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Flashcards in M5 2014 Deck (402):
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Innervation of anterior tongue

Trigeminal n., mandibular branch (V3)

1

Innervation of posterior tongue, soft palate, and oropharynx

Glossopharyngeal n. (IX)

2

Innervation of hypopharynx

Internal branch of superior laryngeal n. (X)

3

Innervation of larynx and trachea

Recurrent laryngeal n.

4

Topicalizing anterior tonsillar pillars with lidocaine will anesthetize what nerve?

Glossopharyngeal n. (Only tonsillar, lingual, and pharyngeal branches, not the whole n.)

5

External branch of superior laryngeal n. supplies motor innervation to what?

Cricothyroid muscle

6

Blocking inferior aspect of greater cornu of hyoid bone will anesthetize what nerve?

Internal branch of superior laryngeal n., which innervates the hypopharynx

7

Only muscle responsible for vocal cord abduction

Posterior cricoarytenoid muscle

8

Only vocal cord muscle NOT innervated by recurrent laryngeal n.

Cricothyroid muscle, innervated by external branch of superior laryngeal n.

9

Block of recurrent laryngeal n. results in vocal cords being affected how?

Partial adduction. Unilateral block = hoarseness. Bilateral block = stridor and possible airway obstruction

10

Most sensitive indicator for a difficult intubation

Mallampati class 3 or 4

11

2nd most sensitive indicator for difficult intubation

Reduced thyromental distance

12

Highest positive predictive value (PPV) for difficult intubation

History of difficult intubation

13

Function of type I and type II pneumocytes

Type I: gas exchange
Type II: produce surfactant, smaller and far more numerous than type I

14

Sensory innervation of lung is provided by which nerve

Vagus nerve

15

Long thoracic n. innervates what muscle

Serratus anterior

16

Winged scapula is a result of damage to what nerve

Long thoracic n.

17

Coronary a. supplying anterolateral wall of LV

Left circumflex

18

Coronary a. supplying anteroseptal wall of LV

LAD

19

Coronary a. supplying inferior wall of LV

RCA

20

Coronary a. supplying inferolateral wall of LV

RCA and LCx

21

Most patients with atrial flutter have a rapid circuit originating from which chamber of the heart

Right atrium and involving tissue near tricuspid valve

22

Aortic arch crosses up, over, and behind which main bronchus

Left main bronchus

23

Aortic dissection creates false lumen in which layer of the aortic wall

Media (intima, media, adventitia)

24

Risk factors for aortic dissection

Uncontrolled HTN, connective tissue disease, vasculitis, trauma

25

Course of subclavian vein in relation to anterior scalene muscle

Anterior

26

Course of subclavian artery in relation to anterior scalene muscle

Between middle and anterior scalene muscles

27

Course of subclavian vein in relation to first rib

Superior to first rib and inferior to clavicle

28

Continuation of internal carotid artery in circle of Willis is called

Middle cerebral artery

29

When does spinal cord move from L3 to L1

By 2 months of age

30

Superior aspect of iliac crest is at which vertebral level

L4

31

Innervation of facet joint between 2 vertebrae

Medial branch of the posterior division of spinal nerves

32

Celiac plexus is located at which vertebral level

L1

33

Which nerve is inadequately blocked following axillary block

Musculocutaneous nerve which innervates lateral forearm

34

Medial forearm is innervated by cutaneous branches of which nerve

Ulnar

35

Relationship of median nerve to brachial artery in the antecubital fossa

Median nerve runs medial to brachial artery

36

Parasympathetic fibers to the heart arise from

Dorsal vagal nucleus and nucleus ambiguous

37

The two plexuses arising from parasympathetic fibers to the heart are located between

Aortic arch and tracheal bifurcation

38

Nicotinic acetylcholine receptors are found in greatest concentration at which heart node

SA node

39

Sympathetic cardiac nerve fibers course with which coronary artery

Left main coronary artery

40

How and when is S3 heart sound made

Early diastole when atrial blood reverberates against poorly functioning ventricular walls. S3 is associated strongly with MACEs (major adverse cardiac events)

41

S1 sound is heard where on an EKG

Just after QRS complex

42

S2 sound is heard where on an EKG

Just after T wave

43

S4 sound is heard where on an EKG

Just after p wave. Sound is caused by atrial contraction ejecting blood into a noncompliant ventricle

44

Where is mixed venous oxygen saturation measured

Right atrium

45

ATP binding to myosin results in

Release of myosin tension from actin

46

Amiodarone is what class of antiarrhythmic agent

Class III, a potassium blocking agent which delays phase 3 repolarization.

