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38 Cards in this Set
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A healthy teenager is undergoing awake arthroscopic shoulder surgery in the sitting position under an interscalene block. He becomes hypotensive and profoundly bradycardic; you surmise he is having a vagal reflex response and appropriately treat him with atropine. Which of the following is the most likely location of the receptors for the afferent pathway of this reflex? Carotid bodies Carotid sinus LV wall Lower extremity veins |
LV wall The Bezold-Jarisch reflex responds to noxious ventricular stimuli sensed by chemoreceptors and mechanoreceptors within the LV wall by inducing a triad of hypotension, bradycardia, and coronary artery dilation. The BJ reflex has also been postulated to play a role in syncope w/ myocardial reperfusion and during neuraxial anesthesia. |
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Which of the following types of ETTs is LEAST appropriate for use with airway surgery using a CO2 laser? Silicone-based Red rubber PVC Metal-wrapped |
PVC Metal-wrapped tubes are most resistant to fire. Red rubber and silicone are equally resistant, but not as resistant as metal. |
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Which of the following is most suggestive of a diagnosis of sodium nitroprusside (SNP) toxicity? Methemoglobin levels >30% Metabolic alkalosis Elevated mixed venous oxygen Peripheral cyanosis |
Elevated mixed venous oxygen SNP toxicity is caused by cyanide and thiocyanate resulting in a triad: Elevated mixed venous O2 SNP tachypylaxis Metabolic acidosis Cyanide toxicity occurs due to interference w/ cellular oxidative phosphorylation (inhibiting cytochrome C oxidase), thereby causing anaerobic metabolism. (B) This generates lactic acid = metabolic acidosis. Because of anerobic metabolism, O2 isn't used and PVO2 becomes elevated. (C) Skin appears bright pink because of the increased PVO2. (D) Treatment = Amyl nitrate works an antidote for cyanide poisoning by converting Hb to MetHb which avidly binds cyanide, converting it to the nontoxic cyanomethemoglobin. |
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A patient paralyzed with coruronium one hour ago is monitored with a twitch monitor applied to her ulnar nerve. When a tetanic stimulus is applied, her adductor pollicis muscle initially contracts but then fades. Which of the following is correct in regards to her tetanic fade? It blunts the effect of a single twitch applied immediately after It is due to blockade of pre-junctional receptors It is primarily caused by a phase I block It can be prevented by pre-administration of IV local anesthetics such as IV lidocaine |
It is due to blockade of pre-junctional receptors Train of four fade and tetanic fade are due to blockade of a3B2 prejunctional receptors. The a3B2 is blocked by non-depolarizing blockers but not by Succs. When these receptors are blocked, the positive feedback is lost and repetitive or continuous stimulation causes a progressive decline in acetylcholine release and muscle response. This results in fade with non-depolarizers, but not depolarizers. |
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Which of the following is NOT an expected side effect of TPN? Hepatic steatosis Hypercarbia Hyperglycemia Hypernatremia |
Hypernatremia Sodium fluctuations are not commonly seen with TPN. Most common metabolic changes seen are: Hypercarbia, Hyperglycemia, Hypophosphatemia, Hypokalemia, Hypomagnesemia, Hyperinsulinemia. Hepatic steatosis occurs due to hyperglycemia. The excess sugar is converted into fats in the liver. (A) |
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Which of the following best describes the airway management of a patient with Pierre Robin syndrome? Awake supraglottic airway placement prior to induction. Early tracheostomy is recommended. Intubation becomes more difficult as the patient gets older. Muscle relaxation is necessary to mask ventilate. |
Awake supraglottic airway placement prior to induction. Pierre-Robin can cause severe obstruction while supine, requiring supraglottic airway prior to induction. These patient's have a posteriorly situated tongue which creates a ball valve effect when supine, leading to obstruction. Treacher-Collins syndrome patients become more difficult to ventilation with age (C) |
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A 35 yo F w/ myotonic dystrophy is about to undergo a lap tubal ligation. Which of the following is safe for use in this patient? Acetaminophen 1/2 NS + 40 mEq K Neostigmine Succinylcholine |
