RANDOM FACTS for SEE 3 Flashcards
SVR and pregnancy
Decrease by 21% by term
Which of the following drugs used in the treatment of rheumatoid arthritis can prolong the duration of succinylcholine?
Cyclophosphamide
The use of cyclophosphamide can
inhibit plasma cholinesterase and prolong the duration of action of succinylcholine.
Agents used in the treatment of rheumatoid arthritis.
Etanercept and adlimumab are anticytokine
The five categories of scoliosis are based on their etiology. They are:..
idiopathic, congenital, neuropathic, myopathic, and traumatic
Neuropathic scoliosis is caused by diseases such as
polio, cerebral palsy, and syringomyelia
Myopathic scoliosis is caused by conditions such as
muscular dystrophy and amyotonia.
Is the most prevalent form of Scoliosis
Idiopathic scoliosis
What is the appropriate dose of 0.3 M sodium citrate in mL for a 20 kg pediatric patient? (provide your answer accurate to a single decimal place)
The pediatric dose of 0.3 M sodium citrate is 0.4 mL/kg. For this patient, the dose would be 8 mL.
What is the appropriate volume of 1:1000 epinephrine to add to a spinal anesthetic to prolong the duration of the block?
0.1-0.2 mL
The subarachnoid space of the spinal canal normally contains between —to —ml of CSF
30 and 80 mL of cerebrospinal fluid.
The spinal cord is enlarged in two locations. Where are the enlarged areas? (select two)
The cervical enlargement occurs at C4-T1 and the lumbar enlargement which occurs from L2-S3.
The 2 cervical enlargement is due to the
nerve roots that produce the brachial plexus and the lumbar enlargement produces the lumbar plexus.
BAEPs are not significantly affected by b.
Benzodiazepines, ketamine, propofol, muscle relaxants, N2O, or barbiturates
Can Inhalation agents affect BAEPs?
BAEPs mildly, affect is proportional to the dose administered.
Nitroprusside administration will result in a decrease in (select three)
Preload
Afterload
cardiac filling pressures
Damage to central or peripheral neural structures that results in abnormal processing of painful stimuli is characteristic of
Neuropathic pain
Hypotonic solutions : Name 2
D5W
1/2 NS
Mannitol should be avoided in patients with which of the following conditions? (select two)
Depressed cardiac function
Intracranial hematoma
Radial artery monitoring during hypothermic cardiopulmonary bypass on aortic pressure
Underestimation
Air in the transducer tubing aortic pressure
Underestimation
Parathyroid hormone on serum calcium ?
increases serum calcium levels by increasing bone resorption of calcium, limiting its renal excretion, and enhancing the gastrointestinal absorption of calcium by activating vitamin D.
PTH on serum phosphate?
It decreases serum phosphate by increasing the renal excretion of phosphate.
How is ondansetron metabolized and eliminated?
metabolized by liver
Thiazide-type diuretics include:
hydrochlorothiazide, chlorthalidone, metolazone, and indapamide.
The normal glomerular filtration pressure is about
60% of the mean arterial pressure or about 60 mmHg.
It is opposed by plasma oncotic pressure which exerts a pressure of about ______ mmHg and bowman’s capsure pressure which exerts about ___mmhg
32 mmHg and Bowman’s capsule pressure which exerts about 18 mmHg.
Pressure : Glomerular filtration, plasma oncotic pressure and bowman’s capsule
Bowman’s Capsule 18
Plasma oncotic pressure 28-32
Glomerular filtration 60
COPD heart signs
Heart sounds Split S2, pulmonary/tricuspid insufficiency
COPD Blood gas exchange
Reduced DLCO; Hypoxemia (most characteristic of
prominent emphysema
Glomerular filtration is also dependent on several physiologic factors:
•s
The pressure inside the glomerular capillaries
• The pressure in the Bowman capsule
• The colloid osmotic pressure of the plasma protein
Myogenic mechanism –>
When arterial pressure rises, the arterial wall is stretched, the vessel constricts, and blood flow remains normal. When arterial pressure decreases, the opposite effect occurs. Therefore, renal blood flow remains constant over a wide range of pressure changes
is an inward force that tends to hold fluid within the glomerulus.
The colloid osmotic pressure created by proteins in the glomerulus (28 mm Hg)
Pressure in the_______ opposes filtration.
Bowman capsule (18 mm Hg)
2 byproducts of sevoflurane
Compound A
Fluoride
Apex of the lumbar curve
L3-L4
The FiO2 delivered by a nasal cannula can vary significantly, but the ranges you can predict that would be delivered by varying flow rates are:
2L/min: 0.26 and 4L/min: 0.36
What postoperative anesthetic complication is common in infants after surgery to treat pyloric stenosis? why?
Ventilatory depression; It is thought this may be due to alkalosis of the cerebrospinal fluid. Because of this potential complication, these patients must be fully awake and responsive prior to tracheal extubation.
2 murmurs associated with MVP
Midsystolic click
Late systolic murmur
What valvular is associated with opening snap?
Mitral stenosis
Pulsus paradoxus is more common in patients with tamponade.
Pulsus paradoxus
Prominent y-descent on a CVP tracing
Kussmaul’s sign
Ventricular discordance
Constrictive pericarditis is similar to cardiac tamponade in many of its features. They both exhibit
pulsus paradoxus and Kussmaul’s sign (jugular vein distention during inspiration) which are signs of ventricular discordance.
Constrictive pericarditis also exhibits Freidreich’s sign, which is a
prominent y-descent on the central venous pressure tracing.
Constrictive pericarditis also exhibits Freidreich’s sign, which is a
prominent y-descent on the central venous pressure tracing.
Which of the following signs and symptoms are consistent with hypoaldosteronism? (select four)
Hyponatremia
Hyperkalemia
Metabolic acidosis
Orthostatis hypotension
How does aldosterone regulate potassium levels?
Aldosterone affects the body’s ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine.
Low aldosterone will lead to high or low K+
High
Plasma cortisol levels less than______indicate adrenal insufficiency (Addison’s disease). Hyperkalemia and hyponatremia are also symptoms.
20 mcg/dL
Adrenal insufficiency is called _____Disease
Addison’s
Metabolic disturbance with addison’s disease
K+, Na+, BP, volume, metabolic disturbance.
Hyperkalemia Hyponatremia Hypotension, Hypovolemia, Metabolic acidosis
Cushing’s syndrome metabolic disturbance
HYPOKALEMIC METABOLIC ALKALOSIS
When the adrenal glands make too much aldosterone. T
Conn’s syndrome
Conn’s disease is
HYPERALDOSTERONISM
Hyperaldosteronism (conn’s disease) what will be the metabolic disturbances what about blood pressure?
SYSTEMIC HTN
Sodium retention
HYPOKALEMIA (polyuria)
METABOLIC ALKALOSIS
Most specific test for Pheochromocytoma?
Vanillyl mandelic acid, a catecholamine metabolite.
Pheochromocytomas are________derived most commonly from
catecholamine-secreting tumors ; chromaffin cells in the adrenal medulla, and less commonly from extraadrenal catecholamine secreting paragangliomas
Pheochromocytomas generally adhere to what is known as the “rule of ten.” They involve both adrenal glands in
approximately 10% of adult patients with the tumor; 10% to 15% of the tumors arise from
extraadrenal chromaffin cells; and at least 10% of the tumors are malignant.
Malignant pheochromocytomas are primarily
extraadrenal
Biochemical testing and subsequent diagnosis of a catecholamine- secreting tumor is based on findings of
elevated concentrations of
- fractionated catecholamines (epinephrine, norepinephrine, dopamine),
- fractionated metanephrine and normetanephrine, and VMA in urine or plasma.
What is the primary imaging modality used for diagnosis of pheochromocytoma?
CT of the abdomen and pelvis
Inherited syndromes that have been linked to
pheochromocytoma include vone.180,183 A
Hippel-Lindau syndrome, MEN type
2A and MEN type 2B, neurofibromatosis type 1 (formerly known as von Recklinghausen disease), and familial pheochromocytoma/ paraganglioma syndrom
pproximately 50% of patients with
MEN type 2A or 2B develop
pheochromocytomas and these tumors secrete predominantly epinephrine177
A number of drugs and conditions can precipitate hypertension in pheochromocytoma patients/
Dopamine antagonists (metoclopramide, droperidol), radiographic contrast media
indirect-acting
amines (ephedrine, methyldopa),
drugs that block neuronal catecholamine reuptake (tricyclic antidepressants, cocaine), and histamine
may enhance the physiologic effects of tumor product
The most common postoperative adverse event with pheorchromocytoma is
sustained hypertension
Elevated T3 and T4 levels, in turn, feedback to suppress
the secretion of both
TRH and TSH. TSH
Elevated T3 and T4 levels, in turn, feedback to suppress
the secretion of both
TRH and TSH.
2 intermediate acting insulin
Human NPH
Lente
Thoracic cross clamping effect on ICP
increased cerebrospinal fluid pressure
Thoracic cross clamping effect on PVR
increased pulmonary vascular resistance
Thoracic cross clamping effect on renal artery blood flow
decreased renal artery blood flow
Thoracic cross clamping effect on cranial vault
vascular engorgement in the cranial vault
Cross-clamping the thoracic aorta is associated with significant decreases in blood flow in the
distal anterior spinal artery and renal artery.
Pulmonary complications can arise from aortic cross-clamping due to T
increased pulmonary vascular resistance with resulting increased pulmonary capillary permeability and pulmonary edema.
The cross clamp results in redistribution of the blood volume with
vascular engorgement in the cranial vault. The increased pressure forces cerebrospinal fluid into the spinal compartment and increases CSF pressure.
A spinal fluid drain is sometimes used to help prevent inordinant increases in CSF pressure during what
Thoracic cross-clamping
Supraventricular tachycardia is any tachycardia.
originating above the ventricles, thus, sinus tachycardia, junctional tachycardia, and atrial tachycardia are all forms of SVT.
SVT most commonly occurs due to a
reentry circuit consisting of anterograde conduction over the slower AV nodal pathway and retrograde conduction over a faster accessory pathway
It can also occur due to enhanced automaticity of secondary pacemaker cells.
SVT
Hyperthyroidism symptoms include
tachycardia
Anemia
Thrombocytopenia
Elevated triiodothyronine
You are preparing to administer ketamine orally to a 33 pound three year-old. Which of the following doses would be appropriate?
75 mg 75 mg
Following a fiberoptic bronchoscopy, the PaO2 of the patient is approximately 20 mm Hg below his PaO2 prior to the procedure. You know that
. this normally occurs and will resolve in 1-4 hours
What hemodynamic change would you expect to see when the anhepatic phase of a liver transplant is initiated?
Hypotension
What government agency issues guidelines as to how medical apps on mobile phones should be regulated?
FDA (Food and Drugs adminstartion)_
Under normal conditions, approximately 93% of the hormone released from the thyroid gland is ___and 7% is is
T4 ; T3.
One of the side effect of atorvastatin
Myalgia
The presence of a bicuspid aortic valve predisposes the patient to the development of
Aortic Stenosis
Which of the following would be most likely to produce hypokalemia? Diuretics type medication
Thiazide diuretics
Extreme flexion at the thigh can result in injury to the
sciatic, obturator, and femoral nerves.
What is the most common postoperative complication in the pediatric patient who has undergone tonsillectomy?
Bleeding
Which of the following statements describes the age-related changes in glomerular function accurately?
The glomerular filtration rate decreases by 1 mL/min each year after age 40
Highly protein-bound drugs display a higher concentration of the free form of the drug in the elderly population. Why is this?
Elderly patients have lower albumin levels
Which of the following would be most likely to increase the risk for bradycardia during strabismus surgery?
Hypercapnia, however, increases the risk of bradycardia due to the oculocardiac reflex which can occur due to traction on the ocular muscles.
Positioning for ERCP
Lateral
Prone
Fibers Believed to exhibit dysfunctional activity in the setting of neuropathic pain.
A and C fibers
Eisenmenger’s syndrome is defined by the
Reversal of a left-to-right shunt when pulmonary vascular resistance increases above that of systemic vascular resistance.
Patent ductus arteriosus is a communication between the
descending aorta and the left pulmonary artery. It normally closes within 48 hours of birth. Prostaglandin inhibition by nonselective COX receptor antagonists such as indomethacin can help promote closure of the defect.
Can can help promote closure of the defect. PDA
Indomethacin
Widened pulse pressure in the ARMS is associated
Coarctation of the aorta
The formula for sevoflurane is .
C4H3F7O.
The formula for desflurane is
C3H2F6O.
The formula for isoflurane is
C3H2ClF5O
The key to distinguishing between them is to count the number of fluorides. Isoflurane has ___desflurane has,___ and sevoflurane has
5,6, 7 fluorides.
To remember the number of flurodise
5,6,7 IDS
The most common congenital abnormality that can result in aortic dissection is
BICUSPID AORTIC VALVE
2 conditions are associated with increased risk for aortic aneurysm and dissection
Although Marfan syndrome and Ehlers-Danlos syndrome are associated with an increased risk for aortic aneurysm and dissection,
Following thoracic aortic surgery, a patient exhibits anterior spinal artery syndrome. What symptoms are associated with this disorder? (select two)
Bowel and bladder dysfunction
Flaccid paralysis of the lower extremities
Tricuspid atresia is a congenital heart defect that is characterized by a
Small right ventricle
Enlarged left ventricle
decreased pulmonary blood flow (that occurs via a ventricular septal defect, patent ductus arteriosus, or bronchial vessels), and arterial hypoxemia.
In tricuspid atresia, Blood passes from the
right atrium to the left atrium (right-to-left shunt) via an atrial septal defect prior to ejection into the systemic circulation causing a cyanotic defect.
Which of the following disorders would be most likely to produce cerebral edema?
Hyponatremia causes the extracellular fluid to become hypotonic. As this occurs, water begins moving into the brain cells causing cerebral edema and intracranial hypertension.
Metabolic alkalosis can be the result of
hyperaldosteronism
Peripheral neuropathies are most common in patients treated with
vincristine
In caucasians, neutropenia is defined as an absolute granulocyte count less than
1500/microliter
Most intraoperative drug reactions are due to exposure to
MUSCLE RELAXANTS
Define preeclampsia
Systolic HTN 140 mmHg or higher or diastolic of 90 mmhg or highter after 20 weeks of gestation with PROTEINURIA
In the absence of proteinuria, the diagnosis can be made when the
new onset HTN with platelet <100K, impaired liver function, renal insufficiency, pulmonary edema, new onset cerebral
Manifestations of preeclampsia include:
hypertension, hypovolemia, oliguria, decreased colloid oncotic pressure, pulmonary edema, arterial hypoxemia, decreased uterine blood flow, disseminated intravascular coagulation, cerebral edema, cerebral hemorrhage, acute tubular necrosis, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).
What is the most common cause of hypotension in the postanesthesia care unit?
Hypovolemia
The critical temperature of nitrous oxide is ___What does it mean?
36.5 degrees Celsius. This means that because its critical temperature is above room temperature, it will remain in liquid form without a refrigeration system.
The vessel-rich group is composed of the T
brain, heart, liver, kidneys, and endocrine glands.
Vesse; rich It comprises _____of the body mass but receives ___% of CO
10% ; 75% of the cardiac output.
The muscle group is comprised of.
muscle and skin
Muscle group accounts for % of body mass and receives _% of CO
50% of the body mass and receives 19% of the cardiac output.
The fat group is comprised of_____ accounts for the ______body mass, and receives __% CO.
adipose tissue; 20%; 6% of the cardiac output.
The vessel-poor group is comprised of ___, __ and ______ accounts for __% of the body mass, and receive ____of the CO
bone, ligament, and cartilage, accounts for 20% of the body mass, and receives a negligible amount (0%) of the cardiac output.
The maximum dose of neostigmine is
0.07 mg/kg.
The usual dose of pyridostigmine is.
0.1 to 0.3 mg/kg
Has the shortest duration of action of the reversal agents.
Edrophonium
Physostigmine has a________ chemical structure.
tertiary amine
Anticholinergic agents like atropine and scopolamine can produce
cycloplegia, which is paralysis of the ciliary muscle of the eye, resulting in mydriasis (pupillary dilation).
Anticholinergic agents like They can decrease
gastric secretions, motility, and peristalsis.
Anticholinergic agents They also decrease the muscle tone in the
bladder (detrusor muscle) which can lead to urinary retention.
