UBP 1

Question 1

What is a known side effect of Amiodarone?

Answer 1

Hypotension

Amiodarone is preferred for patients with systolic heart failure as it does not depress cardiac output and can cause bradycardia.

Question 2

What is the action of Sodium nitroprusside?

Answer 2

Fast acting antihypertensive that causes arterial and venodilation

Sodium nitroprusside does not cause uterine smooth muscle relaxation unlike nitroglycerin.

Question 3

What is the lower limit of cerebral autoregulation for MAP?

Answer 3

70 mmHg

CBF decreases below a MAP of 70 mmHg.

Question 4

What is the relationship between CPP, MAP, and ICP?

Answer 4

CPP = MAP – ICP

Normal ICP is 5 to 15 mmHg.

Question 5

What is the risk associated with Desflurane compared to other anesthetics?

Answer 5

Highest risk of carbon monoxide poisoning

Ranking: Desflurane > Isoflurane > Sevoflurane.

Question 6

Which monitors can detect train of four ratios of ≥ 0.9?

Answer 6

Quantitative monitors

Examples include Mechanomyography (MMG), Electromyography (EMG), Acceleromyography (AMG), Kinemyography (KMG), and Phonomyography (PMG). Currently available are AMG, EMG, and KMG.

Question 7

What phenomenon can occur with nitrous oxide?

Answer 7

Diffusion hypoxia

This can lead to hypoventilation and oxygen desaturation.

Question 8

What should be done for patients requiring hemodialysis when prescribing Methadone?

Answer 8

Decrease the dose by 25 to 50 percent

Methadone is safe for dialysis patients and not removed by hemodialysis.

Question 9

Which opioids are considered safest for renal patients?

Answer 9

Alfentanil, fentanyl, methadone, remifentanil, sufentanil

These drugs do not have active metabolites.

Question 10

How does Etomidate undergo elimination?

Answer 10

Hepatic ester hydrolysis

Recovery from a bolus dose of etomidate is rapid and results from redistribution.

Question 11

What cardiac effects are associated with hypercalcemia?

Answer 11

Shortening of the QT interval and PR prolongation

Question 12

What effect do volatile anesthetics have on the QT interval?

Answer 12

They prolong the QT interval

This is particularly pertinent in patients who already have a prolonged QT interval.

Question 13

What is a significant effect of nitrous oxide on vascular resistance?

Answer 13

Increases in SVR and PVR

This effect is due to its sympathomimetic action.

Question 14

Do currently used volatile anesthetics sensitize the myocardium to epinephrine?

Answer 14

No

Unlike halothane, which increases the risk of arrhythmia due to increased cardiac sensitivity to epinephrine.

Question 15

What is the effect of volatile anesthetics on renal function?

Answer 15

Decrease GFR, RBF, and intraoperative urine flow

Renal autoregulation is preserved.

Question 16

What effect does Ketamine have on renal blood flow and urine flow rate?

Answer 16

Increases RBF but decreases urine flow rate

This is likely due to sympathetic activation.

Question 17

What is one method to preoxygenate a patient?

Answer 17

Tidal volume breathing for 3 to 5 minutes

Vital capacity breathing is also an effective method.

Question 18

What is the most important mechanism of preoxygenation?

Answer 18

Denitrogenation of the FRC

The FRC is the greatest oxygen storage site during preoxygenation.

Question 19

What happens to CBF with increasing doses of volatile agents?

Answer 19

Cerebral autoregulation is impaired

CBF significantly increases above 1 MAC.

Question 20

What is the effect of a bolus dose of etomidate?

Answer 20

Hyperventilation followed by apnea

Question 21

What nerve is associated with the ulnar nerve?

Answer 21

Medial cord

Question 22

What is the most commonly reported side effect of droperidol?

Answer 22

Drowsiness

Other side effects include hypotension and tachycardia due to mild alpha-adrenergic blockade.

Question 23

What does V1 receptor stimulation cause?

Answer 23

Splanchnic, renal, and cutaneous vasoconstriction

Low dose vasopressin can be used for antidiuretic effect via renal V2 receptors.