47

Side effects of amiodarone

Pulmonary fibrosis, hypothyroidism or hyperthyroidism, transaminitis, peripheral neuropathies

48

How does glucagon treat beta blocker overdose

Glucagon increases cAMP and therefore protein kinase A

49

At what heart rate is stroke volume the greatest

60

50

At what heart rate is cardiac index maximized

120

51

Reflex when a hypovolemic pt has bradycardia and hypotension when moved from supine to upright

von Bezold-Jarisch reflex. Receptors in left ventricle

52

Mechanics of alpha 1 mediated vasoconstriction

Phenylephrine -> alpha 1 receptor -> activation of PLC (phospholipase C) -> formation of IP3 (inositol triphosphate) -> Ca release from sarcoplasmic reticulum -> increased contraction

53

Mechanics of beta 2 agonism

Beta 2 receptor -> cAMP -> uptake of Ca back to SR -> decreased contraction

54

Mechanics of NO activity

NO -> cGMP -> decreased contraction

55

Minimum number of days after coronary balloon angioplasty to wait before performing elective surgery

14 days

56

Slope of dose response curve is determined by

Receptor binding characteristics

57

Respiratory depression is mediated by which opioid receptor

Mu2

58

Muscle rigidity is mediated by which opioid receptor

Mu1

59

Hallucinations are mediated by which opioid receptor

Sigma

60

Opioid that decreases contractility, increases heart rate, and causes mydriasis

Meperidine, has atropine like structure causing anticholinergic response

61

Meperidine decreases shivering by agonism of what receptor

Kappa

62

Effects of opioids that are resistant to tolerance

Constipation and miosis

63

High doses of which opioid may induce acute opioid tolerance in the PACU

Remifentanil

64

Baclofen is an agonist of what receptor

GABA-B receptor

65

Aspirin sensitivity with nasal polyps is associated with what medical condition

Asthma. Samter's triad

66

Reason for hypertension and bradycardia during infusion of dexmedetomidine

Cross reactivity with alpha 1 receptor at high doses

67

Benzodiazepine effects of amnesia is explained by hyperpolarization of

Post synaptic neurons primarily in the cerebral cortex

68

Benzodiazepine mediated muscle relaxation occurs through gamma subunit agonism of

GABA-A receptor specifically in the spinal cord

69

Hyperalgesia is mediated by what process

Opioid NMDA agonism, which explains why patients respond well to NMDA antagonists like ketamine, methadone, and dextromethorphan

70

How does activation of opioid receptors affect potassium conductance

Increase

71

Opioids that cause inhibition of serotonin reuptake

Meperidine, methadone, tramadol, dextromethorphan.

72

Pretreatment with what medication decreases incidence of etomidate associated myoclonus

Opioids

73

how much of etomidate is not metabolized after passing through liver

50%

74

Why is it that more active neurons are blocked to a greater extent than less active neurons

Sodium channels in the activated or inactivated state have a greater affinity for local anesthetics than in the resting state

75

rate of systemic absorption of local anesthetic from greatest to least

IV > tracheal > intercostal > caudal > paracervical > epidural > brachial plexus > sciatic > subcutaneous

76

Adding epinephrine to lidocaine will increase duration of peripheral nerve block by about how much?

50%

77

local anesthetics bind to which subunit of the voltage-gated sodium channels

alpha

78

2 ways that epinephrine enhances quality of a nerve block

1) vasoconstriction causing longer period of time that local is exposed to neuron
2) direct adrenergic activation of alpha-2 receptors

79

exception to the rule of pseudocholinesterase metabolism of ester local anesthetic

cocaine

80

Why is block onset faster by adding epi to plain local vs. using premixed local with epi?

Premixed solutions are more acidic to prevent degradation of epi

81

Basic drugs are usually bound to which protein?

Alpha-1-acid glycoprotein

82

Acidic drugs are usually bound to which protein?

Albumin

83

Preservative used with amide local anesthetic

Methylparaben

84

glutamate is an excitatory or inhibitory neurotransmitter?

excitatory

85

how does opioid agonism change the resting potential of a neuron

make it more negative

86

brain needs what percent of cardiac output to cover metabolic needs

15-20%

87

Is obesity a risk factor for POCD postop cognitive decline?

no

88

what area in the brain is pain sensed?

postcentral gyrus

89

Norepinephrine is metabolized by what?

Both MAO (monoamine oxidase) and COMT (catechol O-methyltransferase)

90

which opioid increases cerebral blood flow

sufentanil

91

external or internal intercostal muscles are used for inspiration?

external

92

external or internal intercostal muscles are used for expiration?

internal

93

dead space is what percent of tidal volume in a healthy mechanically ventilated patient?

50%

94

above what shunt fraction would supplemental oxygen not expect to increase PaO2 by more than 10 mmHg?

40%

95

Use ventilation-perfusion ratio (VQI) to calculate shunt

VQI = ( 1 - SaO2 ) / ( 1 - MvO2 ). Therefore 99% SaO2 with 75% MvO2 = 0.01 / 0.25 = 4% shunt in healthy person

96

Decreased FEF 25%-75% (forced expiratory flow) is indicative of what?

early indicator of medium airway obstructive disease. it is theoretically effort independent

97

FRC is classically lowest when after a surgery?

12 hours postop

98

General anesthesia will decrease FRC by what percent?

10%

99

maximal benefit from smoking cessation is how many weeks prior to surgery?

8 weeks or more

100

Classic EKG findings for a COPD patient

signs of right heart strain such as poor R wave progression, enlarged P waves, RBBB, right axis deviation, low voltage

101

Abdominal surgery affects residual volume (RV) how?

increases it by 10%. expiratory reserve volume is decreased by 25%

102

Best surface anatomic estimate for level of the carina

sternal angle

103

best marker for dynamic lung compliance

peak pressure

104

Ach receptor requires binding of how many Ach molecules to activate?

