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APEX mock exam topics > Mock exam 1 > Flashcards

Mock exam 1 Flashcards

1
Q

lipophilic opioids in continuous epidural infusion most likely provide analgesia by:

A
  • acting systemically
  • fentanyl, sufentanil
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2
Q

hydrophilic opioids in continuous epidural infusion most likely provide anesthesia by:

A
  • acting in the spinal cord
  • superior analgesia
  • morphine, hydromorphone
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3
Q

Most appropriate interventions for “can’t intubate, can’t ventilate” situation

A
  • surgical cric
  • transtracheal jet ventilation
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4
Q

Methadone

A
  • only narcotic known to prolong QTi
  • torsades de points
  • antagonizes NMDA, inhibits 5HT & NE, agonizes opioid receptors
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5
Q

LA made of 3 components:

A
  1. Aromatic ring
  2. Intermediate chain
  3. Tertiary amine
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6
Q

Aromatic ring

A

confers lipid solubility

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7
Q

Intermediate chain

A

determines metabolism & allergic potential

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8
Q

Tertiary amine

A

confers H2O solubility

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9
Q

Allergic reaction more common in ester or amide LA?

A

ester (1 “i”)

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10
Q

Allodynia

A

nonpainful stimulus evoking painful response

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11
Q

Hyperalgesia

A

exaggerated pain response

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12
Q

Neuralgia

A

pain localized to a dermatome

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13
Q

Dyesthesia

A

abnormal painful sensation

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14
Q

Recommended bladder width of BP cuff

A

40% of the circumference of the extremity

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15
Q

BP cuff that is too small will give a fale

A

high reading

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16
Q

BP cuff that is too large will give a false

A

low reading

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17
Q

Conditions that increase risk of endocarditis & warrant ABX prophylaxis

A
  • previous infective endocarditis
  • prosthetic heart valve
  • heart transplant w/ valvuloplaty
  • unrepaired cyanotic congenital heart defect
  • dental procedures
  • resp procedures that perforate mucosal lining
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17
Q

West Zone 1

A
  • dead space
  • P alveolar > P arterial > P venous > P intersitial
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18
Q

West Zone 2

A
  • matched V/Q
  • P arterial > P alveolar > P venous > P interstitial
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19
Q

West Zone 3

A
  • shunt
  • P arterial > P venous > P alveolar > P interstitial
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20
Q

West Zone 4

A
  • increased pressure in interstitium (pulmonary edema)
  • P arterial > P intersitial > P venous > P alveolar
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21
Q

Bullae

A
  • large air-filled spaces
  • rupture can lead to pneumo, tension pneumo, CV collapse
  • To prevent rupture: SV until chest opened
  • small Vt w/ high RR to minimize intra-alveolar pressure
  • AVOID N2O
  • DLT airway of choice
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22
Q

Amine

A

NR3

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23
Q

Alcohol

A

ROH

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24
Q

Ether

A

ROR’

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25
Q

Ester

A

RCOOR

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26
Q

Risk factors ischemic optic neuropathy post spine surgery

A
  • Wilson frame
  • Greater EBL
  • Low ratio of colloid:crystalloid resuscitation
  • male
  • obese
  • long surgery
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27
Q

Direct current cardioversion

A

Indications:
- aflutter, afib
- 1st shock = 50-100 j
- increase incrementally to max 360 j

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28
Q

Cutting tip needle

A
  • Quincke
  • Pitkin

increased risk of PDPH

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29
Q

Pencil point needle

A
  • Sprotte
  • Pencan
  • Whitacre

decreased risk of PDPH

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30
Q

Round bevel tip needle

A

Green

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31
Q

Spinal cord protective strategies during thoracic aorta coss slamp

A
  • hypothermia (30-32 C)
  • CSF drainage
  • Proximal HTN
  • avoid hyperglycemia
  • partial CPB
  • steroids, CCBs, mannitol
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32
Q

Gas embolism

A
  • “air lock” in right heart
  • S/S
    1. Dec EtCO2
    2. Inc PAP
    3. Pulm edema
    4. low BP
    5. hypoxia
    6. dysrhythmias
    7. cyanosis
    8. mill wheel murmur
  • TEE most sensitive indicator
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33
Q

Greatest risk of gas embolism during laparoscopic surgery

A

initial insufflation

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34
Q

Na+ nitroprusside & SpO2

A
  • dilates pulm vasculature
  • counteracts HPV
  • increases intrapulm shunt (zone III)
  • decreases SpO2
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35
Q

Pyloric stenosis electrolyte & acid/base imbalance

A
  • olive-shaped mass
  • projectile vomiting
  • low K+, H+, Cl-
  • hypokalemia, hypochloremic, metabolic alkalosis
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36
Q

Losartan

A
  • angiotensin II antagonist
  • SE: hyperkalemia
  • increases lithium reabsorption
  • avoid in pregnancy
  • vasoplegia
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37
Q

Treatment of vasoplegia resistant to volume, neo, epi, NE

A

vasopressin

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38
Q

lung volume that increases w/ age

A

residual volume

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39
Q

Abdominal compartment syndrome

A
  • IAP > 20
  • decreases CO, venous return
  • increases SVR
  • decreases diaphragmatic excursion
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40
Q