Dextran 40 has been shown to improve microcirculation by:
decreasing blood viscosity thereby improving laminar flow in the microcirculatory beds.
Administration of anticholinergics in general results in a ___________gastric secretions, ______peristalsis and intestinal motility, _______Gastric emptying time, ___________esophageal sphincter tone.
decrease in gastric secretions decreased Peristalsis decreased intestinal motility prolonged gastric emptying time reduced Lower esophageal sphincter tone
Anticholinergic and ventricular function or PVR?
There is no significant effect on ventricular function or peripheral vascular resistance.
The pharmacological theory that states that the magnitude of the effect of a drug is proportional to the number of receptors it occupies is known as the
Occupancy theory
Which of the following muscles is responsible for preventing the tongue from falling back against the posterior pharynx and occluding the airway when performing a jaw-thrust maneuver?
Genioglossus
Gas exchange occurs in the airways across which type of cells?
Squamous epithelium
Side effects of histamine include:
increased capillary permeability
When administered concurrently with metoclopramide, those meds increase the likelihood that the patient will experience extrapyramidal symptoms.
phenothiazine derivatives such as thioridazine and chlorpromazine and butyrophenones (droperidol)
Is used in the treatment of extrapyramidal disorders
Benztropine mesylate (Cogentin)
Meds that can antagonize the gastrointestinal effects of metoclopramide.
Anticholinergics such as atropine, glycopyrrolate, and scopolamine
Which of the following is a potential side effect of 5-HT3 receptor antagonists?
QT interval prolongation. They do not produce sedation, extrapyramidal symptoms, or respiratory depression, but can prolong the QT interval slightly and should be used cautiously in patients who already have a prolonged QT interval
Name some 5HT3 receptor antagonists
ondansetron, dolasetron, and granisetron
Which of the following statements regarding buprenorphine is true?
It can produce naloxone-resistant respiratory depression
It can cause respiratory depression that is resistant to naloxone.
buprenorphine
It can produce withdrawal symptoms in patients who are physically dependent on morphine.
buprenorphine
Intentional lung collapse on the operative side is commonly used to enhanced visualization of the operative field. Side effects are primarily due to the large intrapulmonary shunt that develops because the upper lung is still being perfused but not ventilated. Th
The PA-a gradient widens and hypoxemia typically ensues. One-lung ventilation does not appreciably change the arterial CO2 tension.
Intentional collapse of the lung on the operative side and one-lung ventilation during thoracic surgery results in
widening of the PA-a (alveolar to arterial) gradient
The primary causes of respiratory acidosis can be divided into two categories:
those due to alveolar hypoventilation and those due to increased CO2 production.
Other factors that can produce a normal anion gap acidosis include
hypoaldosteronism, renal tubular acidosis, carbonic anhydrase inhibitors or the administration of large volumes of bicarbonate-free intravenous fluids.
The higher the blood:gas partition coefficient is, the more the onset will be slowed
increase in cardiac output
If you’re using an agent with a HIGH blood:gas partition coefficient, the onset will be _______ if there is an increase in CO and ________if there is a decrease in CO
SLOWER; FASTER
Despite having a lower blood:gas solubility coefficient, the rate of rise of the FA/Fi ratio is higher for nitrous oxide than for desflurane. This is due primarily to the what effect?
Concentration effect
Agents with a lower blood:gas partition coefficient exhibit a ________in the FA/Fi ratio.
faster rate of rise
The exception is that nitrous oxide will exhibit a faster rate of rise than desflurane despite the fact that it has a blood:gas partition coefficient of 0.47 and desflurane has a blood:gas partition coefficient of 0.42. The increase with nitrous oxide is due to the fact that it is administered in doses of
50-70% compared to 3-9% for desflurane. This is referred to as the concentration effect.
Which statement is a correct summary of the Meyer-Overton rule?
Potency of an anesthetic is proportional to its lipid solubility
Which blood vessel brings blood into the glomerulus?
Afferent arteriole
Blood enters the glomerulus via the ____artery and leaves via thearteriole. An easy way to remember this is with the letters each words begins with:
afferent ; efferent; A-fferent arteriole A-pproaches the glomerulus and the E-fferent arteriole E-xits the glomerulus.
Typical findings in a patient with cirrhosis include:
Right-to-left shunting, decreased systemic vascular resistance, increased cardiac output, elevated alkaline phosphatase, prolonged INR, thrombocytopenia, hypoalbuminemia, and hypoglycemia.
SVR and CO in a patient with Cirrhosis
Decrease, Increase CO
Albumin and BS in patient with cirrhosis
Hypoalbuminemia and HYPOGLYCEMIA>
Elevated also in cirrhosis
Elevated alkaline phosphatase.
The normal response to the increased venous return in the Trendelenburg position is vaso_____and _____in HR , why?
asodilation and a decrease in the heart rate due to baroreceptor reflex stimulation.
Pt who are hypotensive response to Trendelenburg?
Variable response
Platelet count during pregnancy is
Decreased
GFR and pregnancy
The glomerular filtration rate increases by as much as 50%.
Peripheral vascular resistance and pregnancy
Decreased
The cardiac output, stroke volume, and heart rate all _____during pregnancy
Increase
4 parameters that are decreased during pregnancy
systolic blood pressure, diastolic blood pressure, peripheral vascular resistance, and pulmonary vascular resistance decrease
By which exchange mechanism do large molecules such as immunoglobulins cross the placental barrier?
Pinocytosis
The primary mechanisms of placental exchange are: 12), and
1) Passive Transport
2) Active Transport
3) Pinocytosis
4) Facilitated diffusion
Passive transport for placental exchange are: transport, by which
small ions, respiratory gases, and most drugs under 600 daltons cross,
Active transport for placental exchange, which is responsible for the transfer of
amino acids, vitamins, calcium, and iron
Pinocytosis transport for placental exchange,, which is ho
larger molecules such as immunoglobulins cross the placental barrier,
Facilitated diffusion for placental exchange , which is
mediated by a carrier and includes substances such as glucose.
You are reviewing the preoperative record for a patient about to undergo anesthesia for eye surgery. Which of the following ocular medications will prolong the duration of action of succinylcholine? How long will it lasts
Echothiophate; The duration of paralysis usually does not exceed 20-30 minutes
Appropriate precautions for fire prevention during laser airway surgery include:
- reducing the FiO2 as low as the patient can tolerate
- fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat,
- limit the laser intensity and duration as much as possible, and keep a source of saline on hand in case of fire.
Appropriate precautions for fire prevention during laser airway surgery include:
- reducing the FiO2 as low as the patient can tolerate
- fill the tracheal balloon with saline that has been dyed with methylene blue to signal cuff rupture and help dissipate heat,
- limit the laser intensity and duration as much as possible
- keep a source of saline on hand in case of fire.
What is the most common injury after anesthesia?
Corneal ABrasion
What are 4 factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: (select four)
Obesity Estrogen therapy Prolonged immobilization Pregnancy Advanced age, major surgical procedures lasting longer than 30 minutes, hereditary thrombophilias, spinal cord injury, malignancy, previous thromboembolism, estrogen therapy, pregnancy, and prolonged immobilization.
factors that are associated with an increased risk for the development of deep vein thrombosis and pulmonary embolism include: Surgery time?
major surgical procedures lasting longer than 30 minutes,
One hereditary disease putting the patient at risk for DVT?
hereditary thrombophilias
What surgical procedure has the highest risk for postoperative delirium in elderly patients?
Orthopedic surgery
Which inhaled anesthetic produces the highest levels of carbon monoxide when exposed to dessicated cabon dioxide absorbent?
Desflurane (next is ISOFLURANE)
Which monitors reliably detect a disconnection in the breathing system? (select two)
End-tidal CO2 monitor
Respirometer
If the breathing circuit is disconnected, the oxygen analyzer would
continue to detect oxygen entrained from ambient air and would not necessarily indicate that a disconnection has occurred.
Useless in telling you if the breathing circuit is disconnected?
Oxygen analyzer
Position is associated with RHABDOMYOLOSIS
Lateral decubitus
Factors that result in an increased SVO2 include:
Cyanide toxicity Left-to-right shunts Sepsis Wedged pulmonary artery catheter Hypothermia
Factors that result in a decreased SVO2 include:
Hyperthermia Hemorrhage, Shivering decreased cardiac output decrease in the pulmonary transport of oxygen.
With a right-to-left shunt, the shunted blood mixes with and dilutes the blood coming from the ventilated alveoli resulting in a _______of alveolar partial pressure of the anesthetic. Effect on the the rise in alveolar concentration _____? How does it affect induction _____?
reduction of alveolar partial pressure of the anesthetic. The decrease in the rise in alveolar concentration slows induction of anesthesia.
The extent of slowing a right-to-left shunt will produce in the rate of increase in the alveolar concentration, varies with the
solubility of the anesthetic
The rate of rise of the alveolar concentration of an insoluble agent (low blood/gas coefficient) will be affected (more or less ) with a RIGHT TO LEFT SHUNT
more than that of a soluble anesthetic (high blood/gas coefficient).
In patients undergoing surgical debridement for burns, placement of the ECG leads can be challenging. In situations where the adhesive pads cannot be placed due to the damage they would cause to the burned tissue, the leads should be
stapled to the patients skin or needle electrodes should be used.
When the anesthesia machine ventilator is in use, the amount of fresh gas flow that contributes to the tidal volume during inspiration is increased by
higher I:E ratios
What is the most reliable method of confirming placement of the endotracheal tube in the trachea?
Detection of exhaled CO2
Which anti-epileptic drug is least likely to produce aplastic anemia?
Gabapentin
Antiepileptic drugs associated with APLASTIC ANEMIA They are most commonly seen with
valproate, carbamazepine, and phenytoin.
Valproate, carbamazepine and phenytoin are all associated with
Aplastic anemia
A child with tetralogy of FALLOT having a test spell? what can you do to help?
Squatting increases peripheral vascular resistance and relieves the right-to-left shunt.
Relieves the _______ shunt for patient with tetralogy of fallot can be done by having the patient ______
right to left shunt
squatting
Name 3 short acting insulin
Human regular
Humalog
Novolog.
Glargine lantus peak
NO PEAK
Which of the following surgical conditions is common in patients with acromegaly?
Carpel tunnel syndrome
According to the Occupational Health and Safety Administration (OSHA), the first step a facility should take to decrease the incidence of workplace violence and disruptive behavior is
perform an organization-wide assessment
EGD allowed in pregnant patients?
yes
Versed, pregnancy and fetal
Midazolam crosses the placenta and results in fetal depression, so it is not indicated for pregnant patients.
Depression of the ST segment is typically associated with
subendocardial ischemia
ECG signs is typically associated with transmural ischemia.
ST segment elevation
In mitral regurgitation, your goal is to maintain an ____HR and Afterload.
increased heart rate and decreased afterload,
While the goal in mitral stenosis is to HR and afterload.
maintain a normal or decreased heart rate and normal afterload.
Mitral regurgitation and stenosis: In both disorders, you should maintain
normal sinus rhythm, avoid increases in pulmonary vascular resistance, and maintain preload at normal to increased levels.
Associated with an ‘opening snap’ that occurs in early diastole and a rumbling diastolic murmur heard best at the axilla or apex. .
Mitral stenosis is associated
A holosytolic murmur at the apex that radiates to the axilla is associated with
mitral valve regurgitation
Mitral valve prolapse is associated with a
midsystolic click and a late systolic murmur.
By what principal mechanism does morphine produce nausea?
. Stimulation of the chemoreceptor trigger zone
Many central nervous system neurotransmitters decline with age. Which one is most closely associated with the development of Alzheimer’s disease
Acetylcholine
Neurotransmitters and aging?
CNS concentrations of dopamine, serotonin, GABA, and acetylcholine all decrease with age.
Should not undergo MEP via magnetic stimulation.
Patients with spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy
Motor evoked potentials (MEPs) are useful in the monitoring of functional integrity of ______
motor tracts, namely, the corticospinal tract.
Motor evoked potentials monitor integrity of the
Corticospinal
The Bullard laryngoscope is what kind of laryngococope? What mouth opening does it require? What sizes are available?
indirect fiberoptic laryngoscope that provides direct visualization of the vocal cords. It allows the patient to remain in anatomic position, only requires a mouth opening of 0.64 cm, and is available in adult and pediatric sizes.
Bullard laryngoscope available in pediatric sizes?
Yes
3 that are all associated with the loss of the ‘a’ wave on a CVP waveform.
Atrial fibrillation, ventricular pacing, and asystole
The x descent follows the a wave and represents the
start of atrial systole.
CVP: occurs as a result of the downward pull of the ventricular septum during systole.
The x descent
CVP represents the opening of the tricuspid valve.
y descent
All associated with large ‘v’ waves on the CVP waveform.
VTMR
Tricuspid regurgitation, mitral regurgitation, or a sudden, dramatic increase in intravascular volume are
P wave represents on ECG
Atrial depolarization
End of P to beginning of QRS
Atrial depolarization is completed
QRS is
Ventricular depolarization is beginning and the atria are repolarizing
Isometric line after QRS represents
Ventricular depolarization is completed
T wave of the QRS represents
Ventricular repolarization
Isometric line : Time from T wave to P wave represents
Ventricular repolarization is completed.
A single epidural injection of 80 mg of methylprenisolone can suppress plasma cortisol and the ability to secrete it for how long after injection?
3 weeks after the injection.
Which steroid would be most likely to produce an embolism from inadvertent arterial particulate injection during an epidural steroid injection?
Methylprednisolone
Steroid with the largest particle size?
Methylprednisolone has the largest particle size and would be more likely to produce a significant embolus if injected arterially.
Steroid with the smallest particle size?
Betamethasone has the smallest particles and triamcinolone is between the two.
Steroid with the NO PARTICLE AT ALL ?
Dexamethasone contains no particles at all.
Patients with type _______blood can receive any type of blood.
AB
Because the cells of type O blood don’t contain
contain the A or B surface antigens, it can be administered universally.
The most common reaction from the mixing of type A blood with type B blood is the
agglutination (clumping together) of the cells.
A patient who has the D antigen is referred to as_____If the D antigen is absent, they are called Rh______
Rh positive; RH negative.
Approximately 90% of Americans are Rh ______
positive
The first exposure of an Rh negative patient usually produces _______ Then, what happens? What happens when the patient receives another transfusion of RH positive,
no reaction.Over the next 2-4 weeks, however, the patient develops enough antibodies to produce agglutination of the previously transfused cells still circulating. This is referred to as a delayed transfusion reaction. If the patient receives another transfusion of Rh positive blood, the reaction is as quick and severe as a transfusion of mismatched type A or type B blood.
Thoracic paravertebral block (TPVB) produces both a
somatic and sympathetic block on the side of the injection
Most common complication of a Thoracic paravertebral block?
The most common is pneumothorax.
all potential complications of a thoracic paravertebral block
Although intravascular injection
Nerve damage
Failed block
Axillary Block : A well-defined, localized pulsation of the
Axillary artery is more important to successful blockade than the point at which needle insertion occurs within theaxilla.
Axillary Typically, the median nerve is
anterior to the axillary artery
Provides sensation to lateral aspect of the FA
MCN
What mandates a chest film to evaluate for pneumothorax when performing TPVB?
The aspiration of air
During a TPVB, Once the needle contacts the bone, it should be
walked off the process superiorly and advanced until a loss of resistance is encountered as the needle crosses the superior costotransverse ligament. Usually, this is another 1-1.5 cm beyond the transverse process.
Which ventilator setting guidelines would be the most appropriate for the patient with sepsis?
The current recommended protocol is a low tidal volume, low inspiratory pressure, and the application of PEEP.
The most common cause of hyperphosphatemia is T
renal failure.
Can be used as a temporary treatment for hyperphosphatemia.
The administration of saline and acetazolamide
Will increase gastrointestinal losses of phosphate.
Aluminum hydroxide w
Which conditions will increase the chances of a paradoxical embolus in a patient with a right-to-left cardiac defect? (select two)
Pulmonary hypertension
Valsalva maneuver
In congestive heart failure, sympathetic activation is______(increased or decreased).
increased, which results in increased secretion of norepinephrine
CHF and Circulating vasopressin levels
nearly twice the normal value in patients with congestive heart failure.
Natriuretic peptide levels and CHF,
increase as the ventricles become the principal source of the hormone’s release.
