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ITE Review 1.23.

16
1. E Hypocalcemia
2. D Subarachnoid injection of LA
a. Stellate ganglion block
i. Indications: CRPS, angina, phantom lib pain
ii. Anatony: Inferior cervical ant T1 and T1 sympathetic ganglion
iii. We inject at C6 to decrease risk of pneumothorax
iv. Horners sign should occur EVERY time you do this block
3. A
a. Opioids/LA Weak bases
b. Salicylates/barbiturates Weak acids
c. Henderson-Hasselbach equation
4. E Hyperthermia MAC
a. Acute EtOH MAC, chronic MAC
5. B Hypotension is not a side effect of
intrathecal morphine
a. Common SE: Resp depression, urinary retention, N/V, pruritus
b. Bimodal Resp depression
i. 1-2 hrs: systemic absorption
ii. Delayed 6-24 hours
6. C Respiratory centers are located in medulla
7. D Zones of West
a. Think of slinky.at the top they are pulled apart and at the bottom they are
still tight
b. TopDS; Bottom, shunt
8. DSickle Cell: Autosomal recessive-- Hematocrit would be much lower if the baby
had SC
9. D
10.
D
a. Mass spec: will show expired nitrogen--Most specific
b. TEE: most sensitive
c. Precordial Doppler: most sensitive non-invasive
11.
D
12.
A
13.
C-- Diagnostic criteria: must have score > 5: Petechial rash, CXR, hypoxemia,
fever, HR, RR, confusion
14.
A Cricothyroid: innervated by external branch of SLN
15.
B Oculocardiac reflex
16.
E Atheroemboli are the MCC of distal ischemia
17.
DMuscular dystrophy
18.
BBeckwith Wiedeman: Growth disorder with midline defects: Enlarged
tongue, low glucose, abdominal walld effects, pits or creases in ear, risk of
cancers
19.
C
20.
B Retrobulbars block:
a. Most common complication: retrobulbar hemorrhage
b. Central spread lf LA can occur by injection into dural sheath or retrograde
arterial spread. Other complications Oculocardiac, Subarachnoid block

21.
DTriggering agents for porphyria: barbiturates, diazepam, toradol,
etomidate, phenytoin, birth control pills, sulfonam
22.
B Double lumen tubes (Draw on exam)
23.
ADibucaine number
a. Pseudocholinesterase: Mivacurium, Local anes
b. RBC esterase: Remi/esmolol
24.
DIntrathecal spread of Local anesthetic
a. Major factors: baricity, dose, position
b. Minor factors: level of injection, speed of injection, size of needle, physical
status, intraabdominal pressure
25.
B Pneumothorax will double in volume in 10 min w/ 75% nitrous. 300% in 30
min
26.
E Endpoint: O2 delivery to end organs/UOP
a. Parkland Formula: RL = 4cc x % BSA x wt (1/2 in 1st 8 hrs, in next 16 hrs)
27.
B the pad on the patient is NOT a grounding pad. It disperses the energy
28.
CInfant of diabetic mother
29.
EDecreased FRC
a. Upright to supine: 15% decrease
b. Induction of anesthesia: 10-20% decrease
c. Supine to prone: no effect or increase
d. Peds/obese/pregnant
30.
CPost-dural puncture headache
a. Risk Factors:
i. Beveled (Quincke) needle (pencil-point needles are preferable)
ii. Larger needle (22 G)
iii. Female/pregnancy
iv. Younger age
31.
EMapleson Circuits
a. Spontaneous ventilataion in order of efficiency: ADCB (All Dogs Can Bite)
b. For controlled ventilation (DBCA) (Dead bodies cant argue)
32.
CAxillary nerve block: musculocutaneous nerve lies outside of the sheath
33.
D
a. Deoxy660 nm
b. Oxy 940
c. Red = infrared 85%
34.
A
35.
Dpseudohyponatremia
36.
B
a. 1st stage: onset to 10cm dilation: T10-L1
b. 2nd stage: S2-S4
c. 3rd stage: delivery of placenta
37.
EAbsolute indications for OLV
a. Lung isolation to prevent damage/contamination of healthy lung
b. Control of distribution of ventilation
c. Single lung lavage
d. VATS
38.
Phase II block
39.
E
40.
C
41.
B
a. SE of celiac plexus block: hypotension, diarrhea

42.
43.
44.
45.

B-anterior spinal artery


A
a. Thiopental will not cause prolonged apnea
b. Abx that prolong NMB: Clinda, Amino, Polymyxins, Tetra
D
B
a.
b.
c.
d.
e.
f.
g.

46.
47.
a.
b.
c.
48.
49.
50.
51.
52.
53.
a.
b.
54.
a.
55.
a.
b.
c.
56.
57.
58.
59.
60.

Myotonia is characterized by an abnormal delay in muscle relaxation after contraction. It exists in three forms: myotonic dystrophy (dystrophia
myotonica, myotonia atrophica, Steinert's disease), myotonia congenita (Thomsen's disease), and paramyotonia congenita.
Diagnosis
Repeated nerve stimulation leads to a gradual but persistent increase in muscle tension. The EMG is pathognomonic; myotonic after-discharges are
seen in peripheral muscle, consisting of rapid bursts of potential produced by tapping the muscle or moving the needle. They produce typical divebomber sounds on the loudspeaker.
Response to Muscle Relaxants
The characteristic abnormality is a sustained, dose-related contracture after succinylcholine that makes ventilation difficult for 25 min.225 The response
to nondepolarizing drugs is normal, although myotonic responses have been observed after reversal with neostigmine. 226
Anesthesia
Succinylcholine should be avoided and respiratory depressants used with care. Atracurium or mivacurium, without reversal, is an appropriate choice for
relaxation.

BReview SSEP pathways


C Cerebral autoregulation can be focal
Normal CBF: 50mL/100g/min
EEG changes: 20 ML/100g/min
Cell death: 10
D
D
E
E
EPropofol latency and amplitude
C
Steroids may have affect on inflammatory mediators made by the cells
i. Mostly used for vasogenic edema. Contraindicated in TBI
For every 1mmHg change in PaCO2CBF changes 1mL/100g/min
EReview
Neuronal injury from ischemia is due to ATP depletion
i. K leaks from cells..Na influx
A
susceptible to Sux
susceptible to NMB
Eaton Lambert: AutoAb target pre-synaptic voltage gated calcium channels
sensitivity to BOTH Sux and NMB
C
EHead injuries: DIC, diabetes insipidus, SIADH, hyperglycemia, hypercarbia
BAvoid phenothiazines, reglan, butyrophenones in Parkinsons Disease
ARisk of rebleed highest day1. Risk of vasospasm highest day 6.
ANitrous CBF and CMRO2

Unstable in the presence of soda lime: Sevo/Halo


Iso VP : Iso
What volatile is not an ether? Halo
B:G partition coefficient of 1.4: Iso
Risk of seizures w/ hypocapnea: Enflurane
Indirect sympathomimetic: Ephedrine
Inhibits HPV: Nitroprusside. Dibutamine, iso

Structurally similar to thyroid: Amiodarone


Digoxin is potentiated by hyperCa and HypoK
Tachyphylaxis: Ephedrine, Nitroprusside, labetalol
Structural Ester: Esmolol