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*ACE's > M5 2014 > Flashcards

M5 2014 Flashcards

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1
Q

Innervation of posterior tongue, soft palate, and oropharynx

A

Glossopharyngeal n. (IX)

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2
Q

Innervation of hypopharynx

A

Internal branch of superior laryngeal n. (X)

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3
Q

Innervation of larynx and trachea

A

Recurrent laryngeal n.

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4
Q

Topicalizing anterior tonsillar pillars with lidocaine will anesthetize what nerve?

A

Glossopharyngeal n. (Only tonsillar, lingual, and pharyngeal branches, not the whole n.)

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5
Q

External branch of superior laryngeal n. supplies motor innervation to what?

A

Cricothyroid muscle

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6
Q

Blocking inferior aspect of greater cornu of hyoid bone will anesthetize what nerve?

A

Internal branch of superior laryngeal n., which innervates the hypopharynx

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7
Q

Only muscle responsible for vocal cord abduction

A

Posterior cricoarytenoid muscle

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8
Q

Only vocal cord muscle NOT innervated by recurrent laryngeal n.

A

Cricothyroid muscle, innervated by external branch of superior laryngeal n.

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9
Q

Block of recurrent laryngeal n. results in vocal cords being affected how?

A

Partial adduction. Unilateral block = hoarseness. Bilateral block = stridor and possible airway obstruction

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10
Q

Most sensitive indicator for a difficult intubation

A

Mallampati class 3 or 4

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11
Q

2nd most sensitive indicator for difficult intubation

A

Reduced thyromental distance

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12
Q

Highest positive predictive value (PPV) for difficult intubation

A

History of difficult intubation

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13
Q

Function of type I and type II pneumocytes

A

Type I: gas exchange

Type II: produce surfactant, smaller and far more numerous than type I

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14
Q

Sensory innervation of lung is provided by which nerve

A

Vagus nerve

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15
Q

Long thoracic n. innervates what muscle

A

Serratus anterior

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16
Q

Winged scapula is a result of damage to what nerve

A

Long thoracic n.

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17
Q

Coronary a. supplying anterolateral wall of LV

A

Left circumflex

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18
Q

Coronary a. supplying anteroseptal wall of LV

A

LAD

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19
Q

Coronary a. supplying inferior wall of LV

A

RCA

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20
Q

Coronary a. supplying inferolateral wall of LV

A

RCA and LCx

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21
Q

Most patients with atrial flutter have a rapid circuit originating from which chamber of the heart

A

Right atrium and involving tissue near tricuspid valve

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22
Q

Aortic arch crosses up, over, and behind which main bronchus

A

Left main bronchus

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23
Q

Aortic dissection creates false lumen in which layer of the aortic wall

A

Media (intima, media, adventitia)

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24
Q

Risk factors for aortic dissection

A

Uncontrolled HTN, connective tissue disease, vasculitis, trauma

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25
Q

Course of subclavian vein in relation to anterior scalene muscle

A

Anterior

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26
Q

Course of subclavian artery in relation to anterior scalene muscle

A

Between middle and anterior scalene muscles

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27
Q

Course of subclavian vein in relation to first rib

A

Superior to first rib and inferior to clavicle

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28
Q

Continuation of internal carotid artery in circle of Willis is called

A

Middle cerebral artery

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29
Q

When does spinal cord move from L3 to L1

A

By 2 months of age

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30
Q

Superior aspect of iliac crest is at which vertebral level

A

L4

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31
Q

Innervation of facet joint between 2 vertebrae

A

Medial branch of the posterior division of spinal nerves

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32
Q

Celiac plexus is located at which vertebral level

A

L1

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33
Q

Which nerve is inadequately blocked following axillary block

A

Musculocutaneous nerve which innervates lateral forearm

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34
Q

Medial forearm is innervated by cutaneous branches of which nerve

A

Ulnar

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35
Q

Relationship of median nerve to brachial artery in the antecubital fossa

A

Median nerve runs medial to brachial artery

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36
Q

Parasympathetic fibers to the heart arise from

A

Dorsal vagal nucleus and nucleus ambiguous

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37
Q

The two plexuses arising from parasympathetic fibers to the heart are located between

A

Aortic arch and tracheal bifurcation

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38
Q

Nicotinic acetylcholine receptors are found in greatest concentration at which heart node

A

SA node

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39
Q

Sympathetic cardiac nerve fibers course with which coronary artery

A

Left main coronary artery

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40
Q

How and when is S3 heart sound made

A

Early diastole when atrial blood reverberates against poorly functioning ventricular walls. S3 is associated strongly with MACEs (major adverse cardiac events)

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41
Q

S1 sound is heard where on an EKG

A

Just after QRS complex

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42
Q

S2 sound is heard where on an EKG

A

Just after T wave

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43
Q

S4 sound is heard where on an EKG

A

Just after p wave. Sound is caused by atrial contraction ejecting blood into a noncompliant ventricle

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44
Q

Where is mixed venous oxygen saturation measured

A

Right atrium

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45
Q

ATP binding to myosin results in

A

Release of myosin tension from actin

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46
Q

Amiodarone is what class of antiarrhythmic agent

A

Class III, a potassium blocking agent which delays phase 3 repolarization.