In CHF , there is a chronic increase in
Circulating catecholamines
The chronic increase in circulating catecholamines seen in CHF produces widespread______Then what happens to blood flow to the kidneys?
arteriolar vasoconstriction which shunts blood away from the skin, gastrointestinal tract, heart, and brain. As blood flow to the kidneys decreases, the renin-angiotensin-aldosterone axis is activated which results in sodium retention and interstitial edema.
Which of the following is an oral nonparticulate antacid?
Sodium citrate
MOA of sodium citrate
Increase gastric pH
In the intrinsic pathway, what is the component required to convert factor XII to factor XI?
Prekallikrein
Factor XII reacts with these two to activate Factor XI.
Prekallikrein and other components like High Molecular Weight Kininogen
A patient who is severely ill from chronic ulcerative colitis is presenting for colon resection. You know that this patient’s labwork would likely reveal
Decrease serum albumin
Antacids can slow the absorption of 2 drugs
cimetidine and digoxin
Antacids SPEED the absorption
NSAIDs, like asa, naproxen,
Patients with COPD, the total lung capacity (TLC), residual volume (RV), and functional residual capacity (FRC) are all
normal or increased.
Lung parameters most decreased in patients with COPD
FEV25-75 is decreased the most.
The FEV1/FVC ratio is _______in COPD
Decreased
Hypocalcemia in the presence of a low or normal phosphate level is usually indicative of a 2 things
vitamin D or magnesium deficit.
Which of the following would you expect to see with a myocardial contusion?
Increased serum troponin
Enzymes that may be elevated with y
Chest pain, palpitations, dysrhythmias, ST and T wave abnormalities, and elevated LDH, creatine kinase, and troponin levels
Autonomic dysreflexia 2 main things
Vasoconstriction below the level of spinal cord injury
Vasodilation above the level of spinal cord injury
During acute phase of a high-level SCI patients often develop this shock ______Characterized by
Neurogenic shock
Hypotension requires inotropic support
Autonomic dysreflexia occur s with lesion
above T6
Stimuli that can cause autonomic dysreflexia
Bladder or COLORECTAL DISTENTION
Management of autonomic dysreflexia is to
correct the noxious stimuli
Rapid reduction of BP with nitrates , CAPTOPRIL, hydralazine, and labetalol.
Maximum dose of sodium nitroprusside is
10 mcg/kg per min
Sodium nitroprusside main hemodynamic effect
Decrease both afterload and preload
Decrease cardiac filling pressure
Increase SV and CO
Left ventricular volume are _____With sodium nitroprusside
Decreased
The chemical structure of sodium nitroprusside contains
5 cyanide ions. One binds to methemoglobin to form CYANmethemoglobin. The other 4 undergoes rhodanese-catealyzed conversion to THYOCYANATE By the liver, which thyocyanate undergo renal elimination
To decrease the risk of THYOCYONATE toxicity what should be used with what medications
Infusion pump always with sodium nitroprusside
Name the 3 classes of Calcium channel blockers?
1, 4 Dihydropyridine derivatives (Nifedipine) Benzothiazepines derivatives (Cardizem) Phenylakalanine derivatives (Verapamil)
Non DHPs CCBs are
Verapamil and cardizem
All CCBs have
negative inotropic and chronotropic effects
CCBs on the conduction system
Depress electrical impulses in the SA and AV nodes
CCB and coronary and systemic
They produce coronary and systemic vasodilation.
What is the first sign of adult respiratory distress syndrome?
Hypoxemia resistant to oxygen therapy
2 antibiotics that potentiates NMB
Aminoglycosides (Clindamycin)
Tetracycline
What is it and Why is there a cross reactivity with PCN and cephalosporins?
10% . Because of their common beta lactam ring.
What is it and Why is there a cross reactivity with PCN and cephalosporins?
10% . Because of their common beta lactam rings.
Drug of choice for many surgeries
Cefazolin
Cefazolin is effective against
Streptococcus
Methicillin susceptible Staphylococci
Gram NEGATIVE BACTERIA.
A patient has a higher risk for allergic reaction to protamine if he/she has a known allergy to (select two)
Protamine insulin
Fish products
Guillain-Barre syndrome is associated with (select two)
Previous infection by Campylobacter bacteria
Arreflexia
The clinical presentation of GBS usually includes.
symmetrical paresthesias and weakness starting at the distal extremities and progressing to the proximal extremities and cranial muscles
Pain often accompanies the syndrome as well as
sensory loss and arreflexia. GBS is self-limiting and full recovery usually occurs.
Guillain-Barre syndrome (GBS) is often preceded by a
mild course of gastrointestinal or influenza-like illness caused by the Campylobacter jejuni bacteria, Epstein-Barr virus, or cytomegalovirus. I
Angiotensin converting enzyme inhibitors are associated with
increased bradykinin levels produce angioedema and cough
During laparoscopic surgery on a healthy patient, what hemodynamic effect would you expect to see as a result of insufflation of the abdomen to a pressure of 12-15 mm Hg?
A decrease in stroke volume
During what period following general anesthesia are premature neonates most likely to exhibit apnea and bradycardia?
4-6 hours following surgery
End stage liver disease is generally associated with a very low SVR, increased cardiac index, and increased mixed venous oxygen saturation.
Increase in CI
Within the first hour of the neohepatic period, the patient exhibits a decrease in cardiac output and an increase in systemic vascular resistance. What does this change indicate?
The graft is functioning well
Change during NEOHEPATIC PERIOD Indicative that the graft is functioning well,
Decrease in CO
Increase in SVR
When use Posttetanic count (PTC) use?
When there is no response to the commonly used tests due to 100% paralysis
The value of the PCT is to
attempt to give a rough time estimate as to when recovery may occur.
PTC involves the use of a
50-Hz tetanic stimulation for 5 seconds. followed in 3 seconds by a series of single 1-Hz twitch stimulation.
PTC : you must first understand this
Posttetanic stimulation or potentiation
What is the POSTTETANIC STIMULATION or potentiation?
When the 50-Hz tetanus is applied, there is no response because the patient is 100% blocked. However, application of the 50-Hz tetanus TRANSIENTLY MOBILIZES EXCESS ACH so that after a 3 second pause, you are able to produce a short series of single-twitch response in the hand. Because they only occur after tetanus is applied, that ‘s why its called posttetanic stimulation. The # of twich elicited is counted, THE HIGHER THE COUNT, the less intense the block. Usual count is between 0 (deep block) and 8 (less intense)
With Posttetanic stimulation, the higher the count,
The less intense the block
For rocuronium, for example neogstimine reversal of an intense block where the PTC was 1 to 2 takes
50 minutes
At a PTC of 6 to 8, reversal should occur in
less than 10 minutes.
How is a two-level combined spinal-epidural performed?
The epidural catheter is inserted, then the spinal is performed two interspaces below the epidural
When performing an epidural using the ‘Hanging Drop’ technique, you know that the use of this technique helps verify that the epidural needle
has entered the epidural space. A visible drop of fluid is placed on the hub of the epidural needle. Because the epidural space has a slightly negative pressure, as the needle enters the epidural space, the drop of fluid will be sucked into the epidural space.
Elderly and receptor response changes
a diminished cardiac response to beta-receptor stimulatio
Severely obese patients often have elevated liver enzymes. Which enzyme is elevated due to the blockage of bile canaliculi by triglyceride depositions?
Alanine aminotransferase
ECG changes consistent with obesity.
Low QRS voltage
LVH criteria
left atrial enlargment
t-wave flattening in the inferior and lateral leads, and prolonged QT interval
What is the recommended dose of intravenous nalbuphine in a laboring parturient?
10 mg
What is the recommended route and dosage of butorphanol for a laboring parturient? (select two)
1-2 mg IM
1-2 mg IV
Neonate dose of naloxone
0.1mg
Butorphanol and nalbuphine are which class of medication
Opioid agonist-antagonist
2 meds associated with a ceiling effect?
Butorphanol and Nalbuphine
Butorphanol and nalbuphine are associated with a “CEILLING EFFECT” what does that mean?
incrementally higher doses do not result in increasing respiratory depression.
Advantages of butorphanol and nalbuphine
Less respiratory depression.
Typical Butorphanol dose for labor
1-2 mg IV or IM.
Butorphanol vs morphine
5 times as potent than morphine.
Butorphanol increases PULMONARY artery presure and myocardial work.
Nalbuphine dose for labor
5-10 mg IV, IM or SC
Nalbuphine 5-10mg is equivalent to
10mg of morphine
In pregnancy, insulin resistance
increases due to the effects of lactogen
In pregnancy , insulin resistance is due to the effect of
Lactogen
Caudal anesthetic dosage for kids
0.5 to 1 mL of solution per kg of bodyweight should be injected in a caudal anesthetic to achieve an umbilical level of anesthesia.
Blockade of the medial branch of the _____can relieve pain from sacroiliac joint syndrome.
dorsal rami of L5 and S1-S3 via a facet joint injection
Which evoked potential test is used the LEAST in surgical patients?
VEP
Hypothermia is defined as a core temperature below
Anything less than 36 degrees Celsius (96.8 degrees Fahrenheit) i
What drug is the standard opioid for the treatment of cancer pain?
MORPHINE
What are the two leading causes of end-stage renal disease? (select two)
HTN
DM
The most common congenital heart defect in infants and children
Ventricular septal defects
Which of the following parameters would you expect to increase upon release of an aortic cross-clamp ?
Pulmonary artery pressure
Motor evoked potentials are contraindicated in patients with
spinal or bladder stimulators, metallic foreign bodies, pacemakers, or a previous craniotomy.
What is the most common symptom of overmedication with phenoxybenzamine in the treatment of pheochromocytoma?
ORTHOSTATIC HYPOTENSION
Which of the following is a precipitating factor for acute intermittent porphyria?
PROLONGED NPO TIMES
Identified as a precipitating factor for Acute Intermittent Porphyria.
Fasting
Neuroleptic malignant syndrome closely resemble
MH
When is the optimal time to perform an epidural block for the treatment of postherpetic neuralgia?
Within 2 weeks of the appearance of the rash
May be activated by low blood pressure, increased tubular chloride concentration, or by sympathetic stimulation.
Renin release
Select two ways in which renin release is triggered.
Hypotension
Increased tubular potassium concentration
Renin release may be activated by which 3 mechanisms (HIS)
HoTN (low BP)
Increased tubular chloride concentration
Sympathetic stimulation.
The highest rehabilitation success rate for substance abuse occurs with a minimum of ___ inpatient treatment days and at least ___ treatment days total.
28 and 90
The elimination half life of CO is.
4-6 hours
Elimination half life of CO, therefore, after 3 half lives
3 half lives, and existing CO blood levels would have fallen by over 80%.
May take several weeks to begin to function normally after cessation of smoking.
Mucociliary function
3 factors that determine the regurgitant volume in mitral regurgitation.
The size of the mitral valve opening
The heart rate, and
the pressure gradient across the valve
How does an increase in the diastolic blood pressure affect the severity of aortic regurgitation? (select two)
It results in an increase in the backward pressure gradient across the valve
It increases the left ventricular regurgitant volume
An increase in the diastolic blood pressure increases the backward pressure gradient which results in an increase in the proportion of stroke volume that regurgitates back into the left ventricle.
Hemophilia A is a________ disorder but affects is
sex-linked recessive. both males and females (males are just much more likely to have the disease). It
Decrease in Factor VIII levels
Hemophillia A
Hemophilia B is also known as
Christmas disease because Factor IX
Patients with hemophilia A will exhibit a______PTT
prolonged
The addition of hyaluronidase in LA facilitates the
spread of the local anesthetics into the tissue and speeds the onset of the block.
The addition of dextran to a local anesthetic solution
increases the duration of action. Studies indicate that this effect is most pronounced when the pH of the solution is high.
The addition of a vasoconstrictor such as epinephrine and phenylephrine will
prolong the effect of local anesthetics.
Opioids shift the CO2 response curve to the
RIGHT
There are four types of indicators:.
nonrotating float
skirted float
Ball float
Plumb bob float.
Are referred to as rotating indicators because they have vanes or grooves cut into the top portion that causes them to spin while they float in the tube. This allows the anesthetist to be certain that the float has not simply become stuck in the tube and is accurately measuring the gas flow
The skirted float and plumb bob float
The worst case scenario would be a ______float in the tube giving the impression that adequate oxygen flow is being delivered, when in fact the patient may be in jeopardy of hypoxia.
non-rotating or ball float stuck
Descending bellows are attached to the top of the cylinder. The bellows fall during_____ and rise during the_________ The bottom plate of the bellows is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.
exhalation ; inhalation phase.
The local anesthetic with the highest degree of protein binding is
bupivacaine
LAs with the have the highest degree of protein binding (97%).
Bupivacaine and levobupivacaine
The bottom plate of the DESCENDING bellows and why it isn’t ideal if there is a disconnection?
It is usually weighted to facilitate its fall during exhalation. If a disconnection occurs in the circuit between the bellows and the patient, the bellows will still fall.
The rapid onset of chlorprocaine is because of the
HIGH Concentration that is used.
The rapid onset of chlorprocaine is because of the
HIGH Concentration that is used because its pka is far from physiologic pH
A properly inserted laryngeal mask airway will
protect the airway from pharyngeal secretions
Will show a decline in EEG activity.
Hypoxia and cerebrovascular ischemia
Subanesthetic doses of inhalation agents with nitrous oxide and subanesthetic doses of intravenous anesthetic drugs can
increase EEG activity.
Ketamine administration on EEG activity
increase EEG activity.
Placing a blood pressure cuff on an extremity that is below the level of the heart will
Overestimation of the actual BP
Phospholipase A2, which is the rate-limiting enzyme in the conversion of
arachidonic acid into prostaglandins and leukotrienes, is the primary inflammatory mediator implicated in disc herniation
Cervical epidural steroid injections should be performed at
C6-C7 or C7-T1 and no higher.
Which of the following agents used in controlled hypotension techniques is most likely to produce myocardial depression?
Esmolol
The Kell antigen system is related to
autoimmune diseases.
Type O blood have what antibodies>? T
anti-A antibodies and anti-B antibodies, and patients with Type AB have neither.
The most common reaction from the mixing of type A blood with type B blood is theT
agglutination (clumping together) of the cells.
The type D Rh antigen is____ ____ than the other Rh subtypes.
more antigenic
What increases the risk of postoperative pneumonia by 300%?
Chronic respiratory disease
Factors other than respiratory diseases that increase the risk of postop pna?
Obesity
Age greater than 70 years, and surgery lasting longer than 2 hours
PPV on venous return decreases right ventricular stroke volume during inspiration, and decreases LVEDV during expiration.
Positive pressure ventilation reduces venous return,
PPV on ventricular afterload?
increases right ventricular afterload,
PPV on venous return
Positive pressure ventilation reduces venous return,
PPV on LVEDV?
decreases LVEDV during expiration.
PPV and RV SV
decreases right ventricular stroke volume during inspiration
Most common cause of hyperphosphatemia.
Renal failure is the
Carbohydrate loading can induce _____hosphatemia via an insulin-mediated uptake of phosphorus.
hypophosphatemia. This is the most common form of hypophosphatemia seen in hospitalized patients.
Respiratory alkalosis from
hyperventilation decreases phosphate levels.
Respiratory alkalosis is also presumed to be the cause of hypophosphatemia associated with
gram-negative sepsis and salicylate poisoning.
What is the most common cardiac defect through which a paradoxical embolus will occur?
Patent foramen ovale
It can also occur in other right-to-left cardiac defects such as a
patent ductus arteriosus or atrial septal defect.
The triple therapy drug regimen used for patients with congestive heart failure consists of an
ACE inhibitor, a beta-blocker, and a diuretic (which is often an aldosterone antagonist).
are the compensatory mechanisms that occur in the presence of heart failure. As heart failure ensues, the ejection fraction decreases. As the left ventricle dilates, it accommodates more volume. Thus, the same ejection fraction of an increased volume will still be a normal stroke volume. As venous congestion and ventricular dilatation continues, however, clinical deterioration will eventually occur.
Increased preload and sympathetic tone
Ventricular hypertrophy
Activation of the renin- angiotensin system
are the compensatory mechanisms that occur in the presence of heart failure.
Increased preload and sympathetic tone
Ventricular hypertrophy
Activation of the renin- angiotensin system
As heart failure ensues, what happens to EF?
