Oral

Question 1

Extrathoracic airway obstruction

Answer 1

Flattening of inspiratory limb

Question 2

Reglan sodium citrate H2 antagonist for

Answer 2

Full stomach

Question 3

Desflurane

Answer 3

Not nephrotoxic. Fast on and off

Question 4

Avoid which opioids in renal disease

Answer 4

Morphine and meperidine

Question 5

NS is associated with

Answer 5

Metabolic acidosis

Question 6

Parkland formula

Answer 6

4 x bsa burned x weight in kg

1/2 in first eight hours and the rest in the next 16 hours

Question 7

5 x Fi02 should be the

Answer 7

Pa02

Question 8

Minimum urine output for burn patient is

Answer 8

0.5 mg/kg per hour

Question 9

For burn patients no

Answer 9

Depolarizing and give higher doses of non depolarize muscle relaxants

Question 10

Glasgow coma scale to evaluate

Answer 10

Level of consciousness after traumatic brain injury

Question 11

GCS less then 9 goes with

Answer 11

Severe brain injury

Question 12

Abdominal paracentesis on trauma patient who is hemodynamic unstable to

Answer 12

Quickly diagnose intraabdominal injury requiring an ex lap

Question 13

FAST is used in trauma patient to diagnose

Answer 13

Hemorrhage via ultrasound

Question 14

Fluid status via

Answer 14

Mucous membranes, skin turgor, and 2 second capillary refill

Question 15

In trauma patient place

Answer 15

aSa monitors, foley, a line central line

Question 16

For iv access for trauma patient place

Answer 16

Central line and multiple large bore Ivs

Question 17

Check neck status with collar by asking

Answer 17

If neck pain present, this will show whether to do an awake rsi. Negative neck films on multiple views would help

Question 18

For full stomach with normal airway preixygebate with

Answer 18

100% 02, remove neck collar while having assistant maintain in line stabilization and induce with etomidate and Succ while giving cricoid pressure. Have difficult airway cart in room

Question 19

Hi peak pressure with low blood pressure think

Answer 19

Tension pneumothorax

Question 20

Massive blood transfusion

Answer 20

One blood volume in 24 hours or greater then 50% of blood volume in 4 hours

Question 21

Massive blood transfusion complications include

Answer 21

Thrombocytopenia,coagulation factor depletion, hypocalcemia, hyperkalemia, TRALI, ARDS

Question 22

Wound infection most common serious complication of

Answer 22

Hypothermia

Question 23

Hypothermia also reduces

Answer 23

Platelet function and decreases activation of coagulation cascade

Question 24

Hypothermia treat with

Answer 24

Forced air warning device, heating blankets and heating fluids

Question 25

Acute cardiac tamponade becks triad of

Answer 25

Hypotension, jvd, muffled heart sounds. Echo to look for pericardial fluid

Question 26

PEEP can improve

Answer 26

V/Q matching

Question 27

You find out a trauma patient has been npo for 8 hours is this useful?

Answer 27

No! Acute trauma victims are assumed to be full stomach bc stress response from trauma lowers parasympathetic nervous system and gi motility decreased

Question 28

Decorticate is a score of

Answer 28

3 on gcs

Question 29

Decorticate response

Answer 29

Abnormal flexion to painful stimuli

Question 30

Epidural hematoma

Answer 30

Tear in mid meningeal artery Blood collects between skull and dura Subdural is between arachnoid and dura layers Epidural hematoma is a lucid period Subdural is concave on ct

Question 31

Preinduction a line with those with

Answer 31

Cocaine abuse Have nitroprusside and esmolol infusions in case bp goes up Goood access Don’t use indirect agents like ephedrine bc will get exaggerated response

Question 32

Chronic alcoholism will lead to

Answer 32

Cardiomyopathy

Question 33

Avoid neuraxial in patients with

Answer 33

Liver disease as PT may be elevated

Question 34

Chronic alcohol needs higher

Answer 34

MAC and RSI due to risk for gastritis

Question 35

Can’t use plain x ray to clear

Answer 35

Cervical spine Bc can’t see ligament damage To clear cervical spine, age >4, no cervical tenderness, no neurologic deterioration or parasthesias, lack of distracting injuries. Will need cervical mri if any of these present

Question 36

Prep and drape neck for emergent trach in

Answer 36

RSI patient with head injury with multiple facial injuries making intubation hard

Question 37

Ketamine

Answer 37

Increases ICP so don’t use on neuro patients

Question 38

High icp

Answer 38

Hyperventilate to pac02 of 30 Elevated bed 15-30 degrees Mannitol or furosemide

Question 39

If BP drops during case first make sure

Answer 39

Patient not hypoxic, hypercarbic, or in a malignant arrhythmia Check position of a line transducer Look at surgical field for hemorrhage Open fluids wide and give vasopressor

Question 40

During crani ETc02 to 0 likely for

Answer 40

``` Venous air embolus Mi PE Disconnected ett Malignant arrhythmia like v fib ```

Question 41

Low sodium in neuro patient think

Answer 41

SIADH or Cerebral salt wasting

Question 42

In SIADH

Answer 42

Urine osmlarity is high whereas in cerebral salt wasting it is low or normal SIADH leads to decrease urine output

Question 43

ALI

Answer 43

Is Pa02 between 200 and 300

Question 44

Fi02 of 50% or less to prevent oxygen toxicity in patients with

Answer 44

ARDS, can use peep and diuretics

Question 45

Diabetes patient

Answer 45

Want to know if well controlled, hemoglobin a1c, neuropathy, vasculopathy, or nephropathy

Question 46

Chronic hypertension leads to

Answer 46

Left ventricular hypertrophy

Question 47

Patient with Q waves and LVH

Answer 47

Prior mi. Look at old ekg If the Q waves are new, need to get noninvasive test like stress test or echo

Question 48

Laser does TURP

Answer 48

Penetrates prostatic tissue to appropriate depth, but also poor tissue absorption so it doesn’t damage tissue close by. Risk for fire. Proper googles for staff to filter out wavelength of the laser

Question 49

TURP with LVH should have

Answer 49

ALine Multiple cardiac risk factors and you see risk of massive intravascular volume absorption and thus hemodynamic instability

Question 50

TURP can be done under

Answer 50

Spinal

Question 51

Spinal for TURP

Answer 51

Monitor mental status in case TURP syndrome can occur Reduced opioids post op Don’t need to instrument airways Can lead to intraop anxiety High spinal need to control airway

Question 52

General anesthesia can’t assess

Answer 52

Mental status Systemic opioids are needed post op Necessity of induction with associated hemodynamic fluctuations

Question 53

Single shot spinal and want what level for TURP

Answer 53

T10

Question 54

After spinal for TURP nausea and patient restless due to

Answer 54

Cardiac ischemia, cerebrovascular event, hypoxia, pulmonary edema, bladder perforation Stop irrigation by surgeon Look for hypoxia, hypercarbia, malignant arrhythmia

Question 55

Great ideal irrigation

Answer 55

Isotonic Electrically inert Transparent Nontoxic

Question 56

TURP from acute volume expansion and

Answer 56

Dilutional hyponatremia manifesting as hypertension followed by hypotension, refractory bradycardia and then neurologic symptoms

Question 57

TURP resection using

Answer 57

Cystoscope use continuous fluid to get rid of resected debris

Question 58

Most bladder perforations are extraperitoneal so classic is

Answer 58

Shoulder pain from diaphragmatic irritation

Question 59

Low sodium to 115 with hyponatremia

Answer 59

Start with 3% sodium chloride with goal of correcting Ana at a rate no greater than 0.5 mEq/hr

Question 60

Once sodium level reaches 120 when correcting sodium switch

Answer 60

Hypertonic to normal saline

Question 61

If after 3% sodium given and anesthetic off and unresponsive but vitals good scared for

Answer 61

Cerebral vascular event

Question 62

If increased serum sodium fast can get

Answer 62

Central pontine myelinolysis severe demyelination of brain stem

Question 63

TURP with blindness due to

Answer 63

Glycine as irrigating fluid Glycine induced transient blindness treatment is supportive and gets better but still get ophthalmologist to evaluate

Question 64

More glycine leads to more

Answer 64

Ammonia which is a by product

Question 65

Normal urine output for adult is

Answer 65

0.5 ml/kg/hr

Question 66

Post TURP high heart rate and increases bladder pressure think

Answer 66

Catheter obstruction Tissue resection likely blocking urethra so flush catheter with saline and place patient on continuous bladder irrigation

Question 67

Want to know if aspiration in an infant is

Answer 67

Witnessed Want to know size and nature of aspirated material

Question 68

Want to know if child has

Answer 68

Preexisting respiratory conditions such as asthma

Question 69

Foreign body aspiration differential

Answer 69

Esophageal foreign body, croup, reactive airway disease, anaphylactic reaction

Question 70

Mediastinal shift should occur toward normal side when

Answer 70

Foreign body aspirated

Question 71

IO or spinal needle into proximal tibia two fingerbreadthd distal to tibial tuberosity and screw until

Answer 71

Loss of resistance obtained

Question 72

For foreign body before inducing as premedication give child

Answer 72

Anticholinergic to dry up airway secretions and minimize Vagal response to bronchoscopy

Question 73

In foreign body for induction don’t do

Answer 73

Rapid sequence Inhalational induction and promote spontaneous ventilation to avoid further distal migration of foreign body which can lead to total airway obstruction

Question 74

Aspiration event shortly after induction

Answer 74

Turn child to side, suction in trendelenberg, intubate, suction endotracheal tube, ventilate with 100% oxygen

Question 75

During aspiration keep patient super deep using

Answer 75

Tiva Avoid nitrous Promote spontaneous breathing

Question 76

If patient needs paralysis during aspiration to remove item

Answer 76

Give bolus of Propofol if that doesn’t work give small dose of rocuronium

Question 77

If while grabbing item it goes into patients airway have surgeon push it into

Answer 77

Right mainstem bronchus, if that doesn’t work turn patient lateral or prone, last resort is CP bypass

Question 78

If substance removed after foreign body aspiration is traumatic to patients airway can give

Answer 78

Steroid like dexamethasone, humidified oxygen, nebulized racemic epinephrine

Question 79

Usually no need to intubate during

Answer 79

Foreign body aspiration. If you do intubate it is to check for a leak

Question 80

Racemic epi mechanism of action

Answer 80

Stimulates alpha receptors resulting in vasoconstriction and secondary reduction in mucosal and submucosap edema

Question 81

After you give racemic epinephrine wait 3 hours after last dose to move patient to

Answer 81

Lower level ward as secondary edema can occur

Question 82

Hypoglycemia and hypovolemia can lead to

Answer 82

Nausea

Question 83

Do not give

Answer 83

Phenergen to child under 2 for nausea. Black box warning due to respiratory difficulties

Question 84

TEF repair

Answer 84

Type C has an esophageal atresia with a fistula connecting the distal esophageal pouch to the trachea

Question 85

Diagnosing of TEF

Answer 85

At birth when NGT unable to pass 9-10 cm from mouth, increased drooling, neonate coughing, choking with first feed

Question 86

Other associated abnormalities with TEF

Answer 86

``` Vertebral/skeletal anomalies Anal atresia Cardiac anomalies TEF Limb defects ```

Question 87

Monitors for TEF repair

Answer 87

Standard ASA, pre and post ductal pulse oximiter, preductal aline, prechordial stereoscope

Question 88

TEF want to ventilate lungs without

Answer 88

Ventilating through the fistula leading to abdominal distension

Question 89

TEF intubation

Answer 89

Keep spontaneous | Want ETT distal to fistula and proximal to the carina

Question 90

TEF patient desaturation

Answer 90

``` 100% oxygen Reassess other vitals Precordial stehescope Send off abg Manually hand ventilate and suction ett ```

Question 91

60 weeks post gestational age

Answer 91

Postop apnea much higher in child les than

Question 92

After TEF repair late complications most common is

Answer 92

GERD Strictures, recurrent aspiration can occur as well, pneumonia, reactive airway disease

Question 93

Full MH precautions for any child that has a first degree relative with MH

Answer 93

MH

Question 94

Pyloric stenosis

Answer 94

Hypokalemic hypochloremic metabolic alkalosis

Question 95

Pyloric stenosis definitive diagnosis via

Answer 95

Abdominal ultrasound

Question 96

Suspecting metabolic alkalosis don’t give

Answer 96

Lactated ringers as lactate is converted to bicarbonate, thus worsening acid base imbalance

Question 97

Inducing pyloromyotomy

Answer 97

High risk for aspiration thus pretreat with atropine .02 mg/kg iv and put in og or ng tube prior to induction Fentanyl prop lido roc for rapid sequence intubation

Question 98

Newborn airway compared to adult

Answer 98

Large tounge, long epiglottis, funnel shaped larynx. Glottis is at level of C3-C4 whereas it is C6 in adults

Question 99

Term newborn use

Answer 99

3.0 mm internal diameter tube

Question 100

Bronchospasm

Answer 100

Deepen patient 100% oxygen, check ett position, albuterol, last resort is Epi

Question 101

Post extubation croup is a worry post

Answer 101

Pyloromyotomy. Treat with increased inspired oxygen, nebulizrd epi, humidify inspired gases, avoid excess narcotics

Question 102

Post pyloromyotomy give fluids sigh

Answer 102

Dextrose as hypoglycemia is a concern due to inadequate glycogen stores

Question 103

Congenital diaphragmatic hernia

Answer 103

Bowel sounds heard in left chest

Question 104

Least aggressive ventilation for

Answer 104

Congenital diaphragmatic hernia. It is not a surgical emergency

Question 105

Congenital diaphragmatic hernia

Answer 105

Scaphoid abdomen, barrel chest, bowel sounds on chest auscultation, heart sounds displaced to right, respiratory distress

Question 106

Congenital diaphragmatic hernia causes

Answer 106

Pulmonary hypoplasia from pressure of herniated abdominal contents resulting in decreased number of alveoli Pulmonary hypertension leading to right to left shunt through pfo and pda

Question 107

Avoid increase in pvr

Answer 107

Increases in PVR by hypoxia and acidosis

Question 108

100% oxygen worsens

Answer 108

Pulmonary htn

Question 109

Permissive hypercapnia in CDH

Answer 109

Small tidal volume with high peep, avoids volutrauma

Question 110

Nitric oxide

Answer 110

Stimulation of guanylate cyclase which increases cyclic gmp. Cgmp activates protein kinases that cause relaxation of vascular smooth muscle

Question 111

CDH place

Answer 111

Umbilical central line. Avoid lower central line as can cause IVC compression. Want to preserve neck veins in case need to go on ecmo

Question 112

CDH induction

Answer 112

Inhalational, avoid positive pressure

Question 113

I’m CDH no 100% oxygen

Answer 113

More likely retinopathy of prematurity Worsens oxygenation and ventilation as recruits additional blood flow to less compliant lung and worsens pulmonary hypertension Only 100% to reverse any acute periods of desaturation or hypoxia

Question 114

One hour into CDH bp 40/20 sat down to 80%

Answer 114

Pneumothorax in contra lateral lung Severe pulmonary HTN, acute blood loss, hypovolemia, allergic rxn to drug given, compression of great vessels by surgeon

Question 115

Hypothermia causes increase in

Answer 115

PVR

Question 116

Neonates have decreased glycogen stores and are prone to

Answer 116

Hypoglycemia

Question 117

Skin closure after CDH blood pressure drop

Answer 117

Likely due to IVC compression resulting in decreased cardiac output from diminished venous return. Need to open abdominal cavity and cover defect with a patch

Question 118

If patient with CDH post op doesn’t respond to 100% oxygen and hyperventilate can put on

Answer 118

HFOV. If this doesn’t work and pharmacological intervention I would consider ECMO

Question 119

ECMO improves

Answer 119

Oxygenation ventilation and myocardial function VA has ecmo circuit that oxygenated blood from ij right atrium and given through right common carotid into ascending aorta.

Question 120

Disadvantages of ECMO

Answer 120

Need for anticoagulant, increased bleeding, intracranial hemorrhage and sepsis

Question 121

Most common cause of epiglottis is

Answer 121

Hemophilus influenza type B

Question 122

Epiglottis acute symptoms

Answer 122

Severe sore throat, dysphagia and muffled voice

Question 123

Epiglottis

Answer 123

Usually in children 2 to 5 years old. Fever as high as 104 degrees. Child leans forward

Question 124

Thumb print sign with acute epiglottis in

Answer 124

Lateral view

Question 125

In Peds patient with epiglottis is don’t place iv preop

Answer 125

Can precipitate life threatening laryngospasm

Question 126

Need secure airway for epiglottis

Answer 126

Surgeon can look at swelling Controlled airway Child not aware of what is happening

Question 127

For epiglottis patient want to have

Answer 127

Difficult intubation cart available on standby

Question 128

For epiglottis do inhalational induction

Answer 128

Use ETT .5-1 smaller than what you’d usually use

Question 129

Give reglan on child with epiglottis prior to direct laryngoscopes to lower chance of

Answer 129

Aspiration

Question 130

Epiglottis patient must be transferred to the

Answer 130

Picu post surgery

Question 131

Extubation of child with epiglottis

Answer 131

Patient a febrile with positive leak test Do it in the OR with ENT on standby Visualize edema and if better can extubate

Question 132

Indomethacin

Answer 132

Cox inhibitor that decreases prostaglandin levels

Question 133

Don’t use indomethacin if patient has

Answer 133

IVH or PDA is too big or hyperbilirubin

Question 134

PDA increases risk of NEC

Answer 134

PDA causes blood to flow away from systemic to pulmonary circulation and decreased abdominal organ perfusion. NEC bc gut is deprived of blood

Question 135

Echocardiogram will confirm

Answer 135

PDA

Question 136

PDA monitors

Answer 136

Pulse ox on right hand and lower limb to measure pre and post ductal A line In right upper extremity bc if pda torn need to clamp left subclavian artery

Question 137

Maintenance of pda

Answer 137

Don’t use sevo as lowers svr | Use high dose fentanyl 30-50 mck/kg

Question 138

For PDA want Saturation

Answer 138

87 to 95 as patient at risk of retinopathy of prematurity

Question 139

Always listen during traumas and look for bleeding and at

Answer 139

Suction canisters

Question 140

Ligation of pda leads to systemic hypertension so give

Answer 140

Vasodilator like nitroglycerin

Question 141

Postop pda closure

Answer 141

6 months will need spontaneous bacterial endocarditis prophylaxis

Question 142

Tetralogy of fallot

Answer 142

Vsd, overriding aorta, rvh, pulmonic stenosis

Question 143

VSD

Answer 143

Blood from right to left so skip pulmonary circulation

Question 144

Tet spell

Answer 144

Hypercyanotic attack. Due to increase in right heart pressure. Promotes right to left shunting of deoxygenated blood

Question 145

Tet spell

Answer 145

Place baby on moms shoulders with infants knees tucked up underneath

Question 146

Tet spell

Answer 146

Endocarditis prophylaxis with 50 mg/kg iv amoxicillin Backup is clindamycin 20 mg/kg iv

Question 147

Infective endocarditis prophylaxis

Answer 147

Prosthetic cardiac valve Hx infective endocarditis Valvulppathy after cardiac transplant Unrepaired cyanotic congenital heart disease

Question 148

For TOF

Answer 148

Want to keep sVR low and increase pvr

Question 149

TOF

Answer 149

Don’t want right to left shunt

Question 150

Tetralogy of fallot

Answer 150

Preoxygenate with 100% oxygen | Ketamine, fentanyl and rocuronium

Question 151

Succ use contraindicated in peds

Answer 151

Increases risk for malignant hyperthermia Histamine release from succ can lower svr

Question 152

TOF

Answer 152

Should have blood in the room

Question 153

Hypothermia

Answer 153

Hyperglycemia Decreases plt function Decreases drug metabolism

Question 154

Retinopathy of prematurity only up to

Answer 154

44 weeks gestational age

Question 155

Patient desaturation

Answer 155

100% 02 | Check ETT position send abg

Question 156

Cushings triad is bad in head injury

Answer 156

Bradycardia HTN bradypnea

Question 157

Patients with murmur look out for

Answer 157

ASD/VSD or shunt bc can contraindicated sitting position

Question 158

When looking at SSEPs need

Answer 158

MAC value less then 0.5

Question 159

Tight dura ways to fix

Answer 159

Elevate head Hyperventilating Check oxygenating Give propofol, muscle relaxants and diuretics

Question 160

Sudden drop in Etc02 during neuro case with hypotension and tachycardia think

Answer 160

Venous air embolus

Question 161

Venous air embolus

Answer 161

``` Ask for help and inform surgeon Switch to 100% oxygen Irrigate operative field with saline Aspirate air from central venous catheter Provide hemodynamic support ```

Question 162

If can’t dorsiflex post surgery assume due to sciatic nerve injury and

Answer 162

Order EMG and do nerve conduction studies | Most cases resolve in 6-12 weeks and can see neurologist after if needed

Question 163

Cushings reflex is indicative of

Answer 163

Elevated ICP

Question 164

Cerebral blood flow in adults is about

Answer 164

50ml/100mg

Question 165

Increase in C02 from

Answer 165

40 to 80 doubles CBF

Question 166

CBF remains constant between a MAP of

Answer 166

50-150

Question 167

Hypertension shifts cerebral auto regulatory curve to the

Answer 167

Right

Question 168

For elective intracranial aneurysm clipping type and screen

Answer 168

4 units of pRBCs

Question 169

Don’t want blood pressure too high during

Answer 169

Intracranial aneurysm clipping

Question 170

To not affect eeg need

Answer 170

0.5 Mac value or less

Question 171

BP lower

Answer 171

20% from baseline

Question 172

To decrease transmural pressure across aneurysm

Answer 172

Can ask surgeon to place a clip on feeding vessel of aneurysm

Question 173

Post SAH surgery bigger concern is

Answer 173

Rebleeding and vasospasm

Question 174

VATS for respiratory dependence

Answer 174

Disease severity, possible dependence on home oxygen, response to bronchodilation, factors making it worse or better

