RANDOM FACTS for SEE 2 Flashcards
Dexamethasone should be avoided in patient having what type of surgery and why?
Pituitary surgery: because it can suppress the HPA axis leading false post op test for hypopituitarism.
Protease inhibitors examples are
Ritonavir and sapinavir
How does protease inhibitors affect anesthetic drugs?
They are inhibitors of Cyp450 and can alter duration and effect of sedatives.
DDAVP causes
vWF to split from Factor VIII and increases the serum levels of both components.
A chemical that can bind with a protein to form a new complex is a
Ligand
Typically, it is a signal triggering molecule that binds with a target protein.
Ligand
Renal failure is associated with main electrolyte imbalances. Mnemonic to remember?
Kphos High
CaNa low
Acid
hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis.
Which herbal supplement is used to treat depression and anxiety?
St John’s wort
Herbal used for the treatment of gastritis, ulcers, cough, and bronchitis.
Licorice i
Herbal used for the treatment of gastritis, ulcers, cough, and bronchitis.
Licorice
Which is the most important factor in the rate of rise of FA/FI?
Uptake
Select two factors that may decrease the minimum alveolar concentration (MAC).
Metabolic acidosis and HYPOXIA
Increasing age on MAC
Decrease
Metabolic acidosis and HYPOXIA on MAC
Decrease
Hypothermia on MAC
Decrease
Hyponatremia on MAC
Decrease
Hypo-osmolality on MAC
Decrease
Acute ethanol intoxication on MAC
Decrease
Lidocaine administration on MAC
Decrease
Decreased central neurotransmitter levels on MAC
may decrease MAC levels.
What is myasthenia Gravis?
autoimmune disorder in which acetylcholine receptors are destroyed or inactivated by circulating antibodies at the neuromuscular junction
What is the The clinical hallmark of Myasthenia Gravis?
skeletal muscle weakness.
Myasthenia Gravis has early signs of
ocular and bulbar nerve involvement followed by extremity weakness.
What is the difference between Myasthenia Gravis (MG) and Myasthenic Syndrome?
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.
75% of LEMS (Lambert Eaton Myasthenic syndrome) patients have involvement of the
autonomic nervous system resulting in ataxia, impaired sweating, orthostatic hypotension, and metallic taste in mouth.
Eye muscle weakness in MG vs LEMS(Lambert eaton myasthenic syndrome)
LEMS is uncommon with LEMS
Autoimmune disorder where there are antibodies formed against the voltage-gated calcium channels in the NMJ.
Lambert-Easton syndrome
Channels in the NMJ affected by Lambert eaton syndrome?
Voltage gated Calcium channels.
Myasthenia Gravis is associated with ______and LEMS is associated with _________
Thymoma; Small cell lung CA
Small cell lung CA is associated with MG or LEMS
LEMS
LEMS symptoms are worst __________and improves when and why?
in the morning, improves throughoutthe day as exercise and repetitive movements will lead to increasing accumulation of presynaptic calcium
MG vs LEMS: Autonomic dysfunction
Common with LEMS
Pt with MG and bulbar involvement are at risk of
Aspiration
Myasthenic syndrome and NMBAs
They are sensitive to both Depolarizing and non-depolarizing NMB agents.
MG and LEMS: reflexes
MG normal reflexes
LEMS decrease reflexes
Myasthenia gravis and Depolarizing agents
The ED95 dose of Succinylcholine has been measured at 2.6 times higher than normal.
Avoid this block if you can in MG
ISB because the phrenic nerve paresis may lead to dyspnea.
AminoESTER local anesthetics and myasthenia gravis?
Amino esters LA duration of action will be prolonged because they are metabolized by pseudocholinesterase ,which would be inhibited by anticholinesterase drugs.
How do you differentiate myasthenic crisis vs cholinergic crisis with what test?
Tensilon (Edrophonium) test
Tensilon (Edrophonium) test: if symptoms improves
Myasthenic crisis
Tensilon (Edrophonium) test: if symptoms Worsens
Cholinergic crisis
How is myasthenia gravis diagnosed?
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.
Indicated for Pt with MG with generalized symptoms and Thymoma
Thymomectomy.
Select two rapid-acting anticonvulsants readily available when a perioperative seizure occurs.
Benzodiazepines
propofol
The classic triad of symptoms that accompany severe aortic stenosis are SAC
angina, syncope, and congestive heart failure (dyspnea).
Which drugs are selective beta-1 adrenergic blockers?
Atenolol, propranolol, metoprolol
Which calcium channel blocker can be titrated intravenously as an antihypertensive agent?
Nicardipine
Select two agents that may shorten neuromuscular blockade in patients treated with chronic anticonvulsant therapy.
Phenytoin
Carbamazepine
Patients with pericardial tamponade present with ____triad and what other 3 symptoms
Beck’s Triad
Hypotension
JVD (distended neck veins)
Muffled/distant heart tones,
tachycardia, pulsus alternans, or pulsus paradoxus.
Pulse ____or ______ are associated with pericardial tamponade
pulsus alternans, or pulsus paradoxus.
