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Flashcards in ACE 2013 10B Deck (88):
1

How do NSAIDs affect the kidneys?

They inhibit production of prostaglandins which cause afferent arterial vasodilation which can cause acute renal failure

2

Which is a side effect seen with NSAIDs: obstructive uropathy, elevated BP, renal vasodilation, hypokalemia

Elevated BP - thought to be secondary to Na retention and volume expansion

3

What is the treatment for neurogenic diabetes insipidus?

Infusion of isotonic fluids (use hypotonic fluids if plasma osmolarity reaches 290 mOsm/L or higher) + desmopressin (DDAVP)

4

What is the treatment for nephrogenic diabetes insipidus?

Infusion of isotonic or hypotonic solutions + chlorpropamide or clofibrate (potentiate effects of arginine vasopressin on renal tubules)

5

What is the treatment for nephrogenic diabetes insipidus?

Infusion of isotonic or hypotonic solutions + chlorpropamide or clofibrate (potentiate effects of arginine vasopressin on renal tubules)

6

Which of the following increases risk of postop apnea in a ex-32 weeker: post-conceptual age 60 weeks, intraop caffeine, anemia, hx of necrotizing enterocolitis

Anemia

7

What is the Modified Aldrete Scoring System and what does it consist of?

PACU discharge criteria
Consists of Respiration, oximetry, BP, level of consciousness, and activity

8

What is the Post-Anesthetic Discharge Scoring System and what does it consist of?

PACU discharge criteria
Consists of pain, bleeding, nausea, CV changes, activity

9

What is the Post-Anesthetic Discharge Scoring System and what does it consist of?

PACU discharge criteria
Consists of pain, bleeding, nausea, CV changes, activity

10

Which of the following is an absolute contraindication for ECT: pregnancy, AICD, pheochromocytoma, neuroleptic malignant syndrome

Pheochromocytoma

11

Which of the following is an absolute contraindication for ECT: pregnancy, AICD, pheochromocytoma, neuroleptic malignant syndrome

Pheochromocytoma

12

What level are the cardiac accelerator fibers located?

Sympathetic fibers from T1-T4

13

Why might you see bradycardia following spinal anesthesia to T10?

Reverse Bainbridge reflex: normally, increased venous return causes increased HR (via SNS and inhibition of vagal outflow); this is the opposite where decreased venous return (from spinal) causes bradycardia

14

Why might you see bradycardia following spinal anesthesia to T10?

Reverse Bainbridge reflex: normally, increased venous return causes increased HR (via SNS and inhibition of vagal outflow); this is the opposite where decreased venous return (from spinal) causes bradycardia

15

Name some medications that are given intraoperatively that should be avoided in patients with Parkinson Disease

Promezathine, droperidol, metoclopramide (any medication that decreases the effects of dopamine)

16

How long after cosmetic liposuction via the tumescent technique do you expect peak serum levels of lidocaine?

12-14 hours after injection

17

How long after cosmetic liposuction via the tumescent technique do you expect peak serum levels of lidocaine?

12-14 hours after injection

18

What do you worry about in a neonate with generalized cyanosis and a concave abdomen?

Congenital diaphragmatic hernia

19

What congenital abnormalities are most commonly associated with congenital diaphragmatic hernias?

CVS (50%): ASD/VSD, ToF, Coarctation
GI (40%): malrotation
CNS (20%): spina bifida, hydrocephalus, microcephaly

20

What side effects do you worry about in patients taking cyclosporine?

Acute kidney injury

21

What side effects do you worry about in patients taking bleomycin?

Pulmonary fibrosis

22

What side effects do you worry about in patients taking bleomycin?

Pulmonary fibrosis

23

What are the classic characteristics of obesity hypoventilation syndrome?

1. Obesity (BMI >30)
2. Daytime awake hypercapnia and hypoxia
3. Sleep-disordered breathing without another known cause

24

What are the classic characteristics of obesity hypoventilation syndrome?

1. Obesity (BMI >30)
2. Daytime awake hypercapnia and hypoxia
3. Sleep-disordered breathing without another known cause

25

What medications are capable of producing burst suppression?

Volatile anesthetic gases (~2 MAC), etomidate, propofol, and barbiturates

26

Which is least likely to cause airway obstruction 1 hour after total thyroidectomy: neck hematoma, recurrent laryngeal nerve injury, tracheomalacia, hypercalcemia

Hypercalcemia (total thyroidectomies lead to hypocalcemia from parathyroid removal)

27

Which is least likely to cause airway obstruction 1 hour after total thyroidectomy: neck hematoma, recurrent laryngeal nerve injury, tracheomalacia, hypercalcemia

Hypercalcemia (total thyroidectomies lead to hypocalcemia from parathyroid removal)

28

What do you worry about in chronic methamphetamine users?

1. Depletion of neurotransmitters (NE and epi) - hypotension
2. Cardiomyopathy (40% of patients)

29

PEEP of 10 cm H2O will decrease which of the following: FRC, airway resistance, dead space, arterial oxygen sat

Airway resistance (from increase in lung volume)

30

What does the addition of sodium bicarbonate to lidocaine do?