The ejection fraction decreases. As the left ventricle dilates, it accommodates more volume. thus, the same ejection fraction of an increased volume will still be a normal stroke volume. As venous congestion and ventricular dilatation continues, however, clinical deterioration will eventually occur.
Drugs that are known to decrease the LES and potentially increase the risk for gastric aspiration include: TAD POTS
Thiopetnal Anticholinergics Dopamine, Propofol, Opioids Tricyclic antidepressants Sodium nitroprusside.
Drugs that are known to decrease the LES and potentially increase the risk for gastric aspiration include: Drugs that are known to increase the LES and reduce the risk of aspiration include: metoclopramide, prochlorperazine, edrophonium, neostigmine, pancuronium, alpha-adrenergic agents, and antacids. Succinylcholine increase the LES, but also increases gastric pressure during fasciculations, so the overall barrier pressure is left unchanged.
anticholinergics, dopamine, thiopental, opioids, propofol, tricyclic antidepressants, and sodium nitroprusside.
LES and Dopamine
Decrease
LES and thiopental
Decrease
LES and opioids
Decreae
LES and propofol
Decrease
LES and propofol
decrease
LES and tricyclic antidepressants
Decrease
LES and sodium nitroprusside
Decrease
Drugs that are known to increase the LES and reduce the risk of aspiration include:
metoclopramide alpha-adrenergic agents prochlorperazine, neostigmine edrophonium antacids pancuronium
The extrinsic pathway of the hemostatic response is initiated by the release of a group of proteins known as
Tissues factor
The intrinsic pathway of the hemostatis response is initiated by
Tissue exposure to collagen
Patients with ulcerative colitis are most at risk for the development of which potentially urgent surgical condition?
Toxic megacolon requiring urgent colectomy
Define hypopnea
A 50% decrease in airflow for more than 10 seconds that occurs more than 15 seconds per hour of sleep that is sufficient to result in a 4% decrease in oxygen saturation is the definition of
OHS is a syndrome that results from chronic OSA and occurs in about 5-10% of patients with OSA. It is characterized by
obesity, awake arterial hypercapnia, and insufficient alveolar impairment independent of any other pulmonary disease. It progresses to right ventricular failure.
Hct in emphysema vs chronic bronchitisatients with emphysema typically have a normal resting carbon dioxide level.
The hematocrit is elevated in patients with chronic bronchitis and normal in patients with emphysema.
Hct in emphysema vs chronic bronchitisat
The hematocrit is elevated in patients with chronic bronchitis and normal in patients with emphysema.
Patients with emphysema typically have a normal
resting carbon dioxide level.
Which of the following statements regarding atropine is false?
Maternally administered atropine can produce significant tachycardia in the fetus
Atropine and placenta
Although atropine can cross the placenta (glycopyrrolate cannot), there is no significant change in fetal heart rate after intravenous administration to the mother.
All anticholinergics combine reversibly with the
muscarinic cholinergic receptors and prevent acetylcholine from binding to the receptor.
Anticholinergic drugs
increase the heart rate and shorten the PR interval.
ISA minimizes the
risk of bronchoconstriction in patients with reactive airway disease who require β-blockade. Pindolol, acebutolol, penbutolol, and carteolol are
β-adrenergic blocking agents that possess ISA.
3 facts about pericarditis
It is often relieved by sitting forward
It initially produces diffuse ST segment elevation
It is commonly preceded by a viral infection
2 β-blockers with membrane-stabilizing activity.
Propranolol and pindolol
ARDS patients and PEEP
PEEP is extremely useful in these patients and should be titrated as high as possible while keeping the plateau pressure less than 28-30 cm H2O.
Other potential problems arise with β2-receptor blockade in patients with
peripheral vascular disease and Raynaud phenomenon, because of the possible potentiation
of peripheral vasoconstriction.
Long-term therapy with β-blockers leads to _______of β-receptors or ________in the absolute number and activity of receptors.
up-regulation; increase
Serum potassium levels may also become elevated with______, because
β2-blockade; uptake into skeletal muscle
is inhibited.
BETA BLOCKERS and diabetic patients caution
signs of hypoglycemia may be masked, and the patient’s ability to increase serum glucose levels may be impaired.
Cardiac effects of β-adrenergic blocking drugs.
Negative chronotropic Negative dromotropic. Negative inotropic. Antiarrhythmic. Anti-ischemic
A breathing pattern in an infant that consists of recurrent pauses in ventilation that last no longer than 5-10 seconds is consistent with a diagnosis of
Periodic breathing
The defining characteristics of Hepatorenal syndrome are the
presence of portal hypertension, an increased alveolar-arterial oxygen gradient, and intrapulmonary vasodilation.
During which phase of a liver transplant surgery would you expect to see the greatest degree of hemodynamic instability?
Neohepatic phase
During which phase of a liver transplant surgery would you expect to see the greatest degree of hemodynamic instability?
Neohepatic phase; The greatest hemodynamic changes are typically seen during the neohepatic period when the transplanted liver is reperfused. Reperfusion of the portal vein is associated with a drop in the systemic vascular resistance that is even greater than that seen with vena cava cross-clamp. Severe bradycardia may also be seen, although it is becoming less common due to changes in the preservative solutions used.
Hypocalcemia is a common occurrence following a parathyroidectomy. When would you expect the patient to experience the lowest serum calcium levels?
Hypocalcemia can occur in the immediate postoperative period, but the lowest calcium level seen is usually 3-7 days after surgery.
Which of the following statements correctly describes how to elicit a post-tetanic count? 5-50-3-1
A 5-second 50 Hz tetanic stimulation followed by a 3-second pause, then 1 Hz twitch stimulations
2 associated with CHD
Lung hypoplasia
Tacheapnea
Preoperative autologous donation of blood is most effective
when combined with erythropoetin therapy
Acute normovolemic hemodilution
is performed electively to reduce surgical blood loss
A popliteal block disrupts neurotransmission in the
sciatic nerve
SSEPs assess
integrity of the dorsal spinal column
integrity of the sensory cortex
The addition of epinephrine prolongs the duration of
tetracaine the most, lidocaine moderately, and has almost no effect on the duration of action of bupivacaine.
2 things making the solution hyperbaric
5% and 8% dextrose
What nerve roots contribute to the sciatic nerve? (select two)
L4 and L5
S1-S2
You are performing a combined spinal/epidural anesthetic. You have already administered the spinal anesthetic and are preparing to inject local anesthetic through the epidural catheter. How will this affect the spinal block?
It will increase the height of the spinal block
Injection of solution through the epidural catheter is known to I
increase the spread of the spinal anesthetic.t is believed that the increased volume injected into the epidural space compresses the subarachnoid space, resulting in an increase in pressure that ‘pushes’ the local anesthetic in the subarachnoid space higher. Another cause is the leakage of local anesthetic from the epidural space into the subarachnoid space via the dural puncture made for the spinal anesthetic.
What structure forms the anterior border of the epidural space?
The posterior longitudinal ligament
During a cardiac catheterization for an ablation, for which change in the patient’s condition would you need to immediately notify the electrophysiologist?
An increase in core temperature of 0.2 degrees Celsius
ou are performing a MAC anesthetic for a patient undergoing a cardiac catheterization. The cardiologist is having difficulty placing a stent and has used an extensive amount of contrast dye. In what patient population would this concern you the most?
Patients with diabetes mellitus
The decrease in total body water that occurs with aging is primarily due to
A decrease in muscle mass
In what ways does the hyperinsulinemia associated with obesity contribute to cardiovascular disease? (select two)
It results in chronic activation of the sympathetic nervous system
It results in sodium retention
Which drugs cause vasodilation in the fetus when administered to the mother? (select tw
Magnesium
Nifedipine
Most cellular drug receptors are located
Within the cell membrane
Results from a medial branch block can have a relatively long duration (3-6 months). If the results from a medial branch block are short-lived, a
radiofrequency rhizotomy should be performed.
A patient complains of chronic pain that begins in the lower back, radiates through the posterior thigh, and ends at the knee. Examination reveals paraspinal tenderness and reproduction of the pain with extension and rotation of the lower back. This is consistent with a diagnosis of
facet syndrome
What is capnometry?
Any and all measurements of carbon dioxide levels
Which of the following monitors would be most prudent in a patient with cardiac disease undergoing a posterior cervical laminectomy in the sitting position? (select two)
Central venous pressure catheterCentral venous pressure catheter
Precordial doppler
A decompressive laminectomy is performed via a
posterior, midline approach either prone or in a sitting position with the head secured either in pins or a horseshoe headrest.
Posterior procedures performed in the sitting position place the patient at risk for air embolism. It is prudent in these cases to monitor what?
-Monitor heart sounds with a precordial Doppler and place a central venous line prior to surgery in order to aspirate air should an embolism occur.
What is the principal neurotransmitter responsible for activation of dorsal horn neurons in the transmission of noxious stimuli?
glutamate
Which of the veins listed below does contribute to the portal vein?
Superior mesenteric vein
Inferior mesenteric vein
Splenic vein
According to the American Society for Testing and Materials (ASTM), the maximum pressure a standard 1.5 liter breathing bag can exert if expanded as much as 4 times its normal size is
50 cm H2O
According to the standards set by the ASTM, 3-liter reservoir bags (also called breathing bags) that are distended to. T
four times their normal size should not exert a pressure less than 35 cm H2O or greater than 60 cm H2O.
Bags that are 1.5 L in size or smaller shall not exert a pressure
less than 30 cm H2O or greater than 50 cm H2O when distended to this extent
The lowest pressure to be exerted is to
ensure that the bag is capable of exerting enough minimum pressure to ventilate a patient, and the highest pressure is to limit the amount of barotrauma that a patient may be exposed to when using the breathing bag.
The TOF is 2 Hz stimulation of a series of four twitches applied
every half-second for a total of 2 seconds. You should wait at least 10-12 seconds between assessments.
Which of the following anesthetic agents would be least likely to precipitate a carcinoid crisis in a patient with a carcinoid tumor?
Etomidate
MAC in Cp patients
Decrease
What type of shunt is associated with acyanotic congenital heart disease?
Left-to-right intracardiac shunt
What are the MOST common causes of ACUTE MITRAL REGURGITATION? (MI-PCT)
Myocardial infarction Infectious endocarditis Papillary muscle dysfunction Chordae tendinae rupture, Trauma to the chest
In respiratory alkalosis and acidosis, which value is primarily increased or decreased?
PaCO2
What resource was created by the AANA in 1983 to help provide support on issues surrounding substance abuse?
Peer Assistance Advisors Committee
Which volatile agent doesn’t decrease the cerebral metabolic rate?
Nitrous oxide
All that are able to decrease cerebral metabolic oxygen requirements to an equal degree. VAs
Isoflurane, desflurane, and sevoflurane
Anesthesia for a computed tomography scan vs anesthesia for MRI
exposes the anesthetist to a greater amount of ionizing radiation than an MRI
Which of the following agents produces irreversible inhibition of platelet function by preventing the synthesis of thromboxane A2?
Acetylsalicylic acid
Cyclooxygenase inhibitors such as_____ cause i
aspirin ; irreversible inhibition of platelet cyclooxygenase which prevents synthesis of thromboxane A2.
ADP receptor antagonists such as____and______MOA is
ticlopidine and clopidogrel block the ADP receptor non-competitively and irreversibly inhibit IIb/IIIa platelet aggregation
Phosphodiesterase inhibitors such as dipyridamole act by.
inhibiting phosphodiesterase which results in an increase in cyclic AMP which is an inhibitor of platelet aggregation
cAMP and platelet aggregation?
Increase in cyclic AMP inhibit platelet aggregation
Glycoprotein Iib/IIIa receptor antagonists such as abciximab reversibly block the
Iib/IIIa site by which fibrinogen crosslinks platelets together.
Which disorder exhibits a higher incidence of mitral valve prolapse?
Marfan syndrome
MVP has a higher occurrence in patients with
Marfan syndrome, systemic lupus erythematosus, rheumatic carditis, thyrotoxicosis, and myocarditis.
Patients with polycythemia exhibit (select two)
Increased blood viscosity
Increased risk for thrombosis
Which of the following are associated with the development of interstitial nephritis? (select two)
Allergic reaction to antibiotics
Lupus erythematosus
Acute chest syndrome is associated with what disease process?
Sickle cell disease
What is the second most common cause of hospitalization in sickle cell patients and accounts for 25% of all sickle cell related deaths..
Acute chest syndrome
How is acute chest diagnosed?
the development of new infiltrates on chest film and may be caused by atelectasis, pulmonary microembolic episodes, or pulmonary infection
Acute chest syndrome is a potential complication of sickle cell disease. When it develops, it is typically how long after surgery? how do you treat it?
2-3 days following surgery and requires aggressive hydration, oxygenation, transfusions to treat anemia, antibiotics to treat pulmonary infection, and occasionally nitric oxide may be used to treat pulmonary hypertension.
Diagnosing hemophillia A and B with PT and PTT
Both hemophilia A and hemophilia B exhibit a prolonged PTT and a normal PT. The clinical course of the diseases is virtually identical except that they are treated with different clotting factors. They are both X-linked recessive disorders.
Hemophillia A and B dominant or recessive
recessive
What treatment regimens are effective in ameliorating the symptoms of von Willebrand disease? (select two)
Desmopressin
vWF concentrate
Factor IX-PCC is used in the treatment of
hemophilia B.
3 drugs: rocuronium, Succinylcholine and Propofol inductios doses which one for which body weight
Total body weight: Ideal body weight: Lean body weight:
Succinylcholine –> Total body weight
Propofol induction –> Lean body weight
Rocuronium –> Ideal body weight.
Vd is calculated as
Vd = Amount of drug in body/Plasma concentation of the drug.
The FA:FI difference of a volatile anesthetic is d, but
directly proportion to its rate of uptake
The rate of induction with a volatile anesthetic is
inversely proportional to its rate of uptake.
Which of the following respiratory effects may occur with the administration of local anesthetics?
Decreased ventilatory response to hypoxia
Local anesthetics such as lidocaine can depress the ventilatory response to hypoxia. Systemic absorption of bupivacaine, however,
increases the ventilatory response to CO2.
COX-2 receptor inhibition has been shown to O
Reduce prostacyclin release from the vascular epithelium and can result in increased platelet aggregation. C
COX-1 receptor inhibition results in.
inhibition of thromboxane A2. By doing so, it disrupts thromboxane A2’s ability to promote platelet aggregation
West Lung Zone 1 is
rarely present normally
West Lung Zone 1 only present with
pulmonary hypotension, excessive PEEP, or large tidal volumes during positive-pressure ventilation.
A patient with a history of tuberculosis is currently taking isoniazid. What diagnostic tests may be seriously altered due to this drug?
Liver function tests
Which of the following anesthetic risks are associated with muscular dystrophy?
Aspiration of gastric contents
Gastric hypomotility and decreased laryngeal reflexes predispose the patient to pulmonary aspiration. What patients?
Patients with muscular dystrophy
Which of the following agents will not produce a significant change in the latency or amplitude of somatosensory evoked potentials? (select two)
Ketamine and Fentanyl
On what principle do the mechanical flowmeters on anesthesia machines function?
Flow past a resistance is proportional to the pressure
Cannon a waves are extremely large ‘a’ waves in a CVP waveform. Dysrhythmias such as
junctional rhythms complete AV block PVCs, and disorders such as triscupid stenosis, mitral stenosis, myocardial ischemia, diastolic dysfunction, and ventricular hypertrophy are all associated with the presence of cannon 'a' waves on the CVP waveform.
Most anesthetic agents will alter the latency or amplitude of somatosensory evoked potentials except for
OKE (opioids, ketamine, and etomidate)
hat effect will volatile anesthetics have on somatosensory evoked potential (SSEP) monitoring?
DAIL
Decrease Amplitude
Increase latency
The administration of epidural steroids can produce an antiinflammatory effect primarily by the inhibition of (select two)
Cytokines
Phospholipase A2
What is the minimum time to wait after an epidural steroid injection before attempting a second injection?
2-3 weeks
A single dose of methylprednisolone will suppress cortisol secretion for
3 weeks.
Triamcinolone will suppress ______secretion for how long?
cortisol; one week.
Dexamethasone is non-particulate and is recommended as the preferred agent for
transforaminal injections.