Acetaminophen Pts w/ myotonic dystrophy can develop hyperkalemia following severe myotonia as a result of muscle damage and rhabdo. Therefore, you should avoid extra K if possible. Neostigmine can lead to myotonic crisis due to increased acetylcholine. Succs can also cause myotonic crisis. |
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A pt with ESLD presents to the ED after MI. The patient is noted to be bleeding from all IV insertion sites. Which of the following lab values would be most helpful in determining the cause of the pt's bleeding? Albumin D-Dimer Factor VIII Platelet count |
Factor VIII In this question, one must decipher between DIC and ESLD coagulopathy. Typically, D-dimer is more specific to DIC, but in ESLD, Factor VIII levels would be the more appropriate test to determine the cause of bleeding. In ESLD, D-dimer will always be high, but Factor VIII levels are normal or elevated. If the patient has ESLD with DIC, then the Factor VIII levels would be consumed and be LOW. Albumin is helpful in determining the synthetic function of the liver. D-dimer is elevated in DIC and ESLD. Factor VIII is elevated or prolonged in ESLD, but decreased in DIC. PLTs are decreased in both DIC and ESLD. |
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Which of the following is NOT an expected change in a person who has been at high altitude for two months? Right shift in oxyhemoglobin dissociation curve Increased risk of blood clots Increased cardiac output Increase in minute ventilation |
Increased cardiac output Cardiac output will initially change, but will acclimate and return to normal when Hgb acclimates. The right shift of the dissociation curve occurs due to increased RR due to decreased partial pressure of O2. The increased RR causes alkalosis, which increases 2,3 DPG. This causes a right shift. (A) Increased hematocrit in order to acclimate causes increased blood clots (B). Minute ventilation increases to increase O2 delivery to the tissues (D) |
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Which of the following anesthetics is metabolized to hexafluoroisopropanol by the liver? Dexflurane Halothane Isoflurane Sevoflurane |
Sevoflurane Oxidative metabolism of sev in the liver by P450 enzymes results in hexafluoroisopropanol. |
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Which of the following is least appropriate for managing TBI in the ICU? Maintain CPP between 50-70 mmHg Maintain ICP <20 mmHg Maintain PaCO2 between 25-30 mmHg Maintain normothermia or mild hypothermia |
Maintain PaCO2 between 25-30 mmHg Goals of TBI treatment in the ICU include: CPP between 50-70 ICP <20 Normothermia to hypothermia Maintain PaCO2 WNL (35-40) Maintaining PaCO2 between 25-30 has actually been shown to worsen cerebral hypoxic damage |
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Which of the following is not a risk factor for heparin resistance? ATIII levels <60% of normal PLT count <150,000 Preoperative heparin therapy Use of low molecular weight heparin |
PLT count <150,000 PLT count >300,000 is a risk factor for heparin resistance Heparin resistance is defined as an ACT <480 after 500 u/kg of heparin are administered or ACT <400 at any time during CPB Risk factors for heparin resistance: ATIII <60% PLT >300,000 Preoperative heparin Use of LMWH Age >65 |
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Which of the following parameters is least useful for distinguishing MH from thyroid storm? ET CO2 HR Potassium Temp |
HR Tachycardia is universal in both MH and thyroid storm (TS). MH can be distinguished from TS by the presence of MUSCLE RIGIDITY, rate of EtCO2 rise (MH >> TS), temp increase (MH greater and faster than TS), degree of HTN (TS>MH). Lab differences: MH = Hyperkalemia, myoglobinemia/uria, elevated CK, lactic acidosis. |
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A patient presents 5 months after an ankle injury. She has swelling of her foot, decreased hair growth, and a stiff ankle. If she had presented with severe pain 2 months after her accident, which of the following signs and symptoms would NOT be expected? Ankle stiffness Muscle atrophy Purple or red skin Rapid hair growth. |
Muscle atrophy Muscle atrophy associated w/ complex regional pain syndrome (CRPS) type I is not seen until 6 months after an injury. CRPS Type I is asociated w/ dysregulation of the autonomic nervous system and is typically precipitated by a non-nerve related injury or surgery. When there is a nerve-related injury, the diagnosis is CRPS type II. Stage 1 of CRPS (1-3 months): Severe, burning pain, M spasms, joint stiffness, rapid hair growth, skin redness Stage 2 (3-6 months): Intensifying pain, swelling, decreased hair growth, brittle nails, softened bones, stiff joints, weak muscle tone. Stage 3 (>6 months): Changes no longer reversible, muscle atrophy, limited ROM, contortion of the limbs, involuntary contractions. |
