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ITE-Anes > TL > Flashcards

TL Flashcards

1
Q

Local anesthetics: … have one ‘i’ in their name

A

ester

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2
Q

Local: … agents have two ‘i’s in their name

A

amide

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3
Q

initial treatment for CRPS is …

A

physical therapy

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4
Q

second line treatment for CRPS is …

A

TCA

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5
Q

CRPS type … have been found to involve interaction between sympathetic nervous system and afferent neurons

A

1

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6
Q

CRPS type 1 is also known as …

A

reflex sympathetic dystrophy

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7
Q

CRPS type 2 is also known as …

A

causalgia

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8
Q

A decrease in left atrium compliance leads to an … ‘v’ wave on left atrial pressure readings

A

enhanced

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9
Q

In mitral regurgitation increase in heart rate leads to … in left atrial distention/regurgitant volume

A

decrease

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10
Q

warfarin is [safe/unsafe] in nursing mothers

A

safe

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11
Q

warfarin is [safe/unsafe] in pregnancy

A

unsafe

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12
Q

unlike many other drugs, … determines duration of action in opioids

A

lipid solubility

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13
Q

digoxin competes with … for binding site on Na/K ATPase

A

potassium

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14
Q

hepatic arterial buffer response: decreased blood flow in the portal vein leads to … of hepatic artery and vice versa

A

dilation

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15
Q

cirrhosis disrupts the liver sinusoids, which causes a … in endothelial nitric oxide synthase activity

A

decrease

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16
Q

glucagon causes dose dependent hepatic arterial vaso…

A

dilation

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17
Q

vasopressin … splanchnic vasoconstriction

A

increases

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18
Q

vasopressin … resistance to portal venous flow

A

decreases

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19
Q

8 mg of dexamethasone is equivalent to … mg of hydrocortisone

A

200

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20
Q

dose of dexamethasone to prevent adrenal insufficiency

A

8 mg

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21
Q

CSF volume of infants … mL/kg

A

4

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22
Q

CSF volume of adults … mL/kg

A

2

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23
Q

CSF volume of children … mL/kg

A

3

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24
Q

Infants have … vagal tone compared to adults

A

higher

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25
Q

Spinal cord ends at … in infants compared to … in adults

A

L3 vs L1

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26
Q

hypokalemic periodic paralysis is inherited …

A

autosomal dominant

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27
Q

Reflex Triad: hypertension, bradycardia, irregular breathing

A

cushing’s caused by increased ICP

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28
Q

Imaging technique: intracranial air

A

CT scan

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29
Q

Phenomenon: repeated stimulation of peripheral C fibers resulting in increased action potentials at the dorsal horn causing an amplified response

A

wind-up

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30
Q

Landmark: lateral femoral cutaneous nerve block

A

anterior superior iliac spine

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31
Q

centrifugal vs roller pump: lower risk of air emboli

A

centrifugal

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32
Q

during alkalosis potassium shifts …

A

intracellularly

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33
Q

in respiratory alkalosis, decrease of CO2 by 10 mmHg will cause potassium to decrease by … mmol/L

A

0.5

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34
Q

serum calcium exists in 3 forms: …% protein bound; …% ionized; and the remainder bound to plasma anions

A

50;50

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35
Q

alkalosis causes … binding of calcium to plasma proteins such as albumin

A

increased

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36
Q

increase in pH causes … in glycolytic activity

A

increase

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37
Q

perioperative administration of … mL/kg of isotonic crystalloid over course of anesthetic is acceptable baseline

A

30 +/- 10 mL/kg

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38
Q

acute administration of phenytoin in naive patients will … neuromuscular blockade by aminosteroid NMB

A

enhance

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39
Q

spinal anesthesia in infants vs older children/adults: … onset and … duration of action

A

rapid onset, shorter duration

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40
Q

Toxicity: first sign of spinal toxicity in infants

A

apnea not cardiovascular collapse because of immature sympathetic system

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41
Q

Blood product treatment for AT3 deficiency

A

FFP

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42
Q

Pulsatile flow … urine output

A

increases

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43
Q

OB: drug that provides analgesia and treats neuraxial opioid-induced central pruritus

A

butorphanol

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44
Q

Nitrous oxide can irreversibly oxidize the cobalt atom of vitamin …

A

B12

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45
Q

…caine crosses the placenta and can accumulate to toxic levels due to ion trapping from fetal acidosis

A

Lidocaine

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46
Q

Ultrasound: higher frequency = … resolution and … tissue penetration

A

higher res; decreased pen

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47
Q

Mivacurium is metabolized by …

A

pseudocholinesterases

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48
Q

Neurotoxic opioid metabolite

A

normeperidine from meperidine

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49
Q

lung volume at which small airways begin to close is called

A

closing capacity

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50
Q

age at which closing capacity may surpass functional residual capacity

A

65 yo

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51
Q

age at which closing capacity may surpass tidal volume

A

75 yo

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52
Q

CNS-mediated ventilatory responses to hypoxia, hypercapnia and mechanical stress … with age

A

decrease

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53
Q

Local: 2 spinal drugs that are isobaric

A

bupivacaine and ropivacaine

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54
Q

Local: mixing local solutions with … will make the solution hypobaric

A

sterile water

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55
Q

Local: mixing local solutions with … will make the solution hyperbaric

A

glucose

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56
Q

Bioavailability of midazolam PO is …%

A

<50%

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57
Q

Nerve that provides sensation to upper medial arm that is not apart of the brachial plexus

A

intercostobrachial n.

