Anesthesia ITE Flashcards

Question

In patients with multiple sclerosis, succinylcholine should be used very cautiously because they may have denervation or misuse myopathy leading to a higher risk for hyperkalemia.

Answer 1

Age Group Blood Volume Premature infant 90-105 mL/kg Full-term newborn 80-90 mL/kg Infant 3-12 months 70-80 mL/kg Child 1-12 years 70-75 mL/kg Adult male 65-70 mL/kg Adult female 60-65 mL/kg

Answer 2

It is scored 0-3 with one point each for altered mental status (GCS < 15), respiratory rate ≥22, and systolic blood pressure ≤100 mm Hg. A score ≥2 indicates a worse prognosis.

Answer 3

Dexmedetomidine induces sedation by stimulating the locus coeruleus which ultimately leads to a decrease in histamine release from the tuberomammillary bodies and induces a sleep state. A major advantage of dexmedetomidine is that respiratory drive is preserved, and awakening for neurologic evaluation or commands in the ICU or during operations is maintained.

Answer 4

Acute hyperoxia can manifest with CNS toxicity, presenting initially as a grand-mal seizure. Prolonged exposure can result in pulmonary and ocular toxicity due to increased oxygen free-radical formation

Answer 5

Most pulmonary pathology results in a decreased diffusing lung capacity of carbon monoxide (DLCO).However, The DLCO has been found to be increased in patients with asthma, with obesity, and at high altitudes. Factors that increase the amount of blood exposed to the ventilated air, such as polycythemia, heart failure, left to right shunt, and pulmonary hemorrhage, also increase the DLCO

Answer 6

The trachea can be anesthetized by transtracheal injection of local anesthetic through the cricothyroid membrane.

Answer 7

When providers are monitoring for ischemia, the transgastric midpapillary short-axis view is preferred because it allows the provider to visualize the myocardium perfused by the three coronary arteries in a single image

Answer 8

Prothrombin complex concentrate contains factors II, VII, IX, X. PCC is now preferred over plasma for a correcting coagulopathy.

Answer 9

Peritoneal dialysis is the preferred dialysis modality for patients who are intolerant of the hemodynamic changes induced by hemodialysis. This may include patients with a history of unstable angina, severe aortic stenosis, or heart failure with severely reduced ejection fraction. Peritoneal dialysis is preferred in the pediatric group

Answer 10

By 8 weeks gestation an increase in cardiac output of 50% occurs, this is accompanied by a drastic decrease in systemic vascular resistance. After approximately 20 weeks gestation, in the supine position, the gravid uterus places pressure on the great vessels, which may cause a decrease in uteroplacental blood flow. Blood volume and plasma composition also change during pregnancy. In the first trimester, the blood volume expands and will continue to increase until term. Plasma volume increases faster than the increase in red blood cell mass thus dilutional anemia occurs. A hypercoagulable state is achieved due to increases in fibrinogen, factors VII, VIII, X, and XII. Platelet turnover is enhanced. The respiratory system changes mainly due to an increase in alveolar ventilation by 30% or more by mid-pregnancy. A chronic respiratory alkalosis is seen with a slightly alkaline pH. Oxygen consumption increases as metabolism changes, PaO2 may slightly increase. Functional residual capacity decreases as the uterus expands pushing the diaphragm upward, resulting in decreased oxygen reserve

Answer 11

Patients with known inducible ischemia may receive even more benefit from beta-blocker therapy. It is known that beta-blocker therapy should not be started within 1 day of surgery as that significantly increases the risk of stroke and death. Thus the recommendation is to initiate therapy at least 2 days, but preferably 7-45 days prior to surgery.

Answer 12

Meyer-Overton correlation describes the linear relationship between anesthetic potency and solubility in oil such as olive oil. The hypotheses of inhaled anesthetics with lipid membrane target sites were predominant before shifting to the more current protein-target-based theories.

Answer 13

A few situations exist that necessitate lifelong anticoagulation for these patients. These include patients who have had 2 or more venous thromboses, patients with 2 or more hereditary hypercoagulable disorders, patients with one spontaneous life-threatening thrombosis, and patients with one spontaneous thrombosis at an unusual site. INR goal for warfarin for these patients is 2-3; the same as the general population

Answer 14

Standard error of mean (SE) Standard deviation (SD) Sample size (n) SE = SD / √n The standard error of the mean describes the precision of the sample mean to the population mean

Answer 15

Metabolic acidosis, which results from ketone production in brown fat metabolism (nonshivering thermogenesis), is maladaptive in the neonate and is the most critical consequence of a decrease in temperature. Neonates use nonshivering thermoregulation to control body temperature to metabolize their brown fat

Answer 16

Elevated preop creatinine, complex cardiac procedures, emergency surgery, and preop intraaortic balloon pump carry the highest risk for post cardiopulmonary bypass acute kidney injury. Acute kidney injury occurs in up to 30% of patients following cardiac surgery.

Answer 17

Effective prophylactic medications for the prevention of emergence delirium in children who are undergoing general anesthesia with volatile anesthetics include a single IV dose of ketamine, propofol, midazolam, fentanyl, or dexmedetomidine at the end of surgery

Answer 18

excessive oxygen administration does have predictable and potentially deleterious effects. Hyperoxia will tend to cause systemic vasoconstriction and pulmonary vasodilation. Excess dissolved oxygen in the plasma may cause an increase in circulating reactive oxygen species which mav increase the oxidative stress on the body's systems.

Answer 19

Pudendal nerve block helps relieve pain during the second stage of labor. The pudendal nerve includes somatic nerve fibers from S2-S4.

Answer 20

Material Ingested Minimum Fasting Period Clear liquids 2 hours Breast milk 4 hours Infant formula 6 hours artificial milk, light meal 6 hours Fried, fatty foods, meats 8 hours

Answer 21

Patients with known hypertrophy of the intraventricular septum experiencing hypotension should be treated with fluid & alpha agonists such as phenylephrine

Answer 22

Patients who have allergies to avocados, bananas, and kiwis have been shown to have antibodies that cross react with latex

Answer 23

Goals for a patient presenting with acute stroke include normothermia, normotension, euvolemia, normal blood glucose levels, avoidance of hypoxemia, avoidance of hyperoxia and rapid fibrinolysis

Answer 24

Sepsis and septic shock are medical emergencies and should be rapidly and aggressively managed as soon as a diagnosis is made. Broad-spectrum antibiotics should be initiated within the first hour. Sepsis-induced hypoperfusion should be treated with at least 30 mL/kg of intravenous crystalloid within the 3hr used in combination with volume resuscitation to target an initial MAP of 65 mmH and the recommended initial vasopressor is norepinephrine.

Answer 25

portal vein normally supplies approximately 75% of the total liver blood flow, and the hepatic artery provides the remaining 25% of total liver blood flow. Each supplies approximately 50% of the total oxygen content to the liver The hepatic arterial buffer response is unaffected by intravenous anesthetics.

Answer 26

Most priming solutions for cardiopulmonary bypass are crystalloid based and can include additives such as heparin, mannitol, corticosteroids, and colloid solutions. Adding colloids can reduce the drop in systemic vascular resistance seen with crystalloid priming solutions.

Answer 27

For every decade of life after 40 years, the minimum alveolar concentration (MAC) of volatile anesthetics is reduced by 6%, and for every decade before 40 years, MAC is increased by 6%.

Answer 28

Line isolation monitors monitor the amount of leakage present in an isolated (ie, nongrounded) power system, such as that in the operating room. They typically sound an alarm when a piece of equipment with excessive leakage (ie, equipment with a shorted circuit with low impedance) is plugged into the operating room outlet. The threshold for alarm is typically 5 mA of leakage, to prevent a macroshock which requires 10 mA. Sounding of an LIM alarm does not mean that a macroshock has occurred but that leakage is sufficient to put the patient at risk should further grounding occur.

