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SEE study Flashcards

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1
Q

What is the normal interincisor length in cm?
2
4
6

A

4 cm

This measurement is relevant for certain medical procedures.

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2
Q

What are the time frames that blood thinner must be stopped before surgery ?
Clopidogrel
Abciximab
Ticlopidine
Heparin
3 days
7 days
6 hours
14 days

A

Heparin: 6 hours
Abciximab: 3 days
Clopidogrel: 7 days
Ticlopidine: 14 days

These time frames indicate how long before a procedure these medications should be discontinued.

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3
Q

Where would you do a median nerve block on the wrist?

A

Between the flexor carpi radialis tendon and Flexor palmaris longus tendon

This location is critical for effective nerve blockade.

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4
Q

What is the maximum pressure for Jet Ventilation? (psi)
30
40
50
60

A

50 psi

This pressure limit is important for safe ventilation practices.

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5
Q

Where does ADH work in the kidney?
Loop of Henle
Distal tubule
Collecting ducts

A

Collecting ducts (water reabsorption)

ADH is crucial for water reabsorption in the kidneys.

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6
Q

Where does aldosterone work in the kidney?
Distal Tubule
Collecting Ducts
Loop of Henle

A

Distal tubule (Na+ reabsorption & K+ excretion)

Aldosterone is involved in Na+ reabsorption and K+ excretion.

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7
Q

What devices on a cylinder prevent outflow of high gas pressure?

A

Frangible disc
Fusible plug

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8
Q

Match the following terms ?
Duty: Legal obligation
Breach of Duty: Failure to meet obligation
Causation: Link between breach and harm
Damages: Actual harm done

A

Duty: Legal obligation
Breach of Duty: Failure to meet obligation
Causation: Link between breach and harm
Damages: Actual harm done

These terms are fundamental in legal contexts, especially in tort law.

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9
Q

What is antitrust law?

A

A collection of federal and state government laws that regulate the conduct and organization of business corporations and are generally intended to promote competition and prevent monopolies

These laws are intended to promote competition and prevent monopolies.

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10
Q

Identify the hotspot of a right foot?
Deep peroneal = Top left Medial
Superficial Peroneal = Middle Right Lateral

A

Deep peroneal nerve

This nerve is significant for sensory and motor functions in the foot.

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11
Q

What is the dose of bupivacaine for the first stage of labor?

A

0.0625% Bupi with 1-2 mcg fentanyl at 8-12 mL/hr

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12
Q

Which leads best detect ischemia of LAD? (select 3)
V3
V4
V5
I
avf
III

A

V3
V4
V5

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13
Q

Which medications do not interfere with SSEPs?

A

Ketamine
Precedex
Etomidate
Opioids
Droperidol

These medications are considered safe for use during monitoring.

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14
Q

Which local anesthetic is most protein bound in Order?
Bupivacaine
Ropivacaine
Mepivacaine
Tetracaine
Lidocaine

A

Latina - Levobupi
Babes - Bupi
Ride - Ropi
Massive - Mepivacaine
Thick - Tetracaine
Long - Lidocaine
Penis - Prilo/Procaine
Cumming - Chloroprocaine

Protein binding affects the duration and potency of local anesthetics.

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15
Q

Which alarms can you NOT silence? (select 2)
Asystole
High airway pressure
Apnea

A

Asystole
High airway pressure

These alarms indicate critical situations that require immediate attention.

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16
Q

Which lower extremity nerve do you have to inject at multiple spots?
Saphenous
Sural
Femoral
Sciatic

A

Sciatic (Tibial and common peroneal)

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17
Q

What color glasses do you need for CO2 laser?
Orange
Green
Yellow
Clear

A

Clear

This is essential for safety during laser procedures.

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18
Q

What is a long-acting Beta-2 agonist?
Albuterol
Levalbuterol
Terbutaline
Salmeterol

A

Salmeterol

This medication is used for asthma and COPD management.

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19
Q

How many METS for a person who plays basketball?
4
6
10

A

10

METS are a measure of exercise intensity.

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20
Q

What is the minimum ACT for CEA?
Carotid Endartectomy

A

> 250-300

This is a critical value for ensuring patient safety during carotid endarterectomy.

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21
Q

What are the physiological changes with pneumoperitoneum?

A

Increased BP, Increased Peak pressures (PIP), Decreased Lung Compliance

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22
Q

What increases ETCO2? (select 2)
Bicarb infusion
Hypotension
Tachycardia
Hyperthermia

A

Bicarb infusion
Hyperthermia

These factors can indicate metabolic changes in the patient.

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23
Q

Where is there laminar flow in the lungs?
Terminal bronchioles
Trachea
Alveoli

A

Terminal bronchioles

Understanding airflow dynamics is crucial for respiratory physiology.

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24
Q

What are the signs of Diastolic failure?
Concentric hypertrophy
Eccentric hypertrophy
Preserved EF
Reduced EF

A

Concentric hypertrophy
Preserved EF

These signs are important for diagnosing heart failure types.