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58
Q

intercostobrachial nerve is the lateral cutaneous branch of the … intercostal nerve

A

2nd

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59
Q

Full E-cyclinder oxygen tank contains … L of O2 at 2200 psi

A

680L

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60
Q

Gene defect in malignant hyperthermia patients

A

RYR1

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61
Q

Myxedemia is caused by deposition of …

A

mucin

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62
Q

closing capacity = … volume + … volume

A

closing volume + residual volume

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63
Q

Most important factor in ductus closure in full-term infant

A

oxygen

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64
Q

inspiration of CO2 in healthy awake patients leads to increase in minute ventilation of … L/min for every 1 mmHg of arterial CO2 tension

A

3 L/min

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65
Q

BZD and propofol causes this change in the CO2 response curve

A

decreased slope

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66
Q

Opioids cause this change in the CO2 response curve

A

right-shift

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67
Q

Modified Cormack-Lehane classification system breaks … into 2 subcategories

A

Grade 2 into 2a (partial view of glottic opening) and 2b (epiglottis + posterior arytenoids)

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68
Q

Heparin resistance is caused by …

A

AT3 deficiency

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69
Q

treatment for heparin resistance

A

FFP

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70
Q

Mnemonic for components of MELD score

A

Dialysis CrIBS; INR, bilirubin, sodium

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71
Q

In adults the dural sac extends to …

A

S1/2

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72
Q

Most common cause of death in subarachnoid hemorrhage is … followed by …

A

bleeding followed by rebleeding which peaks within 24 hours

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73
Q

75% of cancer related pain is caused by … and …

A

tumor invasion and metastatic tumor formation

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74
Q

pulmonary vascular resistance is lowest when breathing at …

A

normal tidal volumes

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75
Q

when a vaporizer designed for a lower SVP is misfilled with anesthetic of higher SVP, the volume percentage of volatile anesthetic delivered will be … than the concentration set on the dial

A

higher

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76
Q

Cole formula

A

uncuffed ETT = (age/4) + 4

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77
Q

In preeclampsia there is … of thromboxane A2 and … of prostacyclin levels leading to a vasoconstricted state

A

increase TXA2; decrease prostacyclin

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78
Q

In preeclampsia, uterine and placenta blood flow is …

A

decreased

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79
Q

Desulfurization of thiopental produces …

A

pentobarbital A

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80
Q

Neuraxial fentanyl site of action

A

substantia gelatinosa of the dorsal horn

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81
Q

Neuraxial morphine site of action

A

CSF spread

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82
Q

Morphine’s effect on preload reduction and vasodilation are due to …

A

histamine release

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83
Q

attachment point of the tongue to the mandible is called the …

A

genioglossus

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84
Q

definition of anuria

A

<50 mL in 12 hours or <100 in 24 hours

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85
Q

oliguria for … hours = stage 2 RIFLE: Injury

A

12 hours

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86
Q

oligura for … hours = stage 3 RIFLE: Failure

A

24 hours

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87
Q

Thyrotoxic cardiomyopathy is characterized by infiltration of … and …

A

lymphocytes and eosinophils

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88
Q

4 sites considered most accurate for temp monitoring

A

esophagus, nasopharynx, tympanic membrane, pulmonary artery

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89
Q

Marker for sympathetic block is increase in limb …

A

temperature by 2-3C

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90
Q

valsalva maneuver will … intrapleural pressure

A

increases

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91
Q

T/F: does bupivacaine readily cross the placenta

A

false d/t high protein binding and pKa 8.1

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92
Q

Loss of fetal heart rate variability is an early sign of …

A

fetal hypoxia

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93
Q

Mechanism of early decelerations from fetal head compression

A

Vagal reflex from transient mild hypoxia

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94
Q

4 risk factors for PONV in children

A

duration >30min; age >3yo; strabismus sx; h/o PONV in 1st degree relative

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95
Q

HRT transplant: heart rate generation is dependent on the donor/recipient atrium

A

donor

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96
Q

HRT transplant: resting intrinsic heart rate is … and heart rate variability is … . This is caused by …

A

HR increased with decreased variability due to parasympathetic denervation

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97
Q

interscalene block: nerve plexus is located … from the carotid artery

A

lateral and posterior

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98
Q

interscalene block: which nerve is often spared

A

ulnar nerve

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99
Q

definition of postreperfusion syndrome (PRS)

A

MAPs >30% below baseline for 1-5 min after reperfusion of liver

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100
Q

hyperventilation will result in … ionized calcium

A

decreased

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101
Q

citrate toxicity: product most likely to cause it

A

FFP

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102
Q

citrate toxicity: more common in peds/adults

A

peds

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103
Q

amniotic fluid embolism: first stage

A

pulmonary vasospasm and right heart dysfuction leading to left heart dysfunction and pulmonary edema