Answer 29

Posterior ION is more common and most cases involve spinal surgery. It is caused by decreased oxygen delivery to the optic nerve in the lesser perfused, posterior portion. Hypoxic insult can manifest slowly over days with bilateral involvement being more common. Risk factors include male sex, obesity, use of a Wilson frame, prolonged anesthetic, increased blood loss, and lower percent colloid administration.

Answer 30

Arterial oxygen content (CaO2) is described by the following equation: CaO2 = (1.39 * SaO2 * Hgb) + (0.003 * PaO2)

Answer 31

Lactulose decreases the intestinal absorption of ammonia by decreasing the intestinal pH and trapping ammonia as the ammonium ion, which can no longer cross the intestinal membrane and be absorbed.

Answer 32

Large volume infusion of fluids with zero SID (such as normal saline) will decrease the plasma SID (normally 40 mEq/L). This results in dilutional acidosis. This is true for large saline infusion where the metabolic acidosis results due to reduction in SID, not the hyperchloremia. Strong ion difference (SID) can be reduced by infusing large volumes of fluid that has a SID of zero, such as normal saline

Answer 33

Ketorolac inhibits platelet Agregation and prolongs bleeding time. It and other NSAIDs should therefore be used with caution in patients at risk for postoperative hemorrhage.

Answer 34

The 5-HT3, receptor mediates vomiting and is found in the GI tract and the brain (area postrema). The 5-HT4, receptors are responsible for smooth muscle contraction and platelet aggregation 5-HT5 receptors in the GI tract mediate secretion and peristalsis 5-HT6 and 5-HT7, receptors are located primarily in the limbic system where they appear to play a role in depression. serotonin is a powerful vasoconstrictor of arterioles and veins.

Answer 35

Colors for the most commonly used gases are Black: Nitrogen Blue: Nitrous oxide Brown: Helium Gray: Carbon dioxide Green (*white): Oxygen Yellow (*white and black): Air

Answer 36

Midazolam is a benzodiazepine that will decrease seizure duration thus should be avoided as an anxiolytic or induction agent during electroconvulsive therapy

Answer 37

The most important initial step in management of an incompetent inspiratory valve is to increase fresh gas flow such that rebreathing will be minimized or eliminated.

Answer 38

during mechanical modes of ventilation (eg, volume control), the function of the APL valve is negligible. If this valve is not closed sufficiently, excessive loss of circuit volume due to leaks prevents manual ventilation. However, if the valve is closed too much or is fully closed, a gradual increase in pressure could result in pulmonary barotrauma, gastric insufflation, or hemodynamic compromise.

Answer 39

National Fire Protection Association authors the Health Care Facilities Code, which includes standards for electrical systems, HVAC, gas, and vacuum systems, among others

Answer 40

This is a sign of Occipital neuralgia. Occipital nerve block is both diagnostic and therapeutic in treating occipital neuralgia.

Answer 41

Necrotizing tracheobronchitis is a complication of high-frequency jet ventilation

Answer 42

Flumazenil is a short-acting competitive antagonist of benzodiazepines. Flumazenil has the shortest half-life of all benzodiazepines, with a duration of action of about 45 minutes to one hour. Therefore, any patient who has received flumazenil should be observed for recurrent sedation. Flumazenil can cause seizures as well.

Answer 43

Cerebellum receives large quantities of information from the brain, spinal cord, and vestibular system, supporting proper coordination of movements in agonist-antagonist muscle groups for appropriate balance and fine motor function. Disruptions in cerebellar functions, as in a stroke or congenital ataxic disease (ie, Friedreich's ataxia) can lead to a variety of symptoms including intention tremor, nystagmus, and dysarthria.

Answer 44

Malignant hyperthermia-susceptible patients have RYR1 defects that, in the presence of a triggering agent (succinylcholine or any volatile anesthetic), cause prolonged opening of the channel which leads to sustained muscle contraction. This produces a generalized hypermetabolic state characterized by increased CO2, lactic acidosis, and heat production which can progress to muscle cell breakdown leading to hyperkalemia and rhabdomyolysis

Answer 45

Patients will Hypokalemic periodic paralysis present with flaccid paralytic attacks after eating a carbohydrate-heavy meal and during exercise. Other factors that precipitate these attacks include high salt-containing meals

Answer 46

Ginseng, in particular, may cause intraoperative hypoglycemia if patients are taking it preoperatively Ephedra, also known as ma huang, is used for weight loss and to increase energy. It is a sympathomimetic that increases heart rate and blood pressure. Garlic is used to modify the risk of atherosclerosis as well as reduce blood pressure. It inhibits platelet aggregation and increases fibrinolysis.

Answer 47

Pressure in the "laryngospasm notch" just anterior to the pinna of the ear and under the angle of the mandible may be attempted at this time in order to stimulate and awaken the patient in an effort to proceed through stage 2 of anesthesia faster. This is referred to as the Larson maneuver.

Answer 48

A preoperative coronary catheterization is indicated for patients who fail a stress test or have refractory angina.

Answer 49

with open globe injuries - Propofol is preferred over etomidate or ketamine since the latter two drugs can cause myoclonus and nystagmus, respectively. - Avoid nitrous oxide as it can cause enlargement of intraocular gas bubbles and increase IOP. - Use caution with retrobulbar blocks as large volumes of local anesthetic behind the eye can increase IOP. - Attempt to avoid coughing and bucking with emergence.

Answer 50

Pruritus is a side effect of opioids and is particularly prevalent with neuraxial opioids (60-80%). Nalbuphine is the drug of choice for the treatment of pruritus induced by neuraxial opioids.

Answer 51

For patients undergoing moderate-risk surgeries, an ECG should be considered for those with known cardiac or cerebrovascular disease or cardiac risk factors. For patients with no cardiac risk factors undergoing moderate risk surgeries, generally, no preoperative testing is indicated. For patients undergoing high-risk surgeries, ordering an ECG preoperatively should be considered for patients with known cardiac or cerebrovascular disease or without heart disease but with risk factors.

Answer 52

A stress test is indicated if there is concern that the patient's heart will not be able to tolerate the procedure. If The patient is able to tolerate >4 metabolic equivalents with an ability to walk for 1 mile, so there is no indication for a stress test.

Answer 53

Acupuncture can help prevent PONV Acupuncture is good for pain control

Answer 54

Stimulation of large nerves will eventually lead to activation of GABA and decreased Glutamate excitatory mechanisms to decrease pain stimulation

Answer 55

Echinocandins are the preferred first line treatment of candidemia. They act by inhibiting 1,3-beta-D-glucan synthase and cell wall synthesis. Amphotericin B acts by disrupting the fungal cell membrane by binding to ergosterol in the membrane and creating pores.

Answer 56

Most medications are eliminated by first-order kinetics. drugs that are eliminated by zero-order kinetics are ethanol, cisplatin, phenytoin, and salicylates (at high doses)

Answer 57

Antibodies targeting presynaptic voltage-gated calcium channels are involved in Lambert-Eaton syndrome. This disease presents with proximal limb weakness that improves with increased activity. The antibodies targeting the voltage-gated calcium channel reduce the calcium influx into the presynaptic terminal and the release of acetylcholine at the neuromuscular junction

Answer 58

Stroke volume variation (SVV) can be used to assess fluid responsiveness. SVV is accurate when the following conditions are met: mechanical ventilation , tidal volumes ≥ 8 mL/kg, and normal sinus rhythm. Inaccurate values can result when the patient is spontaneously breathing; there is the presence of arrhythmias, elevated intra-abdominal pressure, or right heart failure; the thoracic cavity is open during surgery; there is a high respiratory rate; and there are low tidal volumes/low lung compliance.

Answer 59

Type II alveolar cells are metabolically active cells and secrete the lung surfactant. They also play a role in pulmonary defense through the secretion of inflammatory mediators. When type I alveolar cells become damaged during acute lung injury, new type I alveolar cells are regenerated through replication of type II cells.

