Valley Mixed Review 49 And 50

Front 1

for caudal anesthesia, what
landmarks are palpated for the
injection to be made at the sacral
hiatus?

Back 1

palpation of the depression
between the sacral cornua is the best place (these ar eon either side
of the sacral hiatus)

Front 2

what 2 nerves are anesthetized in
a popliteal block?

Back 2

tibial and common peroneal
nerves (divisions of the sciatic
nerve)

Front 3

which ester local anesthetic is a
weak acid? what is the pKa

Back 3

Benzocaine (ethyl benzoate)
pKa of 3.5

all others locals are bases with
Pka ranginf from 7.6-9.1

Front 4

what form (mostly ionized
or mostly nonionized) exists when benzocaine encounters
physiological pH?

Back 4

mostly ionized

Front 5

benzocaine is best clinically used
how?

Back 5

topical anesthesia for mucous
membranes

this is b/c it is hgihly iionized at
physiologic pH

Front 6

what is recommended max dose
for topical benzocaine?

Back 6

200-300 mg

20% benzocaine only requires a brief spray and that is max. dose

-r/o methemoglobinemia

Front 7

what local anesthetics make up
EMLA cream

Back 7

Prilocaine 2.5% and lidocaine
2.5%

Front 8

can methemoglobinemia occur
with EMLA cream?

Back 8

yes b/c prilocaine is in it
children are more susceptible (3-
12 months): have immature
reductase pathways

Front 9

4 contraindications to EMLA
cream

Back 9

-mucous membranes
-open wounds
-pt on mexilitine
-pt with history of allergy to
amides

Front 10

4 elements compromising hte
"anatomy of medical negligence
action"

Back 10

-duty
-breach
-damage
-cause

Front 11

define "proximate cause"

Back 11

a cause that was foreseeable
before theevent took place

Front 12

2 common tests used to establish causation

Back 12

but for test: if accident
would not have occurred,
but for the actions of the
plaintiff

substantial factor: if the act
of the defendent was a
substantial factor in the
injury

Front 13

in addition to barbiturate and
propofol, what 3 other anesthetic
agents are compatible with SSEP
monitoring?

Back 13

ketamine, opioids, etomidate

Front 14

how is sterilization different from
disinfection?

Back 14

disinfection does not destroy
bacterial pores

Front 15

is pateurization a high level
disinfection?

Back 15

yes; equipment is immersed in
water at high temperature (70
degrees C) for 30 minutes

Front 16

what is autoclaving

Back 16

Steam sterilization: utilizes
saturated steam under pressure
(temepratures exceed 100 degrees C)

Front 17

when do fat embolism syndrome
(FES) symptoms usually manifest

Back 17

12-72 hours after the insult

Front 18

what agent may be given
prophylactically for pts at risk of
a fat emboli?

Back 18

corticosteroids: they may limit the endothelial damage done by the free fatty acids

Front 19

what triad of symptoms should
arouse suspicion of fat embolus?

Back 19

-petechiae
-hypoxemia
-mental confusion

Front 20

major criteria for diagnosis fo fat
emboli

Back 20

-axillary/subconjunctival
-ptechiae
-hypoxemia
-CNS depression
pulmonary edema

Front 21

minor criteria for diagnosis fo fat
emboli

Back 21

-increaed HR
-hyperthermia
-jaundice
-retinal fat emboli
-renal changes

Front 22

what is the most consistent
symptom of acute pulmonary
embolism?

Back 22

sudden, acute dyspnea

Front 23

what laboratory test when positive is consistent with a PE, but when negative suggests thromboembolism is absent

Back 23

D-dimer: positive means a PE is
possible and negative means that
there isn't one

Front 24

is a mill wheel murmur heard by
esophageal stehoscope an early or late sign of venous air embolism

Back 24

late sign

Front 25

early signs of VAE

Back 25

sudden decrease in ETCO2 and
arterial hypoxemia

Front 26

3 causes of death from a VAE

Back 26

-vapor lock casusing right
side cardiac output to
plummet

-acute cor pulmonale

-arterial hypoxemia from
combined cardiac and
pulmonary insults

Front 27

five steps to managing a gas
embolism durng a laparoscoic
sugery:

Back 27

-halt insufflation

-shut off nitrous

-release the pneumoperitoneum

-place pt in left lateral decub

-aspirate gas through central
line

Front 28

what may result from excessive
cervical flexion in the beach chair

Back 28

this can impede arterial and
venous blood fow cuasing
hypoperfusin of venous
congestion of the brain
can alslo obstruct ETT or put
pressure on tongue leading to
macroglossia

Front 29

how many fingerbreadths should be maintained b/t the chin and sternum during beach chair position to prevent excessive cervical flexion

Back 29

2

Front 30

there are 4 natriuric peptides in
the body:

Back 30

ANP: atrial

BNP:ventricular muscle

CNP: endothelial walls of
major vessels

Urodilatin: urinary tract

Front 31

what do the natriuric peptides do?

Back 31

they are mostly released in
response to increased volume at their areas the induce arterial and venous dilation, increase RBF and GFR,
and suppress the actions of epi, norepi, renin

Front 32

what is the cyclic nucleotide
second mesanger that mediates
the cellular actions of natriuric
pepetides

Back 32

cGMP

Front 33

what is Virchow's triad

Back 33

3 primary abnormlties in
hemosstasis that lead to thrombus formation:

-endothelial injury
-stasis or turbulent blood
flow
-hypercoagulability of the
blood

Front 34

what is phase I on the capnograph

Back 34

end of inspiration= CO2 levels are near 0

Front 35

what is phase II on the
capnograph?

Back 35

emptying of the connecting
airways and beginning of
emptying of alveoli. mixture of
anatomic and alveolar dead space
(Area in the lung with high V/Q
ratio)

Front 36

what is phase III on the
capnograph

Back 36

alveolar plateau: emptying of the
alveoli

Front 37

what is phase IV on the
capnograph?

Back 37

inspiration: CO2 abruptly falls

Front 38

what does an increased alpha
angle on a capnograph mean

Back 38

means that the slope is more
slanted, so the lungs are taking to exhale deadspace volume.

this is seen in obstructive disease or with PEEP

Front 39

what would cause the beta angle
on the capnograph to be increased on the capnograph?

Back 39

rebreathing

Front 40

what is a double circuit ventilator

Back 40

one circuit contains patient gas and the other circiut contains the drive gas
common on modern machines:
separates the breathing system gas form the driving gas

Front 41

what % of the CO traverses
bronchial circulation?
vessels dellivering blood to the
bronchial circulation arise from
what arteries?

Back 41

1-2%
thoracic aorta
intercostal arteries

Front 42

which neurotransmitter is the
most common excitatory nt in the
CNS

Back 42

glutamate

Front 43

**List 3 common inotropic
glutamate receptors in the CNS.
which electrolytes pass through
these receptors upon activation?

Back 43

-NMDA
-AMPA
-Kainate

Na, Ca in and K out

Front 44

describe the anatomy of the
hypogastric plexus

Back 44

-retroperitoneal structure that is
formed by the confluence of the bilateral lumbar sympathetic chains

-pelvic pain that is caused by
inflammatory disease or cancer can be relieved by interruption of the bilateral sympathetic pathways which can be achieved with a superior hypogastric plexus
block

Front 45

which zona of the adrenal cortex
is the only one capable of
synthesizing aldosterone

Back 45

Zone glomerulosa; bc this is the
only one that has aldosterone
synthase

Front 46

Identify 2 stimuli in addition to
the decreased renal perfusion
pressure for the release of renin

Back 46

-sympathetic nervous system
stimulation

-hyponatremia

Front 47

normal hemoglobin (hbg A) has
what globin chains

Back 47

2 beta chains and 2 alpha chains

Front 48

what is hemoglobin-S and how
does it differ from hemoglobin-A

Back 48

In sickle cell anemia Hbg-S has a
valine instead of glutamic acid in
the sixth postition o fhte beta
chain on the Hbg molecule

Front 49

what lymphocytes mediate

humoral immunity?
cell-mediated immunity?

