Special Populations Final exam-cumulative Flashcards
Succinylcholine given to patient with myotonic dystrophy will cause?
a. Exaggerated contracture
What is true of ALS?
a. Progressive muscle decline leading to respiratory failure
Postural hypotension in elderly due to? Select 2
a. Stiffening of veins
b. Cardiac filling changes
Which of the following drugs would you give a patient with Duchenne muscular dystrophy?
a. Captopril (ACE inhibitor)
Infant born at term <46 weeks and premie <60 weeks needs to be kept how long postop to monitor for apnea?
a. 12 hours
Cardiac arrest occurs in MRI, what is the next step?
a. Drag the corpse out and then start CPR
b. It costs approx 100K to refill. Also, the helium released could asphyxiate everyone
if not vented properly.
Metabolic syndrome, which is not included in the diagnosis?
a. BP 120/82 (need 130/85 or higher)
Which medication increases cerebral blood flow?
a. Ketamine
Select 2 that will prolong seizure duration?
a. Etomidate
b. Hypocapnia
Contrast dye is injected to cerebral artery and the patient screams of burning, what is known about this reaction?
a. Burning can be normal
Which statements are true of MS? (select 2)
a. Autoimmune disease targeting T cells of myelin
b. Central nervous system disease
c. Pregnant patients decreased risk of relapse
a. Autoimmune disease targeting T cells of myelin
c. Pregnant patients decreased risk of relapse
Context sensitive 1⁄2 time?
a. 50% decrease in plasma concentration after stopping transfusion
Changes in old people, renal mass decreases by 20-25%, 1⁄2 of all glomeruli decreased by 80 reflects what?
a. Chronic dehydration state
Android obesity reflects?
a. Most dangerous
b. Increased CV disease
c. High rates of LV dysfunction
Obesity hypoventilation/long term OSA results in?
a. Pulmonary HTN
b. R sided heart failure (cor-pulmonale)
Most common indication for A tonsillectomy?
a. Obstructive sleep apnea
Mets are evaluated pre op and can reflect?
a. Cardiovascular reserve
Which med does not increase risk of postoperative cognitive dysfunction in 90 year old?
a. Glyco
b. Atropine
c. Ketamine
d. Demerol
a. Glyco
GFR decreases with aging and what other renal changes happen concurrently?
a. Increased risk of dehydration
b. Increased aldosterone secretion
c. Increased renal drug excretion
a. Increased risk of dehydration
What are important NORA considerations when choosing anesthetics? (choose 2)
a. Quick wake up
b. Post operative pain and agitation
c. Ability to void
d. PONV
a. Quick wake up
d. PONV
Most common complications of NORA? (choose 2)
a. Respiratory depression
b. Respiratory obstruction
CV changes with aging (pick 2)
a. Decreased beta receptor stimulation
b. Stiffening of myocardium, arteries and veins
Age where the protective effect of ischemic preconditioning is no longer present?
a. >65
What is GCS for opens eyes to voice, follows commands and talking but confused?
a. 13
GCS 15- normal
GCS 12-13 is verablly responsive
GCS 5-6 physically responsive
MAC decreases by how much per decade?
a. 6%
What does anesthesia do that can promote venous drainage?
a. Head position
b. Reverse trend
c. PEEP
d. Coughing
b. Reverse trend
MRI safety question what is not true?
a. Anesthesia is always exposed
b. Increase distance
c. Wear lead
a. Anesthesia is always exposed
Where is CSF produced?
a. Choroid plexus
HR 30, BP 210/105, papilledema, trauma patient this is?
a. Increased ICP
How much dantrolene should be available in cart for 68kg patient with history of MH?
a. 36 vials
b. 8
c. 10
a. 36 vials
Surgeon is complaining that the brain needs to be relaxed. What do you do?
a. Mannitol
b. Lasix
STOP Bang score of 5 reflects
a. High risk
ECT what is true?
a. Toradol helps post-procedure myalgias
b. Mask ventilation is insufficient
a. Toradol helps post-procedure myalgias
Half life of Levodopa?
a. 6-12 hours
Guillian Barre syndrome what is true? (select 2)
a. Ascending skeletal muscle weakness
b. Caused by virus or bacteria
c. Chronic progressive paralysis
a. Ascending skeletal muscle weakness
b. Caused by virus or bacteria
Duchenne’s muscular dystrophy, what is true?
a. Succ is the NMBA of choice
b. Increased in females
c. No dystrophin
c. No dystrophin
Something about Parkinsons and environmental exposure farming, beta blocker use, some other crap decreases dopamine.