Of the Rh antigens, which one is responsible for the most common and strongest Rh-related transfusion reactions?
D
The cervical plexus block is unique in that the
Sensory fibers (superficial cervical plexus block) can be blocked separately from the motor fibers (deep cervical plexus block (SS, DM)
A superficial cervical plexus block only provides anesthesia to the cutaneous sensation of the skin between the
face and the T2 dermatome.
Cervical plexus block does not protect against
the carotid sinus reflex and local injection of the carotid sinus at the point where the carotid artery bifurcates is often necessary.
Complications of a cervical plexus block.
Intravenous injection, spread of the local anesthetic into the epidural or subarachnoid space, and blockade of the phrenic or superior laryngeal nerves are potential
The rate of systemic absorption of local anesthetic is proportionate to the vascularity of the site of injection: i
IvTICPEBS
Intravenous > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > subcutaneous.
The most common organism responsible, but numerous other organisms can also result in pneumonia.. and patients with contact with birds may contract Chlamydia pneumonia.
Streptococcus pneumoniae
2 tests that can often provide information about the cause of pneumonia?
Sputum specimens and a detailed history
Hotels and whirlpools associated with what kind of pneumonia?
Legionnaire’s disease (Legionella)
Immunocompromised patients are at greater risk for
fungal and Pneumocystis pneumonia,
What are three primary factors that influence the renal absorption of phosphate? DIP
Dietary intake of phosphate
Insulin-like growth factor
Parathyroid hormone
When does the anterior fontanelle normally close?
Between 9 and 18 months
In 96% of children, the anterior fontanelle closes by
2 years of age.
The posterior fontanelle closes at approximately
4 months
Which reflex would help influence the tidal volume and respiratory rate of an infant by inhibiting deep inspiration?
Hering-Breuer reflex
The cessation of inspiration in response to lung inflation.
The Hering-Breuer reflex
Which patient should not proceed with a scheduled liver transplant?
Patients with portopulmonary hypertension have an extremely high perioperative mortality rate with liver transplant surgery. In fact, a mean PA pressure greater than 50 mmHg is considered an absolute contraindication to liver transplant surgery.
A Common diagnosis in patients presenting for liver transplantation
Renal failure
Absolute contraindications to LIVER TRANSPLANT SURGERY
PA pressure greater than 50 mmHg
Which of the following is true of hepatorenal syndrome?
Norepinephrine is useful in maintaining renal function in this syndrome
Hepatorenal syndrome is functionally related to extreme
Renal vasoconstriction
Diagnostic criteria for hepatorenal syndrome
Cirrhosis with Ascites
Serum Cr>1.5 in the absence of parenchymal kidney disease, shock, or treatment with nephrotoxic drugs.
Types of hepatorenal syndrome and differentiate between the two
Type 1 is more severe, rapid decline in GFR, median survival 2 weeks
Type2 more progressive, slower course of renal failure.
The significance of hepatorenal syndrome presentation
Ominous sign and signals the need for IMMEDIATE TRANSPLANTATION evaluation.
Eyes muscle , extremities, diaphragm correct order in which they would become paralyzed by a nondepolarizing muscle relaxant.
Eyes , Extremities, diaphragm.
The lethal triad that produces a vicious cycle of hemorrhage in the trauma patient is (HAD)
Hypothermia
Acidosis
Dilutional coagulopathy.
The administration of ‘washed’ red blood cells helps reduce the incidence of reactions mediated by
IgA Antibodies
The most common bone to encounter when performing a subarachnoid block via a paramedian approach is the
vertebral lamina.
The sciatic nerve innervates the muscles of the back of the thigh which are?
BSSA (biceps femoris, semitendinosis, semimembranosus, and adductor magnus)
From the back of the thigh to down, As the sciatic nerve continues, it innervates the muscles of the lower leg and foot with the exception of the
with the exception of the extensor digitorum brevis which innervates the 2nd-4th toes and derives from the peroneal nerve).
Which of the following is not decreased in elderly patients?
Circulatory time (is increased)
What is the ideal body weight in kilograms for a 55 year-old male patient who is 6 foot 3 inches tall? (calculate your answer to the nearest whole number)
91 kg
Overweight BMI
25 to 29 kg/m2
BMI is calculated by
Weight in Kg / Height in m2
BMI is the accepted measure of
Body habitus that describes adiposity normalized for height
Underweight BMI
Less than 18.5
Normal BMI
18.5 to 24.9
Obesity Class I BMI
30-34.9
Obesity Class II BMI
35-39.9
Extreme Obesity BMI
> 40
Ropivacaine is better suited than bupivacaine for a lumbar epidural for a laboring parturient because (select two)
It produces less motor block than bupivacaine
It causes less central nervous system toxicity than bupivacaine
Which of the following drugs would cross the placenta more easily? (select two) Charge and proteins
Drugs with no ionic charge
Drugs that bind to albumin (albumin decreases with pregnancy)
Pain in the area of the sacroiliac joint with radiation to the groin, medial buttocks, and posterior thigh with occasional radiation below the level of the knee is consistent with what syndrome?
Pyriformis syndrome
Useful for monitoring basic brainstem function
Brainstem auditory evoked potentials
What is the primary advantage of using an Andrews frame for lumbar spine surgery?
Decreased bleeding.
How does the Andrews Frame decrease the risk of bleeding during lumbar spine surgery?
The Andrews frame secures the patient in knee-chest position with the abdomen hanging freely which reduces intra-abdominal pressure and contributes to decreased blood loss. Because the legs are below the level of the heart, venous return is decreased and severe hypotension can result.
Studies have shown that the efficacy of epidural steroid injections lasts for no longer than
3 months
The nerves that contribute to the lumbar plexus are the
SIgILFO subcostal iliohypogastric genitofemoral, Ilioinguinal, lateral femoral cutaneous, femoral, and obturator.
The nerves that contribute to the lumbar plexus are the
subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator.
Magnesium level 5–7 = SIgns and symptoms
Hypotension
Magnesium level 10 =Signs and symptoms
Respiratory paralysis, coma
Magnesium level 10–15 =SIgns and symptoms
Heart block
Magnesium level 10–24=SIgns and symptoms
Cardiac arrest
Magnesium level 10–24=
Cardiac arrest
At level of mag 10 and up
Respiratory paralysis
Coma
Heart block and cardiac arrest.
A 37 year-old, healthy male suffered a high-voltage electrical burn and fell from a ladder while repairing an electrical line. He is undergoing surgery for repair of a fracture. He also has burns to most of his torso and arms. What is the minimum urinary output you would attempt to maintain in this patient intraoperatively?
1 mL/kg/hour
A vaporizer that splits fresh gas flow between the vaporizing chamber and the bypass chamber is referred to as a
variable-bypass vaporizer
An HME should not be used with a
heated humidifier. The combination of the two can produce a dangerous resistance to airflow.
The most common symptom of carcinoid syndrome is
flushing
2nd is Diarrhea
A reversal of a left-to-right intracardiac shunt due to an increase in the pulmonary vascular resistance is associated with
Eisenmenger’s syndrome
Eisenmenger’s syndrome is a reversal of a
left-to-right intracardiac shunt due to an increase in the pulmonary vascular resistance. Once the pulmonary vascular resistance reaches a level that is equal to or exceeds systemic vascular resistance, the shunt reverses to a right-to-left shunt.
In pharmacokinetics, steady-state refers to a situation in which
All of the tissues in the body have had time to reach equilibrium. The concentration of drug differs between organs, but no longer varies from moment-to-moment.
What is the greatest contributor to the risk of morbidity following a carotid endarterectomy?
With an incidence of 2-5%, myocardial infarction is the greatest contributor to the risk of morbidity following a carotid endarterectomy.
Are anesthetized during an ankle block.
The deep peroneal, saphenous, posterior tibial, sural, and superficial peroneal
The sudden onset of seizures during administration of a retrobulbar block is most likely due to
retrograde injection of local anesthetic through the circle of Willis
Seizures probably represent the inadvertent intravascular injection of the local anesthetic during the procedure. Accidental injection into the opthalmic artery will drive the local anesthetic in r
etrograde fashion through the internal carotid artery and then to the circle of Willis.
Cytochrome P450 enzymes are involved ins. Tr. Drugs such as remifentanil, esmolol, succinylcholine, and ester local anesthetics undergo hydrolysis.
oxidation, reduction, and conjugation reaction
The only metabolic pathway in which CYP 450 enzymes are not present is____, which typically occurs
hydrolysis ; outside of the live
Epidural anesthesia has been reported to be effective in preventing autonomic hyperreflexia from occurring due to uterine contractions, but, because epidurals may spare the sacral segments,
spinal anesthesia is more protective.
Best anesthesia maintenance for hypertrophic cardiomyopathy and why?
Anesthesia is usually maintained by controlled myocardial depression using volatile anesthetics. T
Hypertrophic cardiomyopathy involves
enlargement of the interventricular septum which results in left ventricular outflow obstruction.
Things that worsen Hypertrophic cardiomyopathy?
his obstruction is worsened by increased heart rate or increased myocardial contractility as well as decreases in preload or afterload.
Occurs frequently in patients under the age of 30
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is associated with ______dysrfunction. Symptoms ?
associated with diastolic dysfunction
Patients are typically asymptomatic at rest
The first manifestation of hypertrophic cardiomyopathy in patients younger than 30 years is
often sudden cardiac death, which is also the most common cause of death.
Patients with hypertrophic cardiomyopathy typically suffer from diastolic dysfunction which is exhibited by
increased left ventricular end-diastolic pressures despite an often hyperdynamic left ventricular function.
Hyperdynamic LV function is associated with which cardiomyopathy?
Hypertrophic
Which of the following valvular lesions is most likely to result in eccentric left ventricular hypertrophy?
Aortic Regurgitation
The hallmark characteristic of aortic regurgitation is what kind of LVH?
eccentric left ventricular hypertrophy.
Which of the following agents will precipitate when combined in an intravenous line with thiopental?
If administered shortly after thiopental, vecuronium can react with thiopental to produce barbituric acid, a precipitate that can obstruct the IV.
Electrocardiographic signs consistent with cor pulmonale include.
peaked P waves in leads II, III, and aVF which are consistent with right atrial hypertrophy and right axis deviation and right bundle branch block which are consistent with right ventricular hypertrophy
Lead is helpful in the detection of anterolateral ischemia.
The V5
To create a modified V5 lead,
place the left leg and right arm leads in their normal positions, then place the left arm lead over the anterior axillary line at the level of the fifth intercostal space and select Lead I as the monitoring lead.
Which form of hemoglobin is most commonly found in the normal, adult bloodstream?
Hemoglobin A
Hemoglobin A comprises about
97% of all the hemoglobin found in the normal, adult bloodstream. , and
Hemoglobin C is implicated in a
type of hemolytic anemia
hemoglobin S is found in patients with
sickle cell anemia.
Hemoglobin F is found in
fetuses
Chronic hypertension leads to a contracted fluid volume status, which results in a
concentration of the red blood cells in a smaller space, thereby increasing the hematocrit.
Sickle cell results in the
destruction of red blood cells which lowers the hematocrit.
Dehydration also concentrates
the red blood cells in a smaller fluid space, resulting in an increased hematocrit.
Polycythemia is a condition resulting in an
elevation of the hematocrit due to an overproduction of red blood cells.
Which of the following conditions does not lead to an elevated hematocrit?
Sickle cell crisis
Massive proteinuria (exceeding 750 mg/day) would be consistent with extensive damage to what renal structure?
Glomerulus
You are consulted by the emergency department for a patient exhibiting inspiratory stridor, drooling, sore throat, dysphagia, tachycardia, fever, and prefers a sitting, sniffing position to breathe easier. You suspect that this patient suffers from
Inflammation of the supraglottic airway structures
Which of the following findings is NOT consistent with the respiratory changes you would expect to see with morbid obesity?
Obstructive (it is usually restrictive)
Which of the following findings consistent with the respiratory changes you would expect to see with morbid obesity? 3
Increased alveolar ventilation
Increased CO2 production
Increased oxygen demand
Which of the following classes of drugs inhibits platelet function by increasing the level of cyclic AMP?
Phosphodiesterase inhibitors
What is the primary anesthetic concern when inducing a patient with pyloric stenosis?
Pulmonary aspiration
Which of the following is true regarding the saphenous nerve? It can be blocked by
injecting local anesthetic anterior to the medial malleolus
Multiple sclerosis is characterized by
demyelination of neurons in the central nervous system (peripheral nerves are not affected). think Multiple CENTROSIS
For Multiple sclerosis, You should avoid increases in
body temperature as they may result in relapses. Pregnancy is associated with a decrease in the rate of relapse.
Which of the following symptoms would you expect to be consistent in a patient with systemic lupus erythematosus (SLE)? (select two)
Nephritis
Cognitive dysfunction
SLE is very likely if a patient exhibits three of the following characteristic manifestations:
antinuclear antibodies, nephritis, serositis, thrombocytopenia, or a characteristic rash.
In all muscular dystrophies, there is a ______and NO ______
ymmetric atrophy of skeletal muscle tissue, however, there is no denervation of skeletal tissue, meaning that sensation and reflexes are intact
Cardiac muscle characteristically degenerates with Duchenne muscular dystrophy and may result in what kind of cardiac issues?
mitral regurgitation due to papillary muscle dysfunction.
Cardiac muscle characteristically degenerates with Duchenne muscular dystrophy and may result in what kind of cardiac issues?
mitral regurgitation due to papillary muscle dysfunction.
About 30% of deaths in patients with Duchenne muscular dystrophy are due to
pulmonary causes.
A key difference between latex allergies and sensitivity to other allergens is that the onset of symptoms from latex allergy
do not begin until about 30 minutes after exposure compared to 5-10 minutes for other allergies.
It accounts for approximately 15% of all intraoperative allergic reactions, is mediated by IgE antibodies, and is
Latex
Latex allergy is more common in patients with
more common in patients with fruit allergies, spina bifida, a history of multiple surgeries, and healthcare workers.
Which of the following parameters would be most appropriate for use in calculating the propofol induction dose for an obese patient?
Lean body weight
IM Succinylcholine dose for children
4mg/kg
What is the most sensitive indicator of cardiac ischemia during thoracic surgery when the aorta is cross-clamped?
Transesophageal echocardiography
Which of the following are reduced in patients with severe kyphoscoliosis? (select two)
Residual volume
D. Vital capacity
Which of the following are reduced in patients with severe kyphoscoliosis? (select two)
Residual volume
Vital capacity
What chemical is the starting point for the Kreb’s cycle?
Acetyl coenzyme A
The Kreb’s cycle (also called the tricarboxylic acid cycle and citric acid cycle) is a series of energy-producing reactions that begins with a
Two-carbon molecule derived from acetyl coenzyme A. Most of the energy made available by the oxidative steps of the cycle is transferred as energy-rich electrons to NAD+, forming NADH. For each acetyl group that enters the citric acid cycle, three molecules of NADH are produced.
What is the most common cause of secondary hypertension?
Renal artery stenosis
Which two hemodynamic changes would increase the severity of aortic regurgitation? (select two)
An increase in the diastolic blood pressure
The decrease in heart rate and effect on aortic regurgitation?
increases the diastolic time which adversely affects the patient’s condition by increasing the proportion of the stroke volume that regurgitates backward through the aortic valve.
How does increase in diastolic BP affect aortic regurgitation?
An increase in the diastolic blood pressure increases the backward pressure gradient which results in an increase in the proportion of stroke volume that regurgitates back into the left ventricle.
Which of the following is a likely complication of antiretroviral regimens in the treatment of HIV?
lipodystrophy, dyslipidemia, and insulin resistance.
What is the most common cause of acute glomerulonephritis?
Antigen-antibody complex deposition
The plasma half-life of a drug is______ ______ to its rate of clearance
inversely proportional
Membrane thickness is an important factor in the rate of diffusion as is molecular weight, which affects the diffusion coefficient (p) in the equation, but neither of these variables are as important as
the concentration gradient.
The plasma half-life is inversely proportional to its rate of clearance. Enzyme induction reduces the
plasma half-life of agents that are metabolized by that particular metabolic pathway.
Zero-order kinetics refers to metabolism in which the
amount of the drug eliminated over time is constant.