2

105

Ach receptor uses a pair of alpha or beta subunits?

alpha subunits

106

what does ecothiophate do?

cholinesterase inhibitor

107

dibucaine number for normal person

80%

108

half life of esmolol

10-20 minutes

109

muscle fasciculations after succinylcholine have strongest association with which effect?

increased ICP

110

muscle relaxants metabolized by pseudocholinesterase

mivacurium and succinylcholine

111

steroid muscle relaxant that has no metabolites

rocuronium

112

Extubation criteria for RSBI (rapid shallow breathing index) should be less than

105 (RR/TV)

113

duration of neostigmine

1 hour

114

timing of peak effect of neostigmine

10 min

115

treatment for central anticholinergic syndrome

physostigmine, because its tertiary amine structure allows it to cross blood brain barrier, unlike neostigmine and edrophonium

116

A right to left cardiac shunt will slow the induction more in desflurane or isoflurane

desflurane because so very little desflurane is taken up so when it is further diluted with a right to left shunt, it slows induction

117

decreased cardiac output slows or speeds elimination of inhaled anesthetics

speeds

118

MAC value for ED95 for patient moving in response to surgical stimulus

1.3

119

which electrolyte abnormality increases MAC

hypernatremia

120

inhaled anesthetic that doesn't increase apneic threshold

nitrous oxide, which also does not potentiate muscle relaxation

121

which of the modern inhaled anesthetics is metabolized to the greatest extent

sevoflurane, 5%

122

which modern inhaled anesthetic produces the greatest extent of coronary vasodilatation

isoflurane

123

at what MAC does isoflurane produce burst suppression of EEG

1.5 MAC

124

which modern inhaled anesthetic causes transient increases in sympathetic tone with rapid increases in concentration during induction

desflurane and isoflurane

125

desflurane can be degraded by dessicated CO2 absorbent to produce what?

carbon monoxide

126

A unit of insulin should decrease glucose by how much?

25 mg/dL

127

hypothyroidism is associated with hyper or hypo natremia?

hyponatremia because patients retain free water

128

Chance of cross-reaction between penicillin and cephalosporins

< 2%

129

why is ankylosing spondylitis patient at increased risk for neuraxial and general anesthesia?

GA: cervical neck stenosis
Neuraxial: reduced intervertebral spaces and ossification

130

minimum gas flow rate needed for a carbon dioxide absorber to prevent rebreathing of CO2

5L/min

131

least likely benefit of neuraxial anesthesia

decreased morbidity and mortality from myocardial ischemia

132

Neuraxial anesthesia can be done how many hrs after last dose of daily enoxaparin? And enoxaparin can be restarted how many hrs after block placed?

Block can be placed 12 hrs after last dose. Dose can be given 6 hrs after block is placed.

133

which epidurally given local anesthetic interferes with epidural opioid mediated analgesia

chloroprocaine

134

supraclavicular or interscalene block has higher incidence of transient hemidiaphragmatic paralysis

interscalene

135

which brachial plexus block has highest incidence of chylothorax

infraclavicular block

136

which brachial plexus block performed without ultrasound has highest risk of pneumothorax

infraclavicular block

137

axillary block likely misses what nerve and what sensory region of arm?

musculocutaneous, lateral forearm

138

relationship of ulnar, median, and radial nerves to the axillary artery for axillary block

ulnar is superior-medial
median is superior-lateral
radial is deep to artery

139

what proportion of sodium filtered by glomerulus is typically excreted in the urine

5%

140

Site of action of furosemide

ascending loop of Henle

141

ADH increases aquaporin-2 channels in what part of the nephron?

collecting duct

142

what part of nephron is most responsible for concentrating urine

collecting duct

143

what is the reason to prescribe ACE inhibitor for CHF patient?

interrupt pathological increases in sodium retention

144

mechanism of action of spironolactone

direct aldosterone receptor antagonist, leading to decreased Na/K ATPase activity so potassium-sparing

145

mechanism of action of acetazolamide

carbonic anhydrase inhibitor, leading to inhibition of bicarb uptake at proximal tubule

146

mechanism of action of loop diuretics

inhibit Na-K-2Cl transporter in the thick ascending limb of the loop of Henle

147

mechanism of action of thiazides

inhibit Na-Cl transporter in the distal convoluted tubule

148

furosemide's effect on calcium level

furosemide leads to hypocalcemia

149

thiazide's effect on calcium level

thiazide increase calcium reabsorption -> hypercalcemia

150

which is used to treat hypercalcemia? furosemide or thiazide?

furosemide

151

why do potassium-excreting diuretics increase risk of digoxin toxicity?

digoxin competes with potassium on Na-K ATPase, so hypokalemia worsens risk of digoxin toxicity

152

furosemide causes metabolic acidosis or alkalosis

metabolic alkalosis

153

why does a hyperosmolar state cause hyperkalemia?

Potassium follows water out of the intracellular compartment

154

An increased SIG (strong ion gap) demonstrates what metabolic abnormality

metabolic alkalosis

155

A decreased SIG (strong ion gap) demonstrates what metabolic abnormality

metabolic acidosis

156

Fatter or thinner people are at increased risk of ulnar neuropathy

fatter

157

fatter or thinner people are at increased risk of common peroneal injury

thinner

158

the only sure-proof way to treat "obturator reflex" in a cystoscopy under spinal anesthesia is to?

induce general anesthesia with neuromuscular blockade

159

What causes hyperammonemia in TURP syndrome?

glycine can be metabolized to ammonia

160

Transient blindness in TURP syndrome is caused by?