In adults, burn each arm represents__%
9%,
In adults, burn each leg represents__%
18%
In adults, burn the entire trunk is___%
36% (front 18% and Back 18%
In adults, burn the head is___%
10%
Which agent is a carbonic anhydrase inhibitor used in the treatment of metabolic alkalosis?
Acetazolamide
ECG changes related to hypokalemia include
flattened T-waves and prominent U-waves.
The most serious manifestations in acute liver failure are
acute cerebral edema and intracranial hypertension.
Select two relative contraindications to shock wave lithotripsy (SWL).
Large calcified aortic aneurysm
Implantable cardiac defibrillator
Most lipophillic opioids are
Fentanyl and sufentanil
Most Hydrophillic opioids are
Morphine and meperidine
Which calcium channel blockers inhibit CYP450? (select two)
Diltiazem
Verapamil
Where in the body does metoclopramide block dopamine receptors?
Chemoreceptor Trigger zone
Equation that explains that by increasing the internal diameter of an ETT, the resistance to flow through the tube is decreased exponentially.
Poiseuille’s equation
Adenylyl cyclase functions as part of a secondary messenger system within the cell by converting adenosine triphosphate into
cyclic AMP
During the third trimester of pregnancy, the cardiac output______primarily due to_________
increases primarily due to an increase in stroke volume
Serum Creatinine and pregnancy
Decrease
Enzymes activity that decrease during preganncy
Plasma cholinesterase decrease by 1/3
Plasma cholinesterase activity decreases by about one-third by the second trimester. The duration of action of _____is rarely affected
succinylcholine is rarely affected, however.
During pregnancy, The increase in cardiac output increases
renal blood flow and the glomerular filtration rate.
BUN and CR, during pregnancy
BUN and creatinine both decrease as a result.
The increased renal blood flow can result in the renal
excretion of small amounts of glucose and protein.
Liver enzymes and pregnancy
Enzymes are increased slightly by pregnancy.
2 predictors of difficult epidural placement in obese parturients?
The ability of the patient to flex their back
The ability to palpate bony landmarks
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?
5 minutes
effects of mannitol when administered during vascular surgery
induces osmotic diuresis
decreases endothelial cell swelling
Mannitol and diuresis
Induces OSMOTIC diuresis
Mannitor and cell swelling
Decreases endothelial cell swelling
Mannitol and prostaglandins
increases prostaglandin synthesis which causes renal vasodilation.
It acts as a hydroxyl free radical scavenger
Mannitol
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.
T8 and T12.
The artery of Adamkiewictz joins the
Anterior spinal artery between T8 and T2
In 10 percent of the population, the artery of adamkiewiciz connects
between L1 and L2.
Which of the following agents decreases hepatic glucose production?
Biguanides (Metformin)
Medications for diabetics that enhance tissue sensitivity to insulin.
Thiazolinediones (pioglitazone) and metformin (a biguanide) e
Antidiabetes medications that increase insulin secretion.
Meglitinides such as repaglinide
Antidiabetes medication that increase insulin secretion.
Sulfonylureas such as glipizide
What class of medication is Glipizide
Sulfonylureas
The foot is innervated by branches of the
Femoral and sciatic nerves,
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?
Bezold-Jarisch reflex
What is cardiac stunning?
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.
Diastolic dysfunction is associated with
a normal ejection fraction
Another name for diastolic heart failure is heart failure with
preserved ejection fraction.
You are preparing to implement controlled hypotension in a patient undergoing an extensive neck dissection. Which agent would best maintain cerebral blood flow?
Nicardipine
Which statement represents an accurate understanding of anesthesia for middle ear surgery?
Local anesthesia is appropriate for middle ear surgery
A patient is undergoing cataract surgery and the surgeon plans to use topical anesthesia. You know that the topical anesthetic will
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.
The O’Brien and Nadbath blocks are used to anesthetize cranial nerve
VII and prevent eyelid movement for ocular surgery.
The O’Brien and Nadbath blocks side effects such as
unilateral facial paralysis, they are beginning to be replaced with the orbicularis oculi block.
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
carpal tunnel syndrome.
Fusion of the coccyx into two bones is complete by
25-30 years of age.
The cauda equina normally extends from
L1 to S5
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?
Epidural space
The average distance from the skin to the lumbar epidural space using a midline approach is
5 cm.
The lumbar lordosis and thoracic kyphosis seen in extreme obesity produce what changes in lung parameters?
a decrease in pulmonary compliance
Extreme obesity can also produce a decrease in the
FRC and ERV and premature airway closure.
In adults, about_____ ml/hour of CSF is produced by the choroid plexus of the cerebral ventricles every day.
21
______ ml of CSF produced per day
500 mL a day.
What can both cause an increase in the specific gravity of CSF, which is normally
Hyperglycemia and uremia
Normal CSF specific gravity is
1.004-1.009.
Cauda equina syndrome consists of
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.
Sympathetic innervation to the gastrointestinal tract arises from the
T5 to L2 spinal cord segments.