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47
Q

Side effects of amiodarone

A

Pulmonary fibrosis, hypothyroidism or hyperthyroidism, transaminitis, peripheral neuropathies

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48
Q

How does glucagon treat beta blocker overdose

A

Glucagon increases cAMP and therefore protein kinase A

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49
Q

At what heart rate is stroke volume the greatest

A

60

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50
Q

At what heart rate is cardiac index maximized

A

120

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51
Q

Reflex when a hypovolemic pt has bradycardia and hypotension when moved from supine to upright

A

von Bezold-Jarisch reflex. Receptors in left ventricle

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52
Q

Mechanics of alpha 1 mediated vasoconstriction

A

Phenylephrine -> alpha 1 receptor -> activation of PLC (phospholipase C) -> formation of IP3 (inositol triphosphate) -> Ca release from sarcoplasmic reticulum -> increased contraction

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53
Q

Mechanics of beta 2 agonism

A

Beta 2 receptor -> cAMP -> uptake of Ca back to SR -> decreased contraction

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54
Q

Mechanics of NO activity

A

NO -> cGMP -> decreased contraction

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55
Q

Minimum number of days after coronary balloon angioplasty to wait before performing elective surgery

A

14 days

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56
Q

Slope of dose response curve is determined by

A

Receptor binding characteristics

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57
Q

Respiratory depression is mediated by which opioid receptor

A

Mu2

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58
Q

Muscle rigidity is mediated by which opioid receptor

A

Mu1

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59
Q

Hallucinations are mediated by which opioid receptor

A

Sigma

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60
Q

Opioid that decreases contractility, increases heart rate, and causes mydriasis

A

Meperidine, has atropine like structure causing anticholinergic response

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61
Q

Meperidine decreases shivering by agonism of what receptor

A

Kappa

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62
Q

Effects of opioids that are resistant to tolerance

A

Constipation and miosis

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63
Q

High doses of which opioid may induce acute opioid tolerance in the PACU

A

Remifentanil

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64
Q

Baclofen is an agonist of what receptor

A

GABA-B receptor

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65
Q

Aspirin sensitivity with nasal polyps is associated with what medical condition

A

Asthma. Samter’s triad

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66
Q

Reason for hypertension and bradycardia during infusion of dexmedetomidine

A

Cross reactivity with alpha 1 receptor at high doses

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67
Q

Benzodiazepine effects of amnesia is explained by hyperpolarization of

A

Post synaptic neurons primarily in the cerebral cortex

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68
Q

Benzodiazepine mediated muscle relaxation occurs through gamma subunit agonism of

A

GABA-A receptor specifically in the spinal cord

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69
Q

Hyperalgesia is mediated by what process

A

Opioid NMDA agonism, which explains why patients respond well to NMDA antagonists like ketamine, methadone, and dextromethorphan

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70
Q

How does activation of opioid receptors affect potassium conductance

A

Increase

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71
Q

Opioids that cause inhibition of serotonin reuptake

A

Meperidine, methadone, tramadol, dextromethorphan.

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72
Q

Pretreatment with what medication decreases incidence of etomidate associated myoclonus

A

Opioids

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73
Q

how much of etomidate is not metabolized after passing through liver

A

50%

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74
Q

Why is it that more active neurons are blocked to a greater extent than less active neurons

A

Sodium channels in the activated or inactivated state have a greater affinity for local anesthetics than in the resting state

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75
Q

rate of systemic absorption of local anesthetic from greatest to least

A

IV > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic > subcutaneous

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76
Q

Adding epinephrine to lidocaine will increase duration of peripheral nerve block by about how much?

A

50%

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77
Q

local anesthetics bind to which subunit of the voltage-gated sodium channels

A

alpha

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78
Q

2 ways that epinephrine enhances quality of a nerve block

A

1) vasoconstriction causing longer period of time that local is exposed to neuron
2) direct adrenergic activation of alpha-2 receptors

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79
Q

exception to the rule of pseudocholinesterase metabolism of ester local anesthetic

A

cocaine

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80
Q

Why is block onset faster by adding epi to plain local vs. using premixed local with epi?

A

Premixed solutions are more acidic to prevent degradation of epi

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81
Q

Basic drugs are usually bound to which protein?

A

Alpha-1-acid glycoprotein

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82
Q

Acidic drugs are usually bound to which protein?

A

Albumin

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83
Q

Preservative used with amide local anesthetic

A

Methylparaben

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84
Q

glutamate is an excitatory or inhibitory neurotransmitter?

A

excitatory

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85
Q

how does opioid agonism change the resting potential of a neuron

A

make it more negative

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86
Q

brain needs what percent of cardiac output to cover metabolic needs

A

15-20%

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87
Q

Is obesity a risk factor for POCD postop cognitive decline?

A

no

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88
Q

what area in the brain is pain sensed?

A

postcentral gyrus

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89
Q

Norepinephrine is metabolized by what?

A

Both MAO (monoamine oxidase) and COMT (catechol O-methyltransferase)

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90
Q

which opioid increases cerebral blood flow

A

sufentanil

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91
Q

external or internal intercostal muscles are used for inspiration?

A

external

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92
Q

external or internal intercostal muscles are used for expiration?

A

internal

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93
Q

dead space is what percent of tidal volume in a healthy mechanically ventilated patient?

A

50%

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94
Q

above what shunt fraction would supplemental oxygen not expect to increase PaO2 by more than 10 mmHg?

A

40%

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95
Q

Use ventilation-perfusion ratio (VQI) to calculate shunt

A

VQI = ( 1 - SaO2 ) / ( 1 - MvO2 ). Therefore 99% SaO2 with 75% MvO2 = 0.01 / 0.25 = 4% shunt in healthy person

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96
Q

Decreased FEF 25%-75% (forced expiratory flow) is indicative of what?

A

early indicator of medium airway obstructive disease. it is theoretically effort independent

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97
Q

FRC is classically lowest when after a surgery?

A

12 hours postop

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98
Q

General anesthesia will decrease FRC by what percent?

A

10%

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99
Q

maximal benefit from smoking cessation is how many weeks prior to surgery?

A

8 weeks or more

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100
Q

Classic EKG findings for a COPD patient

A

signs of right heart strain such as poor R wave progression, enlarged P waves, RBBB, right axis deviation, low voltage

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101
Q

Abdominal surgery affects residual volume (RV) how?

A

increases it by 10%. expiratory reserve volume is decreased by 25%

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102
Q

Best surface anatomic estimate for level of the carina

A

sternal angle

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103
Q

best marker for dynamic lung compliance

A

peak pressure

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104
Q

Ach receptor requires binding of how many Ach molecules to activate?

A

2

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105
Q

Ach receptor uses a pair of alpha or beta subunits?

A

alpha subunits

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106
Q

what does ecothiophate do?