The administration of what drugs have been shown to reverse the bile duct spasm that can occur from opioid administration? (select two)
Glucagon
Naloxone
An increase in hydrogen ion concentration on neuronal activity ?..
depresses neuronal activity. It also causes an increase in blood flow to the brain
‘wash away’ the hydrogen ions, carbon-dioxide, and other acid precursors away from the brain which
returns the hydrogen ion concentration back to normal.
What organism is responsible for causing tuberculosis?
Mycobacterium tuberculosis
Which of the following radiographic changes are consistent with cor pulmonale? (select two)
Decreased vascular markings in the peripheral fields
Decreased retrosternal space on the lateral film
Patients taking levodopa for the treatment of Parkinson’s disease may exhibit (select two)
dyskinesias
Orthostatic hypotension
What is a precursor to dopamine?
Levodopa
Carbidopa is combined with a decarboxylase inhibitor to prevent the
peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.
Orthostatic hypotension is also common in these individuals and levodopa therapy may result in
nausea and vomiting as a result of stimulation of the chemoreceptor trigger zone.
It is combined with a decarboxylase inhibitor to prevent the
peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.
Side effects of Levodopa
include dyskinesias (in over 80% of patients after one year of treatment), hallucinations, paranoia, and mania. Increases in cardiac contractility and heart rate occur.
Why is levodopa combined with Carbidopa?
Decarboxylase inhibitor.Peripheral conversion of levodopa to dopamine and increase levels in the central nervous system.
Which of the following would be the most appropriate anesthetic technique for a patient with multiple sclerosis?
Epidural anesthesia with bupivacaine
Pt with multiple sclerosis most common choice for anesthesia? Epidural anesthesia is considered less of a risk than spinal anesthesia.
General anesthesia is the most common choice for anesthesia, but succinylcholine can potentially result in a hyperkalemic response.
Pt with multiple sclerosis most common choice for anesthesia type (spinal, vs. epidural, vs. GA)
General anesthesia is the most common choice for anesthesia but succinylcholine can potentially result in a hyperkalemic response.
Multiple sclerois, what type of anesthesia?
Spinal anesthesia is typically avoided as there is speculation that the lack of myelin predisposes the neurons to the effects of local anesthetic toxicity.
Multiple sclerosis, what type of anesthesia should be avoided?
Spinal anesthesia is typically avoided as there is speculation that the lack of myelin predisposes the neurons to the effects of local anesthetic toxicity.
MS: spinal vs epidural anesthesia
Epidural anesthesia is considered less of a risk than spinal anesthesia.
Which of the following factors is associated with an increased risk for postoperative ventilation following general anesthesia for THYMECTOMY, in patients with myasthenia gravis? (select two)
Daily pyridostigmine dose greater than 750 mg
Disease duration greater than 6 years
COPD
A negative inspiratory pressure less than -25 cm H2O, Vital capacity less than 2.9 L.
Which of the following statements regarding Duchenne muscular dystrophy is true? (select two) “:: Muscle relaxants
Succinylcholine is contraindicated
The response to nondepolarizing muscle relaxants is normal
The Tec 6 vaporizer is heated to ______and pressurized to______.
39 degrees Celsius; 2 atmospheres
Is the TEC 6 Vaporizer a variable bypass vaporizer?
It is not a variable bypass vaporizer and unlike these devices, no fresh gas flows through the sump.
Medical gas tanks connect to the anesthesia machine using a safety mechanism called the
PISS two 5 mm pins that have to align the matching connector to prevent the inadvertent connection of a wrong gas cylinder to an anesthesia machine.
2 true statements regarding the vaporizer pumping effect? (select two)
It can result in elevated vaporizer output
It is more prominent at high respiratory rates
The pumping effect is an
intermittent back pressure caused by positive pressure ventilation or use of the oxygen flush valve, results in elevated vaporizer output.
Pumping effect is more prominent with
low flows low vaporizer dial settings low levels of anesthetic in the vaporizer chamber high respiratory rates, high peak inspiratory pressures.
Which electroencephalogram (EEG) findings would be consistent with light anesthesia or profound surgical stimulation?
HFLV
High Frequency , Low voltage
Which of the following are associated with an increased central venous pressure reading? (select two)
Pulmonary hypertension
Heart failure
are all associated with increased central venous pressure readings.
Right ventricular failure, tamponade, tricuspid stenosis, tricuspid regurgitation, pericarditis, pulmonary hypertension, chronic left ventricular failure, and hypervolemia
Other factors that can increase the
CVP include mechanical ventilation, PEEP, tension pneumothorax, and pulmonary embolism.
What is the purpose of using a leukoreduction filter when administering a blood transfusion?
Reducing the risk of nonhemolytic transfusion reaction
Which of the following are disadvantages to storing blood? (select two)
Adenosine triphosphate levels decrease in stored blood
2, 3 DPG levels decrease in stored blood
When large doses of blood are administered through rapid infusion devices, the sudden increase in
potassium can be hazardous and sudden cardiac arrests have been attributed to it.
What two factors are the primary determinants of the duration of action of a spinal anesthetic? (select two)
The specific drug used
The dose of the drug given
Which of the following statements are true regarding cardiac arrest during a spinal anesthetic? (select two)
It is usually preceded by bradycardia
It is associated with a drop in preload
Which anesthetic types would be appropriate for an anticoagulated patient undergoing cataract surgery? (select two)
General anesthesia
Topical anesthesia
What muscles of the hand receive their motor innervation from the median nerve?
The muscles of the thenar eminence
The area incised for the hamstring graft is innervated by the
Sciatic nerve
You are preparing to perform an intercostal nerve block. After preparing the skin with antiseptic solution, you make a skin wheal
directly over the rib near the midaxillary line
Intercostal nerve block Ideally, the patient is in the
prone position, but can be performed with the patient lying on the unaffected side.
Intercostal nerve block??
The correct rib is identified by palpation, a skin wheal is made directly over it at the level of the midaxillary line, and then a 22 gauge B-bevel needle is walked off the inferior border of the rib and advanced about 0.5 cm. After careful aspiration for blood or air, 3 to 5 mL of local anesthetic is injected
Which of the following statements concerning total laryngectomy are false? (select two)
A tracheostomy tube is necessary
It is necessary to remove the thyroid gland as a part of this procedure
What nerves are most at risk for damage or temporary dysfunction from a carotid endarterectomy? (select three)
Superior laryngeal
Hypoglossal
Recurrent laryngeal
You are performing anesthesia for a 70 kg patient undergoing a carotid artery stent procedure. What dose of heparin would you expect to administer as an intravenous bolus during the case?
Heparin in the range of 50 to 100 units per kilogram is typically administered as a bolus for a carotid artery stent procedure.
Which location would be least appropriate for placement of an arterial line in a patient undergoing surgery on the distal aortic arch?
Left wrist.Because the left subclavian artery may be manipulated during the operation, which would disrupt monitoring in the left radial artery, monitoring pressures via another site would be preferred. The right radial is often used.
Which of the following statements is true regarding the cardiac system of the premature infant?
The heart has a greater dependence upon extracellular calcium concentrations
The fetal heart contains more .
connective tissue, the contractile elements are less organized, and contractility has a greater dependence upon the extracellular calcium concentration.
Infants and autoregulation
Autoregulation is not yet matured, so the heart rate does not respond sufficiently to hypovolemia
The heart of the premature infant is less sensitive to
catecholamines because it is already near the maximum level of beta-adrenergic stimulation.
Digitalis is contraindicated in
premature infants because no resulting increase in contractility or ventricular ejection occurs, but the heart rate does slow down, resulting in a decrease in cardiac output.
Dopamine and neonates
. Neonates exhibit resistance to the cardiac effects of dopamine. Term neonates exhibit resistance to the cardiac effects of dopamine and may not exhibit increased blood pressure and urine output until doses of 50 mcg/kg/min are reached.
Neonates:Myocardial concentrations of digoxin can be as much as ____that of adults at the same serum concentration.
6 times higher than
Which of the following changes occurs during pregnancy? (select two)
Plasma renin activity increases
The left ventricular end-diastolic volume increases
Which of the following obstetric conditions likely warrants a crash induction for emergency cesarean section?
Placenta abruptio
Which of the following thyroid hormones are increased during pregnancy?
Total T3 and T4 levels
Which of the following drugs will cross the placenta? (Vasodilator)
Nitroprussie
Succinylcholine
Heparin
Protamine which one cross the placenta?
None
Which anesthetic technique is most likely to reduce uterine blood flow in an obstetric patient?
Administration of a paracervical block
What is one reason many geriatric patients are more susceptible to hypothermia?
They are more prone to hypothyroidism
Which of the following characteristics do geriatric patients share with neonates?
A higher body surface area to body mass ratio
Which of the following contribute to the prolonged elimination half-life of many drugs in geriatric patients? (select two)
Decreased renal blood flow
Increased lipid stores
A patient is suffering from an exacerbation of chronic ventilatory failure and exhibits severe acidosis (pH = 7.19). You are about to intubate the patient and place him on the ventilator. Which of the following statements are true?
This patient will exhibit a decreased response to exogenous catecholamines
Hypermagnesemia can result from
excess dietary intake of magnesium, excess ingestion of oral antacids, hypothyroidism, hyperparathyroidism, Addison’s disease, and lithium therapy.
One method of treating hypermagnesemia.
Forced diuresis with saline and loop diuretics is
Which cholinesterase inhibitor has the shortest duration of action?
Edrophonium
What is the determining factor in degree of muscle stimulation when using a peripheral nerve stimulation?
Current
The risk for dural puncture, vascular injury, and neural damage is greatest when performing
Cervical epidural blocks
A MAZE procedure is performed to treat
atrial fibrillation
Hyperglycemia results in
hyponatremia, hypophosphatemia, hypokalemia, and hypomagnesemia.
What electrolye abnormalities usually occur with diabetic ketoacidosis? (select four)
hyponatremia, hypophosphatemia, hypokalemia, and hypomagnesemia.
Which of the following is a cause of secondary hyperparathyroidism?
Chronic renal failure
What percent of healthcare workers’ mobile phones test positive for bacteria?
90%
Which of the following does not decrease significantly with age?
. Baseline hepatic function
By age 80, the number of functioning nephrons has .
decreased by 50 percent.
Lean muscle mass with age
decreases
Bone density with age, increasing the risk for fractures.
decreases significantly
Although hepatic mass decreases significantly,
baseline hepatic function remains well preserved with age.
Which pediatric condition would require surgical intervention the soonest after delivery?
Gastrochisis
Baseline hepatic function and aging
does not significantly change
Which of the following drugs affects coagulation by inhibiting cyclooxygenase?
ASA
Lean muscle mass with age
decreases
Bone density with age, increasing the risk for fractures.
decreases significantly
Although hepatic mass decreases significantly,
baseline hepatic function remains well preserved with age.
Which pediatric condition would require surgical intervention the soonest after delivery?
Gastrochisis
Dipyridamole class
phosphodiesterase inhibitor,
Both normal plasma osmolarity and urine osmolarity indicates an
excellent ability of the tubules to concentrate urine. A situation wherein the plasma and urine osmolality become fixed together indicates serious damage to the renal tubules.
What is the normal tissue PO2 in the brain?
35-40 mmHg
Normal urine osmoloarity is about
around 1400 mOsm/Kg
The normal plasma osmolality of about
290 mOsm/Kg)
What is the normal tissue PO2 in the brain?
. 35-40 mmHg
Parathyroid hormone increases serum calcium levels by.
promoting the breakdown of bone, regulation of renal calcium excretion, and altering the GI absorption of the mineral
Analyzers that can’t detect oxygen content true regarding infrared gas analyzers?
infrared gas analyzers
Which of the following acid-base disorders would you expect to see in the patient with pyloric stenosis?
Hypochloremic, hypokalemic metabolic alkalosis
Too rapid administration of DDAVP IV can cause
hypotension.
Analyzers that can’t detect oxygen content true regarding infrared gas analyzers?
infrared gas analyzers?
The sensation that non-painful stimuli is painful
Allodyia
Which of the following are associated with supraventricular tachycardia? (select two)
Syncope
Polyuria
Chronic renal disease can produce renal osteodystrophy (changes in the mineralization of bone). The most important contributors to this are
secondary hyperparathyroidism and a decrease in the production of vitamin D by the kidneys.
Which of the following are indications for the use of pyridostigmine? (select two)
Myasthenia gravis
Nondepolarizing muscle relaxant reversal
As cholinesterase inhibitors can result in
bradycardia,
Which of the following statements is true regarding flumazenil?
Flumazenil administration is not associated with cardiovascular changes
Flumazenil half life is
It has a half-life of about 1 hour, so it is possible that re-sedation can occur with benzodiazepines that have a longer half-life than this.
Flumazenil is metabolized where?
in the liver
The effects of these three anticholinergics can be understood as follows: Antisialogogue:
Scopolamine>Glycopyrrolate>Atropine,
The effects of these three anticholinergics can be understood as follows: Increased Heart Rate:
Atropine>Glycopyrrolate>Scopolamine,
The effects of these three anticholinergics can be understood as follows: Sedation:
Scopolamine>Atropine>Glycopyrrolate
SA nodes action potential phase 4 is initiated and propelled primarily by
An inward flow of both sodium ions and calcium ions
An SA node action potential contains three distinct phases:
Phase 4: the spontaneous depolarization that triggers the action potential once the transmembrane potential reaches threshold (about -45 millivolts). Phase 0: depolarization phase of the action potential Phase 3: repolarization
Disadvantages of using a heat and moisture exchanger (HME) include (select two)
Increased work of breathing
Can result in airway obstruction
The primary disadvantages of HMEs are that they are not nearly as effective at
warming and humidifying the patient airway as water-based, electrical devices
They also increase deadspace and can increase the work of breathing.
If increased airway resistance is experienced during an anesthetic, t
he peak pressure should be measured both with and without the HME in place.
Which disease process is not associated with increased risk for nephrolithiasis?
SLE
Most kidney stones are formed from
calcium oxalate and the potential for and causes of hypercalcemia should be evaluated in patients undergoing anesthesia for kidney stone removal including cancer, sarcoidosis, and hyperparathyroidism.
About half of the patients who develop stones formed from
uric acid suffer from gout.
A patient with a history of spinal cord injury is undergoing a cesarean section. Which anesthetic modality would be the most effective at preventing autonomic hyperreflexia?
Spinal
The roof of the ethmoid sinus is the ______and ______Piercing this sinus can result in a
cribriform plate and anterior skull base.
Communication between the airway and the cranial vault and CSF may be seen leaking from the nose.
A panendoscopy includes _____(3)To provide adequate visualization for the surgeon, intubation with a
laryngoscopy, bronchoscopy, and esophagoscopy. microlaryngeal tube may be used as can jet ventilation. If jet ventilation is used, then a TIVA anesthetic would need to be employed because of the inability to deliver anesthetic gas to the patient.
During general anesthesia for endoscopic surgery of the ethmoid sinus, the surgeon indicates he may have pierced the ethmoid roof. Which of the following actions are contraindicated on emergence?
Vigorous bag mask ventilation to reduce the end-tidal CO2
In pregnant patients, the gastric emptying time is______ ; the gastric secretions are
is not increased; more acidic.
The lower esophageal sphincter pressure can decrease due to the effects of progesterone. The gravid uterus can also increas
the intragastric pressure, making reflux more likely.
Magnesium and Uterine blood flow
increases uterine blood flow in both hypertensive and normotensive subjects
The lower esophageal sphincter pressure can decrease due to the effects of progesterone. The gravid uterus can also increas
e intragastric pressure, making reflux more likely.
Sevoflurane, isoflurane, and desflurane have been shown to exert no change on uterine blood flow between 0.5 and 1.5 MAC. Although with higher levels of inhaled anesthetic (2 MAC or greater), uterine blood flow may be decreased, there have been no reports of impaired fetal gas exchange. Verapamil 0.2mg/kg has been shown to decrease maternal blood pressure and decrease uterine blood flow. Local anesthetics exert a vasoconstrictor property that can reduce uterine blood flow. The normal concentrations used do not normally have this effect with two exceptions: 1) inadvertent intravenous injection of a local anesthetic, and 2) paracervical block. Bupivacaine exerts a greater vasoconstrictor effect than either chloroprocaine or lidocaine.
increases uterine blood flow in both hypertensive and normotensive subjects
Magnesium on uterine blood flow. Even though it may magnify hypotension in patients undergoing epidural anesthesia, magnesium still does
not decrease uterine blood flow.
