TL Deck 2

Question 1

What is the effect of preop clonidine on anesthesia?

Answer 1

Decreases MAC but increases risk of bradycardia and hypotension.

Question 2

What are key treatments for venous air embolism (VAE)?

Answer 2

Flood surgical field with saline, place patient head-down, compress jugular veins.

Question 3

What is the insulin-dextrose treatment for hyperkalemia?

Answer 3

10 units IV insulin + dextrose unless glucose ≥250 mg/dL; lowers K+ by 0.5-1 mEq/L.

Question 4

How does ketorolac affect renal function?

Answer 4

Inhibits afferent renal vasodilation, reducing GFR, especially after 5+ days.

Question 5

Does epinephrine addition change local anesthetic onset?

Answer 5

No significant effect on block onset time.

Question 6

What factors increase the onset of local anesthetics? (3)

Answer 6

↑ Concentration, lipid solubility, pH; ↓ pKa.

Question 7

What is a common response to a second dose of succinylcholine?

Answer 7

Bradycardia, especially in children due to muscarinic receptor activation.

Question 8

What limits flumazenil effectiveness long-term?

Answer 8

Short half-life can cause benzodiazepine sedation to recur.

Question 9

Which central line has higher infection risk?

Answer 9

Nontunneled central venous catheters.

Question 10

Why is pulse oximetry limited on 100% oxygen?

Answer 10

Poor indicator of ventilation.

Question 11

What does Poiseuille’s law say about flow in vessels?

Answer 11

Flow ∝ radius^4; radius has greatest impact.

Question 12

Why are newer CO2 absorbents safer?

Answer 12

Lack strong bases that produce CO with volatile agents.

Question 13

What % receptor occupancy reduces TOF count?

Answer 13

About 70%.

Question 14

How does fresh gas flow affect rebreathing?

Answer 14

↓ FGF = ↑ rebreathing, ↓ waste gas scavenging.

Question 15

What is the defining feature of a closed circle system?

Answer 15

FGF matches metabolic demand; no scavenging required.

Question 16

Do Cobra and Tulip airways protect against aspiration?

Answer 16

No; they are cuffed pharyngeal sealers without esophageal occlusion.

Question 17

Most important factor for spinal block level?

Answer 17

Baricity (e.g. hyperbaric bupivacaine).

Question 18

How is a local anesthetic made hyperbaric?

Answer 18

By adding dextrose.

Question 19

Signs of thoracic duct injury after CVC?

Answer 19

ipsilateral supraclavicular swelling, unilateral pleural effusion, rising ventilator pressures.

Question 20

Where are cardiac parasympathetic fibers found?

Answer 20

SA and AV nodes; they affect chronotropy.

Question 21

Which local anesthetics are most affected by epinephrine?

Answer 21

Lidocaine, mepivacaine, and chloroprocaine.

Question 22

How long should clopidogrel be held before neuraxial block?

Answer 22

5–7 days.

Question 23

Why does etomidate cause injection pain?

Answer 23

Hyperosmolarity; prevent with lidocaine, fast injection, large vein.

Question 24

What side effect does normeperidine have?

Answer 24

CNS stimulation: myoclonus and seizures.

Question 25

What is the intracellular concentration of potassium?

Answer 25

157 mOsm/L.

Question 26

What EEG pattern is seen in sedation?

Answer 26

Alpha waves (8–13 Hz), BIS 65–85.

Question 27

Formula for pulmonary vascular resistance (PVR)?

Answer 27

PVR = [(PA mean - PCWP) / CO] * 80.

Question 28

How is vascular resistance calculated?

Answer 28

Resistance = Pressure / Flow (Poiseuille’s Law).

Question 29

How does metabolic acidosis affect CO2 curve?

Answer 29

Left shift without slope change.

Question 30

Why are infants prone to bradycardia on laryngoscopy?

Answer 30

Predominant parasympathetic tone.

Question 31

Best marker of liver synthetic function?

Answer 31

INR or PT, reflects factor VIIa (short half-life).

Question 32

What are ketone bodies and when are they formed?

Answer 32

Formed from free fatty acids during fasting; used by brain.

Question 33

How does nitrous oxide provide anesthesia and analgesia? (3)

Answer 33

NMDA inhibition, μ-receptor activation, GABA-A activation.

Question 34

What is mannitol’s effect in heart failure?

Answer 34

Increases BP, CO, and PCWP.

Question 35

Main cardiac risks of prolonged propofol? (5)

Answer 35

Bradycardia, acidosis, lipidemia, rhabdomyolysis, acute heart failure. | Prop acts as a direct/indirect myocardial depressant

Question 36

What is ED95 in neuromuscular blockade?

