missed Q bank 1 Flashcards
1
Q
What areas do ISB nerve blocks target?
A
ISB: Trunk
ISB refers to Interscalene Block, which targets the trunk of the brachial plexus.
2
Q
What areas do supraclavicular nerve blocks target?
A
Supraclavicular: Trunk & proximal division
Supraclavicular blocks target both the trunk and the proximal division of the brachial plexus.
3
Q
What is the target for infraclavicular nerve blocks?
A
Infraclavicular: Cords
Infraclavicular blocks focus on the cords of the brachial plexus.
4
Q
What do axillary nerve blocks target?
A
Axillary: Branches
Axillary blocks target the terminal branches of the brachial plexus.
5
Q
what does the body do to attempt to decrease hepatic vascular resistance in liver failure?
A
form collateral vessels that bypass the liver called portosystemic shunts (the blood doesnt benefit from the livers clearing functions)
6
Q
What is the first step when a patient with a magnet over their ICD develops a life-threatening arrhythmia intra-op?
A
Remove the magnet
7
Q
What are the phases of heat loss under general anesthesia?
A
- Redistribution
- Heat loss exceeds heat production (via radiation, convection, evaporation, and conduction)
- Plateau phase: Heat loss equals heat production
radiation (contributes most) and convection (contributes 2nd most)
8
Q
In which procedures is LMA acceptable?
A
T & A procedures
9
Q
List contraindications for LMA usage.
A
- Intestinal blockage
- Decreased compliance
- Uncontrolled GERD
- Full stomach
- Laparoscopic procedures >15min
- Hiatal hernias
10
Q
What is the bronchial take-off angles for adults?
A
- Right: 25 degrees
- Left: 45 degrees
11
Q
What is the bronchial take-off angle for pediatric patients?
A
- Right and Left: 55 degrees
12
Q
What is an absolute contraindication to jet ventilation?
A
Tracheal stenosis
13
Q
What type of block is used for pancreatic cancer pain?
A
Celiac plexus block
14
Q
What type of block is used for chronic pelvic pain?
A
Superior hypogastric plexus block
15
Q
What type of block is used for complex regional pain syndrome?
A
Lumbar sympathetic block
16
Q
What should be avoided in intraoperative myocardial infarction?
A
Hypocapnia
17
Q
What is the formula for PVR index?
A
PVR index = (mPAP - PAOP) / CI x 80
18
Q
What sign is associated with epiglottitis caused by Hib?
A
Thumb-print sign
19
Q
What are the common symptoms of epiglottitis?
A
- Fever
- Sudden onset
- Dysphagia
- Leaning forward
- Drooling
- Thick muffled voice
20
Q
What is the recommended management for epiglottitis during intubation?
A
- DL under inhalation induction with SV
- Positive pressure after intubation
- Surgeon present for induction
- Post-op intubation and ICU until swelling goes down
- NDMR not advised
21
Q
What characterizes laryngomalacia?
A
Omega shaped epiglottis
floppy epiglottis causing stridor
22
Q
What is the highest Aldrete score, and what is the minimum score to go to phase II?
A
Highest is 10, need at least a 9
1- Able to move two extremities voluntarily or on command
1- Dyspnea/ shallow breathing; oral airway; inadequate
1- Blood pressure +/- 20% to 50% of the preanesthetic level
1- arousable to voice
1- SpO2 > 90 but needs supplimental O2
23
Q
What happens to the A-line waveform as you move from Ao to radial?
A
- Peak systolic gets bigger
- Dicrotic notch moves farther down
- Pulse pressure widens
- MAP decreases
- Diastolic nadir decreases
24
Q
What is the pre- and post-ganglionic neurotransmitter in the PNS?
A
Pre: ACh, Post: ACh, NT: ACh (cholinergic)
25
What is the pre- and post-ganglionic neurotransmitter in the SNS?
Pre: ACh, Post: NE, NT: NE, E (adrenergic)
26
What is the exception in SNS neurotransmission?