Answer 60

Klippel-Feil syndrome presents with a fused cervical spine due to lack of segmentation of the cervical spine . Cervical rotation is reduced more than flexion and extension. Cervical immobility can present a challenging intubating condition

Answer 61

Treacher Collins syndrome is inherited in an autosomal dominantly pattern with variable penetrance. It results in zygoma and mandibular hypoplasia. It is associated with ear deformity, deafness, and mental retardation. Unlike Pierre Robin sequence, this syndrome becomes more challenging to intubate with age

Answer 62

Epidural-administered hydrophilic opioids (eg, morphine, hydromorphone) have a slower onset, a longer duration of action, a higher incidence of side effects, a delayed respiratory depression, an extensive cerebrospinal fluid spread, and a delayed onset of analgesia compared to lipophilic opioids (eg, fentanyl). This is mainly due to their low lipid solubility of hydrophilic opioids.

Answer 63

An upper extremity tourniquet should be inflated to at least 50 mm Hg above the systolic blood pressure. A lower extremity tourniquet should be inflated to at least 100 mm Hg above the systolic blood pressure.

Answer 64

Note that for full-term infants, case reports of apneic episodes have been noted at birth so guidelines generally recommend waiting until post-natal age of greater than 4 weeks prior to discharging without observation.

Answer 65

Meperidine is broken down into the neuroexcitatory metabolite normeperidine; this can result in seizures, agitation, and myoclonus if the normeperidine is not cleared by the kidneys.

Answer 66

Etomidate inhibits 11β-hydroxylase resulting in decreased synthesis of cortisol and aldosterone.

Answer 67

Dual anti platelet therapy may be interrupted for elective noncardiac surgery after one month after bare-metal stent placement.

Answer 68

Pregnancy is a prothrombotic state with increased levels of many clotting factors. Factors VII, VIII, IX, X, and XII levels are all increased. In addition there is a decrease in factor C & S levels. This causes shorter PT and PTT times. However, not all factors are increased during pregnancy with factors XI and XIII levels decreasing slightly.

Answer 69

Erythropoietin may be helpful for Jehovah’s Witness patients but requires four to six days to stimulate erythropoiesis Albumin is not allowed in Jehovahs witness patients. Minimize phlebotomy in Jehovah’s Witness patients Cardiopulmonary bypass would likely be an acceptable technique for Jehovah's Witness patients

Answer 70

Oxygen toxicity of the neonate usually manifests as chronic lung disease and central nervous system diseases (i.e. retinopathy of prematurity). When administering oxygen to a neonate, always start with the lowest possible amount of oxygen and titrate FIO2 levels to maintain SpO2 > 94% or PaO2 > 100 mg Hg. Critically ill patients and neonates have been shown to be deficient of anti-oxidant mechanisms and thus are more susceptible to oxygen toxicity.

Answer 71

GLUT 1 is found in the cornea, CNS, placenta GLUT 3 is found in most cells, CNS GLUT 5 is found in kidneys GLUT 2 is a bidirectional transporter, responsible for glucose uptake into the liver.

Answer 72

Induced hypothermia following cardiac arrest can reduce ischemic injury and improve neurologic outcomes. It is accomplished by various cooling methods for a duration of 12-24 hours post-resuscitation with a goal temperature of 32 °C to 36 °C.

Answer 73

The Mapleson A system is the only type of Mapleson system that has the fresh gas inlet near the breathing bag and not near the patient. It is most efficient for spontaneous ventilation. To prevent rebreathing, the FGF must be equal to minute ventilation.

Answer 74

The circle system is the most common breathing system, and a carbon dioxide absorbent is used. most efficient circle system with the highest conservation of fresh gas is one in which the unidirectional valves are closest to the patient with the APL valve immediately downstream of the unidirectional expiratory valve.

Answer 75

Increased cardiac output during pregnancy increases maternal oxygen consumption. In fact, two-thirds of this increase is attributed to fetal, placental, and uterine metabolism increase.

Answer 76

It is known that viral particles can be found in the surgical smoke plume generated from electrocautery units.

Answer 77

Fetal tone is the earliest to function, at 7.5 to 8.5 weeks of gestation. At 9 weeks, the fetal movement center begins functioning. At 20-21 weeks of gestation, fetal breathing begins. During periods of hypoxia or asphyxia, fetal heart rate is the most sensitive to reflect changes, whereas fetal tone is the last component to decrease.

Answer 78

Hypothermia also occurs with regional anesthesia. The thermoregulatory center incorrectly judges skin temperature in blocked regions to be abnormally elevated.

Answer 79

Hypothermia reduces both the arterial partial pressure of carbon dioxide and the arterial partial pressure of oxygen because a decreased temperature causes an increase in gas solubility in the blood.

Answer 80

Though modern volatile anesthetics do inhibit hypoxic vasoconstriction in a dose-dependent manner, this effect appears to become significant only at 1.5-2.0 MAC or greater. No benefit in oxygenation has been demonstrated with TIVA compared to volatile anesthetics around 1.0 MAC during one-lung ventilation

Answer 81

Type II reactions are characterized by moderate to severe hypotension with anaphylactoid features such as bronchoconstriction. Type III reactions result from large heparin-protamine complexes that deposit in the pulmonary circulation resulting in the release of vasoactive mediators causing severe hypotension, elevated pulmonary artery pressures, and potentially right ventricular failure. This collapse of the cardiovascular system may result in the requirement for the patient to be reinstituted on cardiopulmonary bypass.

Answer 82

Favorable respiratory mechanics values include a negative inspiratory force > −20 cm H2O, a RSBI (rapid shallow breathing index) of < 105, and a vital capacity of > 10 mL/kg.

Answer 83

Acupuncture releases ACTH, rise in serum ACTH levels suggests that adrenal stimulation and subsequent cortisol release may play a role in acupuncture-induced analgesia.

Answer 84

Fentanyl does NOT cause IT granuloma. Morphine & hydromorphone can cause IT granuloma

Answer 85

Smoking, however, actually decreases the risk of preeclampsia by 30% to 40%. Aspirin causes a 10% to 20% reduction in the risk of developing preeclampsia

Answer 86

Meralgia paresthetica is frequently associated with pregnancy and delivery. Symptoms worsen with standing or wearing tight clothing

Answer 87

The glottic closure reflex is primarily initiated by stimulation of the internal branch of the superior laryngeal nerve, which provides sensory innervation to the supraglottic region of the hypopharynx. The recurrent laryngeal nerves then mediate vocal cord adduction. Both the superior and recurrent laryngeal nerves are branches of the vagus nerve (CN X).

Answer 88

Lithium potentiates nondepolarizing neuromuscular-blocking drugs (NMBDs) via 2 different mechanisms. First, it activates potassium channels in prejunctional neurons, which interferes with transmission of an action potential to the nerve terminal. Second, it activates potassium channels on the postsynaptic myocytes, which inhibits muscle contraction.

Answer 89

Milrinone increases cAMP levels & smooth muscle vasodilation and decreased peripheral vascular resistance. Milrinone is also a potent pulmonary vasodilator leading to its use in the treatment of pulmonary hypertension. common side effects of milrinone include arrhythmias, hypotension, and thrombocytopenia

Answer 90

Microlaryngeal tracheal tubes are designed with a smaller internal diameter but with a length and cuff size appropriate for the adult airway.

Answer 91

features designed to prevent against delivery of a hypoxic gas mixture include the pressure fail-safe valve, the flow proportioning system, and the way in which the flowmeters are configured

Answer 92

Large volumes of lidocaine may be safely injected because the majority of lidocaine is aspirated during the procedure.

Answer 93

Nerve stimulation is less effective in patients with diabetes and becomes unreliable after the injection of saline or local anesthetic. The incidence of nerve injuries is the same with nerve stimulation and ultrasound guidance techniques for peripheral nerve blocks.

Answer 94

Coronary perfusion pressure: Coronary perfusion pressure (CPP) is represented as the difference between the aortic diastolic pressure (AoDP) and the left ventricular end-diastolic pressure (LVEDP). CPP = AoDP - LVEDP

Answer 95

After brain death, the anterior and posterior pituitary fail causing a dramatic fall in homeostasis.