A

cholinesterase inhibitor

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107
Q

dibucaine number for normal person

A

80%

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108
Q

half life of esmolol

A

10-20 minutes

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109
Q

muscle fasciculations after succinylcholine have strongest association with which effect?

A

increased ICP

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110
Q

muscle relaxants metabolized by pseudocholinesterase

A

mivacurium and succinylcholine

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111
Q

steroid muscle relaxant that has no metabolites

A

rocuronium

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112
Q

Extubation criteria for RSBI (rapid shallow breathing index) should be less than

A

105 (RR/TV)

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113
Q

duration of neostigmine

A

1 hour

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114
Q

timing of peak effect of neostigmine

A

10 min

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115
Q

treatment for central anticholinergic syndrome

A

physostigmine, because its tertiary amine structure allows it to cross blood brain barrier, unlike neostigmine and edrophonium

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116
Q

A right to left cardiac shunt will slow the induction more in desflurane or isoflurane

A

desflurane because so very little desflurane is taken up so when it is further diluted with a right to left shunt, it slows induction

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117
Q

decreased cardiac output slows or speeds elimination of inhaled anesthetics

A

speeds

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118
Q

MAC value for ED95 for patient moving in response to surgical stimulus

A

1.3

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119
Q

which electrolyte abnormality increases MAC

A

hypernatremia

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120
Q

inhaled anesthetic that doesn’t increase apneic threshold

A

nitrous oxide, which also does not potentiate muscle relaxation

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121
Q

which of the modern inhaled anesthetics is metabolized to the greatest extent

A

sevoflurane, 5%

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122
Q

which modern inhaled anesthetic produces the greatest extent of coronary vasodilatation

A

isoflurane

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123
Q

at what MAC does isoflurane produce burst suppression of EEG

A

1.5 MAC

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124
Q

which modern inhaled anesthetic causes transient increases in sympathetic tone with rapid increases in concentration during induction

A

desflurane and isoflurane

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125
Q

desflurane can be degraded by dessicated CO2 absorbent to produce what?

A

carbon monoxide

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126
Q

A unit of insulin should decrease glucose by how much?

A

25 mg/dL

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127
Q

hypothyroidism is associated with hyper or hypo natremia?

A

hyponatremia because patients retain free water

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128
Q

Chance of cross-reaction between penicillin and cephalosporins

A

< 2%

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129
Q

why is ankylosing spondylitis patient at increased risk for neuraxial and general anesthesia?

A

GA: cervical neck stenosis
Neuraxial: reduced intervertebral spaces and ossification

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130
Q

minimum gas flow rate needed for a carbon dioxide absorber to prevent rebreathing of CO2

A

5L/min

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131
Q

least likely benefit of neuraxial anesthesia

A

decreased morbidity and mortality from myocardial ischemia

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132
Q

Neuraxial anesthesia can be done how many hrs after last dose of daily enoxaparin? And enoxaparin can be restarted how many hrs after block placed?

A

Block can be placed 12 hrs after last dose. Dose can be given 6 hrs after block is placed.

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133
Q

which epidurally given local anesthetic interferes with epidural opioid mediated analgesia

A

chloroprocaine

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134
Q

supraclavicular or interscalene block has higher incidence of transient hemidiaphragmatic paralysis

A

interscalene

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135
Q

which brachial plexus block has highest incidence of chylothorax

A

infraclavicular block

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136
Q

which brachial plexus block performed without ultrasound has highest risk of pneumothorax

A

infraclavicular block

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137
Q

axillary block likely misses what nerve and what sensory region of arm?

A

musculocutaneous, lateral forearm

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138
Q

relationship of ulnar, median, and radial nerves to the axillary artery for axillary block

A

ulnar is superior-medial
median is superior-lateral
radial is deep to artery

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139
Q

what proportion of sodium filtered by glomerulus is typically excreted in the urine

A

5%

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140
Q

Site of action of furosemide

A

ascending loop of Henle

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141
Q

ADH increases aquaporin-2 channels in what part of the nephron?

A

collecting duct

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142
Q

what part of nephron is most responsible for concentrating urine

A

collecting duct

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143
Q

what is the reason to prescribe ACE inhibitor for CHF patient?

A

interrupt pathological increases in sodium retention

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144
Q

mechanism of action of spironolactone

A

direct aldosterone receptor antagonist, leading to decreased Na/K ATPase activity so potassium-sparing

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145
Q

mechanism of action of acetazolamide

A

carbonic anhydrase inhibitor, leading to inhibition of bicarb uptake at proximal tubule

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146
Q

mechanism of action of loop diuretics

A

inhibit Na-K-2Cl transporter in the thick ascending limb of the loop of Henle

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147
Q

mechanism of action of thiazides

A

inhibit Na-Cl transporter in the distal convoluted tubule

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148
Q

furosemide’s effect on calcium level

A

furosemide leads to hypocalcemia

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149
Q

thiazide’s effect on calcium level

A

thiazide increase calcium reabsorption -> hypercalcemia

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150
Q

which is used to treat hypercalcemia? furosemide or thiazide?

A

furosemide

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151
Q

why do potassium-excreting diuretics increase risk of digoxin toxicity?

A

digoxin competes with potassium on Na-K ATPase, so hypokalemia worsens risk of digoxin toxicity

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152
Q

furosemide causes metabolic acidosis or alkalosis

A

metabolic alkalosis

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153
Q

why does a hyperosmolar state cause hyperkalemia?

A

Potassium follows water out of the intracellular compartment

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154
Q

An increased SIG (strong ion gap) demonstrates what metabolic abnormality

A

metabolic alkalosis

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155
Q

A decreased SIG (strong ion gap) demonstrates what metabolic abnormality

A

metabolic acidosis

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156
Q

Fatter or thinner people are at increased risk of ulnar neuropathy

A

fatter

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157
Q

fatter or thinner people are at increased risk of common peroneal injury

A

thinner

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158
Q

the only sure-proof way to treat “obturator reflex” in a cystoscopy under spinal anesthesia is to?