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104
Q

amniotid fluid embolism: second stage

A

consumptive coagulopathy from hemostasis

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105
Q

amniotic fluid embolism: third stage

A

ARF and ARDS

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106
Q

BP target for fibrinolysis in acute stroke

A

<185/110 mmHg prior to intervention

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107
Q

ICP measurement: gold standard

A

ventriculostomy catheter

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108
Q

relationship between ketamine and ICP

A

unknown

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109
Q

pheochromocytoma: which receptor to block first

A

alpha ideally 10-14 days prior to surgery

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110
Q

chronic AS what is the contribution of the atrial kick

A

40% of the LVEDV

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111
Q

coronary perfusion equation

A

CPP = DBP - LVEDP

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112
Q

normal LVEDP

A

<15 mmHg

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113
Q

goal during induction of patient with severe AS: HR … and SVR …

A

bradycardia and elevated SVR

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114
Q

effect of hypothermia on post-resuscitation myocardial ischemia

A

exacerbates due to increased catecholamine release

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115
Q

describe the mechanism for amniotic fluid embolism

A

disruption of uterus results in entrance of amniotic fluid or fetal cells entering maternal circulation causing anaphylactoid response leading to cardiovascular collapse

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116
Q

patients with uremia should receive lower doses of premedication with midazolam, why?

A

decreased protein binding and increased free fraction

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117
Q

type of anesthesia for cerclage placement

A

neuraxial

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118
Q

syndrome where manipulation of pacemaker’s pulse generator causes malposition of pacemaker leads leading to pacemaker failure and stimulation of phrenic nerve

A

twiddler syndrome

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119
Q

urine anion gap equation

A

uAG = Na + K - Cl

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120
Q

criteria for intracranial pressure monitoring

A

severe head injury + abnormal CT; age > 40 with SBP <90 or decerebrate/decorticate positioning

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121
Q

desired spinal level for TURP

A

T10

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122
Q

acceptable cold ischemic times for heart and lungs

A

4 hours

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123
Q

acceptable cold ischemic time for liver

A

8 hours

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124
Q

highest frequency brain waves

A

gamma 25-100 Hz

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125
Q

as temperature decreases, gas solubility …

A

increases

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126
Q

chronic use of carbamazepine, phenytoin, phenobarbital, St. John’s wort, dexamethasone, and topiramate have what effect on CYP-3A4

A

induce

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127
Q

systolic wall thickening represents … during ejection

A

myocardial contraction

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128
Q

3 nerves commonly injured by retractors

A

brachial plexus, femoral, LFC

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129
Q

describe the Haldane effect

A

O2 binding hgb to displace CO2 causing left shift of hgb disassociation curve

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130
Q

T/F etomidate is safe to use in pregnant women

A

true

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131
Q

which subtype of Ach receptor are ionotropic?

A

nicotinic

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132
Q

use of INR to guide treatment in cirrhotic patients

A

patients will have elevated INR due to liver dysfuction. TEG is a better test for evaluating coagulopathy

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133
Q

indications on TEG for giving cryoprecipitate

A

K time > 3 or alpha less than 53

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134
Q

describe the effect of midazolam on ventilation

A

dose-dependent effect that is insignificant in healthy patients

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135
Q

mechanism for subjective respiratory weakness following thoracic epidural

A

blockade of afferent proprioceptive signals from the abdomen and chest wall muscles

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136
Q

complications for aneursym clipping

A

rupture or VTE

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137
Q

contrast induced nephropathy risk factors

A

age >75, DM on metformin, HTN

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138
Q

HbCO level for hyperbaric oxygen

A

25%

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139
Q

anti-arrhythmic medication that can cause thyroid storm

A

amiodarone

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140
Q

3 goals of preop endo airway exam

A

clear path to larynx, identify posterior pharyngeal masses, or vascular anterior pharyngeal masses

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141
Q

nasopharynx defined as

A

base of skull to soft palate

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142
Q

oropharynx defined as

A

soft palate to epiglottis

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143
Q

name the 3 paired cartilages of the larynx

A

arytenoid, corniculate, cuneiform

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144
Q

name the 3 unpaired cartilages of the larynx

A

epiglottis, thyroid, cricoid

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145
Q

sux is dosed based on … body weight

A

total

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146
Q

injection of SF6 or C3F8 within the past … days are contraindications for N2O use

A

70

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147
Q

acupuncture point known to help treat PONV

A

P6 inner wrist

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148
Q

2 patient RFs for cardiac or vascular perforation during lead removal

A

female and BMI >25

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149
Q

NPDB data is maintained for … years

A

5

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150
Q

MC reason for licensure action

A

medical negligence

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151
Q

herbal supplement that can cause hypoglycemia with chronic use

A

ginseng

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152
Q

herbal supplement known to active the cell-mediated immune response

A

echinacea

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153
Q

T/F malpractice payments made from personal funds are reported to the NPDB

A

false but all payments made by an insurer on behalf of an individual physician must be reported