Which would be considered the definitive treatment for postdural puncture headache?
Epidural blood patch
Which complication occurs more frequently with an epidural than with a spinal anesthetic?
Backache
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.
2
Which nerve roots are associated with the musculocutaneous nerve?
C5-C7
The cricoid cartilage is an anatomic landmark that corresponds to the vertebral body of
C6.
Which agent is used for IV Bier block?
0.5% Lidocaine
Which nerve roots are associated with the obturator nerve?
L2-L4
Which medication is used for the management of postherpetic neuralgia and chronic pain syndromes?
Gabapentin
Brody’s number is used to calculate
oxygen consumption
Carbon dioxide production
Brody’s number, called the three-quarter power rule, uses the
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.
It is used to calculate oxygen and ventilatory requirements in closed circuit anesthesia.
Brody’s number
Which component of the anesthesia machine can serve as a useful indicator of neuromuscular blockade in a mechanically-ventilated patient?
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.
Could be a sign of carbon monoxide accumulation and would need to be investigated further.
Signs of myocardial hypoxia such as T wave inversion, ST segment changes, or alterations in rhythm
Laryngoscope that has a lever that allows for the flexion of the tip of the blade to further elevate the vallecula and epiglottis.
The McCoy
A Macintosh blade with an altered angle between the handle and blade to accommodate patients with abnormal anatomy is called
Polio blade
What is the straight blade with a flange that looks like two-thirds of a circle when viewed in cross section?
Wisconsin blade
Invasive aline substitute
Arterial tonometer
What is the gold standard in expired gas analysis?
Mass spectroscopy
The monitor determines the degree to which the charged particles are deflected by the magnetic field.
Mass spectroscopy
Some ECG monitors are able to measure respiratory rate and depth using the principle of
impedance plethysmography
Using Impedance plethysmography, how does it work?
increase the electrical impedance of the thorax. As the patient exhales, the impedance decreases
ECG Lead ____evaluates upper chest breaths while lead ____evaluates the lower chest and diaphragm.
ECG lead I; lead II
For PNS monitoring The use of needle electrodes is preferred for patients with
burn injuries over the monitoring location.
Method that assess the number of action potentials occurring in a measured muscle group?
Electromyography
Electromyography measures the action potentials in a muscle group. It uses
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.
What method measures the acceleration of a muscle across a joint?
Acceleromyography
Bispectral index is a measurement of
level of consciousness.
NMBDs will ______the number of action potentials produced during stimulation
decrease; action potentials produced during stimulation.
What are the most common anatomical sites for invasive arterial monitoring line placement?
Radial
Femoral
The factors that determine the response of peripheral nerves to electrical stimulation are :
Placement of electrode
The duration the current is applied
The amount of current applied
Current is measured in
amps or milliamps, not volts.
Rank the order in which the structures would exhibit paralysis after administration of a neuromuscular blocking agent. Abdominal muscles, diaphragm, Eyes and extremities
First - Eye muscles
Second - Extremities
Third - Abdominal muscles
Fourth - Diaphragm
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
reverse order.
IV anesthetics of degree of Protein-binding PMEK
From greatest to least, the degree of protein-binding is as follows: Propofol > Midazolam > Etomidate > Ketamine
Select the two most likely causes of hypocalcemia in the intraoperative period.
Hyperventilation
Massive transfusion of citrated blood
GAS embolism Symptoms include
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.
During extracorporeal shock-wave lithotripsy (ESWL), what component of the ECG waveform is used to trigger the shocks?
R-wave
What types of EEG waves are seen in an alert, awake individual? (select two)
alpha waves
beta waves
ForCed air warmers transfer heat to the patient via\_\_\_\_\_ Resistive heaters (such as warming blankets) use
convection; conduction
ForCed air warmers transfer heat to the patient via which heat transfer process?
convection
Heat lamps and radiant heaters use what type of heat transfer?
radiation
Resistive heaters (such as warming blankets) use what type of heat transfer?
conduction.
Fluids that are preferred when performing volume resuscitation in patients with traumatic brain injury.
Isotonic crystalloids. Normal saline is probably the best option because it can be mixed with packed red blood cells.
Solutions to avoid with patient with traumatic brain injury?
Any solution containing glucose should be avoided.
Any unintended patient injury, harm, or complication that results in a prolonged hospitalization, disability, or death
An adverse event
A powerful and overwhelming event that lies outside the range of human experience
critical incident
Failure to take a known and planned action or using the wrong plan of action to achieve an outcome is known as a
Medical error
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
pre-crisis stage interventions
Intervention strategy designed to help healthcare providers involved in a critical incident return to their normal state of health.
pre-crisis stage interventions
Pre-crisis stage interventionsIt is broken down into interventions that occur in three stages:
the pre-crisis stage, the acute crisis stage, and the post-crisis stage.
Interventions in the pre-crisis stage are designed to help
strengthen coping skills before a critical incident ever happens. Education techniques in stress management and relaxation techniques are included.
