MOCK Exam #1 Notes

Question 1

Prophylaxis for infective endocarditis no longer required for 4 procedures

Answer 1

Unrepaired cardiac valve disease
CABG
Coronary stenting
GI or GU procedures

Question 2

Dental procedures involving _______and ________ requires prophylaxis for infective endocarditis?

Answer 2

Gingival manipulation and or damage to mucosal lining

Question 3

Respiratory procedures requiring ABT prophylaxis for infective endocarditis

Answer 3

Those that perforate the mucosal lining with incision or BIOPSY

Question 4

Congenital heart procedures requiring ABT prophylaxis for Infective endocarditis

Answer 4

Unrepaired cyanotic congenital heart defect
Repaired congenital heart defect within 6 months or with resideual defects near repair or graft. (this inhibits endotheliazation.

Question 5

For heart transplant patient what is an anesthetic consideration for CO?

Answer 5

CO is more dependent on PRELOAD than on HR.

Question 6

The transplanted heart is devoid or severed from what?

Answer 6

Severed from AUTONOMIC influence, meaning t

Question 7

HR is determined by the

Answer 7

INTRINSIC RATE OF PHASE 4 depolarization which the TRANSPLANTED heart is not under that since they are severed from autonomic influence

Question 8

In transplants patient the HR is

Answer 8

Fixed

Question 9

In transplant patient the CO adjusts according to the

Answer 9

Position of the starling curves, increasing preload augment CO until it gets to a point where the ventricular myocytes becomes overstretched and CO falls

Question 10

How does atropine reduces vagal tone

Answer 10

By acting as a competitive antagonist of the M2 receptor.

Question 11

In the absence of vagal input as in ________, atropine has no effect.

Answer 11

Heart transplant

Question 12

What drugs can be used to manipulate myocardial performance with the transplant patient?

Answer 12

Epinephrine

Question 13

Transplant patient anesthetic consideration include

Answer 13

Maintain adequate preload to optimize the frank starling mechanism

Question 14

Medications that should readily be available to augment the HR of transplant patient is

Answer 14

Isoproterenol and diluted epinephrine.

Question 15

Ephedrine and Heart transplant patient

Answer 15

Indirect acting vasopressors, such as ephedrine, partially rely on endogenous catecholamines stores in the post synaptic sympathetic neurons and are therefore less effective.

Question 16

With Heart transplant patient, will cholinesterase inhibitors cause bradycardia?

Answer 16

NO they won’t but they will still cause s/s of parasympathetic NS activation else where in the body.

Question 17

With heart transplant patient, do you need to administer and anticholinergic with reversal

Answer 17

Yes.

Question 18

what might you see on the ECG with a patient with a heart transplant?

Answer 18

May see 2 P waves, one for the recipient’s intrinsic rate of SA node and one from the donor heart.

Question 19

For heart transplant the SA node of the native heart may

Answer 19

Still react to fluctuation in autonomic input, but this will not affect cardiac function.

Question 20

For every 1 unit of PRBCs administered, the hgb and Hct should increase by

Answer 20

1g /dL

Question 21

How can you estimate Hgb from Hct?

Answer 21

hct / 3

Question 22

The spinal circulation consists of

Answer 22

2 posterior spinal

1 anterior spinal artery

Question 23

Posterior spinal arteries arise from the

Answer 23

cerebella arteries

Question 24

The cerebellar arteries supplies what region of the cord?

Answer 24

Dorsal (sensory) region of the cord

Question 25

The anterior spinal artery arises from the

Answer 25

Vertebral arteries

Question 26

Vertebral arteries supply what region of the cord?

Answer 26

Ventral (Motor) region of the cord

Question 27

Both Anterior and posterior arteries received

Answer 27

collageral from the intercostal arteries in the thorax and the lumbar arteries in the abdomen. These

Question 28

2 most appropriate intervention for "can't ventilate and can't intubate" Scenario

Answer 28

Surgical cricothyrotomy | Transtracheal Jet ventilation

Question 29

Intubation technique best used when ventilation is possible?

Answer 29

Retrograde intubation

Question 30

This airway technique Has no place in emergency airway management

Answer 30

Tracheotomy

Question 31

Supraglottic , double lumen device place in the hypopharynx

Answer 31

Combitude

Question 32

The proximal balloon of the combitude occlude the ______while the distal occludes the ______

Answer 32

Hypopharynx | Esophagus

Question 33

With the combitude, if the tip is placed in the esophagus can the lung be ventilated

Answer 33

Yes

Question 34

Should be release when placing the combitube?

Answer 34

Cricoid pressure.

Question 35

At what point during laparoscopy cholecystectomy is a gas embolism most likely to occur?

Answer 35

Initial Abdominal insufflation

Question 36

Gas embolism creates what?

