ITE Second Pass Incorrect Flashcards by Landon Woolf

What is most important landmark for performing lateral femoral cutaneous block?

Anterior superior iliac spine

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In the 2000’s what is the most common malpractice claim according to ASA closed claim project?

Death

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Describe age and range of normal nadir of physiologic anemia in healthy term infant.

8-12 weeks

10.5-11.5

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What is antibiotic prophylaxis for healthy patient undergoing routine lap chole?

No antibiotics indicated

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What measure is used when the same group undergoes more than two repeated measures?

Repeated measure ANOVA (analysis of variance)

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Name 7 precipitating factors for hypokalemic periodic paralysis

High glucose meals
Strenuous exercise
Metabolic alkalosis
Insulin
Stress
Hypothermia

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What is the triad of hepatopulmonary syndrome?

Is the orthopnea worse sitting or standing?

Pulmonary vascular dilation (increased nitric oxide)
Increased A-a gradient
Hepatic failure

Worse hen standing

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What is initial treatment in hyperoxic seizure (hyperbaric O2 therapy)?

Reduce inspired PO2

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Describe the pharmacological mechanism by which acetazolamide works in acute mountain sickness.

Shifts the ventilation-CO2 response curve leftward

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What is Becker muscular dystrophy and what are 4 characteristics?

Decrease in dystrophin gene.

Associated with epilepsy, macroglossia, color blindness, cardiac involvement

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In deep brain stimulator placement for PD which medication will not interfere with the microelectrode recording portion?

Dexmedetomidine

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Stimulation of which receptor will decrease insulin release?

Alpha 2 postsynaptic

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Stimulation of receptor will cause relaxation of the gravid uterus?

Beta 2

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Stimulation of this receptor will augment release of endogenous norepinephrine.

Beta 2

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Which crystalloid has the highest osmolarity?

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What labs are suggestive of ATN?

Muddy brown casts
FENa > 1%
Uosm < 350
UNa > 40 mEq
Low specific gravity
BUN:Cr 10:1 to 15:1

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How does an adductor canal block compare to a femoral nerve block for RKA? (4)

Some motor weakness involvement
More distal
Lower risk falling
Comparable pain relief

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How long after puncture does post-dural puncture headache usually present?

What is incidence when dura is punctured?

6-72 hours after dural puncture

About 50%

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What is the most likely mechanism by which volatile anesthetics cause muscle relaxation?

Inhibition of nicotinic acetylcholine receptors (this is not the same as antagonism)

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What two positional changes cause the largest decrease in FRC?

When going from 60 degress upright to supine

or when placed in trendelenberg more than -30 degrees

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How do you calculate the amount of bicarb needed to correct acidosis?

0.2 * weight * base deficit

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What is usual test dose for epidural?

3 ml 1.5% lidocaine with 1:200,000 epi

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Retrograde cardioplegia would be ineffective in patient’s with what cardiac lesion?

Persistent left superior vena cava

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What cardiac lesion is associated with cleft anterior mitral valve leaflet?

Ostium primum ASD

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What is the best way to prevent arrhythmias during ESWL (immersion extracorporeal shock wave lithotripsy)?

electrocardiogram synchronization

What is the cellular pathophys of MH?

Over activity of pumps and transporters that restore calcium levels.

Name 4 things that can prolong PT.

1. Liver disease 2. CF 3. DIC 4. Warfarin treatment

What are indication for hyperbaric O2 therapy? (6)

1. Pregnancy 2. Ischemia 3. Coma 4. AMS 5. Seizure 6. CO over 40%

Aminoamides are metabolized how?

Hepatic carboxylesterase

What is max dose lidocaine in tumescent lipo?

55 mg/kg

How does compartment syndrome typically present? At what pressure is fasciotomy indicated? What is a late stage finding?

Pain out of proportion and paresthesias 40 mmHg Muscle weakness and paralysis

FRC is reduced the most after what positional change?

