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Respiratory effect of spinal anesthesia
forced vital capacity
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Patient with cardiac risk factor (hx of MI)
Echocardiography
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What herbal supplement interacts with warfarin and increases the risk of thromboembolic events?
St John's Wort
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What increases first in hemorrhage?
Renin
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What affects oxygen content most?
hemoglobin
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Estimated blood volumes in a 70 kg female
70 x 60 = 4200
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Acetylcholinesterase inhibitors side effect's bradycardia
in the table, choose that muscarinic receptors are activated
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When glycopyrrolate is not given because the IV was out, what is one possible side effect of Neostigmine ?
Bronchospasm
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what increases inhalational induction?
cardiogenic shock
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Fastest opioid in epidural spread
sufentanyl
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1 twitch on TOF: How many receptors are pre-occupied ?
90%
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Positive predictive value
80
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Anesthesia circuit leak test: y piece occluded, aPL closed, flow 6L, pressure 30
unchanged
(this is the leak test, so proceed)
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Patient given cefazolin had bronchospasm, hemodynamically unstable
give epinephrine
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Robotic surgery, robot docked, desat over 10 min from 99 to 91
endobronchial intubation
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if you are using sugammadex for reversal, on what drug its it most effective from most to least
roc>vec> cisatra
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which ATB is most likely to prolong NMB blockage?
gentamycin
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you put an arterial with a very long tube, which is least affected
MAP
https://www.sciencedirect.com/topics/medicine-and-dentistry/arterial-catheter#:~:text=This%20is%20the%20area%20where,of%20the%20heart%20is%20determined.&text=The%20distance%20of%20the%20measuring,diastolic%20measurements%20in%20the%20system.
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what is the effect of applying CPAP to an obese patient when ventilating
decrease shunting
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A sedated patient breathing spontaneously using a natural airway with no purposeful response to pain and stimuli. what is the level of sedation?
GA
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Mask ventilation leading to gastric insufflation
20 mm Hg
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Jaw thrust mechanism
TMJ subluxation
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Jaw thrust muscle
genioglossus muscle
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Flumazenil given, what do you expect after a while?
resedation
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Traction femoral fracture table
pudendal nerve injury
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Patient with von willebrand’s disease
give desmopressin DDAVP
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Most important determinant of local anesthetic potency
lipid solubility
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E cylinder oxygen at 6L/min, now 1100 psy
full 2200 psy, 660 L 60 min
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EKG lead I functional lead II not, problem:
left leg
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Arrhythmia of magnesium toxicity
complete heart block
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PONV incidence in female, non smoker
40%
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Bolus fentanyl:
bradycardia
-
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Minimum monitoring after intrathecal morphine
24 h
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Prone position: post surgery, painful blurry vision
closed angle glaucoma
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Opioid dosing for intubation without muscle relaxant:
remifentanil 4mcg/kg
-
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ASA closed claims and OR fire risk
paper drapes
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Remimazolam
water soluble
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STOP-BANG score for high risk for OSA
>/= 3 high risk
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Opioids and post op shivering
remifentanil
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Bare metal stent
at least 4 weeks before elective surgery
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PONV highest with
etomidate
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what would increase blood loss in D&C
general anesthesia
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LR composition
Na 130, K 4, Ca 2.7, Cl 109, lactate 28, Osm 273
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SVR= 80 x (MAP -CVP)/CO
if you decrease CO by half, what happens to SVR
it increases by 100
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Contraindication of jet ventilation
complete upper airway obstruction
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Hydralazine
increases heart rate
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what are the predisposing factors for ropivacaine's side effects
liver disease since it is metabolized by the liver
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Highest plasma concentration of local anesthetic
intercostal
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when changing the I:E ratio from 1:3 to 1:4, what happens?
PEEP decrease, flow rate decrease, and increased risk of atelectasis
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Emergency surgery hemophilia A patient
give cryoprecipitate
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Post anesthesia tremor in normothermic patient
spinal cord recovery before brain
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Redosing succinylcholine
bradycardia
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Risk factor for urine retention
age >50
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What happens to stored blood?
