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Basic Exam > Oral Board SOE high yield > Flashcards

Oral Board SOE high yield Flashcards

1
Q

Can you dart the patient…

A

IM ketamine (5mg/kg)
or IM precedex (2mcg/kg)
or IM midazolam (0.1mg/kg)

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2
Q

Sodium Nitroprusside toxicity

A

Think: cyanide toxicity (prevent cells from using O2)…give Vitamin B12

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3
Q

Neonatal extubation critiera

A

TV 6cc/kg
RR 30-40
O2 sat 90%, 50% FiO2, PEEP 5
Awake, reflexes intact

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4
Q

Neonatal vent settings

A

-O2 sat >90% (no hyperoxia)
-RR 30-40
-PIP <25

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5
Q

Neonatal vitals

A

HR: 120-160
BP: 80 and 60/30
O2 sat: 95% in newborn, 90% in premies
RR: 40-60

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6
Q

Tetralogy of Fallot…how to induce

A

Slow controlled IV induction…less control with mask induction (could overly reduce SVR)

Any R to L shunt…have preductal and postductal monitors

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7
Q

CDH

A

Assume RTL shunt until proven otherwise

For preop management
: follow preductal sat

Intubation:
AFOI, vs RSI

Monitors:
Central line, including umbilical vein catheter
Pre and post ductal pulse ox

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8
Q

Thoracic PFTs…predictors of badness

A

FEV1<30%
DLCO<40%
VO2 max <10cc/kg/min
***
May should not do surgery

Predictors of need for postop ventilation
-FEV1 <2L
-MMEFR (maximal mid expiratory flow rate)<50%

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9
Q

Thoracic primer: complications

A

-Cardiac herniation
-PTX
-Broncho-pleural fistula
-RHF (2/2 chronic hypoxia, pHTN)
-Post-op afib (from stress of surgery, fluids, manipulation of the heart)

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10
Q

Heart transplant…how to preverse roc

A

Give glyco with neostigmine as there is some cardiac reinveration over time + want to reverse other effects of neostigmine

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11
Q

Washing out aspirin and plavix

A

Aspirin: 10 days
Plavix: 7 days

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12
Q

OLV goals

A

-PEEP 5 to 10
-TV 5cc/kg
-Pplt <25-30

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13
Q

TEF…don’t forget

A

VACTERL

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14
Q

ESOPHAGECTOMY

A

Epidural + OLV

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15
Q

Premie considerations

A

Neuro: IVH, retinopathy of prematuirty
Cards: cardiac anomalies,
Pulm: respiratory insufficency, RDS, postop apnea
GI: necrotizing enterocolitis
GU: AKI
MSK: hypothermia
Endocrine: Hypoglycemia

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16
Q

Ligation of PDA…how to maintain anesthesia…

A

Low dose gas (0.2-0.3 MAC gas), remi gtt, some fentanyl/dilaudid at end of case

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17
Q

vWF undifferentiated bleeding

A

Give** humate P** (vWF-Factor 8 concentrate)

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18
Q

Neuro monitoring…

A

Usually: EEG, SSEP, MEP, EMG
For aneurysm: EEG, SSEP (have to paralyze)

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19
Q

Larson’s maneuver

A

Jaw thrust + firm pressure behind the earlobes…to break laryngospasm

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20
Q

SVC compression

A

Must get lower extremity IV access
Consider AFOI

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21
Q

Mediastinoscopy…and A line

A

Only time you need to consider L aline…but have RUE pulse ox

22
Q

Cystic fibrosis…organ involvement

A

Lungs: bronchiectasis, PTX
GI: diabetes, meconium ileus
Heme: coagulopathy

23
Q

Carotid endarterectomy…monitors/wakeup..unique consideration

A

If asleep: EEG, SSEP, cerebral oximeter
Wakeup: consider TIVA for smooth wakeup

Unique considerations: cerebral hyperperfusion syndrome

24
Q

Carotid sinus vs Carotid Body

A

Carotid Sinus: related to HR/BP

Body: resp drive

25
Q

BLocks

A

Don’t forget to check coags…confirm laterality

26
Q

Porphyria

A

Hematin…inhibits porphyrin synthesis

27
Q

Dyspnea in a 4 yo…4 things

A

-URI
-Foreign body aspiration
-Asthma
-Anaphylaxis

28
Q

Carcinoid syndrome

A

-Avoid adrenergic agents (epi, ephedrine)
-Treatment of crisis: octreotide, benadryl, fluids…AVOID epinperhine

