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Anesthesia Board Review

Anesthesia Board Review

by gerald_libranda, Feb. 2014

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	The effects of barbiturates on ischemic areas of the brain include:	Redirection of blood flow to the ischemic areas. Barbiturates cause cerebral vasoconstriction in normal areas. These agents tend to redistribute blood flow to ischemic areas in what is sometimes referred to as a reverse steal phenomenon or Robin Hood effect. Ischemic areas remain maximally dilated and unaffected by the barbiturate.
	Venous irritation associated with the injection of diazepam and lorazepam is secondary to:	the presence of propylene glycol as a solvent The insolubility of diazepam and lorazepam in water requires that parenteral preparations contain propylene glycol, which has been associated with venous irritation.
	In patients with a history of hypertrophic cardiomyopathy, intraoperative management should include:	In patients with outflow obstruction, myocardial depression and maintenance of preload and afterload are desireable. pg. 475 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Correct statements regarding cerebral metabolism include:	The adult brain consumes about 20% of the total body oxygen (50 ml/min). Neuronal cells normally utilize glucose as their energy source, but can also utilize ketone bodies and lactate. Hyperglycemia has been shown to worsen global and focal hypoxic brain injury. pg. 615 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3) hypotension secondary to cement monomer absorption hypoxemia secondary to air embolization hypoxemia secondary to fat embolization hypocarbia decreased pulmonary artery pressure increased end-tidal carbon dioxide	During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, hypoxemia secondary to fat embolization During hip replacement surgery, hypotension associated with the use of acrylic bone cement has been attributed to absorption of methyl methacrylate monomer, embolization of air and bone marrow, lysis of red cells and marrow and conversion of methyl methacrylate to methacrylic acid. Hypoxemia is common. Embolic events cause an increase in dead space with a reduction in ETCO2 with an increase in PaCO2. pg. 1125 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.
	Maternal mortality associated with amniotic fluid embolization is: 10 - 15% 20 - 25% 40 - 45% greater than 50%	Maternal mortality associated with amniotic fluid embolization is: greater than 50% Amniotic fluid embolism is rare with a occurrence of about 1:20,000. However, it carries a very high mortality; some studies quoting as much as 86%. Mortality within the first hour after onset is about 50%. pg. 912 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Absolute contraindications to electroconvulsive therapy (ECT) include: congestive heart failure pregnancy myocardial infarction 5 months prior to therapy increased intracranial pressure	Absolute contraindications to electroconvulsive therapy (ECT) include: increased intracranial pressure Absolute contraindications to ECT include recent MI (usually < 3 months), recent stroke (< 1 month), intracranial mass, or increased ICP from any cause. Relative contraindications include angina, CHF, significant pulmonary disease, bone fractures, osteoporosis, pregnancy, glaucoma and retinal detachment. pg. 660 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	In the fetus, the percentage of cardiac output directed to the placenta is approximately: 10% 25% 50% 100%	In the fetus, the percentage of cardiac output directed to the placenta is approximately: 50% In the fetus, the lungs receive little blood flow. The placenta receives nearly one-half of the fetal cardiac output and is responsible for respiratory gas exchange. pg. 884 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	The elimination half-life of intravenously administered oxytocin in the parturient is approximately: 30 to 120 seconds 3 to 5 minutes 10 to 15 minutes 20 to 30 minutes	The elimination half-life of intravenously administered oxytocin in the parturient is approximately: 3 to 5 minutes Both endogenous and intravenously administered oxytocin have short elimination half-lives of about 3 to 5 minutes. As a result, oxytocin must be administered as a continuous infusion for the induction of labor.
	Clinically significant histamine release has been associated with the use of: vecuronium rocuronium cisatracurium atracurium	Clinically significant histamine release has been associated with the use of: atracurium Atracurium has been associated with histamine release from mast cells and can result in bronchospasm, skin flushing and hypotension.
	The therapeutic range of magnesium in the plasma in order to provide tocolysis and prevent eclamptic seizures is between: 2 to 4 mg/dL 6 to 8 mg/dL 12 to 14 mg/dL 18 to 20 mg/dL	The therapeutic range of magnesium in the plasma in order to provide tocolysis and prevent eclamptic seizures is between: 6 to 8 mg/dL pg. 884 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.