Answer 36

Dose that produces 95% twitch block in 50% of individuals.

Question 37

Which volatile agent potentiates NMBs most?

Answer 37

Desflurane > sevoflurane > isoflurane > halothane.

Question 38

What is sevoflurane metabolized into?

Answer 38

Inorganic fluoride and hexafluoroisopropanol.

Question 39

What makes diltiazem unique among CCBs?

Answer 39

Acts on cardiac and smooth muscle; ↓ PVR and coronary vasodilation. | Aacts as both a vasodilator and a cardiac depressant with little-to-no r

Question 40

What defines hypertensive urgency pre-op?

Answer 40

BP >180/110 mmHg without end-organ damage.

Question 41

Which anesthetics cause methemoglobinemia?

Answer 41

Benzocaine, prilocaine (dose dependent), lidocaine, tetracaine.

Question 42

Which opioid is metabolized by plasma esterases?

Answer 42

Remifentanil.

Question 43

What maintains hepatic perfusion in buffer response?

Answer 43

Portal flow modulates hepatic artery via adenosine.

Question 44

What is the hepatic O2 supply ratio?

Answer 44

Portal vein 75% of flow, 50% O2; hepatic artery 25% flow, 50% O2.

Question 45

Which hormones affect hepatic/portal vasculature?

Answer 45

Glucagon (vasodilation), Ang II & vasopressin (vasoconstriction).

Question 46

How to estimate time to desaturation during apnea?

Answer 46

[FRC ÷ O2 consumption] * %O2 in FRC.

Question 47

How does PaCO2 regulate CBF?

Answer 47

↑ PaCO2 → ↓ CSF pH → vasodilation via prostaglandins and NO.

Question 48

How does CSF pH affect ventilation?

Answer 48

Acts on central chemoreceptors in medulla. | CBF decreases 1 to 2 mL/100 g/min for each 1 mmHg decrease in PaCO2.

Question 49

What causes phase 2 of cardiac action potential?

Answer 49

Ca2+ influx via L-type calcium channels.

Question 50

What are signs of cerebellar dysfunction? (3)

Answer 50

Intention tremor, dysarthria, nystagmus.

Question 51

What is the final step in ammonia elimination?

Answer 51

Conversion to urea in liver.

Question 52

What are signs of hepatic encephalopathy?

Answer 52

Asterixis and confusion due to hyperammonemia.

Question 53

How does pH affect calcium binding?

Answer 53

Alkalosis ↑ binding (↓ ionized Ca); acidosis ↓ binding.

Question 54

How does protein binding affect hepatic metabolism?

Answer 54

↑ Binding = ↓ clearance; binding is ↓ in liver/renal disease.

Question 55

Which conditions increase plasma protein levels? (3)

Answer 55

Obesity, pregnancy, burns.

Question 56

How does nitrous oxide cause bowel distention?

Answer 56

Longer administration and higher concentration.

Question 57

What phase block is potentiated by neostigmine?

Answer 57

Phase I; neostigmine may antagonize phase II.

Question 58

What is hepatorenal syndrome?

Answer 58

Renal splanchnic vasodilation → hypoperfusion from portal HTN

Question 59

What is the Meyer-Overton rule?

Answer 59

Anesthetic potency ∝ lipid solubility in olive oil.

Question 60

What can cause hoarseness after intubation?

Answer 60

Arytenoid subluxation; risk ↑ with poor muscle relaxation.

Question 61

How does dexmedetomidine affect CO2 response?

Answer 61

Preserves hypercapnic response; good for OSA/hypoventilation.

Question 62

What are systemic effects of dexmedetomidine? (4)

Answer 62

Sedation, analgesia, bradycardia, ↓ CBF, mimics non-REM sleep.

Question 63

How does aspirin inhibit platelets?

Answer 63

Irreversibly blocks COX → ↓ thromboxane A2.

Question 64

What do prostacyclins do?

Answer 64

Vasodilation and platelet activation (not aggregation).

Question 65

Main lung immune cells?

Answer 65

Pulmonary alveolar macrophages; neutrophils in smokers or lung injury.

Question 66

Treatment for vasopressor extravasation? (4)

Answer 66

Hyaluronidase, phentolamine, saline irrigation, stellate block.

Question 67

Most common periop nerve injury?

Answer 67

Ulnar nerve; avoid elbow flexion, pad medial epicondyle.

Question 68

Best predictors of fluid responsiveness?

Answer 68

Dynamic measures: SVV >13%, PPV. ## Footnote static measures; (CVP) and pulmonary artery occlusion pressure are inadequate

Question 69

What defines posterior ischemic optic neuropathy (PION)?

Answer 69

Sudden Bilateral painless vision loss, afferent defect, no disc edema (distinguishing factor).