What is T/f?
True
Why are elderly at increased risk for aspiration?
a. Decreased cough reflex
a. Decreased cough reflex
GLP-1 receptor agonists which is not true?
a. Enhance glucagon secretion by pancreas
b. Slow gastric emptying
c. Decreases gastric acid secretion
a. Enhance glucagon secretion by pancreas
1 degree drop in skin temp reflects what difference in core temp?
a. 0.2
Monro Kellie Doctrine, know the relationship between the contents of cranium and ICP. An increase in one will increase ICP unless there is an equal reduction in another
component. TRUE/FALSE
True
Gold standard of ECT treatment ?
a. Methohexital
b. Propofol
c. Etomidate
d. Something else
a. Methohexital
What is the dosage of Mannitol?
a. None of the above
b. 0.5 g/kg-1.5 g/kg
c. 1.5-2 mg/kg
d. Some other dosage
b. 0.5 g/kg-1.5 g/kg (should be GRAM)
Question about MS
a. Pregnancy is associated with a decrease risk of exacerbation
b. Autoimmune disease characterized by T-Cell mediated autoantibodies against myelin
It is Central automimmune disease NOT peripheral
Most important risk factor in CIN (all risk factors, but the most)
a. Previous renal surgery
b. Proteinuria
c. Chronic kidney disease
d. Diabetes
c. Chronic kidney disease
Patient ate a high carb meal and extreme exercise. What paralysis will happen?
a. Hypokalemic Paralysis
b. Hyperkalemic Paralysis
a. Hypokalemic Paralysis
Question regarding burn patient with increased 02 consumption, co2 production and enhanced blood flow to organs indicates what phase?
Hypermetabolic (flow phase) 48-72 hours after injury
Parkland formula question: Patient weight 70kg, 18% TBSA burn. How much fluid would you give patient?
a. 5L ( calculation is: 4x 70kg x 18=5040)
b. 500ml
5040
Healthy 23 year old male, with open eye injury on job site- plan all the following except?
a. RSI with propofol and suxx
b. Have atropine readily available
c. Avoid head down position
a. RSI with propofol and suxx (suxx can transiently increase IOP)
RA question, what is true (all below are true)
a. Larynx is affected causing limitation of vocal cord movement and laryngeal mucosal edema
b. Changes in TMJ can complicate DL and tracheal intubation
c. Autoimmune disorder Affects synovial fluid in joints
Scoliosis surgery indicated cobb angle of lower lumbar:
a. Greater than 40 degrees
b. Thoracic: greater than 50 degrees
Shoulder surgery, beach chair position include all except:
a. 20 mmHg increased cerebral
b. BP with this position
c. Easily convert from arthroscopy to open
a. 20 mmHg increased cerebral
b. BP with this position
While femoral block is considered best plan for total knee, you would use IPACK block to ?
a. Avoid quadricep weakness
Platelets are given to improve this part of the TEG ?
a. Maximum amplitude
All are included in lung protective ventilation except ?
a. Administer 100% FiO2
b. Permissive hypercapnea
c. Vt 6-8ml/kg
d. Plateau pressure less than or equal to 30
a. Administer 100% FiO2
Pregnant trauma patient decompensating?
a. LUD
What clinical sign would coincide with C3-5 injury?
a. Diaphragm weakness
Patient presents with wheezing, cough, and diminished breath sounds what is most likely the cause?
a. Foreign body aspiration
Patient is having ENT surgery on tonsils, appropriate FIO2 ?
a. 0.29%
Anesthesia is responsible for what part of the fire triangle ?
a. Oxidizer
Patient comes in with expected tension pneumo, where would a 16-18g cath be on the patient?
a. 2nd intercostal space midclavicular line
Rule of 9s, both anterior/exterior of lower extremities and trunk ?
a. 72%
The most common bleeding disorder is ?
a. vWB
Picture of eye block (Its a retrobulbar block) pick 2:
a. Less volume needed (2-4ml)
b. Quicker onset of block (2 min vs 10-20 min for peribulbar)
Picture of TEG
a. Which one shows hypercoagulability
Sensory innervation of SLN INNER branch ?
a. Innervates mucosa above vocal cords
b. Criocoid is EXTERNAL branch
a. Innervates mucosa above vocal cords
Spinal Cord Blood supply?
