I NEVER seem TO remember...

Question 1

List the cardioselective Beta-Blockers –>MAN BABE

Answer 1

Metoproplol
Atenolol
Nebivolol

Bisoprolol
Acebutolol
Betaxolol
Esmolol

Question 2

What is the most common tachydysrhythmia seen in patients with WPW syndrome?

Answer 2

AVNRT

Question 3

AVNRT is classified as either

Answer 3

orthodromic (narrow QRS complex)

antidromic (wide QRS complex).

Question 4

Ortho”dRROW”mic AVNRT is much more common (90%–95% of cases) and has _______(narrow/wide)QRS complex

Answer 4

naRROW QRS complex because the cardiac impulse is conducted from the atrium through the normal AV node–His-Purkinje system.

Question 5

Orthodromic AVNRT vs Antidromic which is more common ?

Answer 5

Orthodromic AVNRT is much more common (90%–95% of cases

Question 6

In orthodromic AVNRT, what occurs?

Answer 6

Cardiac impulse is conducted from the atrium through the normal AV node–His-Purkinje system. These impulses return from the ventricle to the atrium using the accessory pathway.

Question 7

In antidromic AVNRT, what occurs?

Answer 7

In the less common antidromic form of AVNRT the cardiac impulse is conducted from the atrium to the ventricle through the accessory pathway and returns from the ventricles to the atria via the normal AV node

Question 8

What drugs are contraindicated with antidromic form of AVNRT? why?

Answer 8

Drugs that SLOW AV nodal conduction (BAC- LiDig)

β-blockers, 
Adenosine
Calcium channel blockers
Lidocaine
Digoxin

Because they may increase conduction along the accessory pathway and are contraindicated.

Question 9

Multifocal atrial tachycardia (MAT) is most commonly seen in patients experiencing

Answer 9

an acute exacerbation of chronic lung disease.

Question 10

Treatment of antidromic AVNRT in patients with stable vital signs includes

Answer 10

IV administration of procainamide 10 mg/kg IV infused at a rate not to exceed 50 mg/min.

Question 11

Treatment of orthodromic AVNRT in conscious patients in stable condition should begin with

Answer 11

vagal maneuvers such as carotid sinus massage or a Valsalva maneuver.

Question 12

If vagal maneuvers are unsuccessful in a patient with AVNRT,–> VABA

Answer 12

Verapamil
Adenosine
β-blockers
Amiodarone may be used as clinically appropriate.

Question 13

Wolff-Parkinson-White (WPW) syndrome is an inherited disorder characterized by

Answer 13

reentrant tachycardias.

Question 14

The diagnosis of WPW syndrome is reserved for conditions characterized by

Answer 14

both preexcitation and tachydysrhythmia.

Question 15

In WPW , Ventricular preexcitation causes an earlier-than-normal deflection of the QRS complex called a

Answer 15

delta wave.

Question 16

ECG changes indicative of new ischemia

Answer 16

new ST-T changes,

new left bundle branch block

Question 17

CABG is preferred over PCI in patients with

Answer 17

• significant left main coronary artery disease
• 3- vessel CAD
• patients with diabetes mellitus who have two- or three-vessel coronary artery disease.

Question 18

Levels of cardiac troponins (troponin T or I) increase within_____hours

Answer 18

3 hours after myo- cardial injury and remain elevated for 7–10 days

Question 19

Levels of cardiac troponins (troponin T or I) remain elevated for how long after MI

Answer 19

7-10 days

Question 20

The criteria for the definition of an AMI have been revised Now this diagnosis requires detection of a rise and/or fall in cardiac biomarkers (preferably troponin with at least one value above the 99th percentile of the upper reference AND what?

Answer 20

(1) symptoms of ischemia
(2) ECG changes indicative of new ischemia, such as new ST-T changes or new left bundle branch block (LBBB)
(3) development of pathologic Q waves on the ECG, or (4) imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality.

Question 21

Reperfusion / Thrombolytic therapy with tissue plasminogen activator (tPA) such as (name 3 )

Answer 21

alteplase, reteplase, or tenecteplase

Question 22

Thrombolytic therapy with tissue plasminogen activator (tPA) should be initiated when?

Answer 22

should be initiated within 30–60 minutes of hospital arrival and within 12 hours of symptom onset.

Question 23

The primary goal in management of STEMI is to

Answer 23

reestablish blood flow in the obstructed coronary artery as soon as possible.

Question 24

What may be preferable to thrombolytic therapy for restoring flow to an occluded coronary artery if appropriate resources are available?

Answer 24

PCI

Question 25

What are the 2 most common atrial dysrhythmias seen with AMI?

Answer 25

Atrial fibrillation and atrial flutter

Question 26

The classic presentation is a hypercyanotic spell (“tet spell”) during which profound

Answer 26

cyanosis develops rapidly, accompanied by hyperpnea, possible loss of consciousness, stroke, seizures, or even death.

Question 27

Treatment of tet spells

Answer 27

Treatment focuses on relieving the RVOT obstruction and reversing (or ameliorating) the right-to-left shunt.
Acute or emergent treatment entails (in escalating order) administration of 100% oxygen, fluid administration, and positioning (bending at the hip or gentle pressure on the abdomen

Question 28

Absolute Indications for Lung separation

Answer 28

A. Isolation of one lung from the other to avoid spillage or contamination (INFECTION and MASSIVE Hemorrhage)
B. Control of the distribution of ventilation: Bronchopleural fistula, Bronchopleural Cutaneous fistula, Surgical opening of major conducting airway

Question 29

Giant unilateral lung cyst or bulla relative vs absolute OLV

Answer 29

Absolute

Question 30

Unilateral bronchopulmonary lavage 1. Pulmonary alveolar proteinosis: relative vs absolute OLV

Answer 30

Absolute

Question 31

Relative indication for one-lung ventilation (OLV)

Answer 31

• Surgical exposure—high priority*
  1. Thoracic aortic aneurysm 2. Pneumonectomy
  3. Thoracoscopy
  4. Upper lobectomy
  5. Mediastinal exposure

Question 32

Absolute OR relative OLV –> –Postcardiopulmonary bypass pulmonary edema/hemorrhage after removal of totally occluding -unilateral chronic pulmonary emboli.

Answer 32

All Relative contraindication

Question 33

The most common complication associated with a DLT is _______

Answer 33

malpositioning

Question 34

Mediastinal Masses: What is the major anesthetic goal?

Answer 34

to maintain spontaneous ventilation, which retains normal airway-distending pressure gradients and can maintain airway patency when positive-pressure ventilation will not.

Question 35

Left axis deviation is associated with what kind of fascicular block?

RIGHT axis deviation is associated with what kind of fascicular block?

Answer 35

Left axis –> LAft ANTERIOR Fascicular block
Right axis –> Left POSTERIOR Fascicular (LA-RP)

Question 36

What is the most common hemiblock?

Answer 36

Left anterior fascicle (LAHB)

Question 37

Why is a LEFT POSTERIOR HEMIBLOCK is uncommon when compared to LEFT ANTERIOR hemiblock?

Answer 37

Left posterior hemiblock (LPHB) is uncommon because the posterior fascicle of the LBB is larger and better perfused than the anterior fascicle.

Question 38

Criteria for RBBB

Answer 38

widened QRS complex (≥120 ms in adults)
rSR′ configuration in leads V1 and V2
Deep S wave (>40 ms) in leads I and V6.

Question 39

Criteria for LBBB

Answer 39

QRS complex of longer than 120 ms in duration in the -absence of Q waves in leads I and V5 and V6, a broad notched or slurred R wave in leads I, aVL, V5, and V6.

Question 40

Crossmatching blood involves

Answer 40

mixing the blood of the donor and recipient together in the lab

Question 41

What are 2 indications for lung transplantation?

Answer 41

Both cystic fibrosis and sarcoidosis

Question 42

Which surgical procedure is most commonly associated with chronic postsurgical pain (CPSP)?

Answer 42

Thoracotomy

Question 43

The most reliable stimulator of arousal in persons with obstructive sleep apnea is

Answer 43

Work of breathing

Question 44

Which epidural needle has wings at the hub in order to stabilize the needle and assist grip during insertion?

Answer 44

Weiss

Question 45

Where in the nephron do thiaziDe diuretics work? and how?

Answer 45

Thiazide diuretics work in the EARLY distal tubule by interfering with this sodium-chloride pump.

Question 46

Part of the nephrons that contains sodium-chloride transporters that move sodium chloride out of the filtrate into the cells of the tubule walls.

Answer 46

The early distal tubule

Question 47

During two-lung ventilation, about _____% of the pulmonary blood flow goes to the dependent lung. Therefore, when one-lung ventilation is instituted, you would expect the patient to experience approximately a____% shunt as blood that is unable to be oxygenated travels through the nondependent lung.

Answer 47

60% ; 40%

Question 48

The recommended initial treatment for portal hypertensive ascites is

Answer 48

salt restriction (2 g/day) and diuretics.

Question 49

Gas exchange occurs in the airways across which type of cells?

Answer 49

Squamous epithelial

Question 50

Thiazide-type diuretics include: (MICH)

Answer 50

Metolazone
Indapamide
Chlorthalidone,
Hydrochlorothiazide

Question 51

Spironolactone and eplerenone inhibit the hormone aldosterone directly in the

Answer 51

collecting duct

Question 52

Amiloride and triamterene inhibit the opening of sodium channels where?

Answer 52

collecting duct, which blocks sodium reab- sorption and potassium secretion.

Question 53

Examples of loop diuretics include: BEF-TO

Answer 53

bumetanide
ethacrynic acid,
furosemide
torsemide.

Question 54

Loops diuretics work how and where in the nephron?

Answer 54

Inhibit sodium and chloride reabsorption at the Na+-K+-2Cl− channel in the thick ascending limb of the loop of Henle.

Question 55

Intravascular injection of epinephrine 10 to 15 mcg/mL in adults produces a

Answer 55

10-beat or greater heart rate increase, or a 15 or greater mm Hg systolic blood pressure (SBP) increase in the absence of BAAG (β blockade, active labor, advanced age, or general/neuraxial anesthesia)

Question 56

• Intravascular injection of epinephrine 0.5 mcg/kg in children produces a__________ in SBP

Answer 56

15 or greater mm Hg increase in SBP.

Question 57

What can produce sedation if injected intravascularly in laboring patients.

Answer 57

• Fentanyl 100 mcg

Question 58

The minimum recommended seizure duration for ECT is

Answer 58

25 seconds.

Question 59

What nerve fibers are thought to exhibit dysfunctional activity in the setting of neuropathic pain? (select two)

Answer 59

A and C fibers

Question 60

The most common congenital abnormality that can result in aortic dissection is

Answer 60

Bicuspid aortic valve

Question 61

Tricuspid atresia is a congenital heart defect that is characterized by a (SEDPA)

Answer 61

Small right ventricle
Enlarged left ventricle
Decreased pulmonary blood flow (that occurs via a
ventricular septal defect,
Patent ductus arteriosus, or bronchial vessels)
Arterial hypoxemia

Question 62

The recommended maximum leakage current allowed in operating room equipment is:

Answer 62

10 μA

Question 63

Bupi- vacaine or ropivacaine, in concentrations of 0.125% to 0.5%, are usually administered with epinephrine 1 : 200,000, to a maximum dose of

Answer 63

2.5 mg/kg body weight.

Question 64

A normal anion gap acidosis is often called a.

Answer 64

hyperchloremic metabolic acidosis

Question 65

The 2 most common causes of a normal–anion gap acidosis are

Answer 65

IV infusion of sodium chloride

GI and renal losses of bicarbonate (diarrhea, renal tubular acidosis, early renal failure).

Question 66

The most common cardiac side effects of tricyclic antidepressants are

Answer 66

increased heart rate and orthostatic hypotension.

Question 67

What congenital disorder is highly suspected if maternal polyhydramnios is present?

Answer 67

TEF

Question 68

Contrast-induced nephropathy is defined as an increase in serum creatinine of _____ mg/dL or a ____ percent increase from the baseline within the first 24 hours.

Answer 68

0.5 mg/dL; 25 percent

Question 69

Hypoplastic left heart syndrome is characterized by 5 things? What are they ? Extracardiac congenital anomalies are typically ________

Answer 69

Left ventricular hypoplasia
Mixing of systemic venous and pulmonary venous blood in a single ventricle which communicates directly with the pulmonary and systemic circulatory systems, Hypoplasia of the ascending aorta
Mitral valve hypoplasia
Aortic valve atresia.

not present.

Question 70

With Hypoplastic left heart syndrome, there is a Rapid decreases in _____ that can result in a

Answer 70

PVR; 
Decrease in coronary and systemic blood flow
Metabolic acidosis
High-output cardiac failure
Ventricular arrhythmias.

Question 71

The veins that contribute to the hepatic portal vein include:

Answer 71

1. superior mesenteric vein 2. inferior mesenteric vein 3. Splenic vein.

Question 72

The renal veins drain into the

Answer 72

inferior vena cava.

Question 73

Preterm infants often display hyperkalemia. The causes of this are principally related to (select two)

Answer 73

immature distal tubule function

relative HYPOALDOSTERONISM

Question 74

Nearly all of the skin of the leg is innervated by the _______nerve.

Answer 74

sciatic

Question 75

When inserting an Eschmann stylet during intubation, the stylet should be advanced into the trachea until

Answer 75

the 25 cm marking is at the lip????

Question 76

COMMON GIVEN MEDICATION Avoided preoperatively in the patient with significantly increased intracranial pressure?

Answer 76

MIDAZOLAM

Question 77

The contraction of the gallbladder is primarily stimulated by the release of

Answer 77

CHOLECYSTOKIN

Question 78

Cortisone has a _____short half-time of only _____

Answer 78

very; only 30 minutes.

Question 79

Triamcinolone, betamethasone, and dexamethasone have elimination half-times between

Answer 79

3.5 and 5 hours.

Question 80

Which of the following substances is the principal neurotransmitter in the activation of dorsal horn neurons following painful stimuli?

