Questions Flashcards
Best intra-op anticoagulation for pt undergoing cardiac surgery with cardiopulmonary bypass with Heparin Induced Thrombocytopenia type 2?
Bivalirudin
Potential complication of TAP block?
Local anesthetic systemic toxicity
Best predictor of difficult intubation?
Class 3 upper lip bite test- cannot bite upper lip with lower incisors
What is a rare complication of high lumbar spinal anesthesia involving the conus medullaris, and what are its symptoms?
Conus medullaris injury, causing sensory and/or motor deficits in multiple nerve distributions, either unilateral or bilateral.
What is an absolute contraindication for percutaneous tracheostomy in infants?
Subglottic stenosis.
In a mid-esophageal aortic valve short axis view (ME AV SAX), which aortic cusp is located next to the inter-atrial septum?
The non-coronary cusp.
What conditions are associated with malignant hyperthermia (MH)?
King-Denborough syndrome, central core disease, and multiminicore disease are associated with MH, and they include RYR1 mutations. Masseter muscle rigidity is also linked to MH.
What cardiovascular effects can dexmedetomidine cause, especially with a loading or bolus dose?
Dexmedetomidine can cause bradycardia, hypotension, and hypertension.
What is the mechanism of action of phenytoin?
Alteration of sodium conductance in motor neurons.
What is the most common cause of adrenal insufficiency in patients with critical illness in the intensive care unit?
Functional adrenal insufficiency
Which serum electrolyte is decreased in DKA?
Sodium (due to hyperglycemia shifting water out of cells)
Hypoglycemic patient who is confused/not alert or sedated but has IV access, next step in management?
IV dextrose
Hypoglycemic patient who is confused/not alert or sedated and has NO IV access, next step in management?
IM glucagon
Hypoglycemic patient who is alert and can tolerate liquids, next step in management?
oral glucose
most common cause of hydrocephalus?
chiari malformation
what is the only organ innervated by cholinergic post-ganglionic sympathetic neurons?
sweat glands
What happens when crystalloids rather than colloids are used for fluid resuscitation?
Crystalloids result in greater peripheral edema.
which drug is associated with triggering a carcinoid crisis?
succinylcholine
what should be avoided as treatment of hypotension in in a pt with HOCM?
inotropes and vasodilators
What is the most common cause of an acute change in peak airway pressures and desaturation when a bronchial blocker is used for one-lung ventilation?
Dislodgement of the bronchial blocker, leading to occlusion of the trachea or the mainstem bronchus of the ventilated lung.
What is Fisher Grade 1?
no blood detected
What is Fisher Grade 2?
diffuse thin layer (<1 mm) of subarachnoid blood
What is Fisher Grade 3?
localized clot or thick layer (>1 mm) of subarachnoid blood
What is Fisher Grade 4?
intracerebral or intraventricular blood with diffuse or no subarachnoid blood
What prolongs the seizure duration for ECT and has a safe hemodynamic profile?
Etomidate
what is the gold standard induction agent for ECT?
methohexital
which medication is associated with myoclonus?
etomidate
what is the pH and lactate of fetal acidosis?
pH <7.21 or lactate >4.8
what is the advantage of subglottic jet ventilation compared to supraglottic jet ventilation?
decreased contamination of the airway
after bicuspid aortic valves, what is the most common congenital heart defect?
perimembranous ventricular septal defect
which electrolyte abnormalities are associated with citrate intoxication?
hypocalcemia and hypomagnesemia
What is the first step in the treatment of a patient who has been rescued after drowning, is not breathing, and is without appreciable pulses?
Provide 2 rescue breaths before initiating chest compressions.
Which regional anesthetic technique is effective only for the first stage of labor?
Lumbar sympathetic block.
Which complication is most concerning for inadvertent removal of the parathyroid glands intraoperatively?
Tetany.
Which statement about nitrous oxide in labor analgesia is true for a pt who declines neuraxial analgesia?
Self-administered nitrous oxide can be used safely in labor analgesia.
A pt with pancreatic cancer undergoes an autonomic block for pain relief. This block would also alleviate visceral pain originating from which other organ?
adrenal glands and kidney
Which hormone is cleaved intravascularly during passage through the pulmonary circulation?
Angiotensin I.
Which medication would increase the seizure duration during electroconvulsive therapy?
Etomidate.
Which of the following is appropriate for preventing thermal burns during MRI?
Padding tubing and wires to reduce skin contact.
Which statement is true regarding anesthesia for ambulatory surgery?
Clonidine as an adjuvant may cause cardiovascular instability.
For pts with congenital prolonged QT syndrome who present with a sudden cardiac arrest, what is the most appropriate treatment?
