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ITE Second Pass Incorrect Flashcards

1
Q

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

A

Anterior superior iliac spine

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2
Q

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

A

Death

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3
Q

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

A

8-12 weeks

10.5-11.5

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4
Q

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

A

No antibiotics indicated

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5
Q

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

A

Repeated measure ANOVA (analysis of variance)

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6
Q

Name 7 precipitating factors for hypokalemic periodic paralysis

A
  1. High glucose meals
  2. Strenuous exercise
  3. Metabolic alkalosis
  4. Insulin
  5. Stress
  6. Hypothermia
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7
Q

What is the triad of hepatopulmonary syndrome?

Is the orthopnea worse sitting or standing?

A
  1. Pulmonary vascular dilation (increased nitric oxide)
  2. Increased A-a gradient
  3. Hepatic failure

Worse hen standing

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8
Q

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

A

Reduce inspired PO2

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9
Q

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

A

Shifts the ventilation-CO2 response curve leftward

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10
Q

What is Becker muscular dystrophy and what are 4 characteristics?

A

Decrease in dystrophin gene.

Associated with epilepsy, macroglossia, color blindness, cardiac involvement

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11
Q

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

A

Dexmedetomidine

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12
Q

Stimulation of which receptor will decrease insulin release?

A

Alpha 2 postsynaptic

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13
Q

Stimulation of receptor will cause relaxation of the gravid uterus?

A

Beta 2

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14
Q

Stimulation of this receptor will augment release of endogenous norepinephrine.

A

Beta 2

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15
Q

Which crystalloid has the highest osmolarity?

A

NS

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16
Q

What labs are suggestive of ATN?

A 
Muddy brown casts
FENa > 1%
Uosm < 350
UNa > 40 mEq
Low specific gravity
BUN:Cr 10:1 to 15:1
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17
Q

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

A
  1. Some motor weakness involvement
  2. More distal
  3. Lower risk falling
  4. Comparable pain relief
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18
Q

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

What is incidence when dura is punctured?

A

6-72 hours after dural puncture

About 50%

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19
Q

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

A

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

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20
Q

What two positional changes cause the largest decrease in FRC?

A

When going from 60 degress upright to supine

or when placed in trendelenberg more than -30 degrees

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21
Q

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

A

0.2 * weight * base deficit

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22
Q

What is usual test dose for epidural?

A

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

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23
Q

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

A

Persistent left superior vena cava

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24
Q

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

A

Ostium primum ASD

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25
Q

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

A

electrocardiogram synchronization

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26
Q

What is the cellular pathophys of MH?

A

Over activity of pumps and transporters that restore calcium levels.

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27
Q

Name 4 things that can prolong PT.

A
  1. Liver disease
  2. CF
  3. DIC
  4. Warfarin treatment
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28
Q

What are indication for hyperbaric O2 therapy? (6)

A
  1. Pregnancy
  2. Ischemia
  3. Coma
  4. AMS
  5. Seizure
  6. CO over 40%
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29
Q

Aminoamides are metabolized how?

A

Hepatic carboxylesterase

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30
Q

What is max dose lidocaine in tumescent lipo?

A

55 mg/kg

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31
Q

How does compartment syndrome typically present?

At what pressure is fasciotomy indicated?

What is a late stage finding?

A

Pain out of proportion and paresthesias

40 mmHg

Muscle weakness and paralysis

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32
Q

FRC is reduced the most after what positional change?

A

Supine to -25 degrees trendeleburg

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33
Q

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

A

PPI (omeprazole)

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34
Q

How do you calculate pulmonary vascular resistance?

A

(mPAP-CWP)/CO

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35
Q

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

A

VOO

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36
Q

In pregnant patient with MS is spinal anesthesia reasonable?

A

Yes. Just have discussion that spinal MAY exacerbate symptoms.

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37
Q

What two metabolic abnormalities are associated with hypothyroidism?

A

Hyponatremia

Hypoglycemia

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38
Q

What is normal PvO2?

List 6 causes of decreased PvO2 (11)

A

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
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39
Q

Vent setting for accurate PPV

A
  1. Controlled PP ventilation
  2. TV > 7-8 ml/kg
  3. No PEEP
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40
Q

INR peaks following donor hepatectomy on what day?

A

POD 1-3

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41
Q

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

A

Systemic circulation

Coronary circulation

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42
Q

Odds ratio estimates risk ratio in what study?

A

Cohort with low incidence

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43
Q

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

A

Methemoglobinemia

Left shift

44
Q

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

A

Factor VIII

45
Q

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

A
  1. Body temp
  2. Nitric oxide
  3. Mixed venous PO2
46
Q

Local anesthetics block peripheral nerves by what mechanism?

A

Reversibly blocking the intracellular voltage gated sodium channels.

47
Q

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

A

Minute Ventilation

48
Q

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

A

1.5:1 or 2:1

49
Q

Addison’s will present with what 4 electrolyte abnormalities?