Sweat gland is sympathetic with post ACh
27
What is the mechanism of action for Bier block?
Diffusion of local then antagonism of peripheral nerves
28
What are the anatomical landmarks for the stellate ganglion?
C7, C8, T1; C6 chassaignac tubercle is landmark
29
What is the stress response to surgery regarding insulin levels?
Insulin is decreased
30
What is clearance directly proportional to?
* Blood flow to clearing organ
* Extraction ratio
* Drug dose
31
What is clearance indirectly proportional to?
* Half life
* Concentration
32
How many days should N2O be avoided after air, sulfur, and fluorocarbon exposures?
* Air: 5 days
* Sulfur: 10 days
* Fluorocarbon: 70 days
33
What is the anterior pituitary also known as?
Adenohypophysis
34
What is the posterior pituitary also known as?
Neurohypophysis
35
What hormones are produced by the posterior pituitary?
* Oxytocin (paraventricular nuclei)
* ADH (supraoptic)
36
What EEG waveforms are associated with general anesthesia?
* Delta
* Theta
37
In the obese patient, what is the induction and maintenance dosage for Propofol based on?
* Induction: Lean body weight
* Maintenance: Total body weight
38
What are the effects of the active metabolites of Dilaudid, Meperidine, and Morphine?
* Dilaudid: Respiratory depression, myoclonus
* Meperidine: Myoclonus, seizures
* Morphine: Respiratory depression
39
Which opioids do not have active metabolites?
* Fentanyl
* Alfentanil
* Sufentanil
* Remifentanil
40
What is an independent risk factor for post-op apnea in preterm infants?
Anemia
41
What ultrasound findings are associated with pneumothorax?
* A-lines
* Barcode
* Horizontal reverberation
42
What ultrasound findings are associated with pulmonary edema?
* B-lines / comet tails
* Vertical reverberation
43
What is the residual volume in obese patients?
Normal
44
What are the components of Phase I metabolism?
* Oxidation
* Reduction
* Hydrolysis
45
What are the drugs associated with each Phase I metabolism component?
* Oxidation: Fentanyl, Versed
* Reduction: Warfarin
* Hydrolysis: Sux, Remifentanil
46
What is the component of Phase II metabolism?
Conjugation
47
What drugs are associated with Phase II metabolism?
* Morphine
* Propofol
48
What changes occur in acid-base balance during pregnancy?
* Respiratory alkalosis
* Metabolic acidosis
49
What is normovolemic hemodilution's effect on cardiac output?
Increases cardiac output because of decreased viscosity
50
What are the physiological effects of normovolemic hemodilution? what are the pt requirements?
* dec viscosity --> inc C.O.
* anemia--> sympathetic surge
* relative hypoxia --> inc tissue O2 extraction
(relative hypoxia from removal of RBCs)
* vasodilation--> Decreases capillary bed shear force
requirements: free from infection and pre-op hgb 12 or >
51
What creates highest risk for TRALI, and what are its associated signs and symptoms?
* FFP creates highest risk for TRALI
* Symptoms: Low spO2 on room air, normal PAOP, transfusion **within 6 hours**, **bilateral infiltrates**, PAO2/FiO2 ratio < 300 (P/F ratio)
52
What increases the risk for TRALI?
* Donor blood from multiparous patient
* Transplant recipient patient
* Patient with prior transfusion
53
What is TACO, and what are its signs and symptoms?
* Most common cause of death in transfusion-related complications
* Symptoms: Increased PAOP, hypervolemia, LV failure, pulmonary edema
54
What medication poses the highest risk for ventilator-associated pneumonia (VAP)?
Pantoprazole (PPI)
55
What is the treatment for malignant hyperthermia (MH)?
* Calcium may be administered to stabilize myocardium
* Dantrolene 2.5mg/kg; maintenance Q6h 1mg/kg bolus for 24-48 hours
56
What are the risks associated with dantrolene?