1 anterior artery supplies 2⁄3, posterior supplies 1⁄3
Artery of adamkawitz is posterior artery that supplies 2⁄3 anterior 1⁄3
posterior- distractor- AKA is ANTERIOR artery.
T2 spinal cord injury, position prone for surgery, foley in place for surgery, patient becomes hypertensive and bradycardic with cutaneous vasoconstriction above T2 ?
a. Foley might be occluded (think autonomic hyperreflexia)
SSEPS monitor ?
a. Dorsal proprioception
Which part of the TEG indicates platelet function ?
a. MA line
Patients with inhalational injuries need ____ % more IVF resuscitation?
a. 30-50%
Patent receives an SF6 injection, what is your first priority?
a. Avoid administration of Nitrous oxide. (for at least 10 days)
Interscalene block what can you mix with experal ?
a. Bupivicaine 0.5%
Patient presents with hemoptysis, dyspnea, hoarseness, stridor, and subcutaneous emphysema ?
a. Upper and lower airway obstruction
b. Tension pneumo
c. Flail chest
a. Upper and lower airway obstruction
Lefort III facial fracture ?
a. It runs parallel to the base of the skull, separating the midfacial skeleton from the base of the skull
Criteria involved in GCS include the following Except?
a. Eye opening
b. Pupil response
c. Best motor response
d. Best Verbal response
b. Pupil response
Broken hip, ORFI needs spinal, 30min prior received lovenox?
a. Wait ten hours and complete spinal
b. General anesthesia
b. General anesthesia
Trauma pt has received multiple blood transfusions and fluids, has received phenylephrine as well but patient continues to be hypotensive, what is your plan?
a. Administer Ca chloride
b. Give more phenylephrine
c. Start vasopressin drip
a. Administer Ca chloride
Severely injured trauma patient experiencing bleeding, what is the first thing to administer?
a. TXA
b. platelets
c. DDAVP
a. TXA
Afferent pathway of oculocardiac reflex ?
a. Trigeminal nerve
Vagus is efferent
Patient experiencing pain how do you know she is experiencing acute compartment syndrome?
a. Pain out of proportion to the injury
What is responsible for attaching platelets to collagen?
a. vWB
Lethal Triad of trauma Triad of Death?
a. Dilutional coagulopathy
b. Hypothermia
c. Acidosis
Deficiency in factors VIII, XIII, vWB, what do you give?
a. Cryo
NIMS tube positioning?
a. Secured midline
b. Must be positioned at the level of the vocal cords
Echothiophate eye medication affects which drug?
a. Anticholinesterase miotic prolongs duration of succinylcholine
Primary hemostasis (unstable platelet plug) what 3 steps?
a. Adhesion
b. Activation
c. Aggregation
Hypoxia, mitochondria …
a. Metabolic acidosis
Trali (Transfusion related acute lung injury) all true except ?
a. No evidence of atrial hypertension
b. Hypoxemia
c. fever
d. Within 6 hours of transfusion
e. Hypertension
e. Hypertension
Scenario where O+ donor blood is available, who do you not give it to ?
a. RH- mom, with second baby who is RH+. Do not give + blood to mom.
All tests will show biliary obstruction EXCEPT: ?
a. ALP
b. GGT
c. 5’ NT
d. Aspartate aminotransferases
d. Aspartate aminotransferases (AST)
Patient getting an exploratory lap for bowel obstruction, you notice the patient now has tachycardia, hypotension and facial flushing. What do you give?
a. Octreotide
b. Fentanyl
c. NSAIDS
c. NSAIDS
These cells get rid of bacteria in the liver ?
a. Kupffer cells
T/F: liver enzyme reactions Phase I reactions conjugates to glutathione and increases water solubility and Phase II reveals a functional group ?