A

induce general anesthesia with neuromuscular blockade

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159
Q

What causes hyperammonemia in TURP syndrome?

A

glycine can be metabolized to ammonia

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160
Q

Transient blindness in TURP syndrome is caused by?

A

CNS depressing effects of glycine

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161
Q

What thoracic level needs to be blocked to ensure loss of sensation for a cystoscopy

A

T8, up to renal pelvis.

162
Q

Why does cardiac output only slightly decrease with large associated increase in afterload with alpha-1 adrenergic stimulation?

A

stimulation of alpha-1 adrenergic receptors on myocardium leads to mild inotropy

163
Q

which vasopressor is best at renal preservation in a severely septic patient with low urine output

A

norepinephrine

164
Q

drugs of choice to treat cardiogenic shock in setting of severe acidosis

A

norepinephrine and dobutamine

165
Q

Primary advantage of a norepinephrine gtt over a dopamine gtt for treating severe hypotension

A

lower rate of arrhythmias, especially high grade tachyarrhythmias

166
Q

What is the end product of catecholamine metabolism?

A

VMA (vanillymandelic acid)

167
Q

Why is dopexamine a bad drug for CHF exacerbation in setting of sepsis?

A

dopexamine’s effects are B2&raquo_space;> B1 as well as potent dopamine receptor effects, which will cause worsening hypotension

168
Q

how does beta 1 agonism increase lusitropy

A

by increasing rate of calcium uptake into sarcoplasmic reticulum during diastole. this uptake is mediated by SERCA (sarco-endoplasmic reticulum calcium ATPase)

169
Q

tachyphylaxis of ephedrine is likely due to

A

depletion of presynaptic norepinephrine stores

170
Q

beta receptors lead to a G-protein mediated stimulation of adenylate cyclase which converts ATP to?

A

cAMP, which ultimately leads to increased intracellular calcium concentrations

171
Q

beta receptor stimulation increases intracelluluar calcium concentrations by what action?

A

cAMP activates protein kinase A which acts on sarcoplasmic reticulum to release calcium

172
Q

Next best step for hypotensive patient with acutely failing right heart and increasing tricuspid regurgitant jet despite the absence of overt left heart failure

A

inhaled nitric oxide

173
Q

mechanism of action of nitric oxide

A

stimulates guanylate cyclase which increases cGMP levels which relaxes smooth muscle which causes vasodilatation

174
Q

reason for rebound hypertension following discontinuing of sodium nitroprusside treatment

A

increased catecholamines and renin-angiotensin release

175
Q

How does nitroglycerin improve myocardial oxygen delivery to consumption ratio?

A

Decreased preload decreases consumption and improves perfusion. As a coronary artery dilator, it helps redistribute blood flow to subendocardium

176
Q

nicardipine and hydralazine nearly exclusively dilate venous or arterial bed?

A

arterial bed

177
Q

how do volatile agents depress myocardial contractility?

A

by indirectly decreasing calcium release by the sarcoplasmic reticulum

178
Q

Cardiac autonomic innervation to the SA node is supplied by?

A

right vagus nerve and sympathetic chain that arises from T1-4 by way of stellate ganglion

179
Q

cardiac autonomic innervation to the AV node is supplied by?

A

left vagus nerve

180
Q

myocardial contractility is predictability depressed by what factors?

A

acidemia, anoxia, decreased sympathetic tone, and hypocalcemia

181
Q

Is LVEDP increased or decreased with LV diastolic dysfunction?

A

Increased because a higher LVEDP is required to fill a stiff ventricle that poorly relaxes

182
Q

The most sensitive and specific monitor for intraop MI is?

A

TEE which can demonstrate wall motion abnormalities which is the most sensitive and specific sign of ischemia

183
Q

Patient who requests no sedation for cataract surgery has symptomatic episodes with slow pulse, what to do next?

A

consult EP

184
Q

neurological outcomes after CPB is worse with pH-stat or alpha-stat strategy?

A

ph-stat because added CO2 causes cerebral vasodilation so small emboli are more likely to get to brain

185
Q

best first line of treatment for a hypertensive patient with aortic dissection

A

esmolol gtt which decreases shear forces that are caused by increased heart rate and cardiac output. next line of treatment would be nicardipine or nitroprusside gtt

186
Q

what type of acid/base abnormality does severe diarrhea cause?

A

non-gap metabolic acidosis with hypokalemia

187
Q

how does thoracic epidural reduce postop ileus?

A

decreases sympathetic outflow to GI tract

188
Q

medications that reduce lower esophageal sphincter (LES) tone

A

anti-cholinergics, opioids, thiopental, volatiles

189
Q

What type of change in lower esophageal sphincter (LES) tone is associated with LMA use?

A

decrease in LES tone

190
Q

gastroparesis and autonomic neuropathy are more common in T1DM or T2DM?

A

T1DM

191
Q

propranolol decreases portal pressure by what mechanism?

A

Beta 2 blockade causes hepatic artery vasoconstriction which decreases liver congestion

192
Q

which coagulation factors are not produced by hepatocytes?

A 
factor III and vWB (endothelium)
factor VIII (endothelium and liver sinusoidal cells)
193
Q

How much of what fluid should be administered for every liter of ascites removed?

A

10-20 cc of 25% albumin for every liter of ascites removed

194
Q

Child-Pugh score includes what components?

A

albumin, bilirubin, PT or INR, clinical judgment of ascites and encephalopathy

195
Q

MELD score includes what components?

A

bilirubin, creatinine, INR

196
Q

how is hepatic blood flow affected by general and neuraxial anesthesia?

A

hepatic blood flow decreases

197
Q

the heart of a cirrhotic “high cardiac output heart failure” patient looks like?

A

structurally normal

198
Q

what are the PA pressures in a cirrhotic patient with high cardiac output heart failure?

A

elevated

199
Q

what is next best step when clamping IVC during liver transplant surgery causes BP to drop dramatically?