VA and uterine blood flow
Sevoflurane, isoflurane, and desflurane have been shown to exert no change on uterine blood flow between 0.5 and 1.5 MAC.
Although with higher levels of inhaled anesthetic (2 MAC or greater), uterine blood flow may be decreased, there have been no
reports of impaired fetal gas exchange.
Uterine Blood flow and Verapamil.
Verapamil 0.2mg/kg has been shown to decrease maternal blood pressure and decrease uterine blood flow.
Local anesthetics exert a vasoconstrictor property that can reduce do what on uteribe blood flow?
uterine blood flow
With Uterine blood flow, The normal concentrations used do not normally have this effect with two exceptions:
1) inadvertent intravenous injection of a local anesthetic, and 2) paracervical block. Bupivacaine exerts a greater vasoconstrictor effect than either chloroprocaine or lidocaine.
All of the lung parameters below increase with age except for
TOTAL LUNC CAPACITY .
Which of the following increases as a result of the aging process?
Catecholamine levels
As a result of aging, the response to beta-receptor stimulation and and parasympathetic activity increase or decrease?
Efficacy of blood pressure control by the baroreflex decreases with age.
Aging: Efficacy of blood pressure control by the baroreflex
decreases with age.
Which statement regarding obesity hypoventilation syndrome (OHS) and obstructive sleep apnea (OSA) is true?
Both have nocturnal respiration program
Which of the following will reduce the hemodilution and dilutional coagulopathy attributed to cardiopulmonary bypass (CPB) priming fluid?
Miniaturized cardiopulmonary bypass circuits
Proper understanding of the appropriate anesthetic management of a patient undergoing a high tracheal resection? What position should be maintained?
. The patient should be maintained in a head-down position during the procedure
During tracheal resection, FIO2? and why?
a high FiO2 should be maintained throughout the case to ensure adequate oxygenation of the functional residual capacity so temporary interruptions in ventilation are tolerated without hypoxia
The primary interventions to improve cerebral perfusion pressure (CPP) in a trauma patient with intracranial hypertension are to maintain a
mean arterial pressure of at least 70-75 mmHg to ensure a CPP of at least 60 mmHg and promote oxygenation and adequate glucose levels without hyperglycemia.
Measures to reduce intracranial pressure may include
reverse Trendelenburg position, short-acting sedatives such as propofol, midazolam or fentanyl, CSF drainage via a ventriculostomy, and neuromuscular blockade.
The primary interventions to improve cerebral perfusion pressure (CPP) in a trauma patient with intracranial hypertension are to maintain a mean arterial pressure of
at least 70-75 mmHg to ensure a CPP of at least 60 mmHg and promote oxygenation and adequate glucose levels without hyperglycemia.
The induction dose of propofol in infants between 1-6 months of age is
3 mg/kg.
The induction dose of propofol in infants between 1-6 months of age is
3 mg/kg.
For children 1-12 years old, it is
1.3-1.6 mg/kg.
Hypotension, tachycardia, cutaneous hyperemia, and hypoxia are signs of mesenteric traction syndrome which is caused by
the release of vasoactive amines (principally prostacyclin) from the vascular bed of the mesentery. As a result, serum prostaglandin levels increase substantially. Non-steroidal anti-inflammatory agents such as aspirin and ketorolac ameliorate these symptoms.
According to the standards set by the American Society for Testing and Materials (ASTM), a reservoir bag of 3 liters that is distended to four times its size shall not exert pressures that are (select two)
Less than 35 cm H2O
Greater than 60 cm H2O
According to the standards set by the ASTM, 3-liter reservoir bags (also called breathing bags) that are
distended to four times their normal size should not exert a pressure less than 35 cm H2O or greater than 60 cm H2O.
Bags that are 1.5 L in size or smaller shall not exert a pressure less than
30 cm H2O or greater than 50 cm H2O when distended to this extent. The lowest pressure to be exerted is to ensure that the bag is capable of exerting enough minimum pressure to ventilate a patient and the highest pressure is to limit the amount of barotrauma that a patient may be exposed to when using the breathing bag.
Gastrochisis Covering membrane
NO
Omphalocele Covering membrane
yes
Gastrochisis –>Location of defect
Right of umbilicus
Omphalocele –>Location of defect
Midline including umbilicus
Umbilical cord insertion: Gastrochisis
Body wall at normal
location
Umbilical cord insertion: Omphalocele
Omphalocele membrane
Herniated abdominal organs : Gastrochisisl Bowel and sometimes liver
Bowel
Herniated abdominal organs : Omphalocele
Bowel and sometimes liver
Associated anomalies Gastrochisis vs Omphalocele
Uncommon with G
Very common with Omphalocele
Prognostic factors Gastrochisis
condition of bowel
Omphalocele prognostic factors
Associated anomalies
TEC 6 vaporize filling?
Although the Tec 6 vaporizer is unique in that
it can be filled while in operation,106 it is safer to turn it off momentarily
Filling a variable bypass vaporizers?
All variable-bypass vaporizers must be shut off while they are being filled
Vaporizers and overfilling
Overfilling may result in discharge of liquid anesthetic from the vaporizer outlet, which has caused patient
injuries
TEC 6 no OUTPUT alarms sound when?
The No Output alarms are activated if the
agent level is less than 20 mL,
if the vaporizer is tilted more than 10 degrees from the vertical,
if there is a power failure lasting longer
than 10 seconds, or if an internal malfunction occurs
Hazards of Modern Vaporizers
Incorrect (unintended) agent administration
• Tipping
• Overfilling with agent
• Reliance on breath-by-breath gas analysis rather than performing regular
preventive maintenance
Responsible for the majority of heat loss.
Radiant heat loss i
Which of the following would decrease the incidence of postoperative hoarseness due to intubation?
The use of low-pressure, high-volume cuffs
When CO2 waveform does not return to baseline?
accumulation of CO2 in the patient due to an incompetent expiratory valve
exhausted CO2 absorbent
the rebreathing of CO2 under the drapes by a spontaneously ventilating patient or potentially, an incompetent inspiratory valve.
A circuit disconnect will generally manifest as
loss of the ETCO2 waveform altogether.
CO2 waveform does not return to baseline, incompetent _____valve
Expiratory.
Which approach to a brachial plexus block is the only one that will provide sufficient analgesia for surgery on the shoulder and upper extremity?
Interscalene
Defined as any abnormal sensation that is unpleasant to the patient?
Dyesthesia
An increased response to a painful stimuli.
Hyperalgesia
Onset of LA is related to what characteristics
Pka
Duration of LA is related to what characteristics
Protein binding (di)
Potency of LA is related to what characteristics
Lipid solubility ( SLP)
You are preparing to perform a Bier block for a procedure that may take longer than 45 minutes. Which of the following methods would be appropriate to help alleviate the pain from the tourniquet?
Use a double tourniquet
In the fetus, the percentage of cardiac output directed to the placenta is approximately:
50%
In the fetus, the lungs receive little blood flow. The placenta receives
nearly one-half of the fetal cardiac output and is responsible for respiratory gas exchange.
Which of the following will exacerbate local anesthetic toxic reactions? (select two)
Hypoxia
Hypercapnia
Utmost importance in the management of inadvertent local anesthetic overdose.
airway control
A patient is in steep Trendelenburg position during a laparoscopic cholecystectomy. The patient suddenly exhibits a decrease in oxygen saturation, subcutaneous crepitation over the chest, and an increase in end-tidal CO2. The first step you should take is
Tell the surgeon to turn off the insufflator.The symptoms listed in the question describe a pneumothorax with entry of the CO2 used for abdominal insufflation entering the lungs. The appropriate immediate measures are to cease insufflation of the abdomen, discontinue nitrous oxide if it is being utilized, increase ventilation, and call for assistance.
Which type of laser produces the greatest amount of smoke and may create the greatest need for protective masks?
CO2 laser
Which of the following complications carries an increased risk in obstetric patients who underwent bariatric surgery prior to conception?
Premature rupture of membranes
Obstetric patients who have undergone bariatric surgery exhibit increased risk for
premature rupture of membranes, small bowel ischemia, nutrient deficiencies, fetal abnormalities, and an increased risk for requiring a cesarean section.
Obstetric patients who have undergone bariatric surgery exhibit
There was a decreased risk for gestational diabetes and pregnancy-induced hypertension and no significant difference in placental abruption, previa, or perinatal complications.
Prior to inducing anesthesia for a patient who has suffered major trauma, changes in the patient’s phonation during the interview may indicate an increased risk for
neurological damage during intubation
Hepatic B vs Hepatitis C in blood transfusion?
The risk of contracting hepatitis B is greater than hepatitis C
can be transmitted by transfusion
The Epstein-Barr virus
Which of the following statements regarding transtracheal block is correct? HOW MUCH AND WHAT % LA
The appropriate dose is 3-5 mL of 2% lidocaine
Which of the following would you expect to occur with a neuraxial anesthetic? (select two) WITH BOWELS?
Generalized constriction of the bowel
Increased peristalsis
Which of the following actions would be appropriate choices for prolonging the duration of a spinal anesthetic? (select two)
Increasing the dose of the local anesthetic injected
Adding 5 mcg of sufentanil to the local anesthetic
You are preparing to perform an intercostal nerve block for a patient suffering from shingles. From superior to inferior, match the structures with the position it maintains in the intercostal neurovascular bundle.
SUPERIOR
MIDDLE
INFERIOR
vein, artery, nerve. (VAN -SMI)
A patient is undergoing surgery on the lower leg and wishes to avoid general anesthesia. You have successfully performed a popliteal block. What other block should be performed to provide complete anesthesia distal to the knee?
Femoral nerve block
A popliteal block spares the
medial anterior calf and medial aspect of the foot. A supplementary femoral nerve block is required to block its terminal saphenous branch which innervates the medial anterior calf and the medial aspect of the foot.
What of the following would decrease the amount of prolapse in patients with mitral valve prolapse? (select two)
Increased intravascular volume
Hypertension
Overall, What decrease the degree of prolapse?.
Any factor that maintains a larger ventricular volume will decrease the degree of prolapse
will decrease the degree of prolapse.
Hypertension, vasoconstriction, drug-induced myocardial depression, and increased preload
Which of the following interventions would be appropriate in the management of a patient with symptomatic cardiac tamponade until a pericardiocentesis can be performed? (select four)
Administering a colloid solution intravenously
Administering a crystalloid solution intravenously
Administration of isoproterenol to prevent bradycardia
Administration of atropine to prevent vagal reflexes
The primary goals in the management of a patient with symptomatic cardiac tamponade include:
- expanding intravascular volume by administering crystalloids or colloids
- maintaining heart rate and contractility by administering catecholamines (including isoproterenol), - administering dopamine to increase systemic vascular resistance if necessary
- administering atropine to prevent vagal reactions to the increased intrapericardial pressure
- correcting metabolic acidosis (metabolic acidosis can have detrimental effects on cardiac contractility).
Correct this electrolyte disturbance in the cardiac tamponade patient?
metabolic acidosis can have detrimental effects on cardiac contractility).
Correct this electrolyte disturbance in the cardiac tamponade patient?
metabolic acidosis can have detrimental effects on cardiac contractilit
According to Poiseuille’s law, if a patient’s airway diameter decreases by half during an asthma attack, then the airway resistance
increases 16-fold
Temperature and decreases in CMRO2
CMRO2 decreases 6-8% for every 1 C drop in temperature.
The perioperative mortality rate for a carotid endarterectomy is
0.5-2.5 percent.
You are performing an anesthetic for a patient undergoing an MRI that is receiving gadolinium contrast dye. What are the most likely side effects of its administration?
Nausea
Biliary stones are considered a posthepatic cause of hepatic dysfunction and are associated with an
increased conjugated fraction of bilirubin, normal to slightly increased aminotransferase enzymes, and most notably, markedly increased alkaline phosphatase levels.
Hepatic dysfunction due to biliary tract obstruction would be consistent with which laboratory finding?
Markedly increased alkaline phosphatase levels
Upon what receptors does nalbuphine act? (select two)
MU, and Kappa
Conditions that warrant postponement of elective procedures for further evaluation include
symptomatic mitral stenosis, new onset ventricular tachycardia, symptomatic ventricular arrhythmias, unstable angina, MI within the past 30 days, severe aortic stenosis, symptomatic bradycardia, and high-grade heart block.
What is the only additive to the local anesthetic for a Bier block that has been proven effective?
Ketorolac
Cisatracurium what you should know
Although a small amount of cisatracurium may be metabolized by plasma esterases, the primary route of metabolism is Hofmann elimination.
Which nondepolarizing muscle relaxant is metabolized predominantly by ester hydrolysis?
Atracurium
A trigger point injection would be most appropriate for the treatment of
myofascial pain
What diagnostic parameter is the most sensitive indicator of the effect of obesity on pulmonary function?
Expiratory reserve volume
It has been shown that the endotracheal tube has a higher likelihood of moving in laparoscopic surgeries in the
morbidly obese patient population.
Patients taking HMG-CoA reductase inhibitors may exhibit (select two)
Elevated creatine kinase
Elevated serum aminotransferase activity
Fibrate anti-lipid medications such as
gemfibrozil and fenofibrate may result in decreased white blood cell counts.
The nerve distribution of the median nerve, which can be blocked by the injection of local anesthetic at the wrist between the
flexor carpi radialis and the palmaris longus tendons.
Which of the following solutions has the highest sodium concentration?
NS
Normal saline has a sodium of
154 mEq/L.
Lactated Ringer’s solution has a sodium of
130 mEq/L
Normosol-R contains ____mEq/L of sodium.
140
Plasma has a sodium concentration of
142 mEq/L
Significant risk for perineal crush injury is associated with which of the following situations?
On traction table to reduce a femur fracture
Arnold-Chiari malformation almost always coexists with Surgical correction is usually performed by a decompressive suboccipital craniectomy with cervical laminectomies to relieve the compression. Because of cranial nerve and brainstem dysfunction, children with this disorder may have abnormal responses to hypoxia and hypercarbia.
yelodysplasia and involves the caudal displacement of the cerebellar vermis, fourth ventricle, and lower brainstem below the level of the foramen magnum.
Medullary cord compression can occur, particularly with
extension of the neck, and patients may present with symptoms such as vocal cord paralysis, swallowing dysfunction, and chronic pulmonary aspiration
Surgical correction is usually performed by a:
Arnold-Chiari malformation
decompressive suboccipital craniectomy with cervical laminectomies to relieve the compression. Because of cranial nerve and brainstem dysfunction, children with this disorder may have abnormal responses to hypoxia and hypercarbia.
You are evaluating a patient who has survived breast cancer and is now presenting for a mammoplasty. Which of the following chemotherapy agents would warrant further investigation into her current hepatic function?
Methotrexate
Which areas of the lower leg would still have sensation after the successful performance of a popliteal block on a patient? (select two)
The medial anterior calf
The medial aspect of the foot
Which of the following indicates a proper understanding of how to apply the thumb and forefinger against the cricoid cartilage when performing the Sellick maneuver?
Pressing backward, upward, and to the right until the fingers blanch directly on the cricoid cartilage
The termination of a large tidal volume breath by signals from stretch receptors within the lung tissue is a result of the
Hering-Breuer reflex
Which of the following conditions are associated with a deficiency of alpha-1 acid antitrypsin?
Emphysema
Transthecal block of the digits: injection
It requires only a single injection
Which diuretic works by decreasing sodium reabsorption and hydrogen ion secretion in the proximal tubules?
Acetazolamide
Which of the following side effects can occur due to the intravenous administration of mannitol? (select two)
Exacerbation of congestive heart failure
A transient decrease in the hematocrit
Which of the following symptoms of cardiac tamponade are indications of ventricular discordance? (select two)
Kussmaul’s sign
Pulsus paradoxus
High airway pressure is a hazard when using a self-inflating manual resuscitator if a pressure relief valve is not utilized. The risk is
greater with endotracheal tubes than with mask or supraglottic devices such as the LMA or laryngeal tube which tend to leak at a lower pressure than an endotracheal tub
Hyperglycemic hyperosmolar syndrome signs
Polyuria, polydipsia, hypotension, tachycardia, hyperosmolarity (>340 mOsm/L) and hypoperfusion of major organs. Intravascular coagulation and mesenteric thrombosis
What is the only indication for intravenous levothyroxine?