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154
Q

T/F simulation is a required part of MOCA

A

false

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155
Q

How many qualifying points must be obtained in a 5 year cycle for MOCA

A

50, with no more than 25 in the last year

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156
Q

albumin dose for hepatorenal syndrome

A

1 g/kg

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157
Q

at what level of sedation is etCO2 monitoring required

A

moderate

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158
Q

antidote for apixaban

A

andexanet alfa

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159
Q

abdominal pressures greater than … is defined as abdominal compartment syndrome

A

20 mmHg

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160
Q

MAC decreases by …% for every decade of life

A

6

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161
Q

2 reflexes to determine if brainstem is intact

A

oculocephalic and oculovestibular

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162
Q

2 MC reasons for delayed discharge after surgery

A

pain and PONV

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163
Q

age range with highest risk of emergence delirium

A

4 +/- 2 yo

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164
Q

compound responsible for bone cement implantation syndrome

A

methyl methacrylate

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165
Q

describe findings of POISE-1 trial

A

preop initiation of BB decreased risk of MI but increased risk of stroke and mortality

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166
Q

jaundice > 3 weeks postop suspect

A

TPN

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167
Q

effect of sux on intraocular pressure

A

increase by 9 +/- 3

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168
Q

gold standard for MH testing

A

halothane-caffeine test

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169
Q

latex-induced allergic response is what type

A

type 1 IgE-mediated with delayed onset ~30 min

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170
Q

scopalamine vs atropine, which is more likely to cause central anticholinergic syndrome

A

scopalamine

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171
Q

lab test to determine liver synthetic function

A

PT/INR

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172
Q

half-life of albumin

A

20 days

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173
Q

antidote for IV extravasation of vasoconstrictors

A

phentolamine, dilute to 0.5 mg/mL and inject 1 mL around extravasation site

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174
Q

antidote for IV extravasation of vesicants

A

hyaluronidase

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175
Q

which core competency revolves around conflict and concern resolution

A

Interpersonal and communication skill

176
Q

effect of AchEi on PONV

A

historically increased risk but new data suggests no effect

177
Q

nerve at risk for injury with brachial artery catheter insertion

A

median n.

178
Q

4 variables to consider for anesthestic of patients with valvular heart disease

A

HR, contractility, preload, afterload

179
Q

relationship between blood:gas coefficient and onset

A

high coefficient = high uptake = 1/onset

180
Q

initial presenting sx of anthrax intoxication

A

flu-like and nonspecific

181
Q

lidocaine dose for tumescent anesthesia

A

55 mg/kg

182
Q

types of surgery for awareness under anesthesia (3)

A

cardiac, obstetric, trauma

183
Q

reaction between desiccated CO2 and … produces the most heat

A

sevoflurane

184
Q

reaction between desiccated CO2 and … produces the most CO

A

desflurane

185
Q

max CO2 absorbed by CaOH

A

10.2 L/ 100g absorbent

186
Q

max CO2 absorbed by soda lime

A

26L / 100g

187
Q

SCh dose to reach phase 2 block

A

3-5 mg/kg

188
Q

what is the lab assay used to characterize plasma cholinesterase abnormality

A

dibucaine number (normal around 80)

189
Q

what is the term for process at the beginning of malpractice suit where documents are exchanged and depositions are made

A

discovery

190
Q

T/F HIPAA does not apply to entities that are workers’ comp insurers, admin agencies or employers

A

true

191
Q

what percent of acute HBV infections progress to chronic HBV infection

A

10%

192
Q

describe the neuraxial changes that occur with aging (4)

A

decreased epidural space, decreased CSF, decreased myelinated fibers, increased dura permeability

193
Q

T/F the ASA has no recommendations for aspiration prophylaxis

A

true

194
Q

describe the results of the ASCEND-HF trial

A

nesiritide improved dyspnea without improvement in 30 day rehospitalization or mortality

195
Q

percentage of anesthesiology residents with history of opioid abuse successfully re-entering residency

A

34%

196
Q

define continual

A

repeated regularly and frequently in steady rapid succession

197
Q

compare standard vs guideline vs practice advisory

A

PA is not considered a requirement

198
Q

describe the effect of preopeartive carbohydrate load on PONV

A

no effect

199
Q

types of surgery where aspirin is contraindicated (4)

A

intracranial, middle ear, posterior eye, and intramedullary spine

200
Q

are implants made of aluminum MRI compatible

A

yes, so are titanium and stainless steel

201
Q

T/F heart valve prostheses and annuloplasty rings are MRI-safe

A

true

202
Q

platelet lifespan is … days

A

5-10

203
Q

patients should be evaluated for (3) after being in a quenched MRI room

A

asphyxia, hypothermia, and ruptured tympanic membranes

204
Q

duration of DAPT for bare metal stents

A

1 month

205
Q

duration of DAPT for drug-eluting stents

A

3 months

206
Q

Regional: high opening injection pressure >20 psi is a sign of …

A

intrafasicular injection

207
Q

Regional: motor response at … is a sign of intraneural needle tip

A

<0.2 mA

208
Q

T/F daily anesthesia machine checks are apart of the basic standards dictated by Joint commision

A

false

209
Q

T/F total time needed to recover from neuraxial anesthesia increases with age

A

false, faster onset and spread but same time to recover

210
Q

elevated SvO2 is classic sign of

A

cyanide toxicity

211
Q

T/F accredidation for office-based anesthesia is the same as ambulatory surgery centers