	Highly specific preoperative screening tests have a: low incidence of false-positives results low incidence of false-negative results result that is specific for one pathologic process low sensitivity	Highly specific preoperative screening tests have a: low incidence of false-positives results The usefulness of a screening test depends on its sensitivity and specificity. Sensitive tests have a low rate of false-negative results, whereas specific tests have a low rate of false-positive results. pg. 10 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Drugs that inhibit coagulation through direct inhibition of thrombin include: heparin warfarin bivalirudin aprotonin	Drugs that inhibit coagulation through direct inhibition of thrombin include: bivalirudin Bivalirudin, hirudin, lepirudin and argatroban are anticoagulants that directly inhibit thrombin. These agents are most commonly used for cardiopulmonary bypass when heparin is contraindicated. No specific reversal agent is available and termination of effect occurs as a result of renal elimination of the drug. pg. 236 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006. Heparin is a biological substance, usually made from pig intestines. It works by activating antithrombin III, which blocks thrombin from clotting blood. Heparin can be used in vivo (by injection), and also in vitro to prevent blood or plasma clotting in or on medical devices. Dosage for heparin reversal is 1mg protamine sulfate i.v. for every 100 IU of active heparin. In patients who are allergic to fish, it can cause significant histamine release resulting in hypotension and br
	Enoxaparin: causes less platelet inhibition than heparin is easily reversed with protamine has a half-life that is 35% less than that of heparin effects are monitored using the INR	causes less platelet inhibition than heparin Symptoms of overdose include hemorrhage. Protamine sulfate has been used to reverse effects (protamine 1 mg neutralizes enoxaparin 1 mg). Monitor aPTT 2-4 hours after first infusion; consider readministration of protamine (50% of original dose). Note: anti-Xa activity is never completely neutralized (maximum of 60% to 75%). Avoid overdose of protamine. Low molecular weight heparins (LMWH), such as enoxaparin, have greater activity against factor Xa than thrombin. As a result, the INR is not a reliable monitoring tool. The LMWHs cause less platelet inhibition and are associated with a lesser incidence of heparin induced thrombocytopenia. pg. 400 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.
	Termination of the effects of succinylcholine at the neuromuscular junction occurs as a result of: succinylcholine hydrolysis by acetylcholinesterase diffusion of succinylcholine away from the receptors succinylchoine hydrolysis by hepatic esterases the competition of succinylcholine with acetylcholine	Termination of the effects of succinylcholine at the neuromuscular junction occurs as a result of: diffusion of succinylcholine away from the receptors Because depolarizing muscle relaxants are not metabolized by acetylcholinesterase, they diffuse away from the neuromuscular junction and are hydrolyzed in the plasma by pseudocholinesterase.
	A occurrence malpractice insurance policy: offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed offers coverage if the policy is in place at the time the claim is filed is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy is the most common form of malpractice insurance in place today	A occurrence malpractice insurance policy: offers coverage if the policy was in place at the time of the incident, regardless of when the claim is filed An occurrence policy offers coverage of an incident resulting in a claim, whenever that claim might be filed. The much more common claims-made policy covers claims that are filed only while the insurance is in force. Umbrella coverage is activated at the time of the need to pay a claim that exceeds the limits of coverage on the standard malpractice policy. pp. 40 - 41 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.
	Ventilatory parameters that are increased during pregnancy include: tidal volume airway resistance PaCO2 bicarbonate	Ventilatory parameters that are increased during pregnancy include: tidal volume Respiratory/ventilatory effects of pregnancy include increased oxygen consumption, decreased airway resistance, decreased FRC, increased tidal volume and rate, increased PaO2, decreased PaCO2 and decreased serum bicarbonate. pp. 875 - 876 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Droperidol: has antiarrhytmic activity causes shortening of the QT interval causes peripheral vasoconstriction is effective for blood pressure control in patients with pheochromocytoma	Droperidol: has antiarrhythmic activity Droperidol has mild alpha-blocking activity and causes vasodilation and has antiarrhythmic properties with prolongation of the QT interval. As a result of the prolongation of the QT interval, droperidol has been associated with torsades de pointes and should not be given to patients with QT intervals measuring more than 440 ms. Patients with pheochromocytoma should not receive droperidol because it can induce catecholamine release.
