General Sciences Flashcards
(172 cards)
1
Q
What is the treatment for LAST?
A
- IV lipid emulsion when neurotoxicity or cardiotoxicity is present
- secure airway
- seizures: benzos
- CV support: ACLS (but reduced amount of epi)
AVOID: local anesthetics, CCB, Beta Blockers and Vasopressin
2
Q
What is the maximum allowable dose of lidocaine in tumescent solution when epi is used?
A
between 35 and 55 mg/kg
3
Q
How to manage an airway fire?
A
- turn off laser
- stop procedure
- stop all gases (oxygen and volatile anesthetics)
- saline poured into airway/endotracheal tube
All flammable items should be removed from the patient. After fire is extinguished, ventilation should be reestablished with room air.
4
Q
What are the most common valvular manifestations of rheumatoid arthritis?
A
- mitral regurgitation (most common)
- aortic regurgitation
5
Q
How to minimize burns during MRI?
A
make sure monitoring cables do not have any loops or coils
6
Q
Why are retrobulbar blocks more advantageous than peribulbar blocks?
A
produce a dense block with complete akinesia
Risks: retrobulbar hemorrhage, optic nerve damage, and central spread of local anesthetic.
7
Q
What is required in office-based anesthesia if volatile anesthetics and succinylcholine are stored?
A
dantrolene for the risk of malignant hyperthermia
8
Q
What is Part IV Maintenance of Certification in Anesthesiology (MOCA) concerned with?
A
clinical practice assessments of the diplomates, who must obtain 50 qualifying points, which are divided into 5 year cycles. No more than 25 points may be obtained in 1 year.
9
Q
What is the initial treatment of hyperoxic seizure during hyperbaric oxygen therapy?
A
- immediate reduction in PO2
The chamber should not be decompressed until after seizure activity has stopped due to risk of pulmonary barotrauma.
10
Q
How does age affect MAC requirement?
A
For every decade of life after 40 yrs, MAC of volatile anesthetics is reduced by 6%. For every decade before 40 yrs, MAC is increased by 6%.
11
Q
What are the changes to lung volumes in the geriatric population?
A
- greater closing capacity
- decreased vital capacity
- increased residual volume
- moderately decreased to unchanged total lung capacity
12
Q
What is a well-known risk factor for transient neurologic symptoms (TNS) with intrathecal lidocaine?
A
pain or dysesthesia in buttock and legs without other neurologic symptoms
13
Q
What is the bilirubin glucuronyltransferase activity in Gilbert syndrome?
A
1/3 normal
14
Q
When is endotracheal intubation contraindicated?
A
in the setting of laryngeal cartilage disruption or laryngotracheal separation
15
Q
What are qualifying circumstances for billing in anesthesia?
A
- extreme of age (patients <1 or >70)
- use of deliberate total body hypothermia
- use of controlled hypotension
- anesthesia complicated by emergency conditions
16
Q
What should office-based anesthesia mirror?
A
the goals of care provided in ambulatory surgery centers
17
Q
What is the most common side effect of NSAID use in the elderly population?
A
dyspepsia
Increased risk of atrial fibrillation, development of CHF, renal toxicity, and GI bleeding.
18
Q
What does volume control ventilation deliver?
A
a constant tidal volume breath at a set frequency
19
Q
What does the post-anesthetic discharge scoring system (PADSS) include?
A
- pain and nausea control
- surgical hemostasis
- patient can ambulate
- responsible adult escort to bring them home
20
Q
What was the leading cause of anesthesia-related malpractice claims?
A
death – 29% of claims
Causes of these deaths were primarily due to airway management.
21
Q
What is required for a specialist to practice medicine within a hospital system?
A
- licensing
- certification
- credentialing
- privileging
22
Q
What is the anesthetic plan for open globe injuries?
A
- adequate depth of anesthesia prior to laryngoscopy
- avoid succinylcholine
- propofol preferred
- avoid nitrous oxide
- use caution with retrobulbar blocks
23
Q
Which weight loss surgery is preferred?
A
gastric stapling procedures
24
Q
What are safe procedures to avoid an airway fire?
A
- laser safe ET tube
- lowest FiO2 possible
- use of air rather than nitrous oxide
- avoidance of paper drapes
25
What are cold ischemic times for various organs?