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25
What nerve roots are blocked for a Carotid Endartectomy ? (select 3) C1 C2 C3 C4 C5
C2 C3 C4 ## Footnote These roots are relevant for cervical anesthesia.
26
How much does maternal CO increase immediately postpartum? 50 % 60 % 75 % 90 %
75%
27
When does RSI for pregnancy start? 8 weeks 10 weeks 12 weeks 18 weeks
18-20 weeks ## Footnote This timing is critical for safe anesthesia practices.
28
What is the first line treatment for neuropathic pain? Amitriptyline Clonidine Lidocaine Fentanyl
Amitriptyline is 2nd Gabapentin is 1 but not choice ## Footnote This medication is commonly used for managing chronic pain.
29
What is the dermatome level for the 4th and 5th digits? C6 C7 C8 T1
C8 ## Footnote This level is important for understanding sensory innervation.
30
What is the MAC to prevent movement in 95% of the population? 1.0 1.2 1.3 1.4
1.3 MAC ## Footnote This value is used for determining anesthetic depth.
31
Where does the LMA sit?
At the Upper Esophageal sphincter ## Footnote Proper placement is crucial for ventilation.
32
What patient population can you not give Methergine? Preeclampsia Gestational Diabetes HELLP
Preeclampsia ## Footnote This medication is contraindicated in certain conditions.
33
What is the hematocrit % of blood (PRBC)? 40 50 70
70%
34
What is the common coagulation pathway Factor? 10 8 9 12
Factor X (10) ## Footnote This factor is crucial in the coagulation cascade.
35
What drags fluid into the capillary vessel?
Capillary Oncotic pressure ## Footnote This pressure is essential for fluid balance in the body.
36
What are the side effects of hypermagnesemia on the neonate? (select 2) Muscle atony (Hypotonia) Hypertonia Respiratory Depression Muscle Hypertrophy
Muscle atony (Hypotonia) Respiratory Depression ## Footnote These effects can impact neonatal health significantly.
37
What is the role of CB1 and CB2 receptors in pain modulation? Cannabis
CB1 = high CB2 = pain modulation ## Footnote These receptors are part of the endocannabinoid system involved in pain perception.
38
Where would the catheter for pain management be placed on a patient undergoing T2 thoracotomy? T4-T6 T3-T4
T4-T6 ## Footnote This level is crucial for effective pain control during thoracic surgeries.
39
What happens to West Zone when excessive ventilation is added?
West Zone 1 opens up
40
Where does NSAID work?
Arachidonic acid to Prostoglandin inhibition COX1 and COX2
41
Match the receptors with their corresponding neurotransmitters. Mu1 Delta Kappa Dynorphins Enkaphalin Endorphin
Mu1 + Endorphin Delta + Enkaphalin Kappa + Dynorphins
42
What are the end products of Soda Lime?
CaCO3 + 2NaOH/KOH ## Footnote Soda lime is used in anesthesia to absorb carbon dioxide.
43
What are the nerve injuries associated with specific positions? - Suprascapular nerve = lateral position rolls semiprone onto dependent arm with shoulder circumduction - Ulnar nerve = arms folded across abdomen or chest with elbows flexed >90 degrees - Brachial plexus = arm abduction and lateral flexion of the head to the opposite side - Saphenous nerve = excessive pressure on medial aspect of leg
Suprascapular nerve = lateral position rolls semiprone onto dependent arm with shoulder circumduction Ulnar nerve = arms folded across abdomen or chest with elbows flexed >90 degrees Brachial plexus = arm abduction and lateral flexion of the head to the opposite side Saphenous nerve = excessive pressure on medial aspect of leg
44
What is the acceptable airway leak in a pediatric patient? (cm H2O) 15 20 25 35
25 cm H2O
45
Which phase one reaction loses electrons? Reduction Oxidation Phosphyrlation
Oxidation ## Footnote The mnemonic 'OIL RIG' helps remember that oxidation involves losing electrons.
46
What is the location of the chromaffin cells? Adrenal Medulla Adrenal Cortex
Adrenal medulla ## Footnote Chromaffin cells are responsible for producing catecholamines.
47
What does an (HME)moisture and heat exchanger do?
An HME conserves heat and humidity by conduction and condensation during exhalation, then evaporation during inhalation.
48
When should you stop Warfarin prior to surgery? 2 days 3 days 5 days 7 days
5 days ## Footnote Stopping anticoagulants is crucial to minimize bleeding risks during surgery.
49
Which medication would have a dose-dependent decrease in tracing on an EEG monitor? Etomidate Precedex Ketamine
Etomidate
50
What placental abnormality results in placental invasion of myometrium and serosa? Accreta Increta Percreta
Placenta Percreta Placenta accreta → attaches to myometrium (no invasion) Placenta increta → invades into myometrium Placenta percreta → invades through myometrium to serosa
51
What is the reason for fade in neuromuscular transmission?
Presynaptic block
52
What increases renin levels? all Decreased renal perfusion Hemorrhage PEEP CHF Liver failure Sepsis SNS activation through Beta 1 Tubuloglomerular feedback
Decreased renal perfusion Hemorrhage PEEP CHF Liver failure Sepsis SNS activation through Beta 1 Tubuloglomerular feedback ## Footnote Renin plays a key role in regulating blood pressure and fluid balance.
53
What contributes to fetal circulation after delivery?
Increased PVR
54
What is the most common complication with bariatric surgery? DVT CHF MI Aspiration
DVT ## Footnote Deep vein thrombosis is a significant risk post-surgery.
55
What inhibitory neurotransmitters are involved in the nervous system? (select 2) Glutamate Glycine GABA NMDA
Glycine GABA
56
What type of reaction is ABO incompatibility? Type 1 Type 2
Type II
57
Which two interventions would you do for a patient undergoing a pituitary gland resection for acromegaly? (select 2) Desmopressin 3% mannitol Hyperventilate Use a smaller ETT
Desmopressin Use a smaller ETT
58
Which medication cannot be reversed with sympathomimetics? Phenoxybenzamine Phentolamine Phenylephrine Vasopressin
- Phenoxybenzamine is a non-competitive non-selective alpha receptor antagonist blocks the alpha mediated activity of EPI and NOREPI,
59
What kind of medication is phentolamine?
Sympatholytic. Competitive alpha receptor antagonist. Reversible with EPI or LEVO
60
The patient’s SBP at the phlebostatic axis is 120 mmHg. What is the patient’s new SBP if the BP is measured 20 cm below the heart?
7.4 each 10 cm so 20 cm = 14.8 - The BP cuff is below the heart so the BP measure will be higher than what it should be - 120 + 14.8 = 134.8 = 135 mmHg
61
Which volatile agents is susceptible to degradation to carbon monoxide the most? Desflurane Isoflurane Sevoflurane
* Desflurane #1
62
Which volatile agent has the greatest potential of producing carboxyhemoglobin? Desflurane Sevloflurane Isoflurane
* Desflurane
63
Which would adversely affect residual NMBA post-op PICK 2? a) Heparin b) Hypermagnesemia c) Upper abdominal Surgery d) Phenytoin
b) Hypermagnesemia c) Upper abdominal Surgery
64
The patient (plaintiff) must prove 4 things to win a negligence malpractice claim: - Duty - Breach of duty - Causation - Damages
65
After abdominal surgery, the patient arrived to PACU with stridor, which was found to be the result of laryngeal edema with vocal cord laceration, secondary to difficult intubation. Damages may be awarded to this patient due to which doctrine? * Respondent superior * Borrowed servant * Res Ipsa loquitor * Harrison
* Res Ipsa loquitor
66
A patient emerged from general anesthesia with brachial plexus palsy. In litigation, the judge placed the burden of proof on the defendant CRNA. The judge acted under what doctrine? * Respondent superior * Borrowed servant * Res Ipsa loquitor * Harrison
* Res Ipsa loquitor
67
Hotspot: Click where the J wave would be on a strip showing severe ST segment elevation.
Can quantify the amount of ST elevation and depression. Changes greater than 1 or less than -1 are significant
68
Which will antagonize nicotinic cholinergic transmission? * Propofol * ETOH * Versed * Trimethaphan
* Trimethaphan ganglionic blocker that inhibits the transmission of signals at the nicotinic receptors in the autonomic ganglia.
69
Patient who had an ear procedure and can’t hear afterwards. What could be the problem? * increased nitrous oxide infusibility
* increased nitrous oxide infusibility
70
What is the acceptable levels, in parts per million (ppm), of inhaled anesthetics in the OR when N2O and a volatile agent are used together? 25 2 0.5
* 0.5 ppm
71