Answer 96

the pulmonic valve is the farthest from the transesophageal echocardiography (TEE) probe, making visualization difficult. In addition, TTE has greater flexibility in probe positioning and angulation compared to TEE. Therefore, the pulmonic valve may be better visualized with transthoracic echocardiography (TTE).

Answer 97

Endotracheal tubes are vulnerable to ignition when exposed to a CO2 laser. Polyvinyl chloride (PVC) is the most likely endotracheal tube material to combust when exposed to a laser Silicone was the most combustion-resistant

Answer 98

Conditions and Comorbidities That Increase Risk of Complications During MAC Age >70 years Severe anxiety disorders ASA physical status of III or IV Chronic liver disease (MELD score >10) Chronic renal failure Morbid obesity (BMI ≥40 kg/m2) Obstructive sleep apnea Pulmonary hypertension Severe cardiovascular disease (coronary artery disease)

Answer 99

In carcinoid syndrome, a neuroendocrine tumor secretes vasoactive substances such as serotonin, which stimulates fibroblast growth and fibrogenesis, resulting in cardiac valvular fibrosis in ~60% of patients. This primarily affects right-sided heart valves because the vasoactive substances are inactivated by the lungs. Tricuspid regurgitation accounts for ~90% of valvular lesions in carcinoid syndrome, but tricuspid stenosis, pulmonic regurgitation, and pulmonic stenosis can also occur in carcinoid syndrome

Answer 100

Indications for EEG monitoring during anesthesia are carotid endarterectomy, cardiopulmonary bypass procedures, and cerebrovascular surgery such as aneurysm surgery requiring temporary clipping or vascular bypass procedures. Common indications in the intensive care unit are barbiturate coma for patients with traumatic brain injury and when subclinical seizures are suspected.

Answer 101

In septic shock, after an initial increase the ADH concentrations decrease to extremely low levels.

Answer 102

Perioperative pediatric fluid management for healthy children involves a 20- to 40-mL/kg bolus of an isotonic salt solution for two to four hours.

Answer 103

Adequate uterine relaxation is critical during an EXIT procedure in order to maintain uteroplacental circulation and fetal gas exchange. This can be accomplished with high-dose volatile anesthetics and/or nitroglycerin.

Answer 104

Baralyme is the most likely to cause carbon monoxide (CO) formation with desflurane. Soda lime can also form CO

Answer 105

Recurarization, or reparalyzing, occurs when neostigmine's duration of action is shorter than that of the NMBA used. Recurarization can be prevented by ensuring that the patient has an appropriate train-of-four (TOF) count prior to administration of neostigmine and by avoiding the use of a long-acting NMBA such as pancuronium. Neostigmine is metabolized by the liver and excreted by the kidneys; thus, decreased renal function will prolong the effects of neostigmine, which helps outlast the effect of NMBAs that are excreted renally, such as rocuronium and vecuronium

Answer 106

Deep brain stimulation (DBS) is an established treatment for movement disorders; the subthalamic nucleus (STN) and the internal globus pallidus (GPi) are the most common targets for DBS treatment in Parkinson disease.

Answer 107

Anesthesia dolorosa is pain in an area that lacks sensation, often involving the face. Anesthesia dolorosa is a feared complication of neurolytic blocks for the treatment of trigeminal neuralgia

Answer 108

Propofol increases hepatic blood flow Pediatric patients can potentially develop a venous air embolism (VAE) during craniotomies in both the supine and prone position because their relatively large heads sit above the level of the heart in both positions. Children are also more likely to become symptomatic from a VAE because their smaller circulatory volume and heart size are more easily overwhelmed by smaller volumes of entrained air.

Answer 109

All personnel and items must be screened prior to entry of Zone III, with non-MRI compatible items such as an infusion pump not allowed closer than Zone III. Zone IV is the MR scanner room and is only accessible via Zone III. Only MRI safe items should be brought into Zone IV.

Answer 110

The posterior cricoarytenoid muscles abduct the vocal cords, whereas the lateral crico-arytenoid muscles are the principal adductors.

Answer 111

Nasogastric tubes and larger bore tubes are associated with increased risk of otitis media and sinusitis when used for a long time. Placing a gastric tube beyond the pyloric junction has not been shown to reduce the risk of pulmonary aspiration

Answer 112

Initial treatment for hypercalcemia should be aimed at volume correction with normal saline or plasmalyte. With restoration of the patient's fluid deficit furosemide can be used to decrease calcium levels.

Answer 113

Methylene blue is a useful therapy for catecholamine-resistant vasoplegic shock, which may occur during the reperfusion of a transplanted liver, or after cardiopulmonary bypass, due to its inhibitory effects on nitric oxide leading to increase in SVR

Answer 114

Immature subunits are present in the fetal state and states of immobilization, burns, upper or lower motor neuron injury, and sepsis and are associated with increased efflux of potassium and hyperkalemia following activation by depolarizing drugs such as succinylcholine.

Answer 115

Lateral pontine syndrome results from infarction to the lateral pons, mainly due to occlusion of the anterior inferior cerebellar artery or perforating branches of the basilar artery. Patients will present with contralateral loss of pain and temperature. Ipsilateral symptoms include facial muscle weakness, decreased salivation and lacrimation, loss of taste from the anterior two-thirds of the tongue, Horner syndrome, limb and gait ataxia, loss of pain and temperature sensation in the face, vertigo, nystagmus, and hearing loss.

Answer 116

Long QT syndrome (LQTS) is characterized by inherited or acquired prolonged QT interval viewed on electrocardiography and can lead to torsade de pointes and ventricular fibrillation. Patients with congenital LQTS should be treated with nonselective ß-blockers such as nadolol and propranolol and/or have an implanted cardiac defibrillator.

Answer 117

Osteogenesis imperfecta is associated with brittle bones that are vulnerable to fracture, joint laxity, joint subluxation, blue-tinted sclera, hearing loss, restrictive lung physiology, cardiovascular anomalies, and there is increased risk of bleeding due to collagen and platelet dysfunction. These patients can be difficult to intubate and backup airway equipment should always be readily available

Answer 118

Respiratory alkalosis, such as from hyperventilation, can cause electrolyte abnormalities, such as hypocalcemia, hypokalemia, and hypophosphatemia. Hypocalcemia is caused by increased calcium binding to negatively charged plasma proteins as the proteins release hydrogen ions to restore physiologic pH

Answer 119

Respiratory depression as a result of over-sedation is the most common mechanism of injury during monitored anesthesia cases.

Answer 120

Etomidate is an induction agent that increases the seizure duration of electroconvulsive therapy (ECT). Etomidate (0.15-0.3 mg/kg) The physiological response to ECT is an initial parasympathetic response that includes transient bradycardia, followed by a sympathetic response including tachycardia and hypertension.

Answer 121

The early initiation of enteral nutrition should be avoided in critically ill patients who are hemodynamically unstable and have not had their intravascular volume fully resuscitated because such patients may be predisposed to bowel ischemia

Answer 122

**Sevoflurane** metabolism has not resulted in the formation of TFA intermediates and the potential for hepatic toxicity is low. Instead, sevoflurane metabolism yields a compound **hexafluoroisopropanol** (HFIP), which does not accumulate and rapidly undergoes phase II biotransformation.

Answer 123

Pulmonary manifestations could include ventilation/perfusion mismatching, atelectasis, hypoxia, hypercarbia, increase in plateau and peak pressures, and an increased work of breathing. Urgent identification of this syndrome is imperative, and abdominal compartment syndrome can be diagnosed by measuring intra-abdominal pressures >20 mmHg. After abdominal compartment syndrome has been diagnosed, management includes immediate paracentesis and opening the abdomen for urgent decompression.

