Anesthesia Quiz from Core Concepts
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Questions and Answers

After the administration of phenylephrine, which hemodynamic responses do you most expect in a heart transplant patient?

  • HR no change, BP no change
  • HR no change, BP increased (correct)
  • HR decreased, BP no change
  • HR decreased, BP increased

    • The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from?

  • T4 - T8
  • L2 - L4
  • L4 - S1
  • T8 - L2 (correct)

    • Which of the following medications should be avoided in the treatment of a woman with congenital long QT syndrome experiencing torsades de pointe?

  • Esmolol
  • Amiodarone (correct)
  • Magnesium sulfate
  • Calcium chloride

    • Which coronary artery do you most expect to be occluded in a patient with nausea, diaphoresis, and bradycardia showing echocardiogram findings of right ventricular ischemia?

    <p>Right coronary artery</p> Signup and view all the answers

    Which of the following monitoring modalities is most important in the setting of tricyclic antidepressant (TCA) poisoning?

    <p>Electrocardiogram</p> Signup and view all the answers

    Which of the following is most often associated with carbon monoxide poisoning?

    <p>Cyanide toxicity</p> Signup and view all the answers

    After an accidental needle stick with a contaminated needle, which of the following viruses carries the highest risk of transmission?

    <p>Hepatitis B</p> Signup and view all the answers

    Which of the following has not been definitely shown to reduce central line infection rates?

    <p>Routine dressing changes</p> Signup and view all the answers

    Disodium edentate or sodium metabisulfite is added to formulations of propofol to:

    <p>Inhibit bacterial growth</p> Signup and view all the answers

    During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of:

    <p>50 psi</p> Signup and view all the answers

    Sensory innervation of the trachea and larynx below the vocal cords is supplied by the:

    <p>Recurrent laryngeal nerve</p> Signup and view all the answers

    Correct statements concerning the use of benzodiazepines in the elderly include:

    <p>Volume of distribution is increased</p> Signup and view all the answers

    The National Institute for Occupational Safety (NIOSH) recommends limiting the operating room concentration of nitrous oxide to:

    <p>25 ppm</p> Signup and view all the answers

    The highest incidence of muscle pain following the use of succinylcholine is seen in:

    <p>Outpatients</p> Signup and view all the answers

    The cardiovascular effects of pancuronium are caused by: (Select 3)

    <p>Ganglionic stimulation</p> Signup and view all the answers

    Anesthetic implications of multiple sclerosis include:

    <p>Exacerbation induced by spinal anesthesia</p> Signup and view all the answers

    Local anesthetics with the potential to form methemoglobin include: (Select 3)

    <p>Prilocaine</p> Signup and view all the answers

    Ulnar nerve injury:

    <p>Occurs more frequently in males</p> Signup and view all the answers

    The potency of local anesthetics increases as the:

    <p>Lipid solubility increases</p> Signup and view all the answers

    A decrease in cerebral blood flow is seen after the administration of:

    <p>Propofol</p> Signup and view all the answers

    The age group with the highest minimum alveolar concentration (MAC) of desflurane is:

    <p>2 - 3 months</p> Signup and view all the answers

    The loss of ventricular filling as a result of acute atrial fibrillation is approximately:

    <p>15-25%</p> Signup and view all the answers

    During surgical repair of a detached retina, the pressure-volume relationship of the bubble will approximately:

    <p>Triple</p> Signup and view all the answers

    During pregnancy, the minimum alveolar concentration (MAC):

    <p>Decreases throughout the pregnancy</p> Signup and view all the answers

    Physiologic effects of electroconvulsive therapy (ECT) include an:

    <p>Initial parasympathetic discharge followed by a sustained sympathetic response</p> Signup and view all the answers

    The postretrobulbar block apnea syndrome:

    <p>Is associated with unconsciousness</p> Signup and view all the answers

    A 76-year-old man is scheduled for a hemicolectomy. Problems with electrocautery use in this patient can be minimized by:

    <p>The use of a bipolar cautery</p> Signup and view all the answers

    The most severe transfusion reactions are due to:

    <p>ABO incompatibility</p> Signup and view all the answers

    Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above:

    <p>15 mm Hg</p> Signup and view all the answers

    The rapid shallow breathing index (RSBI) should be:

    <p>Less than 100</p> Signup and view all the answers

    The perception of an ordinarily non-noxious stimulus as pain is referred to as:

    <p>Allodynia</p> Signup and view all the answers

    Cholinesterase inhibitors that freely cross the blood-brain barrier include:

    <p>Physostigmine</p> Signup and view all the answers

    Ninety percent of congenital diaphragmatic hernias occur:

    <p>Through the left posterolateral foramen</p> Signup and view all the answers

    During fetal monitoring, Type III decelerations are thought to be related to:

    <p>Umbilical cord compression</p> Signup and view all the answers

    Pathophysiologic factors affecting the anesthetic management of patients with hypothyroidism include:

    <p>Difficulty with intubation and airway management</p> Signup and view all the answers

    The most frequent manifestation of sickle cell disease is:

    <p>Pain</p> Signup and view all the answers

    Reactants that are regenerated during the absorption of carbon dioxide by soda lime include:

    <p>Sodium hydroxide</p> Signup and view all the answers

    The effects of barbiturates on ischemic areas of the brain include:

    <p>Redirection of blood flow to the ischemic areas</p> Signup and view all the answers

    In patients receiving vecuronium, the greatest augmentation of neuromuscular blockade is seen with the use of:

    <p>Desflurane</p> Signup and view all the answers

    Local anesthetic solutions that are isobaric with the cerebrospinal fluid include: (Select 2)

    <p>Lidocaine 2% in normal saline</p> Signup and view all the answers

    A fresh E-cylinder of oxygen contains how many liters?

    <p>660 liters</p> Signup and view all the answers

    The most appropriate anesthetic technique for an 82-year-old female with moderate aortic stenosis is:

    <p>Opioid-based general anesthesia</p> Signup and view all the answers

    What effect does the addition of nitrous oxide have on the concentration of desflurane during inhalation anesthesia?

    <p>Decrease in desflurane concentration</p> Signup and view all the answers

    The formation of active metabolites has NOT been associated with the use of which drug?

    <p>Rocuronium</p> Signup and view all the answers

    The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately:

    <p>0.09%</p> Signup and view all the answers

    A decrease in cholinesterase activity has been associated with which condition?

    <p>Burns</p> Signup and view all the answers

    Hormones released by the neurohypophysis include: (Select 2)

    <p>Oxytocin</p> Signup and view all the answers

    Congenital heart diseases associated with right-to-left shunting include: (Select 3)

    <p>Tetralogy of Fallot</p> Signup and view all the answers

    The recommended maximum leakage current allowed in operating room equipment is:

    <p>10 μA</p> Signup and view all the answers

    Hypoxemia during one-lung anesthesia is most effectively treated by:

    <p>Periodic inflation of the collapsed lung</p> Signup and view all the answers

    Sympathetic blockade during acute herpes zoster has been shown to:

    <p>Reduce the incidence of postherpetic neuralgia</p> Signup and view all the answers

    The expected pressure in the nitrous oxide E-cylinder after 60 minutes of use in a 3:2 mixture is:

    <p>745 - 750 psig</p> Signup and view all the answers

    The formation of metanephrine is the result of:

    <p>Catechol-O-methyltransferase metabolism of epinephrine</p> Signup and view all the answers

    Characteristics of human immunodeficiency virus neuropathy include: (Select 2)

    <p>Allodynia</p> Signup and view all the answers

    During placement of a lumbar epidural using a midline approach, which structures does the needle pass through? (Select 3)

    <p>Interspinous ligament</p> Signup and view all the answers

    Prior to pneumonectomy, split lung function testing is indicated in the patient with:

