RANDOM FACTS for SEE 2 Flashcards

1
Q

Dexamethasone should be avoided in patient having what type of surgery and why?

A

Pituitary surgery: because it can suppress the HPA axis leading false post op test for hypopituitarism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Protease inhibitors examples are

A

Ritonavir and sapinavir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does protease inhibitors affect anesthetic drugs?

A

They are inhibitors of Cyp450 and can alter duration and effect of sedatives.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DDAVP causes

A

vWF to split from Factor VIII and increases the serum levels of both components.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A chemical that can bind with a protein to form a new complex is a

A

Ligand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Typically, it is a signal triggering molecule that binds with a target protein.

A

Ligand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Renal failure is associated with main electrolyte imbalances. Mnemonic to remember?

A

Kphos High
CaNa low
Acid
hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which herbal supplement is used to treat depression and anxiety?

A

St John’s wort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Herbal used for the treatment of gastritis, ulcers, cough, and bronchitis.

A

Licorice i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Herbal used for the treatment of gastritis, ulcers, cough, and bronchitis.

A

Licorice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is the most important factor in the rate of rise of FA/FI?

A

Uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Select two factors that may decrease the minimum alveolar concentration (MAC).

A

Metabolic acidosis and HYPOXIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Increasing age on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metabolic acidosis and HYPOXIA on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypothermia on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hyponatremia on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hypo-osmolality on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute ethanol intoxication on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lidocaine administration on MAC

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Decreased central neurotransmitter levels on MAC

A

may decrease MAC levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is myasthenia Gravis?

A

autoimmune disorder in which acetylcholine receptors are destroyed or inactivated by circulating antibodies at the neuromuscular junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the The clinical hallmark of Myasthenia Gravis?

A

skeletal muscle weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Myasthenia Gravis has early signs of

A

ocular and bulbar nerve involvement followed by extremity weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the difference between Myasthenia Gravis (MG) and Myasthenic Syndrome?

A

Myasthenia gravis is an autoimmune disorder affecting the postsynaptic ach receptors at the NMJ. Myasthenic syndrome (sometimes referred to as Lambert-Eaton syndrome) is an autoimmune disorder where there are antibodies formed against the voltage-gated calcium channels in the NMJ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

75% of LEMS (Lambert Eaton Myasthenic syndrome) patients have involvement of the

A

autonomic nervous system resulting in ataxia, impaired sweating, orthostatic hypotension, and metallic taste in mouth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Eye muscle weakness in MG vs LEMS(Lambert eaton myasthenic syndrome)

A

LEMS is uncommon with LEMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Autoimmune disorder where there are antibodies formed against the voltage-gated calcium channels in the NMJ.

A

Lambert-Easton syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Channels in the NMJ affected by Lambert eaton syndrome?

A

Voltage gated Calcium channels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Myasthenia Gravis is associated with ______and LEMS is associated with _________

A

Thymoma; Small cell lung CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Small cell lung CA is associated with MG or LEMS

A

LEMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

LEMS symptoms are worst __________and improves when and why?

A

in the morning, improves throughoutthe day as exercise and repetitive movements will lead to increasing accumulation of presynaptic calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

MG vs LEMS: Autonomic dysfunction

A

Common with LEMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pt with MG and bulbar involvement are at risk of

A

Aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Myasthenic syndrome and NMBAs

A

They are sensitive to both Depolarizing and non-depolarizing NMB agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MG and LEMS: reflexes

A

MG normal reflexes

LEMS decrease reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Myasthenia gravis and Depolarizing agents

A

The ED95 dose of Succinylcholine has been measured at 2.6 times higher than normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Avoid this block if you can in MG

A

ISB because the phrenic nerve paresis may lead to dyspnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

AminoESTER local anesthetics and myasthenia gravis?

A

Amino esters LA duration of action will be prolonged because they are metabolized by pseudocholinesterase ,which would be inhibited by anticholinesterase drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How do you differentiate myasthenic crisis vs cholinergic crisis with what test?

A

Tensilon (Edrophonium) test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Tensilon (Edrophonium) test: if symptoms improves

A

Myasthenic crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Tensilon (Edrophonium) test: if symptoms Worsens

A

Cholinergic crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is myasthenia gravis diagnosed?

A

Short acting anticholinesterases (neostigmine and pyridostigmine) are given to the patient and if there is an increase in strength, though temporary, that supports the diagnosis of myasthenia gravis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Indicated for Pt with MG with generalized symptoms and Thymoma

A

Thymomectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Select two rapid-acting anticonvulsants readily available when a perioperative seizure occurs.

A

Benzodiazepines

propofol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The classic triad of symptoms that accompany severe aortic stenosis are SAC

A

angina, syncope, and congestive heart failure (dyspnea).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Which drugs are selective beta-1 adrenergic blockers?

A

Atenolol, propranolol, metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which calcium channel blocker can be titrated intravenously as an antihypertensive agent?

A

Nicardipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Select two agents that may shorten neuromuscular blockade in patients treated with chronic anticonvulsant therapy.

A

Phenytoin

Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Patients with pericardial tamponade present with ____triad and what other 3 symptoms

A

Beck’s Triad
Hypotension
JVD (distended neck veins)
Muffled/distant heart tones,

tachycardia, pulsus alternans, or pulsus paradoxus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pulse ____or ______ are associated with pericardial tamponade

A

pulsus alternans, or pulsus paradoxus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

In adults, burn each arm represents__%

A

9%,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

In adults, burn each leg represents__%

A

18%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

In adults, burn the entire trunk is___%

A

36% (front 18% and Back 18%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

In adults, burn the head is___%

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which agent is a carbonic anhydrase inhibitor used in the treatment of metabolic alkalosis?

A

Acetazolamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

ECG changes related to hypokalemia include

A

flattened T-waves and prominent U-waves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The most serious manifestations in acute liver failure are

A

acute cerebral edema and intracranial hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Select two relative contraindications to shock wave lithotripsy (SWL).

A

Large calcified aortic aneurysm

Implantable cardiac defibrillator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Most lipophillic opioids are

A

Fentanyl and sufentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Most Hydrophillic opioids are

A

Morphine and meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Which calcium channel blockers inhibit CYP450? (select two)

A

Diltiazem

Verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Where in the body does metoclopramide block dopamine receptors?

A

Chemoreceptor Trigger zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Equation that explains that by increasing the internal diameter of an ETT, the resistance to flow through the tube is decreased exponentially.

A

Poiseuille’s equation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Adenylyl cyclase functions as part of a secondary messenger system within the cell by converting adenosine triphosphate into

A

cyclic AMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

During the third trimester of pregnancy, the cardiac output______primarily due to_________

A

increases primarily due to an increase in stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Serum Creatinine and pregnancy

A

Decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Enzymes activity that decrease during preganncy

A

Plasma cholinesterase decrease by 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Plasma cholinesterase activity decreases by about one-third by the second trimester. The duration of action of _____is rarely affected

A

succinylcholine is rarely affected, however.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

During pregnancy, The increase in cardiac output increases

A

renal blood flow and the glomerular filtration rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

BUN and CR, during pregnancy

A

BUN and creatinine both decrease as a result.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

The increased renal blood flow can result in the renal

A

excretion of small amounts of glucose and protein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Liver enzymes and pregnancy

A

Enzymes are increased slightly by pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

2 predictors of difficult epidural placement in obese parturients?

A

The ability of the patient to flex their back

The ability to palpate bony landmarks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

You have administered ephedrine 10 mg IV to treat hypotension in a laboring parturient. How long would you expect the effects of the drug to last?

A

5 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

effects of mannitol when administered during vascular surgery

A

induces osmotic diuresis

decreases endothelial cell swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Mannitol and diuresis

A

Induces OSMOTIC diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Mannitor and cell swelling

A

Decreases endothelial cell swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Mannitol and prostaglandins

A

increases prostaglandin synthesis which causes renal vasodilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

It acts as a hydroxyl free radical scavenger

A

Mannitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

In 75 percent of the population, the artery of Adamkiewicz joins the anterior spinal artery between In 10 percent of the population, it connects between L1 and L2.

A

T8 and T12.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

The artery of Adamkiewictz joins the

A

Anterior spinal artery between T8 and T2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

In 10 percent of the population, the artery of adamkiewiciz connects

A

between L1 and L2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which of the following agents decreases hepatic glucose production?

A

Biguanides (Metformin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Medications for diabetics that enhance tissue sensitivity to insulin.

A

Thiazolinediones (pioglitazone) and metformin (a biguanide) e

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Antidiabetes medications that increase insulin secretion.

A

Meglitinides such as repaglinide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Antidiabetes medication that increase insulin secretion.

A

Sulfonylureas such as glipizide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What class of medication is Glipizide

A

Sulfonylureas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

The foot is innervated by branches of the

A

Femoral and sciatic nerves,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

A patient is undergoing shoulder surgery. He is awake and in the sitting position and you have performed an adequate brachial plexus block for the procedure. He suddenly experiences severe bradycardia and hypotension and complains of feeling faint. What would most likely explain this phenomenon?

A

Bezold-Jarisch reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is cardiac stunning?

A

When the cardiac muscle is ischemic for less than 20 minutes, cell death is not likely to occur, but the tissue exhibits reversible contractile dysfunction known as cardiac stunning. Because of this, many patients require inotropic support for 12-24 hours following cardiac surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Diastolic dysfunction is associated with

A

a normal ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Another name for diastolic heart failure is heart failure with

A

preserved ejection fraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

You are preparing to implement controlled hypotension in a patient undergoing an extensive neck dissection. Which agent would best maintain cerebral blood flow?

A

Nicardipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Which statement represents an accurate understanding of anesthesia for middle ear surgery?

A

Local anesthesia is appropriate for middle ear surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

A patient is undergoing cataract surgery and the surgeon plans to use topical anesthesia. You know that the topical anesthetic will

A

will not provide akinesia of the eyelids or ocular muscles, however, and some practitioners will augment the anesthetic with ocular regional anesthesia for motor control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

The O’Brien and Nadbath blocks are used to anesthetize cranial nerve

A

VII and prevent eyelid movement for ocular surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

The O’Brien and Nadbath blocks side effects such as

A

unilateral facial paralysis, they are beginning to be replaced with the orbicularis oculi block.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

A cold laser can penetrate as deep as two inches into tissue without producing damage or generating a large amount of heat. It is used as a method of biostimulation to increase healing rates in soft tissues. A cold laser may be used in the treatment of

A

carpal tunnel syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Fusion of the coccyx into two bones is complete by

A

25-30 years of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

The cauda equina normally extends from

A

L1 to S5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the potential space outside the dural sac that is continuous from the base of the cranium to the base of the sacrum at the sacrococcygeal membrane?

A

Epidural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

The average distance from the skin to the lumbar epidural space using a midline approach is

A

5 cm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

The lumbar lordosis and thoracic kyphosis seen in extreme obesity produce what changes in lung parameters?

A

a decrease in pulmonary compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Extreme obesity can also produce a decrease in the

A

FRC and ERV and premature airway closure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

In adults, about_____ ml/hour of CSF is produced by the choroid plexus of the cerebral ventricles every day.

A

21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

______ ml of CSF produced per day

A

500 mL a day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What can both cause an increase in the specific gravity of CSF, which is normally

A

Hyperglycemia and uremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Normal CSF specific gravity is

A

1.004-1.009.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Cauda equina syndrome consists of

A

lower back pain, sciatica, motor and sensory loss, and bladder and bowel dysfunction that has been associated with the use of hyperbaric lidocaine 5 percent in spinal anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Sympathetic innervation to the gastrointestinal tract arises from the

A

T5 to L2 spinal cord segments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Which would be considered the definitive treatment for postdural puncture headache?

A

Epidural blood patch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Which complication occurs more frequently with an epidural than with a spinal anesthetic?

A

Backache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

During a brachial plexus block, the nerve stimulator used in regional anesthesia is adjusted to _______milliamps after the needle has been introduced into the subcutaneous tissues.

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Which nerve roots are associated with the musculocutaneous nerve?

A

C5-C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

The cricoid cartilage is an anatomic landmark that corresponds to the vertebral body of

A

C6.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Which agent is used for IV Bier block?

A

0.5% Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Which nerve roots are associated with the obturator nerve?

A

L2-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Which medication is used for the management of postherpetic neuralgia and chronic pain syndromes?

A

Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Brody’s number is used to calculate

A

oxygen consumption

Carbon dioxide production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Brody’s number, called the three-quarter power rule, uses the

A

patient weight in kilograms to estimate oxygen consumption, cardiac output, carbon dioxide production, and free water requirement. It is used to calculate oxygen and ventilatory requirements in closed circuit anesthesia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

It is used to calculate oxygen and ventilatory requirements in closed circuit anesthesia.

A

Brody’s number

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Which component of the anesthesia machine can serve as a useful indicator of neuromuscular blockade in a mechanically-ventilated patient?

A

Bellows because As a patient’s respiratory efforts begin to increase, movement in the bellows may be noted between ventilator cycles. The breathing bag is excluded from the circuit when the machine is set to mechanical ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Could be a sign of carbon monoxide accumulation and would need to be investigated further.

A

Signs of myocardial hypoxia such as T wave inversion, ST segment changes, or alterations in rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Laryngoscope that has a lever that allows for the flexion of the tip of the blade to further elevate the vallecula and epiglottis.

A

The McCoy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

A Macintosh blade with an altered angle between the handle and blade to accommodate patients with abnormal anatomy is called

A

Polio blade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What is the straight blade with a flange that looks like two-thirds of a circle when viewed in cross section?

A

Wisconsin blade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Invasive aline substitute

A

Arterial tonometer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the gold standard in expired gas analysis?

A

Mass spectroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

The monitor determines the degree to which the charged particles are deflected by the magnetic field.

A

Mass spectroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Some ECG monitors are able to measure respiratory rate and depth using the principle of

A

impedance plethysmography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Using Impedance plethysmography, how does it work?

A

increase the electrical impedance of the thorax. As the patient exhales, the impedance decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

ECG Lead ____evaluates upper chest breaths while lead ____evaluates the lower chest and diaphragm.

A

ECG lead I; lead II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

For PNS monitoring The use of needle electrodes is preferred for patients with

A

burn injuries over the monitoring location.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Method that assess the number of action potentials occurring in a measured muscle group?

A

Electromyography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Electromyography measures the action potentials in a muscle group. It uses

A

two stimulus electrodes, two sensing electrodes, and a ground electrode in between them. It can be used to calculate the number of action potentials that occur after administration of a neuromuscular blocking agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What method measures the acceleration of a muscle across a joint?

A

Acceleromyography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Bispectral index is a measurement of

A

level of consciousness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

NMBDs will ______the number of action potentials produced during stimulation

A

decrease; action potentials produced during stimulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What are the most common anatomical sites for invasive arterial monitoring line placement?

A

Radial

Femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

The factors that determine the response of peripheral nerves to electrical stimulation are :

A

Placement of electrode
The duration the current is applied
The amount of current applied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Current is measured in

A

amps or milliamps, not volts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Rank the order in which the structures would exhibit paralysis after administration of a neuromuscular blocking agent. Abdominal muscles, diaphragm, Eyes and extremities

A

First - Eye muscles
Second - Extremities
Third - Abdominal muscles
Fourth - Diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

With NMBA Eye muscles are the first to be paralyzed, the extremities are affected next, followed by the trunk, abdominal muscles, and lastly, the diaphragm. Recovery is restored in EyeExAdDi

A

reverse order.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

IV anesthetics of degree of Protein-binding PMEK

A

From greatest to least, the degree of protein-binding is as follows: Propofol > Midazolam > Etomidate > Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Select the two most likely causes of hypocalcemia in the intraoperative period.

A

Hyperventilation

Massive transfusion of citrated blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

GAS embolism Symptoms include

A

decreased ETCO2, increased end-tidal nitrogen levels, decreased oxygen saturation, increased pulmonary artery pressures, hypoxia, cyanosis, hypotension, pulmonary edema, a mill-wheel murmur, and detection of air via doppler ultrasound or transesophageal echo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

During extracorporeal shock-wave lithotripsy (ESWL), what component of the ECG waveform is used to trigger the shocks?

