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truelearn advanced exam > ACE Exam 1 > Flashcards

ACE Exam 1 Flashcards

1
Q

MC SE of deep cervical plexus block

A

ipsilateral diaphragm paresis

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2
Q

What nerve block occurs b/w pec major and pec minor?

A

PECS I
-analgesia to upper anterolateral chest wall

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3
Q

What nerve block occurs b/w pec minor and serratus anterior?

A

PECS II
-blocks cutenaous branches of intercostal nerves T2-T6
-analgesia to upper anterolateral chest wall

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4
Q

What area does the serratus anterior plane block block?

A

Cutaneous branches of intercostal nerves
T3-T9
-analgesia to lateral chest wall
-can block long thoracic and thoracodorsal nerves

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5
Q

What does erector spinae plane block cover?

A

Spinal nerve dorsal and ventral rami
-T2-T9 (if blocked at T5)
-anterior, lateral, posterior chest wall covered

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6
Q

What blood product is stored at room temp and why?

A

plts
-cooling causes them to activate and aggregate

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7
Q

If full term infant, at what post conceptual age do you need additional monitoring after GA?

A

< 44 weeks

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8
Q

If preterm infant, at what postconceptual age do you still require monitoring after GA?

A

< 60 weeks

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9
Q

who is more likley to have postop apnea: SGA or LGA?

A

LGA
-SGA protected from apnea

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10
Q

bronchopulm dysplasia and postop apnea

A

does NOT correlate

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11
Q

At what Hct is there an inc risk of postop apnea in neonates?

A

< 30%

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12
Q

Buprenorphine formulations approved for opioid use d/o

A

-sublingual tablets
-sublingual film
-subdermal implant
-extended release solution for injxn
-buccal film

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13
Q

FDA approved buprenorphine formulations for chronic pain

A

-transdermal patch
-buccal film

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14
Q

Buprenorphine mechanism of action

A

-partial mu opioid agonist
-weak kappa antagonist
-delta agonist

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15
Q

Naltrexone

A

mu receptor antagonist
-competitive, displaces opioid drugs

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16
Q

MC complication assoc w/ placement of radial art lines?

A

transient arterial occlusion
(hematoma formation 2nd)

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17
Q

Cerebral perfusion pressure equation

A

MAP - ICP (or CVP whatevers higher)
-if CVP increased w/ PPV -> dec cerebral perfusion
-PPV -> inc intrathoracic pressure -> inc CSF pressure

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18
Q

pt on hospice, COPD, optimized on O2 and resp meds, still has dyspnea, what to do?

A

morphine

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19
Q

How long to desat in an RSI pt breathing room air? healthy otherwise

A

60 seconds

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20
Q

After preoxyengation, healthy patient, how long to desat?

A

7 minutes

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21
Q

Adequately preoxygenated obese pt, how long to desat?

A

1-2 minutes

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22
Q

HIPAA privacy rule

A

identifies personal health info -> estabilishes protection w/ health plans, health care clearing houses, and health care providers

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23
Q

HIPAA Security rule

A

sets the standards for protecting electronic PHI

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24
Q

HIPAA Enforcecment rule

A

establishes the processes by which a breach of HIPAA would be investigated and the sanctions that apply

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25
Q

The Breach Notification Rule HIPAA

A

Require HIPAA covered entities provide notification after a breach of unsecured PHI (regardless if PHI is electronic, paper, or verbal)

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26
Q

Nerves blocked w/ scalp block

A

-greater occipital
-lesser occipital
-auriculotemporal
-supratrochlear
-supraorbital
-zygomaticotemporal

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27
Q

in peds, what age group is most likely to get LAST?

A

under 12 months
-less protein-binding -> more unbound fraction of local anesthetic

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28
Q

At birth where is the conus medullaris?

A

L3/L4

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29
Q

At what age does the conus medullaris go to adult position of L1?

A

1 year old

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30
Q

Where does the dural sac terminate in neonates?