A

false

212
Q

SpO2 sat of 85% is classic for

A

methemoglobinemia

213
Q

initial presentation of malignant hyperthermia

A

respiratory acidosis

214
Q

in healthy patients serum creatinine remains stable from …

A

20 - 70 yo

215
Q

T/F metformin does not need to be stopped preop

A

true. take day before and restart when normal diet is resumed

216
Q

TCA can potentiate the effects of which pressor

A

ephedrine

217
Q

T/F TCAs should be discontinued preop

A

false, increased cholinergic syndrome or worsening psych disease

218
Q

CO2 induces a sympathetic/parasympathetic response

A

sympathetic

219
Q

Peak plasma levels of tumescent lidocaine occurs when?

A

12-14 hours after injection

220
Q

at which vertebrae level is the esophagus the weakest

A

C5/6

221
Q

abdominal compartment syndrome effect on intracranial pressure

A

increases

222
Q

opioid of choice for patients on chronic MAOi

A

fentanyl. morphine/hydromorphone can cause hyperpyretic response

223
Q

T/F postop patient who has vomited can still be fast-tracked through recovery

A

false. minimal nausea okay

224
Q

elevated etCO2 without desaturation during laparoscopy suspect

A

subcutaneous emphysema

225
Q

ASRA: how many days of UFH is an indication for platelet count

A

4 days

226
Q

normal shunt fraction in one-lung ventilation is

A

20-30% (normal for DLV is ~5%)

227
Q

qualifying circumstances for billing (4)

A

age <1 or >70 yo; deliberate hypothermia; controlled hypotension; emergency

228
Q

describe the differences between the Aldrete and White scoring systems

A

for assessing postop recovery transition. White includes pain and PONV

229
Q

Which is worse for the environment desflurane or sevoflurane

A

desflurane has 26x global warming and remains 15x longer in the atmosphere

230
Q

dose of dantrolene for MH

A

2.5 mg/kg up to 10 mg/kg

231
Q

amount of dantrolene in Ryanodex

A

250 mg

232
Q

T/F applying vasoconstrictor to nose increases airway diameter

A

true

233
Q

describe SAFE trial results

A

saline vs albumin fluid evaluation. Albumin had 2x mortality at 28 days in patients with GCS <13 and brain injury

234
Q

initial response after ECT is sympathetic/parasympathetic

A

parasympathetic followed by sympathetic

235
Q

first line drug for ECT and dose

A

methohexital 1 mg/kg

236
Q

INR target for coagulation management in patient with liver disease

A

none. do not use INR

237
Q

T/F cardiac MRI does not require contrast

A

true

238
Q

when can ppx LMWH be restarted after neuraxial catheter removal

A

4 hours

239
Q

mnemonic for ultrasound color scheme

A

BART (blue away, red towards)

240
Q

what percentage of people have a L6 vertebrae

A

10%

241
Q

what supplies the inferior wall of the L ventricle

A

R coronary artery

242
Q

what supplies the AV node

A

posterior descending artery

243
Q

what is the line called that connects the peaks of the iliac crests?

A

intercristal line (Jacoby’s or Tuffier’s)

244
Q

arteria radicularis magna is also known as …

A

artery of Adamkiewicz

245
Q

innervation of the afferent limb of the gag reflex

A

internal branch of SLN

246
Q

muscle that dilates pharynx during swallowing

A

stylopharyngeus

247
Q

where to inject for lumbar facet joint injections

A

inferior articular facet

248
Q

vocal cord abduction muscle

A

posterior cricoarytenoid

249
Q

vocal cord adduction muscles

A

lateral cricoarytenoid, transverse and oblique arytenoids

250
Q

all intrinsic muscles of the larynx are innervated by … except the …

A

RLN except cricothyroid which is innervated by SLN (external branch)

251
Q

T/F VP shunts are a contraindication for spinal anesthesia due to infection

A

false

252
Q

innervation of medial lower leg

A

saphenous (branch of femoral)

253
Q

at rest what is the intracellular to extracellular ratio of potassium

A

150:5

254
Q

at rest what is the equilibrium potential of potassium

A

-85V

255
Q

T/F neuronal membranes are freely permeable to potassium

A

true

256
Q

T/F neuronal membranes are freely permeable to chloride

A

false

257
Q

describe the three phases of heat redistribution

A

P1: redistribution from vasodilation; P2: slow linear decrease; P3: passive thermal plateau

258
Q

thermoregulatory vasoconstriction is initiated by core temps of …

A

33-35C

259
Q

initial effect on cardiac output when shifting from supine to standing

A

decrease

260
Q

respiratory mechanics that do not change during pregnancy (4)

A

lung compliance, spirometry values, respiratory rate, DLCO

261
Q

effect of pRBC on O2 disassociation curve

A

left shift (decreased 2,3-DPG)

262
Q

effect of anemia on O2 disassociation curve

A

right shift (increased 2,3-DPG)

263
Q

P50 for normal O2 disassociation curve

A

27 mmHg

264
Q

pressors not metabolized by lung tissue (3)