- heart: 4-6 hrs
- lungs: 4-6 hrs
- liver: 6-10 hrs
- kidneys: 24 hrs (up to 72)
26
How to handle DNRs in the perioperative period?
must be carefully discussed and documented with the patient's true wishes
27
What is the sole responsibility of the anesthesiologist regarding advance directives during the perioperative period?
to discuss goals of care and resuscitation with any patient who has an advance directive in place
28
What pharmacokinetic changes occur in the elderly?
increased initial peak concentration of anesthetic medications compared to young adults
29
What electrolyte abnormalities are seen with therapeutic hypothermia?
- hypokalemia
- hypophosphatemia
- hypomagnesemia
30
What are the multisystemic physiological effects of hypothermia?
Refer to specific details in the provided content
31
What is a significant risk for anesthesiologists regarding malpractice?
residual anesthetic medication in the recovery room with resultant hypoxia
32
What has the biggest impact on lowering cost in an ambulatory surgery center?
proper utilization of operating rooms
33
What are the clinical signs of fat embolism?
- petechial rash over trunk, face and axilla
- changes in level of consciousness
- tachypnea
- tachycardia
- hypoxia
34
When are medications, protocols, and equipment for malignant hyperthermia needed in office-based anesthesia?
in centers that use triggering agents such as succinylcholine or volatile anesthetics
35
What medical implants are considered safe for MRI?
permanent dental implants
36
What should be suspected in burns and smoke inhalation injury?
cyanide and carbon monoxide toxicity
37
What are the presentations of diaphragmatic injuries?
- herniation of abdominal viscera
- chest and abdominal pain plus shortness of breath
38
What can spinal anesthesia lead to in terms of hemodynamic changes?
extensive sympathetic blockade
39
What variable is closely related to an elevation in INR after a hepatectomy?
amount of liver resected
40
Which is the least appropriate ETT material to use with CO2 lasers?
Polyvinyl chloride (PVC)
41
What are the types of hypersensitivity reactions to IV contrast?
- immediate: within one hour
- delayed: greater than one hour (maculopapular exanthema, delayed onset urticaria/angioedema)
42
What is the most sensitive organ to radiation exposure?
lens of the eye
43
What is the treatment for fat embolus syndrome?
supportive therapy
44
What four elements must be proven to establish medical malpractice?
1. causation
2. duty to patient
3. negligence or breach of duty
4. damages
45
What are the components of the Child-Pugh score?
- bilirubin
- albumin
- INR/PT
- ascites
- hepatic encephalopathy
46
What are the components of MELD?
- INR
- Creatinine
- Bilirubin
- Dialysis
47
What is a potential complication of tumescent anesthesia?
hypothermia
48
According to ABA, what is the maximum number of working days an anesthesia resident may be absent from training during CA 1-3 years?
60 days
49
During thyroid surgery, how can recurrent laryngeal nerve function best be monitored?
electromyography
50
What is the best indicator of liver transplant graft function?
INR
51
What is tourniquet pain?
increased pulse and blood pressure 60 minutes after initial inflation of tourniquet
52
What can be counted towards Part IV of Maintenance of Certification in Anesthesiology?
53
During thyroid surgery, recurrent laryngeal nerve function can best be monitored using which technique?
electromyography
54
What is tourniquet pain?
Can present as increased pulse and blood pressure 60 minutes after initial inflation of tourniquet
55
What physiological changes lead to increased small airway collapse in the elderly population?
* increased closing capacity
* increased chest wall stiffness
* loss of muscle mass
* flattening of the diaphragm
* increased compliance of lung parenchyma
56
What is a long-term risk to anesthesia personnel if they are chronically exposed to ionizing radiation in the operating room?
cataracts
57
What are MLT (microlaryngoscopy tubes) used for?
Smaller bore but standard adult length so they can be used in adult patients but allow for more surgical exposure in surgeries of the larynx
58
What is privileged communication?
A conversation or exchange of information communicated in private between two individuals in a protected relationship
59
What is the dosing of tumescent anesthesia?
35-55 mg/kg lidocaine with 1:1,000,000
60
What is the order of sensitivity from lowest to greatest for venous air embolism?
* ECG
* ETCO2
* pulmonary artery catheter
* precordial Doppler
* TEE
61
What are the benefits of disclosure of medical errors?