CNS depressing effects of glycine

161

What thoracic level needs to be blocked to ensure loss of sensation for a cystoscopy

T8, up to renal pelvis.

162

Why does cardiac output only slightly decrease with large associated increase in afterload with alpha-1 adrenergic stimulation?

stimulation of alpha-1 adrenergic receptors on myocardium leads to mild inotropy

163

which vasopressor is best at renal preservation in a severely septic patient with low urine output

norepinephrine

164

drugs of choice to treat cardiogenic shock in setting of severe acidosis

norepinephrine and dobutamine

165

Primary advantage of a norepinephrine gtt over a dopamine gtt for treating severe hypotension

lower rate of arrhythmias, especially high grade tachyarrhythmias

166

What is the end product of catecholamine metabolism?

VMA (vanillymandelic acid)

167

Why is dopexamine a bad drug for CHF exacerbation in setting of sepsis?

dopexamine's effects are B2 >>> B1 as well as potent dopamine receptor effects, which will cause worsening hypotension

168

how does beta 1 agonism increase lusitropy

by increasing rate of calcium uptake into sarcoplasmic reticulum during diastole. this uptake is mediated by SERCA (sarco-endoplasmic reticulum calcium ATPase)

169

tachyphylaxis of ephedrine is likely due to

depletion of presynaptic norepinephrine stores

170

beta receptors lead to a G-protein mediated stimulation of adenylate cyclase which converts ATP to?

cAMP, which ultimately leads to increased intracellular calcium concentrations

171

beta receptor stimulation increases intracelluluar calcium concentrations by what action?

cAMP activates protein kinase A which acts on sarcoplasmic reticulum to release calcium

172

Next best step for hypotensive patient with acutely failing right heart and increasing tricuspid regurgitant jet despite the absence of overt left heart failure

inhaled nitric oxide

173

mechanism of action of nitric oxide

stimulates guanylate cyclase which increases cGMP levels which relaxes smooth muscle which causes vasodilatation

174

reason for rebound hypertension following discontinuing of sodium nitroprusside treatment

increased catecholamines and renin-angiotensin release

175

How does nitroglycerin improve myocardial oxygen delivery to consumption ratio?

Decreased preload decreases consumption and improves perfusion. As a coronary artery dilator, it helps redistribute blood flow to subendocardium

176

nicardipine and hydralazine nearly exclusively dilate venous or arterial bed?

arterial bed

177

how do volatile agents depress myocardial contractility?

by indirectly decreasing calcium release by the sarcoplasmic reticulum

178

Cardiac autonomic innervation to the SA node is supplied by?

right vagus nerve and sympathetic chain that arises from T1-4 by way of stellate ganglion

179

cardiac autonomic innervation to the AV node is supplied by?

left vagus nerve

180

myocardial contractility is predictability depressed by what factors?

acidemia, anoxia, decreased sympathetic tone, and hypocalcemia

181

Is LVEDP increased or decreased with LV diastolic dysfunction?

Increased because a higher LVEDP is required to fill a stiff ventricle that poorly relaxes

182

The most sensitive and specific monitor for intraop MI is?

TEE which can demonstrate wall motion abnormalities which is the most sensitive and specific sign of ischemia

183

Patient who requests no sedation for cataract surgery has symptomatic episodes with slow pulse, what to do next?

consult EP

184

neurological outcomes after CPB is worse with pH-stat or alpha-stat strategy?

ph-stat because added CO2 causes cerebral vasodilation so small emboli are more likely to get to brain

185

best first line of treatment for a hypertensive patient with aortic dissection

esmolol gtt which decreases shear forces that are caused by increased heart rate and cardiac output. next line of treatment would be nicardipine or nitroprusside gtt

186

what type of acid/base abnormality does severe diarrhea cause?

non-gap metabolic acidosis with hypokalemia

187

how does thoracic epidural reduce postop ileus?

decreases sympathetic outflow to GI tract

188

medications that reduce lower esophageal sphincter (LES) tone

anti-cholinergics, opioids, thiopental, volatiles

189

What type of change in lower esophageal sphincter (LES) tone is associated with LMA use?

decrease in LES tone

190

gastroparesis and autonomic neuropathy are more common in T1DM or T2DM?

T1DM

191

propranolol decreases portal pressure by what mechanism?

Beta 2 blockade causes hepatic artery vasoconstriction which decreases liver congestion

192

which coagulation factors are not produced by hepatocytes?

factor III and vWB (endothelium)
factor VIII (endothelium and liver sinusoidal cells)

193

How much of what fluid should be administered for every liter of ascites removed?

10-20 cc of 25% albumin for every liter of ascites removed

194

Child-Pugh score includes what components?

albumin, bilirubin, PT or INR, clinical judgment of ascites and encephalopathy

195

MELD score includes what components?

bilirubin, creatinine, INR

196

how is hepatic blood flow affected by general and neuraxial anesthesia?

hepatic blood flow decreases

197

the heart of a cirrhotic "high cardiac output heart failure" patient looks like?

structurally normal

198

what are the PA pressures in a cirrhotic patient with high cardiac output heart failure?

elevated

199

what is next best step when clamping IVC during liver transplant surgery causes BP to drop dramatically?

unclamp, check ABG, hct, electrolytes, volume status, and give fluids

200

why is hypocalcemia a sign of high risk for perioperative mortality in setting of pancreatitis?

the hypocalcemia is due to calcium precipitating with fats degraded by pancreatic enzymes. hypocalcemia also occurs in severe fat embolism and rhabdomyolysis

201

chance of infection with needlestick from HCV, HBV, and HIV

HBV ~ 40%
HCV ~ 2%
HIV 0.3%

202

what percent of patient with HCV will develop cirrhosis?