* Muscle weakness
* Thrombus (liver dysfunction in 1% of prolonged usage)
* Increased risk for DIC
* Monitor CK due to peak levels after 12-24 hours
57
What characterizes autonomic hyperreflexia?
* Vasoconstriction below the injury: Cool, pale skin of lower extremities, severe HTN, headache, blurred vision, LV failure, cerebral edema, reflex bradycardia
* Vasodilation above the injury: Flushed warm skin, sweating, nasal congestion
58
What conditions rely on patent ductus arteriosus for aortic blood flow?
* Hypoplastic left heart
* Severe aortic stenosis
* Interrupted aortic arch
59
What conditions rely on patent ductus arteriosus for pulmonary perfusion?
* Pulmonary atresia
* Tricuspid atresia
* Tetralogy of Fallot (TOF)
60
What is the most common atrial septal defect (ASD)?
Ostium secundum
61
What is the most common congenital heart defect?
Ventricular septal defect (VSD)
62
What activates the NMDA receptor?
Glutamate
63
What is the effect of ketamine on the NMDA receptor?
Blocks glutamate from binding
64
What activates the GABA receptor?
GABA
65
What causes falsely low pulse oximeter readings?
* Hypotension
* Methemoglobinemia
* Intravenous dyes
* Non-pulsatile flow (cardiac bypass, left ventricular assist device)
* Venous pulsations (severe tricuspid regurgitation)
66
What are the chemotherapeutics and their associated complications?
* Vincristine: Peripheral neuropathy
* Methotrexate: Myelosuppression
* Doxorubicin: Need cardiac workup/echocardiogram
* Tamoxifen: Causes increased calcium, hot flashes, risk for VTE
67
What is the most common complication of retrobulbar blocks?
Hemorrhage
68
What medications provide equivalent antiemetic properties?
* Droperidol 1.25mg
* Decadron 4mg
* Ondansetron 4mg
69
What is a risk associated with TIPS procedure?
Pulmonary hypertension due to increased venous return
70
What two muscles are penetrated with an infraclavicular block?
* Pectoralis major
* Pectoralis minor
71
Which nerve may be injured in prolonged lithotomy position?
Common peroneal nerve
72
What is the most common primary cardiac tumor of the heart?
Myxoma
73
What syndromes are associated with omphalocele?
* Beckman-Wiedemann syndrome
* Congenital heart defects
* Protruding bladder
74
Which volatile agent increases the potency of neuromuscular blockers the most?
Desflurane
75
What tidal volumes are required when using pulse pressure variation as part of goal-directed fluid therapy?
> 8ml/kg
76
What should be avoided in a patient with hereditary telangiectasia?
Nasal airway
77
What are the determinants of end-systolic volume?
* Outflow impedance
* Ventricular contractility
78
What are the determinants of end-diastolic volume?
* Ventricular compliance
* Filling pressure
79
What cardiac valve disorder is associated with a bisferiens pulse?
Aortic regurgitation
80
Which volatile agent attenuates the baroreceptor reflex the least?
Isoflurane
81
What enzymes causes vasoconstriction?
* Phospholipase C effector molecule in Gq pathway (IP3 and DAG)
* Endothelin-1
82
What causes vasodilation?
* ACh
* Bradykinin (IgE mediated)
* Thrombin
83
What is the exception regarding protein kinase A?
Causes vasodilation but does not activate NO pathway; it is a second messenger in Gs cAMP pathway
84
How can controlled ventilation be provided with Mapleson E?
By manually occluding the distal end of the corrugated tubing to let FGF inflate the lungs
85
What is HELLP syndrome characterized by?
* Hemolysis
* Elevated liver enzymes
* Low platelets
86
What are the signs and symptoms of HELLP syndrome?
* RUQ or epigastric pain
* Headache
* Blurred vision
* Excessive proteinuria
* Platelets < 100k
* Poor fetal growth
87
What is the treatment for HELLP syndrome?
