Incorrects

Question 1

Most common side effect of zofran

Answer 1

Ondansetron side effects:
Common Uncommon
QTc prolongation (20%) Dyskinesia (0.1 - 0.3%)
Headache (11%) Serious cardiac events* (< 0.01%)
Transient increases in AST and ALT (5%) Blurred vision / transient blindness** (rare)
Constipation (4%) Hypersensitivity reactions (rare)
Rash (1%) Abdominal pain (rare)
Flushing / warmth (< 1%) Xerostomia (rare)
Dizziness (< 1%) Weakness (rare)

Question 2

Which inhaled anesthetic has the lowest blood:gas partition coefficient?

Answer 2

Desflurane

Blood:gas partition coefficients of gases
Desflurane 0.42
Isoflurane 1.46
Nitrous oxide 0.46
Sevoflurane 0.65

The speed of onset of nitrous oxide is actually faster than desflurane even though it has a higher blood:gas partition coefficient. Due to concentration effect.

Question 3

Best way to monitor recurrent laryngeal nerve function during thyroid surgery?

Answer 3

Electromyography

During surgery, a surgeon uses a stimulator probe to touch the RLN and surrounding tissues while a neurophysiologist monitors the EMG trends detected by the electrodes on the endotracheal tube

Question 4

Primary cause of symptoms in amniotic fluid embolism

Answer 4

massive inflammatory response to the presence of amniotic fluid in the bloodstream. amniotic fluid contains many vasoactive and procoagulant factors

Question 5

Pacemaker placement is indicated for which arrhythmias?

Answer 5

second-degree (type II) AV block, third-degree AV block, any symptomatic bradyarrhythmia, and refractory supraventricular tachyarrhythmias.

Question 6

Treatment for a myotonic episode

Answer 6

phenytoin, quinine, procainamide, direct infiltration of the affected muscle with local anesthetic, or a high concentration of volatile anesthetic.

Question 7

Chronic, oral dantrolene use can cause what type of toxicity?

Answer 7

Hepatotoxicity

Liver function tests should be assessed periodically in patients who take dantrolene

Question 8

How is uterine blood flow governed during pregnancy?

Answer 8

governed by pressure changes and does not have autoregulatory control.

Question 9

In a known asthmatic with nasal polyps, which class of drug should you avoid intra/perioperatively?

Answer 9

Aspirin and NSAIDs

Question 10

Risk factors predicting the need for mechanical ventilation in myasthenia gravis

Answer 10

Disease duration > 6 years
Chronic respiratory illness
Pyridostigmine dosage > 750 mg/day (newer data suggest > 250 mg/day)
Vital capacity < 2.9 L

Question 11

Treatment for neonatal respiratory distress syndrome.

Answer 11

administration of CPAP, endotracheal intubation if symptoms persist despite CPAP, intratracheal administration of exogenous surfactant, and other supportive measures. PEEP pressures 3-8.

Question 12

Isovolumetric hemodilution causes (increase/decrease) in cardiac output and (increase/decrease) in SVR?

Answer 12

Increased CO and decreased SVR. Decreased SVR is due to decreased viscosity of blood.

Question 13

Side effect of morphine-6-glucuronide

Answer 13

Neuroexcitatory - can cause allodynia, myoclonus, seizures. Can accumulate in renal failure

Morphine-6-glucuronide is potent analgesic

Question 14

Clinically significant vasospasm occurs most frequently in what time frame after SAH?

Answer 14

between days 3 and 15 while rebleeding occurs within the first 48 hours after SAH.

Question 15

Primary treatment for methemoglobinemia

Answer 15

Methylene blue (1-2 mg/kg)

Question 16

Factors associated with increased survival from neuro last LMA

Answer 16

Factors associated with increased survival include:
Extra-abdominal location
Low International Neuroblastoma Risk Group (INRG) classification score
Under 18 months of age on presentation
Primary tumor
No metastasis
Small tumor
Favorable tumor biology
Good surgical resectability

Question 17

Most accurate sites to measure core temperature

Answer 17

nasopharynx, distal esophagus, pulmonary artery, or tympanic membrane

Question 18

What type of effect do you see when 2 NMBAs (steroid and benzisoquinolinium) are coadministered?