20%

203

type of vwD that responds to DDAVP treatment

type I

204

what is done to prbcs to prevent anaphylaxis in IgA deficient patients?

washing of prbcs

205

what is done to prbcs to prevent febrile reactions and alloimmunization

leukoreduction or leukodepletion

206

what is done to prbcs to prevent graft vs host disease?

irradiation of prbcs

207

mechanism of febrile transfusion reactions

recipient antibodies toward donor WBCs

208

TRALI typically resolves within how many hours?

48 hrs

209

most popular theory for the mechanism of TRALI

donor antibodies to HLA and other recipient antigens, also a 2-hit theory: 1) sequestration of neutrophils 2) activation of neutrophils causing a transient short lived leukopenia

210

transfusing a pediatric patient with 4 cc/kg of prbc will raise hemoglobin by how much?

1 g/dL

211

risk of HIV infection due to transfusion

1:2,000,000

212

risk of hep B and hep C infection due to transfusion

1:200,000

213

metabolic acidosis or alkalosis is often seen following massive transfusion?

metabolic alkalosis because large citrate loads is converted to bicarb in the liver

214

carbohydrate CO2 production for every unit of O2 consumed

1.0

215

protein CO2 production for every unit of O2 consumption

0.8

216

fat CO2 production for every unit of O2 consumption

0.7

217

carbonic anhydrase is primarily found where in the body?

RBCs and endothelium

218

Most common triggers for ARDS

pneumonia and sepsis

219

PaO2/FiO2 (P/F) ratio for ARDS criteria

< 200

220

subglottic stenosis is a risk factor when ETT is in place for how long?

> 2 weeks

221

gram negative or gram positive bacteria is most common in sepsis?

gram negative

222

Minimum NIF (negative inspiratory force) for extubation criteria

-20 to -25 cm H20

223

what are the two high-risk conditions that may benefit from H2 blockers to avoid stress related mucosal injury to the stomach

mechanical ventilation > 48 hrs and coagulopathy

224

three biggest risk factors for acalculous cholecystitis

surgery, trauma, and TPN

225

standard for basic anesthesia monitoring under general anesthesia includes:

oxygenation, ventilation, circulation, and temperature

226

natural frequency and dampening of pressure transducer are directly related or inversely related

inversely related.

227

10 cmH20 equates what in mmHg?

7 mmHg = 10 cmH20

228

what is an osborn wave?

positive deflection between QRS and ST segment, aka camel-hump sign or late delta wave, usually observed in hypothermic patients (< 32C)

229

carbon monoxide poisoning results in shift of oxygen-Hb dissociation curve to left or right?

left. O2 sat overestimates the PaO2.

230

anesthetic drug that increases amplitude and has no effect on latency for SSEP signaling

ketamine

231

Evoked potentials that are least sensitive to volatile agents

BAEPS (brainstem auditory evoked potentials), hearing is the last sense to be lost.

232

Best immediate treatment for PACU patient shivering with temp of 34.5C and new onset ST depressions

meperidine, which is faster than warmers to decrease shivering

233

antiseizure meds show significant reductions in seizures within how many days of a TBI (traumatic brain injury)

7 days

234

Best method to prevent phase I hypothermia that is due to vasodilatation and redistribution of heat from central to peripheral compartments

Pre-warming patient with forced air convection blankets prior to induction

235

permanent neurologic injury can result from status epilepticus after how much time?

within 5 minutes

236

why is status epilepticus an emergency?

sustained neuronal oxygen consumption can lead to ischemia

237

Postop pt in PACU has tonic/clonic seizure, what is first step?

assess and establish a patent airway

238

the most common cause of intraop stroke from CEA (carotidendarterectomy)

embolism, which can be caused by placing a stent

239

latex allergies most often occur in children with what diseases?

myelomeningocele, spina bifida, GU disease, indwelling tubes, and multiple surgeries as a child

240

hypothermia or hyperthermia exacerbates multiple sclerosis?

hyperthermia

241

Guillian-Barre syndrome (GBS) is exacerbated by what type of anesthesia?

neuraxial anesthesia, but not lumbar punctures

242

3 big anesthetic things to avoid in patient with myotonic dystrophy

1) succinylcholine
2) neostigmine
3) hypothermia

243

myasthenia gravis has 4 types, the hallmark of type I is?

isolated extraocular muscle weakness

244

A study showed myasthenia gravis patients undergoing thymectomy have what risks that increase likelihood of postop mechanical ventilation

1) disease duration > 6 yrs
2) vital capacity < 2.9L
3) pyridostigmine > 750 mg/day

245

Myasthenia gravis improves or worsens in the last trimester of pregnancy

worsens, and continues into early postpartum

246

Infants of myasthenia gravis mothers have transient myasthenia for how long?

about 1-3 weeks when maternal antibodies are cleared

247

Eaton Lambert syndrome patient's sensitivity to muscle relaxants

increased sensitivity to both succinylcholine and nondepolarizing muscle relaxants. decreased Ach release -> increased Ach receptors

248

How is MAC changed with patient taking TCAs (tricyclic antidepressants)

Increased because neurotransmitter levels are increased

249

Use of ephedrine in a patient on TCAs (tricyclic antidepressants) will be potentiated or ineffective?

potentiated and unpredictable effect

250

lithium causes or treats nephrogenic diabetes insipidus?

causes nephrogenic DI

251

how does lithium affect muscle relaxants?

lithium potentiates both depolarizing and nondepolarizing muscle relaxants

252

Is lithium safe in pregnancy?