A

S3
(s1 in adults)

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31
Q

What can trigger V fib in a pt w/ Brugada syndrome?

A

overload of parasympathetic activation (vagal activity)
-hypoK, hyperK, hyperCa
-CCB, beta blockers, Procainamide

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32
Q

What to give Brugada pt w/ worsening ST elevation?

A

Isoproterenol

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33
Q

SE of etomidate

A

-inc PONV
-thrombophlebitis
-myoclonus (not if given w/ midaz or Mg)
-pain on injxn
-hiccups

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34
Q

Reversal agent for Apixaban

A

Andexanet alfa

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35
Q

Reversal agent for dabigatran

A

idarucizumab

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36
Q

Reversal agent for rivaroxaban

A

Andexanet alpha

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37
Q

What factors are in PCC?

A

II, VII, IX, X

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38
Q

How long before surgery should the oral form of naltrexone be held?

A

48-72 hours

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39
Q

How long before surgery should the extended release naltrexone be held?

A

4 weeks

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40
Q

Preop Optimization for pheo

A

-arterial BP should not exceed 165/90 48 hrs before surgery
-orthostatic hypoTN no lower than 80/45 w/ standing
-no nonpermanent ST-T wave changes on EKG
-no more than 1 PVC every 5 minutes

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41
Q

proper functioningn of O2 fail-safe valve dept on what?

A

pressure! if O2 < 25 psig -> won’t allow other gases to flow through -> goal to prevent hypoxic mixture to pt

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42
Q

Which steroid has the highest glucocorticoid potency?

A

Dexamethasone
-has 0 mineralocorticoid potency

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43
Q

Which steroid has the highest mineralocorticoid potency?

A

Fludrocortisone

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44
Q

What is a sinus venosus defect

A

defect in the atrial septum near SVC or ICV that is assoc w/ anomalous pulmonary venous connection

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45
Q

Tetralogy of Fallot

A

-overriding aorta
-pulm stenosis
-RVH
-VSD

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46
Q

hemodynamic changes in response to hyperbaric O2

A

-inc in SVR
-dec in HR, dec in CO, dec in PVR

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47
Q

effects of abd insufflation on oxygenation and PVR/SVR

A

-SVR decreases -> vasodilation
-PVR inc due to hypercarbia -> inc hypoxic pulm vasoconstriction -> dec intrapulm shunting -> improved oxygenation

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48
Q

What is the best way to relieve catheter-related bladder discomfort

A

preop gabapentin

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49
Q

How long does it take methimazole to work?

A

6-8 weeks

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50
Q

Thyroid storm intraop, best first tx?

A

IV propranolol -> direct beta blocking activity and prevents conversion of T4 to T3
-PTU can only be given rectally or NGT no IV form exists

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51
Q

Meds that don’t cross the placenta

A

He Is Going Nowhere Soon
Heparin (incl LMWH!!)
Insulin
Glyco
NDNMB
Succ

52
Q

What AC is most likely to cross the placenta?

A

apixaban
rivaroxaban

53
Q

which upper extremity blocks most likely to give Horner syndrome?

A

-Stellate ganglion block (MC)
-interscalene

54
Q

What medication assoc w/ inc risk of uterine rupture w/ TOLAC?

A

misoprostol

55
Q

MC cardiac tumor

A

myxoma

56
Q

MC malignant cardiac tumor

A

angiosarcoma

57
Q

Where is a myxoma MC located?

A

LA

58
Q

paraneoplastic syndrome w/ squamous cell carcinoma

A

hyperCa (inc parathryoid hormone related protein)

59
Q

tx of hyperCa paraneoplastic

A

-fluids and loop diuretics
-bisphosphonates

60
Q

What is paraneoplastic cushing syndrome assoc w/?

