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*ACE's > Hall Ch6 > Flashcards

Hall Ch6 Flashcards

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1
Q

Normal tracheal capillary arteriolar pressure is

A

25-35 mmHg

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2
Q

You should wait how many hrs after last dose of BID dosing of lovenox before giving neuraxial anesthesia?

A

24 hrs

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3
Q

Fluoride toxicity anesthesia most closely resembles what type of renal failure

A

Nephrogenic diabetes insipidus

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4
Q

Best prophylaxis against deep vein thrombosis

A

Early ambulation

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5
Q

MCC of postop hypoxemia

A

V/Q mismatch

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6
Q

Symptoms of hypocalcemia usually occur how many hours after inadvertent resection of parathyroid glands?

A

24-72 hrs

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7
Q

Damage to which nerve leads to wrist drop

A

Radial n.

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8
Q

MCC of bronchiectasis

A

Recurrent bronchial infections

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9
Q

Treatment of acute dystonic reaction following administration of an anti-dopaminergic drug

A

Anti-cholinergic drug that crosses blood brain barrier like diphenhydramine or benztropine

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10
Q

Nerve most frequently injured at antecubital fossa by extravasation of IV

A

Median n.

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11
Q

Onset of delirium tremens usually occurs how long after alcohol abstinence

A

2-4 days

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12
Q

Why is postop mechanical ventilation a relative contraindication for tracheal resection?

A

Risk of wound dehiscence because of positive airway pressure

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13
Q

Average 1 yr old weighs how much?

A

10 kg, triple the birthweight.

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14
Q

From age 1-6, children gain how much kg per yr?

A

2 kg

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15
Q

From age 6-10, children gain how much kg per yr?

A

3 kg

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16
Q

Acute threshold changes of a pacemaker are almost always associated with what electrolyte imbalance

A

Potassium

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17
Q

First signs of cerebral ischemia appear on EEG when cerebral blood flow (CBF) falls below what value?

A

22 mL/100 g/min

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18
Q

EEG becomes isoelectric when CBF falls to what value?

A

15 mL/ 100 g / min

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19
Q

Irreversible membrane damage and cellular death occur when CBF falls to what value?

A

6 mL / 100 g / min

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20
Q

Duration of action of anticholinesterase drugs from fast to slow

A

Edrophonium < neostigmine < pyridostigmine

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21
Q

Glycopyrrolate or atropine has longer duration of action?

A

Glycopyrrolate

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22
Q

Which partition coefficient is most closely associate with minimum alveolar concentration?

A

Oil/gas partition coefficient

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23
Q

Succinylcholine is hydrolyzed by?

A

Pseudocholinesterase

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24
Q

Conditions associated with increased DLCO (Diffusing capacity of carbon monoxide)

A

Obesity, asthma, exercise, supine position, left to right shunt, polycythemia

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25
Q

Most reliable early sign of MH

A

Increased end expiratory CO2 (PECO2)

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26
Q

Components of PADSS (post anesthetic discharge scoring system)

A

vital signs, ambulation, pain, nausea/vomiting, surgical bleeding

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27
Q

Does history of uncomplicated general anesthesia reassure that a malignant hyperthermia suspect can be ruled out?

A

No, it is not uncommon for MH-susceptible patients to not trigger initially and then develop fulminant MH with a subsequent anesthetic

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28
Q

Mechanism of action for montelukast (singulair)

A

Leukotriene receptor antagonist. Leukotrienes are inflammatory mediators.

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29
Q

Trismus after giving succinylcholine signals onset of MH in what percentage of patients?

A

Less than 50%

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30
Q

Head flexion can advance the ETT by how much?

A

1.9 cm toward carina

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31
Q

How many days after gas bubble is injected into vitreous for retinal detachment can nitrous oxide be used?

A

10 days

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32
Q

Myocardial oxygen demand

A

HR
wall tension
Contractility
Basal metabolic

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33
Q

Myocardial oxygen supply

A

HR
Oxygen content
Anatomy
Coronary perfusion pressure

34
Q

Normal oxygen consumption of heart

A

8 mL/100 g/ min

35
Q

Oxygen consumption of heart on CPB

A

2 mL/100g/min

36
Q

Cardiac conditions to treat SAM (systolic anterior motion)

A

Big slow heart, decrease contractility, increase afterload

37
Q

Several days after a thermal injury, how does a patient’s sensitivity to depolarizing and nondepolarizing muscle relaxants change?

A

Increased sensitivity to depolarizing agent

Decreased sensitivity to nondepolarizing agent

38
Q

Greater than 60% of all drug-induced allergic reactions during perioperative period is attributable to…

A

Muscle relaxants

39
Q

Succinylcholine should be used cautiously with patients with Huntington’s chorea because of

A

Decreased levels of pseudocholinesterase, therefore prolonging effects of succinylcholine

40
Q

PaO2 is decreased by how much for each degree that body temperature is cooler than 37C?