Answer 80

Glutamate

Question 81

A 56-year-old man is undergoing a right carotid endarterectomy with intraoperative EEG monitoring. Which of the following cerebral blood flow rates BEST defines the range where signs of ischemia first appear on EEG?

Answer 81

15-20 mL/min/100 gm

Question 82

12 French catheter would have an outer diameter of

Answer 82

To determine the outer diameter of the French gauge system, the French gauge is divided by 3, and the answer will be in millimeters. Therefore, a 12-Fr catheter would have an outer diameter of 4 mm.

Question 83

Portal hypertension is defined as a

Answer 83

hepatic venous pressure gradient (HVPG) greater than 5-6 mmHg,

Question 84

Hepatic venous pressure gradient (HVPG) is calculated by the calculating the

Answer 84

difference between portal and hepatic vein pressure.

Question 85

Portal hypertension results in 6 things: Name 2 LESS OBVIOUS

Answer 85

ascites
formation of varices
hepatorenal syndrome
splenomegaly
***splanchnic vasodilation***
***gastropathy****

Question 86

HVPGs in excess of_____ mmHg place the patient at risk for variceal bleeding.

Answer 86

12

Question 87

Where does Aldosterone work in the nephron?

Answer 87

CD
Collecting duct
Distal tubule

Question 88

What is the predisposing factor doubles the risk of bladder cancer?

Answer 88

Smoking

Question 89

The mainstay of treatment of disseminated intravascular coagulation is the administration of

Answer 89

FFP

Question 90

Can infrared gas analyzers directly measure oxygen content?

Answer 90

NO

Question 91

It is an INTRAumbilical abdominal herniation in pediatrics

Answer 91

omphalocele

Question 92

Associated with projectile vomiting in pediatric

Answer 92

Pyloric stenosis

Question 93

Factors decrease in pregnancy

Answer 93

11 and 13 (XI and XIII) (think decrease pregnancy risk in 11 and 13 yrs old)

Question 94

Factors UNCHANGED in pregnancy

Answer 94

2, 5 (II, and V)

Question 95

It is (also known as congenital aganglionic megacolon) in pediatrics

Answer 95

Hirschsprungs disease

Question 96

It is a lack of parasympathetic ganglion cells in the large intestine with resulting distention of the colon and intestinal obstruction in pediatrics?

Answer 96

Hirschsprungs disease

Question 97

It is lateral to the umbilicus (usually to the right side) of pediatric patients? (GI condition)

Answer 97

gastroschisis

Question 98

It is an PERIumbilical abdominal herniation in pediatrics

Answer 98

Gastrochisis

Question 99

The gallbladder normally stores about _____ mL of bile.

Answer 99

50

Question 100

Which of the following Acid / base abnormality is associated with hypoaldosteronism?

Answer 100

Hyperchloremic metabolic acidosis

Question 101

At birth, the T waves are_______ in all chest leads, but become isoelectric or inverted in leads V1-V4 by when? .

Answer 101

upright; one week of age. They remain isoelectric or inverted until adolescence when they become upright again.

Question 102

Failure of the V1-V4 T waves to invert by one week of age can indicate

Answer 102

right ventricular hypertrophy.

Question 103

Which Laminae are located in the dorsal horn of the spinal column.

Answer 103

Rexed laminae I through laminae VI

Question 104

Which laminae are located location in the comprise the ventral horn.

Answer 104

Laminae VII, VIII, and IX

Question 105

When you see a question about shunt or venous admixture, think about _____. Explain.

Answer 105

FRC.
When your FRC is less, the amount of pulmonary blood that comes into contact with oxygenated alveoli per unit time is DECREASED which INCREASES the venous admixture (shunt)

Question 106

In the clinical, when FRC is decreased the patient is at risk for rapid _________and the A-a gradient is

Answer 106

Desaturation ; INCREASED

Question 107

% of RV in total lung capacity

Answer 107

20%

Question 108

How much oxygen is consumed by a 70kg healthy adult at rest? Give your answer in ml/100g/min

Answer 108

Classic formula is 3.5 ml/kg/min

Question 109

Classic answer of O2 consumption at rest for a 70kg adult is

Answer 109

250 mL/min

Question 110

Phenomenon responsible for tachypnea that accompanies pulmonary embolism

Answer 110

J receptor stimulation

Question 111

Phenomenon responsible for tachypnea that accompanies vascular congestion such as CHF

Answer 111

J receptor stimulation

Question 112

Stop inspiration when lungs is hyper inflated?

Answer 112

Hering Bruer Inflation reflex

Question 113

Peak effect of HPV

Answer 113

15 minutes

Question 114

HPV inhibited by

Answer 114

Vasodilators

Question 115

HPV inhibited by 3 med classes

Answer 115

Vasodilators,PDE inhibitors, CCBs

Question 116

HPV during OLV is effective in decreasing the cardiac output to the nonventilated lung by approximately

Answer 116

50%

Question 117

During * two-lung* ventilation, blood flow to the dependent lung averages approximately

Answer 117

60%

Question 118

During OLV Without autoregulation of pulmonary blood flow, a ___% shunt would be anticipated.

Answer 118

40%

Question 119

HPV is a reflex intrapulmonary feedback mechanism in homogeneous lungs that does 2 main things?

Answer 119

Improves gas exchange

Improves arterial oxygenation.

Question 120

Hypoxemia causes________ (dilation vs constriction) in the general circulation

Answer 120

vasodilation

Question 121

Alveolar hypoxia effect on pulmonary arteries.

Answer 121

Vasoconstriction

Question 122

HPV can increase the PVR by

Answer 122

50% to 300%, and the response can persist for long periods of time in the face of chronic hypoxia

Question 123

HPV occurs whether the lung is rendered hypoxic by atelectasis or by ventilation with a hypoxic mixture. It is initiated within _______and reaches its maximum effect in approximately

Answer 123

seconds of hypoxia; 15 minutes.

Question 124

HPV improves arterial oxygenation when the amount of hypoxic lung is between____and ____%

Answer 124

20% and 80%, which occurs during OLV.

Question 125

*****Factors That Reduce Effectiveness of Hypoxic Pulmonary Vasoconstriction. (4HA PEAS)

Answer 125

• Hemodilution
• Hypervolemia (LAP > 25 mm Hg), atrial natriuretic peptide
• Hypocapnia
• Hypothermia
• Prostacyclin
• Excessive tidal volume or PEEP
• Alkalosis
• Shunt fraction < 20% or > 80%

Question 126

*****Medications that Reduce Effectiveness of Hypoxic Pulmonary Vasoconstriction (VCV 1.5 P)

Answer 126

Vasodilators
Calcium channel blockers
Volatile anesthetics > 1.5 MAC
Phosphodiesterase inhibitors

Question 127

Hypoxemia when Oxygen does not help?

Answer 127

Right to left shunt (VET) : VSD, Eisenmenger, Tetralogy

Question 128

The single best predictor of post operative PULMONARY complications is

Answer 128

VO2 max (also hypoalbuminemia and INCREASED BUN are able to do so)

Question 129

Pneumonectomy, how much fluid to be given within the first 24 hours?

Answer 129

< 3L

Question 130

Best predictor test of airflow in the medium size airways?

Answer 130

MMEF

Question 131

Normal MMEF is

Answer 131

> or equal to 75%

Question 132

Severe MMEF is

Answer 132

less or equal to 30%

Question 133

What is the 2 most common ABG finding during an asthmatic attack are

Answer 133

Hypocarbia

Respiratory Alkalosis.

Question 134

When does CO2 retention starts doing an asthmatic attack?

Answer 134

When FEV1 < 25% and it is a sign of IMPENDING RESPIRATORY FAILURE

Question 135

FEV1 in asthmatic that indicates impending respiratory failure is

Answer 135

FEV1 < 25%

Question 136

What does the diffusion capacity for carbon monoxide measure?

Answer 136

How well the lung can exchange gas.

Question 137

DLCO measures the partial pressure

Answer 137

Different between the inspired and expired CO after a known quantity of CO has been inhaled

Question 138

What is a normal DLCO?

Answer 138

17-25 ml/CO/min/mmHg

Question 139

DLCO : higher/lower values correlate with a

Answer 139

significant reduction in diffusing capacity.

Question 140

DLCO Using this law

Answer 140

Fick’s law of diffusion

Question 141

Using Fick’s law of diffusion, the DLCO tell us 2 key characteristics about the alveolocapillary interface, what are they?

Answer 141

Surface area (emphysema)
Thickness (increased by fibrosis and pulmonary edema)

Question 142

Does asthma affect DLCO

Answer 142

NO

Question 143

Chronic Bronchitis : what happens to Blood?

Answer 143

Polycythemia

Increased RBC mass compensates for chronically low PaO2 (tend to retain CO2 (BLUE BLOATERS)

Question 144

Which heart issue is common with chronic bronchitis, what is it a result of ?

Answer 144

Right heart failure, results of pulmonary HTN (think all signs of RV failure)

Question 145

With pulmonary embolism prevents

Answer 145

Blood in the affected vessels form reaching the

Question 146

Best ventilatory strategy for restrictive lung disease ?

Answer 146

Smaller TV 6 ml/kg/IBW

Faster RR 14-18 breaths/min

Question 147

There are five causes of hypoxemia, which ones are associated with normal A-a gradient?

Answer 147

1. High altitude

2. Hypoventilation

Question 148

There are five causes of hypoxemia, which ones are associated with INCREASED A-a gradient?

Answer 148

Diffusion defect
V/Q mismatch
Right to left shunt (O2 not helpful)

Question 149

What is an example of acute intrinsic restrictive lung disease>

Answer 149

Negative pressure pulmonary edema

Question 150

Flail chest chest movement during inspiration and expiration?

Answer 150

Inward during inspiration

Outward during expiration.

Question 151

Best measurement of gas EXchange

Answer 151

DLCO

Question 152

Best measurement of RESPIRATORY MECHANICS

Answer 152

FEV1

Question 153

Best measurement of cardiorespiratory interaction is

Answer 153

VO2 max

Question 154

6 steps (in order of preference) to reverse hypoxemia during OLV. (FDC- PLR)

Answer 154

FIO2 to 100%
DLT position check with fiberoptic 
CPAP 10cm H2O non-dep lung
PEEP 5-10 dependent lung
Ligate/clamp pulmonary artery of non-dependent lung (not always poss)
Resume 2-lung ventilation

Question 155

What are the 2 CLINICALLY SIGNIFICANT examples of the baroreceptor reflex during surgery include

Answer 155

1. Carotid sinus manipulation reflex during CEA (carotid endarterectomy.)
2. Aortic baroreceptor stimulation from pressure exerted on the aortic arch during mediastinoscopy

Question 156

During mediastinoscopy, which receptor can be stimulated?

Answer 156

Aortic baroreceptor stimulation from pressure exerted on aortic arch

Question 157

Mediastinoscopy which site for aline monitoring and why?

Answer 157

Right radial because it provides indication of innominate artery

Question 158

5 possible complications of mediastinoscopy?

Answer 158

hemorrhage
Pneumothorax
dysrhythmias (bradycardia)
bronchospasm
Left RLN
Laceration of trachea or esophagus

Question 159

Chylothorax from mediastinoscopy can occur secondary to

Answer 159

Laceration of the thoracic duct

Question 160

Mediastinoscope can put pressure on the

Answer 160

Innominate (brachiocephalic artery) prior to its division to right common carotid and right subclavian artery>

Question 161

2 things that can be played to monitor perfusion to Right arm during mediastinoscope

Answer 161

Pulse ox or radial artery catheter (a-line)

Question 162

All sympathetic neurotransmitters are synthesized from _______ The synthesis takes place where ?

Answer 162

tyrosine ; in the post-ganglionic sympathetic nerve ending.

Question 163

What is the local anesthetic that is prolonged the most by adding an adrenergic agonist.

Answer 163

Tetracaine

Question 164

Which endotracheal tube is designed to deflect laser beams?

Answer 164

Mallinckrodt tube

Question 165

Constrast-induced neuropathy is can be seen with 2 changes from the baseline what are they?

Answer 165

Serum Creatinine increase by 0.5

BUN increase by 25%

Question 166

At what blood carboxyhemoglobin level is hyperbaric oxygen indicated?

Answer 166

> 30%

Question 167

In the brain, As the MAP decreases within this autoregulation range, the cerebral vessels

Answer 167

dilate to keep CBF constant. (DD : decrease, dilate)

Question 168

During renal transplant, where is the donor kidney anastoamosed?

Answer 168

The donor kidney is anastamosed to the recipient’s external iliac artery and vein

Question 169

When the glomerular filtration reaches____of normal, serum potassium begins to elevate.

Answer 169

10%

Question 170

the QRS axis is_____-sided at birth

Answer 170

right; It shifts leftward by about one month of age. The T waves are upright in all chest leads at birth, but become isoelectric or inverted in leads V1-V4 by one week of age

Question 171

Barbiturates on cerebrovascular resistance

Answer 171

INCREASES cerebrovascular resistance

Question 172

One way to estimate the approximate MAC of an agent is to divide

Answer 172

150 by the oil:gas coefficient. In this case, 150 divided by 100 would equal an estimated MAC of 1.5%.

Question 173

The secretion of hydrogen ions and reabsorption of bicarbonate ions occurs all along the tubules with the exception of the

Answer 173

thin segments of the loop of Henle

Question 174

Deleterious effects of hypothermia include:

Effect on hemoglobin-oxygen saturation Curve

Answer 174

left shift of the hemoglobin-oxygen saturation curve

Question 175

Deleterious effects of hypothermia include:

Effect on Platelet

Answer 175

reversible platelet dysfunction

Question 176

Deleterious effects of hypothermia include: Effect on wound

Answer 176

poor wound healing

increased incidence of infection

Question 177

Deleterious effects of hypothermia include: Effect on Heart

Answer 177

cardiac arrhythmias

increased PVR

Question 178

Deleterious effects of hypothermia include: Effect on Protein

Answer 178

postoperative protein catabolism

Question 179

Deleterious effects of hypothermia include: Effect on drug metabolism

Answer 179

decreased drug metabolism

Question 180

Deleterious effects of hypothermia include: mental status

Answer 180

altered mental status

Question 181

Deleterious effects of hypothermia include: Effect on Kidney

Answer 181

impaired renal function

Question 182

What is the Formula for Closing Capacity?

