Anesthesia

Question 1

What is MAC

Answer 1

concentration at which 50% of patients won’t respond to skin incision.

Question 2

Methohexital properties

Answer 2

GABAnergic, suppresses reticular activating system. May potentiate seizures.

Question 3

What lung capacity is decreased in a pregnant patient and obese patient?

Answer 3

FRC is decreased.

Question 4

Pediatric larynx position compared to adults?

Answer 4

Anterior and superior.

Question 5

Propofol + which HTN medication = hypotensive.

Answer 5

Propofol causes vasodilation.
ACE/ARBs- block RAS.
Patient cannot compensate.

Question 6

Edrophonium/Tensilon test

Answer 6

Test for suspected Myasthenia Gravis. Edrophonium = acetylcholinesterase inhibitor. Looking for approx 5min improvement in muscle strength.

Question 7

When to give adenosine?

Answer 7

Antiarrythmic for tachycardia/SVT conversion if narrow complex and stable. 6mg rpaid push.

0.05-0.1mg/kg in kids.

Question 8

When to give Atropine?

Answer 8

Bradycardia.
0.5mg for Bradycardia.
1mg if asystole/PEA arrest.

In kids atropine is 0.02mg/kg for brady.

Question 9

Dopamine effects on the body

Answer 9

Stimulates alpha, beta-1, and dopaminergic receptors. Pleasure, cognition, memory.

Question 10

Treatment of myotonic dystonia with laryngospasm

Answer 10

Roccuronium + Positive Pressure O2. Avoid Succinylcholine.

Question 11

Ketamine mechanism

Answer 11

NMDA antagonist

Question 12

Malignant hyperthermia is via what enzyme

Answer 12

Creatine phosphokinase.

Question 13

How is MH treated?

Answer 13

IV Dantrolene 2.5mg/kg every 5 mins until reversal. Or up to 10-20mg/kg total. CK should be trended.

Question 14

Nitrous teratogen mechanism

Answer 14

Inhibits methionine synthase and vit B12.

Question 15

Do barbiturates cause seizures?

Answer 15

No. Except for methohexital. Otehrs are seizure treatment.

Question 16

What is the main complication with prolonged intubation?

Answer 16

Tracheal stenosis.

Question 17

Why use a cuff-less tube in pedo patients?

Answer 17

Narrowest portion is at cricoid cartilage. Avoid excess pressure on tracheal tissues and reduce post-extubation stridor.

Question 18

Desflourane has rapid onset and offset due to?

Answer 18

Very low blood gas partition co-efficient. Relatively insoluble in fat making emergence fairly rapid after a long case.

Question 19

Infants blood pressure is dependent on what?

Answer 19

Heart rate.

Question 20

How doe benzodiazepines affect sleep?

Answer 20

Reduce time to sleep onset and increase total sleep time.

Question 21

How much REM sleep at night?

Answer 21

20-25% of total sleep

Question 22

Which narcotic is metabolized by plasma cholinesterases?

Answer 22

Remifentanyl

Question 23

How is articaine metabolized.

Answer 23

Plasma (primarily) and liver. Due to ester side chain.

Question 24

All amide local anesthetics are metabolized in the liver except?

Answer 24

Articaine. Plasma + liver.

Question 25

Compound A

Answer 25

Product of Sevoflourane. Causes Kidney damage.

Question 26

Local anesthetic with lowest pKa

Answer 26

Mepivicaine/Carbacain= .6 Lido,prilo, articaine= 7.8

Question 27

What determines potency of local anesthetics?

Answer 27

Lipid solubility

Question 28

What determines duration?

Answer 28

Protein binding

Question 29

What determines onset

Answer 29

pKA

Question 30

Lidocaine Max dose

Answer 30

4.5mg/kg w/o epi. w epi 7mg/kg

Question 31

Articaine Max dose

Answer 31

7mg/kg

Question 32

Bupivicaine Max dose

Answer 32

1.3mg/kg

Question 33

Carbocaine max dose

Answer 33

4mg/kg

Question 34

Which local anesthetic can significantly prolong succcinylcholine?

Answer 34

Procaine

Question 35

What test can be used to determine is someone has an atypical plasma cholinesterase

Answer 35

Dibucaine number >80 is normal ,80 may have prolonged effects of succs.

Question 36

What happens to lungs as they age?

Answer 36

reduced alveolar surface area.

Question 37

Etomidate side effects?

Answer 37

PONV and adrenal suppresion.