A

epi, isoproternol, dopamine

265
Q

Mapleson: rebreathing during spontaneous

A

ADCB

266
Q

Mapleson: rebreathing during controlled

A

DBCA

267
Q

hepatopulmonary syndrome, the pulmonary system vaso…

A

dilates

268
Q

prolonged hypoxia will have predominance of … waves

A

delta

269
Q

target urine output for 1 day old baby

A

1-2 mL/kg/hr

270
Q

phase of hepatic metabolism responsible for conjugation

A

phase 2

271
Q

prophylactic treatment for hypoxic pulmonary vasoconstriction

A

nifedipine or inhaled beta2-agonist

272
Q

heparin dosing for bypass

A

400 U/kg body weight

273
Q

cortisol deficiency leads to … secretion of ADH

A

increased because corticotropin-releasing hormone is a ADH secretagogue

274
Q

ppoFEVI calculation

A

FEV1 * ( 1 - % lung resected); cutoff 40%

275
Q

how many lung segments in right lung

A

22/42

276
Q

preoperative peak o2 consumption (VO2 max) of less than … mL/kg/min indicates an increased risk of morbidity and mortality

A

15; >20 is ideal

277
Q

which adrenal layer is responsible for catecholamine secretion

A

inner medulla

278
Q

first test to order after return of spontaneous circulation is

A

ECG

279
Q

transpulmonary pressures are highest in patients with … lung disease

A

restrictive due to decreased lung compliance

280
Q

differences in neonate respiratory anatomy

A

large tongue, short omega epiglottis, cephalic funnel-shaped larynx, angled vocal cords

281
Q

full suppression of EEG occurs at what temperature

A

18C

282
Q

after 20 weeks gestation what regulates uterine blood flow

A

pressure, no autoregulation because maximally dilated

283
Q

name the three stages of ventricular filling

A

isovolumetric relaxation, filling (rapid then diastasis), and atrial systole

284
Q

physiologic dead space in upright adult is what percent of tidal volume

A

33% of TV (100-150 mL)

285
Q

% decrease in cerebral metabolic rate per degree C

A

7%

286
Q

alpha-1 agonists … pulmonary vasoconstriction

A

increase

287
Q

ovarian arteries supply …% of uterine blood flow

A

15

288
Q

% of cardiac output directed to uterus at term

A

20%

289
Q

villi form on which side of the placenta

A

fetal

290
Q

upregulation of nAChRs peaks at what time after spinal cord injury

A

7-10 days

291
Q

ICU patients immoblized for > … days have upregulated nAChRs

A

16 days, do not give sux

292
Q

Preg: plasma albumin concentrations decrease by …%

A

30%

293
Q

normal urine-plasma osmolality ratio

A

1-3

294
Q

mAChR signaling pathway

A

Gq

295
Q

myotonic dystrophy is associated with gastic …

A

atony

296
Q

effect of propofol bolus on motor evoked potential (MEP) signal

A

decrease amplitude and increase latency

297
Q

corrected age calculation

A

chronological age - weeks born before 40

298
Q

after being released from the sarcoplasmic reticulum, what does calcium bind to initiate muscle contraction

A

troponin C

299
Q

ATP binds to a cocked/uncocked myosin head

A

uncocked

300
Q

…glycemia is associated with worse neurological outcomes in acute cerebral ischemia

A

hyperglycemia by exacerbating lactic acidosis

301
Q

nitric/nitrous oxide is a pulmonary vasodilator

A

nitric

302
Q

sense of smell is mediated by the … lobe

A

parietal

303
Q

pons vs medulla: respiration

A

pons

304
Q

pons vs medulla: reflexes

A

midbrain

305
Q

pons vs medulla: swallowing

A

pons

306
Q

pons vs medulla: blood pressure control

A

midbrain

307
Q

turning patient’s head to the right will make insertion of bronchial blocker into which bronchus easier

A

left main

308
Q

the ICU liberation bundle is used to liberate patients from what?

A

mechanical ventilation

309
Q

epoprostenol drug class

A

prostacyclin used for pHTN

310
Q

skin temperature monitoring is usually within … C of core temperature

A

2 degrees C

311
Q

dye used for dye dilution

A

indocyanine green

312
Q

absorption of indocyanine green

A

805 nm

313
Q

dye dilution is more accurate than thermodilution during … cardiac output states

A

low; because it does not get absorbed into the surrounding tissue

314
Q

ultrasound frequency is above which range

A

20k cycles per second

315
Q

ground fault current interupter responds to currents greater than what

A

5 mAs

316
Q

describe the let-go value

A

10-20 mA; current at which the hand is unable to let go

317
Q

laser associated with fatal gas embolism

A

neodynmium-doped:yttrium aluminum garnet

318
Q

medical device used to calibrate the tidal volume and minute ventilation measurements on portable transport ventilators

A

respirometer (measure flow in one direction vs spirometer that measure both directions)

319
Q

volatile anesthetic with highest fat/blood solubility

A

sevo

320
Q

T/F pacemaker in asynchronous mode will continue to sense

A

false, magnet induces either AOO, VOO, or DOO

321
Q

by ASTM international guidelines, alarm must sound if anesthesia circuit pressure drops below … for a second

A

-10 cmH2O

322
Q

clark electrode is used to measure

A

PaO2

323
Q

sanz electrode is used to measure

A

serum pH

324
Q

severinghaus electrode is used to measure

A

PaCO2

325
Q

what is absolutely required if the sampling line is not filtered from the patient in the setting of a respiratory viral pandemic?