Answer 182

Closing volume + Residual volume

Question 183

The closing volume does increase from approximately of ____% of the TLC at age 20 years to approximately at ______%age 70 years

Answer 183

30% ; 55%

Question 184

CO2 solubility is _____ mL

Answer 184

0.06 mL

Question 185

This reaction : CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3- is catalyzed by which enzyme? Where does this reaction occurs? and is it slower or faster and why?

Answer 185

Carbonic anhydrase;

Outside the RBC’s, in the plasma, but it is much slower due to lack of CA.

Question 186

CO2 dissociation curve and INHALED anesthetics effect? What about HIGH concentration of inhaled anesthetics?

Answer 186

All inhaled anesthetics depress the ventilatory response to hypercarbia in a dose-dependent fashion.
High concentrations of volatile anesthetics may almost entirely eliminate hypercarbia-induced increases in ventilatory drive.

Question 187

The response of two common classes of IV anesthetics are subtly different – OPIOIDS create a_______ward-shift in the CO2 response curves, whereas benzodiazepines and propofol affect the slope?

Answer 187

Right (OPIOIDS)

Left (Benzodiazepines and Propofol) ; decrease the slope

Question 188

How does Hypoxemia affect the CO2 dissociation curve?

Answer 188

Hypoxemia (paO2 < 65 mm Hg) leads to a LEFT-shift in the CO2 response curve.

Question 189

What are other two causes of left-shift of the CO2 curve?

Answer 189

metabolic acidemia and central etiologies

Question 190

Both of the medications that decrease the slope of the ventilatory response curves

Answer 190

Propofol

Benzodiazepines

Question 191

Inspiration of CO2 in the alert and awake patients ventilatory response.

Answer 191

carbon dioxide in healthy, awake subjects INCREASES minute ventilation by approximately 3 L/min per 1 mm Hg of arterial carbon dioxide tension

Question 192

CO2 dissociation curve as compared to the O2 dissociation curve

Answer 192

The CO2 dissassociation curve is linear in shape and steep compared to O2 dissociation curve

Question 193

What is the appropriate mainstay of initial perioperative management in patients with carcinoid tumors?

Answer 193

somatostatin analog therapy

Question 194

Carcinoid tumors release a variety of subtances (ex. serotonin, catecholamines, histamine) which can cause both

Answer 194

hypertension and hypotension.

Question 195

How do you treat Hypotension in the patients with carcinoid tumors?

Answer 195

vasopressin (β-agonists may increase the release of vasoactive substances) or phenylephrine

Question 196

How do you treat Hypertension in the patients with carcinoid tumors?

Answer 196

α and β-adrenergic receptor blockers

Question 197

Clonidine has intrinsic ability to block conduction in ____- AND____FIBERS

Answer 197

C and Aδ fibers

Question 198

A single induction dose OF ETOMIDATE may inhibit THIS ENZYME LEADING TO _______how long does it last

Answer 198

11β-hydroxylase ⇒Adrenocortical suppression

4-8 hours

Question 199

Etomidate on EEG

Answer 199

initial increase α amplitude followed by progressive decrease in activity

Question 200

The transplanted kidney is attached to the recipient’s vasculature via _____________ (which artery and vein) and the ureter is anastomosed

Answer 200

• **vascular anastomoses of the external iliac artery and vein
• *directly to the bladder

Question 201

Why do many transplant recipients require a central line?

Answer 201

because of the administration of immunosuppressive and vasoactive medications.

Question 202

2 medications that are calcineurin inhibitors used post transplant

Answer 202

Cyclosporine

Tacrolimus,

Question 203

MOA of Calcineurin inhibitors?

Answer 203

Both Inhibits calcineurin and IL-2 production

Question 204

Patients with ESRD are at risk for aspiration due to

Answer 204

Gastroparesis

Question 205

What is the primary stimulus for the release of aldosterone by the adrenal cortex?

Answer 205

Angiotensin II

Question 206

Aldosterone results in increased

Answer 206

sodium and water retention.

Question 207

The circle system test evaluates the circle breathing system from the

Answer 207

common gas outlet to the y-piece and consists of two parts, the leak test and the flow tes

Question 208

The hanging drop technique is used to verify that the epidural needle has passed through the

Answer 208

ligamentum flavum into the epidural space.

Question 209

Write the SODA lime equation

Answer 209

1. CO2 + H2O ↔ H2CO3
2. H2CO3 + NaOH ↔ Na2CO3 + H2O + energy
3. Na2CO3 + Ca (OH)2 → CaCO3↓ + NaOH

Question 210

Water content of the Soda lime is

Answer 210

15-20%

Question 211

Last phase of the soda lime

Answer 211

Na2CO3 + Ca (OH)2 → CaCO3↓ + NaOH

Question 212

Baralyme + Sevoflurane leads to

Answer 212

FIRE

Question 213

What 2 things reduce the production of Compound A

Answer 213

Addition of Ca(OH)2

removal of NaOH

Question 214

High pressure system include

Answer 214

Back up cylinders
Cylinders yoke
Cylinder gauge
Cylinder regulator

Question 215

Monitor lead ____for rhythm, and ____for ischemia

Answer 215

II;

Question 216

V5

Answer 216

Anterior Axillary line

Question 217

Nagelhout says V1-V2 to be placed at

Answer 217

4th ICS

Question 218

Nagelhout says V4-V5 to be placed at

Answer 218

5th ICS

Question 219

Intermediate pressure system include

Answer 219

Pipeline inlet
Check valves
Pressure gauges
Ventilator power inlet
Oxygen pressure system

Question 220

FLOWMETER CONTROL VALVE is part of _______pressure system

Answer 220

Intermediate

Question 221

Pipeline inlet is part of the

Answer 221

Intermediate pressure system

Question 222

Oxygen 2nd stage regulator is part of the

Answer 222

Intermediate pressure system

Question 223

Oxygen flush valve is part of the

Answer 223

intermediate pressure system

Question 224

Part of the Low pressure system

Answer 224

Flowmeters
Vaporizers
Common gas outlets
Check valves (if present)

Question 225

Higher temperature leads to ______vapor pressure

Answer 225

Higher VP

Question 226

SA node primarily in 55% of us

Answer 226

RCA

Question 227

AV node primarily in 90% of us

Answer 227

RCA

Question 228

AV node is supplied by the RCA in

Answer 228

90% of people

Question 229

SA node is supplied by the RCA in

Answer 229

55%

Question 230

When ambient temperature goes high, what happens to fresh gas flow and the vaporizing chamber/ bypass chamber?

Answer 230

Less fresh gas flow to the VAPORIZING CHAMBER

More Fresh gas flow to the BYPASS CHAMBER

Question 231

High pressure system begins and ends where?

Answer 231

Begins at the cylinder

Ends at the cylinder regulators

Question 232

Intermediate pressure system begins and ends where?

Answer 232

Begins at the pipeline

Ends at the flowmeter valve

Question 233

Intermediate pressure system begins and ends where?

Answer 233

Begins at the pipeline

Ends at the flowmeter valve

Question 234

Low pressure system begins and ends where?

Answer 234

Begin at the flowmeter tubes

Ends at the common gas outlet

Question 235

Best test to determine the vaporizer leak is

Answer 235

The negative pressure test

Question 236

Low pressure leak test measure what?

Answer 236

Integrity of the low pressure circuit from the flowmeter valve to the CGO

Question 237

Low pressure system fails if the bulb inflates within _____seconds

Answer 237

10

Question 238

Low pressure leak test is the _____pressure test

Answer 238

NEGATIVE

Question 239

For the low pressure leak test, If there is a minimum FGF when the machine is turned on, then what should be done

Answer 239

the machine must be turned On

Question 240

With the pressure leak test, the FGF and ventilator must be on/off?

Answer 240

off

Question 241

With the pressure leak test, should the vaporizer be on or off, explain

Answer 241

Should be off at first, then the test should be repeated as each vaporizer is turned on. The negative pressure test is best way of detecting a vaporizer leak

Question 242

The high pressure leak test is conducted how?

Answer 242

Closing APL
Pressurize circuit to 30cm H2O
Observe the airway pressure gauge (should remain constant)

Question 243

With the high pressure leak test, what determines which components of the low pressure system are test?

Answer 243

The presence or absence of a check valve.

Question 244

Nagelhout proper placement of V5

Answer 244

Horizontal to V4 on the ANTERIOR AXILLARY line; or, if the anterior axillary line is difficult to identify, then midway between V4 and V6

Question 245

So if you open a cylinder and you hear a hissing sound, what is it ? what should you do?

Answer 245

There is a leak

Tighten the connection.

Question 246

Non metallic cylinder box is

Answer 246

Aluminum

Question 247

Max temperature gas cylinder

Answer 247

130F (57C)

Question 248

Fusible plug up made up of BLT

Answer 248

Bismuth
Lead
Tin

Question 249

Cylinders must be checked every

Answer 249

5 years

Question 250

Set Standards for compressed gas cylinder

Answer 250

US DOT

Question 251

Pre-use checkout procedures created by

Answer 251

FDA

Question 252

Set required components of anesthesia machine

Answer 252

American society for testing and material

Question 253

Oiling valve increases risk of

Answer 253

Fire

Question 254

Cracking a cylinder means

Answer 254

slowly opening the cylinder flush the valve outlet clean of dust and debris.

Question 255

Oxygen fail safe device what oxygen pressure will completely stop the flow of N20?

Answer 255

< 20 psi

Question 256

HYPOXIA prevention safety device is a

Answer 256

Proportioning device

It prevents you from setting a hypoxic mixture with the flow control valves.

Question 257

The annular space is the

Answer 257

area between the WIDEST AREA of the indicator float and side wall of the flowmeter

Question 258

Left axis deviation is

Answer 258

-45 to -90

Question 259

Reynolds’ number formula

Answer 259

Density x diameter x velocity/ viscosity

Question 260

How to calculate Fresh gas coupling

Answer 260

1. first convert FGF from L/min to ml/min
2. I:E ratio of 1:2 would be 20 seconds in inspiration and 40 seconds in expiration so 1/3 of time in inspiration SO –> 1/3 of the ml/min value
3. Divide the ml/min value by the RR
4. Add the results of step 3 to the TV

Question 261

If compliance and peak pressure are given multiople

Answer 261

compliance by peak pressure then substract number from TV.

Question 262

Variable bypass 4 things to think about ?

Answer 262

Flow over
Temperature compensated
Out of circuit
Agent specific

Question 263

Determines splitting ration

Answer 263

Concentration set on the dial

Question 264

Most common cause of a vaporizer leak

Answer 264

loose filler cap

Question 265

ml of liquid anesthetic used an hour

Answer 265

Vol % x FGF x 3

Question 266

Types of oxygen analyzers that must be calibrated daily

Answer 266

Galvanic fuel Cell

Question 267

Types of oxygen analyzers that must is self-calibrating

Answer 267

Paramagnetic device

Question 268

Oxygen analyzers resides in the _______limb

Answer 268

Inspiration

Question 269

Increasing oxygen tension generates a current accross 2 electrodes? what type of oxygen analyzers

Answer 269

Galvanic Fuel cell

Question 270

IS calcium a TREATMENT for hyperkalemia?

Answer 270

No , it stabilizes the membrane till you can treat

Question 271

Sugammadex in order of affinity to NMB

Answer 271

Roc, vec, pancuronium

Question 272

At what pH does ethyl violet change to purple

Answer 272

10.3

Question 273

How many Kilocalories calories with each breath?

Answer 273

1.67 Kcal/breath

Question 274

Exelon patch should be off _______

Answer 274

24 hours

Question 275

Prolong effect of rocuronium

Answer 275

Dehydration

Question 276

Labetalol Beta to alpha

Answer 276

7:1 beta to alpha

Question 277

Control sympathetic output beta blocker

Answer 277

esmolol

Question 278

Post op shivering treatment

Answer 278

Meperidine and Clonidine

Question 279

Clonidine: and warming?

Answer 279

Inhibit warming patient may be shivering

Question 280

ACE Inhibitors overdose antidotes : Name 2?

Answer 280

methelyne BLUE

NOREPINEPHRINE (BEST ANSWER, nitric oxide inhibition)

Question 281

Hydralazine onset

Answer 281

10-15 minutes

Question 282

Cyanide toxicity medication

Answer 282

Nitroprusside

Question 283

Clinical manifestations of neonates born with congenital diaphragmatic hernia include

Answer 283

Dyspnea
Absent breath sounds on the affected side, a
Barrel-shaped chest

Scaphoid abdomen
Tachypnea
Dextrocardia
Severe retractions.

Question 284

Clevidipine contraindicated in

Answer 284

Aortic Stenosis.

Question 285

ARBs major side effect

Answer 285

Hyperkalemia

Question 286

The pediatric dose of intranasal midazolam is

Answer 286

0.1-0.2 mg/kg.

Question 287

After 2 PRBCs you should give

Answer 287

Calcium

Question 288

Heparin needs

Answer 288

AT III

Question 289

Pradaxa inhibits factor

Answer 289

X

Question 290

Antithrombin III deficiency give

Answer 290

FFP

Question 291

A peripheral nerve stimulator used to assess neuromuscular blockade is designed to produce what type of wave signal?

Answer 291

monophasic, square wave signals

Question 292

Vitamin K dependent factors?

Answer 292

2, 7, 9 10 Protein C, Protein S

Question 293

TXA inhibits conversion of

Answer 293

Plasminogen to plasmin

Question 294

TXA inhibits conversion of

Answer 294

Plasminogen to plasmin (and plasmin itself dissolves clot)

Question 295

Which of the following are known side effects of the use of fenoldapam as an agent for producing controlled hypotension?