Back 49

Humoral: B lymphocytes
cell-mediated: T lymophocytes

Front 50

ketamine acts on what CNS
receptor?

Back 50

NMDA: antagonizes

-this is a subtype of glutamate
recetpor

Front 51

list the ester local anesthetics

Back 51

cocaine
procaine
chloroprocaine
tetracaine
benzocaine

Front 52

maximum dose with and without
epi for:

-lidocaine
-mepivicaine
-bupicaine
-ropivicaine

Back 52

plain and (with epi)
lidocaine: 300 mg (500)
mepivicaine:300 mg (500)
bupiviciane: 175 mg (225)
ropiviciane: 300 mg

Front 53

At what pressure should the O2
E-cylinder on an anesthesia
machine be changed

Back 53

when the pressure is <1000 psi
(half full)

Front 54

4 elements of the anesthesia
machine that are exposed to High
pressures

Back 54

-hanger yoke
-yoke block with check
valves
-cylinder pressure gauge
-cylinder pressure regulators

Front 55

what complications can occur
during the wake up test?

Back 55

-extubation in the prone postition

-recall of intraop events (0-20%)

-myocardial ischemia

-self injury

-air embolus (if pt breathing
spontaneously and inhales vigorously)

Front 56

the wake-up test monitors what
region of the spinal cord?
(dorsal/lateral/ ventral)

Back 56

ventral: supplied by the anterior spinal artery

pt asked to squeeze hand

Front 57

what is the wake-up test used for?

Back 57

used to assess the integrigy of the spinal motor pathways
(ventral/anterior)

Front 58

what is the most likely reason a pt who undergoas a non-opthalmic procedure develops blindness
postoperatively

Back 58

optic nerve and retinal ischemia
from compression of the eye
(prone position) or systemic
hypotension

Front 59

if pt in lateral position with no
axillary roll and O2 sat on
dependent hand starts to desat,
what is most likely problem

Back 59

compression of the axillary
neurovascular bundle;
compromising blood flow to the
hand

Front 60

2 reasons why a chest roll is
placed under pt in lateral decub
position

Back 60

lift thorax and relieve pressure on the axillary neurovascular bundle:

-preventing injury to
brachial plexus

-prevent reduced blood flow
to the hand

Front 61

how can compartment syndrome
in a leg be precipitated?

Back 61

-intraoperative hypotension
in conjunction with leg
elevation that causes low flow
rates

-pneumatic compression
boots and fluid
extravasation into tissues

-vascular obstruction of major blood vessels between pelvic retractors

-excessive flexion of knees or hips

Front 62

what is the treatment for
compartment syndrome

Back 62

fasciotomy

Front 63

what is Bullard laryngoscope?
when is it useful?

Back 63

rigid fiberoptic laryngoscope for indirect laryngoscopy: useful when movement of pt head/neck is contraindicated or limited oral aperture

Key feature: oral, pharyngeal, and tracheal axes do not

Front 64

controlled hypotension can result
in many complications, what pt
population is at increased risk of
these?

Back 64

pt with coexisting anemia

Front 65

what are the most frequent
dysrhythmias during extracorpeal
shock wave lithotripsy (ESWL)

Back 65

PVC's and PAC's

Front 66

what are 2 signs of fetal hypoxia?

Back 66

fetal bradycardia and late
decelerations indicate fetal
hypoxia

Front 67

Identify 5 signs and symptoms of
venous air embolism in the
pregnant pt

Back 67

-millwheel murmur over
-pericardium
-chest pain
-dyspnea
-decreased ETCO2
-elevated CVP

Front 68

what is the most common type of
postoperative delirium in the
elderly

Back 68

interval delerium: occurs after a
lucid interval of one or more days
after operation

Front 69

what is the % incidence of post-op delerium in the elderly and after what type of durgery is it most common

Back 69

10-15%
orthopedic

Front 70

what is the most effective
measure for pain associated with
pancreatic cancer?