MAP formula

A

MAP = (SBP x 1/3) + (DBP x 2/3)

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41
Q

complication of rapid correction of chronic hyponatremia

A

central pontine myelinolysis

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42
Q

Drugs to avoid w/ carcinoid crisis

A
  • sux
  • atracurium
  • thiopental
  • epi
  • NE
  • isoproterenol
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43
Q

Consequences of inadequate pain control in pt undergoing abdominal surgery

A
  • decreased Vt, VC, TLC, FRC
  • inability to clear secretions
  • hypoxia
  • atelectasis
  • SNS stimulation
  • PLT aggregation & venous stasis
  • increased urinary sphincter tone - urinary retention
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44
Q

Recommended timing of epidural placement

A
  • individualized
  • after approved by OB, ok to proceed
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45
Q

Drugs that interfere w/ SSEPs

A
  • decrease amplitude & increase latency
  • VA, N2O, propofol, barbs, benzos
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46
Q

Drugs that do NOT impair w/ SSEPs

A
  • ketamine
  • precedex
  • etomidate
  • opioids
  • droperidol
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47
Q

Unilateral RLN injury

A

hoarseness

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48
Q

Bilateral RLN injury

A
  • stridor
  • dyspnea
  • aphonia (chronic)
49
Q

Aldrete score

A
50
Q

Dorsal resp group

A

inspiration

51
Q

Ventral resp group

A

expiration

52
Q

Apneustic center

A

stimulates DRG

53
Q

Pneumotaxic center

A

inhibits DRG

54
Q

Elderly have ______ clearance & _____Vd

A

decreased, decreased

55
Q

Bleomycin

A
  • pulmonary fibrosis
  • at risk for O2 toxicity
  • Keep FiO2 < 30% to maintain SpO2 > 90%
56
Q

Piston ventilator

A
  • electric
  • will not consume O2 tank in pipeline failure
  • PP relief valve opens if circuit pressure > 75
  • Negative pressure relief valve opens at - 8
57
Q

LFT: assess synthetic function

A
  • PT
  • INR
  • albumin
58
Q

LFT: assess hepatocellular injury

A
  • AST
  • ALT
  • GST
59
Q

LFT: assess cholelithiasis

A
  • alk phos
  • GGTP
60
Q

Opioid receptor

A
  • GPCR
  • inhibit adenylyl cyclase
  • block conversion of ATP to cAMP
  • pre-syn nerve - reduced Ca+ conductance decreases NT release
  • post-syn nerve - increased K+ causes hyprepolarization
61
Q

Glucagon

A
  • antagonizes insulin
  • stimulates gluconeogenesis in liver
  • produced by alpha cells in pancreas
  • causes N/V
  • increases myocardial contractility by increases cAMP
  • useful for BB OD, CHF, low CO
62
Q

Distance from subclavian CVC to CAJ

A

10 cm

63
Q

Distance from RIJ CVC to CAJ

A

15 cm

64
Q

Distance from LIJ CVC to CAJ

A

20 cm

65
Q

Distance from femoral vein CVC to CAJ

A

40 cm

66
Q

Distance from right median basilic vein CVC to CAJ

A

40 cm

67
Q

Distance from left median basilic vein CVC to CAJ

A

50 cm

68
Q

CBF decreases _____ ml/100g/min for every ___ mmHg PaCO2 (directly proportional)

A

1-2, 1

69
Q

PE

A
  • decrease EtCO2
  • tachycardia
  • increased CV filling pressures
  • hypotension

Tx: 100% FiO2, HD support w/ fluids, inotropes

70
Q

Transplanted heart

A
  • severed from autonomic influence
  • HR is determined by intrinsic rate of phase 4 depolarization of SA node (100-120 bpm)
  • HR fixed
  • CO dependent on preload
  • use direct-acting drugs (isoproterenol, epi)
  • indirect (ephedrine) less effective
  • 2 p waves on ekg
71
Q

Oculocardiac reflex

A
  • five & dime / V (trigeminal) & X (vagus)
    -Tx: remove stimuli, 100% O2, anticholinergic
72
Q

Most common causes of perioperative allergic reactions

A

NMBs > Latex > ABX > Protamine

73
Q

Best drug for extraction of retained placenta

A
  • NTG
  • relaxes uterus
  • facilitates manual removal
  • venous > arterial
74
Q

cocaine dose

A

1.5 - 3.0 mg/kg not to exceed 200 mg

75
Q

Bite on tongue blade > 5 sec

A

50% receptor blockade (most sensitive)

76
Q

DB stimulation w/o fade

A

60% receptor blockade

77
Q

TOF 4/4

A

70% receptor blockade

78
Q

Vt 5 ml/kg

A

80% receptor blockade

79
Q

Brugada syndrome

A
  • ion channelopathy
  • common in males from Southeast Asia
  • RBBB w/ ST elevation in precordial leads V1-V3
80
Q