A

R-wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What types of EEG waves are seen in an alert, awake individual? (select two)

A

alpha waves

beta waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q
ForCed air warmers transfer heat to the patient via\_\_\_\_\_
Resistive heaters (such as warming blankets) use
A

convection; conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

ForCed air warmers transfer heat to the patient via which heat transfer process?

A

convection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Heat lamps and radiant heaters use what type of heat transfer?

A

radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Resistive heaters (such as warming blankets) use what type of heat transfer?

A

conduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Fluids that are preferred when performing volume resuscitation in patients with traumatic brain injury.

A

Isotonic crystalloids. Normal saline is probably the best option because it can be mixed with packed red blood cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Solutions to avoid with patient with traumatic brain injury?

A

Any solution containing glucose should be avoided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Any unintended patient injury, harm, or complication that results in a prolonged hospitalization, disability, or death

A

An adverse event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

A powerful and overwhelming event that lies outside the range of human experience

A

critical incident

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Failure to take a known and planned action or using the wrong plan of action to achieve an outcome is known as a

A

Medical error

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

According to the Critical Incident Stress Management model, education to help strengthen coping and stress management skills before an incident ever occurs is referred to as

A

pre-crisis stage interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Intervention strategy designed to help healthcare providers involved in a critical incident return to their normal state of health.

A

pre-crisis stage interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Pre-crisis stage interventionsIt is broken down into interventions that occur in three stages:

A

the pre-crisis stage, the acute crisis stage, and the post-crisis stage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Interventions in the pre-crisis stage are designed to help

A

strengthen coping skills before a critical incident ever happens. Education techniques in stress management and relaxation techniques are included.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

WPW SYNDROME PATIENTS with afib treatment and why?

A

Cardioversion ; Because tx with amiodarone, adenosine, digoxin, and non-DHP can cause accelerated ventricular that leads to vfib.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What is SVV?

A

Stroke volume variation used to estimate fluid responsiveness, in ventilated patients using cyclic changes in the intrathoracic pressures during PPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Positive pressure ventilation induces changes in

A

SV and Pulse pressure variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

SVV represents variability of SV during resp cycle”

A

increase during inspiration and decreases during expiration. Opposite with spontaneous ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

4 parameters with EV1000

A

SV, SVV, CO, CI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

3 Goals of management with afib

A

Correct underlying cause
Rate control
AC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

CHA2-DS,VASC

A

To know who needs AC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

AF > 48 h concerns

A

Thrombus in Left atrial appendage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

IS digoxin use for afib acutely?

A

NO; itsmore for chronic afib caused by HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Do not use in decompensated HF

A

Beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

If pt with afib unresponsive to CB and BB, use

A

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What is the minimum seizure duration recommended to ensure adequate antidepressant efficacy when performing electroconvulsive therapy?

A

25 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

The most common anesthetic for electroconvulsive therapy is

A

General anethesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Electroconvulsive therapy (ECT) is associated with

A

Bradycardia followed by hypertension and tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What medications would shorten the seizure duration of electroconvulsive therapy? (select four)

A

Fentanyl
Midazolam
Lidocaine
Diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Which condition is an absolute contraindication to electroconvulsive therapy?

A

Pheochomocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What are the two most common causes of death related to electroconvulsive therapy? (select two)

A

Myocardial infarction

Cardiac dysrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

The increase in peripheral vascular resistance (afterload) in the elderly occurs primarily due to progressive loss of arterial distensibility and leads to

A

concentric left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Obesity is most closely associated with which kind of hypertropy

A

Eccentric Cardiac hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Hypertension produces what kind of hypertrophy?

A

concentric hypertrophy of the left ventricle,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Do Heparin, protamine, or insulin CROSS PLACENTA?

A

do not cross the placenta,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Succinylcholine and nondepolarizing muscle relaxants., CROSS PLACENTA

A

Do not cross the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

When an anesthetized patient is placed in the lateral decubitus position, the upper lung is ____less or more compliants?

A

shifted to a more compliant position and the dependent lung into a less compliant position.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

When an anesthetized patient is placed in the lateral decubitus position the upper lung receives

A

more ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

A ventilation perfusion defect occurs when lateral decubitus position because

A

because the lower lung is perfused more than the upper lung. The functional residual capacity in the lateral decubitus position is decreased.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

The tourniquet should be inflated to about what mmHG ?

A

100 mmHg above the systolic blood pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Tourniquet pain typically begins after

A

45-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Which of the following is increased during pregnancy? Endocrine? by how much and when?

A

T3 T4 increased by end of first trimester by 50%

Follicular hyperplasia leads to 50-70 % increase in the thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Epidural space changes during pregnancy?

A

Because the volume of epidural fat increases and epidural veins enlarge, the volume of spinal CSF is decreased in pregnancy. The size of the liver does not change with pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

In a primiparous patient, LEAST preferred anesthetic and why?

A

Single shot spinal? is it is highly likely that labor would last longer than the duration of the spinal. Intravenous opioids or opioid agonist-antagonists such as nalbuphine or butorphanol would be appropriate options, as would an epidural as long as the patient is not in the latent stage of labor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

The Triple-H therapy used in the treatment of cerebral vasospasm includes

A

hypertension, hypervolemia, and hemodilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

MEdications that should be dosed based on lean body weight? 4 nmbs, 3 opioids, one anesthetics

A

Rocuronium, vecuronium, atracurium, cisatracurium, fentanyl, sufentanil, remifentanil, and induction doses of propofol should be based on lean body weight.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Should be based on total body weight.

A

Succinylcholine, dexmedetomidine, neostigmine, and sugammadex doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

MAC decreases by when in life

A

about 6% percent per decade after the age of 40.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Compared to adult patients, you would expect a term neonate to exhibit (select four)
TBW, body fat, muscle mass,

A

decreased responsiveness to dopamine
a higher proportion of body water
a decreased proportion of body fat
decreased proportion of muscle mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Neonates responsiveness to cardiac drugs? example?

A

Decreased responsiveness. The dose of dopamine required to increase blood pressure and urine output in neonates may be as high as 50 mcg/kg/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Which arrhythmia would you most likely see in a patient following surgical repair of tetralogy of Fallot?

A

Right bundle branch block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

A right bundle branch block is common following surgical correction of tetralogy of Fallot why?

A

due to damage to the conduction system during repair.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

One method of defining frailty is as a syndrome in which at least three of the following criteria are met:

A

unintentional weight loss of more than 10 lbs in the past 12 months, exhaustion, weakness, slow walking speed, and a low physical activity level.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

The decreased ability to retain or eliminate sodium in elderly patients is partially attributed to reductions in

A

aldosterone secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

The most common lung abnormalities in obese patients are decreases in the

A

ERV and FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

Which would be most likely to be decreased in an elderly patient? As far as HR

A

Heart rate variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

CO: It returns to prelabor values within______and to pre-pregnancy values within about_______

A

24 hours; 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Compared to adults , neonates GFR

A

reduced glomerular filtration rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

Neonates have decreased ability to

A

decreased ability of the renal tubules to absorb BAGS

bicarbonate,amino acids.glucose,sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Which of the following are major side effects of meperidine administration to parturients? (select four)

A

maternal nausea and vomiting
Maternal sedation

Fetal Tachycardia
Neonatal depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Can cause decrease beat to beat variability

A

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

The classic symptom triad of TUR syndrome seen in awake patients under regional anesthesia is

A

elevated systolic and diastolic pressures accompanying an increase in pulse pressure, bradycardia, and changes in mental status.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

The average amount of fluid absorbed during a TURP is about

A

20 mL/min of resection time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

For a 25 minute resection, the total amount of fluid absorbed would be estimated as

A

(20 mL/min X 25 minutes) = 500 mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Which irrigating solution for transurethral resection procedures has the highest risk for producing hyperglycemia when absorbed?

A

Sorbitol and glucose irrigation solutions can produce hyperglycemia when absorbed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

A patient undergoing a TURP begins to exhibit widening of the QRS complex and ST segment elevation on the electrocardiogram. Based on this evidence, you would estimate the serum sodium to be

A

115 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Hyponatremia, vomiting begin to appear at about ____mEq/L with and

A

120 mEq/L,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

ECG changes for hyponatremia, occurring at_____ mEq/L,

A

115

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Ventricular tachycardia and fibrillation occurring below

A

100 mEq/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

The primary purpose of an intra-aortic balloon pump is to (select two)

A

decrease afterload

augment myocardial oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Which is the most single effective maneuver to increase Pa02 during one-lung ventilation?

A

Application of CPAP to the nondependent lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

A patient is undergoing general anesthesia for strabismus surgery. Which of the following is not true regarding anesthesia during this procedure?

A

Hyperventilation increases the risk for sudden bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

What is the most common pediatric ocular surgery and may be an indicator that there is underlying disease?

A

Strabismus surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Pediatric ocular surgery is associated with a high incidence of

A

prematurity, cerebral palsy, and craniofacial abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Strabismus surgery is also associated with a higher than normal incidence of

A

malignant hyperthermia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

Hypoventilation resulting in hypercapnia increases the risk of _____Due to the oculocardiac reflex which can occur due to ________

A

bradycardia due to the oculocardiac reflex which can occur due to traction on the ocular muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

Bradycardia during eye surgery can be due to

A

oculocardiac reflex which can occur due to traction on the ocular muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

When does the foramen ovale typically close?

A

1 hour; as left atrial pressure exceeds right atrial pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

A patient with symptomatic hyperparathyroidism is presenting for a parathyroidectomy. What electrolyte disorders would you expect to see in this patient preoperatively? (select two)

A

Hypercalcemia

Hypophosphatemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

The most common airway problem in pediatric patients is upper airway obstruction due to

A

Laryngomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Most of the decrease in hepatic blood flow associated with aging is due to

A

Decreased liver mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

What accounts for most of the 20-40% decrease in hepatic blood flow with age.

A

Decreased liver mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Age associated decrease in hepatic blood flow

A

20-40% in hepatic blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

The obturator reflex results in.

A

external rotation and adduction of the thigh from stimulation of the obturator nerve. Administration of muscle relaxants is required to prevent its occurrence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

Electrocautery current applied to the lateral wall of the bladder as may occur during a transurethral resection of a bladder tumor can stimulate

A

obturator reflex which could result in bladder perforation due to patient movement while instruments are in the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

Regional anesthesia and obturator reflex

A

Regional anesthesia does not reliably block this reflex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

What is the preferred blood glucose range in the management of pregnant diabetics?

A

60-120 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

What ECG changes are associated with a subarachnoid hemorrhage? (select two)

A

ST segment depression and T wave inversion are often noted within 48 hours of a subarachnoid hemorrhage and are associated with the increase in catecholamine release.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

The recommended tidal volume for an obese patient should be estimated as

A

6-8 mL/kg predicted body weight.The recommended tidal volume for obese patients is typically 6-8 mL/kg of the predicted body weight (PBW).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

Larger tidal volumes have not been shown to offer any advantages and result in _______airway pressure without an ______In oxygenation

A

and result in increased airway pressures without an increase in oxygenation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

The principal morbidity and mortality considerations of obesity center around what issues?

A

Cardiovascular disease (ischemic heart disease, hypertension, and heart failure).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

The formation and maintenance of the extra adipose mass requires an extra

A

0.1 L/min of cardiac output for each additional kilogram of fat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

A child presents to the emergency department with a diagnosis of epiglottitis. He is drooling, complains of sore throat, and exhibits stridor. Your preoperative exam for this patient should include what kind of induction?

A

. A plan for an inhalation induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

A child presents to the emergency department with a diagnosis of epiglottitis. He is drooling, complains of sore throat, and exhibits stridor. Your preoperative exam for this patient should include:

A

A plan for an inhalation induction. Also, the importance of a complete blood count and chest x-ray are secondary to securing the airway. The preoperative evaluation should be brief and the efforts of the anesthesia staff should be focused on rapidly securing a difficult airway. Inhalation induction, especially for a pediatric patient, is a suitable induction method.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

Which of the following characteristics do geriatric patients share with neonates?

A

A higher body surface area to body mass ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

Both classes of patients have a high body surface area to body mass ratio.

A

Neonates and geriatric patients. have a higher concentration of body water, and geriatric patients have a lower proportion of body water. Although neonates can have a lower alpha-1 acid glycoprotein level than adults, this value is not normally altered in geriatric patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

The risk of anesthesia-related maternal death is higher in obese patients, primarily due to an increased incidence of

A

airway difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

The risk of maternal death is higher in obese patients due to an

A

increased incidence of diabetes, infection, preeclampsia, and thromboembolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

You are performing an anesthetic for a patient undergoing a hepatic resection near the portal vessels. For which complication should you be prepared?

A

air embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

From the patient’s right to left, the three major vessels leaving the superior aspect of the aorta are:

A

the brachiocephalic trunk (also known as the innominate artery), the left common carotid artery, and the left subclavian artery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

Ascending vs descending bellows?

A

Ascending (standing) bellows are considered safer than descending (also known as hanging) bellows.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

Both ascending AND standing are correct because they are

A

synonymous terms for the same type of bellows.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

In the event of a circuit disconnect, ascending bellows will

A

fail to rise whereas descending bellows will continue to descend due to gravity and ascend during the inspiratory phase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

All sympathetic neurotransmitters are synthesized from

A

tyrosine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

The synthesis of neurotransmitters from tyrosine takes place in the

A

postganglionic sympathetic nerve ending.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

Select two laboratory studies that appear to be associated with increased risk of perioperative pulmonary morbidity.

A

Reduced serum albumin levels

Increased creatinine level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

The only machine safety device that evaluates the integrity of the low-pressure circuit in an ongoing fashion.

A

The oxygen analyzer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

It is the only machine monitor that can detect problems downstream from the flow control valves.

A

The oxygen analyzer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

The latent heat of vaporization is the

A

amount of energy lost by a given liquid as it is converted to a vapor. Specifically, it is defined as the

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

Number of calories required to change 1 gram of liquid into vapor without a temperature change.

A

Latent heat of vaporization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

Factors that may help prevent optic ischemia

A

The use of crystalloids and colloids to maintain intravascular volume and reduction of intra-abdominal pressure to prevent venous congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

Washout of high concentrations of N20 can lower alveolar concentrations of oxygen and carbon dioxide in ?

A

Diffusion Hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

Describes the diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more adequate perfusion?

A

Coronary Steal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

2 primary determinant of coronary blood flow.

A

Perfusion pressure and vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

What is the appropriate initial dose of dantrolene in mg/kg for the treatment of malignant hyperthermia?

A

2.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

Esmolol is metabolized quickly in the

A

blood by an esterase found in the RBC cytoplasm and has a half-life of

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

Esmolol half life

A

9.5 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

Which part of the brain is responsible for increasing the rate and amplitude of ventilation when stimulated?

A

Reticular activating system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

What is the most frequent cause of an acute increase in physiologic dead space?

A

A decrease in cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

Mrs. Frank is considered a full stomach and is scheduled for surgery. Which two agents would raise Mrs. Frank’s gastric pH?

A

Sodium Citrate

Famotidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

Action of Pepcid?

A

Famotidine increases gastric pH and reduces gastric volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

Sodium citrate dose and action

A

(15-30ml) increases gastric pH to >2.5. This dose should be administered within 1 hour prior to surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

What is the most reliable technique for verifying the proper position of a double-lumen endotracheal tube?

A

Visualization with a fiberoptic bronchoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?

A

Nucleus tractus solitarius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

The nucleus tractus solitarius is the main area responsible for

A

relaying afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
273
Q

Where is the nucleus tractus solitarious located?

A

Located within the medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
274
Q

Which neuromuscular blocking agent is metabolized via Hofmann and ester hydrolysis?

A

Cisatracurium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
275
Q

What nerve provides better prediction for intubating conditions and gives visual observation of the response over the eyebrow.

