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OMFS > Medical Assessment > Flashcards

Medical Assessment Flashcards

1
Q

Acute Coronary syndrome is caused by

a) cholesterol plaques causing damage and disease to coronary vessels causing vessel narrowing
b) Blunt cardiac trauma

A

a) cholesterol plaques causing damage and disease to coronary vessels causing vessel narrowing

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2
Q

Treatment of STEMI

a) Aspirin, ACEI, Beta blocker
b) immediate reperfusion
c) angioplasty
d) thrombolytic therapy
e) B, C and D

A

E) STEMI are treated with immediate reperfusion through angioplasty and thrombolytic therapy

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3
Q

Acute heart failure can be ruled out in a cardiac workup for congestive heart failure if

a) Brain natriuretic peptide is elevated
b) Brain natriuretic peptide is normal
c) Brain natriuretic peptide is decreased

A

B - normal brain natriuretic peptide level rules out acute heart failure

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4
Q

Which of the following are associated with systolic heart failure? You can choose more than one answer

a) Preserved ejection fraction
b) Reduced ejection fraction
c) S4 murmur
d) S3 murmur
e) dilated left ventricle

A

A reduced ejection fraction, S3 murmur, and dilated left ventricle are all associated with systolic heart failure

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5
Q

Which of the following is associated with diastolic heart failure?

a) Right atrial hypertrophy
b) Left atrial hypertrophy
c) Right ventricle hypertrophy
d) Left ventricle hypertrophy

A

D) Left ventricle hypertrophy is associated with diastolic heart failure

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6
Q

Congestive heart failure stage C

a) HF symptoms at rest
b) HF symptoms with exercise
c) structural disease with HF symptoms
d) Risk of heart failure due to comorbidities

A

C) CHF stage C is defined at structural disease with HF symptoms and is treated with ACEI, BB, diuretics, and salt restriction

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7
Q

Aortic Stenosis murmur

A

Crescendo-descrendo systolic murmur

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8
Q

Aortic regurgitation murmur

A

Decrescendo blowing diastolic murmur

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9
Q

Mitral stenosis murmur

A

Opening snap

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10
Q

Mitral regurgitation murmur

A

Holosystolic, blowing murmur

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11
Q

Mitral valve prolapse murmur

A

Midsystolic click

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12
Q

Primary cause of primary hypertension

a) No identifiable cause
b) Obesity
c) Tobacco Use

A

A) Primary hypertension has no identifiable cause

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13
Q

Microbe most commonly associated with infective endocarditis secondary to IV drug abuse

A

Staphylococcus aureus

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14
Q

Microbes most commonly associated with infective endocarditis of a native valve

A

Viridians streptococci, S. aureus, enterocci

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15
Q

Microbes most commonly associated with infective endocardities of a prosthetic valve

A

S. epidermis, S. aureus

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16
Q

Culture negative infective endocardities could be caused by HACEK organisms. What are those organics?

A 
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella corrodens
Kingella

as well as Candida and aspergillus for culture negative endocarditis

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17
Q

Two Major criteria for infective endocarditis

A

Positive blood culture

Echocardiogram with evidence of endocardial involvement

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18
Q

5 Minor Criteria for infective endocarditis

A
  • Predisposition to IE (IV drug abuse, indwelling catheter, diabetes
  • Fever
  • Vascular phenomena
  • Microbiologic evidence
  • Immunologic phenomena (osler nodes, roth spots)
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19
Q

For the diagnosis of definite infective carditis, what combination of major and minor criteria must be met?

A

2 major
1 major and 3 minor
5 minor

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20
Q

Treatment of native valve endocarditis

A

Native valve endocarditis is treated with vancomycin and gentamicin

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21
Q

Treatment of prosthetic valve endocarditis

A

Prosthetic valve endocarditis is treated with vancomycin, rifampin, and gentamicin

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22
Q

What are METs when assessing cardiovascular patients?