	Type I pneumocytes: prevent the passage of albumin into the alveolus are more numerous than Type II pneumocytes produce surfactant are capable of rapid cell division	Type I pneumocytes: prevent the passage of albumin into the alveolus Type I pneumocytes are flat and form a tight junction with one another. This prevents the passage of oncotic molecules, such as albumin, into the alveolus. Type II pneumocytes are smaller, but more numerous, and produce surfactant. Unlike Type I pneumocytes, Type II pneumocytes are capable of cell division and can produce Type I pneumocytes when needed. pg. 540 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006. Type I pneumocytes (squamous alveolar cells) are responsible for gas exchange in the alveoli and cover a majority of the alveolar surface area (>95%). While type I pneumocytes account for most of the surface area, they are approximately half as numerous as type II cells, due to differences in size. Type I pneumocytes are large, thin cells stretched across a large surface area, while type II pneumocytes are smaller cells. Type I pneu
	List causes and effects of surfactant deficiency.	Pulmonary surfactant can result from the destructionof type 2 pneumatocytes or from the destruction or inactivation of surfactant. Genetic deficiencies have been described. Surfactant lines the alveolus to provide a host defense barrier and reduces alveolar surface tension preventing collapse (adhesive atelectasis). Deficiency produces diffuse loss of lung volume, shunt, and the influw of intersititial fluid resulting in impaired gas exchange. ARDS, hyaline membrane disease, pneumonia, interstitial lung diseases, alveolar proteinosis, obstructive lung disease, smoke inhalation, CABG, uremia and prolonged shallow breathing are conditions which frequently produce generalized surfactant deficiency. Pulmonary embolism and radiation pneumonitis have a similar effect localized to the affect segment of lung.
	The phrenic nerves arise from the: nucleus ambiguous C1 - C2 nerve roots C3 - C5 nerve roots C6 - T2 nerve roots	The phrenic nerves arise from the: C3 - C5 nerve roots The phrenic nerves arise from the C3 - C5 nerve roots. Unilateral phrenic nerve palsy only modestly reduces most indices of pulmonary function (about 25%). Bilateral phrenic nerve palsies produce more severe impairment, but accessory muscles may maintain adequate ventilation. Cervical cord injuries above C5 are incompatible with spontaneous ventilation. pg. 542 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Large differences between end-tidal carbon dioxide tension and arterial carbon dioxide tension can be caused by: pulmonary embolism intrapulmonary shunting atrial septal defect with left to right shunting all of the above	Large differences between end-tidal carbon dioxide tension and arterial carbon dioxide tension can be caused by: pulmonary embolism Large differences in end-tidal CO2 and PaCO2 are caused by increases in dead space, but little change is seen with increases in shunting. Intra-pulmonary and intra-cardiac shunting do not increase dead space. Conversely, pulmonary embolism produces an increase in ventilated, non-perfused lung (deadspace) and a decrease in CO2 elimination. pp. 699 - 700 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.
	Cessation of smoking 12 -24 hours prior to surgery has been shown to: (Select 2) decrease carboxyhemoglobin levels improvement in pulmonary macrophage function decrease the P50 decrease the postoperative morbidity and mortality improve mucous clearance	Cessation of smoking 12 - 24 hours prior to surgery has been shown to: decrease carboxyhemoglobin levels, improve mucous clearance Benefits from discontinuation of smoking for 12-24 hours prior to surgery include a decrease in carboxyhemoglobin levels, an increase the P50, improved mucous clearance and a decrease in plasma nicotine levels. Acute cessation of tobacco use has not been shown to improve postop morbidity or mortality. pp. 171 - 172 Hines, RL, and Marschall, KE. Stoelting's Anesthesia and Co-Existing Disease. New York and Philadelphia: Churchill Livingstone, 2008. pg. 579 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.