A

unclamp, check ABG, hct, electrolytes, volume status, and give fluids

200
Q

why is hypocalcemia a sign of high risk for perioperative mortality in setting of pancreatitis?

A

the hypocalcemia is due to calcium precipitating with fats degraded by pancreatic enzymes. hypocalcemia also occurs in severe fat embolism and rhabdomyolysis

201
Q

chance of infection with needlestick from HCV, HBV, and HIV

A

HBV ~ 40%
HCV ~ 2%
HIV 0.3%

202
Q

what percent of patient with HCV will develop cirrhosis?

A

20%

203
Q

type of vwD that responds to DDAVP treatment

A

type I

204
Q

what is done to prbcs to prevent anaphylaxis in IgA deficient patients?

A

washing of prbcs

205
Q

what is done to prbcs to prevent febrile reactions and alloimmunization

A

leukoreduction or leukodepletion

206
Q

what is done to prbcs to prevent graft vs host disease?

A

irradiation of prbcs

207
Q

mechanism of febrile transfusion reactions

A

recipient antibodies toward donor WBCs

208
Q

TRALI typically resolves within how many hours?

A

48 hrs

209
Q

most popular theory for the mechanism of TRALI

A

donor antibodies to HLA and other recipient antigens, also a 2-hit theory: 1) sequestration of neutrophils 2) activation of neutrophils causing a transient short lived leukopenia

210
Q

transfusing a pediatric patient with 4 cc/kg of prbc will raise hemoglobin by how much?

A

1 g/dL

211
Q

risk of HIV infection due to transfusion

A

1:2,000,000

212
Q

risk of hep B and hep C infection due to transfusion

A

1:200,000

213
Q

metabolic acidosis or alkalosis is often seen following massive transfusion?

A

metabolic alkalosis because large citrate loads is converted to bicarb in the liver

214
Q

carbohydrate CO2 production for every unit of O2 consumed

A

1.0

215
Q

protein CO2 production for every unit of O2 consumption

A

0.8

216
Q

fat CO2 production for every unit of O2 consumption

A

0.7

217
Q

carbonic anhydrase is primarily found where in the body?

A

RBCs and endothelium

218
Q

Most common triggers for ARDS

A

pneumonia and sepsis

219
Q

PaO2/FiO2 (P/F) ratio for ARDS criteria

A

< 200

220
Q

subglottic stenosis is a risk factor when ETT is in place for how long?

A

> 2 weeks

221
Q

gram negative or gram positive bacteria is most common in sepsis?

A

gram negative

222
Q

Minimum NIF (negative inspiratory force) for extubation criteria

A

-20 to -25 cm H20

223
Q

what are the two high-risk conditions that may benefit from H2 blockers to avoid stress related mucosal injury to the stomach

A

mechanical ventilation > 48 hrs and coagulopathy

224
Q

three biggest risk factors for acalculous cholecystitis

A

surgery, trauma, and TPN

225
Q

standard for basic anesthesia monitoring under general anesthesia includes:

A

oxygenation, ventilation, circulation, and temperature

226
Q

natural frequency and dampening of pressure transducer are directly related or inversely related

A

inversely related.

227
Q

10 cmH20 equates what in mmHg?

A

7 mmHg = 10 cmH20

228
Q

what is an osborn wave?

A

positive deflection between QRS and ST segment, aka camel-hump sign or late delta wave, usually observed in hypothermic patients (< 32C)

229
Q

carbon monoxide poisoning results in shift of oxygen-Hb dissociation curve to left or right?

A

left. O2 sat overestimates the PaO2.

230
Q

anesthetic drug that increases amplitude and has no effect on latency for SSEP signaling

A

ketamine

231
Q

Evoked potentials that are least sensitive to volatile agents

A

BAEPS (brainstem auditory evoked potentials), hearing is the last sense to be lost.

232
Q

Best immediate treatment for PACU patient shivering with temp of 34.5C and new onset ST depressions

A

meperidine, which is faster than warmers to decrease shivering

233
Q

antiseizure meds show significant reductions in seizures within how many days of a TBI (traumatic brain injury)

A

7 days

234
Q

Best method to prevent phase I hypothermia that is due to vasodilatation and redistribution of heat from central to peripheral compartments

A

Pre-warming patient with forced air convection blankets prior to induction

235
Q

permanent neurologic injury can result from status epilepticus after how much time?

A

within 5 minutes

236
Q

why is status epilepticus an emergency?

A

sustained neuronal oxygen consumption can lead to ischemia

237
Q

Postop pt in PACU has tonic/clonic seizure, what is first step?

A

assess and establish a patent airway

238
Q

the most common cause of intraop stroke from CEA (carotidendarterectomy)

A

embolism, which can be caused by placing a stent

239
Q

latex allergies most often occur in children with what diseases?

A

myelomeningocele, spina bifida, GU disease, indwelling tubes, and multiple surgeries as a child

240
Q

hypothermia or hyperthermia exacerbates multiple sclerosis?

A

hyperthermia

241
Q

Guillian-Barre syndrome (GBS) is exacerbated by what type of anesthesia?

A

neuraxial anesthesia, but not lumbar punctures

242
Q

3 big anesthetic things to avoid in patient with myotonic dystrophy

A

1) succinylcholine
2) neostigmine
3) hypothermia

243
Q

myasthenia gravis has 4 types, the hallmark of type I is?

A

isolated extraocular muscle weakness

244
Q

A study showed myasthenia gravis patients undergoing thymectomy have what risks that increase likelihood of postop mechanical ventilation

A

1) disease duration > 6 yrs
2) vital capacity < 2.9L
3) pyridostigmine > 750 mg/day

245
Q

Myasthenia gravis improves or worsens in the last trimester of pregnancy

A

worsens, and continues into early postpartum

246
Q

Infants of myasthenia gravis mothers have transient myasthenia for how long?