Placement of implantable cardioverter-defibrillator
How can the risk of an acute exacerbation be decreased preoperatively in patients with acute intermittent porphyria?
Preoperative administration of IV fluids and glucose therapy can help decrease the risk of an acute exacerbation.
Which change in respiratory physiology would be found in patients with obesity compared to normal-weight patients?
Increased respiratory rate.
Which of the following is an effect of labor epidural analgesia?
It prolongs the second stage of labor.
Which volatile anesthetic used in ambulatory surgical centers has low blood gas solubility and minimal airway irritation?
Sevoflurane.
What is the mechanism by which a magnetic resonance imaging machine causes skin burns underneath a standard pulse oximeter probe?
Induction of electrical current within the probe.
Which laboratory result provides evidence of an acute kidney injury from hypovolemia?
Fractional excretion of sodium < 1%.
Blockade of which nerve would be most effective in disabling the glottic closure reflex and preventing laryngospasm?
Internal branch of the superior laryngeal nerve.
Which drug best treats the central neurologic symptoms of nerve gas poisoning?
Atropine.
According to the American Society of Anesthesiologists guidelines, which antacid is most appropriate to administer to a patient at high risk of aspiration for aspiration prophylaxis?
Sodium citrate.
What is autonomic dysreflexia (AD), and what are its most common causes?
Autonomic dysreflexia (AD), also known as autonomic hyperreflexia, is a complication of a spinal cord injury above the mid-thoracic (T5-7) level, typically triggered by a noxious stimulus below the level of the spinal cord lesion. The most common causes are bladder and bowel manipulation/pain.
How can antibiotic treatment of Gram-negative bacteria result in worsening hypotension?
Through the release of lipopolysaccharide, which provides more antigens for the septic response.
What are the risks and preferred timing for nonobstetric surgery during pregnancy?
Women undergoing nonobstetric surgery during pregnancy are at increased risk of aspiration, miscarriage, preterm labor, low birth weight, and Cesarean delivery. There is no established teratogenicity related to general anesthesia, but it is preferred to delay surgery until the second trimester to avoid fetal organogenesis during the first trimester, if possible.
Which pain treatment would be most beneficial for reducing the risk of postoperative ileus in pt with chronic kidney disease as part of the ERAS (enhanced recovery after surgery) colorectal surgery protocol?
Interfascial plane block.
What are somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) used for, and where are their signals measured?
SSEPs and MEPs are used for detecting spinal cord ischemia in the posterior/lateral cord (SSEPs) or the anterior cord (MEPs). These potentials are measured at the point where their signals terminate, either in the brain (SSEPs) or in the peripheral nerves (MEPs).
What does the S4 heart sound signify?
Atrial contraction against a stiff, non-compliant ventricle.
What may patients who take ginseng preoperatively develop during surgery?
Intraoperative hypoglycemia.
Which respiratory effects do inhaled anesthetics have?
Decreases tidal volume, increases respiratory rate, with overall little effect on minute ventilation. Bronchodilates. Blunts ventilatory response to hypercarbia and hypoxia
Which medication should be avoided or limited in situations where pancreatitis is likely?
Propofol should be avoided or limited in situations where pancreatitis is likely because it can cause or worsen pancreatitis, potentially due to hypertriglyceridemia.
What causes Negative Pressure Pulmonary Edema (NPPE)?
Negative Pressure Pulmonary Edema (NPPE) is caused by a strong negative intrathoracic pressure that increases preload and left ventricular afterload with a decrease in cardiac output, leading to a transudation of fluid into the lungs.
Which drug would be expected to have a similar duration of action in a patient with renal failure compared to a healthy patient?
Propofol is hepatically metabolized into an inactive, renally excreted metabolite and, therefore, is minimally affected by renal function.
what is the alveolar gas equation and what is FiO2?
PAO2 =FiO2×(Patm−PH2O)−PaCO2/RQ
FiO2 = 0.21 regardless of altitude
What is a potential complication of general anesthesia in a patient in whom Duchenne’s muscular dystrophy has been diagnosed?
Patients in whom Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD) has been diagnosed are at an increased risk of aspiration due to respiratory muscle weakness, increased oral secretions, and gastric hypomotility. Respiratory complications are the major cause of morbidity in these patients.
Weakness in which muscle will result after the placement of an adductor canal block?
Vastus medialis
What can cause rebleeding during clipping of a cerebral aneurysm?
Factors that decrease a patient’s intracranial pressure such as profound hyperventilation or rapid cerebrospinal fluid drainage can also worsen the transmural pressure across the wall of a cerebral aneurysm and thereby increase the risk for rebleeding.
What is the optimal tidal volume in acute respiratory distress syndrome (ARDS)?
