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Truelearn Advanced Exam > ACE Exam 4 > Flashcards

ACE Exam 4 Flashcards

1
Q

Hyperaldo lytes

A

hyperNa
met alk
HypoK

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2
Q

Spontaneous ventilation, which Mapleson limits rebreathing?

A

A!
-FGF as far from pt as possible

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3
Q

Mechnical ventilation, which uses least FGF w/ no rebreathing?

A

D or F, where FGF right next to pt

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4
Q

What happens when you quit smoking for 48 hours?

A

-dec carboxyHg
-R shift of O2 dissoc curve
-dec CN levels -> better oxidative phosphorylation
-dec nicotine levels -> improves vasodilation and clearance of toxic substances that may impair wound healing

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5
Q

n most commonly injured in OB deliveries

A

LFCN

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6
Q

obturator n damage symptoms

A

dec sensation on inner thigh
weakness of internal rotation and hip adduction

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7
Q

MC drug to cause anaphylaxis in the OR

A

NMBD

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8
Q

MCC of unilateral RLN injury

A
  1. Cancer
    (surgery is 2nd)
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9
Q

To minimize postop blindness

A

-maintain MAP per pts baseline BP
-neck in neutral position
-avoid direct eye compression
-in high risk pts consider doing staging surgical procedures, break into 2 shorter cases
-higher risk w/ male sex and obesity

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10
Q

what n injury: dec knee extension, dec hip abduction, numnbess on anteromedial thigh and calf, dec patellar reflex

A

femoral n

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11
Q

to minimize work of breathing in an asthmatic

A

put them sitting up or semirecumbant (inc FRC)
-bigger ETT
-slower than normal RR

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12
Q

which trachs are MRI safe?

A

Shiley
-Bivona trachs need to be replaced before MRI

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13
Q

Number of days on mechanical ventilation to have it be considered ventilator assoc PNA

A

2 days
48 hours

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14
Q

only drug to tx asthma that has bronchodilator effects AND anti-inflammatory

A

Aminophylline
-filing it in b/c it has 2 purposes

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15
Q

Benzocaine topilization and then dec SpO2, dx?

A

Met-Hg

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16
Q

When you take a bribe from a vendor thats considered?

A

Fraud

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17
Q

If you steal supplies to go on a mission trip thats considered?

A

abuse

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18
Q

Giving sevo and noticing a prolonged QT fix?

A

switch to TIVA w/ prop
-other meds that prolong QT and to avoid: epi, zofran, amiodaron

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19
Q

hypoxic pulm vasoconstriction and temp

A

decreases w/ hypothermia
-increases w/ hyperthermia

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20
Q

ppx dose of enoxaparin, how long after can you remove a catheter?

A

12 hours

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21
Q

RF for spinal hematoma

A

female
> 65 years old
-spinal cord or vertebral abnormalities
-renal insuff

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22
Q

How long after catheter removal can you give LMWH ppx dose?

A

4 hours

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23
Q

therapeutic LMWH dose, how long do you have to wait to put in catheter?

A

24 hours

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24
Q

what type of vWD will not respond to DDAVP?

A

type 3 b/c they make none

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25
Q

Treacher Collins syndrome

A

-glossoptosis (tongue posteriorly placed)
-micrognathia
-cleft palate
-cardiac abnormalities
-auricular malformationn and deafness
-slanting of palpebral fissure

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26
Q

immunosuppressant causing renal issues

A

tacrolimus
cyclosporine

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27
Q

compared to typical epidural, what does a DPE do better?

A

Better sacral analgesia
=less need for top-up doses than either epidural or CSE
-DPE was assoc w/ less motor blockade than conventional epidural dosing

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28
Q

Best PFT at predicting postop outcomes w/ lobectomies

A

FEV1

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29
Q

black box warning for hyroxyethyl starch

A

inc risk of bleeding and renal injury in pts w/ sepsis

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30
Q

type of rsolution determines u/s machine ability to discriminate structures at different depths

A

axial

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31
Q

u/s ability to distinguish 2 objects at the same depth

A

lateral resolution

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32
Q

u/s ability to distinguishb/w events of rapidly moving structures

A

temporal resolution

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33
Q

what do you use a CHADS-VASc to assess?