A

scavenging

326
Q

describe 4 interventions to minimize mechanical trauma during CVC placement

A
  1. site selection
  2. patient positioning
  3. needle insertion
  4. confirming needle and guidewire placement
327
Q

transcutaneous pacing is a form of atrial/ventricular pacing

A

ventricular

328
Q

initial transcutaneous settings … bpm and … mA

A

80 bpm, and 70 mA

329
Q

thermodilution: factors that cause overestimation

A

warmer solution, lower volume

330
Q

transcardiopulmonary thermodilution sampling occurs where (3)

A

femoral, brachial, or axillary artery

331
Q

needle cricothyroidotomy cannula requires a high/low-pressure O2 source and does/does not rely on a patent upper airway

A

high pressure with patent upper airway for exhalation

332
Q

accurate stroke volume variation calculations requires tidal volumes … mL/kg and a respiratory rate < …

A

TV > 8 mL/kg and RR < 17 bpm

333
Q

heliox vs room air in density

A

heliox has lower density

334
Q

best ultrasound orientation for doppler flow calculation is parallel/perpendicular to flow

A

parallel

335
Q

T/F double burst stimulation is more accurate than TOF

A

false; benefit is improved visual and tactile detection of neuromuscular function

336
Q

wide complex QRS in children is defined as > … ms

A

90 ms; 120 ms for adults

337
Q

T/F CO2 lasers are not visible

A

true;

338
Q

what is the most common visible laser

A

argon

339
Q

anesthesia machines preferable use the highest/lowest pressure gas

A

highest

340
Q

high-pressure regulators decrease tank pressures to … psig

A

30-40 psig

341
Q

respiratory rate target in a critically ill patient on PSV

A

20-35 bpm

342
Q

another name for tracheal tube introducer

A

bougie

343
Q

T/F armored tubes are nonflammable

A

false

344
Q

synonym for periodic sigh maneuver

A

recruitment maneuver

345
Q

T/F no long-term benefit has been seen with periodic recruitment maneuvers

A

true

346
Q

T/F oxyhemoglobin absorbs more red light than deoxyhemoglobin

A

false

347
Q

oxyhemoglobin absorption and emission wavelengths

A

absorbs infrared 950-1000nm and emits red 940nm

348
Q

NASPE/BPEG Generic code, what does position V represent

A

multisite pacing

349
Q

4 factors to improve defibrillation success

A
  1. larger paddles
  2. biphasic waveform
  3. conductive materials
  4. end expiration
350
Q

T/F paddles with gel are more efficacious than paddles with self-adhesive pads

A

false; no difference

351
Q

US color codes: brown

A

air

352
Q

US color codes: gray

A

CO2

353
Q

US color codes: black

A

helium

354
Q

US color codes: yellow

A

air

355
Q

Gas(s) with 1590L in E-cycliner

A

N2O and CO2

356
Q

more dangerous zone in MRI

A

zone 4

357
Q

NIBP: conversion factor for cmH2O to mmHg

A

3:2

358
Q

desflurane vaporizers deliver gas dependent/independent of altitude

A

independent; must increase % at higher altitudes

359
Q

variable bypass vaporizers deliver constant … at different altitudes

A

partial pressure; do not adjust for changing barometric pressures

360
Q

primary indication of intraoperative EEG is …

A

monitor adequacy of cerebral oxygenation

361
Q

main frequencies captured during intraoperative EEG are between

A

1-30 Hz

362
Q

indwelling nerve catheters for > … days has shown to increase catheter colonization

A

4 days

363
Q

T/F the cerebellum is not apart of the brainstem

A

true

364
Q

partial pressure of water vapor

A

47 mmHg

365
Q

ordinal data

A

qualitative data with ranking

366
Q

nominal data

A

qualitative data without ranking

367
Q

parametric data

A

continuous

368
Q

central tendency of nominal data

A

mode

369
Q

central tendency of ordinal data

A

median

370
Q

T/F red cell volume is decreased in pregnancy

A

false; higher mineralocorticoid activity increases total body water which increases plasma and total blood volume

371
Q

T/F pacemaker action potentials lack phase 2 and 3

A

false; lack phase 1 and 2 (depol mediated by Ca and not Na)

372
Q

JG apparatus release renin in response to decreased …

A

chloride

373
Q

T/F Chi-squared test will is a non-parametric test

A

true; requires categorical data

374
Q

Bland-Altman plot is AKA

A

Tukey mean-difference plot

375
Q

Clark error grid is broken down into … regions

A

5

376
Q

which is usually greater standard deviation or standard error

A

standard deviation

377
Q

which test to make diagnosis of chylothorax

A

pleural fluid analysis

378
Q

root of scapular spine corresponds to which nerve root level

A

T3

379
Q

inferior angle of scapula corrresponds to which nerve root level

A

T7

380
Q

site of action for IV regional anesthesia

A

peripheral nerves and trunks

381
Q

how many subunits in nAChR

A

five

382
Q

stellate ganglion is the confluence of what two structures

A

inferior cervical plexus and first thoracic sympathetic ganglion

383
Q

two most common agents for celiac plexus neurolysis are what

A

ethyl alcohol and phenol

384
Q

T/F visualization of chest wall rise and fall is sufficient for monitoring ventilation