Question 175

Hct increase and digital clubbing with

Answer 175

Chronic hypoxia

Question 176

Clopidogrel

Answer 176

ADP receptor inhibitor

Question 177

Aspirin doesn’t lead to increased risk of epidural hematoma

Answer 177

So doesn’t affect what time you do placement

Question 178

Left sided dlt

Answer 178

Preferred

Question 179

Trachea clamped but still

Answer 179

Bilateral breath sounds with DLT, push deeper bc ventilating through bronchial lumen

Question 180

Lateral decubitus position leads to

Answer 180

V/Q mismatch

Question 181

If one lung and sat drops quickly to 85% go back to

Answer 181

Two lung ventilation

Question 182

When hypotensive always ask surgeon if

Answer 182

Active bleeding or another acute event

Question 183

Fi02 x 5 should equal the

Answer 183

Pa02

Question 184

CT and MRI are good to see size of

Answer 184

Mediastinal mass and any tracheal deviation

Question 185

For cardiac status ask if patient has

Answer 185

Baseline chest pain at rest

Question 186

If you take an ekg try to look at

Answer 186

Previous ekg

Question 187

Prolonged untreated HTN can lead to

Answer 187

LVH

Question 188

If patient has right arm weakness from previous stroke

Answer 188

Avoid using that extremity for lines twitch monitor, or other monitors

Question 189

Disadvantages of regional for carotid endarterectomy

Answer 189

Awake patient can move Complications from block Potential need for emergency intubation

Question 190

Regional anesthesia for carotid endarterectomy

Answer 190

Superficial and deep cervical block

Question 191

For carotid endarterectomy under general anesthesia want to have

Answer 191

EEG available

Question 192

Best way to monitor cerebral function

Answer 192

Awake patient

Question 193

For carotid endarterectomy if doing central line do on side with more occlusion bc even if you hit

Answer 193

Carotid artery it doesn’t cause a problem

Question 194

After ensuring you can ventilate give

Answer 194

Rocuronium

Question 195

Always recycle BP if

Answer 195

BP is low

Question 196

High risk of stroke in watershed area of brain if

Answer 196

Non clamped carotid artery can’t perfuse the brain while the other is clamped

Question 197

If surgeon can’t release cross clamp and big eeg changes then tell him to

Answer 197

Apply a shunt

Question 198

Shunts during carotid endarterectomy can lead to

Answer 198

Small mixroemboli going through leading to a stroke

Question 199

If swelling after carotid endarterectomy

Answer 199

Emergency intubation and page surgeon emergently for evacuation of hematoma

Question 200

Carotid sinus often malfunctions after

Answer 200

Carotid endarterectomy and blood pressure can be very high

Question 201

High glucose atlantooccipital

Answer 201

Joint stiffness can make intubation difficult

Question 202

Most CABG you put in a

Answer 202

PA catheter

Question 203

You can put patient in

Answer 203

Trendelenberg if BP is low

Question 204

Heparin dose for CABG

Answer 204

3-4 units/kg Want ACT>300

Question 205

If ACT inadequate you can’t go on

Answer 205

Bypass

Question 206

Protamine dose to reverse heparin

Answer 206

1mg/100 units of heparin

Question 207

Heparin is an acid and

Answer 207

Protamine is a base

Question 208

SIMV is a

Answer 208

Weaning mode of ventilation

Question 209

For AAA want to lower BP

Answer 209

20% from baseline

Question 210

Use beta blocker on day of surgery for

Answer 210

AAA repair

Question 211

Aortic cross clamp leads to major increase in

Answer 211

Afterload proximal to the clamp and a decrease in perfusion distal to the clamp

Question 212

After release of aortic cross clamp BP 80/45 and HR 45

Answer 212

Send for transcutaneous pacer while administering atropine, epinephrine and fluids as a temporizing measure

Question 213

Third trimester bleeding most likely cause

Answer 213

Placenta previa and placental abruption

Question 214

Placenta previa presents with

Answer 214

Painless vaginal bleeding | Abruption is painful

Question 215

Double setup

Answer 215

Vaginal exam where might have to immediately convert to C Section

Question 216

Actively hemorrhaging patient want to do an

Answer 216

General anesthetic as can get sympathectomy from epidural

Question 217

If urine test negative it means cocaine a user hasn’t abused for at least

Answer 217

3-5 days

Question 218

Preeclampsia

Answer 218

Multi organ disorder after 20 weeks gestation and better by 48 hr after delivery

Question 219

Preeclampsia labs

Answer 219

CBC, BMP, liver function test for Helps, Uric acid, 24 hr urine, coag study

Question 220

Magnesium sulfate

Answer 220

Decreases release of Ach, leads to vasodilation, anticonvulsant, sedative, tocolytic(decreases uterine activity) which increases uterine blood flow

Question 221

Side effects of magnesium

Answer 221

Diminished deep tendon reflexes, EKG changes, heart block, respiratory arrest

Question 222

Platelet count above

Answer 222

75k is ok for epidural as long as it didn’t go down abruptly

Question 223

Five minutes after spinal bp on pregnant woman drops to 60/40

Answer 223

Left uterine displacement, 100% oxygen, open fluids, assess level, check fetal HR, give blouses of vasoconstrictor

Question 224

If spinal doesn’t work and need to convert to general anesthesia

Answer 224

Preoxygenate with 100% and give reglan and bicitra Perform RSI with fentanyl, lidocaine, propofol, and succ

Question 225

For vaginal bleed post c section

Answer 225

Large bore iv Stat CBC Prepare or for possible reexploration

Question 226

If bleeding post c section due to uterine atony

Answer 226

100% oxygen and open iv fluids, See if any bad medications were given Give second dose of oxytocin and consider giving hemabate

Question 227

Patient can develop seizure up to

Answer 227

24-48 hours post delivery

Question 228

On pump CABG

Answer 228

Heparin dose is 3-4 mg/kg Check ACT for goal of 300-400 If not achieved can give additional heparin

Question 229

Protamine side effects

Answer 229

Hypotension, anaphylaxis, pulmonary HTN, and anaphylactoid reactions

Question 230

Becks triad

Answer 230

Hypotension JVD Muffled heart sounds

Question 231

For pericardial tamponade

Answer 231

Want to maintain cardiac output, spontaneous ventilation, and BP

Question 232

Patients with HOCM

Answer 232

Elevated EF of 80% due to hypercontractile state of the heart

Question 233

HOCM

Answer 233

Dynamic left ventricular outflow obstruction Mitral regurgitation Diastolic dysfunction MI

Question 234

Coarctation of aorta can do

Answer 234

Regional anesthesia

Question 235

IABP

Answer 235

Counterpulsation device sits in aorta and deflates during systole, reducing afterload, inflated in diastole to increase perfusion to coronary arteries

Question 236

Absolute contraindications to IABP

Answer 236

Absolute are severe aortic valve insuffiency, aortic dissection, aortoiliac disease

Question 237

Always want to see if AICD has

Answer 237

Pacemaker component | Contact manufacturer to see if any special precautions

Question 238

Want to place magnet on pacemaker if surgery is on

Answer 238

Upper abdomen Have defibrillation pads on if needed

Question 239

CP bypass machine

Answer 239

Venous reservoir where deoxygenated blood collects Transferred to oxygenater where it gets oxygenated Oxygenated blood through arterial filter back into arterial cannula then to patient

Question 240

Membrane oxygenater is less traumatic on the

Answer 240

Blood versus bubble oxygenator

Question 241

Aortic cross clamp protect spinal cord

Answer 241

Maintain adequate BP above and below clamp Institute hypothermia Use CSF drainage Avoid vasodilation and inhalation agents

Question 242

Can place epidural for

Answer 242

AAA Less DVTs and better post op pain control Improves GIfunction Can also lead to hypotension through sympathectomy, be careful of giving local anesthetic periop

Question 243

Congenital left to right shunt in downs patients can lead to

Answer 243

Pulmonary HTN

Question 244

For Cystic fibrosis patient

Answer 244

Want coagulation studies and serum glucose levels as these ppl can’t take in fat soluble vitamins

Question 245

One of the first sons of CF in newborn is

Answer 245

Intestinal obstruction

Question 246

MS relapse very unlikely in third trimester of pregnancy

Answer 246

Risk may increase in the first 3 mo postpartum

Question 247

Avoid spinal in MS patient as may increase risk of

Answer 247

Exacerbation

Question 248

If pregnant woman has seizures treat with

Answer 248

Midazolam

Question 249

Epileptic seizures can lead to fetal

Answer 249

Asphyxia

Question 250

Labetalol and Hydralazine can be used for

Answer 250

Pregnancy induced HTN

Question 251

LMWH should be held for

Answer 251

12 hours before neuraxial procedures

Question 252

If high dose like enoxaparin

Answer 252

1 mg/kg daily need to hold for 24 giyeav

Question 253

General anesthesia

Answer 253

16 times higher mortality rate then neuraxial

Question 254

Surgery during the

Answer 254

First trimester most harmful as highest risk bc organogenesis is occurring

Question 255

Always consider the pregnant female a

Answer 255

Full stomach and do RSI

Question 256

Absolute contraindication to epidural

Answer 256

Patient refusal | Coagulopathy, severe uncorrected hypovolemia, sepsis around site of epidural

Question 257

Epidural

Answer 257

Reduces afterload

Question 258

Uterine atony associated with

Answer 258

Overdistension of the uterus

Question 259

Uterine atony

Answer 259

Bimanual compression and uterine msssage first | Oxytocin first like, then intramuscular methylergonavine

Question 260

VwF stabilizes

Answer 260

Factor 8, which promotes clotting

Question 261

Can do MH susceptible case in an

Answer 261

Ambulatory surgery center. Don’t use triggering agents.

Question 262

King Deborough disease makes you susceptible to

Answer 262

MH

Question 263

Charge syndrome can be difficult airway

Answer 263

Cleft lip and palate so have difficult airway cart on standby

Question 264

Need to do ECHO on what type of patient before OR

Answer 264

CHARGE, 75% chance of cardiac problems

Question 265

Pierre robin also has

Answer 265

Glossoptitis

Question 266

Right to left shunt leads to

Answer 266

Blue patient

Question 267

Induce patient for pyloromyotomy

Answer 267

First need to decompress stomach After preoxygenation with 100% oxygen and atropine to prevent Vagal response to laryngoscopy, perform rapid sequence induction with prop and rocuronium

Question 268

Rapid sequence on child post tonsillectomy with continued bleeding

Answer 268

Ketamine and succ to maintain hemodynamic stability

Question 269

Succ in child may precipitate MH if

Answer 269

Undiagnosed myopathy

Question 270

Positive Babinski is a sign of

Answer 270

Neurologic complications

Question 271

Congenital heart disease unrepaired needs

Answer 271

Endocarditis prophylaxis

Question 272

Omphalocele is associated with multiple

Answer 272

Conditions while gastroschisis is not

Question 273

Difficult intubation and cerebral aneurysm ruptured

Answer 273

Can’t do slow induction. Awake intubation with airway blocks, nebulized lidocaine, preinduction a line with esmolol drip available

Question 274

Somnolence goes along with elevation in

Answer 274

ICP

Question 275

Prevent autonomic hyperteflexia by giving

Answer 275

Deep anesthetic

Question 276

Autonomic hyperreflexia

Answer 276

Stimulus below level of transection causing sympathetically mediated HTN, bradycardia, sweating and flushing above the lesion

Question 277

Triple H for cerebral vasospasm

Answer 277

Hypertension, hypervolemia, hemodilution

Question 278

During TURP

Answer 278

Talk to patient, limit duration, lower hydrostatic pressure by minimizing height of irrigation fluid to patient

Question 279

Na 121

Answer 279

During TURP, reduce fluids, administer lasix, don’t correct too fasy

Question 280

GH secreting tumor

Answer 280

Acromegaly makes airway smaller and tougher to get, might need smaller endotracheal tube size

Question 281

Hold lithium

Answer 281

36-72 hours before procedure

Question 282

Urine osmolality high in

Answer 282

SIADH and normal in CSW, also see hypovolemia in CSW

Question 283

EMG studies and neurology after conservative treatment for

Answer 283

Ulnar nerve injury in or

Question 284

MS don’t do spinal but can do epidural

Answer 284

Epidural

Question 285

Allodynia

Answer 285

Pain towards something not normally painful

Question 286

CRPS

Answer 286

Due to dysregulation of the cns leading to pain, burning, swelling and changes in skin color or temperature

Question 287

CRPS type 2

Answer 287

Injury to a nerve bundle

Question 288

Stellate ganglion performed at what level

Answer 288

C7 | Anterior to transverse process C7, anterior to neck of first rib, just below subclavian artery

Question 289

Stellate ganglion complications

Answer 289

Intravascular injection, subarachnoid injection, hematoma, pneumothorax, brachial plexus block, hoarseness due to recurrent laryngeal nerve iniury

Question 290

TENS

Answer 290

Inhibition of pain signals at presynaptic levels

Question 291

Bupivicaine induced cardiac arrest treatment

Answer 291

20% intralipid at 1.5 ml/kg iv over 1 minute followed by infusion at .25 ml/kg If not improves can do bolus 1-2 times

Question 292

Celiac plexus block can lead to

Answer 292

Paraplegia from damage of artery of adamkowitz

Question 293

Transforaminal epidural for

Answer 293

Unilateral back symptoms

Question 294

Epidural

Answer 294

Avoidance of intubation, fewer DVTs, quicker ambulatory

Question 295

After high dose lmwh

Answer 295

Wait 24 hours before removing catheter

Question 296

Low EF

Answer 296

Don’t do neuraxial

Question 297

Lobectomy

Answer 297

Place epidural catheter at level of incision or 1-2 levels lower

Question 298

Don’t give which drugs to asthmatics

Answer 298

NSAIDs

Question 299

Medical conditions associated with latex allergies

Answer 299

Working in rubber industry, urogenital abnormalities like spina bifida

Question 300

Hetastarch side effects

Answer 300

Headache, parotid gland enlargement, coagulation abnormalities like increase in pt/PTT and bleeding time

Question 301

Chest X ray in fat embolus shows

Answer 301

Bilateral infiltrates

Question 302

Magnesium overdose EKG

Answer 302

5 to 8 prolongs pr interval and widen qrs complex 15 leads to SA AV block and 25 cardiac arrest

Question 303

Severe lung disease due to

Answer 303

Sarcoidosis so prefer regional

Question 304

Anaphylactic vs anaphylactoid

Answer 304

Anaphylactic produce ige antibodies which bind mast cells. In anaphylactoid the antigen itself binds mast cells and causes degranulatipn

Question 305

Acute normovolemic hemodilution

Answer 305

Avoid in severe cardiac or renal disease | Avoid if hemoglobin already low(below 11)

Question 306

Mid way during procedure with LMA patient aspirates

Answer 306

Suction remove LMA put back of head up and emergently intubate

Question 307

At 27 weeks start seeing fetal variability

Answer 307

N

Question 308

Arterial line for

Answer 308

Constabt blood pressure | Frequent abgs

Question 309

Pneymonectomy requires

Answer 309

Double lunen tube

Question 310

Need central line for

Answer 310

Transvenous pacing or vasoactive medications to be given

Question 311

Can place cvp

Answer 311

In ij Ej subclavian Arm veins

Question 312

Right ij most dorect riute to the

Answer 312

Heart

Question 313

Hypoxia forst

Answer 313

``` 100% oxygen Hand bag to check for compliance Auscultate chest Check ett placement Check abg ```

Question 314

Dont leave DLT tube after can lead to

Answer 314

Mucosal edema and tracheal stenosis | Also tough for nurses to use

Question 315

Insulin might behore surgery

Answer 315

Reduce hypoglycemua risk 2/3 normal dose of lantus and avoid taking any diabetic meds the morning of surgery Check glucose hourly in perioperative period

Question 316

Hgba1c

Answer 316

Indirectly shows risk of end organ damage | Looks at numver of glycosylated hemoglobin molecules- hemoglobin binding to glucose over 3 month span

Question 317

TURP better to neuraxial can show

Answer 317

Awake patient signs of myocardial ischemia Bladder rupture bradycardia ahoukder or andominal pain Turp syndrome- confusion headache, hypotension arrhythmias

Question 318

Turp caregully monitor

Answer 318

Setum sodium level

Question 319

For TURP syndrome

Answer 319

Need T10 level Use bupivicaine or tetracaine wiyhiut epi lasts 90-120 minutes At t10 can still feel andominal pain of bladder perforation

Question 320

Delayed emergence

Answer 320

``` Residual narcotic Sedative drug effect Neuromusvular blockade Hypoglycemia/kyponatremia Cerebral ischemia Hypothermia Hypoxia/Hypercarbia ```

Question 321

Dibucaine homozygous for atypical allele

Answer 321

32 Usually dibucaine breaks down pauedocholinesterass

Question 322

Vision loss after TURP

Answer 322

Glycine toxicity Ischemic optic neuropathy Corneal abrasion

Question 323

Short acting beta blocker like esmolol

Answer 323

For copd patients

Question 324

Betavblocker start on

Answer 324

Vascular patients who demonstrate risk of ischemia by preoperative testing

Question 325

Positive tropinins but negative CKMB

Answer 325

Acute Mi occured 2-3 days ago and patient has not suffered repeat MI in that time interval

Question 326

Myocardial ischemia oxcurs when there is inadequate oxygen supply to meet

Answer 326

Metabolic demands

Question 327

Atelectasis

Answer 327

Copd or mucus plug

Question 328

Cardiogenic pulomary edema can give

Answer 328

Diuretics

Question 329

Monitor baseline cardiac function by putting

Answer 329

Preinduction pulmonary artery catheter

Question 330

Dont forget which monitors for CABG

Answer 330

BIS and foley

Question 331

PA catheter allows for

Answer 331

Post op monitoring while TEE does not | TEE more sensitive for MI

Question 332

If carotid bruit dont place

Answer 332

Central line on that side can risk thrombus with accidental carotid puncture

Question 333

Keep heparin drip on as risk

Answer 333

Comprimising coronary perfusion

Question 334

Hypotension

Answer 334

Fluids Trendelenberg position Decrease volatile anesthetic Small dose of vasopressor

Question 335

Big BP drop going on bypass due to

Answer 335

Hemodilution and sudden decrease in SVR that often occurs with injection of the dilute priming solution Also think pump malfunction, monitor error, lack of venous flow to btpass machine, kinking of cannulas

Question 336

Face blanching right side mydriasis think

Answer 336

Malpositioning of the arterial cannula with flows of priming solution directed toward inominate artery High risk for cerebral injury

Question 337

Cerebral edema treat with

Answer 337

Mannitol head up position

Question 338

Treat hyperglycemia while on bypass to prevent

Answer 338

Cerebral ischemia

Question 339

Weaning off bypass

Answer 339

Make sure normothermic Get ABG and treat anemia, electrolyte imbalances, turn on all anestgetic abd monitor alarms, zero transducers, check lung compliance and initiate ventilation, make sure to deair heart, look at cardiac function via TEE, give benzo diuring rewarming to prevent awareness, have available pacing device and resuscitative drips

Question 340

Collect hemodynamic data from

Answer 340

PA catheter

Question 341

Pacing leads not capturing due to

Answer 341

MI, lead dislodgement, lead failure, pacemaker malfunction, hypercarbia, acidosis

Question 342

Always ensure

Answer 342

Adequate oxygenation and ventilation

Question 343

Protamine can cause

Answer 343

Anaphylactic reaction Severe pulmonary HTN Hypotension Myocardial depression Guide with the ACT

Question 344

CPB most likely cause of coagulopathy is

Answer 344

Abnormal platelet function

Question 345

Low mixed venous

Answer 345

Reflects inadequate tissue perfusion

Question 346

Most likely awareness during

Answer 346

Rewarming as hypothermic loss of anestgesia stops | Can use bis

Question 347

Asystole

Answer 347

No pulse with no shockable rhythm on ecg

Question 348

Asystole

Answer 348

Start chest compressions 100-120 per minute 2 breaths per 30 Depth 5 cm Keep etC02>30 or dbp>20 Rhythm check each 2 min If shockable biphasic 200j monophasic 300j Check pulse only if signs of rosc(rhythm change, sustained higher etC02) 100% oxygen 10 to 15 L Epi iv 1mg every 3-5 minutes

Question 349

Hyperkalemia

Answer 349

Calcium chloride 1 g Sodium bicarb 1 amp Indulin 10 unites and one amp dextrose

Question 350

Asystole pea differential heart rate

Answer 350

Desufflate abdomen Drain bladdet Remove surgical retractir and sponge

Question 351

For auto peep causing hypovolemia

Answer 351

Disconnect circuit

Question 352

Bradycardia with pulse less then 50 inadequate perfusion

Answer 352

Desufflate abdomen Drain bladder Remove surgical retractor Remove pressure from eyes ears All vagal stimuli Decrease anesthetics or analgesics, atropine .5-1 mg every 3 min up to 3 mg If atropine not effective can give epi Place defib pads and pacer set to 80 increase current until capture

Question 353

SVT

Answer 353

Non compensatory tachy and pulse present Often rate greather then 150 and sudden onset 100% oxygen If unstable like SBP<75 acute ischemia or chest pain Consider sedation cardiovert based on if rhythm regular and how wide qrs is If refractory give amiodarone slow 150mg over 10 minutes

Question 354

SVT stable

Answer 354

Get 12 lead Arterial line abg Consider vagal maneuver first Push adenosine 6 mg iv push then 12 mg then give esmolol but avoid in low EF or WPW

Question 355

V fib or V tach

Answer 355

You do shock After 2nd shock epi 1 mg every 3-5 min After 3rd shock amiodarone 300 mg iv push

Question 356

Hypoxemia

Answer 356

``` 100% 02 Check tube Auscultate Hand bag Suction ett Consider chest x ray or bronch ```

Question 357

Anaphylaxis

Answer 357