Premed:
Octreotide at least a few days prior

29
Q

Pheochromocytoma…what meds to avoid

A

Morphine/succinylcholine…may cause release of catechoalmines

Premed:
Alpha 1 blocker for a week, followed by beta blocker

30
Q

Pyloric stenosis…induction plan

A

RSI vs AFOi…suction prior in multiple positions
Medically optimize: euvolemic, pH 7.3-7.5, bicarb <30
Don’t forget about postop apnea…<60 weeks is a risk

31
Q

Severe AS

A

-Valve area under 1.0, transvalvular gradient >40 (subject to LV fxn, hemodynamics)

32
Q

Pacemaker

A

Favor bipolar cautery

33
Q

Epi dosing for bradycardia

A

2-10mcg/min gtt

34
Q

Neonatal Resuscitation

A

-Supplemental O2 per preductal oxygen level
-Epi 0.01mg/kg

35
Q

Stellate Ganglion Block SOB ddx

A

-Phrenic nerve palsy
-LAST
-Epidural/spinal injection

36
Q

Sick Euthyroid

A

Nl TSH, low T3, T4

37
Q

Thyroid surgery and ETT

A

-Need an ETT with nerve monitoring capabilities
-Potentially an armored ETT for compression
-TIVA for maintenance (smooth wakeup, for nerve monitoring)

38
Q

Thyroidectomy, stridor in PACU

A

-Hypocalcemia
-Hematoma
-B/l recurrent laryngeal nerve injury
-Airway edema
-Upper airway obstruction

39
Q

Aprepitant MOA

A

Neurokinin antagonist

40
Q

How to wean off bypass?

A

-Rewarm the patient (give midaz)
-Correct anemia
-Correct electrolyte derangement, give mag and calcium
-TEE to guide preload, afterload, inotropy
-Reinitiate lung ventilation
-Pacer and pads for chronotropy, arrhythmia

41
Q

Anterior Mediastinal Mass: How to approach airway

A

-Awake fiberoptic, that way can assess level of compression, get tube distal (may even have to advance to patent bronchus)

42
Q

Anterior Mediastinal Mass: Airway Attempted, running into issues…ddx

A

Apnea
Laryngospasm
Bronchospasm
Mass Compression

43
Q

Tet spell, physiology…Tetralogy of Fallot

A

-Increased RV outflow obstruction
-Decreased SVR

*
Txt:
-increase SVR (knees to chest)
-esmolol to decrease inotropy (relieve RV outflow obstruction)

44
Q

Pediatric CPR

A

epi 0.01mg/kg
Compression rate, like adults, is 100-120

(vs neonatal is 120)

45
Q

Anesthesia machine: how do you do a machine check

A

-Check monitors
-Calibrate CO2 and O2-analyzers
-Check for leaks in the high and low-pressure system
-Confirm adequate CO2 absorbent

46
Q

Sevoflurane vs desflurane vaporizer

A

Sevoflurane is a variable-bypass vaporizer… a variable amount of fresh gas flow mixes with the volatile agent

Desflurane is a gas-vapor blender

47
Q

CABG heparin dosing

A

300units/kg
ACT>400

48
Q

Neonate and fluid

A

Should always have D5 1/2 NS maintenance going…no fat stores, high risk for hypoglycemia

49
Q

vWF and epidural placement

A

-vWF and Factor 8 level should be 80%
-If needed, give DDAVP or replacement

50
Q

TEG

A

Prolonged R->give FFP
Prolonged K/decreased alpha angle->give cryoprecipitate
Short MA->give platelets
Rapid loss of amplitude->give TXA

Basic Exam (5 decks)

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