* High BP management to reduce risk of CVA, MI, placental abruption
* Deliver baby as soon as possible
88
What does epidural anesthesia block?
**Slow pain C-fibers** that enter spinal **dorsal roots* *
from **T10-L2** via the
**left and right hypogastric nerves**
89
What deficiencies are patients who undergo malabsorptive bariatric surgery at risk for?
* Vitamin B12 (cobalamin)
* Folic acid (B9)
* All fat-soluble vitamins (A, D, E, K)
* Iron
90
What type of blockers are carvedilol and labetalol?
Mixed alpha and beta blockers
91
What is the beta to alpha ratio for carvedilol and labetalol?
* Carvedilol: 10:1
* Labetalol: 7:1
92
What is unique about atenolol and metoprolol in relation to renal failure and asthma?
* Atenolol: Accumulates in renal failure
* Metoprolol: Best choice for asthmatics
93
What are the properties of propranolol?
Local anesthetic membrane stabilizing properties
94
What causes cauda equina syndrome?
5% lidocaine or spinal micro catheter
95
What symptoms are associated with cauda equina syndrome?
* Incontinence
* Sensory deficits
* Weakness or paralysis
96
What characterizes transient neurologic syndrome?
* Radiating buttock pain
* Caused by positioning, stretching of the sciatic nerve, myofascial strain, and muscle spasm
97
What factors increase the risk of transient neurologic syndrome?
* Lidocaine
* Lithotomy
* Ambulatory
* Knee arthroscopy
98
What is the treatment for transient neurologic syndrome?
* NSAIDs
* Opioids
* Trigger point injections
99
What characterizes anterior spinal artery syndrome?
* Loss of motor (corticospinal tract)
* Variable loss of pain and temperature (spinothalamic tract)
* Intact dorsal column
100
What are the symptoms of an epidural hematoma?
Can present as sensory or motor loss, incontinence
101
What can extremes of intravascular volume impair?
O2 delivery
102
What drugs have an imidazole ring? what does this mean?
precedex, versed, etomidate
gives it hydrophilic and lipophilic properties
water loving + fat loving
103
how are esters metabolized? amides?
esters- plasma cholinesterases
amides- liver CYP450
104
What substances can be released in carcinoid syndrome?
* Histamine (hypotension)
* Bradykinin (hypotension)
* Serotonin (hypertension)
105
What is capnography poor at monitoring?
Oxygenation
106
What are the only neuromuscular blockers that can be administered IM?
Rocuronium and succinylcholine
107
What is a key early sign of myasthenia gravis?
Dysphagia
108
What causes failure to capture?
Resistance to depolarization, occurs with lidocaine and hypokalemia
109
What does methylnaltrexone reverse?
Peripheral effects of opioids- so decreases constipation/nausea and other GI effects of opioids without blocking central pain receptors
110
What are the opioid effects that methylnaltrexone does NOT help with?
* Bradypnea/respiratory depression
* Miosis
111
What effect does N2O have in pulmonary hypertension?
Can worsen pulmonary hypertension in restrictive disease with impaired diffusion capacity
112
What are the common symptoms in both lupus and rheumatoid arthritis?
* Restrictive lung disease
* Anemia
* Peripheral neuropathy
113
What is the most common genetic cardiovascular disease?
Hypertrophic cardiomyopathy
114
What should cuff pressures be below?
< 25 cmH20
115
How do you convert mmHg to cmH2O?
mmHg x 1.36
116
What are the cell body locations in the spinothalamic tract?
* 1st order cell bodies: DRG
* 2nd order cell bodies: Dorsal horn of spinal cord
* 3rd order cell bodies: RAS and thalamus
117
What is the anesthetic management focus for gastrochesis?
Maintaining perfusion to herniated organs and minimizing heat/fluid loss
118
What are the two mechanisms by which mu receptor agonists decrease neuronal transmission?
* Decrease Ca+ permeability in pre-synaptic terminal
* Increase K+ exit in the post-synaptic membrane
119
Is tachycardia a typical feature of long-standing obesity?