Question 38

Why can succ be used w/out issue in myasthenia gravis

Answer 38

fewer funcitonal receptors. These patients require more succ than normal. MG patients ARE more sensitive to non-depolarizing neuromuscular blockers.

Question 39

What anesthetic agents are NOT thought to cause acute intermittent porphyira?

Answer 39

Nitrous and Narcotics.

Question 40

What is the initial dose of Dantrolene for MH?

Answer 40

2-3mg/kg

Question 41

How is dantrolene mixed

Answer 41

60ml steriile water/20mg bottle. Then, the appropriate 2.5mg/kg dose is injected rapidly after reconstitution. Should have 36 bottles on hand for MH crisis if using triggering drugs.

Question 42

What durgs can cause methemmogloinemia?

Answer 42

Articaine, Benzocaine, prilocaine, Bactriim, sulfonamides, dapsone.

Question 43

What is the treatment of methemoglobinemia

Answer 43

O2 and methylene blue 1% solutin dosed at 1-2mg/kg given over 5 minutes.

Question 44

How to treat Torsades?

Answer 44

1-2g Magnesium over 5-60 minutes.

Question 45

Fentanyl Dose

Answer 45

Wide range. Intraop 2-50mcg/kg.

Question 46

Meperidine + MAOIs=

Answer 46

Serotonin Syndrome

Question 47

cardiac instability HTN and hypotension, hyperpyrexia, coma, respiratory arrest

Answer 47

Serotonin syndrome

Question 48

Dilaudid Dose

Answer 48

0.01-0.02mg/kg Can cause histamine release

Question 49

Morphine Dose

Answer 49

0.1mg/kg 5-10% excreted by kidney. Renal failure may prolong duration.

Question 50

Naloxone Dose

Answer 50

Generallysmall doses: 0.1-0.2mg q2-3min. Full reversal is 0.4-2mg

Question 51

Sevoflurane

Answer 51

Blood/gas coefficient is 0.65 MAC is 2. Low solubility and non-pungency

Question 52

Isoflurane

Answer 52

Blood gas coefficient is 1.4. MAC is 1.2.

Question 53

Desflurane

Answer 53

Blood gas coefficient 0.42 MAC is 6 Low solubility in both blood and body tissues causes a very rapid induction and emergence. Rapid increases can lead to transient but significant increases in HR, BP, and catecholamine levels

Question 54

Nitrous

Answer 54

Blood gas coefficient 0.47 MAC 105

Question 55

Prolong exposure to Nitrous causes

Answer 55

Bone Marrow suppression. Megaloblastic anemia.

Question 56

Nitrous in Pregnancy?

Answer 56

Oxidizes Vit B12 so affects B12 dependent enzymes, including methionine synthetase.

Question 57

Halothane

Answer 57

Rare but associated with halothane hepatitis. MAC is 0.75

Question 58

Propofol Dose

Answer 58

1-2mg/kg induction dose.

Question 59

Propofol infusion syndrome

Answer 59

long infusions can cause lipemia, metabolic acidosis, and death = propofol infusion syndrome

Question 60

Etomidate Dose

Answer 60

Induction 0.3mg/kg.

Question 61

Cisatracurium

Answer 61

Hoffman Elimination.

Question 62

Reglan in Parkinsons

Answer 62

Blocks dopamine receptors. Extrapyramidal effects.

Question 63

Ondansetron

Answer 63

5HT3 blocker- can cause QT prolongation.

Question 64

Droperidol

Answer 64

Caution in Parkinsons patients. Also causes prolongation of QT interval.

Question 65

Metoprolol

Answer 65

Beta 1 selective. Given as bolus of 2.5-5mg over 2 minutes in A-fib and RVR.

Question 66

Vasopressin

Answer 66

acts as ADH- Directly stimulates smooth muscle V1 receptors casing vasoconstriction.

Question 67

Levophed

Answer 67

NE. Mostly alpha and beta.1 effects. Usually given as 2-20mcg/min infusion but can bolus 0.1mcg/kg.

Question 68

Epi

Answer 68

Anaphylaxiss usually in 100mcg increments. As a pressor run from 2-20mcg/min.Ph

Question 69

phenylephrine

Answer 69

Primarily an alpha 1 agonist. Can cause rebound bradycardia.

Question 70

Aprepitant

Answer 70

Neurokinin-1 receptor antagonist. Antiemetic.

Question 71

Diltiazem

Answer 71

CCB, inhibits calcium influx into vascular smooth msucle, relaxes smooth msucle. Decraseses SVR, dilates coronaries, and prolongs AV node refractory period. 0.25mg/kg IV for afib with rvr.