    <p>A PaCO2 of 49 mm Hg on room air</p> Signup and view all the answers

    Postintubation croup:

    <p>Is secondary to inflammation of subglottic structures</p> Signup and view all the answers

    Physiologic derangements seen in the patient with scleroderma include: (Select 3)

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Basal metabolic oxygen consumption in a 20-kg patient is approximately:

    <p>95 mL/min</p> Signup and view all the answers

    During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of:

    <p>50 psi</p> Signup and view all the answers

    Acceptable levels of hypotension in a 24-year-old female scheduled for cerebral aneurysm resection would include a mean arterial pressure of:

    <p>50 - 60 mm Hg</p> Signup and view all the answers

    Topically applied ophthalmic medications are absorbed:

    <p>More quickly than subcutaneous administration</p> Signup and view all the answers

    Which of the following is NOT a contraindication to activated charcoal in the setting of suspected aspirin poisoning?

    <p>Two hours since ingestion</p> Signup and view all the answers

    Which of the following is MOST true regarding acetaminophen poisoning?

    <p>5% of acetaminophen is excreted in the urine</p> Signup and view all the answers

    During pregnancy, the minimum alveolar concentration (MAC):

    <p>Decreases throughout the pregnancy</p> Signup and view all the answers

    Correct location of the catheter tip of a central venous line is in the:

    <p>Superior vena cava</p> Signup and view all the answers

    Which of the following is NOT a potential treatment for salicylate poisoning?

    <p>Administration of a reversible COX-inhibitor</p> Signup and view all the answers

    Physiologic effects of electroconvulsive therapy (ECT) include an:

    <p>Initial parasympathetic discharge followed by a sustained sympathetic response</p> Signup and view all the answers

    A 70-year-old man with a DDD-R pacemaker should have it reprogrammed to which of the following during an anterior cervical discectomy?

    <p>Discontinue R function</p> Signup and view all the answers

    During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3)

    <p>Hypoxemia secondary to fat embolization</p> Signup and view all the answers

    Maternal mortality associated with amniotic fluid embolization is:

    <p>Greater than 50%</p> Signup and view all the answers

    Absolute contraindications to electroconvulsive therapy (ECT) include:

    <p>Increased intracranial pressure</p> Signup and view all the answers

    The primary mechanism of intraoperative heat loss resulting in hypothermia is:

    <p>Radiation</p> Signup and view all the answers

    Sinus arrhythmia:

    <p>Causes an increase in heart rate with inspiration</p> Signup and view all the answers

    Of the following, the block associated with the highest blood level of local anesthetic per volume injected is the:

    <p>Intercostal block</p> Signup and view all the answers

    A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in:

    <p>12 to 14 hours</p> Signup and view all the answers

    A 82-year-old female is scheduled for a total hip replacement under spinal anesthesia. Current recommendations regarding the dosing of enoxaparin state that the drug be:

    <p>Held for 10 - 12 hours prior to the spinal anesthetic</p> Signup and view all the answers

    Safety features that prevent filling of the vaporizer with an incorrect agent include:

    <p>Agent-specific keyed filling ports</p> Signup and view all the answers

    A person acting as an amicus curiae:

    <p>Is not a party to the litigation</p> Signup and view all the answers

    The first nurse anesthetist to be appointed to a university medical school faculty was:

    <p>Alice Maude Hunt</p> Signup and view all the answers

    Inhaled agents from highest vapor pressure to lowest are:

    <p>Nitrous Oxide, Des, Iso, Sevo</p> Signup and view all the answers

    Reduction of heart rate seen with the administration of opiates is mediated through the:

    <p>Mu receptors</p> Signup and view all the answers

    The effects of 60-Hz current on a human for 1 second match the current to the physiologic effect.