	During your preoperative evaluation of an 86-year-old 50 kg female for placement of a pericardial window, you discover a "Do Not Resuscitate" (DNR) order. Prior to surgery you should: inform the patient that she is not a candidate for surgery clarify the DNR order with the patient and family ignore the DNR order since it does not apply to patients having surgery report the case to your malpractice carrier	During your preoperative evaluation of an 86-year-old 50 kg female for placement of a pericardial window, you discover a "Do Not Resuscitate" (DNR) order. Prior to surgery you should: clarify the DNR order with the patient and family DNR orders regarding surgical candidates must be clarified with the patient and family prior to surgery. In addition, DNR orders must comply with hospital policies as well as federal and state laws. pg. 1022 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Factors associated with acute lung injury following thoracic surgery include: right pneumonectomy rigorous fluid restriction use of small tidal volumes with increased rate all of the above	Factors associated with acute lung injury following thoracic surgery include: right pneumonectomy Factors associated with primary ALI are: excessive intravascular volume, high ventilation pressures, right pneumonectomy and preoperative alcohol abuse. pg. 601 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	The primary mechanism of intraoperative heat loss resulting in hypothermia is: convection radiation conduction evaporation	The primary mechanism of intraoperative heat loss resulting in hypothermia is: radiation Radiation accounts for approximately 40% of intraoperative heat loss. Convection is the next most significant mechanism of loss accounting for 32%. pg. 384 Starr, M. Anesthesiology Boards: A Survival Guide. Philadelphia: Churchill Livingstone, 2000.
	Sinus arrhythmia: is mediated through sympathetic innervation of the AV node causes an increase in heart rate with inspiration is indicative of SA node ischemia is the primary cause of premature atrial contractions	Sinus arrhythmia: causes an increase in heart rate with inspiration Sinus arrhythmia is a cyclic variation in heart rate that corresponds to ventilation, increasing with inspiration and decreasing with expiration. Sinus arrhythmia is a normal cardiac rhythm and is due to cyclic changes in vagal tone. pg. 420 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	The incidence of venous air embolism during sitting craniotomies is approximately: 5 - 10% 10 - 15% 20 - 40% greater than 50%	The incidence of venous air embolism during sitting craniotomies is approximately: 20 - 40% The incidence of venous air embolism is highest during sitting crainotomies, with an incidence of 20 - 40%. Venous air embolization can occur during any procedure when the wound is above the level of the heart. pg. 638 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	The duration of action of atracurium may be prolonged by: hyperthermia respiratory alkalosis metabolic acidosis all of the above	The duration of action of atracurium may be prolonged by: metabolic acidosis Because of its unique metabolism, the Hoffman elimination, the duration of action of atracurium may be prolonged by hypothermia or acidosis. pg. 221 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in: the first 2 hours 4 to 6 hours 7 to 9 hours 12 to 14 hours	A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in: 12 - 14 hours Tumescent liposuction is commonly done with large volumes of tumescent solution consisting of normal saline with 1:1,000,000 epinephrine and 0.025 - 0.1% lidocaine. Peak serum levels of lidocaine occur 12 - 14 hours after injection and decline over the next 6 - 14 hours. pg. 1350 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.
	Opioids currently NOT approved for epidural or intrathecal use include: fentanyl sufentanil morphine remifentanil	Opioids currently NOT approved for epidural or intrathecal use include: remifentanil Remifentanil is prepared in a solution of glycine, a known inhibitory neurotransmitter. Currently remifentanil is not approved for epidural or intrathecal use. pg. 114 - 115 Stoelting, RK. Pharmacology and Physiology in Anesthetic Practice. Philadelphia: Lippincott Williams and Wilkins, 2006.
	Safety features that prevent filling of the vaporizer with an incorrect agent include: the pin index safety system agent-specific keyed filling ports the diameter index safety system counter-threading of the bottle attachment	Safety features that prevent filling of the vaporizer with an incorrect agent include: agent-specific keyed filling ports Modern vaporizers offer agent-specific keyed filling ports to prevent filling with an incorrect agent. The pin-index safety system is found on e-cylinders to prevent incorrect tank placement. pg. 66 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	A person acting as an amicus curiae: is not a party to the litigation gives expert testimony for the defense gives expert testimony for the plaintiff cannot file a written brief	A person acting as an amicus curiae: is not a party to the litigation Amicus curiae is a phrase that literally means 'friend of the court' -- someone who is not a party to the litigation, but who believes that the court's decision may affect its interest. An expert, not associated with either the defendant or plaintiff may, at the court's discretion, file a brief or give testimony to assist the court in decision making. "Amicus curiae." URL: http://en.wikipedia.org/wiki/Amicus_curiae
	The first nurse anesthetist to be appointed to a university medical school faculty was: Alice Maude Hunt Agatha Hodgen Helen Lamb Alice Magaw	The first nurse anesthetist to be appointed to a university medical school faculty was: Alice Maude Hunt In 1922, Alice Maude Hunt became an instructor in anesthesia at the Yale University School of Medicine and was later promoted to assistant professor. Hunt also pioneered the use of nitrous oxide and oxygen as an anesthetic modality. pg. 4 Nagelhout, JJ, and Zaglaniczny, KL. Nurse Anesthesia. St. Louis: Elsevier, 2005.