What are the acceptable levels, in parts per million (ppm), of inhaled anesthetics in the OR when a volatile agent is used alone? 25 2 0.5
2
72
What can be seen with an intrathecal injection of opioids? * transient fetal bradycardia
Intrathecal opioids have been implicated as contributing to a greater risk for fetal bradycardia when used for labor analgesia compared with non-intrathecal opioid neuraxial analgesic techniques. Transient fetal bradycardia can occur due to the impact of opioids on maternal blood pressure and uterine blood flow.
73
What fluid is best for hypochloremia? 0.9% sodium chloride LR Plasmalyte
0.9% sodium chloride
74
Hotspot: Where do thiazide diuretics work? Distal Convoluted Tubule
75
Which 2 parts of the kidney are impermeable to water? * Ascending Loop of Henle * Late Distal Convoluted Tubule
76
What gets reabsorbed in proximal tubule? Hydrogen Ions Sodium Glucose Urea
* Sodium
77
Where in the kidney does urine get concentrated? Pelvis Glomeruli Cortex Medulla
* Medulla
78
What anesthesia agents inhibit (Hypoxic Pulmonary Vasoconstriction) HPV? (select 2) Volatile agents > 1.5 MAC Excessive PEEP > 15 PDEi Dobutamine Vasodilators and some CCBs Pressors Hypervolemia and ­ CO Large Vt
* Volatile agents > 1.5 MAC * Excessive PEEP > 15
79
What is it called when an anesthesiologist is covering more than 4 rooms at once? Medical Supervision Medical Direction
Medical Supervision
80
Removing an electron is part of what? Phase 1 Reaction Phase 2 Reaction
Phase 1 Oxidation
81
Which nerve has dorsiflexion? * Deep Peroneal Nerve * Superficial Peroneal Nerve * Sural
* Deep Peroneal Nerve
82
Which nerve has plantar flexion? * Tibial * Sural * Peroneal
Tibial
83
What is the normal neonatal O2 consumption? (L/min) a) 2 b) 4 c) 7 d) 10
c) 7 5-7 L/min
84
Placenta abruption is associated with what? a) Increased factor V and VIII b) Hyperfibrinogenemia c) Low platelets
c) Low platelets
85
Why do the elderly have an increased V/Q mismatch? (select 2) Decreased Lung elasticity Increased Lung elasticity Increased lung compliance Decreased lung compliance
Decreased Lung elasticity but increased lung compliance
86
Morbid obesity is associated with a decrease in: (Select 3) a) FRC b) ERV c) Closing Capacity d) Closing Volume e) TLC f) RV
a) FRC b) ERV e) TLC
87
Which is the most specific indicator of obesity lung change? * Decrease ERV
* Decrease ERV
88
How do you increase cerebral perfusion during a craniotomy? - maintain CPP (CPP = MAP – ICP)
(CPP = MAP – ICP)
89
Which tendon are you injecting by when doing a median nerve block? Inject between tendons Flexor Carpi radialis Flexor Palmaris Longus
90
How much does the cardiac output increase for the parturient at term? 50% 15% 20%
50%
91
How much is the cardiac output increased in the third stage of labor? 80% 50% 60%
80%
92
What is a contraindication for a cricothyroidotomy? Hematoma Obesity Radiation to neck Tumors Tracheal Obstruction
Traceal Obstruction
93
Why do you give anti-sialagogue prior to fiberoptic intubation? To minimize secretions
If there’s blood or ↑secretions in airway, then opt for blind (supraglottic) techniques; do not choose FOB!!
94
What is the internal diameter of a CUFFED tube for a 6-year-old?
5 age/4 +3.5
95
Benefit of tube exchanger over the bougie? An Airway Exchange Catheter: * Can be left in place for up to 72 hours * Allows for Jet Ventilation * Provides EtCO2 measurement * Can be used for oxygenation insufflation
96
Pick 2: Which ones can you ventilate through? a) Fiberoptic b) Airway exchanger c) Stylet d) Bronchial Blocker
b) Airway exchanger d) Bronchial Blocker
97
What determines DLT sizing?
Patient’s Height
98
What size DLT is used in women? Height < 160 cm → Height > 160 cm →
Height < 160 cm →35 F Height > 160 cm → 37 F
99
What size DLT is used in men? Height < 175 cm → Height > 175 cm →
Height < 175 cm →39 F Height > 175 cm → 41 F
100
What size DLT is used in a 13-year-old average-sized female? 28 F 24 F 30 F
28 F Children 8-9yrs old = 26 F Children 10+ = 28 F
101
How deep do you insert a DLT in men?
* 29 cm
102
How deep do you insert a DLT in women?
* 27 cm
103
Which is NOT an absolute indication for DLT Esophageal Resection Infection Hemorrhage Surgical opening of airway
Esophageal Resection
104
If you place a left sided DLT and it’s too deep, what structure are you obstructing? a) Upper lobe b) Lower lobe c) Mainstem
c) Mainstem
105
You inserted a left-sided double-lumen tube. After clamping the bronchial lumen, you only hear breath sounds in the left lung. What does this indicate?
The DLT that is too deep on the LEFT
106
On a patient in the lateral decubitus position with two lung ventilation, what is the percent of blood flow is received by the non-dependent compared to the dependent lung?
Nondependent lung 40% Dependent Lung = 60%
107
What is the worst way to secure the airway of a patient who suffered trauma and has blood airway and unstable C spine? DL Fiberoptic Cricothyroidotomy
Fiberoptic
108
Which LMA is contraindicated for MRI?
Fastrack LMA - Metal handle Flexible LMA - Metal Wire reinforced
109
How much Na is in a bag of 0.9% NS?
9 grams or 154 meq of Na
110
Mix and Match for Chemo drugs Bleomycin - lungs Cisplatin - kidneys Doxorubicin - heart Cyclophosphamide-Hemorrhagic cystitis Methotrexate - liver Vincristine - autonomic neuropathy
Bleomycin - Pulmonary fibrosis Cisplatin - Nephrotoxicity Doxorubicin (Adriamycin) - Cardiomyopathy Cyclophosphamide - Hemorrhagic cystitis Methotrexate - Hepatotoxicity Vincristine - Autonomic neuropathy
111
Massive transfusion protocol RBCs, FFP, PLTs: How much of each ratio?
2:1:1
112
Where are the coronary ostia located?
in the sinuses of Valsalva, just above the aortic valve leaflets.
113
Which muscle relaxants better in elderly? (Select 2) Rocuronium Vecuronium Sux Cisatracurium Atracurium
Cisatracurium and Atracurium
114
Which hormone is a precursor to Norepinephrine? Tyrosine Dopamine Epinephrine
Tyrosine → DOPA → Dopamine → Norepinephrine → Epinephrine
115
What nerves to be blocked for nasal intubation? Sphenopalatine, Ethmoidal, palatine
Sphenopalatine primarily
116
Given multiple doses of atropine to an elderly woman, what do you give to her in pacu? Physostigmine Neostigmine Glycopyro
If an elderly patient receives multiple doses of atropine and develops anticholinergic effects in PACU (confusion, agitation, tachycardia, dry skin, urinary retention), the treatment is physostigmine.
117
What medication to give first with a patient with K of 6.5 and cardiac arrhythmias? Insuline IV fluids Calcium Beta blocker
Calcium
118
Which nerve fiber is hardest to block? C fibers B fibers A-gamma A-beta
A-beta based on options here B → C → A-delta → A-gamma → A-beta → A-alpha
119
Which law applies to Jet ventilation? Gay lussacs Pouiseuille Ohms Venturi Effect
Venturi Effect of Bernoulis principle
120
Which nerve is injured with orbicularis oculi? Trigeminal Facial Abducens
CNVII- Facial
121
Osteogensis imperfecta symptoms?
Decreased bone density and Valve regurgitation OI = brittle bones, blue sclera, bad hearing, leaky valves.
122
Which antimuscarinic to use with increased HR? Atropine Glyco Scopolamine
Scopolamine
123
Cricothyroid muscle innervation comes from which nerve? - External branch of the Superior Laryngeal Nerve (SLN) - Internal branch of the Superior Laryngeal Nerve (SLN) - Recurrent Laryngeal
External branch of the Superior Laryngeal Nerve (SLN) Only motor supply to cricothyroid
124
How much CSF is made per hour? (mL) 5-10 15-20 25-30 35-40
15-20 ml/hr 500 mL per day Total CSF volume ≈ 150 mL
125
2 risk factors for Ischemia optic neuropathy?
Wilson frame and long duration of surgery
126
What is the primary neurotransmitter for A-delta fibers ? Glycine NMDA Glutamate Substance P
Glutamate Fast pain Sharp, well-localized First pain you feel
127
What is the primary neurotransmitter for C fibers ? Glycine NMDA Glutamate Substance P
C fibers = slow pain = substance P
128
What nerve feeds most sensory nerves of the foot? Sural Saphenous Deep Peroneal Tibial
The tibial nerve provides most of the sensory innervation of the foot, especially the plantar (bottom) surface.
129
Most common cause of hypotension in pacu?
Hypovolemia
130
Most common place for carcinoid tumor? Ileum Lungs Ovary Appendix
Appendix
131
What is a possible difficult airway issue with patients with Rheumatoid Arthritis?
RA = TMJ + cervical spine → think difficult airway.