A

Facial nerve stimulation (corrugator supercilii )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
276
Q

Specifically, the corrugator supercilii is the muscle responsible for

A

moving the eyebrow (not the orbicularis oculi).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
277
Q

The corrugator supercilli most closely parallels

A

the laryngeal adductors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
278
Q

Which evoked potential is useful in evaluating descending motor pathways?

A

Motor evoked potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
279
Q

What is the intraoperative target glucose range for adults undergoing emergent craniotomy for traumatic brain injury?

A

target blood glucose level of 90 to 180 mg/dL is appropriate for patients undergoing neurosurgical procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
280
Q

The recommended minimum platelet count for a patient having a non-emergent neurosurgical procedure is

A

100,000/mm3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
281
Q

The Glasgow Coma Scale (GCS) evaluates the best

A

verbal response, eye response, and motor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
282
Q

GCS min and max

A

with a minimum score of 3 and a maximum score of 15. A GCS score less than 9 indicates severe brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
283
Q

GCS indicating severe brain injury

A

less than 9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
284
Q

How is the spinal cord perfusion pressure (SCPP) determined?

A

SCPP = MAP - Cerebrospinal fluid pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
285
Q

What are the most important parameters to normalize in patients with brain injury? (select two)

A

Intracranial pressure

Cerebral perfusion pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
286
Q

Which value is primarily increased in metabolic alkalosis and decreased in metabolic acidosis?

A

Metabolic alkalosis and acidosis are described as alterations where primarily HC03- is shifted up or down, respectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
287
Q

Laparoscopy on RESP

A

Pulmonary changes associated with laparoscopy include decreased lung volumes
increased V/Q mismatch, increased pleural and airway pressures, and CEPHALAD displacement of carina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
288
Q

You are evaluating a patient in the recovery room who experienced subcutaneous emphysema during a laparoscopy. What clinical signs should you monitor for postoperatively? (select two)

A

If subcutaneous emphysema persists in the recovery area, the patient should be kept on oxygen therapy and monitored for respiratory acidosis and somnolence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
289
Q

Select two characteristics of a cirrhotic patient.

A

High cardiac output

Low arterial blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
290
Q

Sildenafil, tadalfil, and vardenafil inhibit

A

cyclic GMP (cGMP)-specific phosphodiasterase type-5 (PDE5) in vascular smooth muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
291
Q

Blocking PDE5 stops

A

cGMP breakdown.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
292
Q

With its decline in age, which neurotransmitter is noted for its connection to Alzheimer’s disease?

A

Ach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
293
Q

Select the two most dramatic changes in lung volumes seen with increased age ? what are the other important Resp changes

A

Although decreases in total lung capacity and increases in the functional residual capacity are associated with aging, the most significant changes are the increases in both closing volume and closing capacity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
294
Q

You are concerned about the postoperative fluid status of an elderly patient with a history of congestive heart failure. On what postoperative day would you expect third space fluid to mobilize into the vascular system?

A

Day 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
295
Q

Signs of fluid volume excess such as

A

Rales, crackles, tachypnea, and orthopnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
296
Q

Select two physiologic characteristics that you would expect to be increased in an obstetric patient at term.

A

Minute ventilation

Oxygen consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
297
Q

By term, oxygen demand increases by about mostly due to an increase in tidal volume.

A

33 percent and minute ventilation increases by about 50 percent,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
298
Q

The PaCO2 is usually between at term

A

30 and 32 mmHg, and the PaO2 is higher than 100 mmHg at term.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
299
Q

The most popular opioid agonist-antagonists are

A

butorphanol and nalbuphine for labor analgesia due to their proposed benefits including less nausea, vomiting, and dysphoria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
300
Q

What is the most common complication of central neuraxial blockade in the obstetric patient?

A

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
301
Q

Effective analgesia can be achieved with low concentrations of local anesthetic during the first stage of labor if the ____ dermatomes are blocked.

A

T10-L1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
302
Q

Select two long-acting amides that can provide analgesia in neuraxial blocks for obstetric patients while sparing motor function.

A

Bupivacaine

Ropivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
303
Q

The diagnostic feature of eclampsia that is not present in preeclampsia is

A

convulsions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
304
Q

Severe preeclampsia is defined by the presence of a systolic pressure of at least

A

160 mmHg, a diastolic pressure of at least 110 mmHg, proteinuria of at least 5 grams per 24 hours or evidence of end-organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
305
Q

Eclampsia is present if

A

seizures occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
306
Q

Is the most frequently abused substance among pregnant patients?

A

Tobacco (smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
307
Q

When should chest compressions be initiated in the neonate?

A

Heart rate < 60 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
308
Q

In the normal, full-term infant, you would expect the glottis to be at the level of

A

C4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
309
Q

What are the two most commonly used interventions for the treatment of apnea in premature neonates?

A

CPAP

Caffeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
310
Q

What is the major metabolite of fentanyl?

A

The inactive metabolite norfentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
311
Q

Fibers associated with

A

Muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
312
Q

A-delta fibers are associated with

A

pain and touch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
313
Q

Select two true statements about nerve fibers.

A

Myelinated fibers conduct faster

A-delta and C nerve fibers are associated with pain transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
314
Q

At which plasma concentration of lidocaine would analgesia first be achieved?

A

3 mcg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
315
Q

Through what interlaminar space would you direct your needle when using the Taylor approach to the subarachnoid and epidural space?

A

L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
316
Q

Which local anesthetic would be prolonged the most by adding an adrenergic agonist?

A

Tetracaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
317
Q

What electrolyte disorders are most common in patients on chronic immunosuppressive therapy following organ transplantation? (select two)

A

Hyperkalemia

Hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
318
Q

Select two narcotic agents appropriate for administration to a renal transplant patient.

A

Morphine

Meperidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
319
Q

In adults, how long should surgery be delayed following a viral respiratory infection?

A

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
320
Q

Which is the most significant cause of perioperative morbidity and mortality from an office-based surgical procedure?

A

Pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
321
Q

What are the three components of the ‘fire triad’?

A

Oxidizer, ignition source, and fuel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
322
Q

What is the maximum recommended aspirant amount in an office based liposuction procedure?

A

5000 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
323
Q

Contrast-induced nephropathy is defined as an increase in serum creatinine of _____ mg/dL or a ____ percent increase from the baseline within the first 24 hours.

A

0.5 mg/dL; 25 percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
324
Q

Which is the most sensitive indicator of the effect of obesity on pulmonary function?

A

Expiratory reserve volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
325
Q

What is the most common mononeuropathy after bariatric surgery?

A

Carpal tunnel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
326
Q

What is the maximum cuff volume for a size 4 LMA?

A

30 cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
327
Q

Which statement regarding the Wisconsin blade is false?

A

It is available in 3 sizes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
328
Q

You are preparing to insert a microlaryngeal endotracheal tube for a patient undergoing surgery of the larynx. You anticipate that the use of this tube will likely require (select two)

A

McGill forceps for correct placement

the use of mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
329
Q

Which laryngoscope blade has a handle-operated, articulating tip designed to elevate the vallecula and epiglottis?

A

McCoy blade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
330
Q

The Soper blade is a

A

straight blade with a left-facing flange that makes it a blend between the Miller and Macintosh blades.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
331
Q

Which endotracheal tube is designed to deflect laser beams

A

Mallinckrodt tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
332
Q

The criteria for diagnosing metabolic syndrome are:

A
waist circumference greater than 102 cm in men or 88 cm in women
triglyceride level > 150 mg/dL
HDL cholesterol < 40 mg/dL in men or 
< 50 mg/dL in women
a blood pressure > 130/85 mm Hg
fasting glucose > 110 mg/dl.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
333
Q

Osmotic diuretic that decrease intraocular pressure.

A

Mannitol is an osmotic diuretic that can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
334
Q

Pilocarpine eye drops can produce pupillary

A

constriction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
335
Q

Phenylephrine topical eyedrops can produce pupillary

A

dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
336
Q

What is the most common workplace injury attributed to working 12 hour shifts?

A

Needlestick injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
337
Q

Term that defines longitundinal protrusion of sternum?

A

Pectus Carinatum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
338
Q

Intracellular Na+ content

A

12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
339
Q

Supratentorium pressure best measured in

A

Lateral ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
340
Q

Off Pump cardiac surgery facilitated by device called

A

Octopus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
341
Q

OSA is sleep apnea lasting more than

A

10 seconds or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
342
Q

Permanent remission of 50% of patient associated with this disorder

A

Sarcoidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
343
Q

Cerebral cortex is divided into

A

50 anatomical segments called BRODMAN’S AREAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
344
Q

Predominant inhibitory biogenic amines of CNS

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
345
Q

80% of acute pancreatitis is caused by

A

Gallbladder or alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
346
Q

Most important evoked potential to monitor during pituitary surgery is

A

VISION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
347
Q

Overestimation o2 sat

A

severe anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
348
Q

After acute spinal cord injury, Below the level of injury, the patient will exhibit

A

flaccid paralysis
total absence of sensation, and
loss of temperature regulation and spinal cord reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
349
Q

After acute spinal cord injury, Below the level of injury, the patient will exhibit

A

flaccid paralysis
total absence of sensation, and
loss of temperature regulation and spinal cord reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
350
Q

Dehydration in patients with thyroid storm should be treated with .

A

glucose-containing intravenous fluids. Cooling measures should be instituted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
351
Q

GOAL HR during Thyroid storm

A

Beta-blockers should be titrated to reduce the heart rate less than 90 beats per minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
352
Q

What can be administered to reduce circulating levels of thyroid hormones during thyroid storm?

A

Steroids and anti-thyroid medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
353
Q

Which is the best method for defining coronary anatomy and evaluating ventricular and valvular function?

A

CORONARY ANGIOGRAPHY not TEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
354
Q

What is the half-life of cefazolin?

A

2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
355
Q

Absorbtion of Co2 soda lime

A

26L/ 100g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
356
Q

Which test checks the integrity of the unidirectional valves and detects obstruction in the circle system?

A

Flow test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
357
Q

How do you perform flow test on anesthesia machine?

A

It is performed by removing the y-piece and breathing through each individual hose to observe the movement of each valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
358
Q

In some patients, what position of the elbow can lead to ulnar nerve compression?

A

flexion of the elbow more than 110 degrees can compress the ulnar nerve between the aponeurosis of the flexor carpi ulnaris muscle and the cubital tunnel retinaculum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
359
Q

In about 15% of the population, flexion of the elbow will cause she supine position is correct placement of the arms.

A

Subluxation of the ulnar nerve over the medial epicondyle of the humerus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
360
Q

Placement of the arms on armboards at more than 180 degrees would be more likely to injure the

A

brachial plexus than the ulnar nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
361
Q

Can result in compression of the ulnar nerve.

A

Pronation of the forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
362
Q

Which term describes the administration of a higher partial pressure of anesthetic than the alveolar concentration actually desired for the patient?

A

Overpressuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
363
Q

Overpressuring describes the administration of a higher partial pressure of anesthetic than the alveolar concentration actually desired for the patient, what is it used for?

A

to speed up induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
364
Q

Nagelhout,Normally, the CBF remains constant between MAPs of

A

60 to 140 mmHg. As the MAP decreases within this range, the cerebral vessels dilate to keep CBF constant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
365
Q

The resting adult coronary blood flow is about

A

250 mL/min or 5 percent of the cardiac output.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
366
Q

The QRS complex of the electrocardiogram indicates that ________________ has occurred.

A

Right ventricular and left ventricular depolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
367
Q

Patients with Becker muscular dystrophy have dystrophin, but it is reduced in amount. What is prevalent in these patients?

A

Cardiac involvement is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
368
Q

Which muscular dystrophy is characterized by a reduced amount of dystrophin?

A

Becker MD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
369
Q

Unintentional endobronchial intubation is more likely to occur in the

A

right main bronchus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
370
Q

The right main bronchus is about l_____ong before it initially branches into_____

A

2.5 cm; lobar bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
371
Q

The right main bronchus leaves the trachea approximately______degrees from the vertical tracheal axis in the adult.

A

25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
372
Q

The left bronchus leaves the trachea at about___ degrees.

A

45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
373
Q

Adult vs pediatric epiglottis?

A

The epiglottis is relatively longer and more narrow than in the adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
374
Q

The maximum recommended cuff pressure for a laryngeal mask airway is ______ If an adequate seal cannot be obtained with that amount of pressure, then the

A

60 cm H20. size of the device selected for the patient should be re-evaluated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
375
Q

Two contraindications for cricoid pressure.

A

cervical spine fracture, laryngeal fracture, or who exhibit active vomiting due to the risk of an esophageal rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
376
Q

Absolute indications for OLV

A

Massive hemorrhage, infection, unilateral bullae, unilateral lung lavage, bronchopleural fistula, and video-assisted thoracoscopy are absolute indications for one-lung ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
377
Q

Temperature regulation is facilitated by the

A

anterior hypothalamus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
378
Q

Water metabolism regulation is via the

A

supraoptic hypothalamus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
379
Q

Muscarinic stimulation causes HR , contractility, EYES< Bronchioles, Gastric secretions an d

A

bradycardia, decreased inotropism, miosis, salivation, bronchoconstriction,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
380
Q

Muscarinic stimulation on gastric secretion and GI hypermotility?

A

increased gastric secretion, and GI hypermotility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
381
Q

Parasympathetic on EYE

A

MIOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
382
Q

Besides using a defasculating dose of a non-depolarizing neuromuscular blocking agent, what is the most effective way to prevent myalgia from succinylcholine administration?

A

. Pretreatment with an NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
383
Q

Adductor Pollicis is supplied by which nerve?

A

ULNAR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
384
Q

What is the goal temperature in patients undergoing circulatory arrest for a complicated cardiac procedure?

A

The goal for circulatory arrest is 12-18 degrees Celsius. Profound hypothermia provides greater protection against cerebral ischemia than oxygen administration or anesthetic agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
385
Q

Some cardiac and cerebral procedures such as aneurysm repair can be performed under complete circulatory arrest using profound hypothermia. What C degrees

A

12- 18C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
386
Q

During neurosurgical procedures where the brain is at risk for ischemic damage, a goal temperature of

A

35C to 36C is acceptable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
387
Q

What is the recommended minimum cerebral perfusion pressure for traumatic brain injury patients?

A

60 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
388
Q

You are preparing to emergently intubate a patient with a traumatic brain injury. What associated injury must you assume this patient also has?

A

Cervical spine injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
389
Q

Hemorrhagic shock class III, is characterized with

A

Blood loss between 1500 and 2000 mL

Pulse rate >120/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
390
Q

When using the Henderson-Hasselbach equation, what number is used to represent the solubility coefficient in blood of carbon dioxide (C02)?

A

0.03

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
391
Q

The solubility coefficient in blood of C02 is

A

0.03.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
392
Q

Which is the appropriate fluid treatment for patients that acutely develop water intoxication or seizures due to IV fluid administration?

A

3% saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
393
Q

Magnesium levels of less than 1.2 is associated with

A

Seizures, tetany, and arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
394
Q

Hemodynamic changes during laparoscopic surgery include, SVR, MAP, afterload, Venous return

A

increased systemic vascular resistance, increased mean arterial pressure, increased afterload, and decreased venous return.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
395
Q

The introduction of a pneumoperitoneum and 45-degree head-down positioning during a laparoscopic procedure will result in a decrease in lung compliance by about ____ percent.

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
396
Q

The liver receives how much of the CO

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
397
Q

What is the LARGEST INTERNAL ORGAN?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
398
Q

What is the method of choice to determine whether liver damage is due to necrosis, inflammation, steatosis or fibrosis?

A

Liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
399
Q

You should be cautious in administering a high neuraxial block to a patient with chronic hepatic disease because the block can result in

A

reduction in hepatic blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
400
Q

Select the two most prominent effects of aging on the pulmonary system.

A

Increased stiffness of the chest wall

Decreased stiffness of the parenchyma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
401
Q

Haloperidol is an antipsychotic agent that doesn’t exhibit any significant

A

alpha-adrenergic activity.

402
Q

The principal use of haloperidol is the treatment of

A

delirium and agitation in the intensive care unit.