Back 70

celiac plexus block with alcohol
or pheon

Front 71

what is the difference b/t an
expert witness and a factual
witness

Back 71

according to ASA guideline, there should be no difference
legally: an expert witness can give opinions and a factual witness cannot

Front 72

List the 3 descriptive statistics
that specify the central tendency,
or middle, of numerical data

Back 72

-median: center or midpoint
when it is arranged from
least to greatest

-mode: most frequently
occuring value

-mean: arithmatic average of
the numbers

Front 73

How is the standard of care
established? what 2 sources are
typically consulted to establish the standard of care?

Back 73

standard of care is what the jury says it is. two sources:

-beliefs offered by expert
witness

-the published standards of care, guidelines, practice parameters and protocols

Front 74

what are the 2 types of complex regional pain syndromes and what
is the main difference b/t the two?

Back 74

-CRPS type I: reflex sympathetic dystrophy

-CRPS Type II: causlagia
in Type II, there is a documented nerve injury preceding the CRPS

Front 75

which volatile anesthetic is not an ether?

Back 75

halothane

Front 76

which of the volatiles are methyl
ethyl ethers?

Back 76

enflurane, isoflurane and
desflurane

Front 77

since Sevo is not a methyl ethyl
ether, what type of ether
derivative is Sevo?

Back 77

methyl isopropyl ether

Front 78

which 2 volatiles are isomers of
each other?

Back 78

enflurane and isoflurane

Front 79

which inhaled anesthetic is the
only one containing Bromide

Back 79

halothane

Front 80

what is the medical management
ant tretement for CRPS in
children

Back 80

physical therapy
may need pharmacological
treatment to allow for PT, so
membrane stabilizers (neurontin and tricyclic antidepressants)

Front 81

what regional block may be indicated for circulatory insufficiency of the upper extremity or for relief of CRPS affecting an upper extremity

Back 81

stellate ganglion block

(cervicothoracic sympathetic block)

Front 82

what is the advantage of using a
Jackson table for wilson frame

Back 82

orthopedic frames

-don't compress chest and
abdomen when in prone
position so maintain
normal pulmonary
compliance

-minimize abdominal
pressure, so the inferior
vena cava is not impaired
and venous return is
optimized

Front 83

which volatile differs from Iso
only by replacement of the
chlorine with fluorine?

Back 83

Desflurane (this one change
increase the VP dramatically 669
compared to 240)

Front 84

which 2 anesthetics have only
fluorine as the halogen substitute?

Back 84

Des and Sevo
(this makes them less soluble in
the blood)

Front 85

what is "context sensitive halftime"?

Back 85

the time necessary for the plasma drug concnetration to decreased by 50% after discontinuing a continuous infuction of a specific
duration

*considers the combined effects of distribution and metabolism as well as duration of IV administration

Front 86

BAEPs are usually very resistant to alteration by anything other than structural pathology in the brainstem. What OR room environment variable with "decreased latency and prolonged interpeak intervals?"

Back 86

mild hypothermia

Front 87

what driving pressure is needed to generate sufficient gas flow for transthracheal jet ventialtion thru a 12 or 14 gauge catheter?

Back 87

50 psi

Front 88

chemical name for etomidate

Back 88

it is an imidazole derivative
(R-pentylethyl-1H-imadazole-5
caboxylate sulfate)

Front 89

what is the more comon name of
2-O-chlorophenyl-2-methylamino
cyclohexanone hydrochloride

Back 89

Ketamine

Front 90

above what ICP will a "vicous
cycle" of ischemia and edema
ensue?

Back 90

>30 mmHg

Front 91

during ECT what is the desired
duration of the seizure

Back 91

30-60 seconds

Front 92

how many total seizure seconds
of ECT therapy are generally
needed to see a good therapuetic
effect?

Back 92

400-700 seconds. sicne each sz is 30-60 seconds and can only have 1/day, may take several weeks to see effects

Front 93

what is GPIIb/IIIa

Back 93

platelet glycoprotein; platelet
fibrinogen receptor: it binds
circulating fibrinogen and
promotes platelet aggregation,
leading to a plt plug

Front 94

name 3 GPIIb/IIIa inhibitors
primary use
are they reversible

Back 94

-Abciximab (Reopro): 12-24 hour elimination time

-Eptifibatide (Integrillin):2-4 hours

-Tirofiban (Aggrastat): 2-4 hours prevent plt aggregation: acute coronary syndromes and
percutaneous coronary
interventions they are reversible:

Front 95

what is the major intraop
anesthetic goal for renal
transplantation?