132
EF calculation = EDV-ESV/EDV x100
EDV-ESV/EDV x100 ## Footnote CO = HR x SV
133
Maternal changes - decrease SVR
134
What percentage of Cardiac Output does the Liver receive? 15% 25% 35% 50%
25%
135
What has an increased risk for epidural hematoma?
Epidural hematoma = anticoagulation + trauma, not paramedian technique.
136
Which medication prolongs QT and increases risk of torsades de pointe? Reglan Lidocaine Etomidate Methadone
Methadone
137
How many half-lives needed for a drug to be at 3%? 3 4 5 7
5 After 1 half-life → 50% remains 2 → 25% 3 → 12.5% 4 → 6.25% 5 → ~3% remains
138
Somatostatin is secreted by what cells? Alpha Beta Delta Gamma
Somatostatin Secreted by δ (delta) cells of the pancreatic islets
139
Calcium channel blocker block which phase of the ventricuclar cardiac potential? Phase 1 Phase 2 Phase 3 Phase 4
CCBs block Phase 2 (plateau) Phase 2 = plateau phase (calcium influx via L-type Ca²⁺ channels)
140
Mitral Regurgitation produces what type of murmur? Diastolic Holosystolic Concentric
MR = holosystolic murmur at the apex radiating to the axilla. MRSA
141
With Anterior spinal Cord syndrome what 2 symptoms are lost? Proprioception Vibration Pain and temperature sensation Fine touch Motor function
Motor function (paralysis below the lesion) Pain and temperature sensation
142
Last treatment bolus for 60 kg patient ?
1.5 mL/kg×60 kg=90 mL If pt was greater than 70kg then you bolus 100mL and start infusion
143
First treatment for Bone Cement Syndrome in the OR?
100% FiO₂ FIRSTTT Support blood pressure Vasopressors (phenylephrine, norepinephrine) IV fluids (judicious, avoid overload) Treat hypoxia
144
Which medication is best treatment for chronic bone cancer patient? Acetaminophen Ketamine Gabapentin Ibuprofen
Ibuprofen Bone pain is largely driven by inflammation and prostaglandins NSAIDs: Inhibit COX → ↓ prostaglandins Are especially effective for bone metastasis pain
145
Which fire extinguisher is most commonly used in the operating room?
Carbon Dioxide CO2 extinguisher Nonconductive → safe around electrical equipment Leaves no residue → protects sterile field and equipment
146
Retrobulbar block looking which way to cause worse outcomes?
Looking up and in (superonasal gaze)
147
Taking off ppe sequence? Gown Eye protect hand hygiene mask gloves
1. Gloves 2. Gown. 3. Eye protect. 4. Mask. 5. Hand hygiene
148
During pregnancy which 2 hormones decrease? Progesterone Estrogen FSH LH HCG
Follicle-stimulating hormone (FSH) ↓ Luteinizing hormone (LH) ↓ Pregnancy suppresses FSH and LH via estrogen/progesterone feedback.
149
Incarcerated hernia on 13 Jehovah’s witness - parents refuse surgery. What do you do?
Obtain a court order — and proceed if emergent This is a medical ethics + legal question, and the key factors are: Patient is a minor (13 years old) Parents refuse life-saving treatment Condition is potentially life-threatening (incarcerated hernia)
150
In the lateral position where should the stopcock/transducer for the A line be placed? Mid chest Mid axillary line
Mid Axillary line
151
Normal difference between PaCO2 and Etco2 ? 5 10 15 18
Normal PaCO₂ exceeds EtCO₂ by ~5 mmHg.
152
Downside to syringe pumps - Occlusion detection can be delayed bc of very small volumes
Occlusion detection can be delayed bc of very small volumes
153
S/S of Pyloric Stenosis?
Hypokalemia Hypochloremia Metabolic Alkalosis Persistent vomiting of gastric contents Loss of H⁺ → metabolic alkalosis Loss of Cl⁻ → hypochloremia Kidney compensates by: Retaining sodium Excreting potassium → hypokalemia
154
Anesthetic affect on the brain Cortex = unconsciousness, spinal cord = immobility hippocampus = amnesia amygdala = anxiolysis brainstem = respiration
155
How is plasma cholinesterase affected in prengnacy?
Pregnancy ↓ plasma cholinesterase → slightly prolonged succinylcholine.
156
Which West zone develops with pulmonary hypotension?
Zone 1: PA < Pa < PV (Alveolar pressure exceeds pulmonary arterial pressure) Alveoli are ventilated but not perfused → Dead space
157
What axis is aligned when placing a pillow under an obese patients head for laryngoscopy?
Pharyngeal axis aligned Laryngeal axis aligned External auditory meatus ↔ sternal notch in the same horizontal plane
158
Which % after fluid bolus would indicate needing more fluid? 5 6 8 12
ΔSV or ΔCO ≥12% → give more fluid
159
Cannabis duration of action? Smoking - Oral -
Smoking - 2-4 hrs Oral - 6-8 hrs
160
What gases can be measured with infrared spectroscopy?
Nitrous oxide (N₂O) Volatile anesthetics Sevoflurane Isoflurane Desflurane Halothane NOT OXYGEN
161
Why baby has faster inhalation induction?
Increased alveolar vent compared to relative size of frc Faster turnover for the FRC
162
Hygroscopic Heat Exchanger (HME) vs. Heated Humidifier
Hydrophobic HME Lowest infection risk Acts as a mechanical filter (blocks bacteria + viruses) Most effective at preventing viral transmission Including Hepatitis C Does NOT rely on moisture to filter
163
Substance P → NK-1 receptor Glutamate → NMDA receptor Norepinephrine → α₂ receptor Enkephalin → δ (delta) opioid receptor Serotonin (5-HT) → 5-HT receptors Glycine → GlyR (chloride-linked) GABA → GABAᴀ, GABAᵇ, GABAᶜ
Mix and match
164
Soda Lime end products (chemical formula not by name)?
CaCo3 + 2NaOH/KOH
165
How does the BIS get its reading?
Translate raw EEG data into numbers from 0-100
166
What 3 nerves blocked with fascia iliaca?
Lateral femoral cutaneous Obturator Femoral
167
Nerve injury to Leg? Lateral aspect of leg – common peroneal Posterior calf – saphenous Flexion of hip – femoral Medial thigh – obturator
168
If you have a moisture and heat exchanger where should you sample CO2?
Between the HME and the Y-piece (patient side of circuit)
169
DES vaporizer what does it not have?
Does not have: Elevation compensation, Flow over, Variable bypass, wick
170
Right thoracotomy, with left sided endobronchial tube, what will improve oxygenation?
CPAP to nondep, PEEP to dep, supplemental oxygen
171
Mapleson spontaneous ventilation, where should the APL valve be placed
A, near pt end of circuit as close as possible
172
Matching blood:gas partition coefficient with Anesthetic Gas? Des Nitrous Sevo Iso 1.46 0.65 0.46 0.42
Des- 0.42 Nitrous- 0.46 Sevo- 0.65 Iso- 1.46
173
Which peripheral block is best suited for post operative pain management on a patient post wrist surgery?
Axillary block
174
Complication most commonly seen after parathyroid gland surgery? Laryngospasm Headache HTN
Laryngospasm
175
Total knee arthroplasty, what block is best? Saphenous Sciatic Femoral
Femoral nerve block
176
Where do steroids work?
Steroids act on C fibers and nerve roots by inhibiting phospholipase A₂ and cytokine production.
177
Retrobulbar block and apnea what caused it ?
Optic nerve sheath injection
178
What increases renin?
Decreased renal perfusion, hemorrhage, PEEP, CHF, liver failure, sepsis, SNS activation through Beta 1, tumoglomerular feedback
179
Smallest to Greatest Diameter fibers?
C fibers: smallest, unmyelinated (slow pain, temperature) B fibers: small, myelinated (preganglionic autonomic) Aδ Delta fibers: fast pain, temperature Aγ Gamma fibers: muscle spindle tone Aβ Beta fibers: touch, pressure Aα Alpha fibers: largest, fastest (motor, proprioception)
180
Most ankle blocks come from which nerve? Saphenous Sciatic Lateral femoral
Sciatic
181
What decreases PVR? propofol , nitric, milrinone, nitro
182
The conditions most likely associated with a myelomeningocele?
allergy to latex, spina bifida and chiari malformation, hydrocephalus
183
Precautions during myelomeningocele surgery?
Latex allergy
184
Risk factors for increase bleeding after tonsillectomy: (select 2) ?
child older than 15 reoccurring tonsillitis
185
The patient with this allergy is absolutely contraindicated to get generic propofol? Egg Soy Sulfite Cephalosporoin
Sulfites
186
What is true about hepatorenal disease syndrome type (2): ?
Hepatorenal syndrome is characterized by increased cardiac output and a hyperdynamic, low-SVR circulation.
187
Treatment for the patient with hemophilia a would include (select two): desmopressin PRBC TXA Platelets
Hemophilia A is treated with desmopressin and antifibrinolytics such as TXA. FFP also if answer choice given
188
Which do you not see with intracthecal narcotics? Urinary retention Pruritis Respiratory depression Hypotension