A

6%

41
Q

2 main causes of central cyanosis

A

1) Decreased arterial oxygen saturation

2) Hemoglobin abnormalities (eg. methemoglobinemia and sufhemoglobinemia)

42
Q

Classic signs of fat embolism

A

Tachycardia, dyspnea, mental confusion, fever, petechial rash on upper part of the body

43
Q

Remifentanil is metabolized primarily by

A

Nonspecific esterases

44
Q

MC reason for unexpected hospital admission after outpatient general anesthesia

A

Nausea and vomiting

45
Q

MC reason for prolonged recovery room stay

A

Nausea and vomiting

46
Q

Elimination half life time of factor VIII

A

12 hrs

47
Q

Factor VIII level for a hemophiliac should be raised to what before elective surgery

A

100%

48
Q

What is the best screening test for hemophilia A?

A

PTT because hemophilia A is associated with decreased levels of factor VIII so PTT tests intrinsic coagulation cascade

49
Q

90% of patients have blood to the AV node supplied by which coronary artery?

A

right coronary artery

50
Q

Severe CAD of which coronary artery can lead to complete heart block

A

Right coronary artery

51
Q

How does hypernatremia affect MAC?

A

Increase

52
Q

How does abnormal thyroid function affect MAC?

A

No change

53
Q

Minimum dermatomal level that must be achieved for testicular surgery

A

T10

54
Q

Peak effect of neostigmine

A

10 min

55
Q

Peak effect of glycopyrrolate

A

3 min

56
Q

Long term lithium therapy may be associated with what conditions?

A

Nephrogenic diabetes insipidus, hypothyroidism, decrease MAC, prolong duration of action of pancuronium and succinylcholine. Diuretics increase lithium levels.

57
Q

Best medication to treat hypotension in a patient with metastatic carcinoid

A

Octreotide, a synthetic somatostatin

58
Q

How is insulin metabolized?

A

Liver and kidney, so diabetic with renal disease can have prolonged effects of insulin

59
Q

Why does carboxyhemoglobin not decrease the pulse oximetry reading?

A

Because it has absorbable at 660 nm, which is similar to oxygen rich hemoglobin

60
Q

Mechanism of action of gabapentin

A

Unknown but it involves inhibition of voltage dependent calcium channels

61
Q

Perioperative visual loss is most commonly due to

A

Ischemic optic neuropathy, with associated factors of: prolonged hypotension, anemia, large blood loss, facial edema

62
Q

Drugs used to treat postop shivering other than meperidine

A

Clonidine, droperidol, magnesium, calcium, chlorpromazine

63
Q

For every 10 cm of H2O, how much change in mmHg?

A

7.5 mmHg

64
Q

Specific cytochrome P450 enzyme that facilitates metabolism of codeine, oxycodone, and hydrocodone.

A

CYP2D6

65
Q

Specific cytochrome P450 enzyme that facilitates metabolism of fentanyl, sufentanil, alfentanil.

A

CYP3A4

66
Q

One of the most potent inhibitors of CYP3A4 and CYP2D6, which help metabolize narcotics.

A

Fluoxetine

67
Q

Phase of liver transplantation where greatest degree of hemodynamic instability is expected

A

Reperfusion phase

68
Q

Metabolic and physiologic conditions that prolong duration of action of nondepolarizing neuromuscular blockade.

A

Respiratory acidosis, myasthenia syndromes, hepatic/renal failure, hypocalcemia, hypothermia, hypermagnesemia.

69
Q

Drugs that prolong duration of action of nondepolarizing neuromuscular blockade.

A

Inhaled and local anesthetics, corticosteroids, antibiotics like clinda and flagyl and aminoglycosides, calcium channel blockers, dantrolene, lasix

70
Q

Why is it better to reverse muscle relaxants in pregnant patients with neostigmine and atropine instead of neostigmine and glycopyrrolate?

A

Because glycopyrrolate does not cross into placenta

71
Q

NSAIDSs are contraindicated in patients undergoing spinal fusion because?

A

NSAIDs may impair bone healing

72
Q

Leading causes of malpractice claims against anesthesiologists

A

Death (22%), nerve damage (21%), brain damage (10%)

73
Q

Retinopathy of prematurity is caused by?

A

O2 administration to neonates up to 44 weeks, especially a hazard in extremely premature neonates

74
Q

Greater auricular nerve arises from branches of what nerves?

A

C2 and C3 spinal nerves

75
Q

4-12 days after evacuation of intracerebral hemorrhage, pt develops progressive mental deterioration over several hours

A

Cerebral vasospasm.

76
Q

Why is aspirin contraindicated for thyrotoxicosis?

A

It displaces thyroid hormones from thyroglobin and can aggravate disease

77
Q

The last of the classic signs of compartment syndrome to appear

A

Pulselessness

78
Q

How is dose and duration of spinal anesthetics different in infants compared to adults?

A

Greater dose and shorter duration, infants have more CSF volume per kg

79
Q

If a patient is trapped in MRI machine, what is the greatest hazard patient is in when the MRI machine is shutdown (quenched)

A

Cold

80
Q

Treatment for anthrax

A

Ciprofloxacin (anthrax is gram positive bacillus)

81
Q

Treatment for plague

A

Streptomycin (plague is gram negative coccobacillus)

82
Q

Injury to what nerve causes impaired ankle dorsiflexion, loss of foot eversion and toe extension

A

Common peroneal nerve

*ACE's (27 decks)

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