* enhances patient doctor relationship
* reduces the incidence of litigation
* reduces the likelihood that patients will change doctors
* improves patient satisfaction
* increases trust in the physician
* leads to a more positive emotional response
62
What does reimbursement for office-based anesthesia depend on?
Varies by state or even by county
63
What are the cardiovascular effects of ECT?
* initial transient bradycardia (parasympathetic)
* followed by tachycardia and hypertension (sympathetic)
64
What type of acid-base disturbance is seen with tourniquet use?
metabolic acidosis from anaerobic metabolism in distal tissue
65
What is the relationship between MAC and barometric pressure?
MAC is inversely related to barometric pressure
66
What is the initial cardiopulmonary response to a change in elevation to a location with a lower partial pressure of oxygen?
- increase minute ventilation and cardiac output
67
What are the two most common reasons for discharge delay?
* pain
* postoperative nausea and vomiting
68
When are prophylactic antibiotics not needed for surgery?
For patients who are at low risk for surgical site infection
69
What is the double effect principle?
Allows physicians to responsibly escalate opioid dosing to alleviate pain knowing it may hasten death
70
What is a requirement of anesthetic practice by the Centers of Medicare and Medicaid Services?
A clinician must be available who can rescue a patient from a deeper than intended level of sedation
71
What is discovery in a malpractice lawsuit?
The process at the beginning of a malpractice suit where documents are exchanged and depositions are made
72
What are the challenges with providing anesthesia for non-operating room anesthesia locations?
* limited workspaces
* potential risks such as radiation exposure
* proper planning with required equipment and skills
73
What is a sentinel event?
An event that must reach the patient and cause severe harm
74
What occurs in the autonomic system with aging?
* increase in sympathetic nervous system activity
* decrease in beta receptor responsiveness
* maintained alpha receptor responsiveness
* decreased parasympathetic nervous system activity
75
What is the management of brain dead donors during organ procurement?
* MAP of 60 or greater
* UOP of 1 mL/kg/hr or greater
* left ventricular ejection fraction of 45% or greater
76
What would most interfere with placement of a supraglottic airway device?
Posterior laryngeal mass or a mass of upper esophagus
77
What is looked at when a preoperative endoscopic airway exam is performed?
* an optically straightforward path to larynx
* any posterior pharyngeal masses
* vascular anterior pharyngeal lesions
78
What must be reported to the National Practitioner Databank?
* malpractice payments and settlements
* punitive actions taken by peer-review organizations
* administrative actions from professional review
79
What should data measurement in a quality improvement project be?
Easy to obtain
80
Which medication should be avoided in open globe injuries?
ketamine
81
What increases IOP in open globe injuries?
* succinylcholine
* hypoxia
* hypoventilation
* straining
* coughing
* retching
82
Which nerve can be blocked to help with tourniquet pain?
intercostobrachial nerve
83
What is the most common concern for anesthetic planning in acromegaly?
Difficult intubation by direct laryngoscopy
84
What are the effects of laparoscopic surgery?
Increased risk of postoperative nausea and vomiting
85
What does root cause analysis focus on?
* correctly defining the event
* determining situational awareness
* reasoning behind a decision
86
When is a termination reportable to the National Practitioner Data Bank?
If the hospital revokes that practitioner's privileges after professional review
87
What is the anesthetic management of hiatal hernia repairs?
* laparoscopic repair preferred over open repair
* addition of mesh decreases rate of recurrence
88
What conversations are protected from discovery in a lawsuit?
* risk management
* a spouse
* a psychiatrist
* the insurance company
* lawyers
89
What are indications for hyperbaric oxygen therapy?
* air embolism
* decompression sickness
* carbon monoxide poisoning
* certain types of infections
* ischemia
* hypoxia
* burn injuries
* idiopathic sudden sensorineural hearing loss
90
What is the dose of dantrolene?
2.5 mg/kg IV bolus as soon as diagnosis of MH is suspected
91
What are the risk factors for PONV?
* female sex
* history of PONV or motion sickness
* nonsmoking status
* postoperative opioid use
92
What are potential complications of brachial artery cannulation?
* median nerve damage
* distal ischemia due to lack of collateral circulation
* catheter related bloodstream infections
93
What do vasodilating agents do to cerebral vascular resistance?