WPW SYNDROME PATIENTS with afib treatment and why?
Cardioversion ; Because tx with amiodarone, adenosine, digoxin, and non-DHP can cause accelerated ventricular that leads to vfib.
What is SVV?
Stroke volume variation used to estimate fluid responsiveness, in ventilated patients using cyclic changes in the intrathoracic pressures during PPV
Positive pressure ventilation induces changes in
SV and Pulse pressure variation
SVV represents variability of SV during resp cycle”
increase during inspiration and decreases during expiration. Opposite with spontaneous ventilation
4 parameters with EV1000
SV, SVV, CO, CI
3 Goals of management with afib
Correct underlying cause
Rate control
AC
CHA2-DS,VASC
To know who needs AC
AF > 48 h concerns
Thrombus in Left atrial appendage.
IS digoxin use for afib acutely?
NO; itsmore for chronic afib caused by HF
Do not use in decompensated HF
Beta blockers
If pt with afib unresponsive to CB and BB, use
Amiodarone
What is the minimum seizure duration recommended to ensure adequate antidepressant efficacy when performing electroconvulsive therapy?
25 seconds
The most common anesthetic for electroconvulsive therapy is
General anethesia
Electroconvulsive therapy (ECT) is associated with
Bradycardia followed by hypertension and tachycardia
What medications would shorten the seizure duration of electroconvulsive therapy? (select four)
Fentanyl
Midazolam
Lidocaine
Diltiazem
Which condition is an absolute contraindication to electroconvulsive therapy?
Pheochomocytoma
What are the two most common causes of death related to electroconvulsive therapy? (select two)
Myocardial infarction
Cardiac dysrhythmias
The increase in peripheral vascular resistance (afterload) in the elderly occurs primarily due to progressive loss of arterial distensibility and leads to
concentric left ventricular hypertrophy
Obesity is most closely associated with which kind of hypertropy
Eccentric Cardiac hypertrophy
Hypertension produces what kind of hypertrophy?
concentric hypertrophy of the left ventricle,
Do Heparin, protamine, or insulin CROSS PLACENTA?
do not cross the placenta,
Succinylcholine and nondepolarizing muscle relaxants., CROSS PLACENTA
Do not cross the placenta
When an anesthetized patient is placed in the lateral decubitus position, the upper lung is ____less or more compliants?
shifted to a more compliant position and the dependent lung into a less compliant position.
When an anesthetized patient is placed in the lateral decubitus position the upper lung receives
more ventilation.
A ventilation perfusion defect occurs when lateral decubitus position because
because the lower lung is perfused more than the upper lung. The functional residual capacity in the lateral decubitus position is decreased.
The tourniquet should be inflated to about what mmHG ?
100 mmHg above the systolic blood pressure.
Tourniquet pain typically begins after
45-60 minutes
Which of the following is increased during pregnancy? Endocrine? by how much and when?
T3 T4 increased by end of first trimester by 50%
Follicular hyperplasia leads to 50-70 % increase in the thyroid gland
Epidural space changes during pregnancy?
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.
In a primiparous patient, LEAST preferred anesthetic and why?
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.
The Triple-H therapy used in the treatment of cerebral vasospasm includes
hypertension, hypervolemia, and hemodilution
MEdications that should be dosed based on lean body weight? 4 nmbs, 3 opioids, one anesthetics
Rocuronium, vecuronium, atracurium, cisatracurium, fentanyl, sufentanil, remifentanil, and induction doses of propofol should be based on lean body weight.
Should be based on total body weight.
Succinylcholine, dexmedetomidine, neostigmine, and sugammadex doses
MAC decreases by when in life
about 6% percent per decade after the age of 40.
Compared to adult patients, you would expect a term neonate to exhibit (select four)
TBW, body fat, muscle mass,
decreased responsiveness to dopamine
a higher proportion of body water
a decreased proportion of body fat
decreased proportion of muscle mass
Neonates responsiveness to cardiac drugs? example?
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.
Which arrhythmia would you most likely see in a patient following surgical repair of tetralogy of Fallot?
Right bundle branch block
A right bundle branch block is common following surgical correction of tetralogy of Fallot why?
due to damage to the conduction system during repair.
One method of defining frailty is as a syndrome in which at least three of the following criteria are met:
unintentional weight loss of more than 10 lbs in the past 12 months, exhaustion, weakness, slow walking speed, and a low physical activity level.
The decreased ability to retain or eliminate sodium in elderly patients is partially attributed to reductions in
aldosterone secretion
The most common lung abnormalities in obese patients are decreases in the
ERV and FRC
Which would be most likely to be decreased in an elderly patient? As far as HR
Heart rate variability
CO: It returns to prelabor values within______and to pre-pregnancy values within about_______
24 hours; 3 months
Compared to adults , neonates GFR
reduced glomerular filtration rate
Neonates have decreased ability to
decreased ability of the renal tubules to absorb BAGS
bicarbonate,amino acids.glucose,sodium
Which of the following are major side effects of meperidine administration to parturients? (select four)
maternal nausea and vomiting
Maternal sedation
Fetal Tachycardia
Neonatal depression
Can cause decrease beat to beat variability
Meperidine
The classic symptom triad of TUR syndrome seen in awake patients under regional anesthesia is
elevated systolic and diastolic pressures accompanying an increase in pulse pressure, bradycardia, and changes in mental status.