Answer 295

Increased intraocular pressure

Question 296

extrusion of the abdominal contents into the extraembryonic coelom is known as

Answer 296

Omphalocele

Question 297

Tumescent lidocaine max

Answer 297

50-55mg/kg

Question 298

Max dose of bupivacaine

Answer 298

2.5mg/kg without EPI (3mg/kg WITH EPI)

Question 299

PONV dose of epinephrine

Answer 299

0.5 mg/kg

Question 300

Chloroprocaine pka is high but still works fast why?

Answer 300

because of high concentrations

Question 301

Contact with birds may contract _______pneumonia.

Answer 301

Chlamydia

Question 302

Cancer medication Tamoxifen associated

Answer 302

Hypercalcemia (think Camoxifen)

Question 303

Cancer medication Tamoxifen associated

Answer 303

Hypercalcemia; venous thrombosis.

Question 304

Cancer medication Bleomycin associated

Answer 304

Pulmonary Fibrosis

Question 305

Cisplatin side effects

Answer 305

ototoxicity and renal failure

Question 306

Mitomycin side effects

Answer 306

hemolytic uremic failure and cardiac failure,

Question 307

Which of the following interventions should be avoided in an infant with a congenital diaphragmatic hernia?

Answer 307

MASK VENTILATION –> stomach inflation and worsen mediastinal displacement.

Question 308

Cirrhosis is associated with

Comment on : Na, albumin, anemia, Platelets, Bilirubin

Answer 308

Hyponatremia
Hypoalbuminemia.
Anemia
Thrombocytopenia
Hyperbilirubinemia

Question 309

According to the standards set by the American Society for Testing and Materials (ASTM), a reservoir bag of ____liters that is distended to ____times its size shall not exert pressures that are (select two) less than ______or greater than ____

Answer 309

3L
four times
Less than 35 cm H20
Greater than 60 cm H2O

Question 310

Tension pneumothorax percussion :

Answer 310

Hyperresonance to percussion

Question 311

In what rexed laminae does the 2nd order neurons reside

Answer 311

Lamina V

Question 312

When a GAS embolism is suspected, the patient should be placed in the

Answer 312

left lateral decubitus position. This is called the Durant Maneuver.

Question 313

An increased BUN:creatinine ratio is consistent with

Answer 313

Decreased blood volume

Question 314

Underdosing can lead to myasthenic crisis

Answer 314

Pyridostigmine

Question 315

only cells in the renal tubules that do not synthesize ammonia to be used in the buffer system are the epithelial cells in the

Answer 315

Loop of Henle

Question 316

What anatomic structures collect urine from the papilla and funnel it into the renal pelvis?

Answer 316

Major and minor calyces

Question 317

Forced air warmers transfer heat to the patient via

Answer 317

convection.

Question 318

Heat lamps and radiant heaters use

Answer 318

radiation.

Question 319

Resistive heaters (such as warming blankets) use

Answer 319

conduction.

Question 320

Resistive heat devices such as a heating blanket transfer heat via

Answer 320

conduction.

Question 321

Pacemaker code letters meaning:VOID- TA

Answer 321

V = Ventricle
A = Atria
0 = Neither
I = Inhibited
T = Triggered
D = Dual. A pacemaker that paces the ventricle and does not sense is designated VOO.

Question 322

Most effective at controlling gastric ACIDITY and VOLUME?

Answer 322

PPIs

Question 323

MELD score that is consistent with a 100 percent mortality rate at three months?

Answer 323

40

Question 324

1 thing that will cause the respirometer to register falsely ELEVATED tidal volumes

Answer 324

High flow rates

Question 325

What flow rate will cause the respirometer to register falsely DECREASED tidal volumes?

Answer 325

low flow rates will register falsely decreased tidal volumes.

Question 326

What is the functional unit of the liver?

Answer 326

Lobule

Question 327

heated humidifier is typically set to heat the inspiratory gas to between

Answer 327

34-40 C

Question 328

What are the 8 risk factors for intraoperative awareness?

Answer 328

Female gender
Obesity
Surgery after normal hours
Emergency surgery

Previous awareness
Use of nondepolarizing muscle relaxants
High-risk procedures such as cardiac, thoracic, or obstetric surgery
Young age (young adults, not children),

Question 329

The risk for local anesthetic systemic toxicity is directly related to the _____ of the drug.

Answer 329

Potency

Question 330

Biphosphonates such as pamidronate are administered for the management of

Answer 330

HYPERcalcemia

Question 331

With age, renal cortical mass decreases by as much as

Answer 331

25%

Question 332

Also, by age ___approximately ___%of the glomeruli are lost.

Answer 332

80 yo

50%

Question 333

Extreme flexion of the thighs can result in injury to which nerve? (select two)

Answer 333

Obturator

Sciatic

Question 334

The dose of neuromuscular blocking agents for obese patients should be based upon: Rocuronium, Vecuronium, cisatracurium?

Answer 334

IDEAL BODY WEIGHT (IBW)

Question 335

The use of meperidine in elderly patients is not generally recommended because it is associated with an increased incidence of

Answer 335

Post of delirium

Question 336

Expected side effect of intrathecal ketorolac is

Answer 336

mild decrease in heart rate 15-60 minutes after administration

Question 337

What is the compensatory mechanism that maintains stroke volume in patients with mild mitral stenosis?

Answer 337

An increase in left atrial pressure

Question 338

Infants have a much______proportion of body water than adults and a ______proportion of muscle tissue and______

Answer 338

higher ; lower; body fat.

Question 339

As a result, water-soluble medications have a_______ volume of distribution in neonates.

Answer 339

larger relative

Question 340

Weight-based loading doses for water-soluble drugs such as digoxin, aminoglycosides, and succinylcholine are for _______infants to achieve the same target concentration in the bloodstream.

Answer 340

higher

Question 341

Weight-based loading doses for water-soluble drugs in infants include for drugs such as

Answer 341

digoxin, aminoglycosides, and succinylcholine (DAS)

Question 342

For infants, Because of the lower muscle mass, drugs whose termination of action depends upon redistribution into the muscle tissue may have a _____ (higher/lower) initial peak plasma concentration and ______duration of action.

Answer 342

higher; longer

Question 343

This mediation should be administered per liter of ascites removed to help prevent renal decompensation when performing large-volume paracentesis in a patient with hepatorenal syndrome.

Answer 343

Albumin 6-8 grams per L removed

Question 344

Which of the following represents the normal cerebrospinal fluid pressure?

Answer 344

10-20

Question 345

At an increased altitude, an older Tec isoflurane vaporizer will deliver a______Volume percent than the dial setting.

Answer 345

higher volume

Question 346

The oxygen proportioning system on an anesthesia machine limits the FiO2 when using nitrous oxide to a minimum of

Answer 346

25%

Question 347

The primary site of action for neuromuscular blocking agents is the (pre vs post )

Answer 347

postsynaptic nicotinic cholinergic receptor on the muscle endplate.

Question 348

Retrograde cardioplegia is administered into the

Answer 348

coronary sinus via a catheter placed through the right atrium. (RCSRA)

Question 349

Anterograde cardioplegia is administered directly into the

Answer 349

AAA- CO (Anterograde, Ascending, Aorta, Coronary ostia)

coronary ostia or into a cannula placed in the ascending aorta.

Question 350

Following thoracic aortic surgery, a patient exhibits anterior spinal artery syndrome. What symptoms are associated with this disorder? (select two)

Answer 350

Bowel and bladder dysfuntion

Flaccid paralysis to LE

Question 351

One method postulated to help decrease blood loss from a liver resection is

Answer 351

CVP < 5

Question 352

The BODE index stands for

Answer 352

Body mass index
airflow Obstruction
Dyspnea
Exercise.

Question 353

What does the BODE score assess?

Answer 353

It is a scoring system that uses these variables to predict long-term outcomes for individuals diagnosed with COPD and would be used as criteria for determining lung transplant eligibility.

Question 354

Reflex responses to painful stimuli begin at about

Answer 354

24 weeks gestation

Question 355

Intrathecal adenosine has been shown to be effective at treating (select two)

Answer 355

Allodynia

Hyperalgesia

Question 356

Intrathecal adenosine appears to have antinociceptive activity at adenosine

Answer 356

A1 receptors in laminae I and II of the spinal cord.

Question 357

Adenosine has been shown to be effective at treating

Answer 357

hyperalgesia, allodynia, and neuropathic pain, but not acute pain.

Question 358

Intercalated cells play an important role in what? There are two types of intercalated cells: type A and type B. . ou can remember the function of each cell by its name. Type A cells get rid of Acid and Type B cells get rid of bicarbonate.

Answer 358

Acid-base balance by controlling the reabsorption and secretion of hydrogen ions, bicarbonate, and potassium.

Question 359

2 Types of intercalated cells:

Answer 359

type A and type B.

Question 360

Type A Intercalated cells play an important role in the

Answer 360

presence of acidosis by secreting hydrogen ions and reabsorbing bicarbonate

Question 361

Type B intercalated cells are essentially the opposite of type A cells. Their role becomes important in states of

Answer 361

alkalosis because they secrete bicarbonate and reabsorb hydrogen ions

Question 362

How you can remember the function of each cell by its name. Type A cells get rid ofand Type B cells get rid of bicarbonate.

Answer 362

Acid (A-A)

Bicarbonate (B-B)

Question 363

Sepsis, PCWP, CO and SVR ?

Answer 363

Low pulmonary capillary wedge pressure
high cardiac output
low systemic vascular resistance

Question 364

Endobronchial intubation can occur at any point during a procedure. It is more likely to occur in the right mainstem and can produce asymmetrical

Answer 364

chest expansion, unilateral breath sounds, hypoxemia, and increased peak airway pressures.

Question 365

Calcium and phosphate in ESRD

Answer 365

Low calcium

High phosphate

Question 366

What factor is most closely associated with an increased risk of mortality in patients over the age of 80 who undergo surgery?

Answer 366

ASA status

Question 367

The pediatric dose of 0.3 M sodium citrate is

Answer 367

0.4 mL/kg.

Question 368

The hospital pipeline system has a defect in which the oxygen lines are switched with the nitrogen lines. Which device would detect the presence of such an error the soonest?

Answer 368

Oxygen analyzer

Question 369

TEC 6 features: what if it were loads into a standard vaporizer? is it heated? to what temperature? What is the pressure within the chamber.

Answer 369

if loaded into a standard vaporizer, the amount of vapor produced would be completely out of control.
To prevent that, the Tec 6 vaporizer is electrically heated, and a thermostat maintains the temperature at 39 degrees Celsius. At this temperature, the pressure within the desflurane chamber is at 1500 mmHg or 2 atmosphere

Question 370

Hepatic blood flow can decrease substantially during abdominal surgery. This is most likely due to

Answer 370

Histamine release

Question 371

You are contemplating using ketamine in suppository form for induction of anesthesia. What would be an appropriate dose?

Answer 371

5mg/kg

Question 372

Which condition is characterized by loss of structural integrity of the laryngeal cartilages or abnormal neural control of the laryngeal muscles?

Answer 372

Laryngomalacia

Question 373

Following an anesthetic, preterm infants should be monitored

Answer 373

For at least 12 hours

Question 374

What is the most potent mineralocorticoid produced by the adrenal gland?

Answer 374

ALDOSTERONE

Question 375

You identified an airway fire, removed the endotracheal tube, and rapidly checked for any debris in the oropharynx. What step should you take next?

Answer 375

POUR SALINE IN THE AIRWAY

Question 376

Hepatic venous blood supply is responsible for _____of blood flow to the normal liver (approximately 1 L/min), but only _____of the liver’s oxygen supply.

Answer 376

70%; 50%

Question 377

IS the largest internal organ,

Answer 377

LIVER

Question 378

The functional unit of the liver is the

Answer 378

hepatic lobule or acinus.

Question 379

Blood from the gut contains large quantities of colonic bacilli, and more than 99% of the bacterial load is removed by _________that line the hepatic sinuses

Answer 379

Kupffer cells (mac- rophages)

Question 380

Initiated by epinephrine and glucagon, glycogenolysis is the process of

Answer 380

liberating glucose from glycogen stores found in the liver (and skeletal muscle).

Question 381

Gluconeogenesis is the formation of.

Answer 381

glucose from the noncarbohy- drate molecules lactate and pyruvate, as well as amino acids, all of which are products of anaerobic and catabolic metabolism

Question 382

Gluconeogenesis is stimulated by

Answer 382

A decrease in glycogen stores.

Question 383

________may therefore be encountered in patients with severe liver disease due to

Answer 383

Hypoglycemia

Question 384

Why do people with severe liver disease has an decrease in blood sugar?

Answer 384

Dysfunctions in insulin clearance
Decrease in glycogen capacities
Impaired gluconeogenesis.

Question 385

Preferred energy source for brain

Answer 385

Glucose

Question 386

Once in the liver, the unconjugated bilirubin is conjugated with

Answer 386

glucuronic acid.

Question 387

Heme is converted to_________bilirubin in the

Answer 387

unconjugated bilirubin;

reticuloendothelial cells of the spleen

Question 388

In response to the intestinal hormone__________bile is released by the gallbladder.

Answer 388

cholecystokinin (CCK),

Question 389

The liver aids intestinal digestion by forming bile and secreting it into the

Answer 389

common bile duct (CBD).

Question 390

What is the end product of hemoglobin metabolism?

Answer 390

conjugated bilirubin

Question 391

The common bile duct merges with the pancreatic duct where?

Answer 391

At the ampulla of vater

Question 392

These two ducts merge at the ampulla of Vater

Answer 392

Common bile duct and Pancreatic duct

CPA–> Common bile duct, pancreatic duct –> Ampulla

Question 393

Which factors Is NOT PRODUCED by the liver

Answer 393

Factor VIII

Question 394

In the presence of biliary deficiency, parenteral vitamin K administration helps correct coagulopathy. However, significant hepatocellular disease may dictate the need for _______for IMMEDIATE correction of coagulation factor deficits.

