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42 Cards in this Set
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Which of the following is the best strategy regarding temp management of PLTS and PRBCs in the setting of massive transfusion? Avoid infusing PLTs through a warmer Discard PRBCs that have been at room temp for longer than 1 hour Infuse PRBCs through a warmer Store PLTs between 2-6 degrees C until ready to use |
Infuse PRBCs through a warmer Hypothermia may impair hemostasis, ummune function, and O2 delivery. Classic teaching was against transfusing PLTs through a warmer, but recent research refutes this. (A) Blood may be stored at room temp for 6-8 hrs (B) PLTs should be stored at room temp (D) |
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Which of the following regarding liver disease is true? An AST:ALT ratio <1 is seen with acute alcohol intoxication AST and ALT levels WNL exclude significant liver disease Nucleotidase is a marker of liver injury Plasma albumin has a half life of >2 weeks |
Plasma albumin has a half life >2 weeks Because of this, albumin is a poor diagnostic test for liver function. When both AST and ALT are elevated, if AST is >2x ALT, this is a sign of alcoholism (A) AST and ALT levels can be WNL in end stage liver disease when there is not enzymes left to excrete (B) Nucleotidase is a marker or cholestasis (C) |
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A 7 yo F is scheduled for tonsillectomy. Her mother states she herself has a hx of PONV. Which of the following is a risk factor for her to develop PONV?
7 years of age Female gender Planned surgical procedure Shellfish allergy |
7 years of age Risk factors in kids for PONV: Age >3 years Surgery time >30 mins Strabismus surgery 1st degree relative w/ PONV Female gender is a risk in the adult population (B) Tonsillectomy may cause blood pooling in the throat and stomach, but is not a significant risk factor (C) Shellfish has no role in PONV (D) |
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Which of the following is least likely to occur following a lumbar puncture in a pt with pseudotumor cerebri? Exacerbation of prior visual disturbances Headache Low back pain Paraparesis |
Exacerbation of prior visual disturbances Lumbar puncture would IMPROVE visual disturbances in pseudotumor cerebri pts Headache occurs in ~22% of spinals (B) Back pain occurs in ~25% of spinals (C) Paraparesis occurs ~ 1.5% of spinals |
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Which of the following myocardial regions is most commonly supplied by the RCA? Inferior wall of the LV Apex of the LV Apex of the RV Majority of the interventricular septum |
Inferior wall of the LV The LAD supplies the anterolateral heart and the anterior 2/3 of the interventricular septum (D) as well as the bundle branches and Purkinje system and terminates at the apex of the LV (B). It also supplies the apex of the RV (C) and the anterior LV wall. The RCA supplies most of the anterior and posterior walls of the RV, the RA, the upper 1/2 of the atrial septum, the posterior 1/3 of the interventricular septum, and the inferior wall and posterior base of the LV (A). |
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A volume of gas is heated prior to being delivered to an intubated pt. Which of the following accurately describes the change in humidity of the gas after being heated? Decreased absolute humidity and decreased relative humidity Decreased absolute humidity and no change in relative humidity No change in absolute humidity and decreased relative humidity No change in absolute humidity and increased relative humidity |
No change in absolute humidity and decreased relative humidity If a gas is heated, it can hold more water vapor. If no water vapor is added to the volume of gas when heated, the absolute humidity will not change and the relative humidity will decrease |
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Which of the following statement about buprenorphine is correct? Is a mu opioid antagonist and k-opioid partial agonist Has a ceiling effect at higher doses Has potentially severe withdraw symptoms Is less potent than morphine |
Has a ceiling effect at higher doses The ceiling effect means you get less desired benefits and more side effects (respiratory depression). It functions as a mu opioid partial agonist and a k-antagonist (A) Its potency is 25-40x that of morphine (D) Its half life is 2-3 hours (fentanyl is 7 mins) |
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A patient is receiving 6% Des at high altitude (atmospheric pressure 600 mmHg). The patient moves and you suspect inadequate depth of anesthesia. In comparison to sea level, which of the following variations has most likely caused this scenario? Decreased concentration of vapor Decreased partial pressure Increased concentration of vapor Increased partial pressure |