A

METs are the metabolic equivalents of task and are used to assess the physiologic measurement that expressed energy associated with physical activity

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23
Q

Example of 1 METs

A
  • Can you take care of yourself, walk indoors, feed yourself, dress yourself, walk 1-2 blocks
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24
Q

Example of 4 METs

A
  • Can you climb a flight of stairs, do heavy housework, or participate in moderate recreational activities?
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25
Q

Example of >10 METs

A
  • Can you participate in strenuous sports
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26
Q

Which of the following are obstructive pulmonary diseases? Choose more than one, if they apply

a) Interstitial lung disease
b) Sarcoidosis
c) Asthma
d) cystic fibrosis
e) COPD

A

Asthma, cystic fibrosis, and COPD are all obstructive lung diseases

Restrictive lung diseases include sarcoidosis, interstitial lung disease, and collagen disorders

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27
Q

Is lung volume increased or decreased in obstructive lung disease?

A

Increased

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28
Q

What is the mechanism of action of a beta 2 agonist such as albuterol or salmeterol?

A

Beta 2 agonism causes an increase in cAMP formation, leading to relaxation of bronchial muscle

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29
Q

What is the mechanism of action of montelukast, a leukotriene modified, utilized to treat asthma?

A

Montelukast is a leukotriene receptor antagonist that decreases bronchoconstriction

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30
Q

In treatment of asthma, zilueton can be used, what is its mechanism of action?

A

Zileuton is a 5-lipoxygenase, it inhibits leukotriene formation thus decreasing bronchoconstriction

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31
Q

Ipratropium bromide is an anti-cholinergic utilized in the treatment of asthma. What is the physiologic result of utilizing this medication?

A

Ipratropium blocks cholinergic constriction, thus causing bronchodilation

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32
Q

What are the two types of COPD (blue bloater and pink puffer)?

A 
Chronic bronchitis (blue bloater): Chronic productive cough for 3 months in 2 consecutive years
Emphysema (pink puffer): Enlargement of airways and wall destruction distal to bronchioles
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33
Q

What will an ABG show when evaluating COPD

A

ABG analysis will show hypercarbia and hypoxemia

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34
Q

When treating ARDs, acute hypoxemic respiratory failure associated with bilateral lung infiltrates, what level of tidal volumes are to be used during mechanical ventilation? Should they be low, high, normal

A

Low tidal volumes (roughly 6cc/Kg)

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35
Q

S1Q3T3 refers to what findings on an ECG that are suggestive of what diagnosis?

A

S1 - Large S wave in lead I
Q3 - Large Q wave in lead III
T3 - inverted T wave in lead III
These ECG findings are suggestive of a PE.

Other ECG findings suggestive of a PE include, new right heart strain, nonspecific anterior T wave inversions, and sinus tachycardia

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36
Q

What is the modified Wells-Criteria used for?

A

The Modified Wells Criterias is used to determine the likelihood of a PE
less than or equal to 4 means unlikely PE
>4 likely PE
Criteria Points
Signs and symptoms of DVT - 3 points
PE is primary diagnosis - 3 points
HR >100 - 1.5 points
Immobilized for at least 3 days or surgery in previous 4 weeks - 1.5 points
Previously diagnosed PE or DVT - 1.5 points
Malignancy with treatment within 6 months - 1 point
Hemoptysis - 1 point

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37
Q

Acute renal failure can be divided into three types of acute renal failure, what are they?

A

Pre-renal: Volume depletion, treat with fluids

Renal: Tubular injury, glomerular disorder FENa >1%: BUN/Creatinine ratio 15:1; muddy brown casts; Treat by removing causative agents and treat underlying cause

Post-renal: Urinary tract obstruction; remove obstruction

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38
Q

Urine output less than…for more than 6 to 12 hours cold be suggestive of acute renal failure

a) 0.2cc/kg/hour
b) 1.0 cc/kg/hour
c) 0.5 cc/kg/hour

A

C) 0.5cc/kg/hour

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39
Q

What is in a banana bag?

A

Banana bag is IV fluids for patients with alcoholism
Contains thiamine folate, isotonic saline, 5%dextrose
Administer prior to glucose to prevent Wernicke’s encephalopathy

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40
Q

Define Beta Thalassemia

A

A blood disorder that reduces the production of hemoglobin

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41
Q

Define ASA VI

A

Organ donor patient

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42
Q

Which drug class should be avoided in patients with hypertrophic cardiomyopathy

a) beta blockers
b) ACEI
c) Calcium channel blockers
d) Diuretics

A

D - Diuretics should be avoided in patients with DCM. Dehydration increases the outflow tract pressure

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43
Q

What type of cardiomyopathy is associated with high outflow tract pressures?

a) restrictive
b) dilated
c) idopathic
d) hypertrophic

A

D - hypertrophic cardiomypathy is associated with high outflow tract pressures. There is an associated with left ventricular outflow obstruction.