A

Hyponatremia
Hypoglycemia

Hyperkalemia
Hypercalcemia

JFK holding empty salt and sugar shakers in one hand. Banana and milk in the other.

50
Q

What are HbA1c goals for diabetic prior to elective surgery?

51
Q

The trachea extends from what to what?

A

Cricoid cartilage to carina

52
Q

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

A
  1. AAI
  2. Macrglossia
  3. OSA
  4. Subglottic stenosis
  5. Congenital heart
    6 Hypothyroid
53
Q

What is normal p50 on oxygen-hemoglobin dissociation curve?

54
Q

Name 3 straight laryngoscope blades

A
  1. Miller
  2. Wisconsin
  3. Wis-Hipple
55
Q

Motor stimulation of what value is associated with intraneural injection?

56
Q

What medications experience extensive first pass pulmonary uptake?

A

Lipophilic opioids (fentanyl)

57
Q

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

58
Q

Amniotic fluid embolism is characterized how?

A

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

59
Q

What is the role of Glutamate in pain signaling?

A

It is excitatory

60
Q

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

A
  1. Higher systolic pressure
  2. Wider pulse pressure
  3. Delayed and slurred dicrotic notch
  4. More pronounced diastolic wave
61
Q

Autonomic hyperrefelxia generally occurs under what two conditions?

A

Lesion above T5 and surgery below level of lesion

62
Q

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

A
  1. Increased cyanide and CO levels
  2. Decreased mitochondrian oxidative metabolism leading to acidosis
  3. Vasoconstriction/poor perfusion
  4. Poor wound healing
63
Q

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

A

….inversely proportional to the CO2 partial pressure

64
Q

Stimulation of this receptor will inhibit insulin release

A

Alpha 2 postsynaptic

65
Q

What is the mechanism of action of terbutaline?

A

Beta 2 receptor agonist

66
Q

What nerve is spared with brachial plexus block>

A

Intercostobrachial

67
Q

Each unit of cryo contains how much fibrinogen?

68
Q

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

A
  1. Shunt
  2. Bypass
  3. Hypothermia
  4. Spinal drain
69
Q

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

A

6-7% reduction per degree

70
Q

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

71
Q

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

A

Ropivacaine

Bupivacaine

72
Q

Clonodine additive does what in peripheral nerve blocks?

A

Increases duration of action

73
Q

Polycythemia vera shows what on peripheral smear/labs?

A

Microcytic erythrocytosis

74
Q

Clearance of remifentanil is fastest in whom?

Bomus: What is context-sensitive halftime of remi?

A

Neonates

Bonus: 3 minutes

75
Q

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

A

Paramedian because both abductor and adductor nerves cut

76
Q

2 twitches, how much suppression?

77
Q

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

A

Epinephrine

78
Q

What is the relationship between protein binding and hepatic metabolism?

A

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

79
Q

What does fentanyl (opioids) do to seizure threshold?

80
Q

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

A

Response to perfusion pressure (autoregulation)

81
Q

How are liquids eliminated from stomach? Solids?

A

Exponentially.

Linearly.

82
Q

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

A

Awake fiber optic intubation

83
Q

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

A

Transverse axial ligament

84
Q

What is defined as a reactive non-stress test?

A

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

85
Q

How long should surgery be delayed after:

PCA?
BMS placement?
DES placement?

A
  • 14 days
  • 30 days
  • 180 days (6 months)
86
Q

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

87
Q

What is NOT given in TRALI?

88
Q

Hypotension and increased cardiac output. Diagnosis?

A

Septic shock

89
Q

How does lithium interact with NDNMBs?

A

Potentiates paralytics by interfering with prejunctional neuron action potential transmission

90
Q

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

A

Prop/fent TIVA. This can actually shorten QT

91
Q

Ipratropium binds what receptor to cause bronchial dilation?

92
Q

Sodium nitroprusside preferentially works where?

A

Arterial vasodilator

93
Q

What is IM dose Ketamine for premed?

94
Q

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

95
Q

Following donor hepatectomy, INR peaks on which POD?

96
Q

What is the effect of phenytoin on NDNMBDs?

A

Acute use: Augmentation

Chronic: Markedly shorter duration of action

97
Q

What monitor needs to be continuous (not continual)?

98
Q

What is the physiologic effect of ECT?

A

First: Parasympathetic
Second: Sympathetic

99
Q

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

A

Nicardipine

100
Q

Name two injuries that are contraindications to ET intubation?

A
  1. Laryngeal cartilage disruption

2. Laryngotracheal separation

101
Q

Most common disease that decreased DLco

102
Q

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

A

Blue, green, black

103
Q

What is the t-test used for?

A

Comparing two different means

104
Q

What is the hematologic effect of multiple myeloma?

105
Q

What electrolyte can be high in Loop diuretic use?

A

Uric acid (hyperuricemia)

Anesthesiology (12 decks)

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