Decreased partial pressure Vaporizers will provide a constant concentration of vapor output at all altitudes. This will lead to a decreased partial pressure of gas delivery at high altitude if the dial is not adjusted. The concentration (6% to 7%) will need to be increased in order to deliver the same partial pressure. |
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Which of the following describes midazolam bioavailability, from greatest to least? Assume a dose of 0.1 mg/kg IM, intranasal, and rectal, and 0.5 mg/kg for oral. Intranasal>IM>oral>rectal Intramuscular>rectal>oral>intranasal Intramuscular>oral>intranasal>rectal Intramuscular>intranasal>rectal>oral |
Intramuscular>intranasal>rectal>oral |
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A 64 yo M presents to the ED w/ chest pain, sweating and dizziness. His HR is 40 and ECG shows complete heart block. Left main LAD LCx RCA |
RCA RCA supplies the AV node |
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A 50 kg pts ABG shows the following results: pH 7.14, CO2 39, O2 224, K 4.3, HCO3 13, base excess 13. Which of the following is the approximate amount of NaHCO3 that will normalize the pt's blood pH? 25 50 125 250 |
125 Sodium bicarbonate deficiency = 0.2 * kg * base deficit = 0.2 * 50 * 13 = 130 |
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Which of the following is not an effect of a stellate ganglion block on the ipsilateral face? Ptosis Mydriasis Increased skin temp Injected conjunctiva |
Mydriasis Miosis not mydriasis can occur due to sympathetic inhibition with a stellate ganglion block. Stellate block creates a Horner's syndrome (Ptosis, Anhydrosis, Miosis). |
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Which of the following best describes the Haldane effect? The increased ability for hemoglobin to carry CO2 in veins The increased delivery of O2 to metabolically active tissue The use of helium to deliver airflow to asthmatic patients The ability to ventilate patients with jet airflow during laryngeal surgery |
The increased ability for hemoglobin to carry CO2 in veins The Bohr effect explains the increased delivery of O2 at the tissue level (B). Bohr states that an increase in the CO2 and H ion concentrations will cause Hgb to have a decreased affinity for O2. The Reynolds number and the increase in laminar versus turbulent flow explains why helium helps deliver O2 to asthmatic patients (C) Supraglottic jet ventilation utilizes the Venturi effect (D). This states when velocity increases the pressure decreases. |
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A pt is pulled from a house fire. Her GCS is 10 but she has altered consciousness. Her ABG shows pH 7.2, CO2 45, O2 50 and carboxyhemoglobin 29%. Which of the following is the most appropriate way to treat her elevated carboxyhemoglobin? 100% O2 via non-rebreather Administer 50 mEq of NaHCO3 Hyperbaric oxygen Immediate ETT intubation, administer 50% O2, and hyperventilate |
Hyperbaric oxygen Pt has neurologic sequela from carbon monoxide poisoning with a carboxyhemoglobin level >25%, this indicates hyperbaric oxygen. Reasons for hyperbaric oxygen: 1) Neurologic sequelae 2) Cardiac abnormalities 3) Carboxyhemoglobin >25% 100% O2 would decreased the HbCO half life to 90 mins Hyperbaric oxygen would decrease this down to about 19 minutes |
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Which of the following explains the relationship between the CO2 dissociation curve in blood and oxyhemoglobin? LeChatelier's principle Haldane effect Bohr effect Bernoulli's equation Fick principle |
Haldane effect Haldane effect describes the relationship between the CO2 dissociation curve in blood and oxyhemoglobin. LeChatelier's principle describes a chemical system at equilibrium (A). Ex: relationship between bicarbonate and carbonic anhydrase in H2O Bohr effect describes the binding of H to Hb chains and the O2 release (C). Ex: acidosis shifts the oxyhemoglobin dissociation curve Bernoulli's equation is used in echocardiography to assess the pressure gradient and area of mitral and aortic valves (D) Fick principle is used to calculate O2 consumption (E) |
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Which of the following is least appropriate during ECT? Methohexital Lidocaine Etomidate Succinylcholine Remifentanil |
Lidocaine Lidocaine reduces the duration of ECT-induced seizures. |
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Which of the following statements regarding prolonged muscle relaxation by succinylcholine is true? Dibucain inhibits 20% of the activity of normal pseudocholinesterase A dibucaine number of 60 most likely represents homozygous atypical pseudocholinesterase Phase 1 and phase 2 blocks show decreased contraction with single twitch stimulus A phase 1 block usually occurs after repeated doses of succinylcholine A phase 2 block is characterized by a TOF ratio of >0.7 |