A

neuroendocrine lung tumors
carcinoid tumors
SCLC

61
Q

Paraneoplastic SIADH assoc w/

A

SCLC

62
Q

herniation of brain tissue through a fracture or defect in skull

A

transcalvarial herniation

63
Q

herniation of cortex across the flax

A

subfalcine herniation
-usually due to inc ICP -> pushes one side to the other (R to L herniation)_

64
Q

Leading cause of maternal, fetal, and neonatal morbidity and mortality rates

A

maternal heart dx

65
Q

Worse pregnancy outcomes cardiac dx

A

pulm HTN
-severe LV dyxfxn
-EF < 30%
-severe MS, severe AS
-aortic dilation
-unrepair aortic coarctation

66
Q

TXA inhibits action of what?

A

plasmin/plasminogen

67
Q

Neonatal pain score

A

CRIES
crying
req O2
inc vital signs
expression (grimace?)
sleepless

68
Q

pain scale for 2 months to 7 years

A

Face, Legs, Activity, Cry and Consolability
FLACC

69
Q

Wong-Baker Face Pain Scaled used in what age?

A

3-18 years

70
Q

What would lead to a falsely elevated Hg A1c?

A

things that prolong RBC duration (dec turnover)
-iron def anemia
-B12 and folate def anemia
-renal failure
-hyper TG
-severe hyperbili
-chronic alcoholism
-leald poisoning
-asplenia

71
Q

What would lead to a falsely low Hg A1c?

A

things that shorten PRBC lifespan?
-acute and chronic blood loss
-splenomegaly
-hemolytic anemia, sickle cell anemia
-pregnancy

72
Q
A

pericardial effusion

73
Q

damage to the long thoracic n causes?

A

n to serratus anterior
-winging of the scapula

74
Q

after open thoracotomy pt has severe ipsilateral shoulder pain, what causes it?

A

phrenic n referred pain

75
Q

def of postop delirium

A

w/i 24-72 hours postop

76
Q

def of postop cognitive dysfxn

A

weeks to months after surgery

77
Q

delirium < 24 hrs postop

A

emergence delirium

78
Q

rewarming and postop cog dysfxn

A

slow rewarming is preferred

79
Q

What suppresses the neuronal and basal components to dec CMRO2?

A

hypothermia
-barbs and sleep only dec neuronal

80
Q

post drowning conscious, but hypoxia, next step?

A

CPAP and PEEP -> expands lung volume and improves oxygenation

81
Q

shunt fraction and improvement w/ FiO2 100%

A

-at higher shunt fractions, 100% FiO2 makes less of a difference on PAO2

82
Q

What dx has ketamine infusions shown a significant long-term improvement in pain?

A

CRPS

83
Q

influences likelihood to develop phantom pain

A

pain before amputation

84
Q

what happens after successful mitral valve repair w/ a clip device?

A

commonly a tx for MR
-improved cardiac output
-inc pressure gradient through mitral valve

85
Q

NORA self-inflating hand resuscitator bag should be available and capable of giving what % O2?

A

90%

86
Q

What level of brachial plexus does infraclavicular block cover?

A

Cords

87
Q

Which cord is most likely to be spared w/ infraclavicular block?

A

Posterior –> radial

88
Q

Celecoxib likely to cause a severe rxn in pts who have an allergy to what abx?

A

Sulfonamides

89
Q

If pt needs PCC, but has HIT, what PCC can they NOT get?

A

K centra
-> has heparin in it!

90
Q

What is Profilnine?

A

NINE -> factor IX complex
-nonactivated factors II, IX, X, does not contain heparin
-most useful in hemophilia B (IX def)

91
Q

FEIBA

A

Factor Eight inhibitor bypassing activity
-factors II, VII, IX, X, shortes PTT w/ factor VIII inh
-no heparin, used in hemophilia A and B

92
Q

according to joint commission, who is most likely to be responsible for hospitals sedation policies?

A

director of anesthesia services

93
Q

What factor correlates w/ extent of atelectasis?

A

BMI!