- H + increases
- 2-3 DPG decreases
- glucose decreases
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Morphine doses intrathecal, epidural, IV
0.4
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What to expect after massive transfusion
metabolic alkalosis
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MAP is doubled what happens to CO
MAP proportional to CO
MAP = CO x SVR
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Patient with pacemaker before surgery
consult cardio for interrogation
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Bradycardia on abdomen insufflation
desufflation
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AKI changes
decrease in albumin
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Hypercarbia response
central chemoreceptors are sensitive to changes in CO2/H+ levels in interstitial fluid
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Agent causing venodilation
nitroglycerin
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Epidural test dose in patient taking beta blockers
increase in BP
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Dantrolene dose
2.5 mg/kg
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Best method to assess neuromuscular block
stimulate nerve and measure evoked response (AMG - Acceleromyography )
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Patient on chronic steroids
give a stress dose of 100 mg of hydrocortisone
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Optimal position for intubation
Sniffing position, traditionally used during tracheal intubation, involves near-full extension of the atlanto-occipito and atlanto-axial joints and flexion of the lower cervical spine.
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Fiberoptic difficult view
extend the neck
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Emergency tracheostomy
between thyroid and cricoid cartilage
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K+: 3.2
proceed with surgery if urgent
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DNR before OR
talk to healtcare proxy
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If taking beta blocker pre-op
continue
-
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Zone 2 in lungs
Pa>PA>Pv
At first there is no flow because of obstruction at the venous end of the capillary bed. Pressure from the arterial side builds up until it exceeds alveolar pressure and flow resumes.
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Pulse pressure variation of 20%:
hypotension, tachycardia, improves with fluids
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Compartment syndrome
The lithotomy position is a supine surgical position that is most commonly associated with compartment syndrome.
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Diagnosis of epidural hematoma
MRI
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18 G needle, fastest solution run: length of tube + height
10, 100
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Prophylaxis for endocarditis
MVR, HOCM, unrepaired PFO,
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Laser surgery, tube on fire:
remove tube
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slope for diastolic dysfunction 
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Wrist surgery for 2 hours, what block
axillary
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Pacemaker VVI without interrogation - used monopolar
stops working
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One drug that works peripheral site of action
ketorolac
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Asthmatic:
avoid ketorolac
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Increased inhalational anaesthetic induction
increased alveolar ventilation
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First thing blocked in spinal
autonomic
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Epidural contraindicated with 1 dose given of an anticoag right before?
Low molecular weight heparin
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Patient on TCA what pressor will the patient be resistant to:
ephedrine
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Dead space ventilation
Y piece plus face mask
-
Milrinone mechanism of action
phosphodiesterase inhibitor
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Post op delirium risk factor
-
Patient accidentally given high dose naloxone (4 mg yemken), complication:
pulmonary edema
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Eldery under GA, hypotension, physiologic cause
decreased CO
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Exposure to radiation and relation between distance and source
The radiation Intensity is inversely proportional to the square of the distance.
the inverse square law
For example, the exposure at 4 feet will be 1/16th that at 1 feet
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What is most affected by MRI
EKG
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Benefits of smoking cessation after 24 hours:
decreased carboxyhemoglobin
-
Flow volume loop for patient with mediastinal mass with variable compression
airway obstruction ; plateau on expiration
-
Most sensitive modality for venous air embolism
TEE
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Diabetic with autonomic dysfunction
postural hypotension
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Independent risk factor for post op pulmonary complications
smoking
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Hoarseness after thyroidectomy, what nerve injured
recurrent laryngeal
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Nerve that innervated intrinsic muscles of larynx minus cricothyroid
recurrent laryngeal nerve
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Absorption of local from where is most affected by tissue perfusion
IM
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Laser surgery, what NOT to add to decrease density of O2
NITROUS
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Lab test finding in allergy
TRYPTASE
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Patient after a uro surgery, bl post op low BP, temp 37, tachycardic, RR 20:
urosepsis
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ASA difficult airway algorithm: failed face mask ventilation and direct
laryngoscope:
place LMA
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Predictor of difficult laryngoscopy in mallampati I patient
cannot bite upper lip
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Myocardial wall stress response
LV hypertrophy
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Patient with T4 transection, bradycardic with high BP
autonomic hyperreflexia
-
Obese patient at increased risk for
HTN
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Most potent opioid
sufenta
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Complications of hypothermia
NMBD metabolism prolonged
-
Infection that requires hand washing
C.diff
-
ABG interpretation: pH 7.32, paCO2 34, bicarb 18
metabolic acidosis
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Patient took morphine for pain and then had spinal, complains of restless legs
myoclonus due to morphine
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Inhalational agent affected by CO
iso
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Effect of transducer height, patient with arterial line and BP of 120/80 and arm
was elevated 18 mmHg above transducer, what’s the BP
102/70
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Contraindication to esophageal probe
portal HTN
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Arthritis:
atlantoaxial sublaxation
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Pressure volume loop D to A
stroke volume
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