Answer 394

fresh frozen plasma (FFP)

Question 395

Four techniques for Brachial plexus appraoch

Answer 395

Interscalene
Supraclavicular
Infraclavicula
Axillary

Question 396

This block provides anesthesia for Upper arm, shoulder, and clavicular surgeries

Answer 396

ISB

Question 397

ISB landmarks are

Answer 397

Clavicle
Acromion
Sternocleidomastoid muscle

Question 398

ISB contraindications

Answer 398

COPD

Question 399

ISB depth

Answer 399

1-2 cm

Question 400

Horner syndrome

Answer 400

Miosis
Ptosis
anhidrosis (loss hemifacial sweating)

Question 401

Retrobular and ISB block has a risk of

Answer 401

High spinal

Question 402

Elbow surgery , arm, FA and wrist hand surgery what approach of ISB?

Answer 402

Supraclavicular

Question 403

Landmark for Supraclavicular

Answer 403

Subclavian artery

Question 404

Least reliable for return of

Answer 404

Tibial

Question 405

Only block you can do under GA

Answer 405

TAP block

Question 406

Correct sequence for the cuff BIER BLOCK

Answer 406

1. PULSE CHECK (ALLENS test)
2. Inflate cuff, deflate cuff
3. IV
4. Dual bladder cuff
5. Arm elevated, eachar
6. inflate cuff, make sure

Question 407

IF shorter than 45 mins you

Answer 407

deflate for 3 minutes than reinflate

Question 408

Tourniquet is ______above what pressure?

Answer 408

75-100;

SBP

Question 409

For the upper extremity,_________ more than the patient’s systolic blood pressure should be used.

Answer 409

70–90 mm Hg

Question 410

For the lower extremity,

Answer 410

twice the patient’s systolic pressure should be used

Question 411

Bier block anesthesia, a minimum standard tourniquet pressure of _______mm Hg should be used unless the tourniquet is on the upper leg. In this instance, twice the patient’s systolic pressure should be used unless that amount is less than 300 mm Hg.

Answer 411

250

Question 412

absolute contraindications to mediastinoscopy

Answer 412

Previous mediastinocopy

Question 413

Absolute contraindications to mediastinoscopy

Answer 413

Previous mediastinocopy

Question 414

Systemic Effects of Tourniquet Release
core temperature ? electrolyte disturbances?
central venous oxygen tension ?

Answer 414

Systemic Effects of Tourniquet Release
• Transient decrease in core temperature occurs.
• Transient metabolic acidosis occurs.
• Transient decrease in central venous oxygen tension occurs, but systemic
hypoxemia is unusual.

Question 415

What happens to the pulmonary and systemic arterial What happens to end-tidal carbon dioxide ?

Answer 415

• Acid metabolites (e.g., thromboxane) are released into the central circulation.
• Transient fall in pulmonary and systemic arterial pressures occurs.
• Transient increase in end-tidal carbon dioxide occurs.

Question 416

CO2 after releasing of tourniquet?

Answer 416

Transient increase in end-tidal carbon dioxide occurs.

Question 417

Upon releasing the tourniquet, what acid metabolites are released in the circulation?

Answer 417

• Acid metabolites (e.g., thromboxane) are released into the central circulation.

Question 418

What happens to pulmonary and systemic arterial pressures when tourniquet is released?

Answer 418

• Transient fall in pulmonary and systemic arterial pressures occurs.

Question 419

Ayres T-piece being able to create

Answer 419

BLOW by O2 providsion

Question 420

Ayres T-piece being able to create

Answer 420

BLOW by O2 provision

Question 421

LVOT seen with Hypertrophic cardiomyophaty worsened by________ heart rate or ______myocardial contractility as well as in_____ preload or _____afterload.

Answer 421

increased; increased

decreases; increased

Question 422

Hypertrophic cardiomyopathy –> Anesthesia is usually maintained by

Answer 422

controlled myocardial depression using volatile anesthetics.

Question 423

Mnemonic for HCM /LVOT

Answer 423

Keep slow, lazy, and full, and relaxed

Question 424

Poiseuile’s law

Answer 424

Pi * r^4 Change in P / 8nl

Question 425

When in doubt , 3 to consider?

Answer 425

Circle
Bain
Modified Jackson release

Question 426

Femoral nerve Mnemonic: Lame Soup –> SAIL

Answer 426

Lateral : Sartorius
Medial: Adductor Longus
Superior: Inguinal ligament

Question 427

Break laryngospasm with APL at

Answer 427

20-40 cm H2O

Question 428

Femoral : LATE ME NAVEL

Answer 428

Lateral to medial
Nerve
Artery
Vein
Empty space
L

Question 429

Desflurane and tachycardia.

Answer 429

Turn on to quick, NE release

Question 430

Least pungent is

Answer 430

ISOFLURANE (not sevo)

Question 431

Halothane must know

Answer 431

MOST pungent
High MAC
longer onset
last forever
Sensitize myocardium to catecholamines

Question 432

Fast way to preoxygenate and dinitrogenate

Answer 432

3-5 TV breaths

Question 433

Carbon monoxide worst with which agent?

Answer 433

Desflurane

Question 434

Laser tube use

Answer 434

Blue dye

Question 435

Laser tube use ____to fill the cuff

Answer 435

Blue dye

Question 436

Cardioversion on ________

Answer 436

R wave

Question 437

Measure PA pressure at

Answer 437

END Expiration

Question 438

Big to maintain with AS

Answer 438

Afterload.

Question 439

Phenylephrine , reflex bradycardia and HR increase

Answer 439

Bainbridge reflex

Question 440

Spinal bP drop

Answer 440

Bezold parish

Question 441

Alpha angle increase in EtCO2

Answer 441

Increase angle can be obstructed ETT or exp airflow obstruction

Question 442

Elevate mandible and hyoid bone______maneuver

Answer 442

Larson’s maneuver

Question 443

Larson’s maneuver Landmarks

Answer 443

Base of skull
Condyle
mastoid process

Question 444

MH signs on EKG

Answer 444

Sinus Tachycardia

Question 445

Dr CUMA for hand nerve lesions

Answer 445

Drop –Radial
Claw –> Ulnar
Median nerve –> Ape hand. (Dr. CUMA)

Question 446

Interscalene Block done at the level of the

Answer 446

ROOTS

Question 447

Sufraclavicular at the level of the

Answer 447

Trunks/ Division

Question 448

Supraclavicular at the level of the

Answer 448

TRUNKS

Question 449

Mnemonic to remember

Answer 449

RealTexansColdBeers

I-Sup-In-fA

Question 450

Mnemonic to remember

Answer 450

RealTexansColdBeers

I-Sup-Inf- A

Question 451

Count back for 300 ECG HR rule

Answer 451

300, 150, 100, 75, 60, 50

Question 452

An useful mnemonic to remember the modalities of the lateral spinothalamic tract is “

Answer 452

Pa-Te-La” (Pain, Temperature via Lateral spinothalamic).

Question 453

_____Fibers may be more difficult to anesthe- tize than A-delta fibers;

Answer 453

C fibers

Question 454

ACyanotic are

Answer 454

LRA (think NRA) left to right acyanotic

Question 455

Intracardiac R-L shunt. (RL-TEPE-C)

Answer 455

Tetralogy of Fallot
Ebstein anomaly Decreased pulmonary blood flow Pulmonary stenosis with atrial or ventricular septal
defects
Eisenmenger syndrome

Question 456

With intracardiac R-L are there cyanosis

Answer 456

yes (therefore decrease pulmonary blood flow)

Question 457

With intracardiac L-R are there cyanosis?

Answer 457

NO ; how to remember. –> (LR - Lactated Ringers gives O2) (not physiologically right)

Question 458

The shunt lesion with the RVOT

Answer 458

RL TEPEC
Right to left shunt

Tetralogy of Fallot
Ebstein anomaly Decreased pulmonary blood flow Pulmonary stenosis with atrial or ventricular septal
defects
Eisenmenger syndrome

CYANOSIS

Question 459

Shunt lesion with RVOT obstruction

Answer 459

RL (right to left) shunt

Question 460

In which issue is the Intracardiac L-R and R-L shunts equal?

Answer 460

Dextro-transposition of the great arteries

Question 461

Dextro-transposition of the great arteries : is there Cyanosis?

Answer 461

yes

Question 462

Foot surgery additional combination block

Answer 462

Popliteal and Saphenous BLOCK

Question 463

What nerves are block with the ankle Block?

Answer 463

Super Sa Su Doctor of Podiatry Tibs
DPT (Doctor of Podiatry Tips)

Superficial peroneal
Saphenous
Sural
Deep Peroneal
Posterial tibial

Question 464

Lipid emulsion dosing

Answer 464

1.5 ML/ KG for lipid 20% over 1 minute F/ b 0.25

MAX dose 10 ml /kg

Question 465

Max pressure for classic LMA

Answer 465

60mg.

Question 466

Partial pressure of air

Answer 466

760 * 21 % = 160 mmHg

Question 467

Contraindications of Nasal intubation

Answer 467

Le fort fracture

Question 468

Hates vwf

Answer 468

Hespan

Question 469

Hespan contraindications: and max dose

Answer 469

Renal failure and anaphylactoid reaction

Max dose 20cc/kg

Question 470

Desmopressin dose

Answer 470

0.3 mcg/kg

Question 471

Anaphylactoid reactions

Answer 471

First reaction full blown reaction

Question 472

Anaphylaxis Top 1

Answer 472

NDNMBs

Question 473

Anaphylactoid reactions vs anaphylaxis

Answer 473

First reaction full blown reaction

Question 474

Propofol infusion syndrome : 1st

Answer 474

Unexplainable tachycardia  (short lived, transient) then 
PROFOUND BRADYCARDIA Resistant to treatment

Question 475

Propofol infusion syndrome what cause it

Answer 475

> 12-24 hours propofol infusion

Question 476

2 main bacteria that grows after propofol out in 6 hours

Answer 476

E. coli and pseudomonas

Question 477

Rule of 3 for UTERUS relaxation

Answer 477

3 units IVP

wait 3 minutes (is uterus still boggy ) yes (repeat 3 times)

Question 478

Methergine IM or IV? what is the dose

Answer 478

IM, 0.2 mg

Question 479

Hypertensive patients : hemabate vs methergine

Answer 479

Hemabate because High blood pressure

Question 480

Hemabate releases a lot of histamine so

Answer 480

No for asthma

Question 481

A OK for

Answer 481

Atropine
Ondansetron
Ketorolac

Question 482

Amplitude is a measurement of the

Answer 482

intensity of the response to the signal.

Question 483

Latency is measured in milliseconds and represents the

Answer 483

delay in the response to the stimulus.

Question 484

The latency indicates how long it takes for the

Answer 484

signal and response to travel along the neural pathyway.

Question 485

Pt is on Phenelzine (Nardil). Her anesthetic plan should include: t

Answer 485

The avoidance of meperidine, the avoidance of indirect acting vasopressors

Question 486

Pt is on Phenelzine (Nardil). Her anesthetic plan should include:

Answer 486

The avoidance of meperidine, the avoidance of indirect acting vasopressors

Question 487

What class is phenelzine (Nardil)

Answer 487

MAOI

Question 488

The key factors determining the spread of an epidural block are the

Answer 488

Drug dose

Site of injection, and certain differences among patients.

Question 489

Pediatric The oral dose of dexmedetomidine is.

Answer 489

2-4 mcg/kg and exhibits an onset of 30-60 minutes. Intravenous infusion is usually begun with a loading dose of 1 mcg/kg over 10 minutes followed by a continuous infusion of 0.3-0.7 mcg/kg per hour.

Question 490

The intranasal dose of dexmedetomidine is

Answer 490

1-2 mcg/kg.

Question 491

Precedex 1 mcg/kg dose results in sedation in most children within 60 minutes.

Answer 491

1

Question 492

A one degree reduction in skin temperature correlates to an approximate ___ degree reduction in core body temperature.

Answer 492

0.2

Question 493

Infants COMPARED to Adults : What are the difference in O2 consumption, Closing volume, MV:FRC?

Answer 493

Higher O2 consumption
Higher closing volume
Higher MV:FRC (ie have to maintain elevated RR)
Compliant ribs and less Type 1 muscle in the diaphragm

Question 494

With aortic cross clamping, The most consistent effect is an increase in systemic vascular resistance. The blood pressure can increase by____ with an infrarenal clamp and as much as _____with a supraceliac clamp.

Answer 494

2-10%

50%

Question 495

What are probably the most commonly used adjunct analgesics in the management of both neuropathic and somatic chronic pain? Which medication is the prototype?

Answer 495

TCAs

Amitriptyline is the prototype antidepressant

Question 496

Patients treated with TCAs may have altered responses to anesthesia related drugs. An increase in CNS catecholamine levels may____-(increased/decreased) the minimum alveolar concentration (MAC) of the inhalation anes- thetics.

Answer 496

increase

Question 497

With TCAs, the Increased peripheral catecholamines may produce exaggerated responses to what kind of vasopressors? This exaggerated response is prevalent upon initial TCA administration and lasts for how long?
If a vasopressor is administered, which one is preferred?

Answer 497

indirect acting pressors such as ephedrine.4 to 6 weeks.

A direct acting drug such as phenyl- ephrine

Question 498

NE stimulates____________ to inhibit the further release of NE.

Answer 498

presynaptic alpha2-adrenergic receptors

Pal2

Question 499

Epinephrine (E) and isoproterenol stimulate

Answer 499

Presynapticl beta2-adrenergic receptors to facilitate further NE release.
EpiBet2

Question 500

The suggested spinal block height for lower extremity procedure such as a knee replacement is about

Answer 500

T12.