    <p>Perception Threshold = 1 mAmp Let-Go Current = 15 mAmp Microshock Risk = 100 micro-amps V Fib = 200 mAmp</p> Signup and view all the answers

    Mortality after liposuction procedures most commonly is the result of:

    <p>Pulmonary embolism</p> Signup and view all the answers

    Heart rate:

    <p>Decreases with increasing age</p> Signup and view all the answers

    Pulmonary effects of β2-adrenergic stimulation include: (Select 2)

    <p>Decreased bronchial secretions</p> Signup and view all the answers

    Nervous system changes seen in the pregnant patient at term include: (Select 2)

    <p>Increased sensitivity to local anesthetics</p> Signup and view all the answers

    Clinical signs of tension pneumothorax include:

    <p>Neck vein distention</p> Signup and view all the answers

    Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the:

    <p>Hemorrhoidal veins</p> Signup and view all the answers

    As compared to hygroscopic heat-moisture exchangers, hydrophobic heat-moisture exchangers:

    <p>Are more effective filters of pathogens</p> Signup and view all the answers

    A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is:

    <p>Phenoxybenzamine</p> Signup and view all the answers

    The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the:

    <p>Loop of Henle</p> Signup and view all the answers

    Postoperative ulnar nerve injury:

    <p>Occurs more frequently in males</p> Signup and view all the answers

    In contrast to patients undergoing on-pump coronary artery bypass grafting (CABG), patients undergoing off-pump CABG:

    <p>Usually require relatively high mean arterial pressures during distal anastomoses grafting</p> Signup and view all the answers

    The single greatest cause of mortality in the patient with sickle cell disease is a result of:

    <p>Acute chest syndrome</p> Signup and view all the answers

    The line isolation monitor:

    <p>Monitors the integrity of the isolated power system</p> Signup and view all the answers

    Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they:

    <p>Interfere with the use of the cautery</p> Signup and view all the answers

    The use of nonionic gadolinium contrast media during MRI:

    <p>Is commonly associated with nausea</p> Signup and view all the answers

    The speed in an inhalation induction is slowed by right-to-left shunting. The change in the rate of induction is LEAST pronounced when using:

    <p>Isoflurane</p> Signup and view all the answers

    Study Notes

    Propofol Formulation

    • Current propofol formulations include 0.005% disodium edentate or 0.025% sodium metabisulfite to inhibit bacterial growth.

    Transtracheal Jet Ventilation

    • Sufficient gas flow during emergent transtracheal jet ventilation using a 14 gauge catheter requires a driving pressure of 50 psi.

    Sensory Innervation of Airway

    • The recurrent laryngeal nerve, a branch of the vagus nerve, supplies sensory innervation to the trachea and larynx below the vocal cords.

    Benzodiazepines and the Elderly

    • In the elderly, benzodiazepine volume of distribution increases, enhancing pharmacodynamic sensitivity, and increases the elimination half-lives of both diazepam and midazolam.

    NIOSH Recommendations for Nitrous Oxide

    • NIOSH recommends limiting operating room nitrous oxide concentration to 25 ppm.

    Succinylcholine Myalgia

    • Succinylcholine use is most likely to result in muscle pain in outpatients, with pregnancy and extremes of age showing protective effects.

    Pancuronium Cardiovascular Effects

    • Pancuronium's cardiovascular effects arise from vagal blockade, ganglionic stimulation, and decreased catecholamine reuptake.

    Multiple Sclerosis Anesthesia Considerations

    • Spinal anesthesia may exacerbate multiple sclerosis, while epidural and regional techniques are generally safe with lower anesthetic concentrations.

    Methemoglobinemia in Local Anesthetics

    • Local anesthetics potentially forming methemoglobin include EMLA cream, prilocaine, and benzocaine.

    Ulnar Nerve Injury Risk Factors

    • Ulnar nerve injury is more prevalent in males, high BMI patients, and can happen >48 hours postoperatively, associated with wrist drop.

    Potency of Local Anesthetics

    • Potency of local anesthetics increases with lipid solubility, which is enhanced by a rise in carbon atoms or halogen addition to the molecule.

