R10

Question 1

When does a phase 2 block happen with succs?

Answer 1

repeated doses. very unpredictable blockade, can resemble NDNMB.

TOF <30%, post tetanic potentiation

Question 2

how do we determine the ABO status of a patient?

Answer 2

mix the blood with anti-A, anti-B, and anti-AB antibodies

Question 3

how do we determine the Rh status of the blood?

Answer 3

mix the patient’s blood with anti-D antibodies

Question 4

what is a crossmatch?

Answer 4

patient serum is added to donor blood –> looks for incompatibilities

Question 5

how do we determine antibody screen?

Answer 5

mix patient serum with red cells with known antigens on the surface

Question 6

why can EMLA cream trigger methemoglobinemia?

Answer 6

contains prilocaine which produces aminophenols that oxidize hgb to methemoglobin

methemoglobinemia: when Fe2+ has been reduced to Fe3+ which makes them unable to carry oxygen

Question 7

what drugs should methemoglobinemics avoid?

Answer 7

prilocaine, benzocaine, dapsone, metaclopramide, sulfas, quinine,

Question 8

three main mechanisms of spinal hypotension

Answer 8

venodilation, arterial dilation (both from sympathectomy - 2 to 6 levels above sensory block), bradycardia (from PSNS dominance)

Question 9

what nerve is blocked at palatoglossal folds?

Answer 9

glossopharyngeal

Question 10

what is blocked with a transtracheal injection through the cricothyroid membrane?

Answer 10

recurrent laryngeal nerve

Question 11

where can the Superior laryngeal be blocked

Answer 11

injection at horn of hyoid

Question 12

rule of 4 in relation of alfentanil to fentanyl

Answer 12

4x faster onset
1/4 potency
1/4 duration

Question 13

cushing’s triad

Answer 13

bradycardia, hypertension, respiratory changes

Question 14

who is at most risk for new or worsening neurological injury from a neuraxial?

Answer 14

those with space-occupying extradural lesions

Question 15

pure shunt

Answer 15

perfusion to alveoli with zero ventilation

Question 16

hypoxic pulmonary vasoconstriction

Answer 16

local mediators induce in the setting of decreased alveolar oxygen tension - reduce perfusion to alveoli

Question 17

what is hypercapnia following O2 to COPD patient due to?

Answer 17

v/q mismatch which is driven by inhibition of hypoxic pulmonary vasoconstriction

Question 18

best way to preoxygenate

Answer 18

100% fio2 with tight fitting mask at 10-12LPM

Question 19

is ischemic optic neuropathy painful?

Answer 19

no.

sudden onset after surgeries in prone

Question 20

half life of flumazenil relative to benzos

Answer 20

shorter, might have to re-dose

1. 7-2.6 hours for benzos
2. 7-1.3 for flumazenil

Question 21

FRC goes up with what

Answer 21

increased height and age

3-4L in normal adult

FRC in infants equals adults at day4

Question 22

can you use leukoreduction to prevent graft vs host disease?

Answer 22

no. you need irradiation

Question 23

what does igA deficiency lead to with transfusions?

Answer 23

risk of anaphylaxis

(previous exposure). ige mediated. bronchospasm and hypotension within 1 hour usually

Question 24

why is pao2 increased in cyanide toxicity

Answer 24

oxygen is present but cant be used.

cherry red, almond smell, anion gap acidosis

Question 25

definition of severe aortic stenosis

Answer 25

valvular area <1cm2 or mean gradient > 40mmHg

Question 26

CYP2C9 metabolizes what?

Answer 26

warfarin, ibuprofen, phenytoin

Question 27

CYP2C19 metabolizes what?

Answer 27

PPIs and antidepressants

Question 28

CYP3A4

Answer 28

warfarin, st john’s wort, digoxin, cyclosporine, anticonvulsants