The average amount of fluid absorbed during a TURP is about
20 mL/min of resection time.
For a 25 minute resection, the total amount of fluid absorbed would be estimated as
(20 mL/min X 25 minutes) = 500 mL.
Which irrigating solution for transurethral resection procedures has the highest risk for producing hyperglycemia when absorbed?
Sorbitol and glucose irrigation solutions can produce hyperglycemia when absorbed.
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
115 mEq/L
Hyponatremia, vomiting begin to appear at about ____mEq/L with and
120 mEq/L,
ECG changes for hyponatremia, occurring at_____ mEq/L,
115
Ventricular tachycardia and fibrillation occurring below
100 mEq/L.
The primary purpose of an intra-aortic balloon pump is to (select two)
decrease afterload
augment myocardial oxygenation
Which is the most single effective maneuver to increase Pa02 during one-lung ventilation?
Application of CPAP to the nondependent lung
A patient is undergoing general anesthesia for strabismus surgery. Which of the following is not true regarding anesthesia during this procedure?
Hyperventilation increases the risk for sudden bradycardia
What is the most common pediatric ocular surgery and may be an indicator that there is underlying disease?
Strabismus surgery
Pediatric ocular surgery is associated with a high incidence of
prematurity, cerebral palsy, and craniofacial abnormalities.
Strabismus surgery is also associated with a higher than normal incidence of
malignant hyperthermia.
Hypoventilation resulting in hypercapnia increases the risk of _____Due to the oculocardiac reflex which can occur due to ________
bradycardia due to the oculocardiac reflex which can occur due to traction on the ocular muscles.
Bradycardia during eye surgery can be due to
oculocardiac reflex which can occur due to traction on the ocular muscles.
When does the foramen ovale typically close?
1 hour; as left atrial pressure exceeds right atrial pressure.
A patient with symptomatic hyperparathyroidism is presenting for a parathyroidectomy. What electrolyte disorders would you expect to see in this patient preoperatively? (select two)
Hypercalcemia
Hypophosphatemia
The most common airway problem in pediatric patients is upper airway obstruction due to
Laryngomalacia
Most of the decrease in hepatic blood flow associated with aging is due to
Decreased liver mass
What accounts for most of the 20-40% decrease in hepatic blood flow with age.
Decreased liver mass
Age associated decrease in hepatic blood flow
20-40% in hepatic blood flow
The obturator reflex results in.
external rotation and adduction of the thigh from stimulation of the obturator nerve. Administration of muscle relaxants is required to prevent its occurrence.
Electrocautery current applied to the lateral wall of the bladder as may occur during a transurethral resection of a bladder tumor can stimulate
obturator reflex which could result in bladder perforation due to patient movement while instruments are in the bladder
Regional anesthesia and obturator reflex
Regional anesthesia does not reliably block this reflex.
What is the preferred blood glucose range in the management of pregnant diabetics?
60-120 mg/dL
What ECG changes are associated with a subarachnoid hemorrhage? (select two)
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.
The recommended tidal volume for an obese patient should be estimated as
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).
Larger tidal volumes have not been shown to offer any advantages and result in _______airway pressure without an ______In oxygenation
and result in increased airway pressures without an increase in oxygenation.
The principal morbidity and mortality considerations of obesity center around what issues?
Cardiovascular disease (ischemic heart disease, hypertension, and heart failure).
The formation and maintenance of the extra adipose mass requires an extra
0.1 L/min of cardiac output for each additional kilogram of fat.
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 plan for an inhalation induction
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 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.
Which of the following characteristics do geriatric patients share with neonates?
A higher body surface area to body mass ratio
Both classes of patients have a high body surface area to body mass ratio.
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.
The risk of anesthesia-related maternal death is higher in obese patients, primarily due to an increased incidence of
airway difficulties
The risk of maternal death is higher in obese patients due to an
increased incidence of diabetes, infection, preeclampsia, and thromboembolism.
You are performing an anesthetic for a patient undergoing a hepatic resection near the portal vessels. For which complication should you be prepared?
air embolus
From the patient’s right to left, the three major vessels leaving the superior aspect of the aorta are:
the brachiocephalic trunk (also known as the innominate artery), the left common carotid artery, and the left subclavian artery.
Ascending vs descending bellows?
Ascending (standing) bellows are considered safer than descending (also known as hanging) bellows.
Both ascending AND standing are correct because they are
synonymous terms for the same type of bellows.
In the event of a circuit disconnect, ascending bellows will
fail to rise whereas descending bellows will continue to descend due to gravity and ascend during the inspiratory phase.
All sympathetic neurotransmitters are synthesized from
tyrosine.
The synthesis of neurotransmitters from tyrosine takes place in the
postganglionic sympathetic nerve ending.