No
120
What is the Haldane effect?
O₂'s effect on hemoglobin’s CO₂ transport
121
What is the Bohr effect?
CO₂’s effect on hemoglobin’s O₂ transport
122
What is the primary trigger for central chemoreceptors?
↑ PaCO₂ (via ↑ H⁺ in CSF)
123
What is the primary trigger for peripheral chemoreceptors?
↓ PaO₂ (hypoxia)
124
In the context of hemoglobin, which types of Hgb cause a shift to the right?
DeoxyHgb
125
What causes hypocalcemia in renal osteodystrophy?
Secondary hyperparathyroidism and decreased vitamin D production
126
What are the peripheral chemoreceptors that respond to decreased PaO₂?
Carotid & aortic bodies
127
What conditions do peripheral chemoreceptors also respond to besides hypoxia?
↑ PaCO₂ and ↑ H⁺ in arterial blood
128
In the context of hemoglobin, which types of Hgb cause a shift to the left?
Hbg Met, hgb F, Hgb CO
129
What does a shift to the right in deoxyHgb indicate?
Increased release of oxygen
130
What condition causes hypocalcemia due to secondary hyperparathyroidism?
Renal osteodystrophy
131
What is the target of NIRS cerebral oximetry?
Decreased O2 delivery to the cerebrum
132
What happens between S1 and S2 heart sounds?
Isovolumetric contraction and ejection
133
During a femoral nerve block, what artery is a continuation of the external iliac artery?
Common femoral artery
134
What indicates that the transducer is too caudad during femoral nerve block visualization?
Visualization of 2 arteries on US
135
How is atracurium metabolized?
Partially by non-specific esterase and Hoffman elimination
136
What is esmolol metabolized by?
Non-specific esterases
137
What is another name for pseudocholinesterase?
Butyrylcholinesterase or plasma cholinesterase
Plasma cholinesterase is not the same as plasma esterase (nonspecific esterase) hydrolysis esmolol
138
Which nerves of the ankle are closest to an artery?
Posterior tibial and deep peroneal
139
What is a post-operative pulmonary risk factor in the elderly related to CNS response?
Decreased (attenuated) CNS response to hypercarbia
140
Where are lower motor neurons located?
Ventral horn of the spinal cord
141
Where are upper motor neurons located?
Pre-central gyrus of the cerebral cortex
142
What is the location of the 2nd order neuron in the lemniscal system?
Gracilis nucleus in the brainstem
143
Where is the 2nd order neuron of the spinothalamic tract located?
Dorsal horn of the spinal cord
144
What effect does low albumin have on drug clearance with HER < 0.3?
Alters clearance of drugs
145
List some drugs whose clearance is altered by low albumin. (drugs with hepatic extraction ratio of <0.3)
* Roc
* Diazepam
* Lorazepam
* Methadone
* Thiopental
* Theophylline
* Phenytoin
146
Which of the following is regenerated in soda lime?
A. Sodium hydroxide
B. Calcium hydroxide
C. Carbonic acid
D. Calcium chloride
A. Sodium hydroxide
CO2+ H20--> CA
CA+SH--> SC+ H20+ Heat
SC+ CH--> CC + 2SH
147
Which compounds are the strong bases found in CO2 absorbents facilitate carbon monoxide and compound A production when exposed to volatile anesthetics?
In order to decrease the production of these compounds, Amsorb Plus was formulated by replacing what?
NaOH and/or KOH
Amsorb aka calcium hydroxide lime- replaced NaOH with CaOH2 (calcium hydroxide)
148
desflurane is heated and pressurized to what with a ten 6 vaporizer?
22 degrees celcius
2 atm
149
fail safe device: O2 pressure at which it Proportionately decreases or completely shuts off the flow of nitrous? O2 pressure at which it triggers an alarm
dec or stops flow---20 psi
alarm ----28-30 psi
150
what is the..
- Max PPV pressure
- Max cuff pressure
- Max cuff volume
..of LMA classic?