44
Q

Caution should be given to administering local anesthetics containing vasoconstrictor to hypertensive patients treated with which medication?

a) ACEI
b) Non-selective B blockers
c) CCB
d) ARBs

A

B - Epinephrine causes sympathetic stimulation of both alpha and beta adrenergic receptors. Alpha -1 mediated vasoconstriction is unopposed with beta blockade and can result in severe hypertension and possible reflex bradycardia

45
Q

The agent with the slowest onset of action when treating an acute hypertensive crisis is

a) esmolol
b) labetolol
c) sublingual nitroglycerin
d) hydralazine

A

d - hydralazine has the slowest onset of action
Esmolol is B1 selective (2-10 minutes)
Labetolol is non selective (2-5 minutes)
Sublingual nitroglycerin (2-5 minutes) causes vaso and arterial dilation
Hydralazine is a direct peripheral dilator (5-20 minutes)

46
Q

The laboratory finding most consistent with secondary hypertension associated with hyperaldosteronism

a) hyperkalemia
b) hypokalemia
c) hypercalcemia
d) hypocalcemia

A

B - hypokalemia
Primary aldosteronism produces secondary hypertension associated with hypokalemia and suppressed renin activity. Aldosterone causes potassium excretion and sodium resorption from the distal tubule and collecting duct leading to hypokalemia and hypernatremia with increased extracellular fluid volume

47
Q

A patient with mitral stenosis presents with complaints of fatigue, exertional dyspnea, and some chest pain. He shows JVD, peripheral edema, and hepatosplenomegaly. What are some additional clinical findings you could expect to be seen with cor pulmonale/pulmonary hypertension?

A

You could expect right ventricular hypertrophy and left atrial hypertrophy. ECG findings would consistent of right axis deviation, peaked P waves in II, III, and AVF. You would expect pulmonary arterial pressure elevation.

48
Q

Which heart block types demonstrates a progressive PR interval increase

a) First degree
b) Mobitz second degree
c) Mobitz II second degree
d) third degree

A

B - mobitz I second degree

49
Q

An elderly woman is two days s/p AICBG and continues to have dyspnea with an elevated B-type natriuretic peptide. What does this indicate?

a) PE
b) COPD
c) Metabolic acidosis
d) CHF

A

d - CHF

BNP is a neurohormone released by the ventricular myocardium in response to ventricular volume and pressure overload

50
Q

An elderly male has crushing substernal chest pain shortly of local anesthesia is delivered. This chest pain radiates to his left arm. What intervention should be taken?

a) Sublingual nitroglycerin
b) supplemental oxygen
c) 325mg crushed aspirin PO
d) Intramuscular morphine sulfate

A

B - this is likely an ischemic myocardial injury. Despite MONA, the initial treatment of ischemic heart disease is Oxygen, Nitroglycerin, Aspirin, Morphine (ONAM)

51
Q

ACEI and diuretics are used in combination for the treatment of CHF. What beneficial affects does this combination have?

a) Positive chronotropic and inotropic effects
b) Negative chronotropic and inotropic effects
c) Increase preload and afterload
d) Decrease preload and afterload

A

D) ACEI block the RAA system, producing vasodilation by limiting angiotensin II vasoconstriction, thereby decreasing afterload. The diuretic will decrease extracellular fluid, thereby decreasing myocardial work and energy requirements of the myocardium

52
Q

What is the risk factor for sudden cardiac death for a patient with aortic stenosis?

a) 1%
b) 5%
c) 10%
d) 15%

A

B ) 5% - the risk factor for sudden cardiac death

53
Q 
You see a patient with the following blood gas result
pH 7.32
PaCO2 46
HCO3 23
What is their condition?
a) Resp Acidosis
b) Resp alkalosis 
c) Metab acidosis
d) metab alkalosis
A

Respiratory acidosis occurs when pH <7.36 and PaCO2 above 44. This will occur with a sudden depression of the medullary respiratory center, paralysis of respiratory muscles, and with air obstruction

Metabolic acidosis can be due to extrarenal loss of bicarb, as in diarrheal disease or by high renal excretion of bicarb. Pay attention to Bicarb level, the pH will be low here, but so will the bicarb level. It should be below 22mg/Hg.