Select two laboratory studies that appear to be associated with increased risk of perioperative pulmonary morbidity.
Reduced serum albumin levels
Increased creatinine level
The only machine safety device that evaluates the integrity of the low-pressure circuit in an ongoing fashion.
The oxygen analyzer
It is the only machine monitor that can detect problems downstream from the flow control valves.
The oxygen analyzer
The latent heat of vaporization is the
amount of energy lost by a given liquid as it is converted to a vapor. Specifically, it is defined as the
Number of calories required to change 1 gram of liquid into vapor without a temperature change.
Latent heat of vaporization
Factors that may help prevent optic ischemia
The use of crystalloids and colloids to maintain intravascular volume and reduction of intra-abdominal pressure to prevent venous congestion
Washout of high concentrations of N20 can lower alveolar concentrations of oxygen and carbon dioxide in ?
Diffusion Hypoxia
Describes the diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more adequate perfusion?
Coronary Steal
2 primary determinant of coronary blood flow.
Perfusion pressure and vascular resistance
What is the appropriate initial dose of dantrolene in mg/kg for the treatment of malignant hyperthermia?
2.5mg/kg
Esmolol is metabolized quickly in the
blood by an esterase found in the RBC cytoplasm and has a half-life of
Esmolol half life
9.5 minutes.
Which part of the brain is responsible for increasing the rate and amplitude of ventilation when stimulated?
Reticular activating system
What is the most frequent cause of an acute increase in physiologic dead space?
A decrease in cardiac output
Mrs. Frank is considered a full stomach and is scheduled for surgery. Which two agents would raise Mrs. Frank’s gastric pH?
Sodium Citrate
Famotidine
Action of Pepcid?
Famotidine increases gastric pH and reduces gastric volume.
Sodium citrate dose and action
(15-30ml) increases gastric pH to >2.5. This dose should be administered within 1 hour prior to surgery.
What is the most reliable technique for verifying the proper position of a double-lumen endotracheal tube?
Visualization with a fiberoptic bronchoscope
What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?
Nucleus tractus solitarius
The nucleus tractus solitarius is the main area responsible for
relaying afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves.
Where is the nucleus tractus solitarious located?
Located within the medulla
Which neuromuscular blocking agent is metabolized via Hofmann and ester hydrolysis?
Cisatracurium
What nerve provides better prediction for intubating conditions and gives visual observation of the response over the eyebrow.
Facial nerve stimulation (corrugator supercilii )
Specifically, the corrugator supercilii is the muscle responsible for
moving the eyebrow (not the orbicularis oculi).
The corrugator supercilli most closely parallels
the laryngeal adductors.
Which evoked potential is useful in evaluating descending motor pathways?
Motor evoked potential
What is the intraoperative target glucose range for adults undergoing emergent craniotomy for traumatic brain injury?
target blood glucose level of 90 to 180 mg/dL is appropriate for patients undergoing neurosurgical procedures.
The recommended minimum platelet count for a patient having a non-emergent neurosurgical procedure is
100,000/mm3.
The Glasgow Coma Scale (GCS) evaluates the best
verbal response, eye response, and motor response
GCS min and max
with a minimum score of 3 and a maximum score of 15. A GCS score less than 9 indicates severe brain injury
GCS indicating severe brain injury
less than 9
How is the spinal cord perfusion pressure (SCPP) determined?
SCPP = MAP - Cerebrospinal fluid pressure
What are the most important parameters to normalize in patients with brain injury? (select two)
Intracranial pressure
Cerebral perfusion pressure
Which value is primarily increased in metabolic alkalosis and decreased in metabolic acidosis?
Metabolic alkalosis and acidosis are described as alterations where primarily HC03- is shifted up or down, respectively.
Laparoscopy on RESP
Pulmonary changes associated with laparoscopy include decreased lung volumes
increased V/Q mismatch, increased pleural and airway pressures, and CEPHALAD displacement of carina.
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)
If subcutaneous emphysema persists in the recovery area, the patient should be kept on oxygen therapy and monitored for respiratory acidosis and somnolence.
Select two characteristics of a cirrhotic patient.
High cardiac output
Low arterial blood pressure
Sildenafil, tadalfil, and vardenafil inhibit
cyclic GMP (cGMP)-specific phosphodiasterase type-5 (PDE5) in vascular smooth muscle.
Blocking PDE5 stops
cGMP breakdown.
With its decline in age, which neurotransmitter is noted for its connection to Alzheimer’s disease?
Ach
Select the two most dramatic changes in lung volumes seen with increased age ? what are the other important Resp changes
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.
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?
Day 2
Signs of fluid volume excess such as
Rales, crackles, tachypnea, and orthopnea.
Select two physiologic characteristics that you would expect to be increased in an obstetric patient at term.
Minute ventilation
Oxygen consumption
By term, oxygen demand increases by about mostly due to an increase in tidal volume.
33 percent and minute ventilation increases by about 50 percent,
The PaCO2 is usually between at term
30 and 32 mmHg, and the PaO2 is higher than 100 mmHg at term.