Myxedema coma
What surgical procedure would you expect to have the highest risk for the development of acute pancreatitis postoperatively?
Cardiac thoracic surgery
Dressler’s syndrome is
pericarditis following a myocardial infarction
What are the four types of burns? (select four)
Thermal
Electrical
Chemical
Inhalation
Which is a potential disadvantage of using nitroglycerin for controlled hypotension?
It can increase intracranial pressure
With age, renal cortical mass decreases by as much as
25%
Which of the following is most consistent with Hyperglycemic Hyperosmolar State (HHS)?
dehydration
State Alveolar gas equation
pAO2 = FiO2 (Patm – pH20) – (paCO2/RQ
Alveolar gas equation: known variables
Patm is the atmospheric pressure (at sea level 760 mm Hg), PH2O is partial pressure of water (approximately 47mm Hg). FiO2 is the fraction of inspired oxygen. PaCO2 is partial pressure of carbon dioxide in alveoli (in normal physiological conditions around 40 to 45 mmHg). RQ is the respiratory quotient. The value of the RQ can vary depending upon the type of diet and metabolic state. RQ is different for carbohydrates, fats, and proteins (average value is around 0.82 for the human diet). Indirect calorimetry can provide better measurements of RQ by measuring the VO2 (oxygen uptake) and VCo2 (carbon dioxide production).
Increasing altitude decreases the
atmospheric pressure;
Where in the popliteal fossa can the popliteal artery be found?
Immediately lateral to the semitendinous tendon.
A Wright respirometer is located where in the circuit?
expiratory limb and contains vanes that cause it to rotate when exhaled gas passes across it.
What is the leading cause of death in patients with diabetes mellitus?
Cardiovascular disease
hich of the following laboratory results is associated with damage to the renal tubules?
Increased urinary sodium excretion
Steep reverse Trendelenburg position for surgery on the head is associated with
a risk for air embolus
Abducting the arms less than 90 degrees provides a degree of protection for
stretch injury to the brachial plexus, but has little bearing on the ulnar nerve.
Put the patient’s at risk for ulner nerve injury
Pronation of the hand positions the ulnar nerve directly against the table surface, making it a high-risk position. . Supinating the hand shifts the ulnar nerve above the table surface and allows the olecranon to bear the weight of the arm.
Pt with von willebrand disease not respondiing to DDAVP should be give
Patients with von Willebrand disease should be given desmopressin which increases factor VIII-vWF complex and improves coagulation. If desmopressin doesn’t produce a sufficient response, cryoprecipitate should be considered.
Heart conditions that are consistent with RA
Aortic regurgitation
Pleural effusion
Coronary arteritis
EMLA cream consists of a 1:1 mixture of
2.5 percent lidocaine and 2.5 percent prilocaine in an oil-in-water emulsion.
EMLA cream requires a contact time of at least
It requires a contact time of at least one hour under an occlusive dressing, reaches a depth of analgesia of about 3-5 mm, and has a duration of about 1-2 hours.
Injection of 3 mL of 2% lidocaine bilaterally 1 cm below each greater cornu of the hyoid is a
superior laryngeal nerve block which anesthetizes the airway below the epiglottis as well as a portion of the epiglottis itself.
The lingual and pharyngeal branches of the glossopharyngeal nerve are blocked by
infiltrating local anesthetic into the base of the palatoglossal arch.
The patient with sepsis typically presents with a
Comment on wedge pressure, CO, and SVR
low pulmonary capillary wedge pressure, a high cardiac output, and a low systemic vascular resistance.
Select all of the sites where arginine vasopressin exerts its effects (select two)
Renal collecting ducts
Vascular smooth muscles
Which substance enhances the sensitivity of nerve endings to painful stimuli but does not directly excite them?
Substance P
Sarcoidosis is a disorder of the
immune system.
May produce electrical interference that may be interpreted as a ventricular dysrhythmia by an AICD. This could potentially trigger a defibrillation pulse.
Unipolar cautery
If your patient has an AICD?
It is best to consult with someone who has experience with the specific device prior to surgery or place a magnet over the device to temporarily disable it.
Patients with carcinoid tumors do not always experience symptoms related to the release of hormones from the tumor. Why is this?
Because, Usually, hepatic first-pass metabolism eliminates the hormones from the circulatory system before they can exert any deleterious effects.
Side of the heart not affected by carcinoid syndrome.
Left side of the heart not affected.
Most CVAs are_____(ischemic vs. hemorrhagic) in nature.
ischemic
Hemorrhagic vs ischemic stroke?
Hemorrhagic strokes are four times more lethal than ischemic strokes.
The risk for a stroke is higher in men until age
75 when the risk for men and women is the same. Hyperglycemia is associated with poor outcomes in patients with ischemic stroke.
Patients with Huntington’s Chorea and NMB agents?
have extreme sensitivity to nondepolarizing muscle relaxants, therefore they should be titrated very carefully. Also, because of a decrease in plasma cholinesterase, they exhibit an increased sensitivity to succinylcholine.
Dantrolene Full MOA .
e ryanodine type 1 receptor to inhibit the efflux of calcium from the sarcoplasmic reticulum
Dandrolene dose and mix information
It is packaged as a lyophilized (freeze dried) powder that must be mixed with 60 cc of sterile water prior to injection. It may be administered in doses of 2.5 mg/kg every 5 minutes to a total dose of 10 mg/kg.
Associated with Interstitial nephritis
Proteinuria
Decreased ability to concentrate urine
Hypertension
Interstitial nephritis is a disorder most commonly associated with
allergic reactions to drugs such as sulfonamides, allopurinol, phenytoin, and diuretics.
It is also less commonly associated with diseases such as lupus erythematosus and sarcoidosis
Interstitial nephritis
Hereditary nephritis is a genetic disorder most commonly seen in _____ and is associated with _____ and _____ abnormalities.
Males; Hearing and ocular abnormalities.
Hereditary nephritis is associated with ____and _______. Drug treatment successful or unsuccessful?
systemic hypertension and renal failure. Drug treatment has not proved successful in this class of patients.
What is the standard treatment for the condition for Hyperparathyroidism ?
Surgical excision is the standard treatment for the condition.
Signs and symptoms of hyperparathyroidism?
These signs and symptoms include renal stones, polyuria, hypertension, ventricular arrhythmias, muscle weakness, and osteoporosis.
Drugs to avoid with porphyria
KETT PMN
Ketorolac, thiopental, thiamylal, etomidate, pentazocine, methohexital, and nifedipine should all be avoided.
The most common cause of respiratory distress syndrome in the premature infant is
insufficient surfactant production
3 major contributors to Retinopathy of prematurity
Hyperoxia
Hypoxia
hypotension
Indomethacin is what kind of medication? what is it used for?
Potent prostaglandin inhibitor is administered to stimulate closure of a patent ductus arteriosus.
Signs of sepsis.
Low systemic vascular resistance
Tissue hypoperfusion
Disseminated intravascular coagulation
Which of the following is not associated with septic shock?
Low CO (It is a high CO state)
Brachial plexus position to the subclavian artery?
the brachial plexus is positioned posterior to the subclavian artery
What layer of skin is the rate-limiting layer for the absorption of eutectic mixture of local anesthetic (EMLA) cream?
Stratum corneum
The epidermis is the outer layer of skin. It contains
5 layers.
From bottom to top the layers of the SKIN are named:
stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum.
When performing a wrist block, you inject 3 mL of local anesthetic at the level of the styloid process on the volar aspect of the arm between the palmaris longus and flexor carpi radialis tendons. What nerve are you anesthetizing when you do this?
Median
You are caring for a patient undergoing a posterior cervical laminectomy in the sitting position. You suspect a venous air embolism has occurred. What action should be instituted first?
Have the surgeon flood the surgical field with saline
You are caring for a patient undergoing a posterior cervical laminectomy in the sitting position. You suspect a venous air embolism has occurred. What action should be instituted first? second? Third?Fourth
Have the surgeon flood the surgical field with saline
Turn off N20
100% O2
Aspirate the CVC to remove air.
What are prudent measures prior to beginning the procedure in the sitting position at risk for VAE?
Use of a precordial doppler and placement of a central venous line
What is the most common complication that arises from Transphenoidal Hypophysectomy? Is it permanent or temporary?
Complications related to this procedure may arise from the need for mucosal injection of epinephrine to prevent bleeding, the accumulation of blood in the pharynx and stomach, risk of injury to the cavernous sinus or internal carotid artery, damage to cranial nerves III, IV, V1, and VI that travel near the pituitary gland, and hypofunction of the pituitary gland.
Diabetes insipidus; Temporary
Hormones secreted by the Anterior Pituitary Gland ? FLAG TOP
Follicle-stimulating hormone
Luteinizing hormone
Adrenocorticotropic hormone (ACTH)
Growth Hormone (GH)
Thyroid stimulating hormone
O MelanOcyte
Prolactin
The area of myocardium most vulnerable to ischemia is the:
left ventricular subendocardium
The elimination half-life of intravenously administered oxytocin in the parturient is approximately:
30 to 120 seconds
The posterior pituitary releases
antidiuretic hormone and oxytocin
The most common type of functional pituitary tumor produces
hyperprolactinemia.
The release of prolactin by the tumor can cause
amenorrhea, galactorrhea, or both, in women. In men, it can result in galactorrhea or infertility.
Complications of transphenoidal Hypophysectomy?
need for mucosal injection of epinephrine to prevent bleeding, the accumulation of blood in the pharynx and stomach, risk of injury to the cavernous sinus or internal carotid artery, damage to cranial nerves III, IV, V1, and VI that travel near the pituitary gland, and hypofunction of the pituitary gland.
Cranial nerve that travel near the pituitary gland
CN III, IV, V1 and V
Which electrolyte disorder would be most likely to worsen cerebral edema following a craniotomy?
Hyponatremia
Epidural steroid injections, how long should you wait?
Methylprednisolone contains the largest particles among all steroids used for epidural injections.
The injection should be given at least 2-3 weeks to allow time for the corticosteroid to exert its effects.
Epidural steroid injections, how long should you wait?
The injection should be given at least 2-3 weeks to allow time for the corticosteroid to exert its effects.
Transforaminal injections vs interlaminar injections?
Transforaminal injections have been shown to be more efficacious than interlaminar injections.
contains the largest particles among all steroids used for epidural injections.
Methylprednisolone
Three digit pacemaker codes represent the area in which the pacemaker actually generates a pacing impulse, the area in which it senses impulses, and the response it makes when sensing an impulse.
The first two letters of the code, pacing and sensing, can be either O: none, A: atrium, V: ventricle, or D: dual (both atrial and ventricular). The third letter of the code, response, can be either O: none, I: inhibited, T: triggered, or D: dual (both inhibited and triggered).
Kyphoscoliosis is a pathology of the spine characterized by
anterior curvature (kyphosis) and lateral curvature (scoliosis) that results in compression of the lung tissue, and decreased vital capacity.
The most common causes of death in patients with kyphoscoliosis are
restrictive lung disease and pulmonary hypertension. A poor cough often contributes to an increased risk for pulmonary infections
Vital capacity and Kyphoscoliosis
Decreased Vital capacity
The ventral decubitus position is the same as the
Prone
BMI calculation formula
Weight in Kg/ Height (m^2)
Which of the following is considered the gold standard in evaluating cardiac function and volume status?
Esophageal doppler monitoring
In aortic stenosis, left ventricular compliance______ as the left ventricle_____ resulting in _______DYSFUNCTION.
decreases; hypertrophies; diastolic dysfunction.
AORTIC STENOSIS and myocardial demand?
The myocardial demand is increased due to ventricular hypertrophy and the supply is decreased as the extraordinary compression of intramyocardial vessels during systole restricts arterial flow to the myocardium.
Number of fluoride between desflurane, isoflurane, and sevoflurane mnemonic to remember
IDS 5,6,7
Isoflurane 5
Desflurane 6
Sevoflurane 7
Elective surgery should be postponed in these patients if they exhibit
severe dyspnea, wheezing, pulmonary congestion, or a PaCO2 greater than 50 mmHg.
You are preparing to induce a patient with uncorrected hydrocephalus for placement of a ventriculoperitoneal shunt. Which of the following agents would be least appropriate for this patient?
Desflurane
Desflurane and ICP
Desflurane can increase cerebrospinal fluid production and could potentially increase cerebrospinal fluid pressure prior to placement of the shunt.
Parotidectomy and the ETT tube
The endotracheal tube should be positioned on the opposite side of the mouth from the surgical site
Parotidectomy patient’s head position
The patient should be positioned with the head turned towards the opposite side
Parotidectomy and paralysis
Surgical paralysis is not necessary for this procedure
Drugs such as are associated with INCREASED potassium levels.
BNATS
Beta blockers NSAIDs ACE inhibitors Triamterene Spironolactone
Loop diuretic associated with decreased serum potassium levels
Bumetanide
You are about to perform anesthesia for an opthalmic procedure in which the surgeon wishes for the patient to be awake, but able to tolerate the placement of a lid speculum. Blockade of which nerve would prevent the patient from squinting during the procedure?
Facial nerve
A patient presents for emergency surgery with an open-globe eye injury. Which of the following would present the greatest risk for further ocular damage?
Succinylcholine can increase intraocular pressure slightly and increase the risk for expulsion of the globe contents. However, intubation during light anesthesia can cause a large increase in the IOP. The risk of further eye damage must be balanced with the risk of aspiration.
Silent myocardial infarctions are most common in patients with
diabetes and hypertension.
When using a circle anesthesia circuit, the fresh gas flow rate
determines how much of the exhaled gas returns to the patient
According to ASTM standards, what is the minimum FiO2 a self-inflating manual resuscitator should be able to deliver when connected to an oxygen source?
40%
The low peak pressure alarm is activated when
the ventilator is on
The low peak pressure alarm is activated when the ventilator is turned on. It is designed to
help detect disconnects in the anesthesia circuit. In order to prevent the alarm from triggering, the airway pressure must exceed a preset minimum within a set amount of time (usually about 15 seconds).
What are the 3 ECG changes often seen with hypothyroidism?
Flattened T waves
Low-voltage P waves
Sinus bradycardia
Pt with hypothyroidism are more at risk for
Ventricular dysrhythmias.
The initial treatment for a chemical burn is irrigation of the affected area with (select two)
Water AND SALINE
What is an appropriate volume of local anesthetic for a caudal anesthetic in an adult patient undergoing a procedure that requires anesthesia to the T10 dermatome?
20-30 mL
When inducing general anesthesia for a patient with chronic hypertension, you should strive to maintain the mean arterial blood pressure within what percent of normal?
20%
When administered for induction, etomidate may cause a slight decrease in blood pressure. If it occurs, this is most likely due to a decrease in
Decrease in SVR
What are the 4 major groups tissues are divided into when discussing the transfer of volatile anesthetics to the tissues?
Vessel-poor
Vessel-rich
Muscle
FAT
The primary site of action for neuromuscular blocking agents is the
postsynaptic nicotinic cholinergic receptor on the muscle endplate.
The half-life of thyroxine (T4) in the circulation is about and (T3) is
7 days
The half-life of thyroxine (T3) in the circulation
24-30 hours.
How is a patient positioned for splenectomy?
Lateral decubitus
Ideally the time-out procedure should be performed
before the induction of anesthesia while the patient is awake
Which of the following conditions would explain why a dose of succinylcholine could last for 20-30 minutes?
Pregnancy
In response to an increased MAP, cerebral vessels (dilation vs constriction) constrict. This patient’s MAP rose to 180, therefore CBF would
increase despite compensatory mechanisms.
Between MAPs of 60 and 140 this mechanism is able to keep CBF constant but outside of this range CBF
becomes pressure dependent.
Chronic hypertension effect on the cerebral autoregulation of the brain
shift both the lower and upper limits of the cerebral autoregulation curves to the right
ntracranial hypertension is defined as a sustained increased in intracranial pressure above:
10-15 mmHg
Intracranial hypertension is defined as a sustained increased in intracranial pressure above:
10-15 mmHg
Using cricoid yolk studies, the optimum force necessary to effectively occlude the esophagus without obstruction of the trachea is between
30 and 44 Newtons (3.0 - 4.4 kg).
Cricoid pressure before and after loss of consciousness.
It is recommended that 2 kg of force be applied prior to loss of consciousness and that pressure be increased to 4 kg of force after loss of consciousness.