No, lithium is a teratogen

253

absolute contraindications to ECT (electroconvulsive therapy)

intracranial hypertension, aneurysm, and mass

254

best treatment for acute cocaine toxicity causing diffuse ST elevations, tachycardia, and hypertension

calcium channel blockers

255

drug that is most commonly abused among anesthesiologists and is most likely associated with relapse

fentanyl

256

what is the normal resting (end-expiration) intrapleural pressure

-5 cm H2O, this negative intrapleural pressure is always required to keep lungs from collapsing

257

a high Reynold's number is consistent with turbulent or laminar flow?

turbulent flow

258

turbulent flow is more a function of viscosity or density?

density, turbulent flow is like ping pong balls, the more you have, the more resistance there is

259

Neck flexion can increase or decrease dead space

decrease

260

ventilatory response to hypercarbia is mediated by chemoreceptors where?

on the anterolateral surface of medulla in contact with 4th ventricular CSF

261

part of medullary center that is responsible for coordinating inspiration

dorsal medullary center

262

part of medullary center that is responsible for coordinating expiration

ventral medullary center

263

reason for decreased O2 saturations in a severe COPD patient after giving supplemental O2

interruption of hypoxic pulmonary vasoconstriction, leading to worsening deadspace and V/Q mismatch

264

why is it classic teaching to delay the second carotidendarterectomy (CEA) up to a year after the first CEA?

carotid bodies are dysfunctional (denervated) after CEA and it is assumed that it can take up to a year to return to function

265

what distinguishes chronic bronchitis from emphysema?

frequent cough, copious secretions, CO2 retainer earlier in disease course leading to erythrocytosis and high PA pressures and cor pulmonale

266

definition of very severe COPD

FEV1 < 30% or FEV1 < 50% and cor pulmonale

267

definition of severe COPD

FEV1 < 50% predicted

268

the only proven treatments to affect overall natural history of COPD

smoking cessation and O2 supplementation

269

best ventilation strategy for patients with noncompliant, restrictive lungs

small tidal volumes and increased respiratory rate

270

patient with open pneumothorax breathing spontaneously in lateral decub position, mediastinum will shift which way during inspiration?

down during inspiration and up during expiration. with mechanical ventilation, up during inspiration and down during expiration

271

a large pneumothorax greater than what percent of lung volume should be treated with a chest tube

> 50% of lung volume

272

Next best step in management of a stable patient with small pneumothorax

Repeat CXR in 3-6 hrs to rule out progression

273

intrathoracic lesions cause obstruction on expiration or inspiration

expiration

274

extrathoracic lesions cause obstruction on expiration or inspiration

inspiration

275

null hypothesis definition

two interventions will have the same effect

276

type I error is alpha or beta

alpha

277

false positive is type I or type II error

type I

278

Relationship between power and beta

power = 1 - beta

279

study variable that has an order and the difference between each data point is constant

interval variable

280

study variable that has an order but the difference between each data point is not necessarily constant

ordinal variable

281

study variable with no inherent ordering

nominal or categorical variable

282

standard deviation includes what percent of all data?

1 = 68%
2 = 95%
3 = 99%

283

standard deviation is a measure of what?

variance

284

standard error is a measure of what?

accuracy

285

if standard deviation is low, then the study is considered?

precise

286

student t-test should be used for what type of data?

continuous interval data

287

chi-squared test should be used for what type of data?

data that is not interval

288

ANOVA test should be used for what type of data?

continuous interval data for 3 or more populations

289

difference between student t-test and paired t-test

student t-test compares 2 different groups. paired t-test compares same group before and after an intervention

290

odds ratios are used when the outcome is ?

already known. relative risk is used when outcome is uncertain.

291

Sensitivity is calculated from 2 x 2 table with what equation?

TP / (TP + FN)

292

specificity is calculated from 2 x 2 table with what equation?

TN / (TN + FP)

293

positive predictive value is calculated from 2 x 2 table with what equation?

TP / (TP + FP), only looking at positive results of new test

294

negative predictive value is calculatd from 2 x 2 table with what equation?

TN / (TN + FN), only looking at negative results of new test

295

test's likelihood of correctly identifying a positive result

sensitivity

296

test's likelihood of correctly identifying a negative result

specificity

297

likelihood of a true positive being identified as a positive result by a new test

positive predictive value

298

likelihood of a true negative being identified as a negative result by a new test

negative predictive value

299

Number needed to treat (NNT) is calculated how?

NNT = 1 / ARR
ARR = absolute risk reduction
eg. risk reduces from 5% to 3%, so NNT = 1 / 2% = 50

300

protopathic sensation is noxious or non-noxious?

noxious (painful)

301

fast pain is carried by what type of fibers?

A-delta fibers

302

delayed, slow secondary pain is carried by what type of fibers?