Back 95

maintenance for renal blood flow
SBP>90
MAP>60
CVP>10

Front 96

How long should
immunosuppressive treatment be
continued after transplant?

Back 96

lifelong

Front 97

what type of drugs are tacrolimus
and cyclosporine

Back 97

immunosuppressant drugs used after transplant surgery
calcinuerin inhibitors: they inhibit T-lymphocyte proliferation DNA
cytokine production

Front 98

during liver tranplant,
severe acidosis during the
dissection phase should be treated
with what drug

Back 98

THAM: tris-hydroxymethyl
aminomethane infusion

Front 99

at what point during pregnancy is
cardiac output greatest

Back 99

end of the second trimester

Front 100

EBV for:
premie
neonate
3m - 3yr
>6yr

Back 100

premie: 90-100 ml/kg
nonate: 80-90 ml/kg
3m-3yr: 75-80 ml/kg
>6yr: 65-70 ml/kg

Front 101

a lidocaine spinal anesthetic was administered for an arthroscopic procedure on the left knee.

post-op pt c/o pain in the buttocks. what might have occurred

Back 101

Pain or dysesthesia in buttocks or legs following a spinal with lidocaine are classic symptoms of
transient neurologic symptoms
(TNS) symptoms will disappear within 10 days

Front 102

what is another name for transient neurological symptoms (TNS)

Back 102

post spinal pain syndrome

Front 103

in transtracheal ventilation if 50 psi is used what wil the delivery of O2 (flow rate) be thru:
-20 gauge catheter
-16g
-14g

Back 103

20g = 400 ml/second
16g = 500 ml/second
14g = 600 ml/second

Front 104

3 complications of transtracheal
jet ventilation?

Back 104

-problems with exhalation
-barotrauma
-tissue emphysema

Front 105

when does maternal CO begin to
increase during pregnancy

Back 105

5th week gestation

Front 106

name 3 types of double lumen
tubes

Back 106

carlens: left
white: right
robert shaw (both bronchi)

Front 107

what is the most accurate method for determining correct double lumen tube placement

Back 107

flexible endoscopy

Front 108

what is the optimal shape of the
lighted stylet for nasal intubation

Back 108

for nasal intubation, the shape
should be prepared against the
patient profile

Front 109

what antihypertensive is now
considered first line treatment for
HTN in the preeclamptic pt?

Back 109

Labetalol (normodyne)

Front 110

list 3 other names for idiopathic
hypertrophic subaortic stenosis
(IHSS)

Back 110

-hypertrophic
cardiomyopathy (HCM)

-hypertrophic obstructive
cardiomyopathy (HOCM)

-asymmetric septal
hypertrophy

Front 111

list the anesthetic hemodynamic
goals for the pt iwth IHSS

Back 111

-sinus rhythm

-full: increased preload

-increased afterload

-slightly depressed

-contractility

-nl HR

Front 112

5 complications of the
interscalene block

Back 112

- Horner's syndrome

-Hoarsensess - recurrent laryngeal nerve

- ipsilateral
hemdiaphragmatic paresis
(phrenic nerve is blocked):
very common and not an
issue unless pt has resp
disease at baseline

-cough or chest pain
(pneumothorax)

-Bezold-Jarisch reflex:
sudden bradycardia and
hypotension inthe sitting
position

Front 113

what is the leading non-obstetric
cause of mortality in the pregnant
pt?

Back 113

heart disease

Front 114

what spinal nneedles are
-pencil point
-cutting?
-non-cutting?

Back 114

pencil point: sprotte and whitacre
cutting: Quincke
no-cutting: Greene

Front 115

what is normal BMI?
-overweight
-obese
-severe obesity
-morbidly obese

Back 115

18.5-24.9

Overwt: 25-29
Moderate obesity: 30-34
severe obesity: 35-39
morbidly obese: 40-49

Front 116

what is the HCT of 1 unit of
PRBCs

Back 116

75%