Phase 1 and phase 2 blocks show decreased contraction with single twitch stimulus Phase 1 block causes a TOF ratio >70% Phase 2 block can develop due to repeated succs or pseudocholinesterase deficiency (D). P2 block has a TOF <30% (E) Normal dibucaine number = 80 (i.e. it inhibits 80% of pseudocholinesterase activity). (A). A dibucaine number of 20 indicates a homozygous patient, 40-70 = heterozygous (B) |
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Which of the following is correct in regards to the innervation of bronchial smooth muscle? Most PSNS fibers decussate (innervate the contralateral side) PSNS fibers can cause bronchodilation SNS innervation ins the main determinant of resting tone The neuronal bodies for most fibers controlling bronchial tone are in the intermediolateral column of the spinal cord |
PSNS fibers can cause bronchodilation Resting tone of the airway smooth muscle is primarily mediated by PSNS neurons (B, C) Ipsilateral innervation is much more extensive in the bronchial innervation (A) The neuronal bodies for most fibers controlling bronchial tone are in the medulla (i.e. the vagus nerve) (D) |
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Which of the following statements regarding nitrous oxide and cerebral blood flow is false? At equi-MAC, substituting NO for volatile anesthetic will not affect CBF CBF is increased significantly when NO is administered alone IV anesthetics blunt the CBF changes seen with NO The CBF response to CO2 is preserved with NO use |
At equi-MAC, substituting NO for volatile anesthetic will not affect CBF Substituting NO for a volatile anesthetic, with the same MAC, results in higher CBF |
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Which of the following lung West zones has the greatest dead space to alveolar ventilation (Vd/Va) ratio? Zone 1 Zone 2 Zone 3 All zones have the same Vd/Va |
Zone 1 In zone 1, alveolar pressure (PA) exceeds pulmonary arterial pressure (Pa) and pulmonary venous pressure (Pv). This increases dead space and thus Vd/Va Zone 1 PA>Pa>Pv Zone 2 Pa>PA>Pv Zone 3 Pa>Pv>PA |
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Which of the following is not a known complication of using terbutaline for tocolytic therapy? Maternal pulmonary edema Maternal SVT Maternal hyperglycemia Neonatal hyperglycemia |
Neonatal hyperglycemia Terbutaline (like ritodrine) is a B agonist B agonists will cause maternal pulmonary edema (A), maternal SVT (B), and maternal hyperglycemia (C). Maternal hyperglycemia will cause increased insulin production. Following the birth, the neonate will develop HYPOglycemia (D) |
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Which of the following is not effective at decreasing the incidence of myalgia associated with succs use? Caclium gluconate pretreatment Lidocaine pretreatment Perioperative vitamin C Self-taming succinylcholine dose |
Self-taming succinylcholine dose Self-taming uses a small "defasiculating" dose of succs prior to the intubating dose. It does NOT decrease the incidence of myalgias. Methods shown to decrease myalgias: Calcium gluconate Lidocaine Vitamin C |
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Which of the following techniques would be appropriate for stage 2 of labor in a patient who has Harrington rods in her spine? Lumbar paravertebral block Paracervical block Pudendal block Saddle block |
Pudendal block Options for stage 2 labor analgesia include pudendal block, neuraxial anesthesia, IV analgesia, and inhalational analgesia. Pain during stage 1 of labor is usually due to visceral stimulation from T10-L1 Pain during stage 2 of labor is usually due to stimulation from S2-S4 Lumbar paravertebral blocks would be beneficial for stage 1 of labor (A) Paracervical blocks can be used for stage 1 because they help decrease the pain from cervical dilation (B) Saddle block can be used for stage 2, but would be difficult in a patient with Harrington rods because of difficulty placing intrathecal injections |
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Which of the following factors is not associated with an increased risk of transient neurologic syndrome after spinal anesthesia? Baricity of local anesthetic Early ambulation following surgery Same-day surgery Surgical positioning of patient Type of local anesthetic |
Baricity of local anesthetic TNS is defined as back pain with radiation of pain to the buttocks, thighs, hips, and calves occuring within 24 hours after recovery from an otherwise uneventful spinal anesthetic. Symptoms last 1-3 days and usually resolve spontaneously. Lidocaine is the biggest risk factor (E) Lithotomy is another major risk factor (D) Early ambulation (B) increases the risk Same-day surgery (C) increases risk |
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In which patient is the use of Succs most acceptable? Pt w/ myotonic dystrophy Pt w/ muscular dystrophy Pt w/ myasthenia gravis Pt w/ MS Pt w/ T6 spinal cord transection 2 months ago |
