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33 Cards in this Set
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The context sensitive half time of ketamine is most similar to that of which of the following? Diazepam Etomidate Midazolam Propofol |
Propofol Diazepam has the longest, Midazolam is next, then ketamine/propofol, finally etomidate |
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A 23 yo M presents in the ED w/ wide-complex tachycardia at 160 noted to be WPW. He states he feels normal but nices his pulse racing. Which of the following is the most appropriate treatment for this patient? Adenosine Cardioversion Procainamide Verapamil |
Procainamide Procainamide is a common drug used to break acute tachycardia in pts w/ WPW. |
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A previously healthy 24 yo trauma pt has suspected abdominal bleeding and presents to the OR. She has a 16 gauge IV in her hand. Which of the following will most likely result in the greatest increase in the rate of fluid administration to the patient? Addition of fluid warmer tubing to the existing IV Increasing the length of the IV catheter Placement of the 16 gauge catheter in the EJ rather than the dorsal hand vein Removal of all stopcocks from the IV tubing |
Placement of the 16 gauge catheter in the EJ rather than the dorsal hand vein Flow rate through a system is directly related to pressure and inversely related to resistance (F=P/R) Resistance = (8*length*viscosity)/(n*radius^4) Thus, Flow (Q) = (n*P*r^4)/(8*n*l) n = viscosity Peripheral veins create more resistance than central veins Since the EJ has a larger r, it will have increased flows. Additional fluid warmers will increase resistance (A) Increasing the length will also increase resistance (B) Additional stopcocks will create more resistance, but their effect is minimal compared to the resistance of the peripheral vein (D) |
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Which of the following most likely occurs during acute normovolemic anemia? Decreased P50 Decreased contractility Increased stroke volume Increased PVR |
Increased stroke volume 3 CV compensatory mechanisms take place during anemia: 1)Increased CO 2)Redistribution of blood flow to cerebral and coronary circulation 3)Increased release of oxygen from hemoglobin Increased CO occurs because of decreased afterload from lowered viscosity and thus increased HR & SV. Contractility also increases. (B,C,D) Anemia causes a right shift of oxyhemoglobin dissociation curve, resulting in increased P50 (A) |
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Which of the following is correct in regards to ipratropium? Compared to tiotropium, it has more selectivity for M3 receptors Compared to albuterol, it has a longer duration of action It causes bronchodilation by decreasing intracellular cGMP Side effects include bronchorrhea, bradycardia, and urinary retention |
Compared to albuterol, it has a longer duration of action Ipratropium-induced bronchodilation lasts 6-8 hours Ipratropium and tiotropium both bind to muscarinic receptors; however, tiotropium has more selectivity for M3 (A) Theophylline increases intracellular cGMP, thereby causing bronchodilation (C), but ipratropium blocks muscarinic receptors Ipratropium has minimal systemic side effects due to minimal absorption (D). It may cause tachycardia |
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A 45 yo F w/ COPD is undergoing a VATS procedure for lung volume reduction surgery. Her vitals are HR 76, BP 123/46, SpO2 97% on two lung ventilation. One lung ventilation is started and 2 minutes later her SpO2 is 66% and HR is 40 with a BP of 73/43. Which of the following is the next best step? Conversion to open thoracotomy CPAP to the nondependent lung PEEP to the dependent lung Two lung ventilation |
Two lung ventilation This patient has critical SpO2 and has hypoxia induced bradycardia, requiring immediate intervention. The typically algorithmic approach does not apply in this critical period and two lung ventilation is immediately required. |
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Which of the following meds has the greatest alpha-2 blocking activity? Phenoxybenzamine Phentolamine Clonidine Dexmedetomidine |
Phentolamine Phentolamine and phenoxybenzamine both have alpha blocking capabilities. Phentolamine has more. Clonidine and dexmedetomidine are both alpha agonists |
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Which of the following processes is impaired by glucagon? Gluconeogenesis Glycogenolysis Glycolysis Lipolysis |