Question 501

Mechanism/ cause of Serotonin syndrome

Answer 501

Overstimulation of 5-HT1A and possibly also 5-HT2 receptors through an excess of serotonin precursors or agonists, increased serotonin release, reduced serotonin uptake, and decreased serotonin metabolism

Question 502

Name TCAs

Answer 502

-“end” with triptylines
- “end” with pramine
-doxepine
Amitriptyline
Desipramine Imipramine Nortriptyline Protriptyline Doxepin

Question 503

Name MAOIs

Answer 503

Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline

Question 504

SSRIs are (CeLexPaProZoLu)

Answer 504

Prozac Paxil Zoloft Luvox

Celexa Lexapro

Question 505

Hunter Serotonin Toxicity Criteria used to diagnosed

Answer 505

Serotonin syndrome

Question 506

Most important Hunter Serotonin Toxicity Criteria

Answer 506

Clonus is strongly associated with serotonin toxicity.76

Question 507

First-line therapy of treatment of serotonin syndrome is with

Answer 507

Cryproheptadine, an H1-receptor antagonist with antiserotonergic and anticholinergic properties.

Question 508

Cyproheptadine initial dose and subsequent dose. How often and what is the max?

Answer 508

Started at a dose of 12 mg orally or through a nasogastric tube.An additional 2 mg dose is given every 2 hours until symptoms improve or the maximal dose of 32 mg has been reached. The usual maintenance dose of cyproheptadine is 8 mg three times daily.

Question 509

Cyproheptadine, the first line of treatment for serotonin syndrome is what class of drug?

Answer 509

H1-receptor antagonist

Question 510

Because of the risk of serotonin syndrome, serotonergic drugs and MAOIs should not be used together or within how long of each other?

Answer 510

2 weeks of each other.

Question 511

Antimicrobial agents with MAOi activity

Answer 511

linezolid (Zyvox)

Question 512

Serotonergic drugs used for cough

Answer 512

he cough suppres- sant dextromethorphan, sumatriptan (Imitrex, and generics),

Question 513

Serotonergic drugs used for pain

Answer 513

Tramadol

Methadone

Question 514

Herbal with seronertic active

Answer 514

St John’s Wort

Question 515

Normal Lithium level

Answer 515

For acute treatment, target serum concentrations are 0.8 to 1.2 mEq/L.

Question 516

Warfarin should NOT be used past how many weeks of gestation?

Answer 516

36 weeks gestation

Question 517

inability to adduct the legs? damage to

Answer 517

Obturator

Question 518

Caudal block concentration is

Answer 518

0.175% bupivacaine

Question 519

Pregnancy produces an increase in the minute ventilation and a decrease in the functional residual capacity. That, combined with a decrease in MAC, results in both a

Answer 519

faster inhalation induction AND a faster emergence from anesthesia.

Question 520

The MAC generally begins to decrease by the____or _____week of pregnancy.

Answer 520

8th or 10th

Question 521

For Bier Block, To avoid a rapid bolus of intravenous local anesthetic that could result in local anesthetic toxicity, the tourniquet should remain inflated for a minimum of _____mns.

Answer 521

20 minutes.

Question 522

For Bier block, If 40 minutes has elapsed, the tourniquet can be deflated in a single maneuver. If the duration is between 20 and 40 minutes, the tourniquet should be

Answer 522

deflated, reinflated immediately, and then deflated 1 minute later to prevent the rapid absorption of local anesthetic into the circulation.

Question 523

A decrease in amplitude by _____percent or an increase in latency by _____percent commonly define a significant change in SSEPs.

Answer 523

DA50%IL10% (Decrease Amplitude 50% and Increased Latency 10%)

Question 524

The maximum recommended bupivacaine dose for caudal or epidural injection is ___ mg/kg in neonates and ___ mg/kg in older children

Answer 524

2; 4

Question 525

For Ductus Arteriosus Circulating __________ cause the muscle in the ductus to relax, promoting the continued patency of the ductus.

Answer 525

prostaglandins

Question 526

For Ductus Arteriosus, the administration of ____________, can block this effect and allow the muscle to contract and close the ductus arterioles

Answer 526

Indomethacin, a prostaglandin inhibitor

Question 527

The alveoli and pulmonary vasculature are not mature enough to produce acceptable gas exchange until about _____weeks gestation.

Answer 527

24 to 26 weeks gestation

Question 528

With the first breaths after delivery, the alveoli rapidly convert from being filled with _______ to being filled with _____

Answer 528

being filled with fluid to being filled with air

Question 529

The infant will generate a ________(positive/negative) intrathoracic pressures between_____and _____cm H20 in order to expand the alveoli and clear them of fluid.

Answer 529

negative 40 and 60 cm H2O

Question 530

Within about _____minutes of delivery, the infant will have established a 3 things?

Answer 530

20 minutes
Normal ventilatory pattern
Stable blood gases
Near normal functional residual capacity.

Question 531

For every 1 degree Celsius that the core body temperature decreases, the cerebral metabolic rate of oxygen consumption _____by how much>

Answer 531

Decreases by 8%

Question 532

Which is the MOST SINGLE effective maneuver to increase Pa02 during one-lung ventilation?

Answer 532

Application of CPAP to the nondependent lung

Question 533

Midazolam pediatric PO dose

Answer 533

0.5 mg/kg

Question 534

Propofol and remifentanil are dosed based upon

Answer 534

LBW.

Question 535

Hepatic mass does decrease with age, but the clearance of drugs with a high hepatic extraction ratio relies on

Answer 535

hepatic blood flow not hepatic mass. Hepatic blood flow decreases by as much as 40% by 80 years of age.

Question 536

Hepatic blood flow decreases by as much as

Answer 536

40% by 80 years of age.

Question 537

The segmental spread of an epidural relies primarily upon the _______ and the ______ This is in contrast to spinal anesthesia, which relies more on the

Answer 537

Epidural Spread EDS
Dose of local anesthetic solution used
Site of injection

Spinal Spread (SDBP)
Dose in milligrams of the local anesthetic
Baricity of the solution
Position to determine the spread of the anesthetic.

Question 538

Prior to a Bier block, the tourniquet should be inflated to

Answer 538

300 torr or 2.5 times the patient’s systolic blood pressure.

Question 539

Naloxone dose for fetus at risk for respiratory depression

Answer 539

0.1 mg/kg

Question 540

The ability of newborns to metabolize amide local anesthetics is underdeveloped until about _____ of age.

Answer 540

3 months

Question 541

Succinylcholine dosing for obese based on _______and NDNMB agents dosing for obese based on

Answer 541

TBW for succinylcholine

LBW for NDNMB agents

Question 542

LA that is no longer used for obstetric epidurals because of the higher risk for local anesthetic systemic toxicity.

Answer 542

Bupivacaine

Question 543

Emergence delirium in children between the ages of 2 and 6 years is most common with which VA?

Answer 543

Sevoflurane

Question 544

The neonatal response to hypoxia is typically a short period of _____ followed by _____.

Answer 544

Hyperventilation to Hypoventilation

Question 545

GOC TIM are all typically repaired within the first week following delivery

Answer 545

Gastroschisis
Omphalocele
Congenital diaphragmatic hernia
Tracheoesophageal fistula
Intestinal obstruction
Myelomeningocele

Question 546

The most common congenital primary neural tube defect is

Answer 546

meningomyelocele.

Question 547

Leading cause of maternal death WORLWIDE?

Answer 547

postpartum hemorrhage

Question 548

Compare to an adult with a TV around 7 mL/kg, the tidal volume of an infant is

Answer 548

similar to that of an adult

Question 549

When should chest compressions be initiated in the neonate?

Answer 549

< 60

Question 550

What is the peak onset of heparin for normothermic patients?

Answer 550

<5 minutes

Question 551

You plan to administer acetaminophen to a pediatric patient as part of the postoperative analgesia plan. You know that the maximum dose is _____ in a 24 hour period.

Answer 551

100mg/kg

Question 552

High tracheal resection patient position?

Answer 552

Patient should be kept in the head-down position to prevent aspiration of blood and surgical debris during

Question 553

The 2 hormones in the mother create a tendency towards hyperglycemia and ketosis.

Answer 553

lactogen and cortisol in the mother

Question 554

Emery-Dreifuss syndrome is also a milder form of muscular dystrophy in which the primary concern is

Answer 554

cardiac conduction defects and resulting syncope. In these patients, a preoperative echocardiogram and electrocardiogram are warranted

Question 555

You are preparing to perform a Bier block. After starting an IV in the dorsum of the hand, placing a double pneumatic tourniquet on the arm and exsanguinating the extremity with an Eschmark bandage, you should inflate which cuff first? Then what is inflated?

Answer 555

DISTAL. (in alphabet, D before P)
The distal cuff is inflated first followed by the proximal cuff. The distal cuff is then deflated to allow the area under it to become anesthetized. If the proximal cuff of the tourniquet becomes too painful for the patient to tolerate, the distal cuff can be inflated and then the proximal cuff deflated to allow the surgeon more time to complete the procedure.

Question 556

For children younger than 8 years, the formula for IBW in kilograms is:

Answer 556

IBW = 2 X Age in years + 9.

Question 557

For children 8 years of age or older, the formula for IBW in kilograms is: IBW =

Answer 557

3 X Age in years.

Question 558

The decrease in total body water that occurs with aging is primarily due to

Answer 558

Decrease in muscle mass

Question 559

Select two prominent peripheral vasodilators that are effective in the treatment of postoperative hypertension in cardiac surgical patients.

Answer 559

Nicardipine

Nifedipine

Question 560

Latex allergy can be either a type ___hypersensitivity reaction to chemicals used in latex rubber processing or a type _____ immediate hypersensitivity reaction with_____antibodies formed in response to latex rubber protein.

Answer 560

IV
I
IgE

Question 561

SLE Clinical manifestations include AVM

Answer 561

althralgias, vasculitis and malar rash on the face.

Question 562

What type of allergic reaction: Systemic lupus erhthematosus, serum sickness after a snake bite

Answer 562

Type III Immune complex mediation reaction

Question 563

What type of allergic reaction: serum sickness after a snake bite

Answer 563

Type III Immune complex mediation reaction

Question 564

What type of allergic reaction: Contact sensitivity to poison ivy and metals (jewelry)

Answer 564

Type IV Cell mediation reaction

Question 565

What type of allergic reaction:graft-vs-host reaction

Answer 565

Type IV Cell mediation reaction

Question 566

What type of allergic reaction: Autoimmune thrombocytopenic purpura,

Answer 566

Type II Tissue specific reaction

Question 567

What type of allergic reaction :Graves disease

Answer 567

Type II Tissue specific reaction

Question 568

What type of allergic reaction: Autoimmune hemolytic anemia

Answer 568

Type II Tissue specific reaction

Question 569

What type of allergic reaction: ABO incompatibiliy

Answer 569

Type II Tissue specific reaction

Question 570

What type of allergic reaction Seasonal allergic rhinitis, Anaphylaxis

Answer 570

Type I IgE mediated reaction

Question 571

hallmark is morning stiffness that generally improves with activity. The joints are painful, swollen and warm.

Answer 571

Rheumatoid Arthritis

Question 572

Anaphylaxis causes degranulation of:

Answer 572

Mast cells and basophils

Question 573

What forms of insulin are considered intermediate-acting? (select two)

Answer 573

Human NPH

Lente

Question 574

The incidence of heparin-induced thrombocytopenia is higher

Answer 574

in patients receiving bovine heparin

Question 575

Most common functioning tumor of the pancreas?

Answer 575

Insulinoma

Question 576

What is the cardinal feature of myxedema coma?

Answer 576

Hypothermia

Question 577

Renal failure ______calcium, _____phosphate

Answer 577

Low calcium HIGH phosphate

Question 578

Disulfiram and Alcohol.

Answer 578

inhibits aldehyde dehydrogenase. When alcohol is ingested, acetaldehyde accumulates and produces nausea, vomiting, flushing, diaphoresis, and vertigo.

Question 579

Chronic RF signs consistent with the diagnosis DHS

Answer 579

Hypertension, Dyslipidemia

Silent myocardial ischemia

Question 580

Chronic Renal Failure Electrolyte disturbances:

Answer 580

HIGH MKP

LOW Cal

Question 581

The cardiovascular effects of chronic kidney disease (CKD) are primarily the result of

Answer 581

sodium and water retention.

Question 582

What is the most significant Risk factor for CKD because it contributes to the increased risk for congestive heart failure, coronary artery disease, and cerebrovascular disease seen in patients with CKD.

Answer 582

Congestive heart failure
Coronary artery disease, and c
Cerebrovascular disease seen in patients with CKD.

Question 583

What is the most significant Risk factor for CKD because it contributes to the increased risk for

Answer 583

Congestive heart failure
Coronary artery disease, and c
Cerebrovascular disease seen in patients with CKD.

Question 584

Addison’s disease : Signs and symptoms.

Answer 584

Weakness, Anorexia, Nausea, Vomiting (WANV)
hyperpigmentation
chronic hypotension
hypovolemia
hyponatremia, and hyperkalemia

Question 585

The only metabolite increase with Addison’s disease is

Answer 585

POTASSIUM (hyperkalemia)

Question 586

BP of Addison’s disease and BV

Answer 586

chronic hypotension
hypovolemia
hyponatremia

Question 587

HYPOCALCEMIA QT

Answer 587

prolonged QT interval

muscle spasms, hypotension, and decreased responsiveness to beta agonist

Question 588

HYPERCALCEMIA : QT and PR.

Calcium short quart and Long pickle

Answer 588

SHORT QT , LONG PR

Question 589

Which condition would be most likely to occur as a result of lithium therapy?

Answer 589

Hypothyroidism

Question 590

Tumor Lysis Syndrome : Elevated levels of (PUP)

Answer 590

Phosphate
Uric acid
Potassium

Question 591

Difficult intubation official definition

Answer 591

3 attempts with a trained provider OR intubation taking

10 minutes or more.

Question 592

BONES DIFFICULT MAS

Answer 592

BEARD
OBESITY
NO TEETH
ELDERLY 
SNORES

Question 593

CAN’T INTUBate can’t ventilate: sugammadex dosing.