Question 24

What is the primary nerve involved in the afferent limb of the chemoreceptor reflex?

Answer 24

Nerve of Hering

Question 25

What type of NMBD is Vecuronium considered in infants and neonates?

Answer 25

Long acting NMBD ## Footnote Compared to children and adults.

Question 26

What ECG abnormalities are associated with hypomagnesemia?

Answer 26

* Prolonged PR * Prolonged QT * Wide QRS * ST segment abnormalities (e.g. inverted T-wave) * Ventricular arrhythmia (e.g. Torsades de pointes) ## Footnote Similar to hypocalcemia and hypokalemia.

Question 27

What effect do OCP and pregnancy have on butyrylcholinesterase levels?

Answer 27

Decrease ## Footnote No association with myasthenia gravis (MG).

Question 28

Which nerves provide sensation to the anterior and medial thigh?

Answer 28

* Medial femoral cutaneous nerve * Intermediate femoral cutaneous nerve * Lateral femoral cutaneous nerve ## Footnote Terminates as the saphenous nerve supplying the medial leg, ankle, and foot.

Question 29

What does the sciatic nerve supply?

Answer 29

Posterior compartment of the thigh (hamstrings) ## Footnote The obturator nerve provides motor innervation to hip adductors.

Question 30

Which coagulation factors are not produced by the liver?

Answer 30

* Factor III (tissue thromboplastin) * Factor IV (calcium) * Factor VIII * von Willebrand factor ## Footnote All other coagulation factors are produced by the liver.

Question 31

What is the role of insulin in hypertriglyceridemia treatment?

Answer 31

Promotes synthesis of lipoprotein lipase ## Footnote Hydrolyzes triglycerides into fatty acids and glycerol.

Question 32

What is the current standard of care for VAR detection?

Answer 32

Precordial Doppler combined with ETCO2 ## Footnote Cost effective, easy to use, and non-invasive.

Question 33

Sodium bicarbonate is useful for treating which type of metabolic acidosis?

Answer 33

Non-anion gap metabolic acidosis ## Footnote Example: Hyperchloremic metabolic acidosis.

Question 34

During which phase does right ventricular perfusion occur?

Answer 34

Both systole and diastole ## Footnote Left ventricular perfusion occurs only during diastole.

Question 35

How is the Anion Gap calculated?

Answer 35

Anion Gap = Sodium – (Chloride + Bicarb) ## Footnote Corrected AG = Calculated AG + 2.5 x (Normal Albumin – Measured Albumin).

Question 36

What is Toremifene's effect on sugammadex?

Answer 36

High binding affinity and may displace rocuronium and vecuronium ## Footnote Important in anesthetic management.

Question 37

What does Angiotensin II stimulate via the AT1 receptor?

Answer 37

* Cell growth and proliferation * Catecholamine release * Vasoconstriction ## Footnote Important in the regulation of blood pressure.

Question 38

What type of needle is a Whitacre needle?

Answer 38

Non-cutting (Pencil point) needle ## Footnote Lower incidence of post-dural puncture headache compared to cutting needles.

Question 39

What can acute contrast nephropathy lead to?

Answer 39

Decreased FENa via renal vasoconstriction ## Footnote When not progressed to ATN.

Question 40

What is the normal anion gap value?

Answer 40

12 +/- 2 ## Footnote Important for diagnosing metabolic acidosis.

Question 41

What is the rate limiting step in catecholamine synthesis?

Answer 41

Transformation of tyrosine to DOPA ## Footnote Catalyzed by tyrosine hydroxylase; inhibiting it decreases dopamine, norepinephrine, and epinephrine.

Question 42

What are the primary uses of dihydropyridine calcium channel blockers?

Answer 42

* Hypertension * Coronary vasospasm ## Footnote They cause arterial dilation but not venodilation.

Question 43

What does Mannitol do in the renal system?

Answer 43

Inhibits water reabsorption (Osmotic diuresis) ## Footnote Main site of action is the proximal convoluted tubule.

Question 44

What state cannot be achieved with opioids?

Answer 44

Isoelectric state (burst suppression) ## Footnote Unlike barbiturates, etomidate, inhalational agents, and propofol.