Basic anesthesiology

Question 1

What is the Dibucaine number?

Answer 1

A high number tells you that a person has a normal pseudocholinesterase. Dibucaine inhibits normal pseudocholinesterase. The amount that it inhibits is the amount that you have of the normal receptor. Dibucaine 80 is normal. Numbers < 30 mean you have an abnormal enzyme leading to prolonged succinylcholine

Question 2

What drugs are broken down by pseudocholinesterase?

Answer 2

Succinylcholine, cocaine, procaine, and mivecurium

Question 3

What inhaled agents are most affected by a R to L shunt?

Answer 3

The least soluble. This is because the Pa to Pi ratio takes longer to equilibrate due to the shunt and the fact that less blood is taken up into the alveoli

Question 4

Who is at risk for ulnar neuropathy? What are the signs/symptoms? How do you diagnose it?

Answer 4

1. Males, thin/obese people
2. Decreased sensation to the 4th/5th digits, atrophied intrinsic hand muscles, inability to oppose the 5th digit
3. Diagnosis with EMG: tells exact location of nerve injury, it takes about 4 weeks to obtain abnormal nerve firing (sign of denervation) or nerve conduction (does both motor and sensory)

Question 5

What food group is associated with an increased risk for latex allergy?

Answer 5

tropical fruits

Question 6

What is the treatment for organophosphate poisoning?

Answer 6

1. Atropine
2. Diazepam
3. Pralidoxime (binds out the organophosphate)

Question 7

What is the minimum amount of time you have to wait to do an elective surgery in each of these situations?

1. Recent MI with NO intervention
2. Recent MI with angioplasty
3. Recent MI with bare metal stent
4. Recent MI with drug eluding stent

Answer 7

1. 60 days
2. 14 days
3. 30 days
4. 6 months

Question 8

What can you given in children who are at risk for emergence delirium? What age group is at risk?

Answer 8

1. Dexmedetomidine, fentanyl, ketamine, propofol

2. Age 2-5

Question 9

What are the two locations of non shivering thermogenesis in adults? When does non-shivering thermogenesis not apply?

Answer 9

1. brown fat
2. skeletal muscle
3. Non-shivering thermogenesis does not occur under GA

Question 10

Which nerve is at risk for damage during brachial artery line placement? What are other associated complications?

Answer 10

Median nerve injury
thrombosis
infection

Question 11

What is the gold standard marker for liver function?

Answer 11

PT/INR

Question 12

What are the NPO guidelines?

Answer 12

2 hours: clears
4 hours: breast milk
6 hours: non-milk formula, non-human milk, light snacks
8 hours: full meals

Question 13

What is the gold standard test for detection of malignant hyperthermia?

Answer 13

halothane-caffeine contracture test

Question 14

What are the two most common things that delay outpatient surgical discharge?

Answer 14

1. PONV

2. Uncontrolled pain

Question 15

What is a hydroxyethyl starch? What effects does it have on the body? Explain general dosing differences between hetastarches and tetra starches.

Answer 15

1. hydroxyethyl starches are synthetic colloids that have groups added on to them to increase availablity and half life in the intravascular space. They are relatively CI in renal failure
2. These can interfere with plt function, decrease VIIi and vWF
3. Hetastarches have more subsitutions than tetra starches, so the dosing for hetastarches is lower

Question 16

Who is at risk for negative pressure pulmonary edema? What is the timeline of occurrence?

Answer 16

1. younger people, as they have stronger muscles and can generate a greater negative inspiratory force against obstruction
2. Occurs immediately following relief of the obstruction

Question 17

What hormone increases hepatic artery blood flow? How does it do this?

Answer 17

Glucagon decreases hepatic artery resistance

Question 18

What effects does vasopressin have on hepatic blood flow?

Answer 18

1. Decreases portal venous resistance
2. Increases hepatic artery resistance
   * * this is good for people with increased portal venous pressures and systemic hypotension

Question 19

Describe hepatic blood flow

Answer 19

1. The liver gets 25% of our cardiac output

2. The hepatic artery provides 25% of the liver’s blood supply, while the portal vein provides the other 75%

Question 20

What is the max dose of epinephrine with and without lidocaine?

Answer 20

1. Without lidocaine: 5mg/kg

2. With lidocaine: 7 mg/kg, because the epi makes it more acidic, which means slower onset

Question 21

What is the max dose of lidocaine in tumescence? Epinephrine?

Answer 21

1. 55 mg/kg

2. .055 mg/kg

Question 22

How can you cause median nerve injury during positioning? What is at risk due to constant BP cuff cycling?

Answer 22

1. Forced flexion of the elbow following muscle relaxant

2. constant blood pressure cycling can cause problems with the radial nerve as it is in the musculospiral groove

Question 23

What is the triad of symptoms seen with intra-operative vision loss? What are the two types of ION?