Intrathecal opioids cause pruritus, urinary retention, and respiratory depression—but NOT hypotension.
189
If the catheter is inserted 30 cm into the heart, which tracing will you see? Right Ventricle (2nd waveform)
Right Ventricle (2nd waveform) (Largest waveform)
190
Mix and match for location of action of acetazolamide, furosemide, (thiazide), and spironolactone?
Acetazolamide → Proximal convoluted tubule (PCT) Furosemide (loop diuretic) → Thick ascending limb of the loop of Henle Thiazides → Distal convoluted tubule (DCT) Spironolactone → Collecting duct
191
Which has the least protein binding? Ketamine propofol midazolam Precedex
Ketamine: ~10–50% protein bound (lowest) Midazolam: ~95% protein bound Propofol: ~98–99% protein bound
192
What depth should you use for a brachial plexus block using ultrasound? <2cm, 2-3cm, 4-5cm, >5cm
Ultrasound-guided brachial plexus blocks are best performed at a depth of 2–3 cm.
193
When does the risk of retinopathy of prematurity become negligible at ___? weeks 32 35 38 44
44 weeks or greater
194
When giving PRBCs, what do you not want the crystalloid to contain? Potassium Calcium Heparin Sulfur
Calcium Calcium-containing crystalloids (e.g., Lactated Ringer’s) can: Bind citrate Reverse anticoagulation Increase risk of clot formation in the blood tubing
195
With strabismus surgery, traction on what muscle may initiate the oculocardiac reflex? Lateral rectus Medial rectus Inferior rectus
Medial rectus
196
When do you start left uterine displacement? 6 weeks 20 weeks 30 weeks 32 weeks
18-20 weeks
197
Normal heart axis: ? < −30° -30 through +90 > +90° −90° to −180°
Normal axis: −30° to +90° Left axis deviation: < −30° Right axis deviation: > +90° Extreme axis deviation: −90° to −180°
198
Physical manifestations of hypercalcemia present in most individuals when calcium level reaches: ? 4mg/dL 6mg/dL 7mg/dL 12mg/dL
12mg/dL
199
Butorphanol for labor is beneficial for its effect on what receptor? Kappa Mu Delta
Kappa Effective visceral analgesia Less respiratory depression
200
Mix and match mechanism of action: phenoxybenzamine = prazosin = metoprolol = labetolol =
phenoxybenzamine = alpha 2, prazosin = alpha 1, metoprolol = beta 1, labetolol = beta 2
201
Which contributes to fetal circulation after delivery?
Increased PVR
202
How far do you need to stand from X-ray to be considered safe?
6 ft.
203
Where do you place the bronchial cuff for DLT?
“Bronchial cuff position” → Distal to the carina “Tracheal cuff” → Above the carina
204
Max ProSeal Pressure? H₂O 20 30 40
30cm H₂O
205
Highest complication with CEA? Stroke MI DVT Cranial nerve injury
The most common complication following carotid endarterectomy is myocardial infarction MI.
206
How to preoxygenate an obese patient? CPAP and increased HOB
CPAP and increased HOB
207
Which drugs are administered based on TBW? (select 2) Succinylcholine Propofol Fentanyl Rocuronium Midazolam
Succinylcholine and Fentanyl
208
What type of reaction is ABO incompatibility? Type I Type II
ABO incompatibility is a Type II hypersensitivity reaction. Type II = cells destroyed Think: transfusion reactions, hemolytic disease of the newborn
209
Which LMAs have a lumen for gastric suctioning? (select 3) i Gel C Trach Fastrach Proseal Supreme
i Gel Proseal Supreme
210
What are 2 benefits of Proseal LMA?
Gastric drain tube for decompression Higher peak pressures up to 30cmH20 Bite block Better seal
211
What nerve is blocked for Transtracheal block? Superior laryngeal Recurrent laryngeal
Recurrent laryngeal nerve Needle in cricothhyroid membrane single injection
212
Which nerve needs to be blocked for the trachea and larynx?
Vagus
213
Best way to anesthetize for an awake nasal FOB? - instill topical LA into each nare - spray as you go with the flexible fiberoptic bronchoscope - inject LA through a multi orifice epidural catheter inserted into the suction port of a flexible FOB
- spray as you go with the flexible fiberoptic bronchoscope
214
What are 4 complications seen with jet ventilation? * Subcutaneous emphysema * Mediastinal emphysema * Pneumothorax * Barotrauma
215
When to stop inspiration during jet ventilation?
Chest Rise
216
Who is in charge of checking purity of cylinders? ASTM FDA OSHA DOT
DOT regulates the transportation of hazardous materials, including gas cylinders, ensuring they meet safety standards and are properly labeled.
217
Which lung zone has the most negative intrapleural pressure? Zone I Zone 2 Zone 3 Zone 4
Zone I (apex of the lung) DEAD SPACE
218
Which lung zone has the least negative intrapleural pressure? Zone I Zone 2 Zone 3 Zone 4
Zone III SHUNT
219
What procedure is a patient with HRS-II (hepatorenal syndrome II) coming in for?
* Paracentesis HRS type 1 is acute in onset (less than two weeks) and heralds a poor prognosis. HRS type 2 is more chronic in nature and is associated with less severe kidney dysfunction characterized by refractory ascites resistant to diuretics.
220
TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure?
Connection between portal and systemic circulation (portal vein to hepatic vein) to decompress portal HTN when esophageal varices or refractory ascites are present Complications = Pneumothorax and Hemorrhage/Dysrhythmias
221
Which law relates flow and resistance for BP? Laplace Ohms Boyles
Ohms
222
Which chemicals are released from damaged tissue? ALL * Bradykinin * Substance P * Prostaglandins * Histamine * Leukotrienes * Cytokines
223
Epidural administration of what causes BOTH early and late respiratory depression? (Pick 2) Morphine Fentanyl Sufantanil Hydromorphone
Hydromorphone Morphine
224
Following scoliosis repair surgery, a wake-up test is performed. What part of spinal cord is being tested? Ventral (Spinothalamic Tract) Lateral (Corticospinal Tract) Dorsal column
Lateral (Corticospinal Tract) Limb motor
225
Which disease is associated with fused cervical plate? Klippel-Feil Beckwith Pierre Robin
Klippel-Feil
226
What is the loading dose of magnesium to treat pre-eclampsia?
* 4 grams over 20 minutes
227
Addison's Disease = Problem with what?
Hypoaldosteronism - Hyperkalemia - Metabolic alkalosis - Hyponatremia - Hypotension
228
Four signs and symptoms of Conn’s Syndrome (Hyperaldosteronism):
Hypernatremia Hypokalemia Hypertension Metabolic ALKALOSIS
229
The fire risk with sevoflurane is highest with which CO2 absorber? Baralyme Soda lime Ambsorb
Baralyme Baralyme contains barium hydroxide, which accelerates sevoflurane breakdown. This reaction produces Compound A, a nephrotoxic byproduct
230
Activators in CO2 absorbers? (select 2) NaOH KOH BaOH H2O
NaOH KOH
231
Where does the high-pressure system begin and end?
* Begins→ Cylinder * Ends→ Cylinder Regulators
232
What are the 7 components of the intermediate-pressure system of the anesthesia machine?
1. Pipeline inlets 2. Pressure gauges 3. Oxygen pressure failure device 4. Oxygen second stage regulator 5. Oxygen flush valve 6. Ventilator power inlet 7. Flowmeter VALVES
233
Where does the intermediate-pressure system begin and end?
Begins→ At the pipeline * Ends→ Flowmeter valves
234
What are the 4 components of the low-pressure system of the anesthesia machine?
1. Flowmeter TUBES (aka Thorpe tubes) 2. Vaporizers 3. Check valve 4. Common gas outlet
235
Where does the low-pressure system begin and end?
* Begins→ At the flowmeter tubes * Ends→ Common gas outlet
236
What allows gas to be released in a slow and controlled manner from a cylinder during high temperatures? * Fusible plug * Rupture Disk
* Fusible plug * Rupture Disk
237
Oxygen Pressure Failure Device (Failsafe) purpose?
- protects against low oxygen pressure (not low oxygen concentration) - works when: - depleted O2 tank - drop in pipeline pressure - disconnected O2 hose - part of the intermediate pressure system - has 2 components: 1. alarm that sounds when O2 pipeline pressure falls below 30 psi 2. pneumatic device that reduce or stop N2O flow when pipeline O2 pressure falls below 20 psi Can still deliver hypoxic mixture only monitors change in pressure
238
What are side effects of clonidine administration?
Sedation Dry mouth (xerostomia) Bradycardia Hypotension Constipation Rebound HTN
239
Which drug classes are contraindicated in patients with Parkinson’s ? Phenothiazines (Chlorpromazine) Butyrophenones (Haloperidol)
and also Metoclopramide (Reglan)
240
Which is a RELATIVE contraindication for Parkinson disease?
Phenothiazines (Chlorpromazine)