``` Wheezing Hypotension High inspiratory pressure Angioedema Flushing Hives ```

Question 358

Anaphylaxis treatment

Answer 358

``` 100% oxygen If angioedema quick intubation IV access Give epi to prevent mast cell degranulation 10-100 mcg until clinical improvement sometimes need more then 1mg Turn off volatile and give benzo Head down and lots of fluids ``` Send peak serum tryptase 1-2 hours after reaction onset Monitor for at least 6 hours May add epi vaso norepi infusions Can give bronchodilator

Question 359

Bronchospasm

Answer 359

Inform team If hypotensive may be air trapping so disconnect circuit If hypotension tachy and rash think anaphylaxis

Question 360

Bronchospasm treatment

Answer 360

100% 02 I E ratio 1 to 4 and minimize peep Avoid hyperinflation Bolus propofol and more neuromyscular blockade Auscultate, soft suctoon ett If severe 5-10 mcg iv epi every 3-5 min or 200mcg subq If can ventilate give bronchodilators, consider ketamine 10-50 mg iv and hydrocotisone 100mg iv

Question 361

Delayed emergence

Answer 361

Hypoxemia hypercarbia hypothermia hypotension acidosis Look for high icp cushing Opioid reversal start with 40mcg ivmay double dose every 2 min Flumazinil .2 mg to start Physostigmine 1mg if scop patch Hypoglycemia

Question 362

Optimize positioning

Answer 362

Bed height sniffing position bed elevation to 30 degree | Ensure paralysis and anesthetic depth

Question 363

PE

Answer 363

Sudden decrewse in BP, SP02 and etC02 Incesse in CVP Dyspnea Happens in obstrtrics and long bonefracture

Question 364

PE

Answer 364

Vasopressirs fluids turn off vasodilator or volatile anesthetics Want to mintain sinus rhythm Decrease RV afterload Consider tPA 10 mg iv followed by infusion or thrombectomy

Question 365

Air embolus

Answer 365

Check iv lines for air, flood surgical foekd with saline, head down, aspirate from central line

Question 366

Fat embolus

Answer 366

Petechial rash

Question 367

Urgent C section with amniotic fluid embolus

Answer 367

Urgent

Question 368

Fire

Answer 368

``` Stop fresh gas flow Disconnect breathing circuit from anestgssia machine Clamp ett if absilavle and remove Pour saline down airway Reestaish airway after and minimize Fi02 Bronch and consider steroid ```

Question 369

Laser surgery

Answer 369

ETT below vocal cords Laser resistant ETT Low Fi02

Question 370

If non airwat fire

Answer 370

Stop fresh gas flow Disconnect breathing corcuit and ventilate with ambu bag Remove all burning materials to the floor Elevtrical fire only use c02 fire extinguisher Start propofol infusion

Question 371

Hemorhage

Answer 371

``` Activate massive transfusion ptotocol Large bore iv access Temporize severe hypotension with pressors Head down 100% 02 Ask surgein to pack or get help Rapid infuser and cell saver Transfuse dont wait check all blood 1:1:1 ```

Question 372

Massive transfusion protocol

Answer 372

``` Warm room, use warm fluids A line Foley Actively maintain normal calcium level Give FFP if inr or ptt>1.5 normal Plt if less then 50k and bleeding Fibrinogen less then 80 give cryo each 10 units of cryo raises fibrinogen by 50 Consider txa or pcc if warfarin induced bleeding If refractory can give factor 7a ```

Question 373

SIADH with

Answer 373

Lung cancer or can have hyponatremia from thiazide administration

Question 374

SIADH

Answer 374

Normal total body sodium Elevated urine osmolality and urine sodium Low total body sodium with thiazides

Question 375

Low sodium can put patiebt at risk for

Answer 375

Cerebral edema

Question 376

HTN induced shifting of

Answer 376

Cerebral autoregulation curve to left and decreased cerebral blood flow due to compression ofinominate artery in mediastinoscopy

Question 377

Mediastinoscopy place

Answer 377

Right arterial a line to continuously monitor downstream perfusion pressure of inominate artery to quickly figure out surgical compression Place pulse ox on right and nibp on left arm Inominate is compressed by the scope

Question 378

Inominate supplies blood to

Answer 378

Right arm and head and neck

Question 379

Poorly controlled hypertensives lead to

Answer 379

End organ ischemia

Question 380

Want to lower BP to

Answer 380

140/90 during mediastinoscopy

Question 381

HTN and carotid diseaae

Answer 381

Should delay the case to optimize BP and get vascular surgery consult

Question 382

Mediastinoscopy you need

Answer 382

Type and cross as might have massive blood loss

Question 383

To avoid bucking can

Answer 383

Spray lidocaine on on trachea | Give fentanyl and blockers to prevent exagerated response to laryngoscopy

Question 384

If SVC tear during mediastinoscopy use

Answer 384

Lower extremity iv

Question 385

Stridorous after extubation

Answer 385

Laryngospasm Mass obstruction from lung cancer Recurrent laryngeal neeve injury

Question 386

Bilateral recurrent laryngeal injury

Answer 386

Must intubate

Question 387

Tracheomalacia

Answer 387

Cartiledge around vocal cords is soft and collapses

Question 388

Quick hypotension think

Answer 388

Massive hemorrhage or tamponade post op

Question 389

High aoreay pressure | Increased peak airway pressure>5 cm above baseline or >35?cm H20

Answer 389

Can see wheezing and upsloping C02 Increased EtC02 Decreased tidal volumes Hypotension if air trapping

Question 390

High airway pressure

Answer 390

100% o2 10-15 L Confirm C02 Upslope think obstruction Curare cleft means insufficient neuromuscular blockade Manually ventilate Check et tub Auscultate Soft suction if mucus plug

Question 391

Asymetric breath sounds

Answer 391

Pneumo Endobronchial intubation If wheezing but symmetric think bronchospasm or pulmonary edema if crackles

Question 392

Machine or breathing circuit reasons for high peak pressure think

Answer 392

Circuit obstruction Scavenger closed Ventilator valve malfunction

Question 393

High spinal

Answer 393

100% oxygen epi if severe brady or hypotension If mild bradycardia can give atropine or glycopyrolate Give rapid iv bolus with pressure bag Raise legs to increase preload Maintain neutral position head down makes spinal worse! Monitor fetal heart tones, emergent section, call ob, ensure left uterine displacement

Question 394

HTN causes

Answer 394

``` Inspect surgical field Receipt epi Carotid or aortic clamping Full bladder Hypercarbia Inadequate analgesia Med error Pneumoperitoneum Prolonged tourniquet time ```

Question 395

Rare causes of HTN

Answer 395

``` Autonomic hyperreflexia Spinal cord above T6 reflex bradycardia Ischmia Malignant hyperthermia Pheo Preeclampsia Serotonin syndrome: hyperthermia, tachycardia, rigidity ```

Question 396

Low SVR

Answer 396

Shock Transfusion reaction Vasodilator Neuraxial block

Question 397

Low preload

Answer 397

``` Auto-peep Embolus Hypovolemia Ivc compression Pneumo Right heart failure ```

Question 398

Hypoxemia

Answer 398

Check Fi02 analyzer

Question 399

Pulmonart artety catheter not to put in

Answer 399

At risk for arrhythmias, risks of line placement, pulmonary artery rupture, benefits dont outweigh the risks

Question 400

Epidural to not have huge

Answer 400

Hemodynamic swings

Question 401

Rapid sequence induction

Answer 401

Pregnant is full stomach

Question 402

Arterial line

Answer 402

For hemodynamic monitoring beforehand

Question 403

IHSS

Answer 403

Can cause collapse of LV | Avoid tachycardia or decreased preload

Question 404

Oral approach to fiberoptic

Answer 404

Nasal approach as the nose is friable | Nasal approach is a shorter route

Question 405

Nasal approach with marked epistaxis

Answer 405

Oral approaxh get airway as soon as possible | Volatile anesthetic to minimize awareness and titritable and uterine relaxant

Question 406

Dont use nitrous prior to child out

Answer 406

As want oxygen to go to fetus

Question 407

Hypotension after delovery

Answer 407

Malignant arrhythmias Blood loss Amniotic fluid embolus

Question 408

Bradycardia in neonate

Answer 408

Often due to hypoxia | Suction meconium

Question 409

Meconoum aspiration

Answer 409

Can cause obstruction to oxygen exchange

Question 410

Bradycardia below 60 in neonate after oxygenation and ventilation start

Answer 410

CPR

Question 411

Want to decrease conteactility and increase afterload with

Answer 411

Ihss, dont want lv to collapse

Question 412

Single sjot spinal

Answer 412

Can cause hypotension and lots od tachycardia due to synpathectomy

Question 413

Can perform recruitment breaths on

Answer 413

Hypoxic patient Consider PEEP but use caution if hypotensive Head up position desufflate abdomem

Question 414

Lung ultrasound to check for

Answer 414

Pneumothorax effusion consolidation or interstitial edema

Question 415

LAST present with

Answer 415

Seizures Altered mental status Tinnitus Cardiovascular collapse, hypotension, arrhythmias or bradycardia

Question 416

LAST

Answer 416

Call for lipid emulsion 20% stat If patient unstable call earlt for ECMO or bypass Stop any local anesthetic Give 100% oxygen Bolus 100 ml iv over 2-3 min or 1.5ml/kg then infuse .25 ml/kg/hr for 20 min Can double until patient stable up to 12 ml/kg Once stable continue infusion for 15 minutes Keep in pacu 2 hr if seizure, 6 hr for hemodynamic instability

Question 417

If seizure

Answer 417

Put patient lateral and head down to prevent aspiration | Benzo to treat seizure and if it doesnt work give propofol

Question 418

Give low dose epi in last

Answer 418

0.2-1 mcg/kg iv Vfib vtach unresponsive to defib give 300 mg iv push amiodarone Avoid vasopressin and lidocaine

Question 419

MHyperthermia symptoms

Answer 419

``` Mixed respiratory and metabolic acidosis Increwsee etc02, HR, RR Masseter spasm Hyperthermia Muscular rigidity Myoglobinuria ```

Question 420

MH treatment

Answer 420

``` Stop succ or volatile anesthetic Dont change machine or circuit 100% 02 Maximize minute ventilation Initial dantrolene dose is 2.5 mg/kg Repeat dantrolene 2.5 mg/kg every 5 min until hypercarbia and rigidity are resolved and temperature not increasung ```

Question 421

Severe hyperkalemia start

Answer 421

Urgent dialysis

Question 422

Avoid calcium channel blocjers and sodium channel blockers when treating

Answer 422

MH

Question 423

MH

Answer 423

``` Actively cool if core temp above 38 Need a line Urine myoglobin ck coag lactate Place foley Call mh hotline ```

Question 424

Most mh patients

Answer 424

Relapse so need mechanical ventilation | Need dantrolene 1mg/kg bolus every 4 hours for first 24 hours

Question 425

MI consider

Answer 425

Heparin i fusion Aspirin Treat pain with fentanyl or morphine

Question 426

Can ventiate with ambu bag on

Answer 426

Room air

Question 427

Pneumo

Answer 427

``` Increased peak inspiratory pressures Tachycardia Hypotension Hyperresonance to chest percussion Increased JVD Decreased or asymetric breath sounds ```

Question 428

Unstable and no chest tube available for pneumo

Answer 428

14 or 16 gauge iv catheter in 4th or 5th intercostal space between anterior and mid axillary line

Question 429

Right heart failure

Answer 429

Dyspnea, ecg with rv strain, hypotension, TEE dilated RV, flattening of intraventricular septum

Question 430

Right heart failure

Answer 430

Pulmonary vasodilator like nitric oxide or epoprostenol Lower tidal volume and avoid breath stacking Minimize peep RV dilation and hypertrophy Avoid hypoxemia, hypercarbia, or acidosis

Question 431

Transfusion rxn

Answer 431

Stop transfusion and retain blood product bag 100% 02 Fluid bolus turn down anestgetic Give epi if needed Febrile reaction give antipyretic iv tylenol 1g iv Anaphylactic give epi dexamethasone hydrocortisone

Question 432

Complications if super obese

Answer 432

Difficult airway management Difficulty evaluating cardiopulmonary status due to sedentary lifestyle and/or diabetic neuropathy Rapid desaturation with apnea due to lower FRC Obesity hypoventilation syndrome(pickwinian syndrome)

Question 433

If low risk procedure just get

Answer 433

Preganvy test and serum glucose

Question 434

H2 receptor agonist, reglan, non particykate for

Answer 434

Full stomach

Question 435

Do breathing treatment prior to surgery to optimize

Answer 435

Asthma

Question 436

Diabetic neuropathy can mask warning signs of myocardium at risk such as

Answer 436

Chest pain

Question 437

Blood pressure cuff should encircle at least

Answer 437

75% of upper arm

Question 438

Can do umbilical hernia repair under

Answer 438

Local or regional anesthesia

Question 439

Doing RSI means patient isnt as deep and ashtmatic patient may go into

Answer 439

Bronchospasm

Question 440

Put patient head up to reduce risk of

Answer 440

Passive regurgitation and facilitate rapid intubation

Question 441

Closing capacity isnt affected by moving from upright to

Answer 441

Supine position

Question 442

Induction dose of propofol in obese fenale due to

Answer 442

Ideal body weight

Question 443

Nonopioid alternatives like

Answer 443

Ketamine or precedex

Question 444

Given asthma dont give muscle relaxants with lots of histamine release such as

Answer 444

Atracurium or mivacurium

Question 445

Expiratory wheezing and desaturation go with

Answer 445

Bronchospasm

Question 446

Extubate under deep plane of anestgesia to avoud

Answer 446

Bronchospasm

Question 447

Pulmonary enbolus can cause

Answer 447

Hypoxia and is seen more commonly in the morbidly obese

Question 448

Iv respiratory depression secondaey to morphine

Answer 448

Put head up 100% oxygen and apply CPAP and cpnsider narcan

Question 449

Do epidural without narcotic in obese with

Answer 449

Respiratory depression

Question 450

Keep obese patient on continuous pulse ox until they can maintain

Answer 450

Baseline oxygen saturation

Question 451

PVR is reduced after

Answer 451

First breath. Increased oxygen levels lead to functional closure of PDA with permanent closure over a few months Infants who are hypoxic due to respiratory distress dont make enough bradykinin to ensure closure of pda

Question 452

PDA predisposing factors

Answer 452

Hypoxia Acidosis Respiratory distress syndrome

Question 453

RdS

Answer 453

Due to insufficient surfactant which is usually inadequate prior to 35 weeks gestation

Question 454

Maternal steroid can help in survival of patients with

Answer 454

RDS to increase surfactant production in vivo

Question 455

Indomethacin

Answer 455

Prostaglandin synthetase inhibitor

Question 456

PDA left atrial enlargement due to

Answer 456

Shunting of blood from systemic to pulmonary circulation

Question 457

Infant with pda preop testing

Answer 457

``` Chest/abdominal x ray Abg Urinalysis H and h Coags Electrolytes Type and cross ```

Question 458

No premedication is generally needed for infants

Answer 458

Infants

Question 459

Glycosuria can represent

Answer 459

Hyperglycemia in infant

Question 460

PDA repair

Answer 460

Precordial stethescope to aid in cardiopulmonary monitoring

Question 461

PDA repair nibp on

Answer 461

Right arm in case pda gets torn and need to clamp subclavian Dont need a line or central

Question 462

In premature want Pa02

Answer 462

50 to 70 with sat 87-95%

Question 463

Risk factors fir retinopathy of prematurity

Answer 463

Prematurity Low birth weight Mechanical ventilation Acidosis

Question 464

Neonates respind to cardiovascular depression from volatilesso generally use mix of

Answer 464

Fentanyl plus ketamine and nitrous | Pancuronium increases HR and may be helpful

Question 465

During pda dropping 02 saturation

Answer 465

100% oxygen and ask surgeon to relax any traction on the lung until the patient is stabilized

Question 466

Neutral temperature in neonate

Answer 466

Ambient temperature at which oxygen consumption is minimized 34 for preterm and 28 for adult Stops increased oxygen utilization

Question 467

Heat geberation in infant number one way is

Answer 467

Nonshivering thermogenesis | Metabolism of brown fat

Question 468

Neonatal seizure differential

Answer 468

Intracranial hemmorhage Hypoxic ischemic encepalopathy Crrebral edema Hypoglycemia

Question 469

Benzo or barbiturate to stop seizure in a

Answer 469

Neonat

Question 470

Seizure in pregnant patient is

Answer 470

Eclamptic seizure until proven otherwise | Medication trauma can also cause it

Question 471

Pregnant mother obtunded

Answer 471

Intubate to protect from aspiration and hypoventilation

Question 472

Avoid succ

Answer 472

If really difficult aorway to maintain respirations and do slow induction with ketamine

Question 473

8mg per 12 hours max amount of

Answer 473

Ativan for seizure | Midazolam reversal will lower seizure threshold so dont do it often

Question 474

A line

Answer 474

Place arterial line in obtunded pregnant women to maintain adequate cerebral perfusion and prevent increased icp

Question 475

Increase in icp leading to cerebral ischemia think

Answer 475

Cushings reflex

Question 476

Dilayed and unreactive pupil think

Answer 476

Cn 3 compression by uncal herniation

Question 477

Cushings reflex treatment

Answer 477

Raise head of bed 30 degrees No venous obstruction Stop volatile anesthetics Hyperventilate

Question 478

Mannitol reduces icp bt

Answer 478

Osmotically shifting fluid from intracranial to intravasvular compartment decreasing production of csf Mannitol may worsen cerebral edema if bbb is not intact

Question 479

Widened qrs due to

Answer 479

Elevated intracranial pressure SAH Magnesium toxicity

Question 480

Sticking yourself with hiv needle

Answer 480

Immediately wash with soap and water | Report to employee healty and get post exposure prophylaxis

Question 481

High mag

Answer 481

Draw a level Check deep tendon reflexes Give calcium

Question 482

SOB anterior mediastinal mass

Answer 482

Airway or cardiac compression from mass, lanbert eaton patiebts take 3,4 diaminopyridine and lambert eaton causes SOB

Question 483

Lambert eaton or myasthenic syndrome

Answer 483

Antibodies to prejunctional voltage gated calcium channels results in reduced release of Ach from motor end plate

Question 484

Lambert eaton patients get better with more

Answer 484

Muscle movement

Question 485

Mediasyinal mass with 50% tracheal compression

Answer 485

Get chest x ray PFTs Do chemo radiation prior or case under local due to concern of mediastinal mass

Question 486

For mass mediasyinal

Answer 486

Get cardiac echo in upright and supine positions

Question 487

For fall worry about

Answer 487

Cervical spine, difficult airway, increased ICP due to head trauma

Question 488

Bradycarfia from sick sinus can lead to

Answer 488

Fall | So can mi, pacemaker failure, stroke eue to hypertension

Question 489

Pacemaker want

Answer 489

Type of device Wheyher patient is dependent on antibradycardia pacing function Need for perioperative reprogramming

Question 490

VVE- DDDo

Answer 490

Pacemaker capable of ventricular shock, ventricular antitachycarfia pacing, electrogram detection

Question 491

Pacemaker want to know

Answer 491

``` Why put in Model and type Pacemaker dependent Pacing mode Behavior of device when goes to a magnet Battery life Payients underlying rate and rhythm ```

Question 492

Cautery can lead to

Answer 492

Inhibiting of pacing as might think it is intrinsic heart activity Use bipolar cautery Have temporary pacing and defib in room If pacemaker dependent put in asynchronous mode

Question 493

If using monopolar cautery with pacemaker

Answer 493

Put return plate close to operstibe site and far from cied, need proper edu function, put in asynchronous mode. Limit cautery use

Question 494

Aicd must be checked wothin

Answer 494

6 months and pacemaker within 12 months

Question 495

Magnet doesnt afect

Answer 495

Pacing only to disable tachydysrhythmia sensing and treatment if case is urgent

Question 496

Magnent is good bc if you go into v tach pr v fib you can

Answer 496

Take it off to shock the patient

Question 497

Electrosurgical pad for upper extremity surgery

Answer 497

Put on posterior shoulder contralateal to where aicd is. Want it close to operative site but far from aicd

Question 498

Administer narcotics and lidocaine to

Answer 498

Blunt the sympathetic response to laryngoscopy

Question 499

Transient increase in iop

Answer 499

With succyncholine Can pretreat with rocc Rather give succ if full stomach benefit vs risk

Question 500

Trendelenberg will lead to

Answer 500

Increased iop and decreased FRC

Question 501

Reverse trendelenberg

Answer 501

Inhibits passive reflux of gastric material

Question 502

Failure to capture with lead failure due to

Answer 502

Lead failure,myocardial changes that lengthen therefractory period

Question 503

Patients with full stomach remain at risk

Answer 503

Even after extubation so make sure they are awake | Sucton out stomach when they are deep and give lidocaine and reverse

Question 504

If pacemaker doesnt capture start

Answer 504

Transcutaneous pacing and administer atropine and epinephrine and get ready for chest compressions

Question 505

If not working with transcutaneous paving

Answer 505

Consult cardiologist and consider transvenous pacing or placement of epicardial leads

Question 506

Regular wide complex rhythm with pulse

Answer 506

Give aniodarone and do synchronized cardioversion if patient became unstable

Question 507

Primary concern aortic dissection

Answer 507

Massive hemorhage, cardiac involvrmrnt, end organ ischemia due to intereuption of supplying arteries

Question 508

Debajey 3

Answer 508

Involves only descending aorta and can be treated both medically with blood pressure and pain control

Question 509

Type 1 Debakey

Answer 509

Ascending aorta down to abdominal aorta

Question 510

Type 2 debakey starts in

Answer 510

Ascending aorta and dosesnt go past inominate artery

Question 511

Legal intoxication occurs at blood levels

Answer 511

80-100 mg/dl

Question 512

Acute alcohol increasses risk of

Answer 512

Aspiration and decreases anesthetic requirements and contributes to delayed emergence

Question 513

To clear C spine

Answer 513

Abscense of cervical pain or tenderness Abscense of paresthesias or neurologic deficits Normal mental status Greater then 4 If cant get need cross table lateral c1 to T1 film both anterior and posterior views

Question 514

Aortic dissection diastolic murmur

Answer 514

Propogation of dissection into aortic valve leading to aortic regurgitation

Question 515

Aortic regurg avoid

Answer 515

Bradycardia as more diastolic time leads to increased regurgitant volume and worsening cardiac function

Question 516

Aorticdissevtion

Answer 516

First give pain control and fluid Then start esmolol infusion to decrease intramural pressure that could lead to rupture

Question 517

Dissection

Answer 517

Need to monitor for spinal cord ischemia and often need 1 lung ventilation Have cell saver and rapid transfuser in room

Question 518

Lumbar drain to monitor cSF pressure

Answer 518

Also to drain csf to facilitate spinal cord perfusion

Question 519

If heparin will be used durimg left heart partisl bypass weigh risks of putting in

Answer 519

Lumbar drain

Question 520

Prior to removal of lumbsr drain if worried about coagulopathy

Answer 520

Get coags and neuro checks every 2 hours

Question 521

TEE needed forv dissection

Answer 521

Shows MI as well as aid in assessing lVEDV, valve function and extent of aneurysm

Question 522

During dissection because placing aortic clamp you want

Answer 522

Upper and lower arterial lines | Might need to clamp subclavian so put upper in right extremity to avoid surgical interference

Question 523

PAC during dissection

Answer 523

Fluid management, assess cardiac function, timely identification of cardiac ischemia during case and pistop period

Question 524

Dont do rapid sequence on

Answer 524

Very difficult airway | Do slow controlled IV induction

Question 525

Vtach unstable

Answer 525

Start chest compressions cardiovert consider amiodarone or procainamide If HR>150 with v tach but stable still cardiovert Under 150 and stable just give amiodarone

Question 526

Do adequate hypothermia if

Answer 526

Decreased signals with aortic crossclamp

Question 527

Aorticcross clamp

Answer 527

Decresed EF, cardiac output, renal blood flow and distal perfusion pressure

Question 528

TEG measures

Answer 528

Viscoelastic properties of blood during induced clot formation

Question 529

Teg can show

Answer 529

Platelet dysfunction, primary fibrinolysis, stage 1 and 2 dic as well as residual anticoagulants

Question 530

MA on TEG shows

Answer 530

Platlet number and function

Question 531

Aortic cross clamp and not waking up think

Answer 531

Ischemic, embolic, or hemorhagic stroke

Question 532

After aortic dissection dont want too

Answer 532

High pressures in pacu can place graft anastamoses at risk

Question 533

Lithium overdose signs

Answer 533