Decreases pain on subcutaneous infiltration; although there are more non-ionized forms from the decreased pH, studies have not shown decreases in onset time or block intensity

31

Which is most associated with increased risk of worsening neurologic function in MS: epidural, peripheral nerve block, GA, hyperthermia

Hyperthermia - Uhthoff phenomenon (body temp elevation of 0.5C or more will exacerbate MS symptoms)

32

Which is most associated with increased risk of worsening neurologic function in MS: epidural, peripheral nerve block, GA, hyperthermia

Hyperthermia - Uhthoff phenomenon (body temp elevation of 0.5C or more will exacerbate MS symptoms)

33

What are some ECG findings for hypercalcemia? Hypocalcemia?

Hyper: shortened PR and QTc intervals
Hypo: prolonged QTc interval

34

What medication should you try to avoid in hypercalcemia?

Thiazide diurectics - they will induce hypercalcemia

35

What are common findings for critical illness polyneuropathy?

Respiratory muscle weakness (slow to wean off vent) and distal weaknesses (mostly lower extremity); you do NOT see cranial nerve or facial abnormalities

36

Which is least likely to occur after femoral nerve block: loss of skin sensation over anterior thigh, loss of sartorius muscle function, loss of sensation over medial leg and foot, loss of adductor longus function

Loss of adductor longus function (innervated by the obturator nerve)

37

What nerves make up the femoral nerve? Obturator nerve?

Femoral: Posterior division of L2-L4
Obturator: Anterior division of L2-L4

38

What pain medication can worsen opioid-induced constipation?

TCAs

39

Vacuum-assisted devices in OB increase the risk of what to the infant?

Cephalohematomas and subgaleal hemorrhages

40

Forceps-assisted deliveries in OB increase the risk of what to the infant?

Cephalohematomas and intracranial hemorrhages

41

Forceps-assisted deliveries in OB increase the risk of what to the infant?

Cephalohematomas and intracranial hemorrhages

42

Why doesn't succinylcholine readily cross the placenta?

It is highly ionized and has a low lipid solubility

43

What is the mechanism of action of dexmedetomidine and what hemodynamic effects do you see from it?

Alpha-2 agonist
Bradycardia and hypotension

44

How is dexmedetomidine metabolized?

Liver (conjugation and methylation)

45

How is dexmedetomidine metabolized?

Liver (conjugation and methylation)

46

What are the conditions listed in the Revised Cardiac Risk Index?

1. Hx of ischemic heart disease
2. Hx of CHF
3. Hx of CVA
4. Renal insufficiency
5. DM

47

What are the major cardiac risk factors that should be treated prior to elective surgery?

1. Unstable coronary disease (angina, recent MI)
2. Decompensated heart failure
3. Severe valvular disease
4. Significant dysrhythmias

48

What are the major cardiac risk factors that should be treated prior to elective surgery?

1. Unstable coronary disease (angina, recent MI)
2. Decompensated heart failure
3. Severe valvular disease
4. Significant dysrhythmias

49

How is remifentanil metabolized?

Nonspecific blood and tissue esterases (NOT plasma cholinesterase)

50

How is remifentanil metabolized?

Nonspecific blood and tissue esterases (NOT plasma cholinesterase)

51

What is the first-line therapy for bony metastatic pain?

NSAIDs, then opioids

52

What is the first-line therapy for bony metastatic pain?

NSAIDs, then opioids

53

During a laparoscopic procedure, what do you suspect if you see hypercapnia increase by 25% after 30 minutes of pneumoperitoneum? What if you see hypoxemia after 15 min?

1. Subcutaneous emphysema
2. Bronchial intubation (diaphragm pushed up)

54

During a laparoscopic procedure, what do you suspect if you see hypercapnia increase by 25% after 30 minutes of pneumoperitoneum? What if you see hypoxemia after 15 min?

1. Subcutaneous emphysema
2. Bronchial intubation (diaphragm pushed up)

55

What changes in the respiratory function of a patient who has a spinal to a level of T3?

Abdominal and intercostal muscles involved in active exhalation are affected, causing decreased ERV and thus vital capacity

56

What changes in the respiratory function of a patient who has a spinal to a level of T3?

Abdominal and intercostal muscles involved in active exhalation are affected, causing decreased ERV and thus vital capacity

57

What are some risk factors for developing post-operative ulnar neuropathy?

1. Male (thicker flexor retinaculum and bony protuberance is more prominent with less adipose protection)
2. Obesity or very thin body habitus
3. Prolonged immobilization
4. Older age

58

What are some risk factors for developing post-operative ulnar neuropathy?

1. Male (thicker flexor retinaculum and bony protuberance is more prominent with less adipose protection)
2. Obesity or very thin body habitus
3. Prolonged immobilization
4. Older age

59

How does progesterone affect respiration in pregnancy?

Shifts the CO2 response curve to the left (direct respiratory stimulant) so you have a higher tidal volume
Also is a bronchodilator (increased dead space)

60

How does progesterone affect respiration in pregnancy?