FALSE
T/F: Pericentral hepatocytes have a greater quantity of cytochrome P450 enzymes and are the site of anaerobic metabolism
TRUE
Carcinoid tumors give off histamine and serotonin, the other humoral agent is ?
a. Kallikrein
b. Norepi
c. Epi
a. Kallikrein
LeFort III fracture: ?
a. Nasal base and optic ridge / bone
b. Cribiform plate to ethmoid bone
c. Mandible is most likely to fracture
a. Nasal base and optic ridge / bone
Treatment for Hepatorenal syndrome (HRS): ?
a. Liver transplant
True of hepatitis:
a. Halothane hepatitis is immune mediated
b. Hep A commonly causes cirrhosis
c. Acute alcohol cause cirrhosis
d. Hepatitis is commonly caused by blood transfusions
a. Halothane hepatitis is immune mediated
Severe Reverse T-burg ?
a. Increased CI
b. Increase SVR
c. Increased venous return
b. Increase SVR
Your patient is on IV heparin, it has been stopped for 4 hours. You give the person a regional block. When can you restart the heparin gtt?
a. 1 hour
b. 2 hours
c. 3 hours
a. 1 hour
Patient getting surgery for open globe eye injury, and severe PONV. What is part of your plan?
a. Sugammadex 16mg/kg
b. Cyclopen…drops 1-2%
c. Scopolamine patch
d. Eye block and MAC
a. Sugammadex 16mg/kg
DOD says to give what? With refractory hypotension ?
a. Vasopressin
b. Neo
c. Ephedrine
a. Vasopressin
20 year patient getting T&A and has Type 1 diabetes?
a. Decadron
b. fiO2 < 0.3
c. Epinephrine
b. fiO2 < 0.3
Orthopedic procedure, what is not something that is commonly done:
a. Controlled hypertension
a. Controlled hypertension
Liver patient you will see:
a. Increased cardiac output
Another liver question related to cirrhosis “physiology”
a. Increased cardiac output (also the answer)
Causes of hypercarbia in lap sx: (select 3)
a. Cardiogenic shock
b. Atelectasis
c. Sub q emphysema
d. increased TV
a. Cardiogenic shock
b. Atelectasis
c. Sub q emphysema
T5-7 injury you will see (select 2):
a. Decreased vital capacity
b. Ineffective cough
Above T5 injury (or maybe it was block) you will see:
a. Hypotension
Peritonsillar abscess, these are TRUE (pick 2):
a. They need drainage via surgery
b. You will not have an obstructed view for DL or view of cords
T/F: Your patient has seizures, neurogenic pulmonary edema, hypertension, and bradycardia these are signs of intracranial hypertension?
TRUE
Tension pneumothorax s/s: ?
neck vein distention, tracheal deviation, cyanosis, tachycardia
You patient has muffled heart tones, pulsus paradoxus, tachycardia what is happening?
a. Pericardial tamponade
Scenario where patient is swimming in barrel of whiskey. Patient has some s/s of tension pneumothorax
a. Insert 14G at 2nd mid clav line
b. Give 200mg propofol
c. Give 4 versed and 100mcg fentanyl
a. Insert 14G at 2nd mid clav line
Patient got a T&A and is now rebleeding, but has been NPO the whole day…what is true?
a. She has been NPO for long enough
b. You can estimate blood loss
c. 75% of rebleeds occur in first 6 hours
c. 75% of rebleeds occur in first 6 hours
All are correct about TXA except: ?
a. Prevent PE
b. Prevents HTN
c. Prevent MI or something
d. Used for bleeding control
b. Prevents HTN
30) Afferent nerve in oculocardiac reflex ?
a. Trigeminal
b. Vagus
a. Trigeminal
31) Carboxyhemoglobin toxicity:
a. Metabolic acidosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Respiratory alkalosis
a. Metabolic acidosis
Patient suffered a Maxillofacial injury, what is contraindicated?
a. Nasal intubation is contraindicated
33) S/S of aspiration of foreign body include the following EXCEPT:
a. Erythema
b. Wheezing
c. Cough
d. Diminished breath sounds
a. Erythema
T/F: Scoliosis is associated with obstructive respiratory disease
FALSE, it can cause restrictive lung disease
C5 nerve INJURY results in what ?