403
Q

Which physiologic characteristic would you expect to be doubled by term in an obstetric patient?

A

FIBRINOGEN

404
Q

Rapid sequence induction, cricoid pressure, and a cuffed endotracheal tube are recommended for pregnant women receiving general anesthesia from ____ weeks on even if no symptoms of reflux are present.

A

20 weeks

405
Q

In general, a platelet count of _____is considered suitable for neuraxial anesthesia.

A

100,000

406
Q

Which opioid agent should not be used in a neuraxial block?

A

Remifentanil

407
Q

Which APGAR score reflects some flexion of extremities, grimace, heart rate >100 bpm, completely pink color, and crying?

A

8

408
Q

The four principal causes for low renal blood flow and GFR in utero are

A

low systemic arterial pressure
high renal vascular resistance
low permeability of the glomerular capillaries
small size and number of glomeruli.

409
Q

What is the most common cause of upper gastrointestinal tract obstruction in the neonate?

A

Pyloric stenosis

410
Q

What is the most commonly used IV induction agent in children?

A

Diisopropylphenol (PROPOFOL)

411
Q

Which agent exhibits N-methyl-d-aspartate (NMDA) receptor antagonism?

A

METHADONE

412
Q

Methadone exhibits NMDA blocking properties and

A

inhibits the reuptake of norepinephrine and serotonin.

413
Q

Which agent has both opioidergic and monoaminergic activity in the nociceptive pathways?

A

Tramadol

414
Q

Tramadol enhances

A

spinal inhibition of 5HT and norepinephrine reuptake.

415
Q

The accumulation of 5HT and norepinephrine in the dorsal spinal horn produces

A

analgesia.

416
Q

The negative membrane potential of a resting peripheral nerve is

A

-70 to -90 mV.This can be measured with an electrode placed in the axoplasm of the nerve.

417
Q

What is the suggested block height for patients undergoing cesarean section?

A

T4

418
Q

With a spinal block, which factors have the most significant influence on local anesthetic spread?

A

Patient position and solution baricity

419
Q

two adrenergic agonists that can be added to local anesthetics to prolong the duration of spinal anesthesia.

A

Clonidine and Phenylephrine.

420
Q

Select the two variables that influence the spread and quality of an epidural block the most.

A

Local anesthetic dose

Site of injection

421
Q

You are performing anesthesia for an organ harvest on a brain-dead donor. What is the target blood glucose range for maintaining donor kidney graft quality?

A

120-180 mg/dL

422
Q

What is the most common organ transplanted in the U.S.?

A

Cornea

423
Q

A patient who has had outpatient arm surgery under a brachial plexus block complains of persistent numbness to the arm during the discharge evaluation. You should

A

reassurance that sensation will return

424
Q

What is the most commonly performed cosmetic procedure?

A

Liposuction

425
Q

Moderate sedation

A

the patient responds purposefully to verbal commands either alone or with light tactile stimulation

426
Q

You are anesthetizing a patient for CT scan with contrast. What is an appropriate measure to help prevent contrast-induced nephropathy?

A

Administer a sodium bicarbonate infusion

427
Q

An obese patient is taking phentermine as an appetite suppressant. What are likely side effects of this drug? (select two)

A

Tachycardia

Hypertension

428
Q

What is the preferred bariatric procedure for the treatment of severe obesity?

A

. Roux-en Y gastric bypass

429
Q

What is the reservoir size of a simple adult face mask?

A

100-250 cc

430
Q

Which of the following statements reflects a correct understanding of the use of a combitube? (select two)

A

The proximal pharyngeal cuff is filled with 100 cc of air

It is not available in pediatric sizes

431
Q

How many sizes for the combitube?

A

It is not available in pediatric sizes

432
Q

Combitude lumen

A

It consists of two lumens and 2 cuffs. The proximal pharyngeal cuff is filled with 100 cc of air, but the distal cuff only contains 15 cc of air. It is available in two adult sizes.

433
Q

Proximal pharyngeal cuff of Combitube filled with

A

The proximal pharyngeal cuff is filled with 100 cc of air, but the distal cuff only contains 15 cc of air. It is available in two adult sizes.

434
Q

Nitrous oxide will diffuse into an endotracheal cuff more quickly if

A

A high pressure endotracheal cuff is used

435
Q

What device is a one-way valve for tracheostomy tubes that enables the patient to speak during exhalation?

A

Passy-Muir valve

436
Q

What device is used as a ventilation-exchange bougie that allows fiberoptic intubation through an LMA or other supraglottic airway?

A

Aintree exchange catheter

437
Q

The Aintree intubation catheter was developed by The

A

Cook to be used as a ventilation-exchange bougie that allows fiberoptic intubation through an LMA or other supraglottic airway.

438
Q

The Glidescope and Airtraq laryngoscope are

A

video laryngoscopes.

439
Q

LAs that areare all 95 percent protein-bound.

A

RBL Ropivacaine, bupivacaine, and levobupivacaine

440
Q

Lidocaine is approximately ___protein bound, mepivacine is about LMRBL

A

55-65 percent protein-bound in the adult. Mepivacaine is 75-80 percent protein-bound.

441
Q

Protein binding of LAs from LEAST to MOST

A
LiMRBLe
Lidocaine
Mepivacaine
Ropivacaine
Bupivacaine
Levobupivacaine.
442
Q

The half life of rocuronium is..

A

0.7 hours

443
Q

The half life of Vecuronium is

A

0.9 hours.

444
Q

The half life of Pancuronium is

A

1.7 hours

445
Q

A minor medical error is discovered during the course of an anesthetic. The error does not pose any present or future threat to the patient. The CRNA

A

is not required to disclose the error to the patient

446
Q

Which patient safety initiative seeks to lessen the incidence of surgical errors through techniques such as time outs and marking the surgical site

A

The Joint Commission Universal Protocol

447
Q

Compared to a standard Bain circuit, the longer Bain modification exhibits.

A

increased static compliance, PEEP, and resistance to spontaneous respiration

448
Q

The longer BAIN , If the ventilator settings are kept the same,

A

the peak inspiratory pressure and tidal volume are decreased.

449
Q

Which of the following actions would help prolong the life of an electrochemical oxygen analyzer sensor?

A

Removing the sensor from the breathing system when not being used

450
Q

What are the factors that are associated with the likelihood of a difficult mask ventilation?

A
History of snoring
Limited ability to protrude the jaw
Sleep apnea
 Elevated body mass index
 age greater than 57 years
451
Q

Endotracheal tubes made from which of the following materials typically have a high-pressure endotracheal cuff?

A

Red rubber

452
Q

Red rubber endotracheal tubes are

A

opaque endotracheal tubes that can be cleaned and sterilized for reuse.

453
Q

Red rubber ETT tubes are more prone to

A

kinking, occlusion by secretions, have high-pressure cuffs, and can be a trigger for patients with latex allergy.

454
Q

Polyvinyl chloride endotracheal tubes are

A

transparent, soften when warmed, and are less prone to kinking than red rubber tubes.

455
Q

Polyurethane tubes are a more

A

recent adaptation.

456
Q

Studies show that endotracheal tubes with a POLYURETHANE CUFF

A

polyurethane cuff have a decreased association with early postoperative pneumonia.

457
Q

What is the first step you should take if you notice hypoventilation in a mechanically-ventilated patient?

A

Switch to manual ventilation

458
Q

Which of the following represents the ideal position for the respirometer?

A

On the CO2 absorber

459
Q

A Wright respirometer is located in the I

A

expiratory limb and contains vanes that cause it to rotate when exhaled gas passes across it.

460
Q

If the respirometer is positioned close to the patient, then a

A

proximal circuit disconnection may go unnoticed because it would still register tidal volume. This is unlikely to happen if the respirometer is positioned on the CO2 absorber.

461
Q

Which of the following values are necessary to calculate pulmonary static compliance?

A

Positive end-expiratory pressure
Tidal volume
Plateau pressure

462
Q

Static compliance represents

A

lung compliance during a period of zero gas flow, such as during an inspiratory hold.

463
Q

Static compliance =

A

Tidal Volume/(Plateau Pressure - PEEP)

464
Q

A medical ultrasound machine functions between the frequencies of ____MHz.

A

2-13

465
Q

An ultrasound can identify structures as small as_____ in diameter, but doesn’t have the resolution to accurately identify smaller structures.

A

1 mm

466
Q

Tissue that reflects ultrasound waves poorly appears

A

gray to black on the monitor.

467
Q

A high-frequency ultrasound is best for viewing

A

superficial structures.

468
Q

You administer midazolam rapidly via the IV route to a pediatric patient. The patient begins to exhibit seizure-like activity. What is the most likely cause of this?

A

Myoclonic reaction. Rapid IV or nasal administration of midazolam can produce myoclonus that may have the appearance of seizure-like activity.

469
Q
Compared to adult patients, you would expect a term neonate to exhibit (select four)
Responsiveness to dopamine
Muscle mass
Body water
Body fat
A

Decrease responsiveness to dopamine
Decreased muscle mass
a higher proportion of body water
a decreased proportion of body fat

470
Q

Kids, As a result, the volume of distribution for water-soluble drugs is

A

greater.

471
Q

Because their VD is greater, kids often require a higher loading dose of water-soluble drugs such as

A

digoxin, succinylcholine, and some antibiotics

472
Q

You administer an intramuscular dose of midazolam to a pediatric patient without an IV who cannot cooperate to take PO midazolam. What is the minimum amount of time should you wait before considering a supplemental dose

A

20 minutes

473
Q

The onset time of IM midazolam is ______and the time to peak effect is______

A

3-5 minutes. 10-20 minutes.

474
Q

The volume of distribution and the total body clearance are bothB

A

significantly greater in pediatric patients, which accounts for the faster recovery in children.

475
Q

Premedication with_____ has been shown to reduce the incidence of emergence delirium in pediatric patients.

A

ketamine

476
Q

Increases placental arterial pressure the most, followed by e have

A

Ephedrine; phenylephrine.

477
Q

VASOPRESSORS with no effect on placental arterial pressure when administered to the mother.

A

Epinephrine, norepinephrine, and methoxamin

478
Q

Decreases placental and fetal arterial pressure.

A

Enalaprilat

479
Q

Which of the following agents does not produce fetal vasodilation?

A

CLONIDINE

480
Q

What is the most reliable test for detecting an inadvertent intrathecal or intravascular epidural catheter placement in a laboring parturient?

A

Negative aspiration for CSF or blood

481
Q

The closing volume is ______in the elderly patient.

A

increased

482
Q

Functional residual capacity also_____with age due to an in_____ residual volume.

A

increases ; increase

483
Q

The total lung capacity is_____in elderly

A

decreases slightly or is unchanged.

484
Q

In elderly The loss of elastic recoil around the alveoli results in a

A

decrease in the forced vital capacity and FEV1.

485
Q

FEV1 in elderly

A

Decreased

486
Q

FVC in elderly

A

Decreased

487
Q

For which of the following situations would a rigid bronchoscopy be preferred? 5

A

The patient is a small child
Massive hemoptysis is present
The patient has a foreign body in the airway
An endobronchial resection is anticipated
vascular tumors,

488
Q

Flexible fiberoptic bronchoscopes are preferred when a patient has

A

pneumonia and selective cultures need to be obtained, for the positioning of double-lumen tubes, if the patient has limited mobility of the neck, for the use of difficult intubations, if bronchial blockade is needed, if endotracheal tube position needs to be checked, if the patient has peripheral and upper lobe lesions, or if the amount of hemoptysis is limited

489
Q

Positioning of double-lumen tubes: Flexible vs rigid

A

Flexible

490
Q

Use for difficult intubation: Flexible vs rigid

A

Flexible

491
Q

A patient is presenting for surgical treatment of a perianal fistula. The most common cause of perianal fistulae is

A

Infection within the rectal wall at the dentate line is the most common cause of perianal fistulae.

492
Q

In what patient population should premedication be avoided prior to a tonsillectomy?

A

Patient with OSA

493
Q

What nerve is at risk for damage during ablative electrophysiological procedures?

A

Phrenic (The phrenic nerve is in close proximity to the right upper pulmonary veins and is at risk for damage during ablation)

494
Q

Portal triad clamping is effective in reducing blood loss during a hepatic resection. What structures would be occluded during this procedure? (select three)

A

hepatic artery
portal vein
common bile duct

495
Q

The portal triad is actual a misnomer as it contains five structures:

A

a hepatic artery, hepatic portal vein, common bile duct, lymphatic vessels, and a branch of the vagus nerve.

496
Q

Which of the following has been shown to reduce blood loss during a hepatic resection?

A

Slight Trendelenburg position can help reduce intraoperative blood loss by decreasing intrahepatic venous pressure as well as decreasing the risk of air embolism though severed hepatic veins. Vasopressors will constrict splanchnic vessels and reduce splanchnic pressure.

497
Q

Which of the following is an advantage of the Sanders injection system of oxygenation during rigid bronchoscopy?

A

It allows continuous ventilation

498
Q

When the balloon of a pulmonary artery catheter is inflated, what pressure can be obtained indirectly during ventricular systole? During diastole?

A

left atrial filling pressure; ventricular filling pressure

499
Q

During ventricular systole, the left atrial filling pressure is reflected. During ventricular diastole, the

A

left ventricular filling pressure is measured. When the balloon is inflated, it is referred to as wedged.

500
Q

Which needle has a curved tip that helps guide the direction of an epidural catheter?

A

Tuohy

501
Q

Femoral nerve roots are

A

The L2-L4 nerve roots contribute fibers to the femoral nerve.

502
Q

It is not necessary to cross-match prior to administration

A

FFPs

503
Q

Fresh frozen plasma (FFP) is evaluated for

A

atypical antibodies and should be the same type as the patient.

504
Q

For which application would a particulate steroid be INAPPROPRIATE

A

. Cervical epidural steroid injection

505
Q

A properly performed popliteal block will anesthetize which of the following nerves? (select four) CDTS

A

common peroneal nerve
tibial nerve
deep peroneal nerve
sural nerve

506
Q

A nerve block in the popliteal fossa will anesthetize both

A

he common peroneal and tibial branches of the sciatic nerve which terminate as the superficial peroneal, deep peroneal, sural, and posterior tibial nerves.

507
Q

Common causes of hypercalcemia

A

Prolonged immobilization
Sarcoidosis
Hyperthyroidism
Vitamin D intoxification

508
Q

The normal specific gravity of CSF is

A

1.004 to 1.009.

509
Q

All result in a decreased ETCO2.

Temperature, thyroid, ventilation, perfusion, and lung disorder

A

Hypothermia, hypothyroidism, hyperventilation, hypoperfusion, and pulmonary embolism

510
Q

What is a leading cause of mortality in patients who have suffered a ruptured cerebral aneurysm?

A

cerebral vasospasm

511
Q

The incidence of cerebral vasospasm after ruptured cerebral aneurysm?

A

peaks between the 3rd and 14th day following the rupture.

512
Q

A patient presents for a total laryngectomy. Which of the following represents an accurate understanding of this procedure?

A

The most common indication for this procedure is malignancy

513
Q

Because the trachea is anastomosed directly to the skin surface, a tracheostomy tube or ETT is not necessary unless the patient has

A

severe stomal edema or will require postoperative mechanical ventilation, which is typically not the case.

514
Q

Necessary for a partial laryngectomy.

A

A tracheostomy or endotracheal tube

515
Q

The thyroid gland may be preserved during a

A

total laryngectomy.

516
Q

Laryngectomy, Muscle relaxation may be preferred at the

A

beginning of the case, but nerve monitoring may be used during the neck dissection phase which would preclude its use.

517
Q

Is the most common cause for total laryngectomy.

A

Malignancy of the head and neck

518
Q

You are performing anesthesia for a total laryngectomy. The surgeon intends to perform a tracheostomy using a wire-reinforced endotracheal tube at the beginning of the procedure. What is the most likely complication during this part of the procedure?

A

Endobronchial intubation

519
Q

A patient with hepatorenal syndrome and severe ascites is about to undergo a large-volume paracentesis (approximately 5 liters). What action is recommended to prevent the renal decompensation as a result of the removal of such a large volume of abdominal fluid?