``` Ataxia Widening QRS AV nodal block Hypotension Seizures ```

Question 534

Lithium has potential to reduce anesthetic

Answer 534

Requirements and prolong depolarizing and nondepolarizing blockers

Question 535

Tracheal compression

Answer 535

Know positions where it is the worst Onset and severity of symptoms CT scan of the neck- can tell you degree of tracheal compression

Question 536

Large thyroid masses

Answer 536

Flatten both inspiratory and expiratory limb

Question 537

To evaluate thyroid function get

Answer 537

TSH | Free T3 and free T4

Question 538

Need to know

Answer 538

Free T3 and free T4

Question 539

Hyperthyroid patient where you have to go to surgery

Answer 539

Continue PTU which inhibits organification of iodide | Give beta blocker glucocoticoids ( to reduce thyroid hormone secretion)

Question 540

Add esopageal probe to monitor

Answer 540

Temp to asa monitors

Question 541

Thyroidectomy usually doesnt require a line but

Answer 541

Parathyroidectomy does

Question 542

Anesthesize awake fiberoptic

Answer 542

Maintain spontaneous ventilation Minimal sedation and supplemental icygen Give nebulized lidocaine Topicalize nose in case u need to use it Block superior laryngeal nerves to anesthesize hypopharynx Transtracheal can anesthetize larynx but not appropriate in patient with goiter

Question 543

If patient cant do

Answer 543

Awake intubation keep them spontaneous with sevoflurane facemask and go forward with it

Question 544

Look out for thyroid storm in patient with

Answer 544

Hyperthyroidism

Question 545

Increase in core body temp see

Answer 545

Increase in MAC

Question 546

Patient with tracheal compression that is fixed

Answer 546

Extubate very slowly making sure you can view tube with fiberoptic as you extubate. Have difficult airway equipment in room

Question 547

Unilateral recurrebt laryngeal nerve injury during thyroidectomy

Answer 547

Hoarseness

Question 548

Thyroidectomy get hypocalcemia postop by

Answer 548

Inadvertant taking out of parathyroid

Question 549

Cvostek sign

Answer 549

Twotching of facial muscles when tapping facial nerve at angle of jaw

Question 550

Trossaeu sign

Answer 550

Spasm of hand muscle with occlusion of brachial artery

Question 551

Replace calcium due to hypocalcemia post thyroidectomy with

Answer 551

10 ml of 10% calcium gluconate over 10 minutes

Question 552

Thyroid storm you dont see

Answer 552

Metabolic acidosis Hypercarbia Muscle rigidity but do see it in mh

Question 553

Thyroid storm treatment

Answer 553

Acetominophen Active cooling measures Beta blocker to control tachycardia Gove fluids and replace electrolytes

Question 554

Chronic htn can lead to

Answer 554

Hemodynamic lability and end organ ischemia

Question 555

OSA and acromegaly can lead to

Answer 555

Difficult airway

Question 556

Parasellar extension of tumor with

Answer 556

Headache, blurred vision due to compression of optic chiasm, rhinorrhea)

Question 557

Prolactinoma

Answer 557

Amenorrhea, galactorea, infertility

Question 558

ADH and oxytocin from

Answer 558

Posterior pituitary | Oxytocin causes uterine contraction and ejection of breast milk

Question 559

Bromocriptine to trwat excretion of

Answer 559

Prolactin and GH from functional pituitary tumors. Dopamine 2 agonist Octreotide somatostatin analouge inhibits release of growth hormone

Question 560

Acromegaly

Answer 560

Clinical suspicion - soft tissue connective tissue overgrowth Serum igf1

Question 561

Acromegaly worry about

Answer 561

Difficult airway Hard mask fit Emglarged epiglottos and tounge Worry about coronary disease due to HTN cardiomegaly CHF OSA

Question 562

Sitting cases

Answer 562

Try to do echo to rule out pfo. If pfo sitting position is relatively contraindicated

Question 563

Can put precordial doppler to aid with finding

Answer 563

Venous air embolus

Question 564

Blurred vision from brain tumor can use

Answer 564

Visual evoked potentials

Question 565

Riskof diabetes insipidus

Answer 565

Place foley

Question 566

Increased ICP need to find hypotension

Answer 566

Quickly as can lead to cerebral ischemia

Question 567

Acromegaly patient placement of arterial line

Answer 567

Femoral or dorsalis pedis | Poor collateral blood flow to the hand

Question 568

Visual evoked potentials monitor

Answer 568

Integrity of optic nerves to make sure they dont get injured

Question 569

Cocaine injected into nose can cause total spinal or dysrhythmia when it goes in the

Answer 569

Nose

Question 570

Massive hemorrhage during dissection if brain tumor can lead to

Answer 570

Hypotension | Also think venous air embolus

Question 571

You listen to precordial doppler for air embolus

Answer 571

Sporadic roaring sounds

Question 572

Venous air embolus

Answer 572

100% oxygen Flood field with saline Aspirate air through central venous catheter Give fluid, vasoconstrictors for low BP

Question 573

With air embolus dont give peep

Answer 573

Impaired systemic venous return in a patient with significant cardiovascular dysfunction

Question 574

Blunt sympathetic response to awakening in osa patient with

Answer 574

Iv lidocaine

Question 575

Avoid laryngospasm aspiration by extubating

Answer 575

Awake

Question 576

OSA patient more likely apnea and

Answer 576

Post operative airway obstruction especially when using narcotics Pulmonary edema atelectasis can also lead to postop hypoxia

Question 577

OSA

Answer 577

Avoid narcotics

Question 578

Central diabetes insipidus

Answer 578

Lack of ADH so you piss a lot

Question 579

Endocrine response to burn is

Answer 579

Hyperglycemia

Question 580

Airway edema from burn and inhalation injury can make for

Answer 580

Difficult airway Third soacing can lead to airway obstruction

Question 581

Third spacing of fluids and renal retention of sodium leads to hypovolemia in

Answer 581

Burn patients

Question 582

Burns worry about

Answer 582

Hyperkalemia from tissue obstruction and carbon monoxide poisoning

Question 583

Vasculat trauma indicated by

Answer 583

Pain Pallor Pulselessness Paresthesia

Question 584

Give burn patients fluid to prevent

Answer 584

Hypovolemic shock

Question 585

Burn patients

Answer 585

Lots of fluid from intravascular to interstitial compartment

Question 586

Normal mixed venous oxygen saturation

Answer 586

65-75% | Urine output of .5-1 ml/kg

Question 587

Each leg is

Answer 587

18% in parkland formula

Question 588

Fiberoptic scope after burn injury

Answer 588

Examine lower airways for edema or inhalation injury | Order blood gas, chest x ray and pfts

Question 589

Awakefiberoptic on

Answer 589

Difficult intubation with inhalation injury due to burn

Question 590

Can have vagal response to

Answer 590

Laryngoscopy

Question 591

Bicarbonate problems

Answer 591

Generates additional C02 Leftward shift of oxyhemoglobin curve Hypokalemia due to movement of K from extracellular to intracellular compartment

Question 592

PH below 7.1

Answer 592

Give sodium bicarbonate to prevent dysrhythmia, hypotension, myocardial ischemia, and catecholamine resistance assocoated with severe acidosis

Question 593

Cyanosis with normal pulse ox think

Answer 593

Carbon monoxide poisoning

Question 594

Pulselessness due to

Answer 594

Vascular trauma or compartment syndrome Get intracomparmental pressures if above 30 immediate surgery

Question 595

Use BIS and keep below 60

Answer 595

If worried about recall in patient with shock

Question 596

Post burn for 24 hiurs

Answer 596

Cardiac output is decreased due to circulating myocardial depressant factors, increased SVR, decreased coronary blood flow

Question 597

After 24 hr with burns and volume resuscitation

Answer 597

Increased circulating catecholamines lead to hyperdynamic state where cardiac output is increased and SVR is reduced

Question 598

Pulling tube out by accident and cant ventilate think

Answer 598

Laryngospasm

Question 599

Burn patient keep hematocrit above

Answer 599

30% but take into account hemodynamic instability or any signs of tissue ischemia

Question 600

Fat embolus from lomg bone

Answer 600

Fractures or can get bone cement implantation syndrome

Question 601

Bone cement implantation due to

Answer 601

Hardening and expansion of bone cement increased inteamedullary pressures and embolization of bone marrow debris. Methyl malcralate can lead to decreased SVR

Question 602

Bone cement implantatoo treatmnt

Answer 602

Supportive with 100% oxygen fluids pressors No heparin

Question 603

Rhabdo can occur in

Answer 603

Burn patients

Question 604

Myoglobinuria due to

Answer 604

Skeletal muscle destruction or dark colored urine could be due to hemoglobinuria from incompatibkr blood transfusion

Question 605

Myoglobiuria

Answer 605

Givefluids and diuresis | Canalkalinize urine to lead to excretion of myoglobin

Question 606

Hypotensive oliguric patient post burns and something falling on torso with decreased cardiac output and increased peak airway pressures

Answer 606

Abdominal compartment syndrome Need immediate abdominal decompression

Question 607

Laparoscopy risks include

Answer 607

Capnothorax, c02 emphysema, pneumoperitoneum induced hypotension

Question 608

Potassium above 6 perfer to

Answer 608

Dialyze first If hyperkalemic look for ekg changes such as long pr, peaked t waves

Question 609

Patients with chronic renal failure are prone to

Answer 609

Increased perioperative bleeding secondary to heparin administration during dialysis and chronic plt dysfunction

Question 610

In case of transplantedkidney

Answer 610

Want to avoid blood if possible leukocyte antigens may lead to formation of allosntibodies predisposing to rejection of the transplanted kidney

Question 611

Washed blood for

Answer 611

Iga

Question 612

Irridiated blood to prevent

Answer 612

Graft vs host disease

Question 613

Volume overload, uremia, anemia, acidosis of

Answer 613

Chronic renal failure can lead to HTN, dilated cardiomyopathy, CHF, cad and arrhythmias

Question 614

Obesity puts you at risk for

Answer 614

Aspiration

Question 615

Need coagulation studies if plannig for

Answer 615

Regional

Question 616

Renal dialysis pt get

Answer 616

CXR to assess fluid overload and pulmonary status

Question 617

Avoid lactated ringers in

Answer 617

Hyperkalemics as it contains potassium

Question 618

Third spacing

Answer 618

Fluid intravascular goes to interstitial compartment

Question 619

Aspiration usually occurs in

Answer 619

The right middle lobe of the lung

Question 620

Catheter for epidural oyt 1 hour before

Answer 620

Heparinization for hemodialysis or place 2-4 hr after hemodialysis

Question 621

Subq unfractionated heparin no

Answer 621

Contraindication to neuraxial anesthesia

Question 622

More pulmonary complications associated with

Answer 622

Neck injury

Question 623

Sepsis and hyperglycemia more likely when giving

Answer 623

Steroids

Question 624

PFTs are needed for patient having

Answer 624

Neck surgery with hypoxia on room air and long history of smoking

Question 625

PFTs tell me about

Answer 625

Type and severity of disease, baseline pulmonary function, if there is a reversible component

Question 626

FEV1/FVC less then 70% goes with

Answer 626

Obstructive disease

Question 627

Hypoxic patient

Answer 627

8 weeks of smoking cessation, chest physiotherapy, bronchodilator, glucocorticoid

Question 628

Life threatening delirium tremens starts

Answer 628

72 hours after alcohol withdrawal

Question 629

Benzodiazepine to prevent

Answer 629

Alcohol withdrawal

Question 630

High glucose

Answer 630

More infection Poor wound healing Osmotic diuresis

Question 631

Get ecg on diabetic due to

Answer 631

Potential for early atherosclerosis and silent MI

Question 632

Stop smoking

Answer 632

Less carboxyhemoglpbin shifts curve to right | Less sputum less nicotine

Question 633

SSEPs and MEPs to look for

Answer 633

Spinal cord ischemia in posterior spinesurgery

Question 634

MEPs are important along with SSEPs be ause they are more sensitive to

Answer 634

Motor injury

Question 635

Dont use MEPs if patient has cochlear implant or

Answer 635

Actuve seizures

Question 636

Diabetes mellitus associated with aspiration

Answer 636

Aspiration

Question 637

Cervical spine do

Answer 637

Awake fiberopitiv eith mannual in line stabilization with two operators

Question 638

Always get baseline

Answer 638

MEP and SSEPs

Question 639

SSEP affected by

Answer 639

Hypothermia, hypercarbia hypoxia and anestheyic suppression

Question 640

If bp not going up give direct agent like

Answer 640

Phenylephrine Going prone can obstruct venous return leading to hypotension

Question 641

If bp not going up give direct agent like

Answer 641

Phenylephrine Going prone can obstruct venous return leading to hypotension

Question 642

Autonomic neuropathy due to

Answer 642

Wxcessive glycosylation

Question 642

Autonomic neuropathy due to

Answer 642

Excessive glycosylation

Question 642

Autonomic neuropathy due to

Answer 642

Wxcessive glycosylation

Question 643

Part of spinal cord most vulnerable to injury

Answer 643

Anterior spinal cord due to limited blood supply which arises from the vertebral arteries

Question 644

Anterior spinal artery supplies

Answer 644

Anterior 2/3 of spinal cord and recieves artery of adamkiewicz

Question 645

A serum lactate to look for

Answer 645

Acidosis Alcoholic ketoacidosis

Question 646

Bicarbonate increases C02 and causes

Answer 646

Leftward shift of oxyhemoglobin dissociation curve | Hypokalemia

Question 647

Patient blind post procedure

Answer 647

Elevate head of bed to help with venous drainage, ensure adequate BP, electrolytes, hemoglobin, urgent opthamology consult

Question 648

Pion

Answer 648

Decreased blood supply to a part of the optic nerve

Question 649

High risk for PION

Answer 649

Prolonged surgery greater then 6.5 hours anf 45% estimated total blood volume lost

Question 650

Decreased venous return due to

Answer 650

Increased intrathoracic pressure with positive pressure ventilation

Question 651

You can still aspirate with a trach or endotracheal tube

Answer 651

In place

Question 652

Aspiration leads to intrapulmonary shunting which leads to

Answer 652

Hypoxia

Question 653

If patient aspirated with tracheostomy in place

Answer 653

Place patient in trendelenberg, add air to tracheostomy cuff, and suction trachea and oropharynx

Question 654

Not currently recommebded to give antibiotics for

Answer 654

Aspiration

Question 655

Fresh trach requires

Answer 655

ICU coverage

Question 656

Too small an endotracheal tube leads to

Answer 656

Airway resistance

Question 657

Pressure controlled ventilation

Answer 657

Limits peak inspiratory pressures by allowing low tidal volumes

Question 658

Medical practice

Answer 658

Negligence from the standard of care

Question 659

Aortiv dissection leads to

Answer 659

Hemmorhage and distal or proximal propagation, and interruption of arteries arising from the aorta with resultant end organ ischemia

Question 660

Aortic dissection surgery concerns

Answer 660

Spinal cord ischemia from anterior spinal artery syndrome Myocardial ischemia from clamping and unclamping aorta Renal insufficeny Respiratory failure

Question 661

CAD Aortic stenosis CHF

Answer 661

Place at risk for MI arrhythmia

Question 662

Higher blood pressure

Answer 662

More risk for aneurysm rupture MI Heart failure

Question 663

Be careful of hypotension in patient with

Answer 663

Aortic stenosis

Question 664

Delay systemic heparinization for 60 minutes following placement of

Answer 664

Thoracic epidural

Question 665

If hemodynamically unstable or surgery where hemodynamics are in question

Answer 665

Only give narcotics through epidural

Question 666

Arrhythmia can lead to

Answer 666

Hypotension

Question 667

Best way to provide renal protection with aortic cross clamping is

Answer 667

Maintain adequate intravascular volume and hemodynamic stability Mannitol dopamine loop diuretics

Question 668

Still need renal protection when aortic cross clamp is placed

Answer 668

Infrarenal | Increase in renal vascular resistance, decrease in renal blood flow

Question 669

Clamp causing ST depression

Answer 669

Take it off Put in TEE Slowly put it back on If patient cant tolerate higher pressures due to clamp can ask surgeon to place temporary shunt to increase distal perfusion and avoid ischemic injury

Question 670

Cyanide toxicity is characterized by

Answer 670

Metabolic acidosis

Question 671

Cyanide toxicity treatment

Answer 671

100% oxygen Mechanically ventilating Give sodium thiosulfate

Question 672

Prior to release of aortic cross clamp

Answer 672

Discontinue vasodilators Replace fluid deficit and blood loss TEE to guide more volume Treat sustained reduction in SVR with pressors

Question 673

Postop renal failure mortality high after

Answer 673

Aortic surgery. Make sure foley isnt obstructed and give fluid bolus if oliguric

Question 674

Postop renal failure after clamping think

Answer 674

Renal ischemia Nephrotoxins Air embolization

Question 675

Patient cant move legs post aortic dissection procedure differential

Answer 675

Spinal cord ischemia Intrathecal catheter Epidural/spinal hematoma Discontine epidiral get stat CT/MRI and neurosurgery consult

Question 676

If worried about intrathecal

Answer 676

Try to aspirate csf

Question 677

Anterior spinal cord

Answer 677

Vulnerable to hypoperfusion due to reliance on on a single anterior spinal artery for blood supply

Question 678

Artery of adamkowitz arises from

Answer 678

T9-T12

Question 679

Increase in CSF pressure when you place

Answer 679

Aortic clamp | Avoid hypotension, SSEP and MEPs, drain CSF, shunt or bypass to maintain distal perfusion

