APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Major cause of apnea with neuraxial anesthesia (and what is usually not the cause)
- ANSWER--Usually the result of cerebral hypoperfusion, not phrenic nerve
paralysis
Cause of drowsiness with neuraxial anesthesia - ANSWER--reduces sensory input
to the Reticular Activating System (RAS), causing drowsiness.
saddle block - ANSWER--given at the lower end of the spinal column (sacrum) to
block the perineal area, or hyperbaric solution in lumbar w/ sitting position
maintained until block sets up.
opioid moa - ANSWER--inhibit pain transmission (afferent signals) in the
substantia gelatinosa via the dorsal horn
benefit to using opioids with LA - ANSWER--creates a denser block
Recommendations for block placement: Glycoprotein IIb/IIIa antagonists -
ANSWER--Abciximab: Hold 1-2 days
Tirofiban, Eptifibatide: Hold 8h
Recommendations for block placement: Cox inhibitors - ANSWER--Proceed if pt
has normal clotting mechanism and is not on any other blood thinners
Recommendations for block placement: Thienopyridine inhibitors - ANSWER--
Clopidogrel: Hold 7 days
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Ticlopidine: Hold 14 days
Recommendations for block placement/catheter removal: Unfractionated Heparin -
ANSWER--SQ: Proceed if pt has normal clotting mechanism and is not on any
other blood thinners
IV: Hold 2-4 hours b/f block, and 1h after block placement
Hold 2-4h after removing catheter
Recommendations for block placement/catheter removal: low molecular weight
Heparin - ANSWER--Enoxaparin, Dalteparin, Tinzaparin
Before block placement:
Prophylactic (Once daily): Hold 12h
Therapeutic (twice daily): Hold 24h
Before catheter removal: Hold 12h
After catheter removal: Hold 2h
After single shot block
Prophylactic (Once daily): Hold 6-8h
Therapeutic (twice daily): Hold 24h
Recommendations for block placement/catheter removal: warfarin - ANSWER--
before block: Hold 5d
Can remove catheter when INR < 1.5
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Recommendations for block placement/catheter removal: thrombolytic agents -
ANSWER--TPA, streptokinase, alteplase, Urokinase
Absolute contraindication to neuraxial anesthesia
Recommendations for block placement/catheter removal: Herbal therapies -
ANSWER--Garlic, Ginkgo, Ginseng
Proceed if pt is not on any other blood thinners
Normal length of transient neurological symptoms (TNS) - ANSWER--1-7 days
Most common LA to cause transient neurological symptoms (TNS) - ANSWER--
Lidocaine
List the structures a needle passes through for an epidural block - ANSWER--Skin
-> subcutaneous tissue -> subcutaneous fat -> supraspinous ligament ->
intraspinous ligament -> ligamentum flavum -> epidural space
List the structures a needle passes through for a subarachnoid block - ANSWER--
Skin -> subcutaneous tissue -> subcutaneous fat -> supraspinous ligament ->
intraspinous ligament -> ligamentum flavum -> epidural space -> dura mater ->
subdural space -> arachnoid mater -> subarachnoid space
Organism most likely to cause post-spinal bacterial meningitis? - ANSWER--
Streptococcus viridans
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
neurotransmission is reduced by: - ANSWER---decreased cAMP
-decreased Ca2+ conductance
-decreased K+ conductance
Acinus - ANSWER--Functional unit of liver lobule
-hepatocytes surrounding a central vein
Perfusion of liver lobule (blood flow) - ANSWER--Arterioles: hepatic artery (25%
bld flow, 50% O2) & portal vein (75% bld flow, 50% O2)
Capillaries: sinusoids
Venules: central vein
30% CO
Kupfer cells - ANSWER--Macrophages in the liver that clean the blood of bacteria
b/f it goes to the vena cava
Bile - ANSWER---produced by hepatocytes
-drained by canaliculi into bile ducts ->common hepatic duct
Sphincter of Oddi - ANSWER--controls the flow of bile released from the
common hepatic duct
contraction increases biliary pressure (narcotics - esp morphine)
Space of Disse - ANSWER--Space between sinusoids and hepatocytes where
lymph and proteins drain
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Major cause of apnea with neuraxial anesthesia (and what is usually not the cause)
- ANSWER--Usually the result of cerebral hypoperfusion, not phrenic nerve
paralysis
Cause of drowsiness with neuraxial anesthesia - ANSWER--reduces sensory input
to the Reticular Activating System (RAS), causing drowsiness.