Metabolic alkalosis is caused by vomiting and diuretic use. The pH will be high here, above 7.44, and the bicarb will be above 26mmg/Hg

54
Q

What is the most important risk factor for developing nosocomial pneumonia?

a) malnutrition
b) mechanical ventilation
c) Nursing home residence
d) tobacco abuse

A

Mechanical ventilation

55
Q

Chronic complications of which disease process includes cirrhosis of liver, pancreatic dysfunction, sinusitis, and bronchial hyperreactivity

a) chronic bronchitis
b) cystic fibrosis
c) sarcoidosis
d) tuberculosis

A

B) Cystic fibrosis
Autosomal recessive
Defective chloride transport and increased sodium resorption in airway and ductal epithelia. This creates abnormally thick and viscous secretions. These thick secretions cause obstruction and destruction of exocrine ducts.
Diagnostic criteria are sweat chloride >60mEq/L

56
Q

Which of the following is commonly associated with asthma?

a) decreased lung compliance
b) obtunded cholinergic sensitivity
c) GERD
d) hypocarbia

A

C) GERD - this occurs from direction inflammation and bronchoconstriction from microaspiration

Asthma is an obstructive pulmonary disease

57
Q

Which of the following best characterizes restrictive lung disease?

a) Decreased total lung capacity
b) Decrease in FEV1/FVC ratio
c) Increase in vital capacity
d) increase in airway resistance

A

a) A
The TL, FRC, and and RV will all be decreased. Airway resistance is not affected in restrictive lung disease

A decrease in FEV1/FVC ratio is the hallmark of obstructive lung disease

58
Q 
What is the most likely diagnosis for a patient with the following PFT
FVC Normal
FEV1 - decreased
FEV1/FVC
a) respiratory muscle weakness
B) obstructive lung disease
c) restrictive lung disease
d) spontaneous pneumothorax
A

B - a decrease in FEV1/FVC ratio is the hallmark of obstructive lung disease

59
Q

What is the most definitive diagnosis of pulmonary embolism?

a) ultrasound of femoral popliteal pulse
b) Nuclear ventilation-perfussion scan
c) chest radiograph
d) Contrast-enhanced CT scan

A

D) CT scan

These usually originate in the femoral iliac pelvic veins

60
Q

Which of the following pharmacologic groups is a risk factor for venous thromboembolism?

a) hypercholesterolemics
b) Estrogen replacement therapy
c) NSAIDs
d) ACEI

A

B) Estrogen replacement therapies

61
Q

What is the first course of action for patients strongly suspected to have a DVT?

a) warfarin
b) thrombectomy
c) heparin
d) streptokinase

A

c) Heparin - goal is for 1.5-2.5 times the PTT for 5-10 days.
Heparin potentiates the action of antithrombin III thereby inactivating thrombin and preventing the conversion of fibrinogen to fibrin

62
Q

An older man reports a history of smoking and frequent productive cough for at least three months in each of the last two years. What is the most likely diagnosis?

a) emphysema
b) cystic fibrosis
c) asthma
d) chronic bronchitis

A

D - chronic bronchitis

63
Q

Which PFT is most useful for diagnosing asthma

a) TLC
b) FEV1
c) FRC
d) VC

A

B - FEV1 - this is the amount of air that can be forcibly expelled in one minute and reflects the degree of large airway obstruction. Normal values are 3L for men and 2L for women

64
Q

Which of the following should be avoided in a patient with a history of nasal polyposis nd moderate asthma

a) Acetaminophen
b) ultram (tramadol
c) propoxyphene
d) Diclofenac

A

d) Aspirin induced asthma is severe life threatening caused by utilization of NSAIDs (leukotrienes by products caused by a shift to an alternative pathway of arachidonic acid metabolism when COX1 is inhibited can cause a potent inflammatory response, including bronchoconstriction, mucus secretion, and swelling of nasal mucosa

Samter’s Triad

65
Q

An asthma patient has severe dyspnea and cough with wheezing noted on auscultation. What drug class is the preferential treatment

a) xanthins
b) adrenergics
c) anticholinergis
d) corticosteroids

A

B) Beta adrenergics are the preferred initial rescue medication. The ideal agent would be a pure B2 selective activity. Albuterol is a B2 agonist

Corticosteroids such as hydrocortisone and betamethasone are effective in management of asthma by reduction of lumen mucosa inflammation.