A

about 1-3 weeks when maternal antibodies are cleared

247
Q

Eaton Lambert syndrome patient’s sensitivity to muscle relaxants

A

increased sensitivity to both succinylcholine and nondepolarizing muscle relaxants. decreased Ach release -> increased Ach receptors

248
Q

How is MAC changed with patient taking TCAs (tricyclic antidepressants)

A

Increased because neurotransmitter levels are increased

249
Q

Use of ephedrine in a patient on TCAs (tricyclic antidepressants) will be potentiated or ineffective?

A

potentiated and unpredictable effect

250
Q

lithium causes or treats nephrogenic diabetes insipidus?

A

causes nephrogenic DI

251
Q

how does lithium affect muscle relaxants?

A

lithium potentiates both depolarizing and nondepolarizing muscle relaxants

252
Q

Is lithium safe in pregnancy?

A

No, lithium is a teratogen

253
Q

absolute contraindications to ECT (electroconvulsive therapy)

A

intracranial hypertension, aneurysm, and mass

254
Q

best treatment for acute cocaine toxicity causing diffuse ST elevations, tachycardia, and hypertension

A

calcium channel blockers

255
Q

drug that is most commonly abused among anesthesiologists and is most likely associated with relapse

A

fentanyl

256
Q

what is the normal resting (end-expiration) intrapleural pressure

A

-5 cm H2O, this negative intrapleural pressure is always required to keep lungs from collapsing

257
Q

a high Reynold’s number is consistent with turbulent or laminar flow?

A

turbulent flow

258
Q

turbulent flow is more a function of viscosity or density?

A

density, turbulent flow is like ping pong balls, the more you have, the more resistance there is

259
Q

Neck flexion can increase or decrease dead space

A

decrease

260
Q

ventilatory response to hypercarbia is mediated by chemoreceptors where?

A

on the anterolateral surface of medulla in contact with 4th ventricular CSF

261
Q

part of medullary center that is responsible for coordinating inspiration

A

dorsal medullary center

262
Q

part of medullary center that is responsible for coordinating expiration

A

ventral medullary center

263
Q

reason for decreased O2 saturations in a severe COPD patient after giving supplemental O2

A

interruption of hypoxic pulmonary vasoconstriction, leading to worsening deadspace and V/Q mismatch

264
Q

why is it classic teaching to delay the second carotidendarterectomy (CEA) up to a year after the first CEA?

A

carotid bodies are dysfunctional (denervated) after CEA and it is assumed that it can take up to a year to return to function

265
Q

what distinguishes chronic bronchitis from emphysema?

A

frequent cough, copious secretions, CO2 retainer earlier in disease course leading to erythrocytosis and high PA pressures and cor pulmonale

266
Q

definition of very severe COPD

A

FEV1 < 30% or FEV1 < 50% and cor pulmonale

267
Q

definition of severe COPD

A

FEV1 < 50% predicted

268
Q

the only proven treatments to affect overall natural history of COPD

A

smoking cessation and O2 supplementation

269
Q

best ventilation strategy for patients with noncompliant, restrictive lungs

A

small tidal volumes and increased respiratory rate

270
Q

patient with open pneumothorax breathing spontaneously in lateral decub position, mediastinum will shift which way during inspiration?

A

down during inspiration and up during expiration. with mechanical ventilation, up during inspiration and down during expiration

271
Q

a large pneumothorax greater than what percent of lung volume should be treated with a chest tube

A

> 50% of lung volume

272
Q

Next best step in management of a stable patient with small pneumothorax

A

Repeat CXR in 3-6 hrs to rule out progression

273
Q

intrathoracic lesions cause obstruction on expiration or inspiration

A

expiration

274
Q

extrathoracic lesions cause obstruction on expiration or inspiration

A

inspiration

275
Q

null hypothesis definition

A

two interventions will have the same effect

276
Q

type I error is alpha or beta

A

alpha

277
Q

false positive is type I or type II error

A

type I

278
Q

Relationship between power and beta

A

power = 1 - beta

279
Q

study variable that has an order and the difference between each data point is constant

A

interval variable

280
Q

study variable that has an order but the difference between each data point is not necessarily constant

A

ordinal variable

281
Q

study variable with no inherent ordering

A

nominal or categorical variable

282
Q

standard deviation includes what percent of all data?

A 
1 = 68%
2 = 95%
3 = 99%
283
Q

standard deviation is a measure of what?

A

variance

284
Q

standard error is a measure of what?

A

accuracy

285
Q

if standard deviation is low, then the study is considered?

A

precise

286
Q

student t-test should be used for what type of data?

A

continuous interval data

287
Q

chi-squared test should be used for what type of data?

A

data that is not interval

288
Q

ANOVA test should be used for what type of data?

A

continuous interval data for 3 or more populations

289
Q

difference between student t-test and paired t-test

A

student t-test compares 2 different groups. paired t-test compares same group before and after an intervention

290
Q

odds ratios are used when the outcome is ?

A

already known. relative risk is used when outcome is uncertain.

291
Q

Sensitivity is calculated from 2 x 2 table with what equation?

A

TP / (TP + FN)

292
Q

specificity is calculated from 2 x 2 table with what equation?

A

TN / (TN + FP)

293
Q

positive predictive value is calculated from 2 x 2 table with what equation?

A

TP / (TP + FP), only looking at positive results of new test

294
Q

negative predictive value is calculatd from 2 x 2 table with what equation?

A

TN / (TN + FN), only looking at negative results of new test

295
Q

test’s likelihood of correctly identifying a positive result

A

sensitivity

296
Q

test’s likelihood of correctly identifying a negative result

A

specificity

297
Q

likelihood of a true positive being identified as a positive result by a new test

A

positive predictive value

298
Q

likelihood of a true negative being identified as a negative result by a new test

A

negative predictive value

299
Q

Number needed to treat (NNT) is calculated how?

A

NNT = 1 / ARR
ARR = absolute risk reduction
eg. risk reduces from 5% to 3%, so NNT = 1 / 2% = 50

300
Q

protopathic sensation is noxious or non-noxious?

A

noxious (painful)

301
Q

fast pain is carried by what type of fibers?

A

A-delta fibers

302
Q

delayed, slow secondary pain is carried by what type of fibers?

