Real Board

1. Real Board

2. What will PvO2 be on 100% oxygen (versus a lower Fi02)?Not a real high number - the choices ranged from 40 to 400. The answer is somewhere in the middle.Based on oxygen content.

3. Which receptors are down-regulated in CHF? Beta-1 alpha Beta 2 Dopamine

4. Best TEE view to evaluate LV ischemia? Transgastric 4-chamber LV long axis

5. Which herbals associated with increased bleeding? Gingko garlic (st. john’s wort) ginger vit E feverfew

6. Spinal anesthetic and cardiac arrest - what do you reach for first? Epi (not atropine)

8. Local anesthetics as enantiomers: ropivicaine and levobupivicaine Pt scheduled for minor case, pre-op EKG shows new LBBB, do you investigate or proceed? PROCEED.

9. Cracked oxygen flowmeter above the bobbin. What happens? Decreased exp. Tidal volume decreased FiO2 does N2O go out tube

10. Innervation at the base of the tongue? Glossopharyngeal (Vagus does larynx and periglottis) Ecothiopentate prolongs which drug? Physostigmine, neostigmine, glycopyrrolate Context sensitive half life: The amount of time after an infusion is stopped for the blood concentrations to decrease 50%. Compare etomidate and thiopental.

12. Trigeminal neuralgia - which is better TCA or gasserian ganglion block PF loops: IPF, asthma, bronchial tumor, obesity, subglottic stenosis African american male receives methylene blue and becomes jaundiced. Is this a case of Sickle cell, G6PD deficiency or spherocytosis? When giving dantrolene, which medication is contraindicated? Verapamil (calcium channel blocker)

13. Athlete’s heart - LVH and elevated ST, repolarization abnormality Stable monomorphic VT: amiodarone, verapamil, adenosine Lumbar sympathetic block also blocks which other nerves? Obdurator, hypogastric, celiac An epidural nerve stimulator is indicated for OA, radicular pain, CRP or neuraxial back pain? Phantom limb pain is a syndrome of central pain, neuropathic pain or nociceptive pain?

14. For chronic pelvic pain, which type of block would you perform? Celiac, bilateral lumbar sympathetic, hypogastric plexus A head trauma victim with an initial GCS of 15 suddenly becomes unresponsive, what do you do first? Ventilate, CT, raise head of bed ketamine induction in a healthy patient, changes HR and pressure. Mivacurium in children

15. During an anesthetic your patient becomes cherry red and etCO2 becomes high. This is increased carbon monoxide from dry absorber Which site has the widest pulse pressure for BP measurements? Aorta, pedal, brachial or radial? Pheochromocytoma - which medication for pre-operative stabilization? Phenoxybenzamine Paturient with uterine atony and asthma, what to give?

17. Parkinson’s disease - what is the best anti-emetic? Childe’s class for liver disease and intra-operative mortality Lithotripsy anesthetic - EMLA cream alone is probably not a good choice Open chole - what are the pulmonary effects Cocaine inhibits the reuptake of norepinephrine

18. COX1/COX2: most specific and site of action Why use cryoprecipitate? Hypofibrinogenemia IHSS patient is hypotensive? Give phenylephrine (2003) use which agent? Halothane (2002) myasthenia gravis and muscle relaxants volume resuscitation with 5L of NS gives hyperchloremic acidosis

19. Skyline Ridge

20. Fetal heart rate tracing: decreased beat-to-beat variability occurs with : maternal beta blockers Digitalis toxicity Cardiac tamponade the wedge will equal the CVP. I.e. right and left heart pressures equalize A prone case results in vision loss. Is this due to ischemia or thrombosis? What is the innervation to the space between the first and second toes? Deep peroneal

21. After a stellate ganglion block, your patient has a weak and numb arm. Where did the local anesthetic actually go? C7, prevertebral fascia, posterior to anterior scalene After CABG, your patient has a numb forearm in the distribution of the median nerve, what caused this? Ether screen, transient carpal tunnel, placement of radial art line, excess pronation, harvest of IMA Smoker has low SaO2 and high SpO2. Compared to fresh blood, CPDA-1 preserved blood has higher: ADP, 2-3DPG or K+

22. Gas analyzer uses infra-red to measure, which gas? CO2 What increases “Zone 1” in the lung (alveolar pressure>capillary pressure)? Increased TV, NTG, PEEP, blood loss What are the distinguishing features between CPRS I and II? Nerve injury in type II (Causalgia) like a GSW A patient on warfarin is going immediately to surgery, how do you reverse their anticoagulation? FFP. Vit K if you have 24h. How do you reverse streptokinase (fibrinolytic)? Cyroprecipitate.

23. During the use of which lasers do you need to wear eye protection? CO2, YAG Your capnographic waveform does not return to baseline - what’s up with that? If you turn off nitric oxide abruptly what are the side effects? Decreased PaO2, increased PVR, decreased platelet function Tourniquets cause what derangements in vital signs when released? Increased CO2, Decreased MAP, Decreased CVP What med for carcinoid tumor? Octreotide Which valve is most affected with murmur?

24. Henry Coe State Park

25. When the harrington rod on your scoliotic patient is placed, the SSEPs decrease? Why? Decreased spinal perfusion. Hyperalimentation: Weakness is from which electrolyte deficiency? Phos 3wk of TPN therapy for regional enteritis, surgery in 24h, INR 1.5/platelets normal, which blood product/therapy to give? Vit K IVH in neonate caused by bicarb (very osmolar) Potency of local anesthetic is indicated by which value? pKa, lipid solubility or concentration? Which medication do you give to a patient to prevent postherpetic neuralgia (shingles)?

26. Which medications cause thrombocytopenia? Milrinone and heparin Heparin resistance? Already on heparin, AT3 deficiency Derangements of electrolytes with pyloric stenosis Rash with PCN - do you give Kefzol or Vanco? What causes a falsely low CO on PA catheter? Hole in introducer (smaller volume of injectate), warm injectate

27. What is the differential for an anterior mediastinal mass? Can it secrete catechols? Untreated myasthenia gravis: Decreased sensitivity to sux, increased sensitivity to nondepolarizers Lithotripsy - you can decrease PVCs by synchronizing the machine and the EKG Ebstein’s anomaly- congenital downward displacement of the tricuspid valve into the right ventricle

28. Cocaine using patient presents with preterm labor, which medication do you treat her with (hint: NOT beta blocker or beta agonist)? Magnesium Benzocaine causes methemoglobin. SaO2, SpO2 values Dilantin interacts with local anesthetic, ropivicaine, rocuronium, propofol, thiopental After an ax block, the patient can push and pull, has no palmar sensation, but retains sensation in the dorsum of the thumb. What have you blocked, what have you missed?

29. Which block gives postural hypotension? Celiac or sciatic What is the most common side effect of the celiac block? Sphincter of Oddi dysfunction or bowel distention Extra-oral block of glossopharyngeal gives the patient a seizure. Where did the local anesthetic go? Internal carotid or vertebral? Intrathecal v. epidural clonidine

31. Short barbiturates and renal failure potentiation of resp. depression caused by opioids - more with diphenhydramine or midazolam pulmonary edema is caused by terbutaline, ritodrine, naloxone, magnesium diaphragmatic hernia, when you begin double lung ventilation, the sats acutely decrease, the PTX occurred on the good side and a chest tube is your next step in management

32. Eisenmengers in labor, what cause hypoxemia: ketamine, ephedrine, neosynephrine Obese pt. Requires more: thiopental, suxx, local in spinal, local in epidural, isoflurane