A

RF for stroke w/ a fib

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34
Q

early v last burn phases

A

early: hypovolemic, hypodynamic cardiac

late: hyperdynamic, hypermetabolic state

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35
Q

MC complication w/ TAVR

A

damage to the conduction system requiring a pacemaker

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36
Q

specificity

A

TN/TN+FP

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37
Q

GFR and renal arterial pressure

A

GFR inc w/ inc renal arterial pressure, but then plateaus at ~80

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38
Q

What opioid should be avoided in lactating/breastfeeding?

A

codeine -> dep on enzymes can lead to high conc of morphine in breast milkd

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39
Q

Def of adequate preoxygenation

A

EtO2 > 90%
EtNitrogen < 5%

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40
Q

cirrhotic cardiomyopathy

A

hyperdyamic dec SVR
-inability to compensate w/ stress or exercise
-biventricular systolic and diastolic dysfxn
-dec circulating volume (max dilated splanchnics)
-resistance to beta symp stimulation
-electrophysiological abnormalities, prolonged QT

41
Q

which is higher: radial art line or NIBP cuff during HTN?

A

radial art line

42
Q

which is higher rad art line or NIBP cuff during hypoTN?

A

NIBP

43
Q

what type of regurge is abnormal in pregnancy?

A

AR
-due to inc in LV size and dilation, MR, TR, and PR are all normal

44
Q

common metabolic derrangement after brain death

A

Diabetes Insipidus!

45
Q

MCC of preop anemia

A

iron def anemia

46
Q

SAH and recent surgical femur fracture now gets PE, what to do next?

A

Catheter directed therapy -> direct clot removal or dissolution

47
Q

pt having cataracts surgery, has a hx of controlled HTN and hypothyroidism, preop testing?

A

none indicated

48
Q

risk of hyperthermic intraperitoneal chemotherapy w/ cisplatin

A

-given in dextrose solution -> hyperglycemia
-hypoNa can occur
-must cool pt, see inc HR, CO, O2 consumption, dec SVR (pressure compresses IVC)

49
Q

how does neonate switch from fetal to neonatal circulation?

A

dec in PVR
-inc LA pressure closes PFO

50
Q

what anesthetic drugs dec immune response

A

opioids

51
Q

Goals for spinal drains

A

-MAP 80-100
-CSF pressure 8-12
-draining less than 15-25 cc/hr

52
Q

What drug abuse will screw w/ your teeth?

A

Methamphetamines

53
Q

perk of robotic surgery over laparoscopic

A

more degrees of freedom w/ manipulation of surgical instruments

54
Q

Airway pressure release ventilation

A

basically CPAP, allows pt to breath spontaneously
-ARDS

55
Q

Delayed hemolytic transfusion rxns

A

-minor antigens: Kidd, Duffy, Kell, MNS, RH

56
Q

34 YOM healthy no prev medical problems, MVA rib fx splenic lac, ST elevations in V5 cause?

A

cardiac contusion

57
Q

motor n most likely to be anesthetized w/ adductor canal block

A

n to vastus medialis

58
Q

Methylenetetrahydrofolate reductase def, what to avoid?

A

nitrous oxide

59
Q

which DOAC is most renally excreted?

A

Dabigatran
ran out of the renals

-rivaroxaban and apixaban liver metabolism

60
Q

intrathecal ziconotide complications

A

hallucinations

61
Q

why less resp depression w/ midaz than prop?