    Cerebral Blood Flow and Anesthetics

    • Propofol decreases cerebral blood flow; inhalational agents like isoflurane and ketamine increase it.

    Minimum Alveolar Concentration (MAC)

    • The highest MAC of desflurane is seen in infants aged 2-3 months, which decreases with age.

    Atrial Fibrillation Effects

    • Acute atrial fibrillation results in a 15-25% loss of ventricular filling due to the absence of atrial contraction.

    Sulfur Hexafluoride in Retina Surgery

    • Injection of sulfur hexafluoride gas into the posterior chamber during retina surgery can cause its pressure-volume to triple when N2O is present.

    MAC during Pregnancy

    • The minimum alveolar concentration decreases throughout pregnancy, reducing by 40% at term.

    Electroconvulsive Therapy (ECT) Effects

    • ECT causes an initial parasympathetic discharge followed by a sustained sympathetic response, leading to increased heart rate.

    Postretrobulbar Block Apnea Syndrome

    • This syndrome is potentially caused by local anesthetic injection into the optic nerve sheath, leading to unconsciousness and apnea.

    Electrocautery Use in Pacemaker Patients

    • To minimize electrocautery issues during procedures on patients with pacemakers, using a bipolar cautery is recommended.

    Transfusion Reactions

    • The most severe transfusion reactions are attributed to ABO incompatibility, resulting in intravascular hemolysis.

    Intracranial Hypertension Definition

    • Intracranial hypertension is defined as sustained ICP above 15 mm Hg.

    Rapid Shallow Breathing Index (RSBI)

    • An RSBI of less than 100 is predictive of successful weaning from mechanical ventilation.

    Allodynia

    • Allodynia refers to the perception of harmless stimuli as painful.

    Cholinesterase Inhibitors

    • Physostigmine is the only cholinesterase inhibitor that can cross the blood-brain barrier due to its lipid solubility.

    Congenital Diaphragmatic Hernias

    • 90% of congenital diaphragmatic hernias occur through the left posterolateral foramen (Bochdalek).

    Fetal Monitoring and Decelerations

    • Type III (variable) decelerations in fetal monitoring are primarily associated with umbilical cord compression.

    Hypothyroidism in Anesthesia

    • Patients with hypothyroidism face intubation challenges due to potential anatomical changes like enlarged tongues or goiter.

    Sickle Cell Disease Symptoms

    • Pain is the most frequent manifestation of sickle cell disease, caused by tissue ischemia.

    Reactants in CO2 Absorption by Soda Lime

    • During CO2 absorption, sodium hydroxide is regenerated along with water.

    Barbiturates and Ischemia

    • Barbiturates can redirect blood flow to ischemic areas of the brain, contributing to a reverse steal phenomenon.

    Cerebral Blood Flow and Oxygen Tension

    • Brain blood flow significantly increases in response to hypoxemia and remains stable with hyperoxia.

    Vecuronium Augmentation

    • The greatest augmentation of neuromuscular blockade with vecuronium occurs with desflurane as the inhalation agent.

    Acrylic Bone Cement During Hip Surgery

    • Use of acrylic bone cement during hip replacement can lead to hypotension and hypoxemia due to cement absorption and embolization risks.

    Amniotic Fluid Embolization Mortality

    • The maternal mortality rate associated with amniotic fluid embolism exceeds 50%.

    ECT Contraindications

    • Increased intracranial pressure is an absolute contraindication for ECT; recent myocardial infarction is a significant relative contraindication.

    Intraoperative Heat Loss Mechanisms

    • Radiation accounts for about 40% of intraoperative heat loss, followed closely by convection.### Card 37: Sinus Arrhythmia
    • Sinus arrhythmia is characterized by increased heart rate during inspiration and decreased during expiration.
    • It is a normal cardiac rhythm influenced by cyclic changes in vagal tone, primarily mediated through sympathetic innervation of the AV node.
    • Associated with ischemia of the SA node, and is a principal cause of premature atrial contractions.