Max PPV pressure = 20 cm H2O
Max cuff pressure = 60 cm H2O (target = 40-60 cmH2O)
Max cuff volume = 40mL
Proseal allows PPV up to 30 cm H20
151
absolute indications for OLV
Infection
Massive hemorrhage
Bronchopleural fistula
Large unilateral cyst/bulla
152
relative indications for OLV?
Thoracic aortic aneurysm
Pneumonectomy
Thoracoscopy
Upper lobectomy
Esophageal resection
153
FFP indications
FML DWH:
- Factor deficiencies
- Massive transfusion
- Liver dysfunction
- DIC
- Warfarin reversal (urgent)
- Heparin resistance due to antithrombin deficiency
154
time to closure of ductus venosus, ductus arteriosus, and foramen ovale?
ductus venosus - minutes
foramen Ovale - hOurs
ductus arteriosus (DA)- DAys
155
VSD management goals
dec SVR
avoid hypocarbia
156
age of peak MAC for iso, des, and sevo
iso and des - 3 months old
sevo - 0-6 months old (3.2%)
sevo - 6-12 months old (2.5%)
157
which cardiac defect is often associated with turners syndrome
Coarctation of the Aorta
158
What finding might be present on a CXR of patient with Turners Syndrome?
Turners syndrome often associated with Coarctation of the Aorta- common CXR finding would be rib notching
159
progesterone causes increases in what?
(MRS V increases during preggo)
MV
RAAS
Sensitivity to LA
Vascular relaxation
160
progesterone causes decreases in what?
MAC
airway resistance (bronchodilation)
LES tone (inc r/f aspiration)
161
common complication of paracervical block
fetal bradycardia (esp with bupivicaine)
162
what local anesthetic decreases the efficacy of epidural morphine and antagonizes the mu and kappa receptors in the spinal cord?
2-chloroprocaine
163
prostaglandin F2 is also known as
carboprost and hemabate (250mcg IM or intrauterine) - r/f bronchospasm
164
list the tocolytic agents used to inhibit labor
--B2 agonist (ritodrine, terbutaline) - inc cAMP, inc PK, dec MLC-K
--Mag sulfate
--CCB (nifedipine)
--NO donors (SNP, isosorbide mononitrate)
165
how to treat orthodromic AVNRT WPW ? how to treat antidromic?
orthodromic (narrow QRS)
AABCV
amio
adenosine
beta blockers
cardiovert
verapamil
antidromic (wide)
procainamide
cardiovert
166
phase I metabolism and examples. phase II metabolism and examples
oxidation, reduction, hydrolysis
oxidation - versed, fent
reduction- warfarin
hydrolysis- sux, Remi
conjugation - propofol and morphine
167
transducer height effects on BP reading 1cm? 1in?
1cm inc - 0.75 mmHg dec
1in inc - 2 mmHg dec
168
hypoechoic vs anechoic?
hypoechoic - grey
anechoic- black
169
If an individual receives 8 mrem per second at a distance of 1 foot from a radiation source, how many millirems per second of radiation would they recieve at a distance of 2 feet?
2
equation= 1 / distance2
By doubling the radius from the radiation source, the resultant incident radiation is 1/4th.
170
Yearly max radiation exposure for adults
5 rem
171
Yearly max exposure for fetus of a pregnant worker
0.5 rem
172
what does a dosimeter badge measure
rad and rem
radiation absorbed dose (rad)
radiation equivalent man (rem)
173
what measures the total dose of radiation administered? what measures the total dose of radiation received at the tissues? what measures the effective dose?
roentgen- total administered
Rad- total received at tissues
Rem- effective dose/ recommended max yearly exposure
174
3 ways to limit exposure
distance, duration, shield
175
What are the 2 components of the fail-safe device?
Oxygen supply failure alarm
Fail-safe valve
176
what is the vapor pressure of each volatile anesthetic?
N ---
D 664
S 160
I 240
H 243