Question 680

Always need

Answer 680

``` Emergency ventilation equipment Verify central hoses connected Check high pressure by opening each E cylinder and ensuring adequate gas pressure Inspect circuit Check scavenging ```

Question 681

Hypoxic mixture safety measures

Answer 681

Fail safe alarm | Oxygen failure cut off valves

Question 682

Fresh gas mixes with desflurane vapor due to its high

Answer 682

Vapor pressure and heat of vaporization

Question 683

Sevoflurane

Answer 683

Variable bypass vaporizer

Question 684

Sickle cell

Answer 684

Mutation of chromosome 11 substitution of valine for glutamic acid in beta chains of hemoglobin

Question 685

Sickle cell chronic anemia hypoxia ane hemochromatosis leads to

Answer 685

Cardiomegaly, CHF, pulm htn, acute chest, retinopathy

Question 686

For moderate to high risk surgery in sickle cell patient

Answer 686

Transfuse to Hematocrit of 30% to prevent sickling and increase oxygen carrying capacity

Question 687

Avoid sickling by avoiding

Answer 687

Hypoxemia, hypotension, hypothermia, acidosis, and hypovolemia

Question 688

Treating sickle cell crisis

Answer 688

Iv fluids, oxygen, pain control, treat infection, exchange transfusion to reduce fraction of Hgb S to less than 40%

Question 689

Masseter spasm

Answer 689

Want to know if family history of masster spasm or MH

Question 690

With masseter spasm assume patient susceptible to MH

Answer 690

Give non triggering anesthetic

Question 691

Masseter muscle rigity

Answer 691

Give 100% oxygen and attempt to ventolate If unavle place NPA Then nasal tube fiberoptic if not surgical airway Trend CK place a line look for myoglobinuria

Question 692

Thyrotoxicosis signs

Answer 692

Tachycardia Increase in CO and SV decrease in SVR and PVR Neurologic symptoms like anxiety Sweating, heat intolerance, weakness

Question 693

Glucorticoids reduce

Answer 693

Thyroid hormone secretion and the peripheral conversion of T4 to T3

Question 694

Risk factors for aspiration

Answer 694

Obesity Pregnancy Gerd

Question 695

Aspiration pneumonitis mainly dependent on

Answer 695

Volume and pH of aspirate

Question 696

Aspiration

Answer 696

Apply cricoid Place bed in trendelenberg 100% oxygen If hypoxic need to perform rapid sequence induction

Question 697

Non particulate

Answer 697

Raises pH of gastric content!

Question 698

Preop on cirrhotic

Answer 698

Jaundice, bleeding disorders, encephalopathy, Bilirubin alkaline phosphatase, albumin

Question 699

Cirrohsis

Answer 699

Reduced FRC, restrictive lung disease, pleaural effusion, attenuates hypoxic pulmonary vasoconstriction

Question 700

Good muscle relaxant for cirrhotic

Answer 700

Cisatracurium

Question 701

PDPH

Answer 701

Frontooccipatal headache Better laying down Nausea Neck stiff Conservative treatment is hydration, caffiene pain control Anticoagulants no blood patch

Question 702

Want to get coagulation profile prior to placing

Answer 702

Blood patch | Dont want to expand spinal/epidural hematoma

Question 703

Type C TEF

Answer 703

Esophageal atresia with blind upper pouch and lower segment tracheal fistula

Question 704

TEF goes with

Answer 704

VACTERL

Question 705

TEF induction worry about aspiration

Answer 705

Gastric content through fistula Oral secretions from upper esophageal pouch Also worry difficult intubation, gastric distension from poor placement ett, hypotension, inadequate ventilation due to decreased pulmonary compliance due to prematurity

Question 706

In TEF want tube

Answer 706

Distal to fistula and proximal to carina

Question 707

Spinal epidurals are ok for

Answer 707

Pregnant patients

Question 708

.physilogic changes during oregnancy

Answer 708

20-40% increase oxygen consumption | 40-50% increase in minute ventilation

Question 709

FRC decreases in

Answer 709

Pregnancy while vital and closing capacity dont change

Question 710

Kidney transplant cant delay long

Answer 710

Longer cold ischemia times can lead to failed graft function

Question 711

Higher BP more likely to have

Answer 711

Ventricular dysrhythmias, mi and blood pressure liability

Question 712

Bp above

Answer 712

180/110 would prefer to delay elective procedures 6-8 wks Or above 140 with other contaminant end organ damage

Question 713

If BP above 180 lower to below

Answer 713

160 with beta blocker then sodium nitroprusside over a few hours

Question 714

Maintain adequate intravascular volume for

Answer 714

Earlier onset of graft function in kifney transplant

Question 715

Elective surgery should be cancelled for potassium greater then

Answer 715

5.5

Question 716

Renal disease patient

Answer 716

More likely neuraxial hematoma | Uremic platelet dysfunction and they get heparin pre dialysis

Question 717

Reguonal anestgesia can be used for

Answer 717

Kidney transplant but causes sympathectomy and more risk for hematoma due to uremic plt dysfunction

Question 718

If doing regional

Answer 718

Need adequate hydration, prepare for hypotensuon, get coags, look for signs of bleeding

Question 719

Unclamp iliac vessels after kidney transplant

Answer 719

Following graft placement

Question 720

Pulmonary artery catheter

Answer 720

Severe CAD | Left ventrucke dysfunction, severe copd

Question 721

Want to avoid hypotension or hypertension during

Answer 721

Laryngoscopy

Question 722

Iv lidocaine to attenuate

Answer 722

Sympathetic response to laryngoscopy

Question 723

Dont use sevoflurane for

Answer 723

Kidney transplant as it has a risk for renal toxicity

Question 724

Sevoflurane nephroxtoxicity

Answer 724

Compound A from breakdown of sodium hydroxide | Sevoflurane metabolites form inorganic flouride

Question 725

Dont give lactated ringers to kidney transplant as can lead to

Answer 725

Hyperkalemia

Question 726

Heparin is given during kidney transplant prior to clamping of vessels to

Answer 726

Prevent clotting

Question 727

Hypotension following iliac unclamping in kidney transplant

Answer 727

Washout of vasoactive substances from previously ischemic tissues Acute increase in up to 300 ml to the intravascular space

Question 728

Want to depress cardiac membrane excitability with

Answer 728

Hyperkalemia

Question 729

PEEP helps in pulmonary edema by

Answer 729

Redistribution of alveolar fluid that are less involved with gas exchange, improves oxygenation

Question 730

PEEP and positive pressure ventilation worsen cardiac function secondary to

Answer 730

Decreased preload

Question 731

Need to maintain adequate renal blood flow post transplant

Answer 731

T

Question 732

Uremic platelet dysfunction with

Answer 732

Kidney disease

Question 733

Uremia in esrd patients

Answer 733

Decreased vWF formation and release | Increase synthesis nitric oxide which has platelet inhibitory affects

Question 734

Hemodialysis best way to treat uremic thrombocytopathia

Answer 734

Eliminates uremic acid and quickly restores adequate plt function

Question 735

Oliguria post kidney transplant

Answer 735

Hypovolemia, hypotension, acute graft rejection, renal vein or artery thrombosus, ATN, obstruction of the foley catheter

Question 736

Gastrostomy to decresse stomach size if ventilate by accident through a

Answer 736

TEF Place ETT beyond fistula Suction upper esophageal pouch to prevent aspiration

Question 737

In TEF repair

Answer 737

Place a line and two prechordial stegescopes One over left axilla to monitor ventilation and heart rate One over stomach to make sure youre not ventilating the stomach

Question 738

In nenate want to minimize

Answer 738

Sympathetic stimulation of laryngoscopy as can lead to IVH

Question 739

Gastrostony tube

Answer 739

Reduces risk of gastric distension

Question 740

Give atropine

Answer 740

0.02 mg/kg to ablate sympathetic response to laryngoscopy

Question 741

TEF make sure

Answer 741

``` Adequate monitoring and iv access Place in head up Suction proximal pouch and stomach Atropine .02 mg/kg Rapid sequence intubation ```

Question 742

TEF

Answer 742

Advance tube into right mainstem bronchus and withdraw until only breath sounds on left axilla precirdial stethescope

Question 743

Use uncuffed tubes in children under 8 to minimize

Answer 743

Post extubation croup

Question 744

Use cuffed tube in neonates for TEF but want

Answer 744

Air leak at20-25 cm H20 to prevent post extubation croup

Question 745

Sp02 decrease during TEF repair

Answer 745

Tube may get displaced into rught mainstem bronchus or proxinal to fistula causing gastric distension

Question 746

Managing intraoperative fluid replacement

Answer 746

Maintenance fluids at 4 ml/kg/hr with dextrose containing solution

Question 747

Maintenace fluids neonate

Answer 747

4 ml/kg/hr plus dextrose Insensible losses replace with 6-8 ml/kg/hr

Question 748

Early extubation in TEF to lower pressure on

Answer 748

Anastomotic suture line

Question 749

TEF extubation

Answer 749

``` Want awake pt due to risk of tracheomalacia Complete reversak euronuscular blockade Gag cough reglex 5 to 7 cc tidal volume on cpap Peak inspiratory pressure less than 30 Holding sats with Fi02 40% or below ```

Question 750

Post TEF hard to ventilate

Answer 750

``` Obstruction of tube Movement kd tube Bronchospasm Anastomotic leak Pneumo ```

Question 751

Normal hct of full term neonate is

Answer 751

55#’%

Question 752

Inspiratory stridor due to

Answer 752

Extrathoracic upper airway obstruction such as epiglottitis

Question 753

Barking cough think croup

Answer 753

Treat with nebulized racemic epinephrine and iv dexamethasone .25-.5 mg/kg

Question 754

Tracheomalavia is associated with

Answer 754

Expiratory stridor

Question 755

Requires do require pain tontrol and can do

Answer 755

Epidural post TEF repair or acetominophen 10-20 mg/kg every 4 hr prn

Question 756

RA

Answer 756

Causes vasculitis that occurs secondary to deposition of immune complexes

Question 757

RA

Answer 757

Pulmonary and cardiac issues, peripheral neuropathy, cervical spine issues

Question 758

Treatment for RA

Answer 758

NSAIDs for analgesia | Disease modifying antirheumatic drugs like methotrexate, corticosteroids to rapidly decrease inflammation

Question 759

5 mg of prednisone per day give

Answer 759

Prophylactic steroids

Question 760

RA

Answer 760

Atlantoaxial subluxation | Can lead to TMJ as well

Question 761

Bilateral eye irritation and gritty sensation when blinking after case think

Answer 761

Keratoconjunctivitis due to impaired lacrimal gland function and subsequent inadequate tear formation

Question 762

Type and cross

Answer 762

Mixes receipent plasma with donor RBCs to detect incompatibility

Question 763

Most transfusion reactions are due to

Answer 763

ABO incompatibility secondary to clerical error and usualky result from binding of antiA or antiB IgM antibodies to RBC membranes

Question 764

Acute porphyrias

Answer 764

Deficiency of one of the enzymes in the heme biosynthetic pathway, resulting in too many porphyrins and their precursors

Question 765

Productionof too much

Answer 765

Ala synthetase can lead to AIP When patients have higher heme requirement with anemia

Question 766

Conscious sedation better known as moderate sedation

Answer 766

Drug induced depression of consciousness patients respond purposefully to verbak or tactile stimulation No airway stuff needed

Question 767

Non anesthesia providers need

Answer 767

Two forms of oxygen, appropriate monitord, emergency meds, crash cart, cpr personnel trained ppl

Question 768

Late stage thrombosis risk with stent much higher if stop medications within

Answer 768

Time free of stent

Question 769

If pt stops blood thinners with DES prior to surgery during frame its needed

Answer 769

Try to delay surgery or give loading dose if plavix restart aspirin and wait a few hours before surgery

Question 770

Extubate when

Answer 770

``` Awake and alert Active laryngeal reflexes Effective cough Good vitals/abg Pa02 above 60 pac02 below 50 Arterial pH above 7.3 ```

Question 771

Neonate under 100 HR

Answer 771

PpV If after 30 seconds under 30 intubate start chest compressions 3 to 1 After 30 seconds give epi through umbilical vein or io

Question 772

If mother hypermag might go to

Answer 772

Child after born | Treat with calcium

Question 773

Right upper extremoty for

Answer 773

Preductal flow

Question 774

Myasthenia gravis gos with thyroid cam give succ but be careful giving

Answer 774

Rocuronium

Question 775

Intravascular or intraneural injection can happen from

Answer 775

Retrobulbar block

Question 776

Decreased FRC and osa

Answer 776

Obesity

Question 777

Pregnancy and seeum glucose only on

Answer 777

Diabetic fat woman fir umbilical hernia surgery

Question 778

Give breathing treatment to optimize

Answer 778

Asthma

Question 779

Diabetic neuropathy can mask

Answer 779

Cardiac problems

Question 780

Can do unbilical hernia under

Answer 780

Regional or local

Question 781

Put patient in head up to prevent

Answer 781

Passive regurgitation

Question 782

Give narcotics upfront to

Answer 782

Attain deep level of anestgesia to avoud bronchospasm

Question 783

Reverse trendelenburg helps with

Answer 783

Respiratory mechanics

Question 784

Expiratory wheezing plus desaturation=

Answer 784

Bronchospasm

Question 785

PE happens more commonly in the

Answer 785

Morbidly obese

Question 786

Non opioid analgesics like

Answer 786

Ketorolac are good

Question 787

Epidural to avoid respiratory depression dont add

Answer 787

Narcotic Only local

Question 788

Bradykinin production closes

Answer 788

Ductus arteriosus

Question 789

Materbal sterood administration

Answer 789

Increasees surfactant production in vivo

Question 790

RDS infant

Answer 790

Tachycardia, tachypnea, intercostal retractions, bilateral rales

Question 791

Need type and cross during PDA surgery

Answer 791

Fluid status, chest and abdominal films, abgs

Question 792

Precordial stehescope on

Answer 792

Infants | In pda surgery since clamping of left subclavian likeky put BP cuff or a line on right

Question 793

PDA dont want to lower svr so use

Answer 793

Nitrous and ketamine

Question 794

During PDA if desaturation

Answer 794

100% oxygen tell surgeon to relax any traction on the lung until patient stabilized

Question 795

Neutral temp

Answer 795

Oxygen consumption minimized

Question 796

Heat production in infant by

Answer 796

Nonshivering thermogenesis

Question 797

Neonates hypothermia induced release of norepinephrine leads to

Answer 797

Nonshivering thermogenesis

Question 798

Seizure in neonate

Answer 798

Hypoglycemia Heorhage Cerebral edema

Question 799

Secure airway on someone who cant protect airway and is obtunded

Answer 799

Obtunded

Question 800

Slow controlled infuction using ketamine to keep

Answer 800

Bad airway in adult spintaneous

Question 801

On pregnant lady check

Answer 801

Babys heart tones

Question 802

Ativan reversal can lower the

Answer 802

Seizure threshold

Question 803

Babys heart tones down first

Answer 803

BP good 100% oxygen Left uterine displacement

Question 804

In prescene of incressed ICP dont do spinal

Answer 804

Can potentially lead to brainstem herniation

Question 805

Epidural or spinal anesthesia

Answer 805

In prescense of eclampsia thrombocytopenia makes it more likely

Question 806

ART line to measure

Answer 806

Cerebral percusion in obtunded patienr

Question 807

Mannitol shifts fluid from

Answer 807

Intracranial to intravascular

Question 808

Magnesium toxicity cwj cause

Answer 808

Patient to not wake up

Question 809

Airway and cardiac compression by

Answer 809

Anterior mediastinal mass

Question 810

Chest X rays and PFTs for patient with anterior medistanl

Answer 810

Mass

Question 811

For anterior mediastinal mass causing SOB try

Answer 811

Chemo and radiation first

Question 812

Anterior mediastinal mass

Answer 812

Want echo upright and supine

Question 813

Atlantoaxial instability with downs makes it

Answer 813

Harder intubation

Question 814

Difficult airway

Answer 814

Give enough sedation to maintain airway reflexes and spontaneous ventilation

Question 815

Anterior mediastinal mass

Answer 815

Put a line and iv in lower extremity

Question 816

Cannulate femoral vessels before on bad anterior mediastinal mass to have

Answer 816

Cardiopulmonary bypass ready

Question 817

Caj move patient in lateral or prone position to relieve pressure on trachea from

Answer 817

Anterior mediastinal mass

Question 818

Cholinergic edrophonium test will show

Answer 818

Cholinergic vs myasthenic syndrome

Question 819

Third spacing of fluid from burn can lead to

Answer 819

Airway edema

Question 820

Hyperkalemia from

Answer 820

Tissue destruction from burns

Question 821

Burn patients need fluid to prevent

Answer 821

Hypovolemic shock

Question 822

Head and neck Chest Legs are 18%

Answer 822

Others are 9 including arms on parkland formula

Question 823

People can have a vagal response to

Answer 823

Laryngoscopy

Question 824

Carboxyhemoglobin higher affinity for

Answer 824

Hemoglobin | Shifts oxygen dissociation curve to the left

Question 825

Burn pt needs

Answer 825

Central line | Need foley to monitor urine output and assess for rhabdomyolysis

Question 826

Immediate post burn for 24 hours

Answer 826

Cardiac output is decreased and increased SVR

Question 827

Laryngospasm

Answer 827

Jaw thrust and apy pressure to ascending ramus of mandible

Question 828

Laryngospasm first give

Answer 828

Lidocaine and then succinylcholine

Question 829

If obstruction passing tube

Answer 829

Try smaller tube or prepare for emergent tracheostomy

Question 830

Listen for leak around tracheostomy if

Answer 830

Desaturating

Question 831

Add air to trach cuff if aspiration

Answer 831

Suction and head down and bronch

Question 832

Pressure control

Answer 832

Limita peak inspiratory pressures by allowing smaller tidal volumes

Question 833

CDH leads to

Answer 833

Intrapulmonary shunting, pulmonaryvHTN, impaired gas exchange

Question 834

CDK pulmonary HTN and

Answer 834

PDA and PFO shunt cause more hypoxia hypercarbia acidosis making Pulm HTN worse

Question 835

CDH

Answer 835

Intubate with vety low tidal volunes, get echo and fix hypothermia, abg

Question 836

Avoid positive pressure thus mask ventilation with

Answer 836

CDH

Question 837

Difference in pre and post ductal sat is due to

Answer 837

Shunt

Question 838

If bad shunt in neonate want to

Answer 838

Decrease PVR and increase SVR

Question 839

Emergent chest tube for pneumothorax

Answer 839

22 gauge in 2nd intervostal space in neonate

Question 840

Hypothermia increases oxygen demand and can result in increased

Answer 840

Acidosis and pvr

Question 841

Hydroxyurea works by increasing amount of fetal hemoglobin which thus reduces amount of

Answer 841

Sickled hemoglobin

Question 842

HgbS in venous blood doesnt sickle bc it is time dependent and goes to get

Answer 842

Oxygenated even though it has a low Pa02

Question 843

Aplastic crisis from bone marrow suppression secondaey to infection

Answer 843

Typically parvovirus B19

Question 844

Sickle cell

Answer 844

``` Temp management Volume management Renal pulmonary cardiac dosease More likely infectoion History of vasocvlusive crisis ```

Question 845

Epidural better than spinal

Answer 845

Less sympathectomy, can titrate local anestgetics with fluid

Question 846

Amniotic fluid enbolus

Answer 846

Pulmonary HTN Seizures Hypotension Cardiac arrest

Question 847

During wmniotic fluid embolus

Answer 847

Keep catheter in because dont know coagulation status

Question 848

Reduce risk of sickling by giving

Answer 848

100% oxygen

Question 849

Intravitreal air in the day is

Answer 849

Reabsorbed within 5 days

Question 850

Sulfur hexaflouride avoid

Answer 850

Nitrous for 10 days

Question 851

Citrate can chelste calcium during

Answer 851

Massive transfusion

Question 852

Magnesium toxicity can cause

Answer 852

Hypotension | PE can also occur in pregnant pts

Question 853

Calcium can help with

Answer 853

Magnesium toxicity

Question 854

Prolonged QT from

Answer 854

Hypocalcemia also widened QRS complexes

Question 855

Need to provide pain control to

Answer 855

Chronic opioid users

Question 856

Acute chest

Answer 856

Fever cough tachypnea hypoxemia pulmonary infiltrate and chest pain

Question 857

Trali

Answer 857

Non cardiogenic pulmonary edema

Question 858

Acute chest treatment

Answer 858

Pain control Supplemental oxygen Antibiotics to cover atypicals Correct anemia and consider exchange transfusion

Question 859

Try to avoid tourniquet in pt with

Answer 859

Sickle cell

Question 860

Need to know

Answer 860

Babys condition as will tell you urgency of case

Question 861

For preeclampsia want to know if associated symptoms such as

Answer 861

Cerebral edema, renal insufficency, coagulopathy

Question 862

On Ob patients exam

Answer 862

Airway Coagulopathy Heart function Volume status

Question 863

CXR shows

Answer 863

Pulmonary congestion and cardiomegaly

Question 864

Echo

Answer 864

Shows wall motion abnormalities and can tell you the EF

Question 865

Severe preeclampsia is an indication for

Answer 865

C section

Question 866

C section associated with more

Answer 866

Blood loss Infection Ambulation delayed

Question 867

Need level to

Answer 867

T4 for OB

Question 868

If concern about epidural hematoma do

Answer 868

Hourly neuro checks after removal

Question 869

Preeclamptic pt with cardiac disease

Answer 869

A line pac central prior to induction

Question 870

Epi and atropine every 3-5 min for asystole

Answer 870

Asystole

Question 871

Deliver baby if mother in cardiac arrest not better after

Answer 871

A few minutes Decreases metabolic demand Increases venous return Better compressions

Question 872

Severe cardiac disease maximize oxygen carrying capacity by increasing Hgb to

Answer 872

10

Question 873

Newborn weak

Answer 873

Uteroplavental insufficency Hypermag Hypoglycemua Meconium aspiration

Question 874

Use ph stat in kids on bypass

Answer 874

The C02 added helps brain function

Question 875

Absent x descemt with severe

Answer 875

Mitral regurgitation

Question 876

Ischemia from HTN can lead to

Answer 876

Atrial fibrillation or atrial dilation from worsening mitral regurg

Question 877

If patient goes into irregular rhythm

Answer 877

Can shock or amiodarone ot immediate go on bypass if cardiac case

Question 878

Perfusionist says resevior venous is getting empty

Answer 878

Immediately reduce flows and add fluid to blood to prevent massive air embolus

Question 879

Vigorous inflate lungs after cp bypass helps

Answer 879

Recruit collapsed alveoli | Move air into left heart where it can go out a vent

Question 880

Deairing of heart important to prevent

Answer 880

End organ damage from embolisation of air into cerebral or coronary arteries

Question 881

LVfailure preventing weaning from bypass

Answer 881

First inotropes then iabp

Question 882

Tip of iabp is placed at

Answer 882

Junction of aortic arch and descending aorta

Question 883

Central aortic pressure 30 points above

Answer 883

Radial during peripheral vasodilation of rewarming | Femoral artery good representation of central aortic pressures

Question 884

Tamponade

Answer 884

Higher systolic pressure diring inspiration

Question 885

IV ketamine for combative patient for

Answer 885

Intubation

Question 886

Dint go through nose if

Answer 886

Basilar skull fracture

Question 887

Can remove andmonitor ICP with

Answer 887

Intaventricular catheter

Question 888

Furosemide and barbiturates can

Answer 888

Reduce ICP

Question 889

Hyperventilation can lead to

Answer 889

Cerebral ischemia so use as last resort for lowering ICP

Question 890

Hypothermia

Answer 890

Coagulopathy Cardiac dysrthymias Poor wound healing Impaired renal function

Question 891

Fat emboli happens with

Answer 891

Femur fracture

Question 892

Fat embolus

Answer 892

Sub conjuctival petichiae and hypoxemia and pulmonary edema

Question 893

Diagnosis of ARDS

Answer 893

Acute onset Diffuse bilateral infiltrates on chest x ray Pa02/Fi02<200 PaOP<18

Question 894

High urinary sodium with low serum sodium think

Answer 894

Cerebral salt wasting

Question 895

Cerebral salt waating

Answer 895

Hypovolemia wheras SIADH is euvolemic

Question 896

SIADH do

Answer 896

Water restriction CSWS dont do water restriction and diuresis as patient is hypovolemic