    Card 38: Local Anesthetic Blood Levels

    • The intercostal block is associated with the highest blood levels of local anesthetic per volume injected.
    • Blood concentration of local anesthetic depends on the total volume and concentration injected, with intercostal blocks showing significantly high levels.

    Card 39: Tumescent Liposuction

    • Peak serum levels of local anesthetic typically occur 12 to 14 hours post-tumescent solution injection.
    • Tumescent solution contains normal saline, epinephrine, and lidocaine, with serum lidocaine levels declining over the following 6 to 14 hours.

    Card 40: Enoxaparin Dosing

    • Enoxaparin should be held for 10 to 12 hours prior to spinal anesthesia due to the increased risk of spinal hematoma.
    • This recommendation aligns with guidelines from the American Society for Regional Anesthesia and Pain Medicine.

    Card 41: Vaporizer Safety Features

    • Modern vaporizers utilize agent-specific keyed filling ports to prevent incorrect agent filling.
    • The pin index safety system is used for e-cylinders, while the diameter index safety system also enhances safety against errors.

    Card 42: Amicus Curiae

    • An amicus curiae, or 'friend of the court,' is not a party in litigation and may provide expert testimony or file a brief to assist the court.

    Card 43: First Nurse Anesthetist in Academia

    • Alice Maude Hunt was the first nurse anesthetist appointed to a university medical school faculty in 1922 at Yale University.
    • She is known for pioneering the use of nitrous oxide and oxygen anesthesia.

    Card 44: Inhaled Agents

    • Inhaled agents ranked from highest to lowest vapor pressure: Nitrous Oxide, Desflurane, Isoflurane, Sevoflurane.

    Card 45: Opiate Effects on Heart Rate

    • Reduction of heart rate due to opiate administration is mediated through mu receptors.

    Card 46: Effects of 60-Hz Current

    • 1 mAmp corresponds to perception threshold.
    • 15 mAmp represents let-go current.
    • 100 micro-amps indicate microshock risk.
    • 200 mAmp can induce ventricular fibrillation.

    Card 47: Liposuction Mortality Causes

    • The leading cause of mortality post-liposuction is pulmonary embolism, accounting for 23.1% of related deaths.

    Card 48: Age and Heart Rate

    • Heart rate typically decreases with advancing age, reflecting intrinsic SA node function.
    • Enhanced vagal activity through M2 cholinergic receptors contributes to this decline.

    Card 49: β2-Adrenergic Stimulation Effects

    • Stimulation of β2-adrenergic receptors leads to decreased bronchial secretions and bronchodilation.
    • Sympathetic system has minimal impact on pulmonary vascular tone.

    Card 50: Nervous System Changes in Pregnancy

    • Pregnant women at term exhibit increased sensitivity to local anesthetics and decreased cerebrospinal fluid volume.
    • Other noted changes include increased epidural space potential volume and altered anesthetic spread.

    Card 51: Clinical Signs of Tension Pneumothorax

    • Key signs include contralateral absence of breath sounds, hyperresonance, and neck vein distention indicates tension pneumothorax.

    Card 52: Portal Hypertension Collateral Channels

    • Common collateral channels due to portal hypertension include hemorrhoidal veins, gastroesophageal veins, and periumbilical veins.

    Card 53: Types of Heat-Moisture Exchangers

    • Hydrophobic HMEs are more effective in filtering pathogens compared to hygroscopic HMEs, which can retain more heat and moisture effectively.

    Card 54: Pheochromocytoma Management

    • Phenoxybenzamine, a nonselective α-antagonist, is recommended for preoperative management of patients with pheochromocytoma.

    Card 55: Nephron Function in Urine Concentration

    • The loop of Henle is critical for urine concentration via the countercurrent mechanism in the renal medullary interstitium.

    Card 56: Ulnar Nerve Injury Risk

    • Postoperative ulnar nerve injury is more prevalent in males, with risk factors that also include high BMI and prolonged bed rest.