saddle block - ANSWER--given at the lower end of the spinal column (sacrum) to
block the perineal area, or hyperbaric solution in lumbar w/ sitting position
maintained until block sets up.
opioid moa - ANSWER--inhibit pain transmission (afferent signals) in the
substantia gelatinosa via the dorsal horn
benefit to using opioids with LA - ANSWER--creates a denser block
Recommendations for block placement: Glycoprotein IIb/IIIa antagonists -
ANSWER--Abciximab: Hold 1-2 days
Tirofiban, Eptifibatide: Hold 8h
Recommendations for block placement: Cox inhibitors - ANSWER--Proceed if pt
has normal clotting mechanism and is not on any other blood thinners
Recommendations for block placement: Thienopyridine inhibitors - ANSWER--
Clopidogrel: Hold 7 days
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Ticlopidine: Hold 14 days
Recommendations for block placement/catheter removal: Unfractionated Heparin -
ANSWER--SQ: Proceed if pt has normal clotting mechanism and is not on any
other blood thinners
IV: Hold 2-4 hours b/f block, and 1h after block placement
Hold 2-4h after removing catheter
Recommendations for block placement/catheter removal: low molecular weight
Heparin - ANSWER--Enoxaparin, Dalteparin, Tinzaparin
Before block placement:
Prophylactic (Once daily): Hold 12h
Therapeutic (twice daily): Hold 24h
Before catheter removal: Hold 12h
After catheter removal: Hold 2h
After single shot block
Prophylactic (Once daily): Hold 6-8h
Therapeutic (twice daily): Hold 24h
Recommendations for block placement/catheter removal: warfarin - ANSWER--
before block: Hold 5d
Can remove catheter when INR < 1.5
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
Recommendations for block placement/catheter removal: thrombolytic agents -
ANSWER--TPA, streptokinase, alteplase, Urokinase
Absolute contraindication to neuraxial anesthesia
Recommendations for block placement/catheter removal: Herbal therapies -
ANSWER--Garlic, Ginkgo, Ginseng
Proceed if pt is not on any other blood thinners
Normal length of transient neurological symptoms (TNS) - ANSWER--1-7 days
Most common LA to cause transient neurological symptoms (TNS) - ANSWER--
Lidocaine
List the structures a needle passes through for an epidural block - ANSWER--Skin
-> subcutaneous tissue -> subcutaneous fat -> supraspinous ligament ->
intraspinous ligament -> ligamentum flavum -> epidural space
List the structures a needle passes through for a subarachnoid block - ANSWER--
Skin -> subcutaneous tissue -> subcutaneous fat -> supraspinous ligament ->
intraspinous ligament -> ligamentum flavum -> epidural space -> dura mater ->
subdural space -> arachnoid mater -> subarachnoid space
Organism most likely to cause post-spinal bacterial meningitis? - ANSWER--
Streptococcus viridans
, APEX FINAL 1 LATEST 2024 ACTUAL EXAM 1500+
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
neurotransmission is reduced by: - ANSWER---decreased cAMP
-decreased Ca2+ conductance
-decreased K+ conductance
Acinus - ANSWER--Functional unit of liver lobule
-hepatocytes surrounding a central vein
Perfusion of liver lobule (blood flow) - ANSWER--Arterioles: hepatic artery (25%
bld flow, 50% O2) & portal vein (75% bld flow, 50% O2)
Capillaries: sinusoids
Venules: central vein
30% CO
Kupfer cells - ANSWER--Macrophages in the liver that clean the blood of bacteria
b/f it goes to the vena cava
Bile - ANSWER---produced by hepatocytes
-drained by canaliculi into bile ducts ->common hepatic duct
Sphincter of Oddi - ANSWER--controls the flow of bile released from the
common hepatic duct
contraction increases biliary pressure (narcotics - esp morphine)
Space of Disse - ANSWER--Space between sinusoids and hepatocytes where
lymph and proteins drain
