

107
Q

GBS resembles what on pulmonary function tests?

A

Restrictive Lung Disease

108
Q

What is the Bainbridge Reflex?

A

Tachycardia in response to increased CVP

109
Q

In awake craniotomy if a seizure is caused by cortical stimulation what is first step in treatment (2 things)?

A

Ice and propofol

110
Q

What is the strong ion difference?

A

SID = (Strong cations - Strong anions)

111
Q

What morphine equivalent is recommended prior to considering starting a fentanyl patch?

A

45 mg/day

112
Q

What is the EKG finding for hypocalcemia?

A

Prolonged QT

113
Q

How are caudal blocks dosed in peds?

A

ml/kg. with 0.5-1.5 ml/kg depending on desired level

114
Q

What are the three differences between aortic and peripheral artery waveforms?

A

In peripheral the systolic pressure is higher, diastolic is lower, and pulse pressure is wider

115
Q

The intrinsic pathway includes what factors?

Extrinsic?

A

Intrinsic: I, II, V, VIII, IX, X, XI, XII

Extrinsic: I, II, V, VII, X

116
Q

An oxygen tank is full at what PSI and that correlates with how many liters?

A

2000 PSI, 600 L

117
Q

What is the equation for saturated vapor pressure used to calculate volume percentage in variable bypass vaporizer?

A

Agent SVP/Total pressure = Agent Vapor volume/(Carrier volume + agent vapor volume)

118
Q

What is the mechanism of action of LMWH?

A

Binds AT-III with inhibits factor Xa and Thrombin (indirect inhibition). More specific to factor Xa than unfractioned heparin

119
Q

How does rocuronium and neostigmine differ in children?

A

They are more potent in children compared to adults

120
Q

What drug is administered in Beta Blocker overdose? Why?

A

Glucagon. It works to increase heart rate (and contractility) independent of adrenergic pathways. It works via cAMP.

121
Q

Cyanide toxicity should be suspected when? What is first line treatment?

A

Suspected in fire involving synthetic material (“Tire factory”). Treatment: Hydoxocobalamin

122
Q

Acute renal failure in a patient with cirrhosis and an inciting event?

A

Type 1 hepatorenal syndrome

123
Q

How is pain improved in lumbar spinal stenosis?

A

Back flexion

124
Q

What increases risk of citrate toxicity?

A
  • FFP
  • Peds
  • Liver disease
  • Hyperventilation (decreased Ca++)
  • Hypothermia
125
Q

In patient with ARDS and associated V/Q mismatch, what role does inhaled nictric oxide play?

A

Increases blood flow to only ventilated alveoli without reversing hypoxic pulmonary vasoconstriction

126
Q

Spinal cord and dural sac end where in infants?

A

L3 and S3

127
Q

Why is bradycardia less common in infants under spinal anesthesia?

A

Because they have high vagal tone and immature sympathetic system. Therefore the sympathectomy associated with spinal anesthesia isn’t significant because children are not dependent on their cardiac accelerating fibers (T1-T4)

128
Q

How is neo/glyco dosed in ESRD?

A

No change

129
Q

Ticlopidine is an antithrombotic agent with what mechanism?

A

ADP receptor antagonist

130
Q

What is the modified Bernoulli equation to calculate pressure gradients across valves?

A

Pressure gradient = 4*(peak velocity)^2

131
Q

Explain what the flow volume loop looks like in mediastinal mass. Why?

A

A mediastinal mass causes a plateaued expiratory loop. This is because the mass is a variable intrathoracic lesion. In this scenario there is compression of the airway. During inspiration the negative pressure of inspiration inside the chest serves to stent open the airways. Expiration does the opposite and makes the obstruction worse.

132
Q

What is the primary mechanism behind delayed hemolytic transfusion reaction?

A

Donor red cell antigens

These are antigens to which the recipient has previously been exposed

133
Q

External compression on the eye can cause vision loss via what?

A

Central retina artery occlusion

134
Q

The sacral hiatus is located at what level of the spine?

A

S4-S5

135
Q

Treatment for stridor 2/2 subglottic stenosis?

A

Helium/Oxygen 70/30

136
Q

How do you calculate myocardial oxygen consumption?

A

MVO2 = CBF (AO2-VO2)

137
Q

What is the correlation between strong ion deficit and pH?

A

They follow each other. So a decrease in strong ion deficit corresponds with a decrease in pH

138
Q

What is the mechanism of action of the following antiemetics?

  1. Ondanseton
  2. Metoclopramide
  3. Droperidol
  4. Scopolamine
A
  1. 5-HT3 antag
  2. Dopamine antagonist (notrecommended after Zofran)
  3. Dopamine antagonist
  4. Anticholinergic
139
Q

Why are pregnant women at a higher risk for seizure?

A

Elevated estrogen levels

140
Q

What are the three waves on a CVP?

A

A wave- Atrial systole
C-wave- Systole (ventricular Contraction)
V-wave- Atrial filling (“Villing”)

141
Q

What is an advantage of whole blood over pRBCs?

A

Greater percentage of viable RBCs

142
Q

Which circuit is most efficient user of fresh gas flow during spontaneous ventilation?

A

Mapleson A.

SpontAneous

143
Q

Loss of awareness and recall typically occurs at what MAC?

A

0.4-0.5

144
Q

What is anesthetic concern in myotonia congenita? Can sux be used?

A

Severe masseter spasm.

Not associated with MH and sux can be used

145
Q

What is drug of choice in suspected protamine reaction?

A

Epinephrine

146
Q

What is treatment for botulism?

A

< 1 year -> Immune globulin

> 1 yr -> Antitoxin

147
Q

Medial calf is innervated by what? Branch of what?

A

Saphenous. Branch of Femoral

148
Q

What is the basic type of cellular connection that allows for fast signal propagation in the cardiac myocyte?

A

Gap junctions

149
Q

What are the 4 independent risk factors for PONV in children?

A
  1. Age > 3
  2. Family or personal history
  3. Surgery > 30 min
  4. Strabismus surgery
150
Q

Volatile anesthetics works on what three receptors?

A

GABA
Sodium channels
Background Potassium Channels

151
Q

Which NMBD has a metabolite that is nearly as potent as its parent drug?

A

Vecuronium

152
Q

Central retinal artery occlusion is caused by what mechanism?

A

External eye compression

153
Q

Opioid induced pruritus is due to activation of what? Treatment?

A

Activation of receptors in medulla and trigeminal nucleus. Treatment: Naloxone/Naltrexone

154
Q

What two factors decrease during pregnancy?

A

XI, XIII

155
Q

What is the most common cause of respiratory failure in the pregnant patient?

A

ARDS

156
Q

What is the difference between complex regional pain syndrome type I and Type II

A

Type I is associated with minor injury, type II with major nerve injury

157
Q

Equation for odds ratio

A

(a/b)/(c/d)