Pt w/ myasthenia gravis Pts w/ MG have a decreased response to Succs, but require 2-2.5 mg/kg induction doses |
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Which of the following is least effective for management of postherpetic neuralgia? TCAs Anticonvulsants Sympathetic blocks Transcutaenous lidocaine patch Topical capsaicin |
Sympathetic blocks They may be beneficial for acute herpes zoster, but not for postherpetic neuralgia |
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Which nerve will be block by the injection of local anesthetic in the space that is anterior-caudal to the greater cornu of the hyoid bone? External branch of the superior laryngeal nerve Glossopharyngeal nerve Internal branch of the superior laryngeal nerve Recurrent laryngeal nerve |
Internal branch of the superior laryngeal nerve This provides sensation to the base of the tongue, epiglottis, aryepiglottic folds, and arytenoids. The glossopharyngeal nerve (B) can be blocked at the palatoglossal folds The recurrent laryngeal nerve (D) can be blocked by a trans-tracheal method. It provides sensation below the vocal folds. |
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Which of the following immunosuppressants is most likely to prolong nondepolarizing neuromuscular blockade? Tacrolimus Mycophenolate Azathioprine Cyclosporine |
Cyclosporine Also of note, St John's wort induces CYP3A4 which can cause rapid metabolism of anti-rejection drugs. It has been implicated in at least 2 cases of organ rejection. |
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An ABG is run at 37 degrees. pH 7.25, PaCO2 55. Which of the following would be expected if it was temp corrected for 27 degrees? pH 7.20, PaCO2 60 pH 7.25, PaCO2 60 pH 7.35, PaCO2 45 pH 7.40, PaCO2 40 |
pH 7.40 PaCO2 40 For each degree celsius decrease, pH increase by approximately 0.017. Thus, 7.25 + (10 x 0.017) = 7.42 As temperature decreases, PaO2 and PaCO2 decrease. Thus, PaCO2 = 55 -> 40 |
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Which of the following is least likely to be associated with a pt that has been diagnosed with acromegaly? Dopamine agonist therapy Epiphyseal plate elongation Recurrent laryngeal nerve paralysis Subglottic narrowing |
Epiphyseal plate elongation Acromegaly occurs AFTER the epiphyseal plates have fused, thus they can't elongate. Epiphyseal plate elongation may be seen in GIGANTISM. |
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Which of the following is the recommended initial dose of dantrolene for treatment of acute MH? 1 mg/kg 1.5 mg/kg 2.5 mg/kg 5 mg/kg 10 mg/kg |
2.5 mg/kg |
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A burn patient has normal renal function and electrolytes other than hypoalbuminemia. Relative to a healthy patient, in a burn victim lower doses of which of the following meds should be administered? Fentanyl Midazolam Rocuronium Insulin |
Midazolam Burns cause hypoalbuminemia. Albumin is the primary carrier protein for benzos and opiods, thus there will be increased fractions of these drugs in burn victims. Fentanyl is incorrect, because although burn victims have hypoalbuminemia and albumin is the carrier for Fentanyl, burn victims also develop tolerance to opioids and require high doses. |
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An insulin-dependent diabetic patient arrives for emergent hip arthroplasty after falling at home. Her preop glucose is 250. Which of the following is the best management option? Administer 1/2 the pt's long-acting insulin dose sq Administer the pt's typical long-acting insulin dose sq Administer regular insulin sq based on sliding scale No treatment |
Treatment of preop hyperglycemia in type I and II DMs is to give 1/2 their long-acting and start an insulin drip at 1-2 U/hr w/ hourly glucose checks to titrate. SSI is discouraged because of cardiovascular changes (vasoconstriction and unpredictable uptake) can be detrimental. (C) |
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You are called to assist w/ a preeclamptic pt in labor. The pt is on a mag drip and the nurse notes an infusion pump error. The pt is weak and her BP is 50/35. What is the first therapy? Calcium gluconate Furosemide Initiate emergent dialysis IV fluid bolus |
In symptomatic hypermagnesemia, temporary reversal of the effects of mag can be treated with Ca therapy. Mag levels & effects: 3-4 = Flushing, PR & QT increased 5-6 = Slight BP reduction, increased HR, lethargy 10 = Loss of DTRs 20 = Resp arrest, AV conduction block, QRS widening >25 = CV arrest Mag has NMDA antagonistic effects and thus can be used for pain management. It prolongs nondepolarizing neuromuscular blockers. It blocks calcium channels. |