A

true

385
Q

RFs for bradycardia following spinal (3)

A

above T5, high vagal tone, low cardiac output

386
Q

describe the inverse steal phenomenon

A

hyperventilation induces respiratory alkalosis causing cerebral vasoconstriction leading to a redistribution of CBF to ischemic areas via anastomotic channels

387
Q

neonates have a more pliable rib cage. what is the effect on work of breathing

A

increased

388
Q

compare compliance of lungs and chest wall in neonates vs children

A

lower lung compliance with increased chest wall compliance

389
Q

adrenergic receptor what when blocked causes bronchoconstriction

A

beta-2 (Gs)

390
Q

brain glucose consumption rate

A

5 g/100g/min

391
Q

cerebral oxygen consumption rate

A

3 mL/100g/min

392
Q

how long after cardiac arrest does brain death begin?

A

4-6 minutes

393
Q

how does aging affect volume of distribution?

A

increases due to increased fat and decreased muscle

394
Q

which volatile anesthetic potentiates nNMB the most?

A

desflurane

395
Q

drugs associated with zero-order kinetics (3)

A

phenytoin, ethanol, aspirin

396
Q

electrolyte change caused by digoxin

A

increased intracellular calcium

397
Q

early sign of propofol infusion syndrome can be detected with which lab test

A

lipid panel (hypertriglyceridemia)

398
Q

treatment for paradoxical reaction to midazolam

A

flumazenil

399
Q

effect of steroids on prostaglandin synthesis

A

inhibition

400
Q

pain medication with the greatest propensity for QT prolongation

A

methadone

401
Q

T/F meperidine causes QT prolongation

A

false

402
Q

75% N2O can expand a pneumo to 2x in … minutes

A

10 minutes

403
Q

T/F molecular mechanism for sux-induced hyperkalemia is unknown

A

true

404
Q

definition of hypertensive urgency

A

BP > 180/110 without signs of end organ damage

405
Q

etomidate receptor target

A

GABAa

406
Q

2 indications for bicarb during CPR

A

hyperkalemia and TCA intoxication

407
Q

local anesthetic with lowest chance of placental transfer

A

2-chloroprocaine

408
Q

indication for citric acid + sodium citrate

A

aspiration ppx for emergent surgery

409
Q

effect of opioids on sphincter of Oddi

A

increase tone and biliary duct pressure

410
Q

T/F allergy to NMB is more common in men

A

false; believed to due exposure to topical cosmetics/personal products

411
Q

describe effect of calcium on phase 3 cardiac action potential

A

calcium activates potassium efflux channels

412
Q

describe the Meyer-Overton correlation

A

increased chain = increased lipid solubility = higher potency

413
Q

dose for precurarization

A

10% of ED95

414
Q

lithium interacts with which ion channels

A

potassium both pre and post-synaptic

415
Q

opioids that exhibit some NMDA antagonism (2)

A

tramadol and methadone

416
Q

N2O receptor

A

NMDA (mixed competitive/noncomp antagonist)

417
Q

alfentanil and fentanyl numeric correlation

A

4

418
Q

most common side effect of sugammadex

A

bradycardia

419
Q

propofol infusion pain mechanism

A

bradykinin release

420
Q

effect of methohexital on seizure threshold and duration

A

none

421
Q

toxicity associated with vinca alkaloids

A

peripheral neuropathy

422
Q

propofol effect on GABA receptor is similar to which other class of drugs

A

barbiturates (increased duration of channel opening)

423
Q

how do local anesthetics potentiate nNMB

A

stabilization of postsynamptic membrane through AChR desensitization

424
Q

effect of calcium on nNMB

A

attenuate (Mg potentiates)

425
Q

why do corticosteroids attenuate nNMB

A

increased ACh release and increased immature AChR at postsynaptic membrane

426
Q

loss of pulses is an [early/late] sign of compartment syndrome

A

late; not needed for diagnosis

427
Q

steroid-induced glaucoma is a [open/closed] angle glaucoma

A

open

428
Q

epinephrine is contraindicated in [open/closed] angle glaucoma

A

closed due to mydriatic effect

429
Q

HCTZ is contraindicated if patient has allergy to what

A

sulfa

430
Q

HCTZ alternative in patient with sulfa allergy

A

ethacrynic acid

431
Q

sevo vs iso: lower vapor pressure

A

sevo

432
Q

block onset time is correlated to which property

A

pH

433
Q

pH of epi ampules

A

4

434
Q

most common side effect of fospropofol

A

parasethesia

435
Q

relation of fospropofol to propofol

A

fospropofol is a water-soluable prodrug that requires alkaline phosphatases for metabolizing to propofol

ITE-Anes (2 decks)

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