A

Administer 30-40 grams of albumin

520
Q

Albumin______ per liter of ascites removed should be administered to help prevent renal decompensation when performing large-volume paracentesis in a patient with hepatorenal syndrome.

A

6-8 grams

521
Q

You are performing the anesthetic for a patient undergoing a liver transplant. Because of the risk for coagulopathy and resultant bleeding, you should

A

Administer cryoprecipitate to maintain a fibrinogen level greater than 150 mg/dL

522
Q

Platelet transfusion is typically instituted to maintain platelet levels higherg/dL

A

than 50,000/mm3 (although some studies now indicate that platelet infusion may be detrimental to the liver graft), and cryoprecipitate is administered to maintain a fibrinogen level > 150 m

523
Q

Cardiac myocytes possess low resistance communication channels between one another called

A

intercalated discs that allow for the quick and even spread of electrochemical signals.

524
Q

House the pituitary gland____in what bone?

A

Sella turcica; Sphenoid bone

525
Q

Theoretically, if a hyperbaric spinal anesthetic is injected at the L3 interspace and then the patient is positioned supine, how will the drug spread through the subarachnoid space?

A

It would move both in the cephalad and caudal directions

526
Q

If a patient has a true allergic reaction to a spinal anesthetic, how is it most likely to present

A

pruritus and erythema

527
Q

Where are T-helper lymphocytes predominantly located?

A

the lymph nodes

528
Q

Ankylosing Spondylitis associated with this antigne

A

histocompatibility antigen HLA-B27, the presence of which is detected in more than 90% of Caucasians with the disease

529
Q

Because insertion of a DLT is more complicated, bronchial blockers are more useful in patients with a

A

difficult airway or a tracheostomy.

530
Q

Patient needing tracheostomy are

A

patients who suffered a complete CSI above C-5 should undergo an elective tracheostomy.

531
Q

During Tracheostomy

• Do not use

A

electrosurgery to cut into the trachea.

532
Q

After insertion of the tracheostomy

A

A reassessment of the ventilation should be performed, including the entire procedure of listening to bilateral breath sounds, observing chest excursion, and checking end-tidal CO2 and positive inspiratorypressure, or negative inspiratory pressure. After the anesthesia provider has validated tube placement, the ETT is sutured to the chest wall for the entire surgical duration. At the end of surgery, the reinforced tube
may be switched for a tracheostomy cannula.

533
Q

May be prevented by early tracheostomy

A

Supraglottic complications induced by long-term intubation

534
Q

the anesthetist should consider avoiding surgical cricothyrotomy in favor of needle cricothyrotomy
and PTJV in infants and small children younger than

A

12 years of age. The child’s larynx is small, pliable, and movable, which can make cricothyrotomy very difficult in this population

535
Q

Tracheostomy better for

A

Carotid artery stenting

536
Q

Anterograde amnesia is

A

(i.e., loss of memory for a period after administration of the drug)

537
Q

What kind of amnesia is loss of memory for events before administration of the drug

A

Retrograde

538
Q

Platelets Typical dosing for an adult is a pool of _________ , or ________. This is expected to raise the platelet count by

A

six whole blood derived (sometimes referred to as random donor) platelets, or one apheresis platelet concentrate. This is expected to raise the platelet count by 30,000 to 60,000/uL in a 70 kg patient

539
Q

Clinical Benefits of Leukoreduction

A

Reduced risk of HLA alloimmunization and platelet refraction

540
Q

Reduce NHFTRs, nonhemolytic febrile transfusion

reactions;

A

Leukoreduction

541
Q

______system generates the first-line of defense

and the

A

The innate system

542
Q

Risk of HIV with blood transfusion

A

1: 1,500,000–1 : 2,000,000

543
Q

Likewise, the concomitant use of SNRIs with SSRIs or triptans is not recommended because this may precipitate

A

a serotonin syndrome

544
Q

2 SNRIs

A

SNRIs (duloxetine, venlafaxine)

545
Q

Two theories have been proposed to describe TRALI syndrome. First one is –> The second theory explains TRALI syndrome as a

A
  1. antibodies in donor plasma activate recipient neutrophils, leading to pulmonary capillary leakage.
  2. Two-event model in which a physiologic stressor such as sepsis, leads to sequestration of neutrophils in the lungs. The transfusion of biologically active mediators (the second event) leads to activation of the neutrophils and capillary leakage.
546
Q

Metabolism of methadone is primarily via the

A

CYP450 enzyme, specifically CYP3A4 and CYP2B6, into inactive metabolites that are excreted in the urine

547
Q

____ are probably the most commonly used adjunct analgesics in the management of both neuropathic and
somatic chronic pain.

A

TCA

548
Q

TCAs side effects

A

The TCAs commonly cause anticholinergic effects (urinary retention, constipation, dry mouth, blurred vision, and confusion), orthostatic hypotension, weight gain, sedation, and sexual dysfunction.

549
Q

What is the most common spinal deformity?

A

Scoliosis

550
Q

Should be considered to treat inflammatory pain or neuropathic pain

A

Nonopioid analgesics

551
Q

Pain caused by post-herpetic neuralgia may be treated with neuropathic pain medications including

A

anticonvulsants (gabapentin, pregabalin), antidepressants (TCAs), topical agents (lidocaine), capsacin and opioids.

552
Q

HERPES ZOSTER pain treat with

A

Amitriptyline (TCA)

553
Q

Defined as facial pain in the affected nerve distribution that remains 3 months after skin vesicles resolve. POST HERPETIC NEURALGIA

A

Dorsal root ganglion necrosis,

554
Q

CONTROL of PAIN after abdominal surgery best with

A

GABAPENTIN

555
Q

CONTROL of PAIN after BREAST surgery best with

A

EPIDURAL

556
Q

CONTROL OF PAIN for NERVE PAIN best with

A

VENLAFAXINE

557
Q

HPV: 2 gases have also been shown to only slightly affect arterial oxygenation in patients placed in a lateral position while undergoing esophagogastrectomy

A

Desflurane and sevoflurane delivered at 1 MAC

without N2O

558
Q

Which gas has the GREATEST EFFECT ON HPV?

A

Isoflurane

559
Q

HPV helps to match

A

Regional ventilation and perfusion

560
Q

HPV will cause which action in the lungs?

A

DECREASE BLOOD FLOW to NON-VENTILATED LUNG>

561
Q

This effect explains why deoxygenated blood carry more CO2

A

Haldane

562
Q

Average weight of a 6-year old

A

9 + (age x2)

563
Q

HF resulting from obesity is caused by

A

LV Systolic dysfunction

564
Q

Resting cerebral O2 consumption

A

3.5ml/100g/min

565
Q

Protamine dosing is

A

1mg per 100 units of heparin

566
Q

For which heart rhythm is cardioversion not indicated?

A

Pulseless Vtach

567
Q

Peribulbar block , patient become agitate and complains of pain you suspect

A

Globe punctures

568
Q

Lowest recommended PaCo2 if hyperventilation is used during intracranial tumor resection?

A

30 mmhg

569
Q

Absolute contraindications for ECT

A

MI < 6 weeks
Pheochromocytoma
CVA< 3monhts

570
Q

Valvular disorder with the largest LV volume?

A

Aortic Regurgitation

571
Q

What patient do the anesthetist most want to maintain spontaneous ventilation while undergoing GA

A

Severe AS

572
Q

The mediastinoscope can compress the ______and you have concern about decrease blood flow to the

A

innominate artery ; Right coronary artery

573
Q

Where to place BP and Radial artery during mediastinoscope

A

left arm BP

A-line R hand.

574
Q

When dosing mediations for obese patients, what is the best weight parameters to use

A

Lean body weight.

575
Q

Pyloric stenosis metabolic disturbance

A

HypoKALEMIC HYPOCHLOREMIC META ALKALOSIS

576
Q

Valve disorder that predisposes to Coronary ischemia with hypotension

A

AS

577
Q

Pyloric stenosis metabolic disturbance

A

HypoKALEMIC HYPOCHLOREMIC META ALKALOSIS

578
Q

OMPHALOCELE is less or more common

A

More common

579
Q

Most common type of TEF

A

Type IIIb, Esophageal atresia with a fistula. between the distal esophagus and trachea

580
Q

Is omphalocele midline

A

nO

581
Q

OMPHALOCELE covered?

A

Yes covered with peritoneum.

582
Q

Omphalocele defects lies

A

within the umbilical cord

583
Q

HTN during aortic cross-clamping, the more proximar

A

The more increase the pressure

584
Q

Which induction agent produces effects desirable in patients with Tetralogy of Fallot>

A

Ketamine

585
Q

After epidural test dose, patient complains of heavy legs, what is the cause?

A

Unintentional intrathecal block

586
Q

The patient is receiving echothiophate eye drops for glaucoma, you plan to use succinylcholine. wha tshould you expect

A

PROLONGED DURATION because it decreases cholinesterase activity.

587
Q

Plt count to avoid neuraxial

A

Platelt 75K

588
Q

How does propofol affect uterine blood flow

A

NO CHANGE

589
Q

2 things that increases intraocular pressure

A

Hypoventilation

hypertension

590
Q

A patient is scheduled for ECT what is your main anesthetic concern when calculating dosages for inductions agents

A

SEIZURE QUALITY

591
Q

Cardioversion Electrical shock is synchronized with

A

R wave

592
Q

What emergency medication is essential for penile surgery?

A

Glycopyrrolate or atropine

593
Q

In which valvular disorder is the LV volume approximately normla, but LV pressure is higher than normal

A

Aortic stenosis

594
Q

Which law explain postintubation airway edema

A

Poiseuille’s equation

595
Q

Relative contraindication to PAC placement

A

LBBB

596
Q

Which opioids causes the greatest respiratory depression in newborns?

A

MORPHINE

597
Q

Fetal scalp PHis

A

> 7.25 normal

598
Q

Fetal scalp pH associated with neonatal depression

A

<7.20

599
Q

AT highest risk of DI post what surgery

A

Transphenoidal Hypophysectomy

600
Q

Hypovolemia on SVO2

A

decrease the SvO2

601
Q

LARGE V WAVE on the CVP waveform

A

TRICUSPID REGURGITATION

602
Q

Other name for T4 is

A

Thyroxine

603
Q

The accumulation of frost on a nitrous oxide cannister that is in use is an example of

A

JOULE-THOMPSON effect

604
Q

Life threatening bronchospasm that is unresolved despite treatment is called

A

Status asthmaticus

605
Q

Cor pulmonale is

A

Right sided HF

606
Q

What is the main stay drug therapy for COPD

A

Bronchodilators

607
Q

What disease is seen with eosinophillic glaucoma? HISTOCYTOSIS X

A

PULMONARY FIBROSIS

608
Q

Acoustic neuromas are typically associated with

A

BENIGN TUMORS called SCHWANNOMAS

609
Q

What is a chiari?

A

Congenital displacement of the cerebellum

610
Q

Idiophathic facial paralysis is known as

A

Bell’s palsy

611
Q

Good pasture’s syndrome manifestas as

A

Worsening Glomerulonephritis

lung hemorrhage

612
Q

Transient blindness during TURP syndrome is the result of what neurotransmitter ?

A

GLYCINE

613
Q

Where is the majority of the total body calcium?

A

Stored in bone

614
Q

How many lobes are in the thyroid gland?

A

2

615
Q

HAART Is the drug treatment employed with what condition?

A

HIV

616
Q

Syndrome X is also knowns as

A

Metabolic syndrome

617
Q

Type II chiari is associated with

A

Cerebellar vermis and brainstem herniate into the cervical spinal canal.

618
Q

It is a Dopamine agonist drug

A

Bromocriptine

619
Q

Water soluble vitamin

A

C

620
Q

Vitamin B12 also known as

A

Cobalamin

621
Q

What is the most common cause of acute liver failure worldwide?

A

Hepatitis A

622
Q

Condition results from an enzyme deficiency required for HEME synthesis

A

PORPHYRIA

623
Q

Exaggerated anterior FLEXION of the spine is known as

A

KYPHOSIS

624
Q

Normal magnesium

A

1.2-1.8

625
Q

What catalyzes the conversion of fibrinogen to fibrin?

A

Thrombin

626
Q

Alveolar pressure =

A

intrapleural pressure + alveolar elastic recoil pressure.

627
Q

The slope between 2 points on a pressure-volume curve represents

A

COMPLIANCE

628
Q

The primary component of surfactant is

A

DIPALMITOL PHOSPHATIDYLCHOLINE

629
Q

The muscularis mucosae is found in the

A

GUT WALL.

630
Q

Hormone released from the duodenum?

A

Secretin

631
Q

Glucose + Fructose =

A

Sucrose

632
Q

2 skeletal muscles in the inner ear are the

A

tensor tympani AND STAPEDIUS

633
Q

Preload a.k.a

A

End diastolic ventricular pressure

634
Q

The portion of the lung supplied by a PRIMARY RESPIRATORY BRONCHIOLE IS CALLED

A

AN ACINUS

635
Q

The effect of pH on the ability of Hgb to bind with oxygen is known as the ___effect

A

bohr effect

636
Q

% of resting CO goes to the kidneys

A

20%

637
Q

The calcium stored in bone is in the form of

A

HYDROXYAPATITE

638
Q

Phagocytic cells in the liver responsible for removing particulates from blood are

A

Kuffer cells

639
Q

Fluid drains from the Bowman’s capsules directly into the

A

PROXIMAL TUBULE

640
Q

Class of compound of NE

A

Monoamine

641
Q

Endothelium-derived relaxing factors

A

Nitrous oxide

642
Q

Methohexital avoided in patients with a hx of

A

EPILEPSY (or seizures)

643
Q

What drug is an example of a BUTYPHENONE ANTIPSYCHOTIC?

A

Haloperidol

644
Q

The parasympathetics nervous system does not include fibers from

A

CN 8

645
Q

Normodyne is another name for

A

Labetalol.

646
Q

Which drugs can decrease MAC

A

Ketamine

647
Q

Opioids with the highest degree of plasma protein binding?

A

Sufentanil

648
Q

Prolonged in the hypothermic patient.

A

Anesthetic emergence is

649
Q

Describes the transfer rate of gas through a tissue medium.

A

Fick’s law of diffusion

650
Q

Fick’s law of diffusion : RATE OF TRANSFER directly proportional to (PDM)

A

partial pressure difference (driving force)
Diffusion coefficient (solubility)
Membrane surface area

651
Q

Fick’s law of diffusion : RATE OF TRANSFER INVERSELY proportional to

A

Membrane thickness

Molecular weight

652
Q

Diffusion hypoxia what law

A

Fick’s law of diffusion

653
Q

A patient with COPD has a reduced alveolar surface area, and therefore has

A

a slower rate of inhalation induction

654
Q

Calculation of cardiac output follow which law

A

Fick’s law of diffusion

655
Q

Drug transfer across the placenta follow which law

A

Fick’s law of diffusion

656
Q

Diaphragm contraction increases tidal volume follow which law

A

Boyles

657
Q

Squeezing an Ambu bag follows which law

A

Boyle’s

658
Q

Pneumatic bellows follows which law

A

Boyles

659
Q

Using the bourdon pressure gauge to calculate how much O2 is left in a cylinder (assumes a given flow rate) because of which law?

A

Boyles

660
Q

Ohm’s law says that the current passing through a

A

conductor is directly proportional to the voltage and inversely proportional to the resistance. We can adapt Ohm’s law to understand fluid flow.

661
Q

Omh’s Law Q=

A

Q = Change in P/ R

662
Q

Poiseuille’s law is a modification of Ohm’s law that incorporate.

A

s vessel diameter, viscosity, and tube length

663
Q

There are 3 types of flow:

Re 2,000 - 4,000: Transitional flow

A

laminar, turbulent, and transitional.

664
Q

Re < 2,000: Laminar flow is dependent on(LG)

A

gas viscosity (Poiseuille’s Law)

665
Q

Re > 4,000:___flow (TD)

A

Turbulent flow is dependent on gas density (Graham’s law)

666
Q

Re < 2,000: ___flow

A

Laminar flow i

667
Q

Reynold’s number is calculated

A
     Viscosity
668
Q

Explain how understanding Reynold’s number helps you treat status asthmaticus.