6 mL/kg predicted body weight (PBW) or idea body weight (IBW).
Which medications should be avoided in a patient undergoing resection of a carcinoid tumor?
All medications which cause histamine release should be avoided – commonly used medications include morphine, meperidine, ketamine, and atracurium.
What are common complications of labor epidural placement?
post-dural puncture headache (PDPH) and hypotension
What are the classic risk factors that predict the need for postoperative mechanical ventilation in patients with myasthenia gravis undergoing transsternal thymectomy?
Disease duration > 6 years, chronic respiratory illness, pyridostigmine dosage > 750 mg/day (newer data suggest > 250 mg/day), and vital capacity < 2.9 L.
obesity is consistent with which type of lung disease?
restrictive lung disease, with proportional decreases in all lung volumes
What percentage of spinal cord blood supply comes from the anterior spinal artery?
The spinal cord receives its blood supply from 1 anterior spinal artery, which provides about 75% of the blood supply. The spinal cord also receives blood supply from 2 posterior spinal arteries, which together provide about 25% of the blood supply. The posterior spinal arteries primarily supply the sensory tracts in the spinal cord. The anterior spinal artery primarily supplies the motor tracts in the spinal cord.
What is the first-line therapy for reducing the risk of fatal cardiac events in congenital long QT syndrome?
For patients with congenital LQTS, beta blockers significantly reduce the risk of events like syncope and sudden cardiac death. It is thought that most cardiac events in these patients are related to high sympathetic output to the heart, which is blocked by beta blockers. Propranolol is the beta blocker of choice for the indication.
Conversely, beta blockers are often avoided in patients with acquired long QT syndrome because bradycardia can prolong the QT interval.
What is the best method of providing anesthesia in emergent cesarean deliveries?
general anesthesia with rapid sequence intubation
Chorionic villus sampling reveals a fetus to have one defective β globin allele. Upon delivery, how will the neonate likely present?
This infant with one defective β globin allele has beta-thalassemia minor. Infants with beta-thalassemia minor are asymptomatic at birth and without anemia or hepatosplenomegaly due to their reliance on fetal hemoglobin, which lacks β globins. If symptoms develop, they will begin to emerge around six months of age when production of the γ globin chain decreases.
For a pregnant patient with DIC, what is the most appropriate treatment plan?
Maintain fibrinogen >300 mg/dL and deliver the fetus as soon as possible.
What is negative pressure pulmonary edema and how does it present on a chest radiograph?
Negative pressure pulmonary edema, also known as post-obstructive pulmonary edema, occurs due to large negative intrathoracic forces generated by respiratory efforts against an obstructed upper airway. Findings include hypoxemia and bilateral fluffy infiltrates on the chest radiograph.
What is the most effective means of preventing postherpetic neuralgia (PHN) from a herpes zoster infection?
The most effective means of preventing PHN from a herpes zoster infection is prior vaccination with the varicella vaccine, which decreases the overall incidence of virus reactivation and reduces the severity of the disease and incidence of PHN if reactivation occurs.
What is anatomical dead space?
The portion of the tidal volume that does not participate in gas exchange because it remains in the conducting airways. Conditions that increase the volume of the conducting airways increase anatomical dead space.
What is physiological dead space?
The portion of the tidal volume that does not participate in gas exchange because it reaches poorly perfused alveoli (alveolar dead space). Conditions that compromise pulmonary perfusion increase alveolar dead space.
What conditions can increase alveolar dead space and how?
Alveolar dead space increases with decreased cardiac output (e.g., hemorrhage, hypovolemia, myocardial infarction), increased resistance to blood flow (e.g., ARDS, COPD), and obstructions to pulmonary blood flow (e.g., pulmonary embolism, air embolism, amniotic fluid embolism).
What are the absolute contraindications to TEE (transesophageal echocardiography) probe placement?
Absolute contraindications to TEE probe placement are perforated viscus, esophageal stricture, esophageal tumor, esophageal tear, esophageal diverticulum, and active upper GI bleed.
How does hepatic dysfunction affect the clearance and duration of action of midazolam?
Hepatic dysfunction reduces the clearance of midazolam due to decreased metabolism, leading to a prolonged duration of action. Therefore, benzodiazepines should be administered very carefully in patients with liver disease, and avoidance is often recommended.
which pediatric neurologic disorders would volatile anesthetics be most likely to produce an increased pharmacodynamic effect?
Patients with cerebral palsy (CP) are more sensitive to the effects of volatile anesthetics, and a lower minimum alveolar concentration (MAC) may be required to achieve surgical anesthesia.
What is true regarding prolonged muscle relaxation by succinylcholine?
Phase 1 and phase 2 blocks show decreased contraction with single twitch stimulus.