A

C fibers

303
Q

decreased pain med requirements postop after giving ketorolac is due to?

A

both decreased peripheral and central sensitization of pain

304
Q

how are antivirals effective in treating herpes zoster?

A

reducing the frequency of painful zoster flares

305
Q

Type of CRPS with demonstrable nerve lesions

A

type II

306
Q

severe CRPS patients can result in what problems?

A

severe muscle wasting, severe osteoporosis, ankylosing joints, contractures, glossy skin

307
Q

most effective early management of CRPS

A

series of sympathetic blocks of the affected extremity

308
Q

treatment for severe longstanding CRPS

A

spinal cord stimulator placement, possibly ketamine

309
Q

risk of CRPS is higher in women or men?

A

women (3:1)

310
Q

what age group is CRPS most prevalent?

A

middle age

311
Q

why avoid neuraxial anesthesia in patient with phantom limb pain (PLP)

A

spinal anesthesia can exacerbate symptoms

312
Q

unpleasant sensation with or without a stimulus

A

dysesthesia

313
Q

abnormal sensation without an apparent stimulus

A

paresthesia

314
Q

perception of non-noxious sensation as pain

A

allodynia

315
Q

pain in an area that lacks sensation

A

anesthesia dolorosa

316
Q

increased response to a noxious stimulus

A

hyperalgesia

317
Q

Transcutaneous electrical nerve stimulation (TENS) provides analgesia by what mechanism

A

stimulating large afferent epicritic fibers so original pain will no longer be as well perceived

318
Q

stellate ganglion is classically blocked by locating transverse process of which cervical vertebrae?

A

C6

319
Q

what’s the advantage of intrathecal opioid catheter vs other opioid routes for intractable cancer pain?

A

lower doses reduce side effects

320
Q

lumbar epidural steroid injection is usually successful within how many months of an injury?

A

3 months, and usually takes a series of 3 injections

321
Q

psychiatric disorders not correlated with chronic pain

A

bipolar and schizophrenia

322
Q

cerebral blood flow increases only after PaO2 decreases under what value?

A

< 50

323
Q

normal CMRO2 is about?

A

3.5 mL/100g/min

324
Q

normal cerebral blood flow is?

A

50 mL/100g/min

325
Q

average adult CSF volume and how much is produced a day.

A

150 cc, 500 cc is produced a day

326
Q

What anesthesia MAC level is cerebral blood flow not autoregulated anymore

A

2 MAC or more

327
Q

volume of venous air embolism that is lethal

A

> 300 cc

328
Q

Hunt and Hess scale

A 
Classify severity/mortality of subarachnoid hemorrhage:
1-minimal HA 5%
2-mod HA, nuchal rigidity 10%
3-above + drowsy 30%
4-stupor, hemiparesis 50%
5-coma,decerebrate rigidity 70%
329
Q

greatest risk over the first week after a patient has a ruptured cerebral aneurysm

A

cerebral vasospasm

330
Q

Triple H therapy for prevention and treatment of cerebral vasospasm

A

Hypertension (SBP > 150), Hypervolemia (CVP > 8), Hemodilution (hct 30)

331
Q

Best method for monitoring for cerebral vasospasm

A

frequent neurochecks and transcranial doppler combined

332
Q

Intracranial pressure (ICP) when risk of herniation is much higher

A

ICP > 30-40

333
Q

isolated fractures of C1 and the occipital condyles are in general stable cervical spine injuries, true or false

A

true

334
Q

valsalva is board code-word for?

A

decreased preload

335
Q

handgrip maneuver is board code-word for?

A

increased afterload

336
Q

fastest and most effective way to stabilize a CHF exacerbation with EF 35% with increased pulmonary edema

A

mechanical ventilation, then add lasix and pressors to treat underlying problem of volume overload

337
Q

propofol induction and maintenance doses should be based on?

A

induction: IBW (termination is based on redistribution)
maintenance: TBW (based on clearance)

338
Q

Elevated E to e’ ratio (over 15 or so) is a sign of what?

A

diastolic dysfunction

339
Q

aldrete score includes what parameters?

A

activity, respiration, consciousness, circulation (blood pressure), color

340
Q

Pulmonary test results that predict poor postop pneumonectomy prognosis

A

PaCO2 > 45, PaO2 < 50, predicted postop FEV1 of < 800 mL, FEV1/FVC < 50%, max VO2 < 10 mL/kg/min

341
Q

Which is more effective? PEEP to dependent lung or CPAP to surgical lung during one lung ventilation (OLV)

A

CPAP to surgical lung which allows shunted blood to participate in oxygen exchange

342
Q

advantages of OPCABG (off pump CABG) vs on pump CABG

A

decreased incidence of respiratory infections, afib, inotrope use, and fewer blood transfusions

343
Q

which is the final cannula removed after CPB (cardiopulmonary bypass)

A

aortic cannula

344
Q

mechanism of increased pulmonary artery (PA) pressures after giving protamine following cardiopulmonary bypass (CPB) surgery

A

thromboxane (vasoconstrictor) release from macrophages caused by heparin-protamine complexes activating complement

345
Q

Best strategy to hasten rewarming after CPB (cardiopulmonary bypass) surgery

A

nitroglycerin (NTG) infusion

346
Q

why is first degree AV block common following heart transplant?

A

increased refractory period of transplanted heart and slowed atrial conduction

347
Q

classic presentation of digitalis toxicity

A

increased PVCs (bigeminy most common), anorexia, nausea. Toxicity is exacerbated by hypokalemia and hypomagnesia

348
Q

beta blockers with alpha blocking properties

A

carvedilol and labetalol

349
Q

normal umbilical artery and vein blood gases

A

artery: 7.3/50/20
vein: 7.35/40/30

350
Q

when does fetal Hb start to be replaced by adult Hb

A

around 3 months, and completely at 6 months

351
Q

p50 of fetal Hb

A

19 (27 for adult Hb)

352
Q

normal neonatal glucose for full-term infant can range as low as?