A

ceiling effect -> benzos can only potentiate effects of endogenous GABA -> after a certain dose no more

62
Q

most common operations for pts w/ multiple myeloma

A

ortho ones! bone tractures

63
Q

treatment for hepatorenal syndrome

A

-renal hypoperfusion and inc Na absorption
-splanchnic vasodilation and inc in nitric oxide -> dec in BP -> RAA aldo
-tx: vasopressin, somatostatin, and alpha agonists (NE, midodrine) w/ volume resuscitation

64
Q

biggest predictor of CNS dysfxn after cardiac surgery

A

age

65
Q

ACh and succ at NMJ

A

competitve!

66
Q

minimize fatigue on night shifts

A

-quick 20-60 min naps
-keep overhead lights bright
-strategic caffeine
-limiting night shifts
-short rest breaks
-keeping regular sleep schedule
-work < 16 hrs

67
Q

myotonia dystrophy and cardiac

A

conduction delays are common and can be resistant to atropine, have external pacing readily available

68
Q

if n block and procedure

A

2 time outs

69
Q

ratio of compressions to breaths in neonate

A

3:1
-in 1 minute goal is 90 compressions 30 breaths

70
Q

dose of neonatal epi

A

10 microg/kg

71
Q

HIT but needs CPB what to give?

A

Bival
**only if normal renal fxn

72
Q

cardiac issue w/ highest maternal mortality

A

pulm HTN
EF < 30%
severe MS, AS
-aortic dilation

73
Q

NSAIDs more commonly cause GI bleeding

A

Ketorolac
Piroxicam (cam, need GI cam b/c bleeding)
Sulindac
Indomethadone

74
Q

weird assoc w/ SFLT2 inh: flozins

A

euglycemic ketoacidosis

75
Q

what to avoid in pts who have been scuba diving/

A

nitrous oxide

76
Q

prone positioning helps pts in ARDS why?

A

aeration! improve V/Q

77
Q

how to get pain w/ facet issues?

A

lumbar extension

78
Q

what u/s factor determines lateral resolution?

A

frequency

79
Q

why give gabapentin preop?

A

dec opioid req post op

80
Q

best way to minimize surgical site infxn w/ c/s

A

give ppx abx

81
Q

when to do a preop stress test?

A

risk of inducible ischemia during intraop course

82
Q

when using heliox recommended %

A

30% O2, 70% Helium

83
Q

Oliceridine

A

mu opioid receptor 400x more selection for mu compared to other opioid receptor subtypes, so less resp depression and GI issues

84
Q

New onset a fib after noncardiac surgery tx

A

BB or Verapamil, Diltiazem

85
Q

After quench of MRI what happens

A

-helium floods the room -> can make the environment hypoxic
-makes the room cold can get frostbite

86
Q

Amisulpride MOA

A

Dopamina antagonist
-schizophrenia and PONV

87
Q

What meds are EEG reliable indicators of consciousness?

A

Propofol

88
Q

what meds are unreliable EEG?

A

ketamine (falsely excited)
precedex (falsely deep)

89
Q

What is caffeine used for?

A

PDPH, and preventing apnea and bradycardia in infants
-prolonging sz in ECT

90
Q

MC anti-HTN in preeclampsia used

A

labetalol
hydralazine

if IV not available: nifedipine

91
Q

MC issues w/ VV ECMO

A

renal failure
cannula site bleeding
oxygenator failure

92
Q

Concern for pts w/ neurofibromatosis

A

AIRWAY! can get neurofibromas in airways

93
Q

if someone is a ultrametabolizer of codeine, what pain meds to give and what to avoid

A

give: morphine, fentanyl, methadone, hydromorphone

don’t give: hydrocodone, oxycodone

94
Q

HFNC how much PEEP for 10L of flow?

A

1 PEEP

95
Q

RF for QT prolongation

A

age > 65
female sex
hypoK, hypoMg

96
Q

over 3 c/s risk of placenta accreta?

A

60%

97
Q

risk of accreta w/ 1 c/s

A

3%

98
Q

risk of accreta w/ 2nd c/s

A

11%

99
Q

Ruex en Y, what is connected to small gastric pouch?

A

jejunum

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