	Re-order the list of inhaled agents below from highest vapor pressure to lowest (Highest vapor pressure agent at top of list): * Isoflurane * Sevoflurane * Nitrous Oxide * Desflurane	Re-order the list of inhaled agents below from highest vapor pressure to lowest (Highest vapor pressure agent at top of list): Vapor Pressure of Agents At 20o C, the highest vapor pressure of the inhaled agents is possessed by nitrous oxide (38,700 mm Hg), followed by desflurane (669 mm Hg), isoflurane (238 mm Hg) and sevoflurane (157 mm Hg). pg. 415 Barash, PG, Cullen, BF, Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins, 2009.
	Pulmonary effects of α1-adrenergic stimulation include: inhibition of hypoxic pulmonary vasoconstriction bronchodilation major changes in pulmonary vascular tone decreased bronchial secretions	Pulmonary effects of α1-adrenergic stimulation include: decreased bronchial secretions The tracheobronchial tree receives sympathetic innervation form the T1 - T4 nerve roots. β2 stimulation causes bronchodilation and decreased secretions. α1 stimulation causes decreased bronchial secretions and possible bronchoconstriction. Both α- and β-adrenergic receptors are present in the pulmonary vasculature, but seem to have little effect on pulmonary vascular tone. pg. 542 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Nervous system changes seen in the pregnant patient at term include: (Select 2) increased minimum alveolar concentration increased sensitivity to local anesthetics decreased cerebrospinal fluid volume decreased cephalad spread of spinal anesthetics decreased epidural space pressure increased potential volume of the epidural space	Nervous system changes seen in the pregnant patient at term include: increased sensitivity to local anesthetics, decreased cerebrospinal fluid volume Nervous system effects of pregnancy include a decreased MAC, an increased sensitivity to local anesthetics, an increase in epidural blood volume, increased pressure of the epidural space and a decrease in spinal CSF volume. There is an increase in the cephalad spread of both spinal and epidural anesthetics. pg. 875 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Clinical signs of tension pneumothorax include: contralateral absence of breath sounds ipsilateral hyporesonance to percussion neck vein distention all of the above	Clinical signs of tension pneumothorax include: neck vein distention A tension pneumothorax develops from air entering the pleural space through a one-way valve in the lung or chest wall. Clinical signs include ipsilateral absence of breath sounds, hyperresonance to percussion, contralateral tracheal shift and distended neck veins. pg. 868 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the: hemorrhoidal veins pulmonary veins hepatic vein azygous vein	Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the: hemorrhoidal veins Chronic portal hypertension leads to the development of portal-systemic collateral channels. Four major collateral sites are commonly recognized: gastroesophageal, hemorrhoidal, periumbilical and retroperitoneal. pg. 793 Morgan, GE, Mikhail, MS, and Murray, MJ. Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006.
	A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: phenoxybenzamine doxazosin propranolol terazosin	A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: phenoxybenzamine Phenoxybenzamine is a nonselective α-antagonist used in the preoperative preparation of the patient with pheochromocytoma. Doxazosin and terazosin are selective α1-antagonists. Propranolol is a nonselective β-antagonist. In the preparation of patients with pheochromocytoma, α-blockade and intravascular volume replacement must precede β-blockade, so as to prevent the possibility of unopposed α-stimulation. pg. 1143 Barash, PG, Cullen, BF, and Stoelting, RK. Clinical Anesthesia. Philadelphia: Lippincott Williams and Wilkins, 2006.

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