Supine to -25 degrees trendeleburg

What class of medication increases gastric pH for the longest period of time?

PPI (omeprazole)

How do you calculate pulmonary vascular resistance?

(mPAP-CWP)/CO

What is the appropriate pacing mode for permanent a-fib who is pacemaker dependent and needs monopolar electrocautery?

VOO

In pregnant patient with MS is spinal anesthesia reasonable?

Yes. Just have discussion that spinal MAY exacerbate symptoms.

What two metabolic abnormalities are associated with hypothyroidism?

Hyponatremia | Hypoglycemia

What is normal PvO2? List 6 causes of decreased PvO2 (11)

40 mmHg Increased O2 consumption: 1. Fever 2. Exercise 3. Shivering 4. MH 5. Thyroid storm 6. Pain Decreased O2 delivery 1. Hypoxia 2. HF 3. Anemia 4. Hypovolemia 5. Carboxy-Hb

Vent setting for accurate PPV

1. Controlled PP ventilation 2. TV > 7-8 ml/kg 3. No PEEP

INR peaks following donor hepatectomy on what day?

POD 1-3

In hypoplastic left heart circulation to what (2) is dependent on a patent ductus arteriosis?

Systemic circulation Coronary circulation

Odds ratio estimates risk ratio in what study?

Cohort with low incidence

What is a side effect of nitric oxide what is its effect on the O2 hemoglobin dissociation curve?

Methemoglobinemia Left shift

What lab value is most useful to assess bleeding in patient with end stage liver disease?

Factor VIII

What three endogenous factors influence HPV (hypoxic pulmonary vasoconstriction)?

1. Body temp 2. Nitric oxide 3. Mixed venous PO2

Local anesthetics block peripheral nerves by what mechanism?

Reversibly blocking the intracellular voltage gated sodium channels.

In Mapleson A circuit FGF must be equal to what to prevent rebreathing?

Minute Ventilation

What is the ratio of crystalloid to colloid required for early intravascular fluid resuscitation?

1.5:1 or 2:1

Addison's will present with what 4 electrolyte abnormalities?

Hyponatremia Hypoglycemia Hyperkalemia Hypercalcemia JFK holding empty salt and sugar shakers in one hand. Banana and milk in the other.

What are HbA1c goals for diabetic prior to elective surgery?

6% to 8%

The trachea extends from what to what?

Cricoid cartilage to carina

What are key anesthetic characteristics of down syndrome? (6)

1. AAI 2. Macrglossia 3. OSA 4. Subglottic stenosis 5. Congenital heart 6 Hypothyroid

What is normal p50 on oxygen-hemoglobin dissociation curve?

26.7

Name 3 straight laryngoscope blades

1. Miller 2. Wisconsin 3. Wis-Hipple

Motor stimulation of what value is associated with intraneural injection?

<0.2 mA

What medications experience extensive first pass pulmonary uptake?

Lipophilic opioids (fentanyl)

Which mode is most likely to cause R-on-T phenomenon?

DDD

Amniotic fluid embolism is characterized how?

Pulmonary vasospasm and right heart dysfunction followed by pulmonary edema and left heart dysfunction

What is the role of Glutamate in pain signaling?

It is excitatory

Name 4 differences between and peripheral arterial waveform and a central (aortic) waveform?

1. Higher systolic pressure 2. Wider pulse pressure 3. Delayed and slurred dicrotic notch 4. More pronounced diastolic wave

Autonomic hyperrefelxia generally occurs under what two conditions?

Lesion above T5 and surgery below level of lesion

What are the significant physiologic effects of smoking in the perioperative period? (4)

1. Increased cyanide and CO levels 2. Decreased mitochondrian oxidative metabolism leading to acidosis 3. Vasoconstriction/poor perfusion 4. Poor wound healing

Regarding built-in gas analyzers, intensity of light detected by the infarred spectrophotometer is....