Cause cerebral vasodilation
94
What are the patient selection criteria for ambulatory surgery?
* obstructive sleep apnea
* advanced age (> 65)
* long operative times (> 120 min)
* ASA II or IV
* vascular disease
95
How does radiation intensity change with respect to distance?
Decreases according to the inverse square law
96
What is needed for the use of vasopressors in microvascular surgery?
Additional prospective studies are required
97
What is the best ETT to use to prevent airway fire?
metal
98
What is the MOCA minute requirement?
Consists of 120 questions per year, divided into a maximum of 30 questions per quarter
99
What are the physiological effects of aging on the pharmacology of anesthetic drugs?
* increased sensitivity to most sedatives, hypnotics and analgesics
* increased sensitivity to both peripheral and neuraxial blockade
* increased resting sympathetic tone
* attenuated ventilatory response to hypercarbia and hypoxia
* decrease in hepatic and renal function
* increased permeability of the dura
100
What are the requirements and recommendations by the ASA and Joint Commission in office-based anesthesia?
* use of standard ASA monitoring equipment
* immediate access to CPR equipment
* presence of a PACU or recovery area
101
What are the patient considerations for ambulatory surgery with heart conditions?
* surgery for patients with recent ACS should not be performed at an outpatient facility
* bare metal stents -- 30 days before elective surgery
* drug eluting stents -- 6 months before elective surgery
102
What can nitrous oxide affect during surgical procedures?
Surgical visualization during prolonged procedures
103
How does MLT (microlaryngeal tracheal tube) compare to ETT?
MLT is longer than ETT of the same given internal diameter
104
How does surgical visualization affect prolonged procedures?
It can affect surgical visualization during prolonged procedures, with greater risk of PONV in high-risk patients after exposure of greater than one hour.
## Footnote
PONV stands for postoperative nausea and vomiting.
105
What is the difference between MLT and ETT?
MLT is longer than ETT of the same internal diameter.
* Increased length of MLTs makes them suitable for adult airways.
* MLTs have a larger volume cuff appropriate for adults and are less flexible than ETTs.
106
What is the mechanism of action of pyridostigmine for myasthenia gravis?
It is an acetylcholinesterase inhibitor that prevents the degradation of acetylcholine at the neuromuscular junction.
* Antibodies against nicotinic acetylcholine receptor.
107
What is the most common electrolyte abnormality from rapid infusion of products?
Hypocalcemia due to citrate during the anheptic phase of liver transplantation.
* Hypocalcemia can manifest as hypotension unresponsive to beta agonists.
108
Which medication can be safely administered in ocular trauma?
Midazolam.
109
Which medications should be avoided in ocular trauma?
Avoid:
* Ketamine
* Etomidate
* Nitrous oxide
* Succinylcholine
* Precedex can be used for ocular trauma.
110
Which ophthalmologic anesthetic technique has the highest risk of globe perforation?
Retrobulbar block.
111
What are the short-term adaptations to high altitude?
Short-term adaptations include:
* Increased minute ventilation
* Increased cardiac output.
112
When should you check platelet counts when using unfractionated heparin or LMWH?
When administered for more than 4 days due to the risk of developing heparin-induced thrombocytopenia.
113
How can medication errors be prevented?
Preventative measures include:
* Standard background colors for medication classes
* Tall man lettering for look-alike medications
* Prefilled syringes with safety measures.
114
What are potential causes of nerve damage during the perioperative period?
Causes include:
* Regional anesthesia
* Mechanical injury from cast placement
* Tourniquets
* Positioning in operating room.
115
What does the ASA recommend be available during office-based anesthesia?
Backup power source.
116
What are the effects of abdominal compartment syndrome?
Effects lead to multiorgan dysfunction due to abdominal hypertension, including:
* Increased CVP and PCWP
* Decreased CO
* V/Q mismatch, atelectasis, hypoxia.
117
What are cardiovascular changes in the elderly?
Changes include:
* Decreased compliance of arterial and venous vasculature
* Increased afterload
* Diastolic LV dysfunction.
118
Where do SSEP and MEP measure in the brain?
SSEP measures posterior/lateral cord and terminates in the brain; MEP measures anterior cord and peripheral nerves.
119
What is the best diagnostic tool for comparing renal function with aging?