The most popular opioid agonist-antagonists are
butorphanol and nalbuphine for labor analgesia due to their proposed benefits including less nausea, vomiting, and dysphoria.
What is the most common complication of central neuraxial blockade in the obstetric patient?
Hypotension
Effective analgesia can be achieved with low concentrations of local anesthetic during the first stage of labor if the ____ dermatomes are blocked.
T10-L1
Select two long-acting amides that can provide analgesia in neuraxial blocks for obstetric patients while sparing motor function.
Bupivacaine
Ropivacaine
The diagnostic feature of eclampsia that is not present in preeclampsia is
convulsions
Severe preeclampsia is defined by the presence of a systolic pressure of at least
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.
Eclampsia is present if
seizures occur.
Is the most frequently abused substance among pregnant patients?
Tobacco (smoking)
When should chest compressions be initiated in the neonate?
Heart rate < 60 bpm
In the normal, full-term infant, you would expect the glottis to be at the level of
C4
What are the two most commonly used interventions for the treatment of apnea in premature neonates?
CPAP
Caffeine
What is the major metabolite of fentanyl?
The inactive metabolite norfentanyl
Fibers associated with
Muscle tone
A-delta fibers are associated with
pain and touch.
Select two true statements about nerve fibers.
Myelinated fibers conduct faster
A-delta and C nerve fibers are associated with pain transmission
At which plasma concentration of lidocaine would analgesia first be achieved?
3 mcg/mL
Through what interlaminar space would you direct your needle when using the Taylor approach to the subarachnoid and epidural space?
L5-S1
Which local anesthetic would be prolonged the most by adding an adrenergic agonist?
Tetracaine
What electrolyte disorders are most common in patients on chronic immunosuppressive therapy following organ transplantation? (select two)
Hyperkalemia
Hypomagnesemia
Select two narcotic agents appropriate for administration to a renal transplant patient.
Morphine
Meperidine
In adults, how long should surgery be delayed following a viral respiratory infection?
6 weeks
Which is the most significant cause of perioperative morbidity and mortality from an office-based surgical procedure?
Pulmonary embolism
What are the three components of the ‘fire triad’?
Oxidizer, ignition source, and fuel
What is the maximum recommended aspirant amount in an office based liposuction procedure?
5000 mL
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.
0.5 mg/dL; 25 percent
Which is the most sensitive indicator of the effect of obesity on pulmonary function?
Expiratory reserve volume
What is the most common mononeuropathy after bariatric surgery?
Carpal tunnel syndrome
What is the maximum cuff volume for a size 4 LMA?
30 cc
Which statement regarding the Wisconsin blade is false?
It is available in 3 sizes
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)
McGill forceps for correct placement
the use of mechanical ventilation
Which laryngoscope blade has a handle-operated, articulating tip designed to elevate the vallecula and epiglottis?
McCoy blade
The Soper blade is a
straight blade with a left-facing flange that makes it a blend between the Miller and Macintosh blades.
Which endotracheal tube is designed to deflect laser beams
Mallinckrodt tube
The criteria for diagnosing metabolic syndrome are:
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.
Osmotic diuretic that decrease intraocular pressure.
Mannitol is an osmotic diuretic that can
Pilocarpine eye drops can produce pupillary
constriction.
Phenylephrine topical eyedrops can produce pupillary
dilation
What is the most common workplace injury attributed to working 12 hour shifts?
Needlestick injury
Term that defines longitundinal protrusion of sternum?
Pectus Carinatum
Intracellular Na+ content
12
Supratentorium pressure best measured in
Lateral ventricle
Off Pump cardiac surgery facilitated by device called
Octopus
OSA is sleep apnea lasting more than
10 seconds or more
Permanent remission of 50% of patient associated with this disorder
Sarcoidosis
Cerebral cortex is divided into
50 anatomical segments called BRODMAN’S AREAS
Predominant inhibitory biogenic amines of CNS
Dopamine
80% of acute pancreatitis is caused by
Gallbladder or alcohol
Most important evoked potential to monitor during pituitary surgery is
VISION
Overestimation o2 sat
severe anemia
After acute spinal cord injury, Below the level of injury, the patient will exhibit
flaccid paralysis
total absence of sensation, and
loss of temperature regulation and spinal cord reflexes.
After acute spinal cord injury, Below the level of injury, the patient will exhibit
flaccid paralysis
total absence of sensation, and
loss of temperature regulation and spinal cord reflexes.
Dehydration in patients with thyroid storm should be treated with .
glucose-containing intravenous fluids. Cooling measures should be instituted.
GOAL HR during Thyroid storm
Beta-blockers should be titrated to reduce the heart rate less than 90 beats per minute
What can be administered to reduce circulating levels of thyroid hormones during thyroid storm?
Steroids and anti-thyroid medications
Which is the best method for defining coronary anatomy and evaluating ventricular and valvular function?
CORONARY ANGIOGRAPHY not TEE
What is the half-life of cefazolin?
