TL Deck 1

Question 1

What is the most common side effect of inhaled albuterol?

Answer 1

Tachycardia. It can also cause PVCs, hypokalemia (via intracellular K⁺ shifts), and hypotension.

Question 2

What does a low blood:gas coefficient indicate about an inhaled anesthetic?

Answer 2

It has a fast onset and offset (low solubility).

Question 3

What blood products can be safely administered through a fluid warmer?

Answer 3

fBRc, FFP, platelets, and cryoprecipitate.

Question 4

What temperature defines hypothermia?

Answer 4

<35°C.

Question 5

Describe the afferent and efferent limbs of the laryngospasm reflex.

Answer 5

Afferent: internal branch of superior laryngeal nerve. Efferent: recurrent laryngeal and external branch of superior laryngeal nerve.

Question 6

What is the anatomical relationship of the popliteal artery and vein to the semitendinosus tendon?

Answer 6

Artery is lateral to the tendon; vein is superficial and lateral to the artery.

Question 7

How does norepinephrine affect the cardiovascular system?

Answer 7

α1 > α2 > β1 → vasoconstriction → ↑ BP & CO → reflex bradycardia modulated by ↑ SV & contractility.

Question 8

How is plasma osmolality calculated?

Answer 8

Posm = (2 × Na⁺) + (glucose / 18) + (BUN / 2.8); normal ≈ 290 mOsm/kg.

Question 9

Which drug has been shown to reduce perioperative AKI in CPB patients?

Answer 9

Dobutamine (not dopamine or fenoldopam).

Question 10

What labs are used in the MELD score?

Answer 10

Creatinine, bilirubin, INR, sodium, dialysis frequency. Mnemonic: I Crush Seven Beers Daily.

Question 11

What immune mechanism causes contact dermatitis?

Answer 11

T-cell mediated (delayed-type hypersensitivity).

Question 12

What is the function of nitric oxide in the vasculature?

Answer 12

Vasodilation and inhibition of platelet aggregation (short half-life, seconds).

Question 13

What is a Type I and Type II statistical error?

Answer 13

Type I: false positive (rejecting a true null). Type II: false negative (accepting a false null).

Question 14

What is the most accurate method to confirm venous placement before CVL dilation?

Answer 14

Pressure waveform monitoring.

Question 15

How does succinylcholine affect intraocular pressure (IOP)?

Answer 15

↑ IOP by 6–8 torr within 1–4 mins; returns to baseline in 5–7 mins. Blinking ↑ IOP by 10–15 torr.

Question 16

How do local anesthetics work?

Answer 16

Bind voltage-gated Na⁺ channels → block Na⁺ influx → inhibit action potential propagation.

Question 17

What are the effects of dexmedetomidine on the brain and respiration?

Answer 17

α2 agonist at locus coeruleus/spinal cord → sedation, analgesia, ↓ CBF & CMRO₂. Preserves respiratory drive, but ↓ TV & minute ventilation.

Question 18

What anesthetic and drug increase the risk of postoperative shivering?

Answer 18

High-dose remifentanil and sevoflurane.

Question 19

What is the initial dose of lipid emulsion for LAST?

Answer 19

1.5 mL/kg bolus of 20% lipid emulsion, then 0.25 mL/kg/min infusion.

Question 20

How is cisatracurium eliminated?

Answer 20

Hofmann elimination; increased with higher pH and temperature.

Question 21

Which reflexes are lost with neuromuscular blockers?

Answer 21

Corneal, oculocephalic, and gag reflexes; light reflex remains.

Question 22

Why is midazolam dosed lower in uremia?

Answer 22

Decreased protein binding increases free drug fraction.

Question 23

How does normal saline compare to human plasma osmolality?

Answer 23

NS is hyperosmolar; LR is hypoosmolar; Plasma-Lyte is iso-osmolar.

Question 24

What is the Armitage formula for epidural volume dosing?

Answer 24

0.5 mL/kg for lumbosacral, 1 mL/kg for thoracolumbar, 1.25 mL/kg for mid-thoracic.

Question 25

Name the nerve sheath layers from inner to outer.

Answer 25

Endoneurium (axons), perineurium (fascicles), epineurium (nerve).

Question 26

What is clevidipine's mechanism and metabolism?

Answer 26

Arteriolar vasodilation; rapidly metabolized by plasma and RBC esterases.

Question 27

Why do infants need higher doses of water-soluble drugs?

Answer 27

They have higher total body water (~80%).

Question 28

Most common side effect of amiodarone?

Answer 28

Bradycardia due to calcium channel blocking.

Question 29

How does epinephrine affect renal blood flow?

Answer 29

Decreases RBF without affecting GFR.

Question 30

How do benzodiazepines affect CO2 response?

Answer 30

Blunt ventilatory response to hypercapnia (decrease slope of CO2 response curve).

Question 31

What are IV:oral alpha:beta block ratios of labetalol?

Answer 31

IV 1:7, oral 1:3.

Question 32

Why use dexamethasone for peritumoral edema?

Answer 32

Decreases BBB permeability and tumor size.