Answer 593

Sugammadex 16 mg/kg

Question 594

Prayer sign :

Answer 594

Hypothyroidism (hypocalcemia)

Question 595

Cricoid pressure to apply while they are awake

Answer 595

Start at 10N while they are awake

Question 596

ASA closed claim study % of respiratory events

Answer 596

34% adverse respiratory events

Question 597

Point of insertion of the tongue

Answer 597

Mandible AND hyoid bones

Question 598

Prognathia bad grade

Answer 598

C

Question 599

During nasal intubation, The ETT should be inserted

Answer 599

PARALLEL to the roof of the mouth. SHOULD NOT BE DIRECTED Upwards into the turbinates rather along the floor of the nose formed by the superior aspect of the palatine bone

Question 600

Mandibular protrusion test scoring (1-2-3)

Answer 600

Move past upper lip is Class I
Align with upper lip is Class II
unable to perform class III

Question 601

Awake intubation , first drug to administer

Answer 601

GLYCOPYRROLATE (dry up secretions) give it early about 30 minutes

Question 602

Prognathia test scoring (ABC)

Answer 602

Move past upper lip is Class A
Align with upper lip is Class B
unable to perform class C

Question 603

Angioedema seen order

Answer 603

FFP

Question 604

FRC is _____ml

Answer 604

2500

Question 605

Dose based on weight for mendelson’s syndrome

Answer 605

0.4 ml/kg

Question 606

3 drugs for mendelson’s syndrome

Answer 606

famotidine
reglan
Bicitra

Question 607

Pepcid works on

Answer 607

Parietal cells

Question 608

H2 blockers with CYP

Answer 608

Inhibit

Question 609

Tagamet will affect

Answer 609

CYP 450 and inhibit, give Pepcid instead

Question 610

Reusing LMA (which law)

Answer 610

Deflate before you sterilized (Boyles)

Question 611

Glidescope curve

Answer 611

60 degrees

Question 612

Retrograde intubation (r”Ce”)

Answer 612

45 degree toward hear CEPHALAD

Question 613

Cricothyroidomy intubation degrees

Answer 613

45 degrees toward CAUDAL (CRI-CAUD)

Question 614

Heparin MOA

Answer 614

Binds to AT III and thrombin

Question 615

Cardiac dose of heparin for CPB

Answer 615

Heparin 300-400 units/kg

Question 616

ACT > is needed for CPB

Answer 616

400

Question 617

Protamine Sulfate

Answer 617

Profound pulmonary Edema

Question 618

Joules to administer directly to heart

Answer 618

10-12 J

Question 619

Do not give until patient is

Answer 619

decannulated

Question 620

WIth stents, bare metal

Answer 620

30 days

Question 621

WIth stents, drug eluting stents

Answer 621

6 months

Question 622

5 days of enoxoparin

Answer 622

bridging

Question 623

CPP formula

Answer 623

Aortic DBP - LVEDP

Question 624

CPP autoregulation

Answer 624

60-140 mmhg

Question 625

Tetralogy spell

Answer 625

Tet spells : Push on the belly and KNEE TO CHEST position

Question 626

CPB maintenance The mixed venous O2 saturation should be monitored and maintained at

Answer 626

70%.

Question 627

How do you know rewarming completed
Nasopharyngeal temperature_________
b. Rectal/bladder temperature________

Answer 627

36°C to 37°C

≥ 35°C, but ≤ 37°C

Question 628

Giving protamine over a period of 10 to 15 minutes will decrease the probability of both.

Answer 628

type I (systemic vasodilation-histamine release) and type III (pulmonary vasoconstriction- delayed anaphylactoid) protamine reactions.

Question 629

However, an anaphylactic reaction (type II) can occur at any rate of administration of

Answer 629

Protmaine sulfate

Question 630

Alpha angle of TEG

Answer 630

Rate of Clot formation

Question 631

Max amplitudee

Answer 631

50-73 mm

Question 632

The normal dose of protamine is

Answer 632

1 mg of protamine to reverse every 100 units of heparin that was given.

Question 633

Factors produced by CryoprecipitateL

Answer 633

Fibronectin
fibrinogen
Factor XIII

Question 634

Trauma patients give those :

Answer 634

5 PRBCs
5 FFPs
5 Platelets

Question 635

After group of 5 plus, RBCs, FFPs.

Answer 635

Fibrinogen level, if less than 200, give CRYOPRECIPITATE (some people say < 150).

Question 636

First indicator of transfusion reaction

Answer 636

Urine color change

Question 637

Pain from unpainful things

Answer 637

Allodynia (fibromyalgia)

Question 638

Cation for pain

Answer 638

K and Calcium

Question 639

Succinylcholine and burn when you can’t give and when you can give

Answer 639

Past 24 hours don’t give

Wait 1 year then you can give

Question 640

Duschenne carried by

Answer 640

Female , pass on to male children

Question 641

Normal IOP

Answer 641

20 mmHg

Question 642

Lateral , medial, movement of eye

Answer 642

3, 4, 6

Question 643

Cuff in sitting

Answer 643

never in the lower extremity

Question 644

Pain transmission fibers

Answer 644

A delta (SHARP nociception)
A -beta
C fibers (dull, throbbing pain)

Question 645

Octreotide Too quickly for carcinoid

Answer 645

Bradycardia

Question 646

Aminoglycosies associated with

Answer 646

Ototoxicity

Question 647

Furosemide max mg per minutes

Answer 647

20 mg/min

Question 648

Furosemide associated with

Answer 648

Ototoxicity

Question 649

Blocks prostaglandins meds

Answer 649

NSAIDs

Dexamethasone

Question 650

MA (maximal amplitude):

Answer 650

50-60 mm

Question 651

R (reaction time):

Answer 651

measures from time zero to the beginning of clot formation

Question 652

Rep isor liquitor

Answer 652

Things speak for itself.

Question 653

Tolerance to the analgesic, sedative, and emetic effects of opioids may occur, but the _______and ______seen with opioid use is unlikely to be affected by tolerance to the drugs.

Answer 653

MIOSIS and CONSTIPATION

Question 654

Which factor deficiency is associated with persons descended from the Ashkenazi Jewish population of Eastern Europe?

Answer 654

Factor XI

Question 655

Factor XI deficiency PTT and PT

Answer 655

The PTT is prolonged and the PT is normal

Question 656

Factors associated with an increased risk for postoperative ventilation following thymectomy include:

Answer 656

daily pyridostigmine dose greater than 750 mg
disease duration greater than 6 years, COPD
a negative inspiratory pressure less than -25 cm H2O, and a vital capacity less than 2.9 L.

Question 657

The symptoms of organophosphate poisoning are similar to the effects of cholinesterase inhibitors and the treatment of choice for this condition is

Answer 657

Atropine.

Question 658

Factor IX has a half-life of __________As a result, doses may need to be repeated to sustain sufficient factor IX levels.

Answer 658

18-24 hours.

Question 659

II (prothrombin), factor V, or factor X are rare, autosomal recessive diseases. Patients with severe deficiencies will exhibit prolongation of

Answer 659

both the prothrombin time (PT) and the partial thromboplastin time (PTT).

Question 660

Hypercalcemia QT and PR

Answer 660

SQPP (Short Q, Prolonged PR)

Question 661

Where are T-helper lymphocytes predominantly located?

Answer 661

Lymph nodes

Question 662

The treatment for patients with an overdose to cocaine should include the management of myocardial ischemia through the administration of an alpha-adrenergic antagonist such as

Answer 662

phentolamine or a nitrate such as nitroglycerin or nitroprusside. Administering a beta-blocker can result in cardiac decompensation by decreasing myocardial contractility in the face of an elevated afterload.

Question 663

The treatment for patients with an overdose to cocaine should include the management of myocardial ischemia through the administration of an alpha-adrenergic antagonist such as

Answer 663

phentolamine or a nitrate such as nitroglycerin or nitroprusside. Administering a beta-blocker can result in cardiac decompensation by decreasing myocardial contractility in the face of an elevated afterload.

Question 664

In patients with hypothyroidism, the administration of alpha agonists such as phenylephrine coulde.

Answer 664

substantially increase the systemic vascular resistance against a heart that has limited capacity to compensate by increasing its contractility. The best option for these patients is to administer epinephrine, ephedrine, or dopamin

Question 665

Vasopressor of choice for Hypothyroidism patient?

Answer 665

EPHEDRINE

Question 666

Metabolic/ Electrolyte disturbance associated with hypoaldosterone?

Answer 666

Hyperchloremic metabolic acidosis

Question 667

mainstay of treatment of disseminated intravascular coagulation is the administration of

Answer 667

FFP

Question 668

Phenoxybenzamine administration can produce _________The recommended treatment is beta-blockers.

Answer 668

tachyarrhythmias. beta-blockers.

Question 669

In thalassemia what is the major problem?

Answer 669

The alteration in globin chain synthesis results in the production of defective red blood cells in the bone marrow.

Question 670

In thalassemia there is what with RBCs?

Answer 670

clearance of red blood cells (hemolytic anemia).

Question 671

Hypo(n)aldosteronism Side effects are : 1 hypo

Answer 671

Hyperkalemia

hyponatremia, hyperchloremic metabolic acidosis, and often, hyperglycemia.

Question 672

Typically, the administration of 15-20 mL/kg of FFP will increase the factor levels by about 20-30%.

Answer 672

20-30%.

Question 673

Addison’s disease is a

Answer 673

autoimmune destruction of the adrenal glands causing a decrease in glucocorticoid and mineralocorticoid production.

Question 674

This results in

Answer 674

hyperpigmentation
hyperkalemia
increased urinary sodium excretion
decreased androgen production.

Question 675

Patients with Cushing’s disease have increased serum cortisol levels resulting in

Answer 675

hypokalemia, hyperglycemia, and skeletal muscle relaxation which may require a DECREASED non-depolarizing muscle relaxant dose.

Question 676

Initial signs and symptoms of Duchenne muscular dystrophy are due to the effect of the disease on

Answer 676

weakness in the proximal skeletal muscle groups and manifest as an alteration in gait, difficulty climbing stairs, and frequent falls

Question 677

What are 2 significant risks in hyperglycemic hyperosmolar syndrome?

Answer 677

Intravascular coagulation

Mesenteric thrombosis

Question 678

The four subtypes of schizophrenia are:

Answer 678

1. Disorganized 2. Catatonic 3. Paranoid 4. Undifferentiated

Question 679

In DKA, Hyperglycemia results in

Answer 679

hyponatremia
hypophosphatemia
hypokalemia
hypomagnesemia.

Question 680

In all muscular dystrophies, there is a symmetric atrophy of skeletal muscle tissue, however, there is no

Answer 680

denervation of skeletal tissue, meaning that sensation and reflexes are intac

Question 681

Competitive alpha-1 and alpha-2 receptor antagonist used primarily in the preoperative treatment of pheochromocytoma.

Answer 681

Phentolamine

Question 682

You know that the half-life of desmopressin is approximately

Answer 682

12-24 hrs

Question 683

What is the treatment of choice in the U.S. for factor XI deficiency?

Answer 683

FFP; Factor XI concentrate is not available in the United States, so the treatment of choice in patients with active bleeding is fresh frozen plasma.

Question 684

What is the other name for hypothyroidism?

Answer 684

Myxedema

Question 685

Nonselective alpha-antagonist agents used to manage pheochromocytoma.

Answer 685

Phentolamine

Phenoxybenzamine

Question 686

Concomitant condition is most closely associated with thalassemia?

Answer 686

Splenomegaly

Question 687

Primary adrenal insufficiency (Addison’s) results in the inadequate release of

Answer 687

glucocorticoid, mineralocorticoid, and androgen hormones. (think add 2)

Question 688

Cause of Graves’ disease?

Answer 688

Thyroid-stimulating antibodies

Question 689

Which of the following conditions is associated with chronic renal failure?

Answer 689

hyperlipidemia

HYPOCALCEMIA and elevated potassium, magnesium, and phosphate levels. (PMPlipids)

Question 690

The hypokalemia associated with hyperaldosteronism can result in

Answer 690

skeletal muscle weakness and potentiation of nondepolarizing muscle relaxants.

Question 691

Which clotting factor mechanically stabilizes fibrin to help protect it from fibrinolysis?

Answer 691

Factor XIII

Question 692

The sphincter of Oddi is located where the ______And _______ meet to empty into the ______

Answer 692

common bile duct and pancreatic duct meet to empty into the duodenum. (CPD)

Question 693

Hepatocytes synthesize all of the clotting factors except

Answer 693

von Willebrand factor and factor VIIIC.

Question 694

Prothrombin complex concentrates contain a concentration of factors.

Answer 694

II, VII, IX, and X

Question 695

Transfusion-related acute lung injury is more likely to occur when the donated blood is from

Answer 695

a female donor

Question 696

Chemo drugs that can lead to both produce renal and hepatic dysfunction.

Answer 696

Methotrexate

Question 697

Doxarubicin (Adriamycin) can result in cardiomyopathy and congestive heart failure.

Answer 697

cardiomyopathy and congestive heart failure.

think DoxCARDIArubicin

Question 698

Cyclophosphamide is an alkylating agent that can produce ______ and ______

Answer 698

pulmonary toxicity and pulmonary fibrosis

CycloPULMphosphamide

Question 699

Paclitaxel is a taxane that can produce

Answer 699

peripheral neuropathy.

Question 700

2 common cardiac side effects of tricyclic antidepressants are (select two)

Answer 700

TACHYCARDIA and orthostatic hypotension.

Question 701

Metformin (a biguanide) MOA

Answer 701

enhance tissue sensitivity to insulin

decreases hepatic glucose production

Question 702

Alpha-glucosidase inhibitors MOA

Answer 702

DECREASE postprandial glucose absorption.

Question 703

Requires tyramine-free diet what kind of mediation

Answer 703

MAOI

Question 704

Can produce polyuria medication for bipolar

Answer 704

Lithium

Question 705

The organisms responsible for most surgical site infections are

Answer 705

staphylococcus aureus and staphylococcus epidermidis.

Question 706

Enteral feedings should be discontinued how long preoperatively?

Answer 706

6 hours preoperatively

Question 707

Total parenteral nutrition (TPN) should be continued

Answer 707

perioperatively. If TPN is to be discontinued at all, it should be decreased gradually over 60-90 minutes to avoid hypoglycemia.