Answer 18

Synergistic

Question 19

Which fluids can cause coagulopathy.

Answer 19

Hydroxyethyl starch at large doses (20 mL/kg/day) can result in developing a coagulopathy. Dextran is the only other colloid to be associated with a coagulopathy.

Question 20

Half life of labetalol IV

Answer 20

6 hours when it is administered intravenously and has an effect on blood pressure for ~16 to 18 hours.

Question 21

What happens if the artery of Adamkiewicz is blocked?

Answer 21

loss of motor function in the lower extremities (corticospinal tract and anterior horns), loss of pain and temperature (spinothalamic tract) 1 level below the lesion, sexual dysfunction, and urinary and fecal incontinence (descending autonomic tracts).

Question 22

Most common bacterial cause of peritonsillar abscess

Answer 22

Group A, beta-hemolytic Streptococcus

Staphylococcus aureus, Haemophilus influenza, Neisseria spp, and Fusobacterium as other possible causes.

Can present with trismus

Question 23

What EKG change do you see with TCA overdose

Answer 23

Widening of QRS complex

Question 24

Does creatinine increase with age?

Answer 24

No. Relative decrease in muscle mass with age.

Question 25

What lab abnormality is associated with terbutaline when used as a tocolytic?

Answer 25

Hypokalemia. It is a B2 agonist, driving K into cells.

The beta-receptor agonism results in stimulation of adenylyl cyclase activity, increasing the conversion of ATP to cAMP. This decreases the available intracellular calcium and inhibits MLCK, resulting in impaired contractility.

Question 26

Risk factors for failed neuraxial anesthesia during cesarean delivery

Answer 26

increasing maternal size, late labor epidural placement, and a rapid decision-to-incision interval.

Question 27

What happens to protein C and S in a term obstetric patient?

Answer 27

Protein S decreases
Protein C remains the same
These proteins are anticoagulants, so decrease promotes coagulation

Question 28

What happens to DLCO in asthma and emphysema?

Answer 28

asthma and obesity have been found in several studies to be the most common disorders producing markedly elevated DLCO values

it is believed that patients with mild to moderate asthma may experience sufficient hyperinflation to increase pulmonary blood volumes while also increasing apical lung perfusion, which would elevate DLCO as a result of an increased binding capacity. Meanwhile, compared to a nonobese patient, the average patient with obesity will demonstrate a higher cardiac output, which similarly elevates the binding capacity and the DLCO.

DLCO decreases in emphysema because the alveoli are destroyed

Question 29

What type of molecules freely cross the BBB?

Answer 29

small, lipophilic molecules <500 Da

Question 30

What is the most reliable assessment of dehydration in the newborn?

Answer 30

Weight.
5% weight loss mild, 10% moderate, 15% severe

Question 31

What happens to hematocrit in hypothermia?

Answer 31

Increases due to diuresis causing blood volume contraction.

Question 32

Adenosine effect on hepatic blood flow?

Answer 32

Adenosine is a potent vasodilator that results in increased hepatic artery blood flow. Adenosine is the compound responsible for the hepatic arterial buffer response because its concentration increases in the space of Mall as blood flow through the portal vein decreases, resulting in the regulation of blood flow to the liver between the hepatic artery and portal vein.

Question 33

What is lusitropsy?

Answer 33

Rate of active myocardial relaxation.

Question 34

When considering bronchospasm, binding of acetylcholine to which receptor results in airway constriction?

Answer 34

M3 muscarinic
cholinergic stimulation via the vagus nerve of M3 receptors on the bronchiolar smooth muscle results in an influx of ionized calcium, smooth muscle contraction, and bronchoconstriction.

Question 35

Management of laryngospasm

Answer 35

first step is to suction the patient’s airway, clearing it of any offending stimulus, followed by 100% oxygen with continuous positive airway pressure plus a jaw thrust. If this is unsuccessful in breaking the laryngospasm, increasing the depth of the anesthetic should be attempted. If this is unsuccessful, succinylcholine should be administered.

Question 36

What is the range for cerebral perfusion pressure and what is the formula?

Answer 36

50-70mmHg
CPP = MAP - ICP