FINAL

Question 1

What % is nebulized anesthesia and for how long does it last?
where do you not want to administer it and where do you want to administer it?

Answer 1

4% lidocaine will last 15 min.

Do not administer in holding area, administer in the OR or on the table

Question 2

What would ineffective ventilation with bag mask look like?

Answer 2

no sign of chest rise
no end tidal CO2
no mist in the clear mask

Question 3

What would you place if ventilation is ineffective with Bag mask?

Answer 3

place an oral or nasal airway to relieve airway obstruction.

Question 4

Difficult mask ventilation is often found in patients with? (3)

Answer 4

morbid obesity
beards
craniofacial deformities

Question 5

Difficult airway - Lemon trial, what does LEMON stand for?

Answer 5

Look
Evaluate
Mallampati
Obstruction
Neck movement

Question 6

What are you looking for with the L in LEMON?

Answer 6

facial trauma
large incisors
beard
large tongue

Question 7

What does the Evaluate for E in lemon mean?

Answer 7

evaluate 3-3-2
interincisor distance 3 fingers
hyoidmental distance 3 fingers
thyroid to floor of mouth 2 fingers

Question 8

PREPARATION is a must in what type of intubation?

Answer 8

Awake fiberoptic intubation.

Question 9

What is a Cook retrograde intubation set and what is it used for?

Answer 9

used to assist the placement of an ETT during difficult or emergency airway access procedure.

use seldinger technique via the cricothyroid membrane, go in a cephalad direction (retrograde) with placement of J tipped guide wire exiting orally or nasally.

Question 10

what is a rare but devastating complication following robotic surgery?

Answer 10

postoperative visual loss

Question 11

What is a restriction with robotic surgery?

Answer 11

spatial restriction and inability to re position the patient after docking the robot.

Question 12

cardiovascular increases with robotics?

Answer 12

MAP
CVP
Wedge Pressure
SVR

Question 13

Unchanged cardiovascular with robotics?

Answer 13

HR
SV
mixed venous oxygen saturation

Question 14

The most important goal in managing the hyperthyroid patient is to make the patient?

Answer 14

euthryroid before surgery, if possible

Question 15

If a patient is hyperthyroid and having surgery, what medications should you avoid?

Answer 15

Pancuronium

it is also best to avoid ketamine for induction, even when the patient is clinically euthyroid.

Question 16

What are complications after thyroidectomy?

Answer 16

RLN damage

Tracheal compression secondary to hematoma or tracheomalacia

hypoparathyroidism

Question 17

What is normal total serum calcium concentration?

Answer 17

8.8 to 10.4 mg/dL

Question 18

In general an increase or decrease in albumin by what is associated with a parallel change in total what by what amount?

Answer 18

increase or decrease in albumin by 1 g/dL is associated with a parallel change in total serum calcium of 0.8 mg/dL

Question 19

What typically accompanies hyperparathyroidism (what is responsible for symptoms)?

Answer 19

hypercalcemia

Question 20

what is the most common sign of hypercalcemia?

Answer 20

Nephrolithiasis is the most common manifestation, occurring in 60-70% of patients

Question 21

What needs increased medication dose with hyperparathyroidism (due to the hypercalcemia)?

Answer 21

Vecuronium should be increased, and probably all NDMB, during onset of NMB.

Question 22

duration of safe tourniquet inflation?

Answer 22

2 hours (this should just be for legs and arms should be an hour) 
if longer is needed you should be able to let up for 15 min (perfusion break). then restart the process to repeat exsanguination.

Question 23

what three things can be expected with tourniquet deflation (which is generally well tolerated in a healthy patients.)

Answer 23

transient systemic metabolic acidosis

increased arterial carbon dioxide levels

drop in systemic blood pressure

Question 24

The mechanical effects of peritoneal insufflation impair ventilation… why?

Answer 24

a) Insufflation of the peritoneum displaces the diaphragm in a cephalad direction,
b) decreases functional residual capacity and vital capacity
c) and in turn induces collapse of the dependent regions of the lungs.

Question 25

What is the standard of care in relation to PONV?

Answer 25

multimodal therapy using antiemetics that target different receptors has become standard of care.

Question 26

What do you need to check always before cardioversion? (2)

Answer 26

Make sure the patient has not gone back to NSR (still needs to be cardioverted)
check labs

Question 27

The strongest predisposing factor for postoperative delirium is?

Answer 27

preexisting dementia

Question 28

In healthcare the most common principles are?

Answer 28

• (1) autonomy (patient has the right to make decisions)
• (2) beneficence (do good)
• (3) nonmaleficence (do no harm)
• (4) justice (fair)

Question 29

COPD can not be definitively diagnosed without?

Answer 29

spirometry

Question 30

What is treatment of COPD designed to do?

Answer 30

relieve symptoms

slow the progression of the disease

Question 31

What two intervention can alter the natural history of COPD?

Answer 31

smoking cessation and long-term oxygen administration

Question 32

How long do you have to stop smoking to see max benifits?

Answer 32

6 weeks

Question 33

what is a simple and inexpensive test that provides objective goals and monitoring of patient performance with COPD?

Answer 33

incentive spirometry