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Which of the following anesthetic techniques is best for a cervical cerclage in a 19 yo F w/ a dilated cervix and bulging membranes during her second trimester? Epidural General Pudendal nerve block with sedation Spinal |
General GA is preferred when there is evidence of cervical dilation, especially w/ bulging membranes. The goal is to prevent increases in intraabdominal pressures |
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FGF must be equal to at least which of the following parameters to prevent rebreathing during spontaneous ventilation while using a Mapleson A circuit? MV TV VC 2x MV |
MV FGF must be 1-2x the MV in the Mapleson E system in order to prevent rebreathing in controlled ventillatory patients |
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Which of the following statements is most likely true? In order to perform a successful block, the perineurium must be penetrated by the needle. Needle placement and injection of local anesthetic within the epineurium is considered an extraneural block, as long as the perineurium is not penetrated. The endoneurium is the last connective tissue layer a local anesthetic would penetrate prior to reaching the axon. The perineurium is the outer most connective tissue layer of the peripheral nerve. |
The endoneurium is the last connective tissue layer a local anesthetic would penetrate prior to reaching the axon. Local anesthetic passes through epineurium, perineurium, and endoneurium. Successful block is placement of LA within the adventitia surrounding the epineurium. (A,B,D) |
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Which of the following criteria will most likely predict reduced morbidity and mortality following pneumonectomy? FEV1 of 1.7 liters FEV1/FVC ratio of 35% Maximum voluntary ventilation of 70% predicted DLCO of 35% |
Maximum voluntary ventilation of 70% predicted MVV of >50% of predicted is associated with good prognosis after pneumonectomy. Predictors of INCREASED morbidity & mortality: PaO2 <50 PaCO2 >45 FVC <50% FEV1 <2L (A) FEV1/FVC <50% (B) MVV <50% DLCO of <50% (D) |
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Which of the following approximates the percentage of acetylcholine receptors occupied by rocuronium if there are 2 twitches on TOF? <10 40-50 65-75 80-90 >90 |
80-90 1 twitch = >90 2 twitch = 80-90 3 twitch = 70-80 4 twitch = 65-75 |
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A pt has a BP 113/71, HR 124, RR 14, Temp 38.4, and wBC 11,000. Which of the following is the best diagnosis? Septic shock Severe sepsis Sepsis SIRS |
SIRS Pt has Temp, HR, RR, and WBC but no suspected source (not sepsis) Severe sepsis is associated w/ lactic acidosis, oliguria, or AMS (all signs of organ dysfunction) Septic shock is hypotension after fluid bolus attempts. |
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Which of the following is a characteristic of dexmedetomidine? Excreted unchanged in the urine No need to reduce doses in pts w/ renal or hepatic failure Sedation anxiolysis an no analgesia Terminal 1/2 life of 2 hours |
Terminal 1/2 life of 2 hours
Onset is 15 mins. Elimination 1/2 life of 2-2.5 hours Dexmedetomidine is metabolised in the liver by P450 and eliminated in the urine. No differences have been seen between renally impaired and normal pts. |
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Which of the following statements regarding perioperative fluid management in the pediatric patient is FALSE? Healthy peds patients have higher total body water percentages than adults Evaporative losses are greater in peds pts than adults The initial 10-20% of total body volume lost should be replaced 3:1 w/ crystalloid or 1:1 w/ colloid Evaporative water loss per kg body weight is directly proportional to age |
Evaporative water loss per kg body weight is directly proportional to age Evaporative water loss is INVERSELY proportional to age. |
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Which of the following meds is contraindicated for management of acute MH? Amiodarone Diltiazem Furosemide Mannitol Sodium bicarb |
CCBs are contraindicated in MH that is being treated with Dantrolene. Dantrolene inhibits the release of Ca2+ from SR stores. In MH, a mutation of the RYR1 gene allows excessive release of Ca2+ from SR stores. CCBs would compound the Ca2+ inhibiting effects of Dantrolene and lead to unsafe arrhythmias and hypotension. |