Glomerular filtration rate (GFR).
* Creatinine remains relatively unchanged with age.
120
What are the physiological effects of hypothermia?
Effects include:
* Increased risk of arrhythmia
* Myocardial infarction
* Infection
* Bleeding.
121
What are the MOCA cycle requirements?
250 category 1 CME credits are required every MOCA cycle.
122
What should be considered for anesthesia in ambulatory surgery?
Medication choice is important for decreased side effects, rapid recovery, and adequate postoperative analgesia.
* Clonidine is not typically used for ambulatory surgery.
123
What is fast tracking in ambulatory surgery?
Bypassing phase 1 level of care in PACU and going directly to phase 2, provided patients meet criteria.
124
What is the management of acute mountain sickness?
Management includes:
* Hydration
* Supplemental oxygen
* Descent in altitude
* Acetazolamide
* Dexamethasone.
125
What is the effect of succinylcholine on myasthenia gravis patients treated with cholinesterase inhibitors?
Reduced metabolism of succinylcholine; patients may experience prolonged phase I blockade.
126
What is the treatment for acute methanol poisoning?
Treatment includes:
* Supportive care
* Prevention of conversion to toxic metabolites
* Rapid elimination via hemodialysis.
127
What should be avoided after intravitreous air injection?
Nitrous oxide should be avoided:
* 5 days after intraocular air injection
* 10 days after sulfur hexafluoride injection.
128
What are the features of hepatitis B virus exposure and transmission?
Features include:
* 10% of acute infections progress to chronic state
* Presence of HBeAg indicates active infection.
129
What are the exceptions to LBW dosing in obesity?
Exceptions include:
* Dexmedetomidine
* Succinylcholine
* Synthetic opioids.
130
When should organ donation referral occur?
Referral should occur as soon as a patient is deemed to have imminent death.
131
What is the minimum pressure for upper and lower extremity tourniquet?
Upper: at least 50 mmHg above systolic blood pressure; Lower: at least 100 mmHg above SBP.
132
What hemodynamic changes can occur after insufflation of the abdomen?
Changes include:
* Increased blood pressure
* Bradycardia due to vagal stimulation.
133
What physiological and metabolic alterations occur with tourniquet release?
Alterations include:
* Decrease in arterial blood pressure
* Increase in heart rate and serum lactate.
134
What are the pulmonary consequences during laparoscopic procedures?
Consequences include:
* Reduction in FRC
* Decreased respiratory compliance
* Increased peak airway pressures.
135
What is naloxone's effect on acupuncture?
Naloxone can prevent or reduce acupuncture-induced analgesia.
136
What respiratory changes are associated with obesity?
Changes include:
* Increased work of breathing
* Decreased expiratory reserve volume
* Decreased functional residual capacity.
137
What blood products do Jehovah's Witnesses refuse?
Refuse:
* Allogenic blood transfusions
* Autologous blood transfusions
* Whole blood.
138
How to decrease the risk of thermal injury during MRI?
Strategies include:
* Ensuring compatible equipment
* Checking equipment integrity
* Proper positioning of cables.
139
What complication can occur during tumescent liposuction?
Volume overload and pulmonary edema from the injection of large volumes of saline solutions.
140
What are key features of HIPAA compliant email communication?
Key features include:
* Authentication
* Encryption
* Time stamping
* Informed consent.
141
What is bone cement implantation syndrome?
A complication characterized by:
* Hypoxia
* Hypotension
* Cardiac dysrhythmias.
142
What does disaster surge planning involve?
Involves the four S principle:
* Staff
* Space
* Stuff
* Strategy.
143
What is the maximum acceptable dose of lidocaine during tumescent anesthesia?
35-55 mg/kg.
144
What is carbon monoxide poisoning?
A direct mitochondrial toxin that shifts the hemoglobin oxygen dissociation curve to the left.
145
How does MAC requirement change with age?
MAC for inhaled anesthetics decreases by 6% every decade of life.
146
What does the Cormack-Lehane grading system assess?
It assesses the view of the larynx during intubation.
147
How does the geriatric cardiovascular system change with age?
Changes include:
* Diastolic dysfunction
* Increased reliance on atrial kick for cardiac output.
148
How does MAC requirement differ between children and geriatric patients?
Decreased in geriatric patients due to neurological and pharmacokinetic changes.