Atropine and ipratropium bromide are anticholinergics that act as bronchodilators. They can produce tachycardia

66
Q

A middle aged woman presents with weakness when chewing. She has dipoplia and lid ptosis. She has clinical signs of improvement with edrophonium administration. What would I suspect?

a) mutation in dystrophin gene
b) antibodies to presynaptic voltage gated calcium channels
c) antibodies to sarcoglycan proteins
d) antibodies against the postsynaptic nicotinic acetylcholine receptors

A

D) These findings are consistent with myasthenia gravis. This disease process is a result of autoantibodies to the postsynaptic nicotinic acetylcholine receptor. Cardinal features include weakness and fatigability of muscles, which improves with rest.

Dystrophin is for duchenne muscular dystrophy
Voltage gated calcium channel antibodies are associated with lambert eaton syndrome

67
Q

This syndrome closely resembles myasthenia gravis. It is thought to be caused by autoantibodies agaisnt voltage gated calcium channels which impairs the release of acetylcholine at motor nerve terminals

a) Duchenne muscular dystrophy
b) Lambert eaton syndrome

A

B) Lambert eaton Syndrome

68
Q

A young boy uses his hands on his knees to push himself up. His calf muscles are large compared to his thighs, and he is intellectually impaired

a) Myasthenia gravis
b) Dermatomyositis
c) polymyositis
d) duchenne muscular dystrophy

A

D- Duchenne muscular dystrophy

69
Q

Sturge Weber syndrome is often associated with

a) seizures
b) Lip pits
c) cafe au lait spots
d) mandibular hypoplasia

A

A) seizures
Sturge Weber Syndrome - facial vascular nevi (port wine stain), epilepsy, cognitive deficits, hemiparesis, hemianopia, and glaucoma

McCune Albright syndrome has the cafe au lait spots on the trunk

70
Q

Alzheimers can only be definitely diagnosed with which following exam?

a) Psychiatric
b) neurologic
c) CNS imaging
d) Examination of brain tissue at autopsy

A

d) This disease is characterized by anterograde amnesia, cognitive decline, and dementia. B amyloid plaques and intracellular neurofibrillary tangles of tau protein

71
Q

A patient with rheumatoid arthritis presents for evaluation of partially erupted tooth #32 and the patient takes methotrexate. What medication is avoided?

a) hydrocodone
b) codeine
c) tylenol
d) ibuprofen

A

d) MOA of methotrexate - folate antimetabolite that inhibits DNA synthesis. Irreversibly binds to dihydrofolate reductase, resulting in inhibition of purine and thymidyl acid synthesis.

When administered with NSAIDs, bone marrow suppression, aplastic anemia, and GI toxicity occur. The MOA is thought to be from NSAIDs inhibiting renal elimination of methotrexate

72
Q

What is the etiology of thrombocytopenia associated with liver disease?

A

Portal hypertension is a common sequelae of chronic liver failure. Vascular congestion within the portal system leads to splenomegaly. An enlarged spleen can sequester red blood cells and platelets. Sequestration of platelets by the spleen will leads to thrombocytopenia.

73
Q

Detection of only Hep B surface antibody in the serum is associated with which>

a) chronic infection
b) acute infection
c) immunity
d) initial cellular response

A

C) - this encodes for the viral envelope of the virus

74
Q

The first line treatment for primary peptic ulcer disease

a) H2 blockers and antacids
b) mucosal protectants and antibiotics
c) proton pump inhibitors and H2 blockers
d) proton pump inhibitor and antibiotics

A

D) Primary peptic ulcers are primary when caused by acute medical illness, use of nsaids, alcohol, or smoking. First line is going to be inhibiting gastric acid secretion and antimicrobial agents

75
Q

Barrett’s metaplasia is a complication of which?

a) chronic ulcerative cholitis
b) Peptic ulcer
c) GERD
d) Crohn’s disease

A

C) GERD

This occurs when squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium

76
Q

Which differentiates type I DM from type II DM?

a) ketoacidosis does not occur in DMII
b) Stronger familial link with DMI than II
c) insulin only indicated for DMI
d) DMII has diabetic neuropathy

A

A - insulin production continues to be produced in DMII, ketoacidosis does not occur though insulin may ultimately be required to control hyperglycemia.