Answer 124

In a pneumonectomy, adequate vascular access should be obtained with an arterial line, central venous catheter, and another large-bore venous catheter to permit close monitoring and to allow for targeted resuscitation with vasoactive agents and judicious fluid therapy as needed. Other best practices include restrictive fluid administration, and ventilation with low tidal volumes <5 ml/kg and low pressures.

Answer 125

For lumbar plexus sympathetic blocks, a Blockade of the genitofemoral nerve or lumbar plexus within the psoas muscle may result in numbness in the groin, thigh, or quadriceps and cause prolonged neuralgia and burning pain, especially in the groin, if a neurolytic agent is injected. Other adverse effects include renal or urethral trauma, hematoma, infection, abscess, intravascular injection, perforation of a disk, diskitis, somatic nerve injury, and chronic back pain

Answer 126

In the initial distribution phase immediately after an inhaled anesthetic is discontinued, the anesthetic agent diffuses from the alveoli and VRG to the muscle and fat groups (in addition to being exhaled). In the terminal phase, long after an inhaled anesthetic has been discontinued, the anesthetic agent diffuses from the fat group to the alveoli group, which then gets exhaled.

Answer 127

Doxapram, a pharmacologic respiratory stimulant, may be beneficial in select cases of hypercapnic respiratory failure due to exacerbations of chronic obstructive pulmonary disease, particularly when supplemental oxygen is administered. However, its approved indications are otherwise restricted to the temporary amelioration of drug-induced and postanesthetic respiratory depression, and alternative therapies are often preferred

Answer 128

Closing capacity (CC), defined as the volume at which small airways begin to collapse during exhalation, increases with age.

Answer 129

In the elderly theres an increase in FRC, closing capacity, dead space, and residual volume. Total lung capacity is relatively unchanged in the elderly. Hypoxic pulmonary vasoconstriction is blunted in the elderly (> 65 years) population, and this can cause difficulty with one-lung ventilation.

Answer 130

water warming garments (WWGs) These garments are based on the technology used by astronauts' space suits. The patient is wrapped in a garment that covers well while allowing surgical exposure. Warm water is then circulated next to the patient's skin and the temperature is adjusted via feedback mechanisms

Answer 131

Reflective blankets These are aluminized plastic foils designed to contain 80% of body heat Limited data in the pediatric population exist, however, some reports indicate that at least 60% of the body surface area must be covered in order to maintain normothermia These devices are hence more useful in the out-of-hospital setting where other alternatives may be bulky or require electrical outlets

Answer 132

Convection heat loss is reduced by keeping the patient covered and shielded from the constant flow of air in the operating room environment. Evaporative losses from the respiratory tract and any exposed mucous membranes as well as moist skin surfaces (surgical preparation), however, these tend to be minimally effective for the most part. Conductive heat loss is due to direct contact with objects and this is less common during surgery.

Answer 133

Causes of Nicotinic AChR Upregulation - Nerve Injuries o Stroke o Spinal cord injury - Burns (24 hours up to 1-2 years after burn injury) - Prolonged immobility (risk greatest after 16 days) - Prolonged exposure to neuromuscular blockers - Myopathies o Duchenne muscular dystrophy - Denervation Disorders o Multiple sclerosis o Guillain-Barré syndrome o Amyotrophic lateral sclerosis

Answer 134

Fatty acids from triglycerides are converted to acetyl-coenzyme A prior to metabolism into ATP. The respiratory quotient of lipid metabolism is 0.7.

Answer 135

Intraoperative electroencephalogram (EEG) monitoring is used to monitor cerebral oxygenation. The main frequencies captured during intraoperative EEG are between 1 to 30 Hz. BIS is considered simplified and processed EEG. Delta Waves: 0.5Hz - 4 Hz = surgically anesthetized = BIS of 40-65

Answer 136

Placental abruption typically presents with painful vaginal bleeding, uterine tenderness, and nonreassuring fetal heart rate patterns. Risk factors include hypertension, cocaine and/or tobacco abuse, trauma, and advanced maternal age and parity

Answer 137

One way to grade SAH is to use the Hunt-Hess scale. This scale uses clinical features to approximate prognosis and mortality.

Answer 138

The ganglion impar block is performed for cancer-related pain originating in the perineal area, typically caused by malignancies of the vulva, rectum, and anus. Ganglion impar can also be used to treat intractable sacral and coccygeal pain

Answer 139

The superior hypogastric plexus innervates the descending and sigmoid colon, proximal rectum, uterus, ovaries, testes, seminal vesicles, prostate, and urinary bladder.

Answer 140

Patients with dental Implants are safe for MRI

Answer 141

Destruction of the tubular and epithelial cells in ATN impairs the kidney's ability to concentrate the urine and retain sodium. As a result, the urine is typically diluted with a high Na content. Lab findings suggestive of ATN include: muddy brown casts, FENa > 1%, Uosm < 350 mOsm/kg, UNa > 40 mEq , low specific gravity, and BUN:Cr 10:1 – 15:1.

Answer 142

A fixed airway obstruction, whether intrathoracic or extrathoracic, will cause a reduction in flow in both the inspiratory and expiratory limbs of the flow-volume loop. A variable intrathoracic obstruction has relatively normal inspiration pattern, but reduced flow on expiration. A variable extrathoracic obstruction has a relatively normal expiration pattern, but reduced flow on inspiration.

Answer 143

The duration of benefit is expected to be hours to days for local anesthetics and days to months for local anesthetics with steroids and a 30-80% relief of pain (depending on the source and insurance provider) is required for the block to be considered successful.

Answer 144

Causation asks whether the act of care or omission of care caused the poor outcome. Duty to the patient refers to the provider's responsibility to the patient to provide care. Negligence or breach of duty means that the standard of care in the community was not met. The alleged damages, which can be physical, psychological, or financial, must be foreseeable by the average and reasonably minded practitione

Answer 145

T3 hormone decreases during stress or s

Answer 146

For most intravenously administered drugs, combining drugs with different mechanisms of action causes a synergistic effect. The exception to this rule is ketamine, which may cause additive, infra-additive, or synergistic effects depending on the drug combination.

Answer 147

Isopropofol is metabolized to propofol in the liver.

Answer 148

Steroids will antagonize the effects of rocuronium & nondepolarizing neuromuscular blocking agents

Answer 149

systemic vascular resistance equation central venous pressure is commonly substituted for Right Atrial Pressure

Answer 150

Flow velocities of the middle cerebral artery are typically evaluated by TCD via the temporal isonation window. Isonation windows are areas of the skull where the bone is less dense, and thus more amenable to ultrasound penetration.

Answer 151

EEG wave from with different anesthetic drugs

Answer 152

Pic summary of cardiac disorders

Answer 153

Nitrous oxide does not cause suppression of respiratory drive in spontaneously breathing patients. Nitrous oxide has significant analgesic effects.

Answer 154

Type I or α error = incorrectly rejecting the null hypothesis (false positive) Type II or β error = incorrectly accepting the null hypothesis (false negative)

Answer 155

The sural nerve is purely sensory and forms from branches of the common peroneal nerve and tibial nerve. It provides sensation to the foot's dorsolateral aspect, including the fourth and fifth toes. The sural nerve lies 1-2 cm distal to the tip of the lateral malleolus within the subcutaneous tissues.

Answer 156

Radiant infrared heat lamps provide heat newborns who are otherwise unable to properly regulate their body temperature. The advantage of this heating modality compared to a convection incubator is the ease of access to the patient while they are under heat lamps compared to shut within an incubator. There is a very real risk of thermal burns when using infrared heat lamps, however, and skin temperature monitoring specifically is essential in order to monitor for excessive skin temperatures.

Answer 157

Bilateral carotid endarterectomy carries a relatively high complication rate for bilateral carotid body denervation. One complication of bilateral endarterectomy is damage to the carotid body, in which the glossopharyngeal nerve carries afferent signals. Bilateral damage can result in a complete loss of ventilatory response to acute hypoxia.