Question 897

Pyloric stenosis

Answer 897

Give normal saline and after urine output established start potassium

Question 898

Inhalation induction faster in

Answer 898

Neonate Higher minute ventilation to FRC ratio Increased blood flow to vessel rich organs

Question 899

Extubate pyloromyotomy when

Answer 899

Awake | Give lidocaine prior to extubation if they bronchospasm

Question 900

Less then 50% postconceptual age high risk for

Answer 900

Postop apnea

Question 901

Monitor 24 hr postop for neonate

Answer 901

Less then 50 weeks age risk of postop apnea

Question 902

Magnet can disable

Answer 902

Tachydysrhythmia and sensing

Question 903

Place return plate

Answer 903

Close to operative site but far from AiCD

Question 904

Retrobulbar block high risk

Answer 904

Extrusion of intraocular contents

Question 905

Decreased FRC with increased intraocular pressure from

Answer 905

Trendelenberg position

Question 906

Pacemaker not capturing due to lead failure

Answer 906

Chevk all monitors electrolytes start transcutaneous pacing

Question 907

MI can significantly increasse the energy requirement for depolarization causing pacemaker to not

Answer 907

Capture

Question 908

If risk of pulmonary aspiration extubate patient

Answer 908

Awake

Question 909

Preeclamptic who develops a seizure need to

Answer 909

Intubate

Question 910

Avoid neuraxial if

Answer 910

Spina bifida | Preeclampsia increased risk of epidural hematoma

Question 911

Ketamine is a myocardial depressant when

Answer 911

Catecholamines depleted and increases icp

Question 912

Gastroschisus occurs

Answer 912

Lateral to umbilicus

Question 913

Omphalocele usually associated with

Answer 913

Lung hypoplasia

Question 914

Omphaloecele get

Answer 914

ECHO- not an emergency Need good iv accesss Place og tube

Question 915

Beckwidth Weidman

Answer 915

Omphalocele | Macrosomia, midline abdominal wall defect, hypoglycemia

Question 916

Large blood pressure swings place

Answer 916

Arterial line

Question 917

Omphalocele closure may get high abdominal pressures so place

Answer 917

Lower extremity pulse ox

Question 918

Omphalocele causes

Answer 918

Macroglossia which may lead to difficult airway management Can do awake intubation or rapid sequence if airway is reassuring

Question 919

Omphalocele dont use nitrous

Answer 919

Can diffuse into intestinal tract causing significant bowel distension

Question 920

Diarrhea flushing and cardiac involvement

Answer 920

Carcinoid triad Look at urinary 5-HIAA

Question 921

Carcinoid sybdrome

Answer 921

When carcinoid tumor secretes hormones like bradykinin, serotonin, histamine into systemic circulation

Question 922

Carcinoid syndrome diagnosis

Answer 922

24 hour urine levels of 5 HIAA can be measured Only shows after these substances bypass the portal circulation

Question 923

Cardiac finding in carcinoid syndrome is

Answer 923

TR

Question 924

Vapor pressure of isoflurane is higher than

Answer 924

Sevoflurane

Question 925

Need CVP and foley for

Answer 925

Carcinoid tumor removal

Question 926

Need appropriate depth of anesthesia to not get

Answer 926

Bronchospasm when placing ETT

Question 927

Dont use succ with carcinoid tumor!

Answer 927

Fasiculations and potential histamine release could lead to increased realse of vasoactive substances from the carcinoid tumor

Question 928

Carcinoid crisis or anaphylactic rxn

Answer 928

Hypotension wheezing increases in airway pressures

Question 929

Elevated icp with psuedotumor

Answer 929

Cerebri

Question 930

Elevated serotonin

Answer 930

Delay emergence

Question 931

PFTs to look at

Answer 931

Severity of obstruction and response to therapy

Question 932

Consult hematomogist for patient with increased

Answer 932

Ptt and get individual coags

Question 933

After tonsillectomy bleeding

Answer 933

Ask surgeon to put pharyngeal pack and compress ipsilateral carotid

Question 934

FFP can cause

Answer 934

Calcium chelation leading to hypotensoon

Question 935

Chrinic treatment with exogenous steroids leads to suppression of the

Answer 935

Hypothalamic adrenal pituitary axis

Question 936

Extubate awake to prevent larngospasm

Answer 936

Og tube Position pt laterally Suction oropharynx Administer narcotics, beta 2 agonist, and iv lidocaine

Question 937

Dont give ketorolac to patient

Answer 937

Already bleedung

Question 938

75% of post tonsillectomy hemorrhages occur within the first

Answer 938

6 hours

Question 939

Need chest ct for pneumonectomy

Answer 939

And need anterior and posterior chest x rays

Question 940

Dlco and

Answer 940

V02? Max important in pneumonectomy

Question 941

Ketamine is a myocardial depressant when

Answer 941

Catecholamines are depleted

Question 942

Both omphalocele and gastroschisis

Answer 942

Ovcur more in males, allows extrusion of abdominal wall viscera

Question 943

Gastroschisis less associated with

Answer 943

Congenital abnormalities

Question 944

Neonate omphalocele

Answer 944

Lung hypoplasia | Need good iv access, temp, prevejt infection, decrrss stomegh with og tube

Question 945

Beckwidth wedidman

Answer 945

Present with omphalocele and macrosomia so may be difficult airway

Question 946

Esopaheal probe to monitor

Answer 946

Temp

Question 947

Nitrous leads to

Answer 947

Bowel distension

Question 948

If good airway do

Answer 948

Rapod seqjence if not awake intubation

Question 949

Bmi calculation

Answer 949

Kg/m squared More fat shorter higher bmi

Question 950

OSA

Answer 950

Cessation of airway for 10 seconds 4 or more times per hour decrease in sat > 4% per hour

Question 951

OSA

Answer 951

Higher risk for gerd Hypertensive nephropathy Somnolence

Question 952

Pickeinisn syndrome

Answer 952

BMI>30 with pac02>44 at rest

Question 953

Important awake intubate

Answer 953

First preoxygenate 100% Give 1-2% lidocaine spray or nebulizer Perform superior laryngeal nerve block injecting 2 ml 2% lidocaine just anterior to the Cornu of the hyoid bones Do transtracheal recurrent laryngeal nerve block

Question 954

Des insoluble in fat and has fast wake up so good for

Answer 954

Fat people

Question 955

Have difficult airway equipment available when extubation

Answer 955

Difficult airway

Question 956

Infection wound healing worse with

Answer 956

High glucose

Question 957

PCEA less opioid requirement than

Answer 957

PCA

Question 958

Mg

Answer 958

Autoimmune disorder antibodies to alpha subunit of nicotinic AcH receptor at neuromuscular junction leading to decreased number of receptors

Question 959

Thymoma

Answer 959

Get flow volume loops can show extent of impairment and whether fixed or dynakic

Question 960

Corticosteroids inhibit the production of

Answer 960

Abnormal autoantibodies to Ach receptor in myasthenia gravis

Question 961

Myasthenia avoid

Answer 961

Muscle relaxant If high aspiration risk I would use succ 1.5-2 mg/kg for rapid intubation

Question 962

Nerve stimulators often unreliable with

Answer 962

Myasthenia gravis due to uneven levels fade

Question 963

Succ longer If you give

Answer 963

Preop cholinesterase inhibitor

Question 964

If respiratory insufficiency after for myasthenia gravis

Answer 964

I would reintubate | Consider edrophonium test

Question 965

Severe bulbar or respiratory symptoms from

Answer 965

Myasthenia crisis

Question 966

Cholinergic crisis due to

Answer 966

Overdose of cholinesterase inhibitors Excessive salivation, bradycardia Endotracheal intubation atropine and stop cholinesterase inhibitors for treatment

Question 967

Avoid ester local anesthesia

Answer 967

They are metabolized by plasma volume straw and can worsen symptoms in myasthenia gravis

Question 968

Laryngeal papilloma due to

Answer 968

HPV and want neck ct to see extent of papilloma

Question 969

Expiratory from papilloma causing

Answer 969

Flattening inspiratory limb

Question 970

Long standing chronic airway obstruction can develop

Answer 970

RVH and cor pulmoale Want cardiac echo and ekg Right atrial hypertrophy 2 3 avf peaked t waves

Question 971

Po midazolam for teens

Question 972

If Pt fearful of needles don’t place iv

Answer 972

Prior for laryngeal papilloma can lead to obstruction

Question 973

Laryngeal papilloma

Answer 973

Emergency airway equipment and ent on standby for tracheostomy

Question 974

Intubation not preferred for papilloma removal

Answer 974

Just spontaneous ventilation while under Intubation airway fire airway bleeding airway resistance difficult intubation

Question 975

C02 fire prevention

Answer 975

Wet towel after face neck shoulders Protect eyes Low fi02

Question 976

If not intubated use

Answer 976

Tiva and remi infusion

Question 977

Bronch with mild edema after airway fire

Answer 977

Humidified oxygen steroids racemic Epi with smaller endotracheal tube

Question 978

Pneumo bronchospasm

Answer 978

Low bp high hr desat

Question 979

Bilateral pneumo and subcu emphysema think

Answer 979

Tracheal tear

Question 980

Anemia can precipitate a crisis in a patient with

Answer 980

Sickle cell disease

Question 981

Target hgb in patient with sickle cell is

Answer 981

10

Question 982

Acute chest in sickle cell

Answer 982

Respiratory symptoms, fever, pain hypoxia, infiltrates on cxr

Question 983

No tourniquets in sickle cell if

Answer 983

You can

Question 984

A line and central line good choice in patient with sickle cell going in for

Answer 984

Surgery

Question 985

Prefer no opioid in sickle cell as

Answer 985

Hypoxia and respiratory depression can lead to sickle cell crisis Can give after if other non opioid measures don’t work

Question 986

Acute chest syndrome

Answer 986

Start with supportive mechanical ventilation, broad spectrum abx, simple transfusion or exchange transfusion to maintain hct 30%

Question 987

Echo before liver transplant

Answer 987

High pulmonsry pressures above 50 mm Mercury can’t get transplant Want to know about murmers

Question 988

Liver disease ascites due to

Answer 988

Hypoalbumin, water retention, portal hypertension

Question 989

Can’t do regional during liver

Answer 989

High risk due to coagulopathy

Question 990

Liver transplant

Answer 990

10 prbc 10 FFP 10 plt and 10 cryo

Question 991

Don’t do renal transplantation if

Answer 991

Potassium 6 or more Renal transplant- not emergency Can hold cadevaric kidneys 36-48 hr

Question 992

Gastroparesis

Answer 992

From renal disease makes you full stomach

Question 993

Don’t do kidney transplant

Answer 993

Coagulopathy secondary to urecemia leading to decreased vwf

Question 994

Renal transplant gastriparesis can lead to aspiration do rapid sequence with

Answer 994

Fentanyl etomidate succ

Question 995

Desflurane good for renal transplant bc it is not

Answer 995

Nephrotoxic

Question 996

Clamp iliac vessels in renal transplant

Answer 996

Give heparin prior Surgeon inject verapamil into graft arteries prior to revadvularization to prevent arterial vasospasm and mannitol after for diuresis

Question 997

After unclamping iliacs

Answer 997

Hypotension due to washout of vasoactive substances from renal graft

Question 998

Oliguria

Answer 998

Pre intra post renal | Post is obstruction or kinked foley

Question 999

Increase serotonin from carcinoid tumor

Answer 999

Avoid stress | Delayed awakening and lowers MAC

Question 1000

Carcinoid slow controlled induction

Answer 1000

Fentanyl etomidate rocuronium prevent hypotension catecholamine secretion and histamine release

Question 1001

Acute arrhythmia can cause

Answer 1001

Hypotension Hypovolemia RV failure, anaphylaxis Carcinoid crisis

Question 1002

If pt peak pressure rises with skin flushing and manipulation of carcinoid tumor by surgeon give

Answer 1002

100 mcg of octreotide bolus

Question 1003

Octreotide can cause

Answer 1003

Glucose intolerance

Question 1004

Post op for carcinoid

Answer 1004

Epidural or fentanyl PCA

Question 1005

Taper octreotide over a week

Answer 1005

Post op from carcinoid tumor removal

Question 1006

Pheo need adequate blockade

Answer 1006

Supine blood pressure under 160/90 prior to surgery with no st segment or t. Wave changes

Question 1007

Cardiac status

Answer 1007

Chest pain or SOB Talk to cardiologist Exercise tolerance Look at recent ekg or echo

Question 1008

Detect pheo by seeing

Answer 1008

Plasma metanephrines or urinary vma Endocrine tumors that secrete catecholamines

Question 1009

Pheo

Answer 1009

10% bilateral, 10% malignant, 10% extraadrenal

Question 1010

PAC or TEE can be used on cardiac patients

Answer 1010

Patients

Question 1011

T8 level for pheo under

Answer 1011

Epidural but don’t do if unfamiliar

Question 1012

Pheo avoid which drugs

Answer 1012

Succ bc fasiculations can stimulate tumor cells | Also histamine releasing drugs like atracurium or morphine

Question 1013

Sodium nitroprusside works fast to lower BP due to a

Answer 1013

Pheo

Question 1014

Perception orientation messed up with

Answer 1014

Delirium and happens over hours Post of cognitive dysfunction develops over days

Question 1015

Start 5% dextrose infusion if pt

Answer 1015

Hypoglycemia in pacu with frequent glucose checks

Question 1016

Perfusion to brain is auto regulated at

Answer 1016

MAP 50-150

Question 1017

AS don’t want low

Answer 1017

Coronary perfusion pressure

Question 1018

AS transvalvular gradient that would necessitate correcting valvular surgery

Answer 1018

50 mm hg

Question 1019

Patients auto regulatory mechanism bad with

Answer 1019

Hypertension

Question 1020

Beach chair position

Answer 1020

Venous pooling in sitting position, need pt well hydrated. Cerebral perfusion pressure may be lower than what the bp cuff measures

Question 1021

Induced hypotension

Answer 1021

Decreases intraop blood loss up to 50% and shortens surgical time

Question 1022

Interscalene block for

Answer 1022

Shoulder

Question 1023

Ropivicaine .5% for

Answer 1023

Long lasting analgesia

Question 1024

Check deltoid strength to look at interscalene

Answer 1024

Block well done

Question 1025

Bezold Mariah reflex during shoulder surgery

Answer 1025

Low HR or can be due to carotid sinus hypersensitivity | Give epi and atropine

Question 1026

Phrenic nerve palsy can make patient sob after interscalene block

Answer 1026

B

Question 1027

Difficult airway with as

Answer 1027

Esmolol drip on standby Awake fiberoptic If anxious give some midazolam and more nebulized lidocaine

Question 1028

Bone cement can cause hypotension and gets better

Answer 1028

With iv fluid and pressors

Question 1029

Irregular a fib unstable

Answer 1029

100% oxygen, feel for carotid pulse, cal for help, code, get labs and cardiac enzymes, do synchronized cardioversion

Question 1030

Taking AS patient to icu use

Answer 1030

Midazolam and fentanyl drips as more cardiac stable then Propofol which causes hypotension

Question 1031

High risk of infection with burns

Answer 1031

Pass the skin barrier and can lead to full blown sepsis

Question 1032

Torso on rule of 9s is

Answer 1032

18%!

Question 1033

Cooximeter to measure for

Answer 1033

Carbon monoxide

Question 1034

CO shifts oxygen curve

Answer 1034

Down and to left So does hypothermia alkalosis decreased 2 3 dpg

Question 1035

Burn patients are at risk for

Answer 1035

Curling ulcers so consider them full stomachs

Question 1036

Stridor means

Answer 1036

Soft tissue swelling has happened

Question 1037

Place preinduction a line as burn patients

Answer 1037

Intravascular depleted

Question 1038

Colloids don’t give to burn patients

Answer 1038

Worsen hypovolemia by increasing oncotic pressure of extravascular space

Question 1039

Give LR for burn patients

Answer 1039

Not associated with acidosis like normal saline

Question 1040

Don’t extubate burn patients

Answer 1040

With inhalational injury | Wait and check for a leak good volumes without discomfort the next day

Question 1041

5 x Fi02 =

Answer 1041

Pa02

Question 1042

Minimum urine output for burn patient

Answer 1042

0.5 mg/kg per hour

Question 1043

Burn patients need

Answer 1043

More muscle relaxant

Question 1044

Glasgow coma scale

Answer 1044

Looks at level of consciousness after traumatic brain injury

Question 1045

Abdominal paracentesis in trauma to see

Answer 1045

In hemodynamic unstable pt to see blood to Quickly go for ex lap

Question 1046

FAST exam looks at 4 views

Answer 1046

RUQ, LUQ, subxiphiod, suprapubuc to diagnose hemorrhage using ultrasound

Question 1047

Trauma pt labs

Answer 1047

CBC, bmp, coags, abg and type and cross

Question 1048

Don’t forget

Answer 1048

Kinked ett or anaphylactic reaction

Question 1049

Massive blood transfusion definition

Answer 1049

Greater than one blood volume in 24 hours or greater then 50% of blood volume in 4 hours

Question 1050

Complications massive blood transfusion

Answer 1050

Thrombocytopenia, coagulation factor depletion, hypocalcemia, hyperkalemi, trali, ARDS

Question 1051

Before Extubation want

Answer 1051

Pa02/Fi02>300 | Need appropriate pH>7.25 and paco2 under 45

Question 1052

Hypothermia

Answer 1052

Decreased wound healing and at risk for infection

Question 1053

All pressures up and cardiac index low think

Answer 1053

Pericardial tamponade

Question 1054

Echo to look for

Answer 1054

Pericardial tamponade

Question 1055

Tamponade treatment

Answer 1055

Open fluids support vitals with dopamine and go to or Pericardial window or bedside paracentesis

Question 1056

ARDS

Answer 1056

Pa02/Fi02<200 | Pulmonary cap wedge pressure less than 18

Question 1057

Peep helps with ARDS by

Answer 1057

Prevents alveolar collapse at end expiration and increase lung volume

Question 1058

Acute trauma is

Answer 1058

Full stomach | Gi motility diminished bc stress decreases parasympathetic nervous system activity

Question 1059

Decorticate response

Answer 1059

Flexion to painful stimuli

Question 1060

Epidural hematoma from tear in

Answer 1060

Middle meningeal artery

Question 1061

Cocaine abuse

Answer 1061

Lability bp with severe HTN, acute cocaine use can lead to seizures v fib mi

Question 1062

Cocaine abuse needs

Answer 1062

A line to monitor bp and 5 lead ekg Infusions of esmolo and nitroprusside ready Two large ivs Only direct agent like phenylephrine, might have exaggerated response to indirect agents

Question 1063

Chronic alcoholism

Answer 1063

Hepatic issues | Avoid direct myocardial depressants as may have cardiomyopathy

Question 1064

Need cervical mri to clear c spine

Answer 1064

To see any ligament injury missed on x ray

Question 1065

Ketamine worsens bp on patient already with

Answer 1065

Cocaine abuse

Question 1066

Pa02/Fi02 above

Answer 1066

200 but under 300 is | Acute lung injury

Question 1067

Low Fi02 to prevent oxygen toxicity with

Answer 1067

ARDS

Question 1068

Chronic HTN

Answer 1068

LVH or nephropathy

Question 1069

LVH

Answer 1069

Greater than normal myocardial demand

Question 1070

If new Q waves and LVH

Answer 1070

Hey more tests like echocardiogram

Question 1071

Laser during turp

Answer 1071

Protective goggles Watch out for fire Must penetrate prostatic tissue to appropriate depth but not normal tissue

Question 1072

A line for TURP

Answer 1072

Need a line if cardiac risk factors and massive intravascular volume absorption with irrigation

Question 1073

Want to assess mental status so do

Answer 1073

Spinal for turp

Question 1074

Less anxiety with

Answer 1074

GA | But need to give more opiates

Question 1075

Single shot spinal for

Answer 1075

T10 level for TURP

Question 1076

TURP syndrome stop

Answer 1076

Irrigating immediately

Question 1077

Good irrigating fluid for TURP

Answer 1077

Isotonic Electrically inert Transparent for proper visualization Nontoxic

Question 1078

TURP syndrome

Answer 1078

Due to acute volume expansion and dilutional hyponatremia with HTN Brady and neurologic symptoms

Question 1079

Induce and intubate patieht you’re worried about

Answer 1079

TURP syndrome

Question 1080

Dilutional hyponatremia

Answer 1080

If under 120 start hyperionic saline then normal saline once to 120

Question 1081

Hyponatremia can lead to

Answer 1081

Cerebral vascular event or metabolic disturbance

Question 1082

Central pontine myelinolysis

Answer 1082

Demyelination of the brain stem

Question 1082

Central pontine myelinolysis

Answer 1082

Demyelination of the brain stem

Question 1082

Central pontine myelinolysis

Answer 1082

Demyelination of the brain stem

Question 1082

Central pontine myelinolysis

Answer 1082

Demyelination of the brain stem

Question 1083

Glycine stimulates

Answer 1083

Inhibitory neural pathways which can lead to transient blindness Supportive measures and usually transient

Question 1084

More glycine leads to mote

Answer 1084

Ammonia

Question 1085

High bladder pressure and hr

Answer 1085

Think foley obstruct use saline to pass by clot

Question 1086

Must know if aspiration was witnessed

Answer 1086

And what it was

Question 1087

Child want to know

Answer 1087

Respiratory status prior and asthma

Question 1088

Physical exam child

Answer 1088

Look for increased work of breathing,tripod posturing nasal flaring retractions

Question 1089

Foreign body aspiration differential

Answer 1089

Esophageal foreigj body Croup Reactive airway disease Anaphylaxis

Question 1090

Auscultation chest for foreign body

Answer 1090

Will have decreased breath sounds on that side

Question 1091

IO into

Answer 1091

Proximal tibia two finger breaths distal to tibial tuberosity

Question 1092

Aspiration child

Answer 1092

Anticholinergic give to dry up secretions and minimize Vagal response to bronchoscopy