Shifts the CO2 response curve to the left (direct respiratory stimulant) so you have a higher tidal volume
Also is a bronchodilator (increased dead space)

61

What nerve is injured if you have a foot drop with decrease sensation of the lateral calf and foot?

Lumbosacral trunk

62

What nerve is injured if you have weak quadriceps, decrease sensation of the medial calf, and loss of the patellar reflex?

Femoral nerve

63

What nerve is injured if you have decreased sensation of the medial aspect of the thigh and inability to adduct the thighs?

Obturator nerve

64

What is the mechanism of action of gabapentin: agonism of GABA-A receptors, agonism of GABA-B receptors, NMDA antagonist, or calcium channel modulation

Calcium channel modulation (gabapentin increases release of GABA but is not an agonist)

65

What is the mechanism of action of gabapentin: agonism of GABA-A receptors, agonism of GABA-B receptors, NMDA antagonist, or calcium channel modulation

Calcium channel modulation (gabapentin increases release of GABA but is not an agonist)

66

What does the posterior tibial nerve provide sensation to in the foot? Saphenous? Sural? Superficial peroneal? Deep peroneal?

PT: plantar surface of foot
Saphenous: medial ankle and foot
Sural: lateral foot
Superficial peroneal: dorsal surface of foot
Deep peroneal: web space between first and second toes

67

What does the posterior tibial nerve provide sensation to in the foot? Saphenous? Sural? Superficial peroneal? Deep peroneal?

PT: plantar surface of foot
Saphenous: medial ankle and foot
Sural: lateral foot
Superficial peroneal: dorsal surface of foot
Deep peroneal: web space between first and second toes

68

What is first indicator of hypovolemia in a 3 year old patient with trauma?

Tachycardia (given the underlying SNS tone of children)

69

What TEE view gives you simultaneous information about all 3 major coronary arteries?

Transgastric mid-papillary short axis view

70

What is the landmark used when performing a stellate ganglion block?

Chassaignac tubercle (transverse process of C6)

71

Why do we use leukocyte reduced pRBCs?

Decrease in febrile non-hemolytic transfusion reactions, decreased transmission of CMV, decreased alloimmunization

72

What is more noxious: surgical skin incision or laryngoscopy with intubation? Without intubation?

Laryngoscopy without intubation is less noxious but with intubation is more noxious

73

What are the symptoms of serotonin syndrome?

1. AMS (agitation/delirium/confusion)
2. Autonomic nervous system hyperactivity (hyperthermia, sweating, tachycardia, flushing)
3. Neuromuscular abnormalities (rigidity, tremor, shivering)

74

What is the mechanism of action for tramadol?

Weak mu opioid receptor agonist and wean SNRI

75

What should you worry about if you have immediate bilateral lower extremity numbness and weakness progressing to paraplegia in a patient who had a left-sided TFESI with methylprednisolone?

Spinal cord infarct secondary to arterial injury or intraarterial injection of particular steroid (not likely nerve trauma since it is bilateral)

76

What is the first-line treatment for trigeminal neuralgia?

Carbamazepine

77

What are some more serious side effects of carbamazepine?

SJS, toxic epidermal necrolysis, hyponatremia due to SIADH, aplastic anemia, agranulocytosis, abnormal LFTs, and pancytopenia

78

Which chemotherapeutic agents are associated with cardiomyopathies?

Doxorubicin and danorubicin

79

What chemotherapeutic agent is associated with pulmonary fibrosis?

Bleomycin

80

What is the first thing you do when there is an airway fire?

Call for help and remove the ETT

81

Patient has allergies to fish, soy beans, shellfish, and avocados; which drug(s) might cause an allergic reaction: protamine, propofol, povidone iodine, latex

Latex; the others are associated with but have not been shown to cause an allergic reaction

82

What is supine hypotensive syndrome in the mother and what hemodynamic signs does it present with?

During late pregnancy, nausea/dyspnea, cyanosis and LOC after assuming the supine position (compression of IVC)
Hypotension + bradycardia

83

What is the main advantage of using liposome-encapsulated morphine rather than standard morphine?

Increased duration of action

84

Which medication increases the risk of pediatric emergence agitation: isoflurane, sevoflurane, propofol, dexmedetomidine

Isoflurane (more so than sevoflurane because it is less soluble), the other two are used to treat emergence agitation

85

What is the oculocardiac reflex and what can increase the likelihood of provoking the reflex?

OCR: pressure on the globe, traction on EOM, or manipulation of the conjunctiva which causes bradycardia
Hypoxia and hypercapnia increases likelihood

86

Can the oculocardiac reflex occur with enucleated orbits? In the presence of a retrobulbar block?

Yes for both

87

What is the purpose of the dispersive pad (bovie pad)?

Reduce current density

88

With a double lumen tube, what do you suspect if you have a sudden increase in peak airway pressures and decreased expiratory tidal volumes with elevated HR and BP?

Malpositioning of the DLT; deflate the bronchial cuff and evaluate with a fiberoptic