A

The patient with status asthmaticus suffers from an increased airway resistance, and this increases flow turbulence and the work of breathing. Because turbulent flow is primarily dependent on gas density, we can improve flow by having the patient inhale a lower density gas.
The key here is that we are converting turbulent flow to laminar flow. Helium does NOT improve flow if it is already laminar.

669
Q

An oxygen/helium mixture (Heliox) improves Reynold’s number by

A

reducing density.

670
Q

Key drug interactions that increase the risk of serotonin syndrome include:
SSRI and:

A

Meperidine
Fentanyl
Methylene blue

671
Q

Key drug interactions that increase the risk of serotonin syndrome include:
MAOI and:

A

Meperidine

Ephedrine

672
Q

Neuralgia is ___examples is____

A

pain localized to a dermatome.

Ex: Herpes zoster (shingles)

673
Q

BMI is calculated with

A

Weight (kg) / Height in (m2)

674
Q

Calculate ideal body weight for men and women

A

Men (kg) = Height (cm) - 100

Women (kg) = Height (cm) - 105

675
Q

The key changes that lead to the cardiovascular complications of obesity.

A

The expansion of intravascular blood volume and a high cardiac output state

676
Q

What are the key issues regarding re-entry to clinical practice following a substance abuse disorder?

A

One full year in recovery is recommended prior to returning to anesthesia practice.
Of the ten criteria that should be met prior to considering re-entry, the most salient point is participation in a monitoring program at least 5 years in length with random drug testing.

677
Q

A characteristic syndrome that is the direct result of stopping or reducing the use of a drug.

A

Withdrawal.

678
Q

More drug is needed to achieve a given effect (intoxication) – or – a lesser effect is produced by a given dose of a drug.

A

Tolerance

679
Q

The inability to safely participate in life (or professional) activities.

A

Impairement

680
Q

A need (psychological or compulsive) for a substance. There is often a loss of self-control, where the user continues using a drug despite the desire to stop drug use. This represents a severe stage of chronic substance abuse disorder.

A

Addiction

681
Q

The OSHA limit for an 8-hour span is

A

90 dB, and single noise levels should not exceed 115 dB.

682
Q

What are the physiologic effects of MRI exposure?

A

Lower frequency electromagnetic fields from MRI can cause transient symptoms of nausea, dizziness, vertigo, or light flashes. There are no published regulations limiting occupational exposure to MRI fields.

683
Q

What is the OSHA limit for occupational exposure to ionizing radiation?

A
Annual = 5 rem
Lifetime = (N-18) x 5 rem

N= age in years

684
Q

Research has also shown that 24-hours of wakefulness is equivalent to a blood alcohol content of%).

A

0.1% (legal impairment for driving is blood alcohol content is 0.08

685
Q

Families should be informed that, despite all reasonable efforts to eliminate the need for transfusion, if an emergency occurs,

A

a court order for transfusion will be sought.

686
Q

Emancipated minors are

A

patients younger than 18 years of age who are legally given the rights of an adult by a state court.

687
Q

Although variable by state law, criteria for emancipating a minor may include the fact that they are:

A

Married
A parent, or is currently pregnant
In the military
Economically independent

688
Q

What is a schedule II drug? List some examples.

A

Opioid agonists (fentanyl, morphine, hydromorphone, etc.)
Cocaine
Methamphetamine
Phencyclidine

689
Q

This act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination when a request is made for examination or treatment for an emergency medical condition (EMC) regardless of an individual’s ability to pay.

A

Emergency in Medical Treatment and Active Labor Act?

690
Q

What is vicarious liability? What’s another name for this concept?

A
Tne person (or entity) may be liable for the actions of another person. For instance, a physician might be held liable for the actions of a PA. This concept typically does not apply to CRNAs working under a physician.
Respondeat superior is often used interchangeably with vicarious liability.
691
Q

What is the difference between assault and battery?

A

Assault is the attempt to touch another person.

Battery is touching a person without either expressed or implied consent.

692
Q

What is the difference between assault and battery?

A

Assault is the attempt to touch another person.

Battery is touching a person without either expressed or implied consent.

693
Q

What is the difference between libel and slander?

A

Libel is defamation in the written form.

Slander is defamation in the verbal form.

694
Q

Res ipsa loquitur can shift the burden of proof from the plaintiff to the defendant. This can occur if 4 conditions can be established:

A

(“the thing speaks for itself”)

1) If the injury would not have occurred in the absence of negligence.
2) The injury was caused by something under the complete control of the defendant (provider).
3) The patient did not contribute in any way to the injury.
4) The evidence for the explanation of events is solely under the control of the provider

695
Q

List the 4 things that must be proven in a law suit asserting malpractice.

A

Duty
Breach of duty
Causation
Damages

696
Q

Principle that providers should take action for the benefit of others

A

Beneficence

697
Q

asserts that a provider has an obligation not to inflict hurt or harm—in other words, the Hippocratic oath primum non nocere (first do no harm)

A

Nonmaleficence

698
Q

refers to the patient’s ability to choose without controlling interference by others, and without limitations that prevent meaningful choices.

A

Autonomy

699
Q

are authoritative statements that describe minimum rules and responsibilities for which anesthetists are held accountable.

A

Practice standards

700
Q

systematically developed statements to assist providers in clinical decision making that are commonly accepted within the anesthesia community.

A

practice guidelines?

701
Q

dictates the principles of conduct and professional integrity that guide the decision making and behavior of nurse anesthetists. This document speaks to the anesthetist’s responsibilities as a professional, which holds the individual CRNA accountable for his or her own actions and judgments, regardless of institutional policy or physician orders.

A

AANA Code Of Ethics?

702
Q

What are your options if you lose the airway during induction in the patient with an anterior mediastinal mass?

A

repositioning the patient laterally or prone may restore patency to the airway. A ridged bronchoscope should be available. Emergent femoral-femoral cardiopulmonary bypass may be required if ventilation via the lungs becomes impossible.

703
Q

What is the best induction technique for a patient with an anterior mediastinal mass?

A

Spontaneous ventilation preserves the normal airway distending pressure gradient, but this gradient is often abolished during positive pressure ventilation. The sitting position and maintenance of spontaneous ventilation will minimize, but not always prevent, compression of the vital chest structures.

704
Q

List 3 factors that worsen tracheobronchial compression in the patient with an anterior mediastinal mass.

A

Supine position
Induction of general anesthesia
Positive pressure ventilation

705
Q

Which position provides the most optimal V/Q matching in the patient with ARDS?

A

The prone position provides optimal V/Q matching, which explains why we use the prone position for patients with ARDS.

706
Q

Midcervical tetraplegia is associated with

A

hyperflexion of the neck (chin to chest). Ischemia occurs as a result of stretching and/or compression of the midcervical spinal cord (usually C5).

707
Q

Although the sitting position is most commonly associated with venous air entrainment, this complication can occur in any position that produces a

A

pressure gradient between the atmosphere and the veins at the surgical site.

708
Q

Venous air embolism →

A

right heart → pulmonary vasculature → ↑ dead space & ↑ RV workload

709
Q

Paradoxical air embolism →

A

right heart → patient foramen ovale → left heart → systemic circulation → stroke

710
Q

Compartment syndrome is most common in the

A

lithotomy position.

711
Q

Reduced sensation over anteromedial aspect of the leg

A

Saphenous nerve injury

712
Q

Patient present with Foot drop, nerve injury

A

Common peroneal nerve injury

713
Q

Inability to evert the foot

A

Common peroneal nerve injury

714
Q

Inability to extend the toes dorsally

A

Common peroneal nerve injury

715
Q

Presentation:

Foot drop

A

Common peroneal OR SCIATIC

716
Q

Reduced sensation over the medial aspect of the thigh

A

Obturator nerve injury

717
Q

Inability to ADDuct the leg

A

Obturator nerve injury

718
Q

Excessive cycling of the NIBP cuff, what kind of injury

A

Ulnar nerve injury

719
Q

Upper extremity tourniquet what kind of injury

A

Ulnar nerve injury

720
Q

Sheets that are too tight (if the arms are tucked)

A

Ulnar nerve injury

721
Q

Presentation = Wrist drop

A

radial nerve injury.

722
Q

Unable to oppose the thumb (chronic injury can lead to the ape hand deformity).

A

Median nerve injury

723
Q

the most commonly injured peripheral nerve.

A

The ulnar nerve

724
Q

hich type of nerve injury provides a greater risk for long term injury (sensory or motor)?

A

Sensory deficits are more common, less serious, and tend to resolve on their own (usually 5 days or less).
Motor deficits are less common and more serious.

725
Q

Who is at risk for ulnar nerve injury?

A

Male gender (especially if > 50 years old)
Preexisting ulnar neuropathy
Extremes of body habitus (very thin or obese)
Prolonged hospital stay / bedrest

726
Q

most common signs of an anastomotic leak following gastric bypass?The most common signs and symptoms include

A

Tachycardia (72%)
Fever (63%)
Abdominal pain (54%)
Ketorolac probably increases the incidence of this complication, so it should be avoided in the perioperative period

727
Q

What is the definitive test for OSA.

A

Polysomnography

728
Q

The results of this test Polysomnography allow for the calculation of the

A

apnea-hypopnea index (AHI), which is used to quantify the severity of OSA.

729
Q

The American Academy of Sleep Medicine defines OSA as:
Mild =
Moderate =
Severe =

A

5 – 15 episodes/hr
15 – 30 episodes/hr
> 30 episodes/hr

730
Q

Apnea-hypopnea index (AHI) is calculated by

A

Number of episodes of apnea or hypopnea/ hours of sleep

731
Q

Patients with severe sleep apnea are at higher risk of

A

difficult mask ventilation and difficult intubation.

732
Q

is a bedside tool that allows you to predict the likelihood that a patient has undiagnosed OS

A

The STOP-BANG scoring system

733
Q

STOP BANG for OSA results

A

High risk = > 3 questions answered yes

Low risk = < 3 questions answered yes

734
Q

Ma huang is a natural

A

source of ephedrine, an indirect acting adrenergic agonist and thermogenic agent.

735
Q

Ma huang Any drug interactions that would occur with ephedrine will apply here as well. Complications of

A

adrenergic overstimulation, including hypertension, CVAs, seizures, and death, have occurred with the use Ma huang containing drugs.

736
Q

Orilistat is a ? what must be supplemented?

A

lipase inhibitor that reversibly binds to lipase and hinders the absorption and digestion of consumed fats. Since fat and the vitamins it contains (D, A, K, E) are not absorbed by the gut, they must be supplemented orally. Insufficient quantities of vitamin K will impair synthesis of clotting factors 2, 7, 9, and 10 and may cause a coagulopathy.

737
Q

Insufficient quantities of vitamin K will impair synthesis of clotting factors ,,,

A

s 2, 7, 9, and 10 and may cause a coagulopathy.

738
Q

During the preoperative interview, ask the patient to do what when assessing for thoracic outlet syndrome?

A

clasp her hands behind her head. If she complains of pain, this may suggest an increased risk of thoracic outlet syndrome. It may be prudent to tuck the arms while in the prone position.

739
Q

Cubital tunnel

A

Medial epicondyle of the humerus
Olecranon process of the ulna
Cubital tunnel retinaculum (creates the roof of the cubital tunnel)

740
Q

How does obesity affect the dosing of an epidural?

A

Engorgement of the epidural veins and an increased epidural fat content will cause a greater spread of local anesthetic in the epidural space. For this reason, the dose should be reduced to 75% of the normal dose.

741
Q

How does obesity affect the dosing of opioids?

A

Because of their fat solubility and large Vd, the initial doses of fentanyl and sufentanil are based according to TBW. Maintenance dosing is based on LBW. An increased Vd correlates with a prolonged elimination half-life.

742
Q

How does obesity affect the dosing of opioids?

A

Because of their fat solubility and large Vd, the initial doses of fentanyl and sufentanil are based according to TBW. Maintenance dosing is based on LBW. An increased Vd correlates with a prolonged elimination half-life .Remifentanil is the exception. Since it is rapidly cleared by plasma esterases, it does not behave like a high Vd drug, so remifentanil is always based on LBW.

743
Q

How does obesity affect the dosing of nondepolarizing neuromuscular blockers?

A

Roc/Vec
Induction: LBW
Maintenance: LBW

Cis/Atracurium
Induction: TBW
Maintenance: TBW or LBW

744
Q

How does obesity affect the dosing of succinylcholine?

A

Even though succinylcholine is a water soluble drug, the dose for intubation is calculated with TBW/ This is a clear exception to the rule for water soluble drugs. Shortly stated, the combination of an increased blood volume (increased Vd) and increased pseudocholinesterase activity (increased clearance) necessitates a TBW dose be given to ensure adequate paralysis.

745
Q

How does obesity affect the dosing of propofol?

A

The loading dose of propofol is based on lean body weight. This is because its offset is caused by redistribution and not clearance (which would depend on Vd).
Induction: LBW
Maintenance: TBW

746
Q

How does obesity impact your selection of inhaled anesthetic agents?

A

Sevoflurane or desflurane provide a faster emergence than isoflurane or propofol.
Nitrous oxide is generally avoided, because it restricts the maximum FiO2 that can be delivered.

747
Q

What valvular defect is highly suggestive of pulmonary hypertension in the obese patient?

A

The presence of tricuspid regurgitation on TEE may be the most useful confirmation of pulmonary hypertension.

748
Q

Metabolic syndrome diagnosis: one must have at least

A

3 of the following signs:
Large waist circumference (men > 40 inches & women > 35 inches)
Triglycerides > 150 mg/dL
High density lipoprotein (HDL) < 40 mg/dL for men and < 50 mg/dL for women
Blood pressure > 130/85
Fasting glucose > 100 mg/dL

749
Q

Metabolic syndrome (syndrome X) incorporatesIn order to be diagnosed with metabolic syndrome,

A

a number of disease states that coincide with obesity.

750
Q

Cardiovascular risk in patients with metabolic syndrome is

A

50-60% greater than the general population.

751
Q

Android Obesity ; more common in

A

Apple Shape): men

752
Q

Gynecoid Obesity

A

(Pear Shape): women

753
Q

Characterized by central or abdominal visceral fat accumulation.

A

Android obesity

754
Q

The modified Aldrete scoring system is used to

A

assess readiness for PACU discharge. A score of 0 – 2 is awarded in 5 areas, where a score of 9 or more is generally accepted as discharge ready.

755
Q

Chronic ingestion of which herbal medication can mimic Conn’s syndrome?

A

Licorice

756
Q

List 2 herbal supplements that reduce MAC.

A

Kava kava

Valerian

757
Q

List 4 herbal supplements that increase bleeding risk.

A

Garlic
Ginger
Gingko biloba
Saw palmetto

758
Q

Compare the equianalgesic dose of ketorolac and morphine.

A

Ketorolac 30 mg IV ~ morphine 10 mg IV

759
Q

Transplant rejection is a response to

A

Antigen, primarily HLA antigens on the donor organ

760
Q

Hyperacute Tranplant rejection

A

Hyperacute occurs immediately following transplant and is due to preexisting antibodies in the recipient from a prior graft or blood transfusion of platelet or leukocytes that contains HLA antigens.

761
Q

Avoid hyperacute tranplant rejection by

A

Preop screening for antigraft antibodies

762
Q

Acute transplant rejection is

A

Cell mediated immune response

763
Q

Hypersensitivity reaction Type I

A

Immediate Drugs allergy, hay fever and asthma

764
Q

Hypersensitivity reaction Type II

A

Cytotoxic (cell mediated)

765
Q

Examples of type II hypersensitivty

A

Blood transfusion

Erythroblastosis fetalis

766
Q

Acute transplant rejection is an example of

A

Cytotoxic hypersensitivity type II reaction

767
Q

SLE and RA are what type of Hypersensitivity reaction

A

Type III Immune complex

768
Q

Delayed Transplant rejections and poison ivy

A

Type IV Hypersensitivty reaction

769
Q

Type V hypersensitivity reactions

A

Grave’s disease

770
Q

Intraoperative anaphylaxis grade I

A

Cutaneous signs , generalized erythema, urticaria, angioedema

771
Q

Intraoperative anaphylaxis grade II

A

Cutaneous signs , with hypotenion, tachycardia, cough, difficult ventilation

772
Q

Intraoperative anaphylaxis grade III

A

Hypotension , tachycardia or bradycardia, arrhythmia bronchospasm

773
Q

Intraoperative anaphylaxis grade IV

A

Cardiac and/or resp arrest, PEA.