Glycolysis Glucagon inhibits hepatic glycolysis which allows glycotic substrates to instead be converted to glucose by gluconeogensis. Glucagons role is to INCREASE blood glucose, and glycolysis DECREASES it Glycolysis consumes glucose to create ATP. By stopping glycolysis, the glycotic intermediates into the gluconeogenesis pathway. Glucagon also stimulates glycogenolysis (B), gluconeogenesis (A), lipolysis (D). |
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A 30 yo primigravid has a BP of 150/95 (previously normotensive prior to pregnancy). A urine dipstick is negative for protein. She reports severe headaches for several weeks. What is her classification? Chronic HTN Chronic HTN w/ superimposed features Gestational HTN Preeclampsia |
Preeclampsia Preeclampsia is diagnosed as HTN with either proteinuria or signs & symptoms of severe symptomatology (persistent headaches) after 20 weeks. |
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Which of the following most significantly prolongs neuromuscular blocking agents? Desflurane Isoflurane Nitrous oxide Sevoflurane |
Desflurane All volatile anesthetics prolong neuromuscular blocking agents, but some to a great percent. Since Des is the least potent it has the highest concentration in the blood and therefore has more of an effect on neuromuscular blocking agents. Order of neuromuscular blocking agent potentiation: Des>Sevo>Iso>Halo>TIVA |
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Which of the following is not part of the basic anesthesia standards set forth by Joint Commission? Daily anesthesia machine checks Pt oxygenation monitoring Pt temp monitoring Qualified anesthsia personnel monitoring anesthetized pts at all times |
Daily anesthesia machine checks Joint Commision basic anesthesia standards include: 1) Qualified anesthesia personnel must remain w/ an anesthetized pt at all times 2) Pt's O2, ventilation, circulation, and temp must be continually evaluated |
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Which of the following modified GCS score ranges correlates with a conscious pt with a moderate head injury? 3-5 6-8 9-12 13-15 |
9-12 A modified GCS <8 correlates with a deep coma, severe head injury, and poor outcome (A&B) A modified GCS >12 correlates with mild injury (D) |
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Which of the following is associated with polycythemia vera? Heinz bodies Increased RDW Microcytic erythrocytosis Thrombocytopenia |
Microcytic erythrocytosis Polycythemia vera (PV) causes all 3 blood lines to proliferate. It's associated w/ a mutation of the JAK2 gene. The increased RBC proliferation creates many microcytic RBCs Heinz bodies (A)= G6PD, alpha thalassemia, hemolytic anemias, and chronic liver dz PV causes decreased RDW (B) Thrombocytosis (not thrombocytopenia) is seen in PV (D) |
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Which of the following statements about bronchial smooth muscle tone is true? B2 stimulation causes bronchosonstriction Epi acts on B1 receptors to cause bronchodilation Muscarinic receptor stimulation causes bronchodilation Norepi does not cause significant bronchodilation |
Norepi does not cause significant bronchodilation NE is more selective for B1 than B2. B2 stimulation causes bronchodilation (A,B) Muscarinic INHIBITION will cause bronchodilation (C) |
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Which of the following will occur to a thermodilution CO measurement if the temp of the injectate solution is colder than the programmed injectate temp? No change in measurement Overestimation Underestimation Inability to obtain a reliable reading |
Underestimation Underestimation can occur if the volume injected is larger than programmed or if it is colder than programmed. |
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A pt is at 10,000 feet (barometric pressure 500) and receiving Iso at 1.2%. Which of the following best approximates the concentration (vol/vol%) inside the vaporizing chamber? 1.19% 11.9% 31.3% 47.6% |
47.6% Concentration of agent inside the vaporizing chamber = SVP/BP (SVP = saturated vapor pressure & BP = barometric pressure) SVP of agents: Sevo = 157 Iso = 238 Halo = 243 Des = 669 Thus, for iso: 238/500 = 47.6% Remember, at a higher altitude, the vaporizer will automatically compensate for the decreased barometric pressure and deliver a higher concentration of agent because it is a higher percentage of a lower pressure and thus will deliver the same partial pressure to produce the MAC required (i.e. no matter the elevation, the partial pressure remains the same and the concentration delivered increases or decreases). |