241
Which Leads best detect EKG changes in the Circumflex artery? (select 4) I II III avL V5 V6
I avL V5 V6
242
Which leads best detect EKG changes in the Right Coronary Artery? (select 3) I II III aVF aVR
II, III, aVF
243
Which leads best detect EKG changes in the Left Anterior Descending Artery? (select 4) V1 V2 V3 V4 V5 V6
* V1, V2, V3, V4
244
Which drug would give you an spO2 reading of 85%? Prilocaine and Benzocaine
Prilocaine and Benzocaine due to Methemoglobinemia
245
Which enzyme is inhibited by cyanide toxicity? Cytochrome C Oxidase
Cytochrome C Oxidase
246
Which medication causes cyanide toxicity? Nitroprusside Oxytocin Methergin LIdocaine
* Nitroprusside
247
Which would produce inaccurate in SpO2? Carboxyhemoglobin Methemoglobin
Carboxyhemoglobin (false high) Methemoglobin
248
What is the treatment for methemoglobinemia?
Methylene blue 1-2 mg/kg IV over 5 mins Do not give if Glucose-6 phosphate deficient
249
Which Local Anesthetic has the lowest protein binding?
Procaine
250
Rank the following LA in order of highest to lowest protein binding: 1. Mepivacaine 2. Tetracaine 3. Lidocaine 4. Prilocaine
Latina Babes Ride Massive Thick Length Penis Cumming
251
What is a late finding in the patient with untreated pyloric stenosis? Metabolic Acidosis Metabolic Alkalosis
* Metabolic acidosis If vomiting persists and dehydration is not corrected, impaired tissue perfusion increases lactic acid production and leads to metabolic acidosis.
252
What are signs and symptoms of obesity hypoventilation syndrome? (Pick 3) Pulmonary HTN Arterial hypercarbia Polycythemia
Pulmonary HTN Arterial hypercarbia Polycythemia
253
Which fetal shunt direction is cyanotic?
Right to Left shunt 5 T's Tetralogy of Fallot (most common) Transpostions of arteries Tricuspid valve abnormality Truncus arteriosus Total anomalous pulmonary connection
254
Which fetal shunt direction is NOT cyanotic ?
Left to Right shunt VSD (most common) ASD PDA Coartaction of the Aorta
255
Which is LEAST likely a symptom of pheochromocytoma? a) Headache b) Flushing c) Diaphoresis d) Weight loss e) Tremulousness f) Palpitations g) HTN
b) Flushing Skin is pale due to vasoconstriction
256
How much does MAC decrease by after age 40? (how to calculate too)
6% So if sevo is 2 and patient is 60 yo. you have 2 decades decrease. 6% of 2 = 0.12 0.12 x 2 = 0.24 2-0.24 = 1.76 MAC
257
The essential Triad of Anesthetic action are ? Amnesia Loss of conciousness Immobility
258
Which nerve innervates the hallux, malleolus, posterior foot? Sural Nerve Saphenous Deep Peroneal Tibial Nerve
* Tibial Nerve
259
Which nerve innervates the posterior sole of foot, posterior heel, and portion of Achilles tendon immediately above the ankle? Sural Nerve Saphenous Deep Peroneal Tibial Nerve
Sural Nerve
260
Which nerve innervates the short extensors of toes, to skin on lateral side of hallux and on medial side of 2nd toe? Sural Nerve Saphenous Deep Peroneal Tibial Nerve
Deep Peroneal Nerve
261
Which nerve innervates the medial side of malleolus and skin of medial aspect of lower leg? Sural Nerve Saphenous Deep Peroneal Tibial Nerve
Saphenous
262
Which nerve innervates the vastus lateralis muscle? Lateral femoral cutaneous nerve Femoral nerve Obturator nerve
* lateral femoral cutaneous nerve
263
Which nerve provides sensation to the medial thigh and adducts the leg ? Lateral femoral cutaneous nerve Femoral nerve Obturator nerve
Obturator nerve
264
Which is part of the sacral plexus? PICK 2 Sciatic Posterior femoral cutaneous
265
Where should the strap be placed on a patient in lateral decubitus position?
* At the patient’s iliac crest
266
How can you prevent damage to the brachial plexus when the patient is in the lateral decubitus position?
Place a roll under the thorax, just caudal to the axilla
267
What cranial nerve is blocked by the cervical plexus CN XI - Spinal Accessory
CN XI - Spinal Accessory
268
Artery that landmarks fascia iliaca block ? Deep circumflex iliac artery Femoral artery
- Deep circumflex iliac artery
269
Hypotensive Bradycardic episode post Interscalene block is caused by which reflex? Baroreceptor reflex Bezold Jarish reflex Bainbridge reflex
Bezold Jarish reflex Bradycardia Hypotension Syncope
270
Contraindication to BIS (Bispectral index)? (select 2) a) Seizure b) SSEP monitoring c) Craniofacial trauma d) Prone E) agitated patient
a) Seizure c) Craniofacial trauma
271
Where is the murmur for aortic stenosis best heard?
* Over the second, right ICS ASSS Aortic Stenosis Systolic Sternal border
272
Where is the murmur for aortic regurgitation best heard?
Along the right sternal border * ARDS Aortic Regurgitation Diastolic Sternal border high pitch blowing
273
Where is the murmur for mitral stenosis best heard?
Over the cardiac apex, or the 5th ICS * MSDA Mitral Stenosis Diastolic Axilla Apex opening Snap
274
Where is the murmur for mitral regurgitation best heard?
Over the cardiac apex, or the 5th ICS * MRSA Mitral Regurgitation Systolic Axilla Loud Swishing
275
Which conditions increase the amplitude of the “v wave” on the CVP waveform? (select 2) Tricisupid Regurgitation Tricuspid Stenosis RV papillary muscle ischemia Myocardial Ischemia
Tricuspid Regurgitation RV papillary muscle ischemia
276
Which conditions increase the amplitude of the “a wave” on the CVP waveform? (select 2) Tricuspid Stenosis RV papillary muscle ischemia Diastolic Dysfunction Increase in intravascular volume
Tricuspid Stenosis Diastolic Dysfunction
277
Which conditions cause a loss of the “a wave” on the CVP waveform? (select 2) Atrial Fibrillation Tricuspid regurgiation Tricuspid stenosis V-pacing
Atrial Fibrillation V-pacing
278
Drag and Drop Mitral Stenosis Mitral Regurgitation Aortic Stenosis Aortic Regurgitation Allow for slower heart rate Decrease the SVR (regional anesthesia is good) Increase the heart rate Avoid reduction in SVR
Mitral Stenosis- Allow slower HR Mitral Regurgitation - Increase HR Aortic Stenosis- Avoid reduction in SVR Aortic Regurgitation- Decrease the SVR
279
Hot Spot- Click on the area on the CVP waveform that indicates tricuspid valve closure * C wave is tricuspid closing
* C wave is tricuspid closing
280
What measurement is used for ultrasound? (select 2) a) Decibels (amplitude) b) Millimeters/s c) Nanometers/s d) Hertz (sound frequency)
a) Decibels (amplitude) d) Hertz (sound frequency)
281
Range of medical ultrasound in MHz: a) 1-20 MHz b) 30-50 MHz c) 60-90 MHz
a) 1-20 MHz
282
Brachial Plexus nerves on ultrasound look ? Hyperechoic Hypoechoic Anechoic
Anechoic (black)
283
What structures appear Hypoechoic on ultrasound? (select 3) Solid organs (Liver) Ascites Bone Adipose tissue Cartilage
Solid organs (Liver) Adipose tissue Cartilage
284
Drag and Drop Match each transducer movement and the reason behind the movement. Compression = Finding vessels Lateral Movement = Changing Axis Rocking = Finding Needle
Compression = Finding vessels Lateral Movement = Changing Axis Rocking = Finding Needle
285
What changes would you see if you place the blood pressure cuff on the forearm of an obese patient? Increase SBP Decrease SBP Increase DBP Decrease DBP Increase Pulse pressure
Increase SBP Decrease DBP Increase Pulse pressure
285
Between which two muscles is the interscalene block is done?
Between the anterior and middle scalene muscles
286
Which nerve when blocked causes lack of sensation to lateral arm “patch” of the humerus and inability to abduct the shoulder?
axillary nerve
287
What is the most common peripheral nerve injury caused by poor positioning?
Ulnar Nerve Impaired sensation 4th 5th digits Inability to oppose pinky
288
Which nerve is blocked at the lateral epicondyle? Radial nerve Ulnar nerve Median nerve
Radial nerve ## Footnote Medial epicondyle = Ulnar nerve block
289
Which receptors that increase blood glucose? (select 2) a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
a) Alpha 1 d) Beta 2
290
Which receptor causes pyloric sphincter contraction? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
a) Alpha 1
291
Which receptor causes uterine contraction? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
a) Alpha 1
292
Which receptor cause mydriasis (dilation)? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
a) Alpha 1
293
Which receptor cause uterine relaxation? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
d) Beta 2
294
Which receptor decreases preganglionic Ach release? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