....inversely proportional to the CO2 partial pressure

Stimulation of this receptor will inhibit insulin release

Alpha 2 postsynaptic

What is the mechanism of action of terbutaline?

Beta 2 receptor agonist

What nerve is spared with brachial plexus block>

Intercostobrachial

Each unit of cryo contains how much fibrinogen?

200 mg

Name 4 ways to protect spinal cord from ischemia during aortic aneurysm repair.

1. Shunt 2. Bypass 3. Hypothermia 4. Spinal drain

How much reduction is there in cerebral metabolic rate per degree decrease in temperature?

6-7% reduction per degree

What is the sensitivity of Mallampati score in predicting difficult airway when used alone?

35%

Epinephrine does not increase the duration of action in peripheral nerve blocks of what two local anesthetics?

Ropivacaine | Bupivacaine

Clonodine additive does what in peripheral nerve blocks?

Increases duration of action

Polycythemia vera shows what on peripheral smear/labs?

Microcytic erythrocytosis

Clearance of remifentanil is fastest in whom? Bomus: What is context-sensitive halftime of remi?

Neonates Bonus: 3 minutes

What is the position of the vocal cords with a complete recurrent laryngeal nerve lesion? Why?

Paramedian because both abductor and adductor nerves cut

2 twitches, how much suppression?

80-90%

Pheo with symptoms that are paroxysmal in nature. Catecholamine that predominates?

Epinephrine

What is the relationship between protein binding and hepatic metabolism?

The more protein bound a drug is the less of its free form that is available for hepatic metablism

What does fentanyl (opioids) do to seizure threshold?

Lowers it

The response of cerebral blood flow to what is attenuated by volatile anesthetics?

Response to perfusion pressure (autoregulation)

How are liquids eliminated from stomach? Solids?

Exponentially. Linearly.

What is airway management for trachea trauma in stable and spontaneously ventilating patient?

Awake fiber optic intubation

Which ligament stabilizes the atlantoaxial joint and is weakened in RA?

Transverse axial ligament

What is defined as a reactive non-stress test?

2 accelerations 15 beats above baseline Lasting 15 seconds Within 40 minute period

How long should surgery be delayed after: PCA? BMS placement? DES placement?

- 14 days - 30 days - 180 days (6 months)

What is NOT an inhibitory molecule in dorsal horn in pain transmission?

Glutamate

What is NOT given in TRALI?

Diuretics

Hypotension and increased cardiac output. Diagnosis?

Septic shock

How does lithium interact with NDNMBs?

Potentiates paralytics by interfering with prejunctional neuron action potential transmission

In patient with long QT syndrome what is best choice for maintenance of anesthesia? Why?

Prop/fent TIVA. This can actually shorten QT

Ipratropium binds what receptor to cause bronchial dilation?

Sodium nitroprusside preferentially works where?

Arterial vasodilator

What is IM dose Ketamine for premed?

2-5 mg/kg

What pacemaker setting is most likely to precipitate R on T phenomenon?

DDD

Following donor hepatectomy, INR peaks on which POD?

1-3

What is the effect of phenytoin on NDNMBDs?

Acute use: Augmentation Chronic: Markedly shorter duration of action

What monitor needs to be continuous (not continual)?

EKG

What is the physiologic effect of ECT?

First: Parasympathetic Second: Sympathetic

What can be administered to decrease risk of perioperative stroke in carotid endarterectomy?

Nicardipine

Name two injuries that are contraindications to ET intubation?

1. Laryngeal cartilage disruption | 2. Laryngotracheal separation

Most common disease that decreased DLco

COPD

What three colors of nail polish will most likely interfere with pulse ox?

Blue, green, black

What is the t-test used for?

Comparing two different means

What is the hematologic effect of multiple myeloma?

Anemia

What electrolyte can be high in Loop diuretic use?

Uric acid (hyperuricemia)