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Which of the following is not an indications for the administration of FFP? Rapid reversal of warfarin Treatment of heparin resistance due to ATIII deficieincy Plasma volume expansion Treatment of thrombotic thrombocytopenic purpura |
TTP causes PLT destruction. It involves the deficiency of vWF-cleaving protease activity (ADAMT13). FFP repletes ADAMT13. Plasmapheresis may be used to treat the acquired type of TTP. |
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Administration of which of the following may worsen an episode of acute HTN during adrenalectomy for pheo? Nicardipine Phentolamine Labetalol Nitroprusside |
The B blocking effects can cause unopposed alpha agonism. |
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Which of the following does not increase an infants risk for postoperative apnea? Anemia Born small for gestational age General anesthesia Regional anesthesia w/ IV sedation |
Born small for gestational age Neonates born small for gestational age actually have a decreased risk for postoperative apnea. |
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Which of the following statements about the respiratory effects of dexmedetomidine is most likely true? Hypercapnic ventilatory response is preserved May cause bronchoconstriction at high doses PaCO2 usually decreases RR usually decreases |
Hypercapnic ventilatory response is preserved Respiratory effects of dexmedetomidine: Preserved spontaneous respirations Decreased minute ventilation Small reduction in tidal volume Increased RR Preserved CO2 response curve |
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A pt is undergoing cerebral aneurysm clipping. Prior to clipping the pt develops HTN and bradycardia. her pupils are dilated and the surgeon notes hemorrhage in the surgical field. Which of the following would NOT be a treatment for this clinical picture? Cooling to 33 degrees celsius Administration of propofol bolus Administration of adenosine bolus Administration of phenylephrine bolus |
Administration of phenylephrine bolus The anesthetic plan for ruptured aneurysm should be to avoid wide fluctuations in CPP or dangerous increases in BP. Goals during clipping include: Avoid rapid changes in MAP or ICP Avoid increased aneurysmal transmural pressure (i.e. avoid HTN and CSF draining) Brain relaxation (hyperventilation, mannitol) Maintenance of CPP Adenosine may be given to temporarily halt blood flow to the brain while the surgeon is clipping the aneurysm (C) |
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Which of the following is the most likely explanation for bradycardia following carotid stent deployment? Carotid body chemoreceptor response to hypoxia Carotid body baroreceptor response to reduced stretch Carotid sinus baroreceptor stimulation causing sympathetic inhibition Carotid body baroreceptor stimulation of Bezold-Jarish reflex |
Carotid sinus baroreceptor stimulation causing sympathetic inhibition Any carotid sinus manipulation may result in stimulation of carotid baroreceptors located w/in the carotid sinus. This results in sympathetic inhibition. Bradycardia is NOT result of carotid body chemoreceptor stimulation (A). The carotid bodies do NOT contain baroreceptors (B,D). |
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Which of the following hormones is least likely to directly influence potassium homeostasis? Aldosterone Vasopressin Cortisol Insulin |
Vasopressin Vasopressin indirectly influences electrolyte concentrations. Although serum K may drop slightly due to increased free water retention, total body K is not altered since most of the body's K is stored intracellular Aldosterone activates Na/K pumps (A) Cortisol enhances cellular Na and K exchange and renal K secretion (similarly to mineralocorticoids) on top of its glucocorticoid effects (C) Insulin enhances cellular K uptake (D) |
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Which of the following is most likely to trigger the subambient pressure alarm on the anesthesia machine? Bronchospasm Decreased fresh gas flow Circuit disconnect form the ETT NG tube placed on suction within the trachea |
NG tube placed on suction within the trachea NG tube placement in the airway can cause loss of tidal volume and negative pressure triggering the sub-ambient pressure alarm. The sub=ambient pressure alarm is different from the high/low pressure alarms. This alarm is triggered when the pressure in the breathing circuit falls below atmospheric. Bronchospasm would trigger the high pressure alarm (A) Decreased FGF or circuit disconnect would trigger the low pressure alarm (B,C) |