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A 56 yo M receives a PRBC transfusion. 30 mins later he becomes febrile to 38.4. He has a negative direct antiglobulin test. What is the most likely mechanism of this reaction? Recipient antibodies to transfused leukocytes Transfused antibodies to recipient leukocytes Transfusion of soluble leukocyte mediators Transfusion of Rh positive blood to Rh negative recipient |
Non-hemolytic febrile reaction is what has occurred. The cause is native host antibodies bind to donor leukocytes (HLA antigens) in the transfused blood. Temp increase is usually >1 degree Celsius. TRALI is the leading cause of transfusion-related death. The theory is donor antibodies to the recipients leukocytes which bind in pulmonary capillaries. (B) Transfusion of soluble leukocyte mediators (C) is the mechanism behind TRIM. This is seen in blood products with a longer shelf life (older) and can lead to increased rates of primary cancer. Transfusion of Rh + blood to an Rh - pt can cause a hemolysis (D). |
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A pt is discovered to have hypovolemic hyponatremia following removal of a frontal lobe mass. She is lethargic. Serum sodium is 125. Which of the following is the most reasonable treatment? 3% saline bolus NS bolus Free water restriction No treatment necessary |
Patients w/ Na <130 and symptomatic require aggressive treatment with hypertonic saline. Isotonic sale should be avoided in SIADH (B) because it can result in urinary Na excretion that may worsen water retention and cause further hyponatremia The cornerstone of SIADH treatment is water restriction (C). |
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Which of the following is a reason why a peribulbar block is considered safer than a retrobulbar block? Injection occurs further from vital structures Decreased risk of elevated intraocular pressure Injection of less local anesthetic Quicker onset |
Injection occurs further from vital structures Many ophthamlic procedures can occur with a block near or within the orbital cone. A retrobulbar block places anesthetic into the cone, near vital structures (optic nerve and artery) The peribulbar block is outside of the orbital cone. Since the peribulbar block is not directed at the optic nerve, a larger amount of local anesthetic is used (C). The time of onset is also longer (D). Because of the larger volume, there is also a risk of increased intraocular pressures (B). |
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Which of the following tests should be obtained before a pt with adult polycystic kidney disease undergoes robotic radical prostatectomy? CT angiogram of the head ECG Renal US w/ doppler No specific testing |
CT angiogram of the head Should be ordered to screen for intracranial aneurysms. |
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Which of the following is NOT an advantage of PCA compared with intermittent nursing administration of opioid medications? Decreased opioid consumption Decreased time spent by nurses administering the opioid Higher patient safety Superior analgesia |
Decreased opioid consumption PCA provides significantly greater analgesia (D) and pt satisfaction (C); however, pts use more opioids (A). |
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A pt who is to undergo a pituitary tumor resection is least likely to be taking which of the following medications preoperatively? Cabergoline Thyroxine Vasopressin Glucocorticoids Calcitriol |
Calcitriol Calcitriol is used to treat hypocalcemia associated w/ hypoparathyroidism (which is not controlled by the pituitary gland).
Bromocriptine and cabergoline (A) are dopamine agonists. Dopamine is a neg. feedback NT for the production of prolactin. Prolactinoma is the most common tumor in pituitary tumors. |
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Which of the following statements regarding physiology following cardiac transplantation is false? The atrial remnant of the recipient is responsible for heart rate generation There is a higher intrinsic heart rate following transplantation There is reduced HR variability following transplantation The Frank-Starling mechanism remains intact following transplantation |
The atrial remnant of the recipient is responsible for heart rate generation Heart rate generation is dependent on the donor atrium. The transplanted heart is void of PSNS tone and thus has a higher intrinsic rate w/ less variability (B&C) Frank-Starling mechanisms remain intact since they do not rely on PSNS tone (D) |
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A pt is started on TPN and 24 hours later his phosphorus level has been reduced in 1/2. What is the most likely mechanism for this change? Diuretic administration Glucose induced lowering Inadequate maintenance of phosphorus Increased cathecholamines |
Glucose induced lowering Hypophosphatemis is most commonly caused by an increase in intracellular movement of phosphate, which occurs with glucose loading during TPN administration. |