    Card 57: Off-Pump CABG Characteristics

    • Off-pump CABG often necessitates higher mean arterial pressures during distal anastomoses, as opposed to standard CABG procedures.

    Card 58: Sickle Cell Disease Mortality

    • Acute chest syndrome represents the most significant mortality risk for patients with sickle cell disease.

    Card 59: Line Isolation Monitor Function

    • The line isolation monitor oversees the integrity of isolated power systems within medical environments, mitigating microshock risks.

    Card 60: Irrigation Solutions in Prostate Surgery

    • Electrolyte-containing irrigation solutions are avoided during transurethral resection of the prostate as they can interfere with cautery.

    Card 61: Gadolinium Contrast in MRI

    • Gadolinium contrast used in MRI is commonly associated with nausea but does not emit ionizing radiation nor has frequent allergic reactions.

    Card 62: Inhalation Induction Factors

    • The rate of induction is least affected by isoflurane during right-to-left shunting due to its high blood/gas solubility.

    Card 63: Isobaric Local Anesthetics

    • Bupivacaine 0.75% in normal saline and lidocaine 2% in normal saline are isobaric with cerebrospinal fluid.

    Card 64: E-Cylinder Capacity

    • A fresh E-cylinder of oxygen holds about 660 liters of oxygen and is pressurized to approximately 1900 psi.

    Card 65: Anesthetic Technique for Aortic Stenosis

    • An opioid-based general anesthesia technique is preferred for patients with mild to moderate aortic stenosis to minimize cardiac risks.

    Card 66: Effects of Nitrous Oxide on Desflurane

    • Adding nitrous oxide to a desflurane mixture reduces the concentration of desflurane delivered due to increased gas viscosity.

    Card 67: Neuromuscular Blockade Metabolites

    • Rocuronium is not associated with the formation of active metabolites, unlike vecuronium and pancuronium.

    Card 68: HIV Exposure Risks

    • The seroconversion risk from mucous membrane exposure to HIV is approximately 0.09%, significantly lower than direct percutaneous exposure.

    Card 69: Cholinesterase Activity Influencers

    • Decreased cholinesterase activity is linked to burns, while increased activity may be observed with obesity and alcoholism.### Hormones and the Neurohypophysis
    • Neurohypophysis refers to the posterior pituitary gland.
    • Key hormones include oxytocin and arginine vasopressin (vasopressin, ADH).
    • Hormones are synthesized in the hypothalamus and stored in the posterior pituitary.
    • Arginine vasopressin release is triggered by osmoreceptors detecting increased plasma osmolality.

    Congenital Heart Diseases with Right-to-Left Shunting

    • Right-to-left shunting heart diseases are cyanotic and include:
      • Tricuspid atresia
      • Hypoplastic left heart syndrome
      • Tetralogy of Fallot
    • In tricuspid atresia, blood flow from the right atrium is possible only through a patent foramen ovale (PFO).
    • A patent ductus arteriosus (PDA) or ventricular septal defect (VSD) is necessary for blood flow from the left ventricle to the pulmonary circulation.

    Leakage Current Standards

    • Maximum allowable leakage current for operating room equipment is 10 μA.
    • This level is below the perception threshold and minimizes the risk of microshock.

    Treatment for Hypoxemia during One-Lung Anesthesia

    • Most effective treatment is periodic inflation of the collapsed lung.
    • Other methods such as PEEP and oxygen insufflation may provide marginal improvements.

    Sympathetic Blockade in Herpes Zoster

    • Effective in reducing the incidence of postherpetic neuralgia when applied within two months of onset.
    • Associated with decreased analgesic requirements.

    Nitrous Oxide E-Cylinder Pressure after Usage

    • Expected pressure after 60 minutes of delivering a 3:2 nitrous oxide to oxygen mixture is 745 - 750 psig.
    • Nitrous oxide exists as a liquid at room temperature, and full cylinders contain about 1590 L at a pressure of 745 psig.