b) Alpha 2
295
Which receptor decreases preganglionic NE release? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
b) Alpha 2
296
Which receptor that DECREASE insulin secretion? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
b) Alpha 2
297
Which receptor that INCREASE insulin release? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
d) Beta 2
298
Which receptor increases heart rate? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
c) Beta 1
299
Which receptor increases renin release? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
c) Beta 1
300
Which receptor is stimulated by epinephrine? a) Alpha 1 b) Alpha 2 c) Beta 1 d) Beta 2
c) Beta 1
301
Which medication would have less ionization when given at a pH of 7.35? Thiopental Etomidate Propofol
* Thiopental → it’s a weak acid so it’s unionized at 7.35
302
What kind of medication is ipratropium? Antimuscarinic Sympathomimetic Sympatholytic
Ipratropium - Anticholinergic (antimuscarinic) - Direct acting bronchodilator
303
Which medication is best for vagally induced bronchoconstriction? Ipratropium Salmetrol Albuterol
Ipratropium Anticholinergics work by blocking the action of acetylcholine on muscarinic receptors in the airways, which helps to relax bronchial smooth muscle and reduce bronchoconstriction.
304
Which concept best explains ultrasound transducers? Piezoelectric effect
Piezoelectric effect
305
How do hyperechoic structures appear?
* Bright/Light Bones and Nerves (distal peripheral)
306
How do hypoechoic structures appear?
Grey
307
Which 4 structures appear hypoechoic on ultrasound? * Solid Organ (liver) * Fat * Cartilage * Skin
* Solid Organ (liver) * Fat * Cartilage * Skin
308
How do anechoic structures appear and which structures appear anechoic on ultrasound?
Black Vessels Cysts Ascites Neuraxial Peripheral Nerves
309
Which evoked potential is the most sensitive to anesthesia? Visual Evoked Potentials Motor Evoked Potentials Senosry Evoked Potentials
Visual Evoked Potentials
310
Which intervention is best for the patient who suffered a trauma and has an ICP of 25, SBP of 88, and HR 105? a) Give mannitol (0.25 – 1 g/kg) b) Hyperventilate to PaCO2 of 20-25 c) 1 L bolus
a) Give mannitol (0.25 – 1 g/kg)
311
With PA catheter how much to insert for RV waveform from Right IJ?
25-30
312
At what cm would the PA catheter be at a wedged position? * 25 cm * 35 cm * 45 cm
* 45 cm (40-50) cm
313
Which of the following statements regarding the pulse oximeter is true? Reduced hemoglobin is best read by the 660 waveform
Reduced hemoglobin is best read by the 660 waveform (Red light) which absorbs deoxyhemoglobin venous blood. Lower wavelength = Lower amount of O2
314
What causes the pumping effect in modern day vaporizers? a) Chamber size b) Vapor Flow c) Dial concentration
c) Dial concentration
315
Match each Gas to its Vapor Pressure? Sevoflurane Isoflurane Desflurane Nitrous Oxide 157 238 669 38,000
Sevoflurane - 157 Isoflurane - 238 Desflurane - 669 Nitrous Oxide - 38,000 Increase in temperature= increase in vapor pressure
316
A patient in the first stage of labor will need spinal anesthesia for what levels? * T10 – L1 * S2 – S4
* T10 – L1 Lower uterine segment, cervix
317
A patient in the second stage of labor will need spinal anesthesia for what levels? * T10 – L1 * S2 – S4
* S2 – S4 Vagina, perineum, pelvic floor
318
What dermatome level should be reached for a C-Section? T4 T6 T8 T10
T4
319
What is the advantage of a non-rebreathing circuit in pediatrics? Both Less mechanical dead space Less resistance to breathing
Less mechanical dead space Less resistance to breathing
320
Drag and Drop Fiber and affect? A- Alpha fibers- A- Beta fibers- C fibers- Pressure Pain Proprioception
A- Alpha fibers- Proprioception A- Beta fibers- Pressure C fibers- Pain
321
What is the lethal triad of Trauma? Acidosis Alkalosis Hypothermia Hyperthermia Coagulopathy
Acidosis Hypothermia Coagulopathy
322
Which has the least effect on the fetus? Lidocaine Bupivacaine Choloroprocaine Levobupivacaine
2- Choloroprocaine- Very short duration
323
Which LA reduces the efficacy of intrathecal morphine? Lidocaine Bupivacaine Choloroprocaine Levobupivacaine
Choloroprocaine
324
Which labs should be ordered postoperatively after an autologous transfusion? (select 2) CBC CMP Coagulation Factors ACT
CBC Coagulation Factors
325
Recommended order for administration of uncrossmatched blood ? Type O negative Uncrossmatched Type specific uncrossmatched Type specific partially crossmatched
1. Type specific partially crossmatched 2. Type specific uncrossmatched 3. Type O negative Uncrossmatched
326
An OB patient is pregnant with twins and on magnesium due to preeclampsia. Which medication would you consider giving her after delivery? Methergin Ketamine Carboprost
Carboprost
327
How much Carboprost to give IM in mL to 80kg patient
- 0.25 mg - 250 mcg - 1 mL
328
Which brachial plexus block has higher risk for pneumothorax? Interscalene Supraclavicular Stellate ganglion
Supraclavicular
329
Which nerves are blocked in the cervical plexus? C2-C4 C4-C6 C1-C3
C2-C4
330
What gets blocked when Horner syndrome occurs?
Sympathetic Chain
331
Which hormones are released by the neurohypophysis (posterior pituitary gland)? (select 2) Oxytocin TSH Prolactin Antidiuretic hormone LH
Oxytocin Antidiuretic hormone
332
Which is most likely to cause sore throat after LMA placement? Cuff overinflation Cuff underinflation
* Cuff overinflation
333
Which would cause the capnography waveform would not return to baseline? * Incompetent expiratory valve
* Incompetent expiratory valve
334
What happens when you put Desflurane into a variable pressure vaporizer?
A higher percent of anesthetic than dialed will be delivered * Uncontrolled percentage
335
Hot Spot: Which of the following is the most common type of TEF? A B C D
Type C 90% TOP straight BOTTOM L (hockey stick)
336
Initial dose of 20% lipid emulsion for LAST treatment?
1.5 mL/kg
337
DDAVP (desmopressin) is indicated for which diseases? (select 3) Mild Hemophilia A MI PE Diabetes Insipidus Von Willebrand deficiency
Mild Hemophilia A Diabetes Insipidus Von Willebrand deficiency
338
Why would the initial bolus of a drug be decreased in the elderly? Decreased protein binding Increased protein binding Higher blood volume Increased body water
Decreased protein binding
339
An obese pediatric patient would have what two things? HTN Risk of Thomboembolism Increase TBW Diabetes
HTN Diabetes
340
Which medication should not be given to a pregnant patient receiving an Amide LA? Amlodipine Losartan Amiodarone Cimetidine
Cimetidine inhibits the same hepatic enzymes that metabolize amide LA.
341
Which opioid has quickest onset? Alfentanil Sufentanil Fentanyl Morphine
Alfentanil
342
Which medication is given as antibiotic prophylaxis for heart issues? Amoxicillin Ancef Vancomycin Macrobid
* Amoxicillin most commonly prescribed antibiotic for prophylaxis in heart issues, specifically to prevent infective endocarditis, is amoxicillin
343
What is the initial response to ECT? PICK 2 Hypotension Hypertension Bradycardia Tachycardia
Hypotension Bradycardia for the first seconds Then HTN and Tachy for minutes
344
Which is the most common form to measure anesthetic gases? Infrared Absorption Spectrophotometry Roman Scatter Piezoelectric
Infrared Absorption Spectrophotometry
345
What is the definitive treatment for preeclampsia?
Delivery of fetus and placenta Severe preeclampsia = BP > 160/110 and fetal distress
346
Which is a sign and symptom of metabolic syndrome?
Obesity
347
If you give oxytocin too fast, what would it cause? Hypotension Dyspnea palpitations dysuria
* Hypotension into CV collapse
348
The coronaries react to changes in these EXCEPT? a) CO2 b) PO2 c) Hydrogen ions d) Temperature
d) Temperature
349
HOTSPOT: Which vessel gets compressed during mediastinoscopy and leads to dampening of right radial arterial line?
Brachiocephalic artery (Innominate)
350
Where should the A-line, NIBP, and large bore IV be placed on a patient undergoing mediastinoscopy?
A-line/Pulse ox - Right arm NIBP- Left arm Large bore IV- Lower leg
351
Which antibiotic do you order an echocardiogram for?
Doxorubicin (Adriamycin) = cardiotoxic
352
What is the best treatment for stridor in a child?
* Racemic EPI- 0.5 mL of 2.25% solution in 2.5mL of NS
353