Question 33

What is the risk of meperidine in renal failure?

Answer 33

Seizures due to accumulation of normeperidine.

Question 34

What is metoclopramide’s MOA for aspiration prophylaxis?

Answer 34

Dopamine antagonist; increases gastric emptying and LES tone.

Question 35

What does a Class 3 upper lip bite test predict?

Answer 35

Difficult intubation; >60% chance.

Question 36

How to manage vasopressor extravasation?

Answer 36

Elevate limb, warm compress, saline irrigation, phentolamine, stellate block.

Question 37

How does obesity affect lung volumes?

Answer 37

↓ ERV, ↓ FRC, ↑ RR, ↓ TV; restrictive pattern.

Question 38

What is the pressure:volume ratio of an O2 E-cylinder?

Answer 38

3:1 (2000 psi ≈ 625 L).

Question 39

What does a Uosm:Posm ratio >1.5 indicate?

Answer 39

Prerenal oliguria (e.g. dehydration).

Question 40

Why supplement intercostobrachial block in upper limb surgery?

Answer 40

Prevents tourniquet pain missed by brachial plexus block.

Question 41

Normal intracardiac pressures?

Answer 41

RA 1-10, RV 15-30/0-8, LA 8-10, LV 90-140/4-12 mmHg.

Question 42

Mnemonic for GCS components?

Answer 42

EVM: Eyes 4, Verbal 5, Motor 6.

Question 43

What electrolyte state requires higher NMB doses?

Answer 43

Hypercalcemia.

Question 44

Which muscles are last recruited during resp failure?

Answer 44

Paravertebral and large back muscles.

Question 45

Where does artery of Adamkiewicz originate?

Answer 45

Left aorta, T9–L2; supplies lumbar/sacral spinal cord.

Question 46

What AChR subunit defines immature junctions?

Answer 46

γ replaces ε; seen in burns, sepsis, denervation.

Question 47

What percent of TBW is intravascular space?

Answer 47

8% of TBW; 1/4 of ECF.

Question 48

What opioid risk is increased with MAOIs?

Answer 48

Meperidine → serotonin syndrome.

Question 49

Define pharmacodynamics vs. pharmacokinetics.

Answer 49

Pharmacodynamics = drug effect on body; kinetics = body's effect on drug.

Question 50

What treats opioid-induced pruritus?

Answer 50

Nalbuphine or naltrexone.

Question 51

What converts codeine to morphine?

Answer 51

CYP2D6 via O-demethylation.

Question 52

How is succinylcholine metabolized?

Answer 52

By plasma pseudocholinesterase after diffusion from NMJ.

Question 53

How does lithium affect NMBs?

Answer 53

Potentiates both depolarizing and nondepolarizing NMBs.

Question 54

Which drugs lower MAC or prolong NMB?

Answer 54

Hypothermia, CCBs, antibiotics, magnesium, lithium, diuretics.

Question 55

Context-sensitive half-time of ketamine?

Answer 55

Similar to propofol.

Question 56

What does high blood:gas coefficient mean?

Answer 56

High solubility → slow onset.

Question 57

Dexmedetomidine CV effects?

Answer 57

Bolus: HTN; infusion: bradycardia, hypotension.

Question 58

Most common anesthesia-related errors?

Answer 58

Labeling, incorrect dosing, omission.

Question 59

What is the Parkland burn formula?

Answer 59

4 mL × kg × %TBSA. Give ½ in first 8 hrs, ½ in next 16 hrs.

Question 60

Which nerves injured by LMA use?

Answer 60

Lingual, hypoglossal, recurrent laryngeal.

Question 61

Minimum PACU monitoring?

Answer 61

Every 15 minutes.

Question 62

Steps in aspiration management?

Answer 62

100% O2, deepen anesthesia, Trendelenburg, suction.

Question 63

Effect of lorazepam premedication?

Answer 63

Prolongs extubation, no improvement in satisfaction.

Question 64

What is the half-life and metabolism of labetalol?

Answer 64

6 hours; metabolized via hepatic oxidation and glucuronidation.

Question 65

Do neuromuscular blocking agents interfere with evoked potential monitoring?

Answer 65

No, they do not significantly impact evoked potentials.

Question 66

What medication improves platelet dysfunction in uremic patients perioperatively?

Answer 66

Desmopressin (DDAVP).

Question 67

What determines the spread of epidural anesthesia to a desired dermatome? (2)

Answer 67

Volume of local anesthetic and capacitance of epidural space (inversely related to age).

Question 68

How are most calcium channel blockers metabolized?

Answer 68

By hepatic cytochrome P450 enzymes.

Question 69

What are key side effects and mechanisms of action of amiodarone?

Answer 69

AV block, QTc prolongation; blocks K⁺ channels → prolongs repolarization

Question 70

What makes amiodarone a good choice for patients with reduced EF?

Answer 70

It lacks negative inotropic effects.

Question 71

What are the causes of peritumor cerebral edema? (3)

Answer 71

Multifactorial: hydrocephalic (membrane leak), vasogenic (CSF obstruction), static (venous stasis from compression).