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A 1 day old child has polyhadramnios and is found to have a type C TE fistula. What is the most likely associated anomaly to be found in this child on further investigation? Congenital heart defects GI defects Limb defects Renal defects Vertebral defects |
Congenital heart defects Heart defects occur in up to 35% of kids w/ TE fistula. VACTERL = Vertebral, Anal, Cardiac, Tracheal, Esophageal, Renal, and Limb. GI defects (anal atresia) (B) can be seen in TEF but to a lesser extent and is noted after the child doesn't pass stool in 24 hours. Limb defects (C) are associated w/ TEF but to a lesser extent. Renal defects (D) are the second most common defect (15-25%). Vertebral defects are also associated w/ TEF. |
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A 34 yo F complains of severe M cramps and numbness in her fingers two days after total thyroidectomy. Which of the following would most likely be seen on ECG? Widened QRS Prolonged QT Peaked T waves Inverted T waves |
Prolonged QT Hypocalcemia prolongs QT by slowing ventricular repolarization. |
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Which of the following cannot be used to diagnose CO poisoning? CO levels in the exhaled air of the pt Hx of exposure Pulse ox reading Venous blood carboxyhemoglobin obtained on arrival 24 hours ago |
Pulse ox reading Pulse ox uses two wavelengths of light that cannot distinguish carboxyhemoglobin from oxyhemoglobin. CO levels in the exhaled air of the pt can help confirm the dx (A) A good hx and clinical signs is all that is needed for a dx (B) The CO level in anticoagulated blood sampes is stable for several days (D) |
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Which of the following factors, within typical ranges, has the least effect on the spread of neural blockade with spinal anesthesia? Drug baricity Drug dosage Drug volume Patient position |
Drug volume plays a significant effect on epidural spread, but not spinal. Drug dosage, baricity, and patient position are important factors in SPINAL anesthesia. |
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Which of the following statements about the effects of high altitude on anesthetic delivery is most accurate? The delivered concentration of a volatile anesthetic from a variable bypass vaporizer increases as altitude increases The delivered partial pressure of a volatile anesthetic from a variable bypass vaporizer increases as altitude increases The vapor pressure of desflurane inside a desflurane vaporizer changes with altitude A higher partial pressure of volatile anesthetic is necessary to maintain anesthesia at higher levels |
The delivered concentration of a volatile anesthetic from a variable bypass vaporizer increases as altitude increases Partial pressure of a volatile anesthetic remains constant at all atmospheric heights. In order to maintain this, as elevation increases and barometric pressure decreases, the delivered concentration (pressure) of a volatile anesthetic must increase to compensate. |
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Which of the following nephron segment accounts for the majority of sodium reabsorption? The collecting tubule The distal tubule The loop of Henle The proximal tubule |
The proximal tubule The proximal tubule reabsorbs anywhere from 65-75 percent of the ultrafiltrate formed by the Bowman capsule. The collecting tubule accounts for the reabsorption of 5-7% of the filtered Na (A) The distal tubule accounts for 5% of Na reabsorption The loop accounts for 15-20% of Na reabsorption |
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Which of the following will most likely increase the risk for hypoglycemia after abrupt discontinuation of TPN? Stopping concomitant insulin infusion and starting IV glucose Starting insulin infusion and starting IV glucose Starting IV glucose infusion and frequent monitoring of blood glucose Using TPN solution with a lower glucose-to-lipid ratio prior to discontinuation |
Starting insulin infusion and starting IV glucose Abrupt discontinuation of TPN may place a pt at risk for hypoglycemia. If TPN must be stopped, starting insulin infusion, even with a simultaneous glucose infusion, increases the risk of hypoglycemia. TPN has high glucose load, and the body increases its insulin production dramatically. Using TPN solutions w/ lower glucose-to-lipid ratios prior to discontinuation can reduce the incidence of hypoglycemia after abrupt cessation of TPN. |