a. Diaphragmatic paralysis
b. Deltoid immobility
a. Diaphragmatic paralysis
and impaired respiration
Intraabdominal pressure from CO2 insufflation causes what (select 2)
a. Increase Alveolar arterial gradient
b. Increased FRC
c. Increased pleural pressure
a. Increase Alveolar arterial gradient
c. Increased pleural pressure
Causes of hypoxia from lap sx include all EXCEPT ?
a. Hyperventilation
b. Endobronchial intubation
c. Atelectasis
a. Hyperventilation
Base deficit is -8 ?
a. Moderate shock
b. Mild
c. Severe
a. Moderate shock
Surgeon is injecting bubble of SF6, what do you do?
a. Turn off N2O
Effects of hypercarbia in lap sx ?
a. Pulmonary vasoconstriction
b. Decreased RV afterload
c. Alkalosis
d. All of the above
a. Pulmonary vasoconstriction
Orthopedic surgery? All are advantages of using regional anesthesia EXCEPT ?
a. Decreased nerve injury
b. Decreased Infection
c. Decreased LOS
a. Decreased nerve injury
Something about endovascular aortic repair ?
a. Right radial art line
b. Get ready to cross clamp
c. Keep MAP 70
a. Right radial art line
Deep dermis is burned ?
a. Deep partial thickness
Lung injury with burn, you know the patient will have fluid requirements…which is true?
a. Increased fluids by 30-50%
b. Decrease fluids
c. Increase fluids by 10-20%
a. Increased fluids by 30-50%
Which is NOT a risk factor for optic ischemia ?
a. Using a Jackson frame
b. Male
c. Obesity
a. Using a Jackson frame
You think you have myocardial contusion, blunt cardiac injury, what would help you determine this?
a. EKG 12 lead
b. MRI
c. CT
d. INR
a. EKG 12 lead
Local anesthetic? vasoconstriction and blocks norepinephrine and epinephrine from adrenergic ?
a. Cocaine 4%
b. Bupi 14%
c. Lido 0.4%
a. Cocaine 4%
Lap sx: pneumoperitoneum insufflation will cause?
a. Parasympathetic response
b. Hypovolemia is less pronounced
c. Causes hyperthermia
a. Parasympathetic response
Carbon Monoxide (CO) post inhalational burn injury shifts the oxygen dissociation curve to the ____?
LEFT
Holds onto oxygen more
Symptoms of what?
Autoimmune disease- T and B cell lymphocytes
Inflamed synovium
Morning stiffness more than 30 mins
Symmetrical
Extra articular movement
Affects TMJ and vocal cord movement which can cause airway obstruction/difficult intubation
Cardiovascular disease common
Rheumatoid arthritis
Symptoms of what?
Chronic degenerative disease
Cartilage loss
Morning stiffness less than 30 mins
Asymmetrical
Osteoarthritis
What vessel is responsible for blood supply to the Tonsils?
External Carotid
Acute onset < 6hrs
Hypoxemia
Bilateral pulmonary infiltrates
No evidence of left atrial HTN
All evidence of what?
TRALI
Rhogam is only given to what moms?
Rh- negative
What is the recommended initial intra- abdominal insufflation pressure for laparoscopy?
A. 5–10 mm Hg
B. 10–15 mm Hg
C. 15–20 mmHg
D. 20–25 mmHg
E. None of the above
B. 10–15 mm Hg
What are the regional perfusion effects of intra-abdominal CO2 insufflation?
A. Splanchnic, renal, and cerebral perfusion
increase
B. Splanchnic, renal, and cerebral perfusion
decrease
C. Splanchnic and cerebral perfusion increase
while renal perfusion decreases
D. Splanchnic and renal perfusion decrease
while cerebral perfusion increases
E. None of the above
C. Splanchnic and cerebral perfusion increase
while renal perfusion decreases
Sudden hypotension and a marked decrease in end-tidal CO2 during insufflation of the peritoneum with CO2 would most likely indicate?
A. A severe vagal reflex
B. A capnothorax
C. A pneumothorax
D. A CO2 embolism
E. None of the above
D. A CO2 embolism
Shoulder pain after laparoscopy is likely the result of?