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Patients with strabismus are more susceptible to which of the following as a results of succs administration compared to general pediatric surgical population? Cutaneous flushing Masseter muscle rigidity (MMR) Postoperative delirium PONV |
MMR Kids w/ strabismus are 4x more likely to demonstrate MMR following succs Strabismus increases the potential for PONV, but the addition of succs does not create more (D). |
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Which of the following most accurately describes the original intent for the ASA system? For comparison of anesthetic data For risk stratification of CV events To determine perioperative mortality risk To improve anesthetic billing |
For comparison of anesthetic data It is now used in allocation of resources, anesthetic service reimbursement, and predicting perioperative risk |
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A retrpospective study is conducted to ID factors associated with the development of perioperative MI. A multivariate regression logistic model is applied. Which of the following should be used to determine the effect size? Adjusted odds ratio Confidence interval P value Relative risk |
Adjusted odds ratio The odds ratio allows one to determine the odds of developing an outcome (MI in this case) in those who received a particular treatment (not in the entire population). Therefore, in this case the OR can be used to determine the effect size. OR>1 shows positive correlation OR<1 shows negative correlation CI is used to estimate the precision of the odds ratio (B). If the CI encompasses the number one, there is not good confidence. P values is the probability the result occurred by chance (C) |
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A pt presents w/ NSTEMI. ECHO shows severe MR w/ anteriorly directed regurtiant jet. Which of the following is the most likely involved ischemic vessel? Internal mammary artery LAD Left circumflex Right coronary |
Right coronary The anterior and posterior papillary muscles control the mitral leaflet. The anterior receives blood supply from 2 sources (LAD and LCx) The posterior receives blood supply from only 1 source (RCA) In order to have an effect on the mitral leaflet, the RCA must be affected (if single vessel involvement is asked). The jet direction is not affected by the leaflet in question. The internal mammary supplies the anterior chest and breast (A) The LAD and LCx supply the anterior leaflet (B&C) |
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Which of the following meds, when given in conjunction with cisatracurium, will have a synergistic effect upon neuromuscular blockade? Atracurium Metoclopramide Rocuronium Succinylcholine |
Rocuronium Atracurium has an additive effect (A) Metoclopramide has inhibitory effects on plasma cholinesterases, therefore it may have a prolonging effect on succs and mivacurium (B) |
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Which local anesthetic has the least amount of placental transfer when delivered via the epidural route? Bupivacaine Ropivacaine Chloroprocaine Lidocaine Tetracaine |
Chloroprocaine 2-chloroprocaine is rapidly metabolized by plasma cholinesterase, therefore leaving very little drug available to cross the placenta. |
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During CV bypass, which of the following is most likely to result in ACT variability? Advanced age Hemodilution High plasma levels of heparin PLT count of 70,000 |
Hemodilution Factors that can result in ACT variability: Hemodilution, hypothermia, PLT count 30-50K, and administration of other meds that alter PLTs Pediatric patients are more likely to have variable ACTs (A) because of increased heparin consumption. Low plasma heprain levels are more likely to cause ACT variability (C) Extreme thrombocytopenia (30-50K) can cause ACT variability |
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Which of the following ranks the vapor pressures of volatile anesthetics in order from greatest to least? Des>sevo>iso Des>iso>sevo Iso>sevo>des Iso>des>sevo |
Des>iso>sevo Des = 669 mmHg Iso = 238 mmHg Sevo = 157 mmHg |
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Which of the following would a Jehovah's Witness most likely accept to preserve blood volume? Allogenic blood transfusion PLTs Albumin Autologous blood transfusion collected a week before surgery |