WPW

A
  • paroxysmal SVT
  • short PRi, delta wave, wide QRS
81
Q

Lenegre’s dz

A
  • His-Purkinje defect
  • long pauses, wide QRS, brady
82
Q

Mannitol

A
  • inhibits H2O reabsorption in PCT & LOH
  • dose = 0.25-1 gram/kg
83
Q

Hydralazine

A
  • increases cGMP
  • arterial > venous dilation
  • bareceptor reflex preserved
  • tachycardia common
  • dose = 2.5-20 mg IV
  • can cause lupus
84
Q

Postop delirium

A

acute confusion occurs 1-5 days postop

85
Q

Final products of soda lime reaction

A
  • sodium hydroxide (NaOH)
  • calcium carbonate (CaCO3)
86
Q

Nightshade (Belladonna)

A
  • Anticholinergic OD
  • S/S result of muscarinic antagonism
  • flushing, mydriasis, dry mouth, confusion, hallucinations, hyperthermia, tachycardia
  • ” red as a beet, blind as a bat, dry as a bone, mas as a hatter, hot as a hare”
    -Tx: physostigmine - increases Ach available at muscarinic receptors
87
Q

Most common causes of hypocalcemia in the OR

A
  • hyperventilation (reduces ionized ca+)
  • administration of citrated blood products greater than 1.5 ml/kg/min
88
Q

1 U PRBC increases Hgb by

A

1 g/dL

89
Q

1 U PRBC increases Hct by

A

2-3%

90
Q

Nerve fibers that transmit tourniquet pain

A
  • C fibers
  • slow pain
  • tourniquet pain begins 45-60 min after inflation
91
Q

RCA monitored by which leads & supplies which part of heart?

A
  • II, III, aVF
  • RA, RV, SA/AV node, inferior LV
92
Q

LAD monitored by which leads & supplies what part of heart?

A
  • V3-V5
  • anterolateral LV
93
Q

Circumflex monitored by which leads & supplies what part of heart?

A
  • I, aVL
  • Lateral LV
94
Q

Near-infrared spectroscopy

A
  • assesses cerebral venous O2 sat
  • monitors regional cerebral ischemia
95
Q

C1 esterase inhibitor deficiency

A
  • hereditary angioedema
  • increased bradykinin
  • Tx: FFP (contains C1 esterase)
96
Q

B:G sevo

A

0.65

97
Q

B:G iso

A

1.4

98
Q

B:G des

A

0.42

99
Q

B:G N2O

A

0.47

100
Q

Effects of tourniquet release

A
  • CO2 builds up in ischemic limb
  • delivers large amounts of CO2 to pulmonary circulation
  • transiently increases EtCO2
  • dysrhythmias, hypotension, bradycardia, decreased temp
101
Q

Pheo

A
  • catecholamine secreting tumor (NE > epi)
  • S/S = HA, diaphoresis, tachycardia
  • Block alpha BEFORE beta (A comes before B)
  • Tx: BB, alpha blockers, Nitroprusside
102
Q

Joule Thompson effect

A

gas stored at high vapor pressure that is suddenly release escapes form its container into vacuum. Temp falls. Explains why O2 cylinder opened quickly feels cool to touch

103
Q

dermatome bladder procedures

A

T11-L2

104
Q

dermatome prostate & bladder neck procedures

A

S2 - S3

105
Q

dermatome for TURP

A

T10

106
Q

Retrograde intubation

A
  • puncture cricothyroid membrane & pass wire through VC out mouth
  • ETT loaded over wire & advanced into trachea
  • mostly used in c-spine injuries
  • contraindications: goiter, neck flexion deformity, coagulopathy
107
Q

Ulnar nerve injury

A
  • more common in males, obese, cardiac surgery, pre-existing nerve patho
  • pronation on armboard increases risk
  • ideal on armboard = supination
  • ideal tucked = neutral
108
Q

Gastroschisis

A
  • right of umbilicus
  • not covered by sack
  • prematurity
109
Q

Omphalacele

A
  • midline
  • covered by sac
  • associated w/ congenital defects: beckwith, heart dz, trisomies 13/18/21, cantrell
110
Q

superior rectus eye movement

A

supraduction (CN 3)

111
Q

inferior rectus eye movement

A

infraduction (CN 3)

112
Q

medial rectus eye movement

A

adduction (CN 3)

113
Q

lateral rectus eye movement

A

abduction (CN 6)

114
Q

superior oblique eye movement

A

intorsion/depression (CN 4)

115
Q

inferior oblique eye movement

A

extorsion/elevation (CN 3)

116
Q

BMI formula

A

kg/m^2

inch to cm = in x 2.54
cm to meter = cm / 100

117
Q

adenosine should not be given to which pt d/t increased risk of bronchospasm?

A

asthma

118
Q

Non-OB surgery

A
  • delay until 2nd trimester
  • fetal risks: growth restriction, LBW, demis, preterm labor
  • avoid N2O, benzos
  • regional if appropriate
  • fetal monitoring
119
Q

________________ is the most reliable method to reduce postop pulmonary complications

A

smoking cessation

120
Q

therapeutic index

A

TI = LD50/ED50

APEX mock exam topics (1 decks)

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