Question 1093

Do inhalational induction and promote spontaneous ventilation to

Answer 1093

Promote spontaneous ventilation and avoid migration of foreign body which can lead to total airway obstruction No rapid sequence

Question 1094

Aspiration

Answer 1094

Head doen lateral and suction Intubation Suction ett and ventilate with 100% oxygen

Question 1095

Nitrous Loweers oxygen

Answer 1095

Delivered

Question 1096

Unable to ventilate while taking out foreign object

Answer 1096

Tell surgeon to push it in or get it out immediately Next put pt in lateral or prone and try to get it out

Question 1097

If swelling of airway after foreign body

Answer 1097

Intubate and check for air leak at 25 to 30 | If no air leak keep patient intubated

Question 1098

Noisy breathing in child after Extubation

Answer 1098

Soft tissue relaxation obstruction, mucosal edema or bronchospasm

Question 1099

Upper airway stridor

Answer 1099

Humidified oxygen, steroids, nebulized racemic epinephrine

Question 1100

Racemic epi

Answer 1100

Watch for 3 hour can lead to rebound edema

Question 1101

Phenergan has

Answer 1101

Black box warning in children for respiratory failures

Question 1102

Phenergan has

Answer 1102

Black box warning in children for respiratory failures

Question 1103

Type C

Answer 1103

Esophageal atresia with fistula connecting distal esophageal pouch to trachea

Question 1104

TEF diagnosed by

Answer 1104

NGT can’t ng tube with drooling with choking with first feeds

Question 1105

VACTERL

Answer 1105

``` Vertebral anomalies Anal canal defects like anal atresia Cardiac anomalies TEF Renal defects Limb defects including radial aplasia ```

Question 1106

After TEF diagnosed put baby

Answer 1106

In head up and place og tube to suction blind ending esophagus

Question 1107

No gastrostomy for TEF prior to surgery

Answer 1107

Leads to air leaving trachea instead going into stomach

Question 1108

Monitors for TEF

Answer 1108

Asa monitors Preinduxtio a line Prechordial stereoscope Pre and post ductal pulse ox

Question 1109

Avoid muscle relaxant with TEF until tube is in

Answer 1109

Right spot Spontaneous induction with oxygen and Sevoflurane Place in right mainstem and pull back

Question 1110

TEF goals

Answer 1110

Don’t ventilate through fistula | Avoid hemodynamic instability and aspiration and maintain normothermia

Question 1111

If desat during TEF

Answer 1111

Tube may have gone mainstem or ventilate fistula or kinked tube or mucus plug

Question 1112

Stomach can rupture in TEF if you

Answer 1112

Ventilate fistula. It can impair ventilation

Question 1113

TEF

Answer 1113

Keep patient intubated for 5 days! Worried might mess up suture line Also increased risk of postop apnea in infant under 60 weeks post gestational age

Question 1114

TEF repair early complications

Answer 1114

Anastomotic leak and stricture | Late complication is GERD and feeding issues

Question 1115

Pyloric stenosis differential

Answer 1115

Ileal atresia Intraavdominal hernia Meckels diverticulum

Question 1116

Definitive diagnosis of puloric stenosis

Answer 1116

Abdominal ultrasound

Question 1116

Definitive diagnosis of puloric stenosis

Answer 1116

Abdominal ultrasound

Question 1116

Definitive diagnosis of puloric stenosis

Answer 1116

Abdominal ultrasound

Question 1117

Baby fluid status need to know

Answer 1117

Quantity and frequency of recent wet diapers

Question 1118

Lactated ringers can cause

Answer 1118

Metabolic alkalosis. Lactate is converted to bicarbonate

Question 1119

Dehydration can elevate

Answer 1119

Hematocrit level

Question 1120

Standard asa monitors

Answer 1120

``` Pulse ox Ekg Etc02 Bp cuff Temp probs ```

Question 1121

Before pyloromyotomy decompress stomach in

Answer 1121

Prone lateral and supine positions

Question 1122

Pretreat pyloric stenosis

Answer 1122

With atropine 0.02 mg/kg

Question 1123

Newborns Large tounge Funnel shaped larynx Long epiglottis

Answer 1123

Level of glottis is at C3-C4

Question 1124

Post Extubation croup can be seen

Answer 1124

After pyloromyotomy as well as continued risk of aspiration and pulmonary dysfunction including apnea spells

Question 1125

Infants up to 60 weeks postconceptual age are at increased risk for

Answer 1125

Postoperative apnea

Question 1126

Neonates need

Answer 1126

Dextrose in fluids post op

Question 1127

CDH

Answer 1127

Not a surgical emergency. Stabilize cardio respiratory status want preductal sat>90%, correct acidosis, reduce R->L shunt

Question 1128

CDH physical

Answer 1128

Barrel chest Scaphoid abdomen Bowel sounds chest auscultation Respiratory distress and hypoxemia

Question 1129

Persistent pulmonary HTN with

Answer 1129

CDH causing increase in right to left shunting through pfo and pda

Question 1130

CDH right to left shunt

Answer 1130

PHtn increased PVR causes deoxygenated blood to be shunted through pfo and pda

Question 1131

With pulmonary HTN don’t ventilate with

Answer 1131

100% as it makes pulmonary HTN worst

Question 1132

PH in child can give

Answer 1132

Nitric oxide | High frequency oscillatory ventilation as it improves ventilation with reduced barotrauma

Question 1133

CDH have neck veins available for

Answer 1133

ECMO and place umbilical central line

Question 1134

Avoid positive pressure with

Answer 1134

CDH

Question 1135

For CDH induction

Answer 1135

Keep patient spontaneous and use Sevoflurane and oxygen

Question 1136

Cdh maintenance

Answer 1136

Sevoflurane fentanyl and vecuronium

Question 1137

CDHsudden BP and SAT drop

Answer 1137

Contralateral pneumothorax Severe ph Compression of great vessels

Question 1138

PH

Answer 1138

Reduce pvr and increase svr

Question 1139

Hypothermia can increase

Answer 1139

PVR in CDH patient

Question 1140

Neonates have decreased glycogen stores and prone to

Answer 1140

Hypoglycemia

Question 1141

Don’t extubate after CDH repair due to

Answer 1141

Postop pulmknary complications | Keep on muscle relaxant and fentanyl infusions

Question 1142

If pt desaturation post CDH repair and not improving with 100% oxygen start

Answer 1142

HFOV then ecmo

Question 1143

Ecmo need anticoagulant lion and more risk for bleeding

Answer 1143

Ecmo eliminates right to left shunt | Q

Question 1144

Epiglottitis

Answer 1144

Severe sore throat, muffled voice, dysphagia | Bad fever

Question 1145

Epiglottis is

Answer 1145

Emergency don’t wait for x ray which will show thumbprint sign on lateral view

Question 1146

Don’t place iv prior in epiglottis as can lead to

Answer 1146

Laryngospasm

Question 1147

Have ENT on standby when intubating for

Answer 1147

Epiglottis

Question 1148

Epiglottis induction

Answer 1148

Sevo and oxygen inhalational Place ig after patient is deep Use smaller endotracheal tube

Question 1149

Can give reglan after you get iv in patient with

Answer 1149

Epiglottis

Question 1150

Epiglottitis

Answer 1150

Have ENT on standby for surgical airway

Question 1151

Usually able to extubate patient with epiglottitis in

Answer 1151

24 to 48 hours

Question 1152

Extubate epiglottis when

Answer 1152

Normal temp Use abx Leak around endotracheal tube

Question 1153

Extubate epiglottis

Answer 1153

Do in or with the neck prepped and draped by ent, do general anesthesia to inspect edema and if good extubate

Question 1154

Low sat with

Answer 1154

PDA

Question 1155

Worry about glucose status in

Answer 1155

Pda and degree of pulmonary HTN | Also if on chronic steroids and infection

Question 1156

Indomethacin can sometimes close pda but don’t give to newborn with

Answer 1156

IVH

Question 1157

Necrotizing enterocolitis much higher In PDA patient

Answer 1157

Blood shunted from systemic to pulmonary circulation resulting in decreased abdominal organ perfusion

Question 1158

PDA

Answer 1158

Bounding pulses, widened pulse pressure, CHF manifested by intercostal retractions

Question 1159

Echocardiogram will confirm the prescence of

Answer 1159

PDA

Question 1160

PDA

Answer 1160

Aline central line A line right upper extremity Upper and lower sats

Question 1161

For PDA maintenance want

Answer 1161

High dose fentanyl technique

Question 1162

PDA sat

Answer 1162

87 to 95% | Pa02 50 to 70

Question 1163

PDA

Answer 1163

PE malignant arrhythmia | Hemorrhage secondary to tearing of the ductus

Question 1164

After ligate PDA

Answer 1164

Get systemic HTN so might need vasodilator like nitroprusside

Question 1165

Post PDA closure

Answer 1165

For 6 months after | Neonate should receive SBP prophylaxis for ant procedure

Question 1166

If bad undiagnosed cardiac condition like

Answer 1166

Hypoplastic left heart or coarctation of aorta want to keep PDA open

Question 1167

TOF

Answer 1167

Cyanotic heart defect ``` Pulmonic stenosis RVH Overriding aorta VSD Blood from right to left bypassing lungs ```

Question 1168

Tet spells

Answer 1168

Hyper cyanotic attacks where increase in right sided pressures promote further right to left intracardiac shunting of deoxygenated blood

Question 1169

Crying exercise feeding can cause

Answer 1169

Tet spell | More PVR or less SVR

Question 1170

Increase SVR by tucking child’s knees during

Answer 1170

Tet spell

Question 1171

Tetralogy of fallot antibiotic prophylaxis for infective endocarditis

Answer 1171

Amoxicillin 50mg/kg iv

Question 1172

Infective endocarditis antibiotic prophylaxis for

Answer 1172

Prosthesis cardiac valve Hx infective endocarditis Unrepaired cyanotic congenital heart disease Valvulopayhy after cardiac transplant

Question 1173

Tetralogy of fallot

Answer 1173

Ketamine fentanyl and roc | Ketamine increases SVR and prevents TET spell

Question 1174

Succ can cause histamine release

Answer 1174

Decreasing svr and allowing more blood to flow from right to left with tetrology of fallot

Question 1175

Right to left shunt speeds up

Answer 1175

Iv induction as more blood is diverted to systemic circulation faster

Question 1176

Maintenance for TOF

Answer 1176

Nitrous oxygen ketamine | Nitrous does increase PVR but no big effect on SVR

Question 1177

Hypothermia causes

Answer 1177

Hyperglycemia due to decrease in plasma insulin

Question 1178

Retinopathy of prematurity is only a worry up to

Answer 1178

44 weeks post gestational age

Question 1179

Brain injury first step to lower BP is to lower the

Answer 1179

Icp | Neurosurgeon can drain CSF to lower ICP

Question 1180

Baseline echo needed if doing brain surgery in

Answer 1180

Sitting position if you hear a heart murmur

Question 1181

Furosemide better than mannitol

Answer 1181

Furosemide does not increase CBV or ICP It can be used in renal and cardiac pts Can be used if BBB is compromised

Question 1182

Sitting position

Answer 1182

Better surgical exposure Less bleeding Less cranial nerve damage More complete resection of lesion

Question 1183

CVP for brain surgery in sitting position

Answer 1183

Fluid status and to aspirate air

Question 1184

Precordial Doppler us and expired c02 to monitor for VAE

Question 1185

Sitting position

Answer 1185

Worried about neck hyper flexion and cervical dislocation External pressure on eyes from head set Cerebral ischemia

Question 1186

Use succ for

Answer 1186

Difficult airway

Question 1187

Isoflurane

Answer 1187

Easily titritable and May offer cerebral protection

Question 1188

Normal saline best for brain

Answer 1188

Surgery

Question 1189

Tight dura

Answer 1189

Elevate head to improve venous return Hyperventilate Check oxygenation Give propofol/muscle relaxant

Question 1190

Doris flexing foot issue

Answer 1190

Sciatic nerve

Question 1191

CT or MRI can show the size of

Answer 1191

Hemorrhage

Question 1192

Total cerebral blood flow in adults is

Answer 1192

50mg/100ml

Question 1193

CBF remains constant between map of

Answer 1193

50-150

Question 1194

Hunt hess grade 2

Answer 1194

Moderate headavje with nuchal rigidity

Question 1195

Eeg ssep transcraniak Doppler cerebral oximetry to look at

Answer 1195

Brain function

Question 1196

SSEPs monitor

Answer 1196

Ascending sensory pathways MEPs look at descending motor pathways

Question 1197

Ask surgeon to decrease

Answer 1197

Transmural pressure of aneurysm by clipping the feeding vessel of the aneurysm

Question 1198

SAH post op worry about

Answer 1198

Rebleeding and vasospasm

Question 1199

For rebleeding postop

Answer 1199

Give mannitol and drink CSF

Question 1200

Respiratory status COPD want to know

Answer 1200

Disease severity Response to bronchodilation Needing home oxygen Baseline exercise tolerance

Question 1201

Aspirin doesn’t increase risk of

Answer 1201

Neuraxial hematoma Plavix need off 7 days

Question 1202

Absolute indication for dlt

Answer 1202

Bronchopulmonary lavage Lung abscess Bronchial hemorrhage

Question 1203

If two lung ventilation doesn’t work in VATS think about

Answer 1203

Temporary pulmonary artery clamping

Question 1204

Can do regional nerve blocks or PCA postop for

Answer 1204

Vats

Question 1205

Mediastinal mass svc syndrome

Answer 1205

Confusion headache altered mental status facial cyanosis venous distension of neck or arm

Question 1206

Mediastinal mass can cause

Answer 1206

Airway and cardiovascular collapse

Question 1207

PFTs in mediastinal mass

Answer 1207

Flow volume loops have been shown to correlate poorly with degree of airway obstruction

Question 1208

Asthma patients want to know any

Answer 1208

Recent upper airway symptoms

Question 1209

Pyridostigmine in MG

Answer 1209

Increases concentration of circulating AcH thereby increasing the possibility AcH binds to its receptor

Question 1210

Pyridostigmine

Answer 1210

Continue on day of surgery and may need postop ventilator support

Question 1211

Mediastinal mass

Answer 1211

Need a line in right radial to evaluate I nominate artery compression during mediastinoscopy

Question 1212

Have rigid bronch available

Answer 1212

During mediastinal mass induction

Question 1213

Mediastinal mass

Answer 1213

Inhalational induction and awake fiberoptic. Can give ketamine due to bronchodilator affect and maintains spontaneous ventilation

Question 1214

Lose Etc02 during mediastinal mass after securing airway

Answer 1214

Pass rigid bronch past the obstruction Move pt lateral or prone Final think is Cpulmonary bypass

Question 1215

Compression of great vessels by tumor in anterior mediastinum can lead to

Answer 1215

SVC syndrome

Question 1216

SVC syndrome can decrease preload and severely decrease

Answer 1216

CO

Question 1217

Pyridostigmine weakness after Extubation

Answer 1217

Might be cholinergic or myasthenic crisis

Question 1218

Myasthenic crisis is usually

Answer 1218

Global in nature Cerebral ischemia from right inominate artery compression can occur

Question 1219

Post op renal dysfunction number 1 cause is

Answer 1219

Preop dysfunction

Question 1220

Aortic dissection need two arterial lines

Answer 1220

One proximal and one distal to the clamp

Question 1221

A line for dissection might need to clamp subclavian so place in

Answer 1221

Right radial

Question 1222

Cross clamp increases Afterload and blood pressure

Answer 1222

Don’t want too low as distal perfusion pressure important. Pay close attention if lowering pressure with nitroglycerin

Question 1223

Known side effect of nitroglycerin is

Answer 1223

Tachycardia

Question 1224

Surgeon can place shunt to increase perfusion pressure distal to

Answer 1224

Clamp

Question 1225

Reapply cross clamp if pressure drops a lot after

Answer 1225

Removing it

Question 1226

Hyperglycemia due to decrease in plasma insulin when

Answer 1226

Hypothermic

Question 1227

Previous stroke with residual symptoms

Answer 1227

Dont give succ | Don’t use extremity with residual deficits for lines or monitors

Question 1228

Disadvantage of regional for carotid endarterectomy

Answer 1228

Need for emergency intubation Complication of cervical block Possible patient movement during case

Question 1229

Regional anesthetia for carotid endarterectomy

Answer 1229

Superficial and deep cervical block

Question 1230

Complications of deep and superficial plexus block

Answer 1230

Nerve injury Risk of bleeding Risk of intravascular injection

Question 1231

Want EEG sSEp transcranial Doppler to assess

Answer 1231

Neurologic status | Best is an awake patient

Question 1232

Watershed areas most likely to

Answer 1232

Stroke from not getting enough blood from non clamped carotid

Question 1233

If EEG changes post cross clamp

Answer 1233

Take it off

Question 1234

Place shunt if can’t take off cross clamp

Answer 1234

During carotid endarterectomy

Question 1235

If airway distress with hematoma from carotid endarterectomy

Answer 1235

Immediately intubate

Question 1236

High bp after carotid endarterectomy

Answer 1236

Weeks after think carotid sinus malfunction

Question 1237

Coronary plaques lead to luminal narrowing of arteries

Answer 1237

Leads to CAD from clot formation

Question 1238

Diabetes

Answer 1238

Gastroparesis could be full stomach | Joint stiffness makes intubation harder

Question 1239

ACT over 300 needed for

Answer 1239

Bypass

Question 1240

Off pump CAbG

Answer 1240

No inflammatory response or coagulopathy platelet dysfunction from CPB machine

Question 1241

Increase pump flow rate if pressure down

Answer 1241

Early in cabg

Question 1242

Heparin reversal with

Answer 1242

1mg/100 units of heparin

Question 1243

Heparin is acid and

Answer 1243

Protamine is a base

Question 1244

SIMV after

Answer 1244

CAbG

Question 1245

Blood loss post CAbG in test tubes

Answer 1245

Coagulopathy Thrombocytopenia DIC Inadequate heparin reversak

Question 1246

Protamine

Answer 1246

Can lead to anaphylactoid/anaphylactic reaction Pulmonary HTN Hypotension

Question 1247

AAA need coagulation profile if going to place

Answer 1247

Epidural

Question 1248

AAA lower 20% from

Answer 1248

Baseline

Question 1249

If patient shows signs of sedentary lifestyle and CHF or presents with undiagnosed heart murmur I would get an

Answer 1249

Echocardiogram

Question 1250

AAA is a major vascular operation

Answer 1250

Start beta blocker like metoprolol on day of surgery if not on one

Question 1251

For AAA

Answer 1251

Want PAC to monitor cardiac filling pressures during aortic cross clamp

Question 1252

Nitroprusside

Answer 1252

Cyanide toxicity results in impairment of oxygen utilization. Patient can develop metabolic acidosis and tachyphylaxis

Question 1253

Aortic cross clamp

Answer 1253

Results in afterload proximal to the clamp and decrease in perfusion distal to the clamp

Question 1254

Crossclamp

Answer 1254

Higher risk for renal failure, bowel and spinal cord ischemia

Question 1255

Placental abruption

Answer 1255

Separation of placenta from decidua basalis before delivery

Question 1256

Definitive diagnosis of placenta previa or abruption is by

Answer 1256

Ultrasound

Question 1257

Double set up

Answer 1257

Vaginal exam in or and ready to convert to GA at any time

Question 1258

If OB patient actively hemorrhaging

Answer 1258

Do GA to reduce symphatectomy caused by epidural

Question 1259

Cell salvage can be used in

Answer 1259

Bleeding out OB patieht

Question 1260

If bleeding in OB invasive measures

Answer 1260

``` Uterus packing Uterine balloon tamponade Uterine artery embolization B lynch suture Last is hysterectomy ```

Question 1261

Causes of PPH

Answer 1261

Uterine atony Retained product of conception Placenta accreta Uterine rupture

Question 1262

IVDA

Answer 1262

More likely for poor iv access | Increased risk of transmitted diseases such as hepatitis and hiv

Question 1263

Cocaine abuse and uncontrolled HTN increases the risk of

Answer 1263

Placental abruption

Question 1264

Fetus of drug abuse mother more likely

Answer 1264

IUGR, low birth weight, iVH, congenital abnormalities

Question 1265

Causes of HTN in pregnant

Answer 1265

Untreated chronic HTN, gestational HTN, hypertension from preeclampsia, HTN from abusing drugs

Question 1266

Cocaine users

Answer 1266

Dilated pupils increased HR, arrhythmias

Question 1267

Preeclampsia multi organ disorder that presents after 20 weejs gestation with remission 48 hours after delivery

Answer 1267

Sustained SBP 140/90 and proteinuria of 300mg over 24 hr urine collection

Question 1268

Preeclampsia suspected labs

Answer 1268

CBC, BMP, liver function test to assess for HELLP, Uric acid, UA, coag, 24 hr urine protein

Question 1269

Magnesium

Answer 1269

Vasodilation Anticonvulsant Increases sensitivity to both depolarizing and nondepolarizers Tocolytic which increases uterine blood flow

Question 1270

Magnesium effect

Answer 1270

Diminished deep tendon reflexes at 4-5 Ekg changes 4-7 pr st interval increase widened qrs Somnolence at mg 5 to 7

Question 1271

If plt count low

Answer 1271

Before doing neuraxial check bleeding risk and trend plt count

Question 1272

Low BP after single shot spinal

Answer 1272

Left uterine displacement with supplemental oxygen, open fluids wide, check level, check fetal hr, give pressors

Question 1273

Always preoxygenate and give

Answer 1273

Bicitra and reglan before stat C section

Question 1274

The risk of a preeclamptic patient developing a seizure will stay for

Answer 1274

24-48 hours after delivery so keep patient on magnesium therapy

Question 1275

Heparin initial dose

Answer 1275

3-4 mg/kg

Question 1276

ACT goal for CAbG

Answer 1276

300-400

Question 1277

Protamine side effect

Answer 1277

Anaphylactoid anaphylaxis pulmonary HTN, hypotension

Question 1278

Pericardial tamponade

Answer 1278

Want preinduction arterial line Goals on induction are to maintain cardiac output, spontaneous ventilation and BP Midazolam and ketamine Once pericardial sac is open and drained give rocuronium

Question 1279

HOCM patient

Answer 1279

Higher EF due to hypercontractile state of heart Has LVOT, mitral regurgitation, diastolic dysfunction

Question 1280

Coarctation of aorta

Answer 1280

Can use spinal just don’t wqnt huge hemodynamic changes leading to aortic dissection

Question 1281

IABP

Answer 1281

Counter pulsation device deflates during systole decreasing afterload

Question 1282

IABP contraindications

Answer 1282

Severe AI, aortic dissection, aortoiliac disease

Question 1283

CBP machine

Answer 1283

Venous reservoir takes deoxygenated blood and then transfers it to an oxygenator where it is oxygenated. Blood pumped from arterial cannula back to patient

Question 1284

Membrane oxygenater less traumatic to blood then a

Answer 1284

Bubble oxygenator in CBP machine

Question 1285

Protecting spinal cord during Aortic cross clamp

Answer 1285

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1285

Protecting spinal cord during Aortic cross clamp

Answer 1285

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1285

Protecting spinal cord during Aortic cross clamp

Answer 1285

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1285

Protecting spinal cord during Aortic cross clamp

Answer 1285

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1286

Protecting spinal cord during Aortic cross clamp

Answer 1286

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1286

Protecting spinal cord during Aortic cross clamp

Answer 1286