C fibers

303

decreased pain med requirements postop after giving ketorolac is due to?

both decreased peripheral and central sensitization of pain

304

how are antivirals effective in treating herpes zoster?

reducing the frequency of painful zoster flares

305

Type of CRPS with demonstrable nerve lesions

type II

306

severe CRPS patients can result in what problems?

severe muscle wasting, severe osteoporosis, ankylosing joints, contractures, glossy skin

307

most effective early management of CRPS

series of sympathetic blocks of the affected extremity

308

treatment for severe longstanding CRPS

spinal cord stimulator placement, possibly ketamine

309

risk of CRPS is higher in women or men?

women (3:1)

310

what age group is CRPS most prevalent?

middle age

311

why avoid neuraxial anesthesia in patient with phantom limb pain (PLP)

spinal anesthesia can exacerbate symptoms

312

unpleasant sensation with or without a stimulus

dysesthesia

313

abnormal sensation without an apparent stimulus

paresthesia

314

perception of non-noxious sensation as pain

allodynia

315

pain in an area that lacks sensation

anesthesia dolorosa

316

increased response to a noxious stimulus

hyperalgesia

317

Transcutaneous electrical nerve stimulation (TENS) provides analgesia by what mechanism

stimulating large afferent epicritic fibers so original pain will no longer be as well perceived

318

stellate ganglion is classically blocked by locating transverse process of which cervical vertebrae?

C6

319

what's the advantage of intrathecal opioid catheter vs other opioid routes for intractable cancer pain?

lower doses reduce side effects

320

lumbar epidural steroid injection is usually successful within how many months of an injury?

3 months, and usually takes a series of 3 injections

321

psychiatric disorders not correlated with chronic pain

bipolar and schizophrenia

322

cerebral blood flow increases only after PaO2 decreases under what value?

< 50

323

normal CMRO2 is about?

3.5 mL/100g/min

324

normal cerebral blood flow is?

50 mL/100g/min

325

average adult CSF volume and how much is produced a day.

150 cc, 500 cc is produced a day

326

What anesthesia MAC level is cerebral blood flow not autoregulated anymore

2 MAC or more

327

volume of venous air embolism that is lethal

> 300 cc

328

Hunt and Hess scale

Classify severity/mortality of subarachnoid hemorrhage:
1-minimal HA 5%
2-mod HA, nuchal rigidity 10%
3-above + drowsy 30%
4-stupor, hemiparesis 50%
5-coma,decerebrate rigidity 70%

329

greatest risk over the first week after a patient has a ruptured cerebral aneurysm

cerebral vasospasm

330

Triple H therapy for prevention and treatment of cerebral vasospasm

Hypertension (SBP > 150), Hypervolemia (CVP > 8), Hemodilution (hct 30)

331

Best method for monitoring for cerebral vasospasm

frequent neurochecks and transcranial doppler combined

332

Intracranial pressure (ICP) when risk of herniation is much higher

ICP > 30-40

333

isolated fractures of C1 and the occipital condyles are in general stable cervical spine injuries, true or false

true

334

valsalva is board code-word for?

decreased preload

335

handgrip maneuver is board code-word for?

increased afterload

336

fastest and most effective way to stabilize a CHF exacerbation with EF 35% with increased pulmonary edema

mechanical ventilation, then add lasix and pressors to treat underlying problem of volume overload

337

propofol induction and maintenance doses should be based on?

induction: IBW (termination is based on redistribution)
maintenance: TBW (based on clearance)

338

Elevated E to e' ratio (over 15 or so) is a sign of what?

diastolic dysfunction

339

aldrete score includes what parameters?

activity, respiration, consciousness, circulation (blood pressure), color

340

Pulmonary test results that predict poor postop pneumonectomy prognosis

PaCO2 > 45, PaO2 < 50, predicted postop FEV1 of < 800 mL, FEV1/FVC < 50%, max VO2 < 10 mL/kg/min

341

Which is more effective? PEEP to dependent lung or CPAP to surgical lung during one lung ventilation (OLV)

CPAP to surgical lung which allows shunted blood to participate in oxygen exchange

342

advantages of OPCABG (off pump CABG) vs on pump CABG

decreased incidence of respiratory infections, afib, inotrope use, and fewer blood transfusions

343

which is the final cannula removed after CPB (cardiopulmonary bypass)

aortic cannula

344

mechanism of increased pulmonary artery (PA) pressures after giving protamine following cardiopulmonary bypass (CPB) surgery

thromboxane (vasoconstrictor) release from macrophages caused by heparin-protamine complexes activating complement

345

Best strategy to hasten rewarming after CPB (cardiopulmonary bypass) surgery

nitroglycerin (NTG) infusion

346

why is first degree AV block common following heart transplant?

increased refractory period of transplanted heart and slowed atrial conduction

347

classic presentation of digitalis toxicity

increased PVCs (bigeminy most common), anorexia, nausea. Toxicity is exacerbated by hypokalemia and hypomagnesia

348

beta blockers with alpha blocking properties

carvedilol and labetalol

349

normal umbilical artery and vein blood gases

artery: 7.3/50/20
vein: 7.35/40/30

350

when does fetal Hb start to be replaced by adult Hb

around 3 months, and completely at 6 months

351

p50 of fetal Hb

19 (27 for adult Hb)

352

normal neonatal glucose for full-term infant can range as low as?

