Basic

Question 1

Gold standard temp measurement

Answer 1

Pulmonary artery

Question 2

Not accurate temp reasurements

Answer 2

axillary, rectal, skin

Question 3

why does GA cause heat loss?

Answer 3

vasodilation - redistribution from core to periphery (radiation)

Question 4

how to measure depth of anesthesia

Answer 4

BIS/sedline

Question 5

what to do after intubation

Answer 5

The A’s: adjust, a temp probe/air (bair hugger), antibiotics, another a line/access, acid (OG tube)

Question 6

what positions for sniffing position?

Answer 6

cervical vertebral flexion

extension of head at atlanto-occipital joint

Question 7

predictors of difficult laryngoscopy

Answer 7

high mallampati
short thyromental distance
limited jaw protrusion
inter incisor distance <3 finger breaths
decreased flexion and/or extension

Question 8

risk factors for PONV

Answer 8

female, non-smoker, history of PONV, postoperative opioids

Question 9

zofran MOA

Answer 9

serotonin-receptor antagonist (QT prolongation)

Question 10

dexamethasone MOA for PONV

Answer 10

glucocorticoids (increases glucose)

Question 11

scopolamine

Answer 11

anticholinergic (sedating)

Question 12

haloperidol

Answer 12

antipsychotic (qt prolonging)

Question 13

ASA class 3

Answer 13

severe systemic dz with substative functional limitation, >1 moderate to severe dz

Question 14

if recent (<3 months)

Answer 14

ASA 4

Question 15

ASA 4

Answer 15

severe, systemic dz that is a constant threat to life

Question 16

ASA 5

Answer 16

moribund, not expected to survive without operation

Question 17

aspiration prophylaxis

Answer 17

regional anesthesia
premeds (reglan, H2 receptor antagonist, nonparticulare antaacids)
NGT, evacuate gastric contents
RSI (cricoid, rapid induction, avoid PPV, intubate)
extubate awake

Question 18

if bag masking, what hhmg will you preferentially insufflate abdomen?

Answer 18

20

Question 19

recommended time to delay surgery after MI

Answer 19

balloon angio: 14 days
BMS: 30 days of DAPT (ASA and ADP receptor antagonist) – usually continue ASA perioperatively
DES: 180 days of DAPT
MI without intervention: 60

Question 20

preop smoking cessation

Answer 20

increase airway irritability and secretions, decreases mucociliary transport, decreases FVR and FEF 25-75%, increases CO -> oxyhemoglobin curve left ward -> decred tissue oxygen perfusion, increased cyanide -> inhibit MOM -> acidemia, nicotine promotes vasoconstriction and hampers healing and tissue perfusion

Question 21

quitting smoking 48-72hrs

Answer 21

oh shit, increase in sputum production, more reactive airway

Question 22

drug dosing in morbid obesity

Answer 22

increased CO, TBV, GFR
LBW EXCEPT NMBD (succs = TBW, NDNMW = IBW)
Propofol - induction LBW, maintenance - TBW

Question 23

hypotension after desufflation

Answer 23

increased abdomninal pressure -> blood shirts -> can drop preload (careful if preload dependent!)

Question 24

side effects of NS

Answer 24

mild hyperchloremic non-anion gap MA
causes renal VC and decreased GFR -> UOP
decrease SVR -> hypotension
swelling and redness at injection site. n/v/abd distension

Question 25

how to reverse NMB

Answer 25

T4 ->1mg/kg T2 -> 2mg/kg deep -> 4mg/kg ``` Neo: deep -> not effective, dont do T1->70mcg/kg (up to 5mg max) t2-> 50mcg/kg (up to 5mg max) T3 or more -> 30mcg/kg (up to 5mg max) ```

Question 26

how does twitches correspond to % receptor sites blocked

Answer 26

``` 4 <70 3 >70 2 > 80 1 > 90 0 95-100 ```

Question 27

transfusion reactions

Answer 27

hemolytic: ABO incompatibility MCC = misidentification can occur with only 10-15ml GA - increaed temp, tachy, hypotensive, hemoglobinuria, oozing surgery field stop transfusion, tell blood bank; labs; foley and osmotic diuresis (mannitol) Delayed: kell, duffy, kidd (2-12d) malaise, jaundice, fever Coombs test supportive care

Question 28

non hemolytic transfusion

Answer 28

fever (WBC/plt sensitivity), urticarial rxn, anaphylactic | give steroids, epi, H1/H2 blockers), TRALI (MC with plt and FFP

Question 29

what is preload

Answer 29

ventricular wall stress at the end of diastole

Question 30

what is afterlaod

Answer 30

LV wall stress during systole

Question 31

equation of LV wall stress

Answer 31

(LV pressure x radius)/(2xLV thickness) ventricular hypertrophy is protective mech to decrease wall stress

Question 32

ET gradient increases with

Answer 32

age, emphysema, increased alveolar dead space (low CO, hypovolemia, PE) decreases in pregnancy and with kids

Question 33

coronary blood flow depends on

Answer 33

HR, coronary perfusion pressure =aortic diastolic bp -lvedp / coronary vascular resistance (resistance increased by CAD) LVEDP increased by diastolic dysfunction, CM LV perfused in diastole! RV perfused throughout cardiac cycle

Question 34

average time for denitrogenation with 100% O2

Answer 34

3 min of TV ventilation | 8 vital capacity breaths

Question 35

things that decrease FRC will decrease apnea time for intubation

Answer 35

ok

Question 36

how much of total cardiac output does liver get?

Answer 36

25%

Question 37

liver blood supply

Answer 37

hepatic artery and portal vein hepatic artery - only 25% of livers blood supply, delivers 50% oxygenated blood portal vein - 75% of blood supply delivers 50% of oxygenated blood

Question 38

o2 saturation and pao2 relationship

Answer 38

arterial o2 content = sao2 x 1.34 x hb + 0.003 (pao2) fall off curve after 90% SaO2