Answer 158

Lingual nerve, recurrent laryngeal nerve, and hypoglossal nerve injuries have been reported after laryngeal mask airway use. Risk factors include overinflation of a small-fitting cuff, prolonged operative time (>2-4 hours), lidocaine lubrication, difficult insertion, use of nitrous oxide, and cervical joint disease.

Answer 159

Citrate is used to chelate calcium in the solution, preventing coagulation from occurring; phosphate acts as a buffer to maintain the pH of the storage solution

Answer 160

The RQ is 0.7 for fats, 0.8 for proteins, and 1.0 for carbohydrates.

Answer 161

Vasodilation with increasing doses of volatile agents leads to an attenuation of cerebral autoregulation. With high concentrations (>1 MAC) autoregulation is significantly blunted and cerebral perfusion becomes pressure passive. The order of vasodilating potency of volatile agents is, from greatest to least, halothane > enflurane > desflurane = isoflurane > sevoflurane.

Answer 162

The boiling point of desflurane at 24ºC is near room temperature (20ºC) and, thus, requires a closed storage container and a pressurized and heated vaporizer to prevent boiling and unpredictable vapor concentrations.

Answer 163

Echothiophate inhibits pseudocholinesterase, thereby potentiating the effects of succinylcholine. Echothiophate is an anticholinesterase used to treat refractory glaucoma by causing miosis.

Answer 164

ASA PS 4 - A patient with a severe systemic end stage disease of at least one organ system that is life threatening with or without surgery ASA PS 5 - A patient who is moribund with a low chance of survival even with the surgery ASA PS 6 - A declared brain-dead patient for organ donation

Answer 165

For a TAP block, The Triangle of Petit is outlined by the iliac crest inferiorly, the latissimus dorsi muscle posteriorly, and the external oblique muscle anteriorly.

Answer 166

Endotracheal intubation is generally contraindicated in the setting of laryngeal cartilage disruption or laryngotracheal separation. Awake surgical tracheostomy is the preferred method for airway control

Answer 167

Ablative lasers include carbon dioxide (CO2) and erbium-doped yttrium-aluminum-garnet (Er:YAG) lasers, and non-ablative lasers include pulsed dye (PDL), potassium-titanyl-phosphate (KTP), and neodymium-doped yttrium-aluminum-garnet (Nd:YAG).

Answer 168

placenta previa and a history of multiple previous cesarean sections put an obstetric patient at a dramatically increased risk for placenta accreta and peripartum hemorrhage.

Answer 169

Tizanidine is often prescribed for musculoskeletal pain, but its mechanism of action is via alpha-2 receptor agonism.

Answer 170

In addition to functioning as a passive barrier, the glycocalyx regulates vascular permeability as a mechanotransducer of shear stress.

Answer 171

Potassium-aggravated myotonias will present with a pure myotonia (muscle stiffness w/ no weakness), aggravated by potassium ingestion and variable responses to cold. They are inherited autosomal dominant. Don’t use succinycholine

Answer 172

Hypoxic-ischemic encephalopathy is common in victims who survive a drowning event regardless of the source of water in which the patient drowned. This injury can result in cerebral edema and potentially dangerously elevated intracranial pressures

Answer 173

In Pregnancy, Factors that decrease include XI, XIII, antithrombin III, and tPa. Also, resistance to activated protein C occurs as well as a decline in the level of protein S.

Answer 174

Diastasis (slow filling): as the left ventricle fills, the pressure difference between the left ventricle and atrium decrease. This slows down the filling considerably, and contributes approximately 5% of the preload. This phase occurs mid-diastole. Late rapid filling (atrial contraction): the left atrium contracts, ejecting additional blood into the left ventricle. This phase can contribute 15-20% of the preload. Atrial contraction is the last phase of diastole. The mitral valve closes after the atrial contraction.

Answer 175

Cyanide toxicity results from the binding of ferric (Fe3+) ions on the mitochondrial cytochrome complex. This causes functional hypoxia by inhibiting oxidative phosphorylation, resulting in profound lactic acidosis. Treatment is with sodium thiosulfate, hydroxocobalamin, or amyl nitrate.

Answer 176

Complex regional pain syndrome is divided into types I and II. The key distinguishing feature between these two types is the presence of a definitive nerve injury with subsequent neuropathic pain in type II. In type I, there is no definite nerve injury, and the pain is nociceptive rather than neuropathic.

Answer 177

Arteriovenous malformations (AVM) are surgically resected when they become large in size. A typical AVM consists of feeder arteries, a nidus, and draining veins. The high pressure from the arteries goes directly into the veins due to lack of arterioles and capillary beds. As a result, there is a high risk of bleeding and aneurysmal formations.

Answer 178

Acoustic impedance is the product of the density of a medium and the propagation speed of sound through that medium. Ultrasound reflections that occur at the interface of different mediums are due to the changes in acoustic impedance. Since propagation speed changes slightly between biological mediums, acoustic impedance is primarily dependent upon density.

Answer 179

Transplanted lungs are denervated and cough reflex and mucociliary function will likely be impaired. Lymphatic drainage is also absent and may affect fluid clearance during subsequent anesthetics.

Answer 180

Skeletal muscle contraction

Answer 181

The femoral nerve courses beneath the inguinal ligament where it sits atop the iliopsoas muscle. The femoral nerve lies just lateral to the femoral artery. The nerve travels beneath the fascia lata and the fascia iliaca.

Answer 182

Lambert-Eaton (myasthenic syndrome) patients typically require decreased succinylcholine dosage.

Answer 183

A double-cuff tourniquet can be used to limit the discomfort caused by the tourniquet during a Bier block. When tourniquet pain begins to occur, the distal cuff is inflated over the area that had been previously anesthetized, followed by deflation of the proximal cuff to decrease the pain over the proximal cuff. Tourniquet pain often recurs at the distal cuff, which limits the duration of the Bier block.

Answer 184

Pneumonia is considered an intrinsic (parenchymal) restrictive lung disease because it is associated with reduced lung volumes and reduced respiratory system compliance

Answer 185

By contrast, extrinsic restrictive lung defects such as kyphoscoliosis, morbid obesity, and large pleural effusions reduce chest wall or pleural compliance to decrease certain lung volumes and respiratory compliance. Neuromuscular disorders such as amyotrophic lateral sclerosis, Guillain-Barré syndrome, and diaphragmatic paralysis impair respiratory muscle function and thus impede the mechanics of lung inflation and deflation. Both extrinsic and neuromuscular restrictive defects do not necessarily reduce both FRC and TLC simultaneously, and these are not as commonly associated with reductions in DLCO.

Answer 186

Lung abscesses usually occur due to primary infections, namely aspiration pneumonia, and are commonly caused by anaerobic bacteria such as Bacteroides, Peptostreptococcus. Lung isolation should be utilized if surgical intervention is necessary

Answer 187

Interscalene block is used to anesthetize the shoulder and proximal upper extremity and is not recommended for procedures of the forearm and hand because the ulnar nerve (C8-T1) is usually spared. The interscalene block primarily anesthetizes the ventral rami of C5-C7 and the supraclavicular branches of the cervical plexus (C1-C3).

Answer 188

Morbidly obese patients have both an increase in butyrylcholinesterase activity and extracellular fluid volume.

Answer 189

Simple face masks supply 35-50% FiO2 with flow rates >5 L/min. Nasal cannulas provide an FiO2 of 25-40% with flow rates up to 6 L/min

Answer 190

the postganglionic of the sympathetic fibers are adrenergic and release norepinephrine. The sympathetic nervous system has short preganglionic fibers, long postganglionic fibers, and the ganglia located close to the spinal cord. The innervation of the sympathetic nervous system is from T1-L2.

Answer 191

A stellate ganglion block can be useful in the diagnosis and treatment of sympathetically mediated pain in the upper limb, head, and neck regions such as in complex regional pain syndrome. Although the ganglion lies on the anterior surface of the C7 transverse process, to best avoid complications such as vascular injury to the vertebral artery and pneumothorax, the block should be performed at the level of C6.