30 mg/dL (< 45 mg/dL is hypoglycemia for neonates)

353

Concentration of dextrose used to treat hypoglycemic neonate

D10 or less

354

many sources advise avoidance of succinylcholine in children because?

increased risk of hyperkalemia due to undiagnosed underlying myopathies

355

after 28 days, respiratory distress syndrome (RDS) is called what?

bronchopulmonary dysplasia (BPD)

356

lecithin-sphingomyelin ratio (L/S) that is associated with fetal lung maturity

2 is sufficient surfactant production, < 1.5 is not

357

which muscle relaxant requires a larger dose in infants?

succinylcholine

358

pulse oximeter should be placed where to assess lung function of a newborn?

preductal location such as right hand

359

elective surgery should be delayed till what postconception age for healthy infants to reduce risk of post-anesthetic apnea

44-60 weeks (most authors favor > 50 weeks)

360

infant younger than 50 weeks post conception should be observed how many hours post-op to monitor post-anesthetic apnea?

12 hours after surgery (most conservative approach is 24 hr observation for infants < 60 weeks)

361

chest compression to ventilation ratio for neonate resuscitation

3:1

362

tracheal dose of epinephrine is how many times greater than IV dose?

10 times (0.1 mg/kg for tracheal, 0.01 mg/kg for IV)

363

congenital abdominal defect associated with other midline defects, GI, GU, and cardiac

omphalocoele, intestinal viscera herniate into base of umbilical cord and contained within membranous sac

364

VACTERL

V: vertebral
A: anal
C: cardiac
T: TEF (tracheoesophageal fistula)
E: esophageal atresia
R: renal and radial atresia
L: other limbs

365

how many mL/kg of packed red blood cells (prbcs) will raise hgb by 1 point

4 mL/kg

366

lower or higher doses of local anesthetics for neuraxial anesthesia for pregnant women

lower, they are more sensitive to local anesthetics, epidural vein congestion decreases intrathecal volume and epidural space

367

Preeclampsia should be considered with proteinuria levels greater than what?

above 300 mg/day

368

increased tidal volumes in late-term pregnancy is due to

increased anterior-posterior diameter of the chest

369

cardiovascular changes in pregnancy

cardiac output: 50% increase
stroke volume: 30% increase
heart rate: 15% increase

370

why don't muscle relaxants cross placenta?

they are charged hydrophilic molecules

371

why doesn't bupivacaine cross placenta easily?

it is highly protein bound

372

why do local anesthetics get trapped inside fetus?

fetal pH is lower than maternal pH, thus they become ionized and unable to cross back

373

latent phase of labor is primarily mediated by what spinal levels

T10-T11 (latent phase equals 0-3 cm dilation)

374

Nerve fibers that carry pain of active phase of labor

small visceral afferent fibers of T10-L1 which travel ALONGSIDE sympathetic nervous system

375

second stage of labor involves what spinal levels

pudendal nerve (S2-4) when patient is fully dilated

376

opioid with weak local anesthetic properties

meperidine

377

what's the advantage of epinephrine in epidural infusion

marker for intravascular epidural catheter

378

drug with 75% effectiveness for treating a migraine

sumatriptan

379

reasons for emergency c-section caused by external version of breech presentation

placental abruption or umbilical cord compression

380

fetal scalp pH below what number is abnormal?

below 7.20, above 7.25 is normal

381

most common cause of preeclampsia mortality

cerebral hemorrhage

382

magnesium toxicity should be immediately treated how?

IV calcium

383

risk factors for placenta previa

prior c-section, multiparity, prior uterine surgery, and advanced maternal age

384

risk factors for uterine rupture

prior c-section, excess oxytocin, myomectomy,trauma, forceps delivery

385

most feared consequence of chronic benzodiazepine use in first trimester

cleft palate

386

Most cases of viral croup are due to what virus?

parainfluenza virus

387

treatment of croup

racemic epinephrine

388

why is pulmonary HTN a comorbidity in patients with severe scoliosis

restrictive lung disease causes pulmonary HTN

389

major complication risks of doing a wake-up test during spinal surgery

unintentional extubation, air embolism with deep inspiration

390

dose of epidural duramorph for pediatric patient

0.1 mg/kg

391

Is halothane-caffeine contracture test (HCCT) highly sensitive or highly specific?

highly sensitive

392

A known MH patient should be observed for how long in the PACU?

6 hours

393

hypothermia causes clinically significant functional coagulopathy when temp decreases to what?

33 C

394

intraabdominal pressure that meets definition of abdominal hypertension

12 mmHg, above 20 mmHg is associated with hypoperfusion of abdominal organs

395

small trials have shown pretreatment with what medication may decrease incidence of tourniquet pain?

gabapentin

396

afferent pathway of oculocardiac reflex involves which ganglions?

ciliary and gasserian ganglions

397

geniculate ganglion carries what nerve?

facial nerve

398

petrous ganglion carries what nerve?

glossopharyngeal nerve

399

jugular ganglion carries what nerves?

vagal and accessory nerves

400

which has quicker onset, atropine or glycopyrrolate?

atropine

401

Anterior spinal artery is supplied by which arteries?

Vertebral arteries superiorly. Posterior intercostal arteries in thoracic region. Artery of Adamkiewicz in lumbosacral region.