When should you shut off N2O before hexafluoride bubble for eye surgery? 15 minutes before
15 minutes before and Avoid N2O for 10 days after bubble placed
354
Which elderly issue has the quickest onset? Delirium Impaired concentration Impaired psychomotor skills
Delirium
355
Where is the PISS located? On the pipeline In the cylinder yoke In the machine
* In the cylinder yoke
356
Which medication increases the seizure foci the most during electroconvulsive therapy? Ketamine Etomidate Propofol Midazolam
Ketamine
357
Which position demonstrates the effects that obesity has on the pulmonary system? Supine Prone Lateral
* Supine
358
Who gives us our scope of practice?
Each state's agency or board
359
What is the purpose of the Joint Commission? The Joint Commission certifies hospitals that meet specific safety standards. Not a federal agency
360
What does a quality assurance program do? * It analyzes when a system's performance falls below acceptable levels.
360
What nerve should be blocked for a bunionectomy? Saphenous Femoral Sciatic Sural
* Saphenous (Medial side)
361
Where is Dopamine produced? Substantia Nigra Substantia Jones Medulla
Substantia Nigra
362
Where is dopamine secreted from? Medulla Hypothalamus Pons Frontal Lobe
* Hypothalamus
363
What valve is the ROSS procedure working on?
Defective Aortic Valve is replaced with the patients pulmonary valve.
364
Interscalene block and where you would block the ventral roots? C5 and C6 C6 and C7 C7 and C8
C5 and C6
365
What are 8 required monitors on the anesthesia machine? 1. Pulse Ox 2. EKG 3. BP 4. ETCO2 capnography 5. Inspired O2, with a high priority alarm within 30 seconds if O2 falls below 18% 6. Oxygen supply failure alarm 7. Hypoxia Prevention Safety Device (Proportioning Device) that protects against <21% FiO2 if N2O is in use 8. Anesthetic vapor concentration
366
What is the EBV of an obese patient? 50 mL/kg 60 mL/kg 70 mL/kg
* 50 mL/kg
367
After the aortic cross clamp is released, what would Propofol help with?
Protects againts ischemic reperfusion injury Anesthetic Preconditioning
368
The patient with facial edema and a thoracic mass is susceptible to which syndrome?
Superior Vena Cava syndrome This condition occurs when there is obstruction of blood flow through the superior vena cava, often due to a mass such as a tumor, which can lead to facial swelling, distended neck veins, and other symptoms related to impaired venous return from the head and upper body.
369
Which is the most likely cause of bone loss or issues in Cushing syndrome?
Osteoporosis
370
Which are Water soluble vitamins ?
* Any vitamins that are NOT A, D, E, K (fat soluble) - VitB - VitC
371
What is the max FiO2 for a patient receiving oxygen via nasal cannula at 4 L/min?
36% 1L = 24% 2L = 28% 3L = 32% 4L = 36%
372
Which airway management manipulates the C spine the most? a) Fiberoptic b) iGel c) Miller d) MacIntosh
d) MacIntosh
373
Which IV fluid do you give 16 hours after burns? a) Normal Saline b) D5W c) Albumin d) Lactated Ringer’s
d) Lactated Ringer’s
374
Which of the following can cause subcutaneous emphysema? MI PE COPD Esophageal Tear
Esophageal Tear
375
Which 2 nerves must be anesthetized for an awake intubation? a) Hypoglossal b)Glossopharyngeal c) Vagus (SLN + RLN) d) Spinal Accessory
b)Glossopharyngeal c) Vagus (SLN + RLN)
376
Which agent inhibits the baroreceptor reflex? * Propofol * Dexmedetomidine * Ketamine * Etomidate
* Propofol
377
Where would you place a pericardial stethoscope on a pediatric patient? a) Apex of the heart b) Base of the heart c) Suprasternal d) Substernal
c) Suprasternal (preferably on the LEFT side, so you can hear both heartbeat and breath sounds)
378
What separates the frontal and parietal lobe? Cerebellum Corpus Callosum Central sulcus
Central sulcus
379
What is the cause of apnea when a high spinal occurs?
Apnea associated with a high spinal anesthetic is most often related to hypotension and hypoperfusion of the brainstem.
380
What are the causes for TURP Syndrome effects?
Absorption of large volume of hypo-osmolar irrigation solution Triad: HTNw/­PP Bradycardia (reflex) Change in mental status
381
Scavenging: Closed-Active Systems utilize suction to actively collect and remove gases, ensuring a safe and controlled environment. Closed-Passive Systems rely on natural airflow to direct gases away, offering a simpler solution but potentially less effectiveness. Open Systems allow gases to escape into the atmosphere, relying on room ventilation, which can pose risks to personnel and the environment.
382
Question about patient with anal fistula most likely diagnosis?
Chron’s disease
383
Which Cranial Nerves are Parasympathetic? (select 4) 2 3 5 6 7 9 10
3 Oculomotor 7 Facial 9 Glossopharyngeal 10 Vagus
384
Where do Benzos work at ? (HOTSPOT)
Between alpha and gamma ionophores
385
Which Musculoskeletal disease has the highest risk for aspiration? Guilliane Barre Myasthenia Gravis Multiple Sclerosis Parkinsons
Myasthenia Gravis
386
What 4 factors increase MAC requirements? Cocaine intoxication Acute ETOH Chronic ETOH Hyperthermia Hypothermia Hypernatremia Hyponatremia
Cocaine intoxication Chronic ETOH Hyperthermia Hypernatremia
387
Tank Color markings Match? Oxygen Carbon Dioxide Nitrous Oxide Helium Blue Brown Gray Green
Oxygen- Green Nitrous oxide- Blue Carbon dioxide- Gray Helium- Brown
388
Which patients would have adverse effects to a PCA pump?
COPD Renal or Hepatic disease CHF Head injury AMS Lactating mother
389
What 2 factors are responsible for PACU hypertension? Shivering Foley catheter Hypoventilation Hypoxia
Shivering Hypoxia
390
What are the 2 most common complications to TIPS (Transjugular Intrahepatic Portosystemic Shunt) procedure ? Hemorrhage CHF MI Stroke Pneumothorax
Hemorrhage Pneumothorax
391
How much time must patient wait before they can undergo elective surgery post bare metal stent?
6 weeks
392
How much time must patient wait before they can undergo elective surgery post drug eluding stent?
6 months
393
What are 2 contraindications to LMA? Small mouth opening and Low pulmonary compliance
394
What is responsible for conduction on the CNS? Neurons Oligodendrocytes Axons Dendrites
Axons
395
Most common complications after Cardiac Bypass surgery?
Leak/Bleeding
396
What 2 blood products do not go in the fluid warmer? Cryoprecipitate PRBCS Whole blood Platelets
Cryoprecipitate Platelets
397
When is the biggest risk for bleeding post tonsillectomy? 3 hours 6 hours 24 hours 2 days
6 hours after
398
Match with symptoms ? Croup Epiglottis Foreign body aspiration - cough, wheezing, decreased breath sounds - drooling, dyspnea, tripod position - hoarsness, barky cough, stridor
Croup - hoarsness, barky cough, stridor Epiglottis- drooling, dyspnea, tripod position Foreign body aspiration- cough, wheezing, decreased breath sounds
399
What does the Steeple sign and Thumb sign mean? Croup Epiglottis
Steeple sign = Tracheo laryngeal bronchitis (Croup) Thumb sign = Epiglottis
400
Which drug can be safely used for Wolf Parkinson White (WPW) treatment? Adenosine Amiodarone Labetalol Amlodipine
Amiodarone
401
Order the fluids from highest to lowest pH? LR 0.9 NS Plasmalyte Blood 7.44 7.4 6.5 5
Blood = 7.44 Plasmalyte =7.4 LR = 6.5 0.9 NS = 5 | If asks for PRBC transfusion instead of blood, then blood is #2 at 7.1
402
Which tract transmits fast pain signals? Paleospinothalamic tract Neospinothalamic tract Anterior spinothalamic tract Lateral spinothalamic tract
Neospinothalamic tract, direct pathway Fast A-delta fibers to thalamus
403
How does the kidney increase GFR? Bowmans capsule Juxtaglomerular cells distal convulated tubule Glomerulus
Juxtaglomerular cells
404
What process is done to decrease the incidence of non-hemolytic transfusion reaction? Leukoreduction Washing Irradiation
Leukoreduction
405
What process is done to decrease the incidence of Graft vs Host disease? Leukoreduction Washing Irradiation
Irradiation
406
TXA and Aminocaproic acid are both what?
Lysine analogs
407
Respiratory changes with obesity (select 3) Reduced FRC Reduced ERC CC unchanged
Reduced FRC Reduced ERC CC unchanged
408
Which IV fluid has Calcium in it?
Lactated Ringer
409
Which bellows will rise when the patient exhales?
Ascending bellows rise when patient exhales. Safer, easier to detect circuit disconnect
410
What isthe most fragile component of the O2 E cylinder?
Cylinder Valve
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