``` Maintain adequate BP above and below Institute hypothermia CSF drainage Tell surgeon to place shunt across cross clamp to improve perfusion distal to clamp Avoid vasodilators that can increase ICP ```

Question 1287

Gi or gu procedures don’t need

Answer 1287

Bacterial endocarditis prophylaxis

Question 1288

CF pregnant patient need

Answer 1288

Glucose and coagulation studies | CF patients have poor hepatic function and unable to absorb fat soluble vitskins

Question 1289

CF pregnant payient fetus

Answer 1289

Intestinal obstruction

Question 1290

MS relapse

Answer 1290

Decreases during pregnancy and May increase at 3 months post partum

Question 1291

MS avoid spinal but can place

Answer 1291

Epidural

Question 1292

Treat pregnant seizure with

Answer 1292

Versed

Question 1293

Help syndrome

Answer 1293

Hemolysis Elevated liver enzymes Low platelets

Question 1294

Eclampsia

Answer 1294

HTN complicated by grand mal seizures

Question 1295

ASA and NSAIDs no risk for

Answer 1295

Neuraxial | LMWH should be held for 12 hours prior to neuraxial procedures

Question 1295

ASA and NSAIDs no risk for

Answer 1295

Neuraxial | LMWH should be held for 12 hours prior to neuraxial procedures

Question 1296

Absolute contraindications to epidural

Answer 1296

Refusal Coagulopathy Sepsis with hemodynamic instability Uncorrected hypovolemia with ongoing hemorrhage

Question 1297

Uterine atony

Answer 1297

Initial bimanual compression and uterine massage | Oxytocin is first line and then intramuscular methylergonevine

Question 1298

More intravascular fluid volume in

Answer 1298

Pregnancy

Question 1299

Coronary perfusion pressure

Answer 1299

Aortic diastolic pressure - LV end diastolic pressure

Question 1300

VwF type 1

Answer 1300

Lack of VWF most common and don’t stabilize factor 8

Question 1301

Need MH cart available at

Answer 1301

Ambulatory surgical center

Question 1302

CHARGe syndrome

Answer 1302

Pts usually have cleft lip and palate

Question 1303

Charge syndrome get echo prior

Answer 1303

Prior

Question 1304

Treacher Collins intubation

Answer 1304

Mixrognathic Prep and drape neck with tracheostomy and difficult airway cart in room Give po versed and perform sedated fiberoptic while maintaining spontaneous respiration’s

Question 1305

Venous blood passing lungs from right to left shunt leads to

Answer 1305

Cyanosis

Question 1306

Post tonsillar bleeding induction

Answer 1306

Rapid sequence with rocuronium and ketamine

Question 1307

Down syndrome

Answer 1307

Macroglossia and subglottic stenosis makes airway tough Duodenal atresia makes them full stomach Obstructive airway disease Atlantoaxial instability so don’t move neck much

Question 1308

Omphalocele is located within the

Answer 1308

Umbilical cord

Question 1309

After putting abdomen back in during omphalocele case is child desat

Answer 1309

Due to impaired pulmonary compliance from increased abdominal pressure Open the wound and relieve pressure Staged closure would be better

Question 1309

After putting abdomen back in during omphalocele case is child desat

Answer 1309

Due to impaired pulmonary compliance from increased abdominal pressure Open the wound and relieve pressure Staged closure would be better

Question 1310

Can’t do slow induction with

Answer 1310

Difficult airway

Question 1311

Surgeon in aneurysm case

Answer 1311

Have nitroglycerin and esmolol drips available Always look at ekg for signs of ischemia Surgeon can place temporary clip on the feeding vessel to lower amount of blood entering the aneurysm

Question 1312

For someone with spinal cord transection

Answer 1312

Still need deep general anesthesia for cases to prevent autonomic hyperreflexia

Question 1313

Post bleed can get vasospasm days

Answer 1313

3-15

Question 1314

Post aneurysm clipping for a SAH worry about

Answer 1314

Seizures so give seizure prophylaxis Rebleeding Hydrocephalus

Question 1315

Minimize TURP syndrome by

Answer 1315

Minimize height gradient between irrigation fluid and the patient to reduce hydrostatic pressure Limit duration of procedure Maintain verbal contact with patient throughout procedure

Question 1316

Secure airway if patient during TURP becomes confused and tachycardia

Answer 1316

Restrict fluids if sodium 121 look for ekg changes and can give lasix to get rid of excess fluid

Question 1317

Securing airway of patient with acromegaly

Answer 1317

Awake fiberoptic intubation | 4% nebulized lidocaine glyco small doses of benzos prior to placing the scope

Question 1318

For ECT lithium must be held for 36-7/ hours or May

Answer 1318

Prolong seizure

Question 1319

Lithium can lead to

Answer 1319

Diabetes insipidus

Question 1320

SIADH

Answer 1320

Distal convoluted tubule and collecting duct absorb water not solute

Question 1321

EMG study and neurology consult order if

Answer 1321

Conservative measures don’t treat ulnar nerve injury

Question 1322

Avoid increases in body temp in a patient with

Answer 1322

MS

Question 1323

Tissue damage leads to

Answer 1323

Release of inflammatory mediators which sensitize peripheral nerves

Question 1324

CRPS due to

Answer 1324

Dystegulation of cns | Pain burning swelling changes in skin color and temp

Question 1325

CRPS type 2

Answer 1325

Due to injury to nerve bundle

Question 1326

Stellate ganglion block

Answer 1326

At level of C7 transverse process just below subclavian artery

Question 1327

Stellate ganglion block complications

Answer 1327

Intravascular, subarachnoid injection m, hematoma, pneumothorax, hoarseness due to recurrent laryngeal nerve injury

Question 1328

Tens therapy works by

Answer 1328

Inhibition of pain signals at presynaptic levels

Question 1329

Newborn of mother on methadone

Answer 1329

Worry about neonatal abstinence syndrome | Increased sweating, nasal stuffiness, fever, irratiility

Question 1330

After injecting bupi patient nausea light headed

Answer 1330

100% oxygen open fluids pressors have code cart brought in

Question 1331

Uterine cancer block

Answer 1331

Superior hypogastric as pain arrives from the pelvic viscera

Question 1332

Transforaminal epidural injection for

Answer 1332

Unilateral back pain

Question 1333

Avoid all neuraxial techniques in patient with

Answer 1333

EF<20%

Question 1334

For lung cancer

Answer 1334

Put epidural at level of operation or 1-2 levels lowrr

Question 1335

Coumadin blocks factors

Answer 1335

2,7,9,10 which are vitamin k dependent coag factors

Question 1336

FFP in emergency to reverse

Answer 1336

Coumadin

Question 1337

Patients with asthma should not get

Answer 1337

NSAIDs like ketorolac

Question 1338

To epidural space pass

Answer 1338

Supraspinous, inyerspinous, ligamentum flavum

Question 1339

Paranedian approach to epidural only pass

Answer 1339

Ligamentum flavum

Question 1340

Spina bifida and ppl who work in rubber industry at risk for

Answer 1340

Latex allergies

Question 1341

All meds can lead to

Answer 1341

Anaphylaxis

Question 1342

Fat embolus

Answer 1342

Chest x ray shows bilateral infiltrates, pa02<60, subconjuctival petechiae hr>110

Question 1343

Severe sarcoidosis is bad for lungs so do

Answer 1343

Regional technique

Question 1343

Severe sarcoidosis is bad for lungs so do

Answer 1343

Regional technique

Question 1344

Avoid acute normovolemic hemodilution

Answer 1344

In those with severe cardiac disease and anemia

Question 1345

LMA with aspiration

Answer 1345

Remove LMA Suction to oropharynx Put back of head up Emergently intubate

Question 1346

TPN after starvation leads to

Answer 1346

Refeeding with electrolyte damage

Question 1347

BMS

Answer 1347

Need for 6 weeks

Question 1348

MH algorithm

Answer 1348

``` Discontinue triggering agent Ventilate with 100% oxygen Stop procedure Give 2.5 mg/kg iv dantrolene Up to 30 mg/kg dantrolene Administer bicarb Cool patient Go to icu 24 hr Dantrolene 1mg/kg 4-6 hr for 24 hr Freq abg and check for myoglobinuria ```

Question 1349

For mixed venous sample draw from

Answer 1349

PA port of swan ganz catheter

Question 1350

No sitting position if any septal defect

Answer 1350

Septal defect

Question 1351

Aortic stenosis preload dependent

Answer 1351

Cardiac

Question 1352

ICP elevated

Answer 1352

Blurry vision diplopia somnolence CT scan

Question 1353

Before inducing patient with high ICP need to

Answer 1353

Evaluate pt prior to inducing and doing things to lower the ICP

Question 1354

High ICP medical and surgical management

Answer 1354

Preop evd | Or medical stuff

Question 1355

Heart conductivity is dependent on

Answer 1355

Potassium leading to arrhythmias and hypotension

Question 1356

Central line can give potassium repletion

Answer 1356

Fast

Question 1357

If the patient was high blood pressure with high ICP worry about

Answer 1357

Cushings reflex

Question 1358

Ruled out is a good

Answer 1358

Phrase

Question 1359

Pneumo Carotid sinus syndrome Phrenic nerve palsy

Answer 1359

Central line

Question 1360

Call for help temporizing support

Answer 1360

Stat chest tube 2nd intercostal space midclavicular line

Question 1361

CXR think

Answer 1361

Pneumo

Question 1362

Differential diagnosis

Answer 1362

Given that so and so

Question 1363

No nitrous if pneumothorax

Answer 1363

If something happens during case make sure to reference it

Question 1363

No nitrous if pneumothorax

Answer 1363

If something happens during case make sure to reference it

Question 1364

Wake up or evoked potentials monitoring for

Answer 1364

Neuro cases Thus not required for muscle relaxant EEG can show how derp

Question 1365

Mannitol 12.5 to 25 G per neuro protocol to lower

Answer 1365

Icp | Blood serum reaches mannitol don’t give more

Question 1366

Sudden drop in Etc02 in clinical beach chair

Answer 1366

Venous air embolus

Question 1367

Operation above level of heart

Answer 1367

More likely venous air embolus

Question 1367

Operation above level of heart

Answer 1367

More likely venous air embolus

Question 1368

Decadron for days increases

Answer 1368

Glucose

Question 1369

Osmotic diuresis

Answer 1369

Calculate ins and outs | Osmotic diuresis from mannitol sucks out lots of fluids and they pee out much more

Question 1369

Osmotic diuresis

Answer 1369

Calculate ins and outs | Osmotic diuresis from mannitol sucks out lots of fluids and they pee out much more

Question 1370

Pulse pressure variation in a line and in CVP can look at positive pressure effects on fluid shifts and checking bags to look for gap acidosis

Answer 1370

Fluids

Question 1371

Don’t use amicar in DIC

Answer 1371

Use for fibrinolytic bleeding

Question 1371

Don’t use amicar in DIC

Answer 1371

Use for fibrinolytic bleeding

Question 1372

High oxygen can lead to further atelectasis and after 24 hours

Answer 1372

Diffuse alveolar damage and decrease in vital capacity

Question 1373

Reactive oxygen intermediates from too much

Answer 1373

Oxygen use

Question 1373

Reactive oxygen intermediates from too much

Answer 1373

Oxygen use

Question 1374

Loss of stomach acids leads to

Answer 1374

Metabolic alkalosis

Question 1375

Strabismus use

Answer 1375

Decadron ondansetrikn | Reglan doesn’t help droperidol black box warning

Question 1376

Hypokalemia hypophosphatemia with

Answer 1376

Hyperglycemia

Question 1377

Recurrent laryngeal nerve damage unilateral vocal cord paralysis by keeping

Answer 1377

Ett in over 6 hours

Question 1377

Recurrent laryngeal nerve damage unilateral vocal cord paralysis by keeping

Answer 1377

Ett in over 6 hours

Question 1377

Recurrent laryngeal nerve damage unilateral vocal cord paralysis by keeping

Answer 1377

Ett in over 6 hours

Question 1377

Recurrent laryngeal nerve damage unilateral vocal cord paralysis by keeping

Answer 1377

Ett in long time causing compression

Question 1378

Can use cell salvage if expecting blood loss greater then 500 ml

Answer 1378

May lead to dilutional coagulopathy

Question 1379

ANH you give clotting factors to while cell salvage just give

Answer 1379

Saline and rbcs so leads to dilutional coagulopathy so need to give clotting factors

Question 1379

ANH you give clotting factors to while cell salvage just give

Answer 1379

Saline and rbcs so leads to dilutional coagulopathy so need to give clotting factors

Question 1380

Dka

Answer 1380

First 10-15 ml/kg NS bolus Then give with potassium Once bg down to 250 add dextrose to fluids Give 10U insulin bolus and start drip Recheck blood glucose and electrolytes every 2 hours at beginning

Question 1380

Dka

Answer 1380

First 10-15 ml/kg NS bolus Then give with potassium Once bg down to 250 add dextrose to fluids Give 10U insulin bolus and start drip Recheck blood glucose and electrolytes every 2 hours at beginning

Question 1380

Dka

Answer 1380

First 10-15 ml/kg NS bolus Then give with potassium Once bg down to 250 add dextrose to fluids Give 10U insulin bolus and start drip Recheck blood glucose and electrolytes every 2 hours at beginning

Question 1381

Dyspnea in AS

Answer 1381

Pulmonary congestion

Question 1382

Digoxin

Answer 1382

If arrhythmia continue it

Question 1383

AS syncope

Answer 1383

Inadequate cardiac output

Question 1384

AS need to maintain

Answer 1384

Preload as patient will have diastolic dysfunction and requires higher filling pressures. In absense of mitral valve disease PAOP is lvedp

Question 1385

Patient with AS for risk for pulmonary edema thus

Answer 1385

Not tolerating trendelenberg position

Question 1386

Balanced AS

Answer 1386

Give fentanyl to keep hemodynamics stable without tachycardia

Question 1387

Venous hemoglobin tells you about

Answer 1387

Perfusion status. Worried about low cardiac output status Usually self limited usually from hemolysis

Question 1388

Nif Rsbi Following commands

Answer 1388

Prior to Extubation

Question 1389

Emergence delirium correlated with

Answer 1389

Preop midazolam Length of surgery PaiN Preop state of function

Question 1390

Avoid NSAIDs if pt has

Answer 1390

Peptic ulcer disease

Question 1391

Cardiac thoracicratio high means

Answer 1391

Cardiomegaly

Question 1392

Ace or arb hold on day of surgery worry about hypotension

Question 1393

Pa catheter won’t

Answer 1393

Change management Don’t want pa in field for carotid

Question 1394

Stump pressure

Answer 1394

Pressure on other side of where they clamp to make sure there is a perfusion

Question 1395

Prevent a line by doing Allen’s test

Answer 1395

Occlude radial and ulnar and release one making sure you have collateral

Question 1396

TIA increases risk of

Answer 1396

Carotid endarterectomy it is symptomatic

Question 1397

PA catheter

Answer 1397

Management after in icu Poor heart failure and function and lots of blood loss Cardiac index and mixed venous Mixed venous low Cardiogenic shock or more blood Ci going down give more pressors

Question 1398

Want to have control of bleeding

Answer 1398

During carotid endarterectomy in case something goes wrong like cerebral edema

Question 1399

Bun creatinine function of kidneys and a bmp

Answer 1399

Specially potassium

Question 1400

Ropivicaine or bupi just no toxic dose

Answer 1400

Toxic Chole need diaphragm paralyzed

Question 1401

Functional status after mi can they lay

Answer 1401

Flat

Question 1402

Bnp for cardiac work up and look for

Answer 1402

Lower extremity edema jvd crackles at bases

Question 1403

Scopolamine

Answer 1403

Anterograde amnesia

Question 1404

PA oximetry for mixed venous

Answer 1404

Throughout Tip of the pa catheter way more deoxygenated Takes out so much blood

Question 1405

Morphine

Answer 1405

Histamine release with active metabolites so hesitant to give renally cleared medication

Question 1405

Morphine

Answer 1405

Histamine release with active metabolites so hesitant to give renally cleared medication

Question 1405

Morphine

Answer 1405

Histamine release with active metabolites so hesitant to give renally cleared medication

Question 1406

Neuromuscular relaxant

Answer 1406

Anaphylaxis

Question 1407

More anesthetic during

Answer 1407

Perfusion

Question 1408

Make sure anesthetic on when

Answer 1408

Ventilating patient coming off bypass

Question 1408

Make sure anesthetic on when

Answer 1408

Ventilating patient coming off bypass

Question 1408

Make sure anesthetic on when

Answer 1408

Ventilating patient coming off bypass

Question 1409

Abg TEG other coags prior to giving things with patient

Answer 1409

Oozing | Platelets get sheared going through pump

Question 1410

Give test dose with

Answer 1410

Protamine

Question 1411

Sgot 65

Answer 1411

Go over history of drinking

Question 1411

Sgot 65

Answer 1411

Go over history of drinking

Question 1412

Note from cardiologist

Answer 1412

Is good | RICI looks at multiple risk factors look up!

Question 1413

Decrease BP

Answer 1413

With short acting and titrable

Question 1414

Harrington rod

Answer 1414

High bleeding loss and monitor volume status and maintain perfusion pressure for spinal cord for distraction

Question 1414

Harrington rod

Answer 1414

High bleeding loss and monitor volume status and maintain perfusion pressure for spinal cord for distraction

Question 1414

Harrington rod

Answer 1414

High bleeding loss and monitor volume status and maintain perfusion pressure for spinal cord for distraction

Question 1414

Harrington rod

Answer 1414

High bleeding loss and monitor volume status and maintain perfusion pressure for spinal cord for distraction

Question 1415

High creatinine

Answer 1415

Increases cardiac risk and not filtering metabolites as well Worry about fluid clearance

Question 1416

Fiberoptic with in line

Answer 1416

Stabilization

Question 1417

Digoxin for rate control in

Answer 1417

A fib

Question 1418

Anticoagulant of a fib

Answer 1418

For neuraxial

Question 1419

Lidocaine spinal

Answer 1419

Transient neurologic symptoms

Question 1420

PA pressures go up

Answer 1420

With bome cement

Question 1421

High blood pressure can cause reduced ef

Answer 1421

Ef

Question 1422

Damage to kidneys with high

Answer 1422

Ischemic times

Question 1423

Before cross clamp

Answer 1423

Bicarb calcium lidocaine epi all that ready

Question 1423

Before cross clamp

Answer 1423

Bicarb calcium lidocaine epi all that ready

Question 1424

Graft over subclavian during dissectionso want a line on right

Answer 1424

Right

Question 1425

Diaphragm fastest onset and fastest recovery in neuromuscular blockade

Answer 1425

Last is adductor pollicus so check there and have four twitches prior to reversal

Question 1426

TOF at adductor pollicus should be

Answer 1426

.9 or more prior to reversal

Question 1426

TOF at adductor pollicus should be

Answer 1426

.9 or more prior to reversal

Question 1427

85% of receptors are still blocked at

Answer 1427

TOF of 2

Question 1428

Extubate awake

Answer 1428

Cleft lip | As airway obstruction common after

Question 1429

After positive stress test need

Answer 1429

Heart catheterization with angiography

Question 1430

MAP = CO x SVR

Question 1431

AAA with

Answer 1431

Epidural

Question 1432

Spinal cord injury can affect

Answer 1432

Diaphragm C3-C5 dermatome Vegas nerve so hard to breath

Question 1433

FEV1

Answer 1433

Volume of air forcefully expired in the first second of FVC maneuver

Question 1434

DLCO to look at

Answer 1434

Diffusing capacity of lung

Question 1435

General anesthesia increase airway resistance by reducing

Answer 1435

FRC

Question 1436

Ketamine maintains

Answer 1436

Hypoxic pulmonary construction and is a bronchodilator

Question 1437

Most pulmonary resection

Answer 1437

Limit fluids and no big fluid changes thus CVP or pa catheter not needed However CVP post op as pulmonary edema can occur

Question 1437

Most pulmonary resection

Answer 1437

Limit fluids and no big fluid changes thus CVP or pa catheter not needed

Question 1438

Atelectasis very common post thiracyomy

Answer 1438

IS, aerosolized bronchodilator, effective pain control, early postop ambulatory