77
Q

Cushing’s syndrome is most commony due to

a) a functioning pituitary gland
b) adrenal carcinoma
c) exogenous steroid admin
d) adrenal hyperplasia

A

a) Cushing’s is due to chronic exogenous and endogenous glucocorticoid excess.

78
Q

What are physical findings in a patient with untreated Addison’s disease

a) skin striae
b) hyperpigmentation of oral mucosa
c) centripetal obesity
d) acne

A

B) Primary adrenocortical insufficiency (Addison’s disease) - most often caused by autoimmune destruction of adrenal glands

79
Q

A young boy presents with oral ulcerations, generalized erythematous gingival enlargement a history of abdominal pain and diarrhea. He had an endoscopic evaluation which showed ulcerations of the ileum and cecum separated by areas of normal appearing mucosa. What is this most consistent with?

a. crohn’s disease
b. wegener’s granulmatosis
c. ulcerative colitis
d. ibs

A

a. crohn’s disease

Also high on this differential is wegener’s granulomatosis which is a granulomatous vasculitis affecting the upper respiratory tract, the lungs and kidney’s.
The skip lesions of the bowel described are consistent with crohn’s, whereas ulcerative colitis does not have this skip lesions

80
Q

A 20 something female presents with mandibular prognathism, widely spaced teeth, and bulbous finger tips. What is the cause?

a. hyperthyroidism
b. pheochromocytoma
c. chronic hypercalcemia
d. pituitary adenoma

A

d. pituitary adenoma

These are suggestive of acromegaly, which is the result of excess growth hormone. GH has anti-insulin actions

81
Q

Diabetic neuropathy can directly lead to what?

a. postural hypotension
b. resting bradycardia
c. arrhythmias
d. cardiomyopathy

A

a. postural hypotension

82
Q

An individual with cushing’s syndrome would demonstrate what abnormality?

a. hypovolemia
b. hyperkalemia
c. hyperglycemia
d. hypotension

A

C. Hyperglycemia
Cushing’s disease involves glucocorticoid excess, this results from a pituitary adenoma. Physical and biochemical abnormalities result from a state of prolonged hypercortisolism. These include glucose intolerance, hyperglycemia, hypokalemia, and hypertension

83
Q

Which antihypertensive should be help preoperatively?

a. atenolol (B1 selective)
b. Clonidine (Alpha 2 adrenergic agonist)
c. Lisinopril (ace inhibitor)
d. Minoxidil (vasodilator)

A

C. Lisinopril should be held preoperatively. This is because peri-induction hypotension can result from the loss of sympathetic tone associated with anesthesia induction superimposed upon renin-angiotensin system blockage

84
Q

In regard to beta blocker therapy to prevent ischemic injury in a surgical patient with stable coronary artery disease, which is correct?

a. All beta blocker agents have similar ischemic risk reduction
b. dosage is adjusted to resting rate of 50-60 bpm
c. effects on the heart rate and inflammatory response occur rapidly
d. common side effects include pulmonary edema and bronchospasm

A

B.
Beta blockers exert their cardioprotective effects by
1. Reduction in myocardial demand reduction in heart rate and contractility
2. Improvement in energy efficiency and outcome
3. Antiarrhythmic effect
4. Antiinflammatory effect
5. Antirenin and antiangiotensin properties

The effects on heart rate, contractility and energy substrate shift from fatty acids to glucose occur quickly. The anti-inflammatory response becomes evident only after weeks of treatment

85
Q

Hand-foot-and-mouth disease is caused by

a. coxsackievirus
b. EBV
c. Paramyxovirus
d. Togaviridae

A

A. Coxsackievirus, which belongs to the picornaviridae family. Group A causes hand-foot-and-mouth disease

EBV is associated with mononucleosis, Burkitt’s lymphoma nd nasopharyngeal carcinoma

86
Q 
Which of the following most affects males between ages 15 and 40?
A. juvenile rheumatoid arthritis 
b. Ankylosing spondylitis
c. Psoriatic arthritis
d. Pseudogout
A

