Board Review Duke 1

Front 1

Patients and B-blockers
why?

Back 1

Patients should take prescribed P-blockers on the day of surgery and continue them
perioperatively. Because the receptors are up-regulated, withdrawal may precipitate
hypertension, tachycardia, and myocardial ischemia. Clonidine should also be continued
perioperatively because of concerns for rebound hypertension.

Front 2

peri-induction hypotension responds best to?

Back 2

Under most circumstances peri-induction hypotension responds best to administration of
intravenous fluids and the use of direct-acting sympathomimetics such as phenylephrine.

Front 3

When other causes have been ruled out, persistent and refractory hypotension in trauma or other critically ill patients may be caused by 2x.

Back 3

hypocalcemia or hypomagnesemia.

Front 4

Speed of onset of volatile anesthetics is increased by 4x

Back 4

increasing the delivered
concentration of anesthetic,
increasing the fresh gas flow,
increasing alveolar ventilation,
and using nonlipid-soluble anesthetics.

Front 5

Opioids depress the _______________ to breathe, resulting in
hypoventilation.

Back 5

carbon dioxide-associated drive

Front 6

Termination of effect of intravenous anesthetics is by ...

Back 6

redistribution, not biotransformation
and breakdown.

Front 7

Local anesthetic-induced central nervous system toxicity manifests as

Back 7

excitation, followed
by seizures, and then loss of consciousness. Hypotension, conduction blockade, and
cardiac arrest are signs of local anesthetic cardiovascular toxicity.

Front 8

The risk of clinically significant aspiration pneumonitis in healthy patients having elective
surgery is

Back 8

very low. Routine use of pharmacologic agents to alter the volume or pH of
gastric contents is unnecessary

Front 9

Every patient ventilated with an ascending bellows anesthesia ventilator receives
approximately __________ H20 of positive end-expiratory pressure (PEEP) because of the
weight of the bellows.

Back 9

2.5 to 3 cm

Front 10

The first step in the care of the hypoxic patient fighting the ventilator is

Back 10

to ventilate the
patient manually with 100% oxygen.

Front 11

4 Risk factors for auto-PEEP include

Back 11

high minute ventilation,
small endotracheal tube,
chronic obstructive pulmonary disease,
and asthma.

Front 12

Apatient with new ST-segment depression or T-wave inversion may have suffered a ....

Back 12

a nonST-elevation myocardial infarction.

Front 13

usually an indication of adequate cardiac reserve.

Back 13

If a patient's exercise capacity is excellent, even in the presence of ischemic heart disease,
the chances are good that the patient will be able to tolerate the stresses of surgery. The
ability to climb two or three flights of stairs without significant symptoms

Front 14

"All that wheezes is not asthma." Also consider ...

Back 14

mechanical airway obstruction,
congestive failure,
allergic reaction,
pulmonary embolus, pneumothorax,
aspiration,
and endobronchial intubation.

Front 15

Mechanical ventilation settings for patients with ARDS or ALI include ... 3x

Back 15

tidal volume of at 6 to 8 ml/kg of ideal body weight while limiting plateau pressures to <30 cm H20. PEEP
should be adjusted to prevent end-expiratory collapse. Fi02 should be adjusted to maintain oxygen saturations between 88% and 92%.

Front 16

The best way to maintain renal function during surgery is to ...

Back 16

ensure an adequate
intravascular volume, maintain cardiac output, and avoid drugs known to decrease renal
perfusion.

Front 17

Measures to acutely decrease intracranial pressure (ICP) include

Back 17

elevation of the head
of the bed;
hyperventilation (PaC02 25 to 30 mm Hg);
diuresis (mannitol and/or
furosemide);
and minimized intravenous fluid.
In the setting of elevated ICP, avoid ketamine and nitrous oxide.

Front 18

Malignant hyperthermia (MH) is

Back 18

an inherited disorder that presents in the perioperative
period after exposure to inhalational agents and/or succinylcholine. The disease may be
fatal if the diagnosis is delayed and dantrolene is not administered. The sine qua non of
MH is an unexplained rise in end-tidal carbon dioxide with a simultaneous increase in
minute ventilation in the setting of an unexplained tachycardia.

Front 19

_________ may mimic MH. It is confirmed by an increased serum tetraiodothyronine
(T4) level and is treated initially with P-blockade followed by antithyroid therapy.

Back 19

Thyroid storm

Front 20

A patient with a Glasgow Coma Scale of ____ is sufficiently depressed that endotracheal
intubation is indicated.

Back 20

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