Answer 23

1. sluggish pupils
2. visual field defects
3. PAINLESS vision loss
4. Anterior (cardiac) and posterior (spine)

Question 24

What should you base your dosing on for NDMB and DMB?

Answer 24

1. Non-depolarizers: use IBW

2. Succinylcholine: use TBW

Question 25

What medication should you avoid in ECTs?

Answer 25

Lidocaine, because it shortens seizure duration

Question 26

When should you avoid Midazolam in the pregnancy period?

Answer 26

Third trimester and during deliver: it can result in "floppy baby" syndrome

Question 27

What three nerve injuries are associated with LMA placement?

Answer 27

1. recurrent laryngeal nerve 2. Lingual nerve 3. hypoglossal nerve

Question 28

How long should you wait to place an epidural or deep nerve catheter in a patient receiving 5,000 U of subq heparin BID or TID?

Answer 28

4-6 hours

Question 29

What is true regarding fentanyl administration in the pre operative period as a pre-medication?

Answer 29

In patients without prior chronic pain, it can lead to increased sensitization to pain. Use solely in patients who have chronic pain issues

Question 30

What value is NOT used in the Child-Pugh score?

Answer 30

Creatinine (because urine stinks)

Question 31

What values are used in the MELD calculation?

Answer 31

INR, Creatinine, Bilirubin, Dialysis

Question 32

What precaution do you have to take with local anesthetic administration following tumescence?

Answer 32

1. Levels of injected LA may peak around 12-18 hours | 2. Care must be taken when injecting further levels of LA

Question 33

Describe the difference between moderate and deep sedation.

Answer 33

Moderate sedation: patient is breathing spontaneously and requires NO intervention Deep sedation: patient requires some intervention and respirations may not be adequate

Question 34

Describe the different ASA statuses

Answer 34

ASA 1. normal healthy patient ASA 2. mild disease with no limitations ASA 3. severe disease ASA 4. severe systemic disease that is a constant threat to life ASA 5. Patient will not survive unless they receive surgical intervention ASA 6. Brain dead patient

Question 35

How would you describe the inheritance pattern of MH?

Answer 35

Autosomal dominant with variable penetrance

Question 36

What nerves are involved in laryngospasm?

Answer 36

1. recurrent laryngeal nerve is stimulated, which causes reflex closure of the vocal cords by the RECURRENT LARYNGEAL NERVE

Question 37

What lab test should be done on a patient who is taking long term dantrolene?

Answer 37

LFTs, chronic use of dantrolene can lead to liver failure

Question 38

What are the spirometry changes seen with aging?

Answer 38

Increased FRC, RV, and CC due to loss of lung elasticity, increase in chest wall rigidity, and flattening of the diaphragm

Question 39

What dose of propofol should be given to an unstable patient for induction? What is another agent that can be used instead?

Answer 39

1. 0.4 mg/kg | 2. Consider ketamine! Interestingly enough, in the unstable patient, increase in ICP is NOT a CI to using Ketamine

Question 40

What is the most accurate method for diagnosing resuscitation status?

Answer 40

Pulse pressure variation

Question 41

What cases are associated with the highest rates of intra-operative awareness?

Answer 41

1. cardiac 2. obstetric 3. trauma

Question 42

Which drug can interfere with pacemaker activity?

Answer 42

Succinylcholine. It can cause muscle fasciculations that can be interpreted as electrical activity that would then inhibit the pacemaker from working. It can also possible cause a shock if it has defibrillating capacity

Question 43

What is the difference between schedule 1 and schedule II drugs?

Answer 43

Schedule 1: High abuse potential with no medical use found | Schedule 2: high abuse potential, severe physical or psychological dependence

Question 44

What is the triad of symptoms for fat embolism syndrome?

Answer 44

1. petechiae 2. Hypoxia (respiratory insufficiency) 3. CNS involvement (seizure or AMS)

Question 45

What are the absolute CI to ECT therapy?

Answer 45

1. Recent MI (4-6 weeks) 2. Recent stroke ( < 3 months) 3. Recent intracranial surgery ( < 3 months) 4. intracranial mass or lesion 5. unstable C spine 6. Pheochromocytoma

Question 46

What is the best predictor for difficult airway? Mallampati vs. lower bite test?

Answer 46

Lower bite test

Question 47

Who is a good candidate for awake fiberoptic intubation?

Answer 47

A stable patient who you foresee having difficulties with mask ventilation and intubation

Question 48

Where does A-flutter originate? Why will adenosine not work in termination of A flutter?

Answer 48

A flutter starts around the tricuspid valve. Adenosine blocks the AV node, which is located in the RA, not by the valve. It will slow A flutter, but not terminate it.

Question 49

What are the respiratory changes seen in obese patients?

Answer 49

Increased chest wall rigidity, decreased ERV, decreased FRC, increased 02 consumption, increased RR

Question 50

What are the respiratory changes seen in the elderly?

Answer 50

Increased closing capacity above the FRC, which leads to atelectasis. Unchanged TLC, Increased RV, decreased VC