ACE 2012-9b Flashcards Preview

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Flashcards in ACE 2012-9b Deck (72):
1

Pt is on daily oral naltrexone, what should he do about this drug in preparation for surgery?

Naltrexone should be stopped immediately

2

Opioid requirements for a patient undergoing surgery that has been taking an oral combo drug of extended release morphine and naltrexone (Embeda)

Unchanged if pill is used correctly.

3

T-test is what type of analytical test?

Parametric test that can be used to determine if there is a significant difference between the means of 2 groups

4

2 types of analysis most commonly used for survival analysis

Kaplan-Meier analysis and Cox proportional hazards regression model

5

Jaw necrosis is a well documented complication of what drug?

Bisphosphonates

6

Chronic pain drugs associated with development of osteoporosis

First generation anticonvulsants like phenytoin

7

Common drawbacks of gabapentin

Sedation, weight gain, peripheral edema, cognitive effects

8

Cardiac abnormality associated with hyperthyroidism

Atrial fibrillation

9

Cardiac abnormality associated with hypothyroidism

Pericardial effusion

10

Management of pt with mediastinal mass causing tracheal compression

-Secure airway while awake if possible
-maintain spontaneous ventilation
-monitor airway compromise postop

11

RIFLE criteria for AKI

1 of the following criteria within 48 hrs
-absolute increase in Cr of 0.3
-50% or more increase in Cr
-UOP < 0.5 mL/kg/hr for > 6 hrs

12

Standard stimulation site for SEP

Median nerve

13

Standard response site for MEP

Abductor pollicis brevis

14

Drug dosing based on Ideal body weight or lean body weight in a morbid obese pt would result in too small of a dose

Ideal body weight

15

Dose of propofol for induction and fentanyl and remifentanil should be based on what type of weight for obese pts?

Lean body weight (LBW)

16

Dose of succinylcholine for induction should be based on what type of weight for obese pts?

TBW (total body weight)

17

Dose of vecuronium and rocuronium for induction should be based on what type of weight for obese pts?

IBW (ideal body weight)

18

Larynx of neonate is located at what vertebral level?

C3-4

19

Larynx of adult is located at what vertebral level?

C4-5

20

Anterior attachment of neonate vocal cords in relation to posterior attachment

More caudad. "Anterior = away"

21

Larynx of preterm neonate is located at what vertebral level?

C3

22

Mechanism of action of dabigatran (pradaxa)

Direct thrombin inhibitor

23

Half life of dabigatran (pradaxa)

12 hrs

24

Peak effect of dabigatran (pradaxa)

2-3 hrs

25

Mechanism of action of clopidogrel and ticlopidine

Platelet inhibitors, ADP receptor inhibitor

26

Mechanism of action of tirofiban

Platelet inhibitor, 2b-3a receptor inhibitor

27

Wrist drop and diminished brachioradialis reflex is injury of what nerve?

Radial nerve

28

Loss of thumb abduction is injury of what nerve?

Median nerve

29

Baroreceptors are part of carotid body or sinus?

Carotid sinus

30

Chemoreceptors are part of carotid sinus or body?

Carotid body

31

Propofol's effect on QT interval

Little effect

32

Combo of glycopyrrolate and reversal agent's effect on QT interval

Prolongs QT interval

33

Carboxyhemoglobin level less than what percent does not require supplemental O2 therapy

Less than 10%

34

Carboxyhemoglobin level greater than what percent is an indication for hyperbaric oxygen therapy

Greater than 25%

35

Carbon monoxide's affinity to hemoglobin is how many times greater than oxygen

250 times

36

American academy of pediatrics recommends lateral X-rays for all Down's syndrome kids between what ages?

3-5 years of age

37

How does cervical instability compare between adults and children with Down's syndrome

Same

38

Endotracheal tubes opened and checked can be stored and used within how many hours?

48 hrs

39

Osler-Weber-Rendu syndrome or hereditary hemorrhagic telangiectasia is characterized by formation of multiple...

Arteriovenous malformations, with life threatening locations such as pulmonary, hepatic, and cerebral circulations

40

Most common symptom associated with post dural puncture headache

Nausea, followed by neck stiffness, vomiting, visual, auditory

41

Drugs that increase serum level of lithium

ACE inhibitors, NSAIDS, loop diuretics, metronidazole

42

Drugs that decrease serum levels of lithium

Acetazolamide, theophylline

43

First manifestation of oxygen toxicity

Retrosternal tightness

44

Decrease in vital capacity caused by oxygen toxicity can be detected after how many hours?

24 hrs

45

When does supplemental oxygen cause seizures?

The partial pressure of oxygen is in excess of 2 atmospheres

46

Odds of renal failure and mortality with use of hetastarch compared to crystalloids

Increase

47

How does cessation of smoking 24 hrs prior to surgery affect risk of postop pulmonary complications

Increase in pulmonary complications when smoking cessation began less than 8 weeks prior to surgery

48

Primary sign of autonomic dysfunction

Orthostatic hypotension

49

Drug used to keep autonomic dysfunction patient euvolemic in preparation of surgery

Fludrocortisone, mineralocorticoid that causes sodium retention and increases intravascular volume

50

Why should aspiration prophylaxis be given to Parkinson's patient with severe autonomic dysfunction?

Possible vocal cord dysfunction

51

Main advantage of retrobulbar block compared with peribulbar block

Reduced block onset time

52

Train of four response in a paraplegic patient's normal limb compared to paretic limb

Response is exaggerated in paretic limb compared to normal limb

53

Does a negative molecular genetic test for a patient with family history of MH exclude susceptibility to MH?

NO!!!! Gold standard is muscle biopsy for caffeine halothane contracture test, only 4 testing centers in the US

54

How is rocuronium excreted?

Bile

55

Aminosteroid neuromuscular blockers

Rocuronium, vecuronium, pancuronium

56

Mechanism of action of tapentadol (Nucynta)

Mu opioid receptor agonist, also like tramadol, it prevents neuronal reuptake of norepinephrine and serotonin

57

Why are thiazides contraindicated for treatment of hypercalcemia

Thiazides increase tubular reabsorption of calcium

58

Cardiac output for a parturient is highest when?

Immediately postpartum, up to 75% above prelabor values

59

When does cardiac output postpartum return to prelabor values?

48 hrs postpartum

60

Time to peak analgesia for fentanyl

6.8 min

61

Time to peak analgesia for sufentanil

6.2 min

62

Time to peak analgesia for alfentanil

1.4 min

63

Time to peak analgesia for remifentanil

1.1 min

64

pKa of fentanyl

8.4

65

pKa of sufentanil

8.0

66

pKa of alfentanil

6.5

67

pKa of remifentanil

7.2

68

How does 3 degree decrease in body temp affect plasma propofol concentration

Increase by 30%

69

How does each degree drop in body temp affect MAC of isoflurane?

Decrease by 5%

70

Risk of aortic dissection in a patient with asymptomatic bicuspid aortic valve

Increased

71

Occurrence of neurologic consequences with identifiable embolic events in patients undergoing carotid endarterectomy

Most do not develop a stroke

72

Stage of labor that can be prolonged by neuraxial analgesia

2nd stage when cervical dilation is complete