Answer 36

air lock in the right heart and obstructs forward flow

Question 37

Signs and symptoms of gas embolism

Answer 37

``` Decrease EtCO2 Increase EtN Increase PAP pulmonary edema Decrease BP, ```

Question 38

Mill wheel murmur is associated with

Answer 38

Gas embolism

Question 39

Most sensitive indicator of gas embolism

Answer 39

TEE

Question 40

Aging what happen to lung elastic recoil, what is the implication

Answer 40

Lung elastic recoil is loss leading to an Increased lung compliance. Lung elastic recoil is vital in maintaining airway diameter. Losing that ability lead to collapse of the lung prematurely. Causes trapping which increases RV

Question 41

2 first signs of PE

Answer 41

Precipitous fall in EtCO2 | Tachycardia

Question 42

Most of the reported cases of retrograde intubation described its use in patient with

Answer 42

Cervical spinal injuries.

Question 43

This block anesthetize the vocal cords prior to an away intubation?

Answer 43

transtracheal

Question 44

This reflex forces LA on the vocal cord during a transtracheal block?

Answer 44

cough reflex

Question 45

What is the most reliable method to reduce postop pulmonary compications

Answer 45

Smoking cessation.

Question 46

Anesthesia for VATS for removal of bullae preferred ventilation strategies? Why>

Answer 46

Small TV and High RR (it minimizes intra-alveolar pressures, HFJV is an alternative to PPV)

Question 47

They are large air-filled spaces in the lung that result from damage to normal alveolar tissue?

Answer 47

Bullae

Question 48

If bullae are ruptured, it can lead to ?

Answer 48

Pneumothorax Tension pneumothorax Cardiovascular collapse

Question 49

To reduce the risk of rupture bullae the patient should be allowed to

Answer 49

Spontaneously ventilate until the chest is opened.

Question 50

This ventilation can increase tension and may result in rupture of the bullae>

Answer 50

Positive pressure

Question 51

Unilateral vagus nerve injury lead to

Answer 51

Hoarseness

Question 52

Bilateral vagus nerve injury lead to

Answer 52

Aphonia

Question 53

Unilateral External branch of the SLN injury

Answer 53

Min effects

Question 54

Bilateral External branch of the SLN injury

Answer 54

Hoarseness, easily fatigue

Question 55

Bilateral Internal branch of the SLN injury

Answer 55

NO effect BECAUSE IT IS SENSORY ONLY

Question 56

Bilateral RLN injury

Answer 56

Stridor, dyspnea (acute) aphonia (chronic)

Question 57

Sizing below 3 of LMA

Answer 57

< 5kg = 1 5-10 = 1.5 10-20 = 2 20-30 = 2.5

Question 58

Inspiratory pacemaker is the

Answer 58

Dorsal respiratory center

Question 59

Primarily responsible for caring active exhalation

Answer 59

Ventral respiratory center

Question 60

Triggers inhalation

Answer 60

The apneustic center stimulates the DRC

Question 61

Triggers END of inhalation

Answer 61

Pneumotaxic center inhibits the DRC

Question 62

Le Fort that are associated with basilar skull fractures

Answer 62

Le Fort 2 and 3

Question 63

Le Fort that are associated with Disruption of the cribriform plate

Answer 63

Le Fort 2 and 3

Question 64

When should you not attempt a nasal intubation?

Answer 64

When there is a CSF lead in the nose or the ears Raccoon eyes Periorbital edema

Question 65

Classic presentation of the oculocardiac reflex is

Answer 65

Profound bradycardia | Hypotension

Question 66

What is a potential side effect of losartan?

Answer 66

Hyperkalemia

Question 67

What type of medication is losartan?

Answer 67

Angiotensin II receptor antagonist

Question 68

2 hypertensive medications that can increase maternal and fetal mortality

Answer 68

Losartan and ACEI

Question 69

2 hypertensive medications that can cause post-induction hypotension (vasoplegia)? How do you treat it

Answer 69

ACEIs Losartan Consider vasopressin 0.5 - 1 units OR methylene blue (1-2mg/kg)

Question 70

Cardioversion initial fist shock is

Answer 70

50-100 Joules

Question 71

A shock delivered on the ___________ or _ wave can lead to v-tach or v-fib

Answer 71

Relative refractory period | T-wave

Question 72

Based on the 2016 ACC/AHA guidelines, elective surgery should be postponed for at least ________after a Current generation DES is placed

Answer 72

6 months

Question 73

Elective surgery should be postponed for at least ________after a BARE METAL STATE is placed

Answer 73

30 days (1 month)

Question 74

Name drugs that interfere with SSEPs

Answer 74

``` BDMNP Barbiturates Diazepam Midazolam Nitrous Propofol ```

Question 75

Name drugs that DO NOT interfere with SSEPs

Answer 75

``` KEDOD Ketamine Etomidate Dexmedetomidine Opioids Droperinol ```

Question 76

Drugs the interfere with the accuracy of SSEPs tend to ______amplitude and ___latency

Answer 76

Decrease amplitude | Increase latency

Question 77

What does decrease amplitude mean?

Answer 77

The intensity of the stimulus

Question 78

What does increase latency mean?

Answer 78

Time it takes for the stimulus to travel from point A to point B

Question 79

Resume at question 30

Answer 79

Resume at question 30