    Metanephrine Formation

    • Formed through catechol-O-methyltransferase metabolism of epinephrine.
    • Metanephrine and normetanephrine are further metabolized by monoamine oxidase (MAO) to vanillymandelic acid (VMA).

    Characteristics of HIV Neuropathy

    • Commonly features distal polyneuropathy and painful allodynia.
    • Occurs in 10% to 35% of seropositive patients, usually progressing from distal to proximal.

    Lumbar Epidural Needle Pathway

    • Needle passes through the following structures to reach the epidural space:
      • Supraspinous ligament
      • Interspinous ligament
      • Ligamentum flavum

    Indications for Split Lung Function Testing

    • Indicated if a patient scheduled for pneumonectomy has a PaCO2 level of 49 mm Hg on room air.
    • Recommended criteria include FEV1 > 2 L and maximum VO2 > 15 mL/kg/min.

    Postintubation Croup

    • Results from inflammation of subglottic structures, typically seen in early childhood.
    • More common with uncuffed endotracheal tubes and occurs within hours post-extubation.

    Physiologic Effects in Scleroderma

    • Notable effects include pulmonary hypertension, esophageal dysmotility, and myocardial fibrosis.

    Estimating Basal Metabolic Oxygen Consumption

    • In a 20-kg patient, basal metabolic oxygen consumption is approximately 95 mL/min.

    Transtracheal Jet Ventilation Requirements

    • Requires a driving pressure of 50 psi using a 14 gauge catheter.

    Acceptable Hypotension during Aneurysm Resection

    • Mean arterial pressure of 50 - 60 mm Hg is tolerable in healthy young individuals.

    Absorption of Ophthalmic Medications

    • Topically applied medications are absorbed more quickly than through subcutaneous administration.

    Activated Charcoal Contraindications

    • Bowel obstruction and bowel perforation are contraindications; however, having ingested the substance more than two hours ago is not a contraindication.

    Acetaminophen Poisoning Facts

    • Acetaminophen accounts for around 90% of acute hepatic failure cases in the US.
    • Only 5% of acetaminophen is excreted in urine.

    Changes in Minimum Alveolar Concentration (MAC) During Pregnancy

    • MAC decreases throughout pregnancy, by as much as 40% by term.

    Central Venous Line Catheter Tip Location

    • Correct catheter tip placement is in the superior vena cava.

    Treatments for Salicylate Poisoning

    • Sodium bicarbonate, hemodialysis, and activated charcoal are acceptable treatments.
    • Administration of a reversible COX-inhibitor should be avoided.

    Physiological Response to Electroconvulsive Therapy (ECT)

    • Initial parasympathetic discharge followed by sustained sympathetic response occurs post-seizure induction.

    Pacemaker Adjustment for Surgery

    • In patients with DDD-R pacemakers, it is advisable to discontinue the R function to avoid unwanted tachycardia caused by surgical stimuli.

    Expected Hemodynamic Response Post-Phenylephrine During Heart Transplantation

    • Expected outcome is an increase in blood pressure with no change in heart rate due to denervation of the heart.

    Arteria Radicularis Magna Origin

    • Commonly arises from T8 to L2 and supplies blood to the anterior spinal artery.

    Treatment for Torsades de Pointe

    • Amiodarone should be avoided in treating arrhythmia in patients with congenital long QT syndrome due to its effect of prolonging the QT interval.

    Right Coronary Artery Occlusion Symptoms

    • Symptoms indicating RCA occlusion include nausea, diaphoresis, bradycardia, and echocardiogram findings of right ventricular ischemia.

    Monitoring in Tricyclic Antidepressant (TCA) Poisoning

    • Electrocardiogram monitoring is crucial due to potential life-threatening cardiac effects.

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    Test your knowledge on the core concepts of anesthesia with this quiz. Questions cover drug formulations, including propofol and various additives, as well as their purposes in clinical practice. It's an essential tool for students and professionals in the field of anesthesia.

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