149
What are signs of pulmonary thromboembolism after tumescent liposuction?
Signs include:
* Decreasing oxygen saturation
* Tachycardia
* Shortness of breath.
150
What happens to cardiac output in elderly patients?
Increased reliance on atrial kick for adequate cardiac output
## Footnote
This is due to changes in cardiac function with aging.
151
How does the MAC requirement for a geriatric patient compare to a child?
Decreased due to neurological changes, pharmacokinetic changes related to liver function, kidney function, and body compartment composition.
152
What are signs of pulmonary thromboembolism after tumescent liposuction?
* Decreasing oxygen saturation
* Tachycardia
* Shortness of breath
* Chest pain
153
What does a claims made malpractice insurance policy cover?
Covers lawsuits that are reported during the time the policy is active
## Footnote
If the physician changes malpractice insurance providers, an extension of the policy must be purchased in order to cover any claims that arise (tail coverage).
154
What are geriatric changes to the renal system?
* Decreasing renal mass
* Decreased blood flow
* Decreased creatinine clearance
* Reduced ability to effectively dilute and concentrate urine
155
What is the max dose of lidocaine and epinephrine for tumescent liposuction?
* Lidocaine: 35 to 55 mg/kg
* Epinephrine: 0.07 mg/kg
156
What effect does lidocaine have during ECT?
Decreases seizure duration and should be avoided during ECT.
157
What are the manifestations of malignant hyperthermia?
Due to hypermetabolism and muscle breakdown
## Footnote
Malignant hyperthermia-induced muscle rigidity is maintained by intracellular mechanisms independently of neuromuscular transmission.
158
When are bronchial blockers preferred over double lumen endotracheal tubes (DLT)?
* Selective lobar collapse in patients with prior oral or neck surgery
* Challenging airways
* Patients with tracheostomies
* Children < 12 years old
* Postoperative mechanical ventilation is anticipated
159
What happens to the left ventricle with aging?
Left ventricular hypertrophy develops from having to pump against stiffening arteries.
160
What is the order of cardiovascular changes during ECT?
Induces a tonic-clonic seizure, causing a parasympathetic response with bradycardia, followed by sympathetic outflow (tachycardia and hypertension).
161
What is the highest level a non-MRI compatible infusion pump can go?
Zone III
162
What is the treatment when bradycardia occurs after rapid stretching of the peritoneum?
Immediately communicate with the surgical team to desufflate the abdomen.
163
What causes increased vascular resistance (SVR) during pneumoperitoneum for laparoscopic surgery?
* Increased systemic vasopressin
* Sympathetic discharge
* Activation of renin-angiotensin-aldosterone system
164
What physiological changes are seen after brain death?
* Myocardial dysfunction
* Catecholamine storm leading to hemodynamic instability, hypovolemia, pulmonary edema, hyperglycemia, and polyuria
165
What are the signs of acute compartment syndrome?
* Compartment pressure > 30 mmHg
* Creatine phosphokinase level > 5000
* Loss of normal phasic patterns of tibial venous blood flow
* Loss of distal pulses in the setting of closed extremity injury
* Compartment perfusion pressure < 21 mmHg
166
What physiological changes in the CNS make the geriatric population more sensitive to neuraxial anesthesia?
* Decrease in myelinated nerves in both dorsal and ventral nerve roots
* Reduction in epidural space
* Decreased volume of CSF
* Increased permeability of dura
167
How can airway fires be prevented?
* Avoiding nitrous oxide
* Using the minimum required oxygen concentration
* Using a cuffed ETT
* Letting skin prep fully dry
* Arranging drapes to prevent oxygen buildup
168
What steps should be taken if an airway fire occurs?
* Immediately call for help
* Stop all airway gases
* Remove ETT and other objects in airway
* Pour saline or water into airway
* Work to reestablish ventilation
169
What are the three components of operating room fires?
* Oxidizer (nitrous or oxygen)
* Ignition source (electrocautery)
* Fuel source (sponges, drapes, alcohol-containing solutions)
170
What are the most important initial steps of an airway fire?
Simultaneously extubate patient and turn off airway gas flow.
171
Which neuromuscular blocker should be dosed on total body weight?
Succinylcholine
172
What is weight-based scalar dosing?
See image for details.