2 hours
Absorbtion of Co2 soda lime
26L/ 100g
Which test checks the integrity of the unidirectional valves and detects obstruction in the circle system?
Flow test
How do you perform flow test on anesthesia machine?
It is performed by removing the y-piece and breathing through each individual hose to observe the movement of each valve.
In some patients, what position of the elbow can lead to ulnar nerve compression?
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.
In about 15% of the population, flexion of the elbow will cause she supine position is correct placement of the arms.
Subluxation of the ulnar nerve over the medial epicondyle of the humerus.
Placement of the arms on armboards at more than 180 degrees would be more likely to injure the
brachial plexus than the ulnar nerve.
Can result in compression of the ulnar nerve.
Pronation of the forearm
Which term describes the administration of a higher partial pressure of anesthetic than the alveolar concentration actually desired for the patient?
Overpressuring
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?
to speed up induction
Nagelhout,Normally, the CBF remains constant between MAPs of
60 to 140 mmHg. As the MAP decreases within this range, the cerebral vessels dilate to keep CBF constant.
The resting adult coronary blood flow is about
250 mL/min or 5 percent of the cardiac output.
The QRS complex of the electrocardiogram indicates that ________________ has occurred.
Right ventricular and left ventricular depolarization
Patients with Becker muscular dystrophy have dystrophin, but it is reduced in amount. What is prevalent in these patients?
Cardiac involvement is
Which muscular dystrophy is characterized by a reduced amount of dystrophin?
Becker MD
Unintentional endobronchial intubation is more likely to occur in the
right main bronchus
The right main bronchus is about l_____ong before it initially branches into_____
2.5 cm; lobar bronchi
The right main bronchus leaves the trachea approximately______degrees from the vertical tracheal axis in the adult.
25
The left bronchus leaves the trachea at about___ degrees.
45
Adult vs pediatric epiglottis?
The epiglottis is relatively longer and more narrow than in the adult
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
60 cm H20. size of the device selected for the patient should be re-evaluated.
Two contraindications for cricoid pressure.
cervical spine fracture, laryngeal fracture, or who exhibit active vomiting due to the risk of an esophageal rupture.
Absolute indications for OLV
Massive hemorrhage, infection, unilateral bullae, unilateral lung lavage, bronchopleural fistula, and video-assisted thoracoscopy are absolute indications for one-lung ventilation.
Temperature regulation is facilitated by the
anterior hypothalamus.
Water metabolism regulation is via the
supraoptic hypothalamus.
Muscarinic stimulation causes HR , contractility, EYES< Bronchioles, Gastric secretions an d
bradycardia, decreased inotropism, miosis, salivation, bronchoconstriction,
Muscarinic stimulation on gastric secretion and GI hypermotility?
increased gastric secretion, and GI hypermotility.
Parasympathetic on EYE
MIOSIS
Besides using a defasculating dose of a non-depolarizing neuromuscular blocking agent, what is the most effective way to prevent myalgia from succinylcholine administration?
. Pretreatment with an NSAID
Adductor Pollicis is supplied by which nerve?
ULNAR
What is the goal temperature in patients undergoing circulatory arrest for a complicated cardiac procedure?
The goal for circulatory arrest is 12-18 degrees Celsius. Profound hypothermia provides greater protection against cerebral ischemia than oxygen administration or anesthetic agents.
Some cardiac and cerebral procedures such as aneurysm repair can be performed under complete circulatory arrest using profound hypothermia. What C degrees
12- 18C
During neurosurgical procedures where the brain is at risk for ischemic damage, a goal temperature of
35C to 36C is acceptable.
What is the recommended minimum cerebral perfusion pressure for traumatic brain injury patients?
60 mmHg
You are preparing to emergently intubate a patient with a traumatic brain injury. What associated injury must you assume this patient also has?
Cervical spine injury
Hemorrhagic shock class III, is characterized with
Blood loss between 1500 and 2000 mL
Pulse rate >120/min
When using the Henderson-Hasselbach equation, what number is used to represent the solubility coefficient in blood of carbon dioxide (C02)?
0.03
The solubility coefficient in blood of C02 is
0.03.
Which is the appropriate fluid treatment for patients that acutely develop water intoxication or seizures due to IV fluid administration?
3% saline
Magnesium levels of less than 1.2 is associated with
Seizures, tetany, and arrhythmias
Hemodynamic changes during laparoscopic surgery include, SVR, MAP, afterload, Venous return
increased systemic vascular resistance, increased mean arterial pressure, increased afterload, and decreased venous return.
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.
50%
The liver receives how much of the CO
25%
What is the LARGEST INTERNAL ORGAN?
Liver
What is the method of choice to determine whether liver damage is due to necrosis, inflammation, steatosis or fibrosis?
Liver biopsy
You should be cautious in administering a high neuraxial block to a patient with chronic hepatic disease because the block can result in
reduction in hepatic blood flow
Select the two most prominent effects of aging on the pulmonary system.
Increased stiffness of the chest wall
Decreased stiffness of the parenchyma