Answer 192

-Vital capacity of < 2L -Pyridostigmine dose of >750 mg daily -Disease duration > 6 years -History of COPD -Intraop blood loss of >1 L -History of myasthenic crises -Serum acetylcholine receptor antibody level >100 nM/mL

Answer 193

Many factors decrease the MAC of anesthetic agents including acute ethanol ingestion, pregnancy, metabolic acidosis, and hyponatremia. In general, factors that decrease CNS metabolic activity, neurotransmission, CNS neurotransmitter levels will decrease MAC.

Answer 194

Uterine rupture typically presents with vaginal bleeding, maternal tachycardia & hypotension, cessation of labor, abdominal pain, and non-reassuring FHR patterns. Common risk factors include prior c-section, grand multiparity, and induction of labor with oxytocin or prostaglandin

Answer 195

dexmedetomidine has EEG patterns similar to those seen in normal human sleep, with increased slow wave activity and prominent sleep spindles. Burst suppression cannot be produced even with high doses of dexmedetomidine. Bispectral index values at comparable levels of sedation are lower with dexmedetomidine than with propofol.

Answer 196

Patients will also present with platypnea and orthodeoxia. Platypnea is shortness of breath that worsens when sitting or standing up but improves by lying down. Orthodeoxia is hypoxemia in the upright position that improves when lying down.

Answer 197

Parental presence is most effective when the pediatric patient is anxious and the parent is calm. Parental presence is less effective than premedication in reducing anxiety and increasing compliance in pediatric patients

Answer 198

Blood products and fat emulsions are risk factors for catheter-related bloodstream infections and, if they are administered through a central line, the tubing set should be replaced within 24 hours.

Answer 199

According to the Haldane effect, deoxygenated hemoglobin has a higher affinity for CO2. After the deoxygenated hemoglobin reaches the lungs, the high O2 concentration decreases this affinity, and the CO2 is released.

Answer 200

Wait at least 14 days after balloon angiography before doing elective surgery

Answer 201

It is performed with the patient supine and the neck extended. Insertion of the needle through the cricothyroid membrane in a perpendicular plane with aspiration of air confirms intratracheal location, and then local anesthetic is injected. The patient will cough, but ultimately this reflex will be inhibited by the local anesthetic.

Answer 202

Drugs that have a higher unbound fraction will more readily cross the placenta. If a drug is protein-bound, drugs that bind to albumin have increased placental drug transfer compared to alpha-1-acid-glycoprotein (AAG) bound drugs.

Answer 203

A glucose test is appropriate to differentiate saline from cerebrospinal fluid. Additionally, glucose testing can be done as a point-of-care test with a test strip, giving near-immediate results. The reliability and speed of the point-of-care glucose strip make it the most appropriate test for differentiating dural puncture from loss-of-resistance saline return

Answer 204

TPN should be continued in the perioperative period if at all possible. Close monitoring of electrolytes, specifically potassium, phosphate, and glucose should occur. Blood should not be administered through the same line as TPN using Y-site or piggyback connections. The use of the alternate lumen of a multi-lumen central catheter that is being used to actively infuse TPN is generally considered safe, though some providers will prefer to place and utilize an alternate peripheral intravenous line to avoid any potential increases in infectious risk

Answer 205

One of the major limitations of Anesthesia information management systems (AIMS) is the inadequate vertical integration between one phase of care to another and the standardization across vendors to allow communication between devices.

Answer 206

3) For shockable rhythms, 300 mg of IV/IO amiodarone should be administered after the third unsuccessful defibrillation attempt

Answer 207

Ceftaroline, tigecycline, and Bactrim have the broadest spectrum of activity effecting both Gram positives and some Gram negatives. Many of the other agents effective against MRSA like vancomycin, daptomycin, and linezolid are only effective against Gram-positive organisms.

Answer 208

Post-thoracotomy pain is best-managed with a regional anesthetic technique. Though thoracic epidural is the preferred technique, the paravertebral approach is becoming more widely utilized with much success and is a good alternative to a thoracic epidural.

Answer 209

Hypoglycemia can be seen with acute stoppage of total parenteral nutrition (TPN) because the significant carbohydrate load in TPN causes the pancreas to secrete excess insulin. High Insulin level prevent hyperglycemia during infusion of TPN. However, with acute discontinuation of TPN the pancreas continues to secrete insulin even after TPN is stopped. This period of time prior to the pancreas adjusting to a lower glucose load can cause a patient to experience significant hypoglycemia

Answer 210

bypassing phase 1 recovery and proceeding straight to phase 2 recovery is shown in patients who dont require parenteral medications, experience minimal pain and PONV,TOF >0.9, and rapidly recover baseline hemodynamic and cognitive function following emergence

Answer 211

as PaCO2 increases from 30 to 60 mmHg, CBF doubles. Pathologic states, including trauma, ischemia, or tumors, decrease the response to PaCO2. Mild hypocapnia with PaCO2 levels between 30 and 34 mmHg is used to facilitate surgical access in patients with large space-occupying lesions undergoing craniotomies.

Answer 212

HI-Se, is a way to remember the order of vapor pressure of the volatile anesthetics. From highest to lowest saturated vapor pressure: halothane > isoflurane (243 mmHg) > sevoflurane (160 mmHg) > enflurane.

Answer 213

Hyperglycemia in patients with diabetes who undergo surgery is associated with increased rates of surgical site infection, myocardial infarction, stroke, and death. Intraoperative hyperglycemia is an independent risk factor for perioperative complications in cardiac surgery patients.

Answer 214

Myocardial infarction is the most common cardiovascular cause of death in noncardiac surgical cases and must be thoroughly evaluated preoperatively to reduce its incidence. Revised Cardiac Risk Index (RCRI) can help identify patients at risk.

Answer 215

The normal response to hypoglycemia is an increase in sympathetic discharge, cortisol release, and glucagon release with symptoms of diaphoresis, tachycardia, hypertension, altered mental status, and possibly even seizures.

Answer 216

Bupivacaine crosses the placenta but to a lesser extent than lidocaine because of the high degree of protein binding of bupivacaine. In general, the more protein-bound amide-type local anesthetics (eg, bupivacaine and ropivacaine) less readily cross the placenta compared with less protein-bound local anesthetics (eg, lidocaine). Amide anesthetics cross the placenta more than ester-type anesthetics

Answer 217

In Malignant Hyperthermia, Calcium channel blockers should be avoided in MH as they may interact with dantrolene to produce fatal hyperkalemia and cause cardiovascular collapse. Intravenous calcium should be administered to stabilize the myocardial membrane in the setting of life-threatening hyperkalemia.

Answer 218

Prostaglandin E1 is used to maintain patency or reopen the ductus arteriosus in "ductal-dependent lesions" to improve blood flow to the lungs or systemic circulation, depending on the nature of the congenital lesion. Side effects include apnea, hypotension, fever, and central nervous system irritability.

Answer 219

When assessing the degree of neuromuscular blockade using TOF stimulation after nondepolarizing NMBD administration: 1 palpated twitch indicates >90% suppression. 2 palpated twitches indicate 80-90% suppression. 3 palpated twitches indicate 70-80% suppression. 4 palpated twitches indicate up to 65-75% suppression.

Answer 220

Gabapentin binds and inhibits the alpha2-delta subunit of the voltage-gated calcium channel. This results in a decreased release of the excitatory neurotransmitter glutamate. Gabapentin side effects include nausea, sedation, dizziness, ataxia, nystagmus, peripheral edema, and weight gain.

Answer 221

Safe airway management of acute epiglottitis is founded on inhalational induction in the sitting position with maintenance of CPAP during spontaneous ventilation to prevent inspiratory laryngeal airway collapse or irritation.