B. Ankylosing spondylitis (Marie-Strumpell disease, rheumatoid spondylitis)

87
Q

Apnea is define as cessation of airflow from the nostrils and mouth for at least

a. 5 seconds
b. 10 seconds
c. 15 seconds
d. 7 seconds

A

B. 10 seconds

88
Q

What correlates with infection and length of hospital stay?

a. alpha 1 globulin
b. alpha 2 globulin
c. prealbumin
d. albumin

A

D. Albumin

Chloesterol and serum albumin levels are predictors of cross infection, death, and length of hospital stay

89
Q

Which medication is associated with increased hypertension?

a. ibuprofen
b. versed
c. fentanyl
d. hydrocodone

A

A. Ibuprofen

90
Q

Dexmedetomidine MOA

a. Alpha 2 agonist
b. NMDA
c. Mu receptor agonist
d. GABA

A

A. alpha 2 agonist

stimulation of presynaptic alpha-2 receptors in the central nervous system, activating inhibitory neurons which lead to a reduction in sympathetic output via a negative feedback mechanism

91
Q

Precedex has what property below?

a. Antisialogogue
b. Amnestic
c. Analgesic

A

C. Analgesic

Also sedative and anxiolytic

92
Q

Why are children more sensitive to inhalation anesthetics?

a. Large FRC
b. Higher ventilation rate
c. Greater alveolar surface area
d. Less chest wall compliance

A

B. Higher ventilation rate

Children have a lower FRC, alveolar surface area, chest wall compliance
Children have a higher ventilation rate

93
Q

A young child is being sedated and you provide LR. What happens to the lactate?

a. Excreted in the kidneys
b. Metabolized by the liver

A

B. Lactate is metabolized by the liver

94
Q

Hyperkalemia ECG findings

a. depressed T waves
b. Inverted T waves
c. Peaked T waves
d. large p waves

A

C. Peaked T waves

Hyperkalemia can cause peaked T waves, small p waves, and widened qrs complex

95
Q

Which cardiac valve is most involved with endocarditis?

a. Mitral
b. Tricuspid
c. Pulmonary

A

A. Mitral valve

96
Q

Where is the narrowest point in the child’s airway?

a. Glottis
b. Epiglottis
c. Cricoid cartilage

A

C. Cricoid cartilage

97
Q

Which medication should you limit local/epi with?

a. labetolol
b. atenolol
c. Nitrates

A

A. Labetolol

Avoid epinephrine with non-selective beta-blockers

98
Q

Propofol and remifent infusion is better than inhalation anesthetics due to less

a. Bradycardia
b. Hypotension
c. Post-op pain

A

C. Post-op pain

99
Q

What is the normal glucose level of CSF?

a. 80-120
b. 15-30
c. 60-90

A

C. 60-90

Blood glucose>CSF>Nasal fluid

100
Q

Which paralytic can you NOT give to a MH laryngospasm?

a. Roc
b. Succ

A

B.

101
Q

Redman’s syndrome is infusion of…

a. Unasyn with hypotension and rash
b. Vanco with hypertension and pruritis
c. Vanco with hypotension, rash

A

C. Redman’s syndrome is infusion of vancoycin with development of chest pain, hypotension, and rash

Vanco should be stopped with immediate dose of Benadryl

102
Q

With chronic alcoholic cirrhosis and on erythromycin and methadone, what happens when you acutely stop erythromycin?
A. Increase methadone in patient
B. Decrease methadone in patient
C. No affect on methadone

A

B. Erythromycin increases the level of methadone

103
Q

Is asthma an obstructive lung disease or a restrictive lung disease?

A

Obstructive

104
Q

If FEV1 is increased with utilization of a bronchodilator, this favors the diagnosis of…

a. asthma
b. COPD

A

A. asthma

105
Q

A patient who is vomiting will likely be in

a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis

A

B. Metabolic alkalosis

Elevated serum bicarb levels due to volume contraction

106
Q

A patient has diarrhea will likely be in

a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis

A

A. metabolic acidosis due to loss of alkaline fluid from bowel

107
Q

Zofran MOA

a. serotonin receptor antagonist
b. Serotonin receptor agonist

A

A. Serotonin receptor antagonist (5-HT3)

OMFS (14 decks)

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