Albumin Some Jehovah's Witnesses may accept blood fractionates which include albumin, recombinant human erythropoietin, immunoglobulins, and factor concentrates. In the case of emergency, if there is no documented advanced medical directive, the physician is obligated to administer blood products. In the case of a peds pt, the Dr should attempt to abide by religious beliefs; however, if the convictions interfere with medical care legal action should be taken to override the objections. Allogenic blood transfusion is from another person (A) PLTs would not be accepted (B) Autologous blood transfusion would be acceptable, but it has to be kept in continuous contact with the patient (D) |
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In a study of 100 pts with ACS, the average troponin was 7 w/ a SD of 1. Which of the following is the standard error of the mean (SEM) of their average troponins? 0.01 0.007 0.12 0.1 10 |
0.1 SEM = SD/(sq root of N) SEM = 1/(sq root 100) SEM = 1/10 SEM = 0.1 |
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A 64 yo M had a subarachnoid hemorrhage 3 days ago. Which of the following is not a treatment modality for cerebral vasospasm? Hypervolemia Labetalol Chemical angioplasty Medication induced HTN Hemodilution |
Labetalol Tx of cerebral vasospasm = Triple H (Hypertension, Hypervolemia, Hemodilution) Cerebral vasospasm prophylaxis = Nimodipine |
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Which of the following chronic pain meds can lead to seizures by lowering the seizure threshold? Amitriptyline Butorphanol Gabapentin Meperidine |
Amitriptyline Both tramadol and TCAs lower seizure threshold Butorphanol (A) is a mixed opioid agonist-antagonist with partial agonism of the mu and kappa receptors Gaba (C) will raise seizure threshold. Meperidine (D) has an active metabolite (normeperidine) which can lead to seizures if high doses are produced (renal failure). |
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Which of the following is most likely true regarding citrate added to PRBCs for storage? Hyperthermia may slow its metabolism It is metabolized primarily in the kidney It may cause hypercalcemia It may cause metabolic alkalosis |
It may cause metabolic alkalosis Citrate is metabolized into bicarbonate in the liver and can cause metabolic alkalosis (B,D). A reflex hypokalemia may develop due to the alkalosis Citrate prevents clotting by chelating calcium, which can cause hypocalcemia (C) Hypothermia (A) will slow metabolism |
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A multigravid female is prepped for emergency C-section due to fetal distress and HR of 64. Mask ventilation is adequate, but multiple failed attempts are made at intubation. Which of the following is the next best step in management according to ASA guidelines? Attempt asleep fiberoptic intubation Proceed with case using mask ventilation Wake patient and perform awake fiberoptic intubation Attempt intubation with video laryngoscopy |
Proceed with case using mask ventilation In the OB algorithm, if mask ventilation is adequate, the C-section should proceed. An LMA may also be used. If there weren't fetal distress, you could abort intubation and wake the patient (C) This is different from the standard airway algorithm, which would require videolaryngoscopy (D) |
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Which of the following is the primary site of dexmedetomidine metabolism? Liver Kidneys Plasma The drug is minimally metabolized and is primarily excreted unchanged |
Liver |
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Which of the following is not a true statement regarding cardiac tumors? Cardiac myxomas are the most common benign cardiac tumors in adults Cardiac tumors can cause arrhythmias, ventricular obstruction, and heart failure Metastatic cardiac tumors from adjacent lung cancer is more common than primary cardiac malignancy Cardiac myxomas most commonly arise from the right atrium |
Cardiac myxomas most commonly arise from the right atrium Cardiac myxomas are actually predominantly found in the left atrium (70%) and interatrial septum. Myxomas are most commonly found in females and in the L atrium. Metastatic tumors (from lung or kidneys) are more common than primary cardiac tumors |
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Which of the following changes to a data sample would most likely narrow the limits of a confidence interval? Increasing the SD Increasing the variability Reducing the confidence level Reducing the sample size |
Reducing the confidence level Increasing the SD will increase the standard error and lead to an increase in the width of the CI (A) Increasing the variability will increase the SD and ultimately the SE (B). This will increase the range of the CI. Reducing the sample size will increase the SE and lead to an increase in the width of the CI (D). |