A

30 mg/dL (< 45 mg/dL is hypoglycemia for neonates)

353
Q

Concentration of dextrose used to treat hypoglycemic neonate

A

D10 or less

354
Q

many sources advise avoidance of succinylcholine in children because?

A

increased risk of hyperkalemia due to undiagnosed underlying myopathies

355
Q

after 28 days, respiratory distress syndrome (RDS) is called what?

A

bronchopulmonary dysplasia (BPD)

356
Q

lecithin-sphingomyelin ratio (L/S) that is associated with fetal lung maturity

A

2 is sufficient surfactant production, < 1.5 is not

357
Q

which muscle relaxant requires a larger dose in infants?

A

succinylcholine

358
Q

pulse oximeter should be placed where to assess lung function of a newborn?

A

preductal location such as right hand

359
Q

elective surgery should be delayed till what postconception age for healthy infants to reduce risk of post-anesthetic apnea

A

44-60 weeks (most authors favor > 50 weeks)

360
Q

infant younger than 50 weeks post conception should be observed how many hours post-op to monitor post-anesthetic apnea?

A

12 hours after surgery (most conservative approach is 24 hr observation for infants < 60 weeks)

361
Q

chest compression to ventilation ratio for neonate resuscitation

A

3:1

362
Q

tracheal dose of epinephrine is how many times greater than IV dose?

A

10 times (0.1 mg/kg for tracheal, 0.01 mg/kg for IV)

363
Q

congenital abdominal defect associated with other midline defects, GI, GU, and cardiac

A

omphalocoele, intestinal viscera herniate into base of umbilical cord and contained within membranous sac

364
Q

VACTERL

A 
V: vertebral
A: anal 
C: cardiac
T: TEF (tracheoesophageal fistula)
E: esophageal atresia
R: renal and radial atresia
L: other limbs
365
Q

how many mL/kg of packed red blood cells (prbcs) will raise hgb by 1 point

A

4 mL/kg

366
Q

lower or higher doses of local anesthetics for neuraxial anesthesia for pregnant women

A

lower, they are more sensitive to local anesthetics, epidural vein congestion decreases intrathecal volume and epidural space

367
Q

Preeclampsia should be considered with proteinuria levels greater than what?

A

above 300 mg/day

368
Q

increased tidal volumes in late-term pregnancy is due to

A

increased anterior-posterior diameter of the chest

369
Q

cardiovascular changes in pregnancy

A

cardiac output: 50% increase
stroke volume: 30% increase
heart rate: 15% increase

370
Q

why don’t muscle relaxants cross placenta?

A

they are charged hydrophilic molecules

371
Q

why doesn’t bupivacaine cross placenta easily?

A

it is highly protein bound

372
Q

why do local anesthetics get trapped inside fetus?

A

fetal pH is lower than maternal pH, thus they become ionized and unable to cross back

373
Q

latent phase of labor is primarily mediated by what spinal levels

A

T10-T11 (latent phase equals 0-3 cm dilation)

374
Q

Nerve fibers that carry pain of active phase of labor

A

small visceral afferent fibers of T10-L1 which travel ALONGSIDE sympathetic nervous system

375
Q

second stage of labor involves what spinal levels

A

pudendal nerve (S2-4) when patient is fully dilated

376
Q

opioid with weak local anesthetic properties

A

meperidine

377
Q

what’s the advantage of epinephrine in epidural infusion

A

marker for intravascular epidural catheter

378
Q

drug with 75% effectiveness for treating a migraine

A

sumatriptan

379
Q

reasons for emergency c-section caused by external version of breech presentation

A

placental abruption or umbilical cord compression

380
Q

fetal scalp pH below what number is abnormal?

A

below 7.20, above 7.25 is normal

381
Q

most common cause of preeclampsia mortality

A

cerebral hemorrhage

382
Q

magnesium toxicity should be immediately treated how?

A

IV calcium

383
Q

risk factors for placenta previa

A

prior c-section, multiparity, prior uterine surgery, and advanced maternal age

384
Q

risk factors for uterine rupture

A

prior c-section, excess oxytocin, myomectomy,trauma, forceps delivery

385
Q

most feared consequence of chronic benzodiazepine use in first trimester

A

cleft palate

386
Q

Most cases of viral croup are due to what virus?

A

parainfluenza virus

387
Q

treatment of croup

A

racemic epinephrine

388
Q

why is pulmonary HTN a comorbidity in patients with severe scoliosis

A

restrictive lung disease causes pulmonary HTN

389
Q

major complication risks of doing a wake-up test during spinal surgery

A

unintentional extubation, air embolism with deep inspiration

390
Q

dose of epidural duramorph for pediatric patient

A

0.1 mg/kg

391
Q

Is halothane-caffeine contracture test (HCCT) highly sensitive or highly specific?

A

highly sensitive

392
Q

A known MH patient should be observed for how long in the PACU?

A

6 hours

393
Q

hypothermia causes clinically significant functional coagulopathy when temp decreases to what?

A

33 C

394
Q

intraabdominal pressure that meets definition of abdominal hypertension

A

12 mmHg, above 20 mmHg is associated with hypoperfusion of abdominal organs

395
Q

small trials have shown pretreatment with what medication may decrease incidence of tourniquet pain?

A

gabapentin

396
Q

afferent pathway of oculocardiac reflex involves which ganglions?

A

ciliary and gasserian ganglions

397
Q

geniculate ganglion carries what nerve?

A

facial nerve

398
Q

petrous ganglion carries what nerve?

A

glossopharyngeal nerve

399
Q

jugular ganglion carries what nerves?

A

vagal and accessory nerves

400
Q

which has quicker onset, atropine or glycopyrrolate?

A

atropine

401
Q

Anterior spinal artery is supplied by which arteries?

A

Vertebral arteries superiorly. Posterior intercostal arteries in thoracic region. Artery of Adamkiewicz in lumbosacral region.

402
Q

Innervation of anterior tongue

A

Trigeminal n., mandibular branch (V3)

*ACE's (27 decks)

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