774
Q

Advanced trauma life support classification of Shock blood loss %

A

Class 1 < 15 %
Class 2 15-30%
Class 3 30-40%
Class 4 >40%

775
Q

Advanced trauma life support classification of Shock HR

A

Class 1 < 100
Class 2 >100
Class 3 >120
Class 4 > 140

776
Q

Advanced trauma life support classification of Shock SBP CLASS 1 and 2

A

Normal

777
Q

Advanced trauma life support classification of Shock SBP CLASS 3 and 4

A

Decreased

778
Q

At the trauma, RBCs are replaced to

A

provide oxygen-carrying capacity

779
Q

During trauma, Shed blood replaced with a ratio

A

1: 1 VOLUME OF PRBCS
3: 1 VOLUME OF CRYSTALLOIDS

780
Q

TRAUMA PRIMARY survery ABCDE

A
Airway
Breathing
Circulation
Disability 
Environment/Exposure
781
Q

Discuss the role of the cyclooxygenase enzyme in the arachidonic acid cascade.

A

COX-1 is always present.
It maintains normal physiologic function.
COX-2 is not always present.
It is expressed during inflammation.

782
Q

Inhibition of the COX-2 enzyme produces

A

analgesic, antiinflammatory, and antipyretic effects. Unlike opioids, there is a ceiling effect to analgesia.

783
Q

Inhibition of the COX-1 enzyme impairs

A

platelet function, causes gastric irritation, and reduces renal blood flow.

784
Q

Inhibition of the COX-1 enzyme impairs

A

platelet function, causes gastric irritation, and reduces renal blood flow.

785
Q

What type of reaction is contact dermatitis,

A

Type IV delayed

786
Q

What type of reaction is graft-vs-host reaction

A

Type IV delayed

787
Q

Snake venom reaction, protamine induced vasoconstriction: What type of rection :

A

Type III immune complx mediated

788
Q

ABO-incompatibility, what type of reaction

A

Type II

789
Q

heparin-induced thrombocytopenia What type of reaction

A

Type II

790
Q

Make up 60% of all WBCs (most abundant WBC type).

A

Neutrophils

791
Q

Defend against parasites.

A

Eosinophils

792
Q

B-lymphocytes:

A

Humoral immunity (produce antibodies).

793
Q

T-lymphocytes:

A

Cell mediated immunity (does not produce antibodies).

794
Q

Lymphocytes that does not produce antibodies?

A

T-lymphocytes.

795
Q

H1 receptor function

A

Vasodilation
Increased vascular permeability
SMOOTH MUSCLE CONTRACTION (not vascular)

796
Q

H2 receptor function?

A

Cardiac stimulaion

797
Q

H2 receptor function?

A

Cardiac stimulation

798
Q

Which H receptor is associated with gastric secretion

A

H2

799
Q

TAP block from superficial to deep

A

Subcutaneous tissue → External oblique muscle → Internal oblique muscle → Transverse abdominis muscle → Peritoneum

800
Q

BLOCK that provides analgesia for breast surgery, thoracotomy, and rib fracture.

A

The thoracic paravertebral block

801
Q

Celiac Plexus BlocK: useful what type of procedures? Which part does it not innervate?

A

It does NOT innervate the pelvic organs.

Therefore, it is useful for pain from the upper abdominal organs, but not the pelvic organs (useful in cancer patients).

802
Q

The celiac plexus innervates the _____EXCEPT:

A

upper abdominal viscera (except the left side of the colon).

803
Q

Superior Hypogastric Plexus Block innnervates the

A

pelvic organs.

804
Q

Blockade of the superior hypogastric plexus is useful in patients with pain involving the

A

pelvic organs (useful in cancer patients).

805
Q

Aside from an epidural blood patch, which regional technique is used to release post-dural puncture headache?

A

Sphenopalatine block

806
Q

If a patient reports an allergy to PCN, then s/he may receive a cephalosporin if the reaction:

A

Was NOT IgE mediated (anaphylaxis, bronchospasm, urticaria).

Did NOT produce exfoliative dermatitis (Stevens-Johnson syndrome

807
Q

The most common cause of occupational exposure to HIV is a

A

needle-stick injury with a hollow-bore needle.

808
Q

Seroconversion rates after exposure to HIV-infected blood

A
Percutaneous injury (needle-stick)  =  0.3%
Mucus membrane exposure  =  0.09%
809
Q

Pain due to a stimulus that does not normally produce pain. Ex:

A

Allodynia; Fibromyalgia

810
Q

Abnormal and unpleasant sense of touch.

Ex:

A

Dysesthesia ; Burning sensation from diabetic neuropathy

811
Q

Abnormal and unpleasant sense of touch.

Ex:

A

Dysesthesia ;

Burning sensation from diabetic neuropathy

812
Q

Pain localized to a dermatome.

Ex:

A
Neuralgia
Herpes zoster (shingles)
813
Q

There are 2 types of CRPS:

A
Type I  (reflex sympathetic dystrophy)
Type II  (causalgia)
814
Q

The key distinction is that type II CRPS is always preceded by

A

nerve injury (type I is not).

815
Q

Complex regional pain syndrome is characterized by

A

neuropathic pain with autonomic involvement.

816
Q

Caffeine-halothane contracture test is used to help diagnose

A

malignant hyperthermia

817
Q

Explain what is done during the caffeine-halothane contracture test

A

A muscle biopsy is obtained from the patient and tested. High-doses of caffeine release calcium from the sarcolemma. This effect is enhanced by halothane. When the muscle tissue in patients with malignant hyperthermia is exposed to these two agents it contracts abnormally, confirming a diagnosis of MH.

818
Q

Which muscles would a deep cervical plexus block affect? (select two)

A

The strap muscles of the neck

The prevertebral muscles

819
Q

Hyperalgesia, allodynia, autonomic abnormalities, and pain that occurs spontaneously without an apparent stimulus are features characteristic of

A

Complex regional pain syndrome

820
Q

According to the Critical Incident Stress Management model, what is the term for the intervention that occurs at the end of the day before involved healthcare workers leave for home that allows them to recount the event and express their concerns?

A

defusing

821
Q

is designed to assess the immediate reactions to the event and determine the next course of action. It is led by an authority figure, typically lasts about and should allow the.

A

Demobilization; 10-15 minutes, involved individuals about 20 minutes to relax before returning to work

822
Q

Defusing occurs at the end of the day, but before the involved individuals have left for work. It is an extension of the

A

demobilization phase, is led by an authority figure, and typically last about an hour.

823
Q

Originally designed for emergency service employees and has proven useful to healthcare workers as well. It involves a structured group discussion that occurs

A

Critical Incident Stress Debriefing; 1-3 days after the event

824
Q

The use of counseling or psychological support to an individual throughout the crisis spectrum to help return the individual to a normal level of functioning.

A

One-on-One Intervention

825
Q

It is designed to recount the details of the event, allow individuals to express their concerns, and offer support. . It should include the anesthesia staff involved in the event and is designed to assess for symptoms of acute distress and provide closure.

A

Critical Incident Stress Debriefing;

826
Q

How long should a patient refrain from smoking before the ability of the lungs to respond to pulmonary infection returns to normal?

A

8 weeks

827
Q

Improves significantly at about 8 weeks of smoking cessation.

A

Mucociliary and immune function i

828
Q

Airway management may be made even more difficult prior to that amount of time as there is an __________during the first month of smoking cessation.

A

increase in pulmonary secretions

829
Q

Aspirin inhibits the production of

Aspirin and other NSAIDs acetylate and inactivate platelet cyclooxygenase.

A

thromboxane A2.

830
Q

Aspirin inactivates______what about NSAIDS?

A

cyclooxygenase for the life of the platelet but other NSAIDs inactivate them reversibly, and the effect lasts only about 24 hours.

831
Q

Factor X deficiency is

A

Stuart-Prower deficiency

832
Q

. It also offers greater protection against aspiration. Because this results in an increased risk for tracheal ischemia, it is not suitable for long-term intubations.

A

It offers increased visibility during intubation

It offers better protection against aspiration

833
Q

offers increased visibility during intubation because the cuff lies flat against the tube when not inflated

A

low-volume, high pressure cuff

834
Q

Low volume High pressure cuff : assessing how much pressure is being applied to tracheal wall.

A

Because it requires a high intracuff pressure to overcome the decreased compliance of the cuff wall, it is difficult to assess how much pressure is being applied to the tracheal wall.

835
Q

Not suitable for long-term intubation?

A

Low volume high pressure cuff.

836
Q

What type of cuff provides better protection against aspiration?

A

Low volume high pressure cuff.

837
Q

Phenoxybenzamine administration can produce______ The recommended treatment is ______

A

tachyarrhythmias. beta-blockers

838
Q

Which of the following would be an Appropriate intervention for a patient with acute intermittent porphyria?

A

Administering D5NS while the patient is NPO

839
Q

Medications to avoid with acute intermittent porphyria ? Are beta blockers safe to use?

A

Both ketorolac and barbiturates should be avoided. Beta-blockers are safe for use in these patients.

840
Q

Fasting and acute porphyria?

A

Fasting has been identified as a precipitating factor for As such, prolonged NPO times should be avoided, and the administration of a glucose-saline solution during the NPO time should be considered

841
Q

The overall risk for a perioperative MI in the general population undergoing general anesthesia is

A

0.3%.

842
Q

In the face of chronic vasoconstriction, the juxtaglomerular apparatus does what?

A

releases renin. The end result of renin release is the conversion of angiotensin I to angiotensin II.

843
Q

What is the primary stimulus for the release of aldosterone by the adrenal cortex?

A

Angiotensin II is

844
Q

Aldosterone results in increased

A

sodium and water retention.

845
Q

What is the most common cause of heart failure?

A

CAD

846
Q

As many as 10% of patients with hepatitis B

A

chronic and up to 40% of patients with hepatitis C will develop chronic hepatitis.

847
Q

Hepatitis D can convert into a chronic form but only occurs in patients who

A

already have hepatitis B.

848
Q

Hepatitis B is associated with hepatits

A

D

849
Q

What are the major factors that determine the rate of elimination of amide local anesthetics? (select two)

A

Hepatic blood flow and Enzyme activity

850
Q

The speed at which Hofmann elimination acts to degrade atracurium depends primarily on (select two)

A

ph and temperature

851
Q

What is the recommended intravenous dose of ketamine used for preemptive analgesia?

A

10-20mg

852
Q

A patient in postanesthesia recovery is exhibiting signs of an acute myocardial infarction with cardiac failure. Which of the following agents is contraindicated?

A

Metoprolol

853
Q

Beta-blockers reduce the risk of reinfarction and death by

A

decreasing myocardial oxygen demand.

854
Q

They should only be administered in a hemodynamically stable patient and should not be administered if the patient exhibits low cardiac output or heart failure.

A

Beta blockers

855
Q

All of the serotonin receptors arewith the exception of the 5-HT3 receptor which is a ligand-gated ion channel.

A

G-protein-coupled and affect either adenylyl cyclase or phospholipase C

856
Q

All of the serotonin receptors are___

A

G-protein-coupled and affect either adenylyl cyclase or phospholipase C

857
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

858
Q

The incidence of mitral stenosis is higher in males vs females?

A

Females

859
Q

In mitral stenosis, Over a period of 20-30 years, rheumatic fever causes the

A

mitral valve leaflets to become thickened, the commissure may fuse, and the leaflets and annulus may become calcified.

860
Q

What 2 aspects of the induction of general anesthesia would have detrimental effects on the patient with cardiac tamponade?

A

Peripheral vasodilation from administration of an inhaled anesthetic
Positive pressure ventilation

861
Q

PPV on cardiac tamponate

A

Detrimental

862
Q

The agents of choice of treating HTN, if it is primarily an epinephrine-secreting tumor.

A

Esmolol or labetolol are

863
Q

Esmolol offers the advantage of a

A

short duration of action.

864
Q

What is the chief indicator that diabetes-associated renal impairment has progressed to advanced glomerulonephritis?

A

PROTEINURIA
Patients can be asymptomatic for as long as 15 years, but the appearance of proteinuria is the hallmark sign the glomerulosclerosis is severe.

865
Q

Appearance of proteinuria is the hallmark sign the

A

glomerulosclerosis is severe.

866
Q

What is the most common adverse event in patients receiving hemodialysis?

A

Hypotension

867
Q

Rheumatoid arthritis is characterized by. It is typically In the most severe forms, every joint can be affected except for the lumbar and thoracic spine.

A

symmetric polyarthropathy that affects weight-bearing joints and proximal interphalangeal and metacarpophalangeal joints

868
Q

Rheumatoid arthritis is characterized by.

A

symmetric polyarthropathy that affects weight-bearing joints and proximal interphalangeal and metacarpophalangeal joints

869
Q

Rheumatoid arthritis It is typically In the most severe forms, every joint can be affected except for the

A

lumbar and thoracic spine.

870
Q

Autoimmune destruction of pancreatic beta cells is associated with

A

Type I DM

871
Q

Type I diabetes is associated with

A

T cell-mediated destruction of beta cells although the exact mechanism that triggers the destruction is unknown.

872
Q

A patient has been diagnosed with an ischemic stroke. Which agent should be avoided in the care of this patient?

A

Glucose

873
Q

Patients with SLE are prone to (4). The end result is

A

pleural effusion, pneumonitis, alveolar hemorrhage, and pulmonary hypertension. The end result is a restrictive defect.

874
Q

What treatment modality should you give the highest priority in the care of a patient with acute pancreatitis?

A

AGGRESSIVE HYDRATION

875
Q

The four subtypes of schizophrenia are:

A

DCUP

1. Disorganized 2. Catatonic 3. Paranoid 4. Undifferentiated

876
Q

Intravenous propofol will have what effect of CBF

A

. decrease cerebral blood flow

877
Q

The most common presenting symptoms of SLE are. . Renal disease occurs in over half of the patients with SLE and is the most common cause of death. About 10-20% of patients with lupus erythematosus require dialysis. Because of the increased risk of vasculitis, these patients have a higher risk of CNS disorders such as seizures, stroke, dementia, peripheral neuropathy, and psychosis. A diffuse serositis results in pericardial effusion in over half of these patients, but pericardial tamponade is rare.

A

polyarthritis and dermatitis. A malar rash occurs in about 1/3 of SLE patients

878
Q

The most common presenting symptoms of SLE are. . Renal disease occurs in over half of the patients with SLE and is the most common cause of death. . Because of the increased risk of vasculitis, these patients have a higher risk of CNS disorders such as seizures, stroke, dementia, peripheral neuropathy, and psychosis. A diffuse serositis results in pericardial effusion in over half of these patients, but pericardial tamponade is rare.

A

polyarthritis and dermatitis. A malar rash occurs in about 1/3 of SLE patients

879
Q

About 10-20% of patients with lupus erythematosus require

A

dialysis.

880
Q

SLE Because of the increased risk of ______these patients have a higher risk of CNS disorders such as

A

vasculitis; seizures, stroke, dementia, peripheral neuropathy, and psychosis.

881
Q

Pericardial effusion and SLE

A

A diffuse serositis results in pericardial effusion in over half of these patients, but pericardial tamponade is rare.

882
Q

About 90% of the body’s phosphorus is found in bone.

A

bone

883
Q

The Bain circuit is a modification of the

A

D

884
Q

When carbon dioxide absorbent is exhausted, what chemical accumulates in the cannister?