Question 708

Insulin preparation has the fastest onset time when administered subcutaneously?

Answer 708

Lispro

Question 709

The most serious immediate effects of diabetes insipidus are

Answer 709

hypovolemia and hypernatremia

Question 710

Fludrocortisone is primarily administered for its ______ properties.

Answer 710

mineralocorticoid properties

Question 711

2 opioid receptors are most responsible for producing respiratory DE(UX)pression? (select two)

Answer 711

Mu 2

Kappa

Question 712

The Mu-1 and kappa receptors both produce

Answer 712

miosis.

Question 713

Which local anesthetic would have the fastest onset when used on the oral mucosa?

Answer 713

Benzocaine

Question 714

A panendoscopy includes what 3 procedures?

Answer 714

laryngoscopy, bronchoscopy, and esophagoscopy.

Question 715

During a panendoscopy, To provide adequate visualization for the surgeon, intubation with a

Answer 715

microlaryngeal tube may be used as can jet ventilation.

Question 716

Carotid body chemoreceptor stimulation produces an

Answer 716

increase in vasomotor tone and ventilatory activity.

Question 717

What are 4 signs of mesenteric traction syndrome? which is caused by the release of vasoactive amines (principally prostacyclin) from the vascular bed of the mesentery. As a result, serum prostaglandin levels increase substantially. Non-steroidal anti-inflammatory agents such as aspirin and ketorolac ameliorate these symptoms. Stimulation of the vagus nerve will often cause bradycardia and hypotension, but would not result in hyperemia or hypoxia. Occult blood loss would typically result in tachycardia and hypotension, and possibly hypoxia if severe, but hyperemia would not be present. Norepinephrine release (although not associated with mesenteric traction) would result in bradycardia and hypertension.

Answer 717

Hypotension, tachycardia, cutaneous hyperemia, and hypoxia

Question 718

What are 4 signs of mesenteric traction syndrome?

Norepinephrine release (although not associated with mesenteric traction) would result in bradycardia and hypertension.

Answer 718

Hypotension, tachycardia, cutaneous hyperemia, and hypoxia

Question 719

Mesenteric traction syndrome is caused by the ____what increase?

Answer 719

Release of vasoactive amines (principally prostacyclin) from the vascular bed of the mesentery. As a result, serum prostaglandin levels increase substantially.

Question 720

Norepinephrine release (although not associated with mesenteric traction) would result in (HR and BP)

Answer 720

bradycardia and hypertension.

Question 721

Renal parameter increased in obesity?

Answer 721

GFR

Question 722

Midthoracic levels of neuraxial anesthesia typically leave the tidal volume, respiratory rate, minute ventilation, PaO2, and PaCO2 levels largely

Answer 722

unaffected.

Question 723

To achieve their maximum effectiveness, how long prior to induction of anesthesia should an antacid such as sodium citrate be administered?

Answer 723

15-30 minutes

Question 724

Cessation for ____ weeks prior to general anesthesia produces a substantial decrease in the risk for postoperative pulmonary complications.

Answer 724

8

Question 725

Because normalization of mucociliary function takes ______weeks and sputum production increases during that time, cessation for less than ____weeks may increase the risk for postoperative pulmonary complications.

Answer 725

2-3 ; 4

Question 726

Carbon monoxide levels can be up to ____ times normal in smokers, but can return to normal within ____hours, thus improving oxygenation.

Answer 726

10; 24

Question 727

A patient who exhibits an anaphylactic reaction to propofol on their first exposure to the drug most likely was sensitized previously to

Answer 727

the diisopropyl radicals in dermatologic agents

Question 728

The only cells in the renal tubules that do not synthesize ammonia to be used in the buffer system are the epithelial cells in the

Answer 728

Loop of Henle

Question 729

increased BUN:creatinine ratio is consistent with

Answer 729

Decreased Blood volume

Question 730

expected genitourinary effect of morphine is

Answer 730

. increased urinary sphincter tone

Question 731

Expected genitourinary effect of morphine is

Answer 731

increased urinary sphincter tone

Question 732

The osmolarity of the solutions are: From high to Low LR, NS, D5W , D5LR

Answer 732

D5LR (525 mOsm/L),
D5W (252 mOsm/L),
LR ((273 )
NS ((154 mOsm/L)

Question 733

A tracheostomy mask is considered to be a

Answer 733

LOW capacity

Question 734

Side effect is most associated with topiramate administration?

Answer 734

Paresthesias

Question 735

Cyclical response to pain that produces an abnormal pain response and chronic pain sensation is known as

Answer 735

Windup

Question 736

Hepatic blood flow can decrease substantially during abdominal surgery. This is most likely due to

Answer 736

PROSTAGLANDINS release

Question 737

The volatile agents ________ hepatic blood flow and oxygenation primarily by

Answer 737

increase ;

by increasing blood flow through the portal circulation.

Question 738

ncreased pulmonary vascularity and a normal heart size on chest x-ray in a patient with blunt chest trauma could be indicative of a

Answer 738

ventral septal defect caused by trauma.

Question 739

Retrobulbar and peribulbar block would not be indicated for a patient who is

Answer 739

anticoagulated.

Question 740

What is the ovoid-shaped filamentous protein found in cardiac muscle?

Answer 740

actin

Question 741

According to U.S. standards, the maximum contact surface temperature a forced-air device cannot exceed

Answer 741

48 degrees Celsius.

Question 742

Medications to decrease portal pressures include

Answer 742

nonselective beta-blockers, vasopressin, and somastatin.

Question 743

Is calcium increase or decrease in renal failure?

Answer 743

Decrease

Question 744

This medication can cause naloxone-resistant respiratory depression

Answer 744

buprenorphine

Question 745

What alteration in anesthetic response would you expect to see in a patient who suffers from Conn’s syndrome (hyperaldosteronism)?

Answer 745

Decreased nondepolarizing muscle relaxant dose requirements

Question 746

When performing a controlled hypotension technique, which of the following agents would be best suited for a patient with a history of congestive heart failure?

Answer 746

Nitroprusside

nitroprusside is best suited for the preservation of cardiac output.

Question 747

Specific gravity refers to the The normal specific gravity of CSF is between 1.004 to 1.009. When the two specific gravities are equal, the baricity is equal to 1.0.

Answer 747

density of a substance compared to that of water.

Question 748

Baricity is the ratio of the

Answer 748

specific gravity of the local anesthetic to that of CSF

Question 749

Largest interlaminar space?

Answer 749

L5

Question 750

The level of activity in the reticular activating system is primarily determined by the

Answer 750

amount of sensory information from the body

Question 751

The musculocutaneous nerve is situated between the

Answer 751

pectoralis major and coracobrachialis muscles

Question 752

The risk for dural puncture, vascular injury, and neural damage is greatest when performing

Answer 752

cervical epidural blocks

Question 753

Which herbal agent would disrupt platelet aggregation for the longest period of time after discontinuation?

Answer 753

Garlic

Question 754

Umbilical area is directly anterior to which vertebra?

Answer 754

L3

Question 755

What two factors are the primary determinants of the duration of action of a spinal anesthetic? (select two)

Answer 755

The specific drug used

Question 756

What two factors are the primary determinants of the duration of action of a spinal anesthetic? (select two)

Answer 756

The specific drug used

The dose of the drug given

Question 757

What is the appropriate volume of 1:1000 epinephrine to add to a spinal anesthetic to prolong the duration of the block?

Answer 757

0.1-0.2 mL

Question 758

Total lung capacity and OBESITY

Answer 758

Decreased TLC

Question 759

What is the primary advantage of using an Andrews frame for lumbar spine surgery?

Answer 759

Decrease bleeding

Question 760

Sciatic divides into (SCT)

Answer 760

Common perineal Nerve

Tibial nerve

Question 761

A properly performed popliteal block will anesthetize which of the following nerves? (select four)
SUdeepTico

Answer 761

Common peroneal nerve
Tibial nerve
Deep peroneal nerve
sural nerve

Question 762

A cold laser may be used in the treatment of

Answer 762

carpal tunnel syndrome.

Question 763

The term laser is actually an acronym that stands for LASER

Answer 763

Light 
Amplification
Stimulated 
Emission
Radiation.

Question 764

What is the only additive to the local anesthetic for a Bier block that has been proven effective?

Answer 764

ketorolac

Question 765

Approximately how much cerebrospinal fluid is normally contained in the subarachnoid space of the spinal canal?

Answer 765

80-120 mL

Question 766

Kahler disease is also known

Answer 766

Multiple Myeloma

Question 767

What two muscles form the crease in the axilla in which the ultrasound probe is placed during an ultrasound-guided axillary block?

Answer 767

Pectoralis major

Biceps

Question 768

Which one of the following metabolic reactions is typically enhanced in obese patients?

Answer 768

Conjugation

Question 769

Following weight loss drugs is a serotonin antagonist?

Answer 769

Lorsacerin

Question 770

Shock index (SI) formula?

Answer 770

Heart rate/systolic blood pressure

Question 771

Alcoholic hepatitis is characterized by the combination of he

Answer 771

liver dysfunction and jaundice with a history of excessive alcohol use.

Question 772

Alcoholic hepatitis AST is typically elevated more than the ALT, with most patients exhibiting an AST/ALT ratio

Answer 772

greater than 2.

Question 773

The estimated blood volume for an obese patient should be calculated as ____ mL/kg.

Answer 773

50

Question 774

drug distributes equally to both lean and adipose tissues, then its loading dose should be calculated based on the patient’s

Answer 774

TBW

Question 775

In fact, a mean PA pressure greater than 50 mmHg is considered an absolute contraindication to

Answer 775

liver transplant surgery.

Question 776

Which spinal segments supply parasympathetic innervation to the ureters?

Answer 776

S2-S4

Question 777

The hallmark signs that help identify diabetes insipidus are a urine specific gravity

Answer 777

less than 1.005 and a urine osmolality of 200 mOsm/kg or less.

Question 778

The half-life of thyroxine (T4) in the circulation is:

Answer 778

6-7 days

Question 779

Although this patient exhibits symptoms associated with epiglottitis, the diagnosis is a misnomer. The patient with epiglottitis actually suffers from

Answer 779

generalized irritation and severe edema of all of the supraglottic structures.

Question 780

The defining characteristic of oliguric acute kidney injury (AKI)?

Answer 780

<400ml/day

Question 781

Factors that are elevated in obese patients.

Answer 781

Fibrinogen
factors VII, VIII, von Willebrand factor,
plasminogen activator inhibitor

Question 782

Forces that moves fluid from the capillary to the interstitium?

Answer 782

Capillary hydrostatic Pressure

Interstitial Oncotic pressure

Question 783

Forces that moves fluid from the interstitium to the capillary?

Answer 783

Interstitial Hydrostatic pressre

Plasma Oncotic pressure

Question 784

Net filtration pressure =

Answer 784

(Pc-Pif) (πc - πif)

Question 785

The Brice Questionnaire is used to assess for

Answer 785

intraoperative awareness

Question 786

What is the preferred procedure for MID-ureteral and distal stones that have been UNsuccessfully treated with conservative management. URS is also recommended in patients for whom stopping anticoagulation is not possible.

Answer 786

URS

Question 787

Portal triad clamping is effective in reducing blood loss during a hepatic resection. What structures would be occluded during this procedure? (select three)The portal triad is actual a misnomer as it contains five structures:
Hepatic A-PV : CBD-lymph-branch

Answer 787

Hepatic artery
Hepatic portal vein
Common bile duct
Lymphatic vessels
Branch of the vagus nerve.

Question 788

most serious immediate effects of diabetes insipidus are

Answer 788

Hypovolemia AND Hypernatremia

Question 789

During which phase of a liver transplant surgery would you expect to see the greatest degree of hemodynamic instability? Reperfusion of which structure is hard?

Answer 789

NEOHEPATIC
Reperfusion of the vena cava is usually well tolerated, but reperfusion of the PORTAL VEIN is associated with a drop in the systemic vascular resistance that is even greater than that seen with vena cava cross-clamp. Severe bradycardia may also be seen,

Question 790

Retrobulbar block associated with

Answer 790

Retrograde injection through circle of willis.

Question 791

Hepatorenal syndrome is renal dysfunction associated with hepatic disease. Type I is acute renal decompensation, exhibits a creatinine

Answer 791

> 2.5 mg/dL and is often fatal.

Question 792

Type II hepatorenal syndrome is acute/chronic? Creatinine level? GFR?

Answer 792

Chronic, exhibits a creatinine > 1.5 mg/dL, and a glomerular filtration rate < 40 mL/min.

Question 793

2 medications that can help with Hepatorenal syndrome include?

Answer 793

Norepinephrine and the alpha-1 agonist midodrine have both been shown to improve renal function during liver transplant, however. Creatinine levels can severely underestimate the severity of renal dysfunction in these patients.

Question 794

What medications would you be prepared to administer prior to the reperfusion of a newly transplanted liver?

Answer 794

Bicarbonate

Calcium

Question 795

Which agent produces a paradoxical antidiuretic effect in patients with diabetes insipidus?

Answer 795

Thiazide diuretics

Question 796

Forced vital capacity that indicate muscle strength adequate enough to sustain ventilation and take a large enough breath to cough effectively?

Answer 796

Forced vital capacity of 10-12 mL/kg.

Question 797

The risk of postoperative morbidity is higher in obese patients. However, the risk is more closely linked to the presence of ______diseases rather than the BMI alone.

Answer 797

pre-existing diseases

Question 798

PheNOxybenzamine competitive or noncompetititive antagonist?

Answer 798

NON-competitive

Question 799

The cell membrane is freely permeable to ______ but impermeable to ______.

Answer 799

water; ions

Question 800

The addition of CPDA to whole blood is responsible for

Answer 800

CPDA (citrate-phosphate-dextrose-adenine) is added to whole blood when collected to act as an anticoagulant and provide the blood with a shelf-life of about 35 days.

Question 801

Most water get’s asborbed in the

Answer 801

Thin descending LOOP of HENLE