A. Excessive abduction of the arm during
surgery
B. Brachial plexus injury from shoulder
restraints used during steep Trendelenburg
C. Diaphragmatic irritation
D. Deltoid injury from arm restraints
E. None of the above
C. Diaphragmatic irritation
Hypothermia is a significant risk during laparoscopy because of?
A. Large fluid replacement requirements
B. Room temperature insufflating gas
C. Evaporative losses from the peritoneum
D. Convection losses from the distended
abdomen
E. None of the above
B. Room temperature insufflating gas
Under what condition would general anesthesia with muscle paralysis be preferred over regional anesthesia for a patient undergoing transurethral resection of a bladder tumor?
A. The tumor involves the lateral wall of the bladder
B. The tumor involves the posterior wall of the bladder
C. The tumor involves the anterior wall of the bladder
D. The tumor involves either ureteral inser- tion site in the bladder
E. None of the above.
A. The tumor involves the lateral wall of the bladder
Correction of severe hyponatremia following transurethral resection of the prostate should not exceed:
A. 8 mEq/liter in a 24 hour period
B. 10 mEq/liter liter in a 24 hour period
C. 12 mEq/liter liter in a 24 hour period
D. 14 mEq/liter liter in a 24 hour period
E. None of the above
C. 12 mEq/liter liter in a 24 hour period
Regional anesthesia is preferred to general anesthesia for transurethral resection of the prostate because:
A. mortality rate is lower
B. postoperative myocardial infarction rate is lower
C. TURP syndrome can be detected earlier
D. transfusion rates are less
E. None of the above
C. TURP syndrome can be detected earlier
Five to ten percent of right sided renal cell carcinomas extend into:
A. the bowel
B. the adrenal gland
C. the aorta
D. the vena cava
E. None of the above
D. the vena cava
The liver gets the majority of its blood flow from ?
a. Portal vein
b. Hepatic artery
c. Bilary artery
d. Celiac artery
a. Portal vein
Pheochromocytoma would be most likely to coexist with which of the following?
a. hyperaldosteronism (Conn’s syndrome)
b. carcinoid tumor
c. insulinoma
d. Medullary carcinoma of the thyroid
e. pituitary adenoma
d. Medullary carcinoma of the thyroid
Hypoglycemia in the anesthetized patient ?
A. Is easily recognized under general anesthesia
B. Is confused for “light anesthesia.”
C. Is defined as a blood sugar <80 mg/dL.
D. Rarely presents in patients with renal
failure and diabetes.
B. Is confused for “light anesthesia.”
Which of the following increases ionized serum Ca++?
A. Increase serum albumin
B. Respiratory alkalosis
C. Acute hypomagnesemia
D. Hyperphosphatemia
C. Acute hypomagnesemia
Which of the following is the most potent anti-inflammatory corticosteroid?
A. Cortisol
B. Prednisone
C. Dexamethasone
D. Triamcinolone
C. Dexamethasone
Which of the following is the most potent mineralocorticoid?
A. Cortisol
B. Prednisone
C. Dexamethasone
D. Triamcinolone
B. Prednisone
Patients with mild to moderate hypothyroidism ?
A. Can be safely anesthetized without pre-operative thyroid supplement.
B. Are very sensitive to the sedative effects of anesthetics.
C. Who have coronary artery disease require urgent thyroid replacement.
D. Are a significant risk of requiring postoperative ventilatory support.
A. Can be safely anesthetized without pre-operative thyroid supplement.
A 35-year-old male type 1 diabetic is in the postanesthetic care unit following a lumbosacral fusion. He has a seizure with a blood glucose 35 mg/dL and elevated serum ketones. Of the following, which is the most likely cause of these biochemical abnormalities?
A. Insulinoma
B. Hyperinsulinism
C. Adrenal Insufficiency
D. Hyperthyroidism
C. Adrenal Insufficiency
A 40-year-old female presents for a thyroidectomy for Graves’ disease. Her preoperative preparation should include: ?
A. Administration of potassium iodide
plus propranolol for 10 days
B. A 1-week course of thyroxine (T4)
C. A three-day course of propylthiouracil
D. Iodine-131 treatment
A. Administration of potassium iodide
plus propranolol for 10 days