A

Carbonic acid

885
Q

Formed as the byproduct of the exposure of water to carbon dioxide.

A

Carbonic acid

886
Q

Which factors would result in higher tidal volumes than are set for the patient when the anesthesia machine ventilator is in use? (select two)

A

High I:E ratio

Low Respiratory rate

887
Q

Unless you are using an anesthesia machine that is designed to compensate for it, when the ventilator is being used, a portion of the _______? what increases this effect?

A

fresh gas flow will contribute to the tidal volume. This effect increases if the fresh gas flow rates are high, if the I:E ratio is high, and if the patient has a slower respiratory rate.

888
Q

Pipeline inlet connections –: part of what system (low, high or intermediate)

A

Intermediate

889
Q

Oxygen flush valve : part of what system (low, high or intermediate)

A

Intermediate

890
Q

Flow control valve part of what system (low, high or intermediate)

A

intermediate

891
Q

Pipeline pressure indicators part of what system (low, high or intermediate)

A

Intermediate

892
Q

Pneumatic part of the master switch part of what system?

A

Intermediate

893
Q

Oxygen pressure failure devices, part of what system?

A

Intermediate

894
Q

What is the principal indication for using an armored endotracheal tube?

A

. Situations where the tube may get kinked easily

895
Q

contains an embedded wire that is designed to prevent kinking when the tube is bent.

A

The anode (or armored) tube

896
Q

What coagulation factors are present in fresh frozen plasma?

A

ALL

897
Q

From the options below, which is the most common indication for the administration of cryoprecipitate?

A

Von willebrand disease.

898
Q

Cryoprecipitate is most commonly administered in the treatment of patients with

A

von Willebrand disease or patients with low fibrinogen levels (less than 80 mg/dL).

899
Q

Hemolytic transfusion reaction S?S

A

Hemoglobinuria
Fever
Microvascular bleeding

900
Q

Changes in Banked Blood –> comment of 2,3 DPG, ATP and oxidative

A
  • Depletion of 2,3-diphosphoglycerate (DPG)
  • Depletion of ATP (adenosine triphosphate)
  • Oxidative damage
901
Q

Changes in Banked Blood : metabolic disturbances?

A

Acidosis, Hyperkalemia (as high as 17.2 mEq/L)

902
Q

Changes in bankd blood, Accumulation of what

A

proinflammatory metabolic and breakdown products such as lysophospholipids

903
Q

Changes in bankd blood, Morphology. of RBC

A

Altered morphology of red blood cells (change in shape, decreased flexibility,membrane loss)
Hemolysis

904
Q

Factors absent in banked blood

A

• Absence of factors V and VIII

905
Q

LY30 > 3% what should you administer?

A

Tranexamic acid

906
Q

ACT > 128 OR R value >1.1 Blood transfusion products should be

A

Plasma and RBCs

907
Q

Fibrinogen < 150 give

A

Cryo / Fibrinogen

908
Q

Reversal of WARFARIN, FFP should only be used for the reversal of warfarin anticoagulation when? and only if what is not available?

A

in the presence of major bleeding if prothrombin complex concentrate is not available.

909
Q

In the absence of bleeding, over-anticoagulation with warfarin should be managed by

A

withholding warfarin therapy and initiating oral/intravenous Vitamin K.

910
Q

A common assumption is one unit of PRBCs increases Hgb _____ and HCT _____

A

1 g/dL and Hct 2% to 3%

911
Q

Factor VIII (antihemophilic factor) inheritance pattern?

A

X-linked recessive

912
Q

FFP is usually administered in doses of ______for reversal of warfarin, and ____for all other purposes, a

A

5 to 8 mL/kg; 10 to 20 mL/kg

913
Q

FFPs increases coagulation levels by

A

20% to 30%

914
Q

One unit of FFP typically contains.

A

200 to 250 mL

915
Q

PRBCs are the component of choice for improving.

A

oxygen-carrying capacity

916
Q

Depending on the blood bank, a typical unit of PRBC is good for how many days? PRBC volume _____and Hct _____

A

good for 35 to 42 days, and contains 200 mL of RBCs and a Hct of 65%.

917
Q

PRBC infusions are generally administered in a ratio of

A

1 mL for each 2 mL of blood loss (along with crystalloids or colloids for
volume).

918
Q

Cryoprecipitate is stored for _____at __C and for room temperature ____

A

1 year at −18°C; 4–6 hours at room

temperature once thawe

919
Q

Platelets are stored at what temperature?

A

room temperature

920
Q

Storage of platelets : you should know that

A

Have a relatively short shelf life of 5 days, and are prone to bacterial growth.

921
Q

Platelets Typical dosing for an adult is a pool of

A

six whole blood derived (sometimes referred to as

922
Q

Clinical Benefits of Leukoreduction

A

Reduced risk of HLA alloimmunization and platelet refraction

923
Q

Reduced risk of CMV transmission

A

Leukoreduction

924
Q

Risk of HIV with blood transfusion

A

Human immunodeficiency virus (HIV) 1 : 1,500,000–1 : 2,000,000

925
Q

Risk of Hepatitis B virus (HBV) with blood transfusion

A

1 : 200,000–1 : 360,000

926
Q

Hepatitis C virus (HCV) with blood tranfusion

A

1 : 1,000,000–1 : 2,000,000

927
Q

Two theories have been proposed to describe TRALI syndrome. First one is –> The second theory explains TRALI syndrome as a t

A
  1. antibodies in donor plasma activate recipient neutrophils, leading to pulmonary capillary leakage.
  2. Two-event model in which a physiologic stressor such as sepsis, leads to sequestration of neutrophils in the lungs. The transfusion of biologically active mediators (the second event) leads to activation of the neutrophils and capillary leakage.
928
Q

Graft vs Host Disease is manifested as

A

Rash, leukopenia, and thrombocytopenia

929
Q

GVHD is when

A

donor lymphocytes incorporate themselves into

the recipient tissues causing an immune system attack on the embedded lymphocytes and surrounding tissue.

930
Q

Nonhemolytic transfusion reactions occur in about___% of all transfusion

A

1-5% of all transfusions.

931
Q

Nonhemolytic transfusion reactions symptoms

A

The patient typically exhibits symptoms such as fever, urticaria, and chills.

932
Q

What is the most common causative factor in the mortality of patients undergoing surgery for vaso-occlusive disease?

A

Atherosclerotic disease

933
Q

What is the most common cause of perioperative mortality following an abdominal aortic aneurysm repair?

A

MI

934
Q

Myocardial infarction is responsible for 40-70% of the deaths surrounding

A

abdominal aortic aneurysm repair.

935
Q

In general, regional anesthesia is not contraindicated in obstetric patients with mild preeclampsia if the platelet count is at least

A

A platelet count less than 75,000-80,000 is considered too low to perform a neuraxial anesthetic.

936
Q

What is the advantage of combining opioids with local anesthetics in combined spinal/epidural analgesia?

A

. it improves anesthesia without significant motor block

937
Q

You are administering chloroprocaine via an epidural. What would give the suspicion that the epidural was placed intravascularly?

A

the patient would begin to experience CNS symptoms such as tinnitus, dizziness, and circumoral numbness.

938
Q

What is the caution regarding the use of intranasal ketamine?

A

it can result in neurotoxicity

939
Q

The IM induction dose of ketamine of

A

5-10 mg/kg.

940
Q

The intravenous induction dose of ketamine is

A

1-3 mg/kg.

941
Q

The pediatric dose of intranasal midazolam is

A

0.2-0.3 mg/kg

942
Q

Administration of a large dose of which of the following drugs would be most likely to produce seizures in a pediatric patient?

A

Flumazenil

943
Q

Using normal concentrations and dosages, which ROUTE type of local anesthetic administration would be most likely to affect uterine blood flow?

A

Paracervical

944
Q

Local anesthetics exert a vasoconstrictor property that can.

A

reduce uterine blood flow

945
Q

LAs can exert a vasocontrictor property on uterine blood flow.The normal concentrations used do not normally have this effect with two exceptions

A

: 1) inadvertent intravenous injection of a local anesthetic, and 2) paracervical block.

946
Q

The elimination of hydrophilic agents is prolonged in the elderly primarily due to a

A

decrease glomerular filtration rate and decreased renal blood flow.

947
Q

Strasbismus surgery patient are at increased risk for

A

N/V

948
Q

During opthalmic surgery, the surgeon requests that you administer mannitol. What is the rationale for this?

A

. To decrease intraocular pressure

949
Q

Which of the following are acceptable interventions for lowering intracranial pressure in the treatment of cerebral edema? (select four)

A

mannitol

hyperventilation

950
Q

Which of the following are acceptable interventions for lowering intracranial pressure in the treatment of cerebral edema? (select four)

A

mannitol
hyperventilation
fluid restriction
Corticosteroids

951
Q

When the balloon of a PA catheter is not inflated, what pressures are reflected during diastole?

A

Pulmonary artery diastolic pressure

952
Q

PAC –> Right ventricular systolic pressure is transduced during and PA diastolic pressure is transduced during

A

systole,; diastole.

953
Q

The PA diastolic pressure is also a representation of

A

left atrial (LA) pressure.

954
Q

If the NIBP cuff is not level with the heart, then a correction must be made to compensate for the difference between arm and systemic pressure. For every.

A

10 cm the cuff is above the level of the heart, you must add 7.5 mm Hg to estimate the systemic pressure accurately

955
Q

Likewise, for every 10 cm the NIBP cuff is below the level of the heart, you must

A

subtract 7.5 mm Hg to correctly estimate the systemic pressure.

956
Q

You are using a non-invasive blood pressure cuff that cannot automatically compensate for position changes in the arm. If the machine displays a pressure of 80 mm Hg and the arm is 20 cm below the level of the heart, what would you estimate the pressure to actually be?

A

65 mm Hg

957
Q

THORACOSCOPY The patient is typically placed in the

A

supine position.

958
Q

During thoracoscopy, The video thoracoscope is inserted into a

A

small incision so that the pleural cavity can be assessed.

959
Q

Thoracoscopy : what must be used and why?

A

A double-lumen tube must be used so that the ipsilateral lung is collapsed and proper visualization of the pleural cavity is achieved

960
Q

What are potential complications of Thoracoscopy?

A

Hemorrhage, air embolism, air leak from lung, and damage to intrathoracic structures are potential complications.

961
Q

Which of the following chemotherapy agents would be most likely to produce hypercalemia?

A

Tamoxifen

962
Q

antiestrogen chemotherapy agent used to treat breast cancer.

A

Tamoxifen

963
Q

Potential side effects of TAMOXIFEN include

A

venous thrombosis and hypercalcemia.

964
Q

Splenectomy is the primary treatment for

A

hereditary spherocytosis

965
Q

What is hereditary spherocytosis?

A

the most common RBC membrane defect in which the cells are abnormally shaped and are destroyed by the spleen, resulting in anemia.

966
Q

You are preparing to perform a femoral nerve block. You know that in most patients the femoral nerve can be located at the inguinal crease

A

. about 0.5 cm lateral to the femoral artery

967
Q

What muscles receive innervation from the femoral nerve? (select two)

A

Quadriceps

sartorius

968
Q

The posterior branches of the femoral nerve provide. .

A

motor input to the quadriceps

969
Q

The anterior division of the femoral nerve innvervates the

A

sartorius muscle

970
Q

The psoas major is innervated by

A

anterior rami of L1-L3.

971
Q

The gluteus maximus is innervated by the

A

inferior gluteal nerve.

972
Q

The circle system test evaluates the integrity of the circle breathing system from the

A

common gas outlet to the y-piece

973
Q

The circle system test evaluates the circle breathing system from the common gas outlet to the y-piece and consists of two parts,

A

the leak test and the flow test.

974
Q

The leak test is performed by

A

closing the pop-off valve, occluding the y-piece, and evaluating for a drop in pressure after pressurizing the circuit to 30 cm H2O using the flush valve.

975
Q

The flow test checks the integrity of the

A

unidirectional valves by removing the y-piece and breathing through each individual hose to observe the movement of each valve.

976
Q

Antiepileptic drugs such as phenytoin, carbamazepine, and lamotrigine exert a significant part of their anti-seizure effects by

A

blocking sodium channels

977
Q

Which of the following is representative of normal anion gap acidosis?

A

Hyperchloremic metabolic acidosis

978
Q

Another term for normal anion gap acidosis.

A

Hyperchloremic metabolic acidosis

979
Q

Addison’s disease is characterized by the inadequate release of (select three)

A

GLUCOCORTICOIDS
MINERALCORTICOIDS
androgen hormones

980
Q

Primary adrenal insufficiency AKA_____ results in the inadequate release of glucocorticoid, mineralocorticoid, and androgen hormones.

A

Addison’s disease

981
Q

Secondary adrenal insufficiency results in the inadequate release of

A

glucocorticoid only.

982
Q

Primary vs secondary adrenal insufficiency?

A

Primary adrenal insufficiency results in the inadequate release of glucocorticoid, mineralocorticoid, and androgen hormones. Secondary adrenal insufficiency results in the inadequate release of glucocorticoid only.

983
Q

The hallmark symptoms of autonomic hyperreflexia are

A

hypertension and bradycardia. DILATION ABOVE LEVEL OF INJURY CONSTRICTION BELOW> NASAL STUFINESS COMMON

984
Q

What congenital heart disorders create mechanical obstruction to the trachea? (select three)

A

Absent pulmonic valve
Double aortic arch
Partial anomalous pulmonary venous return

985
Q

What is an appropriate minimum urinary output for a 70 kg patient who has suffered a high-voltage electrical burn?

A

70 mL/hour

986
Q

In patients with high-voltage electrical burns, the minimum urinary output to maintain is

A

1-1.5 mL/kg/hour. In this patient, the minimum would be between 70 and 105 mL/hour.

987
Q

In ordinary burns in adults, the minimum urinary output is

A

0.5 mL/kg/hour.

988
Q

In pediatric patients less than 30 Kg, the minimum is

A

1 mL/kg/hou

989
Q

Abrupt discontinuation of clonidine during the perioperative period can result in (select two)

A

HTN and Tachycardia

990
Q

EKG signs of unstable angina?

A

Transient T wave changes

Transient ST segment changes

991
Q

Unstable angina chest pain characteristics

A

Anginal chest pain that

  • began less than 2 months ago
  • progressively increased in severity, duration, or frequency,
  • responsive to pharmacologic therapy
  • occurs at rest, lasts longer than half an hour, or exhibits - transient T-wave or ST segment changes.
992
Q

Pt with shock that exhibit warm, pink extremities, what kind of shock ?

Because spinal shock disrupts the compensatory vasoconstrictive response, patients with spinal shock will exhibit warm, pink extremities whereas patients with hemorrhagic or cardiogenic will exhibit cool, clammy extremities.

A

Because spinal shock disrupts the compensatory vasoconstrictive response, patients with spinal shock will exhibit warm, pink extremities whereas patients with hemorrhagic or cardiogenic will exhibit cool, clammy extremities.

993
Q

It is generally accepted, however, that patients above a BMI of 50 should undergo

A

Awake intubation or intubation with propofol alone and no muscle relaxation.

994
Q

Which of the following parameters are decreased in patients with extreme obesity? (select four)

A

Chest wall compliance
Total lung capacity
Expiratory reserve volume
FRC

995
Q

The plasma half-life of a drug is inversely proportional to its

A

. rate of clearance

996
Q

Compared to nalbuphine, butorphanol exhibits (select two)

A

greater analgesic qualities

greater sedative effects

997
Q

are the three major factors contributing to the negative chronotropic and inotropic effects of local anesthetics.

A

Hypoxia, hypercarbia, and acidosis

998
Q

Colloids should be administered in a____ratio

A

1:1 ratio for blood loss (for every 1 mL of blood loss, administer 1 mL of colloid).

999
Q

What are the major contributing factors to the development of peripheral vascular disease?

A

DM and SMOKING

1000
Q

Which of the following are recommended infusion rates for continuous epidural analgesia for a laboring parturient? (select two)

A

Bupivacaine 0.0625% at 10 mL/hour

Ropivacaine 0.2% at 10 mL/hour