Answer 222

VCV delivers a set volume breath at a set interval or frequency. With VCV airway pressure is a dependent variable of the breath. The volume of the breath being delivered will not change based on intrinsic factors of the lungs. In PCV, the airway pressure for the breath is set, and the breath size or volume is variable. This means that the volume of each breath changes depending on chest wall compliance, airway resistance, and lung compliance.

Answer 223

Electrocardiographic analysis of a patient with a transplanted heart may demonstrate two P waves, especially during the first few weeks, since one technique involves the native right atrium being sutured to the transplanted right atrium

Answer 224

Moderate to severe aortic insufficiency is an indication for the use of retrograde cardioplegia because antegrade cardioplegia delivered to the aortic root in the presence of a regurgitant lesion will not exclusively traverse the coronary arteries but, instead, be partially diverted into the left ventricle. Other indications for the use of retrograde cardioplegia include severe coronary artery stenosis, previous coronary artery bypass graft with a patent internal mammary graft, and a prolonged anticipated pump run

Answer 225

Moderate to severe aortic insufficiency is an indication for the use of retrograde cardioplegia because antegrade cardioplegia delivered to the aortic root in the presence of a regurgitant lesion will not exclusively traverse the coronary arteries but, instead, be partially diverted into the left ventricle. Other indications for the use of retrograde cardioplegia include severe coronary artery stenosis, previous coronary artery bypass graft with a patent internal mammary graft, and a prolonged anticipated pump run

Answer 226

PaCO2 >45 mm Hg PaO2 < 50 mm Hg on room air FVC < 50% FEV1 < 2 L FEV1/FVC < 50% Maximum voluntary ventilation < 50% DLCO < 50

Answer 227

Lipopolysaccharides found in the outer membrane of Gram-negative bacteria act as endotoxins that can induce a significant immune response. This compound serves to further worsen the sepsis response by indirectly causing the release of multiple cytokines and factors, including nitric oxide

Answer 228

Fontan repairs of congenital heart defects result in single-ventricle physiology in which the single ventricle pumps blood systemically through the aorta and returning circulation returns passively to the right-sided circulation to the lungs without encountering the heart.

Answer 229

For this reason, it is recommended that all metal-containing medications (antacids, laxatives, iron supplements) be given at least 2 hours from the time that these other drugs are given.

Answer 230

Pain stimuli are carried along afferent neurons to the dorsal horn of the spinal cord which results in activation of glutamate and other excitatory neurotransmitters within the secondary neuron. Opioids can disrupt this pain signal transmission at several points along the pathway. Pain stimuli can be attenuated in the periphery by opioids acting at μ-opioid receptors. The strength of action potentials reaching the dorsal horn can be blunted at the presynaptic ending by opioids. Opioids also inhibit the postsynaptic neuron pain signal transmission.

Answer 231

Symptomatic patients with serum Na+ < 120 mEq/L should have the serum osmolality corrected by 3% HS Typically, 50% of the Na+ deficit is corrected during the first 24 hours, and the rate of hypertonic saline administration should never be higher than 100 mL/hr.

Answer 232

The rate should be set 10 to 20 beats per minute higher than the spontaneous heart rate to capture 100% of the beats and avoid R-on-T phenomenon. Pacing thresholds are significantly higher because it requires transmission of the electrical impulse through the chest tissue, which has large impedance

Answer 233

Nonobstetric surgery for the pregnant patient should be performed in the second trimester if possible to decrease the risk of miscarriage.

Answer 234

When a patient’s intrinsic heart rate is greater than the set pacemaker rate along with a pacemaker in an asynchronous mode, an R-on-T phenomenon may occur leading to ventricular tachycardia or ventricular fibrillation.

Answer 235

When a patient’s intrinsic heart rate is greater than the set pacemaker rate along with a pacemaker in an asynchronous mode, an R-on-T phenomenon may occur leading to ventricular tachycardia or ventricular fibrillation.

Answer 236

For example, a patient with complete heart block (CHB) has a DDD pacemaker in place. The pacemaker detects the EMI from the ECU and interprets it as R waves. Since the pacemaker thinks the patient’s ventricle is therefore beating, the pacemaker inhibits itself. In a patient with CHB, no pacing can mean bradycardia (or even asystole) and hemodynamic instability. To prevent this complication, the pacemaker may be changed to DOO perioperatively. Then, the pacer will consistently pace at a set rate (commonly 80-100) and will not sense EMI.

Answer 237

Spinal cord stimulator inhibiting transmission of painful stimuli through the spinothalamic tract via dorsal column stimulation

Answer 238

Aortic axis TEE view

Answer 239

The cause of hypokalemia is due to increased delivery of Na+ to the collecting ducts which is exchanged for K+ via the Na+/K+ ATPase causing efflux of K+

Answer 240

Forced expiratory volume in one second (FEV1) is used to diagnose exercise-induced bronchoconstriction with an exercise challenge test.

Answer 241

For pain first order neuron is dorsal root ganglia, second order is Dorsal horn, Third order is cerebral cortex

Answer 242

Cangrelor is an IV version of the active form of Plavix. Return of platelet function in 60-90min

Answer 243

Other pharmacokinetic characteristics include high liposolubility, high volume of distribution, and high clearance. Unlike many other IV anesthetics, ketamine has low plasma protein binding

Answer 244

Mean arterial pressure is the most accurate blood pressure measurement with oscillometric noninvasive blood pressure monitoring. It occurs at the peak amplitude of arterial pulsations. Systolic pressure is underestimated and diastolic pressure is overestimated with oscillometric noninvasive blood pressure monitoring.

Answer 245

Neonates and infants have a proportionately higher TBW than adults which causes them to require higher doses of water-soluble drugs (succinylcholine, midazolam) to achieve the same effect.

Answer 246

As the pressure and radius of the ventricle increases, the wall tension increases. However, as the thickness of ventricle increases, the wall tension will decrease.

Answer 247

Abdominal compartment syndrome is diagnosed by observing a tense, distended abdomen and by obtaining bladder pressure readings > 20-25 mm Hg via a urinary catheter.

Answer 248

mid Esophageal Aortic valve, short axis view

Answer 249

Goldenhar syndrome pts have cardiac & renalm problems

Answer 250

Amiodarone is associated with pulmonary fibrosis that is further exacerbated when supplemental oxygen is used.

Answer 251

In children, the BIS values paradoxically increase with values of expired sevoflurane greater than 3%. BIS values may also be inaccurate in infants and children with developmental delays.

Answer 252

The activation of these receptors results in profound bradycardia and hypotension due to an inhibition of sympathetic outflow to the heart, and an increase in parasympathetic tone.

Answer 253

Phantom pain following limb amputations is very prevalent and difficult to treat. Preoperative pain is a risk factor for phantom pain, but more studies are needed to determine whether pre-amputation analgesia will prevent the development of phantom pain.

Answer 254

Sodium bicarbonate (mEq) = 0.2 * patient weight (kg) * base deficit.

Answer 255

Hexamethonium is an example of a ganglionic blocking drug which acts as an antagonist at the neuronal-type nicotinic receptors.

Answer 256

adequate hydration to decrease the risk of dehydration and supplementation with glucose to avoid starvation states can decrease risk of an acute exacerbation in patients with acute intermittent porphyria

Answer 257

The large amounts of nitrous oxide entering the alveoli result in a decrease of the partial pressure of oxygen, causing alveolar hypoxia. This hypoxia can be worsened by the rapid washout of carbon dioxide from a phenomenon similar to the second gas effect, leading to a relative hypocarbia and decreased respiratory drive.

Answer 258

Scheduled acetaminophen therapy (> 3 days) in patients on chronic warfarin therapy has been shown to increase INR to supratherapeutic levels in otherwise stable patients.

Answer 259

Balanced salt solutions (such as normal saline) cause electrical current dispersion during TURP but significantly reduce the risk of TURP syndrome. Sorbitol and mannitol solutions may lead to hyperglycemia (sorbitol), intravascular fluid expansion with absorption (mannitol) and an osmotic diuresis (sorbitol and mannitol).

Anesthesia ITE Flashcards

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