94
Q

Concerns for pt w/ Williams Syndrome

A

Elfan syndrome w/ Intellectual disability
-Cardiac! needs preop eval
-DM
-GERD
-hyperCa (hyperPTH)

95
Q

Metabolic Syndrome dx criteria

A

Central Obesity and 2 of following
-inc TG > 150
-reduced HDL < 40 men, < 50 women
-inc BP >130/85
-inc fasting glucose >100 or DM2

**b/c adipose tissue releases proinflammatory cytokines -> insulin resistance

96
Q

abnormal ion channel for paramytonia congenita?

A

Sodium channel

97
Q

What is paramytonic congenita

A

Na channel dysfxn
-exacerbated by the cold!!
-NOT predisposed to MH

98
Q

what channelopathy is assoc w/ myotonia congenita?

A

Cl

99
Q

Calculation of RR using ECG measures does so how?

A

Measuring changes in the axis of the heart (changes based on insp and exh)

100
Q

pt w/ hx of esophagectomy, higher risk of?

A

aspiration PNA

101
Q

timeframe for TRALI

A

1-6 hours

102
Q

Diagnostic criteria for hepatopulm syndrome

A

-PaO2 < 70 while breathing room air (or A-a gradient > 15)
-evidence of intrapulm vascular dilation

103
Q

Why is remimazolam so short acting?

A

b/c of it’s ester side group -> broken down by TISSUE esterases (not blood esterases like remi and esmolol)

104
Q

Contraindications to celiac plexus block

A

-infxn
-uncorrectable coagulopathies
-bowel obstruction

**be careful in pts w/ orthostatic hypoTN

105
Q

Kava SE

A

used for anxiolysis to inc GABA
-SE: inc in gamma-glutamyl transpeptidase levels -> hepatoxicity
-can suppress plt aggregation and COX inhibitor

106
Q

When to stop kava preop

A

24 hours

107
Q

Most common complication after heart surgery?

A

A fib

108
Q

Common dx associated w autism spectrum d/o

A

epilepsy

109
Q

Which ECMO supports only lungs?

A

VV ECMO

110
Q

Which ECMO supports lungs and heart?

A

VA ECMO

111
Q

Why does opioid induced hyperalgesia occur?

A

-spinal sensitization to glutamate and substance P
-NMDA rec involved

112
Q

treatment or ppx of opioid induced hyperalgesia

A

ketamine
low dose buprenorphine
COX 2 inh
Methadone
alpha 2 agonists
regional anesthesia

113
Q

What lyte abnormality is likely to precipitate torsades in long QT syndrome?

A

HypoK
hypoCa
hypoMg

114
Q

Predictive factor for cardiac events in pts w/ long QT?

A

QTc > 500

115
Q

Pt who had anaphylactic rxn has inc serum levels of?

A

Tryptase
(careful baseline elevated in hematologic cancers, CKD, mastocytosis)

116
Q

CVC tip should be where on CXR to be in the correct stop?

A

carina
below inferior clavicle
3rdd frib
T4-5 interspace
take off of R mainstem bronchus

117
Q

treatment of carcinoid syndrome symp

A

octreotide
somatostatin

118
Q

Which inhaled anesthetic is doing the most damage to the ozone layer?

A

nitrous oxide

119
Q

What inh anesthetic has more global warming potential?

A

Des

120
Q

Which substance use d/o can claim disability under americans w/ disabilities act?

A

CURRENTLY abusing alcohol
-for illegal drugs, you have to not be using and in a rehab program

121
Q

if mother addicted to opioids and baby has resp depression tx?

A

intubate!
no naloxone

122
Q

Peds resp to pneumoperitoneum

A

-inc in SVR (dec preload, dec cardiac output -> inc in SVR compensation)
-reflex bradycardia (vgal activation)
-dec FRC and complicance
-dec UOP

123
Q
A

pleural effusion

124
Q

New weakness in peroneus brevis muscle, what n injured?

A

Superficial peroneal n

125
Q

Lithium and effects on muscle relaxants?

A

potentiates both depolarizing and nondepolarizing muscle relaxants

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